Referral Hospital Research Articles

Metagenomic Detection of Bacterial Zoonotic Pathogens among Febrile Patients, Tanzania, 2007-20091.

Bacterial zoonoses are established causes of severe febrile illness in East Africa. Within a fever etiology study, we applied a high-throughput 16S rRNA metagenomic assay validated for detecting bacterial zoonotic pathogens. We enrolled febrile patients admitted to 2 referral hospitals in Moshi, Tanzania, during September 2007-April 2009. Among 788 participants, median age was 20 (interquartile range 2-38) years. We performed PCR amplification of V1-V2 variable region 16S rRNA on cell pellet DNA, then metagenomic deep-sequencing and pathogenic taxonomic identification. We detected bacterial zoonotic pathogens in 10 (1.3%) samples: 3 with Rickettsia typhi, 1 R. conorii, 2 Bartonella quintana, 2 pathogenic Leptospira spp., and 1 Coxiella burnetii. One other sample had reads matching a Neoerhlichia spp. previously identified in a patient from South Africa. Our findings indicate that targeted 16S metagenomics can identify bacterial zoonotic pathogens causing severe febrile illness in humans, including potential novel agents.

Modified by the Innovative Drugs and Strategies-Pattern of Selected Indications for Pediatric Liver Transplantation.

Liver transplantation (LTx) constitutes a major life-saving routine treatment for children with end-stage liver disease. However, the analysis of LTx registries in children provides much information about changes in the indication profiles in the recent years. The article provides a comprehensive review about the successes, hopes, and challenges related to changing indications for LTx in children based on the literature review and our own experience. Retrospective review of the indications for LTx at a tertiary referral pediatric hospital was also presented. In the context of the new therapies that have emerged, the need for LTx has decreased in patients with chronic hepatitis B and C infection and tyrosinemia type 1. In primary hyperoxaluria type 1, new RNAi-based therapy has eliminated the requirement for LTx (both isolated or combined). There is a hope that introduction of ileal bile acid transporter (IBAT) blockers reduces the need for LTx in patients with Alagille syndrome or progressive familial intrahepatic cholestasis. The number of children qualified for LTx with urea cycle disorders (UCDs) as a prophylaxis of neurodevelopmental impairment is increasing.

CFTR mutations and phenotypic correlations in people with cystic fibrosis: a retrospective study from a single centre in south India

Emerging data reveal higher-than-expected prevalence of cystic fibrosis (CF) among non-European populations worldwide including in the Indian subcontinent. Systematic analyses of the CFTR mutation profile, and genotype-phenotype correlations among people with CF from south, east, or northeast India have not been reported before. We wanted to identify CFTR mutations in people with CF, and highlight novel variants, selective phenotypic correlations, and regional variances within India. A retrospective study was conducted at Christian Medical College, Vellore, India (single tertiary referral hospital) from September 2010 to August 2022, involving 120 people with CF from (i) four south Indian states (Tamil Nadu, Andhra Pradesh, Kerala, Karnataka), (ii) in and nearby regions of West Bengal, India and (iii) Bangladesh. Comprehensive CFTR mutation analyses were done by Next-Generation Sequencing, and variants were categorized per American College of Medical Genetics guidelines and compared with validated Locus-specific databases. Demographic characteristics, mutation profile, novel mutations, selective phenotype correlations, and regional variances were assessed. In 120 people with CF, 55 CFTR variants were identified, including six novel variants. F508del was the predominant mutation, yet with a lower allele frequency than reported among European populations (27% versus 70%). Phenotypic correlations suggested high mutational pathogenicity causing severe multi-organ morbidity, and death in 27%. Milder variants associated with pancreatic sufficiency were also evident in 23% of people with CF. Statistically significant regional variances were noted in genotype frequency, and clinical phenotype among people with CF from the two regions. Hotspot exons and introns that could potentially help create targeted mutation panels were identified. The identification of 55 different CFTR variants among 120 people with CF describes the diversity of mutations noted in India, while also revealing the challenges that providers may encounter in timely diagnosis and treatment of CF. However, these single-centre data have specific limitations and cannot be generalised to all people with CF from India or to those of non-European origin. Our data on regional CFTR mutations contribute to the emerging national registry on CF epidemiology in India, help formulate diagnostic and newborn screening algorithms, help optimise clinical care, and highlight urgency to improve access to life-changing modulator therapy. Cystic Fibrosis Foundation, USA (towards the CF-India Demonstration Project) and Christian Medical College, Vellore, India.

