Analytical Cross-sectional Study Research Articles

A survey on mean glandular dose in mammography examination and the factors affecting it in Shahid Sadoughi Hospital, Yazd, Iran.

mammography is the gold standard in the early detection of breast cancer. Due to the increase in the rate of women suffering from this malignancy all over the world, this imaging modality has been widely used. Considering the side effects caused by ionizing radiation to measure the carcinogenic risk of mammography X-rays, mean glandular dose (MGD) is the best parameter to evaluate the dose received by patients undergoing mammography. The aims of this study were to measure MGD in mammography in mammographic craniocaudal (CC) and mediolateral oblique (MLO) projections and investigate the relationship of MGD with compressed breast thickness (CBT), body mass index, age of the patient, and device exposure conditions. this cross-sectional analytical study was conducted on women aged 30-70 referring to the mammography unit of Shahid Sadoughi Hospital in Yazd city from May to August 2022. The TLD-GR 200 (thermoluminescence dosimeter) was placed on the breast of the patients for CC and MLO projections, and then the MGD was obtained by multiplying the entrance surface dose and the normalized glandular dose. Analysis of data (such as demographic information of patients, CBT, kVp, and mAs) was done by SPSS 23 software. The normality of the data was checked using Shapiro-Wilk tests. It was found that except for age, other variables did not have a normal distribution; therefore, equivalent parametric and nonparametric tests were used. In this regard, Spearman's correlation was used to assess the correlation between variables. P-value < .05 was considered as level of significance. The mean±standard deviation (SD) age of patients was 47.3±7.1years. The median±IQR (the interquartile range (IQR) is a measure of statistical dispersion, which is the spread of the data. It is defined as the difference between the 75th and 25th percentiles of the data.) (mean±SD) value of MGD per woman was 1.2±0.4mGy (1.3±0.3mGy). The median±IQR MGD in the MLO and CC projections was 1.6±0.6mGy and 0.9±0.4mGy, respectively. Significant relationships (P-value ≤ .001) were observed between MGD with CBT (R=0.62) and age (R=-0.85). The results showed that the mammography unit at Shahid Sadoughi Hospital in Yazd is functioning properly. The calculated median±IQR MGD per woman referring to this unit (1.2±0.4mGy) was clearly below the dose limit recommended by American College of Radiology and International Commission on Radiological Protection (3mGy). Moreover, among the factors affecting MGD, the highest correlation was seen between MGD and age (R=-0.85).

Differences in Carcinoembryonic Antigen (CEA) Levels Based on the Degree of Histopathological Differentiation of Colorectal Cancer: Single Center Observational Study at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Colorectal cancer is the third malignancy and second leading cause of death in the world. CEA levels before surgery can be used as a cancer marker to help staging, planning, monitoring therapy and disease recurrence. One factor that influences CEA levels is the degree of differentiation of cancer cells. This study aims to determine differences in CEA levels based on the degree of histopathological differentiation in colorectal cancer patients at Dr. M. Djamil General Hospital Padang. Methods: This study was a cross-sectional analytical observational study using medical record data from colorectal cancer patients from January 2021 – August 2023. The sample was 65 patients who met the inclusion and exclusion criteria. CEA examination uses the ELFA method. The Mann Whitney test was used to see differences in CEA levels based on the degree of differentiation, statistically significant if p &lt; 0.05. Results: A total of 65 patients with an average age of 56.89 years, 58.5% men, 41.5% women. A total of 10 patients were stage I, 29 stage II, and 26 stage III. Based on histopathology, 50 patients were classified as low grade and 15 as high grade. Low-grade CEA levels were 67.72 (3.14-200) ng/mL, while high grade were 3.2 (0.57-11.42) ng/mL. There was a significant difference in CEA levels based on histopathological differentiation (p &lt; 0.001). Conclusion: CEA levels are higher in low-grade than high-grade colorectal cancer.

Perceived barriers and factors influencing uptake of breast cancer screening among women: a population-based cross-sectional study

Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value < 0.05 was considered significant. A total of 354 study participants were included in the present study. The mean age of participants was 31.0 ± 11.8 years. The majority of study participants (67.5%, n = 239) were aware of BC screening. However, only (35.3%, n = 125) reported to have ever practised BC screening. Breast self-examination was the most (16.4%, n = 58) frequently used method for BC screening among study participants. Lack of knowledge of all methods of BC screening was the barrier that was perceived by the vast majority (60.2%, n = 213) of the study participants. Having low family income was the only predictor of failure to practice BC screening. In this study, most of the women were aware of BC, however, few of them had undergone breast cancer (BC) screening at the time of the interview. The study also found that the main barrier to BC screening was the lack of knowledge about BC among the study participants. Immediate measures are necessary to increase women's awareness of BC. Such as community sensitization on the importance of screening, can help improve the uptake of BC screening and the early detection of BC.

