Patient Files Research Articles

An evaluation of 30 years’ experience in the use of botulinum toxin injections in the management of sixth nerve palsies

ABSTRACT Intrroduction Sixth nerve palsy is the most common type of extraocular muscle palsy. The therapy options in sixth nerve palsies include monitoring with or without conservative treatment, botulinum toxin injections or strabismus surgery. The aim of this retrospective study was to compare botulinum toxin (BT) injections into the medial rectus to conservative treatment in sixth nerve palsies. The rate of patients improved after intervention and treatment outcomes for the two treatment options were be evaluated at a German tertiary referral center. Methods A service evaluation was conducted on adult patients with sixth nerve palsy. Patient files were reviewed and data including abduction deficit and size of deviation were collected retrospectively. Patients which presented between January 1987 and April 2022 were considered. Patients were allocated into two treatment groups: BT injected into medial rectus or conservative treatment, which included observation, providing occlusion and Fresnel prisms. Inclusion criteria were attendance of two visits with orthoptic assessment. Exclusion criteria included presence of further oculomotor palsies, strabismus, strabismus surgery and suppression. Non-parametric statistical analysis was conducted using IBM® SPSS Statistics. Results A total of 606 adult patients with unilateral or bilateral sixth nerve palsy attended during the named period. A total of 137 adult patients met the inclusion criteria. Of which, 36 had a bilateral palsy, 101 had a unilateral palsy. 45.26% (n = 62) were treated with BT injections and 54.75% (n = 75) were treated conservatively. The median initial abduction deficit was greater in the BT group, (−4 to −5 after Scott and Kraft) than in the conservative treatment group (−1). The initial angle of deviation at distance was significantly larger in the BT group than in the conservative treatment group (p = <0.001). The rate of improvement in the BT group was 24.19% (n = 15) and 20% (n = 15) in the conservative treatment group. When excluding longstanding palsies rates of improvement in both groups increased to 28.85%. The improvement of the angle of deviation at distance in all patients was greater in the BT group (p = <.001). The improvement of abduction in bilateral palsies were greater in the BT group (p = .016), but in unilateral palsies, there was no significant difference in abduction improvement in the two treatment groups (OD p = .3, OS p = .406). Conclusion This service evaluation found that BT injection into medial rectus in unilateral and bilateral sixth nerve palsies did not increase the rate of improvement compared to conservative treatment. But BT injections reduced the angle of deviation to a greater extent than conservative treatment. Additionally, BT was able to improve abduction in bilateral palsies to a greater extent than conservative treatment. It is recommended a BT injection is considered in symptomatic bilateral sixth nerve palsies to enable fixation and improved ocular motility. More research is needed to verify reliable clinical guidelines for the use of BT in sixth nerve palsies.

Exploring chest wall deformities in childhood and adolescence: insights from a case-control study

BackgroundChest wall deformities, though relatively uncommon in childhood and adolescence, significantly affect aesthetic perception and can impact cardiac and respiratory function. This study aims to compare individuals with pectus deformities to a healthy control group, shedding light on the condition’s etiology and prognosis.MethodConducted as a case-control study between 2020 and 2022, the research included a case group of 71 patients with pectus excavatum or pectus carinatum who were followed up at the Pediatric Cardiology outpatient clinic. The control group consisted of 80 children without chronic diseases. Researchers retrospectively reviewed patient files, recording demographic data, echocardiography findings, and serum levels of calcium, phosphate, vitamin D, and alkaline phosphatase.ResultsPatients with chest wall deformities exhibited significantly lower serum levels of vitamin D, calcium, and phosphorus compared to those without deformities. Males constituted 77% of the case group, with 15.5% exhibiting abnormal echocardiogram results, with mitral valve anomalies being most prevalent.ConclusionWhile pectus deformities may lead to cardiac or respiratory issues, patient concerns often center around aesthetics. Unlike typical studies focused on surgical techniques and postoperative patients, our study focused on all diagnosed patients. Findings emphasize the importance of monitoring calcium, phosphorus, and vitamin D levels in pectus patients to manage surgical risks and facilitate recovery.

