City Hospital Research Articles

Nurses Practices Related to Enteral and Parenteral Nutritional Therapy for Unconscious Patients

Background: Enteral nutrition reduces the mortality rate and prevents the development of pressure sores. Specific complications with parenteral nutrition, particularly in unconscious patients, include line sepsis and fluid and electrolyte imbalance. This is important because parenteral nutrition reduces the duration of unconscious patients' hospital stay. Objectives: 1. Assess Nurses’ practice regarding unconscious patients’ nutrition. 2. Identify the demographical characteristics of studied population. 3. Find out the relations between practices of nurses and their demographical and employment characteristics. Methodology: A descriptive – observational study design is the choice to study a specific phenomenon of interest regarding assessing nurses practices regarding enteral and parenteral nutritional therapy from period between (November 2022- July 2024). Non-probability convenient sample of (125) nurses who work in the intensive care units were selected. This study conducted in the intensive care units which located at three teaching hospitals in Al-Hilla city- Iraq. Results: The data reveals that the majority, 55.2%, fall within the 20-30 year age range. Interestingly, the sex distribution is nearly equal with 52% males and 48% females. The result recorded the major of study sample were poor level of practice regarding enteral and parenteral nutritional therapy for unconscious patients. Conclusion: There is a substantial need for improvement in nursing practices related to ENT, such as nutritional assessment, equipment preparation, and adherence to protocols.

Role of rs5743708 SNP in the risk of Bacterial Respiratory Infections in Children of Ramadi city/Iraq

Background and Aim: Respiratory Infections are a major global health and financial burden, so among cause the five most common and deadly for respiratory illnesses is acute lower respiratory tract infections (RTIs), these infections claim over 4 million lives annually. Toll-like receptors (TLRs) are key components of the innate immune system that recognize pathogen which associated a molecular patterns) PAMPs) and initiate an immune response. Understanding the role of TLR polymorphisms in susceptibility to respiratory infections in children is important for developing strategies to prevent and treat these infections. So, the current study aims to "Investigate the potential association between TLR2 gene polymorphisms and susceptibility to respiratory infections in children". Methodology: The study included collect of 300 samples with respiratory infection from both sex with range ages(1-12) years, and other 50 healthy control samples. The samples were collected from general and private hospitals in Ramadi city, Iraq. PCR was carried out using primer for gene target and amplification of target gene. Sanger Sequencing conducted with both direction for all samples. Results and Conclusion: The result of sputum culture indicate that 100 of suspected samples were positive culturing while other demonstrate a negative growth. The results analysis of sequencing according to Query and subjected samples indicated that 4 of patient have SNP of rs5743708 G>A, while there is not found in control samples, and the results of genotype frequencies analysis it was found that TLR2 polymorphism was associated with increased risk for bacterial respiratory infections in children according to under study samples, but no statistical significant differences correlation of rs5743708 G>A and infection, with adjusted odds ratio [OD:5.3; 95%Cl: 0.3-101; P: 0.2].

Epidemiological study of Tinea corporis in Al-Najaf City and the possible sources of infection

Background and objectives. Tinea corporis is a common superficial fungal skin infection presenting complaints in daily practice that can lead to serious consequences caused by dermatophytes. This disease has a significant influence on public health and social life since its spread can be difficult to manage and has a high rate of recurrence. This study aims to determine the demographic characteristics and the possible source of infection with Tinea corporis in Al-Najaf City, Iraq. Materials and methods. A cross-sectional study was conducted on 190 Tinea corporis patients from the 1st of April 2023 to the 31st of July 2023 in the three specialized hospitals in Al-Najaf city all these patients were subjected to a questionnaire developed by the researcher. The questionnaire includes 4 domains regarding sociodemographic characteristics, personal habits, housekeeping habits, and possible sources of infection of the participants. Results. This study found that Tinea corporis affected both males and females equally in the study sample. While the age 20-29 and 30-39-years-old were the most highly affected (20% for each), the lowest was age ≥60 years old (7.1%). The possible source was the human-related possible source (31.1%), animal-related possible source (12.1%), soil-related possible source (5.8%), and among human-related possible source the household-related possible source was of 86.4%. Conclusions. There was no domination of one gender upon the other regarding Tinea corporis infection. Tinea corporis affects post-puberty at the highest rates and the elderly at the lowest rates. The most possible source of infection was human-related and especially household-related.

