Prospective Cross-sectional Observational Study Research Articles

Evaluation of prescription pattern of antifungal drugs in the dermatology department of a tertiary care teaching hospital

Background: In general, fungal infections are one of the contributors of disease burden in the community, but irrational use of antifungal drugs can result in unwanted adverse events or antifungal drugs resistance. The present study was designed to analyze the prescription pattern of antifungal drugs prescribed in the dermatology department of a tertiary care teaching hospital. Methods: After getting permission from the ethics committee, this prospective observational cross-sectional study was conducted by analysis of prescriptions of 900 voluntary participant patients over a period of seven months in the dermatology outpatient department of a tertiary care teaching hospital in western India. Prescribed medicines’ parameters were analyzed as per WHO/INRUD prescription indicators. Results: Overall 900 prescriptions were analyzed, and among them around 50% patients were having tinea corporis and tinea cruris, making it the most common fungal infection. The most commonly prescribed antifungals were Clotrimazole (34.59%), followed by Fluconazole (31.61%) and Luliconazole (23.52%). Percentage of drugs prescribed from the WHO model list of essential medicines was 71.22%. Average number of antifungal drugs per prescription was 2.83 ± 0.57%. Conclusions: This study indicates prescribing practices of anti-fungal drugs and supportive medicines at tertiary care hospital that can be further improved by promoting prescribing by generic names. Overall final list of essential medicines at district level, state level and national level may vary as compared to the WHO list for anti-fungal drugs and doctors can consider alternative drugs as per domestic resistant pattern.

Self-care behaviours of patients with left ventricular assist devices in Israel: changes during the COVID-19 pandemic.

Left ventricular assist devices (LVADs) support the hearts of patients with advanced heart failure. Following LVAD implantation, patients face a complex regimen of self-care behaviours including self-care maintenance, self-care monitoring and self-care management. However, during the COVID-19 pandemic, symptoms of anxiety and depression may have interfered with their self-care. Currently, little is known on how specific self-care behaviours of LVAD-implanted patients changed during the COVID-19 pandemic. We aim to describe the changes in self-care behaviours among patients with an implanted LVAD in Israel during the COVID-19 pandemic and explore the factors related to self-care behaviour change. A prospective observational cross-sectional study design. A convenience sample of 27 Israeli LVAD-implanted patients (mean age 62.4±9, 86% male, 78.6% living with a partner) completed the LVAD Self-Care Behaviour Scale (1=never to 5=always) and Hospital Anxiety and Depression Scale (0=not at all to 3=most of the time). Data were collected before and after the onset of the COVID-19 pandemic in Israel. Statistical analyses included paired t-tests, Pearson's correlations, and one-way repeated measures ANOVAs. During the COVID-19 pandemic, a significant decrease was found in patients' adherence to checking and recording their LVAD speed, flow, power and PI (Pulsatility Index) (P=0.05), checking their INR (P=0.01), and daily weighing (P<0.01). The prevalence of some behaviours (e.g. regularly exercising) increased in some patients and decreased in others. Patients living without a partner worsened their adherence to some of the self-care behaviours (e.g. taking medicines as prescribed), compared with those living with a partner (Mb =5.0±0 and Md =5.0±0, delta=0 vs. Mb =5.0±0 and Md =4.6±0.9, delta=-0.4, respectively; F=4.9, P=0.04). Women, and not men, tended to improve their adherence to the self-care behaviour such as avoiding kinking, pulling, or moving the LVAD driveline at the exit site (Mb =4.0±1.0 and Md =5.0±0, delta=1.0 vs. Mb =4.5±0.9 and Md =4.4±1.2, delta=-0.1, F=4.7, P=0.04, respectively). In total, 41% (11) patients reported neither anxiety nor depression, 11% (3) reported anxiety, 15% (4) reported depression, and 44% (12) reported both anxiety and depression. No associations between anxiety and/or depression and self-care behaviours were found. Priorities in self-care behaviours among patients with implanted LVAD changed after the onset of the COVID-19 pandemic. Factors that assisted with adherence to self-care behaviours included living with a partner and being female. The current results may guide further research on identifying behaviours that are at risk of not being maintained during a time of emergency.

