Retrospective Cross-sectional Study Research Articles

Outcomes in infective endocarditis among adults with CHD: a comparative national study.

Given increased survival for adults with CHD, we aim to determine outcome differences of infective endocarditis compared to patients with structurally normal hearts in the general population. We conducted a retrospective cross-sectional study identifying infective endocarditis hospitalisations in patients 18 years and older from the National Inpatient Sample database between 2001 and 2016 using International Classification of Disease diagnosis and procedure codes. Weighting was used to create national annual estimates indexed to the United States population, and multivariable logistic regression analysis determined variable associations. Outcome variables were mortality and surgery. The primary predictor variable was the presence or absence of CHD. We identified 1,096,858 estimated infective endocarditis hospitalisations, of which 17,729 (1.6%) were adults with CHD. A 125% increase in infective endocarditis hospitalisations occurred for adult CHD patients during the studied time period (p < 0.001). Adults with CHD were significantly less likely to experience mortality (5.4% vs. 9.5%, OR 0.54, CI 0.47-0.63, p < 0.001) and more likely to undergo in-hospital surgery (31.6% vs. 6.7%, OR 6.49, CI 6.03-6.98, p < 0.001) compared to the general population. CHD severity was not associated with increased mortality (p = 0.53). Microbiologic aetiology of infective endocarditis varied between groups (p < 0.001) with Streptococcus identified more commonly in adults with CHD compared to patients with structurally normal hearts (36.2% vs. 14.4%). Adults with CHD hospitalised for infective endocarditis are less likely to experience mortality and more likely to undergo surgery than the general population.

Prediction of refraction error after toric lens implantation with biometric input data uncertainties and power labelling tolerances.

The purpose of this study was to simulate the impact of biometric measure uncertainties, lens equivalent and toric power labelling tolerances and axis alignment errors on the refractive outcome after cataract surgery with toric lens implantation. In this retrospective non-randomised cross sectional Monte-Carlo simulation study we evaluated a dataset containing 7458 LenStar 900 preoperative biometric measurements. The biometric uncertainties from literature, lens power labelling according to ISO 11979, and axis alignment tolerances of a modern toric lens (Hoya Vivinex) were taken to be normally distributed and used in a Monte-Carlo simulation with 100 000 samples per eye. The target variable was the defocus equivalent (DEQ) derived using the Castrop (DEQC) and the Haigis (DEQH) formulae. Mean/median / 90% quantile DEQC was 0.22/0.21/0.36 D and DEQH was 0.20/0.19/0.32 D. Ignoring the variation in lens power labelling and toric axis alignment the respective DEQC was 0.20/0.19/0.32 D and DEQH was 0.18/0.17/0.29 D. DEQC and DEQH increased with shorter eyes, steeper corneas, equivalent lens power and highly with toric lens power. According to our simulation results, uncertainties in biometric measures, lens power labelling tolerances, and axis alignment errors are responsible for a significant part of the refraction prediction error after cataract surgery with toric lens implantation. Additional labelling of the exact equivalent and toric power on the lens package could be a step to improve postoperative results.

Social Vulnerability Index and Dental Caries in Children: An Exploratory Study.

This retrospective cross-sectional study evaluated the association between caries outcomes in a pediatric population visiting a dental clinic and the social vulnerability index, an area-based measure capturing 4 main social determinants of health: socioeconomic status, household composition/disability, minority status/language, and housing/transportation. The Centers for Disease Control Social Vulnerability Index (SVI) and electronic dental record data of children (0 to 18 y) reporting a caries diagnosis at the Children's Hospital Colorado in 2020 were extracted for 9,201 children. Logistic regressions were used to test the association between SVI and the presence or absence of dental caries, adjusting for age, sex, ethnicity, and race. Children with a caries diagnosis had a greater mean overall SVI percentile (62.0, standard deviation [SD] = 29.1) compared with patients without a caries diagnosis (59.1, SD = 29.8; P < 0.001). With each 10-point increase in the overall SVI percentile, having a caries diagnosis visit was 2.7% more likely compared with having a visit without a caries diagnosis (odds ratio [OR] 1.027, 95% confidence interval [CI] 1.012, 1.042; P = 0.0004). Those with an overall SVI percentile between 51 and 75 were 23% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.23, 95% CI 1.07, 1.42; P = 0.003), and those with a percentile >75 were 23.6% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.236, 95% CI 1.09, 1.40; P = 0.001). Children (0 to 18 y) living in socially vulnerable environments or areas were more likely to have a caries diagnosis at their dental exam. This study showed an association between social determinants of health demonstrating social vulnerability and dental caries in children. Ultimately, understanding upstream factors for children living in socially vulnerable areas could support policymakers in creating more effective policies to support socially vulnerable populations.

