National Protocol Research Articles

Profile of Perinatal Infections Among Abandoned Neonates Admitted in a Tertiary Hospital in Oman.

Little is known about the profile of perinatal infections among abandoned neonates, and there are no specific evidence-based guidelines on how to screen and manage these neonates. This study aimed to report the rate of perinatal infections among abandoned babies managed at Sultan Qaboos University Hospital (SQUH), Muscat, Oman, over 15 years (2006-2021). This retrospective cohort study included all abandoned babies admitted at SQUH from January 2006 to December 2021. Demographic data, the area where they were found, anthropometric parameters, symptoms, investigations and management were included in the study. Of the 20 neonates included in this study, 11 (55%) were male and 9 (45%) were female; only 1 baby looked preterm. The estimated median age at admission was 1 day, while the median length of hospitalisation was 30 days. Infectious disease screening was not optimal for syphilis. Among the babies who were tested for perinatal infections such as HIV (n = 20), syphilis (n = 7), hepatitis B (n = 20) and hepatitis C (n = 19), none tested positive and all babies received the hepatitis B vaccine. Overall, 13 out of 20 babies received antibiotics for presumed sepsis. Zidovudine was given prophylactically to 3 neonates until the HIV test result was received. A total of 2 neonates were managed for gastroenteritis, 2 for sepsis and 1 for pneumonia; no death was recorded. A national protocol on what should be included in the screening and how to manage these babies is urgently needed to avoid adverse outcomes in this disadvantaged population.

Clinical and laboratory comparison of severe (Group B and C) Dengue cases with molecular characterization from 2019 epidemics in Dhaka, Bangladesh.

Acute arboviral infections like dengue have a significant negative socioeconomic and health impact on many tropical and subtropical areas of the world. About 3.9 billion Individuals are at risk of contracting the dengue virus and Asia bears the brunt of that load. Bangladesh, like other south-east Asian countries faced a massive outbreak of dengue in 2019. This cross sectional study was done in three tertiary care centers in Dhaka, Bangladesh during this worst outbreak of dengue. The study was conducted from 1st July to 31st December, 2019 with an aim to describe the clinical and laboratory variations among severe dengue cases and to conduct a serotype survey. This might help to understand the future changes in the clinical or serological profile of this virus. The study enrolled 1978 participants who were grouped into group B (Patients with warning signs or risk factors who should be admitted for close observation as they approach critical phase) and C (Patients having severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress, severe organ impairment and severe metabolic abnormalities) according to national guidelines. Furthermore, 81 samples were serotyped using Qiagen One step RT-PCR kit (Cat. No: 210212). In addition sequencing (ABI sequencing platform) of partial C-prM gene of five DENV-3 isolates were done and analyzed (BLAST tool of NCBI) for phylogenetics (MEGA6 software package). Among the 1978 enrolled participants group B and C patients were 1580 (80%) and 398 (20%) respectively. The median (IQR) age of the patients were 26(11 to 41). Maximum proportion of the enrolled were male (72.3%) (p = 0.0002). Most common co- morbidities were hypertension (90; 4.5%) and DM (70; 3.5%). Group C patients more commonly presented with vomiting (p 0.133), diarrhea (p<0.0001) and abdominal pain (p 0.0203). The common mode of bleeding was melaena (12%). Thirteen (0.7%) patients succumbed to death, 12 of them belonged to group B who mostly presented with GI manifestations (99.9%) and melaena (12%). Only 5.6% of the cases were secondarily infected. In group C cases low hemoglobin and hematocrit was observed with high AST (p 0.004, 0.006 and 0.0016 respectively). Fluid requirement was also more in the same group (p<0.0001). Group B patients had a higher platelet requirement (p = 0.0070). Twelve patients (0.7%) required ICU. The management profile of these cases are showcased here which highlights minimal use of antibiotics and no application of steroids, which abides by the current national protocol. Furthermore, 81 samples from enrolled participants were serotyped and majority (79%) yielded DENV-3, followed by DENV 2 & 3 co-infection (13.6%) and DENV-2 alone (7.4%). Following phylogenetic analysis DENV-3 and DENV2 were deemed to be of genotype I and cosmopolitan variety respectively. This study presents the first instance of heterogeneous co-infection with several serotypes since 2000 in Bangladesh. It also gives an overview of serotype prevalence, management evaluation and clinical results that promises to navigate future control planning.