The Treatment Outcomes of Tuberculosis Patients at Adare General Hospital, Southern Ethiopia (A Five-Year Retrospective Study)

Ethiopia is among the countries most heavily affected by tuberculosis, where it is the leading cause of morbidity, the third cause of hospital admission and the second cause of death. To improve tuberculosis management and control, the early detection of cases, effective treatment and the persistent evaluation of treatment outcomes are vital issues that should be taken into consideration. This study was designed to determine the treatment outcomes and associated risk factors among TB patients registered at Adare General Hospital in Southern Ethiopia. A five-year retrospective study was conducted by reviewing the files of the TB patients registered from September 2013 to August 2017. The data were coded, cleaned, entered and analyzed using SPSS version 20 statistical software. Bivariate and multivariable logistic regression with odds ratios (OR) along with a 95% confidence interval was computed and interpreted. A p-value &lt; 0.05 was declared as statistically significant. Among the 1122 cases, 620 (55.3%) were male, 748 (66.7%) were from urban areas, 319 (28.4%) were smear positive, 352 (31.4%) were smear negative and 451 (40.2%) were extra-pulmonary patients. Among the treated patients, 284 were declared cured, 753 completed their treatment, 29 were defaulters, 3 failed to follow up, and 53 died. The overall treatment success rate was 92.4%. The TB patients from urban areas (AOR = 1.44, 95% CI: 0.28, 0.67), and the HIV-negative TB patients (AOR = 5.48, 95% CI; 3.474, 8.64) were significantly associated with successful treatment outcomes. The treatment success rates of tuberculosis at Adare General Hospital were comparable to the national health facility-level coverage, but they should be maintained and strengthened further to attain tuberculosis-related national and millennium goals.

Clinicopathological and epigenetic differences between primary neuroendocrine tumors and neuroendocrine metastases in the ovary

AbstractCurrently, the available literature provides insufficient support to differentiate between primary ovarian neuroendocrine tumors (PON) and neuroendocrine ovarian metastases (NOM) in patients. For this reason, patients with a well‐differentiated ovarian neuroendocrine tumor (NET) were identified through electronic patient records and a nationwide search between 1991 and 2023. Clinical characteristics were collected from electronic patient files. This resulted in the inclusion of 71 patients with NOM and 17 patients with PON. Histologic material was stained for Ki67, SSTR2a, CDX2, PAX8, TTF1, SATB2, ISLET1, OTP, PDX1, and ARX. DNA methylation analysis was performed on a subset of cases. All PON were unilateral and nine were found within a teratoma (PON‐T+). A total of 78% of NOM were bilateral, and none were associated with a teratoma. PON without teratomous components (PON‐T−) displayed a similar insular growth pattern and immunohistochemistry as NOM (p &gt; 0.05). When compared with PON‐T+, PON‐T− more frequently displayed ISLET1 positivity and were larger, and patients were older at diagnosis (p &lt; 0.05). Unsupervised analysis of DNA methylation profiles from tumors of ovarian (n = 16), pancreatic (n = 22), ileal (n = 10), and rectal (n = 7) origin revealed that four of five PON‐T− clustered together with NOM and ileal NET, whereas four of five PON‐T+ grouped with rectum NET. In conclusion, unilateral ovarian NET within a teratoma should be treated as a PON. Ovarian NET localizations without teratomous components have a molecular profile analogous to midgut NET metastases. For these patients, a thorough review of imaging should be performed to identify a possible undetected midgut NET and a corresponding follow‐up strategy may be recommended.

Anthropometric Indices of Obstructive Sleep Apnea Patients in Mauritius.

Background Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder, affecting a significant number of individuals globally.It is associated with poor quality of life and an increased risk of all-cause mortality. It is estimated that most of the patients suffering from OSA are obese. Anthropometric indices can help guide doctors towardthe diagnosis. Objectives This study aimed to establish specific anthropometric thresholds associated with OSA risk, allowing clinicians to identify individuals more likely to have OSA and who may need further evaluation, such as polysomnography. This targeted screening approach would enable better resource allocation to those at higher risk, potentially enhancing the efficiency of OSA diagnosis and management. Methods We conducted a descriptive study using data from the sole private sleep clinic in Mauritius. We analyzed case files of consecutive patients diagnosed with OSA over a 3.5-year period from January 2015 to June 2018. Results The study population comprised 170 patients (79.4% males) diagnosed with OSA by a polygraphy test.The mean age of OSA diagnosis in men and women was 51.7 ± 14.0 years and 53.8 ± 12.5 years, respectively.The mean neck circumference (NC) for males and females was 41.9 ± 3.9 cm and 38.2 ± 3.9 cm, while the mean waist circumference (WC) was 105.6 ± 12.2 cm for men and 103.4 ± 14.5 cm for women. The body mass index (BMI) was 29.1± 5.0 kg/m2 and 31.4± 6.8 kg/m2 for males and females, respectively. The apnea-hypopnea index (AHI) averaged to 42.1 ± 19.7 events/hour for men and 33.3 ± 16.4 events/hour for women.In male patients, we found a positive significant correlation (p<0.001) between AHI and the following parameters: BMI (r=0.443), WC(r=0.337), WC-to-height ratio (WHr) (r=0.378), NC(r =0.274), and neck-to-height ratio (NHr) (r =0.321).In women, we observed a positive significant correlation between apnea severity and the following: BMI (r=0.396, p=0.029), WC (r=0.462, p=0.005), and WHr (r=0.494, p=0.003).No significant relationships were observed between AHI and the following parameters in women: NC (r=0.317, p=0.064) and NHr (r=0.311, p=0.069). A total of 83.5% of patients had a Mallampati score of 3-4. Conclusion This study represents a pioneering effort on the island. While further research is necessary to establish exact anthropometric cutoff values, the findings offer crucial insights for physicians to identify high-risk individuals. With just a scale, measuring tape, and calculator, healthcare professionals can detect important health markers that extend beyond diagnosing OSA. These simple measurements not only help in predicting OSA but also provide a broader view of an individual's overall health, identifying risks that go beyond sleep issues. This research sets an important foundation for future OSA studies within the Mauritian population.

