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 long-term clinical result and patient satisfaction after laser in situ keratomileusis. METHODS: This is a long term (over 3 years) retrospective analysis of 107 eyes (54 patients) that has undergone LASIK since February 1996. RESULTS: Mean preoperative Spherical Equivalent(SE) was -7.81 +/- 4.07D and mean postoperative SE was -0.88 +/- 1.74D at 1 week, -1.18 +/- 1.17D at 1 month, -1.32 +/- 1.71D at 3 month and -2.44 +/- 2.20D after 3 years. At the last visit, uncorrective visual acuity was 0.5 or better in 83.1% and 26.2% of manifest SE was within the +/- 1D. However, in high myopic group (>-10.D), it has decreased to 41.7% and 0% respectively. Myopic progression occurred also in reoperation cases, 81.3% had uncorrective visual acuity of 0.5 or better and 31.3% had manifest SE within +/- 1D at the last visit. In the survey of subjective satisfaction, 80.2% of patient was satisfied with the surgery, which has decreased to 46.2% after long term follow-up. CONCLUSIONS: In conclusion, the higher the preoperative SE, the more myopic regression has occurred (p<0.01) and the clinical result was reversely related to the degree of myopia. There was no statistically significant difference between reoperation cases and the total group (p>0.05). The patient subjective satisfaction has significantly decreased after long term follow-up compared to immediate postoperative visit.
Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ* ; Myopia ; Patient Satisfaction* ; Reoperation ; Retrospective Studies ; Visual Acuity

PURPOSE: To compare the clinical outcomes between refractive-type multifocal intraocular lenses (IOL) (Lentis Mplus(R) LS 313, Oculentis GmbH., Berlin, Germany) and diffractive-type multifocal IOL (Acrysof Restor(R); SN6AD1, Alcon Lab., Fort Worth, TX, USA) with same near added. METHODS: We evaluated 30 eyes implanted with Lentis Mplus(R) IOL and 33 eyes implanted with Acrysof Restor(R) IOL after phacoemulsification. The distant, intermediate, and near uncorrected visual acuities of the 2 groups were evaluated at 2 weeks and 1, 3, and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II(R), Visiometrics, Castelldefels, Barcelona, Spain), higher-order aberrations (HOAs), and patient satisfaction questionnaire of the 2 groups were evaluated at 3 months postoperatively. RESULTS: The visual acuity of intermediate 100 cm was statistically better in the Lentis Mplus(R) group (p < 0.05). There were no significant differences between the 2 groups with distant, intermediate 63 cm, and near vision. At the 3-month postoperative follow-up, objective scatter index, modulation transfer function (MTF) cutoff value, and pseudo-accommodation range measured by OQAS II(R) showed no differences between the 2 groups, but Strhel ratio was higher in the Acrysof Restor(R) group. HOAs of 5 mm and 6 mm increased significantly in the Lentis Mplus(R) group. No significant differences were found in the patient satisfaction questionnaire. CONCLUSIONS: Both refractive and diffractive-type multifocal IOL implantation in patients with cataracts and presbyopia offered good and comparable visual acuity at distance and near. However, the Lentis Mplus(R) IOL provided better intermediate vision than the Acrysof Restor(R) IOL.
Berlin ; Cataract ; Follow-Up Studies ; Humans ; Lenses, Intraocular* ; Patient Satisfaction ; Phacoemulsification ; Presbyopia ; Surveys and Questionnaires ; Visual Acuity

PURPOSE: To evaluate the usefulness, results, and technical problem of endovascular treatment in anteriorcommunicating artery(Acom) aneurysm using a Guglielmi detachable coil(GDC). MATERIALS AND METHODS: We evaluated 18patients with Acom aneurysm who underwent endovascular treat-ment with GDC. Their clinical presentations weresubarachnoid hemorrhage (n=14), decreased visual acuity (n=2), and remnant aneurysm after surgical clipping (n=2).Hunt and Hess grades of 16 pre-surgical patients were Grade 0 in two patients, Grade I in three, Grade II in five,Grade III in one, Grade IV in three and Grade V in two. The size of aneurysms was 20mm in one lesion that wasclassified as large, while other lesions with diameters ranging from 3 to 12mm were classified as small.Theoutcome of treatment and technical complica-tions were analyzed. Clinical results were evaluated using the Glasgowoutcome scale(GOS). RESULTS: Treatment was successful in 13 patients. Complete occlusion was observed in tenpatients and partial occlusion in three. In five patients, the procedure failed to occlude the aneurysms becauseof proximal arterial tortuousity (n=2), wide neck (n=2) or coil fracture during the procedure (n=1). Technicalcomplications in-cluded thromboembolism (n=1) and coil fracture during the procedure (n=1). Among the 13 patientswho were treated successfully, 11 were GOS I. Two patients died after treatment because of procedure-relatedthromboembolism in one patient and progressive vasospasm, demonstrated on angiography before treatment, in theother. CONCLUSIONS: Treatment of Acom aneurysm using a GDC is useful and has many advantages compared tosur-gical clipping. Because of the anatomical characteristics of the Acom, however, technical failure may be morelikely than in the case of posterior circulation aneurysm. Meticulous evaluation of aneurysms and adjacentar-teries on angiography, as well as careful patient selection, is needed.
Aneurysm ; Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Neck ; Patient Selection ; Surgical Instruments ; Thromboembolism ; Visual Acuity