History Of Hospital Admission Research Articles

Assessment of a screening tool to aid home-based identification of adolescents (aged 10-14) living with HIV in Zambia and South Africa: HPTN 071 (PopART) study.

The HPTN071 (PopART) for Youth (P-ART-Y) study evaluated the acceptability and uptake of a community-level combination HIV prevention package including universal testing and treatment (UTT) among young people in Zambia and South Africa. We determined whether a four-question primary care level screening tool, validated for use in clinical settings, could enhance community (door-to-door) identification of undiagnosed HIV-positive younger adolescents (aged 10-14) who are frequently left out of HIV interventions. Community HIV-care Providers (CHiPs) contacted and consented adolescents in their homes and offered them participation in the PopART intervention. CHiPs used a four question-screening tool, which included: history of hospital admission; recurring skin problems; poor health in last 3 months; and death of at least one parent. A "yes" response to one or more questions was classified as being "at risk" of being HIV-positive. Rapid HIV tests were offered to all children. Data were captured through an electronic data capture device from August 2016 to December 2017. The sensitivity, specificity, positive predictive value and negative predictive value were estimated for the screening tool, using the rapid HIV test result as the gold standard. In our 14 study sites, 33,710 adolescents aged 10-14 in Zambia and 8,610 in South Africa participated in the study. About 1.3% (427/33,710) and 1.2% (106/8,610) self-reported to be HIV positive. Excluding the self-reported HIV-positive, we classified 11.3% (3,746/33,283) of adolescents in Zambia and 17.5% (1,491/8,504) in South Africa as "at risk". In Zambia the estimated sensitivity was 35.3% (95% CI 27.3%-44.2%) and estimated specificity was 88.9% (88.5%-89.2%). In South Africa the sensitivity was 72.3% (26.8%-94.9%) and specificity was 82.5% (81.6-83.4%). The sensitivity of the screening tool in a community setting in Zambia was low, so this tool should not be considered a substitute for universal testing where that is possible. In South Africa the sensitivity was higher, but with a wide confidence interval. Where universal testing is not possible the tool may help direct resources to adolescents more likely to be living with undiagnosed HIV. Clinical Trial Number: NCT01900977.

FATORES PREDITORES DE HOSPITALIZAÇÃO E ÓBITO EM IDOSOS COM COMPROMETIMENTO COGNITIVO: UM ESTUDO LONGITUDINAL

ABSTRACT Objective: to identify sociodemographic factors, clinical conditions and sarcopenia parameters that predict hospital admission and death in older adults with cognitive impairment. Method: this is a longitudinal observational study carried out with 170 older adults with cognitive impairment assessed between 2019 and 2021. Predictor variables were sociodemographic characteristics, clinical conditions and sarcopenia parameters. Sarcopenia was operationalized through handgrip muscle strength (dynamometry), muscle mass (calf circumference) and the Timed Up and Go test. Occurrence of hospital admission and death within one year after assessment of older adults were the predicted variables. Analyzes were carried out using descriptive statistics, independent Student’ t-test, Mann-Whitney U test, chi-square test and univariate logistic regression. Results: most participants were female (±77.57 years old), with low education, sedentary, 15.9% with sarcopenia and 13% with a history of hospital admission. It was identified that education level had an effect on occurrence of hospital admission (U=1,423.5, p=0.027) and death (U=647.0, p=0.025) within one-year follow-up. Furthermore, there is an association between history of hospital admission in the last 6 months and occurrence of hospital admission [χ2(1)=4.729; p=0.030] and death [χ2(1)=3.919; p=0.048] within one year follow-up. It was identified that history of hospital admission in the last 6 months was associated with occurrence of hospital admission within one-year follow-up (OR=2.963; 95%CI 1.076-8.165, p=0.036). Conclusion: history of hospital admission in the last six months is associated with occurrence of hospital admission over a year in older adults with cognitive impairment.

Identification of Risk Factors Associated with Tuberculosis in Southwest Iran: A Machine Learning Method.