Women attending the sexual assault treatment unit services in the Republic of Ireland: A 7-year review.

Sexual assault is pervasive in today's society, with the numbers of those reporting it increasing. In Ireland, 50% of women will experience some form of sexual violence in their lifetime. We sought to describe the incident details of females presenting to the Sexual Assault Treatment Unit (SATU) network in the Republic of Ireland and to determine associations between incident characteristics and: (1) victim age, (2) presence of injury, (3) victim-perpetrator relationship, and (4) number of assailants. This was a retrospective cross-sectional study of all females who attended between 2017 and 2023. Descriptive bivariate analysis was performed. There were 5942 female attendances, with an average age of 26 years. The largest age group was women between 18 and 25 years (38.1%, n = 2263). Forensic examinations were performed in 76.6% (n = 4549). Assailants were male in 92% (n = 5469) of incidents, with multiple assailants disclosed in 7.3% (n = 435). Strangers or recent acquaintances were the assailant in 38.5% (n = 2290) of incidents, and close associates in 22.9% (n = 1359). Incidents occurred at the survivor's home in 22% (n = 1306) of incidents, and in the assailant's home in 22.6% (n = 1342). Drug use within 24 h was reported in 15.1% (n = 897) of cases, and alcohol use in 72% (n = 4276). Drug-facilitated assault was suspected by 16.1% (n = 955). Injuries (genital and extra-genital) occurred in 30.3% (n = 1800) of attendances and were more likely to be seen in those who disclosed ingesting alcohol (Relative risk [RR] 1.325, P < 0.001) or drugs (RR 1.111, P = 0.04) in the 24 h preceding the incident, in those who presented within 24 h (RR 1.646, P < 0.001), those aged 18 years or older (RR 1.07, P = 0.003), and those where the incident occurred outdoors (RR 1.24, P < 0.001). This study, one of the largest on female attendances to a national SATU network, offers detailed insights into demographics, incident details, and circumstances. Most were young women, mainly 18 years and older, many of whom were full-time students. Forensic examinations were the primary reason for attendance, underscoring the network's key role in evidence collection. The study also identified factors linked to a higher risk of injury detection, such as immediate post-incident attendance, being over 18, outdoor incidents, perpetration by a stranger, and prior alcohol or drug use.

Cultural and linguistic diversity is associated with increased inter-dialytic weight gain among patients on long-term haemodialysis.

Factors associated with suboptimal interdialytic weight gain have long been established. However, the influence of cultural and linguistic diversity on interdialytic weight gain among patients receiving haemodialysis is not well-understood. This study examined the relationship between interdialytic weight gain and cultural and linguistic diversity among patients receiving haemodialysis. Retrospective cross-sectional study. Demographic and clinical data were collected from electronic medical records of patients receiving haemodialysis at five dialysis units. Logistic regression analysis was performed to determine factors associated with suboptimal interdialytic weight gain. Two hundred and sixty-nine patients, 62% of whom were female, with mean ± age of 65.8 ± 14.8 years, were studied. Most were from culturally and linguistically diverse backgrounds (60%) and a significant number belonged to the most disadvantaged socioeconomic group. Patients from culturally and linguistically diverse backgrounds had significantly higher relative interdialytic weight gain (2.40% ± 1.45%) compared to those from nonculturally and linguistically diverse backgrounds (1.83 ± 1.09%) (mean difference: 0.57%, 95% CI: 0.25-0.90, p = 0.001). Being from culturally and linguistically diverse backgrounds was associated with increased odds of higher relative interdialytic weight gain (OR: 2.40; 95% CI: 1.38-4.17, p < 0.01). Among patients on maintenance haemodialysis, individuals from culturally and linguistically diverse backgrounds had higher interdialytic weight gain compared to those from nonculturally and linguistically diverse backgrounds. Future research focusing on co-developing culturally sensitive interventions to improve self-management capability of patients on maintenance haemodialysis from culturally and linguistically diverse backgrounds is needed.

