Retrospective Sectional Study Research Articles

Statistical Software Applications and Statistical Methods Used In Community Medicine and Public Health Research Studies

Background: The utilization of software in statistical methods and tools has increased very much in last two decades. The easily availability of statistical application software on internet, made easy to analyse, interpretation and conclude the study variables.
 Aim and Objectives: To know the statistical software applications and various statistical methods used in the community medicine and public health research studies.
 Materials & Methods: A cross sectional retrospective study, We had included online community medicine and public health journals of four years (2017 to 2020).By cluster sampling method were used and each cluster includes articles of four different year, 400 randomly selected research articles were downloaded & reviewed. The data was analysed by using SPSS version 23.
 Results: 400 articles were reviewed. 317 (79.25%) were used Ms-Excel software followed by 261 (65.25%) descriptive statistics and 145(36.25%) SPSS and 143 (35.75%) applied cross sectional study design. 91 (22.75%) applied chi-square test, 77(19.25%) applied ANOVA test. 59(14.75%) t-tests. Only 41(10.25%) articles were reported with confidence intervals.
 Conclusion: The current study reveals, Microsoft excels, and SPSS and R-programming were more frequently using software in the community medicine and public health, whereas descriptive statistics, chi-square tests, t-tests and non-parametric tests were commonly using statistical methods.

Multilineage Haematologic Pattern Involvement in COVID-19 - Evaluation from Peripheral Blood Elements

Introduction: Coronavirus disease is a highly contagious disease emerged from the Chinese city of Wuhan in December 2019. The Coronavirus Disease-19 (COVID-19) involves haematopoietic system affecting erythropoiesis, granulopoiesis, lymphopoiesis and thrombopoiesis. Bone marrow is the ultimate source of most cells of innate and acquired immunity. In response to infectious or inflammatory stimuli, bone marrow enhances its output under the influences of growth factors and cytokines. Peripheral blood smear examination is a simple, rapid and cost effective procedure. Thus, examining peripheral blood elements could be helpful, particularly when Real Time Polymerase Chain Reaction (RT-PCR) test is not available at all levels of healthcare. Complete Blood Count (CBC) along with peripheral blood smear examination can reflect the impact of virus on haematopoietic system. Aim: The goal was to describe the peculiar morphological findings of peripheral blood elements in COVID-19 cases and the immune-inflammatory parameters from CBC that would be helpful to assess the disease severity so that early therapeutic intervention can be made. Materials and Methods: This was a cross sectional retrospective study carried out in Department of Pathology, Fakir Mohan Medical College and Hospital, Balasore from 05 June 2020 to 10 August 2020. Among the suspected COVID-19 patients admitted to the isolation ward; 200 adult patients (≥18 years of age) were included in the study. Suspected COVID-19 patient with co-morbidities, pregnant women, paediatric population were excluded from the study. Data including clinical features, co-morbidities, CBC and peripheral blood smear examination was received and compared with RT-PCR result of these patients. The immune-inflammatory parameters like Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR) and Systemic Inflammatory Index (SII) were evaluated from CBC. Data were evaluated for statistical significance using Statistical Package for Social Sciences (SPSS), version 21.0. The categorical variables of the patients were analysed using Chi-square test and presented as numbers and percentages. Parametric continued variables were analysed using Independent Sample Student’s t-test and p-value <0.05 was considered statistically significant. Results: Monolobate neutrophils and plasmacytoid lymphocytes were seen in peripheral blood smear of COVID-19 patients (p<0.05). Giant platelets with cytoplasmic vacuolations was detected in 77.27% (102) of postive cases. The NLR was greater than 12 (mean 18.44±1.735) in all severe patients that were admitted in Intensive Care Unit. Conclusion: In addition to the morphological changes in peripheral blood smear examination, evaluation of immune- inflammatory parameters, particularly neutrophil lymphocyte ratio, may be helpful in the screening, diagnosis, predicting prognosis as well as in treatment of COVID-19.

