Outpatient Department Research Articles

Has Ghana's Rotavirus Vaccine Switch Met Programmatic Expectations? An Analysis of National Surveillance Data; 2018-2022.

Ghana introduced a 2-dose schedule rotavirus vaccine, Rotarix, into childhood immunization in 2012 but switched to a 3-dose schedule vaccine, Rotavac, in 2020 on account of programmatic advantages offered by the latter, including lower cost per fully immunized child and lower cold chain volume requirement. The objective of the study was to assess the effect of the vaccine switch on the trends of rotavirus vaccine uptake and health facility outpatient department (OPD) attendance due to diarrhea among children aged 1-11 months. A retrospective analysis was conducted on childhood immunization and diarrhea surveillance data for 2018-2022. The uptake of the different rotavirus vaccine products and the proportion of health facility OPD attendance attributed to diarrhea, respectively, were compared between the pre- and postswitch study periods. The uptake of rotavirus vaccine was sustained following the switch. There were no significant differences in vaccination coverages (rota1, Rotarix coverage [94.3%], vs rota1, Rotavac coverage [95.3%]; P = .757; rota2, Rotarix coverage [91.3%], vs rota2, Rotavac coverage [92.7%]; P = .789). The proportions of health facility OPD attendance due to diarrhea were comparable (preswitch [12.4%] vs postswitch [12.1%]; P = .838). Ghana's rotavirus vaccine switch yielded expected programmatic benefits without any untoward effects. The trends of vaccine uptake and reduction in diarrhea morbidity were sustained. These experiences and lessons from the rotavirus vaccine switch are vital for potential switches for other vaccines in the current immunization schedule to mitigate the annual vaccine expenditure.

Exploring the factors influencing the health-related quality of life in patients experiencing adverse drug reactions: a cross-sectional study

BackgroundThis study aimed to assess the factors influencing health-related quality of life (HRQoL) in patients experiencing adverse drug reactions (ADRs) at a tertiary care public sector hospital. A cross-sectional study was conducted over a period of 18 months, and included both male and female patients aged 18 years and above. Patients who visited the outpatient and inpatient departments with complaints associated with ADRs were included in this study. HRQoL data were collected using the EuroQol—5 Dimension—5 Level (EQ-5D-5L) questionnaire to assess five dimensions of health on a five-level scale. Descriptive statistics, t-tests, and analysis of variance were used to analyze the data. Multivariate regression analysis was performed to identify the potential determinants of HRQoL.ResultsA total of 316 patients were included in the study among these participants, of which 54% were female, and 65% were from rural areas. The majority (68%) of the patients had moderately severe ADRs, and 63% of the participants had an income < 2.5 lakh Indian rupees (3009 USD). The mean EQ-5D-5L and EuroQoL Visual Analog Scale (EQ VAS) scores of the study participants were 0.714 and 69.73, respectively. The variables ADR severity, income, and age showed a significant difference (p < 0.05) in HRQoL.ConclusionThis study provides insights into HRQoL among patients with ADRs and identifies the determinants of HRQoL. The findings of this study will contribute to improving patient-centered care and optimizing patient outcomes.

How are US hospitals adopting artificial intelligence? Early evidence from 2022.

US hospitals are rapidly adopting artificial intelligence (AI), but there is a lack of knowledge about AI-adopting hospitals' characteristics, trends, and spread. This study aims to fill this gap by analyzing the 2022 American Hospital Association (AHA) data. The novel Hospital AI Adoption Model (HAIAM) is developed to categorize hospitals based on their AI adoption characteristics in the fields of (1) predicting patient demand, (2) optimizing workflow, (3) automating routine tasks, (4) staff scheduling, and (5) predicting staffing needs. Nearly one-fifth of US hospitals (1107 or 18.70%) have adopted some form of AI by 2022. The HAIAM shows that only 3.82% of hospitals are high adopters, followed by 6.22% moderate and 8.67% low adopters. Artificial intelligence adoption rates are highest in optimizing workflow (12.91%), while staff scheduling (9.53%) has the lowest growth rate. Hospitals with large bed sizes and outpatient surgical departments, private not-for-profit ownership, teaching status, and part of health systems are more likely to adopt different forms of AI. New Jersey (48.94%) is the leading hospital AI-adopting state, whereas New Mexico (0%) is the most lagging. These data can help policymakers better understand variations in AI adoption by hospitals and inform potential policy responses.

