Hospital-based Prospective Study Research Articles

Knowledge, Attitude, and Practice of Diabetic Retinopathy among Diabetic Patients in Central Province of Saudi Arabia: A Hospital-Based Prospective and Cross-Sectional Study

Knowledge, Attitude, and Practice of Diabetic Retinopathy among Diabetic Patients in Central Province of Saudi Arabia: A Hospital-Based Prospective and Cross-Sectional Study

Client’s pre-operative expectations and outcome of cataract surgery at the Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Objectives: A cataract is an opacity of the natural crystalline lens that causes vision loss. It is the most common cause of blindness worldwide, accounting for 39% of the 42 million blind people in the world. The optimum outcome from a cataract surgery can be achieved if post-operative subjective outcomes meet pre-operative expectations. It is expressed in different ways including patient satisfaction. This study evaluated clients’ pre-operative expectations and the outcome of cataract surgery at Jos University Teaching Hospital. Materials and Methods: A quasi-experimental, prospective hospital-based study that consecutively recruited 109 participants aged 18 years and above for 6 months. Data regarding the sociodemographic characteristics, pre-operative visual function, and expected post-operative outcome were collected preoperatively, and the subjective outcome and level of patient satisfaction were also assessed 6 weeks after surgery using a visual function index questionnaire. Data were analysed using the Statistical Package for the Social Sciences’ version 23. Frequencies and percentages were determined for categorical variables; mean and standard deviation, median, and interquartile range were calculated for continuous variables. Correlation was used to measure the relationship between overall satisfaction and expected or achieved visual function. A significant level was determined at P < 0.05. Results: A total of 109 participants were seen in this study, of which 60 (55%) were males. The mean age of participants in the study was 64.5 ± 11.1 years. The median (interquartile range) expected and actual post-operative outcome scores were 100 (80–100) and 98 (75–100), respectively. The majority of the participants, 86 (78.9%), were satisfied with the outcome of cataract surgery, and the predictors of satisfaction were insertion of posterior chamber intraocular lens, absence of complications, and absence of ocular comorbidities. We found a significant strong positive correlation between subjective outcome and satisfaction (r = 0.538, P ≤ 0.0001). Conclusion: The majority of the clients were satisfied with the outcome of their surgeries which meets the high expected outcomes from the clients pre-operative. Adequate counselling, training, and retraining of surgeons are key to improving and maintaining satisfaction with the outcome of cataract surgery.

Epidemiological and typing features of HPV co-infections in MSM with mpox: A hospital-based prospective study

ObjectivesRecent mpox outbreaks highlight diverse transmission modes, with sexual behavior prominent in China's IIb strain. Nevertheless, despite HPV being a common sexually transmitted pathogen, there is a paucity of research into its coexistence and genotype distribution within this patients population. MethodsWe conducted a study at the Third People's Hospital of Shenzhen from May to September 2023. We collected information on mpox patients, including their sociodemographic and clinical characteristics. Anal swabs were collected for HPV genotyping. ResultsAmong 73 MSM mpox cases, HIV positivity was 56.2 % (41/73) and HPV positivity 80.4 % (41/51). Multiple HPV infections were prevalent (56.9 %, 29/51), especially among HIV-positive (93 %, 27/29). HPV16 (29.3 %, 12/41) was the most common high-risk genotype, followed by HPV59 (26.8 %, 10/41), HPV42 (19.5 %, 8/41), HPV6 (14.6 %, 6/41), and HPV54 (14.6 %, 6/41). HPV infection was significantly associated with HIV infection (p = 0.001). Additionally, HIV infection (p = 0.001) and PCR-detected positive sites for mpox (p = 0.047) were associated with high-risk HPV infection. ConclusionsIn this study, most of the mpox patients were found to be infected with HPV, mostly with high-risk types and multiple infections. Therefore, it is strongly recommended that mpox-infected individuals intensify HPV-related screening, prevention, and treatment measures.