Brain Tumor Vascularity Estimation by Arterial Spin Label Perfusion MRI—A Preoperative Tool for Patient Prognostication

Abstract Introduction Brain tumors remain a significant cause of morbidity and mortality around the globe. Preoperative estimation of tumor vascularity is of great significance for a neurosurgeon. Aim of our study was to correlate tumor blood flow (TBF) using arterial spin labeling perfusion imaging (ASL-PI) with microvessel density (MVD), tumor grade, and preoperative prognostication of brain tumors. Materials and Methods This was a prospective observational cross-sectional study conducted in 63 patients of primary brain tumors already referred for magnetic resonance imaging. Absolute and relative mean and maximum TBF were calculated using ASL-PI and correlated with tumor grade and MVD at 10x and 40x magnificantion; thereby stydying the role of ASL-PI in brain tumor prognostication. Results The mean of maxTBF values (mL/min/100 g) in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 147.15, 251.55, 96.43, 43.3, and 578.3, respectively. The median of maxTBF value in the gliomas group, meningiomas group, schwannoma group, craniopharyngioma group, and hemangioblastoma group was 131.5, 158.63, 94.5, 43.4, and 578.3, respectively. Discussion Significant correlation between meanTBF and MVD at 10X magnification (p-value &lt; 0.001, rho =0.88) and a positive correlation between meanTBF and MVD at 40X magnification (p-value &lt; 0.001) were seen. Significant correlation was also seen between maxTBF and MVD at 10X magnification (p-value &lt; 0.001, rho = 0.91) and between maxTBF and MVD at 40X magnification. TBF in case of the hemangioblastoma was higher than other types of brain tumors (gliomas, meningiomas, and schwannomas). HighTBF value was seen in high-grade gliomas compared with low-grade gliomas with worse prognosis. TBF was high in typical meningiomas whereas low in atypical meningioma. Conclusion TBF by ASL-PI can be considered a noninvasive in vivo marker in predicting the grade of brain tumors and further assist in envisaging prognosis of the patients with brain tumors.

Temporomandibular joint disorders prevalence and health-seeking preferences among Al-Madinah community: A prospective cross sectional study

Background: Painful temporomandibular joint disorders (TMDs) are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region. The purpose of this study was to investigate the prevalence and awareness of temporomandibular joint (TMJ) disorders in Almadinah Almunawwarah community. Methods: A prospective observational cross-sectional study with convenience sampling was conducted. The patients were selected from the dental college and the hospital at Taibah University in Al-Madinah, Saudi Arabia. A translated Arabic version of Fonseca's questionnaire was employed. The questionnaire asked about the participant's personal information, if they thought they had TMDs, and who to visit for therapy if necessary. These were followed by 10 items from Fonseca's questionnaire, each with a three-point scale. Results: The questionnaire was completed by 518 people. Females made up 57.1% of the participants. TMDs were present in 61% of the population, with varying degrees of severity. Males (44.3%) were less affected than females (55.7%). The difference, however, was not statistically significant (P = 0.354). Out of the 61% TMDs Positive patients, 74.1% had mild TMDs symptoms, while 20.8% and 5.1%, respectively, had moderate and severe TMDs symptoms (P = 0.05). The severity of the symptoms was unaffected by demographic data (P &gt; 0.05). Only 40% seek care, with 64.6% selecting for a dentist or orofacial pain specialists for their management and 24.6% preferring for an orthopaedic specialist (P= 0.008). Conclusions: Participants from Al-Madinah had a greater prevalence of mild TMDs. The majority of the participants had no idea who to go to for treatment. The findings of this study highlight the importance of educational activities to enhance public awareness

5596911 RETINAL AND MACULAR AFFECTION IN EGYPTIAN SICKLE CELL DISEASE PATIENTS USING SPECTRAL DOMAIN OCT AND OCT-ANGIOGRAPHY: A SINGLE CENTER STUDY

