Central Hospital Research Articles

A CASE OF INTRAOPERATIVE ARREST & MOBILE ECMO

Over the past two decades, extracorporeal membrane oxygenation (ECMO) has been increasingly used to support critical patients with cardiac and respiratory failure who fail to respond to conventional management. In refractory cardiac arrest, ECMO can restore perfusion in patients who meet specific criteria designed to maximize survival benefit and good neurological outcomes. In recent literature, there is no report of mobile ECMO in a case of prolonged cardiac arrest with direct cardiac massage. We describe our experience with a 34-year-old man with multiple traumatic injuries following a motor vehicle collision. He was treated in a trauma center hospital in the same city as our center. He was initially in stable condition (spontaneous ventilation with FiO2 0.21, no vasoactive drugs, Glasgow 15, no acute kidney injury or other organ dysfunction). One week after admission, a retained left hemopneumothorax required surgical intervention, as previous drainage was ineffective. Computed tomography imaging was also concerning for parencyhmal injury by the thoracotomy tube. Intraoperatively, when the patient was placed in lateral position, he experienced cardiac arrest, presumed to be secondary to pulmonary embolism. After 18 minutes we were asked to rescue this patient with ECMO, as he had no contraindications to support. After 81 minutes of advanced life support, including direct cardiac massage, return of spontaneous circulation was achieved seconds after ECMO was initiated. He was then transported to our hospital. The patient achieved a favorable neurological outcome (Glasgow Coma Scale score of 15 at 24 h) and was discharged after a 2 month stay. This case highlights the potential benefits of prolonged cardiopulmonary resuscitation and ECMO in patients with refractory in-hospital cardiac arrest. In this case, proper ACLS and CPR allowed time for mobile ECMO support to be initiated from a remote center.

No improvement in pregnancy and perinatal outcomes with combined luteal support in modified natural cycle frozen embryo transfer

ObjectiveWe investigated whether the addition of a luteal phase support drug benefits pregnancy and perinatal outcomes in modified natural-cycle frozen-thawed embryo transfer (mNC-FET) for women up to the age of 35 years.MethodsWe analyzed the clinical data of 3658 mNC-FET cycles of women up to the age of 35 years from the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 in a retrospective cohort study. The cycles were divided into three groups based on the luteal phase support protocol used. The patients in group A received a combination of progesterone soft capsules and dydrogesterone (882 cycles), those in group B received dydrogesterone only (627 cycles), and those in group C received a combination of progesterone vaginal sustained-release gel and dydrogesterone (2149 cycles). Pregnancy and perinatal outcomes were compared among the three groups.ResultsLogistic regression analysis indicated that the three luteal phase support regimens were not associated with the live birth rate [OR(95% CI)B vs A=1.080, p=0.960; OR(95% CI)B vs C=0.252, p=0.291]. There were no significant differences in the newborn weight, premature delivery rate, pregnancy complications rate, and incidence of birth defects among the three groups.ConclusionsIn the mNC-FET cycle, patients under the age of 35 who chose dydrogesterone alone as a luteal phase support drug exhibited no difference in the live birth rate and perinatal outcome from patients who combined dydrogesterone with progesterone soft capsules or with progesterone vaginal sustained-release gel. However, the outcome still requires confirmation by large-sample prospective studies.

The nonlinear correlation between total bilirubin and lumbar spine bone mineral density in patients receiving maintenance hemodialysis.

Patients receiving maintenance hemodialysis (MHD) are at increased risk of osteoporosis. The effects of bilirubin on bone metabolism vary among different disease populations. However, the relationship between total bilirubin (TBIL) and bone metabolism in MHD has not been investigated yet. This cross-sectional study included 122 MHD patients aged ≥ 18 years who underwent regular hemodialysis at the Blood Purification Center of Aerospace Central Hospital from April 2021 to April 2023. Blood sampling and bone mineral density (BMD) examinations were conducted. Multivariate linear regression, restricted cubic spline and subgroup analyses were performed to evaluate the association between TBIL and BMD. TBIL (correlation coefficient: 1.7 (0.17, 3.25); p = 0.04) was independently associated with BMD in the multivariate linear regression analysis. The results showed that BMD was nonlinearly related to TBIL in MHD patients, exhibiting a J shaped curve (p = 0.035). When plasma TBIL level < 0.64 mg/dL, there is an average increase of 5.3 (95% CI: 2.0 - 8.7; p = 0.002) g/cm2 in BMD for every 1-unit increase in plasma TBIL level. The association between TBIL and BMD was not significant when the plasma TBIL level was ≥ 0.64 mg/dL. The relationship between TBIL and BMD in MHD patients is J-shaped, with an inflection point of 0.64 mg/dL.

