December 31st Research Articles

Contrasting bone profiles in PCOS are related to BMI: a systematic review and meta-analysis.

Controversial results have emerged regarding whether PCOS is protective or increases the risk of bone frailty. This study investigated whether the PCOS condition affects bone parameters of premenopausal women. This is an update for a previous meta-analysis published in 2019. We searched MEDLINE and Embase. Studies were considered eligible for the update if published in English between the 1st of October 2018 and the 31st of December 2023. The diagnosis of PCOS should be based on NIH criteria, the Rotterdam Consensus, AE-PCOS society criteria, or ICD codes in women over 18 years old. Only records with the Newcastle-Ottawa Scale > 6 were selected for data extraction. Data were extracted by two independent reviewers. We identified 31 studies that met the inclusion criteria for qualitative analysis from 3322 studies in the whole period (1990-2023). Overall, cross-sectional studies included 1822 individuals with PCOS and 1374 controls, while cohort studies incorporated 30305 women with PCOS and 101907 controls. Contrasting profiles emerged after stratification using a BMI cutoff of 27 kg/m2. Individuals with PCOS and a BMI <27 kg/m2 exhibited lower vertebral and non-vertebral bone density, reduced bone turnover marker (osteocalcin), and increased bone resorption marker (CTX) levels. Conversely, individuals with PCOS and a BMI >27 kg/m2 exhibited increased vertebral and non-vertebral BMD, with no significant changes in bone formation and resorption markers (except osteocalcin). The findings of this study alert for a low bone mass, low bone formation, and increased bone resorption PCOS with a BMI <27 kg/m2.

Implications of Five Different Risk Models In Primary Prevention Guidelines.

A lack of consensus exists across guidelines as to which risk model should be used for the primary prevention of cardiovascular disease (CVD). Our objective was to determine potential improvements in the number needed to treat (NNT) and number of events prevented (NEP) using different risk models in patients eligible for risk stratification. A retrospective observational cohort was assembled from primary care patients in Ontario, Canada between January 1st, 2010, to December 31st, 2014 and followed for up to 5 years. Risk estimation was undertaken in patients 40-75 years of age, without CVD, diabetes, or chronic kidney disease using the Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs), a recalibrated FRS (R-FRS), Systematic Coronary Risk Evaluation 2 (SCORE2), and the low-risk region recalibrated SCORE2 (LR-SCORE2). The cohort consisted of 47,399 patients (59% women, mean age 54). The NNT with statins was lowest for SCORE2 at 40, followed by LR-SCORE2 at 41, R-FRS at 43, PCEs at 55, and FRS at 65. Models that selected for individuals with a lower NNT recommended statins to fewer, but higher risk patients. For instance, SCORE2 recommended statins to 7.9% of patients (5-year CVD incidence 5.92%). The FRS, however, recommended statins to 34.6% of patients (5-year CVD incidence 4.01%). Accordingly, the NEP was highest for the FRS at 406 and lowest for SCORE2 at 156. Newer models such as SCORE2 may improve statin allocation to higher risk groups with a lower NNT but prevent fewer events at the population level.

Men’s Violence against Women as Portrayed in the Swedish Media: The Construction of Victimhood and the Role of the Perpetrator

Men’s violence against women is an international problem and while global and national initiatives have been created to better the criminalization process, the influence of news reporting on violence against women has not been successfully addressed in such policy. The aim of this study is to contribute to understanding how media frames violence against women in the Swedish context, which is both highly protective of crime reporting and where violence against women is a central policy and public discussion issue. A mixed methods approach was used in the analysis of 295 digital news articles that were published by four media outlets (Aftonbladet, Expressen, Svenska Dagbladet and Dagens Nyheter) within the period January 1st, 2019–December 31st, 2021. The study found that digital news articles first frame the issue of violence against women as episodic, but later transform into a thematic frame when follow-up articles were written on a given case. The study found a construction of victimhood by Swedish news media that allowed for two victim personas to be identified: the ideal victim and the ideal minority victim. In connection with the portrayal of the victim, the study also identified two different portrayals of the perpetrator: the ideal foreign perpetrator and the Swedish perpetrator. Both the description of the victim and perpetrator allowed for insights to be made regarding the role of racialization in news reporting and how this effects the framing of social issues. Finally, the study presented a set of news values that were most frequently found in articles that reveal several news factors of violence against women that contribute to the topic being seen as newsworthy.