Healthcare workers attitude regarding kangaroo mother care in Nyeri county referral hospital, Kenya.

Background: Kangaroo Mother Care (KMC) is a system used for the care of preterm babies and low birth weight babies. The World Health Organization (WHO) recommends the use of KMC to help achieve Sustainable Development Goal (SDG) 3.2, with an aim of reducing neonatal mortality to 12 per 1,000 live births per country. Healthcare workers play a significant role in initiating, supporting and sustaining the practice of KMC. This study assessed the healthcare workers attitude regarding KMC in Nyeri county referral hospital, Kenya. Methods: This was a cross sectional descriptive survey study. Census sampling method was used to recruit 28 respondents. A researcher administered questionnaires were used to collect data. Analysis was done using SPSS software Version 26. Descriptive statistics and chi-square tests were used for analysis. Results: The study found that 89% (n=25) of the respondents had a positive attitude about KMC practice. Half of all the healthcare workers 50% (n= 14) had received training on KMC. Majority of the healthcare workers 71% (n=25) preferred incubators over KMC. However there was no significant relationship between (X2 = 0.700, df = 1, p = 0.403) training of healthcare worker and KMC adoption. Conclusion: The study concluded that the healthcare workers had a positive attitude towards KMC. Half of them had received training on KMC however, majority preferred incubators over KMC. The study recommends KMC sensitization seminars and continuous training of healthcare workers on KMC. Establishment of excellent centers as a way of motivating them is also recommended.

Prevalence of cervical cancer and associated factors among women attending gynecological clinic outpatient department at tumbi regional referral hospital, Tanzania

Prevalence of cervical cancer and associated factors among women attending gynecological clinic outpatient department at tumbi regional referral hospital, Tanzania

Trends in osteoporosis prevalence at a tertiary care referral center hospital in Northeastern Thailand: a 20-year analysis (2003-2022).

To investigate the prevalence trends of osteoporosis from 2003 to 2022 using data from the largest tertiary care referral center in Northeastern Thailand. Bone mineral density (BMD) measurements of community-dwelling individuals aged > 45years were reviewed from the medical record database of Srinagarind Hospital, Khon Kaen, Thailand, between 2003 and 2022. Osteoporosis was defined by a T-score of ≤ - 2.5. For each year, crude and age-standardized prevalence rates for osteoporosis stratified by site of measurement were calculated. Trend analysis was performed using the joinpoint regression method. A total of 36,306 BMD measurements were identified between 2003 and 2022. The crude prevalence of femoral neck (FN) osteoporosis increased from 2.4% to 9.2% in men and from 2.5% to 11.2% in women, while the age-standardized prevalence increased less, from 2.6% to 8.3% in men, and slightly decreased from 8.7% to 7.6% in women. Trend analysis revealed increased crude and age-standardized prevalence rates of FN osteoporosis in men, with an annual percent change (APC) of 4.0 (95%CI: - 4.1 to 14.7) and 2.3 (95%CI: - 4.9 to 10.0), respectively. In women, the crude prevalence increased significantly from 2003 to 2011 (APC: 20.8, 95%CI: 5.8-249.3) and plateaued from 2011 to 2022 (APC: 0.8, 95%CI: - 30.3 to 5.9). The age-standardized prevalence was relatively unchanged (APC: 0.1, 95%CI: - 4.2 to 5.4). We observed a significant increase in the crude prevalence of osteoporosis from 2003 to 2022 among individuals receiving BMD measurements in a tertiary care referral center in Northeastern Thailand. Meanwhile, the age-standardized prevalence increased more gradually.

