INTRODUCTION: The National Institute of Health and Care Excellence (NICE) has defined the terms, 'acute coronavirus disease 2019' (COVID-19), 'ongoing symptomatic COVID-19' and 'post-COVID-19 syndrome', with the latter two described as having persistent symptoms after the onset of COVID-19 symptoms for 4-12 weeks and >12 weeks, respectively. Persistent symptoms can either be due to the after-effects of COVID-19 or new-onset diseases after acute COVID-19. All symptoms observed beyond 4 weeks after the onset of COVID-19 need not be present at the time of onset. Previous studies on persistent post-COVID-19 symptoms have not mentioned new-onset diseases after acute COVID-19, and only a select few studies have discussed such new-onset symptoms. METHODS: Ninety-five patients who attended the post-COVID-19 clinic completed the requisite follow-up till 16 weeks after COVID-19 symptom onset. Data was recorded on a predesigned proforma. Necessary investigations were conducted to rule out any other cause of persistent symptoms. RESULTS: Fatigue (62.1%), breathlessness (50.5%) and cough (27.4%) were the most common symptoms present beyond 4 weeks after the onset of COVID-19 symptoms. Forty-nine (51.57%) patients developed post-COVID-19 syndrome - their severity of symptoms (odds ratio [OR] 17.77) and longer duration of hospital stay (OR 1.095) during acute disease were significantly associated with the development of post-COVID-19 syndrome. During follow-up, 25 patients developed new-onset symptoms, such as diabetes mellitus, hypertension and idiopathic tachycardia. CONCLUSION Patients can have persistent symptoms, new-onset symptoms and new-onset diseases after recovery from acute COVID-19.
Humans ; COVID-19/diagnosis* ; Female ; Male ; Prospective Studies ; Middle Aged ; Adult ; Fatigue/etiology* ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; Aged ; Cough/etiology* ; Dyspnea/etiology*

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

We aimed to examine the outcomes of arthritic congenital dislocation of hip in adults after subtrochanteric shortening derotation osteotomy (SSDO) with cementless hip arthroplasty at a minimum follow-up period of five years. Bibliographic databases were searched and isolated studies were divided into three groups (1, 2, and 3) based on the femoral stem type (modular, monoblock, or mixed). We pooled 931 hips/737 patients from 20 studies. The mean difference in the Harris hip score (HHS) before and after the operation was 47.55 (95% confidence interval [CI] 43.16, 51.94). On subgroup analysis the mean differences of 46.59 (95% CI 41.67, 51.51), 48.24 (95% CI 41.37, 55.11), and 47.30 (95% CI 43.85, 50.75), respectively in HHS were noted in groups 1, 2, and 3. The incidence of uncontrolled proximal femur fractures was comparable at 7.9% and 4.2% in groups 1 and 2; however, it was 0% and 16.6% for controlled fractures. The incidences of nonunion, dislocation, nerve paralysis, heterotopic ossification and revision due to any cause were 0.3%, 6.5%, 1.7%, 2.1%, and 7.9% for group 1 and 1.9%, 4.3%, 1.6%, 5.6%, and 7.4% for group 2. Similar improvements in functional outcome for both monoblock and modular stems can be expected. An increased incidence of controlled proximal femur fractures was observed with use of modular stems. The nonunion at the SSDO site was sporadic.

Purpose: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of parents or caregivers of children suffering from migraines at a tertiary care center in North India. Methods: We conducted a cross-sectional study involving 100 parents or caregivers, using convenience sampling. A 20-item questionnaire was administered in English and also translated into the local language (Hindi). The study included children with migraines who visited the pediatric outpatient department within a 6-month period (December 2022 to May 2023). Results: Over 60% of caregivers were aware of the chronic nature of the illness, its triggering factors, the role of family history, and the importance of lifestyle modifications. However, only 46% understood the pathophysiology of the illness, and 53% were aware of the medication used for childhood migraines. More than 85% of caregivers believed that recurrent headaches necessitate a doctor’s consultation, may require regular visits for optimal treatment, and were willing to alter their child’s lifestyle to prevent headaches. However, a significant percentage of caregivers (47%) practised self-medication for their children’s headaches. Most caregivers believed that lifestyle modifications and avoiding triggers were the best treatments for migraines. There were significant associations (P<0.05) between the level of education and responses to questions related to migraine definition, prophylaxis, treatment, investigations, lifestyle modifications, and screen time. Conclusion Most participants were well-educated on migraine, and their KAP regarding migraine prevention and treatment were generally adequate. However, the practice of self-medication without professional guidance is a significant concern.