Relationship between Color-Coded Anatomical M-Mode, Strain Imaging, and Tissue Doppler Imaging in Assessing Myocardial Asynchrony in Normal Subjects

Background: This study aimed to compare the time-to-peak systolic contraction time (Tc) by color-coded anatomical M-mode (AMM), the time-to-peak systolic strain (Tst) by strain rate imaging (SRI), and the time-to-peak systolic velocity (Ts) by tissue Doppler imaging (TDI) in the left (LV) and right (RV) ventricular segments of normal subjects. We also sought to determine the relationship between these methods for defining asynchrony indices in normal subjects. Methods: Conventional echocardiography, color-coded AMM, SRI, and TDI were performed on 44 healthy adult volunteers (at the Tehran Heart Center and Shariati Hospital) to measure Tc, Tst, and Ts for 12 LV and 2 RV segments at mid and basal levels. Additionally, delays and standard deviations (SDs) were measured in all 12 LV segments. Results: In the assessed segments, Tc by AMM and Tst by SRI were significantly greater than Ts by TDI (P&lt;0.001). No significant differences were noted between Tc and Tst in 8 LV and 2 RV segments (P&lt;0.05). For the septal basal segment, the respective values were Ts=170.43±36.76 ms, Tst=372.34±72.21 ms, and Tc=374.19±42.76 ms. A moderate correlation was observed between AMM and SRI in assessing asynchrony and SD for all LV segments, but no correlation existed between AMM and TDI. Conclusion: Tc by AMM and Tst by SRI were significantly higher than Ts by TDI in the LV and RV segments. There was no correlation between AMM and TDI in defining asynchrony indices.

A true experimental study to assess the effectiveness of juice in relieving constipation among older adults in a selected hospital, Kolar

: Chronic constipation becomes more common as people age, in both genders, although it becomes most common beyond age 60. is commonly used as a potent laxative and as a substance to enhance gastrointestinal motility. can be used as a natural remedy for constipation at affordable prices among old age people.Study aimed to assess the effectiveness of aloeAloe vera juice to relieve constipation among older adults.For the present study, a randomized control trial pretest-posttest design was adopted. Subjects consist of 60 (30 Experimental and 30 Control) older adults from R.L. Jalappa Hospital and Research Centre. The pretest was conducted using the Constipation Assessment Scale (CAS) through the Block Randomization sampling technique in both groups. A freshly prepared juice of 100 milligrams per day was given for 20 days. Posttest was conducted in both experimental and control group after 10, and 20 day. The data gathered were analyzed by descriptive and inferential statistical method using frequency, percentage, SD, Independent t test, paired t test and RMANOVA with Posthoc test. The dataset comprised 60 elderly patients. In total, the Majority of respondents 70% and 73.3% reported moderate level constipation in the experimental group &amp; and control group during pretest. Constipation scores of no problem during posttest-I was 93.3% &amp; 96% in experimental group during 10 and 20 day. Whereas in control group remains unchanged with moderate and severe constipation scores. Independent “t”test and RMANOVA found to be significant in experimental group. Constipation remains a clinical problem among elderly. There is a significant relationship between effectiveness of juice in relieving constipation among old age people.Furthermore study emphasize that, home remedy based laxatives which are affordable, available aloevera juice are effective to relive constipation among elderly. , Constipation, Old Age

Endocervical adenocarcinomas and HPV genotyping in an HIV endemic milieu – a retrospective study