Background: Sickle vasculopathy results from a complex interaction between sickles erythrocytes, white blood cells, platelets, activated endothelium, vasoactive factors and inflammation. Improved life expectancy of sickle cell disease (SCD) patients in recent years has led to emergence of more disease-related complications as ocular complications. Sickle maculopathy, an emerging subtle complication, characterized by local macular thinning secondary to ischemia is not always evident by indirect ophthalmoscope. In an earlier study of an Egyptian SCD cohort using flourscein angiography, we detected proliferative sickle retinopathy (PSR) in 32.5% of enrolled patients; youngest being 15 years old. Discrepancies in reported prevalences among pediatric SCD patients are attributed to different definitions of retinopathy, examining methods used, examiner’s ability, patients’ age and treatment modalities. Spectral domain- Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCT-A) are more recent non- invasive tools that allow for early detection of signs of PSR. Aim: This study aimed to assess for retinopathy and maculopathy among an Egyptian cohort of SCD patients using SD-OCT and OCT-A. Methods: This prospective observational cross-sectional study, conducted in Pediatric Hematology Unit, Cairo University Children Hospital, included 80 Egyptian steady state SCD patients (aged 10 years or more) and 20 unrelated healthy age and sex matched subjects as control group. Informed consents were given willingly by all subjects/ guardians before enrollment in the study. SD-OCT (Optovue OCT machine) and OCT-A (Optovue Octa machine) were performed for all enrolled subjects at Opthalmolgy Department, Cairo University. Results: All subjects had normal slit lamp examination. No statistically significant difference was found in best corrected visual acuity (BCVA) of RT eye, Lt eye, slit lamp bio-microscopy or indirect ophthalmoscopy between SCD and control groups (p= 0.059, 0.057, 0.159 & 0.159 respectively). Using SD-OCT, SCD patients had significantly lower mean Rt macular thickness than control group (218.05±19.13 vs 232.1±14.55 micrometer with p-value =0.003). Twelve SCD patients (15%) showed evidence of retinopathy by OCT-A. There was a significant relationship between OCT-A findings and both Rt and Lt macular thickness by SD-OCT (p-value <0.0001 and <0.0001 respectively). OCT-A findings well correlated with Rt BCVA, Lt BCVA, slit lamp bio-microscopy and indirect ophthalmoscope (p-value <0.0001 for all). SCD patients having abnormal OCT-A findings or with macular abnormalities by SD-OCT showed statistically significant higher mean transfusions/ lifetime and longer duration of Deferiprone chelation therapy (p=0.011, 0.014, 0.028 and 0.038 respectively). No significant difference was noted among SCD patients with abnormal vs normal OCT-A findings regarding their studied demographic, clinical or hematologic characteristics. Conclusion: Sickle retinopathy and maculopathy are subtle disease related complications that might affect SCD children and adolescents. SD-OCT and OCT-A are non-invasive useful tools for early timely detection of these complications thus minimizing the risk of sight- threatening retinopathy. Keywords: Retinopathy- Sickle- Egyptian- SD-OCT- OCT-A

Automatic segmentation and quantified analysis of meibomian glands from infrared images.

An algorithm for automated segmentation of meibomian glands from infrared images obtained using a novel prototype infrared hand-held imager has been proposed in this study. Meibomian gland dysfunction (MGD) is quantified in terms of five clinically relevant metrics. A comparison of these metrics in patients with MGD has been presented against a sample of the normative healthy population. This is a prospective cross-sectional observational study. Patients presenting to the clinics were enrolled after written informed consent. The everted eyelids of 200 eyes of patients (of which 100 were healthy and 100 were diagnosed with MGD) were imaged using a prototype hand-held camera. The proposed algorithm was used to process the images using enhancement techniques and the glands were automatically segmented. A comparison of glands of normal eyes versus MGD-affected eyes is performed using five metrics presented in this study: (i) drop-out, (ii) length, (iii) width, (iv) the number of glands, and (v) the number of tortuous glands. The 95% confidence interval for the metrics did not show any overlap between the two groups. In MGD patients, the drop-out ratio was higher than normal. The length and number of glands were significantly lesser than normal. A number of tortuous glands were more in the MGD group. The metrics for MGD versus healthy and cut-off ranges were computed in the results. The prototype infrared hand-held meibographer and the proposed automatic algorithm for gland segmentation and quantification are effective aids in MGD diagnosis. We present a set of five metrics, which are clinically relevant for guiding clinicians in the diagnosis of MGD.

