Retrospective Cross-sectional Analytical Study Research Articles

Temporal trend in quality indicators of diabetes care performance among persons with type 2 diabetes in primary care practice: a serial cross-sectional analytical study, 2013/14 to 2021/22

BackgroundAlthough the national-based policy implemented an initiative program to offer diabetes care management in Thailand, there are limited time trends of evidence to gauge whether the quality of diabetes care in primary care practice is improving. As such, we aimed to identify temporal trends in the quality of diabetes care performance among type 2 diabetes mellitus (T2DM) patients in primary care practice.MethodsUsing assembled patient-level data from a suburban community in northern Thailand, this serial retrospective cross-sectional analytical study obtained adult T2DM patients from nine consecutive fiscal years 2013/14 (n = 976) to 2021/22 (n = 1,242). Based on international and national guidelines recommended, nine quality indicators were examined, namely, smoking cessation, hemoglobin A1c monitoring, foot and eye examinations, albuminuria testing, statin prescription, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) prescription for chronic kidney disease (CKD)/albuminuria, and blood pressure and glycemic control. Rates and time trends achieved in each quality indicator performance were estimated. Differences in the rates of patients who met each quality indicator across reimbursement schemes were explored.ResultsFrom 2013/14 to 2021/22, all quality indicators have increased over time (p for trend <0.05) except for smoking cessation, which remained steady. In 2021/22, only three out of nine quality indicators (i.e., smoking cessation, annual HbA1c monitoring, and annual foot examination) were successfully met at 70% or greater. Differences in quality indicators of diabetes performance were observed, particularly those under the Civil Servant Medical Benefit Scheme compared with other health insurance counterparts. For overall time trends analysis (compared with 2013/14), significant relative changes in the fiscal year 2021/22 were found in the annual foot examination (adjusted 12.1% increase; p = 0.048), annual albuminuria testing (adjusted 12.1% increase; p = 0.048), and ACEI/ARB prescription for persons with CKD or albuminuria (adjusted 22.2% increase; p = 0.025).ConclusionAmong adult T2DM patients from 2013/14 to 2021/22, overall quality indicators for diabetes performance have substantially improved over time. However, health inequity regarding diabetes care performance was found across different reimbursement schemes. Sustainable policy implementation and innovative strategies to narrow health inequity are warranted to optimize diabetes care in primary care practice.

Use of Routine Dual-Energy X-Ray Absorptiometry-Based Bone Mineral Density Measurement in Individuals with Self-Reported Falls within 1 Year as a Warning Sign of Sarcopenia Assessment

This study evaluated the association between self-reported falls within 1 year and fragility fracture among patients who underwent dual-energy X-ray absorptiometry (DXA)-based bone mineral density (BMD) measurement. This retrospective cross-sectional analytic study included 1,283 women and men aged 40–90 years who underwent BMD measurement using DXA. The variables assesses were age, sex, body mass index, self-reported falls within 1 year, fragility fractures and bone site, parental hip fracture, current history of daily smoking and daily excess alcohol consumption, long-term steroid use, rheumatoid arthritis, secondary osteoporosis, BMD and BMD T-scores of the lumbar spine and hip, vertebral fracture assessment results, and diagnostic classifications of osteoporosis. The participants were divided into the faller group (those with at least one fall incident within 1 year) and the non-faller group. Overall, 375 (29.2%) patients reported history of falls within 1 year. A previous history of hip fracture (aOR = 7.674, 95% CI: 3.96– 14.86, P = 0.000), previous non-vertebral fracture (aOR = 6.305, 95% CI: 3.41–11.66, P = 0.000), previous vertebral fracture (aOR = 2.466, 95% CI: 1.61–3.78, P = 0.000), and parental hip fracture (aOR = 2.354, 95% CI: 1.46–3.80, P = 0.000) was associated with self-reported falls within 1 year. In conclusion, self-reported falls within 1 year were strongly associated with fragility fracture. The simultaneous testing of DXA- based appendicular skeletal mass and hand grip strength is recommended for diagnosing coincident sarcopenia on routine DXA- based BMD measurement.

