Prospective Cross-sectional Analytical Study Research Articles

Study of CRP, ferritin, and D-dimer in COVID-19 RICU patients as per HRCT severity in assiut university hospitals

BackgroundInflammatory markers were found to be elevated in patients with coronavirus disease (COVID-19). C-reactive protein (CRP), serum ferritin, and D-dimer levels may predict morbidity and mortality in (COVID-19) patients. Radiology plays a key role in the diagnosis, management, and follow-up of this disease. This study aimed to describe the radiological features of (COVID-19) infection, measure C-reactive protein (CRP), D-dimer, and ferritin levels and to correlate them with patient’s outcome and to consider them as predictors of morbidity and mortality in (COVID-19) patients.MethodsThis prospective cross-sectional analytic study had been done on 159 patients aged ≥ 18 years old, admitted at Assiut University Hospital RICU from November 2021 to November 2022, diagnosed as COVID-19 by positive RT-PCR. All patients were categorized on bases of HRCT chest disease reporting and data system (CO-RADS) scoring system into non-severe (CO-RADS 1,2,3) and severe (CO-RADS 4,5) groups. Inflammatory markers such as CRP, ferritin, and D-dimer were measured. Age, sex, comorbidities, need to mechanical ventilation MV, and mortality rate were reported. Correlation between HRCT(CO-RADS) score, inflammatory markers, and patient’s outcome was assessed.ResultsHigher CRP and serum ferritin levels, lower lymphocytic count, and higher frequency of need for mechanical ventilation were significantly greater in the severe group (P < 0.0001). Predictors of morbidity and mortality were CRP ≥ 133 mg/dl, DM, presence of chronic chest disease (P < 0.0001). A higher mortality rate was in patients of the severe group (65%) versus (9%) in the non-severe group (P < 0.0001).ConclusionsHRCT scan and measurement of CRP and ferritin plasma levels can be considered significant predictors for future prognosis and can early identify patients at risk of death and need for MV. Male gender, presence of DM, and chronic chest diseases are risk factors for severe illness.

Public awareness about common ocular diseases among a sample of Egyptian population

Background Globally, the most common causes of blindness in adults are cataracts, glaucoma, age-related macular degeneration, and diabetic retinopathy. Inadequate knowledge of these conditions leads to lag in medical advice requisition, losing the opportunity for prevention and early intervention with an increased rate of disease complications. Aim This study aimed to detect the level of public awareness about common eye problems in Egypt to help build strategies to prevent complications related to these eye problems. Patients and methods This is a prospective cross-sectional analytical study that used a pre-tested e-questionnaire to collect data from the study participants during the period from September 2022 to June 2023 at Kasr Alainy School of Medicine, Cairo, Egypt. A Google form was created, and participants were invited through social media. It included four sections: socio-demographic characteristics, medical history of study participants, knowledge about common ocular diseases, and sources of gaining knowledge. Results The study included 802 participants, 54.2% of them were females, more than 55% of them were between the ages of 18–30 years, and 74.4% were university graduates. Awareness of cataracts, glaucoma, corneal opacity, diabetic retinopathy, and age-related macular degeneration was reported in 45.7, 34.8, 38.3, 80, and 77.5% of the study participants, respectively. Physicians and social media were the most common efficient sources of gaining knowledge. Higher education and working in a medical profession, especially physicians and pharmacists were associated with higher knowledge scores. Conclusion Low levels of knowledge of most of the blinding conditions among the study participants raise the importance of adopting health education programs by our healthcare systems taking into consideration that physicians and social media were among the most convenient routes to reach the targeted population.

