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 evaluate the clinical outcomes of eyes implanted with a zonal refractive multifocal intraocular lens (IOL) with an inferior segmental near add (M-plus), and to compare the outcomes between M-plus and a diffractive-type multifocal IOL, AT LISA (366D, bifocal). METHODS: We reviewed 19 eyes from 10 patients who were implanted with M-plus and 52 eyes of 26 patients who were implanted with AT LISA. The clinical outcomes of these 2 intraocular lenses were evaluated at 1 day and 2 months postoperatively, and consisted of distant, intermediate, and near visual acuity, contrast sensitivity, degree of tilt, and decentration using anterior segment photography, depth of focus, and patient satisfaction. RESULTS: There were no statistical differences between the 2 groups with respect to distant vision, near vision, refractive error, contrast sensitivity, degree of tilt, decentration, or satisfaction score. The M-plus group demonstrated significantly better intermediate visual acuity. In the defocus curve, the M-plus group also demonstrated significantly better visual acuities for intermediate unfocused vision levels. CONCLUSIONS: The M-plus multifocal IOLs are able to provide satisfactory distant and near visual acuity and visual function. The M-plus multifocal IOLs provide better intermediate vision than the AT LISA.
Contrast Sensitivity ; Fluconazole ; Humans ; Lenses, Intraocular* ; Patient Satisfaction ; Photography ; Refractive Errors ; Visual Acuity

PURPOSE: To compare postoperative clinical outcomes, optical quality, and patient satisfaction between two types of diffractive multifocal intraocular lens (IOL, Acri Lisa 366D and Acrysof ReSTOR +3.00 D). METHODS: In a total of 68 eyes, one of two diffractive multifocal IOL (Acri Lisa 366D and Acrysof ReSTOR +3.00 D) was implanted after cataract extraction. Visual acuity was measured postoperatively at one week, 1 month, and 6 months. Contrast sensitivity, wavefront aberration, and visual function were determined via questionnaire at postoperative 1 month. RESULTS: Intermediate visual acuity of Acri Lisa 366D and Acrysof ReSTOR at 6 months were 0.31 +/- 0.14, and 0.24 +/- 0.11 (log MAR), respectively. At 6 months, near and distant visual acuity results showed no significant differences between the two groups. The photopic contrast sensitivity of Acri Lisa 366D at 6 cycles/degree was 55.36 +/- 7.40 and showed significant differences with Acrysof ReSTOR (47.25 +/- 9.67). The mesopic contrast sensitivity values of Acri Lisa 366D and Acrysof ReSTOR were 40.26 +/- 11.38 and 28.97 +/- 10.45, respectively, and the spherical aberration values were 0.037 +/- 0.039 microm and 0.105 +/- 0.066 microm. The spherical aberration of Acri Lisa 366D was significantly lower than that of Acrysof ReSTOR. Total and high order aberration, coma, and trefoil show no significant differences between the two groups. CONCLUSIONS: The Acri Lisa 366D multifocal IOL showed better contrast sensitivity and spherical aberration compared to Acrysof ReSTOR multifocal IOL, which had an effective intermediate visual acuity.
Cataract Extraction ; Coma ; Contrast Sensitivity ; Lenses, Intraocular* ; Lotus ; Patient Satisfaction ; Visual Acuity

PURPOSE: To evaluate the efficacy and safety of immediate sequential bilateral cataract surgery with respect to patient outcomes and complication rates. METHODS: From January 2010 to December 2014, we conducted a retrospective study of patients who had immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with an interval of one to two months between the first and the fellow eye operations. The changes in visual acuity, manifest spherical equivalent, and refractive error of 140 eyes of 70 patients of both groups were compared postoperatively at one month. The incidence of endophthalmitis was investigated during the same period. RESULTS: At one month postoperatively, log MAR best corrected visual acuity were measured to be 0.06 +/- 0.72 in the ISBCS group and 0.09 +/- 0.66 in the DSBCS group, and that of the fellow eyes were 0.07 +/- 0.64 and 0.07 +/- 0.18, respectively (p = 0.331, p = 0.781, respectively). The postoperative spherical equivalents were -0.18 +/- 0.23 D in the ISBCS group and -0.19 +/- 0.25 D in the DSCBS group, and that of the fellow eyes were -0.15 +/- 0.18 D and -0.16 +/- 0.21 D, respectively. There were no significant statistical differences between the two groups (p = 0.835, p = 0.676, respectively). The postoperative refractive error was -0.20 +/- 0.21 D in the ISCBS group and -0.18 +/- 0.13 D in the DSBCS group, and that of the fellow eyes were -0.14 +/- 0.22 D and -0.19 +/- 0.22 D, respectively (p = 0.482, p = 0.237, respectively). A total of 21,140 eyes had cataract surgery performed, and only 10 eyes (0.05%) developed endophthalmitis. Endophthalmitis did not occur in the ISBCS group. CONCLUSIONS: In experienced hands, with stringent patient selection criteria and with a strict aseptic protocol, ISBCS can safely provide comparable visual outcome and better satisfaction of the patient with good efficacy.
Cataract* ; Endophthalmitis ; Hand ; Humans ; Incidence ; Patient Selection ; Refractive Errors ; Retrospective Studies ; Visual Acuity