Clinical-epidemiological profile and factors associated with viral non-suppression in patients living with HIV/AIDS assisted at the Integrated Treatment Center at the Maputo Military Hospital (CITRA/MMH), 2019 to 2020

BackgroundHIV remains a critical global public health challenge. In 2022, it was estimated that approximately 39.0 million people worldwide were living with HIV, and of these, around 29.8 million were receiving antiretroviral therapy (ART). The objective was to evaluate the clinical and epidemiological profile and factors associated with viral load (VL) non-suppression in people living with HIV/AIDS at the Maputo Military Hospital (CITRA/MMH).MethodsA retrospective cross-sectional analytical study was conducted on 9105 people aged 15 years and over. We use secondary data from participants on ART for at least 2 years being followed up between the years 2019–2020 at CITRA/MMH. Those recently enrolled (on ART < 1 year) were excluded and data analysis was performed using STATA version 16. Pearson's chi-square test and logistic regression were used for statistical modeling of viral non-suppression with a 95%/CI confidence interval and p < 0.05.ResultsAmong a total of 9105 HIV participants included, 52.8% (n = 4808) were female and 13.6% (n = 1235) were military personnel. The average age was 47.9 years (standard deviation ± 12.1), with the most prevalent age group being individuals aged between 25 and 59, totalizing 7,297 (80.2%) participants. Only 5395 (100%) participants had VL results. Among these, 23.1% (n = 1247) had a result VL non-suppressed. Single marital status (Adjusted Odds Ratio [AOR] = 4.8, 95%CI: 3.93–5.76, p < 0.001), with active tuberculosis (AOR = 4.6, 95%CI: 3.15–6.63, p < 0.001) and current ART regimen in categories TDF + 3TC + EFV (AOR = 12.7, 95%CI: 9.74–16.63, p < 0.001), AZT + 3TC + NVP (AOR = 21.8, 95% CI: 14.13–33.59, p < 0.001) and “other” regimens (AOR = 25.8, 95%CI: 18.58–35.80, p < 0.001), when compared to the TDF + 3TC + DTG regime, were statistically significant for viral non- suppression.ConclusionThe study highlights the crucial role of ART adherence and ongoing monitoring to achieve viral suppression, particularly among adults aged 25 to 59. It underscores the need for transitioning eligible individuals to DTG-based regimens and addressing the implications of single marital status and comorbid conditions like active tuberculosis. The study emphasizes the importance of ARV adherence and continuous monitoring to meet the UNAIDS 95–95-95 targets and improve clinical outcomes for people living with HIV/AIDS.

Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

BackgroundUrinary incontinence (UI) after successful closure of obstetric vesicovaginal fistula (VVF) repair is a widely recognized public health problem. However, there is insufficient research evaluating the factors associated with UI after successful obstetric VVF repair in Ethiopia.ObjectivesThe main aim of this study was to assess the magnitude and associated factors of UI following the successful closure of obstetric VVF repair at the Yirgalem Hamlin Fistula Center in the Sidama region of southern Ethiopia.MethodsA retrospective cross-sectional analytical study was performed on patients who underwent obstetric VVF repair at the Yirgalem Hamlin Fistula Center between 2016 and 2020. The data were collected from September to October 2021. EPI Data Version 3.1 and SPSS Version 25.0 were used for data entry and analysis. A multivariable binary logistic regression model was used for all variables significant in the bivariate binary logistic analysis to determine the association between the independent variables and outcome variables. The data are presented in tables and figures. Variables with a p-value < 0.05 were considered to be statistically associated with the study outcome.ResultsIn total, 499 study subjects were included. The magnitude of UI after successful closure of obstetric VVF repair was 23.25%. A Goh type 4 fistula (AOR = 4.289; 95% CI 1.431, 12.852), a fistula size > 3 cm (AOR = 8.855; 95% CI 4.786, 16.382), a partially damaged urethra (AOR = 2.810; 95% CI 1.441, 5.479), and a completely destroyed urethra (AOR = 5.829; 95% CI 2.094, 16.228) were found to be significantly associated factors with the outcome variable.ConclusionsNearly one in four patients who had successful closure of obstetric VVF repair at the Yirgalem Hamlin fistula center had UI, which is above the WHO recommendations. The presence of a Goh type 4 fistula, large fistula size, and damaged urethral status significantly affect the presence of UI. Therefore, interventions are necessary to prevent and manage UI among patients who underwent obstetric VVF repair and had a closed fistula.