Prescription of oral antibiotics and its appropriateness for outpatients in a tertiary care hospital in Korea

Antimicrobial stewardship programs (ASPs) have gained prominence with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescriptions is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescriptions at a tertiary care hospital in Korea. We analysed the patterns of oral antibiotic prescription from June 1, 2018 to May 31, 2023, at the outpatient department of Seoul National University Bundang Hospital. Appropriateness was assessed for prescriptions issued between May 15 and May 19, 2023. The assessment criteria included: indications for antibiotic use, antibiotic choice, duration, dose, and frequency. Pharmacists and infectious diseases specialists performed evaluations. A total of 7,282,407 outpatient visits were recorded within the 5-year duration. Of these, 243,967 (3.4%) were prescribed oral antibiotics. The frequency of antibiotic prescription was highest in dentistry, dermatology, and urology departments. The most commonly prescribed antibiotics were cephalosporins, penicillins, and sulphonamides. Of the 423 prescriptions evaluated, 289 (68.3%) and 134 (31.7%) were for treatment and prophylaxis, respectively. Inappropriate prescriptions were identified in 28.4% (82/289) and 70.9% (95/134) of the treatment and prophylaxis cases, respectively. The primary reason for inadequacy in both treatment and prophylaxis was inappropriate indications, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions. Antibiotics were administered in 3.4% of all outpatient visits, with 28.4% of treatment and 70.9% of prophylactic antibiotics prescribed inappropriately. Proactive and expansive ASP activities by pharmacists should be considered in outpatient settings.

Pharmacists at the Forefront: Identifying and Addressing Prescription Errors in Outpatient Settings of Tertiary Care Hospitals in Pakistan

Objective: The study sought to quantify the frequency and categorize the types of prescribing errors occurring in outpatient settings while evaluating the efficacy of pharmacist interventions in mitigating such errors. Methodology: This study was a cross-sectional, retrospective interventional study conducted over a one-year period from September 1, 2017, to August 31, 2018, at the outpatient departments of one government and one private tertiary care hospital in Hyderabad, Pakistan. A total of 2,552 outpatient prescriptions were randomly collected and evaluated by the researchers to identify prescribing errors, using the British National Formulary (BNF) as a reference guide. The study rigorously adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, ensuring comprehensive reporting, transparency in methodology, analysis, and interpretation of the observational research findings Results: The collected data were analyzed using chi-square tests in SPSS version 25 to assess statistical significance. Among the 2,552 outpatient prescriptions examined, 12,501 (40.4%) prescribing errors were identified. The error rate was higher in the government hospital (6,672; 42.8%) compared to the private hospital (5,829; 38.0%). The most prevalent errors occurred during the subscription stage (2,302; 45.1%), with 1,245 (48.1%) and 1,057 (42.0%) errors in the government and private hospitals, respectively. This was followed by errors in the inscription (3,447; 45.0%), superscription (5,156; 40.4%), and transcription (1,596; 31.3%) stages. Common interventions during the subscription stage addressed incomplete patient information (age, weight, etc.), missing consultant signatures, and stamps. For the inscription stage, frequent interventions involved incorrect drug doses and strengths.Typical interventions for the subscription and inscription stages included adding missing therapy durations and usage instructions, respectively. Pharmacist interventions were accepted at a higher rate in private hospitals (3,669; 62.9%) compared to government hospitals (3,675; 55.1%), with a total of 7,344 (58.7%) interventions accepted. Conclusion: The study revealed a high prevalence of prescribing errors across all stages of the outpatient prescription process, with the subscription stage being the most error-prone. The findings highlight the critical role of pharmacist-led prescription interventions in mitigating prescribing errors, thereby enhancing prescribing practices, optimizing therapeutic outcomes, and safeguarding patient safety.

