Daily Follow-up Research Articles

Incidence of puerperal metritis and associated risk factors in dairy cows in Hawassa, Southern Ethiopia

Metritis has considerable economic impact on dairy herd profitability due largely to reduced reproductive performance. Studies in Ethiopia only report prevalence, with no available data on the incidence of metritis. The present prospective cohort study aimed to estimate the incidence of puerperal metritis, identify risk factors, and isolate the causative bacteria in dairy cows in Hawassa. Daily follow-up of 120 dairy cows from parturition to 21 days postpartum was carried out from November 2019 to February 2021. Of these, 21 developed puerperal metritis with an incidence rate of 0.94 cases per 100 cow days at risk (95 % CI: 0.6–1.4). The cumulative incidence was found to be 17.5 % (95 % CI: 11.8–25.6). Over 90 % of the puerperal metritis occurred within the first 10 days of parturition. The mean day of occurrence of puerperal metritis was 7.7 days postpartum and the mean rectal temperature in metritic cows was 40.5 °C. Retained fetal membranes (RFM) (p < 0.001) emerged as the only predisposing factor for metritis in the final Cox regression model. Cows with RFM faced a 14.9 times higher risk of metritis compared to cows without RFM. A total of 52 bacterial isolates, belonging to 4 genera, were recovered from the aerobic culture of 21 uterine swab samples. E. coli and Staphylococcus spp. were the most frequently isolated bacteria, with recovery from 21 (100 %) and 20 (95.2 %) of the metritic uteri, respectively. Results of this study suggested the importance of reducing incidence of RFM to reduce incidence of metritis in dairy cows.

Using Atrial Fibrillation Burden Trends and Machine Learning to Predict Near-Term Risk of Cardiovascular Hospitalization.

Atrial fibrillation is associated with an increased risk of cardiovascular hospitalization (CVH), which may be triggered by changes in daily burden. Machine learning of dynamic trends in atrial fibrillation burden, as measured by insertable cardiac monitors (ICMs), may be useful in predicting near-term CVH. Using Optum's deidentified Clinformatics Data Mart Database (2007-2019), linked with the Medtronic CareLink ICM database, we identified patients with >1 days of ICM-detected atrial fibrillation. ICM-detected diagnostic parameters were transformed into simple moving averages over different periods for daily follow-up. A diagnostic trend was defined as the comparison of 2 simple moving averages of different periods for each diagnostic parameter. CVH was defined as any hospital, emergency department, or ambulatory surgical center encounter with a cardiovascular diagnosis-related group or diagnosis code. Machine learning was used to determine which diagnostic trends could best predict patient risk 5 days before CVH. A total of 2616 patients with ICMs met the inclusion criteria (71±11 years; 55% male). Among them, 1998 (76%) had a planned or unplanned CVH over 605 363 days. Machine learning revealed distinct groups: (A) sinus rhythm (reference), (B) below-average burden, (C) above-average burden, and (D) above-average burden with decreasing patient activity. The relative risk was increased in all groups versus the reference (B, 4.49 [95% CI, 3.74-5.40]; C, 8.41 [95% CI, 7.00-10.11]; D, 11.15 [95% CI, 9.10-13.65]), including a 21% increase in CVH detection over prespecified burden thresholds of duration (≥1 hour) and quantity (≥5%). The area under the receiver operating characteristic curve increased from 0.55 when using hourly burden amounts to 0.66 when using burden trends and decreasing patient activity (P<0.001), a 20% increase in predictive power. Trends in atrial fibrillation were strongly associated with near-term CVH, especially above-average burden coupled with low patient activity. This approach could provide actionable information to guide treatment and reduce CVH.