Survival status and its predictors among adult victims of road traffic accident admitted to public hospitals of Bahir Bar City, Amhara regional state, Northwest, Ethiopia, 2023: multi center retrospective follow-up study

IntroductionRoad traffic accident is the most common cause of death in adults worldwide. Road traffic accident-related deaths increased from time to time in low- and middle-income countries including Ethiopia; however, there is limited evidence about Survival status and its predictors among adult victims of road traffic accidents admitted to Hospitals in Ethiopia specifically in the study area. Thus, this study aimed to assess Survival status and its predictors among adult victims of road traffic accident admitted to Hospitals.MethodsAn institutional-based retrospective follow-up study was conducted from July 01/2019 to June 30/2022. A total of 402 samples were chosen using simple random sampling. Data was collected by a prepared checklist from the victims’ chart and entered into Epi-Data version 4.6 software and then exported to STATA version 14.1 for analysis. Kaplan-Meier failure function and log-rank test were computed. The assumption was checked by Schoenfeld residual test. All variables in bivariable analysis, p-value < 0.25 were entered into multivariable cox-regression model. Adjusted Hazard Ratio with 95% Confidence Interval was reported to declare the strength of association and statistical significance p-value of < 0.05. Model fitness was checked by using Cox-Snell residual. Data was presented by text, table, and graph.ResultThe median survival time was 504 h. From all, 63(15.6%) deaths, 57% of deaths occurred between 24 and 168 h of follow-up with an overall incidence of 15.34deaths per10, 000 victims-hours observation. According to the Kaplan-Meier failure curve together with the log-rank test, the incidence density rate of death among victims who had a complication during admission was71.86per10,000victims-hour observation (95%, CI:53.66–96.25), which is different from those who did not have complication 5.17per10,000person-hour observation (95%, CI:3.26–8.21). The incidence density rate of death among victims who had low level of arterial oxygen saturation (SPO2 < 95%) during admission was 82.87per10, 000 victims-hour observation (95%, CI: 63.15-108.75), which is different from those who had arterial oxygen saturation ≥ 95% 3.16per10, 000victims -hour observation (95%, CI: 1.75–5.71) Develop complication (AHR = 3.1,95% CI:1.44–6.70), systolic blood pressure measurement value ≤ 89 mmHg (AHR = 2.4,95% CI:1.10–5.19), not admitted intensive care unit (AHR = 0.46,95% CI:0.022–0.97), Glasgow Coma Scale score ≤ 8 (AHR = 2.9,95% CI:1.07–7.75), Glasgow Coma Scale score 9–12(AHR = 3.8,95% CI:1.61–8.97) and, level of arterial oxygen saturation ≤ 95% (AHR = 6.5,95% CI:2.38–17.64) were predictors of outcome variable.Conclusion and recommendationsThe median survival time was short. Complication, low systolic blood pressure measurement value, low Glasgow Coma Scale score, not admit to intensive care unit and low level of arterial oxygen saturation were significant predictors of the outcome variable. So that healthcare providers better give special attention and care to those victims admitted to Hospitals. A further prospective study is recommended.

Nurses Knowledge Related to Enteral and Parenteral Nutritional Therapy for Unconscious Patients

Background: Enteral nutrition is the preferred method of providing essential nutrients to unconscious patients with a functioning gastrointestinal tract. Nurses play a pivotal role in ensuring safe and effective delivery of enteral nutrition therapy support, encompassing a range of responsibilities before, during, and after feeding. Objectives: 1. Assess Nurses’ knowledge regarding unconscious patients’ nutrition. 2. Identify the demographical characteristics of studied population. 3. Find out the relations between knowledge of nurses and their demographical and employment characteristics. Methodology: A descriptive –cross sectional study design is the choice to study a specific phenomenon of interest regarding assessing nurses knowledge regarding enteral and parenteral nutritional therapy from period between (November 2022- July 2024). Non-probability convenient sample of (125) nurses who work in the intensive care units were selected. This study conducted in the intensive care units which located at three teaching hospitals in Al-Hilla city- Iraq. Results: The data reveals that the majority, at 55.2%, fall within the 20-30 year age range. Interestingly, the sex distribution is nearly equal with 52% males and 48% females. The result recorded high percentage fair level of nurses knowledge according to sum score. Conclusion: Nurses demonstrate significant gaps in knowledge across various aspects of ENT, including indications, complications, and nutritional content.

