Prospective Analytical Cohort Study Research Articles

A PROSPECTIVE COMPARATIVE STUDY ON EFFICACY OF ORAL VITAMIN D FORMULATIONS IN PATIENTS WITH CHRONIC LOW BACK PAIN WITH VITAMIN D DEFICIENCY AT A TERTIARY CARE HOSPITAL

Objective: Chronic low back pain is a global health problem with significant medical and economic burden. Vitamin D deficiency and obesity are its risk factors. The objective was to determine efficacy of oral vitamin D formulations in patients with chronic low back pain with vitamin D deficiency.
 Methods: A prospective analytical cohort study was conducted. Patients with self-reported chronic low back pain and with vitamin D concentrations ≤30 ng/dl were identified and randomized into 3 groups namely Granule, Nano syrup and soft gel capsule group. Vitamin D supplementation of 60,000 IUs per dose for ten consecutive days was given in the form of granule (1 g sachet), Nano syrup (5 ml bottle) and soft gel capsule. We measured (25-hydroxyvitamin D [25(OH)D]) concentrations and to assess pain, Visual analogue scale and Modified Oswestry low back pain disability questionnaire (MODQ) were used before and 12 w after the intervention.
 Results: After 12 w 25(OH)D levels increased significantly with vitamin D supplementation in all the groups but more in the Nano syrup group. There was also significant reduction in back pain intensity in all the groups after vitamin D supplementation. However in Nano syrup group, there was a significantly greater reduction in back pain compared with other groups.
 Conclusion: Our findings suggest that vitamin D supplementation in vitamin D deficient adults may improve chronic low back pain. Hence, testing for vitamin D deficiency in those with chronic low back pain may be warranted.

Current developments in bruxism identification

Background and Objectives: Bruxism is a parafunctional activity that can have several causes. Patients with bruxism need an interdisciplinary approach to treatment planning and individualized treatment options. The present study evaluates dentists' knowledge of the bruxism condition and their need for further education. Diagnosis and treatment methods used by practicians from different specialties are emphasized. Materials and Methods: A prospective cross-sectional, observational, and analytical cohort study was conducted. It employed a questionnaire based on information on etiology, diagnosis, and treatment methods and included data from 80 dental practitioners from Cluj County. Results: Most dentists (81.3%) recognized awake and sleep bruxism as separate entities. Most participants identified psychological status as the primary etiological factor (80%), followed by occlusal interferences (13.8%) and other factors (genetics). Anamnesis and clinical examination were performed for bruxism diagnosis (90%). Occlusal balance (%) and occlusal splints (%) were the most encountered treatment methods. Only 27.5% of the practitioners referred patients to other specialists. Physiotherapy and psychotherapy were the primary interdisciplinary approaches. Cognitive behavioral therapy was employed by 43.8%, whereas pharmaceutical therapy by 20% of the practitioners. Conclusions. There is a need for standardized training among dentists due to a lack of information on this topic. When combined with an interdisciplinary approach, complementary diagnostic methods such as polysomnography and BruxApp can yield accurate diagnosis.

Role of Q-heterochromatin and thermal conductivity of the human body in the development of obesity

Introduction and Aim: Obesity, commonly known as a complex multifactorial disease, has emerged as a significant medical and societal issue in recent decades. The objective of this study is to assess if there is a significant impact of Q-heterochromatin (Q-HR) and thermal conductivity (k) in the body on the risk of obesity. Methods: This prospective analytical cohort study included 300 individuals from both genders aged 35.24 4.21 years who do not have oncological, hormonal, or other forms of diseases that predispose to morbid obesity. Results: In obese individuals, the temperature distribution in the peripheral and central parts of the body has a high level of variability relative to the control. In the main group, Q HR has a clear gradient from 0 to 2, and the average numerical parameter is 1.21 0.11, which is more than twice as low as in the control group (2.94 0.14). In obese individuals, the chromatin concentration decreased with increasing temperature gradient (X2 = -16.8; p0.001). Conclusion: The level of Q-HR is considerably lower in obese people compared to the control group. When compared to the control, obese people had a higher k between the central and peripheral sections. The level of Q-HR and k were shown to be inversely correlated.

Procalcitonin levels in maternal serum and cord blood as marker for diagnosis of early onset neonatal sepsis.