T2 MRI visible Perivascular Spaces in Parkinson`s Disease: clinical significance and association with polysomnography measured sleep.

Poor sleep quality might contribute to the risk and progression of neurodegenerative disorders via deficient cerebral waste clearance functions during sleep. In this retrospective cross-sectional study, we explore the link between enlarged perivascular spaces (PVS), a putative marker of sleep-dependent glymphatic clearance, with sleep quality and motor symptoms in Parkinson`s disease (PD) patients. T2-weighted MRI images of 20 patients and 17 healthy control subjects were estimated visually for PVS in the basal ganglia (BG) and centrum semiovale (CSO). The patient group additionally underwent a single-night polysomnography. Readouts included polsyomnographic sleep features and slow-wave activity (SWA), a quantitative EEG marker of sleep depth. Associations between PVS counts, PD symptoms (MDS-UPDRS scores) and sleep parameters were evaluated using correlation and regression analyses. Intra- and inter-rater reproducibility was assessed with weighted Cohen`s kappa coefficient. BG and CSO PVS counts in both patients and controls did not differ significantly between groups. In patients, PVS in both brain regions were negatively associated with SWA (1-2Hz) (BG: r(15)=-0.58, padj=0.015 and CSO: r(15)=-0.6, padj=0.015). Basal ganglia PVS counts were positively associated with motor symptoms of daily living (IRR=1.05, CI [1.01, 1.09], p=0.007, padj=0.026) and antidepressant use (IRR=1.37, CI [1.05, 1.80], p=0.021, padj=0.043) after controlling for age. Centrum Semiovale PVS counts in patients were positively associated with a diagnosis of REM sleep behaviour disorder (IRR=1.39, CI [1.06 , 1.84]), p=0.018, padj=0.11). These results add evidence that sleep deterioration may play a role in impairing glymphatic clearance via altered perivascular function, potentially contributing to disease severity in PD patients.

Incidence of Maxillary Sinus Disorders in Dental Patients Undergoing Cone-Beam Computed Tomography: A Retrospective Cross-Sectional Study

Incidence of Maxillary Sinus Disorders in Dental Patients Undergoing Cone-Beam Computed Tomography: A Retrospective Cross-Sectional Study

Importance of different topographic, biometric, and retinal parameters for calculating IOL power

The objective is to evaluate the parameters significantly related to calculating the power of the implanted lens and to determine the importance of different biometric, retina, and corneal aberrations variables. A retrospective cross-sectional observational study used a database of 422 patients who underwent cataract surgery at the Oftalvist Center in Almeria between January 2021 and December 2022. A random forest based on machine learning techniques was proposed to classify the importance of preoperative variables for calculating IOL power. Correlations were explored between implanted IOL power and the most important variables in random forests. The importance of each variable was analyzed using the random forest technique, which established a ranking of feature selections based on different criteria. A positive correlation was found with the random forest variables. Selection: axial length (AL), keratometry preoperative, anterior chamber depth (ACD), measured from corneal epithelium to lens, corneal diameter, lens constant, and astigmatism aberration. The variables coma aberration (p-value = 0,12) and macular thickness (p-value = 0,10) were almost slightly significant. In cataract surgery, the implanted IOL power is mainly correlated with axial length, anterior chamber depth, corneal diameter, lens constant, and preoperative keratometry. New variables such as astigmatism and anterior coma aberration and retina variables such as the preoperative central macular thickness could be included in the new generation of biometric formulas based on artificial intelligence techniques.

