Morbidity Rates Research Articles

Prevalence of abnormal electrocardiographic findings and associated factors among patients with epilepsy at Jimma Medical Center, Ethiopia; Hospital-based cross-sectional study.

A person with epilepsy experiences recurrent seizures as a result of a persistent underlying disorder. About 50 million people globally are impacted by it, with 4 million of those being in Sub-Saharan Africa. One of the most frequent comorbidities that raise the mortality and morbidity rates of epileptic patients is abnormal Electrocardiographic (ECG) findings. Thus, the purpose of this study is to evaluate the prevalence of abnormal ECG findings in epileptic patients that might lead to increased risk of sudden cardiac death. A hospital based cross-sectional study was at Jimma Medical Center of Ethiopia on epileptic patients who were on follow-up at neurologic clinics during the data collection period. The malignant ECG characteristics and was identified using the ECG abnormality tool. To facilitate analysis, the gathered data was imported into Epidata version 3.1 and exported to the SPSS version 26. The factors of abnormal ECG and sudden death risk were examined using bivariate logistic regression. The study comprised 190 epileptic patients, with a mean age of 32 years. There were more men than women, making up 60.2%. A 43.2% (n = 80) frequency of ECG abnormalities was identified. According to the study, early repolarization abnormalities were the most common ECG abnormalities and increased with male sex and the length of time a person had seizures (AOR) of 4.751 and 95% CI (.273,.933), p = 0.029, compared to their female counterparts. The frequency of malignant ECG alterations in epileptic patients on follow-up at Jimma Medical Center in Ethiopia is described in the study. According to the study, there were significant ECG alterations in epileptic individuals. Male gender and longer duration of epilepsy raise the risk of abnormal ECG findings that could result in sudden cardiac death.

Client satisfaction with abortion care service and its associated factors among women in Ethiopia: a systematic review and meta-analysis

BackgroundThe client’s satisfaction after abortion care is the key to sustaining abortion care and increasing the health status of those who had complications from abortion. Nevertheless, research conducted in Ethiopia stated that the major problem is the need for post-abortion care for females. One of the ways to improve the qualities involved in post abortion care and decrease the mortality and morbidity rates caused by unsafe abortion is by ensuring client satisfaction with abortion care. Strategy making and policy formulation based on systematic review take on the highest priority in developing countries. However, although some independent studies had been carried out in Ethiopia, their findings might not have been representative and conclusive. The main purpose of this systematic review and meta-analysis article is to establish the proportion of abortion clients who are satisfied with their abortion care and the factors that contribute to such satisfaction among clients in Ethiopia.Methods and materialsOnly published articles were considered in this review. The main databases included Medline/Pubmed, Web of Science, Embase, Cinael, Med Nar, Google Scholar, Scopus, the Ethiopian University Repository Online, and the Cochrane Library. The review includes cross-sectional studies that meet the requirements and were written in English. A random effects model was used to calculate the pooled prevalence of client satisfaction with abortion care. The study heterogeneity was tested using Cochrane Q-Static and I2. Publication bias was checked using the Eggers test and funnel plot. PRISMA was used to select and direct the selection of articles for this review. Statistical analyses were conducted using STATA version 14.ResultA review of ten studies comprised 2740 women. In summary, the pooled prevalence of client’s satisfaction with abortion care in Ethiopia was 56.13% [95% CI (42.35; 69.91), I2 = 99.1%, p < 0.001]. In terms of subgroup analysis, Gambella had the highest prevalence of client satisfaction with abortion care at 87.40% [95% CI: 82.38 and 91.82]. However, Amhara had the lowest: 25.00% [95% CI: 21.59, 28.41]. The review also found that client satisfaction with abortion care had a statistical correlation with the type of procedure [OR: 0.25, CI [0.07, 0.42], I2: 76.9%, p-value: 0.041] and the participant’s education level [OR: 0.29, CI [0.09, 0.48], I2: 80.4%, p-value: 0.006].ConclusionThis review found that 56% of Ethiopian women were satisfied with their abortion care. Since this requires a boost to the quality of abortion care in the health facility, understanding women’s expectations and perceptions, training of health care providers, and strict monitoring of the quality of abortion care services by stakeholders like the Ethiopian government, non-governmental organizations, and high-level management of the health facility would help to improve the level of women’s satisfaction with abortion care. Those factors, namely, the type of method to use for the patient and women’s educational level, should be changed through improving awareness among the patients about what procedure to conduct and the health education provided to women about abortion care.

