Specialist Hospital Research Articles

Utilization of Post Exposure Prophylaxis among HIV Exposed Health Care Workers and Non Occupational Exposure at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Utilization of Post Exposure Prophylaxis among HIV Exposed Health Care Workers and Non Occupational Exposure at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Use of orthoses in complex rehabilitation of children that have underwent oncological arthroplasty

Background: The urgency of medical rehabilitation for children with bone sarcoma is extremely high due to the significant impact on a socially important population and the increasing life expectancy of patients with bone sarcomas, leading to long-term orthopedic complications. This necessitates the development of highly effective, comprehensive programs not only for treatment but also for rehabilitation. AIM: Maximizing the recovery of residual quality of life abilities in children with bone sarcomas through the use of orthoses during various perioperative periods. MATERIALS AND METHODS: The study included 61 patients with bone tumors who underwent anti-tumor treatment and surgical intervention involving tumor removal with endoprosthesis implantation. Medical rehabilitation began from the moment of diagnosis and was conducted throughout all periods of anti-tumor therapy to help patients adapt to the treatment, restore functions in the postoperative period, and during remission, as well as to minimize the effects of aggressive specialized treatment. RESULTS: The functional outcome was assessed using the international MSTS scale. Limb function according to the MSTS scale was evaluated 12 and 24 months after surgery. No unsatisfactory results were observed. Functional outcomes improved over the course of 24 months. CONCLUSION: A dynamically evolving individualized rehabilitation program for children with bone sarcomas is necessary, tailored to the patient's condition and needs at the time of observation, along with personalized selection of orthoses and timely surgical correction of orthopedic consequences, which should be performed in orthopedic specialized hospitals.

Assessment of knowledge, attitude, and practice regarding medical waste management among operation room personnel in a tertiary hospital.

Medical waste management (MWM) is of concern to the medical and surgical communities in the hospital. Adequate knowledge, attitude, and practice regarding the management of healthcare waste are important for the proper handling and disposal by physicians and healthcare workers. The aim of this study was an assessment of knowledge, attitude, and practices regarding medical waste management among operation room personnel in a tertiary hospital. This study was a descriptive cross-sectional survey conducted at a single-center government Comprehensive Specialized Hospital operation room from 1-30 September 2022. All specialty operation room healthcare personnel consenting to cooperate and participate were included in the study. The data were collected using a self-administered questionnaire. The collected data were analyzed using SPSS. The results were presented in texts, tables and graphs. From 130 operation room personnel, the results revealed that the majority of the total respondents were male (83.1%). Only 30 (23.1%) of the respondents were involved in training, whereas 100 (76.9%) of the study participants have not participated in training. It was found that 86 (66.2%) of the respondents had good knowledge, 113 (86.9%) of the respondents had a good attitude, and 27 (20.8%) of the respondents had good practice. The authors' study reveals that the majority of study participants have a moderate level of knowledge, a good level of attitude, and poor levels of practice, according to Bloom's cut-off point. The institution should more fully implement the training for operation room personnel to improve their level of knowledge and practice of medical waste management.

Prevalence and associated factors of postoperative suxamethonium-induced myalgia in surgical patients at Debre Tabor Comprehensive Specialized Hospital Ethiopia: a cross-sectional study

