Hospital Files Research Articles

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.

Evaluation of the effectiveness of laparoscopic pectopexy in advanced stage apical prolapse

ObjectiveWe aimed to investigate the effectiveness of the laparoscopic pectopexy procedure in women who want to preserve their uterus for stage III or IV apical prolapse. Study design132 women who underwent laparoscopic pectopexy due to stage III or IV apical pelvic organ prolapse (POP) were included in this study. Demographic data of the patients, duration of surgery, blood loss, hospitalisation, intraoperative and postoperative complications, recurrence rate were searched from the hospital file archive. Pelvic organ prolapse quantification (POP-Q) system was used at postoperative control visits. The patients’ quality of life was evaluated by comparing the results of the pelvic organ quality of life (P-QOL) questionnaire which they filled out at the preoperative and 6th months later. ResultsThe patients’ mean age was 60(52–66)years. The average duration of the surgery was 110(90–150) minutes. Average blood loss was 150(75–220) ml. No intraoperative or postoperative complications were noted. The average hospitalisation was 2(1–3) days. The average follow-up period was 19 (13–26) months. Apical prolapse recurrence was observed in 3 (2.2 %) patients and laparoscopic sacrohysteropexy was performed. There was a significant improvement in the POP-Q scores of the patients in the postoperative period (p < 0.0001). A significant improvement was detected in the P-QOL total score and all each paramaters after surgery (p < 0.0001). ConclusionLaparoscopic pectopexy seems to be a reliable and efficient method for patients in advanced stages apical prolapse whom wants to preservation of the uterus.With all the advantages of minimally invasive surgery, it increases the patients’ quality of life.

Ability of the SMART-COP score to predict the need for intensive care unit admission and mortality in older patients with non-ventilator-associated hospital-acquired pneumonia: A retrospective observational study.

To evaluate the ability of SMART-COP (systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen and pH) score to predict the need for intensive care unit (ICU) admission and mortality among patients with non-ventilator-associated hospital-acquired pneumonia (NV-HAP) and to compare ICU-hospitalized patients with those followed-up in the clinic, as well as the patients who survived with those who died in the ICU, in terms of clinical and laboratory parameters. A total of 203 patients (aged > 65 years) who were diagnosed with NV-HAP while staying in the geriatric clinic were enrolled in this retrospective observational study. Patient information was retrieved from hospital files. In a total of 203 patients with NV-HAP, the rate of ICU admission was 77.3% and the rate of mortality was 40.9%. The SMART-COP score was significantly higher in those admitted to the ICU and those died in the ICU (ICU nonsurvivors). The rate of ICU mortality was 52.9%. The SMART-COP score had significantly poor to moderate ability to predict the need for ICU admission (area under the curve [AUC] = 0.583) and both in-hospital mortality (AUC = 0.633) and ICU mortality (AUC = 0.617) with low sensitivity. The regression analysis revealed that a one-unit increase in SMART-COP score resulted in a 1.2-fold increase in both the hospital and ICU mortality (P < 0.05 for both) and 1.1-fold increase in ICU admission (P = 0.154). The SMART-COP score has poor to moderate ability to predict the need for ICU admission, in-hospital mortality and ICU mortality, and a one-unit increase in the SMART-COP score significantly increases the risk of both hospital and ICU mortality. Geriatr Gerontol Int 2024; ••: ••-••.

COMPARISON OF CLINICAL AND CRIMINAL CHARACTERISTICS OF MALE AND FEMALE CASES IN THE PRISONER SERVICE FOR MURDER OR ATTEMPTED MURDER

Background: The aim of the study is to compare male and female cases who were in the prisoner service and committed murder/attempted murder in terms of clinical and criminal characteristics. Methods: Information about 101 female and 101 male cases who were admitted to the prisoner service for murder and/or attempted murder were collected through a data form as a result of examining the hospitalization files. Results: The rate of men having psychotic disorders (50.8%) was found to be higher than the rate of women (20.4%). While men's rates of having antisocial personality disorder are higher than women's rates, women's borderline personality disorder rates are significantly higher than men's rates. The rate of women's previous history of suicide (50.5%) is higher than the rate of men's history (35.6%). It was seen that the rate of women admitted to the service to be their first crime was higher (87.1%) than men (46.5%). Conclusion: It is important to take gender-based differences into account and organize personalized treatment during the forensic treatment process. More clinical research on gender differences in homicide crimes is needed.

Pediatric COVID-19 in Lesotho and Post-pandemic Implications on Lower Respiratory Infections in Children.

