Since it was first detected, novel coronavirus disease rapidly spread, striking over 4 million people worldwide. 1 While adults with COVID-19 demonstrate a range of disease severity with 20% of infected adults being critically ill and an estimated fatality rate as high as 2%, children mostly suffer from a mild disease, only minority presenting with respiratory distress syndrome or multi-organ failure. [2][3][4] However, the role of infected children in spreading the virus to their older relatives and caregivers is yet to be determined.Many countries struggle to stave off the spreading of COVID-19 by using different strategies. In many countries, including Israel, authorities instructed the public to stay at home and to avoid visiting local clinics and hospitals as much as possible while using more telemedicine-based practice. 5 However, emergent medical situations continue to appear alongside the current outbreak and their diagnosis should still be made promptly. Delayed diagnosis and treatment of those common paediatric conditions may lead to significant morbidity that may overweigh the harm caused by COVID-19 infection.Appendicitis is the most common abdominal surgical emergency in paediatric population. 6 Early diagnosis of appendicitis
Background: Bowel preparation prior to colonic surgery usually includes antibiotic therapy together with mechanical bowel preparation (MBP). Mechanical bowel preparation may cause discomfort to the patient, prolonged hospitalization, and water and electrolyte imbalance. It was assumed that with the improvement in surgical technique together with the use of more effective prophylactic antibiotics, it was possible that MBP would no longer be necessary.Hypothesis: There is no statistical difference in the postoperative results of patients who undergo elective colon resection with MBP as compared with those who have no MBP. Design and Patients:The study includes all patients who had elective large bowel resection at Campus Golda between April 1, 1999, and March 31, 2002. Emergency operations were not included. The patients were randomly assigned to the 2 study groups (with or without MBP) according to identification numbers. All patients were treated with intravenous and oral antibiotics prior to surgery. The patients in the MBP group received Soffodex for bowel preparation.Results: A total of 329 patients participated in the study, 165 without MBP and 164 with MBP. The 2 groups were similar in age, sex, and type of surgical procedure. Two hundred sixty-eight patients (81.5%) underwent surgery owing to colorectal cancer and 61 patients (18.5%) owing to benign disease. The hospitalization period was longer in the bowel-prepared group (mean ± SD, 8.2 ± 5.1 days) as compared with the nonprepared group (mean±SD, 8.0±2.7 days). However, this difference was not statistically significant. The time until the first bowel movement was similar between the 2 groups: a mean±SD of 4.2±1.3 days in the nonprepared group as compared with a mean±SD of 4.3±1.1 days in the prepared group (P =NS). Four patients (1.2%) died in the postoperative course owing to acute myocardial infarction and pulmonary embolism. Sixty-two patients (37.6%) of the non-MBP group suffered from postoperative complications as compared with 77 patients (46.9%) of the MBP group. Conclusion:Our results suggest that no advantage is gained by preoperative MBP in elective colorectal surgery.
The closed or "Nuss" repair of pectus excavatum is widely accepted for correction of moderate to severe deformities. Patients typically report significant subjective improvements in pulmonary symptoms, and short and medium term evaluations (up to 2 years with the bar in place) suggest modest improvement to cardiac function but a decrease in pulmonary function. This study examined the effects at 3 months post-bar removal of closed repair of pectus on pulmonary function, exercise tolerance and cardiac function. Patients were followed prospectively after initial evaluation for operation. All patients underwent preoperative and post-bar removal evaluation with CT scan, complete pulmonary function and exercise testing to anaerobic threshold, as well as echocardiogram. Twenty-six patients have completed the follow up protocol. Preoperative CT index was 4.5 +/- 1.3, average age at operation was 13.2 years, and average tanner stage was 3.5 +/- 0.5. At 3 months or greater follow-up post-bar removal, patients reported an improvement in subjective ability to exercise and appearance (P < 0.05 by wilcoxin matched pairs). Objective measures of FEV1, total lung capacity, diffusing lung capacity, O(2) pulse, VO(2max), and respiratory quotient all showed significant improvement compared to preoperative values, while normalized values of cardiac index at rest did not (All values normalized for height and age, comparisons P < 0.05 by student's paired t test). These results demonstrate a sustained improvement in cardiopulmonary function after bar removal following closed repair of pectus excavatum. These findings contrast with results from previous studies following the open procedure, or with the closed procedure at earlier time points; the long term physiological effects of closed repair of pectus excavatum include improved aerobic capacity, likely through a combination of pulmonary and cardiac effects.
Although both BMP15 and GDF9 promoted activation of human primordial follicles from girls/women (but not human fetuses) in a dose-dependent manner, GDF9 seems more beneficial.
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