Oocyte donors' experience and expectations in a non-profit fertility care setting.

In this survey, we aimed to provide the description of previous oocyte donors' profile in a Belgian tertiary fertility hospital clinic. The research question is as follows: could certain aspects be changed or improved, according to previous oocyte donors? The final purpose is to boost adherence to future oocyte donation (OD) programs, given the large gap between supply and demand. We set up an observational cross-sectional study of oocyte donors who were recruited in a tertiary referral hospital. Participants were asked to join an anonymous online survey with questions about demographic and reproductive variables, reasons to start or discontinue OD, satisfaction rate, experience, and attitude towards presumed anonymity. A total of 218 women were eligible to join the study, with a response rate of 49% (108/218). The emerging profile of the oocyte donor is a well-educated (102/108 with at least a high school degree), employed (86/108) woman in her thirties. Altruism and solidarity were the main drivers of their choice (105/108), and a general permissive attitude towards disclosure of their personal information to the recipient (60/108) was registered. In case of negative experience or discontinuation, concerns regarding pain management and specific long-lasting psychological support were expressed (8/20). Our findings suggest the need to improve pain relief and to offer psychological support even beyond ending the donation process. These interventions could improve both participation and adherence to OD programs, ensuring an autonomous and free choice while avoiding any risk of exploitation.

Outcome of Fetuses with Anterior Abdominal Wall Defects in A Tertiary Referral Hospital

Outcome of Fetuses with Anterior Abdominal Wall Defects in A Tertiary Referral Hospital

Factors associated with postoperative nausea and vomiting after laparoscopic cholecystectomy at the National Referral Hospital, Bhutan: a cross-sectional study

IntroductionPostoperative nausea and vomiting (PONV) are common distressing symptoms experienced after laparoscopic cholecystectomy. We report the rate, and the factors associated with postoperative nausea and vomiting, the patterns of prophylactic antiemetic prescription, and the anesthetic techniques used among patients who underwent laparoscopic cholecystectomy at the Jigme Dorji Wangchuck (JDW) National Referral Hospital, Bhutan.MethodsA cross-sectional study was conducted at the JDW National Referral Hospital, from January to December 2018. All the patients who underwent laparoscopic cholecystectomy under general anesthesia were included in the study. The demographic variables, premedication, induction agents, muscle relaxants, inhalational agents for maintenance, opioid and adjuvant analgesics, the reversal agents used, and the occurrence of PONV within 24 h were recorded. Data were analyzed using SPSS (version 23). Continuous variables were compared using a t-test or Mann-Whitney test, categorical variables were tested using chi-square or Fisher’s exact tests. Binary logistic regression analysis was performed to determine the factors associated with postoperative nausea and vomiting.Results190 patients underwent laparoscopic cholecystectomy under general anesthesia. The rate of PONV after laparoscopic cholecystectomy was 31.1% (59/190). Over half (53.7%, 102/190) of the study population were within 21–40 years of age, over 80% (157/190) were female, and 2/3rd were overweight and obese. The most frequently used premedication was ranitidine (39%, 34/87) and metoclopramide (31%, 27/87). More than half (57.4%, 109/190) of the patients received morphine as an opioid analgesic before induction. Sodium thiopentone was a commonly used induction agent (65.8%, 125/190). Succinylcholine and atracurium were mostly preferred muscle relaxants. Isoflurane and air were the most used inhalational anesthetic agents for the maintenance of anesthesia. Ondansetron was the most preferred anti-emetics during the intraoperative period. Previous history of motion sickness (OR 5.8, 95%CI 2.9–11.2, p < 0.001), and use of sodium thiopental (OR 4.1, 95%CI 1.9–9.1, p < 0.001) were independent risk factors for PONV. The use of antiemetics (OR 0.1, 95%CI 0.0-0.4, p = 0.002), propofol (OR 0.2, 95%CI 0.1–0.5, p < 0.001), adjuvant analgesic paracetamol (OR 0.4, 95%CI 0.2–0.8, p = 0.026), and adequate hydration with IV fluids (OR 0.9, 95%CI 0.9-1.0, p = 0.042) were preventive factors for PONV.ConclusionThe rate of PONV after laparoscopic cholecystectomy was high. History of motion sickness and use of sodium thiopental for induction were independent risk factors of PONV. The use of multimodal prophylactic antiemetics was robust and superior to monotherapy in preventing PONV. This finding re-emphasizes the need for risk stratification and appropriate use of antiemetics and anesthetic agents to prevent PONV.

