Medical Files Research Articles

Factors of Incomplete Inpatient Medical Records Filling at Dr. H. Slamet Martodirdjo Regional General Hospital Pamekasan

Hospitals have an important role in improving health status by providing quality services, including complete medical record data and information. Complete and accurate medical records can be used for health care and patient treatment, evidence in law enforcement, medical discipline and medical ethics, educational and research purposes, basis of payment for health care costs, and health statistical data. This study aimed to identify the factors causing the incomplete filling of inpatient medical records at Dr. H. Slamet Martodirdjo Regional General Hospital Pamekasan. This research applied the descriptive observational method, with data collected through secondary data analysis using document studies and problem exploration using focus group discussions (FGD). The document study was conducted on 80 samples of inpatient medical records, while the FGD was conducted by inviting the head of the planning department, medical records officer, and 8 heads of inpatient wards to find out the causes and solutions for incomplete medical record files. The study results found that the number of incomplete medical records was 76.25%, with the highest percentage of incompleteness due to doctors, pharmacists, and nurses. The main problem causing the incompleteness of medical records was professional caregivers (PPA) who lacked discipline. The solutions obtained were management meetings and evaluations to professional caregivers, constructing policies that regulate reward and punishment systems, monitoring the checklists of medical record completeness, and routine evaluation of medical record files.

Imaging-Based Deep Learning for Predicting Desmoid Tumor Progression.

Desmoid tumors (DTs) are non-metastasizing and locally aggressive soft-tissue mesenchymal neoplasms. Those that become enlarged often become locally invasive and cause significant morbidity. DTs have a varied pattern of clinical presentation, with up to 50-60% not growing after diagnosis and 20-30% shrinking or even disappearing after initial progression. Enlarging tumors are considered unstable and progressive. The management of symptomatic and enlarging DTs is challenging, and primarily consists of chemotherapy. Despite wide surgical resection, DTs carry a rate of local recurrence as high as 50%. There is a consensus that contrast-enhanced magnetic resonance imaging (MRI) or, alternatively, computerized tomography (CT) is the preferred modality for monitoring DTs. Each uses Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), which measures the largest diameter on axial, sagittal, or coronal series. This approach, however, reportedly lacks accuracy in detecting response to therapy and fails to detect tumor progression, thus calling for more sophisticated methods. The objective of this study was to detect unique features identified by deep learning that correlate with the future clinical course of the disease. Between 2006 and 2019, 51 patients (mean age 41.22 ± 15.5 years) who had a tissue diagnosis of DT were included in this retrospective single-center study. Each had undergone at least three MRI examinations (including a pretreatment baseline study), and each was followed by orthopedic oncology specialists for a median of 38.83 months (IQR 44.38). Tumor segmentations were performed on a T2 fat-suppressed treatment-naive MRI sequence, after which the segmented lesion was extracted to a three-dimensional file together with its DICOM file and run through deep learning software. The results of the algorithm were then compared to clinical data collected from the patients' medical files. There were 28 males (13 stable) and 23 females (15 stable) whose ages ranged from 19.07 to 83.33 years. The model was able to independently predict clinical progression as measured from the baseline MRI with an overall accuracy of 93% (93 ± 0.04) and ROC of 0.89 ± 0.08. Artificial intelligence may contribute to risk stratification and clinical decision-making in patients with DT by predicting which patients are likely to progress.

Incidence of hand and wrist disorders in primary care.