MEDICAL STORE MANAGEMENT AT ABVGMC VIDISHA (MP): AN ANALYSIS AT TERTIARY CARE HOSPITAL

Objective: The objective of this study was to perform a qualitative and quantitative comparison of the practice and infrastructure with applicable legislations governing hospital pharmacy while the secondary objective was to calculate the average dispensing time of a prescription in the hospital pharmacy. Methods: Our hospital was established in 2018. A prospective cross-sectional analytic study was carried out in the hospital pharmacy for 6 months (January 23–June 23). A blend of quality control parameters was drafted after referring various guidelines put forward by the statutory bodies. Qualitative data were collected by continuous observation, physical inspection, and after a thorough interview of hospital pharmacists. The collected data were summarized and compared with the standards. Quantitative data on the minimum requirement of hospital pharmacy infrastructure and dispensing time were collected using the designed data collection form and analysis was performed. Results: The hospital pharmacy met all the criteria that are necessary to satisfy legal requirements, availability of medicine, medicine, and general safety, and most of the quality parameters. However, few deviations were observed in the management of the drug store. The shortage in the floor space and waiting area was identified. In the study, we find that the average waiting time for the patient at the drug distribution center is 180 s and the average drug dispensing time was 130 s. On the basis of our good working in pharmacy, we got NABH approval in 2023 which includes pharmacy with other departments of this hospital. Conclusion: Majority of the quality parameters were noted to be compliant with the standards. Few deviations were identified and measures to improve them were suggested.

Surgical Service Utilization and In-Patient Satisfaction in Surgical Service.

The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital. A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0. There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were "very satisfied", 62.5%(95) patients were "satisfied", 2.6%(4) were "neither satisfied nor dissatisfied" and 2%(3) were "dissatisfied" with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64). The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences.

Prevalence and clinical markers of herpes simplex virus infection in oral lesions of bullous pemphigoid.

The manifestations of bullous pemphigoid (BP) and herpes simplex virus (HSV) infection are similar in oral mucosa, and the laboratory detection of HSV has some limitations, making it difficult to identify the HSV infection in oral lesions of BP. In addition, the treatments for BP and HSV infection have contradictory aspects. Thus, it is important to identify the HSV infection in BP patients in time. To identify the prevalence and clinical markers of HSV infection in oral lesions of BP. This prospective cross-sectional descriptive analytical study was conducted on 42 BP patients with oral lesions. A total of 32 BP patients without oral lesions and 41 healthy individuals were enrolled as control groups. Polymerase chain reaction was used to detect HSV. Clinical and laboratory characteristics of patients with HSV infection were compared with those without infection. A total of 19 (45.2%) BP patients with oral lesions, none (0.0%) BP patients without oral lesions, and four (9.8%) healthy individuals were positive for HSV on oral mucosa. Among BP patients with oral lesions, the inconsistent activity between oral and skin lesions (p=0.001), absence of blister/blood blister in oral lesions (p=0.020), and pain for oral lesions (p=0.014) were more often seen in HSV-positive than HSV-negative BP patients; the dosage of glucocorticoid (p=0.023) and the accumulated glucocorticoid dosage in the last 2 weeks (2-week AGC dosage) (p=0.018) were higher in HSV-positive BP patients. Combining the above five variables as test variable, the AUC was 0.898 (p<0.001) with HSV infection as state variable in ROC analysis. The absence of blister/blood blister in oral lesions (p=0.030) and pain for oral lesions (p=0.038) were found to be independent predictors of HSV infection in multivariable analysis. A total of 14 (73.7%) HSV-positive BP patients were treated with 2-week famciclovir and the oral mucosa BPDAI scores significantly decreased (p<0.001). HSV infection is common in BP oral lesions. The inconsistent activity between oral and skin lesions, absence of blister in oral lesions, pain for oral lesions, higher currently used glucocorticoid dosage, and higher 2-week AGC dosage in BP patients should alert physicians to HSV infection in oral lesions and treat them with 2-week famciclovir in time.

Usage of Epworth Sleepiness Scale, Modified Mallampati Scoring and Brodsky Grading in Adults with Hypertrophic Palatine Tonsils and Sleep Disordered Breathing

Objective: We aimed to determine the correlation of Modified Mallampati scoring and Brodsky tonsillar grading as indicative factor for sleep disordered breathing by using an Epworth sleepiness scale in patients with hypertrophic tonsils.Methodology: Data for this prospective cross-sectional analytical study was collected at an ENT Department of PNS Shifa Hospital, Karachi between January to July 2021. Non-probability consecutive sampling technique was used. After taking informed consent, a subject evaluation proforma was filled which involved detailed personal history of the selected subjects with hypertrophic tonsils and sleep disordered breathing. Epworth sleepiness scale was assessed, Physical examination of subjects involved grading of tonsils and examination of the tongue was done. Data was entered and analyzed on SPSS 23.0 software.Results: The present study enrolled (n=54) adult subjects with mean age calculated to be 25.72 ± 7.9 SD. Pre-operative Epworth scores were significantly lower in subjects with Brodsky grade I and II as compared to higher grades which is in accordance with increasing severity of obstruction as tonsil grading advanced. Furthermore, statistically significant association was seen between Epworth scoring and Mallampati grading.Conclusion: The results of the current study generated significant recommendations for the evaluation of the anatomy of pharynx, use of Epworth questionnaire, Mallampati and Brodsky classification might be a rapid, non-invasive screening tool for advance identification and timely intervention for subjects at risk of sleep disordered breathing.