BackgroundCervical cancer is the most prevalent cancer in Mozambique, with endocervical adenocarcinoma accounting for approximately 5.5% of cases. Knowledge regarding the most prevalent HPV genotypes in endocervical adenocarcinoma is limited, within this setting. This study aimed to investigate human papillomavirus (HPV) prevalence and genotypes within a cohort of endocervical adenocarcinoma patients in the context of Mozambique’s recently introduced vaccination programme, considering the country's HIV-endemic setting.MethodsForty consecutive cases of endocervical adenocarcinoma diagnosed at Maputo Central Hospital between 2017 and 2018, with limited clinical data available, were included. Human immunodeficiency virus (HIV) status was determined through serological data or in situ hybridisation on histopathological slides. HPV detection was performed using a multi-methodological approach, including Anyplex II, in-house polymerase chain reaction (PCR), and chromogenic and fluorescent in situ hybridisation techniques.ResultsAll 40 cases exhibited HPV-dependent morphology. Fourteen of the 40 patients were HIV-positive. No significant differences were observed between the two groups regarding age, stage, or histopathological type. hrHPV16, 18, or 45 were detected in all cases. Notably, multiple hrHPV infections were identified exclusively in HIV-negative cases (10/26, p = 0.0075), with hrHPV18/45 co-infection being the most common (n = 8).ConclusionsThese findings suggest that the newly implemented quadrivalent vaccination programme has the potential to prevent morbidity and mortality from endocervical adenocarcinoma, irrespective of HIV infection status, in Mozambique's HIV-endemic environment.

Multiparameter magnetic resonance imaging-based radiomics model for the prediction of rectal cancer metachronous liver metastasis

BACKGROUND The liver, as the main target organ for hematogenous metastasis of colorectal cancer, early and accurate prediction of liver metastasis is crucial for the diagnosis and treatment of patients. Herein, this study aims to investigate the application value of a combined machine learning (ML) based model based on the multiparameter magnetic resonance imaging for prediction of rectal metachronous liver metastasis (MLM). AIM To investigate the efficacy of radiomics based on multiparametric magnetic resonance imaging images of preoperative first diagnosed rectal cancer in predicting MLM from rectal cancer. METHODS We retrospectively analyzed 301 patients with rectal cancer confirmed by surgical pathology at Jingzhou Central Hospital from January 2017 to December 2023. All participants were randomly assigned to the training or validation queue in a 7:3 ratio. We first apply generalized linear regression model (GLRM) and random forest model (RFM) algorithm to construct an MLM prediction model in the training queue, and evaluate the discriminative power of the MLM prediction model using area under curve (AUC) and decision curve analysis (DCA). Then, the robustness and generalizability of the MLM prediction model were evaluated based on the internal validation set between the validation queue groups. RESULTS Among the 301 patients included in the study, 16.28% were ultimately diagnosed with MLM through pathological examination. Multivariate analysis showed that carcinoembryonic antigen, and magnetic resonance imaging radiomics were independent predictors of MLM. Then, the GLRM prediction model was developed with a comprehensive nomogram to achieve satisfactory differentiation. The prediction performance of GLRM in the training and validation queue was 0.765 [95% confidence interval (CI): 0.710-0.820] and 0.767 (95%CI: 0.712-0.822), respectively. Compared with GLRM, RFM achieved superior performance with AUC of 0.919 (95%CI: 0.868-0.970) and 0.901 (95%CI: 0.850-0.952) in the training and validation queue, respectively. The DCA indicated that the predictive ability and net profit of clinical RFM were improved. CONCLUSION By combining multiparameter magnetic resonance imaging with the effectiveness and robustness of ML-based predictive models, the proposed clinical RFM can serve as an insight tool for preoperative assessment of MLM risk stratification and provide important information for individual diagnosis and treatment of rectal cancer patients.

Objective surgical skill assessment based on automatic recognition of dissection and exposure times in robot-assisted radical prostatectomy

PurposeAssessing surgical skills is vital for training surgeons, but creating objective, automated evaluation systems is challenging, especially in robotic surgery. Surgical procedures generally involve dissection and exposure (D/E), and their duration and proportion can be used for skill assessment. This study aimed to develop an AI model to acquire D/E parameters in robot-assisted radical prostatectomy (RARP) and verify if these parameters could distinguish between novice and expert surgeons.MethodsThis retrospective study used 209 RARP videos from 18 Japanese institutions. Dissection time was defined as the duration of forceps energy activation, and exposure time as the combined duration of manipulating the third arm and camera. To measure these times, an AI-based interface recognition model was developed to automatically extract instrument status from the da Vinci Surgical System® UI. We compared novices and experts by measuring dissection and exposure times from the model’s output.ResultsThe overall accuracies of the UI recognition model for recognizing the forceps type, energy activation status, and camera usage status were 0.991, 0.998, and 0.991, respectively. Dissection time was 45.2 vs. 35.1 s (novice vs. expert, p = 0.374), exposure time was 195.7 vs. 89.7 s (novice vs. expert, p < 0.001), and the D/E ratio was 0.174 vs. 0.315 (novice vs. expert, p = 0.003).ConclusionsWe successfully developed a model to automatically acquire dissection and exposure parameters for RARP. Exposure time may serve as an objective parameter to distinguish between novices and experts in RARP, and automated technical evaluation in RARP is feasible.Trial registration number and dateThis study was approved by the Institutional Review Board of the National Cancer Center Hospital East (No.2020 − 329) on January 28, 2021.