Evaluation The Role Of Some Immunological Markers In Coronavirus-19 Infection In A Sample Of Iraqi Patients

Background: cells produce proinflammatory cytokines like il-8, which activates neutrophils and stimulates immunological responses. Il-6 is produced quickly and transiently in response to infections and stimulates hematopoiesis and acute phase responses, aiding host defense. Dysregulated il-6 production can lead to chronic inflammation and autoimmunity despite its transcriptional and posttranscriptional regulation. Objective: the study aims to identify immunological markers that could serve as diagnostic factors for covid-19 infections, using rt-pcr for diagnosis and estimation of interleukin-6 and interleukin-8 levels and evaluating their association with infection progression, given the importance of covid-19 in various medical fields. Methods: blood samples collected from al-zafaraniyah general hospital, fatima-alzahra hospital, and al-yarmook teaching hospital in baghdad city identified 40 patients with coronavirus. The study used the enzyme-linked immune sorbent assay (elisa) approach to detect interleukin-6 and interleukin-8 antibodies in the patients ' serum. Results: the study reveals a strong correlation between immunological markers and corona virus-19 infection, with 40 patients showing higher levels of interleukin-6 and interleukin-8 antibodies, indicating a significant association between these markers. Conclusions: the study found a significant association between coronavirus-19 infection patients and immunological markers, with high levels of interleukin-6 and interleukin-8 antibodies in serum highly associated with coronavirus -19 incidence.

Application of BIM and Virtual Reality of System Integration Design and Development in Medical Building Projects: A Case Study in China

Design outcomes in the Medical Building Projects (MBPs) must satisfy the demand of the medical staff and stakeholders. However, they often do not have the relevant engineering expertise, so the design team is prone to misunderstandings when communicating with them using traditional two-dimensional (2D) Computer-Aided Design (CAD) drawings. The medical staff may not readily visualize and understand the design and then provide feedback to the designer through professional medical requirements or advice, which results in the need to redesign and carry out additional work during the design phase, thus delaying the progress of the MBPs. To address these challenges, this study aims to develop an integrated system based on BIM, advanced rendering engines, and VR technology for use in non-immersive and immersive VR environments. Moreover, in this study, the integrated system was applied to the infection-building project of the People's Hospital of Qingbaijiang District, Chengdu City, and semi-structured interviews were distributed to 16 engineers, designers, contractors, and medical staff who had been involved in the whole project to validate the practicality and effectiveness of the integrated system. The results indicate that this system integration is an efficient visual communication and simulation tool in medical design. Key advantages include enhanced communication efficiency between the design team and medical stakeholders, improved visual interaction, and streamlined decision-making processes within a 3D VR/BIM environment. The successful implementation of this integrated system is expected to significantly aid design teams and stakeholders in effectively managing medical design tasks in future projects.

Long COVID in children and adolescents: a historical cohort study with a population-based control group from Iran

