Center Cross-sectional Study Research Articles

High blood urea nitrogen to creatinine ratio is associated with increased risk of sarcopenia in patients with chronic obstructive pulmonary disease

Background and aimsSarcopenia has been reported to be a prognostic factor for chronic obstructive pulmonary disease (COPD). However, the relationship between the ratio of blood urea nitrogen to creatinine (BUN/Cr) and sarcopenia in patients with COPD remain unclear. Therefore, the purpose of this study is to explore whether the ratio can be used as a predictor of sarcopenia in hospitalized COPD patients. MethodsThe skeletal muscle area index (SMI) at the level of the 12th thoracic vertebra (T12) was used to assess the risk of sarcopenia in patients. This single center cross-sectional study was conducted by analyzing the clinical parameters and identifying the T12 skeletal muscle area (SMA) and density (SMD) on chest CT images of COPD hospitalized patients admitted to the respiratory department of our hospital from March 2018 to August 2021. The study enrolled 265 hospitalized patients. Based on the different statistical properties of the above variables, differences between groups were measured by independent sample Student t-tests, Mann-Whitney U tests, or Chi-Square tests. Multivariable linear regression analysis was used to evaluate the relationship between the value of BUN/Cr and the risk of sarcopenia. ResultsThe serum BUN/Cr ratio was negatively correlated with SMI (r = −0.201, p = 0.001) in COPD patients, and multivariate linear regression analysis showed that this ratio was associated with the risk of sarcopenia (β = −0.109, p = 0.041). The optimal cut-off value of BUN/Cr ratio for identifying COPD patients with sarcopenia was 97.893. There was also a significant negative correlation between serum BUN/Cr ratio and forced vital capacity (FVC; r = −0.235, p < 0.001) and forced expiratory volume in the first second (FEV1; r = −0.219, p < 0.001). ConclusionThe BUN/Cr ratio can be used to predict sarcopenia and evaluate pulmonary function in hospitalized COPD patients.

A study of cardiovascular profile in patients with primary hypothyroidism

Introduction and Aim: Raised cardiovascular morbidity is common among patients with primary hypothyroidism. Study of electrocardiogram (ECG) and echocardiography (ECHO) and correlation with lipid profile may help in early detection of cardiovascular diseases in hypothyroidism. By this study, we aimed at studying the cardiovascular profile in patients with primary hypothyroidism and correlating ECHO and ECG changes in primary hypothyroidism with the LDL cholesterol. Materials and Methods: This was a single centre cross-sectional observational study. All patients diagnosed with primary hypothyroidism were included. The laboratory parameters pertaining to primary hypothyroidism were recorded. ECG and ECHO were noted and correlated with lipid profile. Results: Total 240 subjects were selected according to inclusion and exclusion criteria, of which males were 25% and females 75%. Mean ± SD of LDL-C among subjects having ST-T changes was 160.98 ±14.86. Mean ± SD of LDL-C among subjects having no ST-T changes was 128±10.15. Unpaired student t test was used to compare mean of lipid profile in patient having ST-T changes with patients having no ST-T changes. A strong correlation was observed between LDL cholesterol and ST-T changes in ECG (P value =0.001) Conclusion: Diastolic dysfunction is more common than systolic dysfunction in primary hypothyroidism. LDL levels were high in patients with primary hypothyroidism who had ST-T changes in electrocardiogram. Levothyroxine replacement causes decrease in Total as well as LDL cholesterol in primary hypothyroidism. ECG changes correlated with abnormal lipid profile in patients with primary hypothyroidism.

Characteristics of Pediatric Nasal Foreign Body Cases That Required Multiple Removal Procedures: A Single Tertiary Medical Center Cross-Sectional Study.