Development, Validation, and Diagnostic Accuracy of the Fetal Lack of Responsiveness Scale for Diagnosis of Severe Perinatal Hypoxia.

Background: There are limitations to predicting perinatal asphyxia, as current tools rely almost entirely on fetal cardiotocography (CTG). The fetal lack of responsiveness scale (FLORS) is a new diagnostic alternative based on the physiological phenomena associated with fetal hypoxia. Objectives: The objective of this study was to develop, validate, and assess the diagnostic accuracy of the FLORS for predicting severe perinatal hypoxia (SPH). Study Design: A two-phase retrospective observational cross-sectional analytical study was conducted. Phase 1 involved the formulation and retrospective validation of the FLORS. A total of 366 fetal CTG records were evaluated twice by seven readers. Phase 2 was a collaborative, retrospective, multicenter diagnostic test study that included 37 SPH and 366 non-SPH cases. Results: Phase 1: A numeric, physiology-based scale was developed and refined based on expert opinions. The median time to apply the scale per reading was 38 s. Cronbach's alpha, which is a reliability measure, was significant (p = 0.784). The kappa index for test-retest agreement was moderate to reasonable, with a median value of 0.642. For interobserver agreement, the kappa index per variable was as follows: baseline, 0.669; accelerations, 0.658; variability, 0.467; late/variable decelerations, 0.638; slow response decelerations, 0.617; and trend to change, 0.423. Phase 2, including 37 SPH and 366 non-SPH cases, showed a sensitivity of 62.2% and specificity of 75.4% for the 2-point score, whereas the 3-point score had a sensitivity of 35.1% and specificity of 89.9%. The area under the curve (AUC) was significant at 0.73 (CI 0.645-0.818). Conclusions: FLORS demonstrated significant internal consistency and observer agreement, with a promising sensitivity-specificity balance and significant AUC. Further research is needed to assess its impact on perinatal hypoxia and cesarean delivery.

The Efficacy of Hb and RBCs Indices Components of a Full Blood Count Test on Detection of Colorectal Cancer among Adult Sudanese Patients

Background: One of the most dangerous neoplasms affecting the colon, rectum, and/or anus, colorectal cancer (CRC) has a variety of macroscopic and histopathologic features. The third most prevalent cancer worldwide and the fourth most common cancer-related cause of death is colorectal cancer. The second most prevalent gastrointestinal cancer and the fifth most frequent primary tumor in Sudan is colorectal cancer. A complete blood count (FBC) is a routine blood test that can include up to 20 different blood components and is used in both primary and secondary care. This study was done to assess how well the FBC test works for detecting CRC. Objectives: We hypothesized that the Hb and RBCs indices (RBCs counts, PCV, MCV, MCH, and MCHC) components of a full blood count test have a value in the detection of colorectal cancer among adult Sudanese patients. Material and Methods: This study was a hospital- based retrospective cross-sectional analytical study. The study included 100 patients diagnosed with colorectal cancer. The study was conducted at the Shendi Oncology Hospital and Research Center; University of Shendi. In the period from August 2015 to August 2022. Result: The results of the study showed that the mean values of the RBCs, PCV, and MCV for both gender males and females were significantly higher in the healthy adult Sudanese people compared with the colorectal cancer patients (p=0.000). The mean value of the MCHC for both genders was significantly higher in the colorectal cancer patients compared with the healthy adult people (p=0.002). The mean values of the MCH and Hb were varied according to the gender between the colorectal cancer patients and the healthy adult people. The result also showed that 25 (25%) patients who performed the FBC test before receiving the chemotherapy; had relatively low mean values of Hb, PCV, MCV, MCH, and MCHC compared with 23 (23%) patients who performed the FBC test after they received the chemotherapy. Conclusion: An FBC test can be used to screen individuals who are suspected of having colorectal cancer for iron deficiency anemia, which develops as a result of persistent blood loss from rectal bleeding and is the primary symptom of CRC in the early stages.