Association of Normative and Non-Normative Brain Networks With Cognitive Function in Patients With Temporal Lobe Epilepsy.

Despite their temporal lobe pathology, a significant subgroup of patients with temporal lobe epilepsy (TLE) is able to maintain normative cognitive functioning. In this study, we identify patients with TLE with intact vs impaired neurocognitive profiles and interrogate for the presence of both normative and highly individual intrinsic connectivity networks (ICNs)-all toward understanding the transition from impaired to intact neurocognitive status. This retrospective cross-sectional study included patients with TLE and matched healthy controls (HCs) from the Thomas Jefferson Comprehensive Epilepsy Center. Functional MRI data were decomposed using independent component analysis to obtain individualized ICNs. In this article, we calculated the degree of match between individualized ICNs and canonical ICNs (e.g., 17 resting-state networks by Yeo et al.) and divided each participant's ICNs into normative or non-normative status based on the degree of match. 100 patients with TLE (mean age 42.0 [SD: 13.7] years, 47 women) and 92 HCs were included in this study. We found that the individualized networks matched to the canonical networks less well in the cognitively impaired (n = 24) compared with the cognitively intact (n = 63) patients with TLE by 2-way mixed-measures analysis of variance (impaired vs intact mean difference [MD] -0.165 [-0.317, -0.013], p = 0.028). The cognitively impaired patients showed significant abnormalities in the profiles of both normative (impaired vs intact MD -0.537 [-0.998, -0.076], p = 0.017, intact vs HC MD -0.221 [-0.536, 0.924], p = 0.220, and impaired vs HC MD -0.759 [-1.200, -0.319], p < 0.001) and non-normative networks (impaired vs intact MD 0.484 [0.030, 0.937], p = 0.033, intact vs HC MD 0.369 [0.059, 0.678], p = 0.014, and impaired vs HC MD 0.853 [0.419, 1.286], p < 0.001) while the intact patients showed abnormalities only in non-normative networks. At the same time, we found that normative networks held a strong, positive association with the neuropsychological measures, with this association negative in non-normative networks. Our data demonstrated that significant cognitive deficits are associated with the status of both canonical and highly individual ICNs, making clear that the transition from intact to impaired cognitive status is not simply the result of disruption to normative brain networks.

Body mass index and its impact on outcomes in CABG surgery: the paradox of obesity and underweight risks.

Objective: To explore the impact of BMI on the short-term mortality and morbidity of patients undergoing CABG. Study Design: Retrospective Cross Sectional study. Setting: Department of Cardiac Surgery Rehman Medical Institute, Peshawar, Pakistan. Period: 1st June 2017 to 31st December 2022. Methods: The data was collected from the data base of the cardiac surgery department. Results: Total of 2599 isolated CABG patients were included with mean age of 57.86±9.2 years. The majority was overweight (42%). Approximately 78.1% were male. Hypertension was our dominant co-morbidity (68.7%) followed by dyslipidemia (65.4%) &amp; DM (50.1%). Majority of patients had NYHA-III symptoms (51.2%). A significant proportion of individuals who are classified as underweight are elderly. Generally, there is a significant increasing trend of DM &amp; HTN incidence with increasing BMI. In terms of intra-operative parameters there is increasing trend of intra-operative transfusions and higher rate of IABP insertion in underweight patients. Generally the underweight patients has the higher trend of adverse outcomes (e.g., prolonged mechanical ventilation, blood product requirement, reopening &amp; re-intubation), but not significant. However, they have significantly longer mechanical ventilation time compared to normal. On the other extreme, morbidly obese patients had the highest in-hospital mortality (11.3%) while overweight had the lowest (2.6%) with a P-value of 0.008. Multivariate regression analysis showed that mean age (P 0.034), cross-clamp time (P 0.018) &amp; mechanical ventilation (P &lt;0.001) were significantly associated with in-hospital mortality. Conclusion: Morbidly obese patients undergoing CABG surgery face significantly higher in-hospital mortality rate, conversely overweight patients exhibits the lowest mortality rates confirming a partial obesity paradox. However, underweight patients experience the worst outcomes, including increased requirements for postoperative blood transfusions, a higher incidence of surgical reopening, and significantly extended mechanical ventilation hours, which indicates either extreme of BMI group is associated with worst outcomes.

