Specialist Hospital Research Articles

Prevalence and associated factors of post-stroke depression among patients on follow-up at medical referral clinics of Bahir Dar city public specialized hospitals

BackgroundPost-stroke depression is among the most common neuropsychiatric complications in stroke survivors. Post-stroke depression is commonly under-recognized and under-treated. This study aimed to assess the prevalence and associated factors of post-stroke depression among patients on follow-up at medical referral clinics of Bahir Dar City public specialized hospitals.MethodAn institutional-based prospective cross-sectional study was conducted from September to December 2023 on 394 patients. Public Health Questionnaire-9 was used to diagnose depression. Data was checked for cleanness manually and then exported to SPSS version 25 software for analysis. A systematic randomized sampling method was used to identify study participants. Bivariate and multivariate logistic regression analysis was performed to identify independent predictors of post-stroke depression. A p-value less than 0.05 is considered as significant with a 95% confidence interval.ResultThe overall prevalence of post-stroke depression was found to be 42.9%. Employment status (AOR = 0.282, 95% CI: 0.112–0.709 C, P-value = 0.007), depression before stroke (AOR = 3.237, 95% CI: 1.098–9.544, P-value = 0.033), ischemic heart disease (AOR = 4.090, 95% CI: 1.745–9.583, P-value = 0.001) and physical disability (AOR = 4.051 95% CI: 2.239–7.332, P-value = 0.000) were found to be statistically significant independent predictors of post-stroke depression (PSD).ConclusionThe prevalence of post-stroke depression was found to be high relative to other similar studies. Patients with known depression before stroke, ischemic heart disease, and significant physical disability were at a higher risk of developing PSD. Employed patients had less risk of developing PSD. Sufficient and comprehensive evaluation of stroke patients for depression is recommended.

Return on Investment With Health Care Simulation.

Delivering simulation across a health system can engage the entire workforce by moving beyond traditional educational delivery and focusing on broader organizational needs specific to a particular organization. The commonly known use of simulation as a form of life support education has progressed to include fully immersive simulation experiences focusing on team-based communication, leadership, fellowship, and clinical care. It continues beyond this point with the inclusion of patient safety strategies, root cause analysis investigation, leadership, and management training, and recently, it has included environments that catalyze innovation in complex healthcare systems. The focus on pure fiscal elements of simulation-based approaches does not give a health system the accurate nontangible benefits simulation can provide, and importantly, acknowledging that each location has differing needs is essential when considering what investment should be made and where. A small community hospital will have vastly different needs from specialty hospitals that deliver specialist care. It must also be understood that every simulation center, to some extent, will always be unique, as it should. The commonly quoted statement "when you have seen one simulation center, you have seen one simulation center" really does reflect the reality of this established and rapidly growing specialty. In this article, we reflect on the traditional use of simulation and discuss some wider uses that may engage a wider audience and, importantly, provide a greater return on investment for your facility, making the case for investment more reasonable and impactful to each part of a busy health system.

Increased Wound Prevalence in those Exposed to Xylazine and Fentanyl Compared to Those Exposed to Fentanyl: An Observational Study.

The aim of this study is to determine the difference, if any, in prevalence of wounds in individuals who were exposed to xylazine and fentanyl compared to individuals who were exposed to fentanyl and not xylazine. A large inpatient substance use disorder specialty hospital provided medical records over an 8-month period from July 2023 to February 2024. Individuals were admitted to an American Society of Addiction Medicine 3.7 level of care where a urine drug screen and skin assessment was conducted on admission. If the urine screen noted a presence of fentanyl, the sample was then tested for xylazine exposure. Patients were considered positive for wounds on admission to treatment if any wound was noted during the skin assessment during the admission process. A total of 282 medical records were identified. A chi square test of association was completed and revealed a statistically significant association between xylazine exposure and wounds (P = 0.002, odds ratio = 2.420, 95% confidence interval = 1.376-4.254). This study provides early support for the previously theorized connection between xylazine exposure and wounds.

