Prospective Cross-sectional Observational Study Research Articles

USE OF HAND-HELD OPTICAL COHERENCE TOMOGRAPHY DURING RETINOPATHY OF PREMATURITY SCREENING DEMONSTRATES AN INCREASED OUTER RETINA FROM EARLY POSTMENSTRUAL AGE IN PRETERM INFANTS WITH RETINOPATHY OF PREMATURITY.

To identify structural markers of active retinopathy of prematurity (ROP) in foveal and parafoveal retinal layers using hand-held optical coherence tomography. Hand-held optical coherence tomography images (n = 278) were acquired from a prospective mixed cross-sectional longitudinal observational study of 87 participants (23-36 weeks gestational age; n = 30 with ROP, n = 57 without ROP) between 31 and 44 weeks postmenstrual age excluding treated ROP and features of cystoid macular edema. Six retinal layer thicknesses from the fovea to the parafovea were analyzed at five locations up to 1,000 µ m, temporally and nasally. The mean outer retinal thickness during active ROP increased at the fovea and parafovea from postmenstrual age 33 weeks to 39 weeks ( P < 0.001), whereas the parafoveal inner nuclear layer and retinal nerve fiber layer reduced ( P < 0.001). Outer retinal thickness at the fovea from 33 weeks to 39 weeks postmenstrual age was consistently thicker in infants with ROP across all levels of prematurity (gestational age). Increased foveal and parafoveal outer retina measured using hand-held optical coherence tomography shows potential as a marker for ROP screening.

Nature, severity, and impact of chronic oropharyngeal dysphagia following curative resection for esophageal cancer: a cross-sectional study.

Chronic oropharyngeal dysphagia (COD) and aspiration after esophageal cancer surgery may have clinical significance; however, it is a rarely studied topic. In a prospective cross-sectional observational study we comprehensively evaluated the nature, severity, and impact of COD, its predictors, and the impact of the surgical approach and site of anastomosis. Forty participants were recruited via purposive sampling from the (Irish) National Center between November 2021 and August 2022. Swallow evaluations included videofluoroscopy [Dynamic Imaging Grade of Swallowing Toxicity v2 (DIGESTv2), MBS Impairment Profile, Penetration-Aspiration Scale)]. Functional Oral Intake Scale (FOIS) identified oral intake status. The patient reported outcome measures of swallowing, and Quality of Life (QL) included EAT-10 and MD Anderson Dysphagia Inventory (MDADI). Fourteen (35%) participants presented with COD on DIGESTv2 and 10% had uncleared penetration/aspiration. Avoidance or modification of diet on FOIS was observed in 17 (42.5%). FOIS was associated with pharyngeal dysphagia (OR = 4.05, P = 0.046). Median (range) EAT-10 and MDADI Composite results were 3(0-30) and 77.9(60-92.6), respectively. Aspiration rates significantly differed across surgical groups (P = 0.029); only patients undergoing transhiatal surgery aspirated. Survivors of esophageal cancer surgery may have COD that is undiagnosed, potentially impacting swallow-related QL. Given the small number of aspirators, further research is required to determine whether aspiration risk is associated with surgical approach. A FOIS score below 7 may be a clinically useful prompt for the MDT to refer for evaluation of COD following curative intent surgery. These data present findings that may guide preventive and rehabilitative strategies toward optimizing survivorship.

Frequency of patients presenting with Hand Infection and treatment modalities

Introduction: Infections of the hand are one of the most common infections reported by the caring physicians and surgeons. Common types of hand infections include: bite wounds, felon, necrotizing fasciitis, paronychia, flexor tenosynovitis, subcutaneous/cellulitis, osteomyelitis and septic arthritis. Aims: The aim of this study to identify the main etiological factors, possible complications due to acute hand infection and treatment modalities performed in our selected group of patients. Materials and Method: This was a prospective Cross Sectional Observational Study based on 58 patients conducted at King Abdullah Hospital, Bisha, Saudi Arabia. Period of study was one year from May 2022 to April 2023. Patients of all age group were included. Male patients were 16 (27.5%) while females were 42 (72.4%). Result: Most of the patients were gardener / farmer 15 (25.9%), minor children 12 (20.7%), and housewife / maid 9 (15.5%). Major mechanism of injury was penetrating trauma 41 (70.7%). Majority of the patients were between 20 years to 50 years of age group. The risk factors associated with hand infection includes diabetes mellitus 13 (22.4%) and hypertension 5 (8.6%). The smokers were 13 (22.4%) patients. Most of the patients were Saudi national 30 (51.7%) followed by Egyptian12 (20.7%), Pakistani and Sudanese 4 (6.9% each). Surgical intervention includes, incision and drainage in 40 (68.9%) cases while amputation was performed in 3 (5.2%) cases. There were 15 (25.9%) patients treated with conservative treatment protocol. Major organisms causing infection was staphylococcus aureus 28 (48.30%) including methicillin resistant staphylococcus aureus (MRSA). There was no growth in 5 (8.6%) patients and for 19 (32.8%) patients no drainage collection was available and therefore their samples were not analyzed for bacteriology. We have categorized the diagnosis into 6 groups as subcutaneous infection 27 (41.5%), acute Paronychia 11 (16.9%), web space infection 10 (15.4%), pulp space infection7 (10.8%), flexor tenosynovitis 6 (9.2%) and midpalmer/thenar 4 (6.2%). Conclusion: Early clinical diagnosis based on occupational history and control of co-morbid disease such as diabetes mellites, smoking etc is effective in the treatment and prevention of hand infection to avoid devastating surgical intervention of partial or total diabetic hand amputation.

