Factors affecting the health-seeking behaviour of leprosy patients in a tertiary referral hospital in the Philippines

lettersRE: The burden of Rotavirus gastroenteritis among hospitalized pediatric patients in a tertiary referral hospital in Jeddah Mahmood Dhahir Al-Mendalawi Mahmood Dhahir Al-Mendalawi Search for more papers by this author Published Online:5 Dec 2013https://doi.org/10.5144/0256-4947.2013.634SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: I have 2 comments on the interesting paper by Afifi and Nabiha.1First, despite the implementation of Rotavirus (RV) vaccine in Saudi Arabia in 2006, the prevalence of RV gastroenteritis (RVGE) (42.9%) reported by Afifi and Nabiha1 is still worrisome. I presume that that the worrying prevalence can be attributed to the following 2 points: (1) Saudi pediatric population is not yet completely covered with RV vaccine. This is obvious on noticing that only 2.3% of the studied RV positive GE and 6.1% of the studied RV negative GE received RV vaccine (Table 1).1 (2) It is obvious that temporal and spatial fluctuations in the genotype distribution of human RV are continuously observed worldwide in surveillance studies. New genotypes, such as G9 and G12, have emerged and spread worldwide in a very short time span. In addition, reassortment events have the potential to contribute substantially to genetic diversity among human and animal RV.2 Recent data on the molecular epidemiology of RVGE in Saudi children are scarce. Kheyami3 addressed the distribution of G and P types of RV circulating in the population of Saudi Arabia and demonstrated the presence of serotypes G1-G4, G9, G12, P [4], P [6], and P [8]. However, Obeid4 in his study found that subgroup I (serotype 2) constituted 5.4% of the isolates in comparison to 56.7% for subgroup II (serotypes 1, 3, and 4), whereas 37.8% were nontypeable. Regular surveillance and characterization of RV are, therefore, warranted to confirm RV genotype fluctuations. This, in turn, might partly explain the prevalence of RVGE in Saudi children compared to other viruses. It also helps identify unusual types that could be incorporated into future RV vaccines.Second, Norovirus (NV) is currently recognized as one of the emerging viruses causing infection in humans. It is the leading cause of the outbreaks of viral GE worldwide. In children, NV plays an increasing and important role in enteric infection, apart from RV, especially in the post-RV vaccine era.5 Afifi and Nabiha1 categorized their studied GE cases into 4 groups: RV infection alone (33.6%), adenovirus (AV) infection alone (7%), combined RV and AV infection (9.3%), and other causes of GE (50.2%). I wonder whether they detected the cases of NVGE in their studied cohort and probably included them within the latter group. This is critical to comment that NVGE shares many characteristics of RVGE, namely similar clinical presentation, significant morbidity, mortality and economic burden, and the need for regular molecular and genetic surveillance of the circulating virus.ARTICLE REFERENCES:1. Afifi R, Nabiha M. "The burden of Rotavirus gastroenteritis among hospitalized pediatric patients in a tertiary referral hospital in Jeddah" . Ann Saudi Med. 2013; 33:241-6. Google Scholar2. Matthijnssens J, Bilcke J, Ciarlet M, Martella V, Bányai K, Rahman M, et al. "Rotavirus disease and vaccination: impact on genotype diversity" . Future Microbiol. 2009; 4:1303-16. Google Scholar3. Kheyami AM. "Rotavirus gastroenteritis and strain diversity in Saudi Arabia. Current status and future prospects" . Saudi Med J. 2010; 31:276-9. Google Scholar4. Obeid OE. "Characterization of human rotavirus subgroups and serotypes in children under five with acute gastroenteritis in a Saudi Hospital" . Family Community Med. 2011; 18:22-5. Google Scholar5. Chen SY, Chiu CH. "Worldwide molecular epidemiology of norovirus infection" . Paediatr Int Child Health. 2012; 32:128-31. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 33, Issue 6November-December 2013 Metrics History Published online5 December 2013 InformationCopyright © 2013, Annals of Saudi MedicineThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.PDF download

