Institution-based Study Research Articles

With the rising trend of prostate cancer, where does northern Sri Lanka stand? A cohort study from a tertiary care centre.

Introduction: Prostate cancer is the second most common cancer among males all over the world in 2020. As per the global cancer observatory 1, 414, 259 (7.3%) cases were diagnosed in 2020 worldwide. The study aims to analyse the variations in demographic and clinico-pathological characteristics of prostate cancer in the Northern Province.
 Methods: This is a cross-sectional descriptive institution-based study that recruited all the prostate cancer patients who were treated at the Teaching hospital, Jaffna from August 2019 to August 2022. Data were extracted retrospectively from the clinic records of the patients as well as histopathology documents.
 Results: A total of 141 diagnosed patients at Teaching Hospital Jaffna were analysed. The mean age of the sample was 70.11± 8.43 years. Out of 141 patients, 30.49% were diagnosed to have localized disease and 26.24% and 43.26% with locally advanced and metastatic disease respectively. Out of those who had localized disease 68.5% were managed with radiotherapy, 23.25% with active surveillance and 11.6% with radical prostatectomy. The mean value of PSA was 70.11±8.4. The majority 97.2% had small acinar adeno carcinoma as histology. As per the D’Amico classification system for prostate cancer, 2.83% belonged to low-risk category and 80.1% belonged to high-risk category.
 Conclusion: There is a rising trend in the incidence of prostate cancer in Sri Lanka over the recent past. Most of the cases are advanced at the initial presentation. It implies the need for screening programmes with PSA in near future to detect cancer at early stages, implementation of cancer awareness programmes as practised in Western countries and strict adherence to national guidelines on management and referral pathways.

Prevalence of Anaemia among Antenatal Clinic Attendees at A Tertiary Hospital in South West, Nigeria

Introduction: Anaemia in pregnancy is a global public health problem causing both maternal and perinatal morbidities and mortalities. Prevalent rates vary from one geopolitical region to the other. Efforts have been made to reduce this condition during pregnancy through the use of haematinics and other interventions. However, despite all the efforts put in place, pregnant women still present with this condition. This study was carried out to find out its prevalence rate and the factors responsible for it. Materials and Methods: It was a cross-sectional institutional based study carried out at the antenatal clinic of the University of Medical Sciences Teaching Hospital Complex, Akure, Ondo State, South West, Nigeria. The study used a systematic sampling to recruit 400 antenatal clinic patients over a period of 16weeks starting from the 16th of August to 16th of December 2022.The women were interviewed with copies of a structured questionnaire administered by trained research doctors who also helped in the collection of the blood samples. About 3mls of venous blood was collected from the antecubital vein using plastic disposable syringes into sample bottles containing ethylene diamine-tetra acetic acid (EDTA) and the bottles labelled accordingly. Packed cell volume and red cell morphology were done for the women at the time of recruitment. Data obtained were analysed using the Statistical Package for Social Sciences (SPSS Version 22). Descriptive statistics were computed for all relevant variables, Chi Square test and Multivariate logistic regression were used to test for association and possible risk factors for anaemia. The level of significance was set at ???? < 0.05. Results: Most of the women were within 30years- 39years (51.2%, 205) with a mean age of 31.61years±5.37years. Most of them were married (97.3%, 389), were Christians (94.5%, 378), were Yorubas (82.8%, 331), were traders (40.3%, 161), had tertiary level of education (68.8%, 275) and lived in the urban areas of Ondo State (89.5%,358). Most had their first menses between the ages of 10 to 15 years (79.2%, 317) with a mean age of 14.24 ± 2.12 years. Majority had inter- pregnancy interval of ≤ 2 years (53.7%, 215). There was no history of bleeding in most of the women (91.5%, 366), many of them were in the third trimester of their pregnancy (64.1%, 257) with a mean gestational age of 28.83 ± 6.91 weeks. The prevalence of anaemia among the study participants was 40.0% (160/400) while 60% (240/400) were not anaemic. Among the participants who were anaemic, 77.5% (124/160) had mild anaemia, 22.5% (36/160) had moderate anaemia while none had severe anaemia. The only risk factors identified to be responsible for anaemia among the women were high parity and being in the third trimester of pregnancy. Conclusion: This study showed that the prevalence of anaemia is still high among our women mostly occurring among women of high parity and in the third trimester of pregnancy. Efforts must be intensified to address this condition through the use of haematinics which can be started pre-conception and adequate counselling on the need to fully recover from the effects of one pregnancy before embarking on another.