Usability of a Web-Based Registry for Preclinical Alzheimer's Disease: Implications from a Cross-Sectional Online Survey.

We have been conducting a Japanese trial-ready cohort web study since 2019 as a web-based online registry to enroll individuals with preclinical Alzheimer's disease to facilitate trials on Alzheimer's disease prevention. The usability of a website might be an important factor in determining user participation and retention. We conducted a user questionnaire survey to analyze the usability of the Japanese trial-ready cohort website and user characteristics for future website improvement. This was a cross-sectional prospective observational study. Online survey using Google Forms. Among the Japanese trial-ready cohort web study participants, we enrolled those who provided consent to participate in the study and had completed one or more Cognitive Function Instrument tests before May 2, 2023. We sent an invitation e-mail, including the questionnaire web address, to eligible participants on July 21 and 22, 2023. We analyzed the questionnaire answers, including the system usability scale score and time of response (in 24 h). We also compared the respondents' characteristics with that of all the Japanese trial-ready cohort web study participants to identify features associated with an increased/decreased response rate to the questionnaire. Among the 10,112 Japanese trial-ready cohort web study participants that we sent invitation e-mails, we received 1,574 eligible responses (15.6%) within three weeks of the response acceptance period. The mean system usability scale score was 67.6, and no difference in system usability scale scores was observed in terms of age or sex. Approximately half of the respondents of the Japanese trial-ready cohort web study heard about it online, whereas one-fourth heard about it via newspapers. Contribution to drug development for dementia treatment was the most frequent motivation for participating in the Japanese trial-ready cohort web study (51.5%), followed by participation in the latest research (48.1%), concerns about self-memory (43.4%), and a family history of dementia (34.6%). Female respondents responded approximately 1.5 h later than male respondents. Lastly, those who had participated in the Japanese trial-ready cohort onsite study, were in their 70's, or had a larger number of Cognitive Function Instrument or Cogstate tests completion history were more likely to respond to the current online survey (relative risk of response > 1). We conducted an online survey using Google Forms for participants in the Japanese trial-ready cohort web study to determine the usability. The results of this study might help to improve the user experience of the Japanese trial-ready cohort website itself, increase the web study registrants, maintain user retention, facilitate future online surveys, and serve as a reference for other web-based registries of presymptomatic disease status.

Exploring the Relationship between Epicardial Fat Thickness and Coronary Revascularization: Implications for Cardiovascular Health.

this study aimed to assess the complex relationship between EAT thickness, as measured with echocardiography, and the severity of coronary artery disease (CAD). We investigated whether individuals with higher EAT thickness underwent coronary revascularization. Subsequently, we conducted a three-year follow-up to explore any potential modifications in EAT depots post-angioplasty. we conducted a prospective and retrospective cross-sectional observational study involving 150 patients consecutively referred for acute coronary syndrome, including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. Upon admission (T0), all patients underwent coronary angiography to assess the number of pathologic coronary vessels. Percutaneous transluminal coronary angioplasty (PTCA) was performed based on angiogram results if indicated. The sample was categorized into two groups: non-revascularized (no-PTCA) and revascularized (PTCA). Transthoracic echocardiograms to measure epicardial fat thickness were conducted at admission (T0) and after a 3-year follow-up (T1). findings revealed a positive correlation between EAT thickness and the severity of coronary artery disease (CAD), with patients undergoing PTCA showing decreased EAT thickness after three years. Echocardiography demonstrated reliability in assessing EAT, offering potential for risk stratification. The study introduces a cut-off value of 0.65 cm as a diagnostic tool for cardiovascular risk. Incorporating EAT measurements into clinical practice may lead to more precise risk stratification and tailored treatment strategies, ultimately reducing the burden of cardiovascular disease.