The incidence of different types of hand and wrist disorders in primary care is unknown since there are no specific encodings for it. To determine the overall incidence and the incidence of specific types of hand and wrist disorders in primary care. A healthcare registration database from Dutch general practice, which contains medical records of over 200 000 patients and included approximately 25% of the population of the area of Rotterdam. Patients aged ≥18 years with a new diagnosis of hand or wrist disorder from 1 January 2015 to 31 December 2019 were extracted using a search algorithm based on ICPC coding and search terms in free text. The mean incidence over the study period of a hand disorder was 5.9 per 1,000 persons-years and of a wrist disorder 0.3 per 1,000 persons-years. The incidence of trigger finger/thumb, fracture hand/finger, tendon/ligament tendinopathy, mallet finger and ligament injury hand/finger were 3 (2.69-3.15), 1 (1.03-1.33), 1 (0.98-1.28), 0.6 (0.48-0.69) and 0.1 (0.06-0.14) per 1,000 persons-years, respectively. The incidence of a wrist fracture and ligament injury were 0.2 (0.13-0.25) and 0.1 (0.04-0.12) per 1,000 persons-years, respectively. There is a large difference between the number of patients presenting to the GP with hand and wrist complaints and the number of hand and wrist diagnosis reported in the medical files. Introducing specific ICPC codes for different types of hand and wrist disorders could (potentially) lead to a more accurate registration of a diagnosis and determination of the incidence figures.

Enhancing Medical Record Quality via Coding Accuracy

Elements of coding quality in medical records include reliability, completeness, validity, and timeliness. This analytical study, employing a quantitative approach, evaluated medical record files of patients with injuries and external cause cases at Ibnu Sina Hospital, Gresik, from October to December 2022. Using the Slovin formula, 161 samples were randomly selected from a population of 271 records. The study variables were reliability (diagnosis readability), completeness (diagnostic code completeness), and validity (5th digit use, diagnosis code accuracy, and external cause code accuracy). Data were analyzed using SPSS and the Chi-Square test. The study found significant relationships between the validity of diagnosis codes and the quality of medical records (p = 0.0001). Reliability showed no significant impact (p = 0.470), while completeness (p = 0.0001) and the use of the 5th digit (p = 0.0001) were significantly related to diagnosis code accuracy. These findings highlight the critical role of accurate coding in improving medical record quality and suggest targeted improvements in coding practices. Highlight: Significant Link: Diagnosis code accuracy is crucial for medical record quality. Critical Factors: Completeness and 5th digit use are key for accurate coding. Targeted Improvements: Focused coding practice enhancements can boost record quality. Keyword: coding quality, reliability, completeness, validity, medical records

Outcomes of ilium and iliosacral Ewing's sarcoma resection reconstructed with tibial strut allograft.

Ilium is the most common site of pelvic Ewing's sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients' outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I1, I2, I3, and I4, based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I4 resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed.

From basic research to clinical practice: The impact of laminar airflow filters on surgical site infection in vascular surgery

BackgroundLaminar airflow filters have been suggested as a potential preventive factor for surgical site infections, given their ability to reduce the airborne microbiological load. However, their role is still unclear, and evidence regarding vascular surgery patients is scarce. Our aim was to assess the impact of laminar-airflow filters on surgical site infections. MethodsThis single-centre retrospective cohort study was conducted with vascular surgery patients who underwent arterial vascular intervention through a groin incision between July 2018 and July 2019 (turbulent airflow cohort) and July 2020 and July 2021 (laminar airflow cohort). Data were prospectively collected from electronic medical files. We estimated the cumulative incidence of surgical site infections and its 95% confident interval (95%CI). A propensity score matching analysis was performed. ResultsWe included 200 patients, 78 in the turbulent airflow cohort and 122 in the laminar airflow cohort. The cumulative incidence was 15.4% (12/78; 95%CI: 9.0–25.0%) in the turbulent-airflow cohort and 14.8% (18/122; 95%CI: 9.5 –22.1%) in the laminar-airflow cohort (p-value: 1.00). The propensity score matching yielded a cumulative incidence of surgical site infection of 13.9% (10/72) with turbulent airflow and 12.5% (9/72) with laminar airflow (p-value: 1.00). Risk factors associated with infection were chronic kidney disease (OR 2.70; 95%CI: 1.14–6.21) and a greater body mass index (OR 1.47; 95%CI: 1.01–2.14). ConclusionLaminar airflow filters were associated with a non-significant reduction of surgical site infections. Further research is needed to determine its usefulness and cost-effectiveness. Surgical site infection incidence was associated with chronic kidney disease and a greater body mass index. Hence, efforts should be made to optimize the body mass index before surgery and prevent chronic kidney disease in patients with known arterial disease.