A comparative study of the effect of conventional hemodialysis versus hemodiafiltration on the eye

Background and aim Hemodiafiltration (HDF) seems to be the gold standard concerning dialysis-aided renal replacements. Hemodialysis (HD) and severe renal failure both have visual side effects, including high intraocular pressure, band keratopathy, macular leakage, red eyes, retinal hemorrhage, and optical neuropathy. The purpose of this study is to examine the impact of routine conventional HD versus routine HDF on ocular problems in individuals with chronic kidney disease (CKD). Patients and methods This prospective cross-sectional observational study was conducted on 200 patients divided into 100 patients of CKD on regular HD three times weekly (4 h duration) (HD group) and 100 patients of CKD on regular HDF three times weekly (4 h duration) (HDF group). clinical interview, routine laboratory tests, and complete eye examination were done on all participants. Results Prior to treatment, there was no significant difference between the HDF and HD categories for either eye’s central foveal thickness, average macular thickness, visual acuity, intraocular pressure, anterior segment, or fundus examination. In addition, no significant difference was observed between both groups after therapy in both eyes. Conclusion Regular HDF and HD treatments administered for 6 months each had no negative impact on ocular parameters.

Correlation Analysis of Lactic Acid Level as A Predictor of Severity of Patients with Acute Appendicitis

Perforated appendicitis is a leading cause of morbidity and mortality in all appendicitis cases, both for adults and children. Delay in preoperative diagnosis is the main reason for perforation. In previous studies, it was revealed that diagnostic modalities such as radiological examination and the current scoring system have not been able to predict the onset of perforated appendicitis. Serological biomarkers of lactic acid are associated with intestinal obstruction and ischemia. The increase in the serological value of lactic acid in perforated appendicitis compared to acute one was shown to increase significantly by 0.25 mmol/L (p&lt;0.05) according to a previous study. This study aimed to determine the correlation between lactic acid level and the severity of appendicitis in patients visiting Dr. Hasan Sadikin General Hospital. This was a cross-sectional prospective analytic observational study on adult patients diagnosed with appendicitis who were admitted to the emergency room of Dr. Hasan Sadikin General Hospital from January 1, 2021 to June 1, 2021. Data analysis was performed using bivariate analysis and correlation tests of difference. This study involved 54 subjects with a mean lactic acid level of 2,5093 mmol/L (0.9 mmol/L - 11.8 mmol/L). In the complicated appendicitis group, 20 subjects (37%) was found to experience an increase in lactic acid (OR 1.07; 95% CI: -0.03-0.22; p=0.14). The correlation analysis showed the direction of negative correlation. Thus, it is concluded that there is no significant correlation between lactic acid level and the severity of appendicitis in patients with appendicitis.

Vestibular, Central, and Non-Vestibular Etiologies of Vertigo and Disequilibrium: A Rural Hospital-Based Cross-Sectional Comparative Analysis.

Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin. A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo. Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps. The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium."Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.

Previous exposure to violence among emergency department patients without trauma-related complaints: A cross sectional analysis