Increase in acute mastoiditis at the end of the COVID-19 pandemic.

Common respiratory infections were significantly reduced during the COVID-19 pandemic due to general protective and hygiene measures. The gradual withdrawal of these non-pharmaceutical interventions (NPI) was associated with a notable increase in these infections, particularly in pediatric and adult otorhinolaryngology. The aim of this retrospective monocentric study was to evaluate the impact of NPI during the COVID-19 pandemic on the incidence and severity of acute mastoiditis (AM). Pre-pandemic clinical data of AM cases from 2011 to 2019 were compared with infection counts from January 2020 to June 2023 for seasonal periodicity, age-specific differences, pathogens, and complication rates in a German third-level hospital. Out of 196 patients with AM 133 were children, the majority between 1 and 5years of age. Complications of AM, such as meningitis, brain abscess, and sinus vein thrombosis, were more common in adults (87%) than in children (17%). Morbidity and mortality rates were similar before, during and after the pandemic. Pneumococci were the most common pathogen in both age groups, with a post-pandemic cumulation of Streptococcus pyogenes infections in children. While pre-pandemic cases clustered in spring, seasonality was absent in all age groups during the main phase of the pandemic. The cessation of NPI caused a steep rise in AM cases in both age groups starting from December 2022. NPI during the COVID-19 pandemic reduced the incidence of AM. Their reversal led to a substantial increase in the incidence of AM during the post-pandemic period, which may be due to a general increase in viral respiratory infections and an insufficiently trained immune system.

Arg1 from Cryptococcus neoformans lacks PI3 kinase activity and conveys virulence roles via its IP3-4 kinase activity.

Inositol tris/tetrakis phosphate kinases (IP3-4K) in the human fungal priority pathogens, Cryptococcus neoformans (CnArg1) and Candida albicans (CaIpk2), convey numerous virulence functions, yet it is not known whether the IP3-4K catalytic activity or a scaffolding role is responsible. We therefore generated a C. neoformans strain with a non-functional kinase, referred to as the dead-kinase (dk) CnArg1 strain (dkArg1). We verified that, although dkARG1 cDNA cloned from this strain produced a protein with the expected molecular weight, dkArg1 was catalytically inactive with no IP3-4K activity. Using recombinant CnArg1 and CaIpk2, we confirmed that, unlike the IP3-4K homologs in humans and Saccharomyces cerevisiae, CnArg1 and CaIpk2 do not phosphorylate the lipid-based substrate, phosphatidylinositol 4,5-bisphosphate, and therefore do not function as class I PI3Ks. Inositol polyphosphate profiling using capillary electrophoresis-electrospray ionization-mass spectrometry revealed that IP3 conversion is blocked in the dkArg1 and ARG1 deletion (Cnarg1Δ) strains and that 1-IP7 and a recently discovered isomer (4/6-IP7) are made by wild-type C. neoformans. Importantly, the dkArg1 and Cnarg1Δ strains had similar virulence defects, including suppressed growth at 37°C, melanization, capsule production, and phosphate starvation response, and were avirulent in an insect model, confirming that virulence is dependent on IP3-4K catalytic activity. Our data also implicate the dkArg1 scaffold in transcriptional regulation of arginine metabolism but via a different mechanism to S. cerevisiae since CnArg1 is dispensable for growth on different nitrogen sources. IP3-4K catalytic activity therefore plays a dominant role in fungal virulence, and IPK pathway function has diverged in fungal pathogens.IMPORTANCEThe World Health Organization has emphasized the urgent need for global action in tackling the high morbidity and mortality rates stemming from invasive fungal infections, which are exacerbated by the limited variety and compromised effectiveness of available drug classes. Fungal IP3-4K is a promising target for new therapy, as it is critical for promoting virulence of the human fungal priority pathogens, Cryptococcus neoformans and Candida albicans, and impacts numerous functions, including cell wall integrity. This contrasts to current therapies, which only target a single function. IP3-4K enzymes exert their effect through their inositol polyphosphate products or via the protein scaffold. Here, we confirm that the IP3-4K catalytic activity of CnArg1 promotes all virulence traits in C. neoformans that are attenuated by ARG1 deletion, reinforcing our ongoing efforts to find inositol polyphosphate effector proteins and to create inhibitors targeting the IP3-4K catalytic site, as a new antifungal drug class.