How I diagnose and treat systemic mastocytosis with an associated hematologic neoplasm.

Over the last decade significant advances have been made by honing in on the diagnostic evaluation and the significance of molecular profiles in patients with systemic mastocytosis (SM), non-advanced and advanced.This is reflected in the 2022 iterations of the World Health Organization Edition 5 and International Consensus Criteria classifications.The impact of targeted KIT inhibitor therapies on patients treated within global trials has demonstrated significant improvements in the prognosis and overall survival for patients, leading to a change the treatment paradigm.Patients with SM and an associated hematologic neoplasm (SM-AHN) comprise of up to 70% of those in the advanced SM category, posing varying challenges in diagnosis and clinical heterogeneity due to the occupation of the bone marrow niche by two hematologic neoplasms.We are constantly learning about the complex, heterogenous genotypic and phenotypic spectrum of these patients with a view to provide personalised treatment options, aiming to improve outcomes, quality of life and ultimately a cure. This paper focuses on the management of patients with advanced systemic mastocytosis with an associated hematologic neoplasm and is a personal perspective using some illustrative patient cases treated at our centre, Guys and St Thomas's Hospitals, London: UK centre of excellence in Mastocytosis.

Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study.

Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app's learning center. A total of 7572 pregnant persons were enrolled in the TodaysBaby Program-3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID-a leading cause of infant death after 1 month of age-appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact.

Outcomes and associated factors of cervical human papillomavirus infection among 608 women in Shenzhen, China, 2018–2023

ObjectiveThis study aimed to uncover the patterns of Human papillomavirus (HPV) infection outcomes in women and assess the risk factors that may affect these outcomes.MethodsA retrospective study was conducted on 608 women who tested positive for HPV-DNA during their initial visit to the outpatient department of Shenzhen Longgang Central Hospital from 2018 to 2023 and who had subsequent HPV-DNA testing as part of their post-visit monitoring. The monitoring intervals were every 6 months. The rank sum test was used to analyze ranked data. The Kaplan–Meier method was used to analyze the turning negative time. Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using the Cox model to analyze independent risk factors.ResultsThe results showed that the median age was 40.00 years (interquartile 33.00–47.00 years), the total conversion rate of the HPV-negative patients was 38.98%, and the median conversion time of the HPV-negative patients was 8.95 months (interquartile 4.20–16.175 months). Age, infection status and type of health insurance were significantly correlated with HPV outcome (p &amp;lt; 0.05).ConclusionAmong women infected with HPV, the overall rate of negative HPV infection was 38.93%, and the duration of negative conversion was 8.95 months. The study revealed that age, HPV infection status, and type of medical insurance are independent predictors of the persistence of negative HPV test outcomes.

Mortality and morbidity patterns in Yaoundé, Cameroon: an ICD-11 classification-based analysis

BackgroundIn Cameroon, like in many other resource-limited countries, data generated by health settings including morbidity and mortality parameters are not always uniform. In the absence of a national guideline necessary for the standardization and harmonization of data, precision of data required for effective decision-making is therefore not guaranteed. The objective of the present study was to assess the reporting style of morbidity and mortality data in healthcare settings.MethodsAn institutional-based cross-sectional study was carried out from May to June 2022 at the Yaoundé Central Hospital. A questionnaire was used to assess the need to set up a standard tool to improve the reporting system. Medical records were used to collect mortality and morbidity data which were then compared to the International Statistical Classification of Diseases and Related Health Problems-11 (ICD-11) codification. Data were analyzed using IBM-SPSS version 26.ResultsOut of 200 patients’ morbidity causes recorded, nearly three-quarter (74.0%) were heterogeneous, and two over five (41.0%) of mortality causes reported were also heterogeneous. Most of respondents stated the need to set up a standard tool for collecting mortality and morbidity data (83.6%). Less than one-fifth (18.2%) of health care providers were able to understand data flow, correctly archived data (36.6%) and used electronic tools for data quality control (40.0%).ConclusionThere were high levels of heterogeneities of morbidity and mortality causes among patients admitted to the Yaoundé Central Hospital in 2021. It is therefore urgent that Cameroon national health authorities implement the ICD-11 to allow the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in Yaoundé Central Hospital at different times; and ensure interoperability and reusability of recorded data for medical decision support.