Retrospective evaluation of acute kidney injury in paediatric COVID-19 patients: a tertiary referral hospital experience.

Coronavirus disease 2019 (COVID-19) has been recognised as a risk factor for acute kidney injury (AKI). Our aim was to investigate the risk factors contributing to hospitalised and outpatient paediatric COVID-19-associated AKI. A retrospective observational study was conducted on patients aged 1month to 18years with diagnosed COVID-19-associated AKI applied to a tertiary paediatric referral hospital between March 1, 2020 and March 1, 2022. A total of 6683 patients were evaluated and 486 patients were included in the study. Acute kidney injury was observed in 3.7% of outpatients and 23.9% of hospitalised patients. Multivariate logistic regression analysis showed that, on admission, a history of contact with a COVID-19 positive person (p < 0.001), age below 12months (p = 0.004), presence of comorbidities (p < 0.001), abdominal pain (p = 0.008), anorexia (p = 0.003), dyspnoea (p = 0.005), higher lactate dehydrogenase values (p = 0.004), neutrophilia (p < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (p = 0.003), higher white blood cell counts (p = 0.006), elevated C-reactive protein (CRP) levels (p = 0.002), anaemia (p = 0.015), hypoalbuminaemia (p < 0.001), hyperglycaemia (p = 0.006), and presence of proteinuria (p = 0.003) were independent predictors of AKI. Higher rates of hospitalisation (p < 0.001) and admission to the paediatric intensive care unit (PICU) (p < 0.001), longer length of hospitalisation (p < 0.001), and greater need for mechanical ventilation (p < 0.001) were associated with AKI. This study reveals that not only hospitalised children, but also paediatric patients are at risk for AKI. The presence of comorbidities, abdominal pain, anorexia, dyspnoea, anaemia, inflammation, hypoalbuminaemia, proteinuria and history of contact with a COVID-19 positive person were the main risk factors for AKI. COVID-19-associated AKI was associated with worse outcomes.

Association between metabolic syndrome and cervical cancer among women in Southwestern Uganda: A case-control study

ObjectiveTo determine the association between MetS and its components with cervical cancer among women in South-western Uganda. MethodsWe conducted an unmatched case-control study on 470 participants in a 1:2 case-to-control ratio among women in southwestern Uganda. We recruited 157 women with cervical cancer as cases and 313 women without cervical cancer as controls at the Mbarara Regional Referral Hospital Cervical Cancer Clinic. We assessed for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We used a multivariable binary logistic regression analysis to determine the association between MetS and its components with cervical cancer adjusted for potential confounders. We reported the adjusted odds ratios (aOR) and 95% confidence intervals (CI). ResultsCases were significantly older than controls: 52.4 ± 13.15 versus 41.9 ± 11.9 respectively, p < 0.001. We found MetS was independently associated with cervical cancer (aOR 1.66; 95 % CI 1.07–2.57). Age ≥ 50 years (aOR-2.20; 95 % CI 1.35–3.56), HIV infection (aOR 2.51, 95 % CI 1.56–4.05), increasing parity (aOR 1.16, 95 % CI 1.06–1.26), and a lack of formal education (aOR 6.41, 95 % CI, 1.33–30.86) were also associated with cervical cancer. However, none of the components of MetS was associated with cervical cancer. ConclusionIn Ugandan women, MetS was associated with a higher likelihood of cervical cancer. We, therefore recommend combined screening for MetS and cervical cancer in order to reduce morbidity and mortality from both Mets and cervical cancer.