Case Report: Multi drug resistant tuberculosis in an 18-month-old boy with seizure, vomiting, and loss of vision

Multi drug resistant tuberculosis (MDR-TB) in children is rare and requires tremendous skill and knowledge of clinicians for early detection and treatment. This case highlights the complexities in diagnosing and treating MDR-TB in young children. An 18-month-old immunocompetent boy presented with prolonged fever, sudden onset of vision loss, vomiting, and seizures, which led to a suspicion of meningitis. Given his family history of treated pulmonary TB (TB) in the father and uncle one year ago, the initial treatment followed the Nepali national protocol for non-MDR tuberculous meningitis (TBM). However, the child's lack of response to this treatment raised concerns about MDR-TB, particularly after discovering on close questioning that the uncle, who lived with the boy’s family, had actually been diagnosed with MDR-TB. The diagnosis was confirmed by molecular tests of cerebrospinal fluid (CSF) and customized treatment for MDR TBM administered. The boy then slowly improved and became less irritable, afebrile, seizure-free, developed spontaneous movements of all four limbs, and was discharged after one month. Delays in suspicion, confirmation, and treatment of MDR TBM led to complications of leptomeningitis with non-communicating hydrocephalus and bilateral optic atrophy, which was confirmed by magnetic resonance imaging (MRI) scan of the brain. This case highlights the importance of taking a very thorough and proper history and considering the possibility of MDR, especially in countries like Nepal where TB in general is rampant so that timely diagnosis and treatment is possible and complications are avoided.

Multidrug-Resistant Urinary Tract Infections in Pregnant Patients and Their Association with Adverse Pregnancy Outcomes-A Retrospective Study.

Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant women, as well as their impact on obstetrical and neonatal outcomes. Methods: A total of 371 pregnant patients with UTIs were included in the analysis and were segregated into the following groups based on the type of bacterial resistance to antibiotics: MDR UTIs (70 patients, group 1), UTIs resistant to one class of antibiotics (108 patients, group 2), UTIs resistant to two classes of antibiotics (102 patients, group 3), and sensitive UTIs (91 patients, group 4). We used descriptive statistics for characterizing and comparing the microbial spectrum and the clinical characteristics of the patients. A multinomial logistic regression model for evaluating the relationship between the type of urinary tract infection and adverse obstetric or neonatal outcomes was employed. Results: In the case of MDR UTIs, the bacterial spectrum mainly included Escherichia coli, Enterococcus faecalis, and Klebsiella species. We found almost universal resistance to ampicillin. Our data confirmed an increased risk of preterm birth, premature rupture of membranes, neonatal respiratory distress syndrome, and neonatal intensive care unit admission for patients with MDR infections. Conclusions: The increased incidence of pathogens resistant to commonly used antibiotic classes in pregnancy suggests the need for the development of local and national protocols that adapt therapeutic and prophylactic regimens to clinical realities.

Hospital pharmacists’ education, career paths, and continuous education: A cross-sectional survey in Batna, Algeria

Background: This cross-sectional survey aimed to evaluate the perspectives of 61 hospital pharmacists in Batna, Algeria, regarding education, career choices, and continuous education (CE). Methods: Convenience sampling was employed to select pharmacists working in public health hospitals within the Wilaya of Batna. Data were collected using a structured questionnaire administered through Google Forms between December 20, 2023, and March 20, 2024. The questionnaire covered demographics, reasons for choosing the pharmacy profession, perceived relevance of university studies to current job, satisfaction with career trajectory, and engagement in CE. Results: The study found that 73.8% of respondents were female, with a mean age of 37.74 years and an average of 10.34±3.38 years of work experience. The most influential factor in choosing pharmacy was valuing a respectable job (3.69±1.51). Regarding education relevance, respondents rated their university studies to their current job with a moderate mean score of 2.97±1.16, with the fifth and fourth years emerging as the most relevant years of study to their current job (3.25±1.36 and 3.11±1.31, respectively). Factors influencing job selection included work environment, location of work, and level of responsibility. Over 50% had either not engaged in any CE or had done so more than a year ago, while barriers preventing engagement in CE included the lack of national protocols and personal time. Conclusion: It is urgent to improve the alignment between pharmacy education and job roles and implement CE activities through a national protocol. Additionally, targeted strategies are warranted to enhance job satisfaction and retention among hospital pharmacists in Algeria.

Recovery rate and predictors among children aged 6-59 months with severe acute malnutrition in Addis Ababa, Ethiopia: a retrospective follow-up study.