Removal of nasal foreign bodies in children should be completed as few numbers of times as possible to reduce the burden on the child. This study aimed to reveal the characteristics of pediatric nasal foreign body cases that required multiple removal procedure and to investigate the appropriate removal method for each shape of foreign body. We retrospectively reviewed patients who visited a pediatric emergency department because of nasal foreign body from November 1, 2018, to October 31, 2020. We compared the characteristics of patients, foreign bodies, and treatment between the success and failure groups in the first removal procedure. Moreover, we described the detail of patients in the failure group. We also showed final successful removal methods according to the shape of the foreign bodies. We included 104 children in our analysis. Between the success and failure groups in the first removal procedure, there was no statistically significant difference in the characteristics of patients and foreign bodies but a significant difference in the removal method ( P < 0.001). In the failure groups, the most frequent number of times required for removal is 2 and the most common methods in the first removal procedure was the parent's kiss, most of which were performed on spherical foreign bodies in younger children, Finally, only 7 cases (6.7%) failed to remove the foreign body. According to the shape of the foreign bodies, the percentage of forceps and clamps used for successful removal was high in every shape. There was a significant difference in the removal method between the success and failure groups in the first removal procedure, but finally, most foreign bodies were removed by emergency physicians. Therefore, further research is needed to determine the appropriate removal method for each patient and foreign body.

Factors associated with high glucose variability in patients with type 1 diabetes

BACKGROUND: High glucose variability (GV) is recognized as a risk factor for vascular diabetic complications and hypoglycemia. Factors affecting GV in patients with diabetes needed to be clarified.AIM: To determine the factors associated with high GV in adult patients with type 1 diabetes.MATERIALS AND METHODS: We conducted a single center cross-sectional observational study. In-patients with type 1 diabetes aged 18 to 65 years on basal bolus insulin therapy were included. Day-time and nocturnal Coefficient of Variation (CV), Mean Amplitude of Glycemic Excursions (MAGE), Mean Absolute Glucose (MAG) were calculated from continuous glucose monitoring data. The values of CV, MAGE, MAG within the upper quartile were considered high.RESULTS: The study included 400 individuals, including 111 on continuous subcutaneous insulin infusion (CSII). Patients with high GV had lower fasting and postprandial C-peptide levels and higher insulin doses. According to ROC analysis, daily insulin dose &gt;0.69 U/kg and estimated glomerular filtration rate (eGFR) ≥90.5 ml/min×1.73 m2 were associated with high nocturnal CV values. Dose of basal insulin &gt;0.292 U/kg and bolus insulin &gt;0.325 U/day were associated with nocturnal MAGE. Body mass index (BMI) ≤23.2 kg/m2, waist circumference ≤80.5 cm, daily insulin dose ≥0.69 U/kg, HbA1c ≥8.3%, eGFR ≥89.5 ml/ min×1.73m2 increased risk of high MAG at night. High day-time CV values were associated with daily insulin dose ≥0.675 U/kg and daily dose of BI ≥0.286 U/kg. The risk of high MAGE was increased with HbA1c ≥8.24% and basal insulin dose ≥0.286 U/kg. BMI ≤23.2 kg/m2, waist circumference ≤80.5 cm, daily insulin dose ≥0.69 U/kg, daily dose of bolus and basal insulin ≥0.325 and ≥0.29 U/kg respectively, and HbA1c ≥8.33% were the risk factors for high day-time MAG. Patients on CSII had lower MAGE (p&lt;0.001) and MAG (p=0.008) compared to those on multiple daily injections.CONCLUSION: In type 1 diabetes, high GV is associated with undetectable residual insulin secretion, normal or reduced body weight, preserved kidney function, supraphysiological doses of insulin, and non-target HbA1c. Patients on CSII have a lower GV than those on multiple daily injections.