Tuberculosis is a principal public health issue. Reducing and controlling tuberculosis did not result in the expected success despite implementing effective preventive and therapeutic programs, one of the reasons for which is the delay in definitive diagnosis. Therefore, creating a diagnostic aid system for tuberculosis screening can help in the early diagnosis of this disease. This research aims to use machine learning techniques to identify economic, social, and environmental factors affecting tuberculosis. This case-control study included 80 individuals with TB and 172 participants as controls. During January-October 2021, information was collected from thirty-six health centers in Ahvaz, southwest Iran. Five different machine learning approaches were used to identify factors associated with TB, including BMI, sex, age , marital status, education, employment status, size of the family, monthly income, cigarette smoking, hookah smoking, history of chronic illness, history of imprisonment, history of hospital admission, first-class family, second-class family, third-class family, friend, co-worker, neighbor, market, store, hospital, health center, workplace, restaurant, park, mosque, Basij base, Hairdressers and school. The data was analyzed using the statistical programming R software version 4.1.1. According to the calculated evaluation criteria, the accuracy level of 5 SVM, RF, LSSVM, KNN, and NB models is 0.99, 0.72, 0.97,0.99, and 0.95, respectively, and except for RF, the other models had the highest accuracy. Among the 39 investigated variables, 16 factors including First-class family (20.83%), friend (17.01%), health center (41.67%), hospital (24.74%), store (18.49%), market (14.32%), workplace (9.46%), history of hospital admission (51.82%), BMI (43.75%), sex (40.36%), age (22.83%), educational status (60.59%), employment status (43.58%), monthly income (63.80%), addiction (44.10%), history of imprisonment (38.19%) were of the highest importance on tuberculosis. The obtained results demonstrated that machine-learning techniques are effective in identifying economic, social, and environmental factors associated with tuberculosis. Identifying these different factors plays a significant role in preventing and performing appropriate and timely interventions to control this disease.

Bronchiolitis hospital admission in infancy is associated with later preschool ventilation inhomogeneity.

Rhinovirus (RV)positive bronchiolitis episodes in infancy confer a higher risk to develop asthma in later childhood with associated lung function impairments. We aimed to investigate the association between the type of virus causing a bronchiolitis hospitalization episode and lung ventilation inhomogeneities at preschool age. Infants hospitalized with a clinical diagnosis of moderate (ward admission) or severe (pediatric intensive care ward admission) bronchiolitis were prospectively followed-up at preschool age to assess nitrogen (N2 ) multiple breath washout (MBW).Lung clearance index (LCI),functional residual capacity (FRC), and concentration normalized phase III slope analysis (SnIII ) indices were reported from ≥2 technically acceptable trials. Differences between groups were calculated using logistic and linear regression and adjusted for confounders (sex, age at bronchiolitis admission, height at visit, maternal asthma, and doctor-diagnosed asthma, including interaction terms between the latter three).An interaction term was included in a regression model to test for an interaction between RV bronchiolitis severity and MBW parameters at preschool age. One hundred and thirty-nine subjects attended preschool follow-up, of which 84 out of 103 (82%) performing MBW had technically acceptable data. Children with a history of RV positive bronchiolitis (n = 39) had increased LCI (adjusted β-coefficient [aβ] = 0.33, 95% confidence interval [CI]0.02-0.65, p = 0.040) and conductive airways ventilation inhomogeneity [Scond ] (aβ = 0.016, CI 0.004-0.028, p = 0.011) when compared with those with a RV negative bronchiolitis history (n = 45). In addition, we found a statistical interaction between RV bronchiolitis and bronchiolitis severity strengthening the association with LCI (aβ = 0.93, CI 0.20-1.58, p = 0.006). Children with a history of hospital admission for RV positive bronchiolitis in infancy might be at a higher risk of lung ventilation inhomogeneities at preschool age, arising from the peripheral conducting airways.

Low vitamin B12 blood levels in sickle cell disease: Data from a large cohort study in Tanzania.

Sickle cell disease (SCD) is associated with high rates of undernutrition and stunting. Undernutrition in combination with chronic haemolysis may lead to deficiencies in micronutrients necessary for erythropoiesis. Here we examined selected levels of ferritin, vitamins B2 , B6 , B9 and B12 , and vitamin C that were measured in blood samples from 820 SCD patients from Tanzania with no history of hospital admission, infections or painful episodes in the previous 30 days. We studied children (0-8 years), early adolescents (9-14 years), late adolescents (15-17 years) and adults (≥18 years). Severely low levels of vitamin B12 were observed across the four age groups. Despite the lowered vitamin B12 concentrations, total homocysteine concentrations were normal across both genders in all age groups. We found no significant gender-related differences between the other measured micronutrients. In this large SCD population, spanning the whole life cycle, a low level of vitamin B12 was consistently found across both genders and all age groups. Given the pivotal role of vitamin B12 in cellular metabolism, particularly in erythropoiesis, more studies are required to unravel how to better detect clinically relevant vitamin B12 deficiency among SCD patients, and thus to identify more precisely those who need supplementation of vitamin B12 .