Background The United States Agency for International Development (USAID) Reaching Impact, Saturation, and Epidemic Control (RISE) program funded Jhpiego to support the Government of Lesotho's COVID-19 response, including two national COVID-19 treatment centers. To evaluate the status of post-pandemic pediatric respiratory care in Lesotho, we analyzed pediatric treatment center data and healthcare worker (HCW) performance on pediatric COVID-19 training offered to HCWs at COVID-19 treatment centers. Methods We conducted a retrospective cohort study of patients 15 years of age or less hospitalized at two COVID-19 treatment centers in Lesotho from May 1, 2020, to April 30, 2022. Patient data were extracted from hospital files. We used the independent sample t-test, Mann-Whitney U test, or Fisher's exact test to evaluate associations between exposure variables and death. We also assessed differences between pre- and post-training examination scores of three one-day HCW training on pediatric COVID-19 using paired t-tests. Results Overall, <15-year-olds comprised 18/1,448 (1.2%) hospitalizations. Twenty-two percent (4/18) of children were hypoxemic (oxyhemoglobin saturation <94%) within the first 24 hours and 44% (8/18) at any point in the hospitalization. Oxygen utilization increased over the two-year period (p=0.004) and all eight children with hypoxemia received oxygen (p<0.001). Four of 18 (22%) patients died. For HCW training, pre- and post-training examinations were completed by 76/82 (92.7%) participants. The overall mean pretraining score was 44.6% (standard deviation (SD) 15.7%). Mean scores improved by an average of 32.2% (95% confidence interval (CI) 27.7%, 36.6%, p<0.001) on the same day post-training examination. Conclusions National COVID-19 treatment center data indicate a low burden of severe pediatric COVID-19 disease in Lesotho. However, recognized HCW knowledge gaps suggest deficiencies in identifying and referring severely ill children, which may detrimentally impact the ongoing post-pandemic care of children with severe lower respiratory infections.

Predictors of limb saving in diabetic foot ulcer.

This study was aimed to determine the various factors which could serve as predictor of saving of lower limb from amputation in patients with diabetic foot ulcer (DFU). This three-year retrospective study was conducted in the Diabetes and Endocrinology Unit of Hayatabad Medical complex Peshawar, Pakistan. Demographic, clinical, laboratory and radiological information of the diabetic patients with DFU admitted between January 2020 to December 2022 was retrieved from the hospital files. Information regarding initial and final decision regarding amputation and the outcome of the ulcer was also recorded. A total of 502 patients of diabetes mellitus (DM) with DFU were included in the study, of whom there were 279 (55.6%) males and 223 (44.4%) females. The mean age of the study population, mean duration of DM and mean HbA1c were 55.2 ± 9.8 years, 13.7 ± 6.7 years and 11.2 ± 2.4 %, respectively. Patients who had an amputation of their lower limbs had an increased age (p= 0.034), raised total leucocyte count (TLC) (p= <0.001), higher HbA1c (p= 0.025), had osteomyelitis (p= <0.001), and had a higher-grade ulcer (p= <0.001). On binary logistic regression analysis, ulcer grade (OR=7.4, p= <0.001), osteomyelitis (OR=11.8, p= <0.001), and initial decision of no amputation at the time of admission (OR=33.6, p=<0.001) were independently associated with the lower limb salvage. DFU which were of grade I to II, had no evidence of osteomyelitis and for which an initial decision was of no amputation were more likely to be salvaged.

Occupational therapy practice for post-acute COVID-19 inpatients requiring rehabilitation.

COVID-19 caused significant occupational disruption to people's life roles, with some people requiring an inpatient rehabilitation admission. Occupational therapists assessed and treated these patients using previous knowledge of similar conditions due to limited specificity in available guidelines to inform practice. The aim of this study was to investigate current practice with post-acute COVID-19 (PAC) patients within an inpatient rehabilitation setting in Australia, to better understand the role and impact of occupational therapy. A mixed-method study was conducted, including electronic medical record audits (October 2021 October 2022) and descriptive patient interviews at a large metropolitan subacute service. Descriptive statistics and qualitative analysis were used to summarise and interpret data. No involvement. A total of 24 patient electronic medical records were audited, and 10 patient interviews were completed. Three overarching categories were identified within the 685 occasions of occupational therapy service audited-occupational engagement, education provision and discharge planning. Patients identified the value of occupational therapy by reflecting on their lived experiences of engaging with occupational therapists and associated changes in occupational performance between COVID-19 diagnoses and discharge home. Occupational therapists possess a unique skill set that directly addresses the occupational needs and priorities of PAC patients. This study adds to the growing body of evidence supporting the contribution of occupational therapy to the management of COVID-19; however, further research is needed to develop evidence-based practice resources and advocate for system changes that improve quality of life for COVID-19 patients. During the COVID-19 pandemic, a lot of people got very sick. Some of these people needed more time and support to get better. Occupational therapists were important during this time because they helped these people to do their daily activities again. Because there were not many resources on how to do this, we looked into what occupational therapists were doing to help these people. We looked at patient hospital files and also talked to them to understand this better. We found that occupational therapists focused on three main areas: helping patients do activities that were important to them, teaching them about COVID-19 and helping them plan to leave the hospital. This study shows that occupational therapists are skilled at helping people with COVID-19. But more research is needed to make resources and also help with changing the healthcare system to further help people get better from COVID-19.