The impact of mothers’ postnatal sense of security on their breastfeeding self-efficacy and postpartum depression

Objective: This study aimed at determining the impact of mothers' postnatal sense of security on their breastfeeding self-efficacy and postpartum depression. Method: An analytical cross-sectional study was designed. The study included a total of 340 puerperal women who were admitted to the puerperal ward of a state hospital located in southern Turkey. The data for this study were collected using the puerperal women information sheet (PWIS), the Mothers’ Postnatal Sense of Security Scale (MPSSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Results: It was determined that the mean age of the participants was 27.92 ± 5.12, educational background 40.2% of them were undergraduate and higher graduates, 71.1% of them were not working. The mean scale scores of the mothers were 47.86 ± 10.36 for MPSSS, 53.69 ± 11.23 for BSES-SF, and 8.79 ± 5.67 for EPDS. The sub-scale scores for MPSSS were as follows: Empowering behaviors: 16.75 ± 5.1, General well-being: 11.18 ± 3.49, Affinity Within the Family: 11.82 ± 3.4, and Breastfeeding: 8.11 ± 2.53. Empowering behaviors scores were found to be moderately positively correlated with Affinity Within the Family, Breastfeeding, and BSES-SF scores (p

Functional constipation in the general population of Cotonou: influence of defecatory habits and physical activity

Introduction: Constipation is a relatively common symptom worldwide. In its management, advice on physical activity and defecatory habits play a significant role. This work aimed to study the influence of defecatory habits and physical activity in the occurrence of constipation in the general population of Cotonou in the Republic of Benin. Methods: This was a cross-sectional descriptive and analytical study conducted in 2017 in 7 districts of the commune of Cotonou, using cluster sampling. Constipation was defined according to Rome IV criteria. Defecatory habits of participants were collected. Physical activity was assessed using the Marshall questionnaire. Results: A total of 1058 participants were included, including 574 men (sex ratio of 1.2), with an average age of 29.3 ± 14.7 years [15-92 years]. Constipation was functional in 256 cases (24.2%). Defecatory habits associated with functional constipation were: squatting during defecation (p=0.015), not going to the toilet as soon as needed (p&lt;0.001), not systematically going to the toilet in the morning (p=0.033). Not engaging in moderate physical activity was also a factor associated with constipation (p&lt;0.001). Conclusion: Defecatory habits appear to be associated with the onset of constipation in this Cotonou study. Moderate physical activity appears to protect against constipation in the population studied.

Knowledge level and constructs of the theory of planned behaviour (TPB) to the practice of unsafe abortion among postnatal mothers attending Mkonze health center, Dodoma Region, Tanzania

BackgroundUnsafe abortion is now a global agenda because 45% of all global abortions are unsafe, and 97% are occurring in developing countries. In Tanzania, one million reproductive-aged women face unplanned pregnancies per year, and 39% end up with abortion. About 16% of maternal deaths are reported per year in Tanzania, and unsafe abortion takes the second position. There are several efforts to prevent and intervene unsafe abortions, such as equipping healthcare facilities across all levels of healthcare, approval of Misoprostol use, establishment of comprehensive post-abortion care (PAC), revising policy guidelines and standards, provision of emergency contraceptives, and capacity building of healthcare providers. There is little documentation about how the constructs of the theory of planned behaviour, knowledge, and sociodemographics influence the practice of abortion.ObjectivesTo assess the association of knowledge level, sociodemographic characteristics, and constructs of the theory of planned behaviour (TPB) to the practice of unsafe abortion among postnatal mothers at Mkonze Health Center in the Dodoma region.MethodologyIt is an analytical cross-sectional study design conducted in Dodoma-Tanzania and involved 206 postnatal women. A validated questionnaire was used and analysis was performed in the Statistical Package for the Social Sciences (SPSS), through descriptive and inferential statistics.ResultsThe practice of unsafe abortion in the current study is 28/206 (13.6%), influenced bytheir lower educational level and being single women. It was found that the majority had adequate knowledge of unsafe abortion 129 (62.6%), positive attitude 130 (63.1%), good subjective norms 113 (54.9%), and positive perceived behavioral control111 (53.9%). Knowledge, attitude, subjective norms, and perceived behavioral control were not significantly associated with the practice of unsafe abortion.ConclusionThe majority of the respondents had high knowledge, attitudes, subjective norms, and perceived behavior control on unsafe abortion. This is an indicator that the implemented initiatives are effective. Maintaining the ongoing effort and improving strategies are promising to mitigate the burden of unsafe abortion. Future research needs to find out hidden factors associated with attitude and how health beliefs might influence someone’s attitude towards unsafe abortion.