Health-related quality of life and its determinants among patients with psoriasis at a referral hospital in Northwest Ethiopia.

This study assessed health-related quality of life (HRQoL) and its determinants among patients with psoriasis having follow-ups at the University of Gondar Comprehensive Specialized Hospital (UoGCSH). A cross-sectional institutional-based study was conducted at the dermatologic clinic of UoGCSH from June to August 2022. Four hundred eligible patients with psoriasis were included in the study using a systematic random sampling technique. The Dermatology Life Quality Index (DLQI) measurement scale was used to assess HRQoL. The relationship between HRQoL and independent predictor variables was investigated using bivariable and multivariate logistic regression analyses. Statistical significance was defined as a p-value of <0.05 at the 95% CI. Of the 422 study subjects approached, 400 respondents with psoriasis were included in the final analysis. The mean (±SD) age was 39.8 (±17.2) years, and 56% were women. The most commonly prescribed medications were topical corticosteroids (68.3 %). The mean (±SD) DLQI was 13.05 (7.82). More than three-fourths (78.5%) of the patients' HRQOL was affected, and its severity ranged from very large to extremely large. Being male (adjusted odd ratio) (AOR) = 0.373, 95% CI (0.171, 0.773), the use of alternative therapy (AOR) = 0.237, 95% CI (0.114, 0.494), duration of diseases (AOR) = 0.184, 95% CI (0.061, 0.557), duration on medication (AOR) =3.75, 95% CI (1.32, 10.73), presence of comorbidity (AOR) = 6.199, 95% CI (1.921, 20.00), and income were found to have a significant association with poor HRQoL. Psoriasis patients had reduced HRQoL, which was lower than that of the normal population. The study identified that several variables contributed to this reduced HRQoL. Predictors that take into account interventions were essential for preserving patients' HRQoL.

The Quality of Discharge Summaries at Al-Shaab Hospital, Sudan, in 2022: The First Cycle of a Clinical Audit.

Background The discharge summary is a vital component of the modern health system. It is defined as a synopsis of information regarding events occurring during the inpatient care of a patient, to allow for a safe, quick, and effective patient-centered discharge process. It contains important information about the patient's hospital stay, including the reason for admission, treatment received, and follow-up needed. Low-quality discharge summaries pose a great risk to patient healthcaresince the most frequent reason for error in clinical settings is poor communication.In the United Kingdom, the Professional Record Standards Body (PRSB) has adopted the Academy of Medical Royal Colleges (AoMRC) "Standards for the Clinical Structure and Content of Patient Records" and produced a standard discharge summary form. This study aimed to assess the quality of discharge summaries at Al-Shaab Hospital in Sudan in terms of information, filling adequacy, and adherence tointernational guidelines and evaluate the discharge interviews. Methods A cross-sectional institution-based study was conducted in the period of September to December 2022 at Al-Shaab Teaching Hospital in Khartoum, Sudan. Systematic random sampling was used to select the study participants from the discharged patients. A total of70patients were met in their wards over a period of two months, and the contents of their discharge cards were compared to items on an online checklist based on the Professional Record Standards Body (PRSB) and the Academy of Medical Royal Colleges (AoMRC) standard discharge summary. The patients were also interviewed to assess their knowledge regarding their discharge information. Results The hospital's discharge summary formcontained only four headings: date, patient name, age, and ID number. The assessed cards were found to be missing valuable information, including date of admission (missing in 83%), filling doctor's name (missing in 71%), and medication changes (missing in 70%). Only half of the summaries were clearly readable. The majority of patients had poor knowledge regarding their medication side effects (89%) and how to act in an emergency (86%), while knowledge of medication doses and follow-up details was good in 80% and 66%, respectively. Conclusion The patients are discharged with inadequately filled discharge forms. This may be due to the poor design of the form, so a newly designed form will be proposed, based on international standards. The discharge interview is also in need of improvement, to make sure patients are fully aware of their condition.