Factors affecting the effectiveness of ‘ruqyah’ treatment among Muslim community in Malaysia

ABSTRACT This study investigates the factors affecting the effectiveness of Ruqyah (Islamic healing) treatments in Malaysia’s Darussyifa’ Islamic Treatment Center, focusing on the roles of Symptoms of Illness, Patient Management, Daily Patient Follow-up Practice, and Illness Disorder Assessment. The research aims to understand how these factors contribute to the effectiveness of treatments provided by Ruqyah practitioners. A conceptual model was developed to outline the expected relationships between these predictors and treatment outcomes. Utilizing a cross-sectional, quantitative approach to examine cause-and-effect relationships, data from 272 respondents were collected through surveys and analyzed using the PLS-SEM method. The findings reveal that, except for the Illness Disorder Assessment’s role as a moderating factor, which showed no significant impact, all other relationships in the model were significant. Daily Patient Follow-up Practice emerged as the most critical factor for improving treatment effectiveness, followed by Patient Management. Additionally, the identification of symptoms plays a crucial role in enhancing patient management practices at the Darussyifa’ Malaysia center. This research highlights the importance of continuous patient engagement and effective management in optimizing Ruqyah treatment outcomes, while suggesting areas for further investigation regarding the unanticipated insignificance of Illness Disorder Assessment.

Adolescent Emotional Reactivity in Family and School Contexts: Prospective Links to Adolescent Psychopathology.

Emotional reactivity has been linked to adolescent psychopathology and mental health problems. However, limited research has investigated the distinct associations between emotional reactivity in multiple interpersonal contexts and the development of adolescent psychopathology. The current study examined emotional reactivity to interparental conflict, parent-adolescent conflict, and school problems as predictors of adolescent internalizing problems, depressive symptoms, and anxiety symptoms six months later. The sample included 139 adolescents (54% girls; Mage = 13.30, SDage = 0.73) and their parents who completed 10-day daily reports and 6-month follow-up assessments in Taiwan. Results showed that negative emotional reactivity to interparental conflict was associated with increased internalizing problems, depressive symptoms, and anxiety symptoms, after controlling for emotional reactivity to parent-adolescent conflict and school problems, outcomes at baseline, mean negative emotions, and sex. Furthermore, the associations between both positive and negative emotional reactivity to interparental conflict and adolescent anxiety symptoms was stronger for girls than boys. Findings suggested that heightened emotional reactivity to interparental conflict is a risk factor for predicting adolescent psychopathology, especially for girls' anxiety symptoms. Results highlight the importance of emotional reactivity across multiple interpersonal contexts in adolescence.

Nursing process for patients with chronic wounds: A series of successful cases

The care of patients with chronic wounds represents a significant challenge for nursing. Recently, healing protocols have been developed that employ extracellular matrices (ECM), achieving complete wound regeneration. These protocols require an individualized care plan led by nurses, who work in multidisciplinary teams and provide a holistic view of the patient, thus improving care management processes. The nursing process, which includes research, logical analysis and interpersonal techniques, has been shown to improve the quality of care. In this study, evidence was presented on the successful management of chronic wounds through a comprehensive protocol in a first level hospital in Girón, Colombia. Three patients with venous insufficiency who had received conventional management without success were selected. The assessment was performed using the NANDA domains, with a diagnosis of impaired skin integrity. The protocol included disinfection, application of Regenesis® matrix and appropriate dressings, with daily photographic follow-up. The first patient, a 74-year-old woman with a 22-year-old venous ulcer, showed complete wound closure in six weeks. The second patient, a 53-year-old woman with a five-year-old venous ulcer, achieved closure in five weeks. The third patient, a 47-year-old man with a three-year-old venous ulcer, experienced complete closure in eight weeks. All patients showed significant improvements in their wound characteristics and had no adverse events. The study concluded that the healing protocol, which integrates the nursing process, is effective in closing chronic wounds in a short period, even in patients who have not responded to conventional treatments. These results underscore the importance of strict adherence to standardized protocols and nurse-patient interaction for successful treatment

Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study.

