Secondary Referral Hospital Research Articles

Outcome of Laparoscopic Appendectomy: A Retrospective Study From a Local Secondary Referral Hospital

Outcome of Laparoscopic Appendectomy: A Retrospective Study From a Local Secondary Referral Hospital

Strategies for scaling up pre-ART advanced HIV disease screening at a secondary referral hospital—Malawi: a qualitative study

BackgroundImplementation of the World Health Organization (WHO) recommended Advanced HIV Disease screening package, remains poor in most settings with limited resources. More than 50% of newly diagnosed-HIV clients are missed on screening as a result of implementation barriers. It is important to mitigate the existing barriers and leverage enablers’ inorder to maximize uptake of the advanced HIV disease screening. This study aimed to identify strategies for scaling up implementation of advanced HIV disease screening among newly HIV-diagnosed clients in pre-ART phase using a Consolidated Framework for Implementation Research-Expert Recommendation for Implementing Change (CFIR-ERIC) guiding tool.MethodsA qualitative study was conducted at Rumphi district hospital in Malawi (August – September, 2023). Two sessions of Focus group discussions (FDGs) involving key stakeholders were facilitated to identify specific strategies following the initial study on exploration of barriers and facilitators of advanced HIV disease screening package. Participants comprised healthcare providers, purposively selected from key hospital departments. A deductive approach was used to analyze FDG transcripts where emerging themes were mapped with ERIC list of strategies. CFIR-ERIC Matching tool version 1.0, was used to generate an output of the most to least expert-endorsed Level 1 and Level 2 strategies.FindingsAbout 25 key healthcare workers participated in FDGs. Overall, 6 Level 1 strategies (≥ 50% expert endorsement score) and 4 Level 2 strategies (≥ 20%, ≤ 49% expert endorsement score) were identified, targeting barriers associated with availability of resources, intervention complexity, access to knowledge and information, communication; and implementation leads. Most of the reported strategies were cross-cutting and aimed at enhancing clinical knowledge of the intervention (distributing training materials, educational meetings), developing stakeholders’ interrelations (network weaving) as well as improving clinical workflow (environmental restructuring). Use of evaluative and iterative strategies such as monthly data collection for evaluation were also recommended as part of continuous improvement while an AHD coordinator was recommended to be formally appointed inorder to spearhead coordination of AHD screening services.ConclusionThrough the involvement of key stakeholders and the use of CFIR-ERIC matching tool, this study has identified cross-cutting strategies that if well implemented, can help to mitigate contextual barriers and leverage enablers for an improved delivery of AHD screening package.

Psychometric Properties and Concurrent Validity of a 10-Item Questionnaire for Patients With Vestibular Disorders.

This study aimed to investigate the psychometric properties and concurrent validity of the Haukeland Dizziness Questionnaire (HDQ-10), a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. Cross-sectional study. Secondary referral hospital. Out of 238 consecutive patients examined for suspected vestibular disease at an otolaryngology clinic, 201 completed the questionnaire. The psychometric properties of the HDQ-10 were examined by exploratory factor analysis and analysis of internal consistency. Concurrent validity was determined in comparison with the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), and the Hospital Anxiety and Depression Scale. The factor analysis revealed 3 subscales of the questionnaire covering "function,""unsteadiness," and "emotion."The examination of the total scale (α = .866) and its subscales indicated satisfactory psychometric properties. The HDQ-10 correlated highly with both DHI (r = .732. P < .001) and VSS-SF (r = .720. P < .001) indicating good concurrent validity. The HDQ-10 is a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. It has satisfactory psychometric properties and good concurrent validity compared to existing dizziness questionnaires.

Evaluation of clinical presentation and management outcome of burns, experience at secondary referral hospital in a low-income, sub-Saharan country: A cohort study

PurposeBurns are considered as serious health problem in low-income country. They lead to patients’ morbidity and mortality beside their burden on the health care system. This study was conducted to review the clinical presentation and management outcome in a secondary referral hospital in Sudan (sub-Saharan country). MethodsThis is a retrospective hospital-based cohort study. It was conducted during 2019–2021. Data was collected to determine socio-demographic characteristics of patients, site of burns, cause of burn and management outcome. Any patient presented with burns during the study periods was enrolled in the study area. ResultsTotal number of surgical emergency admitted during the study periods were 8126. Total number of patients who are included in this study were 133 with male predominant (53 %). Seventy-two of them are below age of 10 years. Half of the patients (53 %) presented with scalding burn. Only, 36 % of them presented to the emergency department during the first 12 h. Seventy eight percentage of them were treated and discharged while 6 % of them died. Open wound dressing was done for 84 % of patients while skin graft was done in 12 % of patients. ConclusionThis study demonstrates the situation in a low-income setting with higher prevalence among children. There are challenges and difficulty in managing burn patients.