HMGB1: A New Target for Ischemic Stroke and Hemorrhagic Transformation.

Stroke in China is distinguished by its high rates of morbidity, recurrence, disability, and mortality. The ultra-early administration of rtPA is essential for restoring perfusion in acute ischemic stroke, though it concurrently elevates the risk of hemorrhagic transformation. High-mobility group box 1 (HMGB1) emerges as a pivotal player in neuroinflammation after brain ischemia and ischemia-reperfusion. Released passively by necrotic cells and actively secreted, including direct secretion of HMGB1 into the extracellular space and packaging of HMGB1 into intracellular vesicles by immune cells, glial cells, platelets, and endothelial cells, HMGB1 represents a prototypical damage-associated molecular pattern (DAMP). It is intricately involved in the pathogenesis of atherosclerosis, thromboembolism, and detrimental inflammation during the early phases of ischemic stroke. Moreover, HMGB1 significantly contributes to neurovascular remodeling and functional recovery in later stages. Significantly, HMGB1 mediates hemorrhagic transformation by facilitating neuroinflammation, directly compromising the integrity of the blood-brain barrier, and enhancing MMP9 secretion through its interaction with rtPA. As a systemic inflammatory factor, HMGB1 is also implicated in post-stroke depression and an elevated risk of stroke-associated pneumonia. The role of HMGB1 extends to influencing the pathogenesis of ischemia by polarizing various subtypes of immune and glial cells. This includes mediating excitotoxicity due to excitatory amino acids, autophagy, MMP9 release, NET formation, and autocrine trophic pathways. Given its multifaceted role, HMGB1 is recognized as a crucial therapeutic target and prognostic marker for ischemic stroke and hemorrhagic transformation. In this review, we summarize the structure and redox properties, secretion and pathways, regulation of immune cell activity, the role of pathophysiological mechanisms in stroke, and hemorrhage transformation for HMGB1, which will pave the way for developing new neuroprotective drugs, reduction of post-stroke neuroinflammation, and expansion of thrombolysis time window.

Lactic Acid Bacteria-Derived Postbiotics as Adjunctive Agents in Breast Cancer Treatment to Boost the Antineoplastic Effect of a Conventional Therapeutic Comprising Tamoxifen and a New Drug Candidate: An Aziridine-Hydrazide Hydrazone Derivative.

Breast cancer is associated with high mortality and morbidity rates. As about 20-30% of patients exhibiting ER-positive phenotype are resistant to hormonal treatment with the standard drug tamoxifen, finding new therapies is a necessity. Postbiotics, metabolites, and macromolecules isolated from probiotic bacteria cultures have been proven to have sufficient bioactivity to exert prohealth and anticancer effects, making them viable adjunctive agents for the treatment of various neoplasms, including breast cancer. In the current study, postbiotics derived from L. plantarum and L. rhamnosus cultures were assessed on an in vitro breast cancer model as potential adjunctive agents to therapy utilizing tamoxifen and a candidate aziridine-hydrazide hydrazone derivative drug. Cell viability and cell death processes, including apoptosis, were analyzed for neoplastic MCF-7 cells treated with postbiotics and synthetic compounds. Cell cycle progression and proliferation were analyzed by PI-based flow cytometry and Ki-67 immunostaining. Postbiotics decreased viability and triggered apoptosis in MCF-7, modestly affecting the cell cycle and showing a lack of negative impact on normal cell viability. Moreover, they enhanced the cytotoxic effect of tamoxifen and the new candidate drug toward MCF-7, accelerating apoptosis and the inhibition of proliferation. This illustrates postbiotics' potential as natural adjunctive agents supporting anticancer therapy based on synthetic drugs.