Anatomical variations of sphenoid sinus based on computerized tomography (CT)

ObjectivesCurrently in Sri Lanka otorhinolaryngologists are vastly involved in functional endoscopic sinus surgery (FESS), while transsphenoidal approach to sellar lesions is becoming popular among neurosurgeons. There is a possibility of endoscopic supra sellar, lateral skull base and clival surgery to take off in near future although no sufficient database is available about the anatomical variations of the sphenoid sinuses of Sri Lankans. This research is aimed at filling this deficit.Design and MethodsA cross sectional retrospective study of 200 CT scans of 0.5mm intervals of the ‘nose, paranasal sinus and brain” of Sri Lankans who were seen at district general hospital Trincomalee were analyzed. Details were collected regarding pneumatization, sellar budge, protrusion and dehiscence of the walls of maxillary nerve (MN), optic nerve (ON), vidian nerve (VN) and internal carotid artery (ICA) and the different types and attachment of the sphenoid sinus septum.ResultsWe found no conchal pneumatization but 100% of the study population to have presellar area of the sphenoid body pneumatization, 87% to have sellar and 39.5% to have post sellar area of the sphenoid bone pneumatization. Superior extension of pneumatization into anterior clinoid process (ACP) was found among 13.5% and extension in to posterior clinoid process (PCP) in 4.5%. Lateral extension in to opticocarotid recess was found in 60% and pneumatization in to greater wing of sphenoid (GWS) was found in 42% while 13.5% had pneumatization of lesser wing of sphenoid (LWS). Anterior pneumatization extended in to vomer and ethmoid bones and was 25%and 19% respectively. Posterior extension in to clivus was 34.5% while pneumatization extended inferiorly in to pterygoid process in 54.5 %. The sellar bulge was well defined in 75.5% and not so in 24.5%. The Intersinus septum was absent in 0.5% while single Intersinus septum was present in 86.5% and 8% had a transverse septum. 29.5% had multiple Intrasinus septum while 64.5 % had accessory septa. Occurrence of protrusion and dehiscence in optic nerve, maxillary nerve, vidian nerve and internal carotid artery were, 54%, 8.5%, 24.5% and 79% and, 23%, 7%, 14% and 57.5% respectively.ConclusionsThe sinus anatomy has a racial difference and regional anatomy varies randomly. Posterior, inferior and lateral extensions of pneumatization could make orientation and relative positioning of vital structures confusing. Septal attachments to vessels and nerves are much higher than appreciated previously. Individual study with greater attention to detail in CT scans is recommended prior to surgery to minimize complications.

Dermatological patients in the Intensive Care Unit – a hospital record based retrospective study

Background: Various dermatological conditions can be life threatening and may require admission in the intensive care unit for monitoring and management. We carried out this study to assess the profile of dermatological admissions in the intensive care unit. Materials and Methods: It was a cross sectional retrospective study in which the records of all patients of various dermatological disorders admitted in the intensive care unit over a period of three years was studied and the clinical details were assessed. Results: Over a period of three years, a total of 16 patients (M:F 10:6), aged between 16-71 years (mean 46±2.31 years) were admitted with an underlying dermatological disorder. The most common condition requiring admission was Stevens Johnsons Syndrome (n=5), followed by Pemphigus vulgaris (n=4), erythroderma(n=2), pustular psoriasis, dermatomyositis, necrotizing faciitis, dapsone hypersensitivity syndrome and cutaneous lymphoma in 1 each. Interventions like mechanical ventilation were required in 2 patients, inotropic support in 2 patients, central venous line placement, renal replacement therapy and tracheostomy in one patient each. The mean duration of ICU stay was 14.2 days and mortality was the outcome in 2 patients of pemphigus vulgaris which was attributed to septicemia and shock. Conclusions: Dermatological disorders can cause significant morbidity and may require proper care in the intensive care unit. Timely initiation of intensive care can help in reducing the morbidity and preventing mortality.

A clinico-pathological and neuro-radiological study of angiomatous meningioma: Aggressive look with benign behaviour

Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.

