Analytical Cross-sectional Study Research Articles

A study of knowledge, attitude and behavior of patients towards their illness and their relation to sociodemographic factors

Background: This study was conducted to assess basic knowledge, attitudes, and practices of patients to their illness and find its correlation with various socio-demographic factors. Method: This was a cross-sectional questionnaire-based analytical study. All patients over 18 years of age who attended the OPD or were admitted to the medical ward and who agreed to participate in the study were included. A questionnaire regarding the demographic characteristics of the study participants as well as the patient’s knowledge, attitudes, and practices regarding their disease was administered regularly by experienced physicians dealing with OPD and IPD both type of patients. Results: Out of total 100, only 38% patients came for regular follow up and only 57% brought old records. 36% were not taking medications regularly for various reasons (trying alternative medicine (22.2%), advice from others (11.1%), found medicines ineffective and stopped without reconsulting (8.3%), fear of adverse effects (8.3%), couldn’t afford (8.3%), worsening of symptoms (5.6%) etc. 19.4% had no reasons. 67% patients got medicines prescribed from a qualified clinician while other sources were pharmacist (9%), relatives/friends (5%) and self-medication (6%). Significantly more females, educated and employed were aware about their medical condition and medications. Significantly more educated and employed brought old records and came for regular follow up (p-0.0187), Significantly more educated seeked qualified doctor’s advice as compared to uneducated. (p=0.0002). Conclusion: There is a need to educate patients about the importance of medication awareness, adherence, regular follow up, disadvantages of unscientific and unreliable information to improve compliance to treatment.

Characteristics, management, and major adverse cardiac events of ST-elevation myocardial infarction (STEMI) patients in rural area: a Jember acute coronary syndrome medical records study

The mortality and morbidity of ST-elevation myocardial infarction (STEMI) remain high, and it is still the leading cause of death worldwide. Timely reperfusion lowers the risk of MACE and improves survival. However, reperfusion delay is still a significant issue in developing countries, particularly rural area. This study aimed to determine the characteristics, management, and major adverse cardiac events of STEMI patients in Jember Distric to enhance reperfusion therapy in rural areas. It was an analytical observational cross-sectional study with a quantitative method. A total of 108 medical records of STEMI patients of the Dr. Soebandi District Hospital, Jember in period of 2019 to 2020 were included using the consecutive sampling technique. As much as 78 (62%) of the patients did not receive reperfusion therapy while the remaining patients (41 or 38%) received the therapy, namely percutaneous coronary intervention (20 or 18.5%), fibrinolytic therapy (19 or 17.6%), and both (2 or 1.9%). Multivariate analysis for reperfusion was statistically significant (p=0.016; OR 3.688 95% CI: 1.274-10.679). The level of education, health funding, and distance to the hospital did not affect the delay of the reperfusion therapy. Reperfusion was highly associated with the incidence of MACE and this study discovered a threefold benefit of reperfusion in lowering the occurrence of MACE (p=0.016). In conclusion, the majority of STEMI patients does not get reperfusion therapy. Delays in reperfusion treatment are not related to the patient's level of education, health funding, or distance to the hospital. Nonetheless, the delay my be attributed to the Jember community's lack of awareness of STEMI symptoms.

Knowledge and Perceptions about Diagnosis, Clinical Management, and Prevention of Dengue Fever among Physicians during the 2023 Outbreak: A Cross-Sectional Study in Peru.