To assess the diagnostic accuracy of Procalcitonin in maternal serum and umbilical cord blood samples to predict Early onset neonatal sepsis (EONS). It was a Prospective analytical cohort study. Pregnant women ≥34 weeks gestation in active labour, with risk factors for EONS were included in the study. Maternal blood samples at recruitment and umbilical cord blood samples after delivery were taken for Total leucocyte count (TLC), high sensitivity C-Reactive Protein (hs-CRP) and Procalcitonin. Newborns were classified into non-infected, suspected and proven infection. Sensitivity, specificity and diagnostic accuracy of maternal and cord blood procalcitonin, TLC and hs-CRP were calculated. A total of 200 women were recruited. Maternal procalcitonin had a superior diagnostic accuracy of 99% compared to maternal TLC and maternal hs-CRP. Also, cord blood procalcitonin had a diagnostic accuracy of 95%. Procalcitonin in both maternal as well as cord blood is a promising biomarker to detect EONS with high diagnostic accuracy.

Clinical Profile and Outcomes of Neonates Exposed to Maternal COVID-19 Infection in a Tertiary Care Centre—A Cohort Study (NeOCoM Study)

Background COVID-19 infection during pregnancy was reported to cause adverse outcomes. Such knowledge stands low quality evidence due to lack of internal controls and inferential statistics. Objectives To assess impact of COVID-19 in pregnancy on fetal and neonatal outcomes. Study Design Prospective analytical cohort study (July 2020 to March 2021). Setting Level III NICU of teaching hospital in India. Participants COVID positive mothers (exposed = 239) each matched with 2 women delivered consecutively by same mode without COVID (unexposed = 478) and enrolled at admission during delivery. Procedure Maternal demographic, comorbidities, and obstetric characteristics; fetal growth, pregnancy complications, and neonatal details of 242 and 482 neonates born to exposed and unexposed mothers respectively were analyzed. Infants were followed until neonatal period. Outcomes Incidence of prematurity was primary outcome. Secondary outcomes were incidence of abortions, IUD, stillbirth, neonatal mortality, neonatal resuscitation at birth, SFD, NICU admission, neonatal morbidities, length of hospitalization, in-hospital mortality, infant positivity rate for SARS COV-2. Results Incidence of prematurity was not significantly different between mothers with and without COVID-19 infection [42(17.3%) vs 94(19.3%), IRR (95%CI) 1.04(0.83,1.31), P = .833]. Neonatal mortality, adverse fetal outcomes, PROM, fetal distress, SGA, neonatal resuscitation, NICU admission did not differ significantly between groups. Gestational hypertension was associated with COVID-19 infection [14(5.9%) vs 11(2.3%), (p=0.014)]. Infant swab positivity was 7%. Swab positivity and neonatal symptoms were associated significantly (10/17(58.8%) vs 7/17(41.1%), P = .0001). Conclusion Asymptomatic COVID-19 infection during pregnancy does not increase adverse fetal and neonatal outcomes. COVID positive neonates become symptomatic and hence need monitoring in health-care facility.

Would Cutibacterium acnes Be the Villain for the Chronicity of Low Back Pain in Degenerative Disc Disease? Preliminary Results of an Analytical Cohort.

In the last decade, several studies have demonstrated Cutibacterium acnes colonization in intervertebral discs (IVDs) in patients with lumbar disc degeneration (LDD) and low back pain (LBP), but the meaning of these findings remains unclear. Being aware of this knowledge gap, we are currently conducting a prospective analytical cohort study with LBP and LDD patients undergoing lumbar microdiscectomy and posterior fusion. The IVDs samples collected during the surgeries are subjected to a stringent analytical protocol using microbiological, phenotypic, genotypic, and multiomic techniques. Additionally, pain-related scores and quality-of-life indexes are monitored during patient follow-up. Our preliminary results for 265 samples (53 discs from 23 patients) revealed a C. acnes prevalence of 34.8%, among which the phylotypes IB and II were the most commonly isolated. The incidence of neuropathic pain was significantly higher in the colonized patients, especially between the third and sixth postoperative months, which strongly suggests that the pathogen plays an important role in the chronicity of LBP. The future results of our protocol will help us to understand how C. acnes contributes to transforming inflammatory/nociceptive pain into neuropathic pain and, hopefully, will help us to find a biomarker capable of predicting the risk of chronic LBP in this scenario.