The use of propensity score matching to assess the effectiveness of the endometrial receptivity analysis in patients with recurrent implantation failure

BackgroundOne potential cause of implantation failure is abnormal endometrial receptivity, and how to objectively evaluate endometrial receptivity has been a matter of great concern. Endometrial receptivity analysis (ERA), a next-generation sequencing-based test that assesses endometrial gene expression, may be valuable in predicting endometrial receptivity, but whether ERA improves pregnancy outcomes in patients with recurrent implantation failure (RIF) is currently controversial. The purpose of this study was to investigate the effect of ERA on pregnancy outcomes in patients with RIF.MethodsWe performed a retrospective cohort study analysis for a population of patients with RIF undergoing frozen embryo transfer (FET) cycles in the reproductive center of the Third Affiliated Hospital of Zhengzhou University from January 2019 to December 2022(n=1598). FET cycles with personalized embryo transfer (PET) under ERA guidance were included in the ERA group (n=43); after using propensity score matching (PSM), a total of 120 FET cycles were included as a control group. Pregnancy outcomes were compared between the two groups. Further, the relationship between the number of previous implant failures and the rate of implant window displacement was discussed. The factors affecting the window of implantation (WOI) displacement were also assessed.ResultsThere was no statistically significant difference in embryo implantation rate, clinical pregnancy rate, spontaneous abortion rate, and live birth rate between the ERA group and the matched control patients (P &amp;gt; 0.05). There was no significant difference in the rate of WOI displacement between patients in the moderate or severe groups (P &amp;gt; 0.05) and no significant difference in pregnancy outcome ( P&amp;gt;0.05). Finally, analysis of the clinical data of patients in the receptive and non-receptive groups did not uncover any factors influencing WOI displacement.ConclusionThe results of the study showed no significant difference in pregnancy outcomes in patients who received ERA compared to those who did not.

The Effect of Genotype Differences on Cardiac Involvement in Cases Diagnosed with Duchenne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is the most frequently seen muscular disease in childhood. Cardiac involvement is extremely important in terms of morbidity and mortality in these patients. Different studies have shown that mutations occurring in various exons are cardioprotective or increase cardiac involvement in DMD cases. The aim of this study was to examine the effect of genotype differences on cardiac involvement in patients diagnosed with DMD with genetic analysis. A retrospective analysis of DMD patients followed up in the Muscle Diseases Centre of Health Sciences University Izmir Tepecik Training and Research Hospital was done. Evaluation was made of 120 male DMD patients with a mean age of 9.66 ± 5.10 years. According to the genetic analysis results, 76.7% deletions, 15.8% mutations, and 7.5% duplications were determined. Of the mutations determined, 65.8% were between exons 44 and 54, 17.5% between exons 1 and 18, and 9.2% between exons 19 and 43, 5.8% were non-sense mutations, and 1.7% were on exons >54. In the cases determined with cardiac involvement, the mean age of onset was 11.87 ± 3.11 years. When ejection fraction (EF) <56% or fractional shortening (FS) <28% was accepted as systolic dysfunction cardiac effect, 12.5% of the cases were determined with cardiac involvement. Of the cases determined with cardiac effects, 86.7% were aged >10 years. Electrocardiography was evaluated as normal in 54.5%, sinus tachycardia in 24.2%, short PR in 15.2%, and right and left ventricle hypertrophy in 8.1%. No statistically significant difference was determined in mutation types and location according to the age of cardiac involvement. The left ventricle (LV) posterior wall thickness value determined in the exon 44-54 group was higher than in DMD cases with other mutations. Although not statistically significant, an important result was that the LV posterior wall and IVSed values were evaluated to be high. The current study results and findings in literature have not found a clear relationship between genotypes and cardiac involvement in DMD cases.

Deep Learning and Numerical Analysis for Bladder Outflow Obstruction and Detrusor Underactivity Diagnosis in Men: A Novel Urodynamic Evaluation Scheme.