ASSESSMENT OF ANTIBIOTIC STEWARDSHIP IN TERTIARY HEALTH CARE TEACHING MEDICAL INSTITUTION IN CENTRAL INDIA

Objective: The objective of the study was to mitigate the impact of antimicrobial resistance and ensure continued access to effective treatments for bacterial infections. This study was undertaken to explore the hospital status of antibiotic prescription and evaluate the impact of antibiotic stewardship in clinical wards of tertiary health care settings. Methods: This is hospital-based observational prospective study carried out in a tertiary health care settings. All patients of either sex of any age who came in outpatient department and admitted in inpatient department of medicine, orthopedics, surgery, and pediatric departments and prescribed antibiotics were selected randomly in the study. Results: Study response rate was male predominance (57%). Empiric antimicrobials were mainly prescribed orally (47.3%), significantly higher than injectable route (22.8%) (p<0.001), while the majority were not given an empiric antibiotic by a clinical expert. A significantly high number of patients were prescribed injectable 1st Antimicrobial after surgery/culture, namely, injectable piperacillin+tazobactum (35.5%), followed by injectable cephalosporin (34.0%), amikacin injection/4.5%, and injection carbapenem/1.8% (p<0.001). Its frequency is significantly high with BD dose (66.8%) and the majority prescribed for period of 6–10 days (63.5%) followed by 1–6 days (19.5%) (p<0.001). Conclusion: As all prescriptions got optimal dose and duration of therapy, the stay of patients in the hospital was following Indian Council of Medical Research (2019) guideline therefore, it can thus be said that the results of this study revealed precise prescribing pattern of antibiotics. However, emphasis on information technology staff and patient education is vital in incorporating stewardship protocols. Emphasizing the importance of conducting antibiotic time-outs within 48–72 h is crucial for reassessing the necessity and choice of antibiotics. Such stewardship studies are instrumental in monitoring patterns of antibiotic usage and aid in future policy-making steps.

Surgical site infection and antimicrobial use following caesarean section at QECH in Blantyre, Malawi: a prospective cohort study

BackgroundSurgical site infections (SSIs) are one of the most common healthcare-associated infections and preventable complication of surgical procedure; continue to threaten public health with significant effects on the patients and health care human and financial resources. Therefore, this study aimed to determine the incidence of SSIs, risk factors and common microorganisms associated with SSI and assess the practice of antimicrobial use in women following Caesarean Section (CS) at Queen Elizabeth Central Hospital (QECH).MethodsThis was a hospital-based quantitative prospective study design involving pregnant women who underwent a CS between February, 2023 and July, 2023 at QECH with 30 day-follow-ups. Wound specimens (wound swabs) were collected from all infected CS wounds and processed at QECH main laboratory, and susceptibility testing was conducted using the Kirby-Bauer disk diffusion method with results reported only as susceptible, intermediate, or resistant and the collected data was analyzed using Stata.ResultsThe overall cumulative incidence of SSI recorded at QECH during the study period was 9.61% (20 cases out of 208). Of these, 19 (95%) of them reported superficial SSI following CS. The mean age was 26.1 years with a standard deviation of 6.2. All pregnant women who underwent for CS received antibiotic prophylaxis. This study revealed that 138 (66.35%) patients received both preoperative antibiotics (ceftriaxone) and post-CS antibiotics without knowing the specific bacterial organism isolated. This study revealed that ruptured membrane had twice the incidence of SSIs compared to intact membrane (χ2 = 2.0922), though not statistically significant. The majority of patients with SSIs (n = 12, 60%) were readmitted and 5 (25%) out of 20 with SSIs had antimicrobial resistance following susceptibility testing. Staphylococcus aureus was the most common organism (3, 60%) and other bacterial isolates included were Enterobacteriaceae and Acinetobacter baumanni.ConclusionThe incidence of SSIs and inappropriate antimicrobial use following CS remains a challenge at QECH. Therefore, due to increased number of SSIs following CS with relative emergence of AMR ensure intensive infection prevention and control practices, establishing AMS program and routine surveillance of SSIs at QECH.