Prescription pattern of usage of analgesics in pain relief in cancer patients at a tertiary care teaching hospital - An observational prospective study

Objective The World Health Organization has developed guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents to provide evidence-based guidance to healthcare providers on the adequate relief of pain associated with cancer. This prospective study was done to evaluate the prescription pattern of analgesics for the treatment of cancer pain. Material and Methods This prospective observational study was conducted in cancer patients attending the pain clinic of the Anesthesia and Radiotherapy Outpatient Department. Approval was obtained from the Institutional Human Ethics Committee. Inclusion criteria were age ≥18 years of either gender, willing to provide written informed consent, and patients undergoing radiotherapy, chemotherapy, or palliative treatment. Exclusion criteria were patients having psychiatric illness, not willing to provide written informed consent, patients having renal and or hepatic dysfunction, patients with comorbidities with chronic pain, and patients who underwent surgical intervention. Results A total of 100 participants were recruited during the study period of July 2022–April 2024 whose data were assessed. Participants were prescribed different classes of analgesic drugs, which included 30% participants on opioid analgesics, 30% on non-opioid analgesics, and 40% on combination therapy. Among opioid analgesics, morphine was the most commonly prescribed. Among non-opioid, paracetamol was the most commonly prescribed. Among combination therapy, tramadol was the most commonly prescribed. Pregabalin was most commonly used as an adjuvant analgesic. Conclusion This study also emphasizes on need for adequate treatment of cancer pain and vigilant monitoring of patients on opioids to prevent drug abuse, drug dependence, and adverse drug reactions.

Case series of retroperitoneal cyst: a clinical challenge and diagnostic dilemma

Cyst in retroperitoneal region is a rare occurrence with reported incidence of 1 in 5750-2,50,000. They present incidentally in one third patients or with pain or sometimes clinical palpable painless mass. Their management remains a clinical dilemma. Here, we report five cases of retroperitoneal cyst which presented to our hospital between August 2022-February 2023 and summarize the clinical features, diagnosis, and their treatment. All patients presented to our outpatient department. All patients were female youngest 20 years and oldest 76 years of age. Two patients had pain abdomen with clinically palpable mass. Two patients had painless mass. One patient was detected incidentally. All the patients were evaluated with CECT and MRI pelvis wherever needed. Cyst excision was done laparoscopically in 3 patients and by open laparotomy in 2 patients and histopathology report was followed post operatively. All patients were discharged without any complications. Retroperitoneal cyst is uncommon pathology of abdomen. Their presentation is quite vague. Imaging is the key in diagnosis. It poses a great clinical challenge in the management of such patients due to suspected malignancy. Our study shows that these cysts can be managed with simple excision irrespective of size after evaluation and laparoscopic approach is better where feasible.

Misuse of Antibiotics in Pediatric Patients – A Comprehensive Review .

To identify and assess the likely causes of antibiotic overuse in the Pediatric outpatient department (OPD) of a busy teaching hospital. Overuse of antibiotics has emerged as a significant global pediatric concern. Specifically, the sale of drugs without a prescription from a doctor and other circumstances may have an impact on the abuse of antibiotics. Antibiotic resistance is encouraged by the misuse of antibiotics, particularly when antibiotics are used, even when they are not the recommended course of therapy. The Centers for Disease Control and Prevention estimate that between one-third and half of all antibiotic usage in humans is unwarranted or improper. Viral pathogens are the primary cause of respiratory tract infections (RTI) in children compared to adults. Interestingly, compared to adults with RTI, very little is known regarding the usage of antibiotics in children.

A clinical randomized controlled study on the psycho-cardiological therapy for patients with coronary atherosclerosis disease