Assessment of hepatitis B virus infection and tuberculosis among people living with HIV at the Kankan Regional Hospital (Republic of Guinea)

Objective: The aim of this study was to determine the tuberculosis and hepatitis B virus co-infection among people living with HIV at the Kankan Regional Hospital (HRK) in Guinea and to describe the biological and clinical signs associated to the co-infections. Methods: It was 4 years retrospective study (January 1st, 2015-December 31st, 2018. data was collected from lab registers and hospitalization files. Results: On a total of 345 PVVH, HBsAg testing was carried out. Thus 9.3% (32/345) were co-infected with HIV/HBV with the presence of jaundice in 8.1% (28/345). All patients (100%) had oropharyngeal candidiasis (thrush). About 44.1% (152/345) of patients tested positive for tuberculosis, while 49.6% (171/345) presented with prurigo. The results of the study showed that the female gender was predominant with a sex ratio (M/F) = 0.69. The average age of the patients was 38.45±13.38 [16-80 years]. The most represented age group was ≥35 years (55.9%), followed by 25-29 years (16.8%) and 30-34 years (14.2%). More than half of the patients were married (51.6%), and singles accounted for 31.0%. On a socio-professional level, workers were in the majority (54.7%), followed by farmers (15.1%) and traders (14.5%). Conclusion: All of these results show that the prevalence of tuberculosis and hepatitis B was high among people living with HIV at the Kankan Regional Hospital.

Serum Cadmium and Lead Levels in Thalassemic Patients of Najaf Governorate, Iraq.

Thematological is a class of hereditary hematologic illnesses resulting from abnormalities in the production of one or more hemoglobin chains. Patients with β-Thematological may have a reduction in heavy metal levels as a result of iron chelate medication. The aim is to study the levels of heavy metals (toxic) in the blood of beta-Thematological patients and compare them to healthy people for the purpose of arriving at indicators through which it is possible to assist in early diagnosis of this disease or reduce symptoms. The study included 80 patients in comparison with age- and gender-matched 40 healthy individuals as controls. Samples were gathered between July 1, 2023, and September 1, 2023. The patients were interviewed for socio-demographic variables, and their medical histories were obtained from the hospital files. Cadmium and lead concentrations were determined using flame atomic absorption spectrometry (FAAS). All samples from Thematological patients were taken after the chelating therapy. Cadmium levels in Thematological patients were found to be lower in both genders in the control group. Lead levels were found to be greater in male Thematological patients and lower in female Thematological patients than those in the control group of female Thematological patients. Additionally, it was observed that patients from areas outside of Najaf's city center had greater levels of lead and cadmium than patients from the city center. Cadmium and lead levels in the serum were often low in Thematological patients. Heavy metals are eliminated when deferasirox chelate is taken.