The Correlation between Quantitative Cervical Vertebral Maturation and Mandibular Dimensions in Children Aged 8-16 Years: A Cross-Sectional Analytical Study

Background: During growth modification, the mandible plays a crucial role in functional orthopaedic treatment. To maximize the efficacy and efficiency of functional appliance therapy, one must know when to initiate treatment. To maximize the efficacy and efficiency of functional appliance therapy, one must know when to initiate treatment. To accurately determine when to initiate functional appliance therapy, the contemporary maturity indicators utilised are subjective with poor reproducibility and validity. Quantitative cervical vertebral maturity indicators are quantitative with good reproducibility. Objective: To determine the correlation between quantitative cervical vertebral maturation and mandibular dimensional changes in 8–18-year-old growing children. Material and Method: In this prospective cross-sectional analytical study, 164 samples were employed with an age range of 8–18 years. Samples were divided into four groups as per the quantitative cervical vertebral maturity indicator. Pubertal staging was analysed utilising the Li Chang, et al. method on a lateral cephalometric radiograph, and mandibular dimensions were measured as the total mandibular length of a condylon-gnathion line, the height of the mandibular ramus from the condylon-gonion intersection line, and the length of the mandibular body from the gonion intersection-gnathion line. Statistical Analysis: The data obtained was analyzed using Statistical Package for the Social Sciences (SPSS) software; descriptive statistics, student t test and bivariant analysis were applied. Results: The mean total mandibular length was seen at its maximum in periods of high acceleration velocity. Intergroup analysis shows significant differences between the groups, and there is a strong correlation between maturational stage and mandibular dimensional change. Conclusions: During functional orthopaedic treatment planning, the mandible can be utilised as a skeletal maturity indicator.

Association of Serum Ferritin With Severity of Disease in Real-Time Reverse Transcription-Polymerase Chain Reaction Negative COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) is still causing disastrous effects in various parts of the world through recurring waves. Real-time reverse transcription polymerase chain reaction (RT-PCR)-negative COVID-19 is particularly challenging as these patients are less likely to receive treatment and more likely to progress to severe disease. Thus, it is imperative to find markers that can predict the severity of disease at an early stage. The objective of the present study was to analyze the association of ferritin levels with severe disease in RT-PCR-negative COVID-19 patients. A prospective cross-sectional analytical study was conducted in adults with COVID-19 pneumonia with a negative RT-PCR test from October 2020 to September 2021. Hematologic, biochemical, and inflammatory parameters were investigated within 24 h of hospitalization. Demographic, clinical, and laboratory findings were compared between patients with and without severe disease. A total of 220 patients were included. The mean age of the study participants was 47.3 ± 14.2 years, and 55.5% (n=122) were male. C-reactive protein, D-dimer, and ferritin levels were significantly higher in patients with severe disease (p<0.01). Receiver operating characteristic curve analyses were performed, and ferritin was found as significant predictor of severe disease (area under the curve=0.642, p<0.001). Early analysis of ferritin can predict the severity of disease in COVID-19 patients, irrespective of the RT-PCR status.

The outcome of different forms and regiments of antituberculous drugs in Assiut Governorate