A retrospective study of mandibular fractures in tertiary care hospitals of Karachi.

Objective: To check the prevalence and causes of mandibular Fracture in the teaching hospital of Karachi Pakistan. Study Design: Crossectional, Observational, Retrprospective. Setting: Department of Oral &amp; Maxillofacial Surgery, Karachi Medical and Dental College Abbasi Shaheed Hospital Karachi and Department of Oral and Maxillofacial Surgery Baqai Dental College University, Karachi. Period: 1st December 2018 to 30th November 2019. Methods: This study was based on randomly selected cases of one year of work at the Department of Oral and Maxillofacial Surgery Abbasi Shaheed Hospital Karachi and Department of Oral and Maxillofacial Surgery Baqai Dental College Baqai Medical University Karachi. Results: Road traffic accident like Bike accidents were top in position with 69 %, falls were next in position with 12 %, assault were recorded 10%, sports injuries were 7% and fire arm injuries2%. Mandibular fractures were found to occur at a rate of 22.1% in the parasymphysis, 12.8% in the body, 11.42% at the angle of the jaw, 12.1% in the condyle, 12.14% in the dento alveolar area, 6.4% in the symphysis, and 2.85 % in the ramus. Conclusion: To properly reduce and fix the fractures, a variety of treatment methods were employed. It has been determined that most patients were masculine and between the ages of 20 and 50. The most frequent locations for mandibular fractures were the parasymphysis and body, and the most common cause of trauma in the study participants was auto accidents.

Prevalence of ichthyoses in Denmark - a nationwide registry-based study.

The results demonstrate a prevalence of all types of ichthyoses of 1.6 per 10,000, which are based on large Danish National Patient registries, including all patients with relevant diagnoses alive on December 31st, 2021. A study of this size and depth has not been completed before but may still underestimate the prevalence and potential burden of the diseases.

A machine learning model for the early diagnosis of bloodstream infection in patients admitted to the pediatric intensive care unit.

Bloodstream infection (BSI) is associated with increased morbidity and mortality in the pediatric intensive care unit (PICU) and high healthcare costs. Early detection and appropriate treatment of BSI may improve patient's outcome. Data on machine-learning models to predict BSI in pediatric patients are limited and neither study included time series data. We aimed to develop a machine learning model to predict an early diagnosis of BSI in patients admitted to the PICU. This was a retrospective cohort study of patients who had at least one positive blood culture result during stay at a PICU of a tertiary-care university hospital, from January 1st to December 31st 2019. Patients with positive blood culture results with growth of contaminants and those with incomplete data were excluded. Models were developed using demographic, clinical and laboratory data collected from the electronic medical record. Laboratory data (complete blood cell counts with differential and C-reactive protein) and vital signs (heart rate, respiratory rate, blood pressure, temperature, oxygen saturation) were obtained 72 hours before and on the day of blood culture collection. A total of 8816 data from 76 patients were processed by the models. The machine committee was the best-performing model, showing accuracy of 99.33%, precision of 98.89%, sensitivity of 100% and specificity of 98.46%. Hence, we developed a model using demographic, clinical and laboratory data collected on a routine basis that was able to detect BSI with excellent accuracy and precision, and high sensitivity and specificity. The inclusion of vital signs and laboratory data variation over time allowed the model to identify temporal changes that could be suggestive of the diagnosis of BSI. Our model might help the medical team in clinical-decision making by creating an alert in the electronic medical record, which may allow early antimicrobial initiation and better outcomes.

The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis

IntroductionMedical tourism refers to the process of patients travelling outside of their native country to undergo elective surgical procedures and is a rapidly expanding healthcare phenomenon [1–3]. Whilst a multitude of established Private Healthcare Providers (PHPs) offer cosmetic surgical procedures within the United Kingdom (UK), a growing number of patients are opting to travel outside of the UK to undergo cosmetic surgery. AimTo assess the number of patients presenting to the Canniesburn Plastic Surgery Unit, with cosmetic surgery tourism complications, from outside of the UK, and the associated costs to NHS Scotland over a five-year period. MethodsA retrospective case review of a prospectively maintained trauma database, which records all acute referrals, was undertaken analysing patients referred from January 1st 2019 to December 31st 2023 inclusive. Results81 patients presented over five years with complications of cosmetic surgery tourism. The most common presenting complaints were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9327.90 per patient. ConclusionThis is the largest single centre cohort of cosmetic surgery tourism complications reported within the NHS to date; with rates on the rise, demand grows for increased patient information regarding healthcare tourism risks, a national consensus on the extent of NHS management and urgent international collaboration with policymakers is required to address this issue across borders.