The relationship between leg muscle strength and static balance in surfers

Background: Surfing is a type of water sport that involves playing on the waves by using a surfboard to maneuver on the waves. It requires good static balance and good leg muscle strength. Methods: The method used in the analytical cross-sectional study design. This research was conducted on February 25, 2023. The inclusion criteria for male surfers aged 18-25 years have ever surfed (nor in the training or learning process). According to the screening assessment, the exclusion criteria included individuals who have experienced a lower extremity injury in the last 3 months (except lacerations or injuries with open wounds). The sampling technique used was a nonprobability sampling method with a purposive sampling technique. The number of samples obtained in this research was 46 samples. Results: Data collection was carried out by measuring leg muscle strength and static balance. Leg muscle strength was measured with a leg dynamometer while static balance was measured with the Stork Standing Test. Based on the non-parametric Spearman rho analysis test, the value of p = 0.000 (p &lt; 0.05) and the correlation coefficient r = 0.954. Conclusion: Based on the research results, it can be concluded that there was a significant relationship between leg muscle strength and static balance in surfers.

Extraarticular manifestations of juvenile idiopathic arthritis and their impact on health-related quality of life.

The objective of this study is to investigate extraarticular manifestations (EAMs) in patients with juvenile idiopathic arthritis (JIA) and assess their impact on health-related quality of life (HRQoL) among these patients. This cross-sectional analytic study was carried out on 117 patients with JIA. EAMs were identified clinically by history and examination. Sicca symptoms, peripheral neuropathy, enthesitis, and skin lesions were picked up during clinical examination. Pulmonary involvement was evaluated by high-resolution CT chest. Patients were assessed by abdominal ultrasonography to assess the size of liver and spleen. Atlantoaxial subluxation was evaluated by cervical spine x-rays. Patients were evaluated by Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL-3 arthritis module. The median age of patients was 14years with a median disease duration 4years, 82.9% were females. Of the studied 117 JIA patients, 85 patients (72.6%) had at least one EAM. Persistent fatigue (51.3%) was the most prevalent EAM, followed by recurrent skin rash (16.2%), enthesitis (15.4%), recurrent fever (13.7%), and uveitis (12%). Patients with EAMs scored significantly lower in physical functioning (p = 0.001), emotional functioning (p < 0.001), social functioning (p = 0.005), and school functioning (p = 0.001). Regarding PedsQL arthritis module, patients with EAM had also significantly lower scores than did patients without EAM on the domains of pain and hurt (p < 0.001), daily activities (p = 0.008), and worry (p = 0.001). EAMs are prevalent among JIA patients and have a negative impact on their HRQoL. So, early identification and treatment are highly recommended. Key Points • A large percentage of JIA patients experienced at least one extraarticular manifestation (EAM). • Persistent fatigue and recurrent skin rash are the most prevalent EAMs in JIA patients. • JIA patients with EAMs have worse scores in almost all domains of HRQoL.

Predictors of parenting stress and childbearing motivations in mothers of children with autism spectrum disorder: A cross-sectional study from Turkey

Aim: The study aimed to identify the predictors of parenting stress and childbearing motivations among mothers of children with autism spectrum disorder. Methods: An analytical cross-sectional study was conducted with 165 mothers of children diagnosed with autism spectrum disorder in Turkey from November 2021 to January 2022. Data were collected using Questionnaire-Form, Parenting-Stress Index-Short Form, and Childbearing Motivations Scale. Multiple linear regression analyses examined the relationship between parenting stress and childbearing motivations, and the independent variables. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Results: The parenting-stress score was higher, while positive childbearing-motivation score was lower than the mean scores of the scales among the mothers. The mother's age, education status, sibling rank of the child with autism spectrum disorder, and the effect of autism spectrum disorder on the decision to have another child were among the predictors of the parenting-stress levels up to 20.1%. The mother’s educational and income status, sibling rank of the child with autism spectrum disorder, and the desire to have another child were predictors of the level of positive childbearing motivations up to 18.7%. A positive moderate relationship was found between parenting-stress and negative childbearing-motivations. Conclusion: Mothers tend to engage in negative childbearing-motivation regarding having another child. Improving socioeconomical status and decreasing parenting-stress might help mothers adopt positive childbearing-motivation and prevent negative childbearing-motivation.