Association between SARS-CoV-2 Seropositivity and Severity of Out-of-Hospital Acute Ischemic Stroke Following Asymptomatic/Mild COVID-19 in Children

Abstract Objective This article investigates the frequency of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and its association with the severity of new-onset acute ischemic stroke (AIS) among previously healthy children with asymptomatic/mild coronavirus disease 2019 (COVID-19). Methods A case–control study that included children < 18 years with out-of-hospital AIS of undetermined etiology and a control group of healthy children. Exclusion criteria were current respiratory symptoms, previous COVID-19 diagnosis, prior COVID-19 vaccination, active SARS-CoV-2 infection, history of hospital admission in the last 6 months, and having a stroke predisposition. We screened children for SARS-CoV-2 immunoglobulin G antibodies using enzyme-linked immunosorbent assay. The severity of stroke was evaluated using the Pediatric National Institutes of Health Stroke Scale (PedNIHSS). Results The current study included 25 children (15 males and 10 females; median age 24 months) with out-of-hospital AIS and 25 healthy controls (11 males and 14 females; median age 24 months). SARS-CoV-2 seropositivity was detected in 15 (60%) of AIS children and 11 (44%) among controls (p = 0.258). Compared with seronegative AIS children, those seropositive for SARS-CoV-2 had higher PedNIHSS scores (median 19 vs. 8.5; p = 0.001), pediatric intensive care unit admission (93.3% vs. 40%; p = 0.007), need for mechanical ventilation (53.3% vs. 10%; p = 0.040), and D-dimer levels (median 3.5 vs. 1.75 μg/mL; p < 0.001). Conclusion SARS-CoV-2 seropositivity may be associated with more severe AIS affecting previously healthy children during the postacute phase of asymptomatic/mildly symptomatic COVID-19.

Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study.

Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF. We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. Adults (aged ≥18 years) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single-arm pilot study from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. Participants (N=14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform "glitches," participants generally found the remote monitoring platform to be "helpful" and "motivating." A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention.

Sickle Cell Anaemia (SCA) related priapism in Kano, North- Western, Nigeria; re-emphasizing the important role of haemolysis

Background: Priapism is a common albeit under reported complication of Sickle Cell Anaemia (SCA) despite the pain, psychological stress and attendant risk of erectile dysfunction. Some changes in both clinical and laboratory parameters have been associated with priapism in SCA. Aim:This study seeks to determine the clinical and laboratory characteristics of patients with SCA related priapism. Method: A total of 102 adult male patients with SCA were recruited at steady state into this cross-sectional study. Clinical data was extracted using interviewer administered questionnaire and clients’ folders while FBC, haemolytic and biochemical markers were determined for each participant. Data was analysed using SPSS version 21.0 and p < 0.05 was considered significant. Results: The prevalence of priapism was 36.3%. There was no significance difference between SCA patients with and without priapism in terms of age (p = 0.11), age at diagnosis (p = 0.81), marital status (χ2 = 2.06, df = 4, p = 0.09), painful crisis (χ2 = 0.95, df = 4, p = 0.41) and history of hospital admission (χ2 = 0.28, df = 4, p = 0.59). However, SCA patients with priapism had more blood transfusions (χ2 = 46.70, df = 4, p = 0.01), lower haemoglobin (p = 0.01), higher reticulocyte count (p = <0.001) and serum LDH (p = <0.001) compared to SCA patients without priapism. History of blood transfusion (OR = 3.4, 95% CI = 1.6 – 6.5, p = 0.03), higher reticulocyte count (OR = 8.9, 95% CI = 2.4 - 14.8, p = 0.01) and serum LDH (OR = 13.6, 95% CI = 7.6 – 24.3, p = 0.01) were positive predictors of priapism among adults with SCA. Conclusion: Priapism is a high among patients with SCA and haemolytic markers can serve as important determinants of SCA related priapism. There is need for increase awareness of this complication and researches to exploit mechanistic pathways of priapism in SCA.

Reduced protective efficacy of hepatitis B vaccine among fully vaccinated children in Ethiopia.