Objective: To explore the prognosis efficacy of psycho-cardiological therapy and management on patients with coronary atherosclerosis disease (CAD). Methods: This was a clinical randomized controlled study. This study included inpatients with CAD at the cardiology department in Beijing Anzhen Hospital, Capital Medical University from August 2021 to January 2024. The patients enrolled in this study were asked for basic information, and received measurements for depression, anxiety, sleep quality and living quality by the scales of Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder scale-7 (GAD-7), Athens Insomnia Scale (AIS), EuroQol 5-dimension 5-level (EQ-5D-5L) respectively. The patients were randomly grouped into a regular treatment group and a psycho-cardiological treatment group which included WeChat management or antidepressant/antianxiety medical therapy according to the situation. After the patients discharging from hospital for 2, 4, 12, 24, 48, 72, and 96 weeks, professional cardiovascular doctors would follow up by telephone, WeChat, and outpatient department, including scales (2-48 weeks), and cardiac events (2-96 weeks). Kaplan-Meier survival curve and multivariate Cox proportional hazards model were used for analyzing the association between psycho-cardiological treatment and cardiac events. Results: This study recruited a total of 552 patients with CAD, aged 61.0(54.0, 67.0) years, and 379 (68.7%) were male. There were 279(50.5%) in the regular treatment group and 273(49.5%) in the psycho-cardiological treatment group. After treatment for 4, 12 and 48 weeks, the PHQ-9 score in psycho-cardiological was significantly lower than the regular treatment group; After treatment for 12 weeks, the EQ-5D-5L effective value in psycho-cardiological group was higher than the regular treatment group; After treatment for 2, 4, 12, 24 and 48 weeks, the EQ-5D-5L VAS score in psycho-cardiological group was higher than the regular therapy group (all P<0.05). The Kaplan-Meier survival curve showed that, during the different follow-up periods, the rate of cardiac events in psycho-cardiological treatment group was lower than regular treatment group (log-rank P<0.001). The multivariate Cox proportional hazards model adjusted the factor of age, the psycho-cardiological treatment contributed to reducing the cardiac events rate by 80.3% (HR=0.197, 95%CI: 0.067-0.582, P=0.003). Conclusion: Psycho-cardiological treatment is beneficial for improving psychological stress, living quality, and reducing cardiac events, and helps to improve prognosis and psycho-cardiological rehabilitation in CAD patients.

A Prospective, Interventional, Comparative Study to Evaluate the Efficacy of Using Combined Platelet-Rich Plasma and Platelet-Rich Fibrin Over Standard Cleaning and Dressing in Chronic Wounds.

Chronic wounds are defined as wounds that have failed to proceed through the orderly process that produces satisfactory anatomic and functional integrity or that have proceeded through the repair process without producing an adequate anatomic and functional result. The majority of wounds that have not healed in three months are considered chronic, although a duration as low as four weeks has been used to indicate chronicity.Our study aimed to compare the efficacy of autologous platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) versus standard cleaning and dressing as a regenerative medicine strategy to promote healing in chronic wounds. A prospective randomized controlled trial was undertaken to test the efficacy of autologous PRPand PRFin the healing of chronic wounds. A series of 60 cases was compiled from patients attending the outpatient department regularly for the management of chronic wounds. A total of 30 cases were randomly chosen for study with autologous PRP and PRF and 30 cases received conventional dressing. The average healing duration in the study was significantly shorter for the PRP & PRF group. The mean healing time for this group was 4.45 weeks (31.2 ± 3.07 days) compared to 9.61 weeks (67.27 ± 9.19 days) for the conventional dressing group. PRP and PRF belong to a new generation of platelet concentrates that help efficaciously for enhanced healing and functional recovery, safely and cost-effectively. They help by shortening the recovery period overall, improving the quality of life of patients, and altogether eliminating the additional morbidity of operative procedures.

Artificial Intelligence in Detecting the Severity of Diabetic Retinopathy

BACKGROUND Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness among individuals with diabetes mellitus. Early detection and timely intervention are crucial for preventing irreversible vision loss. However, traditional methods of DR screening are labor-intensive and reliant on the availability of skilled personnel, posing challenges in resource-constrained settings. Objective This study aims to evaluate the effectiveness of artificial intelligence (AI) in detecting the severity of DR compared to conventional ophthalmological assessments. METHODS A hospital-based observational study was conducted at the ophthalmology outpatient department of Tertiary care hospital, India over a six-month period. A total of 300 diabetic patients were included, and fundus photographs were obtained using a fundus camera. The images were then analyzed using an AI model trained on a diabetic retinopathy dataset. The severity of DR was graded according to established criteria, and the accuracy of the AI model was compared to that of ophthalmologist grading. RESULTS The AI model demonstrated an accuracy rate of 95.25% in grading the severity of DR. Comparison between AI and ophthalmologist grading showed close sensitivity and specificity rates across different DR grades, with the AI model slightly outperforming in certain categories. CONCLUSIONS Artificial intelligence shows promise as an effective and efficient tool for the screening and diagnosis of diabetic retinopathy. Its integration into healthcare systems could enhance early detection and treatment of DR, particularly in underserved regions with limited access to ophthalmological services. Further research and validation are warranted to optimize the use of AI in diabetic eye care and ensure its equitable distribution and ethical use.