Prevalence and Predictors of Mortality for Older Adults Referred to a Hospital Avoidance Program

A cross sectional retrospective data linkage study of older adults discharged from local hospital avoidance program between January 2017 and January 2018 was undertaken (N=286; mean age 80.5 years). The prevalence of death at 3 months, 6 months, 12 months, 18 months and 33 months was calculated. Patient demographic characteristics associated with participant’s risk of mortality at 33 months after discharge was examined using Cox multivariable regression. Patient demographic and health characteristics associated with participant mortality within 12 months of discharge was examined using multivariable logistic regression for patients with complete health characteristic data (n=195). The mortality prevalence was 17% at six months and the cumulative prevalence at one year, 18 months and 33 months post discharge were 24%, 29% and 36% respectively. Patient demographic characteristics associated with participants’ risk of mortality at 33 months after discharge were gender, age and household arrangements. Health and demographic characteristics associated with mortality within 12 months of discharge were lower cognition, increased burden of comorbidity, decreased physical function, a weight less than 55 kilograms, older age and male gender. These results indicate that a significant proportion of people attending a hospital avoidance program are likely to be entering into the final year of their life. This suggests that hospital avoidance programs should routinely identify patients who are likely nearing end of life, and support advance care planning for this patient group.

Gender Differences in Sociademographic Characteristics and Risk Factors Among Condyloma Acuminata Patients in DR. Moewardi General Hospital Surakarta

Condyloma acuminata (CA) known as anogenital wart is the most frequent sexually transmitted infection worldwide. This highly infectious disease is caused by the human papilloma virus, whose its high reccurence rates contribute to direct medical costs, productivity loss and increased psychosocial impact. Thus, the prevention of this viral disease is more important than focusing on its treatment. This cross sectional retrospective study assesed the gender differences in sociodemographic characteristics and sexual risk factors of CA patients. There were 94 newly diagnosed CA patients, 47 males (50%) and 47 females (50%) during the period of January 2013- December 2017. The demographic data were taken from medical record and the additional data about the risk factors were from the questionnaires. Chi-square test was performed to compare between genders and p < 0.05 was considered statistically significant. There was significant difference between genders on all sociodemographic characteristics (age, occupation, education, marrital status) and risk factors (HIV/AIDS infection, condom using, age at the first sexual intercourse, number of lifetime sexual partner, type of intercourse) among CA patients. Our study revealed that male CA patients were mostly single, employed and multipartner, while CA female patients were mostly married, housewives and singlepartners.

Evaluating The Effectiveness Of Donor Recruitment Strategies Towards Improving Availability Of Blood Product In Nigerian Tertiary Health Institution

Abstract Introduction/Objective Over the years, many strategies has been put in place to improve blood donations and overcome socio-cultural myths and fear that has held groups of people from voluntary blood donation in Nigeria and other subsahara africa countries. Among these are adequate education, approaches through religious group leaders, non-monetary incentives like giving them special awards during world blood donor day. The aim of this study is to evaluate the effectiveness and adequacy of our blood donor recruitment and retention strategies in improving availability of blood product in our institution Methods For this cross sectional retrospective study, Data including blood donation and break down of pattern of donations, request for blood products, monthly units of blood issued gotten from our 5 year Transfusion services records were searched, same entered into Microsoft Excel and the were analysed Results Our voluntary non-renumerated blood donation steadily increased from 4.55 in 2015 to 33.3% in 2019, this represent a five fold increase in our voluntary donor recruitment within the period under review. However overall blood donation rate remained steady at approximately 12000 units per annum over this period of time. There is an increase in request rate, on the average the rate of blood request was 1214 units per month in 2015, but in 2018 this has increased to an average of 1738 units per month and by 2019 average rate of request was 2300 units per month. Out of this huge request only 67.9% of them was met, implying a huge deficit in our blood availability despite increasing pool of voluntary blood donor. Conclusion Findings in this study revealed a steady increase in the pool of voluntary blood donor which did not reflect in our overall blood availability. This might be due to concurrent decrease in our family replacement donor. This finding also suggests that even though our current strategy used in donor recruitment and retention might seems effective, they are still not adequat, as there is no commensurate rise in blood donation to match the progressive increase in blood demand. In the face of this inadequacy it might be expedient to also audit the blood ordering pattern in our centre in order to reduce wastage while we continue to work towards increasing the voluntary blood donor base.