IntroductionThe Emergency Department (ED) is a critical setting for the treatment of acute violence-related complaints and violent victimization is associated with numerous long-term negative health outcomes. A trauma-informed care framework can prevent re-traumatization of victims within the healthcare setting, but currently there are insufficient mechanisms to detect previous exposures to community violence within the ED. The current study sought to determine the prevalence of community violence and characterize the types of violence exposures among adult ED patients without trauma-related complaints to determine if there may be a need for expanded screening for previous exposure to violence for ED patients. MethodsThis was a prospective cross-sectional observational study of adult ED patients without a trauma-related chief complaint at an urban public hospital. Adult patients were approached by trained research staff and answered questions adapted from the Survey of Exposure to Community Violence (SECV), which measures lifetime exposure to community violence, including both witnessing and victimization. The SECV was modified for clarity, brevity, and to assess exposure to violence within the previous 3 months and 3 years from enrollment, in addition to lifetime exposure. Enrollment occurred from June 2019 to September 2022 with a 19-month gap due to the COVID-19 pandemic. Demographics and results within SECV domains were analyzed using descriptive statistics. Comparisons between males and females in types of violence experienced during one's lifetime were made by fitting logistic regression models adjusting for age. ResultsA total of 222 respondents completed some or all of the modified SECV. Ages ranged from 19 to 88, with 47.7% of respondents identifying as female and 50.9% as male. Of all respondents, 43.7% reported directly witnessing violence during their lifetime, 69.4% being personally victimized by violence, and 55.4% personally knowing someone killed by a violent act. Of those personally victimized, 47.4% occurred within the preceding 3 years and 20.1% within 3 months. Among all respondents, lifetime victimization was reported in the following domains: slapping, hitting, or punching (45.9%); robbings or muggings (33.8%); physical threats (28.8%); verbal or emotional abuse (27.5%); being shot at (18.0%); uncomfortable physical touch (15.3%); forced entry while home (14.4%); sexual assault, molestation, or rape (13.5%); or being attacked with a knife (13.5%). Comparing male and female respondents, 63.5% of females and 76.6% of males reported any violent victimization over their lifetime (aOR 1.88; 95% CI 1.04–3.43). Additionally, 31.7% of females and 56.3% of males reported witnessing violence (aOR 2.86; 95% CI 1.64–5.06). Males were more commonly exposed to physical violence, violence with weapons, and threats while females more commonly reported sexual assault, molestation, and rape. ConclusionBoth lifetime and recent exposure to community violence was common among adult ED patients without trauma-related complaints. Broader adoption of a trauma-informed care framework and the development of efficient ED screening tools for previous exposure to trauma is reasonable in areas where community violence exposure is highly prevalent.

Factors associated with anxiety and depression in cancer patients: Demographic factors and the role of demoralization and satisfaction with care.

Anxiety and depression are common in cancer patients and seem to affect quality of life, treatment compliance and even survival. Defining factors related to anxiety and depression and exploring the role of demoralization and satisfaction with care, could contribute to the improvement of patients' quality of life and quality of health services as well. A convenience sample of 150 cancer inpatients and outpatients from two oncology centers, with various types of solid tumors, participated in a prospective cross-sectional observational study. The psychometric tools used were the Greek versions of the Hospital Anxiety and Depression Scale, FAMCARE-Patient Scale and Oncology Palliative Care (FAMCARESCALE) and Demoralization Scale (DEMORALIZATION SCALE II, DS-II). Patients mean age was 62years (20-85years) and 89 patients (59.3%) were women. Among patients, 33% had breast, 24% gastrointestinal and 15% lung cancer. Eighty-two patients (54.7%) had metastatic disease. Women showed higher rates of anxiety (p=0.054). Anxiety was inversely related to age (p=0.043) and positively correlated with time since diagnosis (p=0.076). Unmarried patients presented with higher rates of depression (p=0.026). Multiple linear regression showed a statistically significant impact of Demoralization factor 'Meaning and Purpose' on anxiety (p<0.001, R2 =36.3%) and depression (p<0.001, R2 =49%). Moreover, higher educational level (p=0.038, R2 =3.1%) is related to higher levels of anxiety and higher scores of FAMCARESCALE factor-Information/interaction with the health care professionals, is related to lower levels of depression (p=0.008, R2 =2.7%). The results highlight the significant impact of demoralization on anxiety and depression in cancer patients. Early recognition of demoralization and early referral to mental health professionals will hopefully alleviate the mental burden of cancer patients.

Hurdles of intravenous thrombolysis in acute ischemic stroke at Balochistan

Background and objective:&#x0D; Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan.&#x0D; Methods:&#x0D; A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data was collected, tabulated, and statistically analyzed using an IBM Statistical Package for the Social Sciences (SPSS), version 20.&#x0D; Results:&#x0D; Out of 272 patients, 156 patients were male and 116 patients were female. Only two patients presented within 4.5 hours of onset of acute ischemic stroke, 27 patients within 13- 24 hours,44 patients within 25-72 hours and 171 patients beyond three days. Two-hundred patients first took advice from faith healer (peer), 50 patients from general practitioner and 22 patients preferred neurologist.&#x0D; Conclusion:&#x0D; Very few patients presented within Alteplase window. Major reason of delay was contacting faith healer first. There is necessity of awareness campaigns to overcome this hurdle and to minimize barriers for improving access to thrombolysis and specialized stroke care in Balochistan.