The objective of this study was to evaluate the knowledge level and perception of dengue fever management among Peruvian physicians and to determine the factors associated with higher knowledge. We conducted an analytical cross-sectional study based on an online survey. To evaluate the factors associated with a high level of knowledge (≥70% of correct answers), we used crude (cPR) and adjusted (aPR) prevalence ratios by the Poisson regression model. Of 359 respondents (median age: 33 years; male: 56.5%), 78.8% achieved a high level of knowledge. Multivariable analysis showed an independent association with having read the Peruvian clinical practice guidelines for dengue management (aPR: 1.29; 95% CI: 1.12-1.49), having experience in treating patients (aPR: 1.32; 95% CI: 1.03-1.68), and having treated cases frequently (aPR: 1.22; 95% CI: 1.02-1.46). Residing in the eastern macroregion (aPR: 0.83; 95% CI: 0.71-0.97) was associated with a low level of knowledge. In conclusion, Peruvian physicians had a high level of knowledge about dengue fever. This was associated with having clinical experience in dengue management. However, given the low level of knowledge in the eastern macroregion, educational campaigns are necessary in this area.

Influence of social media on health-related decision-making among adults attending an outpatient department of a tertiary care centre in India: A cross-sectional analytical study.

Background Social media platforms, especially Facebook and WhatsApp, can spread public health information effectively. We aimed to estimate the influence of health-related messages circulated through these social media platforms on health-related decision-making and its associated factors. Methods We did a cross-sectional analytical study among adults (aged >18 years) who visited the outpatient department of a tertiary care hospital in suburban West Bengal, during July-September 2021. A structured questionnaire was used regarding receiving health-related messages on social media and the subsequent effect on health-related decision-making in the past year. Results A total of 673 individuals participated in the study. Their mean (SD) age was 34.4 (10.2) years and 56.8% (382) were men, 50.8% (342) were graduates, 63.6% (428) were from rural areas and 82.9% (558) were active users of more than one social media platform. A total of 474 (70.4%; 95% CI 67.0-73.9) study participants reported health-related decision-making based on social media messages, whereas 44.7% (301) reported checking the authenticity of forwarded messages or posts or updates with healthcare professionals before making a decision. On adjusted analysis, participants who had secondary education (adjusted prevalence ratio [aPR] 1.40; 95% CI 1.01-1.94), used both the media (aPR 1.31; 95% CI 1.09-1.58) and checked the authenticity of the messages with a healthcare professional (aPR 1.52, 95% CI 1.38-1.68) were significantly more influenced by the messages, posts or updates received on social media platforms. Conclusion WhatsApp forwards or updates and Facebook posts or updates influence health-related decision-making among the Indian adult population.

Opportunities for Reproductive Health Programs in the Implementation of Schools Re-Entry Policy on Teenage Pregnancy and Sexually Transmitted Infections: Case of Selected Urban Schools in Kenya

Purpose: This study was designed to determine the opportunities available for the ministry of health as the custodian of reproductive health programs on mitigating teenage pregnancy and sexually transmitted infections in Kenya. Methodology: This was an analytical cross-sectional study that triangulated various sampling techniques. Based on unmitigated increase number of school pregnancies and sexually transmitted infections, the study obtained information on opportunities available to introduce and implement reproductive health program from the specialists in the ministries of health and education using Focus Group Discussions, Key Informant interviews and questionnaires techniques. A total of 16 respondents was realized using the standard saturation point method. Multistage followed by cluster sampling techniques were used to identify selected urban towns. A sample size of 174 school-female teenage participants female were tested for pregnancy and sexually transmitted infections in the eight urban areas. Analysis of data was done by use of descriptive statistics, Analysis of Variance (ANOVA) and content analysis. Findings: The study found out that the ministry of health through the National Sexual and Reproductive Health Policy and its strategic plans had not taken up the opportunity to perform its role of supporting re-entry policy and reproductive health education in schools. Although the Ministry of health, through its established organs had a role to play in mitigating Teenage Pregnancy and Sexually Transmitted infections, it had not put structures in place for its implementation in schools. Unique contribution to Theory, practice and Policy: The ministry of health needs to support school-entry policy as part of its mandate. Successful programs and policies require the involvement of all stakeholders in designing, developing and implementing and must be inclusive and well resource supported. The findings of this study need to be appraised by the policy makers and implementers for fresh and improved interventions.