Benign Lesions of Larynx and Its Micro-Laryngeal Surgery - A Clinical Evaluation

BACKGROUND&#x0D; The larynx is a unique organ in the spectrum of functions it performs. Its role in normal respiration, maintenance and protection of the airway. Simple laryngeal lesions are not uncommon. The great majority of the cordal benign lesions are non-neoplastic, usually in a ratio of about 6:1. They are the product of some form of irritation and do not have the histological characteristics of true neoplasms. Therapy is directed at restoring as much normal function of the larynx as possible. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.&#x0D; Objectives&#x0D; The study was undertaken to identify the common types of benign lesions of the larynx and the age, sex distribution, symptomatology, sites of involvement and histopathology of the lesions following micro-laryngeal surgery. Microlaryngeal surgery and postoperative voice rest offer a cost-effective, useful and safe approach to the management of benign laryngeal lesions.&#x0D; METHODS&#x0D; A prospective study was conducted from February 2017 to September 2019 at NRM ENT Hospital, Raichur, Karnataka and a secondary referral hospital. 30 patients with benign laryngeal lesions were included based on the patient’s clinical symptoms and findings on indirect laryngoscopy in the age group of 13–65 years. All non-operative cases and malignant cases were excluded. Routine preoperative surgical work-up and therapeutic micro-larnygoscopic procedures were employed.&#x0D; RESULTS&#x0D; A male preponderance with a male-to-female ratio of 1.3:1 was observed. The majority of the patients were in the age group of 31–40 years. Non-neoplastic lesions are much more common than neoplastic lesions. Vocal nodules, polyps, and angiofibromas with the same pathogenesis were common lesions. Abuse of voice, exposure to a known agent, and trauma were causative factors. Most of the lesions are solitary and unilateral, arising from the vocal cord. The right side is the common side, and sessile lesions are more numerous than pedunculated. Only 10% of cases are true neoplastic; vocal polyps, nodules, and angiofibromas with the same pathophysiology account for 70% of cases.&#x0D; CONCLUSIONS&#x0D; Benign lesions of the larynx are common in males, but in this series, amusingly, housewives are at the top of the list. Voice abuse, exposure to a known agent and trauma are the etiological factors. A common symptom is hoarseness of voice. On the basis of this study, it has been emphasized that the removal of the tumor should be flushed from the surface of the vocal cords to aviod any injury to the epithelium, which can be done either under microscopic or endoscopic view.

The Association Between Dehydration and the Prognosis of Sudden Sensorineural Hearing Loss.

There is an urgent need to identify undetermined risk factors for sudden sensorineural hearing loss (SSNHL) for the development of effective treatment strategies. SSNHL is likely associated with vascular insufficiency; however, no study has evaluated the relationship between dehydration and SSNHL. This study aimed to investigate the role of dehydration in the development and prognosis of sudden sensorineural hearing loss. Retrospective case-control study. Secondary referral hospital. This was a comparative study that compared dehydration parameters between healthy subjects without SSNHL (n = 94) and patients with SSNHL (n = 94). The study also evaluated the effect of dehydrated conditions on the prognosis of SSNHL. We compared dehydration parameters, such as the blood urea nitrogen-to-creatinine ratio (BUN/Cre) and plasma osmolality (Posm), between matched healthy subjects without SSNHL and patients with SSNHL. To evaluate the effect of dehydrated conditions on the SSNHL prognosis, the SSNHL patients were divided into 2 groups based on the cutoff value obtained from the receiver operating characteristic analysis: hydrated (n = 50; BUN/Cre <21.4) and dehydrated (n = 44; BUN/Cre ≥21.4) groups. Subsequently, the severity and prognosis of SSNHL were analyzed. The dehydration parameters, BUN/Cre and Posm, were significantly higher in patients with SSNHL than in healthy subjects. The initial hearing levels and SSNHL grades were worse in the dehydrated group than in the hydrated group. Moreover, a dehydrated condition (BUN/Cre ≥21.4) was associated with a poor SSNHL prognosis in all models of the multiple logistic regression analysis. The dehydration parameters of BUN/Cre and Posm were higher in patients with SSNHL than in healthy subjects. Additionally, a dehydrated condition (BUN/Cre ≥21.4) was an independent prognostic factor for SSNHL. Level of evidence: Level 4.

Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana

BackgroundLow birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.MethodsA constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.ResultsEmerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.ConclusionA coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.

Barriers and facilitators to implementing advanced HIV disease screening at a secondary referral hospital -Malawi: a convergent parallel study

BackgroundMalawi continues to register HIV/AIDS mortality despite increased expansion of ART services and as well as advanced HIV screening as outlined in the 2020 -2025 Malawi National HIV Strategic Plan (NSP). This study aimed to explore factors influencing the implementation of the advanced HIV disease (AHD) screening package at Rumphi District Hospital, Malawi.MethodsWe conducted a mixed method, convergent study at a secondary referral hospital with 8 659 clients on ART. Guided by a consolidated framework for implementation research (CFIR) we conducted semi-structured Interviews with healthcare professionals, purposively selected from various key departments that were actively involved in AHD screening. Transcripts were organized and coded using NVivo 12 software with thematically predefined CFIR constructs. Newly HIV-positive client records extracted from ART cards (July –Dec, 2021) were analyzed using STATA 14 software.ResultsOne hundred one ART records met inclusion criteria for review and analysis of which 60% (n = 61) of the newly diagnosed HIV clients had no documented results for CD4 Cell count. Barriers to AHD screening emerged from four major CFIR constructs: intervention complexity, communication, availability of resources and access to knowledge and information. The specific barriers included poor work coordination among implementers, limited resources to support the expansion of AHD screening, and knowledge gap among providers. External support from Ministry of Health implementing partners and the availability of committed focal leaders coordinating HIV programs emerged as major enablers of AHD screening package.ConclusionThe study has identified major contextual barriers to AHD screening including knowledge gap, poor communication systems and inadequate supporting resources. Improving uptake of AHD screening services would therefore require overcoming the existing barriers by adopting a comprehensive approach in developing barrier-tailored strategies.

COVID-19 Vaccination and Clinical Outcomes at a Secondary Referral Hospital During the Delta Variant-dominant Period in West Sumatra, Indonesia.

The second wave of coronavirus disease 2019 (COVID-19) cases in Indonesia, during which the Delta variant predominated, took place after a vaccination program had been initiated in the country. This study was conducted to assess the impact of COVID-19 vaccination on unfavorable clinical outcomes including hospitalization, severe COVID-19, intensive care unit (ICU) admission, and death using a real-world model. This single-center retrospective cohort study involved patients with COVID-19 aged ≥18 years who presented to the COVID-19 emergency room at a secondary referral teaching hospital between June 1, 2021 and August 31, 2021. We used a binary logistic regression model to assess the effect of COVID-19 vaccination on unfavorable clinical outcomes, with age, sex, and comorbidities as confounding variables. A total of 716 patients were included, 32.1% of whom were vaccinated. The elderly participants (≥65 years) had the lowest vaccine coverage among age groups. Vaccination had an effectiveness of 50% (95% confidence interval [CI], 25 to 66) for preventing hospitalization, 97% (95% CI, 77 to 99) for preventing severe COVID-19, 95% (95% CI, 56 to 99) for preventing ICU admission, and 90% (95% CI, 22 to 99) for preventing death. Interestingly, patients with type 2 diabetes had a 2-fold to 4-fold elevated risk of unfavorable outcomes. Among adults, COVID-19 vaccination has a moderate preventive impact on hospitalization but a high preventive impact on severe COVID-19, ICU admission, and death. The authors suggest that relevant parties increase COVID-19 vaccination coverage, especially in the elderly population.