Liver Transaminase Levels and Neutrophil to Lymphocyte Ratio as Prognostic and Predictor in Coronavirus Disease 2019

Introduction: COVID 19 was a disease caused by the SARS-CoV 2 virus with severe respiratory distress syndrome. SARS-CoV 2 can attack the gastrointestinal and liver system. In several studies, elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were reported, ranging from 14% to 53%. The increase of neutrophil to lymphocyte ratio (NLR) also increases the risk of mortality in COVID 19. This research wants to study ALT, AST, and NLR as prognostic and predictor in COVID 19.
 Methods: A cross sectional retrospective study conducted on COVID 19 patients. The diagnostic criteria are based on the recommendations of the Indonesian Ministry of Health. The patient's blood was examined in a central laboratory at hospital. Data analysis were done using SPSS version 22. 
 Results: A total of 126 patients with COVID 19 were included in this study. There are 57 (45.2%) patients having abnormal liver test. There was a significant difference in the mean AST and NLR between COVID 19 patients with nonsurvival and survive outcome (82.91 ± 103.82 vs. 40.54 ± 33.59 U/L; p = 0.0001 and 7.42 ± 3.65 vs. 3.47 ± 2.41; p = 0.0001). High AST (≥34.5 U/L) and NLR (≥4.7) independently associated with nonsurvival outcome in COVID 19 patient with odds ratio (OR) 5.31 and 9.49 [1.89 – 14.95, 95% CI; p = 0.002 and 3.57 – 25.22, 95% CI; p = 0.0001].
 Conclusion: This study revealed that high AST and NLR at hospital admission was associated with high mortality risk in COVID 19 patients. Therefore, the AST and NLR can be a significant prognostic of outcome in COVID 19 patients.

Blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia: Retrospective cross sectional study.

IntroductionTuberculosis disease is the leading cause of death worldwide along with HIV/AIDS. Sputum smear microscopy plays an essential role for initial TB diagnosis and treatment follow up. But, misdiagnosis of sputum smear microscopy revealed a high economical crisis and missing of active TB cases. This study was aimed to determine blinded rechecking of sputum smear microscopy performance in public health facilities in Tigray region, Northern Ethiopia.Materials and methodsA cross sectional retrospective study was conducted from January, 2017 to December, 2018 year. Data was collected retrospectively using electronic and paper based in Tigray health research institute. The data was analyzed using the SPSS version 25 software. The sensitivity, specificity, positive predictive value, and negative predictive value of the smear readings were calculated using 2X2 contingency table. The reading agreement between the microscopic center and reference center was determined using kappa statistics.ResultsA total of 23,456 blinded rechecked smear results were reviewed. In average, the performances of sputum smear quality were 61%, 68%, 64%, 66%, 62% and 75% for specimen quality, staining quality, smear size, smear thickness, smear evenness and smear cleanliness respectively. Of the total error (0.48%) reported, 0.25%, 0.19% and 0.085% were false positive, false negative and quantification errors respectively. The concordance rate of health facilities for smear reading was increased to 90% by the end of 2018. Overall, the sensitivity, specificity, PPV, and NPV of the smear readings were 95%, 99.7%, 93% and 99.8% respectively. Likewise, the smear reading agreement was also perfect with kappa value, 0.87.ConclusionThe overall performance of public health facilities for blinded rechecking of smear microscopy was satisfactory. But, the high false positive and false negative errors found calls for continuous evaluation and monitoring of the health facilities by reference center.

