Observational Study Design Research Articles

Venovenous Extracorporeal Membrane Oxygenation Candidacy Decision-Making: Lessons and Hypotheses From a Single-Center Observational Analysis

BackgroundUtilization of veno-venous extracorporeal membrane oxygenation (V-V ECMO) is increasing, but candidacy selection processes are variable and subject to bias. Research QuestionWhat are the reasons behind V-V ECMO candidacy decisions, and are decisions made consistently across patients? Study Design and MethodsProspective observational study of all patients, admitted or outside hospital referrals, considered for V-V ECMO at a tertiary referral center. Relevant clinical data and reasons for candidacy determination were cross-referenced with other non-candidates and candidates and qualitatively assessed. ResultsEighty-one consultations resulted in 44 (54%) non-candidates, 29 (36%) candidates (9 were subsequently cannulated), and 8 (10%) deferred decisions. Fifteen unique contraindications were identified, variably present across all patients. Five contraindications were invoked as the sole reason to decline a patient. In patients with three or more contraindications, additional contraindications were cited even if their severity was relatively minor. All but four contraindications invoked to decline a patient were non-prohibitive for at least one other candidate. Contraindications documented in non-candidates were present but not mentioned in 21 (47%) other non-candidates. Twenty-six (90%) candidates had at least one contraindication that was prohibitive in a non-candidate, including a contraindication that was the sole reason to decline. Contraindications were proposed as informing three prognostic domains, through which patterns of inconsistency could be better understood: (1) irreversible underlying pulmonary process, (2) unsurvivable critical illness, and (3) clinical condition too compromised for meaningful recovery. InterpretationECMO candidacy decisions are inconsistent. We identified four patterns of inconsistency in our center and propose a three-domain model for understanding and categorizing contraindications, yielding five lessons that may improve candidacy decision processes until further research can more definitively guide practice.

Do some prefer to pay? Identifying bias against free COVID-19 tests

ObjectivesIn the United States, a federal emergency program has made SARS-CoV-2 self-test kits available at no cost. It is unclear how widely free tests are preferred. We conducted a survey to estimate the proportion of respondents who do not prefer a free test. We hypothesized that free tests would not be preferred universally, and that a preference for paying would be more common among those with conservative politics than with liberal politics, regardless of income. DesignObservational study design. MethodsA national sample of US adults completed an online survey. To reduce potential enrollment bias, the survey’s focus was not specified beforehand. To prioritize a high-risk group, participation was limited to those who were unvaccinated or were incompletely vaccinated in the primary series against COVID-19. Participants reported their testing preferences and socio-demographic characteristics, including political affiliation. The main outcome assessed if a participant preferred to pay for a self-test or receive a free one (subsidized by the US government). ResultsAmong 1215 participants, (73%, n = 886) preferred free self-testing, while 27% (n = 329) preferred to pay for the same testing. After adjusting for income, the odds of preferring to pay for self-testing were 66% higher in “strong” Republicans compared to “strong” Democrats (odds ratio = 1.66, 95% confidence interval = 1.07–2.62). ConclusionsMore than a quarter of individuals preferred paying for these tests. This preference was more likely among those with right-wing politics. Policy implications are discussed, along with future research directions.

Exploring causal correlations between circulating levels of cytokines and colorectal cancer risk: A Mendelian randomization analysis.

Colorectal cancer has the highest mortality rate of all digestive system diseases. Considering the debate about cytokines and biases that exist in traditional observational study designs, we performed a two-sample Mendelian randomization (MR) analysis to explore the association of circulating cytokines with CRC risk. In this study, we used cytokine genetic variants from a recently published genome-wide association study (GWAS) including 14,824 European-ancestry participants. Summary-level data for colorectal cancer were obtained from genome-wide association analyses of the FinnGen consortium. In addition, we conducted independent supplementary analyses using genetic variation data of colorectal cancer and cytokines from a large public GWAS in 2021. Among 91 circulating factors, we only found IL-12B to be significantly associated with CRC risk (odds ratio [OR]: 1.19; 95% confidence interval [CI]: 1.00-1.42; p = .046). We used 2021 data for analysis and found that higher Interleukin-12p70 levels (IL-12p70) were revealed to have a significant positive association with CRC risk (OR: 1.27; 95% CI: 1.13-1.43; p < 1.22 × 10-3). Moreover, CRC was suggestively correlated with an elevated level of vascular endothelial growth factor (VEGF) (OR: 1.17; 95% CI: 1.02-1.35; p = .026), macrophage colony-stimulating factor (M-CSF) (OR: 0.85; 95% CI: 0.76-0.96; p = .005), IL-13 (OR: 1.15; 95% CI: 1.02-1.30; p = .028), IL-10 (OR: 1.23; 95% CI: 1.01-1.49; p = .037), and IL-7 (OR: 1.19; 95% CI: 1.02-1.39; p = .024). Our MR studies support that one cytokine IL-12 is significantly associated with CRC risk and that five cytokines VEGF, M-CSF, IL-13, IL-10, and IL-7 are associated with CRC risk.