The association between serum HDL levels and infertility among American women aged 20-44 years: A retrospective cross-sectional study of NHANES, 2013-2020.

Infertility is a significant national public health concern, and the World Health Organization (WHO) predicts that it will rank as the third most prevalent disease following tumors, cardiovascular and cerebrovascular diseases. The impact of dysfunctional lipoproteins on female infertility remains relatively understudied; therefore, the research focuses on exploring the relationship between serum high-density lipoprotein (HDL) concentration and infertility. This is a retrospective cross-sectional study where we employed multivariate logistic regression analysis to examine the association between serum HDL concentrations and female infertility. The strength of association was quantified using odds ratios (OR) along with their corresponding 95% confidence intervals and statistical significance was evaluated at a level of P < 0.05 (two-tailed). The study found that there was a significant correlation between serum HDL and infertility without adjusting the model (OR = 0.62, 95%CI 0.48-0.82, P<0.001). After adjusting for covariates, a weak correlation between HDL and infertility remained (OR = 0.70, 95%CI 0.49-1.00). When HDL concentrations were divided into quartiles, there was a trend of strengthened correlation between HDL and infertility risk with the increase in HDL concentrations. Specifically, individuals in the highest concentration quartile exhibited a 44.0% lower risk of infertility compared to those in the lowest concentration quartile (95% CI 0.38-0.84). In the age-stratified analysis, after adjusting for covariates, the correlation between HDL and infertility was statistically insignificant across all age groups. Furthermore, after categorizing HDL levels into quartiles, we observed a dose-dependent trend between HDL and the reduction of female infertility risk in the adjusted models of the secondary infertility group. Specifically, in the adjusted model, the high-concentration group exhibited a 67.0% lower risk of infertility compared to the low-concentration group (OR = 0.33; 95% CI: 0.12-0.940, P = 0.04). Our research findings suggest weak negative correlation between serum HDL and female infertility. However, upon stratified analysis by age, the correlation between HDL and infertility did not attain statistical significance. In cases of secondary infertility, a subtle dose-dependent trend was observed between serum HDL and infertility.

Rifampicin-resistant Tuberculosis and Associated Factors Among Pulmonary Tuberculosis Patients in Mahakali Provincial Hospital, Nepal

The study aims at assessing the prevalence of RR-TB and identify associated factors among pulmonary TB patients using GeneXpert MTB/RIF assay data from January to December 2023. Tuberculosis (TB) continues to pose a significant global health threat, with rifampicin-resistant (RR) strains presenting a formidable challenge to disease control efforts. This study based the retrospective cross-sectional study conducted at Mahakali Provincial Hospital in Nepal. Out of 2587 presumptive TB cases, 11.8% were confirmed positive for TB, with males constituting a significantly higher proportion (66.1%) than females (33.9%). Among TB-positive cases, 3% showed resistance to rifampicin, predominantly affecting males (77.8%). Age group analysis revealed higher TB detection rates in the 46-60 years group, while rifampin -resistance tuberculosis (RR-TB) cases were more evenly distributed across age groups without statistical significance. Ethnicity and residential locality did not show significant associations with RR-TB. Multivariate logistic regression highlighted gender as RR-TB and associated factors among pulmonary tuberculosis patients in a Mahakali Provincial Hospital, Nepal. Rifampicin-resistant TB (RR-TB) remains a significant challenge at Mahakali Provincial Hospital, with a 3% prevalence, predominantly affecting males. Gender is a key factor in RR-TB prevalence. To manage and reduce RR-TB effectively, it is necessary to implement targeted interventions for high-risk groups, particularly males, and to enhance diagnostic capabilities.