No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey

PurposeWhole-body computer tomographic examinations (WBCT) are essential in diagnosing the severely injured. The structured clinical evaluation in the emergency trauma room, according to ATLS® and guidelines, helps to indicate the correct radiological imaging to avoid overtriage and undertriage. This retrospective, single-center study aimed to evaluate the value of WBCT in patients with an inconspicuous primary survey and whether there is any evidence for this investigation in this group of patients.MethodsThis retrospective, single-center study was conducted with patients admitted to a maximum-care hospital and supraregional trauma center in Germany and part of the TraumaNetwork DGU® in southwest Germany between January 2012 and November 2017. Hospital files were used for evaluation, and WBCT was carried out using a 32-row MSCT device from Siemens Healthineers, Volume Zoom, Erlangen, Germany. For evaluation, non-parametric procedures such as the chi-square test, U test, Fisher test, and Wilcoxon rank sum test were used to test for significance (p < 0.05).ResultsFrom 3976 patients treated with WBCT, 120 patients (3.02%) showed an inconspicuous primary survey. This examination did not reveal any trauma sequelae in any of this group. Additionally, 198 patients (4.98%) showed minor clinical symptoms in the primary survey, but no morphological trauma sequence could be diagnosed in WBCT diagnostics. Three hundred forty-two patients were not admitted as inpatients after WBCT and discharged to further outpatient treatment because there were no objectifiable reasons for inpatient treatment. Four hundred fifteen patients did not receive WBCT for, e.g., isolated extremity trauma, child, pregnancy, or death.ConclusionNot one of the clinically asymptomatic patients had an imageable injury after WBCT diagnostics in this study. WBCT should only be performed in severely injured patients after clinical assessment regardless of “trauma mechanism.” According to guidelines and ATLS®, the clinical examination seems to be a safe and reliable method for reasonable and responsible decision-making regarding the realization of WBCT with all well-known risk factors.

Abstract 4855: Identifying hot spots of breast cancer and industrialized areas in Hermosillo, Sonora, Mexico

Abstract Background: Sonora, a state in Mexico, has the highest rates of breast cancer in the country and has a history of industrial pollution. These factors may contribute to an increased risk of breast cancer. Hermosillo, the state capital, exhibits both of these characteristics. Given these conditions, it is important to further evaluate the prevalence of breast cancer hotspots and the potential links between breast cancer and industrialized areas. Objective: Identify breast cancer hot spots and their association to industrialized areas in Hermosillo, Sonora, Mexico. Methods: This study collected clinical data on breast cancer cases (current, survivors, deceased) from hospital files in Hermosillo that were 10 years old. The primary unit of analysis was neighborhoods. The study estimated breast cancer prevalence by analyzing the number of females per neighborhood, based on data reported by INEGI Census 2020. The data was categorized by age groups (age group no. 1 of 18 to 59 years old, no. 2 of 60 to 64 years old, and no. 3 of 65 years old or older). The estimated prevalence was depicted on a map using ArcGIS software, version 10.8.2. Hot spot analysis was used to identify neighborhoods with high breast cancer prevalence. The study also categorized neighborhoods as industrialized areas if they contained at least six hazard-generator industries. Results: A total of 1394 cases of breast cancer were gathered from hospitals. Location information for 3697 industries was provided by INEGI. Out of the 756 neighborhoods studied, 95 (12.6 %) were found to be industrialized areas, while 661 (87.4 %) were non-industrialized. Four neighborhoods in Hermosillo's southeast were observed to have breast cancer hot spots (unadjusted). After adjusting for age, one hot spot was found in the southeast for age group no. 1 (one neighborhood), while hot spots for group no. 2 (three neighborhoods) and no. 3 (33 neighborhoods) were in Hermosillo's northwest. The hot spots were related to industrialized areas (unadjusted OR = 6.94, 95% CI (0.94, 50.8), p-value = 0.05). After age adjustment, this association was statistically significant for group no. 3 (OR = 2.70, 95% CI (1.27, 5.72), p-value = 0.009), but not for group no. 1 (OR = 1.69, 95% CI (0.06, 41.74), p-value = 0.748) or group no. 2 (OR = 2.56, 95% CI (0.23, 28.46), p-value = 0.44). Conclusions: Our research found a link between industrialized areas and high breast cancer rates. We also found hotspots for women aged 65+ in Hermosillo, with 33 affected neighborhoods in the city's northwest. This is the first comprehensive study examining breast cancer prevalence in Hermosillo over a ten-year period. More extensive studies are needed in other cities in Sonora, Mexico, to confirm our findings. Citation Format: Diana Evelyn Villa-Guillen, Aurelio A. Mata-Valenzuela, Hector Tecuanhuey-Tlahuel, Andres M. Galvez-Arevalo, Kenneth L. Garcia-Castellon, Yoahana E. Guzman-Hernandez, Karla S. Ortega-Landa, Fatima Y. Pelayo-Rodriguez, Jose R. Silva-Rivera, Rogelio A. Ureña-Acosta, David O. Garcia, Jorge A. Villa-Carrillo. Identifying hot spots of breast cancer and industrialized areas in Hermosillo, Sonora, Mexico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4855.