Holter ECG Monitoring in Assessing Arrhythmias in Patients with Palpitation

BACKGROUND Palpitation is one of the most common indications for Holter study. 24- hour Holter monitoring helps to detect abnormal cardiac rhythm which can be managed earlier if picked up sooner. Spot ECG has less sensitivity to pick episodic abnormal rhythm so longer monitoring time is essential. Various treatment modalities can thus be planned for non-benign and relatively benign arrhythmias like VT and PSVT respectively.&#x0D; METHODS This was a single center prospective observational cross-sectional study conducted at BPKIHS, Dharan for three months between July 2023 to September 2023. The primary objective was to study abnormal cardiac electrical events in patients having palpation. There were 38 patients of palpitations that underwent 24-hour Holter study after fulfilling inclusion criteria. The data was recorded on an excel sheet and was analyzed using software SPSS 20.&#x0D; RESULTS There were 47.4% (18) males and 52.6% (20) females. The mean age was 49.61± 17.63 years. There were 36.8% (14) patients in age group &lt;45 years while 42.1% (16) were in age group 45 to 65 years and 21.1% (8) were in the age group &gt;65 years. The maximum and minimum Heart rate were 180 and 35 beats per minute respectively. There was abnormal Holter ECG in 57.9% (22) and 42.1% (16) had normal ECG. Most common arrhythmia was VPC 17(77.2%) in our study. The association between the age group and Normal vs Abnormal Holter ECG was statistically significant (P Value=0.023) (Table 8). DM was the most common co-morbid illness in 5(13.2%), one participant had DM and HTN along with Dyslipidemia and other findings were smoking (5.3%), dyslipidemia (5.3%). There was no association between comorbid conditions and normal vs abnormal ECG Holter rhythm (P Value = 0.448).&#x0D; CONCLUSION Out of 38 participants VPC was the most common (77.2%) arrhythmia. The association between Age group and Normal vs Abnormal Holter was statistically significant (P Value=0.023). Most of the arrhythmias were benign. Diabetes was the most common risk factor present while 50% of subjects had no co-morbid illness.

Study of age, sex and body mass index wise variation in C-peptide level among urban population of Northern part of Bihar

Background: Different factors regulate the insulin level in blood. Earlier C-peptide was considered as by product of insulin biosynthesis and its role in body seems to be negligible. C-peptide at low physiological concentrations mimics the effects of insulin. However, in the presence of elevated level of insulin concentrations concomitant raised level of C-peptide may blunt peripheral effects of insulin age. This study was carried out to verify the age, sex, and BMI wise variation in level of C-peptide among apparently healthy individual and its contribution in fine-tuning of the tissue’s metabolism under different physiological conditions. Methods: This is a prospective cross-sectional observational study. Estimation of serum c-peptide level was done by solid phase direct sandwich enzyme linked immunosorbent assay (ELISA) kit method. Glucose is estimated by Glucose oxidase peroxidase (GOD-POD) end point colorimetric method and HbA1C was estimated by ion exchange resin method (kit method). Result: Serum C-peptide level is significantly high in advance age and males in compared to younger age and females respectively. The mean level of serum C-peptide is higher in higher body mass index (BMI) group compared to lower, but this difference is statistically insignificant. Conclusions: In normal subjects, the level of C-peptide shows positive correlation with age and BMI. Males have higher level of C-peptide in comparison to females. Apart from these variation C-peptide contributes to different biological effects.

Comparative Evaluation of Broth Microdilution With Disc Diffusion and VITEK 2 for Susceptibility Testing of Colistin on Multidrug-Resistant Gram-Negative Bacteria.