Polysaccharide, Conjugate, and mRNA-based Vaccines are Immunogenic in Patients with Netherton Syndrome

BackgroundNetherton syndrome (NS) is a rare, severe genetic skin disorder, currently classified as an inborn error of immunity (IEI) due to previously reported immune dysregulation. We recently reported the results of an immunological evaluation showing no evidence for a relevant B- and/or T-cell mediated immunodeficiency, but immune responses after vaccination were not evaluated in that study. Therefore, we evaluated immune responses to three vaccine platforms in adult NS patients to further investigate the presence of a clinically relevant B- and/or T-cell immunodeficiency.MethodsVaccination responses in eight adult NS patients were assessed in a cross-sectional study performed between January and August 2022. Clinical patient data were retrospectively retrieved from electronic patient files. Immune responses to a polysaccharide Streptococcus pneumoniae vaccine (PPV23) and conjugate Haemophilus influenzae type b vaccine (ActHiB) were measured. SARS-CoV-2-specific (functional) antibody and T-cell responses following booster vaccination with an mRNA-based COVID-19 vaccine were compared to controls.ResultsNone of the included patients suffered from recurrent and/or severe infections that could be attributed to a B- and/or T-cell immunodeficiency. ActHiB induced immune responses were normal in 7/7 NS patients. PPV23 induced responses were absent in 1/7, diminished in 2/7, and normal in 4/7 patients. Levels of SARS-CoV-2-specific binding and neutralizing antibodies after mRNA-based COVID-19 booster vaccination in NS patients were comparable to controls. SARS-CoV-2-specific CD4 + T-cell responses were detectable in all NS patients. In contrast, SARS-CoV-2-specific CD8 + T-cell responses were detectable in only 2/6 NS patients. T-cell responses to a positive control antigen pool were comparable to controls.ConclusionsVaccine-induced immune responses were detectable after polysaccharide, conjugate and mRNA-based vaccination in our cohort of NS patients. A spectrum of responsiveness to vaccine challenges was found, with the ranges of vaccine responses overlapping those demonstrated in healthy control populations.

Valuation of prescription patterns of &lt;i&gt;Helicobacter pylori&lt;/i&gt; drugs in outpatient department, Meru Teaching and Referral Hospital

BACKGROUND Helicobacter pylori infects up to half of the world’s population. Infection with Helicobacter pylori is a major contributing factor for gastric ulcers, gastric carcinoma, and extra gastric disease. The main aim of this study was to observe the prescription patterns of Helicobacter pylori drugs at Meru Teaching and Referral Hospital, Meru. This infection is mostly treated by a triple-drug regimen for successful eradication. The available regimens are a combination of proton pump inhibitors, antibiotics, bismuth sulfate, and histamine blockers. METHODOLOGY A cross-sectional retrospective review of the patient files for Helicobacter pylori was done at Meru Teaching and Referral Hospital (MeTRH). Systematic random sampling was used to select 262 medical records for review. Data was collected using the pre-tested abstraction forms and was coded and analyzed for descriptive statistics. RESULTS Out of the 262 medical records that were reviewed, 147 (56.4%) were males prescribed the Helicobacter pylori drug regimen. Among all the young adults (age: 12-39 years) were more likely to get Helicobacter pylori infection. The medication regimens that were highly preferred at MeTRH were 14-day and 7-day clarithromycin triple-based therapy. The 14-day triple therapy accounted for 74.5% of all patient files. The most administered drug class for Helicobacter pylori were proton pump inhibitors at 45.3% followed by antibiotics at 38.8% and the least prescribed drugs were the H2 blockers with 15.9%. CONCLUSION Regarding the most prescribed drug, the proton pump inhibitors while the most preferred regimen was the 14-day clarithromycin triple-based therapy. This data will certainly be important for the pharmaceutical management chain to manage the stock of analyzed drugs and also can spread awareness regards the appropriate handling of drugs which can improve adherence and reduce the rate of treatment failure and the emergence of antibiotic drug resistance.