Tzanakis score as a diagnostic tool for an acute appendicitis: An institution-based retrospective study

Introduction: Acute appendicitis is the most common pathology encountered among the patients with acute abdominal pain. Nowadays, different scoring systems are used to diagnose acute appendicitis. One of them is Tzanakis scoring, which is a combination of clinical examination, ultrasonography, and laboratory markers of inflammatory markers. Hence, this study was done to assess the diagnostic accuracy of Tzanakis scoring system in diagnosing acute appendicitis and compare its accuracy with histopathological examination. Methods: A retrospective observational study of all cases of acute appendicitis was conducted from July 2018 to June 2019 at the Department of Surgery, Western Regional Hospital.Out of 403 patients who had undergone appendicectomy during the period of one year, the necessary documents of 83 patients could not be collected. Hence, 320 patients were included in our study. The ethical approval was taken from the Institutional Review Committee (Ref. No. 14. 2077/078). Total Tzanakis score of all patients who underwent appendicectomy during this period was calculated and compared with histopathology report. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Results: The sensitivity,specificity of Tzanakis score of all 320 patients who underwent appendicectomy was 84% and 71% respectively. The diagnostic accuracy was 84% with positive predictive value 98% and negative predictive value 17%. Conclusions: The Tzanakis scoring system is simple, effective and easy to be applicable for the diagnosis of acute appendicitis.

Determinants of pre-eclampsia among pregnant women attending antenatal care and delivery services at Bahir Dar public hospitals, northwest Ethiopia: A case-control study.

Pre-eclampsia (PE) is a pregnancy-related syndrome that occurs after 20 weeks of pregnancy. The current study was designed to evaluate the determinants of PE in pregnant women following antenatal and delivery services. An institution-based case-control study was performed in governmental hospitals of Bahir Dar city. The data were collected using an interview-administered questionnaire and analyzed by SPSS version 20 software. Bivariate and multivariable logistic regression models were utilized for the analysis of variables. A p < 0.05 was used to declare the level of significance. In this study, the mean ages (in years) of cases and controls were 28.20 ± 5.66 and 27.52 ± 4.70, respectively. Factors such as: being primiparous (adjusted odds ratio [AOR]: 3.19 at 95% confidence interval [CI]: 1.71, 5.97), family history of hypertension (HTN) (AOR: 4.14 at 95% CI: 1.71, 10.05), previous history of PE (AOR: 7.97 at 95% CI: 2.42, 26.63), number of antenatal care (ANC) visits (AOR: 5.43 at 95% CI: 2.86, 10.33), not taking iron and folic acid supplement (AOR: 4.46 at 95% CI: 1.59, 12.48), body mass index ≥25 kg/m2 (AOR: 3.47 at 95% CI: 1.78, 6.77), not consuming vegetables (AOR: 1.99 at 95% CI: 1.07, 3.69) and not consuming egg, milk and milk products (AOR: 3.00 at 95% CI: 1.47, 6.11) were the determinants of PE. In this study, different determinants of PE were identified. Hence, special attention should be given for primiparous women, women having previous history of PE and family history of HTN. Moreover, nutritional counseling should be given for pregnant women during ANC visits. Besides, higher officials should design an appropriate strategy to increase the number of mothers to complete their ANC visits and to take iron and folic acid supplements. Furthermore, to verify the determinants of PE, community-based cohort studies are warranted.

Study of clinical and biochemical profile of scrub typhus in a tertiary care hospital of West Bengal

Background: Humans are accidental hosts in the zoonotic disease Scrub typhus. The disease though widespread in our county, it remains grossly underdiagnosed because of its non-septic clinical manifestations and lack of access to specific laboratory facilities. Aims and Objectives: The objective of present study is to evaluate the clinical presentations of Scrub Typhus among the study group. Furthermore, to assess the various laboratory findings in Scrub Typhus cases among the study group is the other objective of this study. Materials and Methods: The present study is an Institution-based, observational, and cross-sectional study conducted for 18 months with the admitted patients having 14–70 years of age. Data collected regarding patients’ demographic profile, symptoms, clinical findings, laboratory, and radiological findings. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Results: In our study, we found that most of the patients were 14–20 years old and female population was higher. It was found that 34.3% of patients had Eschar, 42.9% of patients had Rash, and 91.4% of patients had Pallor, 8.6% of patients had Ascites, 25.7% had Edema, 8.6% of patients had Jaundice, 11.4% had shock, and 57.1% had pneumonia/pneumonitis. The present study showed that 65.7% of patients had drug response (Doxycycline). Conclusion: Knowledge of geographical distribution, evidence of exposure to vector, clinical features such as fever, rash, eschar, headache, and myalgia along with high index of suspicion are crucial factors for early diagnosis and that helps in timely treatment of the cases.