Injuries in elite football (soccer) academy: A 4-year observational cohort study of five categories and 515 players

Background Youth football (soccer) players in professional teams face a higher likelihood of injury compared to adults. The interplay between football and injury hinges on the contextual environment. Despite this, a gap in knowledge persists regarding the epidemiology within Italian elite football academies. Purpose Assessing injury incidence and distribution in an Italian professional football academy ( n = 515 from U14 to U18) during match and training to understand injury incidence, severity, types, and related factors. Study design Observational cohort study. Methods A descriptive epidemiological study was conducted in a football academy (Campionato Nazionale Serie A) from July 2014 to June 2018. We analyzed data from 515 players divided into five age categories (U14 to U18). Injury occurrence was monitored using a custom data reporting tool adhering to FIFA and UEFA injury surveillance protocols. Injury incidence was calculated as the number of injuries/1000 h of exposure. Injury distribution was classified according to severity, location, type, playing position, and period of injuries across different age categories. Results Eight hundred thirty-two injuries were documented with 4.7 injuries/1000 h of training, 12.4 injuries/1000 h of match and 5.9 injuries/1000 h of total exposure. The months with the lowest number of injuries were June, July, and August ( p &lt; .019). Of all injuries, 430 (51.7%) were caused by trauma, while overuse contributed to 402 injuries (48.3%). Conclusion Findings revealed that injury epidemiology within an Italian professional football academy can be compared to other European countries. These data can serve as a reference for clinicians and sports scientists.

Neuropsychological and biopsychosocial evolution, therapeutic adherence and unmet care needs during paediatric transplantation: study protocol of a mixed-methods design (observational cohort study and focus groups) - the TransplantKIDS mental health project.

The present article describes the protocol of a mixed-methods study (an observational cohort design and focus groups), aimed to examine neuropsychological functioning and other biopsychosocial outcomes, therapeutic adherence and unmet care needs in paediatric population undergoing solid organ or allogeneic hematopoietic transplant during the pre- and post-transplant phases. Following a multi-method/multi-source approach, neuropsychological domains will be comprehensively measured with objective tests (SDMT, K-CPT 2/CPT 3, TAVECI/TAVEC, WISC-V/WAIS-IV Vocabulary and Digit Span subtests, Verbal Fluency tests, Stroop, ROCF, and TONI-4); ecological executive functioning, affective and behavioral domains, pain intensity/interference, sleep quality and therapeutic adherence will be assessed through questionnaires (parent/legal guardians-reported: BRIEF-2 and BASC-3; and self-reported: BASC-3, BPI, PROMIS, AIQ and SMAQ); and blood levels of prescribed drugs will be taken from each patient's medical history. These outcomes will be measured at pre-transplant and at 4-weeks and 6-months post-transplant phases. The estimated sample size was 60 patients (any type of transplant, solid organ, or hematopoietic) from La Paz University Hospital (Madrid, Spain). Finally, three focus group sessions will be organized with patients, parents/guardians, and transplant clinicians (n = 15, with 5 participants per group), in order to qualitatively identify unmet care needs during the pre-, and post-transplant stages of the process. The study protocol was registered at ClinicalTrials.gov (NCT05441436).