Evaluation of anemia as comorbidity in elderly subjects aged 65 years and above admitted to hospital for other medical problems

Objectives: The objectives of this study were as follows: (1) To find out the proportion of anemia in the elderly aged 65 years and above admitted to hospital for other medical problems. (2) To determine the association between sociodemographic variables, other comorbidities, and anemia in the elderly aged 65 years and above. Material and Methods: Hospital-based analytical cross-sectional study was done. This study was conducted for period of one year among 236 geriatric patients who were admitted for other medical disorders and they were evaluated for anemia. Patients with hemoglobin cutoff value <13% g for men and <12% g for women were considered for further evaluation of anemia (using clinical and biochemical evaluation). Ethical principals were adhered. Data were analyzed using the Statistical Package for the Social Sciences Software version 23.0. Results: Among the 236 elderly patients, recruited in the study, 65.3% were anemic. About 75.8% had at least one comorbidity such as coronary artery disease, chronic respiratory illness, renal diseases, arthritis, liver diseases, gastrointestinal diseases, cardiovascular accidents, carcinomas, diabetes, and hypertension. All these comorbidities except diabetes and hypertension had shown to be significantly associated with anemic status of the elderly patients. Conclusion: This study concludes that, anemia was highly prevalent among hospitalized elderly patients and it is highly associated with other comorbid conditions.

Screening for common mental disorders in people with epilepsy in Goma, in the Democratic Republic of the Congo: A cross-sectional study

Objectives: Epilepsy is a chronic neurological disease that is highly susceptible to a variety of mental health problems due to its enormous biological, social, and psychological burdens. The purpose of this study was to determine the prevalence and identify risk factors for common mental disorders (CMDs) in people with epilepsy (PWEs) in Goma, in the Democratic Republic of the Congo (DRC). Material and Methods: This is an analytical cross-sectional study conducted at the Neuropsychiatric Hospital Center in Goma (DRC) from March to April 2022, involving 302 PWEs. A questionnaire was administered to collect socio-demographic data, personal and family history, clinical features, and management of epilepsy. CMDs were assessed using the self-report questionnaire-20. Bivariate analysis was performed, followed by multivariate analysis, and variables with P < 0.05 in the final model were considered as risk factors associated with CMDs. Results: The study included 302 PWEs, of which 56.9% were men, and the mean age was 28.4 ± 11.0 years. CMDs were present in 39.1% of the participants. The presence of CMDs was significantly associated with having five or more seizures in the month preceding the survey (adjusted odds ratio [aOR] = 3.8; 95% confidence interval [CI]: 1.7–8.3) and having medical co-morbidities (aOR = 3.1; 95% CI: 1.5–6.4). Conclusion: The prevalence of CMDs in PWEs was high (39.1%), suggesting that this is a public health issue. Therefore, early detection and recognition of CMD symptoms should be a routine activity when managing PWEs.

ECAD study: Evaluating agreement degree among paediatricians in hip dysplasia assessment by the Graf ultrasound method.

Developmental dysplasia of the hip (DDH) is the most common musculoskeletal anomaly of childhood. This study analyses paediatrician's concordance performing hip ultrasound according to Graf's method. An analytical cross-sectional study is designed. Patients' hips are evaluated by Graf's ultrasound method at 4-6 and 12-16weeks of age. Demographic characteristics, pregnancy history, factors related to DDH, hip type, and α and β angles are collected. To assess the agreement degree of hip diagnosis and hip types Kappa index (I. kappa) is used. Intraclass correlation coefficient (ICC) evaluates the concordance of α and β angles. A p value < 0.05 is considered statistically significant. All results are represented with their 95% confidence interval (95% CI). Four hundred sixty-seven neonates are recruited and meet the inclusion criteria. A total of 3182 images were analysed. Agreement between paediatricians according to hip diagnosis and different types ranges from moderate to almost perfect I. kappa 0.6-1.0 (95% CI 0.5-0.7; 95% CI 1.0-1.0). α angle ICC for paediatricians is between 0.75 and 0.88 (95% CI 0.61-0.86; 95% CI 0.80-0.92). β angle value agreement degree among paediatricians at both visits is moderate. The Graf method is the most popular ultrasound technique for hip assessment. In our setting, paediatricians carry out children follow-up; therefore, they should perform universal screening. In this study agreement degree between paediatricians varies between substantial and almost perfect. Conclusion: The Graf ultrasound procedure performed by paediatricians is a reliable test and can be used for DDH screening. What is Known •Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal anomaly of childhood. Early diagnosis and treatment improve DDH prognosis. Lack of detection can cause complications such as lameness, early osteoarthritis and need for hip replacement at an early age. What is New •Today, the best screening method is still subject of debate. But it seems that with selective screening many pathological hips go unnoticed. Universal screening implementation may be a challenge in some countries. But the question is if this could be carried out by paediatricians as part of healthy child follow-up.

