Objective: To identify specific clinical characteristics and patient signs and symptoms that increase the risk of developing severe/critical COVID-19 disease or death in the pediatric population, and identify strength of these associations Methodology: A systematic search was done in PubMed, Science Direct, Cochrane Library and grey literature databases focusing on severe and critical COVID-19 disease in the zero to eighteen year old age group until August 26, 2020. Data regarding patient characteristics, signs and symptoms on admission and disease severity were extracted. Outcomes measured were severe or critical COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C) or death. Results were pooled and meta-analyzed. Results: Four eligible studies with a total of 292 pediatric patients with COVID-19 were examined. Older children (MD=6.62, 95%CI=4.23 to 9.00, p-value<0.00001, I2=33%) significantly present with a higher percentage of severe disease. Shortness of breath (OR=8.14, 95%CI=2.33 to 28.47, p-value=0.001, I2=42%) was also found to be associated with severe COVID-19 disease. The presence of a pre-existing medical condition (OR=4.02, 95%CI=1.55 to 10.43, p-value=0.004, I2=0%), especially cardiac disease (OR=6.40, 95%CI=1.45 to 28.38, p-value=0.01, I 2=13%) and diabetes (OR=7.01, 95%CI=1.54 to 31.95, p-value=0.01, I2=0%) was noted to be a risk factor for severe disease. Conclusion Based on poor quality observational studies, older age group, shortness of breath, and a pre-existing medical condition, especially cardiac disease or diabetes were found to be associated with poor outcomes in children with COVID-19.
COVID-19 ; Pediatrics ; Patient Acuity

Background: Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. Methods: A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. Results: A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542). Conclusion Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.
Psoriasis--diagnosis ; Patient Acuity ; Quality of Life--psychology ; Patient Health Questionnaire

Objective: This study aimed to determine the demographic profiles of admitted COVID-19 patients, the association of coagulation and platelet tests on COVID-19 severity and compare the coagulation and platelet profile across the spectrum of the disease in terms of severity among adult COVID-19 patients admitted to the Philippine General Hospital from March 2020 to December 2022. : Methodology. Medical records of a sample of adult COVID-19 patients admitted to the emergency room of the Philippine General Hospital from March 2020 to December 2022 were reviewed. The demographics, initial COVID-19 diagnosis and initial coagulation and platelet test results were gathered and tabulated. Comparison of the initial coagulation and initial platelet results were made per disease category. Results: Three hundred eighty-five (385) patients were included; 194 were males, and 191 were females. The mean age of all patients was 56.18 years old. There was a total of 30 patients classified as mild and 105 patients are under moderate category. 141 patients were classified as severe, whereas 109 patients were classified as critical. Platelet count test and Activated Partial Thromboplastin Time (APTT) were mostly normal in all disease categories. Prothrombin time was normal in a majority of patients from the mild and severe categories. INR and D-dimer were all elevated mostly in all disease categories. Conclusion Platelet counts and APTT were mostly normal in all disease categories. Prothrombin time and D-dimer had a significant association with disease severity. Platelet count, APTT and INR did not show significant association with disease severity. Prothrombin time, APTT, INR and D-dimer means had significant differences versus disease categories.
Partial Thromboplastin Time ; OVID-19 ; Patient Acuity

The Korean Triage and Acuity Scale (KTAS) is a localized modification of the Canadian Triage and Acuity Scale (CTAS). Although CTAS was not intended for defining the severity of individual patients or to be used in reimbursement processes, the misuse of KTAS is commonplace in Korea. In particular, the national assessment of emergency medical facilities in 2019 includes several indicators based on the improper application of KTAS scores.
Emergencies ; Humans ; Korea ; Organization and Administration ; Patient Acuity ; Triage

INTRODUCTION

For detecting myocardial injury in severe and critical COVID-19, the electrocardiogram (ECG) is neither sensitive nor specific, but in a resource-poor environment, it remains relevant. Changes in the ECG can be a potential marker of severe and critical COVID 19 to be used for predicting not only disease severity but also the prognosis for recovery.