Esophageal replacement in children - 27 years of experience in a University Hospital.

esophageal replacement in children is indicated when it is impossible to maintain the native esophagus, which in the pediatric population includes patients with esophageal atresia and esophageal caustic stenosis. The objective of this communication is to report the experience of a university service with two techniques of esophageal replacement. this is a retrospective study based on the revision of hospital files. The study population consisted of patients who underwent esophageal replacement from 1995 to 2022, at the Hospital de Clínicas of the State University of Campinas. The analyzed data were age, sex, underlying disease, technical aspects, complications, and long-term results. during the study period, 30 patients underwent esophageal replacement. The most common underlying diseases were esophageal atresia (73.33%) and caustic stenosis (26.67%). Twenty-one patients underwent gastric transposition (70%), and nine underwent esophagocoloplasty (30%). The most frequent postoperative complication was fistula of the proximal anastomosis, which occurred in 14 patients. Most of the patients with fistulas had a spontaneous recovery. There were three deaths. Of the 27 survivors, 24 can feed exclusively by mouth. esophageal replacement in children is a procedure with high morbidity and mortality. Esophagocoloplasty and gastric transposition have similar results and complications, with the exception of proximal anastomotic fistulas, which are generally self-resolving and are more common in esophagocoloplasty. The choice of the best surgical technique must be individualized according to the patients characteristics and the surgeons experience, as both techniques offer the ability to feed orally in the short or medium term.

The prevalence and spectrum of thyroid dysfunction among children with Down syndrome attending the paediatric services at two tertiary hospitals in Pretoria, South Africa

Background. Down syndrome (DS) is the most common chromosomal abnormality in the paediatric setting, and thyroid dysfunction is more commonly encountered in this population than among the general population. The literature shows that the most common type of thyroid dysfunction seen in these children is subclinical hypothyroidism.Objective. The purpose of this study was to establish the prevalence and spectrum of thyroid disease in this population with the aim of establishing easy-to-follow protocols. Method. A retrospective study was conducted in children with DS who were seen at the paediatric genetic clinic at two academic hospitals. Data were collected from the hospital files and the results were extracted from the National Health Laboratory Service database system. Results. A total of 158 children were recruited; 25 children were excluded as they had had no thyroid function tests done. From the total of 133 included children, 70 (52.6%) were male. Babies born in one of the two hospitals numbered 60 (45.1%), whereas 54.9% were born in the other hospital. A total of 77 (57.9%) were found to have thyroid dysfunction; 55.8% of these patients were male. The most common thyroid abnormality was subclinical hypothyroidism in n=66/133 (49.6%), accounting for 85.7% of the causes of the thyroid dysfunction. Most children (n=45/133 (33.8%)) had their first thyroid function test done before the age of 2 months, followed by the age group of 1 - 5 years (n=34/133 (25.56%)). The total number of children started on treatment for their thyroid dysfunction was n=5/77 (6.49%). Conclusion. Thyroid dysfunction is seen more commonly in children with DS compared with the general population, which was very evident in the present study. A standardised protocol will have a significant impact on the early management of these children, to prevent further cognitive impairment, especially in developing countries and at any level of healthcare. The recommendations for thyroid dysfunction screening by the American Academy of Pediatrics can be adjusted and tailored for the South African population. Early diagnosis and referral of children with DS to a secondary- or tertiary-level facility is of utmost benefit for these children for screening and treatment of comorbidities and complications.

The Benefit of an Extensive Cancer Screening Strategy After the First Episode of Unprovoked Pulmonary Embolism.

The etiological assessment after an acute unprovoked pulmonary embolism (PE) represents an essential step in the overall management of the patient, with the aim of adapting the duration and type of anticoagulant to be used, avoiding recurrence and thus improving overall morbidity and mortality, but this is not such a simple question to answer. The main objective of this work is to know the benefit of a limited etiology strategy versus an extensive strategy after a first episode of acute non-provoked PE, first on all-cause mortality, and then the superiority of one strategy over another on the diagnosis of cancer at 1 year in patients admitted to a cardiac intensive care unit. This is a single-center, retrospective study from 2014 to 2021, which includes all patients, admitted to a cardiac intensive care unit for a first episode, at high or high intermediate risk of mortality at day 30. The included patients were divided into 2 groups: those who received a limited cancer screening strategy, and those who received, in addition to the latter, an injected cerebral and cervical-thoracic-abdominal scan, and the determination of tumor markers. All data were extracted from the medical hospital files. In total, we included 130 patients. The mean age of our patients was 87.19 (SD = 6.1), with a female predominance with a percentage of 55.4%. Eighty-seven patients benefited from an extensive cancer screening strategy, versus 43 patients who benefited from a limited strategy. First, for mortality at 1 year, 27 deaths were found between the 2 groups but without significant difference (hazard ratio; 0.53; P = 0.16), and for the mean duration from embolic episode to death, there was a mean of 20 weeks for the limited strategy group and 24 weeks for the extensive strategy group, with a nonsignificant difference ( P = 0.106). For the diagnosis of cancer at 1 year, 28 patients were diagnosed with cancer: 13 patients in the limited strategy group versus 15 in the extensive strategy group, with no significant difference (hazard ratio, 1.983; P = 0.082). The mean time to diagnosis was 22 weeks in the limited strategy group and 20 weeks in the extensive strategy, with no significant difference ( P = 0.729). To date, no scientific evidence has been established for the extensive versus the limited strategy, therefore, a minimal etiological workup is also effective in the detection of cancer after unprovoked PE.