This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan. A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool. The cohort was followed until discharge, removal of peripheral intravenous catheter, or study conclusion. Of 258 patients studied, 139 (53.9%) were females. A significant number of the participants 104 (40.3%) were young adults of age 20-40 years. The incidence of phlebitis was 39.1%. Tuberculosis (TB), peripheral intravenous catheter dwell time before initial assessment, administration of IV fluids, and dissatisfactory nursing care at Day 1 were associated significantly with the development of phlebitis. There was a doseresponse relationship between the catheter dwell time in hours before initial assessment and the development of phlebitis. This study found an increased incidence (39.1%) in three months of PIVC-induced phlebitis among adult patients. In addition to patient-related and PIVC-related risk factors considered in this study, PIVC-induced phlebitis is found to be significantly associated with the level of PIVC care provided by nurses. Continuous nursing education, developing standard care plans for PIVCs, and proper documentation of care are recommended.

Perioperative and Postoperative Outcomes of Proximal Hip Fracture: A Comparison of Orthopedic and Geriatric Care Models.

Introduction Orthogeriatric patients with femur fractures, despite their multiple comorbidities and associated healthcare costs, have a promising new approach. This approach suggests that most patients should be hospitalized in the geriatric department, with daily orthopedic follow-up. The potential for lower mortality rates through orthogeriatric co-management and dual care is a reason for hope in our field. Methods This study is retrospective and involved 285 patients with proximal hip fractures. Two treatment models were compared: hospitalization in orthopedic and geriatric departments with different treatment protocols. The study analyzed demographic data and postoperative outcomes. It also included an analysis of 26 patients who received conservative treatment. Results Our study revealed significant differences between patients hospitalized in the orthopedic and geriatric departments. Geriatric department patients, who were significantly older and had higher comorbidities, experienced extended hospitalization and higher mortality rates during hospitalization, at 30 days, and at one-year follow-up (p<0.05). Notably, a significantly higher proportion of geriatric patients were discharged to home rehabilitation at the end of hospitalization compared to orthopedic patients (17.5% vs. 7.4%; p<0.01). Among non-operated patients, the mortality rate was 57.7% compared to 16.5% in patients who underwent surgery during the one-year follow-up. Discussion Our study suggests that elderly patients with hip fractures may benefit from management in the geriatric department. Despite experiencing significantly longer hospital stays, these patients have a higher likelihood of being discharged home compared to those managed in the orthopedic department. These findings have important implications for the care of orthogeriatric patients and may help guide future treatment strategies.

Use of a mobile application to monitor drain sites and surgical wounds after discharge from acute care - a feasibility study in Singapore

PurposeThis study aimed to demonstrate the compliance, feasibility, and acceptability of telehealth monitoring among surgical patients discharged with wounds or drains. MethodologyThis is a cross-sectional feasibility study. Post- surgical breast, plastic, and hepatobiliary patients with wounds and/or surgical drains were recruited using convenience sampling. The control group received conventional care which consisted of daily telephone follow-up. The intervention group used a mobile wound application to take wound and drain images, report drainage amount and symptoms. Compliance was assessed by measuring the percentage of actual to expected patient entries, feasibility was assessed by comparing detection of abnormalities and unexpected hospital visits, and acceptability was assessed by subjective feedback from nurses and patients from the intervention group. Results59 patients were recruited, with 30 patients in the control group and 29 patients in the intervention group. 9 specialty nurses were involved in the patients’ post- discharge care. The mean compliance rate for the hepatobiliary, breast and plastic patients were 89.9%, 89.5% and 75.9% respectively. 4 patients from the intervention group (13.8%) and 6 patients from the control group (20.1%) were flagged as having potential abnormalities. As for unexpected hospital visits, there were 2 (6.9%) in the intervention group and 1 (3.4%) in the control group. 25 patients and 9 specialty nurses responded to the feedback survey. 22 patients (88%) did not face any application issues. 18 patients (72%) preferred to self-report symptoms via the application rather than to call the nurses and reported feeling safe knowing that they are remotely monitored. Most nurses found the app convenient and timesaving (n=7, 78%), with monitoring through pictures as more accurate than phone conversation (n=8, 89%). ConclusionThe results suggest that use of a mobile application by surgical patients discharged with wounds or drains is feasible and serves as a viable monitoring tool.