BackgroundAfter recovering from the acute phase of COVID-19, some of the infected children manifest long COVID symptoms. The present study aims to identify long COVID symptoms in children and adolescents admitted to hospitals in Bushehr, Iran, during 2021 to 2023, and compare them with the non-affected group.MethodsThis historical cohort study with a population-based control group was conducted on 141 children and adolescents with COVID-19 hospitalized in Bushehr city hospitals and 141 non-affected peers. Out of 10 comprehensive health service centers in Bushehr city, 5 centers were selected by random sampling and the non-Covid-19 group was chosen from them (matched by gender and age with the affected group). The data were collected using the data recorded in the patients’ records, conducting telephone interviews and completing the prevalent long COVID symptom form. Data were analyzed using SPSS version 18. Descriptive statistics, Chi-square/Fisher’s exact tests, and stepwise logistic regression were used. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with p < 0.05 as the significance level.ResultsThe mean age of the hospitalized children with COVID-19 was 79 ± 5.24 months old, 57.4% of whom were boys. Also, 46 individuals of the COVID-19 group (32.6%) manifested long COVID symptoms. The most prevalent symptoms included fatigue (54.3%), impaired attention or concentration (41.3%) and depression or anxiety symptoms (34.7%). Among the hospitalized children experiencing long-term COVID symptoms, 65.2% exhibited moderate disease severity. A significant relationship was identified between disease severity and muscle and joint pain (P = 0.025), as well as between the length of hospital stay and cough (P = 0.022), weight loss (P = 0.047), and symptoms of depression or anxiety (P = 0.008). Older age [(6–11 y; OR = 3.18, CI = 1.03–9.88); (12 ≥ y; OR = 4.57, CI = 1.40-14.96)] and having history of smoking or being exposed to secondhand smoke (OR = 12.45, CI = 3.14–49.36) were considered as risk factors for long COVID.ConclusionsThe variables of age and history of exposure to tobacco smoke exhibited a significant independent relationship with the occurrence of long-term COVID symptoms in children hospitalized due to COVID-19. Specifically, as age increases and the history of tobacco smoke exposure rises, the likelihood of experiencing long-term COVID symptoms also increases.

Exploring Role of SMAD3 in Serum of Rheumatoid Arthritis Patients

Background: Being an autoimmune and inflammatory illness, rheumatoid arthritis results from the body's immune system attacking healthy cells by mistake, creating inflammation in the affected areas. Aim of study: The purpose of this study was to use ELISA to assess the serum concentration level of SMAD3 in RA patients and control groups.. Methodology: The research was conducted between October 15, 2023, and January 15, 2024.The study, conducted at the Medical City Hospital under the Baghdad Government, involved male and female participants ranging in age from 18 to over 75. All participants in the trial provided a total of 90 clinical specimens (5 ml of blood): 45 patients and 45 controls. To use ELISA (Enzyme Linked Immune Sorbent Assay) to examine the immunological parameter Smad3, blood was taken from the patients. Results: There were statistically significant variations in the means of the concentration levels of the parameter Smad3 in RA patients (12.11±4.91) and controls 1.89 (0.98_4). Expression of Smad3 (ng/ml): For RA patients, the male median was 11.21±5.09 (range: 7.33–15.83), whereas the female median was 12.61±4.83 (range: 8.32–16.29). In Stage 1, Smad3 achieved 7.26±2.75, in Stage 2, 10.25±1.46, in Stage 3, 12.3±4.04, and in Stage 4, 18.97±1.72. Conclusion: There were statistically significant variations between the means of the concentration levels of the parameter Smad3 in RA patients and controls. There may be a slight correlation between RA stages and biomarker levels (Smad3), however this relationship is not statistically significant, and the effects are small.

Role the (IL1, IL6, and TNF) with Chronic Autoimmune Diseases in Mosul City / Iraq

Objective: Our study examined the relationship of the levels of cytokines IL1, 6, and TNF in three different immune diseases with age and Sex. Material and methods: The samples of the study were obtained from in Mosul city hospitals for the period from October 2023 to February 29, 2024. The study included 90 different medical cases suffering from immune diseases, 50 of whom were suffering from rheumatoid arthritis, 16 were suffering from erythematosus, and 24 were suffering from Celiac disease. The ages of the study participants were between 10 years and 65 years. Outcomes: Serum samples were examined for IL1, 6, and TNF using the ELISA technique. The results of ELISA revealed that Concentrations of Interleukins and TNF were low in all patients because the patients in the chronic phase of Autoimmune Diseases take treatment to reduce the cytokines which is hyperactive Therefore, cytokines concentrations appeared lower than standard concentrations. However, the results show a significant association between measuring IL-1 for a CD and measuring IL-6, TNF for an SLE among Autoimmune disease patients and their sex, and age. Conclusion: significance and impact of study: IL1, 6, and TNF are one of the most common cytokines on the globe. It has been connected directly or indirectly with various disorders, including autoimmune diseases. However, the link between IL1, 6 - TNF and Autoimmune Diseases is still controversial. Our results indicate that they play a possible role in the development of autoimmune diseases; however, more studies on a larger scale are required to confirm the results.