Hepatitis B vaccination is recommended for all children at birth within 24 hours or during childhood. This study was aimed to evaluate protective efficacy of hepatitis B vaccine and estimate the sero-prevalence of hepatitis B virus infection among vaccinated children. A community-based cross-sectional study was conducted from March, 2021 to October, 2021 in Debre Markos town. A simple random sampling technique was used to select 165 fully vaccinated children aged 5-12 years old. A serum sample was used to determine hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (anti-HBc), anti-hepatitis B surface antibody titer (anti-HBs) using ELISA. The seroprevalence of HBsAg and anti-HBc anti-body was found to be 4.2% and 4.8% respectively. Of 165 fully vaccinated children, 129 (78.2%) had anti-HBs titer ≥ 10 mIU/ml. Among 129 sero-protected children, 76 (58.9%) were hypo-responders whereas the rest 53 (41.1%) were good responders. Those children within the age group of 5-7 years were 2.9 times (AOR: 2.873, 95% CI: 1.156, 7.141) (P<0.023) more likely to respond to HBV vaccine. Multivariate logistic regression revealed that children who were born from HBV positive mothers (AOR 3.917, 95% CI: 1.456, 5.365, P<0.027) and those who had history of injectable medications (AOR 9.232, 95% CI: 1.503, 11.697, P<0.016) were more likely to be HBsAg positive. Children who had history of hospital admission (AOR 6.973, 95% CI: 1.495, 8.530, P<0.013) were more likely to be anti-HBcAb positive. There was an intermediate prevalence of childhood HBV infection despite being vaccinated suggesting low protective efficacy of hepatitis B vaccine in the study area.

Determinants of tuberculosis in Central Region of Eritrea: a matched case-control study

Background: The WHO has recommended the need for holistic approach towards TB, including addressing the underlying socio-economic determinants in conjunction with direct observed treatment short-course (DOTS). However, there is lack of epidemiological data in Eritrea regarding factors that are associated with TB and this study aimed to assess such factors. Methods: A matched case-control study was used to assess factors that are associated with TB in the Central Region of Eritrea. A structured questionnaire was used to collect data about socio-demographic characteristics, living status, housing conditions, and medical history of the study participants. All TB patients in the eight DOTS treatment centers and two age-and-sex-matched controls for each case were included. Bivariate and multivariable conditional logistic regression models were used to identify the main risk factors of TB. Results: The study recruited 67 cases and 134 controls. Bivariate analyses indicated that BCG vaccination scar, past alcohol drinking habit, history of hospital admission, previous history of TB, and family history of TB were found to be factors associated with TB. Moreover, results of multivariable analysis showed that, absence of BCG vaccination scar, family history of TB, past drinking habit, and history of hospital admission were found to be factors associated with TB among the study participants. Conclusions: This is the first study in the Central Region of Eritrea that assessed the determinant of tuberculosis. Absence of BCG vaccination scar, family history of TB, past alcohol consumption and history of hospital admission were found to be independent risk factors for TB.c

Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae among clinical isolates in Turaif general hospital, northern borders- Saudi Arabia.

Enterobacteriaceae that produce extended-spectrum beta-lactamase (ESBL) are quickly spreading, posing a threat to world healthcare. 138 gram-negative bacteria were collected from different samples (stool, urine, wound, blood, tracheal aspirate, catheter tip, vaginal swab, sputum, and tracheal aspirate) from hospitalized patients. Samples were subcultured and identified in accordance with their biochemical reactions and culture characteristics. Against all the isolated Enterobacteriaceae, an antimicrobial susceptibility test was performed. VITEK®2 system, phenotypic confirmation, and Double-Disk Synergy Test (DDST) had been utilized to identify the ESBLs. Of the 138 samples studied, the prevalence of ESBL-producing infections among the clinical samples of the present study was 26.8 % (n = 37). E. coli was the commonest ESΒL producer at 51.4% (n = 19) followed by K. pneumoniae at 27% (n = 10). The potential risk factors for the ESBL development that produces bacteria were as follows, patients with the presence of indwelling devices, previous history of hospital admission, and usage of antibiotics. ESBL is statistically (p ≤ 0.05) higher among the patients with indwelling devices, ICU admission, who had a previous hospital admission in the last 6 months as well as who was given antibiotics (quinolones and/or cephalosporins) in the last 6 months. One hundred thirty-two (95.7%) of ESBL isolates were resistant to amoxicillin, while the lowest resistance was for fosfomycin (15.2%). ESBL-producing Enterobacteriaceae are highly prevalent in Turaif General Hospital setting with some potential risk factors. A strict policy to be made available on the usage of antimicrobials in hospitals and clinics should be established.