The Effect of Concomitant Spinal Cord Injury on Postoperative Health-related Quality of Life After Traumatic Subaxial Cervical Spine Injuries: A Nationwide Registry Study

ObjectiveTo evaluate the effect of spinal cord injury (SCI) on the health-related quality of life (HRQoL) in patients surgically treated for traumatic subaxial cervical spine injuries and investigate the agreement between objective neurologic outcomes and patient reported outcome measures (PROMs) in that context. Study DesignObservational study on prospectively collected multi-institutional registry data. SettingSweden. ParticipantsPatients with traumatic subaxial spine injuries identified in the Swedish Spine Registry (Swespine) between 2006 and 2016. InterventionsAnterior, posterior, or anteroposterior cervical fixation surgery. Main OutcomesPatient-reported outcome measures (PROMs) consisting of EQ-5D-3Lindex and Neck Disability Index (NDI). ResultsAmong the 418 identified patients, 93 (22%) had a concomitant SCI. In this group, 30 (32%) had a complete SCI (Frankel A), and the remainder had incomplete SCIs (17%) Frankel B; 25 (27%) Frankel C; 22 (24%) Frankel D. PROMs significantly correlated with the Frankel grade (P<.001). However, post hoc analysis revealed that the differences between adjacent Frankel grades failed to reach both statistical and clinical significance. On univariable linear regression, the Frankel grade was a significant predictor of a specific index derived from the EQ-5D-3L questionnaire (EQ-5D-3Lindex) at 1, 2, and 5 years postoperatively as well as the NDI at 1 and 2 years postoperatively (P<.001). Changes of PROMs over time from 1, to 2, and 5 years postoperatively did not reach statistical significance, regardless of the presence and degree of SCI (P>.05). ConclusionOverall, the Frankel grade significantly correlated with the EQ-5D-3Lindex and NDI and was a significant predictor of PROMs at 1, 2, and 5 years. PROMs were stable beyond 1 year postoperatively regardless of the severity of the SCI.

A guide to improving the design and analysis of observational studies on the long-term safety of topical corticosteroids.

Despite a long track-record of use, patients and clinicians continue to have concerns about the safety of topical corticosteroids (TCS). Observational studies in routinely collected health data provide an opportunity to address those concerns but are challenging to conduct in a way that minimizes bias and confounding. We review challenges and potential solutions for the conduct of observational studies on the long-term safety of TCS.

Associations of habitual sedentary time with executive functioning and short-term memory in 7th and 8th grade adolescents

BackgroundWhile there is increasing evidence for negative physical health consequences of high volumes of sedentary time and prolonged sedentary time in adolescents, the association with cognition is less clear. This study investigated the association of volumes of habitual sedentary time and prolonged sedentary time with executive functions and short-term memory in adolescents.MethodsThis study has a cross-sectional observational study design. Volumes of sedentary time and prolonged sedentary time (accumulated sedentary time spent in bouts of ≥ 30 min) were measured using the Axivity AX3 accelerometer. Six cognitive functions (spatial and verbal short-term memory; and working memory, visuospatial working memory, response inhibition and planning as executive functions) were measured using six validated cognitive assessments. Data were analysed using generalised linear models.ResultsData of 119 adolescents were analysed (49% boys, 13.4 ± 0.6 year). No evidence for an association of volumes of sedentary time and prolonged sedentary time with spatial and verbal short-term memory, working memory, and visuospatial working memory was found. Volumes of sedentary time and prolonged sedentary time were significantly related to planning. One hour more sedentary time or prolonged sedentary time per day was associated with respectively on average 17.7% (95% C.I.: 3.5–29.7%) and 12.1% (95% C.I.: 3.9–19.6%) lower scores on the planning task.ConclusionsNo evidence was found for an association of volumes of habitual sedentary time and prolonged sedentary time with short-term memory and executive functions, except for planning. Furthermore, the context of sedentary activities could be an important confounder in the association of sedentary time and prolonged sedentary time with cognition among adolescents. Future research should therefore collect data on the context of sedentary activities.Trial registrationThis study was registered at ClinicalTrials.gov in January 2020 (NCT04327414; released on March 11, 2020).

Association between proliferative-to-secretory endometrial compaction and pregnancy outcomes after embryo transfer: a systematic review and meta-analysis.