Comparison of the Results of Different Surgical Techniques in the Treatment of Chronic Subdural Hematoma in a Training and Research Hospital

Background: Chronic subdural hematoma can cause compression of brain tissue followed by neurological deficits. There are several methods for the treatment of chronic subdural hematoma, but the most appropriate treatment is still controversial. we compared 5 different surgical methods applied by five different surgeons in a single center and we suggest the most appropriate treatment method in the literature. Methods: In this study, the files of patients diagnosed with chronic subdural hematoma who underwent surgery at the Neurosurgery Clinic of S.B.U. Bursa City Hospital were retrospectively examined. The patients were evaluated in terms of their complaints, neurological examinations, type of operation, use of subdural drain and postoperative complications. Five different surgical techniques were applied to the patients. Results: We collected data from 185 patients who underwent surgery due to chronic subdural hematoma. Different surgical techniques were used in the treatment of patients. Only one burr hole was opened in 22 of the patients, one burr hole was opened in 40 of them and 1 drain was placed in the subdural space, only two burr holes were opened in 41 of them, two burr holes were opened in 58 of them and 1 drain was placed in the subdural space, and mini craniotomy was performed in 24 patients. Conclusion: Five different surgical methods used in the treatment of chronic subdural hematoma have advantages and disadvantages. We believe that a study conducted by increasing the number of patients, ensuring homogenization of groups, and increasing surgical techniques will shed light on the literature.

Urinary tract infection pathogens diagnosed in Basra city hospitals

Background. Urinary tract infection (UTI) is the growth of pathological bacteria within the urinary tract, and is one of the most common types of bacterial infections worldwide. Bacterial resistance to antibiotics is a major public health concern. Antibiotic-resistant bacterial infections exacerbate the situation in developed, developing and underdeveloped countries. Objective. The aim of this research is to identify the frequency of different bacterial pathogens and their sensitivity to different types of antibiotics in patients suffering from UTI in Basra city hospitals. Method. This cross-sectional study included 505 samples positive for bacterial growth. It was conducted by data extraction from hospital laboratory records, where information was obtained about bacterial examination of urine samples taken from patients with urinary tract infection. The samples were cultured and antibiotic sensitivity was tested by laboratory workers, in order to determine the appropriate treatment for patients. Results and conclusions. The average age of patients was 43.5 years, of whom (60.4%) were females. The most common bacteria was Escherichia coli (40.6%). In antibiotic susceptibility testing process, gentamicin (5.7%), ciprofloxacin (4.7%), trimethoprim (4.7%), trimethoprim/sulfamethoxazole (4.1%), and cefepime (3.9%) were the most frequently used antibiotics, while cefotetan (0.06%), ampicillin-sulbactam (0.09%), mupirocin (0.2%), cefazolin (0.2%), fosfomycin and amoxicillin (0.2%) were the least used. The highest sensitivity shown by cultured bacteria was to linezolid (95.5%), ertapenem (91.7%), teicoplanin (79.4%), nitrofurantoin (75.2%) and amikacin (72.4%). The highest resistance shown by cultured bacteria was to cefazolin (100%), oxacillin (94.6%), fusidic acid (91.2%), ampicillin (90.4%), and amoxicillin (88.2%).