The Effect of Body Temperature Changes on Inflammation Response and Patients’ Comfort in Patients Undergoing Laparotomy with General Anesthesia

Abstract Background: Surgery and general anesthesia are responsible for disrupting the normal balance between heat production and loss. Inadvertent perioperative hypothermia is a common complication in patients undergoing surgery with general anesthesia. General anesthestic agents are known to cause suppression of thermoregulatory defense mechanisms during general anesthesia, which results in perioperative hypothermia. Hypothermia carries significant various adverse effects; patients’ discomfort and inflammatory stress response are the two variable which will be studied. Materials and Methods: This is a prospective observational analytic cohort study, conducted in the central operating theater of Sanglah Hospital, Bali over a period of 4 months. We included all eligible patients who underwent elective laparotomy and gave consent to the study. Body temperature was measured in three different locations: axilla, tympanic membrane, and nasopharynx, before, during, and after surgery. We measured C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (PLR) before and after the surgery. Patients’ comfort level was obtained using the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) scoring system. Results: A total of 60 patients were included. There was a significant increase of inflammatory markers, CRP, PLR, and NLR, before and after the surgery (P < 0.001), as well as reduced body temperature during surgery (P < 0.01); however, there was no significant relationship between the two (P > 0.05). The changes of body temperature significantly affect patients’ comfort level (P < 0.001), whereas room temperature did not show significant impact on patients’ comfort level. On linear regression, there is no significant correlation between body temperature changes and inflammatory response escalation. The increase of CRP was significantly correlated with gender, women, and blood loss, whereas the increase of PLR was related significantly with blood loss and age. Conclusion: Surgery and general anesthesia are causing hypothermia and escalation of inflammatory response. This study result supports prior publication in which both surgery and general anesthesia are the cause of inadvertent perioperative hypothermia; yet, hypothermia does not induce significant rise in all of inflammatory responses measured in this study. It is believed that the major surgery stress response is the cause of significant increase in inflammatory responses.

Effect of early feeding regimen in pre-terms with abnormal antenatal dopplers: a prospective analytical COHORT study

Background: Enteral feeding in preterm neonates with intrauterine growth restriction (IUGR) and absent or reversed end diastolic flow (AREDF) on umbilical artery (UA) Doppler is delayed owing to an increased risk of necrotizing enterocolitis (NEC). Delaying enteral feeding with longer duration of parenteral nutrition (PN) carries an increased risk of various neonatal morbidities.Methods: It was a prospective observational non randomized cohort study. Data was collected prospectively from the NICU records. Neonates fulfilling the inclusion criteria were classified as early feeding regimen and late feeding regimen. A strict feeding regimen was followed. Data was analyzed for primary and secondary outcomes.Results: The 50 neonates were enrolled. Baseline characteristics were comparable. A significantly higher time to full feeds was recorded in the delayed feeding regimen by a mean of 3.9 days. The duration of hospital stay was significantly higher for delayed feeding regimen (+12.7 days). Days of mechanical ventilation were also significantly higher (+1.6 days) in the neonates in delayed feeding group. There was no difference in the incidence of feed intolerance, NEC, incidence of culture positive sepsis and mortality across the two regimens, however neonates in the delayed feeding group needed longer support with parenteral nutrition.Conclusions: Early feeding will lead to earlier time to full feeds and decreased duration of hospital stay without additional increase the incidence of feeding intolerance and NEC in neonates with AEDF/REDF. Individualized feeding strategy in these compromised neonates should be the primary objective to optimize outcomes.

Impact of Right Heart Failure on Clinical Outcome of Left Ventricular Assist Devices (LVAD) Implantation: Single Center Experience.

The aim of this study was to examine the incidence and significance of right heart failure (RHF) in the early and late phase of left ventricular assist device (LVAD) implantation with the identification of predictive factors for the development of RHF. This was a prospective observational analytical cohort study. The study included 92 patients who underwent LVAD implantation and for whom all necessary clinical data from the follow-up period were available, as well as unambiguous conclusions by the heart team regarding pathologies, adverse events, and complications. Of the total number of patients, 43.5% died. The median overall survival of patients after LVAD implantation was 22 months. In the entire study population, survival rates were 88.04% at one month, 80.43% at six months, 70.65% at one year, and 61.96% at two years. Preoperative RHF was present in 24 patients, 12 of whom died and 12 survived LVAD implantation. Only two survivors developed early RHF (ERHF) and two late RHF (LRHF). The most significant predictors of ERHF development are brain natriuretic peptide (BNP), pre-surgery RHF, FAC < 20%, prior renal insufficiency, and total duration of ICU stay (HR: 1.002, 0.901, 0.858, 23.554, and 1.005, respectively). RHF following LVAD implantation is an unwanted complication with a negative impact on treatment outcome. The increased risk of fatal outcome in patients with ERHF and LRHF after LVAD implantation results in a need to identify patients at risk of RHF, in order to administer the available preventive and therapeutic methods.