Exploring the Relationship between Melioidosis Morbidity Rate and Local Environmental Indicators Using Remotely Sensed Data.

Melioidosis is an endemic infectious disease caused by Burkholderia pseudomallei bacteria, which contaminates soil and water. To better understand the environmental changes that have contributed to melioidosis outbreaks, this study used spatiotemporal analyses to clarify the distribution pattern of melioidosis and the relationship between melioidosis morbidity rate and local environmental indicators (land surface temperature, normalised difference vegetation index, normalised difference water index) and rainfall. A retrospective study was conducted from January 2013 to December 2022, covering data from 219 sub-districts in Northeast Thailand, with each exhibiting a varying morbidity rate of melioidosis on a monthly basis. Spatial autocorrelation was determined using local Moran's I, and the relationship between the melioidosis morbidity rate and the environmental indicators was evaluated using a geographically weighted Poisson regression. The results revealed clustered spatiotemporal patterns of melioidosis morbidity rate across sub-districts, with hotspots predominantly observed in the northern region. Furthermore, we observed a range of coefficients for the environmental indicators, varying from negative to positive, which provided insights into their relative contributions to melioidosis in each local area and month. These findings highlight the presence of spatial heterogeneity driven by environmental indicators and underscore the importance of public health offices implementing targeted monitoring and surveillance strategies for melioidosis in different locations.

Machine Learning Approaches in Atrial Fibrillation Detection

Atrial fibrillation (AF) characterized by rapid and irregular electrical activity in the atria represents a prevalent form of cardiac arrhythmia that significantly challenges healthcare systems due to its links to heightened mortality and morbidity rates. Early detection of AF is critical for accurate and effective management and treatment. In response to this pressing need, numerous researchers have used machine learning (ML) to enhance the precision and efficiency of AF detection. By analyzing available datasets, signal lengths, preprocessing techniques, and a diverse array of ML approaches, this paper aims to cover methodologies of AF detection using electrocardiogram (ECG) data and ML.

Infrapopliteal Bypass In Patients On Dialysis: Patency And Survival.

Portugal has one of the highest prevalence of patients on a regular dialysis program. This population has a higher incidence of peripheral arterial disease with higher rates of postoperative morbidity and mortality. Our goal was to compare outcomes between dialysis and non-dialysis patients with chronic limb threatening ischemia (CLTI) submitted to infrapopliteal bypass. A retrospective single-center study of infrapopliteal bypass for CLTI was performed between 2012 and 2019. Patients were divided in two groups based on dialysis status (group 1 incorporated patients on dialysis). Primary end point was 1-year freedom from CLTI. Secondary end points were limb-salvage, survival and primary (PP) and tertiary patency (TP) rates at 3 years of follow-up. A total of 352 infrapopliteal bypasses were performed in 310 patients with CLTI. Fourteen percent of the revascularizations were performed on dialysis patients (48/352). Median age was 73 years (interquartile range - IQR 15) and 74% (259/352) were male. Median follow-up was 26 months (IQR 42). Overall, 92% (325/352) had tissue loss and 44% (154/352) had some degree of infection. The majority of revascularization procedures were performed with vein grafts (61%, 214/352). The 30-day mortality was 4% (11/310), with no difference between groups (p = 0.627). Kaplan-Meier analysis showed no difference between groups regarding freedom from CLTI (76% vs. 79%; HR 0.96, CI 0.65-1.44, p=0.857), limb-salvage (70% vs. 82%; HR 1.40, CI 0.71-2.78, p=0.327) and survival (62% vs. 64%; HR 1.08, CI 0.60-1.94, p=0.799). PP rates were 39% in group 1 and 64% in group 2 (HR 1.71, CI 1.05-2.79, p=0.030). TP rates were not different between groups (57% and 78%; HR 1.79, CI 0.92-3.47, p=0.082). Infrapopliteal bypass for CLTI, on dialysis patients, resulted in lower PP rates. No differences were observed in freedom from CLTI, TP, limb salvage and survival.