Prevalence and Risk Factors of Trichomonas vaginalis Infection among Female Students of Prince Abubakar Audu University, Nigeria

Objective: This study aimed to determine the prevalence rate and associated risk factors of Trichomonas vaginalis infection among undergraduate female students at Prince Abubakar Audu University, Anyigba, Kogi State, Nigeria.&#x0D; Methods: This cross-sectional and institutional-based study involved female students who consented to screening. A total of four hundred (400) high vaginal swab samples were randomly collected from consenting female students and analyzed by wet mount preparation. Demographic and clinical information about the participants was obtained using prepared questionnaires.&#x0D; Results: It was observed that the overall prevalence of T. vaginalis infection among the 400 female participants was 170 (42.5%). The age ranges 14–18 and 24-28 had the highest prevalence of 50%, while the age range 19–23 had the least prevalence of 41.2%. The Ebira tribe had the highest prevalence of 60%, while the lowest prevalence was 0.0% among Hausa and others. Islam had the highest prevalence of 66.7%, while Christianity had the lowest prevalence of 40.5%. Students at the 100 level had the highest prevalence of 50%, and those at the 200 level had the least prevalence of 38.5%. There was no significant association between T. vaginalis infection and predisposing factors such as douching, sanitation, and sexual habits. However, the study did find that females who did not use sanitary pads were at a significantly higher risk of infection, while females who did not douche their vagina with antiseptic or deodorant products had a slightly higher risk of infection.&#x0D; Conclusion: It is clear from the results of the present study that Prince Abubakar Audu University's undergraduate female students are at a high prevalence of 42.5% for Trichomonas vaginalis infection. The study offers crucial information about the incidence of T. vaginalis infection and the risk factors connected to it among female participants in the study area. The high prevalence of infection highlights the need for increased awareness and education about the infection and its prevention in the study area.

Knowledge about Ergonomics and Musculoskeletal Disorders among Dental Practitioners - An Institutional-based Study

Background and Purpose: Dental students and practitioners are frequently prone to work-related musculoskeletal disorders (MSDs) due to the unawareness of ergonomic principles when practicing dentistry. The aim of the study was to assess the knowledge about MSDs in dental practitioners. Materials and Methods: A self-administered 28-item online questionnaire study was conducted among 100 dental practitioners. The study questionnaire captured demographic details of the participants as well as knowledge of ergonomic practices and MSDs and the nature of treatment. Descriptive analysis was done wherein the qualitative variables were expressed as percentages and proportions, whereas quantitative data were expressed as mean and standard deviation. The Chi-square test was used to check statistical associations and P &lt; 0.05 was considered statistically significant. Results: All the participants practiced four-handed dentistry. Only 12% of the responders stated that the ideal position for treating the maxillary arch in patient as supine, whereas 86% responded as semi-supine and 2% as sitting position. Similarly, 97% of the responders rightly answered that the ideal position for treating mandibular arch in patient as semi-supine. Forty percentage of them answered correctly that the word ergonomics means work and law. Seventy-two percentage of the responders think that knowing ergonomics is useful in routine dental practice. Fifty-eight percentage of the dentists believe that stretching exercise during work will reduce muscle tension and stress. Conclusion: The present study provides an insight into ergonomics for dental students during routine dental procedures. Hence, emphasis on providing ergonomic principles both theoretically and practically to dental health-care professionals must be placed in all educational institutions and at continuing dental health programs, and it should be included in the curriculum.

Prospective study on outcome of MDR-TB using the shorter regimen during COVID-19 pandemic.