Severe acute malnutrition (SAM) is a critical public health concern in Ethiopia, contributing to high morbidity and mortality rates among children. Despite the improvement in hospital coverage and the development of standardized WHO treatment guidelines, recent reviews indicated a wide range in recovery rates (34%-88%) due to several context-specific factors. Understanding the factors influencing the recovery time can help inform targeted interventions and improve the overall management of SAM cases. Therefore, this study aimed to assess the time to recovery and predictors of children aged 6-59 months with severe acute malnutrition in Addis Ababa, Ethiopia, in 2023. An institutional-based retrospective follow-up study was conducted among children aged 6-59 months who were admitted to Tirunesh Beijing Hospital (TBH), Addis Ababa, Ethiopia, from July 2019 to June 2023. The Kaplan-Meir estimate and survival curve were used to compare the time to recovery using a log-rank test among different characteristics. A Cox proportional hazard regression analysis model was used to identify significant predictors of time to recovery. Finally, a p-value of <0.05 was used to declare a significant association. The median survival time to recovery was 17 (95% CI: 16.39-17.60) days, and the incidence rate of recovery from SAM was 37.8 per 1,000 child days. Moreover, exclusive breastfeeding [adjusted hazard ratio (aHR): 1.97, 95% CI: 1.45-2.68], amoxicillin provision (aHR = 1.62, 95% CI: 1.11-2.35), and deworming (aHR = 2.14, 95% CI: 1.48-3.09) were protective factors. However, complications at admission (aHR = 0.41, 95% CI: 0.23-0.73) and diarrhea during admission (aHR = 0.64, 95% CI: 0.45-0.91) were identified as risk factors of recovery from SAM. The time to recovery among the current study participants was low compared with the sphere standard. Besides, exclusive breastfeeding, complications at admission, diarrhea, amoxicillin provision, and deworming were independent predictors. Therefore, appropriate provision of routine medication and early management of medical comorbidity as per the national SAM management protocol can reduce the mortality of children with severe acute malnutrition significantly.

Contribution of TB-LAM Urine Test to Tuberculosis Diagnosis in HIV-infected Adult Patients in Burkina Faso

Aims: With the aim of improving the diagnosis of tuberculosis in patients living with HIV, we set out to evaluate the contribution of the TB-LAM urine test to the diagnosis of tuberculosis in PLWHA in Burkina Faso, in real life. Methodology: The study was conducted in the Infectious Diseases Departments of the Yalgado OUEDRAOGO (CHU-YO), Souro SANOU (CHU-SS) and Bogodogo (CHU-B) University Hospitals. These 03 centers are among the most important reference centers in Burkina Faso. This was a descriptive and analytical cross-sectional study with prospective data collection over 12 months, from January 1, 2023 to December 31, 2023, and involved PLWH inpatients and outpatients. Data were collected using the KoBoCollect v1.30.1 application and analyzed using STATA 16 software. Binary uni and multivariate logistic regression with a statistical significance level of 0.05 was used to identify associated factors. Results: A total of 113 patients were included in the study. The mean age was 43 ± 1.35 years, with a sex ratio of 0.85. The TB-LAM urine test was positive in 76 patients, for a positivity rate of 67.26%. The diagnosis of tuberculosis was confirmed by bacteriology in accordance with the national tuberculosis management protocol in 18/113 (15.93%) patients. Bacilloscopy and the Xpert test performed on all biological fluids, combined with the TB-LAM urine test, enabled the diagnosis of 81/113 (71.68%) patients in the study. Patients already on antiretroviral therapy (ORa=0.06 [0.06-0.73], p=0.02) were less likely to test positive for urinary TB-LAM, and those with unexplained asthenia (ORa=15.76 [1.19-20.66], p=0.03) were more likely to test positive. Conclusion: The TB-LAM urine test, combined with other tuberculosis diagnostic tools, increases the diagnostic yield of tuberculosis in PLWHA.