Predictive Value of Cord Blood Bilirubin for Hyperbilirubinemia in Term Neonates with ABO Incompatibility

Introduction: Jaundice affects 60% of full-term and 80% of preterm neonates. Feto-maternal ABO incompatibilities occur in 20-25% of pregnancies, but severe haemolytic disease develops in only 10%. ABO-incompatible babies have doubled the risk of jaundice requiring treatment and a 5-10 times increased risk of exchange transfusions. Objective: Aim of this study was to determine if cord blood bilirubin (CBB) can predict hyperbilirubinemia in term babies with ABO setup prior to discharge that would help to decrease readmission and subsequently complications due to jaundice. Methods: A hospital-based prospective observational study was conducted at Patan Hospital. Cord blood group and bilirubin levels were collected from newborns of O positive mothers. Babies with A positive and B positive blood groups had their CBB levels measured and were followed daily for 72 hours. Serum bilirubin was tested based on clinical judgment to detect hyperbilirubinemia and treated per NICE guidelines. Data were analysed using SPSS v21.0, Mann-Whitney test, ANOVA, and ROC analysis. Results: Among 66 cases, significant hyperbilirubinemia was seen in 7 neonates (10.6%). It was more common in B positive babies (12.2%) compared to A positive (8%). Mean CBB was 3.45 ± 0.57 in those developing significant hyperbilirubinemia. A CBB of 2.95 mg/dL had the highest sensitivity (86%), specificity (94%), and negative predictive value (98%) for predicting hyperbilirubinemia in ABO setup babies. Conclusion: Term babies with ABO incompatibility and CBB<2.95 mg /dL are unlikely to need further evaluation, while those with cord bilirubin level ≥2.95 mg/dL should have frequent early follow-ups.

Methicillin and vancomycin-resistant Staphylococcus aureus and associated risk factors among patients with wound infection in East Wallaga Zone, Western Ethiopia

Methicillin and vancomycin-resistant S.aureus have become increasingly problematic in recent years. This may be explained by the indiscriminate use of this antibiotic. The aim of this study was to determine the prevalence of methicillin-resistant and vancomycin-resistant Staphylococcus aureus (VRSA) and associated risk factors in patients with wound infections in the East Wallaga Zone, Western Ethiopia. A hospital-based cross-sectional prospective study was conducted on 384 patients with wound infections including surgical wound who sought healthcare at Nekemte Specialized Hospital. Wound samples were collected using aseptic techniques and cultured on blood agar and mannitol salt agar. Vancomycin E-test and cefoxitin (30 μg) antibiotic disc diffusion were used to detect MRSA and VRSA, respectively. Data were analyzed using SPSS version 23, and a P-value of less than 0.05 was considered statistically significant. Of the 384 wound samples collected, 109 (28.4%) were identified as Staphylococcus aureus. Of these, 40.4% (44/109) were identified as MRSA, and 7.3% (8/109) were VRSA. Thirty-two (72.7%) MRSA isolates were showed multidrug resistance. The depth of the wound, patient setting, history of wound infection, and history of antibiotic use became significantly associated with the prevalence of MRSA wound infection. This study found significant levels of S.aureus, MRSA, and VRSA in patients with wound infection. Therefore, it is crucial to implement effective infection prevention and control measures to prevent the spread of antimicrobial resistance.

Assessment of Diaphragmatic Dysfunction in Mechanically Ventilated Patients with Ultrasonography.

The reliability of the diaphragm thickening fraction in predicting weaning failure in mechanically ventilated patients in the intensive care unit (ICU), as well as the relationship between the patients' diaphragmatic inspiratory excursion and diaphragmatic thickness. Fifty mechanically ventilated patients participated in this hospital-based cross-sectional prospective study in a tertiary care teaching hospital. Patients who had been on a mechanical ventilator for at least 7 days and whose legal guardian was willing to provide consent were also included in the research. People with hemodynamic instability and those whose legal guardians were reluctant to comply were excluded. Using diaphragmatic thickening fraction as a diagnostic criterion, the weaning failure group consisted of 24 patients, out of which we predicted diaphragmatic dysfunction (DD) in 19 patients. The weaning success group consisted of 26 patients, of which we predicted no DD in 21 patients. Weaning success or failure was predicted by diaphragmatic thickening fraction with a sensitivity of 79.16% and a specificity of 80.76%, diaphragm excursion with a sensitivity of 70.8% and an 80.7%, and diaphragmatic thickness with a sensitivity of 66.66% and a specificity of 73.91%, respectively. Diagnosing DD in mechanically ventilated, figuring out if extubation would be effective or not, monitoring respiratory effort, and assessing atrophy in ICU patients, ultrasonography may be an effective and accurate technique for mechanical ventilation patients, and it provides a convenient, noninvasive, affordable, and secure way to assess DD.