Ototoxicity associated with hematopoietic stem cell transplantation; what are the risk factors?

Background Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematologic malignancies but can lead to complications, including ototoxicity. Aim/objectives This study aims to explore the relationship between patient-specific factors and ototoxicity in adult HSCT patients. Material and Methods We conducted a retrospective analysis of 129 adult patients who underwent HSCT between 2003 and 2020. Age, gender, transplant indications, conditioning regimens, and pre- and post-transplant audiometry thresholds data were collected from patient files. A hearing loss of 10 decibels or more at two consecutive frequencies or a hearing loss of 20 decibels or more at a single frequency was considered as significant hearing loss (SHL). Statistical analyses were performed to describe factors associated with SHL. Results SHL occurred in 16.3% of patients. Older age was significantly associated with an increased risk of SHL (p = .035). Poorer pretransplant hearing thresholds at 4000 Hz and 6000 Hz were also significant predictors of SHL (p = .039 and p = .014, respectively). There was no significant relationship between the donor type of HSCT (autologous vs. allogeneic) and ototoxicity (p = .45), and between conditioning regimens and ototoxicity (p = .860). Conclusions Age and pre-existing hearing levels are significant predictors of ototoxicity post-HSCT. Careful management and monitoring are essential to prevent and address hearing loss in HSCT patients to improve hearing-related quality of life.

Determinants of successful transition from adolescent to adult HIV treatment in Zambia: a facility-level based comparative study

Background: Successful transition from adolescent to adult care has not been extensively evaluated, in Zambia. The study aimed to assess the relationship between facility-based socio-demographic traits and successful transition to adult HIV care, in Zambia. Methods: A retrospective descriptive cross-sectional analysis of 7275 patient files from 718 PEPFAR sponsored facilities. Data was extracted from the National Electronic Health Record (EHR) system and imported into STATA SE v-16 for analysis. Descriptive statistics were calculated on socio-demographic features and facility-level performance. Logistic regression was used to analyse the association between level of facility and successful transition to adult care, comparing third level facilities to lower-level facilities. Chi-square was employed to evaluate the association between socio-demographic traits and effective transition outcomes at a significance level of 0.05. Results: 43.2% had successfully transitioned to adult care. Health posts performed the best, with 57.3% of patients successfully transitioning to adult care. The study found that health post type, private ownership, rural location, and province were significant factors in successful transition. Adolescents in lower-level facilities had a 59.9% success rate compared to those in third-level facilities. Conclusions: The study stresses the importance of health system structure and posits that successful transition depends on many factors, not simply adolescent traits.

Eosinophilic cationic protein and D-Dimer are potential biomarkers to predict response to antihistamines but not to omalizumab in chronic spontaneous urticaria

ABSTRACT Introduction: Biomarkers that could reliably anticipate the effectiveness of antihistamines and omalizumab in treating chronic spontaneous urticaria (CSU) have not been conclusively identified. Our objective was to examine how eosinophilic cationic protein (ECP), tryptase, D-dimer, and total Immunoglobulin E (IgE) impact the response to antihistamine and omalizumab treatments in individuals with CSU. Methods: In this cross-sectional retrospective study, CSU patients that had undergone treatment with either antihistamines or omalizumab for a minimum of 12 weeks between 2015 and 2021 at an Allergy and Immunology Department were analyzed. Several demographic and laboratory parameters including eosinophil counts, mean platelet volüme (MPV), sedimentation, C-reactive protein (CRP), antinuclear antibodies (ANA) and Anti-thyroperoxidase (Anti-TPO) and total IgE, tryptase, ECP and D-dimer were retrived from patient files. The association of these biomarkers with Urticaria Control Test (UCT) and the effect of these biomarkers on treatment response were evaluated. Treatment response was assessed using the UCT, with a score of UCT ≥ 12 indicating a responder and UCT < 12 indicating a non responder. Results: The patients in the omalizumab group were older, had a longer disease duration and had worse urticaria control (lower baseline UCT scores). 421 patients were treated with antihistamines and 88 patients were treated with omalizumab. ECP was found to be inversely correlated with baseline UCT (p < 0.001 r=−0.268). ECP and D-dimer levels of non-responder patients in the antihistamine group were significantly higher than in responder patients (ECP: 49 ng/mL vs 28.1 ng/mL, p < 0.001) (D-dimer: 0.60 mg/L vs 0.30 mg/L, p < 0.001), while there were no significant difference in terms of tryptase and total IgE. These four biomarkers were similar, in omalizumab responders and non responders. Conclusion: In this study with CSU, we looked at predictors of responses to treatments. ECP can serve as a marker of poor urticaria control and may predict antihistamine refractoriness along with D-dimer.