Blockchain with optimal deep learning assisted secure data sharing and classification on future healthcare systems

In the future of healthcare, Blockchain (BC) technology holds immense potential for improving the security and privacy of data. By allowing the secure and immutable storage of medical files and healthcare-related transactions, BC ensured that sensitive medical data remains tamper-proof and open only to authorized parties. Patients have greater control over their data's development, revoking or granting access as required, but healthcare workers can streamline data sharing and ensure the integrity of important data. The decentralized nature of BC networks decreases the risk of centralized data breaches, eventually fostering trust and transparency in the healthcare ecosystems. Conversely, deep learning (DL) has great to revolutionize healthcare diagnostics in the future, offering quick and extremely accurate estimates of medical conditions. This technology has greatly enhanced patient solutions, decreased medical expenses, and improved the burden on medical staff by providing appreciated insights into an extensive range of conditions, from cancer to neurological disorders. With this stimulus, this study presents a novel BC with optimal DL-based secure data sharing and classification (BCODL-SDSC) technique in the future healthcare system. The goal of the BCODL-SDSC technique is to secure and thoroughly examine healthcare data using BC and DL techniques. Primarily, the BCODL-SDSC technique enables BC technology to store and maintain the patient’s data from the procedure of several transactions and enable access control to the various stakeholders. For the security of the medical images, the BCODL-SDSC technique applies the Fractional Order Lorenz system (FOLS) based encryption technique with tuna swarm optimization (TSO) algorithm based optimal key generation process. Finally, a multi-stage process performs the classification of the medical images: MobileNetv1 feature extractor, artificial rabbit’s optimization (ARO) based hyperparameter tuning, and stacked recurrent neural network (SRNN) based classification. The experimental outcome of the BCODL-SDSC technique was examined on a benchmark medical image database. An extensive comparative study reported that the BCODL-SDSC technique reaches an effective performance with other models with a maximum accuracy of 99.11%.

Sleep-Disordered Breathing, Advanced Age, and Diabetes Mellitus Are Associated with De Novo Atrial Fibrillation after Cardiac Surgery.

Background: Postoperative de novo atrial fibrillation (POAF) is one of the most frequently encountered complications following cardiac surgery. Despite the identification of several risk factors, the link between sleep-disordered breathing (SDB) and POAF has barely been examined. The objective of this prospective observational study was to determine whether severe SDB is associated with POAF in patients after elective coronary artery bypass grafting (CABG) surgery. Study design and methods: The incidence and preoperative predictors of in-hospital POAF were assessed in 272 patients undergoing CABG surgery at the University Medical Center Regensburg (Germany). In-hospital POAF was detected by continuous telemetry-ECG monitoring and 12-lead resting ECGs within the first seven postoperative days. POAF that occurred after hospital discharge within 60 days post CABG surgery was classified as post-hospital POAF and was ascertained by standardized phone interviews together with the patients' medical files, including routinely performed Holter-ECG monitoring at 60 days post CABG surgery. The night before surgery, portable SDB monitoring was used to assess the presence and type of severe SDB, defined by an apnea-hypopnea index ≥ 30/h. Results: The incidence of in-hospital POAF was significantly higher in patients with severe SDB compared to those without severe SDB (30% vs. 15%, p = 0.009). Patients with severe SDB suffered significantly more often from POAF at 60 days post CABG surgery compared to patients without severe SDB (14% vs. 5%, p = 0.042). Multivariable logistic regression analysis showed that severe SDB (odds ratio, OR [95% confidence interval, CI]: 2.23 [1.08; 4.61], p = 0.030), age ≥ 65 years (2.17 [1.04; 4.53], p = 0.038), and diabetes mellitus (2.27 [1.15; 4.48], p = 0.018) were significantly associated with in-hospital POAF. After additional adjustment for heart failure, the association between sleep apnea and postoperative atrial fibrillation was attenuated (1.99 [0.92; 4.31], p = 0.081). Conclusions: Amongst established risk factors, severe SDB was significantly associated with in-hospital POAF in patients undergoing CABG surgery. Whether SDB contributes to POAF independently of heart failure and whether risk for POAF may be alleviated by proper treatment of SDB merits further investigation.