Correlation Between RET-He and Quality of Life in Chronic Kidney Disease Patients with Routine Hemodialysis: A Study at Ulin General Hospital Banjarmasin

Background: The 2018 Riskesdas report revealed that the incidence of chronic kidney disease (CKD) affects 0.38% of Indonesia’s population. Anemia frequently complicates CKD, especially in patients undergoing regular hemodialysis. Reticulocyte hemoglobin equivalent (RET-He) assesses hemoglobin content in reticulocytes, indicating iron availability for erythropoiesis in the bone marrow. CKD significantly impacts patients' socio-economic status, heightening morbidity and mortality while diminishing quality of life. The relationship between RET-He and the quality of life in CKD patients on routine hemodialysis remains unclear. Objective: To investigate the correlation between RET-He and quality of life in CKD patients undergoing routine hemodialysis. Methods: A cross-sectional observational analytical study with data from medical records of CKD patients receiving routine hemodialysis between October 1st and October 30th, 2021. The Spearman correlation test was used for analysis. Results: This study included 92 patients, consisting of 40 males and 52 females, with a median age of 50 years and RET-He values at 31. Quality of life metrics included physical function (800, range: 0-1000), physical limitations (300, range: 0-400), body pain (175, range: 75-255), general health (475, range: 225-600), vitality (320, range: 200-400), social function (175, range: 75-200), emotional limitations (300, range: 100-300), and mental health (380, range: 160-500). The correlation analysis revealed no significant relationships: physical function (p=0.359), physical limitations (p=0.813), body pain (p=0.373), general health (p=0.547), vitality (p=0.616), social function (p=0.828), emotional limitations (p=0.482), and mental health (p=0.136). Conclusion: There is no significant correlation between RET-He levels and the quality of life in CKD patients undergoing regular hemodialysis.

Acute Kidney Injury Incidence in COVID-19 Patients Receiving Remdesivir Therapy at Awal Bros Panam Hospital

Background: Remdesivir is one of the pharmacological therapies for moderate COVID-19 patients. Remdesivir is an antiviral that can increase the risk of nephrotoxicity. Objective: The study aims to evaluate the incidence of acute kidney injury (AKI) in COVID-19 patients receiving remdesivir. Methods: This is a cross-sectional analytic study of 238 COVID-19 patients receiving remdesivir therapy at Awal Bros Panam Hospital for the period 2020–2022. AKI was diagnosed using the KDIGO criteria. The chi-square test was used to determine the correlation of AKI incidence with age, gender, and comorbidities, with a significance level of p &lt; 0.05. Results: AKI was found in 32 patients (13.4%). The majority of AKI patients (75%) were aged 60 years or older, with 65.6% being male. Additionally, 84.4% of these patients had comorbidities, and 53.1% of them died. Around half of the patients were diagnosed with stage 1 AKI, and the majority, specifically 84.4%, did not undergo renal replacement therapy (RRT). The association between the incidence of AKI and age and comorbidities was shown to be statistically significant (p=0.000; RR 5.11; 95% CI 2.44-10.8 and p=0.009; RR 3.05; 95% CI 1.22-7.64, respectively). Conclusion: The main risk factors for AKI are primarily observed in the older population and individuals with several medical conditions. Greater emphasis should be placed on administering remdesivir to COVID-19 patients who are elderly and have comorbidities, as they are at a higher risk of developing AKI.