Palliative care for cardiovascular patients: description of motives for referral and actual care provided

Abstract Background Palliative care (PC) for cardiovascular patients remains suboptimal, whereby only a small proportion of patients are referred to specialist palliative care, and often too late in the disease course. We investigated the reasons that prompted cardiologists to request an intervention from the PC team, and we describe the actions implemented by the PC in response to referrals from the cardiology department. Methods This retrospective study included all patients with cardiovascular disease who were referred to the mobile palliative care team of a large University Hospital in France between 2010 and 2020. All data were extracted from the medical hospital files. For all patients referred to PC during the study period, we recorded the original motive for requesting assistance, as cited in request sent from cardiology to PC. We also recorded the types of services provided by PC, the date of the first and last consultation of the patient with PC, and the number of PC consultations per patient. Results From a total of 142 cardiology patients for whom PC assistance was requested, 136 (95.8%) died, while 6 (4.2%) are still alive. In 42 patients (29.6%), there was a generic request for intervention without indicating any particular domain where specific assistance was needed. In other cases, a motive for referral to the PC mobile team was provided by cardiologists, with ethical dilemmas (35 patients; 24.6%), symptom management (23 patients; 16.2%), and discussion about where the patient could live (11 patients; 7.7%), as the most common motives (see Figure 1). In response to these referrals, the PC team provided assistance with ethical dilemmas in 69 patients (48.6%), symptom management in 28 patients (19.7%), discussion about where the patient could live in 15 patients (10.6%), 2 or more of these issues in 16 patients (11.3%), and other issues in 14 patients (9.8%) (e.g. reorientation to oncology or family support). The majority of patients had 1 (n=90, 63.4%) or 2 PC consultations (n=27, 19%), while 10 patients (7%) had 3, 9 patients (6.4%) had 4, and 6 (4.2%) had 5 or more PC consultations. Among those who died, the median number of days between the first and the last PC consultation was 0 (quartile 1=0, quartile 3=3). Conclusion This study shows that cardiologists do not necessarily have a specific motive in mind when referring patients to PC. Because many more patients received assistance with ethical dilemmas than was requested, this indicates that cardiologists may not be aware of the ethical issues at stake in the care of cardiology patients, or that they only refer patients to PC when they have no other solution or do not know what else to do for the patient. There is clearly a need to raise awareness among cardiologists about ethical issues and about the services that the PC team can provide.

Evaluation of pediatric patients installed due to acute gastroenteritis

Objectives: Acute gastroenteritis is one of the most prevalent causes of death and morbidity in children and a significant health issue in Turkey, as well as developed and developing nations. The purpose of this study is to analyze retrospectively the patients with acute gastroenteritis who sought treatment at the Kızıltepe State Hospital in Mardin. Methods: This study was designed as a single-center retrospective study in which demographic variables were evaluated by taking fresh stool samples from the patients who applied to the Mardin Province Kızıltepe State Hospital between 01/11/2020 and 31/10/2021 with the complaint of diarrhea. The information of rotavirus, enteric adenovirus and amoeba viruses in stool samples was investigated by qualitative immunochromatographic test. The researcher assessed the research data utilizing the hospital's file archive materials and three factors set by the researcher. The researcher extracted the information about these factors from the patient files and stored it in a Microsoft Office Excel file. Results: According to the gender variable of the research participants, Amoeba positive rates were considerably higher in males than in girls (35.8% versus 22.6%, p = 0.046, respectively). According to the age groups variable, rotavirus antigen positive was statistically significantly greater in the 5-24 month age group compared to other age groups (p = 0.034). Similarly, Amoeba positive was statistically substantially higher in the 5-24 month age group compared to other age groups (p = 0.001). There was no significant variation between age groups in the distribution of adenovirus. According to the seasonal variable, rotavirus antigen positivity was most prevalent in the spring, and the difference between the spring and other seasons was statistically significant (p = 0.001), whereas amoeba positivity was most prevalent in the summer, with no statistically significant difference between the seasons (p = 0.003). The frequency of undiscovered variables was greater during the spring-summer months, and a statistically significant difference (p = 0.041) was identified between the groups. The seasonal variation in the prevalence of Adenovirus antigen positive was not statistically significant (p = 0.394). Conclusions: As a result, in poor and underdeveloped nations, it is among the top five causes of death in children under the age of five, in relation to acute gastroenteritis. Furthermore, the majority of these deaths may be minimized by preventative and prevention strategies. It is the responsibility of governments, health professionals, and families to foster a safe and healthy environment for all infants and children during their infancy and development. Community-based health strategies should be undertaken to lower the morbidity and death rates of millions of people worldwide who are exposed to harmful environmental conditions and malnutrition.