Do social and environmental factors affect level of stress during COVID-19 among nursing students? Results from single center cross-sectional study in Malaysia

Introduction: Stress in nursing students has been documented in many studies and this will lead to various health problems. However, there is scanty research assessing the level of stress among nursing students during Covid-19 in Malaysia. Hence, this study aimed to assess the level of stress and its association with social and environmental factors amongst nursing students in Universiti Malaysia Sabah, Malaysia. Methods: A cross-sectional study was conducted by random sampling among nursing students in Universiti Malaysia Sabah between March and May 2021. The primary outcome was stress symptoms, derived from the validated Perceived Stress Scale-10 (PSS) questionnaire. Socio-demographic, social, and environmental factors were also assessed. T-test was used to assess the associations between level of stress and social and environmental factors. Results: A total of 115 responses were received with the mean (SD) age of the students being 20.5 (1.3) years old. Of all the students, 84.9% were female, 54.6% received financial support from National Higher Education Fund Corporation and 46.2% were in nursing Year 2 followed by the nursing year 1 (28.6%) and nursing year 3 (25.2%). The students in this study reported a higher level of stress. The students who reported most or all the time being trapped in a hostel (p&lt;0.01), challenges of online classes (p=0.03), and catching up with class projects (p=0.03) had a higher level of stress compared to those who reported none or little or some of the factors. Conclusion: This study showed that social and environmental factors may play a role in determining the stress level among nursing students. Hence, authorities should foster supporting strategies to lower student stress and tackles the unwanted consequences.

Reduced leukocyte mitochondrial copy number in metabolic syndrome and metabolically healthy obesity.

ObjectiveThis study aimed to investigate the associations between peripheral blood leukocyte mitochondrial copy number, metabolic syndrome, and adiposity-related body composition phenotypes in a high prevalence population.MethodsA single center cross-sectional study was conducted, consisting of 521 middle-aged subjects of Maltese-Caucasian ethnicity. Participants were stratified according to the presence of metabolic syndrome and different metabolic health definitions based on NCEP-ATP III criteria. Relative leukocyte mitochondrial DNA copy number was determined by quantitative polymerase chain reaction and corrected for leukocyte and platelet count. The associations between mitochondrial copy number and metabolic syndrome components was evaluated and adjusted for age and gender.ResultsSignificant negative correlations between mtDNA copy number and BMI, waist circumference, triglyceride levels, fasting plasma glucose, HbA1c, HOMA-IR and hsCRP were observed, along with a positive correlation with HDL-C levels. Mitochondrial copy number was lower in individuals with metabolic syndrome. When compared to metabolically healthy normal weight subjects, a reduction in mtDNA copy number was observed in both the metabolically healthy and unhealthy obese categories.ConclusionOur data supports the association between reduced leukocyte mtDNA copy number, obesity, and metabolic syndrome. This investigation expands on the spectrum of associations between mtDNA copy number and metabolic phenotypes in different populations and underpins the role of mitochondrial dysfunction in the development and progression of metabolic syndrome and its components.

Monitoring of adverse events after immunization against a new coronavirus infection among young people

BACKGROUND: To increase public confidence in vaccine prevention and to actually assess the safety of vaccines against COVID-19, it is necessary to study the frequency and structure of adverse events after immunization in the post-registration period of vaccine use.&#x0D; AIM: To assess the frequency and structure of adverse events after immunization against COVID-19 among young people during the period of post-registration use of vaccines.&#x0D; MATERIALS AND METHODS: A single center cross-sectional study was conducted based on a questioning of 333 respondents aged 1825 years (76.88% female, 23.12% male). The questionnaire included 2 groups of questions: general and special (nature of post-vaccination reactions, history of COVID-19 disease before and after vaccination). Statistical processing of the results was carried out using standard Microsoft Office Excel 2016 software packages.&#x0D; RESULTS: The most common complaints after vaccination were soreness at the injection site (57.66%), weakness (54.65%) and body aches (24.92%). There were local and general/combined (weak, moderate, strong) reactions, they were observed in 30.93% of respondents after 1 dose and 45.35% after 2 doses. In the structure of reactions after the first immunization, general weak reactions (15.32%, p=0.001) were significantly more common than others, after the second local ones (21.92%, p 0.0001). A strong correlation was established between responses to the 1st and 2nd doses of the vaccine (r=0.94, p 0.0001). When studying the frequency and structure of post-vaccination reactions in sex groups and in those who had COVID-19 before vaccination and those who did not, no significant differences were found.&#x0D; CONCLUSIONS: The study found that among young people, the majority did not have objective reactions after immunization against a new coronavirus infection. General weak and local reactions were more common among the objective post-vaccination reactions.