Cross-sectional Observational Study on the Demography of the Neurosurgical Emergency Admissions in a Year 2014 at Gurayat General Hospital, Saudi Arabia

Gurayat General Hospital is a 350 bed secondary referral hospital of Kingdom of Saudi Arabia. This is one of the busiest hospitals in Al-Jouf region. Trauma is very common in this city and the ER department is mostly overwhelmed by Neurosurgical emergency patients. The aim the study was to evaluate the age sex, types of injuries and causes of injuries of the neurosurgical emergency patients. This was a cross-sectional descriptive observational study. Ethical approval was achieved from proper authority. Good Clinical Practice (GCP) ICH E6 protocol was followed in order to ensure safety and efficacy. Data was collected from the log book of the ER department. Data were transferred to a spreadsheet to make a master sheet. Valuables of individual columns were analyzed and tabulated. Comparison was performed between the result of this study and other international studies. About 7.3% of all ER admissions were for the Neurosurgical cases. Among the Neurosurgical cases (n=3588) there was clear predominance of male gender (81%). Majority (45%) of the Neurosurgical patients were from children and teen age group. Nearly 50% of the patients reported to ER with the history of Road Traffic Accident (RTA). Head injury was the commonest (61%) type of injury. Approximately 45% patients were admitted in to general ward whereas 42% patients were discharged from ER after providing primary treatment. When the results of this study were compared to the results of the other international studies fair similarities were observed.

REVIEW ON CO-MORBIDITIES IN DIABETES MELLITUS

Aim and objectives: The aim of this study was to determine cost of illness and cost of utility in the study population and making recommendations to decrease the economic burden of the treatment by following the life style modifications. Methodology: It is a cross sectional pharmacoepidemiological study. Totally 132 diabetic patients both in-patients and out patients of medical and surgical departments in a secondary level referral hospital were included in this study which was conducted for a period of 6 months. All patients with diabetes type-II, continuing anti diabetic drugs (Metformin, Glibenclamide and Insulin,) for their diabetes management are included and patients who are diagnosed as Diabetic type-I and pregnancy and pediatric patients were excluded. Data was analyzed by Carlson comorbidities Index. Results: A total of 132 diabetic patients were included, in which male and famales were nearly equal in number. Based upon the comorbid conditions, it was found that the most of the subjects (69%) were suffering with diabetes along with hypertension and 9.9% are having comorbidity of hypertension &amp; acute renal failure along with DM and treatment costs more economic burden to the patients. The average utility of drugs is more for the combination of Metformin+Glibenclamide+Insulin than metformin+glibenclamide. Conclusion: Finally we concluded that study place is a rural area and most of people are with poor knowledge and having lack of awareness on both disease and treatment. By applying Charlson Co morbidities index we found the patient’s economic status by which we found that many of the diabetic patients facing economic burden, especially daily wager are feeling much difficulty to face even therapy cost also. In co morbidities side, we noticed 55% of the study population are having diabetes with hypertension. Although all the patients were provided with education regarding their disease and drugs for improving their quality of life, but it has an influence on very few people.

Patterns and management outcome of paediatrics burn in a general surgical department: experience from a secondary referral hospital.

Burns are considered the fourth most common type of traumatic injury worldwide with significant morbidity and mortality. The aim of this study is to disclose the incidence, etiological factors, treatment and outcome of paediatric burns in Sudan. This is a retrospective hospital-based study, conducted during 2016-2019. Patients who presented with burn injuries and managed in the hospital were included in the study. Flowchart sheets were used to collect the data. Then, it was entered and analysed using Statistical Package for the Social Sciences version 21 statistical software (IBM Corporation, Chicago, IL). The total number of patients who fulfill our criteria is 85 with a median age of 4 years (7 months-15 years). Sixty-five percent of them were under 5 years with male predominance (55%). Most patients' burns occurred at home. The median percentage of burn is 18% (2%-90%) which is caused by scalding burn among 55.3% followed by the flame burn in 41.2% of patients. Regarding fluid management, 60% received fluid. Open dressing for burn wounds was done for 75% and close dressing among 15% of patients. More than 80% of the patients in this study were treated and discharged in a good condition while the mortality was 5.9%. This study showed the significant burden of paediatric burns management on general surgery units in a referral hospital. Therefore, equipping the hospital and founding these specialities will decrease this load and will improve the outcome.