Impact of COVID-19 Towards Antibiotic Consumption in a Major Specialist Hospital: A Non-COVID-19 Hospital Perspective

The Coronavirus disease 2019 (COVID-19) pandemic heavily affected healthcare services and medication supply. Literatures showed that the consumption of antibiotics was significantly increased during the pandemic especially in COVID-19 hospitals, however, little is known about the collateral impact of the pandemic in non-COVID-19 healthcare settings, such as Hospital Queen Elizabeth II (HQEII) based in Malaysia. This study aimed to compare the prevalence of antibiotic consumption before (2018 & 2019) and during (2020 & 2021) the pandemic, and to explore its impact on antibiotic-acquired cost and bacterial resistance. This is a descriptive observational study where the antibiotic consumption from 1st January 2018 to 31st December 2021 in HQEII was reviewed. The antibiotics selected were Meropenem, Vancomycin, Piperacillin-tazobactam, Ceftazidime and Ceftriaxone. The antibiotic consumption, antibiotic-acquired cost and cases of multidrug resistant organism (MRO) before (2018 & 2019) and during (2020 & 2021) the COVID-19 pandemic were compared, with combined 2 years data for comparison. The overall consumption of the selected antibiotics significantly increased by 45.2% (34.8 vs 50.5, p<0.001) during the COVID-19 pandemic. Intensive care unit had the highest increase in antibiotic consumption (+114.3%, p<0.001). There was a raising trend for the use of Vancomycin, Meropenem, Ceftazidime and Piperacillin-Tazobactam (p<0.005). All these contributed to a significant increase in antibiotic-acquired cost by 64.4% during the COVID-19 pandemic (RM909,898.80 vs RM1,486,791.20, p<0.001). Notably, cases of multidrug resistant organisms also increased, especially MRO Acinetobacter (+197%) and Carbapenem-resistant Enterobacterales (+92%). High antibiotic consumption, antibiotic-acquired cost and MRO cases were observed in non-COVID-19 healthcare setting during the pandemic, but the factors contributing to the surge were not explored in this study.

Prevalence of antibacterial resistance among hospitalized patients in Tigray, Ethiopia, 2021: A cross-sectional design

ObjectiveTo describe the prevalence of antibacterial resistance among hospitalized patients in Tigray. MethodsA cross-sectional study design was applied in hospitalized septic medical patients in Ayder Comprehensive Specialized Hospital from March 2020 to January 2021. Socio-demographic, clinical, and laboratory-related data was collected, and descriptive analysis was done to present the result. ResultIn this study, a total of 153 hospitalized septic patients were included with a median age of 30 IQR (22-49) years. A total of 187 different samples were collected from 153 participants of the blood and foci of infection, and bacterial isolates were found in 103 (55%) samples. A total of 70 (45.6%) septic patients showed antibacterial resistance at least to one antibiotic. The most common isolates were Klebsiella pneumonia, followed by Escherichia coli and Acinetobacter species with equal distribution. These isolates were found to be resistant to ampicillin (79.9%), cotrimoxazole (64.1%), and ciprofloxacin (64.1%). ConclusionThis study revealed a significant problem of antibacterial resistance in the referral hospital. The most commonly prescribed and affordable antibiotics were found to be resistant. So, the hospital and the country as well are expected to minimize the magnitude of the problem through different AMR strategic stewardship initiatives.

Lung abscess caused by Streptococcus constellatus: Case report

This case report presents a detailed case study of Lung abscess caused by Streptococcus constellatus. This case underscores the critical role of accurate microbiological diagnosis in the effective management of lung abscesses, highlighting the necessity for precise identification and targeted treatment strategies. A 47-year-old male who exhibited persistent fever and mucopurulent cough, leading to a visit to the Emergency Department of a local hospital in Riobamba, Ecuador. Initially, the patient was diagnosed with pneumonia and treated with moxifloxacin and itraconazole. However, as his condition deteriorated, he was transferred to a specialty hospital in Quito, Ecuador. Chest X-rays identified a cavitary lesion, which was further confirmed by CT chest imaging to be a lung abscess. Additional diagnostic work through CT-guided biopsy and culture confirmed the presence of Streptococcus constellatus. The patient's treatment regimen included targeted antibiotic therapy with piperacillin-tazobactam, resulting in a six-week hospitalization. The patient's condition significantly improved, and he was subsequently discharged.