The association between BMI and continuity of etonogestrel (ENG)-releasing implant.

The etonogestrel-releasing implant is a long-acting reversible contraception that is recommended by the Food and Drug Administration for 3 years and has been proven to be highly effective and convenient. Adverse effects including irregular bleeding patterns, weight gain, and acne are reported to be the main reasons for treatment discontinuation. The aim of this study is to learn the association between body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) and the incidence of side effects and adherence to treatment. This is a retrospective cohort study, conducted at a single university-affiliated medical clinic, including all women who underwent etonogestrel-releasing implant (Nexplanon®; New Jersey, USA, Organon USA Inc., Merck and Co) insertion between January 2019 and December 2021. Cases where abnormalities were reported during the insertion procedure or missing data were excluded from the study. Information on patients' demographic, medical history, obstetric and gynecological history, and follow-up was collected from electronic medical files. The primary outcome was defined as the rate of implant removal in the different obesity classes. Data are presented as median and interquartile range. The study was approved by institutional review board. The study population included 1318 women, of whom 466 (35%) requested early removal of the implant. Women's demographic and clinical characteristics were comparable between women who requested early removal and those with full-length treatment. The median time for early removal was 12 (6-20) months from insertion. Irregular bleeding was the most frequent reason for early removal in both groups and was more than twice as prevalent in the early removal group (239 [51.29%] vs 193 [22%], P = 0.001). The early removal group had fewer obese women (BMI ≥30) compared with women who had full-length treatment (163 [31.8%] vs 350 [68.2%], P = 0.03), with comparable rates of class 3 obesity women (BMI ≥40) (P = 0.68). Multi-regression logistic analysis including age, BMI, parity and side effects found that the presence of side effects is the only independent predictor significantly associated with early implant removal (B = 1.74, P = 0.04). Continuation of etonogestrel-releasing implant contraception treatment was associated with the presence of side effects that were more often reported in non-obese women. BMI was not found to be a significant factor influencing adherence to treatment.

Practice patterns and survival outcomes for muscle-invasive bladder cancer: real-life experience in a general population setting.

Bladder cancer (BC) is a common malignancy in Europe and North America. Among BCs, muscle-invasive BCs (MIBCs) are distinguished, as they require aggressive treatment due to their spreading potential and poor prognosis. Despite its clinical relevance, little information on MIBC in a general population setting is available. This study aims to report practice patterns and survival outcomes for MIBC patients in a general population setting. MIBCs among BC incidence in 2011 and 2012 recorded in a French population-based cancer registry (810 000 inhabitants) were included in the study. Data were extracted from the medical files. Individual, tumour-related characteristics and initial management including diagnostic tools, multidisciplinary team meeting (MDT) assessment, and treatment delivered were described. Cystectomy, chemoradiation, radiotherapy, and chemotherapy were considered as specific treatments. Matching between MDT decision and the treatment provided was detailed. Management practices were discussed according to the guideline's recommendations. Overall survival (using the Kaplan-Meier method) and net survival (using the Pohar-Perme estimator) were calculated. Among 538 incident BC cases, 147 (27.3%) were MIBCs. Diagnostic practices displayed a relevant locoregional assessment of BC. Almost all cases (n = 136, 92.5%) were assessed during an uro-oncological MDT with a median time from diagnosis of 18 days (first quartile:12-third quartile:32). Discrepancies appeared between MDT decisions and treatments delivered: 71 out of 86 subjects received the recommended cystectomy or chemoradiation (with or without neoadjuvant chemotherapy); 6 out of 11 had the recommended radio- or chemotherapy; and 9 patients did not undergo any specific treatment despite the MDT decision. Cystectomy was the most common treatment performed; the time to surgery appeared consistent with the guideline's recommendations. Forty people only received supportive care. Still, the 5-year overall and net survival was poor, with 19% (13-26) and 22% (14-31), respectively. The 5-year net survival was 35% (23-48) for people who underwent curative-intent treatments. MIBC management remains challenging even for cases assessed during an MDT. Many people did not undergo any specific treatment. Prognosis was poor even when curative-intent therapies were delivered. Efforts to reduce exposure to risk factors such as tobacco smoking and occupational exposures must be maintained.