PS-C16-5: RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS AND CLINICAL OUTCOMES IN COVID-19 PATIENTS WITH HYPERTENSION:A REPORT OF THREE PEAK WAVE PERIODS IN SEMARANG, INDONESIA

Objective: We aimed to assess the association between RAAS inhibitors (ACEi or ARB) and the clinical outcomes of COVID-19 patients with hypertension in the First Wave, Second Wave and Third Wave at Secondary Referral Hospital, Indonesia Methods: This cross sectional study was based on an electronic medical record in the Dr Adhyatma MPH Tugurejo General Hospital, Semarang, Indonesia. All patients more than 18 years old who confirmed COVID-19 case in the first wave (November 2020 to January 2021), second wave (May 2021 to July 2021) and third wave (January 2022 to February 2022) were included in this study. Data about demographic, comorbidities, features of antihypertensive drugs and clinical outcomes were collected. The clinical outcomes included mortality and prolonged hospitalization (length of stay (LOS) &gt; 10 days). The statistical measures calculated were Chi square test and Fischer's exact test. Results: From three periods of peak wave, data from 1560 COVID-19 patients was collected in the first wave (304;19.5%), the second wave (1038;66.5%), and the third wave (218;14.0%). Subjects were dominated by males (50.4%) and a median of age 50 (19 -91) years old. The common comorbidities in studies were diabetes mellitus with 318 (20.4%) and hypertension with 254 (16.3%). In the main analysis, 99 (39%) patients with hypertension receiving RAAS inhibitors were compared with 155 (61%) patients receiving other antihypertensive drugs. Our results showed that RAAS inhibitors was not associated with a higher risk of COVID-19 mortality (RR:1.01; 95% CI: 0.61–1.67; p:0.969) or prolonged LOS (RR:0.86; 95%CI: 0.60–1.26; p:0.408). Conclusions: In COVID-19 patients with hypertension, the use of RAAS inhibitors showed no increased mortality or prolonged LOS compared to patients without RAAS inhibitors. COVID-19 patients and patients exposed to the COVID-19 pandemic should not discontinue ACEi or ARBs.

Initial experience with laparoscopic revisional single anastomosis duodeno-ileal bypass (SADI-S) after failed sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed bariatric operation, but re-do surgery may be necessary in up to half of the patients. Single anastomosis duodeno-ileal bypass (SADI-S) is quickly gaining recognition as a revisional procedure after failed SG. To discuss the surgical technique and analyze initial outcomes after introduction of SADI-S after SG with 1-year follow-up. This is a retrospective cohort study of consecutive patients who underwent re-do bariatric surgery - revisional SADI-S - in 2021 at a secondary referral public hospital. All patients' follow-up was completed 1 year after. 14 consecutive patients, 6 (43%) males and 8 females, were included. Median maximal body mass index (BMI) was 52.29 (47.96-77.16) kg/m2, BMI before SADI-S was 43.09 (41.64-48.99) kg/m2. No perioperative morbidity was recorded. Four (28%) patients reported recurrent abdominal crampy pain and diarrhea that required dietary advisement and pharmacological therapy in the postoperative period. No reoperations, mortality or readmissions were recorded during 1-year follow-up. SADI-S was associated with further weight loss, resulting in median BMI of 37.55 (36.29-39.43) kg/m2 1 year after SADI-S. Observed additional percentage total weight loss (%TWL) 1 year after SADI-S was 18.65% (17.25-21.89%), while additional percentage excess body mass index loss (%EBMIL) was 35.88% (29.18-41.92%). There was 1 case of diabetes mellitus type 2 remission and improvement in glycemic control in 1 patient. 4/6 patients (66.67%) had improvement in control of hypertension. SADI-S is promising re-do surgery after SG with low postoperative morbidity. Additional %TWL 1 year after SADI-S is ~19%, while additional %EBMIL is ~36%, with significant improvement of obesity-related comorbidities.