Feasibility, safety, and efficacy of endovascular treatment of anterior cranial fossa dural arteriovenous fistulas: a systematic review and meta-analysis with a subanalysis for Onyx.

Dural Arteriovenous Fistulas (dAVFs) of the anterior cranial fossa (ACF) are uncommon but carry a high risk of hemorrhage and pose substantial treatment challenges. Recent advancements in endovascular treatment (EVT), including the introduction of novel liquid embolic agents, have markedly bolstered EVT's role in managing ACF-dAVFs, with notable series published in the last five years. We aimed to assess the feasibility, safety, and efficacy of EVT for ACF-dAVFs. We searched Medline, Scopus, Web of Science, and Cochrane Library databases following PRISMA guidelines. Eligible studies included those with ≥ 5 patients undergoing embolization of ACF-dAVFs, detailing both angiographic and clinical outcomes. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Publication bias was assessed by funnel-plot analysis and Egger's test. Outcomes included complete occlusion following embolization, unsuccessful endovascular embolization attempts, incomplete occlusion following embolization, symptom resolution or clinical improvement following embolization, recurrence; procedure-related complications, morbidity, and mortality. Additionally, a subanalysis for studies exclusively utilizing Onyx™ embolic system was done. Eighteen studies comprising 231 ACF-dAVF were included. Unsuccessful endovascular embolization attempts rate was 2%. Complete occlusion rate was 85%, with 4% of complications. Incomplete occlusion rate was 10%. Successfully embolized patients experienced either symptom resolution or clinical improvement in 94% of cases. Morbidity and mortality rates were 1% and 0%, respectively. Onyx subanalyses showed an overall rate of 0% for unsuccessful attempts, 95% for complete occlusion, and 5% for incomplete occlusion. Symptom resolution or clinical improvement was 98% and recurrence rate was 0%. EVT for ACF-dAVF is highly feasible, effective, and safe, with a low rate of complications, morbidity, and mortality. The subanalyses focusing on Onyx embolizations revealed superior efficacy and safety outcomes compared to the findings of the primary analyses involving all included studies.

The Hepatoprotective Effect of Trigonelline in Diabetic Rat Through Insulin-related IRS1-GLUT2 Pathway: A Biochemical, Molecular, Histopathological, and Immunohistochemical Study

The Hepatoprotective Effect of Trigonelline in Diabetic Rat Through Insulin-related IRS1-GLUT2 Pathway: A Biochemical, Molecular, Histopathological, and Immunohistochemical Study

Emergency Profile of Pediatric Patients Based on Pediatric Early Warning Score in the Emergency Department of the Adam Malik Hospital

Background: High morbidity and mortality rates in pediatric patients indicate the necessity of a Pediatric Early Warning Score (PEWS) capable of early clinical deterioration identification and providing an opportunity for healthcare professionals to promptly manage patients. This study aimed to serve as foundational data and as an evaluative tool to enhance the proficiency of healthcare workers in assessing patient deterioration. Methods: This study utilized a descriptive method with a cross-sectional design and consecutive sampling technique who were treated from January to December 2022. Results: there were 119 samples, the majority of gender was male (54.6%), the majority of the age group was 1-4 years old (37.8%), and the majority of the disease group was infection (31.1%). Both male and female majority had green PEWS (54.6%) and (45.4%), the majority of patients with an age range of 1 month to 5 years had red PEWS, the majority of infectious disease group had green PEWS, and the majority of patients with green PEWS had discharge outcome. Conclusion: This study provides an overview of characteristics in pediatric patients and shows the majority of pediatric emergency department patients come with non-emergency conditions.

Point-of-Care Electrochemical Immunosensor Applied against Nosocomial Infection: Staphylococcus aureus Detection in Human Hand Skin.

Staphylococcus aureus is an important pathogen that causes nosocomial infections, resulting in unacceptable morbidity and mortality rates. In this work, we proposed the construction of a nanostructured ZnO-based electrochemical immunosensor for qualitative and semiquantitative detection of S. aureus using simple methods for growing zinc oxide nanorods (ZnO NRs) on a sensor board and immobilizing the anti-S. aureus antibody on ZnO NRs through cystamine and glutaraldehyde. The immunosensor detected S. aureus in the 103-107 colony-forming unit (CFU) mL-1 range and showed a limit of detection (LoD) around 0.792 × 103 CFU mL-1. Beyond a satisfactory LoD, the developed immunosensor presented other advantages, such as high versatility for point-of-care assays and a suitable selective factor that admits the detection of the S. aureus concentration range in human hand skin after washing. Moreover, the immunosensor showed the potential to be an excellent device to control nosocomial infection by detecting the presence of S. aureus in human hand skin.

Evaluation of Three-Dimensional Reconstruction Technology in Precision Hepatectomy for Primary Liver Cancer

Abstract Background Primary Liver Cancer has become a potent threat to the world due to its high morbidity and mortality rate. Up till now, Liver transplantation is the most suggested treatment but it is not feasible owing to the unavailability of donors and high cost. Hepatectomy provides an alternative treatment to this deadliest disease. Precision hepatectomy is performed with the aid of traditional 2 dimensional technology and image processing such as CT scan and Magnetic Resonance Imaging. However, it requires extensive expertise and pose challenges to the young doctors in decision making. Modern imaging and computer technology has opened the new avenues in medical field with the advent of 3 dimensional Reconstruction and visualization methods. Material and Methods We conducted a cohort retrospective study. In this study, we tried to evaluate the efficacy an impacts of 3 dimensional reconstruction on the preoperative planning of hepatectomy, intraoperative conditions and postoperative complications. We took 95 patients and divided them in two groups A and B. Group A has 67 patients who underwent hepatectomy before the application of 3 dimensional reconstruction and 28 patients on whom hepatectomy was performed according to the planning and methods of 3dimensional reconstruction and results were evaluated. Results Our study found that 3 dimensional reconstruction can help in better diagnosis, resection planning and reduce the postoperative complication. Results were not significant difference p &gt; 0.05 on the incidence of postoperative complication between group A and B. Results were significant p &lt; 0.05 for the intraoperative blood loss, optimal surgery time and postoperative hospitalization. Conclusion Hence, 3 dimensional reconstruction is a landmark discovery in medical sciences for the accurate evaluation and resection of complex liver cancers.

Resolvin D1 Inhibits IL-6-Induced Epithelial-Mesenchymal Transition of Colorectal Cancer Cells by Targeting IL-6/STAT3 Signaling.

Colorectal cancer (CRC) has emerged as a prevalent malignancy worldwide, exhibiting the high morbidity and mortality rates. Resolvin D1 (RvD1) can exert anti-inflammation and anti-cancer effects on various diseases. This study is aimed to explore the role of RvD1 in CRC cells. HCT15 and SW480 cells were stimulated with IL-6 in our study. A series of assays such as CCK-8, colony formation, wound healing, Transwell, Western blotting, and immunofluorescence staining were designed and conducted to figure out the role of RvD1 in CRC cells. RvD1 suppressed IL-6-induced SW480 and HCT15 cell proliferation. In addition, RvD1 inhibited IL-6-induced SW480 and HCT15 cell migration, invasion, and EMT process. In mechanism, RvD1 inhibited the activation of IL-6/STAT3 signaling in SW480 and HCT15 cells. Angoline strengthened the inhibitive effect of RvD1 on cell malignancy. RvD1 inhibited cell growth, migration, invasion and EMT process by inactivating IL-6/STAT3 signaling in CRC.

Cholinergic Mechanisms in Gastrointestinal Neoplasia.

Acetylcholine-activated receptors are divided broadly into two major structurally distinct classes: ligand-gated ion channel nicotinic and G-protein-coupled muscarinic receptors. Each class encompasses several structurally related receptor subtypes with distinct patterns of tissue expression and post-receptor signal transduction mechanisms. The activation of both nicotinic and muscarinic cholinergic receptors has been associated with the induction and progression of gastrointestinal neoplasia. Herein, after briefly reviewing the classification of acetylcholine-activated receptors and the role that nicotinic and muscarinic cholinergic signaling plays in normal digestive function, we consider the mechanics of acetylcholine synthesis and release by neuronal and non-neuronal cells in the gastrointestinal microenvironment, and current methodology and challenges in measuring serum and tissue acetylcholine levels accurately. Then, we critically evaluate the evidence that constitutive and ligand-induced activation of acetylcholine-activated receptors plays a role in promoting gastrointestinal neoplasia. We focus primarily on adenocarcinomas of the stomach, pancreas, and colon, because these cancers are particularly common worldwide and, when diagnosed at an advanced stage, are associated with very high rates of morbidity and mortality. Throughout this comprehensive review, we concentrate on identifying novel ways to leverage these observations for prognostic and therapeutic purposes.

Measuring the perceived wellbeing of hemodialysis patients: A Mind Genomics cartography.

Chronic Kidney Disease patients under hemodialysis have high morbidity rate, which tends to considerably affect their health-related quality of life. Multiple studies that have made use of different questionnaries report the poor life quality of this patient group. The research in hand implemented the Mind Genomics Approach as a method to asses the health-related quality of life of hemodialysis patients, while relying on conjoint measurements to group individuals with similar patterns of responses to a certain mindset. The study is conducted in 3 clinics with 219 patients. It uncovers three clusters or mindsets: Mindset 1- Feels guardedly optimistic but worried about money, Mindset 2-Feels strongly positive because the state guarantees and the family supports, Mindset 3-Feels positive only about money. Based on the analysis of the collected data, the findings of this study suggest that the quality of life in hemodialysis patients is highly correlated to their financial status. The current study is one of the few first attempts to apply Mind Genomics in medical settings and the first, to our knowledge, in hemodialysis centers. This technology might enable healthcare proffesionals to provide personalized psychological treatment and additional social support to patients, which in turn could improve their clinical outcomes. The study is an example of using technology as a service.

Impact of Malnutrition on Survival and Treatment-Related Morbidity of Cancer in Children

Background: Malnutrition is a prevalent and severe issue in pediatric oncology, affecting treatment outcomes and survival rates significantly. In developing countries, where access to comprehensive healthcare is limited, malnutrition's impact is even more profound, complicating treatment protocols and increasing morbidity and mortality rates among children with cancer. Objective: To evaluate the effects of malnutrition on survival rates and treatment-related morbidity in pediatric cancer patients, and to assess the efficacy of nutritional interventions in improving these outcomes. Methods: This retrospective study was conducted at SKMCH &amp; RC, involving 160 newly diagnosed cancer patients aged between one and eighteen years. Patients were followed from January 2021 through March 2023. Malnutrition was assessed using WHO growth charts and defined using BMI and weight/height Z-scores. Data analysis was performed using SPSS software, version 25, focusing on survival rates, incidence of febrile neutropenia (FN), and nutritional status changes over time. Statistical significance was set at a p-value of 0.025. Results: At diagnosis, 42.5% (n=68) of the children were malnourished. After six months, 35% (n=56) remained malnourished, indicating some improvement. Malnourished children showed significantly lower survival rates, with those having a BMI Z-score ≤ -2 at six months post-diagnosis having a mortality rate HR of 4.05 (95% CI= 1.58-6.33, P = 0.009). Children experiencing a weight/height loss of &gt;10% had an HR of 1.98 (95% CI= 1.23-6.91, P=0.04) for increased mortality. Increased episodes of FN were correlated with severe malnutrition (HR 7.32, 95% CI=1.98-10.14, P=0.0007). Conclusion: Malnutrition significantly impacts the survival rates and treatment-related morbidity in pediatric cancer patients. Early and aggressive nutritional interventions can improve survival outcomes and reduce the rate of hospitalizations due to complications like febrile neutropenia.

Exploring the Experiences of Health Care Providers and Managers in the COVID-19 Pandemic: A Summative Content Analysiss

Background: The rapid morbidity and high mortality rates associated with COVID-19 have placed significant strain on healthcare systems. Mazandaran, as the third province, has been affected by this infectious pandemic. Objectives: The present study aimed to explore the experiences of healthcare providers and managers during the COVID-19 pandemic. Methods: The present qualitative research study was conducted using the content analysis approach between April 2022 and August 2022 to provide deep insights into the experiences of healthcare providers and managers during the COVID-19 pandemic. The participants included 15 hospital managers, comprising 2 clinical nurse supervisors, 3 matrons, and 10 chief executive officers. The participants were purposefully selected from hospitals affiliated with Mazandaran University of Medical Sciences, Iran. Data were collected through semi-structured individual interviews and the assessment of documents from the vice-chancellors of treatment, food and drug, development, and human resources. Results: The category of "challenges and strategies" emerged during the process of reducing and abstracting the codes. The challenges category evolved from three subcategories, including care and cure challenges, challenges related to providing physical resources and personal protective equipment (PPE), and challenges faced by healthcare providers. Similarly, the strategies category emerged from three subcategories, including strategies to improve patient care and treatment outcomes, strategies for procuring PPE and physical resources, and strategies for human resource management. Conclusions: The results of the present study revealed several challenges and strategies experienced by healthcare managers at Mazandaran University of Medical Sciences and hospital managers. Additionally, based on the existing infrastructure of Mazandaran University and the managerial skills of the managers, successful strategies were employed to tackle these challenges. These experiences can be utilized to inform revisions to health-related policies. Documenting these experiences can aid in better management of future infectious pandemics.

A mortality indicator in acute pulmonary embolism: the inferior vena cava contrast reflux score feasibility

Objective: Acute pulmonary embolism (APE) is frequently associated with high morbidity and mortality rates. Numerous studies have investigated the prognostic significance of cardiovascular computed tomography (CT) parameters. This study aimed to investigate potential CT scan predictors of 24-hour mortality in APE and to evaluate the value of the inferior vena cava (IVC) reflux score calculated on CT scan in predicting mortality. Methods: This study was a single-center, retrospective study. Approval from the local ethics committee (decision no. 2023/76) was obtained before patients’ data scanning. Patients who were admitted to the emergency department (ED) of a tertiary education and research hospital in Turkey between January 1, 2019, and December 31, 2021, who were diagnosed with APE at CT scan in the ED and whose treatment was started, and who did not meet the exclusion criteria were included in the study. The relationship between CT scan findings and early and late mortality was evaluated. Results: The study population comprised 226 patients, meeting the inclusion and exclusion criteria. Of the 226 patients, a total of 39 (17.3%) patients died, 16 (7.1%) within the first 24 hours. In evaluating CT scan parameters, the inferior vena cava (IVC) reflux score showed a statistically significant difference between the groups with and without mortality (24-hour P=0.001; 30-day P=0.001). Patients who died within the first 24-hour and 30-day after admission showed a reflux grade 3 into IVC more often than survivors (24-hour odds ratio (OR): 14.57, 95% confidence interval (CI): 3.64,58.1; P=0.001); 30-day (OR: 6.54, 95% CI: 2.51,16.98; P=0.001). However, other CT parameters were evaluated, and no statistical relationship was found between the groups with and without mortality. Conclusion: The cardiovascular CT scan findings may not be suitable for use as predictors of mortality. However, the IVC reflux score may be a good indicator of both early and late mortality.