A retrospective study to assess the effectiveness of bath in burns healing by reducing the Length of Stay in hospital at Apollo Speciality Hospital, Vanagaram

Background: Ours is a dedicated burns unit at Apollo Speciality Hospitals, Vanagaram. This study deals with two mass casualties at Neyveli Lignite Corporation (NLC) and Pharmaceutical company (Pondicherry). This came to initiate the quick recovery of the patient of the hospital stay. Methods: Retrospective cohort study research design was taken for this study. The study was conducted at Apollo Speciality Hospitals, Vanagaram for a duration of 3 months, 60 samples using simple random sampling who met the inclusion criteria were selected as study samples. Data collection tool such as Socio- Demographic Data (Age in years, Sex, Average Length Of Stay, Scar sites) and clinical variables proforma of cleansing modality, cleansing solution, additives, frequency were used. Result: Percentage of total body surface area will reflect in Average Length Of Stay. 33 responders were given the bathroom bath was discharged with 11-20 days of hospital stay. 4 responders of bathroom bath were discharged with 21-30 days of hospital stay. In this study the estimation of hospital Length Of Stay was calculated as 1 day per percent total body surface area burn (1 day/%TBSA) by improving the wound healing by giving bathroom bath. Conclusion: Wound cleansing and dressing is the basic procedure where the wound healing begins.

Impact of alcohol use disorder on antiretroviral therapy adherence in adults with HIV/AIDS at University of Gondar, Northwest Ethiopia

Background Alcohol use disorder in people living with the human immunodeficiency virus is an important public health problem associated with high rates of HIV infection and lower antiretroviral treatment adherence. However, little is known about the prevalence of alcohol use disorders and its impact on ART adherence among people living with HIV/AIDS (PLWHA). Thus, this study aimed to evaluate the magnitude of alcohol use disorder and its impact on medication adherence among PLWHA attending the ART clinic. Methods A hospital based cross sectional study design was conducted at University of Gondar Comprehensive Specialized Hospital (UOGCSH) ART clinic from September 30, 2023 to February 30, 2024. The World Health Organization’s Alcohol Use Disorders Identification Tool (AUDIT) was utilized to assess alcohol use disorder. Bivariate and multivariate logistic regression analyses were employed to investigate the relationship between AUDs and other variables. Statistical analysis was conducted using SPSS version 26, with a significance level set at P < 0.05. Results The overall prevalence of AUDs was 38.8%, with hazardous use, harmful use, and alcohol dependence accounting for 24.6%, 6.1%, and 8.1% of the total, respectively. In addition, 67.8% of the participants had medication adherence above 95%. Factors associated with alcohol use disorder were male AOR = 1.52; 95% CI (1.01, 2.30), cigarette smoking AOR = 2.384, 95% CI (1.183, 4.80), educational status AOR = 1.96, 95% CI (1.016, 3.764), and age 45–57 years AOR = 3.05, CI (1.587, 5.871). In present study, compared with social drinkers, harmful drinkers and alcohol dependents showed low medication adherence under 95% (AOR = 4.08 and AOR = 8.89, respectively). Conclusion The study reveals a high prevalence of alcohol use and dependence in PLWHA, underscoring the need for effective detection and intervention strategies particularly for males, cigarette smoker, and age between 54 and 75 years in healthcare and community settings. Alcohol use is strongly associated with poor adherence to antiretroviral therapy (ART). Individuals with hazardous alcohol use are four times more likely to have low adherence, while alcohol-dependent individuals are nearly nine times more likely to have low adherence compared to social drinkers.

A Comprehensive Evaluation of the Preanalytical Phase in Laboratory Medicine, Nephrology, Emergency Specialties, Visceral Surgery, Pediatrics, Internal Medicine and Neonatology Hospital Departments: In-Depth Insights derived from an analysis of practices at a Medical University Centre in Morocco

Background and Aims: The precision of biological examination results hinges on meticulous preparatory measures before analysis, known as the pre-analytical phase. This phase contributes significantly to error rates (48-68%). Our study assessed the pre-analytical phase in seven hospital departments at Mohammed VI University Hospital. The objective was to address key causes of pre-analytical nonconformities. Materials and Methods: During this investigation, we observed 331 samples from various departments: Central Laboratory, Nephrology, Internal Medicine, Visceral Surgery, Emergency Specialties, Paediatrics, and Neonatology. Our evaluation identified 4945 instances of pre-analytical nonconformities. These cases encompassed issues with the prescription sheet (501), patient preparation (848), equipment preparation (295), sampling process (1957), waste management (323), and sample transfer (422). Results: Our analysis highlighted a multitude of pre-analytical nonconformities within the surveyed hospital departments. These discrepancies illuminated the critical areas where corrective and preventive measures were imperative to adhere to the standards set by the International Standard ISO15189 and to optimize patient care. Conclusions: The findings from this study underscore the paramount importance of the pre-analytical phase in ensuring accurate biological examination results. By implementing a series of targeted actions in the concerned hospital departments, we addressed the identified nonconformities. These actions encompassed ongoing education, staff awareness and support, regular audits, provision of technical resources such as manuals and sample catalogues, as well as the utilization of appropriate equipment for sample collection and transportation. Continuous learning remains essential, encompassing proper sampling techniques, packaging and transportation requisites, as well as procedures for identifying and rectifying biological sample nonconformities