Introduction The prescription of effective and well-tolerated antituberculosis (TB) treatment regimen is an important step in the management of TB. Objective To compare the outcome of fixed-dose combination (FDC) therapy versus standard treatment (ST) in treatment of pulmonary tuberculosis (PTB) and extrapulmonary TB in Assiut Governorate. Patients and methods In this prospective cross-sectional analytic study, 120 patients were included. Overall, 60 had PTB based on sputum-positive acid-fast bacilli, and 60 had extrapulmonary TB based on biopsy or culture from the affected sites. Patients were classified into two groups: 80 patients received FDC in the form of four-drug combinations in the intensive phase and the two-drug combination therapy in the continuation phase (group 1) and 40 patients received ST in the form of four separate drugs in the intensive phase and the two separate drugs in the continuation phase (group 2). Follow-up of clinical data, laboratory markers, sputum conversion in PTB during the course of treatment, drug tolerance, compliance, and developing of adverse effect was done in both groups. Results There is no statistically significant difference between both groups regarding improvement of the fever and anorexia and weight loss (P > 0.05 for each). Moreover, there are no statistically significant changes in the sputum conversion between both groups after 2, 4, and 6 months, respectively. There is a statistically significant increase in the percentage of the patients, with increase of alanine aminotransferase, aspartate aminotransferase, and bilirubin level along the course of the treatments in patients receiving FDC and ST (P < 001) but still within normal limits, and there is no need to stop or change the therapy. No significant difference between the two groups regarding the adverse effects such as nausea, vomiting, anorexia, blurred vision, peripheral neuropathy, arthralgia, and skin rash is recorded. Conclusion Both FDC and ST have comparable results, with no superiority of either one over the other.

Factors Associated with Acute Kidney Injury among Children with Severe Malaria at Kiryandongo General Hospital, Uganda.

Malaria remains one of the leading health problems of the developing world, and acute kidney injury (AKI) is a well-recognized complication of severe malaria in adults; but the clinical importance of AKI in paediatric severe malaria is not well documented. Knowledge of the prevalence and factors associated with AKI among children with severe malaria is among the key strategies, which can help to reduce the burden of AKI among this vulnerable group. Methodology. A hospital-based prospective cross-sectional descriptive and analytic study of children with severe malaria was carried out at Kiryandongo General Hospital. The study involved 350 children with severe malaria attending the study site from August to October 2021. Questionnaires were administered to caretakers to obtain sociodemographic characteristics. Medical data were obtained through physical examination followed by laboratory tests. Blood samples were tested for creatinine and blood smear for malaria. Data were analyzed using binary logistic regression (bivariate and multivariate) to assess for the factors associated with AKI. A p value < 0.05 was considered statistically significant. The mean age of children with severe malaria was 7.0 ± 3.8 years, and 54.3% of them were male. Of the 350 children enrolled, 167 had AKI, giving an overall AKI prevalence of 47.7% (95% CI: 42.5-53.0). The factors that were significantly associated with AKI among children with severe malaria included caretaker with no formal education (aOR = 21.0, 95% CI: 1.68-261.18, p = 0.018), caretaker with primary education level (aOR = 4.5, 95% CI: 1.41-14.12, p = 0.011), age of child < 5 years (aOR = 1.8, 95% CI: 1.07-2.88, p = 0.025), history of receiving NSAIDs (aOR = 5.6, 95% CI: 2.34-13.22, p < 0.001), moderate anemia (aOR = 3.1, 95% CI: 1.39-6.94, p = 0.006), and severe anemia (aOR = 3.8, 95% CI: 1.66-8.55, p = 0.002). The prevalence of AKI was high among children with severe malaria in Kiryandongo General Hospital. Acute kidney injury among children with severe malaria was associated with low level of education of caretakers, age of children less than 5 years, history of receiving NSAIDs, and anemia. The management of severe malaria should include screening for AKI especially in children under five years of age, anemic, and those who have received NSAIDs.

A Cross Sectional Study of Discharge Against Medical Advice Cases at a Tertiary Care Hospital of Central Gujarat Region

Background: Discharge Against Medical Advice (DAMA) is an obnoxious reality and dissatisfying event to both ends - patient and healthcare provider. It’s pertinent that periodical survey at single or multicentre be done to identify the predictors and seek solutions and suggest recommendations. Aim and Objectives: Aim of this study was to analyze the predictors of DAMA cases. Objectives were to find out prevalence and predictors of DAMA cases. Methodology: A prospective cross sectional analytical study was done at a tertiary level multi super speciality hospital of central Gujarat. Participants were all those cases who seek DAMA for one other attribute and consented to participate in the study by non-randomised method. After consent, details from DAMA cases were collected in pre-validated questionnaire forms from patients and relatives. All data was analysed statistically for descriptive and analytical statistics. Observations: Maximum DAMA cases were of age group 20-59 years (55%). followed by 60-100 years (25%). Most common reason for obtaining DAMA (56%) was financial constraints. Most of DAMA patients who were having financial constraints (70 &amp; 46) were admitted to Medical Intensive Care Unit (33.11%) and Male Medicine ward (21.22%) respectively. Conclusion: DAMA cases are damaging not only patient morbidity and mortality wise, but also burdens healthcare staff and resources negatively. The reasons for DAMA cases should be discussed and analysed at every healthcare facilities regularly to prevent this futile dissatisfying event.