Does the change in endometrial thickness (EMT) from the end of the follicular/estrogen phase to the day of embryo transfer (ET) determine subsequent pregnancy outcomes? Endometrial compaction from the late-proliferative to secretory phase is not associated with live birth rate (LBR) and other pregnancy outcomes. Endometrial compaction has been suggested to be indicative of endometrial responsiveness to progesterone, and its association with ET outcome has been investigated but is controversial. A systematic review with meta-analysis was carried out. PubMed, EMBASE, and Web of Science were searched to identify relevant studies from inception to 18 November 2022. The reference lists of included studies were also manually screened for any additional publications. Cohort studies comparing ET pregnancy outcomes between patients with and without endometrial compaction were included. A review of the studies for inclusion, data extraction, and quality assessment was performed by two independent reviewers. The effect size was synthesized as odds ratio (OR) with 95% CI using a random-effects model. Heterogeneity and publication bias were assessed by the I2 statistic and Egger's test, respectively. The primary outcome was LBR. Secondary outcomes included biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), miscarriage rate (MR), ongoing pregnancy rate (OPR), and ectopic pregnancy rate (EPR). Seventeen cohort studies involving 18973 ET cycles fulfilled the eligibility criteria. The pooled results revealed that there were no significant differences between endometrial compaction and non-compaction groups in LBR (crude OR (cOR) = 0.95, 95% CI 0.87-1.04; I2 = 0%; adjusted OR (aOR) = 1.02, 95% CI 0.87-1.19, I2 = 79%), BPR (cOR = 0.93, 95% CI 0.81-1.06; I2 = 0%; aOR = 0.88, 95% CI 0.75-1.03, I2 = 0%), CPR (cOR = 0.98, 95% CI 0.81-1.18; I2 = 70%; aOR = 0.86, 95% CI 0.72-1.02, I2 = 13%), MR (cOR = 1.09, 95% CI 0.90-1.32; I2 = 0%; aOR = 0.91, 95% CI 0.64-1.31; I2 = 0%), and EPR (cOR = 0.70, 95% CI 0.31-1.61; I2 = 61%). The OPR was marginally higher in crude analysis (cOR = 1.48, 95% CI 1.01-2.16; I2 = 81%) among women with compacted endometrium, but was not evident in adjusted results (aOR = 1.36, 95% CI 0.86-2.14; I2 = 84%). Consistently, the pooled estimate of LBR remained comparable in further subgroup and sensitivity analyses according to the degree of compaction (0%, 5%, 10%, 15%, or 20%), type of ET (fresh, frozen, or euploid only), and endometrial preparation protocol (natural or artificial). No publication bias was observed based on Egger's test. Although the number of included studies is sufficient, data on certain measures, such as EPR, are limited. The inherent bias and residual confounding were also inevitable owing to the observational study design. Furthermore, inconsistent definitions of pregnancy outcomes may affect the accuracy of our pooled analysis. Given the lack of prognostic value, assessing endometrial compaction or repeated EMT measurement on the day of ET may not be necessary or warranted. This work was supported by Natural Science Foundation of Jiangxi Province (20224BAB216025), National Natural Science Foundation of China (82260315), and Central Funds Guiding the Local Science and Technology Development (20221ZDG020071). The authors have no conflicts of interest to declare. CRD42022384539 (PROSPERO).

Assessment of global antimicrobial resistance campaigns conducted to improve public awareness and antimicrobial use behaviours: a rapid systematic review

IntroductionPublic health campaigns with a well-defined outcome behaviour have been shown to successfully alter behaviour. However, the complex nature of antimicrobial resistance (AMR) creates challenges when evaluating campaigns aimed at raising awareness and changing behaviour.AimsTo determine what campaigns have been conducted and which reported being effective at improving awareness of antimicrobial resistance and changing behaviour around antimicrobial use in members of the public. It also sought to determine the outcome measures studies have used to assess campaign effectiveness.MethodsA systematic search of Ovid MEDLINE and Embase, was conducted in October 2022 using a predefined search strategy. Studies which were published between 2010 and September 2022 that outlined a campaign or invention aimed at the public and focusing on AMR or antibiotic usage were eligible for inclusion and studies which solely targeted healthcare professionals (HCP) were excluded.ResultsLiterature searches retrieved 6961 results. De-duplication and screening removed 6925 articles, five articles from grey literature and reference screening were included, giving a total of 41 studies and 30 unique interventions. There was a distribution of campaigns globally with the majority run in Europe (n = 15) with most campaigns were conducted nationally (n = 14). Campaigns tended to focus on adult members of the public (n = 14) or targeted resources towards both the public and HCPs (n = 13) and predominately assessed changes in knowledge of and/or attitudes towards AMR (n = 16). Campaigns where an improvement was seen in their primary outcome measure tended to use mass media to disseminate information, targeted messaging towards a specific infection, and including the use of HCP-patient interactions.DiscussionThis review provides some evidence that campaigns can significantly improve outcome measures relating to AMR and antibiotic usage. Despite a lack of homogeneity between studies some common themes emerged between campaigns reported as being effective. However, the frequent use of observational study designs makes it difficult to establish causation between the campaign and changes seen in the studies outcome measures. It is important that clear evaluation processes are embedded as part of the design process for future campaigns; a campaign evaluation framework for use by campaign developers may facilitate this.