Prevalence of Congenitally Missing Lateral Incisors and Peg Laterals in Patients Receiving Orthodontic Treatment

Introduction: Maxillary lateral incisor is a common congenitally missing tooth in the oral cavity. Maxillary lateral incisor is also the most common varying tooth in form than any other tooth. The objective of the study is to estimate the prevalence of congenitally missing maxillary lateral incisors and peg laterals in patients receiving orthodontic treatment.
 Materials & Method: This is a cross sectional retrospective study carried out among 204 orthodontic patients. Panoramic radiographs taken during the diagnostic procedure of orthodontic treatment was used to confirm the presence or absence of lateral incisors. The presence of peg laterals was determined by dental casts.
 Result: Prevalence of missing maxillary lateral incisors and peg laterals was found 2.5% and 3.9% respectively. Prevalence of missing lateral in male was 5.7% while among female no missing laterals were observed. Prevalence of peg laterals in male and female was 1.1% and 6% respectively. Among the missing lateral incisors, prevalence of bilaterally missing lateral incisors was 60% while prevalence of both right and left unilateral missing laterals was 20%. Among the peg laterals, bilateral peg laterals were present in 50% patients, followed by left unilateral 37.5% and right unilateral 12.5% peg laterals.
 Conclusion: The present study shows higher prevalence of peg laterals than missing lateral incisors. Prevalence of missing lateral incisors was higher in male and prevalence of peg laterals was higher in female. Prevalence of bilaterally missing laterals and bilateral peg laterals was higher than unilateral presentation.

PROFILE OF EPILEPSY PATIENTS IN THE PEDIATRIC WARD AT DR. SOETOMO GENERAL HOSPITAL, SURABAYA IN THE PERIOD OF JANUARY-DECEMBER 2017

Background: Various risk factors of epilepsy in children had been reported although differences were found amongst regions. Objective: To determine the differences in risk factors and type of epilepsy patients with febrile seizure history in children aged 0-17 years old at the Pediatric Ward, Dr. Soetomo General Hospital, Surabaya in 2017. Material and method: This is a cross sectional retrospective study, using secondary data from medical records of epilepsy patients with febrile seizure history in children aged 0-17 years old at Pedicatric Ward, Dr. Soetomo General Hospital, Surabaya in the period of January-December 2017. Data analysis was done using t-test and the Chi-Square test (Microsoft Excel 2007 and SPSS 22); level of significance was p<0.05. Result: Seventy-four male and 38 female patients were included. Febrile seizure history is observed in 42 patients and there was no significant difference between febrile seizure history and prevalence of epilepsy. The general type of seizure was found in 79 patients; mostly from Surabaya and the parents’ occupation is private employee. The most observed type of seizure is general type. Conclusion: In this study, epilepsy was predominance in males than females; and significantly more patients without febrile seizure history. General type of seizure is the most common type amongst others. These patients were mostly from Surabaya, with parents' occupation was private employees.

Determinants related to the risk of using ED among paediatric patients receiving home care services

Abstract Introduction Pediatric home care services (PHC) are recommended to avoid hospital visits or readmission in children with chronic or complex conditions and to reduce the use of emergency departments. It would be useful to know the association of sociodemographic, clinical and health supply factors with Emergency Department (ED) access by patients receiving PHC. Methods A cross sectional retrospective cohort study was held from 2012 to 2017 in Pediatric home care services in Italy. Participants are children aged 0-18 years receiving pediatric home care services. Collected data are: sociodemographic variables (sex, age, presence or absence of an unfamiliar caregiver); distance from the ED in minutes; clinical variables (mortality rate at home, mortality rate in the ED, pathology responsible for the PHC activation and pathology determining the ED access); health supply variables (PHC proposed duration as stated by the proponent, subjects directing the patient to the ED, place of discharge after ED access, and arrival time to the ED). Results A total of 1236 PHC events contributed to 769 ED accesses. Receiving PHC services after hospital discharge (RR:1.26) and longer duration of charge-taking significantly increased the risk of experiencing ED access. The RR significantly decreased among children >5 years-of-age (RR:0.84; RR:0.62; RR;0.57; in 5-9; 10-14; 15-18 years respectively) and among children with neoplastic (RR:0.7), respiratory (RR:0.69), trauma (RR:0.4) or musculoskeletal diseases (RR:0.31) at first evaluation. Conclusions Confirming that ED accesses are issue present among children receiving home care services, this study has the main strength of demonstrating which risk factors are associated with ED accesses by children using home care services. Knowledge of them is necessary in order to implement adequate prevention strategies on both management and quality of care. Key messages Determinants associated with the risk of using emergency departments among paediatric patients receiving integrated paediatric home care services. ED visit is shown to be an issue among children receiving PHC and some determinants emerged as associated with ED visits by children in PHC.