Chemotherapy Effect on Estradiol Levels in Patients with Triple-negative Breast Cancer: A Clinical Prospective Study from Indonesia

Research Background: This study aimed to scrutinize the chemotherapy’s effect on estradiol levels in patients with triple-negative breast cancer (TNBC) at low-resource country. Methods: This prospective analytic observational cohort study involved patients with TNBC who had undergone surgery and had never received chemotherapy or hormonal therapy before. Patients were checked for estradiol levels before and after chemotherapy. This study was conducted at the Surgical Oncology Department of Regional Public Hospital Dr. Moewardi, Surakarta Indonesia, from April 2020 to March 2021. Descriptive data were presented in a frequency table based on age, menopausal status, parity status, breastfeeding status, hormonal contraception, hormonal contraception duration, family history, stage, and histological grade. Differences in estradiol changes before and after chemotherapy (mean+sd) were then reported.&#x0D; Results: From a total of 23 patients, 21 patients (91.3%) experienced a decrease in estradiol levels, while two patients (8.7%) underwent an increase in serum estradiol levels after chemotherapy. The mean decrease was 11.57 pg/ml. The two samples that experienced an increase in estradiol levels had a mean increase of 16.5 pg/ml. There was a significant difference between estradiol levels before and after undergoing chemotherapy, with p-value=0.001.&#x0D; Conclusions: In this research, chemotherapy reduced estradiol levels in TNBC patients. Statistically significant reductions in estradiol levels were based on the disease stage.

Interest of Procalcitonin Measurement in Children with Cerebral Malaria in Southern Benin

Introduction: Cerebral malaria is a major complication of the Plasmodium falciparum infection with a high case fatality rate. The objective of this study was to determine the relationship between cerebral malaria and high serum procalcitonin (PCT) level in children. Method: This was a prospective descriptive and analytical cohort study conducted over 12 months, on a series of PCT blood tests in children aged 6 months to 15 years old hospitalized for cerebral malaria in the pediatric wards of four hospitals in southern Benin. The cerebral malaria diagnosis was done based on WHO criteria. Blood samples for PCT measurement were collected on admission, 24 hours and 48 hours after the malaria therapy initiation. Student’s test, Pearson’s chi2 test, Fisher’s test and Kruskal-Wallis test were used where appropriate. For all comparisons the difference was significant when p was less than 5%. Results: Sixty-five children were included in the study with a sex ratio of 1.41. The age group of children under 5 years was the most represented, at 57%. PCT levels were high in 92.3% of children at admission, 90.8% at 24 hours and 84.6% at 48 hours. Forty-nine children had a positive clinical outcome while 16 died (24.6%). PCT levels were generally high over the three days of hospitalization, but higher at admission in case of death (p = 0.000). The association between PCT level and parasitemia at admission was significant (p = 0.04). Conclusion: In the view of the results, blood PCT level measured at admission could be predictive of the disease outcome in children with cerebral malaria.

Determination of Spectrum of Symptoms Observed Followed by Administration of 1st and 2nd Doses of COVISHIELD™ Vaccine in Datta Meghe Institute of Medical Sciences (Deemed to be University) – A Study Protocol