Observational Study of Rotavirus Related Gastrointestinal Tract Infection in Pediatric Age Group in Kut City Hospitals

In this study, the prevalence and impact of rotavirus infections on pediatric patients under six years old were investigated. Rotaviruses emerged as a predominant cause of severe diarrheal illness in newborns and young children globally. A comprehensive observational study in Al Kut city from May to September 2022 included 99 cases, revealing a 46.5 % positive rate for rotavirus. Statistical analysis indicated a significant association between rotavirus infection and increased frequency of diarrhea episodes (P=0.004) and severe dehydration (P=0.001). Moreover, rotavirus-positive cases were more likely to require intravenous fluid therapy (P=0.02). These findings underscore the substantial burden of rotavirus on both the healthcare system and society, emphasizing its role as a major contributor to infant gastroenteritis, often leading to severe complications and hospitalization

Investigating of Resilience Scale of Selected Hospitals in Yazd City during Disaster Conditions in 2023

Background: The need for healthcare is one of the fundamental needs of humans in critical and emergency situations. Hospitals and healthcare centers are among the first units that can reduce casualties by providing optimal and timely healthcare services. Therefore, the present study aims to evaluate the resilience status of selected hospitals in Yazd city during the crisis in the year 2023. Methods: This research is a descriptive-cross sectional study conducted in 2023 in 5 selected hospitals in Yazd (classified by hospital ownership: university hospitals A, B, C, charity hospital D, and private hospital E). The resilience level of the hospitals during a crisis was assessed using Zhong's standard questionnaire, which evaluated 9 dimensions of resilience. Responses to the questions were based on a 5-point Likert scale (always to never), and data were analyzed using SPSS 26 software. Quantitative data were reported with central (mean) and dispersion (standard deviation) indicators, followed by qualitative (demographic) data as numbers and percentages. Results: The results showed that the overall resilience status of the hospitals in this study averaged 3.95 ± 0.69, which was evaluated at a good level. The highest score was for the private hospital E with an average of 4.30 ± 0.55, and the lowest score was for the public hospital A with an average of 3.75 ± 0.55. Hospital A's score was at a moderate level, while the remaining hospitals were rated at a good level. Conclusion: Considering the average resilience of hospitals in a number of areas, it is suggested to develop and present training programs related to preparing for critical situations and holding maneuvers and conducting exercises with emphasis on training key employees.

Age-Related Variations in Treatment Patterns for Axial Spondyloarthritis

Aim: This study examines treatment patterns and preferences among patients diagnosed with Axial Spondyloarthritis (AxSpA) across different age groups. Material and Method: Ankara Bilkent City Hospital registry enabled a comprehensive cross-sectional analysis of 2,811 patients stratified into three age groups: 18-40, 41-55, and over 55 years. These groups were compared in terms of their treatments. Results: Our findings indicate an increasing prevalence of female patients and comorbidities with age. Medication usage patterns showed a trend towards increased use of Methotrexate and Colchicine with age, while Sulfasalazine and Leflunomide were more commonly prescribed in older age groups. Notably, the use of biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs), including anti-Tumor Necrosis Factor (anti-TNF)", "anti-Interleukin (anti-IL) agents, demonstrated a declining trend with advancing age, though not reaching statistical significance. This trend was also reflected in gender-specific treatment distributions, where no significant difference was found in bDMARDs administration among patients over 55 years, contrasting with a higher usage rate in younger male patients. Conclusion: Our study highlights a shift towards more conservative treatment approaches, such as increased conventional synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) use in older patients, likely due to their safety profile and the specific challenges associated with treating older adults, including higher comorbidity rates and medication side effects. These findings emphasize the need for personalized treatment strategies and suggest potential adjustments in clinical practices to better accommodate the aging population, advocating for ongoing research to optimize treatment efficacy and safety for elderly patients with AxSpA.

The Influence of Emotional Intelligence and Work Culture on Work Commitment and Its Implications on Nurse Performance

This study examines the influence of Emotional Intelligence and Work Culture on Work Commitment and its implications for Nurse Performance in hospitals in the Banten Province. Nurses play a pivotal role in the delivery of quality healthcare services, directly impacting patient recovery and overall hospital performance. The study adopts a quantitative approach with a survey method, collecting data from nurses at four city hospitals in Banten. The results show that both Emotional Intelligence and Work Culture have a significant positive effect on Work Commitment, which in turn, strongly influences Nurse Performance. Emotional Intelligence enables nurses to manage their emotions effectively, fostering stronger emotional engagement with their work. Meanwhile, a supportive Work Culture enhances collaboration and communication among nurses, further strengthening their commitment to their jobs. The findings also reveal that Work Commitment serves as a crucial mediator in the relationship between Emotional Intelligence, Work Culture, and Nurse Performance. Nurses with higher Emotional Intelligence are better equipped to handle stress and build stronger relationships with patients and colleagues, leading to improved performance. Similarly, a positive Work Culture fosters an environment where nurses feel valued and supported, increasing their dedication and job satisfaction. The study concludes that hospitals should prioritize strategies to enhance Emotional Intelligence and cultivate a positive Work Culture to improve both nurse performance and the overall quality of healthcare services.