According to Indian TB report 2020, 66,225 MDR/RR-TB cases were detected in India, 56,569 (85%) were put on treatment, and 40,397 (75%) were initiated on shorter drug regimens at the time of diagnosis. In the absence of an effective vaccine, there is an urgent need for new treatment regimens, drugs, and diagnostics to slow the evolution of drug resistance and limit transmission of resistant variants, as well as to ameliorate the treatment outcome of patients infected with MDR/XDR M. tuberculosis strains. To evaluate the efficacy of a shorter drug regimen in MDR-PTB and estimate the adverse effects of drugs used in the regimen. This is an institution-based prospective study which included 135 confirmed MDR-PTB patients. Patients with extra-pulmonary MDR-TB and use of SLI for more than one month were excluded. The success rate using a shorter regimen was 65.2% which is respectable, given the COVID-19 pandemic considered during the study period. Minor adverse events such as nausea (39.3%) and vomiting (34.8%) were reported. Rare adverse effects such as hearing loss (8.9%) and hypothyroidism (0.2%) were also seen in the study population. Overall treatment success was similar when compared to other studies done previously. A shorter drug regimen was associated with minor adverse effects such as gastrointestinal adverse effects such as vomiting and hearing loss observed in elderly patients. Baseline unknown drug resistance and lower BMI were associated with unsuccessful outcomes. Measures should be taken to improve nutrition. Our results argue the need for improving baseline DST at peripheral areas in order to effectively evaluate resistance to other drugs, especially in settings with high levels of first and second-line drug resistance.

Severe impact on family planning programme due to COVID-19 pandemic in urban population

Background: Contraception and sexual health are a fundamental human right and an integral part of women’s health services. Postpartum period is the unique opportunity for counseling and availing contraception. COVID-19 pandemic hindered routine and special services like postpartum clinics has negative impact on family planning services. Aims and Objectives: The objective of study was to compare the change in contraceptive services due to COVID-19 in two consecutive financial years (2019–2020 and 2020–2021) at Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India. Materials and Methods: An institution-based, retrospective, and cohort study was carried out in Nil Ratan Sircar Medical College and Hospital among the users of contraceptive services at the department of family planning for the financial year 2019–2020 and 2020–2021. During the period, 226,700 beneficiaries attended department of family planning for the financial year 2019–2020 and 98,584 beneficiaries attended department of family planning for the financial year 2020–2021. Template was generated in MS excel sheet and analysis was done on SPSS software. Results: During the year 2019–2020, 94.73% availed combined oral contraceptives while in the year 2020–2021, 93.97% availed combined oral contraceptives. Lap ligation was decreased by 96.42%, post-abortion ligation was decreased by 85%, Interval IUCD was decreased by 79.62% and PAIUCD was decreased by 76%. During the year 2019–2020, OCP was used by the maximum beneficiaries, that is, 219,654 while in the year 2020–2021 OCP was used by 97,353 beneficiaries. Conclusion: During COVID-19 pandemic, family planning services suffer a huge setback as it is does not came under emergency services. With the ongoing COVID-19 crisis and continuous need for contraception, there is a need to refocus and motivate eligible couples for long-acting reversible contraceptive methods with significantly lower failure rates.

Status and Factors Affecting Patient Safety Culture at Dilla University Teaching Hospital: A Mixed-Method Cross-Sectional Study.

Patient safety culture is now at the forefront of the global health agenda and has been designated as a human right. Assessing safety culture is seen to be a prerequisite for improving safety culture in health-care organizations. However, no research has been conducted to examine the current study setup. Therefore, this study aims at assessing the status and factors influencing patient safety culture at Dilla University Teaching Hospital. This cross-sectional institutional-based study was conducted from February to March 2022 at Dilla University Hospital. The study used both qualitative and quantitative methods. A total of 272 health professionals were included in the survey. The qualitative data was collected using Key Informant Interviews and In-depth Interviews and 10 health professionals were selected purposively to meet the study objective. The overall composite positive patient safety culture response rate in the current study hospital was 37% (95% CI: 35.3, 38.8). Out of the 12 dimensions, teamwork within hospital units was the highest (75.3%), while frequency of event reporting was the lowest (20.7%) positive percentage response. Only two of the 12 dimensions scored above 50%. Factors affecting patient safety culture majorly at organizational and individual level were poor/low attitude of health professionals, poor documentation practice, and poor cooperation by clients, lack of training and continuous education, lack of standard operating procedure, Staff shortage and high work load. This study revealed that the overall composite positive patient safety culture response rate within the surveyed facility was alarmingly low compared to other hospitals in various countries. The results indicate that there is a need for improvement in areas such as event reporting, documentation, health-care workers' attitude, and staff training. Hospitals must prioritize patient safety by cultivating a strong safety culture through effective leadership, adequate staffing, and education to enhance overall patient care.