Background: The 2019 novel coronavirus (2019-nCoV or SARS-CoV-2) was first detected in December 2019 in Wuhan City of Hubei, Province of China with population of 11 million, after outbreak of pneumonia. Present study deals with acceptability of newly manufactured vaccines against Covid 19 disease component of social misconceptions regarding the post vaccination symptoms and/or adverse events. Main rationale of this study is to list all post vaccination symptoms observed at multiple points of time to clear misconceptions resulting in possible increase in acceptability of newer vaccines.&#x0D; Aim: To determine the spectrum of symptoms observed followed by administration of 1st and 2nd doses of COVISHIELD™ vaccine in Datta Meghe Institute of Medical Sciences (deemed to be university).&#x0D; Methods: This will be a Prospective analytical cohort study conducted over a period of 5 years. &#x0D; Procedure: Followed by letter of informed consent, pre validated questionnaire will be circulated amongst the healthcare professionals having been administered the 1st and 2nd doses of COVISHIELD™ vaccine filled and submitted to authorized email for further study and will be evaluated for enlisting post vaccination symptoms with time of onset and duration following 1st and 2nd doses of COVISHIELD™ vaccine. Follow up will maintained at regular intervals and questionnaire will be amongst participants at 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after the 2nd dose of COVISHIELD™ vaccine.&#x0D; Expected Outcome: Post vaccination symptoms following 1st and 2nd doses of COVISHIELD™ vaccine with range of time of onset and duration of the same will enhance status of the COVISHIELD™ vaccine awareness, social acceptability and willingness.&#x0D; Conclusion: All conclusions will be drawn after proper statistical analysis.

The Charcot Foot: An Emerging Public Health Problem for African Diabetes Patients.

Background: Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. Aim: To characterize the epidemiology and the clinical burden of CN in a large diabetes population in Tanzania, and to evaluate outcomes of persons with the condition. Methods: This was a prospective analytic cohort study conducted between January 2013 through December 2015. Following informed consent, patients were followed at the outpatient clinic. Detailed clinical assessments and documented presence of diabetic peripheral neuropathy (DPN), macrovascular disease and microvascular disease were recorded. Education and counseling were part of the follow-up program. Results: 3271 ulcerations were presented at the clinic during the 3-year study period. 571 (18%) met the case definition for CN; all patients had Type 2 diabetes. The prevalence for each of the years 2013, 2014, and 2015 was 19/1192 (1.6%), 209/1044 (20%), and 343/1035 (34%), respectively; the increases in the slope of the trendline was statistically significant (P < .001). Conclusion: The prevalence of CN is increasing in the Tanzanian diabetes patient population, and is strongly associated with neuropathy. CN can lead to severe deformity, disability, and amputation. Due to the risk of limb amputation, patients with diabetes must seek immediate care if signs or symptoms appear and avoid delay in seeking medical attention. Early diagnosis of CN by caregivers is extremely important for successful outcomes.

Lung Volume Head Ratio: A Potential Parameter for Prediction of Respiratory Distress in Newborn.

This study aimed to evaluate the role of fetal lung biometry profile including fetal lung volume head ratio (LVHR) in predicting the occurrence of respiratory distress (RD) in early preterm newborn. Prospective analytical cohort study was done to evaluate the clinical value of fetal sonographic measures, such as the total lung area (TLA), total lung volume (TLV), TLA head ratio (TLHR), LVHR, in pregnant women between 30 to 34 weeks' gestation who were expected to deliver within the next 72 hours. The cases with RD were compared with controls who had normal outcome. A total of 30 (27.4%) out of 110 patients, who underwent early preterm delivery, with RD rest 80 (72.6%) were controls. The TLA was 694.1 ± 373.1 mm2 in cases whereas 1,149.0 ± 506 0.7 mm2 in controls with significant difference between the two groups (p < 0.001). Similarly the lung volume (p < 0.001) and the LVHR were significantly less (p < 0.001) in cases compared with controls. The TLV was a better parameter (sensitivity, 73.7% and specificity, 86.4%) compared with TLA (sensitivity, 68.4% and specificity, 81.5%). Among the lung head ratios, LVHR had the best sensitivity of 95.5%, specificity: 80.3%, positive predictive value (PPV): 58.3%, and negative predictive value (NPV): 97.0% at the cut-off of 46.5. RD was observed in nearly one-third of the preterm infants born between 30 and 34 weeks of gestation and could be predicted accurately in over 9 out of 10 cases using the novel parameter TLVR. · Preterm newborn.. · Fetal lung volume.. · Respiratory distress..