Characterization of infectious bacterial keratitis in Östergötland County, Sweden: a 10-year retrospective study.

The aim of this study was to characterize bacterial species, aetiology and antibiotic susceptibility connected to bacterial keratitis infections in Östergötland, Sweden. Retrospective cross-sectional study based on electronic health records for the period 2010-2019. Records of patients diagnosed with infectious keratitis were screened for microbiology confirmed infectious bacterial keratitis. Bacterial species and their susceptibility to antibiotics were determined from microbiology test results. One-hundred and ninety patients with lab culture-confirmed infectious bacterial keratitis were included in the analysis. The most frequently found bacterial species were coagulase-negative staphylococci (39%), Staphylococcus aureus (17%) and Cutibacterium acnes (10%). Pseudomonas spp. was the most frequently found Gram-negative bacterial species (7%). Contact lens wear and severely ill/blind eye were the top two aetiologies associated with bacterial keratitis, 22% of the patients with bacterial keratitis were also diagnosed with glaucoma. Most isolates, 157 out of 173, were susceptible to fluoroquinolones, and 145 out of 155 isolates were susceptible to chloramphenicol. Our results revealed a positive rate of bacterial keratitis of 59% for the samples sent to the laboratory. There was a high susceptibility of the bacterial species to the recommended antibiotics. Our results indicate that it is likely that patients are receiving the correct treatment. Future studies are necessary to monitor changes in antibiotic susceptibility.

Fecal zonulin as a prognostic marker of atopic march in children with food allergy

Introduction. The onset of allergic diseases most often occurs in early childhood with the onset of food allergies, which can subsequently lead to the implementation of the atopic march. Increased intestinal permeability with high production of zonulin, the main moderator of intestinal tight junctions, can be an important link in the development of comorbid allergic diseases.Material and methods. In order to study the significance of fecal zonulin as a marker for predicting the atopic march in children with food allergy, a cross-sectional retrospective study was conducted on 73 children aged 5 years who were diagnosed with food allergy (FA) to cow’s milk proteins in the first year of life. In all children, when the diagnosis was made in the first year of life, the content of zonulin in feces was determined using the ELISA method.Results. As a result of dynamic observation, all children with food allergy were divided into 2 groups: the first group consisted of children with food allergy who developed allergic rhinitis and/or bronchial asthma within 5 years (group I, n = 39), group 2 consisted of 34 children with food allergy who did not implement the atopic march within 5 years of observation (group II, n = 34). Our study showed statistically significant differences in the fecal zonulin level in the first year of life: group I Me = 2.39 ng/ml (Q1-Q3: 1.78–2.65 ng/ml), group II Me = 1.85 ng/ml (Q1-Q3: 0.49–0.91 ng/ml), p = 0.034. Strong direct correlations were found (Spearman correlation coefficient S = 0.681 (p &lt; 0.05)) between the zonulin level in feces at the onset of the disease and the development of allergic rhinitis and/or bronchial asthma up to 5 years of age, the data were confirmed by comparing the areas under the curves during ROC analysis, AUC in the study of fecal zonulin as a prognostic marker of the risk of atopic march in children is 0.887, the optimal threshold (cutoff point) is 1.94 ng/ml.Conclusions. Fecal zonulin level in children with food allergy can be an effective prognostic marker of atopic march development, its values in feces above 1.94 ng/ml allow us to predict with a high degree of probability the risk of atopic march development in children with food allergy to cow’s milk proteins within 5 years

Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study

Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study

Real world evidence on the effectiveness and safety of tofacitinib in ulcerative colitis in Lebanon