Effect of Intravenous Dexmedetomidine Before Extubation on Emergence Delirium after Nasal Surgeries.

To investigate the role of single dose of dexmedetomidine (0.5 mcg/kg) in reducing the incidence and severity of postoperative emergence delirium (EmD). A randomised controlled trial. Place and Duration of the Study: Department of Anaesthesia, Security Forces Hospital, Riyadh, Saudi Arabia, from 1st December 2022 to 30th March 2023. Patients, aged between 18-65 years, with ASA 1-3 scheduled to undergo nasal surgeries under general anaesthesia, were inducted in the study. Exclusion criteria were patient refusal, later request for removal from the study, inability to give consent, known allergy to dexmedetomidine, body mass index (BMI) more than 35, history of obstructive sleep apnoea, history of psychiatric illness, pregnancy, and presence of liver and renal diseases. The primary outcome measure of the study was the incidence of emergence delirium in the postoperative period. The frequency of EmD after nasal surgery was 52.38% in the control group compared to 14.28% in the dexmedetomidine group (p = 0.01). Pain scores were not statistically different between the two groups. The duration of post anaesthesia care unit (PACU) stay was significantly lesser in dexmedetomidine group (p <0.001). The satisfaction score on the visual analogue scale (VAS) was also found to be higher in patients who received intravenous dexmedetomidine (p <0.001). The use of single dose dexmedetomidine before extubation in nasal surgeries reduces the EmD and improves patient satisfaction. Dexmedetomidine, Emergence delirium, Nasal surgery, Opioid consumption, Pain control.

Gender disparities in lymphocyte counts and cytokine expression in COVID-19

Background: This study seeks to assess gender differences in the severity of COVID-19 infection, which have been noted in different regions during the early stages of the pandemic. Methods: A cross-sectional study conducted at Baquba Teaching Hospital in Diyala, Iraq, from October 1st to December 31st, 2020, included 132 confirmed COVID-19 patients. These patients underwent a comprehensive set of routine laboratory tests, including complete blood count, blood biochemistry, and D-dimer assessment. Statistical analysis was carried out using SPSS-20, with significance set at p &lt; 0.05. Results: The study included patients with a mean age of 45.61 (±11.32) years, predominantly male (63.0%), residing in urban areas (57.6%), and presenting with comorbidities (78.8%). All patients exhibited positive results on CT scans (100%) and CRP tests (100%). However, PCR testing confirmed COVID-19 infection in 87.2% of cases, with 12.8% testing negative. Among males, there was a significant increase in IL-6 and IL-10 levels (42.57 ± 7.64 pg/ml and 255.27 ± 21.03 pg/ml) compared to females (16.43 ± 4.19 pg/ml and 187.48 ± 20.35 pg/ml), with p-values &lt;0.001 and 0.003, respectively. Conversely, there was no significant difference in IFN-ɣ levels between males (165.73 ± 16.54 pg/ml) and females (176.12 ± 17.10 pg/ml), with a p-value of 0.105. However, lymphocyte levels were significantly lower in males (4.79 ± 0.85%) compared to females (14.01 ± 1.36%), with a p-value &lt;0.001. Conclusion: Overall, COVID-19 affects males more severely than females, with males showing weaker immune responses and higher levels of inflammatory cytokines like IL-6 and IL-10. While IFN-ɣ levels do not differ significantly between genders, males have lower lymphocyte counts compared to females.