Nicotine Dependency Levels Among Adult Electronic Cigarette Smokers in Jeddah, Saudi Arabia: An Analytical Cross-Sectional Study.

Electronic cigarettes (ECs) are a recent method to deliver nicotine with less harmful effects than traditional cigarettes. Studying nicotine dependence in adult EC users is a crucial area, but few measures are available to evaluate nicotine dependence induced by EC. Our study aims to estimate the levels of nicotine dependency among adult EC smokers using a modified Fagerström Test of Nicotine Dependence (e-FTND) in Jeddah, Saudi Arabia, and to identify EC-associated sociodemographic and smoking-related factors affecting nicotine dependency. An analytical cross-sectional study was conducted on adults 18 years of age and older in Jeddah, Saudi Arabia, from December 2023 to March 2024. Data were collected from the participants using a pre-tested structured self-administered questionnaire, and nicotine dependence was assessed using the modified e-FTND. Descriptive statistics such as frequency, mean, and standard deviation were applied. Chi-square was used to assess the association between categorical variables. Ordinal regression was used to predict the nicotine dependency levels with different variables. A total of 344 participants were included in the study. The mean e-FTND score for EC users was 4.14 ± 2.45. Females had a lower likelihood of experiencing higher dependence compared to males (OR = 0.52, 95% CI: 0.32, 0.85). Using ECs for more than three years was associated with higher odds of increased dependence (OR = 3.18, 95% CI: 1.28, 7.98; p < 0.001). The use of Pod system devices lowered the odds of developing high nicotine dependence (OR = 0.32, 95% CI: 0.13, 0.75; p = 0.01) compared to Iqos device users, while mechanical Mod device users exhibited a trend towards higher dependence, although it was not statistically significant. Nicotine concentration in ECs had a significant impact on the degree of nicotine dependence. Higher concentrations were associated with increased odds of higher dependence (12-18 mg: OR = 3.26, 95% CI: 1.55, 6.91; >18 mg: OR = 4.53, 95% CI: 2.37, 8.75; p < 0.001). Most exclusive EC users in the study developed a moderate nicotine dependence level. The EC device type and nicotine concentration were significant drivers of nicotine dependence. Additionally, the personal characteristics of the users, such as male gender and duration of use, were associated with a higher risk of dependence. An in-depth understanding of the magnitude of nicotine dependence among EC users will enhance the opportunity for tailored health-enhancing interventions and policies.

Predictors of under-weight among children younger than 24 months in Nimule Border Town, Eastern Equatoria State, South Sudan: a community-based cross sectional study

BackgroundUnderweight is a public health problem globally, and more severe in South Sudan with wide sub-regional differences. In Nimule border town, which represents other border towns in South Sudan, data on underweight among children below two years is unavailable. Thus, this study set out to assess predictors of underweight among children younger than 24 months in Nimule border town, Magwi County, Eastern Equatoria State, South Sudan.MethodsAn analytical cross-sectional study was conducted in Nimule boarder town targeting 390 children younger than two years. Systematic sampling and simple random sampling methods were used. Data were collected through a researcher-administered questionnaire with both open and closed ended questions. Data was entered in EpiData and then exported into Statistical Package for Social Sciences research (SPSS) version 20 for analysis. Descriptive data analysis was conducted and data were summarized into frequencies and percentages, means with standard deviations, and medians with interquartile ranges. Bivariate analysis was conducted with the Chi-squared and Fisher's exact tests for categorical independent variables, and the student’s t-test for numerical variables. Finally, multivariate analysis was done via logistic regression analysis and results were stated as odds ratios (OR) with corresponding 95% confidence interval (CI). The level of statistical significance was set at 5%.ResultsOut of the total 390 participants, 112 (28.7%) were under weight. The study showed primary (aOR, 0.38; 95% CI, 0.12–1.18; P = 0.095) and secondary (aOR, 0.37; 95% CI, 0.12–1.17; P = 0.091 levels of education were associated with underweight but not tertiary level of education (aOR, 0.76; 95% CI, 0.21–2.74; p = 0.671). Household income of 5000 to 10,000 (aOR, 0.26; 95% CI, 0.10–0.68; P = 0.006) and above 10,000 (aOR, 0.11; 95% CI, 0.04–0.28; P < 0.001) South Sudanese pounds, supplementary feeding before 6 months (aOR; 0.01; 95% CI, 0.02–0.05; P < 0.001) were associated with underweight and irregular hand washing (aOR; 2.17; 95% CI, 1.14–4.11; P = 0.018) was associated with increased odds of underweight.ConclusionsThis study established a high prevalence of underweight. Maternal level of education particularly primary, secondary, higher household incomes in excess of 5,000 South Sudanese pounds reduced the risk of underweight. While irregular hand washing was a risk factor for underweight.