To automatically identify and diagnose bladder outflow obstruction (BOO) and detrusor underactivity (DUA) in male patients with lower urinary tract symptoms through urodynamics exam. We performed a retrospective review of 1949 male patients who underwent a urodynamic study at two institutions. Deep Convolutional Neural Networks scheme combined with a short-time Fourier transform algorithm was trained to perform an accurate diagnosis of BOO and DUA, utilizing five-channel urodynamic data (consisting of uroflowmetry, urine volume, intravesical pressure, abdominal pressure, and detrusor pressure). We used fivefold cross-validation, constructing training and internal test sets from 1725 patients from Renmin Hospital of Wuhan University (RHWU) at a 4:1 ratio, and used an independent external validation set consisting of 224 patients from The Central Hospital of Wuhan (TCHO) to build and evaluate the DI model. We further conducted subgroup analyses to provide a more detailed description of the AI model's interpretability regarding urodynamics. The AUC scores of BOO and DUA, which were measured through the STFT-based deep learning method, were 0.945 ± 0.020 and 0.929 ± 0.039 in RHWU and 0.881 and 0.850 in TCHO, respectively. The diagnostic efficiency of other subgroup analyses and indicators was also effective. In this study, the proposed deep neural network combined with the short-time Fourier transform method is robust and feasible for interpreting the results of urodynamics in men and has the potential for application to assist clinicians in real clinical settings.

COVID-19 and HIV: Clinical Outcomes and Inflammatory Markers in a Cohort from a Reference Hospital in Rio de Janeiro, Brazil

Background: Severe COVID-19 presents a variety of clinical manifestations associated with inflammatory profiles. People living with HIV (PLWH) could face a higher risk of hospitalization and mortality from COVID-19, depending on their immunosuppression levels. This study describes inflammatory markers in COVID-19 clinical outcomes with and without HIV infection. Methods: We analyzed 112 inpatients of the Hospital Center for COVID-19 (INI/FIOCRUZ), including 22 cases of COVID-19 in PLWH (COVID/PLWH group). Plasma samples were tested for a panel of 15 cytokines by Luminex. Sociodemographic, clinical, and laboratory data were collected from patients’ clinical records. Results: COVID-19 individuals were stratified according to the WHO clinical severity profiles at hospitalization. Significant differences in clinical scores, symptoms (coughs), and the occurrence of HIV infection were found among the groups. Clinical blood parameters and plasma cytokines were analyzed among COVID-19 groups with distinct severity profiles. Critical COVID-19 cases showed higher levels of inflammatory markers (Bilirubin, D-dimer, PCR, and urea, as well as IL-8, IL-10, TNF-α, INF-α, IL-1β, IL-17A, IL-23, IL-6) than moderate and severe groups. The COVID/PLWH group had lower CD4 counts (64 cells/mm3) and cytokine levels than other COVID-19 patients. Conclusions: Overall, critically ill COVID-19 patients exhibited heightened inflammatory responses, while COVID/PLWH demonstrated unique immunological characteristics without increased mortality risk.

Perceptions and satisfaction of oncology pharmacy services among cancer patients and healthcare providers at the central zone hospital's oncology section.

Our research focused on assessing the satisfaction of cancer patients with oncology pharmacy services, as well as evaluating the satisfaction levels of other healthcare and supportive staff associated with the oncology pharmacy unit. This qualitative cross-sectional study, based on a questionnaire, aimed to evaluate the best practices of oncology pharmacy services for patients and the efficiency of services provided by healthcare professionals and administrators at Benjamin Mkapa Hospital (BMH). The study was conducted at the adult oncology unit from July to August 2022. It included all consenting patients and staff who attended or served in the unit and met the inclusion criteria during this period. A total of 62 cancer patients and 53 BMH staff members working closely with the unit were interviewed. Among the patients, approximately 86% expressed satisfaction with the overall care provided by the oncology pharmacy services, 79% were satisfied with the dispensing practices and pharmaceutical care, and 64% were pleased with the patient-pharmacy personnel relationship. The staff survey, conducted among those closely collaborating with the oncology pharmacy unit, revealed that 85% were satisfied with the unit's plan and mission, 72% were content with the teamwork and motivation of the pharmacy personnel, and 92% were satisfied with the competencies of the oncology pharmacy staff. Our thorough study revealed notably high levels of satisfaction and acceptance concerning the services provided by oncology pharmaceutical personnel. Pharmacists should ensure their presence during patient visits and dedicate adequate time for counselling to enhance patients' therapeutic alliance. Furthermore, optimising pharmacy workflow and adopting a patient-centred approach will help create a more organised and welcoming environment, reducing turnaround time.