Correlation of ABO Blood Group Susceptibility to Disease Severity of SARS-COV-2: An Original Research

ABSTRACT COVID-19, the Ecumenical Pandemic that hit Wuhan, Hubei Province, China, in 2019 has instigated an emergency situation all over the globe. Current scientific corroborations highlighted the role of zoonotic cross-over species transmission for the spread of the deadly virus SARSCoV2. The proposition of ABO blood grouping to susceptibility for various infectious diseases has been documented in the past since blood group antigens constitute polymorphic traits that are inherited among humans, therefore are frequent targets in epidemiological studies. Aim: To correlate the ABO blood group susceptibility to disease severity in COVID-19-positive cases among Indian populations. Objectives: Association of ABO blood group patterns to disease severity in COVID-19-positive cases. Materials and Methods: A cross-sectional, observational study design was conducted among 700 confirmed COVID-19-positive cases admitted to the tertiary health care center in Maharashtra, India. The data collected were subjected to statistical analysis. Results: Blood group ‘A’ positive was frequent (40%) in severe COVID-19 (E group) disease, and ‘O’ positive blood group was frequent in moderate COVID-19 disease (34.62%). Conclusion: ABO Blood grouping can be used as one of the efficient biomarker for COVID-19, thereby providing a new platform for therapeutic applications in the field of research.

A real-world pilot study assessing treatment satisfaction with avanafil in patients with erectile dysfunction.

Avanafil is a second-generation phosphodiesterase type 5 (PDE5) inhibitor, and offers a rapid onset of action (15minutes). Its real-world data, including treatment satisfaction, are still lacking. The study sought to investigate the treatment outcomes of avanafil and the factors impacting treatment satisfaction in a real-world setting. Between November 2021 and February 2023, erectile dysfunction (ED) patients prescribed avanafil were consecutively enrolled in this phase 4, open-label, cross-sectional, observational study. At each follow-up visit (4-week intervals), participants completed a questionnaire for assessing the use and treatment-emergent adverse events of avanafil, ED severity, and treatment satisfaction. The outcome measures included the Sexual Health Inventory for Men (SHIM), and Erectile Dysfunction Inventory of Treatment Satisfaction. Among 234 patients enrolled, 112 (47.9%) patients had follow-up visits and answered the questionnaire. Treatment with avanafil significantly improved the mean SHIM total score from 10.2 ± 5.6 at baseline to 17.5 ± 6.2 (P < .001). Of the patients treated with avanafil, 71.4% (n = 80 of 112) reported a >4-point improvement in the SHIM total score, and 33.1% (n = 37 of 112) reported normal erectile function. The proportion of patients satisfied with avanafil treatment (defined as Erectile Dysfunction Inventory of Treatment Satisfaction index score ≥60) was 87.5%. Several physical factors (younger age, lower waist circumference, and lower level of low-density lipoprotein), and sexual function factors (shorter duration of ED, higher SHIM total score at baseline, PDE5 inhibitor treatment naive, and acquired premature ejaculation) tended to contribute to satisfaction with avanafil treatment. Treatment-emergent adverse events occurred in 41.1% of patients, and all were mild in severity. This study identifies the factors associated with treatment satisfaction of avanafil, which may ultimately lead to better treatment outcomes. This is the first study to provide real-world evidence of avanafil for ED treatment, and validated questionnaires were used to assess erectile function and treatment satisfaction. However, the limitations of this study include single-center observational study design, small sample size, and short-term follow-up. Avanafil is an effective treatment for ED, and satisfaction rate is high in an outpatient setting. The awareness of identified factors related to patient satisfaction may improve treatment outcomes.