Background The rise of antibiotic resistance, particularly in Gram-negative bacteria, poses a significant global health threat. Colistin, a last-resort antibiotic, has witnessed renewed use. However, accurate susceptibility testing for colistin is challenging, with various methods available, leading to potential discrepancies. Ensuring reliable testing is crucial for effective patient treatment and antimicrobial stewardship. This study addresses the need to compare different colistin susceptibility testing methods, providing insights into their accuracy and relevance in clinical settings. Methods In this one-year prospective observational cross-sectional study conducted atIndira Gandhi Institute of Medical Sciences (IGIMS), Bihar, India, atertiary care hospital from July 2021 to June 2022, we aimed to evaluate the concordance between two widely used methods, VITEK 2 and Disc Diffusion, for antibiotic susceptibility testing in clinical multidrug-resistant Gram-negative bacterial isolates. These isolates, including species like Klebsiella pneumoniae, Acinetobacter baumannii, Klebsiella oxytoca, Pseudomonas aeruginosa, Citrobacter freundii, and Escherichia coli, were isolated from various clinical specimens. After rigorous species-level identification and quality control measures, antibiotic susceptibility testing was performed using both methods, and their agreement was assessed through Percentage Agreement analysis. Results In our study, we isolated and identified bacterial isolates from 105 patients, with a mean age of 47.30 years, demonstrating a wide age range. Pus samples were the most common type (25.7%), and K. pneumoniae was the most prevalent organism (45.7%). Antibiotic resistance patterns revealed significant challenges in treating infections caused by K. pneumoniae and A. baumannii, with resistance rates exceeding 70% for certain antibiotics. Among the 48 isolates of K. pneumoniae, the agreement was 93.8%, with 89.6% being sensitive and 6.3% being resistant by Disc Diffusion, while VITEK 2 indicated 0% resistance. E. coli isolates (n=21) had an agreement of 90.5%, with 90.5% sensitivity and 9.5% resistance by Disc Diffusion, and no resistance by VITEK 2. Conclusion The comparative analysis of antibiotic susceptibility testing methods reveals the superior performance of the VITEK 2 system, particularly in sensitivity and negative predictive value, emphasizing its potential as a reliable tool for guiding antibiotic therapy decisions.

Major outcomes of premenstrual syndrome associated with food: a prospective observational cross-sectional study

The present study developed a cross-sectional observational research, in which eating habits and behaviors of women were collected, focusing on changes present during periods of the menstrual cycle, such as the follicular and luteal phases. The correlations present in the literature with subsequent hormonal variations and their outcomes (estrogen, progesterone, cortisol, serotonin, and endorphin) were also described. The variations mentioned above are correlated with emotional and concomitant eating disorders, in general these disorders are developed due to the lowering of serotonin levels and the increase in cortisol; Thus, eating sweet and high-calorie foods is done in search of “pleasure”, due to the release of endorphins and consequently the reduction of cortisol. To this end, information on habits and lifestyle was collected from 50 women, aged between 18 and 45 years, through a questionnaire validated by the reliability of Cronbach's alpha coefficient and developed on the Google Forms platform, to evaluate the perception of these about the association of food according to the phase of the menstrual cycle in which they are. As a result, there was a reduction in the consumption of foods such as citrus fruits, meat, eggs, milk, and proteins in general, and vegetables during the luteal phase. The interviewees were asked about the symptoms noticeable during the luteal phase of the menstrual cycle, including increased appetite, depression, cramps, edema, satisfaction with appearance, emotional instability, anxiety, irritability, difficulty concentrating, insomnia, excessive sleep, constipation, and headache. All interviewees reported having at least one of the symptoms described above. It was concluded that premenstrual syndrome is characterized by symptoms that cover the physical, behavioral, and emotional spheres. In this way, the intensification of consumption of foods from groups such as fats, processed foods, fried foods, chocolates, candies, ice cream, and sweets in general during the Premenstrual Syndrome phase is visible, in addition to the various behavioral changes that involve emotional and perception changes. of the corporeal image. Thus, it confirms the need for nutritional monitoring of these women, to provide dietary adjustments during the menstrual cycle and, therefore, reducing drastic changes that directly impact their behavior.

Chronic Effects of e-Cigarette Aerosol Inhalation on Macular Perfusion Assessed Using OCT Angiography.

Purpose: To determine whether there are significant differences in the microvasculature and central retinal thickness (CRT) between e-cigarette users (user group) and age-matched nonusers (control group) using optical coherence tomography angiography (OCTA). Methods: In this prospective cross-sectional observational study, OCTA images were acquired of 52 eyes of 26 users and 25 eyes of 25 age-matched nonusers. Daily e-cigarette users with no ocular history were identified from provider information in the electronic medical record. A custom algorithm was used to calculate the foveal avascular zone (FAZ), vessel area density (VAD), and vessel length density (VLD). OCT software was used to calculate the foveal, superior, inferior, nasal, and temporal CRT. Generalized estimating equations using the Z-statistic were used to determine how the FAZ, VAD, VLD, and CRT parameters varied between groups and to assess the differential contribution of descriptive data in the user group. Results: No statistically significant difference was found between the user group and control group in the FAZ, superficial vascular complex (SVC) VAD, SVC VLD, or deep vascular complex (DVC) VAD. A statistically significant difference was found for DVC VLD (P = .002), with the user group having a slightly higher VLD on average. Superior, temporal, and inferior inner macular thicknesses were significantly thinner in the user group (P = .038, P = .012, and P = .035, respectively). Conclusions: Significant negative differences were found in CRT measures but not in retinal microvasculature parameters between e-cigarette users and nonusers. Decreased inferior, temporal, and superior inner macular thickness in e-cigarette users may show an early chronic structural effect that warrants further assessment of retinal effects as this population ages and continues to use e-cigarettes.

