Secondary Care Hospital Research Articles

Evaluation of the Early-Mid-Term Results of Isolated Tibial Insert Exchange After Total Knee Arthroplasty.

This study aimed to assess the early and mid-term results of patients who had undergone total knee arthroplasty (TKA) and then underwent an isolated tibial insert exchange due to tibial insert fracture and/or melting. A retrospective study was conducted at the Orthopedics and Traumatology Clinic in a secondary-care public hospital in Türkiye on seven knees of six patientsaged 65 years and abovewho underwent an isolated tibial insert exchange and were followed up for at least six months. Pain and functional assessments of the patients were made with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) performed at the last control before the treatment and at the final follow-up visit after the treatment. The median age of the patients was 70.5 years. The median length of time between the primary TKA and the isolated tibial insert exchange was 5.96 years. After isolated tibial insert exchange, the patients were followed for a median of 268 days and a mean of 414 days. The WOMAC pain, stiffness, function, and total indexes were median 15, 2, 52, and 68, respectively, before the treatment. In contrast, the final follow-up WOMAC pain, stiffness, function, and total indexes were median 3 (p = 0.01), 1 (p = 0.023), 12 (p = 0.018), and 15 (p = 0.018), respectively. It was observed that the median VAS, which was "9" preoperatively, showed a statistically significantimprovement to become "2" in the postoperative period. A strong negative correlation was found between age and the amount of decline in the total score of the WOMAC pain scale (r = -0.780; p = 0.039). There was a powerful negative correlation between the body mass index (BMI) and the amount of decline in WOMAC pain scores (r = -0.889; p = 0.007). A strong negative correlation was found between the length of time passing between two surgical procedures and the amount of decline in the WOMAC pain score (r = -0.796; p = 0.032). Individual patient factors and prosthetic conditions should be considered undoubtedly when determining the best revision strategy in TKA patients. In cases where the components are well-aligned and well-fixed, isolated tibial insert exchange is an alternative to revision TKA since it is less invasive and more cost-effective.

A Questionnaire Based Study on Practice of Visits Related to Post-Operative Anesthesia

Aims: To assess the frequency of anesthesiologists practicing post-op anesthesia visit and to determine the reasons of not regularly performing post-operative anesthesia visit. Study design: Cross-sectional study. Place and duration of study: Tertiary and Secondary care hospitals of Karachi from 7th November 2019 to 7th April 2020. Methodology: One hundred and eighty four anesthesiologists were enrolled. The eligibility of the anesthesiologist was assessed based on the eligibility criteria. The PI or the study team member was met the anesthesiologist on the decided date and time and asked him/her to complete the questionnaire. The questionnaire would take 10-15 minutes. This questionnaire was used to assess post-op practice and reasons for not performing post-operative anesthesia visit. Results: The average age of the participants was 30.94±2.98 years. 52.72% of the anesthesiologists do not practice PAVs and 47.28% reported that they perform PAVs. Furthermore, majority of the anesthesiologist who do not practice PAVs reported that lack of time the most common reason for not performing PAVs regularly (80.4%) followed by long distances to the patients to be covered (19.6%), patients already discharge (18.6%) extensive research (17.5%) and others (13.4%). Conclusion: Most of the anesthesiologists do not practice PAVs. Considering the high appreciation of post-anesthesia visits by anesthesiologists, as well as the relevant incidence of postoperative complications detected during these visits, it seems desirable to consider organizational improvements for post-anesthesia care. Keywords: Post-operative anesthesia visit, Surgeon satisfaction, Post-operative complications of anesthesia

Physicians’ attitudes and knowledge toward artificial intelligence in medicine: Benefits and drawbacks

The use of artificial intelligence (AI) in the medical field is increasing and is expected to shape future clinical practice and job security. Therefore, this study aimed to assess the opinions and attitudes of practicing physicians in Bahrain regarding the benefits and drawbacks of AI for their future daily practice. A cross-sectional survey of practicing physicians with a minimum of five years' experience across the main secondary and tertiary care hospitals in Bahrain was conducted. An online questionnaire was used to collect data on demographics, knowledge of AI, attitudes towards the use of AI in 10 tasks of daily clinical practice, and opinions on the benefits and drawbacks of AI. A total of 114 physicians participated in the survey. Among them, 43 (37.7%) were registered psychiatrists, 15 (13.2%) were pathologists, 17 (14.9%) were radiologists, and 39 (34.2%) were surgical specialists. The participants' attitudes were overall positive towards AI. Pathologists were particularly in favor of using AI to “Formulate personalized medication and/or treatment plans for patients” and to “Interview patients in a range of settings to obtain medical history.” Most participants agreed that AI would reduce the time needed to establish a diagnosis and negatively affect employment rates. There were no correlations between the responses and the participants’ age, gender, years of experience, or AI knowledge. This study demonstrates that the attitudes towards the use of AI in medicine among practicing physicians in Bahrain are similar to those of physicians in developed countries in that they are positive and welcoming of AI implementation in practice. However, the potential effects of AI on job security are a major concern.

Case–control study of serum vitamin D concentrations in hospitalised patients with COVID-19 and hospitalised controls suffering with respiratory tract infections of differing aetiology

This study explored the prevalence of low serum vitamin D in patients admitted with acute respiratory tract infections (ARTIs) such as COVID-19. This study investigated whether patients with COVID-19 had...

Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial.

Surgery for nail bed injuries in children is common. One of the key surgical decisions is whether to replace the nail plate following nail bed repair. The aim of this RCT was to assess the clinical effectiveness and cost-effectiveness of nail bed repair with fingernail replacement/substitution compared with repair without fingernail replacement. A two-arm 1 : 1 parallel-group open multicentre superiority RCT was performed across 20 secondary-care hospitals in the UK. The co-primary outcomes were surgical-site infection at around 7 days after surgery and cosmetic appearance summary score at a minimum of 4 months. Some 451 children presenting with a suspected nail bed injury were recruited between July 2018 and July 2019; 224 were allocated to the nail-discarded arm, and 227 to the nail-replaced arm. There was no difference in the number of surgical-site infections at around 7 days between the two interventions or in cosmetic appearance. The mean total healthcare cost over the 4 months after surgery was €84 (95 per cent c.i. 34 to 140) lower for the nail-discarded arm than the nail-replaced arm (P < 0.001). After nail bed repair, discarding the fingernail was associated with similar rates of infection and cosmesis ratings as replacement of the finger nail, but was cost saving. Registration number: ISRCTN44551796 (http://www.controlled-trials.com).

Vonoprazan poses no additional risk of developing Clostridioides difficile infection compared to proton pump inhibitors.

The use of proton pump inhibitors (PPIs) has been repeatedly reported as a trigger of Clostridioides difficile infection (CDI), a leading cause of nosocomial diarrhea. However, only a few studies have reported on the association between vonoprazan, a novel potassium-competitive acid blocker providing potent acid suppression, and CDI, with no studies having been conducted in a clinical setting. We therefore evaluated the association between various classes of acid suppressants and CDI with special attention paid to differences in the magnitudes of association between PPIs and vonoprazan. A retrospective hospital-based cohort from a secondary-care hospital in Japan (n=25821) was collected, wherein eligible CDI cases were defined as hospital-onset cases (n=91). A multivariable adjusted logistic regression analysis for the entire cohort and propensity analyses for subgroups consisting of PPI and/or vonoprazan users at various doses (n=10306) were performed. The overall CDI incidence rate was 1.42/10000 patient-days, which was comparable with previous reports. A multivariable analysis showed that both PPIs and vonoprazan were positively associated with CDI (odds ratios [95% confidence intervals]: 3.15 [1.67-5.96] and 2.63 [1.01-6.88], respectively). In addition, matched subgroup analyses showed that PPIs and vonoprazan had equivalent magnitudes of association with CDI. We found that both PPIs and vonoprazan were associated with CDI, and the magnitude of the association was comparable. Because vonoprazan is widely available in Asian countries, further studies on the association of its usage with CDI are warranted.

Swallowing evaluation in patients who underwent Partial CO2 LASER Epiglottectomy for Sleep Apnea treatment

ObjectiveTo evaluate swallowing in patients who underwent CO2 LASER Partial Epiglottectomy (CO2-LPE) for Obstructive Sleep Apnea Syndrome and to assess the risk of aspiration with this technique. Material & MethodsChart review of adult patients who underwent CO2-LPE between 2016 and 2020, in a secondary care hospital. Patients underwent surgery for OSAS, in accordance to Drug Induced Sleep Endoscopy findings and an objective swallowing evaluation was done at least 6 months after surgery. Eating Assessment Tool (EAT-10) questionnaire was applied and Volume-Viscosity Swallow Test (V-VST) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Dysphagia was classified according to Dysphagia Outcome Severity Scale (DOSS). ResultsEight patients were included in the study. The mean time between surgery and the swallowing evaluation was 50 (±13,2) months. Only 3 patients presented ≥ 3 points on EAT-10 questionnaire. Two patients presented signs of decreased efficacy of swallowing (piecemeal deglutition) but none had a decrease in safety, according to V-VST. Although 50% of the patients presented some pharyngeal residue on FEES, it was classified as trace to mild in most of the cases. No evidence of penetration or aspiration was identified (DOSS ≥ 6 in all patients). ConclusionThe CO2-LPE is a potential treatment for OSAS patients with epiglottic collapse and no evidence of swallowing safety compromise was found.

Knowledge of cytomegalovirus and available prevention strategies in pregnancy: a cross-sectional study in Portugal

Objective Maternal and fetal congenital infection by cytomegalovirus (CMV) during pregnancy is the leading infectious cause of neurologic impairment and hearing loss. Efforts at limiting CMV exposure are based on hygienic measures. This study assessed the relationship between CMV knowledge and pregnant women’s time perspective as per the Zimbardo Time Perspective Inventory (ZTPI) scale. Methods We conducted a prospective descriptive study at a secondary-care Portuguese hospital between October to November 2021. All consecutive pregnant women in antenatal third-trimester appointments were included. The questionnaire included: sociodemographic data, knowledge about CMV, and the ZTPI scale, validated to our population. The number of correct answers in the knowledge section of the questionnaire was tallied to determine the individual knowledge score (KS). We investigated patients subjective perceptions of CMV infection during pregnancy, CMV knowledge, and CMV serologic status of pregnant women. Results We enrolled 96 pregnant women. 81.0% had not previously heard about CMV and only 8.8% had heard about it through their obstetrician. No significant association between awareness of CMV and education level was detected. 16.0% of pregnant women declared that they were aware of the hygienic measures for CMV. The CMV serology was performed in 21.3% of those enrolled in the preconception assessment, and 13.8% proved to be immune. From the time perspective, half of the women displayed a future-oriented attitude. Future-oriented women had significantly higher KS. No significant association was found between KS and education level, age, or previous pregnancy. There was a significant association between KS and women that work in health care. Conclusions Most patients had no knowledge of CMV. Being a medical professional and having a future-oriented outlook increases knowledge about CMV. Primary health care and obstetrics doctors may play a crucial role in informing pregnant women of antenatal appointments. The CMV serology coverage is scarce in this sample. This study constitutes a first step toward raising the awareness of the general population about CMV.

Role of healthcare professionals in drug-drug interactions and clinical interventions

Introduction and aim. Healthcare professionals including prescribers, pharmacists and nurses must have adequate knowledge of drug-drug interactions because they can cause toxicity, loss of efficacy, and side effects. This study was aimed to assess the respective roles of healthcare professionals in preventing drug-drug interactions by clinical interventions. Material and methods. This study was conducted at a Secondary Care Hospital of Pakistan in which total 1000 prescriptions were assessed for drug-drug interactions. Questionnaires and descriptive statistics were tools to assess the satisfaction of prescribers with pharmacists and their own prescribed medications before and after the clinical interventions. Modifications in medication therapies were done accordingly after the evaluation and acceptance of interventions. Results. The p-value was highly significant (p&lt;0.05) which showed that the collaboration between healthcare professionals is necessary to avoid drug-drug interaction by clinical interventions. Acceptance rate of interventions was 77%. Clinical interventions are a useful tool in minimizing and preventing drug-drug interactions. The compliance of prescribers with their own prescribed medication regimens increased after clinical interventions. Conclusion. Prescribers, pharmacists and nurses have their respective roles in preventing drug-drug interactions and they must review the appropriateness of every medication order for clinical interventions.

The dermoscopic characteristics of melasma in relation to different skin phototypes, distribution patterns and wood lamp findings: a cross-sectional study of 236 melasma lesions.

Melasma is an acquired, pigmentary disorder characterized by the appearance of brown to bluish-gray patches with well-demarcated or ill-defined borders, most commonly on the face. This challenging hyperpigmentation disorder is generally observed in women; sun exposure, pregnancy, oral contraceptive use, genetic influences and chemical agents are some etiopathogenetic factors. Even though readily diagnosed by clinical examination; dermoscopy, Wood lamp findings and histopathology may also help the clinicians to confirm the diagnosis and to disclose the features of the melasma such as melanin depth and melasma type. In our study, we aimed to investigate the dermoscopic properties of facial melasma in accordance with different skin phototypes, age, distribution patterns, presence of other facial dermatoses, etiological factors and wood lamb findings. In the present cross-sectional study, patients clinically diagnosed with facial melasma in a secondary care hospital were included. Demographical data, personal history, distribution patterns of the melasma, dermoscopic features, Wood lamp examination findings, the presence of any other facial dermatosis, possible underlying risk factors and skin phototypes were determined. One hundred fifty nine patients with a total number of 236 melasmas with variable distribution patterns were included. The mean age was 37.91years, whereas the mean age at the onset of the melasma was 32.43years. One hundred thirty three participants were females, whereas 26 were males. The most prevalent risk factors of melasma were exposure to UV light (62.2%), pregnancy (50.6%) and genetic predisposition (43.6%). The most common melasma localization was cheek (43.6%) followed by T zone (33.1%). The most common dermoscopic findings were brown reticular pseudonetwork (73.3%), increased vascularity and telangiectasia (51.7%) and brown clods (33.1%). Brown reticular pseudonetwork was present at a higher rate in patients with skin phototype V compared to the ones with skin phototype II (p = 0.033). Our study shows that dermoscopic findings of melasma may differ across different skin phototypes, melasma localizations, possible associated risk factors and age.

Incidence and risk factors of acute bilirubin encephalopathy in neonates with hyperbilirubinemia presenting at secondary care hospital.

In neonates, hyperbilirubinemia is the most common problem. Acute bilirubin encephalopathy is serious problem in less developed nations and their incidence varies with geographical location. Our objective was to find out the incidence and risk factors of acute bilirubin encephalopathy in neonates with hyperbilirubinemia. This was a prospective cross sectional study carried out at the department of pediatrics, THQ Hospital, Pindigheb in Punjab from October 2020 to October 2021. The inclusion criterion for our study was all the neonates of both the gender diagnosed with hyperbilirubinemia. Blood samples were collected from all the neonates and were sent to hospital laboratory for total serum bilirubin (TSB) measurement. The risk factors like delivery place, Rh/ABO incompatibility and preterm delivery were recorded. SPSS version 23 was used to input and analyze all of the data. In this study, a total of 350 neonates were included. The prevalence of acute bilirubin encephalopathy in our study was 16% (n=56). Seven (12.5%) neonates with acute bilirubin encephalopathy were preterm which was the major significant risk factor for acute bilirubin encephalopathy in hyperbilirubinemia neonates (p<0.05). The other risk factors such as hospital delivery, birth weight, Rh and ABO incompatibility were also observed but were non-significant (p>0.05). Our study observed 16% prevalence of acute bilirubin encephalopathy in neonates with hyperbilirubinemia. The preterm birth was a significant risk factor associated with the acute bilirubin encephalopathy in neonates with hyperbilirubinemia.

Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study

Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.

The Prevalence and Management of Chronic Tonsillitis: Experience From Secondary Care Hospitals in Rabak City, Sudan.

Background Tonsillitis is defined as an inflammation of the tonsils, which is a common clinical condition caused by either bacterial or viral infections. It affects a significant percentage of the population especially children. Chronic tonsillitis (CT) is described as when an individual suffers from seven or more attacks of tonsillitis per year. Aim This study aimed to determine the prevalence and management of CT among patients attending all secondary care hospitals in Rabak city, Sudan. Methods A cross-sectional descriptive study was conducted in June-September 2022. A structured questionnaire was used to screen 297 Patients who presented to all ENT clinics within the study period. Out of the 297 patients, 77 patients were confirmed to be having CT based on the inclusion criteria. Data collected were analyzed using SPSS version 21 and arranged into a simple frequency table. Results The prevalence of CTwas found to be 25.9 % (77) among all screened patients. The majority (67.5%) of the patients with CT were male, and mostly between the age of 11-20 years (32.4%). A considerable number of them (32.4%) were residing in the urban-industrial part of the city, and about 36.3% are not working. All the patients with CT complained of throat pain, while 88% presented with red inflamed tonsils.Laboratory investigations of these patients revealed 64% to have Neutrophilia, while 54 and 50% had high ESR and positive ASO titer, respectively.57%of the patients underwent tonsillectomy while (30%) were managed medically. Conclusion The prevalence of CT was found to be high in the agro-industrial area of Rabak city and more among teenagers, and most cases were managed by tonsillectomy.

Point Prevalence Study (PPS) of Antibiotic Usage and Bacterial Culture Rate (BCR) among Secondary Care Hospitals of Small Cities in Central India: Consolidating Indian Evidence.

Objective Indian hospitals (especially government-run public sector hospitals) have a nonexistent antimicrobial stewardship program (AMSP). After successfully initiating AMSPs in tertiary care hospitals of India, the Indian Council of Medical Research envisages implementing AMSP in secondary care hospitals. This study is about the baseline data on antibiotic consumption in secondary care hospitals. Materials and Methods It was a prospective longitudinal observational chart review type of study. Baseline data on antibiotic consumption was captured by a 24-hour point prevalence study of antibiotic usage and bacterial culture rate. The prescribed antibiotics were classified according to the World Health Organization (WHO) Access, Watch, and Reserve classification. All data were collated in Microsoft Excel and summarized as percentages. Results Out of the 864 patients surveyed, overall antibiotic usage was 78.9% (71.5% in low-priority areas vs. 92.2% in high-priority areas). Most of the antibiotic usage was empirical with an extremely low bacterial culture rate (21.9%). Out of the prescribed drugs, 53.1% were from the WHO watch category and 5.5% from the reserve category. Conclusion Even after 5 years of the launch of the national action plan on AMR (NAP-AMR) of India, AMSP is still non-existent in small- and medium-level hospitals in urban cities. The importance of trained microbiologists in the health care system is identified as a fulcrum in combating antimicrobial resistance (AMR); however, their absence in government-run district hospitals is a matter of grave concern and needs to be addressed sooner than later.

Assessing Thai Hospitals’ Evacuation Preparedness Using the Flexible Surge Capacity Concept and Its Collaborative Tool

According to the concept of “flexible surge capacity,” hospitals may need to be evacuated on two occasions: (1) when they are exposed to danger, such as in war; and (2) when they are contaminated, such as during the Covid-19 pandemic. In the former, the entire hospital must be evacuated, while in the latter, the hospital becomes a pandemic center necessitating the transfer of its non-contaminated staff, patients, and routine activities to other facilities. Such occasions involve several degrees of evacuation—partial or total—yet all require deliberate surge planning and collaboration with diverse authorities. This study aimed to investigate the extent of hospital evacuation preparedness in Thailand, using the main elements of the flexible surge capacity concept. A mixed method cross-sectional study was conducted using a hospital evacuation questionnaire from a previously published multinational hospital evacuation study. The tool contained questions regarding evacuation preparedness encompassing surge capacity and collaborative elements and an open-ended inquiry to grasp potential perspectives. All 143 secondary care, tertiary care, and university hospitals received the questionnaire; 43 hospitals provided responses. The findings indicate glitches in evacuation protocols, particularly triage systems, the inadequacies of surge planning and multiagency collaboration, and knowledge limitations in community capabilities. In conclusion, the applications of the essential components of flexible surge capacity allow the assessment of hospital preparedness and facilitate the evaluation of guidelines and instructions through scenario-based training exercises.

The epidemiology and burden of neuromyelitis optica spectrum disorder, multiple sclerosis, and MOG antibody-associated disease in a province in Thailand: A population-based study.

Central nervous system inflammatory demyelinating diseases (CNSIDDs) have notable interracial heterogeneity. The epidemiology of CNSIDDs in Thailand, a mainland Southeast Asian country, is unknown. To determine the cumulative incidence, point prevalence, and disease burden of neuromyelitis optica spectrum disorder (NMOSD) and other CNSIDDs in Thailand using population-based data of Chumphon. Searching for CNSIDD patients at a public secondary care hospital in Chumphon, the only neurology center in the province, from January 2016 to December 2021 was implemented using relevant ICD-10-CM codes. All diagnoses were individually ascertained by a retrospective chart review. Cumulative incidence, point prevalence, attack rate, mortality rate, and disability-adjusted life years (DALYs) were calculated. Aquaporin 4-IgG-positive NMOSD was the most prevalent CNSIDD in the Thai population at 3.08 (1.76-5.38) per 100,000 persons. The prevalence of multiple sclerosis (MS) followed at 0.77 (0.26-2.26) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) at 0.51(0.14-1.87) per 100,000 adults. In the pediatric population, the incidence of acute disseminated encephalomyelitis was 0.28 (0.08-1.02) per 100,000 persons/year. Among other idiopathic demyelinating diseases, idiopathic optic neuritis had the highest incidence at 0.58 (0.24-0.92) per 100,000 persons/year, followed by acute transverse myelitis at 0.44 (0.14-0.74). Idiopathic demyelinating brainstem syndrome was also observed at 0.04 (0.01-0.25) per 100,000 persons/year. Although most had a fair recovery, disability was worst among NMOSD patients with DALYs of 3.61 (3.00-4.36) years per 100,000 persons. Mortality rate was the highest in NMOSD as well. CNSIDDs are rare diseases in Thailand. The prevalence is comparable to that of East Asian populations. A nationwide CNSIDDs registry would better elaborate the epidemiology of these diseases.

A 20-year trend of prevalence and susceptibility to trimethoprim/sulfamethoxazole of Stenotrophomonas maltophilia in a single secondary care hospital in Korea

Stenotrophomonas maltophilia is a Gram-negative opportunistic pathogen that can cause serious infection. We aimed to analyze the prevalence and susceptibility rates to trimethoprim/sulfamethoxazole of S. maltophilia. We conducted a retrospective study of S. maltophilia isolates from a university hospital from 2001 to 2020. Clinical information, the numbers of isolates and susceptibility rates were analyzed by year. Susceptibility rates and changes in respiratory and non-respiratory samples were compared. 1805 S. maltophilia isolates were identified, of which 81.4% (1469/1805) were from respiratory samples. There was a male predominance and 52% of the isolates were from general wards. The average susceptibility rate was 87.7% and there was no significant annual trend (P = .519). The susceptibility rate was 88.7% in respiratory samples and 84.1% in non-respiratory samples (P = .018). Susceptibility analyses using clinical data over long periods can guide the choice of antimicrobials especially for pathogen whose treatment options are limited.

Postnatal women’s perception on person-centered maternity care in twin cities of Rawalpindi and Islamabad: a descriptive study

BackgroundPerson-Centered Maternity Care (PCMC) is known as one of the most important components of maternal care. Every woman has the ultimate right of respectful health care. Previous research documents that lack of supportive care and respectful behavior experienced by pregnant women can act as a barrier to the utilization of health care services. Few studies have used PCMC tool to document this phenomenon. The objective of this descriptive study was to assess the women’s perception of PCMC in Pakistan.MethodsThree hundred and seventy-seven (377) postnatal women of ages 18–49 years participated in the research. The study sites were secondary and tertiary care hospitals located in the twin cities of Rawalpindi and Islamabad. The PCMC tool used in this study is a validated scale with three sub-domains of i) communication and autonomy, ii) supportive care, and iii) dignity and respect. Data was analyzed using SPSS version 16, and descriptive and bivariate analysis was undertaken.ResultsThe PCMC mean score was 54 ± [10.7] out of 90. About half (55%) of women had good perception of PCMC. Sub-domain of supportive care scored the lowest as compared to the other two domains. Overall, 36% women reported physical abuse while 22% reported verbal abuse at the hands of the healthcare providers. Most of the women (88%) said that health providers did not introduce themselves. About 30% women claimed that health care providers never asked for permission before doing any medical procedures and 20% of women claimed that doctors did not describe the purpose of examination while 178 (47%) of women said that health provider explained the purpose of medications all the time, additionally, about 14% were never given the choice to ask questions.ConclusionThe study concluded that the majority of postnatal women perceived that they were not getting optimum Person-Centered Maternity Care. Some core aspects in supportive care domain were missing. In order to improve the quality of hospital-based childbirths, efforts are needed to improve the quality of care.

Evaluation of a Machine Learning-Based Dysphagia Prediction Tool in Clinical Routine: A Prospective Observational Cohort Study

Based on a large number of pre-existing documented electronic health records (EHR), we developed a machine learning (ML) algorithm for detection of dysphagia and aspiration pneumonia. The aim of our study was to prospectively apply this algorithm in two large patient cohorts. The tool was integrated in the hospital information system of a secondary care hospital in Austria. Based on existing data such as diagnoses, laboratory, and medication, dysphagia risk was predicted automatically, and patients were stratified into three risk groups. Patients’ risk groups and risk factors were visualized in a web application. Prospective predictions of 1270 admissions to geriatric or internal medicine departments were compared with the occurrence of dysphagia or aspiration pneumonia of routinely documented events. The discriminative performance for internal medicine patients (n = 885) was excellent with an AUROC of 0.841, a sensitivity of 74.2%, and a specificity of 84.1%. For the smaller geriatric cohort (n = 221), the AUROC was 0.758, sensitivity 44.4%, and specificity 93.0%. For both cohorts, calibration plots showed a slight overestimation of the risk. This is the first study to evaluate the performance of a ML-based prediction tool for dysphagia in a prospective clinical setting. Future studies should validate the predictions on data of systematic dysphagia screening by specialists and evaluate user satisfaction and acceptance. The ML-based dysphagia prediction tool achieved an excellent performance in the internal medicine cohort. More data are needed to determine the performance in geriatric patients.

A prospective evaluation of breast thermography enhanced by a novel machine learning technique for screening breast abnormalities in a general population of women presenting to a secondary care hospital.

Artificial intelligence-enhanced breast thermography is being evaluated as an ancillary modality in the evaluation of breast disease. The objective of this study was to evaluate the clinical performance of Thermalytix, a CE-marked, AI-based thermal imaging test, with respect to conventional mammography. A prospective, comparative study performed between 15 December 2018 and 06 January 2020 evaluated the performance of Thermalytix in 459 women with both dense and nondense breast tissue. Both symptomatic and asymptomatic women, aged 30-80 years, presenting to the hospital underwent Thermalytix followed by 2-D mammography and appropriate confirmatory investigations to confirm malignancy. The radiologist interpreting the mammograms and the technician using the Thermalytix tool were blinded to the others' findings. The statistical analysis was performed by a third party. A total of 687 women were recruited, of whom 459 fulfilled the inclusion criteria. Twenty-one malignancies were detected (21/459, 4.6%). The overall sensitivity of Thermalytix was 95.24% (95% CI, 76.18-99.88), and the specificity was 88.58% (95% CI, 85.23-91.41). In women with dense breasts (n = 168, 36.6%), the sensitivity was 100% (95% CI, 69.15-100), and the specificity was 81.65% (95% CI, 74.72-87.35). Among these 168 women, 37 women (22%) were reported as BI-RADS 0 on mammography; in this subset, the sensitivity of Thermalytix was 100% (95% CI, 69.15-100), and the specificity was 77.22% (95% CI, 69.88-83.50). Thermalytix showed acceptable sensitivity and specificity with respect to mammography in the overall patient population. Thermalytix outperformed mammography in women with dense breasts and those reported as BI-RADS 0.