Efficacy of Steroid Therapy in Management of Sydenham’s Chorea in Children: A Comparative Prospective Study

Abstract

Objective: To determine the efficacy of steroid therapy in Sydenham’s chorea in children.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Inpatient and Outpatient Department of Pediatric Neurology, Children Hospital and Institute of Child Health, Lahore Pakistan, from Dec 2019 to May 2020.
 Methodology: Sixty-eight children of Sydenham’s chorea were divided in Group A and B. Each Group was treated with Diazepam (0.3mg-1mg/kg/day) and an injection of Benzathine Penicillin. Group-B was given additional oral prednisolone (2mg/kg/day) for four weeks, with tapering in the next two weeks. Epidemiological data, clinical features and laboratory parameters were collected. The Universiade Federal de Minas Gerais Sydenham’s chorea Rating Scale (USCRS) was applied to both groups at the presentation after two weeks and four weeks.
 Results: Out of 68 patients, the mean Universidade Federal de Minas Gerais (UFMG) Sydenham's Chorea Rating Scale (USCRS) got progressively better in Group-B (mean score improvement was 25.73±5.56 at two weeks and 41.06±6.89 at four weeks) than in Group-A (mean score improvement was 9.12±3.75 at two weeks and 17.97±3.89 at four weeks) with p-value of <0.05.
 Conclusion: Steroid therapy significantly improved patients with Sydenham’s chorea compared to those who did not receive any steroid therapy.Keywords: Efficacy, Steroid therapy, Sydenham chorea.

Lean Methods to Optimize Operations in Emergency Departments During the Height of the COVID-19 Pandemic

“…The COVID-19 pandemic and corresponding increase in patient flow revealed new limitations of the hospital resources under traditional practices [4]. Lean healthcare has been proven in previous research to benefit healthcare operations by both identifying causes to issues within healthcare processes and aid in improving systems in a wide variety of medical contexts [5]. While lean healthcare techniques could assist in addressing shortages in resources brought about by the pandemic, the necessary expertise in both process improvement and medicine is rarely available to implement changes where they are needed.…”

“…Several principles and practices, originally associated with lean manufacturing and Six Sigma, have been found to be helpful in healthcare operations, including: elimination of waste, Ishikawa diagrams, spaghetti diagrams, value stream mapping, 5S and other tools [6,7]. While many similarities exist between the implementation of lean in healthcare compared to other business sectors, regulations and lack of education in lean systems can cause a barrier to utilizing these tools to benefit patients and healthcare providers alike [5,7]. However, for those places where lean tools have been successfully applied, organizations have seen increases in patient satisfaction, decrease in waiting times, reduction of costs, improved patient flow and other improvements [4, 5, 6 & 8].…”

“…Despite positive gains in patient satisfaction and operational metrics from lean implementation, lack of education amongst frontline workers (nurses, doctors, support staff) makes it difficult to apply lean solutions where they are needed most [5]. While lean tools could help to make systems more responsive and agile in the face of the pandemic, there was a shortage of application in complex environments or during times of crisis [6].…”