Choriocapillaris and choroidal thickness in all Leber hereditary optic neuropathy stages using swept source technology.

The role of the choroid in Leber hereditary optic neuropathy (LHON) remains unclear. The literature is scarce, with conflicting results and lacks axial length measurements. Therefore, we aimed to analyse the choriocapillaris (CC) vessel density (VD) and choroidal thickness (ChT) in all stages of LHON using swept source (SS) technology and considering the possible influence of axial length on choroidal parameters. This was a prospective cross-sectional observational study. A total of 119 eyes of 60 patients with molecularly confirmed LHON across all stages and 120 eyes of 60 control participants were included. We obtained the CC VD using optical coherence tomography angiography maps centred on the fovea. ChT was measured from the Bruch's membrane to the choroid-sclera interface in the macular and peripapillary regions. The CC VD was not significantly affected in any sector or average, except for a slight change in the superior region of chronic eyes (52.08 ± 1.62% vs. 53.50 ± 2.29%, p = 0.002). ChT demonstrated a trend towards decreased values in asymptomatic eyes and increased values in the symptomatic stages that failed to reach statistical significance in sectors corresponding to the papillomacular bundle except for the macular nasal inner sector of chronic eyes (281.10 ± 67.12 μm vs. 252.08 ± 70.55 μm, p = 0.045). No significant correlations were observed between visual acuity and CC VD or ChT. The CC VD remained stable across the LHON stages. Choroidal vasculature does not appear to play a role in LHON pathophysiology. Further research is needed on ChT as a potential biomarker of LHON.

Prognostic Value of Coronary Artery Calcium in the Intermediate-Risk Population of Developing Coronary Artery Disease

Background: The present study was designed to estimate the coronary artery calcium score (CACS) and its association with the incidence of major adverse cardiovascular events (MACE) in asymptomatic patients who are at risk of coronary artery disease (CAD). Objective: To estimate the CACS and its association with the incidence of MACE in asymptomatic patients. Methods: In this prospective cross-sectional observational study, 108 consecutive patients were enrolled. Demographic details and clinical data including lipid profile, systolic blood pressure, electrocardiography, 2D echocardiography, and routine blood investigations were reported. CACS was derived from computed tomography using a 256-slice scanner with a rotation time of 270 milliseconds. MACE was recorded at a one-year follow-up. Results: The mean age was 54.55 ± 7.7 years with male predominance (62%). CACS categories 0, 1-99, 10-399, 400-999, and more than 1000 constituted 43.5%, 28.7%, 18.52%, 8.33%, and 0.93% respectively. The correlation between the groups of positive and negative CACS and the presence or absence of standard risk factors was found to be statistically significant in diabetes mellitus (P=&lt;0.001), hypertension (P=&lt;0.001), and history of CAD in the family (P = 0.036). Although the association between smokers and calcium was statistically insignificant, it had clinical significance (P= 0.294). Out of 108 patients, MACE was observed in 16 (14.81%) patients with positive CACS at the 1-year follow-up. Conclusion:CACS measurement is often regarded as the primary non-invasive approach for risk stratification, MACE estimation, and promptly identifying high-risk asymptomatic individuals. Keywords: Coronary Artery Calcium Score; Cardiovascular Events; Coronary Calcification; Risk Stratificationa

A Prospective Study Between Molecular Marker P53 Analysis and HPE, for Tumour Positivity in Primary Resected Margins in Head and Neck Squamous Cell Carcinoma.