Comparison of State-Trait Anxiety and Fear of Childbirth According to Attachment Styles of Pregnant Women.

Fear of childbirth (FoC) and its extreme form, tokophobia, is a clinical condition that can lead to many negative consequences, and its importance is increasingly understood. This article aims to assess the severity of FoC and anxiety levels according to different attachment styles and to investigate the relationships between these factors. A cross-sectional study was conducted in a state hospital in the largest city in Turkey. Three hundred pregnant women attending the Antenatal Outpatient Clinic were included. A sociodemographic questionnaire, Wijma Delivery Expectancy/Experience Questionnaire-version-A (W-DEQ), Spielberger State-Trait Anxiety Inventory and Adult Attachment Style Scale were administered. 8.1% of participants had tokophobia (W-DEQ sum score ≥85). FoC was significantly higher in pregnant women who had a history of pregnancy loss and past psychiatric history. For multiparous women, adverse birth outcomes were also associated with higher FoC. State and trait anxiety were positively correlated with FoC levels. Regarding the attachment patterns, pregnant women with avoidant attachment styles presented with higher levels of FoC than those with secure attachment styles. In logistic regression analysis, higher anxiety levels, adverse birth outcomes, and insecure attachment styles were found to predict severe and clinical FoC. FoC has a considerable effect on pregnant women, albeit at different clinical levels. Adverse birth outcomes, high anxiety levels, and insecure attachment styles were associated with higher FoC. Therefore, antenatal patients with adverse birth outcomes and higher anxiety levels, which are risk factors for FoC, should be carefully evaluated in terms of tokophobia and referred to mental health professionals when necessary.

Predictors for COVID-19-Specific and Non-COVID-19-Specific Deaths: A Cohort Study in Taiwan

Predictors for coronavirus disease 2019 (COVID-19)-specific and non-COVID-19-specific deaths have not been extensively studied. This cohort study in Taiwan investigated predictors for COVID-19-specific and non-COVID-19-specific deaths among hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. From January to July 2022, 2196 COVID-19 patients at Taipei City Hospital were consecutively recruited in this cohort study. Among the 175 deceased COVID-19 patients, 147 (84.0%) and 28 (16.0%) had COVID-19-specific and non-COVID-19-specific deaths, respectively. After controlling for other covariates, multinomial logistic regressions showed that age ≥ 65 was significantly associated with higher risks for both COVID-19-specific, adjusted odds ratio (AOR) = 6.21; 95% confidence interval (CI) [3.12, 12.35]; and non-COVID-19-specific deaths (AOR = 6.06; 95% CI [1.34, 27.34]). Fully vaccinated individuals (AOR = 0.50; 95% CI [0.33, 0.74]) and Paxlovid recipients (AOR = 0.45; 95% CI [0.20, 0.98]) had lower COVID-19-specific death risks, while comorbid cancer or end-stage renal disease patients faced higher risks of non-COVID-19-specific deaths. Our study findings suggest that vaccination and Paxlovid treatment are crucial for reducing SARS-CoV-2-specific mortalities, while comorbid patients need careful monitoring to reduce non-COVID-19-specific deaths.