Evaluation of Preparation and Outcome of the Joint Admissions and Matriculation Board Examinations Among First Year Medical Students in Rivers State

Background: In most countries of the world, entrance into tertiary institution is regulated by statutory examining councils / bodies, after passing recommended examinations. The aim of this study was to evaluate the determinants of success at the Nigerian University Tertiary Matriculation Examination (UTME) among first year undergraduate medical students in Rivers State in the year 2022. Materials and Methods: A retrospective cross-sectional analytical study was carried out among first year undergraduate medical students in four universities. Data was collated and analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: There were 219 (45.1%) males and 267 (54.9%) females, and their mean age was 19.45±2.80 years. Majority (n=372, 76.6%) of students prepared daily for at least 3-4 hours over at least 3 to 4 months (n=179, 36.8%) before passing their examinations. There were computer-related (134, 27.6%) and other issues. Only 257 (52.9%) students passed their UTME at first attempt. The number of UTME attempts reduces as average daily preparation hours increases; the higher the average daily examination preparation hours, the higher the chances of scoring above 200 in first attempt; the higher the number of months of active preparation, the lower the number of attempts at UTME; and these relationships were statistically significant (being p=0.000, p=0.009, and p=0.036 respectively). Conclusion: The determinants of success at the UTME of the JAMB among others are associated with students’ quality of input in preparing for the examinations. There are roles to be played at multiple levels to achieve needed improvement.

Frequency of Co-Morbidities in Patients with COVID-19

Background: This very contagious virus and the pandemic that resulted from its effects on human health resulted in major disruptions and has virtually interrupted every aspect of daily human life including transportation, business, education, and health care delivery worldwide. Patients of COVID-19 having various co-morbidities have worse outcomes when compared with patients without any co-morbidities. Patients with COVID-19 having history of diabetes mellitus, cardiovascular disease, obesity, hypertension and chronic lung disorders have poor prognosis and often lead to worsening outcomes like Pneumonia &amp; ARDS. Old patients, patients with chronic kidney disease and patients with various cancers are not only at risk for acquiring COVID-19, but there are increased chances of mortality among these patients. Objective: The objective of our study was to determine frequency of co-morbidities in patients with COVID-19 Pneumonia. Study Design: Retrospective Cross-sectional Analytical study. Settings: Isolation Wards/HDU of Allied Hospital, Faisalabad Pakistan. Duration: 06 Months from April 16, 2021 to October 15, 2021. Methods: 100 Patients diagnosed with COVID-19 according to definition and inclusion criteria were included in the study. Following demographic features of the patients admitted in Isolation wards/ HDU’s of Allied Hospital were collected: age; sex; clinical presentation; smoking history; duration between onset of disease and presentation to hospital; history of co-morbid factors like hypertension, diabetes mellitus Obesity, Cardiovascular Disease, Malignancy, history of intake of Immunosuppressive agents. Mean ± SD was calculated for the age of the patients, oxygen saturation of patients and lung involvement of patients. Frequency and percentages were calculated for the Co-Morbidities for COVID-19 pneumonia, gender of the patients, symptoms of patients. Comparative analysis of lung involvement with co-morbidities of patients was done with p value of ≤ 0.05 being considered significant. Results: Our study included 100 patients. 52 patients (52%) were males while 48 (48%) were females. Mean Age of patients was 54.91 ± 15.56 and mean oxygen saturation was 90.88 ± 5.8. Mean lung involvement of patients with COVID-19 was 30.82 ± 16.27. Fever was the commonest symptom amongst the patients included in the study (40%), followed by cough (33%) and shortness of breath (29%). Amongst the co-morbidities in patients with COVID-19, diabetes was found in 54% of the patients, followed by hypertension 34% and ischemic heart disease 6%. Conclusion: Our study concludes that individuals having underlying chronic diseases are more prone to contract COVID-19 virus and eventually develop more severe disease as compared to normal healthy persons. Thus, vaccination of this segment of society and early identification of disease among these people can help reduce morbidity and mortality. Keywords: Co-Morbidities, COVID-19, Diabetes, Hypertension.

Human examination and artificial intelligence in cephalometric landmark detection-is AI ready to take over?