Evaluación de la calidad y manejo de la cefalea en un paciente ingresado en el área de Neurociencia. Estudio CALMA

IntroductionHeadache is a very common neurological symptom. It is the first reason for consultation in neurology. About hospitalized patients, we do not have epidemiological data on the global prevalence of headaches in hospitalized patients. ObjectiveTo describe the prevalence of headaches in hospitalized patients, their triggers, and the level of compliance with nursing records. MethodologyThis is a descriptive, observational, and cross-sectional study at the Vall d’Hebron University Hospital (HUVH). The data collected were sociodemographic, related to the reason for admission and pain during admission. Statistical analysis was performed with R v4.1.1. ResultsOf the 45 admitted patients, 55% (25/45) participated, 55% (25/45) participated, 64% (16/25) were women. 60% (15/25) had presented headaches during admission, of which 73.3% (11/15) occurred in the last 24hours. The 33.3% (5/15) recognized stress as the most frequent trigger, noise (5/15), and income derivatives (3/15). During the daily follow-up by the nurse, 100% (25/25) of the patients answered that they had been asked about pain in general and 32% (8/25) specifically about headaches. No records were obtained due to the computer program's non-existence of nursing clinical variables. ConclussionHeadache is a symptom that occurs prevalently in hospitalized patients. Stress and noise seem to be triggers of this situation. Certain behaviors on the part of health centers and professionals could help improve the care of these patients.

Factors Associated with Reliable Contact Tracing During the 2021 Ebola Virus Disease Outbreak in Guinea

BackgroundIn 2021, an Ebola virus disease (EVD) outbreak was declared in Guinea, linked to persistent virus from the 2014–2016 West Africa Epidemic. This paper analyzes factors associated with contact tracing reliability (defined as completion of a 21-day daily follow-up) during the 2021 outbreak, and transitively, provides recommendations for enhancing contact tracing reliability in future.MethodsWe conducted a descriptive and analytical cross-sectional study using multivariate regression analysis of contact tracing data from 1071 EVD contacts of 23 EVD cases (16 confirmed and 7 probable).ResultsFindings revealed statistically significant factors affecting contact tracing reliability. Unmarried contacts were 12.76× more likely to miss follow-up than those married (OR = 12.76; 95% CI [3.39–48.05]; p < 0.001). Rural-dwelling contacts had 99% lower odds of being missed during the 21-day follow-up, compared to those living in urban areas (OR = 0.01; 95% CI [0.00–0.02]; p < 0.01). Contacts who did not receive food donations were 3× more likely to be missed (OR = 3.09; 95% CI [1.68–5.65]; p < 0.001) compared to those who received them. Contacts in health areas with a single team were 8× more likely to be missed (OR = 8.16; 95% CI [5.57–11.96]; p < 0.01) than those in health areas with two or more teams (OR = 1.00; 95% CI [1.68–5.65]; p < 0.001). Unvaccinated contacts were 30.1× more likely to be missed compared to vaccinated contacts (OR = 30.1; 95% CI [5.12–176.83]; p < 0.001).ConclusionFindings suggest that contact tracing reliability can be significantly influenced by various demographic and organizational factors. Considering and understanding these factors—and where possible addressing them—may be crucial when designing and implementing contact tracing strategies during future outbreaks in low-resource settings.

Assessment of quadriceps muscle mass by ultrasound in the postoperative period of cardiac surgery

BackgroundPatients undergoing cardiac surgery are exposed to many factors that activate catabolic and inflammatory pathways, which affect skeletal muscle and are, therefore, related to unfavorable hospital outcomes. Given the limited information on the behavior of muscle mass in critically ill patients, the objective of this study was to evaluate the impact on quantitative and qualitative measurements of quadriceps muscle mass using ultrasound after cardiac surgery. To accomplish this, a prospective, descriptive, and correlational study was conducted at a tertiary care hospital. Quadriceps muscle mass was evaluated via ultrasound in 31 adult patients in the postoperative period of cardiac surgery, with daily follow-up until postoperative day 7, as well as an assessment of associations with negative outcomes at 28 days.ResultsA 16% reduction in the cross-sectional area of the rectus femoris was found (95% CI 4.2–3.5 cm2; p 0.002), as well as a 24% reduction in the pennation angle of the rectus femoris (95% CI 11.1–8.4 degrees; p: 0.025). However, changes in the thickness of the rectus femoris, vastus internus, vastus lateralis, the length of the fascicle of the vastus lateralis, the pennation angle of the vastus lateralis, the sarcopenia index, and the Hekmat score were not statistically significant. There was no significant association between quadriceps muscle mass measurements and Intensive Care Unit (ICU) length stay or 28-day mortality.ConclusionsPatients in the postoperative period of cardiac surgery evaluated by ultrasound exhibit both quantitative and qualitative changes in quadriceps muscle mass. A significant reduction in muscle mass is observed but this is not associated with unfavorable outcomes.