Prevalence of treatment-resistant depression and associated factors among major depressive disorder follow-up patients at Saint Amanuel Mental Specialised Hospital in Ethiopia: a cross-sectional study

ObjectivesThis study aimed to assess the prevalence of treatment-resistant depression (TRD) and associated factors among patients with major depressive disorder (MDD) on follow-up at Amanuel Mental Specialised Hospital, Addis Ababa,...

Prevalence of suicidal ideation and associated factors among pregnant women attending ANC follow-up clinic in Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2022

Suicide is a worldwide concern and ranks as the third leading cause of death among individuals of reproductive age. According to many findings, Ethiopia remains to suffer with a considerable number of suicide deaths and attempts, so more research on the prevalence of suicidal ideation is necessary. Since there is limited research available about suicide ideation/attempts specifically from the study area, evidence-based and solution-oriented research is necessary. This study sought to determine the prevalence of suicidal ideation and its contributing factors among pregnant women visited ante-natal care (ANC) at the University of Gondar Specialized Compressive Hospital. Institutional based cross-sectional study was conducted among 174 pregnant women who visit ante-natal care (ANC) at the University of Gondar Specialized Compressive Hospital, from June 01 to August 30, 2022. Participants were selected by using a systematic random sampling method. The World Mental Health (WMH) survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to measure suicidal ideation and attempt. The data was entered into SPSS version 25 for analysis, and descriptive and inferential statistics were done. Bivariable and multivariable binary logistic regression analyses were done to identify factors associated with suicidal ideation and attempt among pregnant women. Variables with a P value less than 0.05 were considered statistically significant with 95% CI. In the current study 174 pregnant women were screened, and 168 volunteered to participate with a response rate of 96.5%. The finding showed that the prevalence of suicidal ideation and a suicidal attempt was 5.4% (95% CI: 1.8–8.9) and 4.8% (95% CI: 1.8–8.9) respectively. Unplanned pregnancy [AOR: 1.9(1.22–0.88)], history of abortion [AOR: 2.5(1.5–12.6)], history of stillbirth [AOR: 2.32(1.7–13.2)], HIV status of seropositive [AOR: 1.5(01.2–16.0)] and history of lifetime substance use [AOR: 1.6(1.3–12.0)] were significant positive predictors of prevalence of suicidal ideation. The study finding shows that the prevalence of suicidal ideation and attempt among pregnant women was low. Unplanned pregnancy, history of abortion, history of stillbirth, HIV status of seropositive, and history of lifetime substance use were variables significantly associated with suicidal ideation among pregnant women.

Neurocognitive impairment and its associated factors among patients with diabetes mellitus who have follow up at referral hospital in Northwest, Ethiopia