NEUROLOGICAL ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI) ON HEALTH WORKFORCE OF A SECONDARY REFERRAL HOSPITAL IN SOUTH SULAWESI WHO RECEIVED THE

Background: The COVID-19 vaccination can relate to the occurrence of neurological adverse events following immunization (AEFI) that could impact work and daily activities. This problem is particularly important in the health workforce. However, little is known about neurological AEFI among the health workforce working in peripheral facilities. Objective: To study the neurological AEFIs and their impact among the health workforce who received the COVID-19 vaccination in a secondary referral hospital in South Sulawesi, the Andi Makassau Hospital (Rumah Sakit Umum Daerah Andi Makassau/RSAM). Methods: The COVID-19 pandemic, we created a questionnaire about neurological AEFIs and their effects which were distributed online using the Google Form application to the health workforce at the RSAM who had received at least one dose of COVID-19 vaccination. Results: We obtained 97 subjects. There were 78.5% neurological AEFIs with the most reported type being muscle pain (16%). Most neurological AEFIs were experienced by women (84.9%), age group 21-35 years (53.8%), and non-doctors/nurses (60.8%). The significant influencing factors in multivariate analysis were age group 36-45 years (p = 0.04), nursing proffesion (p = 0.005), and non- viral-based baccine type (p = &lt; 0.0001). Conclusion: Neurological AEFI is commonly found among the health workforce who received the COVID-19 vaccination. However, it only has a little impact on their work and attitudes towards vaccination. This may be because all subjects experienced mild neurological AEFI.

Sexually Transmitted Diseases in Northern Israel: Insights From a Large Referral Laboratory.

The aims of the study are to investigate the distribution and frequency of different sexually transmitted diseases (STDs) among a large study population of individuals undergoing STD investigation both in inpatient and STD clinic settings and to evaluate influence of test anonymity on the positivity rate of pathogens. A retrospective study retrieved epidemiologic data from the following 3 sources: a secondary referral hospital and 2 STD clinics in Northern Israel. Positivity rate of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium , and Trichomonas vaginalis (TV) was assessed and stratified based on age, sex, site of sampling, and anonymity of test. Adjusted odds ratios (ORs) were calculated by multivariable logistic regression. Overall, 3,753 assays were performed on 2,407 patients who were screened for STD. Chlamydia trachomatis (4.8%) was the most frequently detected STD, followed by NG (2.1%), MG (1.9%), and TV (0.6%). Mycoplasma genitalium (OR, 4.32; 95% CI, 1.70-10.97; p = .001) and NG (OR, 6.08; 95% CI, 2.18-16.96; p < .001) were significantly associated with male sex, while TV was more frequently encountered among female individuals (OR, 4.34; 95% CI, 1.49-12.50; p = .003). Mycoplasma genitalium infection was detected most commonly by urine samples, while rectal swabs were the leading source of positive tests for CT. Compared with fully identified patients, those tested anonymously were 6-fold more likely to be tested positive for TV (adjusted OR, 6.49; 95% CI, 2.06-20.42; p = .001). Chlamydia trachomatis and NG are the leading non-HIV STDs in Northern Israel. Anonymous tests predict higher positivity of TV. Rectal sampling should be increasingly used because of its efficacy in detecting CT infections.

Age and Knee Osteoarthritis Severity Relationship in Indonesian Secondary Referral Hospital

Osteoarthritis is a chronic joint disease that causes pain, disability, and loss of function. More than 80% of cases of osteoarthritis affect the knee joint. The exact cause of knee osteoarthritis is still unknown, but it is generally associated with aging and obesity. This study aimed to determine the relationship between age and the severity of knee osteoarthritis. This research used a cross-sectional study involving patients who suffered from knee osteoarthritis. Data on gender and the severity of osteoarthritis was collected from medical records. The severity of knee osteoarthritis was assessed using the Kellgren-Lawrence system. The data was analyzed using the Spearman correlation. There were 3 patients (8.1%) in the category of late adulthood, 7 patients (18.9%) in the middle-aged category, 13 patients (35.1%) in the early-onset elderly category, and 14 patients (37.8%) in the elderly. Seven patients (23.7%) suffered from osteoarthritis grade 1, 13 patients (35.1%) had grade 2, 16 patients (43.2%) had grade 3, and one patient had grade 4. The Spearman test showed that there was no significant relationship (p&gt;0.05) between age and the severity of knee osteoarthritis. According to the study's findings, there was no correlation between age and the severity of knee osteoarthritis in women and men patients at Baptis Hospital, Batu City.

Is there any correlation between physical activity and severity of knee osteoarthritis in secondary referral hospital in Indonesia?