ObjectiveTo evaluate the effectiveness and safety of tofacitinib in patients with ulcerative colitis (UC) in clinical practice in Lebanon.DesignThis was a retrospective cross-sectional study. The data were collected from hospital records. Patients with moderate to severe UC treated with tofacitinib between 2018 and 2021 were included. Patients’ demographics, disease-specific characteristics, clinical assessment at three time points (8, 26, and 52 weeks), endoscopic evaluation at 24 weeks, and adverse events were collected.ResultsA total of 60 UC patients with a mean duration of disease of 7.9 ± 4.7 years were enrolled. 61.7% of patients had extensive disease, and 58.3% had received ≥ 1 biologic prior to tofacitinib. Clinical remission was reported in 25, 34, and 31 patients (41.7%, 56.7%, and 56.4%) at 8, 26, and 52 weeks respectively. Endoscopic remission (endoscopic Mayo score 0 or 1) was observed in 58.3% of patients at 52 weeks. About one-third of patients (31.7%) stopped tofacitinib at one year, primarily for lack of efficacy or loss of response, with no significant difference between biologics-naïve and experienced patients (24% vs. 37.1% respectively). No serious adverse events or deaths were reported. Adverse events were reported in 3 patients (5.0%) - one C. difficile infection, one case of reversible lymphopenia, and one case of facial acne. No serious adverse events or deaths were noted. On multivariate analysis, biologic-naïve status and reduction or normalization of CRP were associated with clinical remission (OR = 10.87, 95% CI = 1.57, 100, and OR = 78.47, 95% CI = 2.09, 2940.32 respectively), while reduction or normalization of CRP was associated with endoscopic remission at 1 year (OR = 19.03, 95% CI = 1.64, 221.09).ConclusionTofacitinib was effective in the treatment of moderately severe ulcerative colitis in this real-world cohort in Lebanon. Further, the predictors associated with clinical and endoscopic remissions were found to be biologic-naïve status and reduction in CRP. Observed AEs were consistent with the known safety profile. One of the major limitations of this study is the smaller sample size and the retrospective nature of the study.

Neonatal Bilirubin Assessment After Implementation of Enhanced Recovery After Caesarean Section

Objective: The implementation of Enhanced Recovery After Cesarean (ERAC) is associated with significant improvement in maternal outcomes; however, its impact on neonatal outcomes remains limited. This study aims to evaluate the impact of ERAC protocol on neonatal outcomes. Methods: A retrospective cross-sectional study was conducted at Bunda Women and Children Hospital, Jakarta, Indonesia between 2021 and 2022 on women who performed cesarean delivery at 37 weeks and above. The primary outcome was neonatal bilirubin level and the secondary outcome was neonatal length of stay and breastfeeding rate. Results: Differences between outcomes were analyzed by comparing each parameter in non-ERAC (n = 356) and the ERAC groups (n = 331). The median bilirubin levels and neonatal length of stay did not exhibit significant differences between the non-ERAC and the ERAC group (9.5 mg/dL vs 9.5 mg/dL, P = .545, for bilirubin levels, and 3 days vs 3 days, P = .060 for neonatal length of stay). However, the ERAC group demonstrated a significantly higher breastfeeding rate compared to the non-ERAC group (3 hours vs 5 hours, P &lt; .001, respectively). Conclusions: The implementation of the ERAC protocol does not influence neonatal bilirubin levels and the length of neonatal hospital stays but it increases breastfeeding rate.

Nosocomial carbapenem-drug resistant Acinetobacter baumannii, related factors and clinical outcomes in Northeast Iran