Suxamethonium is considered by many to be the best drug for providing ideal intubating conditions, short surgical procedures, and rapid sequence induction. However, its usefulness is limited by the frequent occurrence of adverse effects like postoperative myalgia. Therefore this study aimed to assess the prevalence and associated factors of postoperative suxamethonium-induced myalgia. An institutional-based cross-sectional study was conducted on 210 patients who underwent surgery with general anesthesia. The data was collected by using structured and pretested questionnaires and analyzed using SPSS version 20.0. Logistic regression was conducted to identify significant predictors based on a P-value of less than 0.05 with a 95% confidence level. Among 210 patients the prevalence of suxamethonium-induced postoperative myalgia in the first 48 h was 88 (41.9%). Patients having previous anesthesia and surgical exposure (AOR 5.29, 95% CI 1.86–15.05), patients having a co-existing disease (AOR 2.69, 95% CI 1.08–6.67), patients that had not taken premedication (analgesia) (AOR 4.64, 95% CI 1.69–12.74), anesthesia maintenance using halothane (AOR 4.5 95% CI 1.7–11.4) and relaxation maintained with suxamethonium (AOR 3.1, 95% CI 1.2–8.1) were significantly associated with the prevalence of postoperative myalgia. The magnitude of suxamethonium-induced postoperative myalgia was high. So it is better to do with preventive techniques. As much as possible it is better to avoid using suxamethonium and necessary to use better to Premedicate with nonsteroidal anti-inflammatory drugs and non-depolarizing neuromuscular medications.

Incidence and predictors of acute kidney injury among asphyxiated neonates in comprehensive specialized hospitals, northwest Ethiopia, 2023

Acute kidney injury (AKI) is characterized by a sudden decline in the kidneys' abilities to remove waste products and maintain water and electrolyte homeostasis. This study aims to determine the incidence and predictors of acute kidney injury among neonates with perinatal asphyxia admitted at the neonatal intensive care unit of West Amhara Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Multicentred institution-based retrospective follow-up study was conducted from October 1, 2021, to September 30, 2023, among 421 perinatal asphyxia neonates. A simple random sampling technique was used. The data were collected using a data extraction checklist from the medical registry of neonates. The collected data were entered into EPI-DATA V.4.6.0.0. and analyzed using STATA V.14. The Kaplan–Meier failure curve and log-rank test were employed. Bivariable and multivariable Cox regression was carried out to identify predictors of Acute kidney injury. Statistical significance was declared at a p ≤ 0.05. The overall incidence of AKI was 54 (95% CI 47.07–62.51) per 100 neonate days. C/S delivery (AHR = 0.64; (95% CI 0.43–0.94), prolonged labor (AHR = 1.43; 95% CI 1.03–1.99) low-birth weight times (AHR = 1.49; (95% CI 1.01–2.20), stage three HIE(AHR: 1.68; (95% CI (1.02–2.77), No ANC follow up (AHR = 1.43; 95% CI 1.9 (1.07–3.43) and Hyperkalemia (AHR = 1.56; 95% CI 1.56 (1.05–2.29); 95% CI) were significant predictors. The incidence rate of acute kidney injury was higher than in other studies conducted on other groups of neonates. Cesarean section delivery, prolonged low birthweight, no Anc follow-up, stage 3 HIE, and neonatal hyperkalemia were predictors of acute kidney injury. However, it needs further prospective study. Therefore, the concerned stakeholders should give due attention and appropriate intervention to these predictors.

PATIENT SAFETY CULTURE ANALYSIS IN THE STAFF OF A SPECIALTY HOSPITAL IN ECUADOR: A CROSS SECTIONAL STUDY.

Background There are millions of deaths attributable to low levels of quality and patient safety in healthcare. One of the first steps in the journey to high reliability is to establish a solid patient safety culture. This study sought to determine the level of patient safety culture in the personnel of a specialty Hospital in Ecuador. Methods A cross-sectional study was conducted with a descriptive phase comprising the presentation of results of the patient safety culture level in the staff, and an analytical phase to determine conditioning factors of this aspect. Results 344 hospital staff answers were included in the study. The most significant group of personnel who responded to the survey corresponded to medical staff (39.83%). An overall patient safety culture level of 63.86% was determined, with higher scores observed in leadership positions (73,55%) and among the medical staff (69,90%), followed by support positions (60,97%), Other staff positions (60,44%), and nursing (56,74%). The dimensions of patient safety culture identified as strengths were teamwork and hospital management support in patient safety, and as improvement areas figured response to error, and staffing and work pace. Significant differences were found between the results of the patient safety culture domains and: staff position, working time in the hospital, working time in the current area or unit, weekly working hours, and typical contact with patients during daily activities (p < 0.05). Conclusions The patient safety culture level in the Ecuadorian context was determined, as well as its strengths and improvement areas. In this study, the support of hospital management support in patient safety stands out as a strength. Additionally, aspects of the staff were found to be significantly associated with the results of the patient safety culture dimensions indicating potential areas of focus for efforts to improve patient safety culture.