Maternal and neonatal outcome in pregnant women undergone induction of labor at Muhimbili National Hospital, Dar Es Salaam, Tanzania

IntroductionLabor induction is a common obstetric intervention aimed at initiating labor when spontaneous onset is delayed or deemed necessary for maternal or fetal well-being. Despite its widespread use, the practice’s impact on maternal and neonatal outcomes remains a subject of ongoing research and debate. This study aims to evaluate the maternal and neonatal outcomes associated with labor induction in a tertiary hospital setting in Tanzania.MethodologyA descriptive analytical cross-sectional study was conducted over a seven-month period from January 2021 to July 2021 at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 120 pregnant women who underwent labor induction during this period were included in the analysis. Data on maternal demographics, obstetric characteristics, indications for induction, methods of induction, labor outcomes, and neonatal outcomes were collected from medical records and analyzed descriptively.ResultsAmong 4773 deliveries during the study period, 120 women underwent labor induction, accounting for 120 (2.5%) of all deliveries. The most common indications for induction were postdate pregnancy 60 (50%), hypertensive disorders of pregnancy 38 (31.7%), and premature rupture of membranes 22 (17.5%). The majority of induced women 74 (61.7%) delivered vaginally, with 46 (38.3%) undergoing cesarean section. Maternal complications were minimal, with the most common being failed induction of labor 17 (14.2%). Neonatal outcomes were generally positive, with 120 (100%) of neonates having Apgar scores of 7 or higher at five minutes, although 10 (8.3%) required admission to the neonatal ward for further care.ConclusionLabor induction at Muhimbili National Hospital demonstrated favorable maternal and neonatal outcomes, with low rates of maternal complications and positive neonatal Apgar scores. Postdate pregnancy emerged as the most common indication for induction. While the study highlights the benefits of labor induction, its retrospective nature and single-center setting limit the generalizability of findings. Prospective studies with larger sample sizes are warranted to validate these findings and inform evidence-based obstetric practices.

Postoperative Hemoglobin Drop and the Associated Factors among Elective Orthopedic Surgeries in Northern Tanzania.

Having an estimated level of Hb drop in different orthopedic surgeries would help plan for surgery from pre- to postoperative periods. The aim of this study was to assess the Hb drop and the associated factors during the intraoperative period among elective orthopedic surgeries. This was an analytic cross-sectional study conducted between October 2022 and March 2023, which included all patients admitted for elective orthopedic surgery who met the inclusion criteria. Data were collected before and after the patient was operated on. Information was analyzed using t-tests and ANOVA to establish the statistical significance of the Hb drop. A total of 195 participants were enrolled. The majority of the participants were male (62.1%), with the main etiology of symptoms being motor traffic accidents (31.8%). The most affected site was the femur (36.4%), followed by the spine (23.6%). The highest mean Hb drop was in total hip replacement surgeries (4.19 g/dL), with the overall mean Hb drop being 2.75 g/dL. A statistically significant difference was identified in diathermy use, duration of surgery, and patients with chronic illnesses. With a mean Hb drop of 2.75 g/dL, the application of diathermy and surgeries with shorter durations resulted in a reduced Hb drop. These factors should be incorporated to minimize the drop in Hb in orthopedic surgeries. Accounting for differences in surgeries, there should not be delays in patients who have a preoperative Hb level that can sustain the mean Hb drop recorded in the study.