Management of Secondary Glaucoma Postscleral Buckle Surgery: A Tertiary Hospital Experience in Southwest Nigeria

Abstract Purpose: To evaluate the rate of postoperative intraocular pressure (IOP) elevation and its management in patients who have undergone scleral buckle surgery as a primary intervention for retinal detachment. Materials and Methods: This was a retrospective review of hospital files of scleral buckle surgeries for retinal detachment from January 2016 to December 2021 at the University College Hospital Ibadan. All patients with a previous history of glaucoma, vitreoretinal surgery, or a combination of vitrectomy and scleral buckling procedures were excluded from the review. An IOP of ≥22 mmHg after surgery was considered elevated. Results: A total of 148 patients’ charts were reviewed with 125 patients (131 eyes) included in the study. There were 81 males (64.8%) and the mean age of patients was 45.2 (±18.8) years, with a range of 5–81 years. Rhegmatogenous retinal detachment accounted for 97.7% (128 eyes) of all cases and 118 eyes (90.1%) were recent detachments. Seventy-nine eyes (60.3%) recorded elevated IOP postscleral buckle surgery. The mean elevated IOP postbuckle surgery was 27.9 (±6.2) mmHg and the mean antiglaucoma medications prescribed was 2.4 (±2) with a range of 2–5 medications. Four eyes (5.1%) needed surgical intervention for the elevated IOP. The last follow-up mean IOP was 14.3 (±4.1) mmHg. Conclusion: Elevated IOP frequently complicates scleral buckle procedure and medical treatment is usually sufficient. As a common complication, this should be considered in advance when planning for the procedure, especially in low-income countries like Nigeria where scleral buckling surgery is still in common practice.

Epilepsy Frequency and Risk Factors Three Years After Neonatal Seizures

BackgroundNeonatal seizures, one of the main risk factors for the development of epilepsy, remain a clinical concern. In children with neonatal seizures, early recognition of risk factors is important for the early diagnosis and appropriate treatment of epilepsy and for improving prognosis. In this study, we aimed to determine the frequency of and the risk factors for the development of epilepsy in patients with neonatal seizures. MethodsThe hospital files of 228 children who experienced seizures in the neonatal period were reviewed. The frequency of epilepsy and risk factors for the development of epilepsy were determined at age 36 months. ResultsEpilepsy was diagnosed in 40.8% of the cases. Univariate analysis revealed family history of epilepsy, parental consanguinity, abnormal neurological examination findings, microcephaly, unresponsiveness to antiepileptic drugs or antiseizure medication, use of more than one antiepileptic drugs to antiseizure medication at discharge, status epilepticus, electroencephalography abnormalities, abnormal neuroimaging findings, invasive ventilation requirement, myoclonic seizures, central nervous system malformation, and congenital metabolic disease as risk factors for the development of epilepsy. Of these, a family history of epilepsy, abnormal neurological examination findings at discharge, and use of at least two antiepileptic drugs to antiseizure medication at discharge were found as independent risk factors in multivariate analysis. ConclusionsNeonatal seizures appear to be associated with epilepsy in more than one-third of the patients. Of the newborns with seizures, those with a family history of epilepsy, abnormal neurological examination findings at discharge, and those using at least two antiepileptic drugs to antiseizure medication at discharge should be monitored more carefully for the development of epilepsy.

A different approach to the evaluation of the genotype-phenotype relationship in biotinidase deficiency: repeated measurement of biotinidase enzyme activity.