Background & Objective: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis has always been associated with high morbidity and mortality. Consensus committees of international organizations have recommended packages to reduce the high mortality. We evaluated the 2016 Surviving Sepsis Campaign (SSC) package with 3 and 6-hour sepsis packages and the 2018 SSC with 1-hour sepsis package on the mortality of septic patients who came to a tertiary referral hospital.
 Methodology: We enrolled 164 retrospective cohort patients in the tertiary emergency referral general hospital resuscitation ward. The patients were followed up for 48 h of observation. Sepsis and septic shock criteria are based on the Third International Consensus Definition of Sepsis and Septic Shock (Sepsis-3) 2016. Patients were divided into 3 groups, based upon compliance with SSC 16 at 3 h, 6 h, and SSC 18 at 1 h, and the mortality was recorded before 48 h and after 48 h.
 Results: Compliance rates at 1 h (27.4%), 3 h (39.6%), and 6 h (43.3%) were significantly associated with patient mortality (P ≤ 0.001). Population patients who met the criteria for SSC, 73.3% had been referred from peripheral hospitals. The mortality rate was 76 (46.34%) for < 48 h and 37 (22.56%) for more than 48 h.
 Conclusion: Compliance with sepsis management contributes to improved patient condition and a better prognosis when the Surviving Sepsis Campaign package is adequately implemented.
 Abbreviations: SSC - Surviving Sepsis Campaign; SOFA - Sequential Organ Failure Assessment; qSOFA - quick Sequential Organ Failure Assessment; VIS - Vasopressor Inotropic Score
 Key words: Sepsis; SSC Sepsis Bundle Compliance-2016; 1 Hour SSC Sepsis Package 2018; Death; Vasopressors; Outcome; Mortality
 Citation: Utariani A, Semedi BP, Salinding A, Hamzah H. Compliance with the 2016 Surviving Sepsis Campaign Bundle and the 2018 Surviving Sepsis Campaign 1-Hour Bundle and patient outcomes in emergency presentation at a tertiary referral hospital. Anaesth. pain intensive care 2023;27(5):478−485; DOI: 10.35975/apic.v27i5.1852
 Received: March 26, 2022; Reviewed: December 21, 2022; Accepted: August 08, 2023

ABSTRACTOBJECTIVES To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil.METHODS This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year.RESULTS Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients’ complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95).CONCLUSIONS Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.

Interventional Radiology in China: Current Status and Future Prospects.

Introduction: Cellulitis and erysipelas belong to a group of diseases that are considered global health burdens. Epidemiological data on these diseases in Indonesia is still limited. Purposes: This study aimed to identify the clinical profile of cellulitis and erysipelas in the tertiary referral hospital in West Java, Indonesia. Method This was a retrospective, descriptive study using a cross-sectional design. Data were obtained from outpatient and inpatient records of cellulitis and erysipelas patients in the tertiary referral hospital in West Java, Indonesia, in a three-year period during January 2020–December 2022. Result The results of the study showed that cellulitis was most common in women within the 45–64-year age group with normoweight nutritional status, while erysipelas mostly occurred in men within the > 65-year age group without a certain nutritional status predominance. In general, the risk factor for cellulitis was skin barrier disruption, while that for erysipelas was metabolic disorders. Fever was present in less than half of cases with cellulitis and erysipelas, and the lower extremities were the most often affected. The most frequent portal of entry in cellulitis was scratched skin, whereas erysipelas had no particular predominance. Additional skin lesions, such as bullae and/or erosions and suppuration, were found in some cases of these diseases and usually showed Gram-positive cocci with leukocytosis. Normal saline dressing was given to all cases, and some of them were treated with additional wound dressings and 2% mupirocin cream. Clindamycin was the most commonly administered oral antibiotic, while ceftriaxone was administered parenterally. Conclusion The clinical profile of cellulitis and erysipelas in the tertiary referral hospital in West Java, Indonesia, is consistent with findings from other previous studies. Additionally, clindamycin is the most commonly used oral antibiotic for the treatment of cellulitis and erysipelas.

The aim of this study was to review the frequency, indication, associated risk factors, rates of maternal morbidity and mortality as well as neonatal outcome after emergency peripartum hysterectomy at a tertiary care referral hospital. A retrospective observational study carried out from November 2008 to 2011. The study comprised of 29 patients at Mansoura University Hospitals a tertiary referral hospital Egypt. Frequency, indications, associated risk factors and maternal morbidity and mortality were reported as well as neonatal survival and outcome. The frequency of emergency peripartum hysterectomy in our study period was (29/10000 deliveries = 0.29%) and the mean age and parity of the patients were 36.4 ± 8.9 years and 2.9 ± 1.56 respectively. The mean gestational age at the time of delivery was 35.45 ± 2.9 weeks. Twenty-five patients (86.2%) had a history of previous cesarean delivery(ies) meanwhile the others (4/29 = 13.8%) had vaginal delivery(ies). Abnormally adherent placenta and severe postpartum hemorrhage were the main indication for the procedure (11/29 = 37.9%). Other indications included rupture uterus (7/29 = 24.1%), severe uterine atony (7/29 = 24.1%), multiple uterine fibroid (3/29 = 10.3%) and 1 case with severe uterine infection (1/29 = 3.4%). All women received blood transfusion, 5 cases (17.2%) required intensive care unit admission, and 3 cases (10.3%) developed intraoperative arrest, 5 patients (17.2%) had urinary bladder injuries and 2 cases (6.8%) had wound infection. The maternal mortality occurred in 4 cases (13.8%) while overall neonatal survival rate was 86.2% (25/29). Emergency peripartum hysterectomy is still high in our locality representing a significant risk for the mother and the baby; hence health care authorities should raise the problem to decrease this burden.