Risk factors for readmission after sepsis and its association with mortality

BackgroundSepsis is associated with an approximately 20 % 30-day readmission rate and with subsequent mortality. ObjectivesTo determine the demographics, comorbidities that had been documented prior to sepsis onset, processes of care, commonly administered laboratory tests measured near discharge, and post-sepsis infections that may be associated with readmission and, secondarily, whether readmission is an independent risk factor for 90-day mortality. MethodsUsing a database of patients who met Sepsis-3 criteria divided into Construction and Validation groups, we used logistic regression to estimate the factors independently associated with readmission within 30 days after discharge and proportional hazard regression to estimate the factors independently associated with 90-day mortality. ResultsOf the 30,798 patients ≥ 18 years at our combined referral and community hospital and were discharged alive who met Sepsis-3 criteria between July 10, 2009 and September 7, 2019, 5943 (19 %) were readmitted within 30 days. Thirteen thousand, four hundred forty-four (44 %) of the patients were female, 25,293 (82 %) White, 3523 (11 %) Black, and the mean age was 59 ± 17 years. Among the readmitted patients, 894 (15 %) died within 90 days from the original discharge compared to 11 % (p < 0.001) who had not been readmitted. Seven comorbidities, five processes of care (presepsis platelet transfusion, postsepsis platelet transfusion, operation, ICU length of stay, and hospital length of stay), five culture results, two discharge laboratory values, and discharge location were associated with readmission. The model had good discrimination, 0.770 ± 0.004 (Construction Group) and 0.748 ± 0.006 (Validation Group) and good relevancy (area under the precision recall curve), 0.390 ± 0.004 (Construction group) and 0.476 ± 0.005 (Validation group). Readmission within 30 days was independently associated with a 56 % higher risk of death (HR=1.562, 95 % CI=1.434, 1.703, p < 0.001) within 90 days from discharge. ConclusionsComorbidities, abnormal laboratory values, processes of care, and post-sepsis onset culture results, but not demographic characteristics, were associated with 30-day readmission. Readmission was associated with 90-day mortality.

The implementation of the acute care surgery model in the management of patients with acute appendicitis - A 5-year single-center, retrospective experience: An observational study.

We conducted this study to assess the effects of the acute care surgery (ACS) model in the management of patients with acute appendicitis (AA) based on our 5-year single-center, retrospective experience. The current single-center, retrospective, observational study was conducted in a consecutive series of the patients with AA who had been surgically treated at a tertiary referral hospital in Seoul, Korea, between January 2016 and December 2020. At our institution, the ACS model was first introduced in March 2018. Therefore, our clinical series of the patients were divided into 2 groups: the pre-ACS group (March 2014 to February 2018) and the post-ACS group (March 2018 to December 2022). Key time intervals include emergency department registration to request for surgical consultation, request for surgical consultation to decision on surgery, decision-to-operating room, time to decision on surgery and length of emergency department stay. Moreover, outcomes include rates of perforation and complications and discharge within 24 or 48 hours. We compared key time intervals, outcomes, and length of hospital stay between the 2 groups. A total of 900 patients with AA were finally included in the current study, 447 and 453 of whom were divided into the pre-ACS group (n = 447) and the post-ACS group (n = 453), respectively. There were significant differences in key time intervals, outcomes, and length of hospital stay between the 2 groups (P < .05). In conclusion, our results showed that the implementation of the ACS model was effective in improving key time intervals, rates of perforation, and discharge within 24 or 48 hours in the patients with AA.