The admitting and interval ECGs of 1333 COVID-19 patients were reviewed in a 2-year, single-center, retrospective cohort study. Each was evaluated for 29 predefined ECG patterns under the categories of rhythm; rate; McGinn-White and right ventricular, axis, and QRS abnormalities; ischemia/infarct patterns; and atrioventricular blocks before univariate and multivariate regression analyses for correlation with disease severity, need for advanced ventilatory support, and in-hospital mortality.

Of the 29 ECG patterns, 18 showed a significant association with the dependent variables on univariate analysis. Multivariate analysis revealed that atrial fibrillation, heart rate greater than 100 beats per minute, low QRS voltage, QTc of 500 milliseconds or greater, diffuse nonspecific T-wave changes, and “any acute anterior myocardial infarction” ECG patterns correlate with disease severity, need for advanced ventilatory support, and in-hospital mortality. S1Q3 and S1Q3T3 increased the odds of critical disease and need for high oxygen requirement by 2.5- to 3-fold. Fractionated QRS increased the odds of advanced ventilatory support.

The ECG can be useful for predicting the severity and outcome of more than moderate COVID-19. Their use can facilitate rapid triage, predict disease trajectory, and prompt a decision to intensify therapy early in the disease to make a positive impact on clinical outcomes.

OBJECTIVE: To investigate the length of hospital stay (LOS) after stroke using the database of the Korean Health Insurance Review & Assessment Service. METHODS: We matched the data of patients admitted for ischemic stroke onset within 7 days in the Departments of Neurology of 12 hospitals to the data from the database of the Korean Health Insurance Review & Assessment Service. We recruited 3,839 patients who were hospitalized between January 2011 and December 2011, had a previous modified Rankin Scale of 0, and no acute hospital readmission after discharge. The patients were divided according to the initial National Institute of Health Stroke Scale score (mild, ≤5; moderate, >5 and ≤13; severe, >13); we compared the number of hospitals that admitted patients and LOS after stroke according to severity, age, and sex. RESULTS: The mean LOS was 115.6±219.0 days (median, 19.4 days) and the mean number of hospitals was 3.3±2.1 (median, 2.0). LOS was longer in patients with severe stroke (mild, 65.1±146.7 days; moderate, 223.1±286.0 days; and severe, 313.2±336.8 days). The number of admitting hospitals was greater for severe stroke (mild, 2.9±1.7; moderate, 4.3±2.6; and severe, 4.5±2.4). LOS was longer in women and shorter in patients less than 65 years of age. CONCLUSION: LOS after stroke differed according to the stroke severity, sex, and age. These results will be useful in determining the appropriate LOS after stroke in the Korean medical system.
Female ; Humans ; Insurance, Health ; Length of Stay* ; Neurology ; Patient Acuity ; Patient Readmission ; Stroke*

MIN GLASSES is specially manufactured in order to enhance satisfaction of wearer and therefore increase the effectiveness of treatment of an amblyopia and a diplopia. One of the lens is specially grounded and coated to blur vision. Cosmetically, the eye appears to wear regular glasses through the blur lens. We prospectively studied 58 amblyopic children and 10 diplopic adults. Each patient was treated with MIN GLASSES for cosmetic problems. We checked linear visual acuity of pre- and post-treatment. Questionnaires were given to the patients and parents regarding cosmetic satisfaction with treatment. In amblyopic children. 44 patients(75.9%) showed visual acuity improvement of 1.61 +/- 1.50 lines by Han's visual acuity chart. Patient compliance was 87.9%(51 patients) with patient satisfaction based on a questionnaire response. Parents were 87.9%(51 parents) positive response. In diplopic adults, 10 patients(100%) were positive response with satisfaction and demonstrated to be free of symptom of diplopia. MIN GLASSES is effective in high compliance satisfaction of amblyopia and diplopia, and improvement of visual acuity of amblyopia.
Adult ; Amblyopia* ; Child ; Compliance ; Diplopia* ; Eyeglasses* ; Glass* ; Humans ; Parents ; Patient Compliance ; Patient Satisfaction ; Prospective Studies ; Surveys and Questionnaires ; Visual Acuity