Role of Tobacco Consumption Habits in the Causation of Precancerous Lesions: A Cross Sectional Study

Oral carcinoma is quite common and increasing trend in India and worldwide. Smoking and smokeless tobacco both are increasing worldwide. The common oral precancerous lesions are oral leukoplakia, erythroplakia, nicotina palati and oral sub mucous fibrosis (OSMF). Screening is best tool to find out such lesions. The current study is conducted to know the prevalence of tobacco consumption and also to examine oral cavity of tobacco consumer to detect precancerous lesions among the staff. Method: The present study was cross sectional study carried out tertiary care hospital staff. The study was conducted over a period of 6 month from May 2017 to October 2017. Ethical clearance for study was obtained from Institutional Ethical Committee. The staff members of class 3 and class 4 of hospital were taken as a study participants involving both of sex and who provided written informed consent. Sample of 120 staff members were enrolled for the study from provided sampling frame with the use of random sampling method. Study participants with previous history of hospital admission for any systemic illness, immunodeficiency or immunosuppressive patients, and participants who already diagnosed to have malignant cancer lesions in any part of body were excluded. Result: Of 120 study participants, 40% were belongs to 31 – 40 years of age group and majority were male (80%) and belonged to Hindu (90.83%) religion. The prevalence of tobacco consumption in any of form is 85%; of them 43.33% used smokeless tobacco and 10.83% used to with smoking and 30.83% had both forms of tobacco. Oral Sub Mucosal Fibrosis (OSMF) was the most common (70.58%) precancerous lesion found in the present study, followed by leukoplakia (16.67%). Conclusion: Current study revealed the high prevalence. There is urgent need to plan de-addiction at various level. Also those having the precancerous lesion need to warn and treat accordingly.

Evaluation of the Clinical Features of Bronchiolitis in Paediatric Patients and Exploration of the Risk Factors

Background: In general, bronchiolitis presents as a progressive viral respiratory illness in children younger than 2 years of age, most commonly between 2-6 months. Objective: The study was conducted to assess the clinical presentations of acute bronchiolitis in infants and young children and to evaluate the individual characteristics and environmental factors which can increase the risk of severe disease and hospitalization. Methodology: This descriptive study was conducted in the department of Paediatrics, Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj. A total of 70 patients were included in the study, who were admitted to the hospital with a clinical and radiological diagnosis of acute bronchiolitis and were followed up in the Paediatric department during January, 2021 to December, 2021. Data collection was done by using a questionnaire form and by physical examination. The information for the questionnaire was provided by the childrens’ mothers. The SPSS software was used for data analysis. Results: According to the results of the study, 39(55.7%) children were infants, aged between 2-6 months, 21(30.0%) were between 7-12 months and 10(14.3%) children of more than 12 months of age. Boys (47, 67.1%) were affected more commonly than girls (23, 32.9%) in a ratio of 2:1. Some 60 (85.7%) of the children had siblings and 46 (65.7%) children lived in crowded environment at home. Many (25, 35.7%) parents of the children were cigarette smokers and 37(52.9%) children were given formula feeds. There was previous history of hospitalization among 14(20.0%) cases and 5(7.1%) children were pre-term. The most common clinical presentations of bronchiolitis were cough among 61(87.1%) cases, wheeze in 56(80.0%), respiratory distress in 49(70.0%) and feeding difficulty in 28(40.0%) children. Conclusion: The risk factors for bronchiolitis were young age (2-6 months), presence of a sibling, a history of hospital admission, crowding and paternal smoking at home and formula feeding. The most common clinical presentations were cough, wheeze and respiratory distress. J Monno Med Coll June 2022;8(2): 48-52

The prevalence and influencing factors of gag reflex in children aged 7-14 years in the dental setting.

Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology. The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting. This cross-sectional study was carried out among 320 children aged between 7 and 14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) was used for both children and mothers. Statistical analysis was done with SPSS program. The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ2 =53.121, p < 0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p < 0.001). Higher CFSS-DS scores of children increase risk of gagging (OR=1.052, p=0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR=10.990, p < 0.001). It was concluded that negative past dental experiences, previous dental treatments with local anaesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.