10 years after treatment with renal denervation of the sympathetic nerves for resistant hypertension: what happened to the patients and their office blood pressure? An observational study

Abstract Background Catheter-based renal denervation of the sympathetic nerves (RDN) for resistant hypertension has long been controversial. A renewed clinical and scientific interest in defining the appropriate role of RDN in the treatment of resistant hypertension has become evident in recent years. The efficacy and safety of RDN treatment is mainly based on available data up to three years, whereas data concerning the long-term effect and safety are scarce. Purpose We therefore wanted to investigate the long time change in blood pressure (BP) in patients treated with RDN for resistant hypertension. Methods A review of data from the electronic patient journal concerning all RDN treated patients was initiated and completed in October 2023. Every registration of an office BP listed in the patient file, antihypertensive treatment, cardiovascular events, and renal function between 2012 and 2023 were registered. For each patient the average of all office post RDN blood were averaged for every year and for their complete follow-up. The outcome in blood pressure was the change in BP from baseline pre RDN office to follow-up Results Between January 2012 and October 2013, 19 consecutive patients underwent RDN treatment, 10 men and 9 women with a median age of 63 years (range 35-74 years). At baseline the median systolic office BP was 181 mmHg (range 162–230 mmHg) and the diastolic office BP 97 mmHg (range 82-123 mmHg) on a median of 5 (range 0-7 ) antihypertensive drugs. During follow-up the number of antihypertensive drugs were reduced in 7, unchanged in 10, and increased in 2 patients. Two patients left the outpatient clinic with normal BP after 2 years. Two patients developed heart failure after 7 years and were censored at that time-point. 15 (79%) patients had office BP recorded up to 9 or 10 years. In the 15 (79%) patients with available office BP 9 to 10 years after RDN the median systolic and diastolic office BPs were reduced by 39 mmHg (range -2 to - 66 mmHg) and 18 mmHg (range -11 to - 55 mmHg) respectively, relative reduction 22% (range 5-36%) and 20% (range 6-32), respectively. Conclusion During a follow-up of 9 to 10 years after RDN without a step-up in antihypertensive medication a relative decrease of ~20% in systolic and diastolic BP was observed.

Rethinking electronic health records implementation in Germany: a value-based health system approach

Abstract Problem The Digital Act (Digital-Gesetz) in Germany stipulates that electronic health records (elektronische Patientenakte; ePA) will be set up for all persons under the statutory health insurance (SHI) in 2025; those who do not wish to use ePA can object. This opt-out approach aims to increase the coverage of ePA among the SHI population to 80%, which has been ca. 1.5% since its launch in 2021. According to law, ePA is managed solely by the patient and does not replace the conventional patient file stored in the medical practice management system. Without appropriate measures, it is likely that multiple parallel patient files are created, with the risk of ePA being side-lined over time. Description The Ministry of Health aims to make ePA the central platform for patients’ healthcare provision throughout their life. With ePA, patients should receive useful information about their healthcare as well as reminders and tailor-made medical advice. For healthcare providers, ePA should become an essential part of the healthcare process with containing reliable information and supporting the treatment. However, understanding ePA as more than a digital health solution, factors beyond technical interoperability must be considered for its successful implementation. Results The full potential of ePA and its positive impact on healthcare to tackle the fragmentation issue can only be realised when it is viewed as a helpful tool of collaboration for all involved parties. The existing regulatory frameworks in Germany create disincentives for greater integration, coordination, and interconnection, with each sector following its own reimbursement system and reinforcing the division between them. This contradicts with the idea of ePA fostering patient-centredness and inter-sectoral collaboration. Lessons How a health system functions and how health services are governed and remunerated have a substantial impact on the healthcare providers’ acceptance of digital services. Key messages • Changes in the governance of health systems may be necessary when implementing electronic health records to bring person-centred care and overcome the separation of in-patient and out-patient sectors. • Rather than a paternalistic approach, the relationship between the patient and healthcare provider should move towards a partnership model, based on the motivation of keeping individuals healthy.