Sociodemographic and work-related factors associated with psychological resilience in South African healthcare workers: a cross-sectional study

BackgroundPsychological resilience facilitates adaptation in stressful environments and is an important personal characteristic that enables workers to navigate occupational challenges. Few studies have evaluated the factors associated with psychological resilience in healthcare workers.ObjectivesTo determine the prevalence and factors associated with psychological resilience in a group of South African medical doctors and ambulance personnel.Materials and methodsThis analytical cross-sectional study used secondary data obtained from two studies conducted among healthcare workers in 2019 and 2022. Self-reported factors associated with resilience, as measured by the Connor-Davidson Resilience Scale-10 (CD-RISC-10), were evaluated. R statistical software was used for analysing the data and performing statistical tests.ResultsA total of 647 healthcare workers were included in the study, of which 259 were doctors and 388 were ambulance personnel. Resilience scores were low overall (27.6 ± 6.6) but higher for ambulance personnel (28.0 ± 6.9) than for doctors (27.1 ± 6.0) (p = 0.006). Female gender (OR 1.94, 95%CI 1.03–3.72, p = 0.043), job category (OR 6.94 95%CI 1.22–60.50, p = 0.044) and overtime work (OR 13.88, 95%CI 1.61–368.00, p = 0.044) significantly increased the odds of low resilience for doctors. Conversely, salary (OR 0.13, 95%CI 0.02–0.64, p = 0.024) and current smoking status (OR 0.16, 95%CI 0.02–0.66, p = 0.027) significantly reduced the odds of low resilience amongst doctors. In addition, only previous alcohol use significantly reduced the odds of low resilience for ambulance personnel (OR 0.44, 95%CI 0.20–0.94, p = 0.038) and overall sample (OR 0.52, 95%CI 0.29–0.91, p = 0.024).ConclusionsResilience was relatively low in this group of South African healthcare workers. The strong association between low resilience and individual and workplace factors provides avenues for early intervention and building resilience among healthcare workers.

An analytic cross-sectional study of Somali women on the sexual and psychosocial status during pregnancy

BackgroundPregnancy is associated with physical, psychological, hormonal, and social alterations that may lead to detrimental effects on sexual function and psychological well-being. This study sought to examine sexual function and psychosocial well-being of pregnant women in Somalia in comparison with their non-pregnant counterparts.MethodsWe enrolled 487 consecutive women in monogamous marriages. Data included maternal age, gravida, parity, gestational week, education status of wives and husbands, and residence area. The participants completed the Female Sexual Function Index (FSFI) and the Brief Symptom Inventory-18 (BSI-18).ResultsOf 487 women, 241 were pregnant, and 246 were non-pregnant. The overall incidence of sexual dysfunction was 57.7%, being 64.0% for pregnant and 51.6% for non-pregnant women (p = 0.010). Pregnant women exhibited significantly lower FSFI scores on desire, arousal, lubrication, and orgasm, and significantly higher total BSI, anxiety, depression and somatization scores. The frequencies of sexual dysfunction were 57.9%, 45.9%, and 78.9% during the first, second, and third trimesters, respectively (p = 0.0001). As compared with the first and second trimesters, and non-pregnancy, the third trimester of pregnancy was associated with a significantly lower total FSFI score and significantly decreased levels of desire, arousal, lubrication, and orgasm, as well as a significantly higher total BSI score and a significantly increased level of anxiety. In regression analysis, pregnancy was inversely associated with sexual function parameters of desire, arousal, lubrication, and orgasm, and with BSI parameters of depression, anxiety and somatization.ConclusionOur findings suggest that pregnant women experience considerable sexual and psychosocial deterioration as compared with their non-pregnant counterparts.