Pattern and frequency of neurological and neurosurgical care of adult inpatients and outpatients at a tertiary referral hospital in Kenya.

BackgroundThe exact prevalence of type 2 diabetes mellitus (T2DM) and pre-diabetes in Swaziland remains unknown. Estimates suggest that the prevalence rate of type 2 diabetes mellitus is between 2.5 and 6.0% in Swaziland. The disparity in these estimates is due to a lack of quality data but the prevalence of diabetes is increasing in Swaziland. This study estimates the prevalence of type 2 diabetes mellitus and pre-diabetes among patients in a tertiary hospital in Manzini, Swaziland.MethodsA cross-sectional observational survey was used to estimate the crude and age-adjusted prevalence rates of diabetes and pre-diabetes (impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)) in the Manzini regional referral hospital of Swaziland. Diabetes was defined as a fasting blood glucose (FBG) ≥ 7.0 mmol/L (126 mg/dL) and pre-diabetes was defined as an FBG of 6.1–6.9 mmol/L (110–125 mg/dL) and an FBG < 7.0 mmol/L (< 126 mg/dL), respectively for IFG and IGT. A random sample of 385 participants was used. Data analysis was done using SPSS version 26 and the level of statistical significance was set at α < 0.05.ResultsThe crude prevalence of type 2 diabetes mellitus and pre-diabetes was 7.3% [95% CI 4.9–10.3] and 6.5% [95% CI 4.2–9.4], respectively, with clear gender differences in the prevalence of diabetes (men 1.6% vs women 5.7%, p = 0.001). On the other hand, significantly more men (3.6%) had pre-diabetes than women (2.9%) (p = 0.004). The overall age-adjusted prevalence rates of type 2 diabetes mellitus and pre-diabetes were 3.9 and 3.8%, respectively. Among the diabetic group, 3 (10.7%) had known T2DM, whereas 25 (89.3%) were newly diagnosed during the study. Advancing age, gender, raised blood pressure, abnormal body mass index, and wealth index were significant risk factors for T2DM or prediabetes.ConclusionThe prevalence of type 2 diabetes mellitus among adult outpatients in the Raleigh Fitkin Memorial hospital was higher than previously reported in the health facility in Manzini; suggesting the need for routine T2DM screening at outpatient departments.

The present study aimed to determine the prevalence of bacterial and fungal infections of the eye and also to assess the antibiotic susceptibility pattern of bacterial isolates at a tertiary referral eye care hospital in Bari, Italy. Two hundred seventy three samples collected during a 2-year observation period. Culture, Gram's stain, potassium hydroxide mount and occasionally Giemsa staining was done for the clinical specimens. Antibiotic susceptibility testing was performed for bacterial growth. Out of 273 samples processed, 236 (86.4%) yielded growth: of them, 183 (77,5%) were bacterial, 26 (11%) fungal, and 23 (9,7%) specimens showed the presence of Acanthamoeba. Among bacterial infections, 99 (54.5%) bacterial isolates were Gram-positives, and 82 (44.8%) were Gram-negatives. Among Gram positives, Tigecycline showed the greatest susceptibility (93.8%), followed by Linezolid (97%) and Daptomycin (95.18%). Gram negative bacteria strains were susceptible to Imipenem (95%), Meropenem (98,5%) and Amikacin (91%) Multidrug in vitro resistance (resistance >3 classes of antibiotics) was found in 45 Gram positive (63%). and 33 Gram negative (44%). Conjunctival specimens yielded mainly bacterial growth with Staphylococcus species being the predominant isolate followed by Pseudomonas species. Findings from the current analysis evidence a substantial level of in vitro resistance to ≥3 antibiotics.