Barriers and enablers towards integrated care for sexual violence victims in humanitarian settings

Abstract Background Sexual violence (SV) is a complex public health issue that necessitates a coordinated multisectoral response. Ideally, this response should be provided through an integrated care package to strengthen timely access and comprehensive care for victims. However, in humanitarian settings with high levels of SV, care is often offered through fragmented silos, exacerbating the burden on the health workforce and victims. Methods Using the Valentijn framework, a qualitative, real-time Delphi study was conducted with 17 SV care experts representing 7 geographical subregions to gain informed opinions on key contextual and health system barriers and enablers for integrated care for SV victims in humanitarian settings. Results Challenges and enablers reported across the diversity of the participants’ contexts showed consistency. Contextual challenges included volatile contexts, collapsed health systems, and poor infrastructure. Professional challenges included a lack of expertise among healthcare providers (HCPs), high staff attrition, and compassion fatigue among HCPs. Health systems challenges included poor referral and coordination mechanisms, insufficient resources, misaligned donor-programme priorities and low prioritisation of SV comprehensive care. Key enablers reported were effective networking, community engagement, capacity building, co-locating services, participatory management, promoting staff’s sense of ownership, digitalised information systems, and joint patient files. Conclusions The sustainability of integrated care for SV victims can be strengthened by ensuring HCPs access regular psychological support and training and are incentivised to provide quality care. Regular coordination among actors, including donors, can support integrating care that responds to patients’ holistic needs. Further research is needed to assess HCPs’ and SV victims’ experiences of current service delivery and how to optimise integrated care in humanitarian settings. Key messages • Addressing care providers challenges in humanitarian settings, such as high attrition, lack of training, psychosocial support, and burnout, can ensure proper integration of sexual violence care. • Integration of sexual violence care demands systemic changes, including aligning donor-programme goals, building accountability mechanisms and the buy-in of political and community leaders.

Pattern and outcome of the first manifestation of cardiovascular disease among patients with type 2 diabetes mellitus in Cameroon: a cross-sectional study

BackgroundCardiovascular diseases (CVDs) are the most common cause of morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a paucity of data on the pattern of first manifestation of CVD and the outcome among patients with T2DM in Cameroon.ObjectivesWe aimed to examine the pattern of the first manifestation of CVD and the outcome among patients with T2DM.MethodsBetween January 2017 and December 2023, files of patients with T2DM hospitalized for the first observed CVD were reviewed. We identified cases of three incident overt clinically manifest CVD complications (acute myocardial infarction [AMI], stroke, and heart failure) in hospitalized T2DM patients. Patients with a previous history of CVD were excluded.ResultsOut of the 1091 patients hospitalized with T2DM, we identified 261(23.9%) patients with clinically overt CVD, of whom 129 (49.4%) were females. The mean age was 63.9 ± 12.1 years and ranged from 15 to 91 years. Women were significantly older compared to men (65.4 ± 11.4 years vs. 62.5 ± 12.6 years; p = 0.042). Hypertension was reported in 201 (77%; 95% CI: 71.4–82) patients. Any form of chronic kidney disease was seen in 15 (5.8%; 95% CI: 3.3–9.3) patients. HIV infection was seen in 5 (1.9%; 95% CI: 0.6–4.4) patients. Stroke was the most common incident clinically overt CVD in 144 (55.2%; 95% CI: 48.9–61.3) patients, followed by heart failure in 105 (40.2%; 95% CI: 34.2–46.5) patients, and Acute MI in 12 (4.6%; 95% CI: 2.4–7.9) patients. The mean length of hospital stay was 9.7 ± 6.6 days. Patients with stroke had a significantly longer hospital stay > 7 days (63% vs. 48.7%, p = 0.021). The in-hospital case fatality was seen in 35 (13.4%; 95% CI: 9.5–18.2) patients.ConclusionNearly 1 out of 4 hospitalized patients with T2DM was hospitalized for a first CVD. Stroke and heart failure are the most common initial manifestations of CVD. More than three-quarters of the patients had concomitant hypertension and the in-hospital case fatality was high.Clinical trial numberNot applicable.

Deep neck infections mortal complications: Intrathoracic complications and necrotising fasciitis.