Risk factors of mortality in patients with rheumatoid arthritis-associated interstitial lung disease: a single-centre prospective cohort study

ObjectivesTo determine the risk factors for mortality in Korean patients with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) in comparison to patients with RA but without ILD (RA-nonILD).MethodsData were extracted from a single-centre prospective cohort of RA patients with a chest computed tomography scan at an academic referral hospital in Korea. Patients with RA-ILD enroled between May 2017 and August 2022 were selected, and those without ILD were selected as comparators. The mortality rate was calculated, and the causes of each death were investigated. We used Cox proportional hazard regression with Firth’s penalised likelihood method to identify the risk factors for mortality in patients with RA-ILD.ResultsA total of 615 RA patients were included: 200 with ILD and 415 without ILD. In the RA-ILD group, there were 15 deaths over 540.1 person-years (PYs), resulting in mortality rate of 2.78/100 PYs. No deaths were reported in the RA-nonILD group during the 1669.9 PYs. The primary causes of death were infection (nine cases) and lung cancer (five cases), with only one death attributed to ILD aggravation. High RA activity (adjusted HR 1.87, CI 1.16–3.10), baseline diffusing capacity for carbon monoxide (DLCO) < 60% (adjusted HR 4.88, 95% CI 1.11–45.94), and usual interstitial pneumonia (UIP) pattern (adjusted HR 5.13, 95% CI 1.00–57.36) were identified as risk factors for mortality in RA-ILD patients.ConclusionPatients with RA-ILD have an elevated risk of mortality compared with those without ILD. Infection-related deaths are the main causes of mortality in this population. High RA activity, low DLCO, and the UIP pattern are significantly associated with the mortality in patients with RA-ILD.

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BackgroundCerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.MethodsA hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.ResultsEighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08–6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days’ hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.ConclusionsThe clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.

Clinical impact of drug-drug interactions on abemaciclib in the real-world experience of AB-ITALY study

Abemaciclib demonstrated clinical benefit in women affected by HR+/HER2− advanced breast cancer (aBC). Drug-drug interactions (DDIs) can lead to reduced treatment efficacy or increased toxicity. This retro-prospective study aimed to evaluate outcomes, DDIs’ impact, and toxicities of abemaciclib combined with endocrine therapy in a real-world setting. Patients from 12 referral Italian hospitals with HR+/HER2− aBC who received abemaciclib were included. Clinical data about comorbidities, concurrent medications, outcomes, and adverse events (AE) were collected. Drug-PIN® (Personalized Interactions Network) is a tool recognizing the role of multiple interactions between active and/or pro-drug forms combined with biochemical and demographic patient data. The software was used to define the Drug-PIN score and Drug-PIN tier (green, yellow, dark yellow, and red) for each patient. Univariate and multivariate analyses were performed to identify predictors of patients’ PFS or toxicity. One hundred seventy-three patients were included. 13% of patients had >75years. The overall response rate (ORR) was 63%. The general population’s median PFS (mPFS) was 22 months (mo), while mOS were not reached. Patients treated with abemaciclib in combination with AI and fulvestrant had a mPFS of 36 and 19 mo, respectively. The most common toxicities were diarrhea, asthenia, and neutropenia detected in 63%,49%, and 49% of patients. The number of concomitant medications and comorbidities were not associated with survival outcomes (22 vs 17 mo, p = 0.068, p = 0.99). Drug-PIN tier from dark yellow to red and Drug-PIN score >12 were associated with shorter PFS compared to no/low-risk DDIs and score <12 (15 vs 23, p = 0.005, p = 0.0017). Drug interaction was confirmed as an independent biomarker in a multivariate model (p = 0.02). No difference in any grade AE, severe toxicities, and diarrhea were detected among different age subgroups. No association was found between Drug-PIN score or Drug-PIN tier and overall toxicity (p = 0.44), severe AEs (p = 0.11), or drug reduction (p = 0.27). The efficacy and safety of abemaciclib plus ET were confirmed in a real-world setting, even in the elderly population and patients with comorbidities. Evaluation of DDIs with Drug-PIN appears to be an independent predictor of PFS.