Role of physical activity for glycemic control among patients with type 2 diabetes mellitus

Background: Lifestyle modification and physical activity are very important parts of diabetes management. Regular physical activity has been shown to improve glycemic control through increased insulin sensitivity and glucose tolerance. The aims of this study were to assess the glycemic level and pattern of physical activity among type 2 diabetic patients. Methods: This hospital-based cross-sectional study was carried out from July 2022 to October 2022 among 305 purposively recruited diabetic patients who came to receive care at the outpatient department of a teaching hospital in Dhaka, Bangladesh. A semi-structured questionnaire was used to describe socio-demographic information. Physical activity was assessed using the validated version of international physical activity questionnaire short form/ global physical activity questionnaire (IPAQ/GPAQ). Glycemic control was measured by HbA1C report done within 120 days of the interview. Blood pressure and body mass index were also measured at the time of inclusion. The physical activity level was categorized according to IPAQ scoring protocol as high level, moderate level and low level. Chi square test was carried out to determine the association of physical activity with type-2 DM, body mass index, glycemic and blood pressure control. Statistical significance was defined as p&lt;0.05. Results: Among the participants only 0.3% had high level of physical activity. Moderate level of physical activity was found among 32.8% and low level of physical activity has been found among 66.9%. Among the participants 92.1% spent their time sitting during the weekdays while the time spent at home, at work, while doing course or class and during leisure activities. Among them 21% had the maximum 10 hours sitting time during the last week. The study showed that the persons who spent walking on at least 7 days has negative correlation with blood glycemic level and among them who spent time on sitting has positive correlation with blood glycemic level. Nearly two thirds of the respondents were female. The mean age was 53.09 ± 12.15 years. Majority of the participants were from urban area (69.83%) and the rest are from rural (21.31%) and sub urban (8.2%) area. There was no significant relation of level physical activity with any sociodemographic factors except monthly income, which showed low monthly income was associated with higher level of physical activity. Conclusion: The findings of our study focus on developing more awareness and providing facilities for physical activity to achieve the glycemic goal. BIRDEM Med J 2024; 14(3): 143-150

Seroprevalence of SARS-CoV-2 infection in pediatric patients in a tertiary care hospital setting.

Globally, cases of children's coronavirus disease 2019 (COVID-19) have been reported since the pandemic started. Most children have an asymptomatic or mild infection. Therefore, the incidence rate of COVID-19 in children might have been underestimated. This study aimed to determine (1) the seroprevalence (and seroconversion rates) of COVID-19, including associated risk factors, in pediatric patients visiting hospitals; and (2) the immunological responses to COVID-19. This was a prospective, cross-sectional study. Patients aged 0-18 years who visited the hospital from September 2020 to February 2022 were included. Demographic, clinical, and laboratory data were reviewed. A total of 1,443 pediatric patients were enrolled. Of these, 323 (22.6%) had a history of COVID-19. In the pre-Delta period, the seroprevalence increased from 4.1% to 70.6% in all included patients and from 0.5% to 10% in patients without a known history of COVID-19 compared with the Delta-Omicron period. The seroconversion rate was 6.8% (19 per 100 person-years) in pediatric patients with COVID-19. Risk factors for COVID-19 seropositivity were respiratory symptoms, being in an outpatient department setting, and infection during the Delta-Omicron period. Exposure to household members with confirmed COVID-19 was a risk factor for seropositivity and seroconversion. Infection during the Delta-Omicron period and testing conducted >2 weeks after the onset of symptoms was associated with spike immunoglobulin (Ig) M and spike and nucleocapsid IgG, respectively. High nucleocapsid IgG levels were associated with pneumonia in pediatric patients with COVID-19. Pediatric patients exposed to household members with COVID-19 and respiratory symptoms should be tested for COVID-19. Nucleocapsid IgG can be used as a surrogate marker to identify patients who may have experienced pneumonia from COVID-19 and as a screening tool for the COVID-19 outbreak, regardless of COVID-19 vaccination status.