To compare the precision of two cephalometric landmark identification methods, namely a computer-assisted human examination software and an artificial intelligence program, based on South African data. This retrospective quantitative cross-sectional analytical study utilized a data set consisting of 409 cephalograms obtained from a South African population. 19 landmarks were identified in each of the 409 cephalograms by the primary researcher using the two programs [(409 cephalograms x 19 landmarks) x 2 methods = 15,542 landmarks)]. Each landmark generated two coordinate values (x, y), making a total of 31,084 landmarks. Euclidean distances between corresponding pairs of observations was calculated. Precision was determined by using the standard deviation and standard error of the mean. The primary researcher acted as the gold-standard and was calibrated prior to data collection. The inter- and intrareliability tests yielded acceptable results. Variations were present in several landmarks between the two approaches; however, they were statistically insignificant. The computer-assisted examination software was very sensitive to several variables. Several incidental findings were also discovered. Attempts were made to draw valid comparisons and conclusions. There was no significant difference between the two programs regarding the precision of landmark detection. The present study provides a basis to: (1) support the use of automatic landmark detection to be within the range of computer-assisted examination software and (2) determine the learning data required to develop AI systems within an African context.

Sharps injuries with Lovenox and generic enoxaparin prefilled safety syringes: A 12-year retrospective cross-sectional analytical study.

Sharps injuries with Lovenox and generic enoxaparin prefilled safety syringes: A 12-year retrospective cross-sectional analytical study.

Red cell distribution width in the prognosis of surgical correction of congenital heart diseases

To evaluate the capacity of red cell distribution width (RDW) to predict mortality in children undergoing cardiovascular surgery at the Fundación Hospital Infantil Napoleón Franco Pareja, in Colombia. Retrospective cross-sectional analytical study that included 45 individuals aged 0 to 17 years operated for congenital heart disease. The RACHS-1 (Risk Adjustment in Congenital Heart Surgery) scale and laboratory variables including the RDW were applied. The association between RDW and mortality was determined by ROC curve analysis and Spearman’s rho correlation. An RDW greater than 15.52% represented 1.6 times more risk, compared to individuals below that value (95% confidence interval: 1.01-2.6; p = 0.034). The RDW values did not correlate with days of hospital stay or complications. The preoperative RDW and RACHS-1 score were significantly higher in the mortality group. The relationship between presurgical RDW and the RACHS-1 score was significant. In our study, the preoperative RDW had moderate power to discriminate perioperative mortality in the surgical correction of congenital heart disease. More studies with a larger sample size are required.

Post-COVID symptoms and recovery times in hospitalized mild and moderate COVID-19 patients

Settings and Design: Retrospective online cross-sectional analytical study. Introduction: Infection with SARS-CoV-2 virus led to COVID-19 pandemic with varied clinical manifestations and multisystem involvement, which persisted beyond acute stage. To evaluate the post discharge symptoms in hospitalized mild and moderate COVID-19 patients during the initial phase of pandemic. Factors associated with post-COVID symptoms and delayed recovery times were determined. Materials and Methods: One hundred and thirty-two hospitalized patients of mild or moderate COVID-19 infection diagnosed by a positive real-time polymerase chain reaction, responded to an online questionnaire. They were followed up monthly, telephonically for post-COVID symptoms and recovery times. Microsoft Excel-Student's t-test, Fischer's exact test, Chi-square test. Results: The mean age of the patients was 51.14 ± 13.78 years with male: female ratio, 1: 0.29. 80.35% had post-acute COVID symptoms. Most frequent symptoms were cough in 37.9%, breathlessness in 36.4% and fatigue in 34.8%. New onset symptoms were insomnia in 16.67%, anxiety in10.6%, depression in 9.8%, loss of libido in 5.3%. Long COVID syndrome occurred in four patients. The factors significantly associated with post-COVID symptoms were older age, comorbidities, longer hospitalization, and moderate COVID infection, whereas delayed recovery times were associated with older age, female gender, and moderate COVID illness. Conclusions: Post-COVID symptoms occur in majority of the patients. Persistent symptoms are dry cough, dyspnea, fatigue, anosmia, and ageusia. They are significantly associated with older age, underlying comorbidities, prolonged hospitalization, and moderate COVID infection. Complete recovery occurs in most patients but delayed recovery is seen in females, elderly, and moderate COVID infection. Few may develop long COVID syndrome. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.