Histomorphometric Survey of Placentas of HIV-positive Mothers in Relation to their Clinical Stage in a Teaching Hospital in Uyo, South-South Nigeria.

HIV infection in pregnancy affects the mother, her placenta, and fetus resulting in perinatal/maternal morbidity and mortality. Studies show that HIV-positive mothers have several placental morphological changes. This study aimed to describe the histomorphometric parameters/lesions of placentas of HIV-positive mothers in Uyo, Akwa Ibom State, Nigeria. A prospective cross-sectional hospital-based analytical study was conducted at the departments of Obstetrics and Gynecology, and Histopathology, University of Uyo Teaching Hospital, Nigeria from December 2015 to May 2016. We studied 144 pregnant mothers (48 HIV-positive as the test group vs. 96 HIV-negative as controls). Their placentas (fetal membrane, umbilical cord, and placental disk) were collected post-delivery and evaluated (grossly/microscopically) to determine the range of histomorphometric placental parameters/lesions. Relevant obstetric data were obtained from their case notes. The test group delivered more through cesarean section than the control group (52.1% vs. 31.3%), with mean birth weights of 2.8±0.7 and 3.1±0.6 kg (p = 0.004). The mean placental weights were 57±190.1 and 664.6±167.4 g (p = 0.003), with mean placenta-birth weight ratio of 20.1±4.8 and 20.5±4.57% (p = 0.33). The test groups placental fetal membranes, umbilical cords, and disks mainly displayed acute chorioamnionitis (47.9%), acute umbilical phlebitis (14.6%), and villous vasculopathy (33.3%). The test group had a higher stage/grade of placental inflammation than the control group. In the test group, two stage 4 HIV disease state cases presented with the most severe form of placental inflammatory lesions. The commonest placental histomorphometric parameters/lesions were acute chorioamnionitis, acute umbilical phlebitis, and acute intervillositis. There was no significant association between HIV/AIDS disease stage with the most severe forms of placental inflammatory lesions.

Topographic Positions of the Wharton's Duct Orifice in Children

Sialoendoscopic, orthodontic, and surgical interventions within the floor of the mouth require precise knowledge of the topography of the Wharton's duct orifices which is still lacking for the pediatric population. We aimed to establish a normative database for the topography of these orifices in children. The prospective cross-sectional analytic study was performed during January to December 2021. The distances between the mandible gonions and each orifice and the lingual frenulum were defined as primary outcome variables. The secondary outcome variables were the inter-position of the orifices and their location against the base of the tongue and the mandibular alveolar ridge. The segments of the cohort were classified by sex and age groups (4 to 7, 8 to 14, 15 to 17years old) as the primary predictor variables. The data were evaluated by a 3-way ANOVA for analysis of selected distances with the level of significance at P≤.05. The correlation analysis between sex and locations of the orifices was performed using χ2 criterion (95% confidence interval) and r≥0.60 was counted as a strong correlation. The study involved 3,000 healthy children from 4 to 17years of age. The orifices were symmetrical (89.3%), frenulum-independent (78.0%) openings that were usually located in the middle part of the floor of the mouth. The distance between the orifices varied from 0mm in the frenulum-attached cases to 4.6±1.8mm for 4 to 7years old, 7.6±1.9mm for 8 to 14years old, and 9.1±2.6mm for 15 to 17years old individuals. The orifices were attached to the frenulum (5.7%), were frenulum-related (16.3%), and frenulum-independent (78.0%). The sagittal asymmetry of the orifices was noted in 10.7%, and in 1.6% the lateral asymmetry was detected. No statistically significant sex-related differences were noted. In the pediatric population, the Wharton's duct orifices are usually symmetrical frenulum-independent openings that are located in the middle part of the floor of the mouth. The distance between the orifices normatively varies according to sex and age. The size of the mandible does not influence the positions of the orifices. The position of the duct orifices must be established prior to submandibular sialoendoscopy, orthodontic interventions, frenotomy, and other oral surgeries.