Implementasi Algoritma Rivest Shamir Adleman (RSA) Untuk Keamanan Data Rekam Medik Penyakit Pasien Rumah Sakit

Medical records are records of the who, what, where, and how of patient care while in hospital. One aspect of the use of medical records is the documentation aspect, namely medical records contain important information that is useful for various parties. Medical records contain data regarding past and present health and contain health professional notes regarding the patient's current condition in the form of physical findings, results of diagnostic and therapeutic procedures and patient responses. Medical record documents belong to doctors, dentists and health service facilities, while the contents of medical records belong to the patient. What can be given, recorded or duplicated by the patient is a summary of the medical record. Patients have the right to know the contents of medical records, however, the entire medical record file can only be held by authorized health/medical records officers and cannot leave the location of the health facility. This aims to maintain medical confidentiality (because medical information can be misused) and prevent medical records from being lost or damaged. To overcome this problem, a computerized system is needed that is able to secure medical record data so that unauthorized parties cannot read it. One technique that can be used to secure medical record data is cryptography. Cryptography comes from Greek which consists of the words kryptos which means hidden and graphia which means something written so that cryptography can be interpreted as something written in secret or hidden.. In applying the Rivest Shamir Adleman (RSA) method in securing medical record data at home Mitra Sejati Medan Hospital, namely by inserting program coding from Shamir Adleman's Rivest method into the programming language used. Next, form a public and private key, then carry out the encryption process for medical record data

Sterilization Surgery Trends in Texas After Passage of the Texas Heartbeat Act [ID 2683648

INTRODUCTION: On September 1, 2021, abortion became illegal in Texas once electric embryonic cardiac activity can be detected. Before that, elective abortions were allowed up to 20 weeks postfertilization. In order to primarily avoid unwanted pregnancy, a trend for younger women to seek a definite contraception method has been observed; however, this has not been studied yet. The aim of this study was to compare the characteristics of women requesting surgical sterilization before and after the Texas Heartbeat Act went into effect. METHODS: This is a retrospective study including all women who underwent bilateral salpingectomy for surgical sterilization between May 2020 and November 2022. Women who underwent surgery 15 months before the new laws (controls) were compared to women who underwent surgery 15 months after the change (study group). Demographic, clinical characteristics, operative, and postoperative data were collected from women's medical files. RESULTS: Two hundred five women met inclusion criteria, of them 131 (64%) in the study group and 74 (36) controls. The rate of women with managed care insurance was significantly higher in the study population (P=.04). Median age was similar between the groups (P=.98). Parity was significantly higher in the controls (P=.004); however, the rate of nulliparous women more than doubled in the study population (37 [28%] versus 8 [11%]; P=.004). Surgery as first contraception method was reported in 63 (48%) and 41 (19%) of the women in the study and control groups, respectively (P=.58). Complication rate was found higher for the study group, but the difference did not reach significance [4 (3.1%) versus 0 (0); P=.13]. CONCLUSION: Since the passage of the Texas Heartbeat Act, more women with managed care insurance were undergoing surgical sterilization. Although the mean age to undergo the surgery did not change compared to the period before the change in the law, the rate of nulliparous women preferring this method for contraception significantly increased.