BackgroundNeurocognitive impairment is a condition that makes it difficult for a person to make decisions that affect memory, learning new things, concentration on daily activities, and can range from mild to severe forms. It is a major health problem, less known and less addressed complication of diabetes mellitus.ObjectivesThe aim of the study is to assess prevalence of neurocognitive impairment and associated factors among diabetic mellitus patients.MethodsWe conducted an institutional-based cross-sectional study involving 512 diabetic patients under follow-up at XXX Specialized Hospital from March 1 to April 30, 2023. Data on cognition, behavior, and depression were collected using standardized tools, including the Mini Mental State Examination for cognition, the CAGE assessment tool for alcohol-related behavior, and the PHQ-9 for depression. These assessments were conducted through face-to-face interviews and chart reviews. A diagnosis of diabetes is confirmed in adults when fasting blood glucose levels exceed 126 mg/dl in three consecutive follow-up measurements. Data entry was performed using Epidata version 4.6, and analysis was conducted using SPSS version 26. Variables with a P-value &amp;lt; 0.25 in bivariate analysis were included in multivariable logistic regression. Statistical significance was set at P ≤ 0.05 with a 95% CI. Results were presented using tables, graphs, and descriptive text.ResultsThe prevalence of neurocognitive impairment among diabetic patients at XXX Comprehensive Specialized Hospital was 28.3% [95% CI: 24.57–32.39]. Factors associated with this impairment included being female (AOR=2.29 [95% CI: 1.43-3.67]), rural residence (AOR=3.16 [95% CI: 2.01-4.95]), comorbidity (AOR=3.30 [95% CI: 2.08-5.23]), diabetes duration of 6-10 years (AOR=1.72 [95% CI: 1.01-2.94]), diabetes duration &amp;gt;10 years, and blood sugar level &amp;gt;126 mg/dl (AOR=2.25 [95% CI: 1.42-3.57]). Patients are encouraged to adhere to proper medication regimens to effectively control their blood glucose levels. This study found a high prevalence of neurocognitive impairment (NCI) among diabetic patients, affecting about one-fourth based on MMSE scores. Key risk factors identified include female gender, rural residence, comorbidities, longer duration of diabetes, and elevated blood glucose levels.

Successful biventricular assist device Berlin heart implantation leading to heart transplant in a complicated pediatric case: an experience from a single center

The use of the Berlin heart EXCOR ventricular assist device (VAD) as a bridge to heart transplantation in pediatric patients has become increasingly widespread. This case report presents a detailed account of the successful implantation of a biventricular assist device (BIVAD) Berlin heart device in a complex pediatric case at the esteemed King Faisal Specialist Hospital and Research Center. The patient, diagnosed with dilated cardiomyopathy (DCM) and Kawasaki disease, underwent a series of interventions and treatments before requiring extracorporeal membrane oxygenation (ECMO) support and subsequently receiving the Berlin heart device. The post-implantation period was marked by significant challenges, including instances of bleeding and clot formation, necessitating multiple interventions and careful management. Ultimately, a heart transplant was performed; however, the patient encountered humoral rejection, leading to additional targeted treatment. Despite these intricate complications, the patient exhibited substantial improvement in left ventricular ejection fraction (LVEF) following the transplant, indicating a positive outcome. This case underscores the successful use of a BIVAD Berlin heart device as a viable bridge to heart transplantation in a complicated pediatric case, highlighting the crucial role of a multidisciplinary approach and meticulous management of complications throughout the entire treatment process.

A Comparative Study of Imipramine and Tolterodine for the Treatment of Children with Primary Nocturnal Enuresis

Background: Nocturnal enuresis (NE), or bed-wetting, affects children aged ≥5 years after ruling out organic causes. The ICCS defines NE as intermittent urinary incontinence during sleep, categorized into monosymptomatic (MNE) and non-monosymptomatic (NMNE) forms. NE is also classified by onset: primary (no dry period) and secondary (bed-wetting after a dry period). Contributing factors include sleep disorders, stress, hereditary predisposition, and delayed bladder development. Management involves behavioral and pharmacological treatments, with desmopressin and anticholinergic drugs being common options. Aim of the study: This study aims to find out an alternate effective and safe drug for the treatment of primary nocturnal enuresis. Methods: This study was conducted at the Department of Urology(outdoor), Shahid Sk. Abu Naser Specialized Hospital, Khulna, Bangladesh from January 2020 to December 2021. After excluding 12 patient’s pre-randomizations for non-cooperation, 60 patients were split into two groups: Group A received 25mg of imipramine before bedtime, while Group B took 1mg of tolterodine tartrate twice daily evaluated efficacy over 6 months, including a 2-week behavioral modification baseline and follow-ups at 3 and 6 months. Data were analyzed using SPSS 26, employing various statistical tests with significance set at p &lt;0.05. Result: The study involved 60 children (mean age 10.0±3.1 years, 55% male), assessing bed-wetting patterns and treatment outcomes. The majority (80%) had unsatisfactory behavioral modifications, with 35% having a family history of enuresis. Both groups (A and B) showed no significant difference in bed-wetting episodes at baseline or after 3 months of treatment. Complications were more common in Group A, including dry mouth, nausea, and insomnia. Imipramine led to a higher proportion of patients with fewer than 50 dry nights after drug withdrawal, while Tolterodine showed better results at month 3 but a higher decrease in dry ...

Depression, performance status, and discontinued treatment mediate an association of curability belief with prognosis in advanced cancer patients

Individuals diagnosed with advanced cancer often experience stress and depression, factors linked to worse survival. Curability belief—defined as the hope and expectation of cure through treatment, based on affective forecasting—may differ from the patient’s actual life expectancy (i.e., likelihood estimation) and has shown variable associations with cancer survival. In this study, multivariate Cox regression analyses were used to examine the effect of curability belief and depression on 1-year survival after adjustment for physical factors. Additionally, regularized partial correlations among physical and psychological factors were assessed using mixed graphical models to elucidate their roles in mediating the relationship between curability belief and 1-year survival. This multi-center cohort study, conducted across 13 tertiary hospitals (including four ranked among the ‘World’s Best Specialized Hospitals 2025’ in oncology), involved 382 adults with stage IV advanced cancer and an oncologist-estimated survival of more than 6 months. Baseline data included demographics, primary tumor site, number of metastatic sites, symptom burdens (EORTC QLQ-C15-PAL), performance status (ECOG-PS), depression levels (PHQ-9), anti-cancer treatment type, patient’s life expectancy estimation, and curability belief. Follow-up data included 1-year survival and end-of-life care (place of death) for deceased patients. Multivariate Cox proportional hazards models were used to assess adjusted hazard ratios (aHRs) for curability belief, depression, and their interaction on 1-year survival, adjusting for significant demographic and clinical factors from univariate Cox regressions. The Kaplan–Meier method was used to plot survival probability by curability belief and depression interaction. Mixed graphical models estimated regularized partial correlations among 1-year survival, curability belief, patient’s life expectancy, depression, primary tumor site, anti-cancer treatment type, performance status, and symptom burden. In terms of healthcare utilization, patients with curability belief were more likely to receive standard or advanced anti-cancer therapy, while those without curability belief tended to suspend or discontinue therapy (P < 0.001). Among patients who did not survive the 1-year follow-up (N = 161), end-of-life care settings differed significantly between those with curability belief (predominantly nursing homes and home settings) and those without (primarily hospice and tertiary/secondary hospitals; P = 0.036). In multivariate Cox regression, curability belief (P = 0.003), depression (PHQ-9 score ≥ 10; P = 0.003), and their interaction (P = 0.040) were significantly associated with 1-year survival, after adjusting for sex, residential area, primary tumor site, performance status, anti-cancer treatment type, and symptom burdens (fatigue and appetite loss). The relationship between curability belief and 1-year survival was significant only in patients without depression [PHQ-9 score < 10; aHR (95% CI) = 2.20 (1.31–3.70); P = 0.003]. In the mixed graphical model, node predictability values for curability belief, depression, and 1-year survival were 0.68, 0.50, and 0.70, respectively, with curability belief showing partial correlations with depression (r = 0.30) and patients’ life expectancy (r = 0.20); depression correlated with fatigue (r = 0.53), anorexia (r = 0.16), life expectancy (r = 0.24), performance status (r = 0.23), and curability belief; and 1-year survival correlated with suspended/stopped anti-cancer treatment (r = 0.45), primary tumor site (r = 0.24), and performance status (r = 0.15). Partial correlations of performance status with depression and discontinued treatment mediated the association between curability belief and 1-year survival. Curability belief among stage IV advanced cancer patients with an oncologist-estimated survival of over 6 months was associated with depression levels and patients’ perceived life expectancy estimations. Performance status, depression, and anti-cancer treatment status mediate the relationship between curability belief and improved 1-year survival in patients without depression. Further research using longitudinal modeling of depression, performance status, and healthcare utilization, with curability belief and primary tumor site as covariates, is warranted.Trial registration: Clinical Trial Number (ClinicalTrials.gov): NCT03222258; Study Registration Dates (First submitted: 2017-06-05; First submitted following the QC criteria: 2017-07-16; First posted: 2017-07-19).