Feasibility of a noninvasive heart failure telemonitoring system: A mixed methods study.

The aim of this study was to examine the feasibility of a noninvasive telemonitoring system used by heart failure patients and nurses in a pilot program of the Heart Hospital unit in Tampere, Finland. This cross-sectional observational study used a mixed methods design. Quantitative data were collected with one self-generated questionnaire for patients, and qualitative data were collected with a questionnaire for patients and semi-structured focus group interviews for patients and nurses. The questionnaire was sent to 47 patients who were in the pilot program, and 29 patients (61.7%) responded. Purposefully selected 8 patients and 8 nurses attended the interviews. We used descriptive statistics to assess the quantitative data from the questionnaire and inductive thematic analysis to identify themes deriving from the focus group interviews. We categorized the themes into facilitators and barriers to telemonitoring. Both the quantitative and qualitative data show that the telemonitoring system is easy to use, supports self-care and self-monitoring, and increases the feeling of safety. The chat tool of the system facilitated communication. The patients and nurses considered the system reliable despite some technical problems. The focus group interviews addressed technical challenges, nurses' increased workload, and patients' engagement with daily follow-up as possible barriers to telemonitoring. The noninvasive heart failure telemonitoring system used in the pilot program is feasible. We found facilitators and barriers to telemonitoring that should be considered when developing the noninvasive telemonitoring of heart failure in the future.

The association of dietary antioxidants and the inflammatory potential of the diet with poor physical function and disability in older Australian men: the Concord Health and Ageing in Men Project.

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.

Effectiveness of continuity of care after robot-assisted laparoscopic adrenalectomy under ambulatory mode: a single-center intervention study.

To investigate the effectiveness of continuity of care after robot-assisted adrenal tumor resection under ambulatory mode. Patients who underwent robot-assisted laparoscopic adrenalectomy (RALA) in the ambulatory surgery department and urology department of our hospital from January 2022 to January 2023 were selected as study subjects. Among them, 50 patients in the Department of Urology as the control group were given routine care. The 50 patients in the ambulatory surgery department as the observation group were given continuity of care on the basis of routine care. Observation indexes include: wound healing, blood pressure, blood potassium, renal function impairment, self-care ability in daily life, medication compliance, follow-up rate, and patient satisfaction. There were no remarkable discrepancies between the two groups in terms of demographic data and basic preoperative conditions of the patients. Compared with the control group, the observation group significantly improved the patients' wound healing, postoperative blood pressure and blood potassium and kidney function (P value all < 0.05). Compared with the control group, the observation group significantly improved postoperative patients' ADL scores, follow-up rates within three months after surgery, and patient satisfaction scores (P value all < 0.05). For patients receiving ambulatory mode robot-assisted laparoscopic adrenalectomy, continuity of care can effectively reduce postoperative complications, improve patients' postoperative self-care ability in daily life, medication compliance and follow-up rate, and improve patient satisfaction, which is worthy of promotion and application by nursing workers.