Root causes of first-case start time delays for elective surgical procedures: a prospective multicenter observational cohort study in Ethiopia

BackgroundDelays in surgery start times can lead to poor patient outcomes and considerable increases in healthcare expenditures. This is especially true in developing countries that often face systemic inefficiencies, such as a shortage of operating rooms and trained surgical personnel. With substantial effects on patient outcomes, healthcare efficiency, and resource allocation, identifying delays in first-case elective surgery is a crucial area of research.MethodsA multicenter observational study was conducted at three comprehensive and specialized hospitals in the Amhara region of Ethiopia from May 1 to October 30, 2023. The primary aim of the study was to determine the occurrence of late first-case start times, defined as a patient being in the operating room at or after the hospital’s incision time of 2:30 a.m. The secondary aim was to discover potential root causes of delayed first-case start times. All patients scheduled for elective surgery as the first case on the operating list throughout the study period were included in the study. Every emergency, day case, after-hours case, and canceled case was excluded.ResultsA total of 530 surgical patients were included during the study window from May 1 to October 1, 2023. Of these, 41.5% were general surgeries, 20.4% were gynecology and obstetrics surgeries, and 13.2% were orthopedic surgery procedures. Before the procedure started, nine (1.7%) of the participants had prolonged discussion with a member of the surgical team. Patients who arrived in the operating room waiting area at or after 2:30 a.m. were 2.5 times more likely to experience a first-case start time delay than those who arrived before or at 2:00 a.m. (AOR = 2.50; 95% CI: 1.13–5.14). Furthermore, participants with abnormal investigation results were 2.4 times more likely to have a late first-case start time (AOR = 2.41; 95% CI: 1.06, 5.50). Moreover, the odds of a late first-case start time were increased by 10.53 times with the surgeon being in the operating room at or after 2:30 a.m. (AOR = 10.53; 95% CI: 5.51, 20.11).ConclusionThe research highlights a significant occurrence of delayed start times for the first elective surgical procedures. Therefore, directing attention to aspects such as ensuring patients and surgical teams arrive promptly (by or before 2:00 a.m.) and timely evaluation and communication of investigative findings before the scheduled surgery day could facilitate efforts to maximize operating room efficiency and enhance patient health outcomes.

Anticholinergic burden and health-related quality of life among adult patients in a resource-limited setting: a cross-sectional study.

Anticholinergic medications are now widely acknowledged for their unfavorable risk-to-benefit profile owing to their adverse effects. Health-related quality of life (HRQoL) is commonly regarded as a crucial person-centered outcome. This study aimed to investigate the association between anticholinergic burden and HRQoL in hospitalized and ambulatory patients seen in Ethiopia. This cross-sectional study utilized a questionnaire and medical records to collect data from a convenience sample of adult patients attending both inpatient wards and ambulatory clinic of University of Gondar Comprehensive Specialized Hospital between April and September 2022. Anticholinergic burden was measured by anticholinergic cognitive burdens scale (ACBS), while HRQoL was measured using EQ5D-index (Euroqol-5 dimensions-5-Levels index) and EQ5D-VAS (visual analogue scale). Linear regression was used to assess the influence of high anticholinergic burden (ACBS score ≥ 3) on EQ5D-index and EQ5D-VAS, with adjustments made for sociodemographic and clinical confounders. A total of 828 patients participated in this study (median (IQR) age was 45.0 (30, 60) and 55.9% were female). On multiple linear regression analysis, high anticholinergic burden was associated with a statistically significant decline in HRQoL, as evidenced by reductions in both EQ5D index (- 0.174 (- 0.250, - 0.098)) and EQ5D-VAS scores (- 9.4 (- 13.3, - 5.2)). A significant association between high anticholinergic burden and diminished HRQoL was found among a relatively younger cohort in a resource-limited setting, even after adjustment for important confounding variables. Clinicians should be cognizant of the cumulative impact of anticholinergic burden on HRQoL outcomes and strive to minimize anticholinergic burden.