Prescription pattern in ischemic heart disease inpatients at B. P. Koirala Institute of Health Sciences: a cross sectional study

Background: Drug utilization pattern studies seek to screen, evaluate and suggest appropriate modifications in prescription practices. It would help to make patient care rational and cost effective. Objective was to analyze the drug prescribing pattern for treatment of ischemic heart disease (IHD). Methods: A prospective cross-sectional observational study was conducted in patients of IHD admitted in intensive coronary care unit and medicine ward for the period of six months. Data were collected in preformed case record form. The data were analyzed for drug use indicators, demographic parameters, morbidities, pattern of drug use using Microsoft excel 2010. Results: A total of 145 patients were enrolled out of that 89 (61.38%) were males. The mean age was 60.01±12.71 years and majority (26.89%) belonged to age group of 61-70 years. A total of 1208 drugs were prescribed in 145 patients. Most frequently prescribed drugs were antiplatelet group of drugs 100% encounters, followed by hypo-lipidemics (98.62%). Average number of drugs per encounter was 8.33 and percentage of drugs prescribed by generic name was 5.04%. Conclusions: IHD was more common in males than females. The most commonly prescribed drug classes were anti-platelet drugs followed by hypolipidemic agents.

Prevalence and pattern of isolated fungi from bronchoalveolar lavage among patients with lung cancer: a prospective cross-sectional study

BackgroundFungal colonization or infection has recently been reported in patients with lung cancer, and it is possible that it has a role in the pathogenesis of lung cancer or having an effect on treatment and outcome. Aim of work was to assess the prevalence and pattern of isolated fungi from patients with lung cancer at the time of diagnosis. In this prospective cross-sectional observational study, patients with suspected lung tumors were subjected to fiberoptic bronchoscopy (FOB) for biopsy, bronchoalveolar lavage (BAL) with its culture for fungal growth. After a pathological diagnosis, 100 cases of confirmed lung cancer were entered into the study analysis. The prevalence and type of isolated fungi have been determined and compared to the characteristics of the participants and cell types of lung cancer.ResultsFungi were isolated from 68% of the studied lung cancer cases. The most common isolated fungi were Candida albicans (32%), Aspergillus niger (28%), and Aspergillus fumigatus (8%). Fungi were isolated with a higher frequency in lung cancer cases with the following characteristics: males (p = 0.008), current or ex-smokers (p = 0.002), and chronic obstructive pulmonary disease (COPD) association (p = 0.01). In comparison to lung cancer cases with negative fungal culture, detection of fungal colonization was more associated with increasing severity of clinical presentation: higher grades of dyspnea (grade 1 vs. grade 2, p 0.001), a higher cough score (score 1 versus score 3, p 0.001), a higher chest pain score (score 0 versus score 1, p 0.001), and higher scores of hemoptysis (score 0 versus score 3, p 0.001). Otherwise, no difference was detected regarding age, frequency of comorbidities, chest computed tomography (CT) findings, lung cancer cell type, and staging in lung cancer patients with fungal colonization (p > 0.05).ConclusionFungi were isolated in more than two thirds of lung cancer cases at the time of diagnosis with higher frequency among males, smokers, and those having associated COPD. This may negatively affect the response to treatment and prognosis of lung cancer. ClinicalTrials.gov (NCT 05575388).

Deep Optic Nerve Head Structures Associated With Increasing Axial Length in Healthy Myopic Eyes of Moderate Axial Length