Should test for dry eyes be done before age-related cataract surgery?

Objectives: This study aimed to determine if tests for dry eyes should be done routinely before age-related cataract surgery. Materials and Methods: This was a hospital-based observational prospective study. Patients 50 years and above with age-related cataracts that met the inclusion criteria scheduled for manual small incision cataract surgery (MSICS) were assessed for dry eye disease (DED) before and after surgery. Numerical variables were described using the mean and standard deviation (SD) with a 95% confidence interval and P < 0.05. Results: A total of 81 patients were studied: 60.5% (49) males and 39.5% (32) females. The mean pre-operative Schirmer’s test value was 14.09 mm (SD = 10.7 mm). Post-operative schirmer’s test values were 18.12mm (SD = 11.81mm) at 1 week, 14.98mm (SD = 11.26mm) at 4 weeks and 16.20 mm (SD = 11.06 mm) at 6 weeks. Pre-operative mean tear break-up time (TBUT) was 10.05 (SD = 5.13 s), 9.46 s (SD = 4.18 s) at 1 week, 10.13 s (SD = 4.29 s) at 4 weeks and 9.80 s (SD = 4.33 s) at 6 weeks postoperatively. Lissamine green staining score (LGSS) Grade 0 was 80% at 1 week post-operative, Grade 0 increased to 85%, 90% at 4 weeks and 91% at post-operative 6 weeks. Conclusion: This study showed that DED is not associated with MSICS, and it is not associated with objective worsening of previously diagnosed DED. Testing for DED preoperatively plays a significant role in the pre-operative evaluation of patients and symptomatic expectations, but its testing before MSICS might not always be necessary.

Total Knee Replacement Among Elderly: The Role of Tranexamic Acid.

Background Tranexamic acid (TXA) administration in total knee replacement (TKR) surgery has been shown to reduce blood loss and transfusion requirements. However, its efficacy and safety in elderly patients undergoing arthroplasty remain under investigation. This study aimed to assess the impact of TXA on blood loss and post-operative outcomes in TKR patients among a local elderly population. Methodology A prospective descriptive-analytical hospital-based randomized study was conducted, involving 79 TKR patients who received TXA. Demographic data, comorbidities, pre- and post-operative hemoglobin levels, length of hospital stay, transfusion requirements, and post-operative complications were recorded. Statistical analysis was performed using SPSS (IBM Corp., Armonk, NY), including descriptive analysis and comparative tests. Results The mean drop in hemoglobin levels post-operatively was -1.55 g/dL (SD = 0.94). The majority of patients (78, 98.7%) did not require packed red blood cell transfusions post-operatively, and complications were minimal (1, 1.3%). The length of hospital stay was relatively short (mean = 4.84 days). Comparison with existing literature revealed TXA's effectiveness in reducing blood loss compared to studies without TXA administration. Conclusion TXA administration in TKR surgery effectively reduced blood loss, transfusion requirements, and post-operative complications, supporting its use as a standard adjunctive therapy. These findings emphasize the importance of TXA in optimizing patient outcomes and minimizing surgical complications in TKR patients. Limitations of the study include the relatively small sample size and the exclusion of patients with certain comorbidities, which may limit the generalizability of the findings. Further research is warranted to validate these findings in larger patient cohorts and explore long-term effects.

Assessment of vitamin B12 and folate status and their determinants in children aged 6–59 months with severe acute malnutrition admitted to a tertiary-care centre in North India