The prevalence, risk factors and the management outcome of placenta praevia at Federal Teaching Hospital Gombe: A 5-year retrospective study

Background: Placenta praevia is one of the main causes of antepartum haemorrhage, which may be associated with severe maternal and perinatal morbidity and mortality, especially in developing countries. This study aimed to evaluate the prevalence, risk factors and the feto-maternal outcome of placenta praevia among patients managed in Federal Teaching Hospital Gombe, Northern Nigeria. Methodology: This was a retrospective study where all cases of placenta praevia managed in Federal Teaching Hospital Gombe, over 5 years, from January 1st 2017 to December 31st 2021 were analyzed using SPSS V 20. Results: There was a total of 11,937 deliveries during the study period and 63 cases of placenta praevia were managed, giving an incidence of 1.9%. Also, a total of 2,907 Caesarean deliveries were done during this period, and placenta praevia cases contributed 2.2% of the CS. About half of the cases also (47.4%) were asymptomatic and diagnosed incidentally with routine ultrasound scan while painless vaginal bleeding (32.2%) and warning bleeds (20.4%) were the other noted symptoms. The commonest risk factors noted in this study were previous dilatation and curettage (28.6%), previous CS and multiparity (22.6%) each. The fetal complications noted in this study were low birth weight (13.2%), birth asphyxia (10.3%) and 2.9% had intrauterine fetal death. Maternal complications were postoperative anaemia 55.4%, shock 7.7%, and 1.5% had peripartum hysterectomy. There was no maternal mortality noted in this study. Conclusion: Placentae previa is fairly common at our Centre and associated maternal and perinatal morbidities. Therefore, routine late obstetric ultrasound scan should be performed to diagnose it in women with risk factors so that they can receive optimal care.

Capital Structure, Corporate Governance and Profitability of Listed Industrial Goods Firms in Nigeria

Nowadays, industrial goods firms have experienced draught in debt financing due to the lending preference of financial institutions to firms in the oil and gas sector, corporate failures and financial scandals as well as the overstatements of accounts of some firms in and outside Nigeria blamed to be as a result of account improprieties and ineffective board of directors also Issues of the mixed outcome of previous researches; thus, necessitating and justifying the need for undergoing more investigations into the subject area. The objective of this study is to determine the overall effect of capital structure and corporate governance on profitability with the influence of firm size of the sampled industrial goods firms. The study used multiple regressions as a tool for analysis. The population of the study includes the thirteen (13) industrial goods firms listed by the Nigerian Stock Exchange as of 31st December 2022 out of which ten (10) are considered as sample size. The study employed panel data analysis by using random-effect estimation model as alternatively considered more appropriate. Secondary data explored from the annual reports and accounts of the sampled firms for the period of ten (10) years from 2013 to 2022 were analyzed. The results revealed that Leverage, board size and firm size are negatively significant at 1% level of significance. While board composition is positively significant at 5% level of significance to the profitability of the sampled firms. In view of the findings, it is recommended that the financial managers/ management of the industrial goods firms should have more independent directors of its board size to enhance proper control over the activities of the managers through which profit level would be increased. It is therefore recommended to conduct careful evaluation and take into consideration on leverage, board size and firm size that influence the profitability of their firms before making major business decisions as this will go a long way in improving their profitability.

Acute Normovolemic Hemodilution (ANH) impacts postoperative coagulation profile and bleeding in Adult Cardiac Surgery

Introduction: The coagulation profile of cardiac surgery patients is impacted by pro-inflammatory effects caused by procedures involving cardiopulmonary bypass. In order to counteract these effects, pharmacological therapies and allogeneic blood transfusions are required. The strategy of Acute normovolemic hemodilution also known as “intraoperative autologous donation” is also a viable option to address these negative effects. The theoretical basis for ANH is that the removed blood of a patient’s own self is shielded from the inflammatory response of blood cells to the bypass circuit. ANH is an infrequently practiced strategy at various cardiac surgery institutes within Pakistan to enhance coagulation profile, decrease the need for blood transfusions despite being an established approach abroad. Aims and Objectives: The objective of our study is to compare the effect of ANH on patients undergoing adult cardiac surgery in a sample group versus a control group with the primary endpoint of postoperative drain output as a measure of effectiveness of blood coagulation profile. Blood coagulation profiles were also compared between the two groups as secondary variables. Place and Duration of study: The study was conducted at the Faisalabad Institute of Cardiology from December 21st, 2023 to February 13th, 2024. Material and Methods: A randomized controlled trial involving 60 patients over the age of 12 years who were to undergo adult cardiac surgery was conducted. An online research randomizer software randomly selected them into two equal groups, sample and control (n=30). The ANH volume retrieved from the patient's central vein in the sample group was used to fill the CPD blood transfusion bags after administering anesthesia. After the patients in both groups were weaned off CPB and protamine administered to neutralize heparin, ANH blood was infused back into the patients in the sample group whereas the control group received allogenic blood only. Chi square test was applied to all qualitative variables and Independent Samples t-test for all quantitative variables. The results were analyzed using SPSS version 25, and a p-value ? 0.05 was considered statistically significant. Results: Hemoglobin (12.9±0.90 g/dL in ANH and 11.8±1.00 g/dL in non-ANH) and aPTT levels (34.2±6.06 seconds in ANH and 54.2±10.95 seconds in non-ANH) were statistically significant (p-value &lt;0.01). In the ANH group, the mean value (623.3±86.28 mL) of postoperative drain output significantly decreased by approximately 220mL compared to the non-ANH group (842.3±99.26 mL) (p-value &lt;0.01). Conclusion: ANH positively conserves most of the coagulation profile parameters. It assists in reducing postoperative bleeding and the volume of allogeneic blood required perioperatively in cardiac surgery.