Head and neck malignancies are the seventeenth most common malignancies, worldwide and second most common malignancy in India. So current study aims to compare between molecular marker p53 analysis and HPE for tumour positivity in primary resected margins in head and neck SCC. 61 patients with head and neck SCC were included in this prospective observational cross-sectional study performed in tertiary care hospital. A detailed history general physical examination blood investigation was done before the surgery. After the surgery, primary lesion from the resected tumour was sent for HPE analysis. From the same specimen, the margins at distance of 0.5-1cm from primary tumour were sent for p53 mutation analysis. Report of p-53 mutation was noted and entered to the Performa. In our study we found out that in PDSCC HPE negative margins were found positive for p53 mutation in 81% cases. Which suggest that evaluation for p53 mutation should be done in PDSCC cases for HPE negative margins with in 1cm. In patients of head and neck squamous cell carcinoma with free margins on HPE p-53 mutation is significantly associated to the PDSCC and margin upto 0.7mm so recommended for p-53 profile can be beneficial in cases of the PDSCC and margins up to 0.7mm for further management or for possibility of recurrence and its management to improve patients survival and decrease morbidity and mortality.

Impact of diabetes mellitus severity, treatment regimen and glycaemic control on atrial fibrillation prevalence. A report from the NOMED-AF prospective cross-sectional observational study

Abstract Introduction Diabetes mellitus (DM) is a well-known risk factor for atrial fibrillation (AF), but the mechanism(s) by which DM affects AF prevalence remains unclear. The pathophysiological background underlying the frequent coexistence of diabetes and AF seems to be multifactorial, involving changes in left atrial size, abnormal proinflammatory mediators and endothelial dysfunction. Purpose This study aims to evaluate the impact of diabetes mellitus severity, expressed as its known duration, antihyperglycemic treatment regimen and glycaemic control reflected by HbA1c level on AF and its silent, asymptomatic form (SAF) prevalence. Methods The cross-sectional NOMED-AF trial schedule comprised multistage, stratified and clustered population sampling with subsequent clinical evaluation and long-term non-invasive AF screening. AF was screened using a telemonitoring vest for a mean of 21.9± 9.1 days. From the representative sample of 3014 participants (mean age 77.5, 49.1% female), 881 participants (mean age 77.6 ± 0.25, 46.4% female) with concomitant DM were involved in the analysis. Results The mean DM duration was 12 ± 0.35 years, but no significant impact of DM timespan on AF and SAF prevalence was observed. There were also no differences in the course of DM treatment pattern (oral medication vs insulin vs both - oral + insulin) among the study population with and without concomitant AF (p=0.106). From the study population 72% (95% CI: 68.7-75.1) received only oral hypoglycaemic medication; 12.9% (95% CI: 10.7-15.5) was taking both oral treatment + insulin injections; and 15.1% (95% CI: 12.7-17.8) were administered with insulin only. Metabolic control reflected by HbA1c levels showed no significant association with AF prevalence (p=0.635; p=0.094). On multivariate analyses, age (Odds Ratio (OR) 1.35, 95%CI: 1.18-1.53, p&amp;lt;0.001), p=0.042), body mass index (BMI; OR 1.043, 95%CI: 1.01-1.08, p=0.027) and LDL&amp;lt;100 mg/dl (OR 0.64, 95%CI: 0.42-0.97, p=0.037) were independent risk factors for AF prevalence, while age (OR 1.45, 95%CI: 1.20-1.75, p&amp;lt;0.001), LDL&amp;lt;100 mg/dl (OR 0.43, 95%CI 0.23-0.82, p=0.011), use of statins (OR 0.51, 95%CI: 0.28-0.94, p=0.031) and HbA1c ≤6.5 (OR 0.46, 95%CI: 0.25-0.85, p=0.013) were associated with silent AF prevalence. Conclusions Diabetes duration, diabetic treatment pattern or metabolic control per se did not significantly impact the prevalence of AF, including silent AF detected by prospective continuous monitoring. Independent predictors of AF were age, BMI and low LDL levels, with statins and HbA1c ≤6.5 being additional independent predictors for SAF.

Serum sclerostin is associated with recurrent kidney stone formation independent of hypercalciuria.