Hip Geometry and Proximal Femoral Fractures among Elderly Filipino Women: A Single Centre Cross-Sectional Study.

Introduction:Few controlled studies explore proximal femoral geometry and association with femoral neck (FN) or intertrochanteric (IT) fractures, especially among the elderly Filipino population. Previous reports, however, still reveal multiple inconsistencies. The objective of the study is to establish a possible association between radiographic hip geometry and proximal femoral fractures based on measurements taken from elderly Filipino women.Materials and methods:This is a cross-sectional study of 182 Filipino women ≥ 60 years old at a single institution last 2019-2020. Patients were divided into groups with femoral neck fractures (n=84), intertrochanteric fractures (n=64), and those without diagnosed hip fractures (n=34). Standard pelvic radiographs with control of hip internal rotation was done and the following radiographic parameters were compared: hip axis length (HAL), femoral neck length (FNL), neck shaft angle (NSA), horizontal offset (HO), femoral head diameter (FHD), and femoral neck diameter (FND).Results:Data suggests that an increased FND increased the risk for acquiring both femoral neck (OR = 1.31, 95% CI 1.06 - 1.62; p=.011) and intertrochanteric fractures (OR: 1.22, 95% CI 1.07-2.16; p=0.018). For intertrochanteric fractures alone, a wider NSA (OR 1.27, 95% CI 1.02 - 1.58, p=0.033) and larger HO (OR 1.29, 95% CI 1.02 - 1.64, p=0.036) also increased the risk for this fracture type while a longer HAL was protective (OR 0.85, 95% CI 0.73 - 0.98, p=0.30). Other radiographic parameters and ratios revealed no association.Conclusion:Results show that there are certain hip geometric parameters that play a role in the risk and incidence of developing femoral neck or intertrochanteric fractures. These measurements may aid in identification of patients at risk. This study may act as a guide for future implant design and increase accuracy of hip reconstruction among elderly Filipino women.

Axial length measurements in same sized DALK grafts – new insights

Introduction: At the Sri Jayawardenapura General Hospital (SJGH), Deep Anterior Lamellar Keratoplasty (DALK) for keratoconus is performed by a single surgeon with graft sizing done on vertical corneal height and same-sized grafting done for all patients.Method: A single centre cross-sectional descriptive study was conducted from 01. 01. 2020 to 01. 04. 2020 at the SJGH. Patients who had completed two years of follow up after DALK for keratoconus had refraction, topography and biometry on a planned hospital visit.Results: The study included 71 patients (97 eyes). Mean age at surgery was 23.9 years; standard deviation (SD) – 6.9 years. The mean, postsurgical duration was 63.1 months (SD=23.4) and refractive SE was – 1.18 D (SD=1. 88). Hyperopic SE was seen in 21.5% of eyes. Mean axial length (AXL) was 23.50 mm (SD=1.16) and mean anterior chamber depth (ACD) was 3.578 mm (SD=0.36 mm). Mean AXL had significant negative correlation with SE (r= -0.676, P=0.000). ACD was correlated with average topographic keratometry (P=0.048). Mean topographic cylinder was -3.237 D (SD=1.85).Conclusion: Axial length measurements should be performed in pre operative work up in DALK. Patients with short eyes need to be counseled for postoperative hyperopia. Vitreous length may be a better measurement than axial length as it may not be affected by changes in ACD in keratoconus.

Differential effects of obstructive sleep apnea on the corneal subbasal nerve plexus and retinal nerve fiber layer.