Machine learning model for predicting stroke recurrence in adult stroke patients with moyamoya disease and factors of stroke recurrence

ObjectThe aim of this study was at building an effective machine learning model to contribute to the prediction of stroke recurrence in adult stroke patients subjected to moyamoya disease (MMD), while at analyzing the factors for stroke recurrence. MethodsThe data of this retrospective study originated from the database of JiangXi Province Medical Big Data Engineering & Technology Research Center. Moreover, the information of MMD patients admitted to the second affiliated hospital of Nanchang university from January 1st, 2007 to December 31st, 2019 was acquired. A total of 661 patients from January 1st, 2007 to February 28th, 2017 were covered in the training set, while the external validation set comprised 284 patients that fell into a scope from March 1st, 2017 to December 31st, 2019. First, the information regarding all the subjects was compared between the training set and the external validation set. The key influencing variables were screened out using the Lasso Regression Algorithm. Furthermore, the models for predicting stroke recurrence in 1, 2, and 3 years after the initial stroke were built based on five different machine learning algorithms, and all models were externally validated and then compared. Lastly, the CatBoost model with the optimal performance was explained using the SHapley Additive exPlanations (SHAP) interpretation model. ResultIn general, 945 patients suffering from MMD were recruited, and the recurrence rate of acute stroke in 1, 2, and 3 years after the initial stroke reached 11.43%(108/945), 18.94%(179/945), and 23.17%(219/945), respectively. The CatBoost models exhibited the optimal prediction performance among all models; the area under the curve (AUC) of these models for predicting stroke recurrence in 1, 2, and 3 years was determined as 0.794 (0.787, 0.801), 0.813 (0.807, 0.818), and 0.789 (0.783, 0.795), respectively. As indicated by the results of the SHAP interpretation model, the high Suzuki stage, young adults (aged 18–44), no surgical treatment, and the presence of an aneurysm were likely to show significant correlations with the recurrence of stroke in adult stroke patients subjected to MMD. ConclusionIn adult stroke patients suffering from MMD, the CatBoost model was confirmed to be effective in stroke recurrence prediction, yielding accurate and reliable prediction outcomes. High Suzuki stage, young adults (aged 18–44 years), no surgical treatment, and the presence of an aneurysm are likely to be significantly correlated with the recurrence of stroke in adult stroke patients subjected to MMD.

Retrospective observational study of antibiotic prescribing in an out-of-hours doctors service