Snuff Usage and Knowledge Regarding Its Effects Among Pakistani Male Students of Public Medical University, Peshawar

In Pakistan, snuff, locally known as Naswar, was introduced decades ago, and is usually processed into a loose moist form, and its use is widespread in the country. The evaluation of carcinogenic risks of smokeless tobacco by the International Agency on Research for Cancer (IARC) has confirmed that smokeless tobacco is carcinogenic to human and the main target organ being the oral cavity where the products are applied locally. So, this study is done about snuff usage and knowledge regarding its effects among Pakistani Male Students in Khyber Medical University, Peshawar. Descriptive cross sectional institutional based study with sample size of 400 was done from 5251 the study population (Pakistanis male students at the Khyber Medical University, Peshawar) during the academic year 2018-2020, in which random sampling technique was used. Data was collected using self-administrated questionnaire. Data were analyzed using statistical package for social science (SPSS) (IBM v. 25). The overall knowledge level was very high within non-snuff dippers i.e., 92%, which was very high according to Likert measure, whereas the knowledge level among snuff dippers was (76.4%) which was also high. The prevalence of snuff usage among Pakistani male students was 174 (43.5%) n = 400. The greatest predisposing factor was the friend’s effect (81.5%), whereas the least predisposing factor was the advertisement effect (23.8%). There was a significant relationship between knowledge level and snuff usage. In conclusion, snuff usage prevalence among students was high, the overall knowledge level was very high, effect of friends was the most common risk factor for snuff usage, so there is an urgent need for intervention by providing tobacco prevention program for raising awareness regarding to the health hazards of tobacco use and counselling to help and encourage users for cessation and to prevent tobacco initiation.

Time to development of surgical site infection and its predictors among general surgery patients admitted at specialized hospitals in Amhara region, northwest Ethiopia: a prospective follow-up study

BackgroundSurgical site infection is an infection occurring within 30 days after surgery. It is recently reported that evidence-based information on the specific time when the majority of surgical site infections would develop is a key to early detect the infection as well as to preventing and early intervene against their pressing and fatal complications. Therefore, the current study aimed to determine the incidence, predictors, and time to development of surgical site infection among general surgery patients at specialized hospitals in the Amhara region.MethodAn institution-based prospective follow-up study was conducted. The two-stage cluster sampling procedure was used. A systematic sampling technique with a K interval of 2 was applied to prospectively recruit 454 surgical patients. Patients were followed up for 30 days. Data were collected using Epicollect5 v 3.0.5 software. Post-discharge follow-up and diagnosis were done by telephone call follow-up. Data were analyzed using STATA™ version 14.0. Kaplan–Meier curve was used to estimate survival time. Cox proportional regression model was used to determine significant predictors. Variables with a P-value less than 0.05 in the multiple Cox regression models were independent predictors.ResultThe incidence density was 17.59 per 1000 person-day-observation. The incidence of post-discharge Surgical site infection was 70.3%. The majority of surgical site infections were discovered after discharge between postoperative days 9 to 16. Being male (AHR: 1.98, 95% CI: 1.201 – 3.277, diabetes Mellitus (AHR: 1.819, 95% CI: 1.097 – 3.016), surgical history (AHR: 2.078, 95% CI: 1.345, 3.211), early antimicrobial prophylaxis (AHR: 2.60, 95% CI: 1.676, 4.039), American Society of Anesthesiologists score ≥ III AHR: 6.710, 95% CI: 4.108, 10.960), duration of the surgery (AHR: 1.035 95% CI: 1.001, 1.070), Age (AHR: 1.022 95% CI: 1.000, 1.043), and the number of professionals in the Operation Room (AHR: 1.085 95% CI: 1.037, 1.134) were found to be the predictors of time to development of Surgical site infection.ConclusionThe incidence of surgical site infection was higher than the acceptable international range. The majority of infections were detected after hospital discharge between 9 to 16 postoperative days. The main predictors of Surgical site infection were Age, Sex, Diabetes Mellitus, previous surgical history, the timing of Antimicrobial prophylaxis, American Society of Anesthesiologists score, pre-operative hospital stay, duration of surgery, and the number of professionals in the operation room. Hence, hospitals should give great emphasis on pre-operative preparation, post-discharge surveillance, modifiable predictors, and high-risk patients, as they found in this study.