HEART vs EDACS Scores on Predicting Major Events Among Patients With Suspected Acute Coronary Syndrome at the Cardiac Emergency Department.

To compare the accuracy of HEART and EDACS scores in predicting major events among patients suspected of ACS in the cardiac emergency department (ED). A prospective correlational observational study design was performed on cardiac ED patients who presented with suspected ACS. Three tools were utilized to collect data pertinent to the study: Tool I comprises patients' assessment (personal characteristics, risk factors for ACS, and chest pain assessment sheet); Tool II is the risk assessment tool that includes HEART and EDACS scores; and Tool III is MACE incidence among studied patients within 30days. HEART score was significantly (P <.01) higher among patients for whom MACE was present than absent. However, EDACS score showed no significant difference (P >.05) among patients whose MACE was present or absent. HEART risk score >6 correctly predicted MACE cases with sensitivity and specificity of 77.46% and 48.28%, respectively. However, EDACS score >18 correctly predicted MACE cases with sensitivity and specificity of 42.25% and 75.86%, respectively. This study concludes that HEART score has better sensitivity than EDACS in predicting MACE among suspected ACS patients at the cardiac ED. The HEART score provides the nurses with a quicker and more reliable predictor of MACE shortly after the arrival of the suspected ACS patients at the cardiac ED than the EDACS score. The study recommended the implementation of a HEART score in the cardiac ED for predicting MACE in suspected ACS patients. Follow up closely for high-risk patients to MACE. An educational program should be made for nurses about the implementation of the heart score in the cardiac ED.

Wellens Syndrome: prevalence, risk factors and coronary angiographic variation. A cross-sectional study.

Wellens syndrome complicates acute coronary syndrome and, if unmanaged, can lead to immanent myocardial infarction. This study aimed towards determining the prevalence of Wellens syndrome among acute coronary syndrome patients while focusing on both types and identifying the associated risk factors, then exploring the variation in affected coronary arteries within patients fulfilling Wellens syndrome criteria. Implementing a descriptive cross sectional hospital based observational study design, at Ahmed Gasim Teaching Hospital for Cardiac Surgery and Renal Transplantation in Khartoum North, Sudan, the study was conducted following using a non probability convenience sampling of patients fitting the inclusion criteria. Data was collected using closed ended structured questionnaires. Ethical clearance was obtained from relevant authorities. Statistical analysis was done using descriptive and comparative data analysis with the aid of the SPSS software, and STROBE guidelines were followed. A total of 120 patients were included, 70 males and 50 females, majority in their fifth decade. 14 patients had no documented risk factors. 42.5% had STEMI, 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%), 55.6% of them were type A and 44.4% were type B. Most frequently encountered risk factor among Wellens syndrome patients was Diabetes (50%). Out of 16 Wellens syndrome patients who underwent coronary angiography, 50% had mid LAD involvement, most were type A; 25% had proximal LAD involvement and 25% had normal coronary angiography. There was some association between Wellens syndrome and NSTEMI, but no significant association with any specific risk factor. Wellens syndrome complicates 15% of acute coronary syndrome patients with a 55.6% possibility of becoming type A, it can present even without a specific predisposing risk factor and coronary angiographic variation other than the proximal part of the LAD artery may occur, including multiple vessels involvement. This is a descriptive cross sectional study conducted at Ahmed Gasim Teaching Hospital in Sudan, to determine the prevalence and risk factors of Wellens syndrome. Data was collected using questionnaires and analyzed with the SPSS software. Out of 120 patients, 14 patients had no documented risk factors. 34.2% had NSTEMI and 23.3% had unstable angina. Patients fulfilling Wellens syndrome criteria were 18 (15%). The commonest risk factor among Wellens syndrome patients was Diabetes (50%). 50% of Wellens syndrome patients had mid LAD involvement. The study concluded that Wellens syndrome is not rare, it can present without specific risk factor and coronary angiographic variation other than the proximal LAD artery can occur.

A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain.

Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: "initially moderate pain intensity remaining moderate" (n = 62), "initially mild pain intensity remaining mild" (n = 221), and "initially moderate pain intensity decreasing to mild" (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: "initially high level of MME/day gradually decreasing" (n = 89), "initially low level of MME/day remaining low" (n = 108), and "initially moderate level of MME/day decreasing to low" (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the "initially mild pain intensity remaining mild" trajectory were less likely than those in the "initially moderate pain intensity remaining moderate" trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06-0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28-2.54] and 0.95 [0.22-4.13]). Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.