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for Gender Affirmation [ID 2683658

INTRODUCTION: The process of transitioning from female to male in transgender persons usually includes medical treatment as well as surgical interventions, including removal of the uterus and ovaries. Nulliparity and prolonged exposure of the vaginal mucosa to testosterone, which are common among transgender men, may present challenges to perform a vaginal hysterectomy with salpingo-oophorectomy. The aim of this study is to describe outcomes of vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) approach to perform hysterectomy among transgender men as part of their gender-affirming care. METHODS: This is a case series observational study conducted at single tertiary medical center including all patients undergoing hysterectomy with bilateral salpingo-oophorectomy by vNOTES approach for gender-affirming care between February 2022 and April 2023. Primary outcome was defined as compound complication rate including intraoperative and postoperative. Patients' demographic and clinical charectaristics were collected from the electronic medical files. Pain at postoperative follow-up was evaluated using visual analog scores, which ranges from 0 (no pain) to 10 (worst pain possible). RESULTS: The study population included eight transgender men, all of whom were nulliparous and had undergone testosterone treatment for more than a year. Median age at surgery was 24 years and median body mass index was 30 kg/m2. Mean operative time of the surgery was 111 minutes (range: 91–143 minutes) and none required converting from vNOTES to an alternative approach. No extensive bleeding or organ damage was reported. For one patient, there was one small vaginal laceration requiring suture. All but one patient was discharged the same day. The patient requiring next-day discharge was complicated by postoperative urinary retention. On postoperative follow-up, median pain score was 3 (range: 1–5). CONCLUSION: Outcomes from this case series suggest that a vNOTES approach to hysterectomy among transgender men can be performed without surgical complications and with low self-reported pain.

Completeness of Filling Out Medical Record Documents and the Accuracy of Codes at Reksodiwiryo Hospital

A hospital is an institution whose primary function is to provide health services to the community. One of the government's efforts to provide health services to the community is implementing the National Health Insurance Program (JKN), which the Social Security Program Organizing Agency organizes in the health sector. This research analyzed the factors associated with delays in BPJS claims at Dr. Hospital. Reksodiwiryo Padang. This research was a descriptive quantitative study with a cross-sectional study design. The research showed that six medical record files (6.5%) had inaccurate codes, while 86 (93.5%) used the correct ones. In addition, 91 files (98.9%) of inpatient medical records needed to be completed, and only one file (1.1%) was completed. Inaccuracy in diagnostic coding affects delays in submitting claims at Dr. Hospital. Reksodiwiryo Padang. It is hoped that officers can understand the coding rules based on ICD-10 for diagnoses and ICD-9 CM for actions or procedures to guarantee the quality of service at the hospital.

Perancangan Sistem Informasi Peminjaman dan Pengembalian Berkas Rekam Medis Rawat Jalan dengan Metode Waterfall

Wiyung Sejahtera Hospital in recording the borrowing and returning of outpatient medical records still uses expedition books which are recorded manually. The research aims to design and develop an information system to facilitate the process of borrowing and returning outpatient medical record files using the Waterfall method approach. The Waterfall method was chosen because of its ability to divide system development into structured stages, starting from requirements analysis to maintenance. The needs analysis stage involves an in-depth study of existing processes and user needs. Next, system design is carried out by building a design plan that includes database structure, user interface design, and system workflow. System implementation is carried out by developing applications based on previous designs, while system testing is carried out thoroughly to ensure quality and performance before full implementation. The maintenance stage is carried out to ensure system operation and carry out continuous repairs and improvements. As a result, it is hoped that this system can improve the efficiency and quality of outpatient medical record file management and health services as a whole. The conclusion of this research is the successful design and development of a computer-based information system for borrowing and returning outpatient medical records at Wiyung Sejahtera Hospital using the waterfall method.

Analysis of Clinical Features of Pulmonary TB Patients at Dr. Hospital. P.P. Magretti Saumlaki in 2022