Introduction and Aim: Osteoarthritis is a pathological condition of the joints that is degenerative and progressive, affecting two-thirds of people over 65 years of age, with a prevalence of 1.39 million among males and 1.69 million in females. The main clinical manifestation of osteoarthritis is joint pain. The incidence and progression of knee osteoarthritis are strongly influenced by risk factors, consisting of systemic factors including age, sex, hormonal factors, and biomechanical factors such as obesity, physical activity, and muscle weakness. The purpose of this study was to determine if there was a relationship between physical activity, the severity of knee osteoarthritis and the level of pain based on the Kellgren-Lawrence system in gender. Materials and Methods: This research was conducted in a cross-sectional design with 26 participants at Baptis Hospital in Batu City. As references for the interview, the GPPAQ and the WOMAC questionnaire were used. The Kellgren-Lawrence system is used to assess knee osteoarthritis. Results: The Spearman correlation test results showed no significant relationship between physical activity and the severity of knee osteoarthritis, and no significance between physical activity and the degree of pain in general or by gender. Conclusion: There was no statistically significant relationship between physical activity with the severity of knee osteoarthritis and the level of pain in males and females patients at Baptis Hospital in Batu City.

Surveillance of Antimicrobial Susceptibility and Resistance Among Enterobacteriaceae Isolates from The Clinical Specimens in Secondary Referral Hospital

The aim of our study is to assess the pattern of antimicrobial susceptibility and resistance to the bacterial pathogens isolated from patient specimens. The main objectives are to evaluate the pattern of antimicrobial susceptibility and resistance to the bacterial pathogens isolated from patient specimens, to determine the proportion of antimicrobial sensitivity and resistance against specific antibiotics by bacterial pathogens isolated from various specimens collected and to assess the difference in Resistance of bacterial isolates to various antibiotics within different years. Emergence of antimicrobial resistance is a major public health problem worldwide. Antimicrobial resistance is one of the ten threats identified by the World Health Organization in 2019. Approximately 0.7 million people die every year from AMR. The WHO estimates 350,000,000 deaths could be caused by AMR by 2050. For three years the retrospective observational study was conducted among all the age groups of people. Antibiograms were used based on CLSI guidelines. A total of 2430 samples, 1226 males and 1204 females, are there. The samples were collected by different types like Urine Blood, Pus, Tissue culture, Stool culture, swab culture, CSF, and other fluids. Among all the isolated bacteria E. coli, Klebsiella, and Enterobacter were more isolated and were more resistant to the penicillins and cephalosporins category of drugs. The study shows that isolated gram-negative bacteria were resistant to ampicillin, amoxicillin, cephalothin, ciprofloxacin, cefuroxime, cefepime, ceftazidime, and ceftriaxone. So, these drugs can be replaced with organism-sensitive antibiotics like amikacin, chloramphenicol, colistin, and gentamicin to treat bacterial infections. When compared to year to year, the resistance will be increased.

Low Back Pain Patient Distribution in Malang's Secondary Referral Private Hospital: A Single-Center Study

The number of occurrences of Low back pain (LBP) in patients, especially the elderly, who still doubt the results of a treatment or surgery. Our study aims to review and summarize the latest literature on the distribution of LBP patients who come to specialist doctors by looking at the purposes of referral and use of BPJS (Indonesian Health Insurance). This data provides an overview of the LBP roadmap in a secondary referral hospital. We took Medical Record data from all patients who came to the Specialist polyclinic at Lavalate Hospital Malang as a Type B Referral from 2018 – 2021 (n= 644). The incoming data is grouped based on Gender, Patient Origin, Medical Expense Guarantee, Designated Medical Specialist, and Medication. The study was conducted descriptively and processed with a statistical program. The majority of the number of patients who came were dominated by the age of 51 – 70 years (25%), with more women (68.3%) than men (31.7%). The most choices for patients with LBP came to Orthopedics Specialists and Neurologists who had the same number of patients, namely 239 patients (36.1%). Most of the patients who came to the specialist clinic received therapy (81.9%) with NSAIDs as the most choice (69.3%) as the choice of medication. Antispasmodic and antiepileptic were followed as the next most popular choice, but each specialty has its uniqueness in treating LBP patients.