Impact of 25-hydroxy vitamin D levels in severe acute respiratory syndrome coronavirus 2 patients with respect to clinical and biochemical profile: An experience from a tertiary care hospital

IntroductionAmong the many micronutrients, Vitamin D deficiency has been associated with the severity of Severe Acute Respiratory Syndrome Coronavirus 2 patients. Design and MethodsA retrospective observational study was conducted on Severe acute respiratory syndrome coronavirus 2 patients admitted to a tertiary care hospital between April 5, 2021, and May 5, 2021. ResultsAmong 285 patients,77.2% of the patients who stayed for more than 14 days were either Vitamin D insufficient or deficient [P value<0.05]. In our study, the mean oxygen saturation at admission was 85.7% in the Vitamin D deficiency group compared to 95.6% in Vitamin D sufficiency patients. [P value<0.05]. Mean serum ferritin was 398ng/ml in the Vitamin D deficiency group compared to 393ng/ml in Vitamin D sufficiency patients[P value>0.05]. The mean C-reactive protein was 107.6mg/ml in the Vitamin D deficiency group compared to 21.8ng/ml in Vitamin D sufficiency patients[P value<0.05]. The mean D-Dimer was 2268 ng/ml in the Vitamin D deficiency group compared to 781 ng/ml in Vitamin D sufficiency patients. [P value<0.05].In the non-survivor group,97.4% were Vitamin D deficient and insufficient. Only 2% of the patients who survived were Vitamin D deficient. [P value<0.05]. ConclusionWe observed that low 25-hydroxy Vitamin D levels were associated with lower oxygen saturation and higher acute physiology and chronic health evaluation II scores, requiring a more extended stay in the hospital. C-reactive protein and D-dimers were significantly higher in Vitamin D deficient patients, suggesting severe disease. We did not find statistically significant findings in the case of the correlation of serum ferritin levels with Vitamin D status.

Current problems of complications of bacterial meningitis

A review of modern Russian and foreign, predominantly English-language, literature on bacterial meningitis and complications resulting from its outcome was carried out. Publications not older than 5 years published in specialized medical journals and manuals were taken into account. The review includes studies in which participants had a verified diagnosis of bacterial meningitis according to modern clinical and laboratory criteria, and were under 18 years of age at the time of the disease. Eligible observational study designs for our review included case-control observational descriptive and analytic studies and cohort studies. Studies were excluded in which participants suffered from any somatic pathologies that could affect the results or provoke complications as a result of neuroinfection. The review also included data from the Russian Reference Center for Monitoring Bacterial Meningitis for 2019.

Meta-Analysis the Effect of Pregnancy with Hepatitis B on Preterm Birth and Gestational Diabetes Mellitus

Background: HBsAg positive pregnant women are responsible for around 50% of the global disease burden. Hepatitis B is caused by inflammation or infection of liver cells caused by the HBV virus. Pregnant women with hepatitis B can experience increased levels of cytokines which then cause pregnancy disorders. This study aims to examine the effect of pregnancy with hepatitis B on the incidence of preterm birth and Gestational Diabetes Mellitus (GDM). Subjects and Method: This study is a meta-analysis study and a systematic review. The articles used were obtained from several electronic databases including PubMed, Science Direct, Research Gate, and Google Scholar. The articles used in this study were articles that have been published from 2012-2022. The keywords to search for articles are as follows Pregnancy AND (“Hepatitis B” OR HBV OR HBsAg) AND (“pregnancy outcome” OR “fetal outcome”) AND (“preterm birth” OR “preterm delivery” OR premature) AND (“gestational diabetes mellitus” OR GDM). The researched article is a complete text with an observational study design. Articles were collected using the PRISMA diagram, and analyzed using the Review Manager 5.4 application. Results: A total of 14 prospective and retrospective cohort studies were analyzed. Articles were originated from China, Hong Kong, France and Botswana. Hepatitis B in pregnancy increased the risk of preterm birth (aOR=1.20; CI 95%=1.09 to 1.33; p&lt;0.001) and gestational diabetes mellitus (aOR= 1.20; CI 95%= 1.12 to 1.28; p&lt;0.001). Conclusion: Hepatitis B in pregnancy increases the risk of preterm birth and GDM significantly. Keywords: Hepatitis B, pregnancy;, preterm birth, gestational diabetes mellitus Correspondence: Alfi Zamilul Haniah. Master’s Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: alfizamilul11@gmail.com. Mobile: +6281334801248.