Background: Pulmonary Tuberculosis is the most common disease in 2022 at RSUD dr. P.P. Magretti Saumlaki Tanimbar Islands, Maluku. Purpose: This study aims to determine the clinical picture of patients according to the characteristics of person, place and time. The retrospective approach is presented in descriptive form. The sampling technique uses purposive sampling. Method: The sample was 51 pulmonary TB patients in the isolation room in 2022 with complete medical record files. Results: The research results showed that the largest age group was 19-44 years, 24 people (47.1%); the male gender was more numerous, numbering 28 people (54.9%); The most common clinical symptoms were shortness of breath, 15 people (29.4%); The highest number of supporting examinations with Ro Thorax was 36 people (70.6%); The most common diagnoses were pulmonary TB on OAT as many as 22 people (43.1%); More patients returned home and recovered, namely 17 people (33.3%); the longest length of stay was 21.6% (3 days). Conclusion: The conclusion of this study is that pulmonary TB patients in the isolation room at RSUD dr. P.P. More Magretti in 2022: male gender, age 19-44 years, clinical symptoms of shortness of breath, AP/PA Thorax X-ray examination, discharged home recovered, and 3 days of hospitalization.

Stroke incidence increases with diabetic retinopathy severity and macular edema in type 1 diabetes

BackgroundAs the retina is suggested to mirror the brain, we hypothesized that diabetic retinopathy and macular edema are indicative of stroke risk in type 1 diabetes and sought to assess this association in individuals with type 1 diabetes.MethodsWe included 1,268 adult FinnDiane Study participants with type 1 diabetes (age 38.7 ± 11.8 years, 51.7% men vs. 48.3% women, and 31.5% had diabetic kidney disease), data on baseline diabetic retinopathy severity, and first stroke during our observational follow-up. Retinopathy was graded by the Early Treatment Diabetic Retinopathy Study (ETDRS) scale, and macular edema as clinically significant (CSME) or not. Strokes identified from registries were confirmed from medical files. Adjusted hazard ratios (HR) for stroke by retinopathy severity and CSME were calculated by Cox models adjusted for clinical confounders, including diabetic kidney disease.ResultsDuring median 18.0 (14.1–19.3) follow-up years, 130 strokes (96 ischemic, 34 hemorrhagic) occurred. With no–very mild (ETDRS 10–20) retinopathy as reference, the adjusted HR for stroke was 1.79 (95%CI 1.02–3.15) in non-proliferative (ETDRS 35–53), and 1.69 (1.02–2.82) in proliferative (ETDRS 61–85) retinopathy. Corresponding adjusted HR for ischemic stroke was 1.68 (0.91–3.10) in non-proliferative and 1.35 (0.77–2.36) in proliferative retinopathy. The adjusted HR for hemorrhagic stroke was 2.84 (0.66–12.28) in non-proliferative and 4.31 (1.16–16.10) in proliferative retinopathy. CSME did not increase HR for any stroke type after adjustment for clinical confounders (data not shown).ConclusionsStroke incidence increases with the severity of diabetic retinopathy independently of comorbid conditions, including diabetic kidney disease.

Efficacy and Safety of Amenamevir, a Helicase-Primase Inhibitor for the Treatment of Acyclovir-Resistant Herpes Simplex Virus 1 Keratitis.

The purpose of this study was to describe the efficacy and tolerance of amenamevir (AMNV), an inhibitor of the viral helicase-primase, for the treatment of recalcitrant herpes simplex keratitis (HSK) caused by acyclovir-resistant (ACVR) herpes simplex virus 1 strains. In this retrospective case series, 6 consecutive patients with HSK caused by an ACVR herpes simplex virus 1 strain with a failure of conventional antiviral therapy were included after having been treated with AMNV (there was no control group of comparable patients for whom previous treatment would have been continued despite its inefficacy). Medical files were assessed for clinical data including reason(s) for AMNV introduction (frequent recurrences despite appropriate preventive antiviral treatment and/or clinical resistance to suppressive antiviral treatment of an ongoing clinical relapse), genotypical resistance to herpes simplex virus 1 documentation, immune status, clinical types and number of HSK episodes before and during AMNV treatment, adverse effects observed during AMNV treatment, and best corrected visual acuity. Of 6 patients, 4 (66%) did not experience a single recurrence during AMNV therapy while 2 others had recurrences (1 over 24 months of treatment and 2 over 23 months, ie two-fold less frequently than with conventional preventive treatment). On the overall history of these 6 patients, AMNV appeared to be associated with a reduction in HSK recurrences, with a mean of only 0.02 ± 0.04 episodes/month during follow-up under AMNV as compared to 0.14 ± 0.04 episodes/month in the year preceding AMNV introduction (P = 0.03). Improvement in vision acuity was also observed (mean best corrected visual acuity 0.17 ± 0.12 logarithm of the minimum angle of resolution at the end of follow-up vs. 0.30 ± 0.35 before AMNV onset), albeit nonsignificant probably due to the limited number of patients (P = 0.38). Neither clinical nor biological adverse effects were observed while under AMNV during the follow-up (16.5 ± 5.8 months). Although there was no control group, AMNV may be a valuable option to reduce ACVR HSK recurrences.