Chemotherapy-related adverse effects with anthracycline and taxane-containing regimens in patients with localized Breast cancer: a descriptive study

BackgroundAlthough the side effects of chemotherapy are frequently described in research studies, there is little evidence on how common they are in everyday clinical care. This study’s goal was to assess the most prevalent short-term side effects experienced by patients with localized breast cancer, undergoing chemotherapy based on anthracyclines and taxane-containing treatments, at the medical oncology department of the Mohammed VI University Hospital of Marrakech, Morocco.MethodsThis was a descriptive study. We conducted a listening session at the outpatient department of the hospital with the help of a structured questionnaire. The session engaged 122 women who had undergone cycles of chemotherapy. A chi-square test was used to compare the incidence and relative risk of short side effects with both anthracycline and taxane-containing regimens.ResultsThe average age of participants was 49.1 years. In both regimens, the findings highlighted the frequency and relative risk of the following adverse effects: systemic symptoms (fever, asthenia and sleep disorder), gastrointestinal toxicity (Vomiting, nausea, diarrhoea, constipation, mucositis and loss of appetite), dermatological toxicity (Skin reactions on hands/feet, nail toxicity, allergies, alopecia and peripheral edema), neurological toxicity (neuropathy), arthromyalgia and ocular toxicity.ConclusionsIn conclusion, it is crucial for healthcare professionals to be conscious of the significance of these adverse effects. They must also know how to manage them. Likewise, the listening approach highlights its importance in the daily follow-up and monitoring of patients.

Pain@home: An integrated, holistic, multimodal, digital approach to the prevention of chronic pain.

Chronic pain is one of the most debilitating medical conditions and one of the greatest medical challenges globally. In Western countries, almost 25% of adults are suffering from recurrent and prolonged pain symptoms. Chronic pain has a huge negative impact on the quality of life of patients, such as sleep disturbances, limitation in daily activities, and prolonged sick leaves. &#x0D; The best treatment for chronic pain is preventing it from occurring in the first place through an aggressive and multimodal approach to acute pain conditions. Such an approach has been previously described as pre-emptive analgesia. Despite multiple previous research projects, the ideal approach to the prevention of chronic pain has still not been identified. We hereby propose an integrated, multidisciplinary approach to the prevention of long-lasting pain syndromes. &#x0D; This innovative approach was previously tested and refined in patient populations at high risk of developing chronic pain, such as adolescents undergoing pectus operations, and young adults undergoing scoliosis correction procedures. Its rationale is based on the early activation of a digital follow-up before the nociceptive insult has even occurred. At the moment a potential future pain-inducing medical act has been identified (eg surgical procedure, initiation of chemotherapy or radiotherapy, traumatic injury) inclusion in digital long-term monitoring is initiated. The first step in the follow-up consists of the identification of patient-specific risk factors through the application of a validated nociceptive risk identification survey. After an individual risk profile has been completed a daily follow-up is initiated through the application of diaries. &#x0D; After that, a personalized anti-nociceptive approach is conceptualized. One of the major risk factors for the chronification of pain is the presence of fear or catastrophizing behavior. If these are identified during the pre-operative screening process, an integrated and multidisciplinary approach will be tailored to tackle these problems at the individual level. In addition, the interval between the initiation of the follow-up and the start of the medical treatment is used to start a pre-emptive treatment (in most cases gabapentin). Furthermore, educational material is provided to the participating patients in order to educate them on crucial matters such as the pathophysiology of pain, the importance of physical activities, and training in coping strategies.&#x0D; &#x0D; At the moment of hospitalization, patients receive a personalized pain treatment regimen based on the pre-op home-based assessment. Experience has learned us that this improves the health-related quality of life of patients while reducing length of stay significantly. &#x0D; After discharge from the hospital, remote monitoring is reinitiated. Patients are kept under digital supervision during the entire postoperative period, with multidisciplinary support and a strong focus on the functional reintegration of the concerned patients. When functional outcomes are obtained and the use of analgesics is stopped then the remote follow-up is discontinued.&#x0D; The described care pathway is an innovative approach to the prevention of chronic pain. All healthcare providers are gathered around the patient, who is treated as much as possible in a trusted home environment. The application of digital technologies creates a unique opportunity for this long-term interdisciplinary approach.