Pediatric headache is a common condition that often results in frequent outpatient visits. There are two broad etiological groups of headaches—primary and secondary headaches—with the former being more prevalent. Migraine, a type of primary headache, shares similarities with those experienced by adults, albeit with some variations in diagnostic criteria. The secondary causes of headache should be differentiated from the primary headaches with proper clinical evaluation and focussed investigations. The management of migraine focusses on lifestyle modifications, behavioral therapy, and pharmacotherapy for acute episodes and long-term preventive therapy. There are many novel promising treatment modalities. This review article provides an overview of pediatric headache epidemiology, classification, and pathophysiology and then elaborates on management and prevention strategies.

Posterior methods for cervical myelopathy include laminoplasty and laminectomy with/without fusion. A more recent innovation in these treatments is the use of an ultrasonic bone shaver for osteotomy. In this study, we examined the perioperative results after laminectomy/laminoplasty between conventional methods (rongeur/high-speed drill) vs. piezosurgery-based instruments. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and the search was performed on four databases (PubMed, Scopus, EMBASE, and Google Scholar). Seven comparative studies were chosen after thorough screening by the authors and a meta-analysis was performed between piezosurgery and conventional technique to ascertain intraoperative and postoperative results after laminectomy/laminoplasty. The analysis includes four retrospective cohort studies and three randomized controlled trials published between 2015 and 2022. The mean age ranged from 55.5 to 64.2 years. Blood loss was significantly reduced in the piezosurgery group, other findings were not significant. On subgroup analysis, laminoplasty dramatically reduced blood loss and the rate of iatrogenic dural rips in the piezosurgery group. The use of ultrasonic bone shaver for osteotomy in cervical spondylotic myelopathy is related to significantly decreased blood loss and no significant increase in postoperative drainage, operative time, complication rate, and functional outcomes as compared to traditional techniques. We noticed significantly reduced blood and rate of dural tears in the laminoplasty subgroup with the use of ultrasonic bone shaver, which was not mirrored in the laminectomy subgroup. Careful intraoperative handling of the instrument can help prevent iatrogenic dural tears and nerve damage.

Background/Aims: Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC.
Methods: Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included.
Results: Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2–10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40–50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC.
Conclusions One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.

BACKGROUND/AIMS: The aim of this study was to study the efficacy and safety of zolpidem for sleep disturbances in patients with cirrhosis. METHODS: Fifty-two Child-Turcotte-Pugh (CTP) class A or B cirrhotics with Pittsburgh Sleep Quality Index >5 were randomized to either zolpidem 5 mg daily (n=26) or placebo (n=26) for 4 weeks. RESULTS: The therapy of 4 weeks was completed by 23 patients receiving zolpidem (3 stopped treatment due to excessive daytime drowsiness) and 24 receiving placebo (2 refused to continue the study). In the zolpidem group, after 4 weeks of therapy, there was significant increase in total sleep time (TST) and sleep efficiency compared to baseline and improvement in polysomnographic parameters of sleep initiation and maintenance (i.e., decrease in sleep latency time, decrease in wake time, and decreases in number of arousals and periodic limbs movements per hour of sleep), without any significant change in sleep architecture. CONCLUSIONS: Four weeks of 5 mg daily zolpidem in CTP class A or B cirrhosis patients with insomnia led to significant increases in TST and sleep efficiency and improvement in polysomnographic parameters of sleep initiation and maintenance without any significant change in sleep architecture.
Arousal ; Cytidine Triphosphate ; Extremities ; Fibrosis ; Humans ; Sleep Initiation and Maintenance Disorders