Dengue Fever Perception and Knowledge for Endemicity Control among University Students of Karachi

Objective: To determine the knowledge and the risk perception regarding dengue fever among the educated population along with their behaviors towards prevention in the backdrop of rising cases of dengue at the national level.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Departments of Electrical, Software Engineering, Computer Sciences and Geophysics of Bahria University, Karachi Campus, Pakistan, from October 2021 to March 2022.Methods: With an observational analytical study design, 333 students were recruited through convenient sampling. Data were collected using a structured questionnaire. The socio-demographic traits and general information about dengue fever spread and prevention were presented in frequencies and percentages while dengue fever knowledge, risk perception, and behavior of respondents were compared using a chi-square test with the significance level set at 0.05. Results: It was found that 79.8% of the students recognized that transmission of dengue is through mosquitoes, whereas only 17.4% identified the correct species of dengue infection. Twenty-two percent knew that dengue is a viral illness. Sixty-eight percent marked contaminated water as a mosquito breeding site, while 52.8% believed it to be trash/garbage. Eighty-nine, sixty-nine and fifty-two percent reported the use of window screens, bed nets/mesh, and insect repellents as protective measures, respectively. Fifty-seven percent of participants considered dengue a fatal illness. Eighty-eight and seventy-five percent recognized dengue as a preventable and curable disease, respectively. Conclusion: Educated participants in this study were misapprehensive that they had satisfactory knowledge, risk perception, and behavior toward dengue fever. Very few had the correct knowledge regarding transmission mode and spread and protective and preventive strategies. Information regarding transmission mode and spread, as well as protective and preventive strategies, were insufficient.&#x0D; How to cite this: Qureshi FM, Bari SF, Wazir SM, Wazir M, Zehra S, Khalid A. Dengue Fever Perception and Knowledge for Endemicity Control among University Students of Karachi Life and Science. 2024; 5(1): 75-82. doi: http://doi.org/10.37185/LnS.1.1.373

Survey of UK veterinary students' perceptions about a career in equine practice

SummaryBackgroundWorkforce shortages are challenges facing veterinary practice. Anecdotal evidence suggests that veterinary students are less interested in entering equine practice than previously.ObjectivesInvestigate veterinary students' perceptions about equine veterinary education and about working in equine practice.Study designObservational study: online survey.MethodsSurvey distributed via social media to veterinary students in the United Kingdom. Open and closed questions to document intended career path of students and evaluate perceptions about careers in equine practice.ResultsSeven hundred and forty‐four students completed the survey—from 10 veterinary schools. 88.8% intended to work in clinical practice (32.9% mixed; 25.3% small animal; 20.2% equine; 10.9% farm; 10.7% other/undecided). Factors considered most important for their first job included: mentoring and support (47.0%), team and practice culture (26.2%), working hours (including out‐of‐hours; 9.2%), location (6.6%), salary and benefits (5.7%) and familiarity with the practice (3.1%). 55.2% felt there were barriers to entering equine practice. 46.9% had ridden a horse regularly; 14.2% had never ridden. Respondents in clinical years rated their university training in equine practice as ‘Excellent’ (10.0%), ‘Good’ (45.9%), ‘OK’ (35.3%), ‘Poor’ (7.0%) and ‘Rubbish’ (1.8%). 48.9% of respondents felt extra mural studies (EMS) had contributed most to their equine training. Statistical associations were identified between the following variables and intention to work in equine practice: owning a horse, having ever ridden a horse, confidence in handling horses, student membership of BEVA and desire to undertake an internship.Main limitationsPotential selection bias.Conclusions20% of students reported an intention to work in equine practice, but risk of selection bias. The results indicate a potential mismatch between the number of students interested in equine practice and the availability of equine jobs for new graduates. Students with pre‐existing equine interest/experience are more likely to want to enter equine practice. EMS appears important for students' training in equine medicine.