Profil and Evaluation of Resistant Tuberculosis Drug’s Side Effect in Diabetes and Non Diabetes Mellitus Patient at RSUD Arifin Achmad

Backgrounds: Diabetes mellitus (DM) increases the risk of reactivation of tuberculosis included multi-resistant drug tuberculosis (MDR-TB). This situation is threatening Riau province due to the high prevalence of DM. Since 2014 Arifin Achmad Hospital as a referral hospital of MDR-TB management. It’s treatment especially in DM patients, requires an evaluation of both outcome and side effects. This evaluation needs to be compared with non-DM MDR TB patients. The aim of this study was to evaluate and analyse patient’s characteristic, conversion of smear or culture, drugs side effect and treatment outcome. 
 Methods: This is a cross sectional retrospective study in RSUD Arifin Achmad Pekanbaru on April-October 2018. Sample of this study were all patients from 2014 – 2017. This study was divided into 2 groups, namely the DM and non-DM groups, then analysed the differences between the two groups 
 Results: There were 113 MDR TB patients had its treatment, which 61% of the patients were male. Baseline data show 26.5% of MDR TB patients have comorbid DM. The most common side effects were nausea and vomiting (100%) in all subjects. In the MDR TB DM group, we found included: well controlled plasma glucose level was 33.3%, severe side effects was16.7%, conversion in the second month 40% and cured or complete treatment was 30%.
 Conclusions: As many as 26,5% of MDR TB patients had DM comorbidity. There were no differences in the percentage of drugs side effects, smear conversion in the second month and treatment outcome between MDR TB DM and MDR TB non-DM group. (J Respir Indo. 2020; 40(3): 156-62)

Diagnostic Accuracy of Color Doppler and Calcium Scoring versus Dual-Energy Computed Tomography Angiography in the Assessment of Peripheral Arterial Diseases of Lower Limb.

Objectives:Peripheral arterial disease (PAD) leads to narrowing and hardening of arteries which leads to increased risk of lower extremity amputation. Hence, the accuracy of non-invasive diagnostic methods such as calcium scoring and color Doppler needs to be assessed in comparison to the gold standard dual-energy computed tomography (DECT) angiography. This study aims to evaluate the accuracy of color Doppler and calcium scoring when compared to DECT angiography in the assessment of PAD of the lower limb. It is a cross- sectional retrospective study.Material and Methods:The study included 55 patients aged between 40 and 70 years. All the patients with symptoms suggestive of PAD underwent color Doppler study of lower limb arterial system. Afterward, the patient underwent CT angiography. The first plain images were taken for calcium scoring following which contrast was given and further images were taken.Results:As compared to CT angiography assessment, Doppler assessment was 88.1% sensitive but only 69.2% specific with diagnostic accuracy of 83.6%. For angiographically detected atheromatous changes, color Doppler had sensitivity and specificity of 86.2% and 76.9%. The derived cutoff value >149.1 of calcium score in lower limb arteries was in 100% agreement with CT angiography detected PAD, whereas, for atheromatous changes, total calcium score at a cutoff value of >842.2 had sensitivity and specificity of 75.9% and 80.8%.Conclusion:Calcium scoring as compared to color Doppler has a higher diagnostic efficacy for the detection of DECT angiography confirmed PAD, whereas calcium score lacks adequate sensitivity at projected cutoff in the evaluation of atheromatous changes.