An institution-based non-randomised prospective study to estimate the efficacy and adverse effect profile of apremilast for moderate to severe refractory palmoplantar psoriasis

Background: Psoriasis is an immune-mediated inflammatory papulo-squamous disorder presenting as chronic plaque, pustular, erythrodermic, nail, scalp, drug induced, inverse, guttate etc. Palmoplantar psoriasis causes significant functional, cosmetic and psychological disability. Apremilast is a relatively newer drug being PDE-4 inhibitor, having negligible adverse effects with minimum blood monitoring. Methods: It is an institution-based, non-randomised, prospective study conducted over a period of 3 months. 42 patients of moderate to severe disease (assessed using PPPASI), refractory to conventional line of therapy (for atleast 3 months) or had contraindications for the same were selected from our Dermatology OPD. Follow up was done monthly for 6 months. Results: 42% of the patients were good responders. 1 patient did not respond and 2 had progression of the disease. There was a decrease in the mean DLQI from a baseline of 25 to less than 15 by the end of 1st month and around 5 by the end of 6th month.60% of patients showed onset of response by the 1st month. 45% of the patients showed adverse effects, mostly being nausea followed by dizziness. Conclusions: From our study and those in the existing literature, it can be inferred that apremilast is a promising drug for palmoplantar as well as other forms of psoriasis, especially in patients with comorbidities or treatment refractory psoriasis.

Perceived quality of care for severe acute malnutrition management among caregivers of under-five children with severe acute malnutrition in Addis Ababa, Ethiopia, 2022: a mixed-method study.

All the factors at the institutional, provider, and client levels have an impact on the quality of care. In low- and middle-income countries, poor quality of severe acute malnutrition (SAM) management at health institutions is a major contributor to child morbidity and mortality. This study aimed to determine the perceived quality of care for SAM management among caregivers of under-five children. This study was conducted in public health facilities that provide inpatient SAM management in Addis Ababa, Ethiopia. An institution-based convergent mixed-method study design was implemented. Quantitative data were analyzed by using a logistic regression model, while thematic analysis was used to analyze the qualitative data. A total of 181 caregivers and 15 healthcare providers were recruited. The overall perceived quality of care for SAM management was 55.80% (CI: 48.5-63.10). Urban residence (AOR = 0.32, 95% CI: 0.16-0.66), college and above level education (AOR = 4.42, 95% CI: 1.41-13.86), working as a government employee (AOR = 2.72, 95% CI: 1.05-7.05), readmitted to the hospital (AOR = 0.47, 95% CI: 0.23-0.94), and length of hospital stays >7 days (AOR = 2.1, 95% CI: 1.01-4.27) were found to be significantly associated factors with perceived low-quality care for SAM management. Additionally, lack of support and attention from higher levels of management, and lack of supplements, separate units, and laboratory facilities were among the factors that impede the provision of quality care. Perceived quality of SAM management services was low against the national goal of quality improvement to meet the expectations of both internal and external clients. Rural residents, those with more educational qualifications, government employees, newly admitted patients, and patients who stayed longer in hospitals were the most unsatisfied groups. Improving support and logistic supply to health facilities, providing client-centered care, and responding to caregivers' demands may help to improve quality and satisfaction.

Global Health in Undergraduate Education: Knowledge, Attitude, and Practice of Sudanese Medical Students towards Global Health Education: a cross-sectional study

IntroductionGlobalization and other relevant phenomena such as healthcare workforce, ageing of the population, brain drain etc. all necessitate medical curricula to transcend national medicine and encompass a more global approach. This is especially true in the context of developing countries which currently act as passive recipients of ongoing global decisions, health inequities or pandemics. The aim of this research was to study the Knowledge, Attitude, and Practice of Sudanese medical students towards global health education and the impact of extra-curricular activities on their knowledge and attitudes.MethodsThis was a descriptive cross-sectional institutional based study. The study was conducted in five Sudanese Universities and participants were selected using systematic random sampling. An online-based, self-administered questionnaire was used, samples were collected between November 2019 until April 2020 and data was analyzed using SPSS version 25.Results1176 medical students were involved. The study revealed a poor level of knowledge among 72.4%, and only 2.3% of respondents revealed a good level of knowledge. Mean knowledge scores between Universities slightly vary and have shown positive correlation according to the grade of the medical student. Regarding attitude, the results demonstrated the high level of interest of medical students in global health, their agreement in including global health in their official medical education curriculum (64.8%) and their consideration of including global health as part of their future career (46.8%).ConclusionThe study concluded that there is a knowledge gap among Sudanese medical students regarding global health education, although students showed good attitudes and willingness to include global health in their official curriculum.RecommendationsGlobal health education should be implemented in the official curriculums of Sudanese Universities, and Universities should do global partnerships and increase the learning and teaching opportunities in this interesting field.