We planned this study considering that complications of deep neck infections can be seriously life threatening. To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity. This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1, 2024. When the patient files were retrospectively examined, 16 of 188 patients (8.5%) were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications. There were a total of 16 patients in this study, 9 males (56.25%) and 7 females (43.75%). All patients were adults (> 18 years) and the mean age was 50.37 years ± 15.37 years. Female patients had a mean age of 40.42 years ±13.38 years, whereas for male patients was 58.11 years ± 12.44 years. Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries, intensive care unit monitoring, and mechanical ventilator support. Higher rates of morbidity and mortality should be expected in these patients who are hospitalized for longer periods of time.

Validation of Albumin Prescription in Vali Asr and Ayatollah Musavi Zanjan Hospitals

Background: Human serum albumin (HSA) is a versatile protein exclusively produced by hepatocyte cells in the liver, constantly released into the bloodstream. Substantial quantities of HSA are employed to ameliorate a variety of clinical conditions. The purpose of this study was to assess the accuracy of albumin serum administration as recorded in the patient files of Valiasr and Ayatollah Mousavi Hospitals in Zanjan, Iran Methods: his study aimed to assess the accuracy of albumin prescriptions in adult departments of Ayatollah Mousavi and Valiasr hospitals from March 2013 to March 2019. Data on albumin consumption and patient information were collected by reviewing the medical records of patients, resulting in a selection of 316 cases. The study developed a reference framework for assessing albumin administration accuracy. A scoring mechanism was used to categorize prescriptions into appropriate, inappropriate, questionable, and ambiguous classes. Statistical analysis was conducted using SPSS software. Results: The findings indicated that the average patient age was 62.2 years. Among 316 patients, 60.4% were male. The mean serum albumin level was measured at 3.14 g/dL. The collective volume of albumin administered to patients across both hospitals was 5016 units, averaging 15.77 units per patient, and this was utilized over a total of 2253 days. Among the studied patients, 197 passed away during treatment, 110 were discharged, and nine were transferred to other wards. Based on the established reference, it was observed that 5.5% of prescriptions were accurate, 51.9% were inaccurate, 26.4% were debatable, and 0.6% were undetermined. The total cost of prescribing this quantity of albumin in both hospitals amounted to 9,274,584,000 Rials, distributed as 8,347,125,600 Rials and 927,458,400 Rials in their respective proportions. Conclusion: Ultimately, the study highlighted that physician-prescribed albumin, guided by provided instructions, contained numerous errors necessitating vigilant and ongoing oversight. After a comprehensive review of all the data presented, it is apparent that there is no conclusive evidence supporting the existence of a formalized strategy for a consistent reduction in albumin consumption within the hospitals.

The Stockholm Spinal Cord Uro Study: Changing patterns of urological surgery in a regional prevalence group through 50 years - Outcomes and lessons learned.

To examine the number and types of urological surgical procedures carried out in a regional prevalence population of patients with traumatic spinal cord injury (SCI) during five decades, evaluate objective and patient-reported outcomes and to consider lessons learned for further improvement of surgical treatment in this patient group. In a cross-sectional study of 412 patients with traumatic SCI, one-third had undergone urological surgery through a period of up to 50 years. Data on types of surgery, complications, follow-up and outcomes were collected in a retrospective review of patient files. S-creatinine, S-cystatin-C, renal ultrasound and a questionnaire regarding complications during the preceding year were assembled as part of a yearly follow-up. Descriptive statistics were calculated. Logistic regression was used to determine risk profiles for the incidence of urological surgery. A total of 137 patients had undergone 262 urological surgical interventions. The incidence was highest amongst persons with a cervical-thoracic neurological level of spinal cord lesion and during the first 2 years after SCI. Surgery for urinary stones constituted 29% of all procedures. One-fourth of the patients had undergone 47% of all procedures, notably urinary diversion and ensuing complications, implants and revisions, repeated stone interventions or bladder outlet procedures. After reconstructive surgery functional outcomes and patient-reported satisfaction were generally favourable, but long-term signs of renal complications were frequent. Urological surgery after SCI involves imperative as well as reconstructive procedures, some of which are challenging and call for centralisation to devoted teams. Prospective studies of reconstructive urology are warranted, including more extensive patient-reported outcomes.

Investigation of Acoustic Voice Characteristics of Individuals Diagnosed with Muscle Tension Dysphonia.