To elucidate which swept-source optical coherence tomography (OCT)-derived optic nerve head (ONH) parameters are associated with longer axial length (AXL) in healthy myopic eyes. Prospective cross-sectional observational study. Two hundred eleven healthy eyes of 140 participants (96 emmetropic-mild myopic [AXL: 22.2-24.5 mm], 83 moderately myopic [24.5-26.0 mm], and 32 highly myopic [26.0-27.4 mm] eyes) were enrolled. Bruch membrane opening (BMO), anterior scleral canal opening (ASCO) area and ovality, minimum rim width, parameters defining misalignment between the BMO and ASCO planes, OCT-defined region of perineural canal retinal epithelium atrophy and externally oblique choroidal border tissue, circumpapillary retinal nerve fiber layer thickness (cpRNFLT), circumpapillary choroidal thickness (cpChT), lamina cribrosa parameters, and peripapillary scleral (PPS) angle were calculated from BMO-centered radial scans reconstructed from 3D raster scans. Multivariate linear mixed models were used to elucidate ONH parameters that are independently associated with AXL. Longer AXL was associated with a greater misalignment between ASCO and BMO planes, larger region of externally oblique choroidal border tissue, thinner cpChT, larger PPS angle, larger ASCO area, and thicker cpRNFLT (all P < .040 after Bonferroni's correction for number of included explanatory variables). A greater misalignment between BMO and ASCO planes, thinner choroid, a more posteriorly bowed PPS, an enlargement of ASCO, and thicker cpRNFLT were each associated with longer AXL. An enhanced understanding of these AXL-associated configurations should provide essential information to improve our ability to detect glaucoma-induced ONH morphology in myopic eyes.

Comparison of Microbiological Results of Superficial Swab versus Deep Tissue Biopsy in Diabetic Foot Infections: A Prospective Observational Study from North India

Introduction: Diabetes mellitus is the leading cause of nontraumatic lower extremity amputation worldwide. Risk of developing a foot ulcer in diabetic patients has increased to 12-25% during their lifetime. Inappropriate sampling technique leading to contaminated samples is a well-known threat among patients of diabetic foot. In this study we compared two microbiological sampling techniques, superficial swabbing and deep tissue biopsy for identification of pathogens. Material and Methods: It was a prospective observational cross-sectional study. Diabetic foot was defined as per standard guidelines. Careful and meticulous examination of diabetic foot ulcer was done. Two specimens were collected from each wound. The first specimen was a wound swab collected by using Levine technique; another was taken via punch biopsy from the ulcer base. It was a deep tissue sample of 4 mm size. Results: A total of 120 diabetic patients with diabetic foot infection were included in this study. In swab culture 80.83% patients had mono microbial growth, 15% had polymicrobial and 4.10% had no growth. In deep tissue culture 87.50% had mono microbial growth, 2.50% had poly microbial and 10% were sterile. Staphylococcus aureus was most common isolate followed by E. coli. It was observed that though monomicrobial growth was most common in both the types of samples but was higher in deep tissue biopsy than in superficial swab samples. Conclusion: The isolation of microorganism via deep tissue sampling in diabetic foot ulcer patients is more reliable compared to superficial swab samples and a better guide to antibiotic therapy.

Correlation of MLR with CRP and MPVPCR with LED in Traumatic Brain Injury

BACKGROUND: Traumatic brain injury (TBI) contributes greatly to high rates of death and disability globally. It may be divided into primary and secondary injuries. Primary head injuries occur at the moment of impact which causes mechanical loads and accelerations both linearly and rotationally, causing injury to the brain. After the primary brain injury, further biochemical and cellular processes occur that lead to secondary injury. Secondary insult in TBI may lead to several neuroinflammation processes that are reflected on laboratory markers. The monocyte-lymphocyte ratio and mean platelet volume-platelet count ratio (MPVPCR) theoretically have the potential to be used as neuroinflammation markers in TBI. AIM: This study was conducted to assess the relationship between monocyte-lymphocyte ratio (MLR), MPVPCR with both C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) regarded as inflammation markers in relation to secondary brain injury. METHODS: This study was a cross-sectional prospective analytic observational study conducted at the Sanglah hospital emergency department from February to May 2022. Patients diagnosed with TBI aged 18 years and over that were willing to be included in the study by consecutive sampling. Patients with a history of autoimmune disease, history of taking immunosuppressant drugs, and fractures of &gt; 2 long bones were excluded and the presence of infection characterized by fever was excluded from the study. History taking and physical examination were done to obtain data regarding age, gender, mechanism of injury, Glasgow Coma Scale, fainting duration, and memory loss. The blood sample was taken at 24 h after trauma to obtain MLR, MPVPCR, CRP, and ESR results. Pearson correlation test was done to determine the correlation between MLR and MPVPCR with CRP and LED. RESULTS: There are a total of 85 patients included in this study with the mean of age which is 36 ± 2.5 years old. Most of them are men (71.3%) with the mean of GCS on admission which is 12. Mean ± (SD) of the monocyte, lymphocyte, and platelet was 1.12 ± 0.82 × 103/μL, 1.83 ± 1.69 × 103/μL, and 259.34 ± 85.79 × 103/μL consecutively. MLR with CRP had a weak positive correlation and was statistically significant (r = 0.215; p = 0.045), as well as MPVPCR with ESR also had a weak positive correlation and was statistically significant (r = 0.276; p = 0.010). While both MLR with ESR and MPVPCR with CRP had no correlation. CONCLUSION: MLR can be an option representing CRP in predicting the magnitude of inflammation in head injury and MPVPCR can be considered to be used as a predictor of thrombotic phenomena in TBI.