PurposeObstructive sleep apnea (OSA) is an established independent risk factor for peripheral neuropathy. Macro and microvascular changes have been documented in OSA, including high levels of potent vasoconstrictors. In diabetes, vasoconstriction has been identified as an underlying risk factor for corneal neuropathy. This study sought to establish a potential relationship between OSA and corneal nerve morphology and sensitivity, and to determine whether changes in corneal nerves may be reflective of OSA severity.DesignSingle center cross-sectional study.MethodsSixty-seven patients were stratified into two groups: those with OSA and healthy controls. Groups were matched for age, sex, race, smoking, and dry eye status. Outcome measures included serologies, a dilated fundus exam, dry eye testing, anthropometric parameters, corneal sensitivity, subbasal nerve plexus morphology, retinal nerve fiber layer (RNFL) thickness, and the use of questionnaires to assess symptoms of dry eye disease, risk of OSA, and continuous positive airway pressure (CPAP) compliance.ResultsNo significant differences were observed in corneal nerve morphology, sensitivity, or the number of dendritic cells. In the OSA test group, RNFL thinning was noted in the superior and inferior regions of the optic disc and peripapillary region. A greater proportion of participants in the OSA group required a subsequent evaluation for glaucoma than in the control. In those with OSA, an increase in the apnea hypopnea index was associated with an increase in optic nerve cupping.ConclusionsOSA does not exert a robust effect on corneal nerves. OSA is however, associated with thinning of the RNFL. Participants with glaucomatous optic nerve changes and risk factors for OSA should be examined as uncontrolled OSA may exacerbate glaucoma progression.

Glandular involvement in primary Sjögren's syndrome patients with interstitial lung disease-onset and sicca-onset, a single centre cross-sectional study.

Primary Sjögren's syndrome (pSS) is an autoimmune exocrinopathy classically presenting with sicca symptoms. Nonetheless, disease onset with extraglandular manifestations, including interstitial lung disease (ILD), is increasingly reported. However, studies investigating pSS patients presenting with ILD (pSS-ILD) are limited.Aim of this study was to better characterise the phenotype of pSS patients presenting with ILD in comparison to pSS patients with classicsicca-onset. We especially investigated whether the two groups differed in glandular involvement comparing functional, imaging andhistologic findings, as well as patient reported outcome (PRO). Consecutive newly diagnosed pSS patients, all fulfilling the ACR/EULAR 2016 criteria, were included in this cross-sectional study from September 2016 to October 2021. Presence of ILD at pSS diagnosis was defined based on clinical findings, imaging assessment and pulmonary function tests (PFT). In addition to functional tests, a minor salivary gland biopsy was performed in all cases, recording number of foci, focus score (FS) and GC-like structures. Salivary glands ultrasonography (SGUS) was graded using the OMERACT semiquantitative scoring system (0-3) based on parenchyma inhomogeneity. PRO including ESSPRI, OHIP and OSSDI were collected.Extraglandular clinical features and biological abnormalities included in the ESSDAI were recorded. Data were expressed as mean±SD for continuous variables and as absolute frequencies and percentages for categorical variables. Chi-Square test and Mann-Whitney U-test and ANOVA were performed for comparisons of categorical variables and continuous variables, respectively. We included 178 newly diagnosed pSS patients (F:M=158:20). ILD was the first pSS manifestation in 11 (6%) cases, 8 F and 3 M, with a median time from ILD onset to pSS diagnosis of 2 years (25-75 IQ 1-4.5). Of the 11 pSS-ILD patients, HRCT pattern was defined as NSIP in 4, UIP in 4, NSIP+OP in 2 and LIP in 1 patient. Dyspnoea on exertion or chronic cough were reported by 7/11 (63.6%) patients.In comparison to sicca-onset patients, pSS-ILD patients presented an older age at diagnosis (55±13 vs. 70±7, p= 0.001) and a higher ESSDAI (3.9±4.7 vs. 12.3±4.3, p=0.001), driven by the pulmonary domain. Regarding glandular involvement, pSS-ILD patients reported milder xeropthalmia (VAS 5.8±3.1 vs. 2.8±3.5, p=0.002) and significative lower scores in OSDI (35.6±24.9 vs. 15.3±22.9, p=0.04) and OHIP (4.8±4.4 vs. 1.4±3.8, p=0.04), despite no significant differences observed between the two groups in ocular tests and unstimulated salivary flow rate. With respect to histology, no significant differences were found in number of foci, FS and GC-like structures. We observed a significantly different distribution of the SGUS OMERACT score in the two groups: none of pSS-ILD patients presented a SGUS OMERACT score ≥2 in the submandibular glands (SG), in contrast to 41/132 (31.1%) of the patients in the classical sicca-onset group (p=0.03). Finally, no significant differences were observed between the two groups with respect to non-pulmonary extraglandular manifestations, serologic features and other biological parameters. ILD-onset pSS patients represent an atypical phenotypic subset, with less pronounced sialadenitis structural changes in salivary glands, and with sicca symptoms probably overshadowed by the respiratory disease.

Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient's clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.

Characteristics of the gut microbiota in women with premenstrual symptoms: A cross-sectional study.

Premenstrual symptoms can negatively impact the quality of life of women through a range of mood, behavioral, and physical symptoms. The association between the microbiota and brain function has been extensively studied. Here, we examined the characteristics of the microbiota in women with premenstrual disorders (PMDs) and the association between premenstrual symptoms and the microbiota. In this single center cross-sectional pilot study, we recruited 27 women reporting premenstrual symptoms and 29 women with no serious premenstrual symptoms. Among them, we further selected 21 women experiencing premenstrual symptoms resulting in interference to their social life (PMDs group) and 22 women with no serious premenstrual symptoms and thereby no interference to their social life (control group). The severity of symptoms was evaluated by a premenstrual symptoms questionnaire (PSQ). Inflammatory markers were analyzed in blood samples, including C reactive protein, soluble CD14, and lipopolysaccharide binding protein. Sequencing of 16S ribosomal ribonucleic acid genes was performed on stool samples. Inflammatory markers in blood samples did not differ significantly between the PMDs and control groups. A difference in beta, but not alpha diversity, was detected for the gut microbiotas of the PMDs and control groups. The relative abundance of the Bacteroidetes phylum was lower in the PMDs group. At the genus level, the prevalence was decreased for Butyricicoccus, Extibacter, Megasphaera, and Parabacteroides and increased for Anaerotaenia in the PMDs group, but after false discovery rate correction, these differences were no longer significant. Linear discriminant effect size analysis revealed a decrease in Extibacter, Butyricicoccus, Megasphaera, and Parabacteroides and an increase in Anaerotaenia in the PMDs group. The PSQ total score correlated with Anaerotaenia, Extibacter, and Parabacteroides. Multiple regression analysis showed that Parabacteroides and Megasphaera negatively predicted the PSQ total score. The properties of the gut microbiota are associated with premenstrual symptoms.

Bacterial and fungal co-infections among ICU COVID-19 hospitalized patients in a Palestinian hospital: a retrospective cross-sectional study

Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient’s clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.

Preoperative Anxiety in the Surgical Transfer and Waiting Area: A Cross-Sectional Mixed Method Study.