A Lower Dose of Mgso4 for Control of Convulsions in Bangladeshi Eclamptic Women

Introduction: Eclampsia is the third major cause of maternal death in Bangladesh contributing to 16 percent of total maternal mortality rate (MMR)¹. Standard practice in eclampsia is urgent control of convulsions and prevention of its recurrence with the help of a suitable anticonvulsant, prompt initiation of general and obstetric care and control of hypertension if needed. Methodology: This prospective cross-sectional analytic study was conducted in Dhaka Medical College Hospital (DMCH) eclampsia unit during August 2004 to January 2005 in order to determine whether 8 g of magnesium sulphate heptahydrate is sufficient in controlling convulsion and preventing recurrences in lighter Bangladeshi women instead of 10 g of magnesium sulphate (MgSO4) as loading dose that is now being used. One hundred consecutive eclamptic patients who were eligible for magnesium sulphate therapy were assigned by lottery to receive either 8 g of magnesium sulphate heptahydrate (MgSO4. 7H₂O) (group A) or 10 g of magnesium sulphate (group B). The two groups were well-balanced and comparable on important characteristics. Result: The results show that there was no significant difference between the two groups with respect to recurrent convulsion, time needed to regain consciousness and maternal and perinatal morbidities and mortalities. Conclusion: The results reveal that 8 g magnesium sulphate heptahydrate is as effective as 10 g MgSO4 (as loading dose) in management of eclamptic convulsion of Bangladeshi women. If 8 g of magnesium sulphate heptahydrate can be used, it will be more economic, painful intramuscular injections will be avoided and the risk of toxicity will be reduced

To determine the role of ultrasonography as a primary imaging modality as compared to MRI in patients with shoulder pain.

ABSTRACTContext:Prevalence of shoulder pain in general population worldwide ranges from 16 -26%. It is necessary to evaluate different causative factors in shoulder pain and explore the utility of ultrasonography in rotator cuff and non-rotator cuff diseases as a primary imaging modality and reserve MRI for unequivocal casesAims:To evaluate patients with shoulder pain using ultrasound as first line of imaging modality compared to MRI.Methods and Material:A Prospective Cross-sectional Descriptive and Analytical study was done in patients with shoulder pain referred to radiology department for USG and MRI.Statistical Analysis Used:Analysis was performed using STATA (14.2). Descriptive statistics was used to portray baseline profile of study population. Sensitivity, specificity, PPV, NPV and Kappa value usedResults:In the resent study the maximum patients were between 40-59 years with Male: Female ratio of 3.5:1. Trauma was the most common etiological factor and restricted range of motion was seen in 47 (94%). Supraspinatus tendon was the most common tendon to show abnormality followed by Subscapularis. For Supraspinatus tendon and Subscapularis tendon partial thickness tear- USG had a sensitivity of 90.62% and 100%, specificity of 88.88% and 95.74%, PPV of 93.5% and 60.00% and NPV of 84.21% and 100% respectivelyConclusion:Ultrasound although being operator dependent and not as accurate as MRI, provides rapid real time non-invasive cross-sectional imaging of joint and thus can be considered as primary modality for imaging rotator cuff pathologies, as it is readily available and cost effective.