Cervical cancer screening by cytology and the burden of epithelial abnormalities in low resource settings: a tertiary-center 42-year study

BackgroundCytological screening remains a high-impact practice, particularly in low-resource settings, for preventing cervical cancer. The examination of screening practices over time and the prevalence of epithelial abnormalities have not been investigated in longitudinal studies in one of the largest countries in the Middle East and Africa.MethodsRoutine healthcare data, between March 1981 and December 2022, were extracted from the database of the Early Cancer Detection Unit in a tertiary referral university hospital in the Greater Cairo Region, Egypt. Cervical smears were obtained using a standardized technique and sent to the cytopathology laboratory for conventional cytology examination by expert pathologists. The anonymous data were analyzed to determine the temporal trend of the number of women screened each year and the prevalence of epithelial abnormalities.ResultsData included the results of satisfactory smears from 95120 women. The mean age (SD) of the women at the time of screening was 38.5 (10.5). None of the included women received an HPV vaccine. Abnormal epithelial cells were reported in 5174 women (5.44%). Of these epithelial abnormalities, the majority were low-grade squamous intraepithelial lesions in 4144 women (4.36%). Other abnormalities included atypical squamous cells in 378 women (0.40%), high-grade squamous intraepithelial lesions in 226 women (0.24%), atypical glandular cells not otherwise specified in 184 women (0.19%), adenocarcinoma in 165 women (0.17%), squamous cell carcinoma in 70 women (0.07%), and atypical glandular cells favoring neoplasms in 7 women (0.01%). Women who were at an early age at first intercourse, those who opted for routine cervical cytology screening, and those who were older at screening were more likely to have epithelial abnormalities. The yearly number of screened women was positively associated with the detection of low-grade squamous intraepithelial lesions (correlation coefficient [95% CI] = 0.84 [0.72, 0.91]) and negatively associated with the detection of squamous cell carcinoma (correlation coefficient [95% CI] = -0.55 [-0.73, -0.29]).ConclusionsThe small number of annually screened Egyptian women and the temporal trend in epithelial abnormalities critically demonstrate the need for establishing and scaling up a structured population-based program to achieve the goal of eliminating cervical cancer.

Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight

Early interventions improve neurodevelopmental outcomes after preterm birth, but few studies of early intervention have focused on preterm infants whose families reside in low- or middle-income countries (LMICs). To evaluate whether parent-guided early intervention improves the neurodevelopmental outcomes of preterm infants in an LMIC. This randomized clinical trial was performed at a high-risk obstetric referral hospital in Brazil, with outcome evaluations by examiners masked to randomization group. Eligibility criteria were (1) birth at the study hospital, (2) residence within 40 km of the birth hospital, and (3) gestational age of less than 32 weeks or birth weight of less than 1500 g. Of 138 enrolled infants, 19 died after randomization and 19 withdrew from the study; all other enrollees (50 per randomization group) were evaluated for the primary outcome. Data were collected from January 1, 2016, to May 31, 2022, and analyzed from June 10 to July 31, 2022. On postnatal day 7, infants were randomized to usual care, consisting of support for lactation, kangaroo care, and routine developmental therapies, or to a parent-guided enhanced developmental intervention, consisting of usual care plus infant massage and enhanced visual stimulation, auditory stimulation, social interactions, and support for motor development, instructed by developmental therapists. The primary outcome was the Bayley Scales of Infant and Toddler Development-Third Edition score at 18 months of age adjusted for prematurity. Among the 100 infants included in the analysis, mean (SD) gestational age was 28.4 (2.2) weeks, and 57 (57%) were male. The mean (SD) gestational age for the intervention group was 28.3 (2.3) weeks; for the usual care group, 28.5 (2.2) weeks. Female infants accounted for 21 infants (42%) of the intervention group and 22 (44%) of the usual care group; male infants, 29 (58%) and 28 (56%), respectively. The enhanced developmental intervention group had higher cognitive scores at 18 months of corrected age (mean [SD], 101.8 [11.9] vs 97.3 [13.5]; mean difference, 4.5 [95% CI, 0.1-8.9]). In this randomized clinical trial of a parent-guided developmental intervention for early cognitive function of very preterm or very low birth weight infants implemented in an LMIC, the intervention improved very preterm infants' neurodevelopmental outcomes at 18 months of adjusted age. Parent-guided early intervention can improve neurodevelopmental outcome of very preterm infants born in LMICs. ClinicalTrials.gov Identifier: NCT02835612.