Severe preoperative anxiety (SPA) in surgical patients may have clinical consequences and worsen satisfaction. Some institutions have a surgical transfer and waiting area (TWA) for patient reception/dispatch to operating rooms. We measured the frequency of SPA, investigated predicting factors, and quantified the effect of the TWA stay on anxiety levels in a single centre cross-sectional study. Preoperative anxiety was assessed using three scales. Patients’ perceptions/suggestions were studied by a psychoanalyst. A total of 933 adult patients, undergoing elective procedures, were interviewed. SPA was detected in 24.7%, non-modified by anxiolytic premedication. Patients’ median stay was 9 min, and anxiety level was decreasing in those with SPA. In multivariable analysis, female sex, inpatient settings, and pain before the procedure were predictive for SPA. Previous operating room experience, and a supine arrival position were associated with less SPA. Patients complained about a lack of information, and an uncomfortable environment in the waiting area. To reduce anxiety, they mainly asked for warm blankets/music (physical/sound barriers), and extra sedative agents. The holding area may be a place to measure patients’ anxiety by paramedical staff, and to apply simple non-pharmacological interventions. The psychological concept of psychical envelopes may be useful for the development and investigation of such interventions in improving patients’ experience.

Abstract #1184783: A Single center Cross-sectional Study of Body Composition in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

Prediabetes and type 2 diabetes is closely associated with obesity and is considered major risk factor for the development of T2DM. BMI is commonly used as a surrogate measure of obesity may not correspond to the Indian thin-fat phenotype that carries a much larger proportion of visceral fat. The aim of the study was to examine the body mass composition of patients with newly diagnosed type 2 diabetes.

Association of COVID-19 severity with body mass index and underlying comorbid conditions-a hospital-based cross-sectional study

Background: To reduce the severity of the disease among COVID-19 patients with co-morbidities is the need of the hour. Obesity may contribute to adverse outcomes in coronavirus disease 2019 (COVID-19). This study aimed to find the association between the COVID-19 biomarker values and the underlying comorbid conditions and assess the severity of the disease according to the patients' body mass index (BMI).Methods: A single centre cross-sectional study was conducted in a tertiary hospital among 184 COVID-19 patients admitted for one month (June-July 2021).Results: The results show a statistically significant association between the COVID-19 severity and co-morbidity status of the patients, with diabetes mellitus being the most prevalent co-morbidity among the patients, followed by diabetes with hypertension. A statistically significant association was also seen between age and co-morbidity and biomarkers and co-morbidity.Conclusions: Obesity and other comorbid conditions like diabetes mellitus and hypertension should be given utmost importance during treatment among COVID-19 patients. Biomarker screening should be routinely done in patients with co-morbidities and obesity. Awareness among the COVID-19 patients regarding the comorbid conditions and BMI is the need of the hour.

Post-COVID-19 fatigue as a major health problem: a cross-sectional study from Missouri, USA.

BackgroundFatigue following acute viral illnesses is a major issue that complicates the clinical course of several epidemic and non-epidemic viral infections. There is a noticeably higher trend of patients with symptoms that persist after initial recovery from acute COVID-19. This study seeks to obtain more data about the prevalence of post-COVID-19 fatigue and the factors associated with higher fatigue frequency among patients who had COVID-19.MethodsA single center cross-sectional study was performed between May 2021 and January 2022 at University Health, Kansas City, Missouri, USA. The Fatigue Assessment Scale (FAS) was utilized to measure post-COVID-19 fatigue. Descriptive and comparative statistics were used to describe clinical and sociodemographic features of patients. Analysis of variance (ANOVA), the chi-square test, and Fisher’s exact test were used to examine the statistical association between the FAS score and other clinical and sociodemographic factors.ResultsOne hundred and fifty-seven patients who had been diagnosed with COVID-19 and diagnosed at University Health were enrolled in our study. Overall, 72% of patients (n = 113) were female. The mean ± standard deviation of the FAS score was 21.2 ± 9.0. The prevalence of post-COVID-19 fatigue among our studied sample was 43.3%. The findings of this study suggest that female patients have a significantly higher fatigue score compared with male patients (P < 0.05).ConclusionsPost-COVID-19 fatigue is a major issue following the initial acute illness with COVID-19, with a prevalence of 43.3%. We recommend implementing standardized measures to screen for post-COVID-19 fatigue, especially among female patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11845-022-03011-z.