Effects of Slow Breathing Exercises on Cardiac Autonomic Functions in Anxiety Disorder-A Randomised Control Trial.

Anxiety disorders are commonly associated with a higher risk of fatal cardiovascular diseases (CVD). Anxiety disorders lead to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, thus weakening the key neuronal components of the autonomic nervous system (ANS) that are involved in cardiovascular functions, leading to increased cardiovascular risk. Impaired ANS activity, as reduced parasympathetic tone is strongly associated with an increased risk of CVD in anxiety disorders. Slow pranayama influences the ANS by activating the parasympathetic tone and deactivating the sympathetic tone in healthy volunteers and various diseased conditions. Therefore, we aimed to study the effects of slow pranayama and savasana on cardiac autonomic function tests in anxiety disorder patients. Anxiety disorder patients (N = 140) of either sex between the age group 18 and 40 years attending the psychiatry outpatient department (OPD) in JIPMER were recruited for the study and were randomly assigned into the pranayama group and control group. The Pranayama group practised slow pranayama and savasana for 8 weeks along with routine psychiatric care, while the control group continued with routine psychiatric care only. Outcome measures were heart rate variability (HRV), baroreflex sensitivity (BRS), 30:15 ratio during lying to standing, E: I ratio during deep breathing, and ∇DBP during isometric handgrip, which were assessed before and after the intervention period. After 8 weeks in the Pranayama group, the HRV parameters showed significant improvement towards the parasympathetic domain. Also, there was a significant increase in parasympathetic reactivity with a decrease in sympathetic reactivity and significant improvement in BRS. Slow pranayama and savasana practice in anxiety disorder patients as an adjunct to routine psychiatric care effectively improves cardiac autonomic function with a shift towards parasympathetic predominance, with significant improvements in cardiovascular parameters. Slow pranayamas with savasana may be incorporated into the routine care of these patients to enhance their cardiovascular health.

Relationship Between Serum Copper, Zinc Level and Tumour Aggressiveness in Invasive Cervical Cancer

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Cervical cancer, a leading cause of cancer-related morbidity and mortality, exhibits considerable variability in aggressiveness. The role of trace elements such as copper and zinc in influencing tumor behavior and progression has garnered attention. This study investigates the relationship between serum copper and zinc levels and tumor aggressiveness in invasive cervical cancer.&amp;lt;i&amp;gt; Methods:&amp;lt;/i&amp;gt; A cross-sectional comparative study was conducted among 150 women with invasive cervical cancer attending the outpatient department and Colposcopy Clinic of the Department of Gynecological Oncology, BSMMU, Dhaka, from April 2022 to March 2023. Participants were divided into two groups based on tumor aggressiveness: Group 1 (less aggressive) and Group 2 (more aggressive), with 75 women in each group. Serum copper and zinc levels were measured and analyzed for differences between groups. &amp;lt;i&amp;gt;Result:&amp;lt;/i&amp;gt; Serum copper levels were significantly higher in Group 2 (152.31 ± 41.81 µg/dL) compared to Group 1 (139.31 ± 25.52 µg/dL) with a p-value of 0.023. Conversely, serum zinc levels were significantly lower in Group 2 (55.24 ± 28.13 µg/dL) compared to Group 1 (66.29 ± 31.58 µg/dL) with a p-value of 0.025. The copper/zinc ratio was significantly higher in Group 2 (2.76 ± 1.20) compared to Group 1 (2.10 ± 1.00) with a p-value of &amp;lt;0.001. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; Elevated serum copper levels and copper/zinc ratio, along with decreased zinc levels, are associated with more aggressive cervical cancer. These findings suggest that trace element imbalances may serve as biomarkers for assessing tumor aggressiveness and could inform future therapeutic strategies.