Evaluation of the prevalence of hepatitis C virus through rapid test in public health services users in Campina Grande-PB

Chronic hepatitis C is a silent evolution disease that can lead to outcomes such as liver cirrhosis and hepatocellular carcinoma (HCC), a public health problem due to high universal morbidity. It is transmitted by single-stranded ribonucleic acid (RNA) virus, discovered in 1989 through studies of contaminated chimpanzees. Unsafe health practices, use of illegal intravenous drugs and tattoos are among the major risk factors for the transmission of this virus. Currently, it is estimated that 71 million people are infected worldwide, in Brazil, the prevalence of 0.7% indicates that 1.032.000 individuals are contaminated. With quick execution and rapid results availability, Rapid Tests (RT) facilitate epidemiological studies and early diagnosis of hepatic impairment, allowing the modification of the natural history of the disease. To evaluate the presence of Anti-HCV antibodies and epidemiological characteristics of hepatitis C in users of health services in Campina Grande-PB. A prospective cross-sectional observational study, from February 2015 to July 2018. Individuals born between 1945 and 1970 who sought health services voluntarily underwent structured questionnaires and the Bioeasy® Rapid Anti-HCV Test. A total of 385 individuals were studied, with a prevalence of Anti-HCV antibodies of 1.84% (n = 7). Of the interviewees, the majority (29.7%) were in the age group between 45 and 50 years and 67.7% were female. Intravenous illicit drug use, tattooing and male sex presented the highest statistical relevance as a risk factor in the study population. A prevalence higher than that estimated for the country was found, which highlights the need to implement strategies aimed at the early detection of virus carriers.

RDW as a Prognostic Marker of Sepsis and its Comparison with APACHE II Score: A Prospective Observational Cross-sectional Study

Introduction: Sepsis is one of the most important and common cause for Intensive Care Unit (ICU) admission. Life-threatening organ dysfunction is caused by a dysregulated host response to infection. Clinical scoring system is cumbersome for prognosticating sepsis outcome. Red cell Distribution Width (RDW) is a part of routine investigation done in the form of Complete Blood Count (CBC), inexpensive and easily available. Aim: To evaluate RDW as a prognostic marker of sepsis and its comparison with APACHE II (Acute Physiology And Chronic Health Evaluation II) score. Materials and Methods: The present study was a prospective observational cross-sectional study which included 110 patients diagnosed with sepsis. The patients were divided into survivors and non survivors group. CBC, liver function test, kidney function test, serum electrolytes, Arterial Blood Gas (ABG) analysis, blood culture, site-specific culture were done and APACHE II was calculated. Results: Out of the 110 patients enrolled in the study, 61 were males and 49 were females. Mean±SD age of the non survivors (n=42) was 57.45±22.93 years and that of survivors (n=68) was 58.59±17.18 years. APACHE II score in the non survivors was 18.50±6.80 while that among the survivors was 10.51±6.61 (p&lt;0.001). RDW in the non survivors was 17.62±4.29 while that in the survivors was 13.99±1.66 (p&lt;0.001). Conclusion: RDW was found to be significantly higher in non survivor group as compared to survivor in this study. So RDW at admission can be used as simple, easy to perform prognostic marker of sepsis.

Clinico-Epidemiological Profile and Short-Term Outcomes of Patients with Acute Poisoning Presenting to an Emergency of a Tertiary Care Center in Western Rajasthan.

This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate.