Secondary Care Centres Research Articles

Experiences of Preoperative COVID-19 Screening in Pediatric Patients in a Secondary Care Center

Experiences of Preoperative COVID-19 Screening in Pediatric Patients in a Secondary Care Center

Level of Anxiety and Factors Influencing Anxiety among Orthopedic Surgical Patients in a Secondary Care Center in India

Background: The purpose of the present study aimed to assess the level of anxiety and factors influencing anxiety among orthopedic surgical patients admitted to a secondary care center in India. Methods: The study was conducted for a period of 3 months. A quantitative approach with a descriptive design was used. Simple random sampling was used to select 46 orthopedic inpatients. Demographic and clinical data were collected using a self-developed pro forma. State-Trait Anxiety Inventory form Y-1 was used to assess anxiety, and factors influencing anxiety were assessed by a self-developed questionnaire. Results: Out of 46 participants, 60.90% have low anxiety, 15.20% have moderate, and 23.90% have severe anxiety. Regarding factors influencing anxiety, 78.30% have fear about postoperative pain; 60.90% have fear about surgery; 58.70% have fear about anesthesia, the outcome of surgery, and economic issues; and 52.20% have fear of dependency and postponement of surgery. Some other factors are fear of complications and lack of sleep during night 45.70%, fear about family issues 37%, fear of postoperative nausea 34.80%, fear of death 23.90%, fear about the structure of the ward 17.40%, and fear due to lack of preoperative instructions 13%. Conclusions: Anxiety is common among patients waiting for orthopedic surgery. It is important to identify the factors influencing anxiety as a routine nursing care to reduce anxiety level.

Prognostic Factors in Patients with COVID-19 Disease: A Retrospective Study in a Secondary Care Center

The aim of this study was to identify clinical and laboratory characteristics with impact on outcome of patients with SARS-CoV2-Infection in a secondary care center in Germany. Therefore, a total of 69 hospitalized patients with COVID-19, detected with positive Multiplex real-time PCR result, were recruited from March 2020 to May 2020 to investigate the influence of comorbidities, demographic information and laboratory parameters on outcome. Data of routine laboratory examinations of 57 patients were collected at admission to detect prognostic factors. Mean age of patients was 70.0 years (21-99 years, median 74.0 years, SD 16,9). 28 patients (40,6%) had a severe course of disease (death and/or need for intensive care medicine), 20 patients (29%) died. LDH > 460 U/l (p=0.004, OR 12.99, 95% CI 2.23-75.67), Diabetes mellitus (p=0.021, OR 9.53, 95% CI 1.14-64.48) and Troponin T > 38 pg/ml (p=0.026, OR 6.04, 95% CI 1.24-29.43) were associated with occurrence of severe illness in multivariate analysis. Elevated Troponin T > 38 pg/ml (p=0.002, HR 8.22, 95% CI 2.19 – 30.88) and Diabetes mellitus (p=0.05, HR 3.14, 95% CI 1 – 9.85) were also associated with death. Patients with these conditions should be monitored closely.

Clinical spectrum of chronic liver disease with final outcome in children at a tertiary centre: A single - centre study.

Background and Objectives:Chronic liver disease (CLD) in children present a broad spectrum of symptoms. Limited resources in Paediatric Hepatology in developing countries like Pakistan present considerable challenges in investigating and treating children with chronic liver disease in a timely fashion. This study aimed to determine the spectrum and outcomes of CLD other than chronic hep B & C virus (HBV& HCV) liver disease in children.Methods:This retrospective descriptive study was conducted at the Paediatric Gastroenterology and Hepatology Department, Pakistan Kidney and Liver Institute and Research Centre in Lahore, Pakistan. The duration of the study was from August 2019 to January 2020. A total of 162 children of CLD were seen during this period of time. Of 162 there were 130 children with chronic HBV & HCV who were excluded from this study. 32 children aged 15 years or younger with chronic liver disease were included. The referrals were received from primary and secondary health care centres in different parts of the country. The data were collected from hospital electronic medical records database and then incorporated into a spreadsheet for analysis. The statistical analysis was performed by applying t-test with p value determined.Results:Of 32 children autoimmune hepatitis (n=11; 34.3%) was the most common cause for chronic liver disease referrals, followed by progressive familial intrahepatic cholestasis type-2, (n=7; 21.8%), post Kasai for biliary atresia, (n=4; 12.5%), glycogen storage disease type-1 (n=5; 15.6%), Wilson disease (n=3; 9.3%) and primary sclerosing cholangitis (n=2; 6.2%). The diagnosis was principally established with the assistance of liver ultrasound, liver biopsy, magnetic resonance cholangiopancreatography and genetic testing.Conclusion:Autoimmune hepatitis was the most common chronic liver disease. Our systematic approach, in addition to an extensive workup, helped us to diagnose and then initiate an appropriate treatment, which resulted in a more optimal outcome. Prompt referrals to tertiary centres are recommended where resources and expertise are available to reduce patient morbidity and mortality.

Effects of the outbreak of COVID-19 on oral health-care workers (HCWs) at the regional dental center in Qassim, Saudi Arabia

Introduction: Since the emergence of the 2019 novel coronavirus (COVID-19), the pandemic has rapidly spread all over the globe, affecting millions of people and resulted in over 1,900,000 deaths. During the outbreak of COVID-19 situation, health-care workers in general and dental team specifically are at risk of developing psychological distress and other mental health symptoms.Aim: The study was conducted to investigate the effects of outbreak of coronavirus (COVID-19) on oral health-care workers (HCWs) at the Regional Dental Center in Qassim and how it affects their practice and daily life in terms of psychological, mental, behavioral manner, and social well-being.Materials and Methods: This is a cross-sectional, single dental care facility-based study. A bilingual questionnaire was distributed to a convenience sample of 150 HCWs. The questionnaire contained 26 questions covering the following domains: (a) demographic data, (b) knowledge testing and sources of information, (c) personal precautions and infection control measures, and (d) behavioral and psychological aspects. The questionnaire was distributed through the social media platform. Data were analyzed using SPSS version 22. Descriptive statistics were used for data summarization and presentation.Results and discussion: The response rate was 72% , with the age range from 18 to 54 years, with female 60% to male 40% distribution. A very high level of awareness about the COVID-19 ranging from 60% to 100% was found among participants. The main sources of information regarding coronavirus were Ministry of Health (MoH), social media, followed by the World Health Organization website. Almost 90% started regular hand hygiene and paying attention to the proper use of personal protective equipment. Almost 70% agreed to stop treating patients due to their perception of the risk of contamination. Almost 90% of them felt afraid of transferring the infection to their families. Majority of them spent their time on social media, while nearly 50% on reading and sleeping. Almost two-third of the participants do highly trust the precautions which have been taken by the MoH and the Regional Dental Center in Qassim.Conclusions: It is concluded that the HCWs had good knowledge and awareness about COVID-19. They are concerned about their safety and possibility of spread of infection to their families and considered to stop regular dental treatment. Their satisfaction is moderate about the safety measures provided by MoH and the center. Future research should be carried out at multicenter, primary, secondary, and tertiary care centers to generalize the findings.

Pattern of Fungal Dermatoses Investigations in Upth: A Five-Year Review

Background: Infectious dermatoses are rife in resource limited settings. Fungi skin infection constitutes the majority of infective skin conditions seen by physicians in primary, secondary, and tertiary health care centers, in Nigeria. Methods: A retrospective five-year review of the pattern of fungal dermatoses investigations among patients attending the University of Port Harcourt Teaching Hospital between 2015 – 2020 was carried out. Results: There were five hundred and fifty-five (555) patients referred for fungal investigations over the five-year period. The data showed that most of the patients referred for fungal investigations were between 21 – 30 years (36.4%) and 31 – 40 years (18.2%) respectively. Most of the patients were observed to be female (57.1%). The bulk of the referrals originated from the dermatology/medical outpatient clinic (90.3%). About 45% (252/555) of the referrals was observed to have fungal growth. The most common fungi isolated was <i>Aspergillus</i> sp (41.67%) and <i>Candida</i> sp (35.3%) with Blastomyces spp and Fusarium spp being the least isolated fungi (0.4% each). Conclusion: The study showed that the pattern of dermatoses was not significantly associated with age or gender. Superficial fungi infections still need to be addressed as a public health problem among the growing populace of Nigeria. Similarly, there seem to be a relative increase in the prevalence of skin infections among elderly people in the period under review.

Status of eye health among tribal school children in South India.

Purpose:Global trends show a high prevalence of refractive errors among children. The prevalence of vision impairment due to uncorrected refractive errors among school children is increasing and the need for management of other ocular conditions is also reported. This study presents the status of eye health and pattern of daily activities among the school children of a tribal location in Tamil Nadu, South India.Methods:A cross-sectional study was conducted in 13 schools of Karumandurai cluster, Salem district in Tamil Nadu, India. A three-phased comprehensive school screening protocol was conducted to understand the prevalence of vision impairment, refractive error, and other ocular conditions along with a survey about the daily activities of the children at school and home.Results:Among the 3655 children screened, the prevalence of vision impairment was found to be 0.62% (n = 23, 95% confidence interval [CI] 0.42–0.94) and prevalence of refractive error was 0.30% (n = 11, 95%CI 0.17–0.54), among which 0.11% (n = 4) were already wearing spectacles. A total of 44 children (1.20%; 95%CI 0.90–1.61) were found to have other ocular problems and among them, 14 (0.38%) had visual acuity less than 20/30 (6/9). Almost 84% of children required surgical or specialty eye care services. Vision impairment was more in children with other ocular conditions compared to refractive errors (P < 0.001).Conclusion:The prevalence of vision impairment and refractive errors in this tribal area was less. Ocular conditions were more prevalent than refractive errors in this tribal region with the majority of children needing specialty or surgical eye care services. This implies the need for access to secondary or tertiary eye care centers.

Experiences of training and delivery of Physical therapy informed by Acceptance and Commitment Therapy (PACT): a longitudinal qualitative study

ObjectivesPhysiotherapy informed by Acceptance and Commitment Therapy (PACT) is a novel intervention that is related to improved disability and functioning in people with chronic lowback pain. This study explored physiotherapists experiences over time of the PACT training programme and intervention delivery. DesignA longitudinal qualitative study using semi-structured, in-depth, individual interviews at three time points was conducted. MethodsA phenomenological approach underpinned the methods. Interviews followed topic-guides developed a priori. Transcribed interviews were coded inductively to generate themes. Data were member checked by participants and validated by two researchers. ParticipantsEight clinical physiotherapists from three secondary care centres in the United Kingdom (n = 5 female; age, 24 to 44 years; duration of practice, 3 to 14 years) were included. ResultsFive themes emerged from the data. Experiential learning techniques were challenging but valued because they bridged theoretical principles and concepts with practice. Ongoing individual and group supervision was beneficial, but required tailoring and tapering. PACT delivery extended physiotherapy skills and practice, including techniques that acknowledged and addressed patient treatment expectations. With experience, participants desired greater flexibility and autonomy to tailor PACT delivery. ConclusionsPACT training and delivery were acceptable to physiotherapists. Existing skills were developed and additional, applicable approaches were provided that addressed psychosocial and behavioural aspects of chronic low back pain.

The Long-Term Stability of the Electrical Stapedial Reflex Threshold.

To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness. Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time. Secondary care center. Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period. Cochlear implantation, eSRT testing, and, electrical upper limits of loudness. The eSRT over multiple appointments and the cochlear implant recipients' final upper limits of loudness. Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = -0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3. Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.

Increasing Azithromycin resistance Salmonella bacteremia in pediatric population in a secondary care center in India

Background: Typhoid fever is an endemic bacterial infection with high morbidity and mortality. It remains a significant health problem in south East Asia and Africa affecting children and lower socioeconomic strata. Due to the emergence of resistance to first line antibiotics (ampicillin, cotrimoxazole and chloramphenicol), Azithromycin and third generation Cephalosporins are increasingly being used in the treatment of invasive Salmonella infections. Rising incidence of cephalosporin and azithromycin resistance in Salmonella is of significant concern in developing countries like India. Errant use of Azithromycin in upper respiratory tract infections and over the counter availability of drug without prescription also add to the woes. Methods and materials: A retrospective analysis of all samples received for blood culture from April 2018 to September 2018 was done. Clinical, demographic and antimicrobial sensitivity pattern were studied in the pediatric population (<12 years) having Salmonella bacteremia from the medical record department. Blood culture was done with BD Bactec™ 9050 Blood Culture System. Antibiotic susceptibility testing was done with Kirby-Bauer disc diffusion method and Zone diameter was interpreted as per CLSI 2018. Results: Out of the 452 samples received in the laboratory, 139 beeped positive (positivity rate – 30.75%). Out of the total 139 positive cultures, 111 (79.8%) were of pediatric age and among these, 60 were having Salmonella bacteremia. Most of the patients were from ward 34 (56.7%) f/b OPD 24 (58.3%) and 2 from NICU (3.3%). Male predominance were seen 32 (53.3%). Most of the patients were admitted with fever (59, 98.3%) and 7 (11.7%) were presented with Acute Gastroenteritis. Mean age of the population was 7.7 years. Median time to Bacteremia was 2 days (range: 0–4). Salmonella resistance to Azithromycin was seen in 73.3% (n = 44) and for Ciprofloxacin was 30%(n = 18) whereas ampicillin sensitivity was 81.2% (n = 49) and 3rd generation cephalosporins were 97% (n = 58) sensitive. Conclusion: Knowledge of the antibiotic resistance pattern serves as a significant platform in improving the empirical antibiotic therapy. There is a need for continuous surveillance of antimicrobial susceptibility pattern. Resistance rates in Salmonella spp. are alarming, in particular for azithromycin and ciprofloxacin. This warrants nationwide surveillance and revision of treatment guidelines.

Post-breastfeeding stress response and breastfeeding self-efficacy as modifiable predictors of exclusive breastfeeding at 3\u2009months postpartum: a prospective cohort study

BackgroundThe rate of exclusive breastfeeding at 3 months postpartum is only 50% in Japan. In order to increase this rate, we aimed to examine modifiable factors related to exclusive breastfeeding at 3 months postpartum by focusing on breastfeeding-related and psychosocial variables at 1 month postpartum.MethodsThis prospective cohort study was conducted at a secondary medical care center in Osaka, Japan from February 2017 to October 2018. Demographic variables, infant feeding modality, breastfeeding-related variables, and psychosocial variables were obtained using questionnaires at 1 month postpartum. Daytime salivary cortisol levels before and after breastfeeding at 1 month postpartum were measured as a biological marker for stress responses associated with breastfeeding. Each infant’s feeding modality was re-assessed at 3 months postpartum. Multiple logistic regression analyses were performed to examine factors affecting exclusive breastfeeding at 3 months postpartum.ResultsOf the 104 participants, 61 reported exclusive breastfeeding at 3 months postpartum. The following factors were significantly associated with exclusive breastfeeding at 3 months postpartum: multiparity (adjusted odds ratio, 95% confidence interval: 11.13, 2.08–59.59), having a university degree (5.25, 1.04–26.53), no plan to return to work by 6 months postpartum (0.02, 0.00–0.46), and exclusive breastfeeding (42.84, 6.05–303.52), lower cortisol level after breastfeeding (0.00, 0.00–0.02), and higher breastfeeding self-efficacy scale score (1.07, 1.00–1.14) at 1 month postpartum. In parity-specific analyses, exclusive breastfeeding (25.33, 4.75–134.98) and lower cortisol level after breastfeeding (0.00, 0.00–0.21) at 1 month postpartum in primiparous women, and lower cortisol level after breastfeeding (0.00, 0.00–0.94), higher breastfeeding self-efficacy score (1.18, 1.05–1.32), and absence of breast complications (0.09, 0.01–0.82) at 1 month postpartum in multiparous women were associated with exclusive breastfeeding at 3 months postpartum.ConclusionsStress levels after breastfeeding, breastfeeding self-efficacy, and the presence of breast complications could be modifiable factors associated with subsequent exclusive breastfeeding. Further research is needed to examine whether approaches to reducing breastfeeding-related stress, improving breastfeeding self-efficacy, and preventing breast complications during lactation are effective to increase exclusive breastfeeding practices.

Palyatif bakim merkezlerinde tedavi gören hastaların değerlendirilmesi

Introduction: Palliative care centers (PC centers) provide multidisciplinary care for patients with multiple comorbid conditions. This study aimed to assess and compare patients’ diagnoses, length of hospital stays, and demographic data and coordination with home health care services.Methods: This is a descriptive, cross-sectional and retrospective study. Patients who were hospitalized in PC centers of secondary and tertiary care hospitals between 01.08.2018 and 01.08.2018 were retrospectively assessed. Patients’ demographic characteristics diagnoses of hospitalization, and length of hospital stays and centers where they received treatment were recorded. Results: Median age of 830 patients included in the study was 79 (24-102). Out of 830 patients, 48.9% were male and 51.1% were female. Mean length of hospital stay was 14 days and median length was 8.7 (0.6-112) days. The three most common comorbid diseases followed up were malignancy (21.8%), cerebrovascular disease (15.2%) and malaise-fatigue-senility (10.7%). The group with Alzheimer's disease was the oldest patient group. The group with nutritional deficiency-malnutrition was the patient group with the longest hospital stay (p=0.030). The number of patients who were hospitalized for cerebrovascular diseases was the highest in secondary care centers and the number of patients who were hospitalized for malignancy was the highest in tertiary care centers. Patients hospitalized in secondary PC center were older. The hospital stays were longer in tertiary PC center. Patients receiving treatment at a tertiary PC center had a significantly higher rate of mortality. The number of patients who were discharged was lower in the tertiary PC centers. Hospitalization to a secondary PC center through home care units was significantly higher. Conclusion: In this study, the rate and diagnoses of hospitalization and length of hospital stays were different in secondary and tertiary PC centers. Our study has made an assessment about palliative care centers at various levels of health care and can be considered as prior knowledge for other studies.

Management of Molar Incisor Hypomineralisation (MIH): A 1-Year Retrospective Study in a Specialist Secondary Care Centre in the UK.

(1) Background: Molar incisor hypomineralisation (MIH) is an enamel defect that affects an estimated 14.2% of children worldwide. Care takes place in primary and secondary care facilities. (2) Aim: To investigate how children with MIH are managed within a specialist centre in the north of England. (3) Method: A retrospective service evaluation within the paediatric dentistry department was registered with the clinical governance unit. Children who attended consultant-led new-patient clinics between 1 January and 31 December 2015 with a diagnosis of MIH were included. The data collected concerned the pre-referral treatment, the history and diagnoses and the treatments completed. (4) Results: Out of 397 records reviewed, 48 (12.1%) had MIH, where 81.3% and 18.8% of patients had severe and mild MIH, respectively. The majority of patients (n = 44 (91.7%)) were referred appropriately. Treatment was completed at the specialist centre for 44 (91.7%) patients. Twenty-five (52.1%) patients had an extraction of one or more first permanent molar teeth. Sixteen patients had the extractions at between 8 and 10 years old and 2 had the extractions later as part of an orthodontic plan. (5) Conclusion: Most children had severe MIH and were referred at an appropriate time to facilitate the consideration of loss of poor prognosis of first permanent molars (FPMs). Most children required specialist management of their MIH.

Intravesical injection of botulinum toxin A for treatment of overactive bladder in anticoagulated patients: Is it safe?

This study aimed to identify the complication rate, specifically bleeding, in patients who received anticoagulation undergoing intravesical botulinum toxin A injections. This study included all patients (n=430) undergoing intravesical injection of botulinum toxin A in a single secondary care center between January 2013 and December 2018. We recorded the use of anticoagulants/antiplatelets and complications. Logistic regression was used to investigate the association between anticoagulant/antiplatelet use and the complications arising, while controlling for age and sex. We identified 430 procedures in 94 men and 336 women (mean age, 60 years). A total of 79 patients received anticoagulants (18%). Aspirin was the most common anticoagulant (52%). Complication rate in anticoagulated patients was 6% (n=5), and it was 2% in those not on anticoagulants/antiplatelets (n=7). Complications were over 3 times more likely in patients who received anticoagulants/antiplatelets (odds ratio=3.233; 95% confidence interval=0.873, 11.38; p=0.067). There was no difference in the complications between patients with idiopathic symptoms and those with neuropathic overactive bladder. No patients required further surgical intervention, and all except 1 were Clavien-Dindo grade I-II with no mortalities. Anticoagulated patients undergoing intravesical injections have higher complication risks; however, the treatment outcome is unaffected with no significant morbidity/mortality. This is the first study to demonstrate safe outcomes for this subgroup and can assist in decision making and consenting.

Impact of Prostate Specific Antigen and Testosterone Hormone Levels in Patients of Benign Prostatic Hyperplasia in Khartoum State-Sudan

Lower Urinary Tract Symptoms (LUTS) and Benign Prostatic Hyperplasia (BPH) are progressive ailments resulting from androgenic imbalances and aging that can lead to serious long term complications. Objective of this study was to determine the relationship between prostate-specific antigens and testosterone hormone levels in patients with BPH before transurethral surgery. This case control study was done on 112 serum samples collected from two secondary care centres in Khartoum, Sudan. Collected serum samples were analyzed by ELISA and fluorescence enzymes immunoassay to measure testosterone, total PSA level and free PSA levels, respectively. Out of 112 patients, 56 BPH diagnosed patients were included in the study with mean age 67.10±7.90 years. Total PSA (T. PSA) levels were higher in patients (14.1±10.6 ng mL-1) than the control group (2.21±1.01 ng mL-1). Total 52% of patients had total PSA level in the gray zone (4-10 ng mL-1) and 33% had total PSA more than 10 ng mL-1. Testosterone levels were low in patients 3.97±2.84 ng mL-1 when compared to the control group 4.95±0.59 ng mL-1. The present study revealed that, there was a strong association between T. PSA level and testosterone hormone in BPH patients, which suggested that monitoring of testosterone level is useful in patients with prostate enlargement.

Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial

ObjectiveTo assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women.DesignParallel group randomised controlled trial.Setting23 community and...

Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial

ObjectiveTo evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor...

Long-Term Study of Hepatitis Delta Virus Infection at Secondary Care Centers: The Impact of Viremia on Liver-Related Outcomes.

Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have, however, been mainly from tertiary care centers, with risk for referral bias toward patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside the human immunodeficiency virus co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of patients with hepatitis B and D co-infection, cared for at secondary care centers in Sweden. In total, 337 patients with anti-HDV positivity, including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline, were retrospectively studied, with a mean follow-up of 6.5years (range, 0.5-33.1). The long-term risks for liver-related events (i.e., hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8-fold and 2.6-fold higher, respectively, in patients with HDV viremia compared with those without viremia, although the latter was not statistically significant. Among patients with HDV viremia with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0% after 5 and 10years of follow-up, respectively. This corresponds to an incidence rate of 0.04 cases per person-year. HDV RNA viremia is associated with a 3.8-fold higher risk for liver-related outcomes. The prognosis was rather poor for patients with HDV viremia without cirrhosis at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings may be of importance when making decisions about treatment and evaluating potential outcomes of upcoming antivirals against HDV.

Sustained Maternal Hyperandrogenism During PCOS Pregnancy Reduced by Metformin in Non-obese Women Carrying a Male Fetus.

ContextLarge, longitudinal studies on androgen levels in pregnant women with polycystic ovary syndrome (PCOS) are lacking. While metformin has a mild androgen-lowering effect in non-pregnant women with PCOS, its effects on maternal androgen levels in pregnancy are less well understood.ObjectiveTo describe androgen patterns in pregnant women with PCOS and in healthy control women, and to explore the potential effects of metformin on maternal androgen levels in PCOS.Design and SettingA post hoc analysis from a randomized, placebo-controlled, multicenter study carried out at 11 secondary care centers and a longitudinal single-center study on healthy pregnant women in Norway.ParticipantsA total of 262 women with PCOS and 119 controls.InterventionThe participants with PCOS were randomly assigned to metformin (2 g daily) or placebo, from first trimester to delivery.Main Outcome MeasuresAndrostenedione (A4), testosterone (T), sex-hormone binding globulin (SHBG), and free testosterone index (FTI) at 4 time points in pregnancy.ResultsWomen with PCOS versus healthy controls had higher A4, T, and FTI, and lower SHBG at all measured time points in pregnancy. In the overall cohort of women with PCOS, metformin had no effect on A4, T, SHBG, and FTI. In subgroup analyses, metformin reduced A4 (P = 0.019) in nonobese women. Metformin also reduced A4 (P = 0.036), T (P = 0.023), and SHBG (P = 0.010) levels through pregnancy in mothers with a male fetus.ConclusionMetformin had no effect on maternal androgens in PCOS pregnancies. In subgroup analyses, a modest androgen-lowering effect was observed in nonobese women with PCOS. In PCOS women carrying a male fetus, metformin exhibited an androgen-lowering effect.

Proportion of pulmonary tuberculosis cases diagnosed at different levels of health care across fourteen districts of Kerala

Background: It is estimated that 10.4 million cases and 1.7 million deaths occur due to tuberculosis (TB) globally. More than one quarter of TB cases and TB-related deaths worldwide occur in India each year. Kerala's TB incidence is estimated to be 67 cases per 100,000. Objective was to estimate the proportion of Pulmonary TB cases diagnosed at different levels of the health care system across all the fourteen districts of Kerala from January to September 2019.Methods: A secondary data analysis was conducted on information obtained from the NIKSHAY portal from January to September 2019. Proportion of cases detected at PHC, CHC, THQ, District hospital and other tertiary care facilities was computed. Statistical analysis was performed using statistical package of social sciences (SPSS) version 23.0.Results: The maximum number of new TB cases (70.8%) was being detected at the primary care level, while 20.3% of new cases were detected from tertiary care centres and 8.9% from secondary care centres. At the primary healthcare level, the maximum number of newly diagnosed TB cases was reported from Wayanad district (88.0%) while, in the secondary and tertiary care levels, Kollam district was found to diagnose the maximum number of new TB cases (24.0% and 48.4% respectively).Conclusions: In this study, majority of the new TB cases were being diagnosed at the Primary health care level. However, in few districts the secondary and tertiary care centres were found to be diagnosing a greater number of cases.