ABSTRACT Background Vitamin B12 and folate are essential micronutrients, a deficiency of which causes anaemia, poor growth and an increased risk of infections, along with irreversible neurological damage to the developing brain in children. Methods A hospital-based prospective observational study was conducted in 100 children with severe acute malnutrition (SAM) aged 6–59 months admitted to a tertiary-care facility in northern India from July 2021 to June 2022. A structured proforma was used to record socio-demographic information, a detailed clinical history, results of general and systemic physical examination and a detailed anthropometric assessment. Serum folate and vitamin B12 were estimated by electrochemiluminescence. Results The mean age of the children was 24.18 months, and 64.0% were aged 6–12 months. The male-to-female ratio was 1.08:1. Anaemia was present in 87.0% of the children, and it was severe in 35% of them. There was serum vitamin B12 and folate deficiency in 61.0% and 19.0%, respectively. A deficiency of vitamin B12 was significantly associated with delayed developmental milestones in all domains, a mid-upper-arm circumference of <11.5 cm, severe anaemia, a low platelet count and folate deficiency, and a folate deficiency was significantly associated with older age, delayed developmental milestones in all domains, severe anaemia, a low platelet count and vitamin B12 deficiency. Conclusion Vitamin B12 deficiency is highly prevalent in children aged 6–59 months with SAM, but the prevalence of folate deficiency is much lower. Apart from iron and folic acid supplementation, government programmes should consider vitamin B12 supplementation for children aged 6–59 months.

Out-of-pocket and indirect expenditure of spina bifida and hydrocephalus patients admitted for inpatient treatment and follow-up at two university-affiliated hospitals in Ethiopia.

In Ethiopia approximately 3,200,000 babies are born annually and 41.09 per 10,000 live births are affected by spina bifida. Hydrocephalus (HCP) is another common pediatric neurosurgical condition with studies in Ethiopia showing the most common etiology is post spina bifida closure. The out-of-pocket expense (OOPE) and indirect expense of patients treated surgically for spina bifida and hydrocephalus during the first year of life were assessed. A prospective hospital-based study was done on patients treated surgically for spina bifida and HCP in two university-affiliated hospitals, between April 1st, 2022, and April 1st, 2023. Data on direct and indirect expenses were collected during inpatient care and follow-up. Catastrophic health expenditure (CHE) was assessed, defined as total expenditure exceeding 10% of the total annual household expenditure. A total of 245 patients were eligible for analysis. The median annual total expenditure of households for treatment was ETB 11,510.00 with ETB 5700.00 being indirect expenditure. Forty-nine percent of the households suffered CHE. In multivariate analysis, the factors which were found to have a statistically significant association with CHE were the hospital where the patient received the treatment, the household's wealth quintile, the place of residency, and pre-admission duration of stay. Our study revealed a high CHE in households with spina bifida and HCP. We recommend working on primary prevention of spina bifida, expanding surgical services regionally to minimize costs associated with travel for surgical care, and reducing pre-admission duration of stay by improving evaluation and investigations at outpatient clinics.

Evaluation of ventilator-associated pneumonia care practice in the intensive care units of a comprehensive specialized hospital in Northwest Ethiopia: a 1.5-year prospective observational study.

Nosocomial infections pose a global health threat, with Ventilator-Associated Pneumonia (VAP) emerging as a prominent hospital-acquired infection, particularly in intensive care units (ICU).VAP is the commonest form of pneumonia in ICUs, contributing significantly to morbidity and mortality rates, which can reach around 30%. Despite the substantial impact of VAP on healthcare, there is a lack of data on adherence to VAP prevention protocols in our hospital. Consequently, this study aims to assess the adherence to ventilator-associated pneumonia care bundles in critical care units at a comprehensive specialized hospital in northwest Ethiopia. A hospital-based prospective observational study was conducted from July 3, 2022, to January 7, 2024. All adult patients who were on mechanical ventilators for more than 48h during the study period were included. Data were collected using the Institute of Healthcare Improvement VAP prevention standards as checklists via direct observation and chart review. The data were entered and analyzed using SPSS version 20. A total of 300 surgical and medical ICU patients were observed. Among the patients, 66.3% were from the medical ICU. In terms of admission reasons, 22.3%, 15.7% and, 12% were attributed to infections excluding respiratory origin, respiratory disorders, and other causes, respectively. The rate of compliance with all components of the bundle was 70%. A 100% adherence rate was observed for the prophylaxis for peptic ulcer and deep vein thrombosis (DVT). The lowest adherence rate was observed in the practice of oral hygiene with 0.5% chlorhexidine solution (0%) followed by humidification with heat and moisture exchangers (23.3%). Endotracheal tube cuff pressure measurement and use of endotracheal tubes with subglottic suction were not applicable. The study revealed suboptimal compliance with the VAP care bundle, indicating unsatisfactory overall practice. Specific attention is warranted for subglottic suction, cuff pressure measurement, humidification, oral care with chlorhexidine, and sedation vacation.