Abstract Introduction Surveillance of antibiotic use is a key part of Ireland’s National Action Plan for Antimicrobial Resistance 2021-2025. A higher proportion of patients are reported to be prescribed antibiotics in out-of-hours (OOH) doctors services compared to daytime general practice.[1] Challenges with antibiotic prescribing in this setting include unfamiliarity between doctor and patient, lack of follow-up, access to medical history and diagnostics. Surveillance of antibiotic use in OOH services is important to develop tailored antimicrobial stewardship (AMS) interventions in this setting. In Ireland, a national Preferred Antibiotic Initiative encourages prescribers in community settings to avoid, where possible, a list of Red (less preferred) antibiotics, and choose from a Green (preferred) list, if an antibiotic is required. Aim To evaluate antibiotic prescribing patterns in OOH services in the Cork/Kerry region to inform future AMS interventions and to ascertain trends in prescribing of Red antibiotics. Methods A retrospective, observational study was conducted of all oral antibiotic prescriptions in OOH doctors’ consultations between 1st December 2019 and 31st December 2021 in the region. Data were gathered on age, gender, date and time of consultation, consultation method (in person, remote), antibiotic and its indication. Data were analysed using Microsoft Excel v2018 and SPSS v28. Results Overall, 17% (69,017 of 406,812) of the OOH doctors’ consultations resulted in an antibiotic prescription, with considerable variation over the study period just prior to and during the COVID-19 pandemic, ranging from 31% in December 2019 to less than 2% in April 2020 and 22% in December 2021. During the COVID-19 pandemic part of the study period (April 2020 to December 2021), 66% of antibiotics prescribed were from remote consultations, prior to which antibiotic prescribing from remote consultations was rare. Of the antibiotics prescribed, 21% were in children under 6 years old. Respiratory tract infections (RTIs) were the most common indication for antibiotics (60%). Amoxicillin was the most commonly prescribed antibiotic (40% of all prescriptions). Red (reserved) antibiotics accounted for 19% of all prescriptions, which is substantially lower than national figures reported for the study period (35-45%)[2] and the national target of less than 34% for 2021. Red antibiotics were more commonly prescribed during the overnight shifts and in older adults, and less commonly prescribed in remote consultations. Conclusion Low antibiotic prescribing levels during the early stages of the pandemic were not sustained. Antibiotic prescriptions from remote consultations were common. Red antibiotic prescribing proportion is lower than the national mean in this OOH service. Key opportunities for AMS are addressing the volume of antibiotic prescribing for RTIs, particularly in children, AMS in telemedicine and the higher proportion of Red antibiotics prescribed by the overnight shift doctors. This is the first study describing indications antibiotic prescriptions in the OOH setting in Ireland. A limitation of this study is clinical presentation was not available for all OOH consultations. This would have given opportunity to assess the proportion of infectious presentations resulting in an antibiotic prescription to identify further of areas for AMS intervention.

Patient safety climate research in primary care dentistry: A systematic scoping review.

Patient safety climate constitutes an important element for quality improvement. Its current evidence base has been generated in hospital settings in developed countries. Studies in dentistry are limited. To systematically explore the evidence regarding assessing patient safety climate in dentistry. We developed a search strategy to explore MEDLINE, SCOPUS, and Web of Science databases from January 1st, 2002, to December 31st, 2022, to include observational studies on patient safety culture or patient safety climate assessment. Methodological features and item data concerning the dimensions employed for assessment were extracted and thematically analyzed. Reported scores were also collected. Nine articles out of 5584 were included in this study. Most studies were generated from high-income economies. Our analysis revealed methodological variations. Non-randomized samples were employed (ranging from 139 to 656 participants), and response rates varied from 28% to 93.7%. Three types of measurement instruments have been adapted to assess patient safety climate. These mainly consisted of replacing words or rewording sentences. Only one study employed an instrument previously validated through psychometric methods. In general, patient safety climate levels were either low or neutral. Only one study reported scores equal to or greater than 75. Despite diverse assessment tools, our two-decade analysis reveals a lag compared with medicine, resulting in methodological variations for assessing patient safety climate. Collaboration is vital to elevate standards, prioritize patient safety across oral healthcare services, and advocate for integrating safety climate into local and national quality and patient safety strategies.

The skåne emergency medicine (SEM) cohort

BackgroundIn the European Union alone, more than 100 million people present to the emergency department (ED) each year, and this has increased steadily year-on-year by 2–3%. Better patient management decisions have the potential to reduce ED crowding, the number of diagnostic tests, the use of inpatient beds, and healthcare costs.MethodsWe have established the Skåne Emergency Medicine (SEM) cohort for developing clinical decision support systems (CDSS) based on artificial intelligence or machine learning as well as traditional statistical methods. The SEM cohort consists of 325 539 unselected unique patients with 630 275 visits from January 1st, 2017 to December 31st, 2018 at eight EDs in the region Skåne in southern Sweden. Data on sociodemographics, previous diseases and current medication are available for each ED patient visit, as well as their chief complaint, test results, disposition and the outcome in the form of subsequent diagnoses, treatments, healthcare costs and mortality within a follow-up period of at least 30 days, and up to 3 years.DiscussionThe SEM cohort provides a platform for CDSS research, and we welcome collaboration. In addition, SEM’s large amount of real-world patient data with almost complete short-term follow-up will allow research in epidemiology, patient management, diagnostics, prognostics, ED crowding, resource allocation, and social medicine.