Outcome and Indication of Caesarean Section amongst Pregnant Women Experiencing Premature Rupture of Membranes

Premature rupture of membranes (PROM) is characterized by the spontaneous rupture of chorioamniotic membranes more than one hour before the onset of labor. This condition typically arises spontaneously in most cases, affecting a significant portion of pregnancies. Notably, PROM can also occur in full-term pregnancies. This cross-sectional follow-up study was conducted among pregnant women had premature rupture of membranes and experiencing Caesarean Section (CS) in the department of Obstetrics and Gynaecology of Dhaka National Medical College Hospital (DNMCH), Dhaka, Bangladesh during the period of March to August 2011. The main aim of the study was to find out the indication and outcome of pregnant women with PROM and completed CS. A total of 90 data were collected purposively from all pregnant women more than 28 weeks of gestational age with PROM admitted in the Department of Obstetrics and Gynaecology, DNMCH, Dhaka for labour and underwent CS during study period. The data were collected using a semi-structured data sheet through direct questioning of the patients and physical examinations. Daily follow-ups were conducted until the patients were discharged, and data were also obtained from the clinical records of the patients. PROM patients encompassed all age groups, with ages ranging from 18 to 38 years. The overall educational level of the participants was low, with less than two-third (61.1%) belonging to the low socio-economic status. The average gestational age was 36.65 weeks, with 53.3% being primigravida, 45.6% being multigravida and grand multipara was 1 (1.11%). Only two had multiple pregnancies, and 11 respondents had experienced per vaginal bleeding. During previous gestations, 20 had a history of Caesarean section, 12 had experienced abortion, and 2 had previous cases of PROM. Nutritional deficits were found in 36.7% of patients, Pregnancy Induced Hypertension (PIH) in 35.6%, infections in 12.2%, and chronic hypertension in 5.6%. Four foetuses were in breech presentations, one had a single compound presentation, and two had a transverse or oblique lie. All the women were experiencing gushing of fluid per vagina, with one-fifth (20.0%) having meconium-stained and 12.2% blood-stained vaginal discharge. Attempts to prolong pregnancy were not very successful, with the longest duration being 75 hours. Caesarean sections had to be performed in all cases, with 34.4% within 24 hours and 41.2% within the next 24 hours. Elective caesarean sections following PROM were 28.9%. Indications for emergency caesarean section included a previous history of Caesarean section in 19 cases, foetal distress was found in 18 cases, failed induction in 7 cases, chorioamnionitis in 6 cases, foetal malpresentation was in 5 cases, and other reasons in 9 cases. More than one-third (35.56%) respondents had morbid condition to complicate the postpartum period. Among the complications, 21.11% suffered from wound infection; followed by puerperal sepsis 8.89% and postpartum haemorrhage 5.56%. At termination, all 92 foetuses were alive, but 6 babies had an Apgar score &lt;7 at 5 minutes after delivery, 30.4% of babies had low birth weight and 73.9% were in good condition, whereas 26.1% were admitted in neonatal ward, and out of the admitted 7 died with neonatal sepsis being the primary cause of death. A better understanding of the diagnosis babies and management of PROM will enable obstetric care providers to optimize perinatal outcomes and minimize neonatal morbidity and mortality. Therefore, this study finds the indication and outcome of caesarean section in pregnant women experiencing PROM. Bangladesh Med J. 2022 May; 51(2): 45-53

Exploring Patterns of COPD Exacerbations and Comorbid Flare-Ups.