Remote monitoring of patients with chronic heart failure: A prospective randomized study

BACKGROUND: Chronic heart failure is one of the key problems of the Russian domestic healthcare system. E-health can be used to improve medical care quality and reduce the of hospitalizations and mortality. AIM: To examine the effect of telemedicine monitoring on mortality, frequency of hospitalizations, and clinical and functional states of patients with chronic heart failure. MATERIALS AND METHODS: A prospective, controlled, randomized study was conducted in the Central City Hospital No. 20 in Ekaterinburg (Russia), covering the period from December 2020 to December 2022. Patients with a confirmed diagnosis of chronic heart failure were randomized using the envelope method into three groups: group 1, a telephone control group (n=58); group 2, a remote control group using a Russian medical platform Medsenger (n=52); and group 3, the standard control group (n=103). All patients were examined, including NT-proBNP measurement and echocardiography on the first day of the study and at 3, 6, and 12 months. The occurrence of primary and secondary outcomes was evaluated at these reference points. Stata14 and jamovi software were used for statistical processing. RESULTS: The study involved 213 participants, and all three groups were comparable in terms of basic demographic and clinical characteristics. The advantage of remote control (groups 1 and 2) over face-to-face observation in reducing cardiovascular mortality was observed after 3 (odds ratio 2.73, 95% confidence interval 1.1–7.39; p=0.042) and 12 (odds ratio 2.1, 95% confidence interval 1.1–3.7; p=0.027) months and that in reducing the occurrence of the combined primary endpoint (odds ratio 2.1, 95% confidence interval 1.1–5.6; p=0.015) after 12 months. The use of the Medsenger platform also demonstrated an advantage over face-to-face observation in the development of the combined secondary endpoint (odds ratio 1.39, 95% confidence interval 0.19–0.81; p=0.011) after 3 months and over telephone control by a nurse after 12 months in reducing cardiovascular mortality (odds ratio 0.177, 95% confidence interval 0.06–0.487; p=0.021) and development of the combined secondary endpoint (odds ratio 0.427, 95% confidence interval 0.189–0.964; p=0.041). When using the Medsenger platform, the ejection fraction increased from 47% initially to 55% after 12 months (p=0.004). The NT-proBNP level decreased from 817 to 582 pg/mL (p 0.001) after 3 months and then to 233 pg/mL after 12 months (p 0.001). CONCLUSION: Remote monitoring protocols can be a good alternative to the traditional face-to-face monitoring of patients with chronic heart failure, which may improve clinical and functional health indicators.

Efficacy of N-acetylcysteine in reducing inflammation and oxidative stress to prevent complex regional pain syndrome type 1.

This study aimed to evaluate the effectiveness of N-acetylcysteine (NAC) in preventing complex regional pain syndrome type 1 (CRPS-1) by reducing proinflammatory cytokines and oxidative stress markers in patients with distal radius fractures. A retrospective single-center study at Bursa City Hospital involves patients over 50 years of age with distal radius fractures treated between January 2021 and December 2023. A total of 60 patients (mean age, 62.8 ± 5.1 years; 26 males and 34 females) were analyzed. Patients were divided into 2 groups: the NAC group (31 patients receiving 600-mg NAC daily for 3 months) and the control group (29 patients with no prophylactic medication). CRPS-1 diagnosis was based on Budapest criteria during multiple follow-up visits. Serum levels of interleukin (IL)-1 beta, IL-6, tumor necrosis factor-alpha (TNF-α), total oxidant status (TOS), and total antioxidant status (TAS) were measured at baseline and study end point. CRPS-1 positive patients had significantly higher levels of IL-6, TNF-α, and IL-1 (P < .001 for all), higher TOS (P < .001) and oxidative stress index (P < .001), and lower TAS (P < .001) compared with CRPS-1 negatives. The incidence of CRPS-1 was significantly lower in the NAC group (9.7%) compared with the control group (31.0%; P = .039). Logistic regression indicated a 78% reduction in CRPS-1 odds ratio with NAC treatment (odds ratio, 0.219 [95% confidence interval, 0.053-0.895]; P = .0322). NAC significantly reduced end-point levels and changes in IL-6 (P < .001), TNF-α (P < .001), and IL-1 (P = .038) and improved oxidative stress markers, showing higher TAS (P < .001), lower TOS (P < .001), and oxidative stress index (P < .001) compared with controls. NAC significantly reduced the risk of developing CRPS-1 by decreasing levels of proinflammatory cytokines and oxidative stress. This study highlights NAC's potential as a preventive treatment for CRPS-1 and emphasizes the importance of early intervention.