Disordered Eating Behaviors and Insulin Restriction in Saudi Adolescents and Young Adults with Type 1 Diabetes

Background and Objectives: The prevalence of disordered eating behaviors (DEBs) in type 1 diabetes (T1D) has been studied globally; however, data from Saudi Arabia and Arab-speaking countries are scarce. This study aimed to measure the prevalence of DEBs and associated clinical characteristics in adolescents and young adults with T1D, and the impact of DEBs on glycemic parameters. Materials and Methods: A total of 265 adolescents and young adults with T1D (aged 12-25 years) were recruited randomly from the registry at the Jazan Endocrinology and Diabetes Center, Saudi Arabia. Participants completed the Diabetes Eating Problem Survey-Revised (DEPS-R) questionnaire. Other measures included hemoglobin A1c (HbA1c) in addition to sociodemographic, anthropometric, and clinical data. Results: The prevalence of DEBs among T1D was 27.2%. Females (32.5%) had a higher proportion of DEBs than males (18.6%) (p = 0.01). About 27% of the participants reported insulin restriction. A history of hospital admission in the previous 6 months due to DKA and frequent hypoglycemia was more frequently reported in T1D participants with DEBs compared to those without (p = 0.03). Participants with DEBs had higher HbA1c and higher BMI compared to those without DEBs. Conclusions: Adolescents and young adults with T1D with disordered eating and insulin restriction have higher glycated hemoglobin, and are at higher risk of DKA. Routine screening for DEBs should be an essential element in diabetes care, especially among highly vulnerable groups.

Polypharmacy and potentially inappropriate medications among hospitalized older adults with COVID-19 in Malaysian tertiary hospitals

IntroductionOlder adults are among the most vulnerable groups during the COVID-19 epidemic, contributing to a large proportion of COVID-19-related death. Medication review and reconciliation by pharmacist can help reduce the number of potentially inappropriate medications but these services were halted during COVID-19.AimTo assess the prevalence and factors associated with inappropriate medicine use among older populations with COVID-19.MethodsThis was a cross-sectional, retrospective analysis of medications among hospitalized older adults with COVID-19. Potentially inappropriate medication use was categorized using the Beer’s and STOPP criteria.ResultsCombining both criteria, 181 (32.7%) of the 553 patients were identified to have used at least one or more potentially inappropriate medication. A marginally higher number of inappropriate medications was documented using the Beers 2019 criteria (151 PIM in 124 patients) compared to STOPP criteria (133 PIMS in 104 patients). The long-term use of proton pump inhibitors (n = 68; 12.3%) and drugs which increases the risk of postural hypotension were the most commonly reported PIM (n = 41; 7.4%). Potentially inappropriate medication use was associated with previous history of hospital admission in the past 12 months (Odds ratio [OR]: 2.27; 95% CI 1.29–3.99) and higher number of discharge medications.ConclusionsNearly, one in three older adults with COVID-19 had been prescribed a PIM, and the proportion of older adults with polypharmacy increased after discharge. This highlights the importance of having clinical pharmacist conducting medication reviews to identify PIMs and ensure medication appropriateness.

Retained peripherally inserted central catheter guidewire with vegetation.