Background and objectivesNosocomial infections, including drug-resistant Acinetobacter baumannii infections, continue to impact the health of hospitalized patients. This study sought to determine the prevalence of these infections and assess the associated risk factors and clinical outcomes in Gorgan, Iran.MethodsA retrospective cross-sectional study was conducted on 143 infected patients with Acinetobacter baumannii in two educational hospitals in Gorgan city, Iran between 2016 and 2018. Patient information including age, gender, reason and duration of hospitalization, background of diseases, type of sample culture, symptoms, laboratory findings, prescribed antibiotics, and antibiogram were collected and analyzed. The Logistic regression and survival statistical methods were used by software of SPSS 26.ResultsA total of 37 patients (25.87%) died during hospitalization. The less than one year and 45–65 years age groups demonstrated more deaths (29.7%; p-value < 0.001). Being single (not being married) was found to be a risk factor in increasing the chance of death among patients (OR = 2.154, 95% CI: 1.02–4.53; p = 0.048). Hospitalization in intensive care units (ICUs) was a risk factor for the death of patients (OR = 4.655, 95% CI: 7.6–83.2). The resistance to carbapenems was reported to be an important risk factor for the death of patients.ConclusionsAcinetobacter baumannii infections, particularly those resistant to carbapenems, are a significant risk for patients in ICUs and can lead to higher mortality rates.

Epidemiological profile of patients with osteogenesis imperfecta assisted at a reference children's hospital in Brazil

Objective: To characterize the profile and care of patients with osteogenesis imperfecta (OI) treated at a reference hospital in southern Brazil. Method: This retrospective cross-sectional observational study analyzed secondary data from electronic medical records between 2010 and 2021. Data from patients aged 0–22 years with a confirmed OI diagnosis who underwent care at a reference hospital. Results: 97 medical records were included. The mean age of the children was 11 ± 4.99 years, with a prevalence of males (51.8%). Most obtained the postnatal diagnosis and were classified as type I (50.9%). The number of fractures, orthopedic surgeries, and cycles of pamidronate were higher in type III subjects. As for access to medication, 88.54% were hospitalized for the administration of pamidronate and 32.29% for zoledronate. Independent walking and type I modified independent walking (walker) and type IV, and the use of a wheelchair and type III had an association (X2 = 67.832; p=0.000) between them. Conclusions: The profiles of the individuals in this study reflect the characteristics of the classic division of types I to IV. The reference center offers multidisciplinary care, access to specific drugs, and essential orthopedic surgeries to improve the quality of life of patients with osteogenesis imperfecta.

Role of blood urea nitrogen to creatinine ratio in the assessment of hypovolemia who have undergone major surgeries- a cross-sectional study

BackgroundMajor surgeries are being carried for certain ailments. Surgeries can be major or minor depending on the extent of intervention. Major surgeries are prone to cause lots of complications such as shock, haemorrhage, wound infection, deep vein thrombosis, pulmonary complications, organ rejection, reactions to anaesthetics etc. Early identification of complications could reduce morbidity and mortality. Laboratory variables used in the assessment of hypovolemia include blood urea nitrogen, sodium, osmolality, hematocrit, and arterial blood gas. This study was undertaken to assess the utility of blood urea nitrogen: creatinine ratio (BCR) in the utility of assessment of hypovolemia in the first post-operative day in individuals who had major surgeries.Methods and materialsThe retrospective cross-sectional study included participants from the Departments of Orthopedic Surgery, Obstetrics and Gynecology, General Surgery and Cardiothoracic Surgery. Patients who underwent major surgeries between January 2019 and January 2020 were included. Study participants of 30 to 60 years of both genders were recruited into the study. Data were collected from the Medical Records of a tertiary care hospital in Chennai, India. Ethics approval was obtained, the institutional ethics committee (Ref: CSP/21/SEP/99/479 dated 30–12-2021). Waiver of consent was obtained since the patients were treated and discharged from the hospital. The data were analyzed by SPSS version 16. P value ≤ 0.05 was taken to be significant.ResultsBCR showed statistically significant difference across the groups with P = 0.02. BCR showed statistically significant difference between cardiac patients with total knee replacement and total abdominal hysterectomy surgeries. BCR showed positive correlation with age, fluids intake and negative correlation with pulse rate and respiratory rate.ConclusionBCR is a simple diagnostic tool for identifying hypovolemia in individuals who undergo major surgeries especially in the first postoperative day. It is significantly altered across the groups with highest value in individuals who have undergone knee replacement surgeries. BCR has high specificity and positive predictive value.