An alternative communication model for breastfeeding intervention in antenatal clinics

Objectives: This study evaluated the effectiveness of the dual-feedback loop communication model in countering misconceptions about exclusive breastfeeding among pregnant women attending routine antenatal clinic at Specialist Hospital, Yola Adamawa State, Nigeria. The specific objectives of the study are to: (a) Use a pre-test to identify misconceptions pregnant women have on exclusive breastfeeding; (b) implement a behavior change intervention that targets the knowledge, attitude, and practices (KAPs) of pregnant women; and (c) administer a post-test to determine a variance in the KAPs of pregnant women after the intervention. Material and Methods: A mixed-method design that combines quantitative and qualitative methods was adopted for the study. Data for the study comprised health talks delivered in antenatal clinics and responses of cross-section of participants in pre- and post-tests. Thirty-three (33) pregnant women selected purposively served as participants for the study. Participants who met the inclusion criteria had previously breastfed and have been attending the routine antenatal clinical sessions at Specialist Hospital, Yola. The rhetorical structure of the health talks were examined based on insights from discourse and communication theories. Results: Results of the qualitative analysis revealed misconceptions on exclusive breastfeeding arising from inadequate (K)nowledge, poor (A)ttitudes, and unhealthy (P)ractices. The quantitative analysis revealed significant variation between maternal (K)nowledge (KEBF r = 0.636, P &gt; 0.05), (A)ttitude (AEBF r = 0.595, P &gt; 0.05), and (P)ractices (PEBF r = 0.757, P &gt; 0.05) on exclusive breastfeeding and the intervention’s impact. Conclusion: Misconceptions about exclusive breastfeeding and defects in the communication model used in delivering health talks perpetuate misconceptions among pregnant women attending antenatal clinic in the health facility studied. Empowering pregnant women attending antenatal clinics with requisite knowledge of the health benefits of exclusive breastfeeding using a dual-feedback loop communication model can promote compliance to exclusive breastfeeding, which, ipso facto, can reduce the incidence of child mortality resulting from non-compliance to exclusive breastfeeding. Further research is needed to test the effectiveness of the dual-feedback loop model in countering misconceptions in other health talks in Nigeria.

Prognostic Significance of DSCC1, a Biomarker Associated with Aggressive Features of Breast Cancer

Background and Objectives: Invasive breast cancer (BC) was traditionally investigated visually, and no technique could identify the key molecular drivers of patient survival. However, essential molecular drivers of invasive BC have now been discovered using innovative genomic, transcriptomic, and proteomic methodologies. Nevertheless, few evaluations of the prognostic factors of BC in Saudi Arabia have been performed. Evaluating the biomarkers associated with the development of early-stage BC could help determine the risk of metastasis and guide treatment decisions. In a previous study, using large BC cohorts and artificial neural network techniques, DNA replication and sister chromatid cohesion 1 (DSCC1) was found to be one of the principal genes in invasive BC samples. To date, no studies have addressed the prognostic significance of DSCC1 in invasive BC and its association with aggressive tumor behavior. This research aimed to address this gap. Materials and Methods: The association of clinicopathological features and patient outcomes with DSCC1 expression at the mRNA level was assessed using the Molecular Taxonomy Breast Cancer International Consortium (METABRIC; n = 1980) and The Cancer Genome Atlas (TCGA; n = 854) cohorts. DSCC1 was also evaluated at the protein level using immunohistochemistry on samples from invasive BC patients (n = 100) presenting to King Abdul Aziz Specialist Hospital in Saudi Arabia. The association of clinicopathological parameters (including patient age, tumor grade, tumor size, and patient outcome) with protein level was also evaluated. Results: In both METABRIC and TCGA cohorts, high expression of DSCC1 was significantly associated with high histological grade, large tumor size, lymphovascular invasion positivity, and hormone receptor negativity (all p &lt; 0.001). A high DSCC1 mRNA level was associated with poor outcomes (p &lt; 0.001 for METABRIC, p = 0.23 for TCGA). At the protein level, high DSCC1 expression was associated with high histological grade (p = 0.001), lymph node presence (p = 0.008), hormone receptor negativity (p = 0.005), high Ki67 expression (p = 0.036), and shorter survival (p = 0.008). Conclusions: This study confirmed the prognostic significance of DSCC1 in invasive BC patients. DSCC1 could be a therapeutic target in BC cases with poor outcomes.