In the present study, we aimed to evaluate the genotype-phenotype relation in patients with biotinidase enzyme deficiency based on repeated biotinidase enzyme measurements. The hospital file information of patients with biotinidase, enzyme deficiency was assessed retrospectively, and the relationship between the BTD gene mutations analysis results and biotinidase enzyme activity following the first and repeated enzyme activity assessments was analyzed. One-hundred-ten patients were included. In the first enzyme evaluation, profound biotinidase enzyme deficiency was identified in 15 (13.6 %), partial biotinidase enzyme deficiency in 63 (57.3 %), and heterozygous biotinidase enzyme deficiency in 32 (29.1 %) of the patients. The BTD genetic analysis revealed 42 (38.2 %) homozygous, 42 (38.2 %) heterozygous, and 26 (23.6 %) compound heterozygous variants. The most common homozygous variant, p.Asp444His, was evaluated with 130 repeated enzyme measurements and was consistent with a partial biotinidase enzyme deficiency in 55.4 % of cases, heterozygous biotinidase enzyme deficiency in 43.8 % of cases, and profound biotinidase enzyme deficiency in one (0.8 %) case. Clinical symptoms developed in 17 patients during follow-up, of which 70.6 % were related to neurodevelopment. The most common variant was homozygous p.Asp444His (29.4 %) among the patients who developed symptoms. This is the first study to date to evaluate thegenotype-phenotype relationship in patients with biotinidase deficiency through repeated measurements of biotinidase enzyme activity. The study reveals that biotinidase enzyme activity alone is inadequate for diagnosing biotinidase enzyme deficiency or evaluating disease severity, asgenetic investigations are also required for a definitive diagnosis of biotinidase enzyme deficiency.

EVALUATION OF FETAL AND MATERNAL OUTCOMES IN MULTIPLE PREGNANCIES

Multiple pregnancies are an important topic of obstetrics as they are interesting and carry high risk. The increasing use of ultrasonography (USG) has made it possible to detect multiple pregnancies early. In the last 30 years, there has been a significant increase in the number of multiple pregnancies, especially in developed countries, with the increase in gestational age and the use of progressively developing assisted reproductive techniques (ART). Complications related to preterm birth and prematurity are observed with an increased frequency in these pregnancies. Therefore, multiple pregnancies constitute a process that should be monitored much more closely than singleton pregnancies due to many accompanying maternal and fetal complications. In this study, it was aimed to evaluate the maternal and fetal outcomes of multiple pregnancies with assisted reproductive techniques or spontaneous delivery in our clinic. Among all pregnant women who gave birth in our hospital between January 2018 and March 2022, 53 multiple pregnancies were included in the study. Maternal age, gestational week, delivery history, mode of delivery, birth weight and apgar scores (1st and 5th minutes) of the patients in the hospital database and file records were evaluated in terms of obstetric pathologies and perinatal outcomes. Level 1 and level 2 ultrasonography measurements and Doppler ultrasonography measurements of all patients were made by our radiology doctor in our hospital. Patient follow-ups were managed by the same gynecologist and obstetrician. There was no significant difference in the mean age of the participants according to birth weight, week of birth and mode of delivery (p&gt;0.05). There was a significant difference in the mean age of the participants according to the presence of maternal hypertension (p&lt;0.05). There was a statistically significant relationship between birth weight and multiple pregnancy status (p&lt;0.05). The rate of birth weight of &lt;1000 g and 1000-1500 g was higher in triplet pregnancies, and birth weight was found to be significantly lower than in twin pregnancies and this finding is consistent with the literature. There was a statistically significant relationship between the week of birth and multiple pregnancy status (p&lt;0.05). The frequency of delivery between 24-28 and 28-32 weeks in triplet pregnancies was found to be significantly higher than in twin pregnancies and this finding is consistent with the literature. There was no statistically significant relationship between the presence of maternal Diabetes Mellitus (DM) and Hypertension (HT) and twin and triplet pregnancies (p&gt;0.05). A statistically significant difference was found between twin pregnancy and triplet pregnancy in terms of both Apgar 1st Minute and Apgar 5th Minute scores (p&lt;0.05). Both Apgar scores were higher in twin pregnancies. In a similar study, a high correlation and a statistically significant relationship was found between the 1st and 5th minute Apgar scores and the week of birth. One of the most determining factors on perinatal morbidity in multiple pregnancies is chorionicity. Perinatal outcomes are particularly related to week of birth and chorionicity. The biggest limitation of our study is the lack of sonographic evaluation of chorionicity in our file record information. Therefore, the relationship between neonatal outcomes and chorionicity could not be evaluated in this study and this is considered a limitation of the study.