ДИАГНОСТИЧЕСКИЕ КРИТЕРИИ СИНДРОМА ВИСЦЕРОАБДОМИНАЛЬНОЙ ДИСПРОПОРЦИИ ПРИ ГАСТРОШИЗИСЕ

The objectives of this study were to determine the frequency and search for additional criteria for the diagnosis of visceroabdominal disproportion syndrome (VADS) in newborns with gastroschisis. Materials and methods of research: prospective controlled observational cross-sectional analytical study was carried out in 61 newborns with gastroschisis, admitted from June 2009 to July 2021. To search for the most significant factors indicating the presence of VADS, the following parameters were recorded in the studied patients: the size of the defect in the anterior abdominal wall, the composition of eventrated organs, the presence of a conglomerate of intestinal loops, the diameter of the intestinal tube, the thickness of the intestinal wall, the degree of visceroabdominal disproportion (VAD). Results: VAD was detected in 50 (82%) newborns with gastroschisis. In 10 (17%) cases, VAD was mild, in 27 (44%) – moderate, and in 13 (21%) patients – severe. A moderate direct relationship was found between the size of the anterior abdominal wall defect (r=0.29, p=0.022), intestinal tube diameter (r=0.56; p=0.001) and the severity of VAD. There was a strong direct correlation between the thickness of the intestinal wall, and the frequency and severity of VAD (r=0.93, p=0.001). A direct association was found between the presence of a conglomerate of intestinal loops in the eventrated organs and the frequency of VAD (p=0.002). There was no statistically significant relationship between the number of eventrated anatomical structures with the frequency and degree of VAD (p=0.36). Conclusion: to determine VADS, it is advisable to diagnose the following pathological conditions in patients with gastroschisis: thickening of the intestinal wall, dilatation of the intestinal tube, the presence of a conglomerate of tightly welded eventrated organs, the severity of which is directly proportional to the degree of disproportion.

Using World Health Organisation near miss approach to assess preventable maternal morbidity and mortality at a tertiary care hospital.

To determine frequency of severe maternal complications, maternal near-miss cases and maternal deaths in obstetric patients in a tertiary care setting. The prospective cross-sectional analytical study was conducted at the Obstetrics Unit of Combined Military Hospital, Kharian, Pakistan, from January to June 2019, and comprised cases of severe maternal complications, critical interventions and life-threatening situations. A conditions as defined by the World Health Organisation guidelines. Severe maternal outcome ratio, maternal near-miss, maternal mortality ratio, near-miss-to-mortality ratio and the mortality index were calculated. Data was analysed using SPSS 20. Of the 1054 live births during the study period, there were 42(3.9%) near-miss cases and 4(0.3%) maternal deaths. Management-based criteria identified 34(80%) cases, followed by clinical 14(33%) and laboratory criteria 2(4.7%). Maternal mortality ratio was 379/100,000 and near-miss-to-mortality ratio was 39/1000 live births. Severe maternal outcome ratio was 4.36 (42+4/1054). For near-miss cases, the mortality index was 8.6, and the maternal near-miss-to-maternal death ratio was 10.5:1. The use of a standardised near-miss criterion makes audit and comparison of results between hospitals and even countries having the same resources possible and reproducible.

The association between pulsatile tinnitus and degree of carotid stenosis

Background A pulsatile tinnitus may be the first and sole manifestation of carotid artery atherosclerosis and stenosis. The objective of this study was to detect the association between pulsatile tinnitus and degree of carotid stenosis by carotid Doppler ultrasound parameters. Patients and methods This prospective cross-sectional analytical study has been conducted on 40 selective cases complaining from pulsatile tinnitus. Carotid duplex ultrasonography scanning was done. Research has been approved by the Research Ethical Committee of Otolaryngology Department, Faculty of Medicine for Girls, AL-Azhar University. Results Carotid artery atherosclerosis and stenosis were diagnosed as a cause of pulsatile tinnitus in five patients (12.5%). The internal carotid artery (peak systolic velocity and end diastolic velocity) values were significantly higher in patients whose intima-media thickness was greater than 1 mm and the lumen diameters were smaller. Conclusion A pulsatile tinnitus may be the first, unusual, and sole manifestation of carotid artery atherosclerosis and stenosis. So, early screening and accurate diagnosis of atherosclerosis will prevent stroke and other central nervous system complications.