The relationship between social media dependency and psychological distress due to misunderstanding and fear of COVID-19 in medical students

Improper use of social media during the COVID-19 outbreak, leading to fear and misunderstanding, can contribute to psychological disorders in vulnerable populations. This descriptive and analytical cross-sectional study was conducted in 2023 on 511 medical students of Babol University of Medical Sciences. Data were collected using demographic, psychological distress, fear and misunderstanding questionnaires related to COVID-19 and social media dependency. A total of 511 medical students, with an average age of Mean and S.D; 23.57 ± 3.03 participated in the study. The average psychological distress score was 23.82 ± 7.73 (out of 54), the average score of social media dependency was 17.53 ± 3.09 (out of 30), for the fear of COVID-19 was12.63 ± 2.56 (out of 35), and for the misperception of COVID-19 was 0.53 ± 0.09 (out of 18). Path analysis results) showed that direct path from improper use of social media to psychological distress is significant (P < 0.001, B = 0.19) but this relationship is not significant through fear and misperception related to COVID-19. Improper use of social media, identified as the strongest predictor, can directly increase psychological distress in medical students, without mediation through fear and misperception related to COVID-19. These findings should be taken into consideration when designing and evaluating interventions aimed at promoting mental health and fostering appropriate use of social media among students during disease outbreaks.

Correlation of Subject Characteristics, Work Stress Levels, and Smoking Patterns among Educational Personnel at X University, Indonesia

Human resources are among the crucial aspects of an organization, including in higher-education organizations. Educational personnel, a key component of the education system, are prone to work stress, which may trigger smoking behavior. Personal characteristics may also influence smoking behavior. This cross-sectional observational analytic study aimed to analyze the relationship between characteristics, work stress level, and smoking behavior of educational personnel of X University, Indonesia. On 30 April–Mei 2021, subjects were recruited through total sampling based on inclusion and exclusion criteria (n=100, all males). A questionnaire that had been tested for validity and reliability was used to collect data on subject characteristics and behaviors, while DASS-42 was used to measure work stress. Age, education level, length of work, and work stress were the independent variables, while smoking was the dependent variable. Data collected were analyzed univariately and bivariately using the chi-square test, with p&lt;0.05 considered significant. Age, education, and length of work were found to be significantly correlated with smoking (p=0.007, 0.016, and 0.009, respectively). However, stress levels did not correlate with smoking (p=0.786). This suggests that age, education, and length of work significantly influence smoking behavior. It's crucial to interpret these findings with caution, especially considering that all subjects are males, who have been proven less prone to stress than females. This caution is necessary to ensure a comprehensive understanding of the factors influencing smoking behavior among educational personnel.

Radiological abnormalities of the cervicothoracic vertebrae in Warmblood horses with primary neck-related clinical signs versus controls.

Radiological observations at the cervicothoracic junction in horses with or without related clinical signs have not been comprehensively described. The aim was to evaluate the seventh cervical (C7) to second thoracic (T2) vertebrae in horses with neck-related clinical signs (neck pain and/or stiffness, neck-related forelimb lameness, or general proprioceptive [spinal] ataxia) and control horses. This prospective analytical cross-sectional study included 127 control horses and 96 cases, examined using standardized clinical and radiological protocols. Univariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) to identify factors associated with radiological abnormalities. Severe modeling of the articular processes at C7-T1 was more likely in cases compared with controls, OR, 4.25; CI, 1.04-17.36; P=.04. Cases were more likely to have spondylolisthesis at C7-T1 than controls, OR, 3.61; CI, 1.75-7.44; P<.001. There was a lack of uniformity of disc space width at C6-C7, despite normal alignment of the vertebrae, in five (5.2%) cases and no control horses. Discospondylosis was seen in 9 (9.4%) horses at C7-T1 and 10 of 64 (15.6%) at T1-T2. The sagittal ratio for T1 was smaller for horses with neck-related forelimb lameness (P<.0002), neck pain/ stiffness (P=.04), or neurological cases (P<.001) than controls. The prevalence of radiological abnormalities at C7-T1 and T1-T2 highlights the importance of careful evaluation of the cervicothoracic junction in horses with neck-related signs.