Asymptomatic nasopharyngeal carriage of multidrug resistant bacteria among children at University of Gondar Hospital Northwest Ethiopia Revealing Hidden Health Risks

Gram-negative bacteria in the nasopharynx can eventually invade bacteria-limited sites and cause serious illnesses such as meningitis, otitis media, and pneumonia. However, data related to the carriage of these bacteria in children attending outpatient departments in the study area are limited. To assess nasopharyngeal carriage, antibiotic susceptibility patterns, and associated factors of gram-negative bacteria among children attending the outpatient department at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted from September 1, 2023, to December 30, 2023. A total of 385 children aged 3 to 14 years were enrolled using a systematic random sampling technique. Sociodemographic and clinical data were collected using a semistructured questionnaire. A total of 385 nasopharyngeal samples were collected using a sterile specimen collection nasopharyngeal swab, transported using Amie’s transport medium, and subsequently inoculated on chocolate agar, blood agar, modified thayer martin agar, and MacConkey agar plates. Bacterial species were identified by colony morphology, Gram staining, and biochemical tests such as oxidase tests, satellitism tests, and carbohydrate utilization tests. An antibiotic susceptibility test was performed using the Kirby–Bauer and modified Kirby–Bauer methods on Mueller–Hinton agar plates. The data were entered into Epi-Data version 4.6.0.6 and exported to SPSS version 25 for analysis. The adjusted odds ratio at a 95% confidence interval with a P value of < 0.05 in the binary logistic regression model was considered to indicate statistical significance. The overall nasopharyngeal carriage of gram-negative bacteria was 146 (37.9%) (95% CI: 33.2–42.9). Among these, nonfastidious gram-negative bacteria represented 45 (11.7%), followed by M. catarrhalis 41 (10.6%), N. meningitidis 34 (8.8%), and H. influenzae 26 (6.8%). The isolates exhibited high resistance to tetracycline (85; 75.9%), trimethoprim-sulfamethoxazole (105; 71.9%), ampicillin (76; 67.9%), and amoxicillin/clavulanic acid (60; 69.8%) but high susceptibility to meropenem (122; 83.6%), gentamicin (73; 84.9%), and minocycline (87; 72.5%). There were 99 total multidrug-resistant strains (67.8%, 95% CI: 59.7–75.0). Male sex (AOR = 1.785, 95% CI: 1.102–2.892, P = 0.019), smoking (AOR = 2.675, 95% CI: 1.149–6.230, P = 0.022), and large family size (≥ 5) (AOR = 1.857, 95% CI: 1.140–3.023, P = 0.013) were risk factors for nasopharyngeal colonization. Increased nasopharyngeal colonization of multidrug-resistant gram-negative isolates was observed in this study. Gentamicin, minocycline, and meropenem were the most effective antibiotics for the tested isolates. Bacterial colonization increased with increasing family size, smoking status, and male sex. Therefore, a definitive diagnosis in the outpatient pediatric department should be based on culture and susceptibility test results.

Evaluation of Musculoskeletal Physiotherapy Service Quality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia

Evaluation of Musculoskeletal Physiotherapy Service Quality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia

Affordability of health services and associated factors among patients with diabetes mellitus under regular follow-up at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia

BackgroundThe burden of chronic illnesses, including cardiovascular disease and diabetes, is increasing in low- and middle-income countries. However, health systems often struggle to meet the needs of chronically ill patients. Affordability is crucial in ensuring access to quality healthcare for patients with diabetes mellitus (DM) and evaluating healthcare costs. Therefore, this study aimed to assess the affordability of health services and identify associated factors among DM patients receiving regular follow-ups at Dessie Comprehensive Specialized Hospital in Northeast Ethiopia, 2023.MethodsA cross-sectional study was conducted among 392 DM patients at Dessie Comprehensive Specialized Hospital (DCSH) from July 1 to 30, 2023. Data was collected using a structured questionnaire and chart review checklist. Systematic random sampling was employed, and the data were analyzed using EPI INFO version 7 and SPSS version 26. The outcome variable, affordability of health services, was measured by five items using a structured questionnaire. Logistic regression analysis was performed to identify significant factors associated at 95% confidence interval using odds ratio.ResultsMost participants were married (74.2%), and 55.9% were male. Among the DM patients, 211 (53.83%) found the health services affordable, with an interval of 48.85–58.72% at a 95% confidence interval with a p-value less than 0.05. Factors significantly associated with healthcare affordability included marital status, family size, average monthly income, and brand prescription.ConclusionThe study revealed that healthcare services were affordable for approximately half of the DM patients. However, this level of affordability falls short of the ideal standard. Improving the affordability and accessibility of healthcare services for DM patients, particularly those from low-income backgrounds, is crucial to ensuring better health outcomes.