Sir, Central venous cannulation is often a necessity for patients in intensive care units or in patients with difficult peripheral access. Loss of the guidewire is a serious and potentially life-threatening complication with reports of fatalities in up to 20% of cases, when the complete guide wire is lost.[1] A 2-year 3-month-old female child presented to our institute with chief complaints of poor weight gain, abdominal discomfort, and decrease in appetite. Chest X-ray of the patient showed a radio-dense wire extending into inferior vena cava (IVC) and right atrium [Figure 1]. Patient had a history of hospital admission at the age of 8 months for jaundice. Peripherally inserted central catheter (PICC) was inserted at that hospital in right femoral vein due to difficult peripheral venous cannulation. PICC line was kept for 12 days and later it was removed. Later on, patient presented to our institute with above mentioned complaints. Computerised tomography (CT) scan showed evidence of a linear radio-dense wire extending from infrarenal IVC into the right ventricle. Its tip was seen in the superior vena cava suggestive of foreign material [Figure 1b]. Transthoracic echocardiography showed a hyperechoic mobile structure of size 20 × 10 mm (possibly a vegetation) in the right atrium having attachment to the superior vena cava and IVC with to-and-fro movement across tricuspid valve and near total occlusion of IVC by hyperechoic structure till mid abdomen level [Video 1]. Moderate to severe tricuspid regurgitation (TR) was seen on transthoracic echocardiography. Surgical removal of PICC guidewire was planned. Complete blood count, serum electrolytes, coagulation profile, liver, and kidney function tests were done preoperatively. Preoperative electrocardiogram showed sinus tachycardia and nonspecific ST-T wave changes. The open surgical repair was planned under hypothermic cardiopulmonary bypassFigure 1: (a) Chest X-.Ray PA view showing a radio dense wire extending into inferior vena cava and right atrium. (b) Computerised tomography scan showing evidence of a linear Ra: Right atrium dense wire extending from infrarenal IVC, extending into right ventricle and the tip is seen in superior vena cava suggesting foreign material. (c) Guidewire with vegetation. (d) Right atrium opened with blocked IVC. IVC: Inferior vena cava {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_0bc3rv32"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Patient was induced with general anaesthesia and endotracheal intubation carried out after injecting fentanyl 5 mg/kg, midazolam 0.1 mg/kg, and vecuronium 0.1 mg/kg. Five lead electrocardiogram, invasive arterial blood pressure, central venous pressure, temperature, end tidal carbon dioxide, pulse oximetry, and urine output were monitored intraoperatively. Cardiopulmonary bypass (CPB) was established after cannulating ascending aorta and right atrium. Total circulatory arrest was initiated. Right atrium was opened and removal of guidewire with vegetation from right atrial wall and tricuspid valve leaflet were done [Figure 1c and 1d]. Tricuspid valve was checked for tricuspid regurgitation and anteroseptal commissuroplasty was done. Post repair, moderate to severe tricuspid regurgitation was present. CPB was instituted again, and tricuspid valve was repaired. After complete rewarming, patient was weaned off CPB uneventfully. 180 ml of packed red blood cells was transfused intraoperatively. Total duration of surgery was four hours. Patient was shifted to paediatric intensive care unit and was extubated on second postoperative day. Complications pertaining to the retained guide wire include complete loss of wire, injury to the vessel from the wire, fracture of the wire, and bleeding.[1–5] Patients undergoing foreign body removal pose a challenge for the anaesthesiologist as there can be risk of arrhythmia, bleeding causing haemodynamic instability, prolonged aortic cross clamp time, and postbypass myocardial dysfunction. Percutaneous retrieval was not possible in this case due to the extent of guide wire with associated vegetation and risk of its embolisation. Therefore, decision was made for surgical plan to remove guide wire under cardiopulmonary bypass. This case highlights the importance of formulating a plan for the anaesthetic management of patients undergoing guidewire removal and preparedness for postoperative management. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Internalized stigma and associated factors among people with mental illness at University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2021

BackgroundInternalized stigma has been found to be high among people with mental illness (PWMI) and it results in poor treatment outcome, increased disability and high economic burden. So, this study was designed to determine the prevalence and associated factors of high internalized stigma among PWMI attending psychiatric follow-up at University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2021.MethodsA cross-sectional study was conducted among PWMI (n = 365), and internalized stigma was measured by using internalized stigma of mental illness 29 (ISMI-29) scale. The data was entered in to EPI DATA software (4.6.0.2) and analyzed by Statistical Package for Social Sciences version 20. A binary logistic regression was used to identify factors associated with internalized stigma and reported with 95% confidence interval (CI). P-value < 0.05 was considered as statistically significant.ResultsThe prevalence of high internalized stigma was found to be 27.9% (95% CI 23.1–32.6). A male gender (AOR = 0.332; 95% CI 0.175–0.629), occupation, specifically government employee (AOR = 0.309; 95% CI 0.118–0.809), life time substance use (AOR = 3.561; 95% CI 1.867–6.793), low self-esteem (AOR = 8.313; 95% CI 3.641–18.977), and history of hospitalization (AOR = 4.236; 95% CI 1.875, 9.570) were factors significantly associated with higher internalized stigma.ConclusionThe result of this study showed that there was an intermediate prevalence of high internalized stigma among PWMI at University of Gondar Comprehensive Specialized Hospital. The hospital needs to take immediate action to fight internalized stigma by focusing on females, people with low self-esteem, individuals with history of lifetime substance use, and people who have history of hospital admission.