Factors associated with the rabies vaccination status of dogs in households in Beni City, D.R. Congo.

Human rabies transmitted by dogs still kills thousands of people each year worldwide. Dog bites are common in the city of Beni (Democratic Republic of Congo), which shows low rabies vaccination coverage. This study aimed to determine the factors associated with the rabies vaccination status of dogs. A cross-sectional analytical study was conducted in the town of Beni among dog owners, during a household survey selected using a multistage sampling. The information sought concerned the knowledge and characteristics of the dog owners as well as the vaccination status of these dogs. Logistic regression was used to investigate associations between the vaccination status of the dogs and the main independent factors. Rabies vaccination coverage in Beni was 26% (95% confidence interval [CI]: 22% - 30%). The main factors associated with the rabies vaccination status of the dog were primary education level of household head (adjusted odds ratio [aOR]:4.8; 95% CI: 1.2- 19.8); university education level of household head (aOR: 5.9; 95% CI: 1.6-22); perceived rabies severity (aOR: 44. 4; 95% CI: 10.4-188), having more than one dog in the household (aOR: 2.6; 95% CI: 1.6-4.3); age range 7-12 months (aOR: 0.2; 95% CI: 0.1-0.6) and confined dog breeding (aOR: 3.9; 95% CI: 1.1-14.9). The low vaccination coverage in Beni requires mass vaccination campaigns against canine rabies targeting the dog owners with low education levels, those raising more than one dog, with stray dogs or dogs less than 12 months old.

Therapeutic drug monitoring for valproate: deriving a novel formula for calculation of free concentration.

Monitoring free valproate concentrations, as with other highly protein-bound anticonvulsants, is essential in clinical situations where protein binding may be disrupted. Conversion of measured total concentrations to approximate free concentrations offers a cost-effective alternative. This study evaluated the relationship between total and free valproate concentrations for discordance and the impact of key determinants. A novel formula was devised that incorporates significant variables. A multicentre, cross-sectional observational analytical study included 101 subjects 18 years and older using valproate for 6 months or longer. Participants were recruited from private and public sector healthcare settings from primary to tertiary level in, South Africa, during 2017-2019. Free valproate concentrations could be measured for 84 subjects. Discordance for concomitant total and free valproate concentrations was 79.1%. Among 19 participants with elevated free concentrations, 15 (78.9%) had total valproate concentrations within the recommended reference range. Calculations based on the study-derived formula were more accurate in predicting free valproate concentration than previously proposed methods. This study proposes that the novel formula for calculating free valproate enables more accurate prediction.

Psychiatric Comorbidity in Children and Youth with Epilepsy

Introduction: Psychiatric comorbidities of epilepsy are common. Yet psychiatric disorders are often under-prevented, under-diagnosed, and under-treated. Objectives: to assess the prevalence of different psychiatric disorders in children and adolescents with epilepsy and to determine associated risk factors. Methods: This is a descriptive and analytical cross-sectional study of patients treated for a psychiatric disorder comorbid with epilepsy, conducted in the Child Psychiatry Department at Ar-Razi Hospital in Salé, Morocco, from January 1st to December 31st, 2022.Data were collected using a questionnaire concerning the socio-demographic and clinical characteristics of our patients. Psychiatric disorders were assessed using the diagnostic criteria of the DSM-5 psychiatric manual. Results: Our study included 70 patients followed for epilepsy comorbid with a psychiatric disorder. The most common psychiatric comorbidities were intellectual development disorder, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). 72.9% suffered from a single psychiatric comorbidity, while 27.1% had two or more. Several sociodemographic and clinical factors were associated with different psychiatric disorders. Gender was associated with conduct and behavior disorders, with males predominating (p=0.043), while age was significantly associated with psychosis (p=0.047). Mood disorders were associated with the type of epilepsy. Seizure recurrence was associated with behavioral and anxiety disorders. Conclusion: The co-morbidity of psychiatric disorders and epilepsy in children and adolescents is common, underscoring the importance of early detection for improved management.