Comorbidities are known to complicate disease management in patients with Chronic Obstructive Pulmonary Disease (COPD). This is partly due to lack of insight into the interplay of acute exacerbations of COPD (AECOPD) and comorbid flare-ups. This study aimed to explore patterns of AECOPDs and comorbid flare-ups. Data of increased symptoms were extracted from a 12-month daily symptom follow-up database including patients with COPD and comorbidities (chronic heart failure (CHF), anxiety, depression) and transformed to visualizations of AECOPDs and comorbid flare-up patterns over time. Patterns were subsequently categorized using an inductive approach, based on both predominance (ie, which occurs most often) of AECOPDs or comorbid flare-ups, and their simultaneous (ie, simultaneous start in ≥ 50%) occurrence. We included 48 COPD patients (68 ± 9 years; comorbid CHF: 52%, anxiety: 40%, depression: 38%). In 25 patients with AECOPDs and CHF flare-ups, the following patterns were identified: AECOPDs predominant (n = 14), CHF flare-ups predominant (n = 5), AECOPDs nor CHF flare-ups predominant (n = 6). Of the 24 patients with AECOPDs and anxiety and/or depression flare-ups, anxiety and depression flare-ups occurred simultaneously in 15 patients. In 9 of these 24 patients, anxiety or depression flare-ups were observed independently from each other. In 31 of the included 48 patients, AECOPDs and comorbid flare-ups occurred mostly simultaneously. Patients with COPD and common comorbidities show a variety of patterns of AECOPDs and comorbid flare-ups. Some patients, however, show repetitive patterns that could potentially be used to improve personalized disease management, if recognized.

Homoeopathic Treatment of Mild Cases of COVID-19 on Home Isolation: A Retrospective Observational Study

AbstractWhile the world grappled with the pandemic of coronavirus disease 2019 (COVID-19), medical fraternity and policy makers tried desperately to control its spread in the absence of any definite treatment protocol. The scope of homoeopathy, which has been historically found effective in epidemics, has been investigated in the present study. This study was conducted to evaluate the effect of individualised homoeopathic medicine on mild cases of COVID-19 under home isolation. A retrospective, single-arm, non-randomised, open-label, observational trial was conducted on 185 laboratory confirmed mild cases of COVID-19 at Nehru Homoeopathic Medical College and Hospital, Delhi, during September to December 2020. Complete symptom resolution days was the primary outcome (from baseline to total zero symptom score); Each COVID-19 symptom and sign was assessed on a scale of 0 to 3 (0–absent, 1–mild, 2–moderate, 3–severe) to assess the symptom incidence and severity both at baseline and during daily follow-up for 14 days after enrolment to assess the effect of individualised homoeopathic medicines as the secondary outcomes. Intention-to-treat sample (n = 185) was analysed in SPSS IBM version 20. Of all the patients (n = 185), 165 (90%) successfully completed the follow-up period. The mean (interquartile range [IQR]) age was 35 (26–45) years; the male: female ratio was 11:9.2. Fever (56%), cough (54%), fatigue (45%) and sore throat (36%) were the most common symptoms reported. Median (IQR) time for resolution of symptoms was 4 (3–8) days. Sixty-eight per cent patients recovered within 6 days and rest within 7 to 14 days. The most prescribed medicines were Bryonia alba (30%), Arsenicum album (25%) and Pulsatilla nigricans (12%) accounting for 67% of the total medicines. This study, though preliminary, revealed a positive treatment effect of individualised homoeopathic medicines in promptly alleviating the symptoms of mild COVID-19. Randomised controlled trials with greater scientific rigour are warranted.

Aluminum Phosphide Poisoning in the North of Iran: A Register-based Research.

Aluminum phosphide (ALP) poisoning is considered one of the health care issues in Iran, which is associated with the mortality outcome of patients. According to the ALP poisoning that commonly results in death, we aimed to evaluate the prevalence of ALP pill poisoning by employing register-based research. In this descriptive cross-sectional study, all selected patients diagnosed and confirmed with ALP poisoning by a specialist and referred to the poisoning ward from the beginning of April 2016 to the end of October 2017 were enrolled, and data were registered in the Disease Registration System by a technical expert for daily follow-up during hospitalization. Approximately 12.4% of patients had neurological problems, with the majority having paresis (68.3%). Self-poisoning with the purpose of suicide was documented for 96.2% of cases, with the most common cause being family problems (54.1%). In 97.3% of cases, the method of contact with the toxic substance was oral. Hypotension, cardiac, and respiratory complications were observed in 25.2%, 30.8%, and 25% of the patients, respectively. The most gastrointestinal symptoms were nausea and vomiting (86.7%). The results indicate that the rate of ALP pill poisoning is relatively high. Suicide is the most important cause of ALP poisoning, which is more common in men under 40 years of age.