Application of the workload indicators of staffing need (WISN) to assess dietetic workforce needs in South African central and tertiary public hospitals

South Africa faces both under- and over-nutrition, highlighting the need for prioritizing nutrition services. Registered dietitians are crucial for delivering appropriate and quality nutrition services. Consequently, this case study employs the World Health Organization evidence-based Workload Indicators of Staffing Need to ascertain the requisite dietetic workforce needed at central and tertiary public hospitals in South Africa. Head dietitians from 21 of 22 central and tertiary public hospitals participated in an online survey to provide data and consensus on workload components and activity standards via Delphi technique. Data were analyzed using the World Health Organisation Workload Indicators of Staffing Need software. Dietetic staffing needs were determined based on the difference between existing and required numbers of dietitians. WISN ratio was used as a metric to gauge dietitians’ workload pressure. Majority (95%) of hospitals experienced dietetic staff shortages and few (14%) had requisite staff to cover basic health services. Majority (76%) exhibited a WISN ratio below 0.5, indicating fullfilment of less than 50% of staff requirements. Based on the Workload Indicators of Staffing Need, dietitians in South African central and tertiary public hospitals experience high workload pressures due to extreme understaffing. The results can guide future profession workforce planning to facilitate enhanced nutrition outcomes in South Africa.

Evaluation of five questionnaires for obstructive sleep apnea screening in the elderly

Obstructive sleep apnea (OSA) often leads to complications in the elderly. This study compares the usefulness of five screening tools for OSA in elderly patients. Data from elderly patients diagnosed with OSA, collected from the Sleep Medicine Center of the First Affiliated Hospital of Guangzhou Medical University from January 2012 to June 2017, is analyzed. The sensitivity, specificity, predictive values, area under the curve (AUC), and diagnostic odds ratio (DOR) of the five screening tools are computed and compared. 273 elderly patients with suspected OSA are included, of whom 189 are male (69.2%). The Berlin Questionnaire has an AUC of 0.670 (95%CI: 0.611–0.725) at different cut-off points. The sensitivity and specificity of the Berlin Questionnaire are noticeably high at 0.653 (0.587–0.719) and 0.608 (0.497–0.719), 0.699 (0.621–0.776) and 0.533 (0.449–0.616), and 0.803 (0.713–0.892) and 0.503 (0.433–0.572) when the AHI is 5, 15, and 30 times/hour, respectively. The GOAL Questionnaire has the highest DOR at AHI cut-off points of 5 and 15 times/hour, while Berlin has the highest DOR at an AHI cut-off point of 30 times/hour. Comprehensive use of these five screening questionnaires for suspected OSA in elderly patients aged 60 years and older is valuable and worth promoting among the elderly population.

A Prospective Study of Drug Utilization and Evaluation in Gastrointestinal Disorders at a Tertiary Care Teaching Hospital

Drug Utilization Evaluation (DUE) is a comprehensive study examining the marketing, distribution, prescription, and use of medications within a society. This evaluation encompasses a range of medical, social, and economic factors related to drug use, with the primary goal of ensuring that drug therapy adheres to current standards of care. This prospective observational study conducted at Navodaya Medical College Hospital and Research Centre (NMCH &amp; RC) from 15th February to 15th August 2024 aimed to evaluate prescription patterns for gastrointestinal disorders, focusing on drug utilization from the Essential Drug List (EDL) and adherence to WHO core prescribing indicators.150 prescriptions were analyzed, revealing that 64.66% of patients were male, with the majority aged 20-39 years. Acute gastroenteritis was the most common diagnosis (34%), and common symptoms included abdominal pain, loose stools, and vomiting. Antibiotics, particularly metronidazole, were the most prescribed drug class (25.35%). Of the prescribed drugs, 75.95% were from the EDL, but only 8.91% were prescribed by generic name, and 64.82% involved injections. The average number of drugs per prescription was 6.65, indicating polypharmacy and drug interactions were prevalent. The study highlighted concerns about moderate antibiotic use, high injection rates, low generic drug prescriptions, and polypharmacy, underscoring the need for improved rational prescribing practices to enhance patient safety and cost efficiency.