Pertinence of Five Different Regression Equations of Mixed Dentition Analysis in West Godavari District Children: A Comparative Study.

The orthodontic diagnosis and treatment planning are the fundamental goals during the mixed dentition period. Numerous methods have been proposed to date. The study was designed to determine the mesiodistal (MD) widths of the lower permanent canines and premolars from Tanaka and Johnston, regression equation (RE) proposed for north Indian population (RE-NIP), Bernabé and Flores-Mir C, Moyers', and Ling and Wong mixed dentition analysis (MDA) and to determine the correlation coefficients for the Eluru population. The study population was selected using cluster random sampling. A total of 3,572 children were clinically examined from the Outpatient Department of Pediatric and Preventive Dentistry, St Joseph Dental College and Hospital, Eluru district, Andhra Pradesh. Out of these, 140 children aged 11-16 years were randomly selected for the study based on the inclusion and exclusion criteria. The MD width of permanent incisors, canines, premolars, and molars was measured with the help of a digital vernier caliper; summed up and compared with the above-mentioned REs. The data obtained were subjected to statistical analysis using SPSS version 22, employing Student's t-test, Pearson correlation coefficient, and Kruskal-Wallis test. The RE-NIP underestimated the values, whereas the remaining equations overestimated the sum of permanent canines and premolars in both arches in the study population. The predicted values obtained from the abovementioned methods overestimated the actual values, and a new RE for the Eluru population should be suggested to better represent the size of unerupted canines and premolars. Measuring the MD widths of the upper and lower permanent incisors and molars during the mixed dentition period from different REs will help a pedodontist in proper treatment planning to predict the MD width of unerupted canines and premolars. Kanaparthi S, Done V, P Madu GS, et al. Pertinence of Five Different Regression Equations of Mixed Dentition Analysis in West Godavari District Children: A Comparative Study. Int J Clin Pediatr Dent 2024;17(8):871-876.

Frequency of Carbapenem Resistance in UTI Patients in a Tertiary Level Hospital

Background: Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria may not be detected by routine disk diffusion susceptibility test, leading to inappropriate use of antibiotics and treatment failure. The aim of this study was to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from patients with community acquired urinary tract infections (UTIs) at Comilla Medical College Hospital, Comilla as well as identification of ESBL producers in the population of different uropathogens. Objectives: To obseve the frequency of carbapenem resistance in UTI patients in a tertiary level hospital. Methods: This cross sectional observational study was done on inpatients and outpatients department of Comilla Medical College Hospital, Comilla in 6 months’ period. Formal ethical approval was taken before commencement of the study. Adult patients presenting with features of UTI were approached and finally selected in accordance to selection criteria. Convenience sampling technique was applied to enroll the total 100 study population. Following describing the purpose, methods and benefits of study written consent was taken from each patient. All patients were subjected to detail history, clinical examination and relevant investigation. Value of clinical investigations were noted on questionnaire. Following data collection, all were verified and prepared for data entry. Final analysis was done by using SPSS version 19. Results: Out of 100 patients attending in Comilla Medical College Hospital with symptoms suggestive of UTI, 31% had culture positive. Our study showed a high prevalence of UTI in females (61%) than in males (39%). Most common symptom was urgency (88%) followed by abdominal pain (77%), dysuria (67%) and ........

Prevalence of Malaria among Patients Visiting Public Hospitals in Mogadishu, Somalia-Cross-Sectional Study