PURPOSE: To compare the clinical outcome between Tecnis ZM900 and Tecnis ZA9003. METHODS: We reviewed 20 eyes of 11 patients implanted with Tecnis ZM900 and 20 eyes of 20 patients implanted with Tecnis ZA9003. The clinical outcomes of these two intraocular lenses were evaluated one month after operation and consisted of distant, intermediate, and near visual acuity; depth of focus; contrast sensitivity; wavefront aberration; and patient satisfaction. Six months after the operation a reevaluation was performed for the group who had received the Tecnis ZM 900 implant. RESULTS: Near and intermediate vision was better in the Tecnis ZM900 group. There were no statistical differences between the two groups with respect to distant vision and wavefront aberration. Contrast sensitivity was better in the Tecnis ZA9003 group and depth of focus was deeper in the Tecnis ZM900 group. There were no statically significant differences in the result between one month and six month after the operation. CONCLUSIONS: The Tecnis multifocal ZM900 IOL can be effective at improving patient satisfaction after cataract surgery as well as for correcting presbyopia.
Cataract ; Contrast Sensitivity ; Eye ; Humans ; Lenses, Intraocular ; Patient Satisfaction ; Presbyopia ; Vision, Ocular ; Visual Acuity

The 24 cases of primary optic neuritis diagnosed by pattern shifted visual evoked potential (PSVEP) were studied and the following results were obtained. 1 The sex ratio was equal but over sixties of age all patients were male. Fifty percent of patients developed from 10 years to 30 years old with peak incidence of age. 2. Among 24 patients, 8 patients were diagnosed within 1 month, 9 patients from 1 to 6 months, and 7 aptients after 1 year. 3. The visual disturbance developed in all cases, but eye ball pain in one case. 4. The visual acuity of 36 years of optic neuritis revealed below 0.4 in 80%, but over 0.8 in 3 cases. 5. Among 6 patients who developed symptom at left side only, 4 patients revealed abnormal PSVEP at left side only but 2 patient revealed abnormal PSVEP at right side only, but 1 patient abnormal PSVEP bilaterally; among 11 patients who developed symptom bilaterally, 9 patients revealed abnormal PSVEP bilaterally, but 1 patient left side only and 1 patient right side only. 6. Among 7 patients who developed abnormal fundus finding at left side only, 4 patients revealed abnormal PSVEP at left side only but 3 patients bilaterally; among 7 patients who developed abnormal fundus finding at right side only, 6 patients revealed abnormal PSVEP at right side only but 1 patient bilaterally; among 10 patients who developed abnormal fundus finding bilatreally, 8 patients revealed abnormal PSVEP bilaterally, but I patient left side only and 1 patient right side only. 7. Forteen patient with corticosteriod treatment, 7 patients improved and almost improved patients were female below 40 years old.
Adult ; Evoked Potentials, Visual* ; Female ; Humans ; Incidence ; Male ; Optic Neuritis* ; Patient Rights ; Sex Ratio ; Visual Acuity

PURPOSE: We present a case of a patient who underwent corneal refractive surgery to improve their corrected visual acuity due to a complication of hyperopic laser-assisted in-situ keratomileusis (LASIK). CASE SUMMARY: The patient complained of decreased vision after hyperopic LASIK surgery 12 years prior. The corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/32 in the left, with manifested refractions of +1.25 +2.00 × 90 and -0.25 +2.00 × 80, respectively. The patient had a with-the-rule astigmatism. The values of corneal and total spherical aberration, which can be determined as coefficients of the Zernike polynomials, were respectively -1.027 µm and -0.773 µm in the right eye and -0.965 µm and -0.881 µm in the left eye. Slit lamp biomicroscopy revealed no remarkable findings. We performed surface ablation surgery to flatten the central cornea of the patient's right eye. At 12 months after surgery, the CDVA of the patient's right eye was 20/30 and the negative corneal spherical aberration was reduced. CONCLUSIONS: Corneal refractive surgery to reduce negative corneal spherical aberration by flattening the central cornea is one of possible treatment options for the reduced corrected distance visual acuity after hyperopic LASIK.
Astigmatism ; Cornea ; Humans ; Keratomileusis, Laser In Situ ; Patient Rights ; Refractive Surgical Procedures ; Slit Lamp ; Visual Acuity