Factors Associated with the Perception of Prehospital Internship Training of Dental and Other Health Sciences Students in the COVID-19 Context

During the COVID-19 pandemic, pre-internship training of Health Sciences students took on an essential role. The shift to virtual practices and a project-based learning approach brought challenges, but also opened doors for adaptation and learning in a constantly evolving healthcare landscape. To determine the factors associated with the perception of Peruvian health sciences students during the period of isolation due to the COVID-19 pandemic regarding their training prior to hospital internship. A Cross-sectional analytical study was performed. Students from professional schools of health sciences who entered the hospital internship 2022 and students from the year prior to the internship from a Peruvian public university were evaluated. Data collection was performed with a 49-question questionnaire. Female participants were more prevalent with 384 (70.98%) students while the medical career had the highest participation with 152 respondents (28.1%) followed by the dental career with 134 (24.77%). In the adjusted logistic regression model no influence of associated factors on students' perception of their preparedness for hospital internship in the isolation period due to the COVID-19 pandemic was found. Peruvian Health Sciences students self-perceive themselves prepared for hospital internship in Comprehensive Care, Prevention, Collaboration and Self-Learning, but less so in Practical Skills, Understanding Science, Interpersonal Skills and Confidence.

Comparative study of two laboratory techniques for the detection of HLA-B27 in patients with axial spondyloarthritis: a cross-sectional analysis

BackgroundThe diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA.MethodsAn analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele’s presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant.ResultsOf the participants, 90.3% (n = 56) were HLA-B27 positive according to FC, while 79% (n = 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived.ConclusionsFC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs.

Changes in Retinal Ganglion Cell (RGC) and Retinal Nerve Fiber Layer (RNFL) Thickness in Children with Type 1 Diabetes Mellitus at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Type 1 diabetes mellitus (DM) is a chronic metabolic disorder that causes hyperglycemia and increases the risk of morbidity and mortality. Diabetic retinopathy, a microvascular complication that often occurs in DM patients, can cause visual impairment and even blindness. Regular eye examinations are important for early detection of diabetic retinopathy. Optical coherence tomography (OCT) is a non-invasive method that can be used to measure the thickness of retinal layers, including RGC and RNFL. It is thought that thinning of the retinal layer can be a sensitive biomarker in detecting diabetic retinopathy in type 1 DM patients. This study aims to determine changes in RGC and RNFL thickness in children with type 1 DM. Methods: This cross-sectional design analytical observational study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital Padang in November 2023-March 2024. A total of 46 eyes from 46 people, divided into two groups: the type 1 DM group and the control group, were recruited in this study. RGC thickness was measured using AS-OCT GC-IPL thickness analysis and RNFL with optic disc RNFL thickness analysis. Data analysis was carried out using the unpaired T-test. Results: The results showed RGC depletion in the type 1 DM group (RGC 83.48 ± 3.75) compared to the control group (RGC 86.70 ± 4.87) with a value of p = 0.016 (p &lt; 0.05). There was no statistical difference in RNFL thickness between the type 1 DM group (RNFL 102 ± 11.80) and the control group (RNFL 100.96 ± 10.97) with a value of p = 0.581 (p&gt; 0.05). Conclusion: This study found RGC thinning in type 1 DM patients, but did not find differences in RNFL thickness between the two groups. This RGC depletion is thought to be caused by apoptosis of retinal neuronal cells due to chronic hyperglycemia. Examination of RGC thickness with OCT can be developed as an early detection of diabetic retinopathy in children with type 1 DM.

What are blood cortisol levels in anxious, depressive, mixed, and healthy controls in high altitude?

ObjectiveWe aim to determine the difference in blood cortisol levels between major depression, mixed anxious depressive disorder, generalized anxiety disorder, and healthy controls during COVID-19 social isolation in Cusco (3400 m.a.s.l.). MethodsNon-experimental, cross-sectional analytical design study, designed to determine the difference in blood cortisol levels between anxiety, depression, and mixed disorders in adults aged 25–65 living in Cusco, at the Mental Health Community Center of San Sebastian. ResultsSignificant differences were found in the morning, afternoon, and ratio (Afternoon/Morning cortisol) in all the groups. All the pathological groups showed increased cortisol levels than the healthy controls. Major depression group showed a flattening of the normal regulation line of cortisol. ConclusionsThe blood cortisol test shows significant values for the discrimination of affective pathology, particularly between depressive and anxious disorders and normal controls.