Correlation between CRP and ferritin in dengue patients: A hospital-based prospective observational study

ABSTRACT Background: In India, dengue is one of the health challenges and a leading cause of hospitalization, especially during the monsoon. C-reactive protein (CRP) is an independent marker for dengue severity. The present study aimed to analyze the correlation between CRP and ferritin and with other hematological markers in dengue fever (DF). Methods: A hospital-based prospective study was conducted over one year. With the patient’s consent, A total of 189 dengue-diagnosed hospitalized patients aged more than 18 years were included in the study group. Demographic features, total leukocytes, total platelet counts, packed cell volume, CRP, and ferritin were monitored in both severe and non-severe cases. Significant univariate parameters were correlated and significant associations were analyzed from the correlation coefficient and P value respectively. Result: A total of 189 dengue-diagnosed, hospitalized patients were recruited, among them 30 patients were diagnosed as severe and 159 patients were diagnosed as non-severe. The mean age ranged between 41 ± 16.7 and 42 ± 15.9 years. In univariate analysis, total leucocytes, CRP, and ferritin were significantly higher in dengue severe cases in comparison to non-severe dengue cases. The association between CRP and ferritin revealed a positive correlation whereas, the association between ferritin and total platelet count showed a negative correlation. Conclusion: A significant positive correlation between CRP and ferritin indicates that ferritin can be an additional biomarker along with CRP for the hospitalization of dengue patients and may be useful for severity prediction at an early stage of infection.

Etiological spectrum of acute kidney injury and adverse outcome: A single-center observation.

The present study aims to evaluate the etiological spectrum with clinicopathological parameters and adverse outcomes of acute kidney injury (AKI). A hospital-based prospective observational study was conducted for a spectrum of AKI in 103 AKI patients and their AKI-associated adverse outcomes. The AKI patients were included as per the KDIGO definition. The patients with a known chronic kidney disease (CKD) were excluded from the study population. A clinicopathological association with AKI was observed. Adverse outcomes and the need for renal biopsy were recorded in 3 weeks followed up to 6 months. A single-center study recorded that the incidence of AKI was 8.6% with a mean age of 34 ± 16 years. The cause of AKI due to medical reasons was maximum (70.8%), followed by obstetric (21.3%) and surgery (7.7%). The AKI mortality rate was 16% (P < 0.05). Renal biopsy in 34 cases showed that acute tubular necrosis was higher (38%), followed by acute cortical necrosis (23%). The spectrum of AKI was very diverse. In the 6-month follow-up, the adverse outcome was observed in 27.2% of patients, where the mortality rate was 16.5% and 10.7% of patients progressed to CKD. The spectrum of AKI was diverse among the population, and most of the etiologies are preventable. This alarms the need for better preventive strategies with a better referral system. The obstetric population with AKI, which majorly leads to either mortality or progression to CKD, is the section that seeks more attention.

Comparative Analysis of Platelet-rich Plasma and Triamcinolone Acetonide Injections in the Management of Plantar Fasciitis: A Prospective Study

Abstract Context: Plantar fasciitis, a prevalent cause of heel pain, poses challenges in treatment due to diverse therapeutic options and variable outcomes. Platelet-rich plasma (PRP) and triamcinolone acetonide (TA) injections have emerged as potential interventions, yet their comparative effectiveness remains debated. Aims: The aim of the study was to compare the effectiveness of PRP and TA injections in relieving pain, improving function, and promoting healing in individuals with plantar fasciitis. Settings and Design: The study design was a prospective, hospital-based, experimental study. Subjects and Methods: A 2-year prospective hospital-based experimental study was conducted, enrolling patients aged 30–60 years with plantar fasciitis. Patients received either PRP or TA injections. Preoperative assessments and 3 months of monitoring were performed. Foot and Ankle Outcome Score (FAOS) survey was utilized for outcome evaluation. Statistical Analysis Used: T-test was applied. Results: Ninety patients were included, with both treatment groups demonstrating significant improvement in foot symptoms. PRP administration showed superiority in descending and ascending stairs, rising from sitting, and walking on flat surfaces compared to TA. FAOS scores indicated significant improvement posttreatment in both groups, with PRP yielding better outcomes than TA. Conclusions: Both PRP and TA injections effectively alleviate foot symptoms in plantar fasciitis patients. However, PRP demonstrates superior outcomes in specific functional activities and quality-of-life components compared to TA. These findings suggest PRP as a preferred intervention in the management of plantar fasciitis.