Background: In tropical and subtropical areas, malaria is one of the main causes of death and morbidity. Malaria is a major worldwide health concern, especially in sub-Saharan Africa, which includes Somalia, where the majority of cases and deaths from the disease occur. Malaria has a negative impact on both public health and the economic growth of many developing nations. Examining and quantifying the prevalence of malaria among outpatients who have visited hospitals were the study's goal. Study was conducted between September, and November 2023. Methods: A structured questionnaire was administered to 278 were collected patients visit two general hospitals at single time with obtained consented, blood samples were diagnosis used by rapid diagnosis test (RDTs), this study was identified the species of plasmodium used standard keys. Thus, this study design was cross-sectional and quantitative study. The data source was primary information, and was nonrandom sampling. The data generated was analysis using percentage and present in graph forms. Chi- square was used to determine the degree of association between malaria prevalence and factors influencing its transmission, performed by (SPSS 20 version). Results: total of 278 was recruited to conduct the study at outpatient department OPD in two hospitals, Mogadishu, Somalia. Out of 278 persons examined for malaria parasites, 12 (4.3%) were positive. Females were more participated than males 185 (66.5%). The respondents were observed 43.5% use it most of the time sleep under mosquito net. Conclusion: The investigation clearly showed that the persons with malaria infection was minimal. Because the participants aware of the threat posed by mosquitoes in their area, they placed a strong emphasis on vector control measures as reduce the number of mosquito breeding sites. They also understood the significance of indoor residual spray (IRS), which is essential for both mosquito prevention and control.

A Comparative Study of Anterior Segment Optical Coherence Tomography and Gonioscopy in Detection of Narrow, Occludable Angles.

Introduction Glaucoma is a group of progressive optic neuropathies and is a leading cause of blindness. Primary angle-closure glaucoma is a global health problem, and if left untreated, it can lead to irreversible vision loss. Anterior segment imaging with optical coherence tomography (AS-OCT) is a rapidly advancing field in ophthalmology. Early detection of narrow, occludable angles using AS-OCT can lead to early and prompt management, resulting in the preservation of vision. Methods We conducted a cross-sectional, outpatient department (OPD)-based study of 212 eyes of patients. Eyes with narrow angles were selected for this study. Eyes identified as having narrow angles on Van Herick (grade ≤2) were confirmed by gonioscopy, and the angles were graded according to the Shaffer gonioscopy grading system. These eyes were further tested using AS-OCT, and the angles, measured in degrees, were graded according to the degrees given in the Shaffer anterior chamber angle grading system. The grades obtained on AS-OCT were compared with those obtained on gonioscopy. The correlation between the narrow angles measured on AS-OCT and those measured on gonioscopy was determined. Results The mean age of the participants was 58.64 years. Of the 212 eyes found to have narrow angles on gonioscopy, 206 eyes (97.2%, 95% CI: 94.0%-99.0%) also had narrow angles on AS-OCT, while six eyes (2.8%, 95% CI: 1.0%-6.1%) were found to have open angles. The chi-square test for association yielded a p-value of <0.001, indicating a statistically significant relationship between AS-OCT and gonioscopy grading. Conclusion This study showed a high correlation between AS-OCT and gonioscopy for grading narrow angles. Gonioscopy remains the gold standard for detecting and managing narrow angles. AS-OCT can be used to identify narrow angles in busy OPDs where these cases can easily be missed. These patients can then be further evaluated with gonioscopy and managed if necessary.

Health related quality of life and associated factors among patients treated for ischaemic heart disease in two public sector hospitals of Karachi, Pakistan.

To determine the level of health-related quality of life among patients treated for ischaemic heart disease in two public-sector tertiary care settings. The analytical cross-sectional study was conducted from July to September 2021 at two tertiary care hospitals in Karachi after approval from the ethics review boards of the National Institute of Cardiovascular Diseases and the Dow University of Health Sciences, and comprised patients of either gender treated for ischaemic heart disease after being diagnosed within the preceding year who were coming for follow-up in the outpatient department. Data was collected using the short version of the World Health Organisation quality of life tool. Association of socio-demographic and clinical variables with health-related quality of life was explored. Data was analysed using SPSS 21. Of the 300 patients aged 25-85 years, 212(70.7%) were males and 88(29.3%) were females. The mean total quality of life score was 6.1+/-1.4, while mean general health was 52.6+/-10.5. The lowest score among quality of life subscales was for environmental 44.7+/-15.1, while the highest score was for psychological 60.1+/-10.7 domains. Quality of life was significantly associated with patients' age, education, comorbidities, marital status, monthly income, body mass index, activities of daily living and smoking status (p<0.05). ischaemic heart disease patients had average health-related quality of life in all domains, but showed low quality of life in the environmental domain.