Prevalence & Factors Associated With Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention at a Tertiary Healthcare Facility in Tanzania.

Coronary artery disease (CAD) is the leading cause of mortality and morbidity globally. Percutaneous coronary intervention (PCI) is a minimally-invasive lifesaving intervention for these patients; however, acute kidney injury (AKI) is a serious complication of the procedure commonly occurring due to radiocontrast-induced nephropathy. A retrospective cross-sectional analytical study was carried out at the Aga Khan Hospital, Dar es Salaam (AKH,D), Tanzania. A total of 227 adults who underwent a percutaneous coronary intervention from August 2014 to December 2020 were enrolled. The AKI was defined based on an increase in absolute and rise in percentage creatinine using the Acute Kidney Injury Network (AKIN), and contrast-induced acute kidney injury (CI-AKI) by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Bivariable and multivariable logistic regression was utilized to analyze factors associated with AKI and the outcomes of these patients. Twenty-two of the 227 (9.7%) participants sustained AKI. The majority of the study population was male and of Asian ethnicity. No statistically significant factors were associated with AKI. The in-hospital mortality rate was 9% for the AKI versus 2% for non-AKI groups. The AKI group had a longer hospital stay and required ICU care and organ support including hemodialysis. Nearly 1-in-10 patients undergoing PCI are likely to develop AKI. The in-hospital mortality rate isx4.5 times higher for patients with AKI post-PCI compared to those without AKI. Further larger studies are recommended to determine factors associated with AKI in this population.

Prevalence and factors associated with non-suicidal self-Injury and suicidality in children and adolescent attending Emergency department in Oman

IntroductionNon-suicidal self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry (1). NSSI is defined as intentional destruction of one’s body tissue without suicidal intent and has a prevalence rate in adolescents of approximately 30–40% in clinical samples (2). Suicide prevalence is around 24–33% (3).There are many factors leading to suicidal or self-harming behavior. A prior history of self-injurious behavior is one of the strongest predictors of future suicidal behavior, both cross-sectionally and longitudinally (6) . Additionally, longitudinal studies have found that a previous suicide attempt increases the risk of a future suicide attempt threefold.Suicide and NSSI have a significant impact on families and communities. Hence, considerable required clinical attention is warranted to develop preventive strategies.ObjectivesThe aim of this study is to investigate the prevalence of non-suicidal self-Injury (NSSI) and suicidality among children and adolescents presenting in emergency department of the tertiary psychiatric services and to study their demographic and clinical characteristics.MethodsThis is a retrospective cross-sectional analytical study included all children and adolescent patients attended the emergency department at Sultan Qaboos University Hospital between June 2021 to March 2016. The data was collected using the hospital´s electronic database to retrieve the medical records of children and adolescents who visited the emergency department. Patients who were 18 years of the age or younger were included in the study. The included patients must had been evaluated by psychiatrist during their presentations in the emergency department.ResultsDuring the 63 months of observation, 114 patients attended the emergency department and required psychiatric evaluation, 44.7%(n=51) of patients presented with NSSI and/or SA. The mean age was 15.7. 80.4%(n=41) were females while 19.6%(n=10) were males. 37.3% had a primary diagnosis of major depressive disorder (MDD) and 21.5% had comorbid medical illness. 44% of suicidal attempts were with drug overdose, mostly paracetamol overdose, while the most used method for NSSI was cutting the body with a razor, 57%.19 patients had a primary diagnosis of major depressive disorder, 17 patients had no clear diagnosis at presentation.22% of the patients had other medical comorbidities, 5 patients with epilepsy. 51% of the patients had positive family history of mental illness.ConclusionsConsidering that NSSI and suicidality were found to be the main reasons for presenting to a child and adolescent emergency psychiatric service, it seems crucial for physicians at PEDs to provide proper crisis intervention and referral to mental health services when appropriate. Early identification of risk factors is highly recommended.Disclosure of InterestNone Declared

Bone Mineral Density in Patients with Pediatric Inflammatory Bowel Disease Using Dual Energy X-Ray Absorptiometry.

Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated condition that affects the gastrointestinal system and alters bone growth and bone mineral density (BMD). Here we aimed to study the prevalence and predictors of a low BMD in pediatric patients with IBD. This retrospective cross-sectional analytical study included pediatric patients with IBD in whom BMD was evaluated using dual energy X-ray absorptiometry of the total body and lumbar spine. Osteoporosis was defined as a BMD Z-score ≤-2, osteopenia as -2 to -1, and normal as >-1. Clinical and laboratory findings were compared between patients with and without osteoporosis. Of the 48 patients, 30 (62.5%) were males, 35 (72.9%) had Crohn's disease, and 13 (27.1%) had ulcerative colitis. The mean age at diagnosis was 9.9±2.8 years. The median age at the time of the BMD scans was 11.9 (interquartile range, 9.9-14.3) years. Total body BMD scans identified 13 (27.1%) and 16 (33.3%) patients with osteoporosis and osteopenia, respectively. Spinal BMD scans revealed that 17 (39.5%) and 14 (32.6%) patients had osteoporosis and osteopenia, respectively. A low body mass index (BMI) Z-score (p=0.038), ileocolonic disease location (p=0.008), and a low calcium level (p=0.008) were significant predictors of osteoporosis on the total body BMD scans. A low BMI Z-score (p=0.039), decreased hemoglobin level (p=0.018), low calcium level (p=0.033), and infliximab use (p=0.019) were significant predictors of osteoporosis on the spinal BMD scans. This study showed a high prevalence of low BMD among pediatric patients with IBD. A low BMI, ileocolonic disease location, low hemoglobin and calcium levels, and infliximab use were significantly associated with osteoporosis.

Características clínico-epidemiológicas de pacientes fallecidos por COVID-19 en un hospital de referencia en Paraguay entre enero de 2021 a julio de 2022

Introduction. The COVID-19 pandemic from its beginning until August 13, 2022, has caused 19,478 deaths in Paraguay with a fatality rate of 2.78%. The objective of the study is to compare the characteristics of patients who died from COVID-19 in two years, January-December 2021 and January-July 2022. Material and Method. A retrospective cross-sectional analytical study of adult and pediatric patients who died from COVID-19 hospitalized in the respiratory area of the hospital. The patients were confirmed by RT-PCR in nasopharyngeal swabs. Results. Out of 5265 patients hospitalized with COVID-19, 1512 died, yielding an overall lethality rate of 28.7%, in 2021 was 26.3% (1164/4423) and 41.3% (348/842) in 2022. There was a higher percentage of men (53, 6%) among the deceased, significantly higher (p=0.045) in 2022 (58.3%) than in 2021 (52.2%); 69% of the deceased were over 60 years of age in 2022 and 48.3% in 2021; 79.2% of the patients had some risk factor, significantly higher in 2022 (84.3%) than in 2021 (77.7%), especially in AHT (54.3% vs 42.2%), heart disease (15.8% vs 9.7%), CKD (14.4% vs 5.4%), COPD (11.5% vs 5.4%), immunodeficiency (6.3% vs 2.5%) and neurological disease (3.4% vs 1.5%). The need for MRA was significantly (p &lt;0.001) higher in 2022 (50.3%) than in 2021 (31.1%). Conclusion. A high global lethality rate was observed in a reference hospital in Paraguay with mortality predictors similar to those reported worldwide.

Effects of COVID-19 Pandemic on the Frequency of Complicated Appendicitis in Pediatric Populations