Advance directives in patients with head and neck cancer - status quo and factors influencing their creation

BackgroundAdvance Care Planning including living wills and durable powers of attorney for healthcare is a highly relevant topic aiming to increase patient autonomy and reduce medical overtreatment. Data from patients with head and neck cancer (HNC) are not currently available. The main objective of this study was to survey the frequency of advance directives (AD) in patients with head and neck cancer.MethodsIn this single center cross-sectional study, we evaluated patients during their regular follow-up consultations at Germany’s largest tertiary referral center for head and neck cancer, regarding the frequency, characteristics, and influencing factors for the creation of advance directives using a questionnaire tailored to our cohort. The advance directives included living wills, durable powers of attorney for healthcare, and combined directives.ResultsFour hundred and forty-six patients were surveyed from 07/01/2019 to 12/31/2019 (response rate = 68.9%). The mean age was 62.4 years (SD 11.9), 26.9% were women (n = 120). 46.4% of patients (n = 207) reported having authored at least one advance directive. These documents included 16 durable powers of attorney for healthcare (3.6%), 75 living wills (16.8%), and 116 combined directives (26.0%). In multivariate regression analysis, older age (OR ≤ 0.396, 95% CI 0.181–0.868; p = 0.021), regular medication (OR = 1.896, 95% CI 1.029–3.494; p = 0.040), and the marital status (“married”: OR = 2.574, 95% CI 1.142–5.802; p = 0.023; and “permanent partnership”: OR = 6.900, 95% CI 1.312–36.295; p = 0.023) emerged as significant factors increasing the likelihood of having an advance directive. In contrast, the stage of disease, the therapeutic regimen, the ECOG status, and the time from initial diagnosis did not correlate with the presence of any type of advance directive. Ninety-one patients (44%) with advance directives created their documents before the initial diagnoses of head and neck cancer. Most patients who decide to draw up an advance directive make the decision themselves or are motivated to do so by their immediate environment. Only 7% of patients (n = 16) actively made a conscious decision not create an advance directive.ConclusionLess than half of head and neck cancer patients had created an advance directive, and very few patients have made a conscious decision not to do so. Older and comorbid patients who were married or in a permanent partnership had a higher likelihood of having an appropriate document. Advance directives are an essential component in enhancing patient autonomy and allow patients to be treated according to their wishes even when they are unable to consent. Therefore, maximum efforts are advocated to increase the prevalence of advance directives, especially in head and neck cancer patients, whose disease often takes a crisis-like course.

The Knowledge, Attitude and Practices of COVID-19: A Survey Among Medical Students in the East Coast of Peninsular Malaysia Public Medical Schools

COVID-19 has affected university medical students, resulting in the new norm of learning and practice. Understanding these students’ knowledge, attitude and their practice would be essential as they would serve as the future doctor in Malaysia. The study attempted to evaluate medical students’ knowledge, attitude and practice (KAP) in the east coast states of Peninsular Malaysia. An online and multi centre cross-sectional study was undertaken among all the three public medical schools in the east coast region of Peninsular Malaysia, between 8th July to 21st July 2020. The questionnaire consisted of sociodemographic data and the three domains which included COVID-19 KAP. Students were invited to participate via social media platform such as WhatsApp and students’ email. A total of 1,008 medical students voluntarily participated in the study with female to male ratio of 2.6:1. A total of 356 (35.3%) of the medical students had satisfactory knowledge score, with 75% of them were female. The majority of the students had positive attitude towards COVID-19 and practiced meticulous social distancing during the pandemic. We noted that seniority influenced knowledge score, and this was evident as 264 (26.2%) of the students were in their clinical year. Overall, the knowledge scores regarding COVID-19 among the medical students in East Coast of Peninsular Malaysia was reasonable and there were opportunities to augment these standards. Meticulous plans are needed to enhance knowledge and preparedness of the current crops of medical students to be competent future frontliner for Malaysia.