Impact of COVID-19 on asthma and COPD patients’ hospital care: a lesson for future pandemics

Abstract Objectives Preventive measure for COVID-19 spread have dramatically affected patients with chronic diseases worldwide, including asthma/chronic obstructive pulmonary disease (COPD) patients. This study aimed to examine the impact of the COVID-19 outbreak and the associated lockdown on the medical care provision of asthma/COPD patients in Jordan. The healthcare behaviours and perceptions of these patients regarding the outbreak were also investigated. Methods A population-based cohort study was conducted on asthma/COPD patients seeking medical care during 2019–2021 at a tertiary hospital in Jordan. Patients were interviewed by phone call, their medical files were also accessed. Demographics, clinical information, and those related to healthcare access (clinic visits, hospital admissions, and emergency room [ER] visits), exacerbation management and medication adherence were all collected. Key findings A total of 371 cases were identified, the majority (65.2%) were asthmatics. The most (76.3%) were not vaccinated (influenza or pneumococcal), none had a written action plan. The study findings showed reduced healthcare utilization (hospital admission and ER visits) during the study period (P &amp;lt; 0.05). Clinic visits also decreased over 2019–2020 (P &amp;lt; 0.05). Accordingly, the pattern of acute exacerbation treatment also changed with fewer antibiotics and inhaled corticosteroids administered during the pandemic (P &amp;lt; 0.05). Medication adherence was relatively low (14.6%–17.25%). Telemedicine was not provided during the study period. Conclusions The study demonstrated disruption in healthcare utilization. There is need for better preparedness for future pandemics to maintain the routine medical care services. Telemedicine should be introduced as part of healthcare systems. Efforts are still needed to optimize medication adherence in Jordan. Future research is needed to better address COVID-19 impact on chronic patients.

Ictal Coprolalia: Three Cases with Nondominat Frontal Lobe Involvement and Review of the Literature.

Objective: Coprolalia is defined as the involuntary use of obscene, socially unacceptable, and derogatory words. Ictal coprolalia is a rare presentation of epilepsy. This study aimed to determine the localizing and lateralizing value and frequency of ictal coprolalia in epilepsy patients. Methods: Medical files, discharge summaries, and electroencephalography (EEG) reports of 2238 patients were reviewed retrospectively. We identified patients who suffered from ictal coprolalia. Electroencephalography reports, neuroimaging [brain magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (FDG-PET), single-photon emission computerized tomography (SPECT)] records, F-18 FDG fused on MRI images, and ictal SPECT fused on MRI images were evaluated. Also, original and review articles were identified through a systematic search of Pubmed, Scopus, and Clarivate Analytics. Results: Ictal coprolalia was detected in 3 male (0.15%) patients. In all patients, ictal semiology was extratemporal-frontal type, and potential/proven epileptic focus was non-dominant hemisphere frontal lobe. Topectomy was done in one of the patients, including the suspected dysplastic area plus the area where the electroencephalographic ictal and interictal changes occur, on the left frontal lobe, and the patient had an Engel's classification class IIA. The data depending on the published cases showed that ictal coprolalia was dominant in the male gender and the responsible epileptic area tended to be located in the non-dominant hemisphere frontotemporal region. Conclusion: The rate of ictal coprolalia in the Turkish population is lower compared to other series. Our results are consistent with previous studies in which reported that male preponderance for ictal coprolalia and involvement of non-dominant frontal lobe.