Low Risk of COVID-19 Infection in an Ambulatory Gastrointestinal Endoscopy Center in Argentina

Background and Objectives. Since the onset of the COVID-19 pandemic, concerns have been raised regarding the risk of infection to both healthcare staff and patients during gastrointestinal endoscopy procedures. Given the importance of performing routine endoscopic procedures to an individual’s future health, we sought to estimate the risk of COVID-19 infection for healthcare staff and patients undergoing endoscopic studies at an ambulatory endoscopy center during the pandemic. Material and Methods. This is a prospective(and) analytical cohort study conducted in an ambulatory gastroenterology center located in the Autonomous City of Buenos Aires, Argentina. Patients undergoing different endoscopic procedures were evaluated for COVID-19 between April 14 and August 31, 2020. COVID-19 was also evaluated in all healthcare and associated staff during the same time period. The risk (cumulative incidence) of acquiring COVID-19 in all patients and staff was calculated. Results. Between April 14 and August 31, 2020, procedures were performed in 3,745 patients with a mean age of 51.12 years; 2,102 (56.18%) were male and 1,643 (43.82%) were female. Follow-up was completed in 3,492 patients, 18 of whom tested positive for COVID-19 standing for an incidence of 0.52% (95%CI 0.31 – 0.81%). Six (5.45%) out of 110 staff members were infected with COVID-19 (1 endoscopist, 4 endoscopy assistants and 1 administrative staff member). In this group, the incidence of positive tests for COVID-19 was 5.45% (95%CI: 2.03 – 11.50%). The increased rates of positive cases among our patients and healthcare professionals were respectively 7.9 and 23.6 times lower than in general population. Conclusion. During the study period, the proportion of COVID-19 infections in our ambulatory specialized in gastrointestinal endoscopy was low and much lower than that in the general population for both patients and healthcare professionals. Endoscopic procedures undertaken at this center were low risk, likely due to strict compliance with established pandemic protocols. Future studies should compare the risk of infection in the hospital setting.

Iron status in late pregnancy is inversely associated with birth weight in Colombia.

Gestational anaemia (GA) is common in developing countries. This study assessed the relationship of late GA and negative perinatal outcomes in participants recruited in a reference maternity unit of the Caribbean region of Colombia. Prospective analytical birth cohort study. Maternal Hb and serum ferritin (SF) levels were measured. GA was defined as Hb levels <6·82 mmol/l (<11 g/dl), SF depletion as SF levels <12 µg/l. Birth outcomes such as low birth weight (LBW), preterm birth (PB) and small for gestational age (SGA) were examined. Mothers in the first stage of labour, living in urban or rural areas of Bolívar, were enrolled in an obstetrical centre located in Cartagena, Colombia. Blood and stool samples were taken prior delivery. Maternal blood count, SF levels and infant anthropometric data were recorded for analysis. 1218 pregnant women aged 18-42 years and their newborns. Prevalence of GA and SF depletion was 41·6 % and 41·1 %, respectively. GA was positively associated with poverty-related sociodemographic conditions. Prenatal care attendance lowered the risk of PB, LBW and SGA. Birth weight was inversely associated with Hb levels, observing a -36·8 g decrease in newborn weight per 0·62 mmol/l (or 1 g/dl) of maternal Hb. SF depletion, but not anaemia, was associated with PB. SGA outcome showed a significant association with anaemia, but not a significant relationship with SF depletion. Birth weight and other-related perinatal outcomes are negatively associated with Hb and SF depletion. Prenatal care attendance reduced the risk of negative birth outcomes.

Early hearing threshold changes and peculiarities of audiometric assessments among patients in a drug-resistant tuberculosis treatment center.

Hearing threshold changes occurred relative to baseline at both one and two weeks after onset of aminoglycoside therapy. To assess changes in audiometric hearing thresholds between pre-treatment values and two weeks into therapy. To document observed changes, and occurrence of ototoxicity within the period. Prospective analytical cohort study on drug-resistant tuberculosis patients. Basic demographic parameters were taken. Three-point audiometric assessments within two weeks into therapy were done. Percentage of patients with ototoxicity were calculated. Pure tone threshold changes between the three audiometric values were compared. Audiograms of 53 patients comprising 56.6% males; age range was 13 to 91 years. Both air and bone conduction hearing thresholds significantly worsened between baseline and one week into therapy (p=0.011, and 0.015 respectively), and between baseline and two weeks into therapy (p=0.003 and 0.042 respectively). Minimal insignificant reduction occurred between both air and bone conduction hearing values of week 1 and week 2 of therapy (p= 1.000 and 0.856 respectively). By audiometric criteria, 4 patients (7.5%) developed ototoxicity within two weeks of treatment. Audiometric assessments within two weeks into therapy with anti-tuberculous therapy may not represent baseline audiometry. 7.5% of the patients developed ototoxicity within two weeks of therapy.

The Rhinoplasty Health Care Monitor: Using Validated Questionnaires and a Web-Based Outcome Dashboard to Evaluate Personal Surgical Performance.

Background: Self-assessment provides valuable feedback in the life-long process of mastering rhinoplasty. This study presents a method to measure and evaluate data-based performance of a single surgeon using a web-based dashboard. Methods: In this prospective analytic cohort study, all patients referred to the senior author for functional-aesthetic (revision) rhinoplasty between April 2014 and September 2020 are included. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, Utrecht Questionnaire (UQ), and visual analog scales before and after rhinoplasty. Questionnaire scores were exported to a customized web-based dashboard: the rhinoplasty health care monitor. Supported by real-time graphic output, this monitor automatically analyzes functional and aesthetic outcomes. Results: Of 603 referred patients, 363 were eligible for rhinoplasty. Mean NOSE scale scores decreased from 66.6 ± 23.5 to 23.2 ± 24.0 (p < 0.001), and mean UQ scores decreased from 12.2 ± 6.3 to 7.1 ± 3.9 (p < 0.001) 1 year after surgery. The rhinoplasty health care monitor visualizes numerous outcome parameters that help the surgeon to analyze results, identify learning needs, and detect trends in performance development. Conclusions: This automated outcome dashboard transparently measures individual surgeon performance. Gauging performance provides means to enhance surgical development and, consequently, patient satisfaction.

Incidence of Vascular Injuries in poly-traumatized Patients

Background: Vascular injury resulting from trauma is a leading cause of morbidity and mortality worldwide. Exsanguination is perhaps the most important cause of potentially preventable death after injury. The resulting ischemic tissue damage leads to high rates of amputation in a characteristically young and active population. Objective: To determine the incidence of vascular injuries, modes and mechanisms of trauma and their relations with regional vascular injury distribution and the outcome of vascular injuries in polytrauma patients. Patients and methods: This is a prospective observational analytical (cohort) study that included 520 patients who were presented by multiple causes of trauma to Mansoura University Emergency Hospital, Mansoura, Egypt. A level 1-trauma center with about 250,000 visits and 25000 trauma cases admission per year. This study was conducted over the period of 1 year from January 2019 to December 2019. Results: According to abbreviated injury scale (AIS) ≥3, patients with vascular injuries had considerable more severe injuries than other patients. The most common regions with vascular injuries were peripheral vascular injuries in 95.8% [52.6% in lower limb and 43.2% in upper limb], followed by central vascular injuries in 4.2% [1.6% in neck, 1.6% in thorax and 1 % in abdomen]. Blunt trauma was considerably more common than penetrating trauma in both groups. Moreover, blunt trauma was more common in all regional vascular injuries (66.7% of neck, 75% of lower limb, and 100% of thoracic and abdominal vascular injuries) except upper limb (in 47.8%). Conclusion: The vascular trauma is associated with more injury severity AIS, injury severity score (ISS) and higher mortality rate than other polytrauma patients.

Incidence of Vascular Injuries in poly-traumatized Patients

Background: Vascular injury resulting from trauma is a leading cause of morbidity and mortality worldwide. Exsanguination is perhaps the most important cause of potentially preventable death after injury. The resulting ischemic tissue damage leads to high rates of amputation in a characteristically young and active population. Objective: To determine the incidence of vascular injuries, modes and mechanisms of trauma and their relations with regional vascular injury distribution and the outcome of vascular injuries in polytrauma patients. Patients and methods: This is a prospective observational analytical (cohort) study that included 520 patients who were presented by multiple causes of trauma to Mansoura University Emergency Hospital, Mansoura, Egypt. A level 1-trauma center with about 250,000 visits and 25000 trauma cases admission per year. This study was conducted over the period of 1 year from January 2019 to December 2019. Results: According to abbreviated injury scale (AIS) ≥3, patients with vascular injuries had considerable more severe injuries than other patients. The most common regions with vascular injuries were peripheral vascular injuries in 95.8% [52.6% in lower limb and 43.2% in upper limb], followed by central vascular injuries in 4.2% [1.6% in neck, 1.6% in thorax and 1 % in abdomen]. Blunt trauma was considerably more common than penetrating trauma in both groups. Moreover, blunt trauma was more common in all regional vascular injuries (66.7% of neck, 75% of lower limb, and 100% of thoracic and abdominal vascular injuries) except upper limb (in 47.8%). Conclusion: The vascular trauma is associated with more injury severity AIS, injury severity score (ISS) and higher mortality rate than other polytrauma patients.