Background: The clinical course of acute appendicitis, one of the most common diseases needing surgical intervention in children, was affected by the coronavirus disease 2019 (COVID-19) pandemic. The global fear and panic about the outbreak and governmental decisions on lockdowns and restrictions led to an increasing number of complicated forms of appendicitis. Objectives: This study aimed to compare different aspects of appendicitis and its complications between the pre-pandemic and pandemic periods. Methods: In a retrospective cross-sectional analytical study, we enrolled all patients with a diagnosis of acute appendicitis for two consecutive years. Only children under 14 years of age were included in the study. The patients were divided into two groups based on the time of disease presentation, the pre-pandemic and pandemic periods. Demographic features, as well as clinical, laboratory, and imaging findings, were compared between the two groups. Results: Out of 369 patients included in the study, 173 were placed in the pre-pandemic group. There was no significant change in the incidence of appendicitis between the two periods (P = 0.232). However, the incidence of complicated appendicitis increased remarkably during the pandemic (27% vs. 11%, P &lt; 0.001). No substantial differences were found in parameters like age, sex, laboratory findings, and the length of hospital stay between the two groups (P &gt; 0.005). The patients who tested positive for COVID-19 had a significantly higher hospitalization duration (P &lt; 0.001). Conclusions: Our results suggested that the rate of complicated appendicitis was substantially higher during the pandemic compared to the pre-pandemic time. Also, the proportion of midline laparotomy was significantly higher after the outbreak. These findings suggested that delays in care provision during the COVID-19 outbreak could have probably contributed to the rise in the incidence of complicated appendicitis in children.

Making a difference? A retrospective review of peripherally inserted central catheters: A single-center experience in Colombia.

Peripherally inserted central catheters (PICCs) are an effective tool as a medical device in patients who require them. However, it is a procedure that has been associated with multiple complications and possible negative outcomes for the health of the patients. This paper seeks to describe the main complications derived from the insertion and maintenance of peripherally inserted central venous catheters (PICCs), based on the experience of a vascular accesses group in a cardiovascular center in Colombia. A retrospective cross-sectional analytical study of the adult population undergoing PICC insertion at the Fundación Cardioinfantil-Instituto de Cardiología, during the period between 2019 and 2020 by the vascular access program, was performed. The frequency of any registered complication was 15.9% for 2019 and 11.2% for 2020. Bleeding at the procedure site occurred in 15.3% during 2019 and 7.0% in 2020, making it the most frequent complication during the procedure. All the variables of complications associated with infection (bacteremia, phlebitis, and catheter-related infection) showed a decrease in 2020 compared to the previous year. The central line-associated bloodstream infection registered for the year 2019 was 1.94 bacteremia's/1000 catheters-day compared to 0.29 bacteremia's/1000 catheters-day. There has been a 4.7% reduction in the frequency of any registered complication after the implementation of the vascular access groups. Global and specific complications decreased significantly from 2019 to 2020. Notably, bacteremia, a common post-procedure complication, showed a substantial decrease in frequency compared to national and worldwide literature. It is also been described that complications associated with infection showed a decrease in 2020 compared to 2019. Whether or not all these findings are directly or somewhat related to the results stemming from the vascular access groups still needs further investigation.

Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia

Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018. Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus.

Role of Chest Radiograph in Diagnosis of Acyanotic Congenital Heart Disease

Background: Early diagnosis of acyanotic congenital heart disease could lead to early referral and treatment before the onset of irreversible sequelae. Despite the development of modern imaging methods, conventional chest radiographs remain an important component of diagnostic process in pediatric cardiology. The aim of this study is to determine the accuracy of the results of chest X-ray examination with echocardiography results in patients with suspected acyanotic congenital heart disease at H. Adam Malik General Hospital Medan in 2019-2020.&#x0D; Methods: This study was a retrospective cross-sectional analytical observational study with a diagnostic test design to compare the sensitivity and specificity of conventional chest radiography compared with echocardiography of patients with suspected acyanotic CHD with shunts. The sample population was all children &lt;18 years with suspicion of cyanotic CHD who came for treatment at H. Adam Malik Hospital Medan in the period January 2019 - December 2020. The study used data from medical records at H. Adam Malik Hospital Medan. The collected data is then analysed for diagnostic tests.&#x0D; Results: This study had a sample of 64 people with the highest proportion of samples being women, the average age was 67.9±54.1 months, and the results of echocardiography of the ductus arteriosus were persistent. The results of the diagnostic test showed a sensitivity of 78% and specificity of 80%, 95% PPV value and 40% NPV value, LR+ 3.8 and LR- 0.2.&#x0D; Conclusions: chest X-ray is adequate as a diagnostic tool in acyanotic congenital heart disease with left-to-right shunt. Clinical suspicion accompanied by chest X-ray results suggesting acyanotic congenital heart disease should be further assessed.