Muscle tension dysphonia (MTD) is a functional voice condition that causes irregular and imbalanced laryngeal and paralaryngeal muscle activation. Our study aimed to examine the acoustic characteristics of patients with MTD and reveal the differences between genders. The study retrospectively reviewed the acoustic examination findings from the files of patients diagnosed with MTD during evaluations in the laryngology outpatient clinic at a tertiary reference hospital between 2015 and 2022. The parameters assessed in prolonged vowel phonation analysis were fundamental frequency (F0), jitter, shimmer, noise-to-harmonic-to-ratio, and soft phonation index; in the counting task analysis, they were intensity, frequency, and semitone. Gender differences in acoustic measurements obtained during prolonged vowel phonation and counting tasks were also examined. The study included 80 individuals diagnosed with MTD. Although all parameters in the acoustic analysis of/a/ phonation were increased, differences were statistically significant only in the F0 and jitter parameters between females and males (p≤0.05). In the analysis of the counting task, the mean and minimum F0 parameters were significantly higher in females than in males (p=0.000). The mean dB level was decreased, particularly in the counting task, but the results for the intensity parameter did not differ significantly between genders (p>0.05). The values in the acoustic voice analysis parameters of patients with MTD were determined. These acoustic parameters are thought to guide the clinician in evaluating voice and determining voice therapy goals for MTD patients.

Evaluation of the Effect of Vaccination Status on Lung Involvement and Hospitalization in COVID-19 Patients

Background: The spectrum of COVID-19 in adults ranges from asymptomatic infection to mild respiratory tract symptoms to severe pneumonia with acute respiratory distress syndrome (ARDS) and multiorgan dysfunction. In our study, it was aimed to investigate the effects of COVID- 19 vaccine on lung involvement and hospitalization. Materials and Methods: Cases over the age of 18, who had a history of contact with cases infected with COVID-19 or had clinical findings suggestive of COVID-19, who applied to the emergency department and who were diagnosed with COVID-19 by reverse-transcriptase-polymerase chain reaction (RT-PCR) were included in the study. Age, gender, comorbid diseases, hospitalization status, thorax tomography findings, and vaccination status in the last 3 months of the patients included in the study were obtained by examining the hospital information system and patient files. Results: Our study included 496 patients. One hundred eighty-three of the cases were vaccinated and 42.6% (n = 78) of the vaccinated patients were male. Of the 313 unvaccinated patients, 36% (n = 113) were male. Comorbid disease was observed in 55.2% (n = 101) of the vaccinated patients and 38.7% (n = 121) of the unvaccinated patients. Of the 313 unvaccinated patients, 72.2% (n = 226) were discharged from the emergency department, 19.8% (n = 62) were admitted to the service, and 8% (n = 25) were admitted to the intensive care unit. Of the 183 vaccinated patients, 78.1% (n = 143) were discharged from the emergency department, 16.4% (n = 30) were admitted to the service, and 5.5% (n = 10) were admitted to the intensive care unit. In the vaccinated patient group, both the service admission rate and the intensive care hospitalization rate were found to be significantly lower than the non-vaccinated patient group (p &lt; 0.05). Thoracic tomography findings of 32.9% (n = 103) of 313 unvaccinated patients were reported as CORADS 1-2-3, and thoracic tomography of the remaining 210 patients was reported as CORADS 4-5. The number of patients whose thorax tomography report was CORADS 4-5 was found to be significantly higher in the unvaccinated group than in the vaccinated group (p &lt; 0.05). Conclusion: In our study, it was found that vaccination significantly reduced hospitalization in COVID-19 patients. Although the mean age was higher in the vaccinated patient group, both the service admission rate and the intensive care admission rate were found to be lower.

Current oral care practices in an acute aged care setting: An Australian metropolitan hospital perspective

Purpose To evaluate current oral care practices in an acute aged care hospital setting, and staff perceptions of the barriers and enablers to delivery of evidence-based oral care practices. Method A mixed method study comprised of retrospective file audit and cross-sectional survey was conducted within a single acute aged care unit. Medical records of patients aged ≥ 65 years admitted over a 6 month period were retrospectively audited. A clinician survey was used to explore barriers to and enablers of the delivery of oral care practices using the Capability, Opportunity, Motivation, Behaviour (COM-B) questionnaire. Result were analysed using descriptive statistics. Result Patient file audits (n = 206) found 13.6% (n = 28) of patients had oral care completed, despite 23% (n = 47) of patients being recommended by a speech language pathologist to receive oral care. Staff survey respondents (n = 31) reported they do not have the physical or social opportunities to provide oral care (i.e. adequate resources, time, and social support), however, they were motivated and reported they have the required knowledge and skills to provide oral care. Conclusion There is a need for implementation strategies to enable an interprofessional response to improve the delivery of evidence-based oral care practices and optimise patient outcomes.