Prophylactic occlusion balloons of both internal iliac arteries in caesarean hysterectomy for placenta accreta spectrum disorder reduces blood loss: A retrospective comparative study

BackgroundThe placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. MethodsA retrospective monocentric cohort study was conducted in the Department "C" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. ResultsA total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p < 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p < 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups. ConclusionThe intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.

Cloud-Based Accounting Information Systems and Financial Reporting Quality of Listed Information and Communication Technology Firms in Nigeria

The confluence of cloud-based Accounting Information Systems (AIS) adoption and financial reporting quality within Nigeria's Information and Communication Technology (ICT) sector is explored in this study. Given the dynamic landscape of the ICT industry characterized by technological advancements, evolving market dynamics, and regulatory shifts, ICT firms are increasingly turning to cloud-based AIS to streamline their accounting processes and adapt to changing business requirements. The population of the study consists of all eight (8) Information and Communication Technology (ICT) enterprises that are listed on the Nigerian Exchange Group as of 31st December 2022. As a result, this study delves into the impact of Cloud-Based AIS adoption on the Financial Reporting Quality of Listed ICT Firms in Nigeria over a decade-long period from 2013 to 2022. Utilizing a Panel Regression Technique (Random Effect Model), the study identifies a significant overall effect of Cloud-Based AIS on the Financial Reporting Quality of Listed ICT Firms in Nigeria. Moreover, it highlights the significant influence of Cloud Security Investment on financial reporting quality among ICT firms in Nigeria, while Cloud Expenditure Growth is found to have no statistically significant effect. The study emphasizes the need for strategic resource allocation and exploration of cost optimization opportunities, given that cloud expenditure growth may not directly impact financial reporting quality. However, the study recommends for prioritizing cloud security investments to safeguard financial data integrity, mitigate cybersecurity risks, and enhance trust in financial reporting practices, thereby bolstering investor confidence.

Prevalence of Tuberculosis in Children

Background: Pulmonary TB is a relatively common disease in developing countries including Iraq . A relatively small proportion (5–10%) of the approximately 2 billion people infected with M. tuberculosis worldwide will develop TB. Objective: To show the prevalence of T.B. among children in Abu-Ghraib city Patients and Methods: A descriptive retrospective center-based study in the Abu-Ghraib health sector (chest and respiratory disease unit) was conducted to show the distribution of TB in children ≤ 18 years from the 1st January 2001 till the 31st December 2020. Results: A total sample of 248 patients which represents 15.1% of all patients with TB in Abu-Ghraib (1642) from1st January 2001 till 31st December 2020. Female (152; 61.2%) and male (96; 38.8%). Most common age group affected was 13-18 years which represents 71.7% of patient. The prevalence of TB in Abu-Ghraib during the study period for children was (3.4/100,000). Conclusion: The prevalence of all forms of TB in Abu-Ghraib during the study period was (3.4/100000). Females were affected more than males with a mean of 6.7+/-1.5 Extra-pulmonary TB was found to be more common than pulmonary TB.

Diphtheria in a Swiss Asylum Seeker Reception Centre: Outbreak Investigation and Evaluation of Testing and Vaccination Strategies.

Objectives: To describe a suspected diphtheria outbreak in a Swiss asylum seeker reception centre, and to analyse its management response regarding testing and vaccination. Methods: We retrospectively analysed clinical, microbiology, and case management data of all asylum seekers tested for C. diphtheriae between 28th August and 31st December 2022 while residing at the centre. Results are reported descriptively. Results: Among 265 individuals tested, ten cases of cutaneous diphtheria, one simultaneous respiratory and cutaneous case, and nine respiratory carriers were identified. Mass throat screening, targeted throat testing and targeted wound testing yielded 4.8%, 4.3%, and 17.4% positive results, respectively. No respiratory carrier was identified among cutaneous cases undergoing a throat swab, and no symptomatic case was identified among individuals with unspecific throat symptoms. Rates of vaccination implementation of newly arriving asylum seekers before and after the outbreak were low (17.5% and 15.5%, respectively), as were rates of targeted vaccination among cases and close contacts. Conclusion: We provide evidence for transmission both prior to arrival and within the setting, suboptimal practices and timeliness of testing, and implementation gaps in vaccination.