Prospective hospital-based cohort studies of Respiratory Syncytial Virus (RSV) infections in infants under one year during and after the SARS-CoV-2 pandemic in Japan

ObjectivesIn Japan, population-based epidemiological data on respiratory syncytial virus (RSV) infections are limited. To elucidate the epidemiology of RSV before the introduction of new prophylactic drugs, we conducted a population-based study during and after the SARS-CoV-2 pandemic. MethodsThis study was performed in four hospitals in Chiba City and three hospitals in Ichihara City. Clinical information and residual samples from RSV rapid antigen tests of infants under one year old were collected. Samples from patients with lower respiratory tract infections (LRTI) were analyzed using the FilmArray Respiratory 2.1 panels. ResultsA total of 1200 infants underwent the RSV rapid antigen test, with 497 diagnosed with LRTI. Although five samples could not be stored, 252 out of 492 (51.2%) were positive for RSV. Among the RSV PCR-positive infants, 63 (25.0%) had underlying diseases, compared to 100 out of 240 (41.7%) RSV PCR-negative infants (P < 0.05). In Chiba City, the annual incidence of hospitalization per 1000 children was 12.7 in 2021, 4.4 in 2022, and 9.2 in 2023. ConclusionsDuring and after the SARS-CoV-2 pandemic, most hospitalized infants with RSV-LRTI did not have underlying diseases. Widespread use of prophylaxis in infants without underlying disease is desirable.

Smoking and cluster headache presentation and responsiveness to treatment

BackgroundThough an association between cluster headache (CH) and smoking has been postulated, data from the Middle East region is scarce.Aim of workTo study the relationship between smoking and CH clinical characteristics and responsiveness to therapy in Egypt.MethodologyThis was a prospective cohort hospital-based study conducted on patients with episodic and chronic CH in a tertiary headache clinic in Egypt during the period between 2019 and 2023. Patients were consecutively recruited at the time of their presentation and were followed up for two weeks after initiation of prophylactic treatment and steroids (as transitional therapy).ResultsOf 172 patients with CH recruited, 144 (83.7%) were smokers. Twenty-eight patients (16.3%) had chronic CH. The mean age was 42.08 ± 10.93 (20–66) years, and 131 (76.2%) were males. Smokers had a significantly higher median number of cluster bouts in the past five years (3.0 (IQR2.0–4.0) versus 2.0 (IQR 1.0–2.0)) and worse HIT-6 scores [51.0 (44.0–59.75) versus 41.0 (38.0–41.75)] than non-smokers (p < 0.001). The number of cluster bouts in the past five years was positively correlated with the smoking index (r = 0.249 (p = 0.006) and the smoking duration (in years) (r = 0.392 (p < 0.001)). HIT-6 scores were significantly correlated with the age at smoking onset (r=-0.190, = 0.023), smoking index (r = 0.519, p < 0.001), smoking duration (r = 0.611, p < 0.001), and number of cigarettes consumed per day (r = 0.392, p < 0.001).ConclusionSmoking is significantly correlated with the daily frequency of CH attacks, the frequency of CH bouts in the past five years, and the HIT-6 scores among our cohort.

Correlation of Pseudocholinesterase Level with Clinical, Biochemical Parameters Including Cardiac Profile and the Outcome in Organophosphorus Poisoning.

Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available "over the counter." OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly. It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0-3 is considered mild poisoning, 4-7 as moderate poisoning, and 8-11 as severe poisoning. Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20-30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities. This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes.

Association between late pregnancy prehypertension and adverse outcomes among newborns of women delivered at a tertiary hospital in Eastern Uganda: a prospective cohort study

BackgroundPrehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.AimsThe study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.Methods and materialsBetween September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.ResultsComposite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10–2.42, p = 0.037), 9.0 (95% CI 1.15–70.16, p = 0.010), and 1.55 (95% CI 1.16–2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).Conclusion and recommendationsPrehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.