Background: In response to the COVID-19 outbreak, the widespread imposition of social distancing and lockdown orders had an unintended secondary effect on reducing and changing the characteristics of facial injury presentations to tertiary referral hospitals. As the pandemic curve plateaued and indeed fell, these restrictions were periodically repealed, engendering an anticipated rise in the frequency facial injuries. Objective: The purpose of this study was to determine whether the frequency and characteristics of facial injury presentations to our tertiary referral hospital returned to pre-COVID levels following the repeal of COVID-19 social distancing and lockdown laws on the far side of the pandemic curve. Methods: The authors designed and implemented a retrospective study of patients who sustained a facial injury over 3 comparable 8-week periods in 2019 (pre-COVID), 2020 (COVID lockdown) and 2023 (post-repeal of COVID lockdown laws). The study was conducted in the Department of Maxillofacial Surgery at a level 1 tertiary referral regional trauma hospital in Newcastle, Australia. Results: The principal finding was an increase in facial injury frequency in the post-COVID cohort (n = 149), compared to the COVID lockdown (n = 37) and pre-COVID groups (n = 103). Across all 3 periods, males consistently outnumbered females, with a common peak in the 20 to 30 age group. Bony injuries predominated in all cohorts, with no difference in management approach. The leading cause of injury pre-COVID was interpersonal violence, which shifted to falls during lockdown and post-COVID. There was also an increase in workplace and animal-related injuries post-COVID. Conclusion: The frequency and characteristics of facial injury presentation finally stabilized and returned to pre-COVID levels following the repeal of social distancing laws. This was most notable as communities entered the far side of the pandemic curve. The findings are in keeping with a very small number of comparable studies sourced from literature.

Challenges in the handover process of the new-born with congenital heart disease

Indications for total parenteral nutrition in the hospitalized patient: A prospective review of evolving practice

Introduction Transcatheter edge-to-edge repair (TEER) has proven to be an effective therapeutic alternative for certain cases of mitral regurgitation (MR) in patients who are not surgical candidates. Accumulated experience and technological advances allow TEER in selected patients with complex mitral valve anatomy who might initially be considered non-candidates for percutaneous treatment. Our main objective was to analyse the mid-to long-term characteristics and prognosis in patients with complex mitral valve anatomy treated with this technique compared to those with non-complex mitral anatomy. Methods An observational study was conducted on a prospective cohort of patients from a tertiary referral hospital, which included all cases of severe MR treated using TEER from November 2011 to January 2024. Two groups of patients were compared: those with complex valve anatomy (CVA) versus those who did not present it (NCVA). Mitral valve complexity was defined as the presence of mitral cleft, calcification in the grasping zone, mitral valve area (MVA) ≤3cm2 , mobile posterior leaflet length &amp;lt;7mm, rheumatic leaflet thickening or presence of Barlow syndrome. Clinical, analytical and echocardiographic variables were analysed at baseline and during follow-up. Baseline characteristics and event-free survival, defined as death or hospitalisation for heart failure (HF) during follow-up, were compared between the CVA and NCVA groups using Kaplan-Meier curves. Results A total of 191 patients were analysed (67% male, median age 74 (64-80) years), of whom 53 cases had complex valve anatomy. Among these, 7 cases presented with a mitral cleft, 2 cases had calcification in grasping zone, 3 cases had MVA≤3cm2, 35 cases with a mobile posterior leaflet length &amp;lt;7mm, 3 cases with rheumatic leaflet thickening and 8 cases had Barlow syndrome. Baseline clinical characteristics of both groups showed no significant differences, though there was a higher prevalence of hypertension in the CVA group, as shown in table 1. Most patients were in NYHA III-IV (62.3% CVA vs 72.4% NCVA, p=0.40) with a high percentage of prior hospitalization for HF in both groups without significant differences. The most common etiology of MR was functional with no differences between groups (CVA 77.4% vs NCVA 78.2%, p=0.43). With a median follow-up of 24 [9-50] months, event-free survival for readmission due to HF or all-cause mortality was 67% in CVA group, versus 64% in NCVA group, with no significant differences in median survival between them (p=0.41) (Figure 1). Conclusions In patients with MR and complex mitral valve anatomy who were initially not candidates for surgical or percutaneous treatment, a high event-free survival from death or readmission due to HF was achieved in the medium to long term. In centres with accumulated experience, TEER represents an effective therapeutic tool even in cases with complex anatomy, with no differences compared to those with more favourable anatomy. Baseline clinical characteristics. Kaplan-Meier curves

An analysis of health economics related to hospital-associated infections: A prospective case–control analysis of 7-year data from a tertiary referral corporate hospital in India

Developing a multidisciplinary HCV direct-acting antivirals utilization management and assessment program