Evaluation of agreement between clinical and histopathological diagnosis of subtype of leprosy by skin punch biopsy

Introduction: Leprosy is chronic granulomatous disease caused by Mycobacterium leprae. Clinically diagnosed cases of leprosy can be evaluated by punch biopsy. It can be classified according to Ridley and Jopling Classification.
 Objective: To study the different spectrum of leprosy and its Bacillary Index (BI), evaluate the agreement between clinical and histopathological diagnosis.
 Materials and Methods: This is a hospital based cross sectional retrospective study done for the period of 6 months from January to June 2019. The data were subjected to kappa analysis by using SPSS version 24 to see the agreement between clinical and histopathological diagnosis.
 Results: Out of 62 cases of clinically diagnosed cases of leprosy three (4.83%) cases turned out to be other granulomatous diseases. According to Ridley and Jopling classification, clinical and histopathological agreement was seen in 38 (61.29%) cases. Agreement of 100% was seen in Indeterminate leprosy (IL) and Borderline tuberculoid leprosy (BT). The BI was more in Lepromatous leprosy (LL), Borderline lepromatous (BL) whereas IL, BT and Tuberculoid leprosy (TT) showed less BI. Overall there was moderate agreement between clinical and histopathological diagnosis (kappa- 0.505) which was statistically significant (p value <0.05).
 Conclusion: There was moderate agreement between the clinical and histopathological diagnosis of subtype of leprosy. The Bacillary load was high in LL whereas least in TT and is determined by immune system.

P109 Influenza vaccine uptake

Abstract Background Patients on immunosuppressive csDMARDs and bDMARDs for inflammatory and autoimmune conditions are more susceptible to infection. Viral infection in these patients is associated with an increased likelihood of severe outcomes such as bacterial pneumonia, hospitalisation and death. The influenza vaccine is a simple and effective measure to protect patients from seasonal flu. Traditionally uptake has been patchy in rheumatology patients for unclear reasons. Methods Aim: To assess the uptake of the influenza vaccine amongst at risk patients in a secondary care rheumatology department and investigate the factors that may affect uptake. Methodology: This is a cross sectional retrospective study with a sample size of 200. Patients were invited to complete a paper survey when they attended their outpatient rheumatology clinic in May/June 2019 about the previous winter 2018/19 influenza season. Chi square tests were used to determine whether age, educational level and ethnicity had an impact on vaccine uptake. Results 5% of the population were aged between 18 - 30, 21% between 31 - 50, 48% between 51 - 70, 25% between 71-90 and 1% were above 90. 56% attained secondary school level education, 13% completed college/A levels,18% had completed university,12% completed vocational education and only 1% attained primary school level alone. Most of the patients were Caucasian (93%) with only a small percentage of different ethnic groups represented in the sample. 62% of the patients were on DMARD treatment. Of those who were on DMARD treatment, 78% were vaccinated against influenza in the last season. 55% of those not on DMARD treatments were vaccinated. Chi square tests showed a significant relationship between age and vaccine uptake with older patients more likely to have the vaccine(p < 0.001). The tests also showed that higher education levels were associated with higher vaccine uptake(p < 0.02). Those on DMARDs were also significantly more likely to be vaccinated than those not on DMARDs (p < 0.001). The sample sizes in the different ethnic groups weren’t big enough to assess the effect of ethnicity on uptake. The top three reasons given by patients for not having the vaccine were that they didn’t feel it was necessary, worrying that they’d get sick afterwards and not finding the time to have it done. Conclusion Age, education level and being on DMARD treatment had an impact on influenza vaccine uptake. Further patient education on the importance and benefits of the influenza vaccine needs to be provided to patients to improve vaccination rates in at risk individuals. Influenza vaccine should be discussed with all patients at routine follow up visits, appropriate educational provided and general practitioners alerted to the need to place immunosuppressed rheumatology patients on call up schemes for influenza vaccination Disclosures B. Noureldin None. N. Erb None.