Audiological results of myringoplasty performed by trainee surgeons (ENT residents) under supervision—analytic study

BackgroundMyringoplasty is one of the most common surgeries performed in otology centers, with many factors influencing the success rate, including the size and site of perforation, function of the Eustachian tube, revision surgery, and expertise of the surgeons. It is well established that the perforation closure rate is lower when performed by trainee surgeons than by senior otologists. Myringoplasty performed by trainees tends to pose more iatrogenic trauma to middle ear mucosa, less gentle manipulation of ossicles, and prolonged operation time compared with operations performed by experienced surgeons, all of which might produce more damage to middle ear structures and consequently negatively affect the closure rate of TM and audiological outcome. This study aimed to assess the audiological outcomes of successfully closed perforation myringoplasty performed by a trainee under supervision.MethodsThe study design was an analytic cross-sectional study of 35 patients aged between 6 and 62 years diagnosed with safe TM perforation. All patients had two audiograms, one before surgery and the other 3 months after surgery. The exclusion criteria included any case with cholesteatoma, tumor, tympanosclerosis, or ossicular erosion/fixation because this study aimed to study the sole effect of closing TM perforation without any other confounding factor.ResultsThe results indicate a mean hearing improvement of 12.25 dB of ABG and 10.6 dB of AC thresholds at the four frequencies of 500, 1000, 2000, and 4000 Hz. The mean of the residual ABGs at the four frequencies is 14.2 dB. There were no correlations between the amount of air conduction threshold improvement and age, gender, side of the affected ear, area of perforation, or duration of disease (p > 0.05 for all tests).ConclusionAlthough the rate of perforation closure in myringoplasties performed by trainees is lower than that of experienced surgeons, the audiological outcomes of myringoplasties performed by trainees under supervision were acceptable; however, further research is recommended.

A hospital-based survey assessing the health facility-level factors that contribute to delayed diagnosis of cervical cancer; patients views

Background In Kenya, Cervical Cancer is the 2nd commonly diagnosed type of cancer and the leading cause of cancer-related death among women. Globally, more than 50% of Cervical Cancer diagnoses are made late, with this proportion rising to 80% in developing countries. Poor Health systems can cause delays in diagnosis; thus, this study focused on determining the health facility level factors that contribute to delayed diagnosis among Cervical Cancer patients at Kenyatta National Hospital (KNH). Methods An analytical cross-sectional mixed method study was adopted to collect data on hospital and referral experiences from 139 Cervical Cancer patients systematically sampled at the KNH, using a semi-structured questionnaire. Associations between stage at diagnosis and hospital and referral experience were tested using a logistic regression model at a 95% Confidence Interval. Results 86 (61.9%) patients were diagnosed with advanced stages III and IV. The potential predictors for delayed diagnosis were a higher number of hospital referrals (p =0.000), facing referral challenges (p =0.041), longer time taken for diagnosis appointment (p =0.059), and longer time taken for diagnostic results (p =0.007) in the bivariate analysis. A higher number of hospital referrals (p =0.001) and longer time taken for diagnostic results (p =0.025) were significantly associated with delayed diagnosis of cervical cancer in the multivariate logistic regression test model. Referral challenges include misdiagnosis, cost of diagnosis, and prolonged diagnosis appointments. The study concluded that the advanced stage at presentation for most patients was due to poor health and referral systems, inadequate medical personnel, and diagnostic equipment. Conclusion This study recommends improving referral systems and encouraging partnerships to decentralize diagnostic centers and equipment and to train more experts on Cervical Cancer.