Hyperglicemia at the Admission as Predictor of Severity

Background: Diabetes Mellitus is a factor for the development of micronagiopathies, it is well known at the level of retina, renal and peripheral nervous system. However, it is important to mention that high levels of glucose have deleterious effects on the walls of the vessels, causing microangiopathic damage to the lung, consequently this leads to pulmonary dysfunction. There is local oxidative stress, increased vascular permeability, producing changes in the secretion of the mucus that leads to reduced lung volumes, lung diffusion capacity, decrease bronchodilation.Knowing this complication at the pulmonary level derived from poor control of Diabetes Mellitus, diabetic pulmonary microangiopathy represents a challenge for the COVID-19 pandemic. There is a high prevalence of diabetic patients hospitalized for COVID-19 and the complications derived from this, that is why the idea arose to carry out this review and evaluate the impact that admission glucose levels have on the clinical evolution and prognosis of these patients. Elevated serum glucose levels have deleterious effects on the walls of blood vessels, leading to microangiopathy. Such a destructive process also involves the pulmonary circulation, where it is known as diabetic pulmonary microangiopathy. This hypothesis has been confirmed in histopathological examinations of the lung parenchyma, as well as in lung function tests. However, until now there have been no clinical implications of these findings.1Histopathological evidence of pulmonary involvement in subjects with diabetes mellitus has included thickened pulmonary capillary basal plates and alveolar epithelial plates, the latter suggesting existing pulmonary microangiopathy. Abnormal lung function has been detected in some diabetic patients. Glycosylation-induced non-enzymatic alteration of lung connective tissue is the most likely pathogenetic mechanism underlying mechanical lung dysfunction in diabetic subjects. while the most sustainable explanation for altered pulmonary microangiopathy.2Metodos: This short review looks at the main findings, prospective cross-sectional analytical study, in Guatemala Central America that included 319 patients with COVID 19, hospitalized with comorbidities like type 2 Diabetes Mellitus, hypertension and chronic kidney disease as medical history. These patients did not have a history of pulmonary pathology and who required a low- and high-flow oxygen device since admission, presenting moderate and severe COVID-19. These laboratories were carried out in the first chemistry performed after the onset of respiratory symptoms in the arrival at the hospital. Chi square was used for categorical variables and t student for numeric variables for the rest of the variables. Results: The study showed that in the severe group of patients the median age was 52 years old and in the moderate group it was 51. In the severe group of patients, a male gender predominance with 50.7% and 49.3% in moderate; showing the female sex 46% and 53% respectively. Regarding glucose levels at admission, there was a mean of 189mg / dl for severe patients and 156 mg / dl in moderate patients, with a P: 0.021. Conclusion: The primary point in this study is to see how the correlation was measured since they had to be two numerical variables for it to be correlation. In this case, blood glucose and vascular damage, the most severe cases were related to blood glucose levels greater than 125 mg/dl. In our study, we conclude that the presence of glycemic levels below 125 mg/dl is a protective factor with respect to mortality with an OR 0.521 (CL 0.324–0.835, Po.007). That means, that those patients who are admitted with glycemic levels greater than 126 mg/d have twice the risk to die at 28 days of admission than those who do not have levels greater than 125mg/dl. In the same way, those patients who were admitted with less than 95% saturation were compared and there was no significant difference OR 1.174 (0.492–2.806, p0.822). 1. Kuziemski, Krzysztof Specjalski et a. lEndokrynol Pol. 2011; 62 (2): 171–6. Microangiopatía pulmonar diabética: ¿realidad o ficción? Publicated: Ewa Jassem. https://pubmed.ncbi.nlm.nih.gov/31637580/ 2. Krzysztof Kuziemski et al ¿Es el pulmón un “órgano diana” en la diabetes mellitus? Publicated: 2196023 https://pubmed.ncbi.nlm.nih.gov/19722145/

Induced Myopia among Readymade Garment (RGM) Workers

Background: To determine the induced refractive error among the readymade garment workers. Those who are working in the knitting section and those who are working other than the knitting and computer section. Methods: It was a prospective cross-sectional analytic study among 600 workers in 2 factories at Joydevpur, Gazipur, Bangladesh on January 2020. Group: A comprises 300 workers who were working at knitting section for a minimum of six hours a day and 5 days a week. Group: B comprises another 300 workers who were appointed for loading-unloading, care-taker, driver and security guard also. Prevalence of refractive error in two groups was compared. Results: The mean age of participants in group: A was 26.61 ± 4.99 (CI 95%, 26.04 ± 27.18) and in group: B was 28.51 ± 5.69 (95% CI 27.86 ± 29.15). Prevalence of refractive error between two groups was 52 and 28.3 respectively. The chi-square statistic is 44.9775. The p-value is <0.00001. Significant at p < 0.05. Strong positive correlation shows in Pearson’s correlation between time duration of knitting and refractive error (R is: 0.7619). Visual acuity between two groups chi-square statistic is 33.1866. The p-value is <0.00001. Significant at p < 0.05. Conclusion: Knitting workers at readymade garment (RGM) are more prone to develop late onset myopia than other workers in the same premises.