Validity S.T.O.N.E. nephrolithometry scoring to predict stone free status in kidney stone patients after percutaneous nephrolithotomy

Background: Kidney stone still a health problem in the world. Today, the choice of therapeutic modality is also increasingly varied, percutaneous nephrolitotomy (PCNL) is still the first line for stone therapy with varying success rates, some high or low. Sometimes need additional measures such as extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) for the rest stone and good preventive behaviour are needed. This can be influenced by several risk factors, a risk factor predictor is required to get a high stone free rate in patients after PCNL.Methods: This research is a cross sectional retrospective study, we recorded 50 patients at the Medical Records Installation at Sanglah Education General Hospital in Denpasar since January 2018-November 2019 with kidney stones performed by PCNL, each patient will be calculated S.T.O.N.E Nephrolithometry score can be seen on CT Stonography and the presence or absence of stone after PCNL. The parameters of S.T.O.N.E Nephrolithometry are size, tract obstruction, number of calyces, essence. And calculated the best cut off, sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of the S.T.O.N.E Nephrolithometry score to predict stone free status after PCNL.Results: The best cut off value in this study is <9, where patients with S.T.O.N.E Nephrolithometry score < 9 have a risk stone free after PCNL 25 (50%) patients, while the S.T.O.N.E Nephrolithometry score >9, has a risk of not being free and there are stones left  25 (50%) patients. S.T.O.N.E Nephrolithometry had % sensitivity 60.6%, specificity 70.6%, and 64 % accuracy in this study. Positive predictive value and negative predictive values were 80% and 48%.Conclusion: from this study the S.T.O.N.E Nephrolithometry score sensitively predicts stone free status in kidney stone patients after PCNL and can be used as a tool to education the patient before PCNL and therapy.

Drug Resistant Tuberculosis in Oyo State, Nigeria: A Retrospective Study

Aim: The focus of this work was to evaluate the prevalence of rifampicin resistant tuberculosis in Oyo State, Nigeria.
 Study Design: A cross sectional retrospective study
 Place and Duration of Study: St Mary’s Catholic Hospital, Ibadan, Nigeria, between October 2016 and March 2018
 Methodology: In this study, 1044 patients diagnosed in the GeneXpert laboratory was conducted using the laboratory register. The age, gender, HIV Status, MTB analysis results and resistance to rifampicin were collected and analyzed.
 Results: Of the 1044 tested, 177 (17%) tested positive for TB while 19 (10.7%) of the 177 were resistant to rifampicin. Fourteen (73.7%) of the 19 were male and 5 (26.3%) were female. Fourteen (73.7%) of the 19 fell between 21 - 40 years of age. Seven (36.8%) of the 19 resistant to rifampicin were HIV positive. Of the total 1044 patients tested, 601 (57.6%) were females and 443 (44.4%) were male.
 Conclusion: This study showed that rifampicin resistant tuberculosis is high in Nigeria especially among the economically productive age group in the country. More attention should be committed to quick accessibility of diagnosis, treatment and monitoring by the policymakers.

Epidemiology and Clinical Characteristics of Patients with Hepatocellular Carcinoma in North-East of Iran

Background: Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is a life-threatening disease worldwide. The aim of this study was to investigate the epidemiology and clinical features of HCC patients who referred to Omid hospital in Mashhad, northeast of Iran. Materials and Methods: In this cross sectional retrospective study, we reviewed the medical records of patients who referred to Omid hospital – a cancer research center– in Mashhad during 1991 to 2012. Medical records of 29 patients with primary liver cancer proven with biopsy, CT scan or MRI were analyzed in this study. Results: Of 25 eligible cases, 68% were men and the rest were women. The majority of HCC patients were in the 60-69 age group. Also, 44% of patients were found to be hepatitis B virus surface antigen (HBsAg) positive. Conclusion: The age distribution and male preponderance of HCC patients observed in the present study in line with other conducted studies in Iran and other countries. Since this is a retrospective study, a comprehensive study with a larger sample size in a case-control study is needed to establish other HCC-related factors in our province.