Evaluation of Anterior Intercostal Artery Perforator Flap for Oncoplastic Immediate Reconstruction Following Breast-Conserving Surgery in Lower Breast Quadrants Lesions; an Institutional-Based Study

Evaluation of Anterior Intercostal Artery Perforator Flap for Oncoplastic Immediate Reconstruction Following Breast-Conserving Surgery in Lower Breast Quadrants Lesions; an Institutional-Based Study

Customised enriched coconut oil as panacea for oral biofilm mediated diseases - A prospective study.

To evaluate a customised enriched formulation of coconut (CEC) oil with Arimedadi Tailam (AT) and 0.2% chlorhexidine mouth rinse (CHX) for their plaque control and potential anticaries effects using the oratest in healthy volunteers. Parallel, double-blinded (outcome assessor and statistician), randomised controlled institution-based pilot study. 60 adults (18-22 years) having DMFT score of 2-11, gingival and plaque index as zero, no history of antibiotics for one month or fluoride application in 2 weeks were randomly divided (computer-generated list) and allocated into 3 groups (A-CHX, B-CEC, C-AT) of 20 subjects each based on the intervention. Oratest at baseline, days 15 and 30 were recorded. Due to 5 dropouts on day 30, data were analysed based on the intention-to-treat (ITT) approach. The difference in oratest scores (baseline vs. day 15 and 30) were found to be normally distributed (Shapiro-Wilk test and Levene's test). One way ANOVA followed by Tukey's post hoc test was used to determine the statistically significant difference (P < 0.05) between groups. Plaque and gingival index was zero throughout the study period. Difference in oratest scores was highest with CEC oil, followed by CHX and AT though there was no statistically significant differences between groups at baseline vs day 15 (P = 0.203) and baseline vs day 30 (P = 0.085) and between oils from baseline vs day 30 (P = 0.068). Within the limitations of the pilot study, both oils are comparable to CHX for their antiplaque and anticaries potential. Clinically, CEC was better than AT though statistical difference was not there.

دراسة حول الافكار الانتحارية ومحاولة الانتحار بين مرضى فيروس نقص المناعة البشرية في مركز امدرمان القومي للارشاد النفسي والفحص التطوعي ولاية الخرطوم - السودان (2021-2022)

Background: Suicidal ideation and attempt are more frequent in HIV patients than general population Objective: The aim of this study was to assess the suicidal ideation and attempt among HIV patients in Omdurman National Voluntary Counseling and Testing Center, Khartoum state, Sudan. Methods: Descriptive cross-sectional institutional based study was conducted among HIV patients attending Omdurman national voluntary counseling and testing Center. Systematic random sampling technique was used to select 235 participants from March to May 2021, data was collected by using a questionnaire consisted of sociodemographic and clinical characteristics and validated tool (Mini international neuropsychiatric interview for suicidality- the Arabic version), data was analyzed using SPSS 26 edition and Chi squire test, the t test and Multivariate test were used for the associations between variables Results: Suicidal ideation in the last month was (14.5%), suicidal attempt in the last month was (0.4%) and lifetime suicidal attempt was (4.3%). Suicide risk were high in (2.5%), moderate in (10.6%) and low in (12.7%). Marital status, occupation, duration of diagnosis, WHO stages and opportunistic infections were significantly associated with suicidal ideation, whereas opportunistic infections and marital status were significantly associated with suicidal attempt. Conclusion: The suicidal ideation and attempt in the HIV patients in the last month were 14.5% and 0.4% respectively, and the lifetime suicidal attempt was 4.3%. There is significant association between suicidal ideation and attempt and some sociodemographic and clinical characteristics of the patients.