Idiopathic Multicentric Castleman's Disease with Concurrent Renal Involvement

Introduction Castleman Disease (CD) is a rare non-clonal benign lymphoproliferative disease.CD can be classified into various subtypes based on etiology, clinical and histological findings. Management of CD varies based on the diagnosis and patient's condition and it can range from surgical excision to more aggressive systemic therapies such as anti-IL-6, steroids, and chemotherapy. It can rarely present with renal involvement, which is poorly understood. Case Presentation A 31-year-old male patient with a history of hospital admission one month prior to the present illness for persistent abdominal pain, with an incidental finding of splenomegaly and generalized lymphadenopathy on imaging, was admitted to the hospital for a 2-week history of generalized swelling with associated 20-pound weight gain, poor oral intake, nausea, vomiting, and loose stools. Laboratory work-up (TABLE 1) revealed hyponatremia with sodium of 117 mmol/L and renal failure with a creatinine of 1.6 mg/dL. Urinalysis showed proteinuria of 2+ and 24-hour collection revealed 300 mg of total protein. Heart failure was not noted on echocardiogram and biochemical or imaging findings were not suggestive of liver cirrhosis. Fluid restriction and diuretics were initiated. The patient improved initially but his hospital course was complicated by worsening renal failure and normochromic, normocytic anemia. Nephrology, Gastroenterology, Pulmonology, and Surgery were consulted. Excisional lymph node biopsy was performed revealing multicentric Castleman's Disease, negative for HHV-8. A kidney biopsy was performed later, consistent with thrombotic microangiopathy (Figure 1). VEGF and IL-6 were elevated. Hemodialysis was entertained,steroids were started, and Siltuximab was ordered but could not be obtained at the institution. Tocilizumab was started instead. The patient had a dramatic improvement after the treatment initiation and a week later the patient was discharged home. The patient's renal function was back to baseline and he was asymptomatic during the one-month follow-up visit. Discussion CD is a rare lymphoproliferative disease and renal involvement in CD is even rarer. There is still no consensus on how to manage CD patients with renal involvement. Here, we present an iMCD-NOS patient with renal involvement. Given the different therapeutic approaches, a final diagnosis of CD subgroups is important. The diagnosis of TAFRO, a rare clinicopathologic variant of idiopathic multicentric Castleman disease characterized by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly was under consideration but discarded due to the patient lacking thrombocytopenia and it was decided to classify the patient under the not otherwise specified category. Renal complications from CD are uncommon and can include a variety of histopathological findings on biopsy, including thrombotic microangiopathy and membranoproliferative glomerulonephritis, among others.Our patient had thrombotic microangiopathy based on the renal biopsy findings. The pathophysiology of CD is not well understood. It is well known that IL-6 plays a role as increased levels of this proinflammatory marker have been associated with disease activity. Interestingly, increased serum levels of IL-6 and other cytokines have been observed in patients with several diseases characterized by renal thrombotic microangiopathy. Therefore, we hypothesize that increased IL-6 levels in patients with CD create an unhealthy environment for the renal microarchitecture that may result in thrombotic microangiopathy. As demonstrated by our case, improvement of renal function can be achieved after treating this pro-inflammatory state with systemic therapy. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical and Non-Clinical Predictors of Length of Stay in Indonesian hospitalized COPD (Chronic Obstructive Pulmonary Disease) Patients

Background: COPD (chronic obstructive pulmonary disease) is a chronic disease characterized by persistent airflow limitation and is a major cause of morbidity and mortality. Objectives: This study aimed to analyze potential predictors of length of hospitalization (length of stay/   LOS) of COPD patients in the Anutapura Hospital, Central Sulawesi Province, Indonesia. Material and Methods: This study is an analytical descriptive using a cross-sectional design. The data were collected from medical records of COPD patients at Anutapura Hospital, Central Sulawesi Province, during 2018-2021. Information about demographic data (age, gender, weight), clinical data (comorbidities, single/combination antibiotics, route of antibiotic administration, type of antibiotics, oxygen therapy, history of hospital admission due to pneumonia, with/without exacerbations), and non-clinical data (type of insurance and treatment class) were extracted. Multivariate linear regression was used to identify the predictors of LOS. Results: A total of 210 COPD patients were identified. The results of univariate analysis showed that there were several potential predictors of LOS in COPD patients (p &lt; 0.25), namely: age (B: 0.03, 95% CI: 0.01-0.05), treatment class (B: 1.16, 95% CI: 0.01-2.33), exacerbation (B: 0.55, 95% CI: -0.24-1.35), comorbidities (B: 0.68, 95% CI: 0.25-1.12), and single/combination antibiotics (B: 1.43, 95% CI: 0.33- 2.54). The results of the multivariate analysis indicated that the older (B: 0.03, 95% CI: 0.01-0.06, p = 0.02) COPD patients and the more comorbidities (B: 0.54, 95% CI: 0.07-1.00, p = 0.02) that they had, the longer the LOS that they experienced. Conclusions: In this study, age and patient comorbidities are independent predictors of LOS in COPD patients in the Anutapura Hospital, Central Sulawesi Province, Indonesia.