Kidney stones are frequent in industrialized countries with a lifetime risk of 10 to 15%. A high percentage of individuals experience recurrence. Calcium-containing stones account for more than 80% of kidney stones. Diet, environmental factors, behavior, and genetic variants contribute to the development of kidney stones. Osteocytes excrete the 21kDa glycoprotein sclerostin, which inhibits bone formation by osteoblasts. Animal data suggests that sclerostin might directly or indirectly regulate calcium excretion via the kidney. As hypercalciuria is one of the most relevant risk factors for kidney stones, sclerostin might possess pathogenic relevance in nephrolithiasis. We performed a prospective cross-sectional observational controlled study in 150 recurrent kidney stone formers (rKSF) to analyse the association of sclerostin with known stone risk factors and important modulators of calcium-phosphate metabolism. Serum sclerostin levels were determined at the first visit. As controls, we used 388 non-stone formers from a large Swiss epidemiological cohort. Sclerostin was mildly increased in rKSF in comparison to controls. This finding was more pronounced in women compared to men. Logistic regression indicated an association of serum sclerostin with rKSF status. In hypercalciuric individuals, sclerostin levels were not different from normocalciuric patients. In Spearman correlation analysis we found a positive correlation between sclerostin, age, and BMI and a negative correlation with eGFR. There was a weak correlation with iPTH and intact FGF 23. In contrast, serum sclerostin levels were not associated with 25-OH Vitamin D3, 1,25-dihydroxy-Vitamin D3, urinary calcium and phosphate or other urinary lithogenic risk factors. This is the first prospective controlled study investigating serum sclerostin in rKSF. Sclerostin levels were increased in rKSF independent of hypercalciuria and significantly associated with the status as rKSF. It appears that mechanisms other than hypercalciuria may be involved and thus further studies are required to elucidate underlying pathways.

Assessment of adherence to treatment with injectable extended-release antipsychotics within a pharmacotherapeutic follow-up program

ObjectiveTo describe an injectable extended-release antipsychotic pharmacotherapeutic follow-up program and to assess adherence among patients included in the program. MethodA coordinated program is described involving hospital and primary care pharmacy, which included electronic prescription, reviewing, and dispensing of injectable antipsychotic agents in mental health and primary health care centers. Adherence to treatment was assessed in a 1-month prospective observational cross-sectional study which included all patients under treatment with injectable extended-release antipsychotics in a health area of more than 500,000 inhabitants. The variables collected were: medication administered, frequency of administration, administration center, and whether or not the patient attended the center. Patients were considered to have adhered to treatment if they had attended their appointments within a margin of ± 7 days. ResultsA total of 919 patients and 1,073 appointments were included. Eleven mental health units and 40 primary health care centers participated in data collection. In 95.7 % (1,027) of cases, the patients attended the appointment. No differences were found in adherence between drugs or administration frequency. However, differences were found between mental health units and primary health care centers. Patient adherence was slightly higher in mental health units (97.6% vs 91.1%; P < 0.001). ConclusionsThe high adherence rate shows that the described follow-up program is effective. Further long-term studies are needed to confirm this trend.

Urinary Detection of COVID-19 Virus and its Implication in Urology Practice

Background: More than 25 crores of world population is affected by the pandemic corona virus SARS-CoV-2 since its first detection from Wuhan, china on December 2019. The widely accepted routes of human to human transmission for COVID-19 are through respiratory droplets and direct contact, however viral shedding in urine has been reported and infection transmission through infected urine remains a possibility. Objective of the study: To investigate the presence of COVID-19 virus in urine of infected patients and evaluate the probability of infection transmission through urine in different urological procedure. Methodology: After obtaining approval from institutional review board (IRB) of BSMMU this prospective cross-sectional observational study was conducted in the department of urology BSMMU from September 2020 to august 2021. Informed written consent was taken from the patients, the patients who are in ventilators legal guardian signed the consent form. After taking relevant history from the patients admitted in covid dedicated unit of BSMMU urine of the patients was collected in sterile container and with appropriate labeling and it was sent in virology department to detect the presence of SARS-COV-2 by quantitative real time polymerase chain reactions (RT-PCR). The date of covid 19 infection, date of urine sample collection, previous renal status, present renal function all were recorded. Results: Fifty patients were enrolled for investigation for detection of covid 19 virus in urine who were infected with SARS-COV-2. Thirty patients were male and Twenty were female. Male and female sex ratio was 3:2. We found the presence of SARS-COV-2 in urine of 2 patients, one male and one female. The rate of detection of SARS-COV-2 virus in urine of patients infected by covid 19 virus was 4%. Conclusion: Urinary detection of COVID-19 Virus was lower than oropharyngeal and rectal samples. Urological surgical intervention should be performed with caution considering the possibility of urine infection and possibility of COVID-19 transmission through this route. Sir Salimullah Med Coll J 2023; 31: 116-119

A cross-sectional study on the prognostic value of the RAPID score in pleural infection in patients attending a tertiary care hospital in Central India