Enhancing Clarity and Patient Safety: Evaluating the Inclusion of Laterality in Orthopaedic Outpatient Correspondence in Galway, Ireland.

Background In medical documentation, accurate mention of laterality, whether a condition or treatment pertains to the left or the right side of the body, is critical for avoiding errors like wrong-site surgeries, which can have severe repercussions. This study aims to assess compliance regarding the mention of laterality in outpatient clinic letters at Galway University Hospital. Methods An analytical cross-sectional study was conducted at Galway University Hospital from February to August. We reviewed outpatient letters in the Orthopaedic Department. The Fisher exact and Chi-square tests were employed to observe the association between the levels of practitioners and laterality. Results A total of 278 outpatient letters from 37 practitioners in one week were analyzed. The overall laterality rate was 65.1%.It was observed that there was a male predominance in the workforce (31; 83.8%). Conclusion In conclusion, our study revealed satisfactory improvement in the prevalence of mentioning laterality among healthcare providers. It is recommended that educational sessions and re-auditing be carried out to enhance the quality of care.

Factors associated with depression in patients undergoing rehabilitation for chronic pain: a cross-sectional analytical study at a referral hospital in Peru.

Despite the well-known impact of depression on patients with chronic pain and its association, few studies have evaluated its related factors in Physical Medicine and Rehabilitation settings. The objective of the present study was to assess the factors associated with depression in adult patients undergoing rehabilitation for chronic pain at Hospital Rebagliati (HNERM) in Peru. A cross-sectional analytical study was conducted between June and August 2023, involving 212 adult patients with chronic pain undergoing rehabilitation at HNERM. Data were collected through a survey, including sociodemographic information, pain characteristics, and depression assessment using the Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included descriptive statistics and generalized linear models to identify factors associated with depression. Among 212 participants, 17.9% had a depression diagnosis based on the PHQ-9 (cutoff score: 10 points). Factors associated with a higher frequency of depression included a time since pain diagnosis of 3-6 months [adjusted prevalence ratios (aPR): 1.15, 95% confidence interval (CI): 1.04-1.27], severe pain (aPR: 1.17, 95% CI: 1.04-1.32), comorbidities (for 1: aPR: 1.21, 95% CI: 1.08-1.35; for 2: aPR: 1.17, 95% CI: 1.06-1.29; for ≥3: aPR: 1.27, 95% CI: 1.10-1.47), use of ≥2 medications for pain management (aPR: 1.27, 95% CI: 1.13-1.42), and receipt of psychological therapy (aPR: 1.26, 95% CI: 1.09-1.46). Nonpharmacological interventions did not show an association with an increased prevalence of depression. These findings underscore the significance of adopting a comprehensive approach to chronic pain management, including the screening, assessment, and treatment of associated depression.

Structural relations of illness perception, fatigue, locus of control, self-efficacy, and coping strategies in patients with multiple sclerosis: a cross-sectional study

BackgroundPatients with multiple sclerosis (MS) experience extensive problems due to fatigue and illness perception. Reducing these problems may improve these patients’ quality of life (QoL). Accordingly, the current study is aimed at investigating the mediating role of self-efficacy, locus of control, coping strategy, and outcome expectancy in the relationship between illness perception and fatigue severity in patients with MS.MethodsIn a cross-sectional analytical study, data of 172 MS patients were collected by self-report questionnaires including illness perception questionnaires (IPQ-R), Multiple Sclerosis Self-Efficacy (MSSES) scale, health locus of control (MHLC), coping strategies in MS(CMSS), outcome expectancy, level of physical activity (IPAQ-SF), patient activation measure (PAM-13) and fatigue severity scale (FSS). The data were analyzed using linear and multiple regression analysis in SPSS software version 24 (SPSS Inc., Chicago, IL, USA).ResultsThe final model explained 62% of the fatigue variance. Illness perception both directly and indirectly (through self-efficacy, physical activity level, internal health locus of control, patient activation, and negative coping strategies) could predict the participants’ fatigue severity. Among the mediating variables, internal health locus of control, self-efficacy, and negative coping strategies had the greatest impact, respectively. moreover, outcome expectancy variable did not a mediating role in the aforementioned relationship.ConclusionsTo enhance the well-being of MS patients and to improve the efficiency of treating MS related fatigue, a comprehensive treatment protocol is needed, encompassing psychological factors affecting fatigue severity.