Profile and Outcome of Patients Admitted to Pediatric Intensive Care Unit at a General Referral Hospital

Introduction: Nepal has made substantial progress in child health primarily through preventive care. There is an increasing need for critical care services across the country which is highly resource intensive. Periodic data of critical care admissions help plan the utilization of scarce resources in a low-income country like Nepal. This study aimed to analyze the epidemiologic patterns of critically ill pediatric patients admitted to the pediatric intensive care unit (PICU). Methods: This descriptive study of all children admitted to PICU at Tribhuvan University Teaching Hospital for 18 months between October 2017 and April 2019 was conducted by a retrospective review of hospital records. Demographic data, etiologies of PICU admissions and outcomes of children admitted to the PICU were analyzed. Results: PICU admitted 413 children during the study duration from all over the country. Children under the age of 2 years (36%) were admitted in the largest number and boys outnumbered girls (65.1%). Respiratory illnesses, neurosurgical and neurological problems, infectious disorders and airway foreign bodies were the most common etiologies for admission. The average length of ICU stay was around 4.4 days. Almost one-third of patients required circulatory and respiratory support. At the time of exit from PICU, 14.3% of patients died; 4.3% patients had opted for withdrawal of life support or decided to leave hospital against medical advice. Conclusion: Patients with diverse etiologies were admitted to ICU from all over the country. A similar analysis from PICUs across the country can serve as the basis for development of newer intensive care facilities in the country, developing dedicated protocols for critical care and redistributing the ICUs’ available resources for optimal efficiency.

Oxygen therapy practice and associated factors among nurses working at an Ethiopian Referral Hospital

ObjectiveSupplemental oxygen therapy is suppling oxygen at quantities higher than those found in the atmosphere (>21 %) and is mostly prescribed for hypoxic patients. To avoid hypoxemia, hypercapnia, and oxygen poisoning, nurses closely monitor patients receiving oxygen therapy. There are considerable gaps in nurses' practice of oxygen therapy. Patients who receive inappropriate oxygen therapy may have negative effects, and it has financial repercussions for both individuals and nations. The aim of this study was to assess oxygen therapy practices and associated factors influencing oxygen administration among nurses in an Ethiopian Regional Hospital. MethodFrom March 1 to March 30, 2019, a cross-sectional institutional study using quantitative methods was performed amongst nurses working at a referral hospital in northwestern Ethiopia. Data was gathered using structured self-administered questionnaires. ResultIn this study, 147 participants (91.3 %) were found to have inadequate practice with oxygen therapy. Nurses' lack of knowledge about carbon monoxide, adult patients' typical breathing rates, cardiopulmonary function, and devices (face mask, nasal cannula, oxygen concentrators, pulse oximeter and others) that are difficult for patients to accept were found to be factors associated with oxygen administration practice. ConclusionThe findings of this study showed that nurses' use of oxygen administration was subpar. The institutional factors, knowledge gaps, and attitudes of nurses were identified as the determinants affecting oxygen administration practice. Nurses would do better to read up on oxygen administration, interact with one another and undertake further training.