Social workers’ views on neglect of people with disabilities: From perspectives to practices

Summary This research explores the neglect of people with disabilities from the perspective of social workers in Israel, delving into the key issues and dilemmas surrounding their treatment. A qualitative approach was employed for this research. The study involved 40 social workers, with 25 completing an online qualitative survey and 15 participating in in-depth interviews. Thematic analysis was used to identify major themes related to the studied issue. Findings The research identified three major themes. The first theme focuses on social workers’ perspectives on neglect of people with disabilities. The second theme explores challenges in social workers’ coping with the phenomenon of neglect of people with disabilities. The third theme delves into factors impeding treatment in cases of neglect of people with disabilities. Applications The neglect of people with disabilities constitutes a serious social problem that demands changes in policy and practice. Consequently, there is a pressing need to establish a clear definition of neglect, implement a national protocol for addressing the phenomenon, enhance the training of social workers, and bolster supervision and control to improve the response to neglect experienced by people with disabilities.

The decriminalization of illicit drugs in British Columbia: a national evaluation protocol

BackgroundOn January 31st, 2023, the province of British Columbia (BC), Canada, was granted a federal exemption allowing adults (aged 18 +) to possess up to 2.5 g of select illicit drugs. The exemption will be in place for three years (2023–2026), marking the first formal decriminalization of illicit drug policy reform in Canada. BC’s decriminalization initiative is premised on several goals. This project seeks to evaluate each of these goals and their individual and combined contributions to determine the overall success of this policy.MethodsThe following protocol paper provides a detailed outline of a five-year (2022-2027) national evaluation of BC’s decriminalization initiative, as well as the specific objectives, methodologies, and planned analyses for eight interrelated sub-studies that comprise the evaluation. These sub-studies fall under the following five topical areas of research: 1) people who use drugs (PWUD), 2) the police and the criminal justice system, 3) the general public, 4) the health services system, and 5) an economic analysis. Additional research activities may also be explored.ResultsThe overall evaluation and specific sub-study designs were informed by intensive stakeholder engagement. The evaluation was developed in collaboration with an international expert committee who came together to undertake a nominal group technique to decide on the final evaluation design and corresponding logic model. The evaluation will also employ an advisory board and individual sub-study working groups comprised of experts and PWUD who will oversee the development and implementation of the overall evaluation as well as each sub-study.DiscussionThis evaluation will draw on implementation science research practices to evaluate and understand the full impacts of this novel drug policy experiment. Results will be widely disseminated through manuscripts, reports, presentations, and infographics, which will be adapted and tailored for specific audiences. The protocol identifies several anticipated challenges and limitations. This evaluation’s evidence-based findings will be poised to offer pivotal insights that can shape and refine the discourse on drug policy and will serve as a critical resource for understanding the multifaceted impacts of decriminalization.

Intraoperative Germinoma Staining: A Technical Note.

As the main treatment modality of central neural system germinomas is radiotherapy and/or chemotherapy, the exact initial diagnosis of the disease is crucial. Depending on the different national protocols, histologic verification can be obligatory in some instances. This is a serious challenge, taking into account the usual location and nonspecific macroscopic appearance of these lesions. Here, we propose a safe and effective method of intraoperative tumor enhancement that can increase the confidence of the surgeon during the intervention.

Multi-Site Benchmark Study for Standardized Relative Cerebral Blood Volume in Untreated Brain Metastases Using the DSC-MRI Consensus Acquisition Protocol.

A national consensus recommendation for the collection of DSC (dynamic susceptibility contrast) MRI perfusion data, used to create maps of relative cerebral blood volume (rCBV), has been recently established for primary and metastatic brain tumors. The goal was to reduce inter-site variability and improve ease of comparison across time and sites, fostering widespread use of this informative measure. To translate this goal into practice the prospective collection of consensus DSC-MRI data and characterization of derived rCBV maps in brain metastases is needed. The purpose of this multi-site study was to determine rCBV in untreated brain metastases in comparison to glioblastoma and normal appearing brain using the national consensus protocol. Subjects from three sites with untreated enhancing brain metastases underwent DSC-MRI according to a recommended option that uses a mid-range flip angle, GRE-EPI acquisition and the administration of both a pre-load and 2nd DSC-MRI dose of 0.1 mmol/kg GBCA. Quantitative maps of standardized rCBV (sRCBV) were generated and enhancing lesion ROIs determined from post-contrast T1-weighted images alone or calibrated difference maps, termed delta T1 (dT1) maps. Mean sRCBV for metastases were compared to normal appearing white matter (NAWM) and glioblastoma (GBM) from a previous study. Comparisons were performed using either the Wilcoxon signed-rank test for paired comparisons or the Mann-Whitney nonparametric test for unpaired comparisons. 49 patients with a primary histology of lung (n=25), breast (n=6), squamous cell carcinoma (SCC) (n=1), melanoma (n=5), gastrointestinal (GI) (n=3) and genitourinary (GU) (n=9) were included in comparison to GBM (n=31). The mean sRCBV of all metastases (1.83+/-1.05) were significantly lower (p=0.0009) than mean sRCBV for GBM (2.67±1.34) with both statistically greater (p<0.0001) than NAWM (0.68 +/- 0.18). Histologically distinct metastases are each statistically greater than NAWM (p<0.0001) with lung (p=0.0002) and GU (p=.02) sRCBV being significantly different than GBM sRCBV. 49 patients with a primary histology of lung (n=25), breast (n=6), squamous cell carcinoma (SCC) (n=1), melanoma (n=5), gastrointestinal (GI) (n=3) and genitourinary (GU) (n=9) were included in comparison to GBM (n=31). The mean sRCBV of all metastases (1.83+/-1.05) were significantly lower (p=0.0009) than mean sRCBV for GBM (2.67+1.34) with both statistically greater (p<0.0001) than NAWM (0.68 +/- 0.18). Histologically distinct metastases are each statistically greater than NAWM (p<0.0001) with lung (p=0.0002) and GU (p=.02) sRCBV being significantly different than GBM sRCBV. dT1=delta T1; GBCA=gadolinium-based contrast agent; NAWM=normal appearing white matter; normalized relative cerebral blood volume=nRCBV; relative cerebral blood volume=rCBV; standardized relative cerebral blood volume=sRCBV.

6877 Withdrawing Growth Hormone Treatment at Mid-Puberty in Idiopathic Isolated Growth Hormone Deficiency: Baseline Characteristics in Patient-Preference Design Study

Abstract Disclosure: J. Vliegenthart: None. J. Wit: None. B. Bakker: None. A. Boot: None. C. de Bruin: None. M. Finken: None. J.V. Heyden: None. M. Houdijk: None. H. van der Kamp: None. E. Van Mil: None. A. Reedijk: None. T. Sas: None. D.A. Schott: None. P. van Setten: None. S. Straetemans: None. V. van Tellingen: None. B. Touwslager: None. A.V. Trotsenburg: None. P. voorhoeve: None. A.C. Hokken-Koelega: None. D.C. van der Kaay: None. Background: The majority of children diagnosed with idiopathic isolated growth hormone deficiency (IIGHD) show a normal growth hormone (GH) secretion (assessed by GH stimulation tests) when retested at near adult height (NAH). It appears plausible that, if normal stimulated GH secretion is observed in mid-puberty, continuing recombinant human GH (rhGH) treatment may only have a minor effect on NAH. The effect on NAH has never been investigated in a prospective study. Aim: To evaluate patient preference in the choice to (dis-)continue GH treatment from mid-puberty, and to study whether patients who discontinued treatment differed in baseline characteristics from those who continued treatment. Methods: The study population consisted of adolescents who were diagnosed in childhood with IIGHD (GH peak at diagnosis between 1.7 ug/L and 10 ug/L) and who had started rhGH therapy between 2005-2018. According to the national treatment protocol, GH secretion was retested in mid-puberty (males: Tanner stage G3/4, testicular volume &amp;gt;12 ml and bone age (BA) 13-16 years; females: Tanner stage B3/4 and BA 11-14 years). In this multicentre prospective patient-preference design study, adolescents who tested GH sufficient at mid-puberty (GH peak &amp;gt;6.7 ug/L) had the choice to discontinue or continue rhGH treatment until NAH (height velocity &amp;lt;2cm/year). Results: In total 127 patients (95 male, 75%) participated in this study. Forty-four patients (35%) chose to continue GH treatment until NAH (group 1), and 83 patients (65%) chose to discontinue GH treatment (group 2). Mean height at inclusion (group 1: -0.76±0.69 SDS vs group 2: -0.47±0.85 SDS; P=0.055), target height SDS (group 1: -0.73±0.54 SDS and -0.58±0.53 SDS, P=0.15) and age at inclusion (group 1: 14.0±1.1y and 13.9±1.1y, P=0.69) did not significantly differ between groups. Males and females did not differ in these characteristics. Currently, 109 patients (86%) have reached NAH. Conclusions: The majority of patients (65%) preferred to discontinue rhGH treatment after sufficient GH retesting in mid-puberty. An anticipated difference in baseline data between the groups (adolescents who choose to discontinue treatment may be taller and older) could not be confirmed. Data are being collected until all patients reach near adult height. Presentation: 6/3/2024

9262 Withdrawing Growth Hormone Treatment at Mid-Puberty in Idiopathic Isolated Growth Hormone Deficiency: Baseline Characteristics in Patient-Preference Design Study

Abstract Disclosure: J. Vliegenthart: None. J. Wit: None. B. Bakker: None. A. Boot: None. C. de Bruin: None. M. Finken: None. J.V. Heyden: None. M. Houdijk: None. H. van der Kamp: None. E. Van Mil: None. A. Reedijk: None. T. Sas: None. D.A. Schott: None. P. van Setten: None. S. Straetemans: None. V. van Tellingen: None. B. Touwslager: None. A.V. Trotsenburg: None. P. voorhoeve: None. A.C. Hokken-Koelega: None. D.C. van der Kaay: None. Background: The majority of children diagnosed with idiopathic isolated growth hormone deficiency (IIGHD) show a normal growth hormone (GH) secretion (assessed by GH stimulation tests) when retested at near adult height (NAH). It appears plausible that, if normal stimulated GH secretion is observed in mid-puberty, continuing recombinant human GH (rhGH) treatment may only have a minor effect on NAH. The effect on NAH has never been investigated in a prospective study. Aim: To evaluate patient preference in the choice to (dis-)continue GH treatment from mid-puberty, and to study whether patients who discontinued treatment differed in baseline characteristics from those who continued treatment. Methods: The study population consisted of adolescents who were diagnosed in childhood with IIGHD (GH peak at diagnosis between 1.7 ug/L and 10 ug/L) and who had started rhGH therapy between 2005-2018. According to the national treatment protocol, GH secretion was retested in mid-puberty (males: Tanner stage G3/4, testicular volume &amp;gt;12 ml and bone age (BA) 13-16 years; females: Tanner stage B3/4 and BA 11-14 years). In this multicentre prospective patient-preference design study, adolescents who tested GH sufficient at mid-puberty (GH peak &amp;gt;6.7 ug/L) had the choice to discontinue or continue rhGH treatment until NAH (height velocity &amp;lt;2cm/year). Results: In total 127 patients (95 male, 75%) participated in this study. Forty-four patients (35%) chose to continue GH treatment until NAH (group 1), and 83 patients (65%) chose to discontinue GH treatment (group 2). Mean height at inclusion (group 1: -0.76±0.69 SDS vs group 2: -0.47±0.85 SDS; P=0.055), target height SDS (group 1: -0.73±0.54 SDS and -0.58±0.53 SDS, P=0.15) and age at inclusion (group 1: 14.0±1.1y and 13.9±1.1y, P=0.69) did not significantly differ between groups. Males and females did not differ in these characteristics. Currently, 109 patients (86%) have reached NAH. Conclusions: The majority of patients (65%) preferred to discontinue rhGH treatment after sufficient GH retesting in mid-puberty. An anticipated difference in baseline data between the groups (adolescents who choose to discontinue treatment may be taller and older) could not be confirmed. Data are being collected until all patients reach near adult height. Presentation: 6/3/2024

Burden of HCV among Prevalent Haemodialysis Patients in Kafr Elsheikh after National Egyptian HCV Eradication Program

Abstract Background Hepatitis C Hepatitis C virus (HCV) infection is one of the most commonly reported viral infections in both developing and developed countries, causing significant mortality and morbidity and costing billions of dollars annually. The prevalence of HCV infection in hemodialysis patients varies substantially among different geographical regions. Recent studies have shown that the HCV prevalence in hemodialysis patients varies from 1.4%–28.3% in developed countries and 4.7%–41.9% in developing countries Aim of the Work to estimate the prevalence of HCV infection and to determine the seroconversion rate in prevelant hemodilaysis in Kafr Elsheikh governorate after the hepatitis C virus infection National eradication program in Egypt and to identify the demographics leading to then non-compliance to hepatitis C virus medications and missed follow up among the prevalent hemodialysis patients with HCV infection in Kafr EL sheikh governorate, Egypt. Patients and Methods All patients were assessed for eligibility criteria and were included in the study only when they had met the following inclusion criteria: age older than 18 years old, maintained on regular hemodialysis session for more than 3 months. On the other hand, the exclusion criteria encompassed patients with acute kidney injury or any conditions necessitating temporary dialysis or patient age is less than 18 years old. 1162 prevalent hemodialysis patients in kafr el sheikh governorate, Egypt have been enrolled at our cross sectional study (multi-centric study) applying the proposed standards of the inclusion and exclusion criteria of our study design. Results Among these 1162 patients, 403 patients (34.68%) had history of positive PCR for HCV infection prior and during the national eradication campaign. Among those patients, 212 patients (52.61%) received HCV infection treatment in the form of oral and parenteral medications, while 191 patients (47.39%) didn't receive treatment. Among the patients who didn't receive the prescribed medications for HCV virus, 107 patients (56.02%) had concerns about drug complications, 22 patients didn't receive the prescribed medication due to lack of counselling while 20 patients (10.47%) did not receive treatment due to other causes as being mentally retarded, or having advanced medical comorbidities as advanced liver disease or decompensated heart failure while 42 patients (21.99%) refused to receive treatment without giving reasons. Conclusion The prevalence of HCV infection among the studied prevalent hemodialysis patients in Kafr El-Sheikh governorate is 19.4% after the HCV national eradication protocol and can be considered a major health problem. A significant percentage of the prevalent hemodialysis patients with hepatitis C virus infection refused to apply to the prescribed antiviral medications or being non complaint on medication that was mostly due to fear of developed major side effects of the prescribed medications and lack of counselling.

Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals: Outcomes of a Functional Resonance Analysis Method (FRAM) Study.

Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]). Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30). Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses' perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints. The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.

Structure Of The Single Health System For Diagnosis Of Htlv-1/2 In The Northern Region Of Tocantins

Background: The Human T-cell Lymphotropic Virus (HTLV), the first human retrovirus discovered, is associated with oncogenesis and is subdivided into several groups, with types 1 and 2 being the most prevalent and clinically relevant. Its main forms of transmission include unprotected sexual intercourse, blood transfusions, tissue and organ transplants, as well as vertical transmission (mother to newborn). In Brazil, mandatory testing for HTLV was implemented in the 1990s for blood donations and transplants, and expanded in 2024 by Ordinance No. 3,148 of the Ministry of Health, which includes testing during prenatal care. Objective: This study aimed to evaluate the structure of the Unified Health System (SUS) in the municipalities of the far north of Tocantins for the diagnosis of HTLV-1/2. Methodology: This is a qualitative study, in which semi-structured questionnaires were applied to Primary Care professionals and municipal health managers. Results: The results indicated significant deficiencies in knowledge of national protocols and the absence of a structured municipal flow for testing. Conclusion: It can be concluded that the health structure of the municipalities evaluated is insufficient for the effective diagnosis of HTLV-1/2

A Study on the Evaluation of Image-Guided Treatment Use in Radiotherapy Centers in Türkiye

This study presents a preliminary investigation into the use of image-guided radiation therapy (IGRT) in radiotherapy centers in Türkiye, based on survey data. Radiation therapy technologists were administered a 67-item Internet-based questionnaire. The first five items focused on demographic data, while the remaining items pertained to IGRT applications in the clinics where the technicians worked. Statistical data of the answers obtained were used in SPSS 28.0. While evaluating the study data, descriptive statistical methods (frequency, percentage) were used. A total of 314 individuals participated in the survey, with 45.9% (n=144) being female and 54.1% (n=170) being male. The study focused on patients with stomach (20.6%), rectum (18.9%), prostate (17.6%), head and neck (14.5%), lung (14.3%), and breast (13.9%) cancers. It was observed that megavoltage (MV) ports (35.7%) were used more frequently during daily checks. It has been stated that 1-25 MV ports are drawn daily. This is followed by Cone Beam Computer Tomography (CBCT) and kilovoltage (kV) port checks. In our country, it is seen that important steps have been taken in IGRT and its use is quite common. It has been observed that the technical infrastructure and manpower in the clinics are sufficient. It is predicted that the development of systems that reduce the doses received by patients and employees with IGRT and the development of wage policies will increase the use of IGRT. We hope that this result will be supported by future large-scale studies. Although we think that the use of IGRT is at an adequate level, there are differences in practices between clinics. It is thought that the establishment of national protocols for the use of IGRT will be in favour of patients and technicians.

Fulvestrant en la práctica clínica: análisis de efectividad en pacientes uruguayas con cáncer de mama HR+/HER2.

Fulvestrant demonstrated benefits in overall survival and progression-free survival in patients with advanced breast cancer, who are hormone receptor-positive and human epidermal growth factor receptor 2 negative. The characteristics, evolution, and survival of patients with hormone receptor-positive, HER2-negative breast cancer treated with fulvestrant were evaluated according to the national treatment coverage protocols of the National Resources Fund, with the aim of understanding the efficacy of fulvestrant in patients treated in usual clinical practice and comparing our results with those from pivotal studies. A database from the National Resources Fund covering the period from 2009 to 2022 was used. Survival curves were assessed using the Kaplan-Meier method, and differences were analyzed using the Log-Rank test. A total of 1085 patients with an average age of 63,66 years were included. Following a follow-up of 14 months, the median overall survival was 16 months, and the median progression-free survival was 6 months. The presence of liver and bone metastases was associated with a shorter overall survival. Patients from the public sector and those with a better performance status experienced longer overall survival. Our findings provide a valuable perspective for treatment management in a context of limited resources. Overall survival and progression-free survival were somewhat lower than those reported in pivotal clinical trials. The presence of liver and bone metastases was associated with worse prognosis and survival; additionally, patients with worse performance status had shorter overall survival. These findings underscore the need for personalized therapies, opening new lines of future research.

Effects of nationwide adjustment of tocolysis protocol in the Netherlands on neonatal outcomes in women with threatened preterm birth and delivery at 30-32 weeks of gestation: A cohort study

ObjectiveIn 2019 the Dutch national prevention of preterm birth (PTB) protocol was adjusted to withhold tocolysis for threatened PTB above 30 weeks of gestation due to insufficient evidence regarding its effectiveness on improving perinatal outcomes. The aim of this study is to evaluate neonatal outcomes of children born in the Netherlands between 30 and 32 weeks of gestation before and after the national protocol change. Study designWe performed a nationwide retrospective cohort study comparing outcomes of births in the years 2018 (tocolysis) and 2020 (no tocolysis). Tocolytic therapy consisted of either nifedipine or atosiban. Data were extracted from the national Perinatal Registry (PERINED). Women with a spontaneous PTB from 30 + 0 to 31 + 6 weeks of gestation were included. The primary outcome was a composite of mortality, severe intraventricular hemorrhage, severe necrotizing enterocolitis, cystic periventricular leukomalacia, and retinopathy of prematurity needing therapy. Secondary outcomes included additional neonatal outcomes. The odds ratio (OR) with corresponding 95 % confidence interval (CI) was calculated by logistic regression analysis for the year 2020 compared with 2018. ResultsComposite neonatal outcome did not differ between 2018 compared to 2020 (8.4 % (18/215) vs 8.2 % (25/306), OR 0.95; 95 % CI 0.51–1.77). No difference in composite neonatal outcome was found when analyzing groups as singletons (7.1 % vs 9.3 %, OR 1.35; 95 % CI 0.64–2.87), and multiples (13.3 % vs 5.9 %, OR 0.41; 95 % CI 0.13–1.26). ConclusionThere was no significant difference in composite neonatal outcome in pregnancies resulting in spontaneous PTB between 30 and 32 weeks of gestation in 2018 (with tocolysis) compared to 2020 (no tocolysis). These results support the protocol adjustment to withhold tocolytic treatment in women with threatened PTB above 30 weeks of gestation.

Association of CD34 Expression with Future Relapse in Pediatric T-cell Acute Lymphoblastic Leukemia

Background: Developing novel prognostic markers is crucial for childhood T-cell acute lymphoblastic leukemia (T-ALL). Objectives: This study aimed to investigate whether the prognostic impact of CD34, a progenitor marker, is associated with outcomes. Methods: This retrospective cohort study included 82 risk-adapted pediatric patients with T-ALL who were treated under the National Protocol of Childhood ALL in China (NPCLC)-ALL2008 from March 2008 to December 2016. Results: CD34 expression was observed in 37.8% of all T-ALL patients, with a median expression level of 62.7%. Patients with CD34 expression had a favorable event-free survival (EFS, 74.2% [66.3% - 82.1%]) with a hazard ratio of 0.69 (P = 0.33) and a reduced cumulative incidence of relapse (CIR, 22.6% [15.0% - 30.2%]; P = 0.86) at five years. Even after adjusting for potential factors and competing events in multivariable regression models, there was no connection between the CD34 immunophenotype and the risk of recurrence. Conclusions: CD34 expression did not serve as a predictive factor for relapse in this limited series. Larger multicenter studies are recommended to determine whether this biomarker at initial diagnosis can predict outcomes.