Pleural infections pose a significant clinical challenge, with diverse outcomes that are often difficult to predict. The renal (urea), age, fluid purulence, infection source, dietary (albumin) (RAPID) score, a clinical tool designed to assess the risk of adverse outcomes in pleural infections, holds the potential as a prognostic indicator. This study aims to evaluate the prognostic value of the RAPID score in patients with pleural infections attending a tertiary care hospital in Central India. This hospital-based prospective cross-sectional observational study will span from July 2022 to June 2024, enrolling 50 adult patients aged 18 years and older admitted to the Department of Respiratory Medicine, a tertiary care hospital in central India. Data will be collected using a structured proforma, encompassing demographic data, clinical history, and comorbidities. Diagnostic investigations, including pleural fluid analysis, laboratory tests, sputum analysis, and radiological assessments, will be performed upon enrolment. RAPID scores will be calculated at admission, stratifying patients into low, medium, and high-risk categories. Treatment will follow established pleural infection protocols, with patients receiving empirical antibiotics and tailored treatment based on culture sensitivity results. Patients will be monitored for three months post-admission, and outcomes such as hospital stay duration, tube thoracostomy need, intercostal drainage tube duration, medical management success, surgical referral rates, surgical interventions, and 30-day and 90-day mortality rates will be assessed. This study aims to contribute valuable insights into the prognostic value of the RAPID score in pleural infections and factors influencing patient outcomes. The findings may facilitate more informed clinical decision-making and improve the management of pleural infections, ultimately enhancing patient care and outcomes.

Evaluation of chemiluminescence immunoassay as a screening test for syphilis on blood donor samples

Background and objectiveGlobal re-emergence of syphilis among blood donors necessitates novel diagnostic and prevention approaches that encourage timely intervention. Thus, the present study was planned to evaluate the efficiency of Chemiluminescence immunoassay (CLIA) as a screening test for syphilis. Material and methodsThis prospective cross-sectional observational study was conducted from October 2021 to September 2022. A total of 344 donors were enrolled by purposive sampling method, including additional 16 donors who were reactive by the Rapid plasma reagin test (RPR) during the study period. Data from three screening tests - RPR test, Treponema pallidum haemagglutination assay (TPHA) and CLIA for 360 blood donors were analysed. TPHA was considered the gold standard test. ResultsOf the total 360 samples tested, 21 (5.8 %) were reactive by the RPR test. Of these 21 RPR reactive samples, 19 (90.5 %) were reactive by both TPHA and CLIA, while 2 (9.5 %) RPR reactive samples were non-reactive by both TPHA and CLIA. Of the remaining 339 RPR non-reactive samples, 1 (0.3 %) sample was reactive by both TPHA and CLIA, and 1 (0.3 %) was reactive by CLIA alone. CLIA was found to have sensitivity and specificity of 100 % and 99.7 % and positive predictive value (PPV) and negative predictive values (NPV) of 95.2 % and 100 % respectively, while it was 95 %, 99.4 %, 90 %, and 99.7 %, respectively, with the RPR test. ConclusionCLIA was found to have a higher sensitivity, specificity, PPV and NPV than the RPR test. Thus, CLIA can be an acceptable alternative for syphilis screening in blood donors.

Clinical Profile of Children with Thalassemia Admitted for Blood Transfusion at a Tertiary Health Care Center

IntroductionThalassemia is a prevalent hereditary hematological disorder that is characterized by a reduction or absence of globin chain synthesis. The objective of this study is to determine the clinical profile of children with thalassemia who undergo repeated packed cell transfusions.MethodsA prospective cross-sectional observational study was conducted from January 1, 2023, to May 31, 2023, in the Pediatric ward at Bharatpur Hospital. Ethical clearance was obtained from the Institutional Review Committee of Bharatpur Hospital (Ref: 078/79-018). A total of 53 cases of Thalassemia, who were receiving regular blood transfusions, were included in this study.ResultsThe prevalence of thalassemia was 3.68% (with 95% CI 2.7% to 4.65%). The average age at diagnosis was 15.58 months, with a range of 2 to 97 months. The majority of cases, 32 (60.37%), were diagnosed before the age of one year, with a male-to-female ratio of 1.2:1. Thalassemia was more prevalent in the Tharu community (58.5%) compared to other communities. ConclusionsThalassemia is a hematological disorder that predominantly affects the Tharu community. Common clinical manifestations of transfusion-dependent thalassemia in children include pallor, hepatomegaly, splenomegaly, and facial deformities. Therefore, it is imperative to monitor serum ferritin levels to detect iron overload early and initiate chelation therapy promptly to prevent complications. Such measures can significantly improve the quality of life of affected individuals and reduce the burden of this genetic disorder on affected communities.