Self-efficacy of PLHIV for self-management at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: a cross-sectional study

BackgroundSelf-efficacy is the ability to execute, and it is a critical predictor of health-related outcomes among people living with human immunodeficiency virus (PLHIV). Self-efficacy directly determines treatment outcome. However, there is no evidence on the self-efficacy of PLHIV for self-management in Ethiopia. Currently, HIV is considered a manageable chronic disease. However, the burden remains high despite all the taken measures.ObjectivesThis study aimed to assess the self-efficacy of PLHIV for self-management at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), northwest Ethiopia, 2022.MethodsA cross-sectional study was conducted on PLHIV selected by a systematic random sampling technique using an interviewer-administered questionnaire at the UOGCSH from August 10 to September 30, 2022. The data was entered and analyzed using the Statically Package for Social Science version 25.0. Categorical variables were summarized as frequency (percentage) of the total. Both descriptive and inferential statistics, such as the Kruskal-Wallis H test and Mann-Whitney U test were performed to detect difference. P-value < 0.05 was considered to indicate statistically significance.ResultsOverall, 405 PLHIV participated in the study, giving a 96% response rate. The overall median (Interquartile range) self-efficacy score of PLHIV for self-management was 22 (4) and 67.4% of the PLHIV self-efficacy score was above the median. A statistically significant difference was detected between the social support groups (χ2 (2) = 37.17, p < 0.0001), education background (U = 10,347, Z = 2.279, P = 0.023, r = 0.113), living conditions (U = 12,338, Z = 2.457, P = 0.014, r = 0.122) and medication adherence (U = 9516.5, Z = 3.699, P < 0.0001, r = 0.184).ConclusionMost participants’ self-efficacy score was above the median. Statistically significant differences in self-efficacy were observed based on individual, environmental, and clinical factors. We suggest training and workshops for healthcare workers and the hospital and adherence support groups should work to improve the self-efficacy of PLHIV.

Outcomes of deep venous thrombosis management and associated factors among patients in tertiary hospitals in Addis Ababa, Ethiopia: a multicenter retrospective cohort study

BackgroundPulmonary embolism (PE) and deep venous thrombosis (DVT) are the two most important manifestations of venous thromboembolism (VTE). DVT remains a significant condition since associated morbidity is significant and has elevated healthcare-related costs.MethodsA retrospective cohort study was conducted among DVT patients admitted to Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and St. Paul’s Hospital Millennium Medical College on follow-up from July 1, 2017, to July 01, 2020. Data on sociodemographic characteristics, types of DVT, laboratory findings, medications, risk factors of DVT, complications and outcomes of DVT were collected. The data were analyzed using SPSS version 25. Multivariate logistic regression analysis was conducted to determine predictors of DVT recurrence and major bleeding. A P value < 0.05 was considered to identify significant predictors.ResultsThe mean age of the participants was 45.2 years, with SD of 15.36. The major causes of DVT included immobilization (29.9%), previous surgery (27.5%) and cancer (21.1%). The DVT recurrence rate was 22.5%. Nine (2.2%) of the participants died, and 19.9% developed complications. Bilateral DVT (Adjusted odds ratio (AOR) = 2.8, 95% Confidence interval (CI) = 1.14, 6.66), obesity (AOR = 3.3, 95% CI = 1.15, 9.59), hypertension (AOR = 6.5, 95% CI = 2.90, 14.70) and retroviral infection (AOR = 6.3, 95% CI = 2.34, 16.94) were predictors of recurrent DVT. Nineteen (4.7%) patients had major bleeding, and patients with bilateral DVT, active cancer and terminal age had an increased risk of major bleeding.ConclusionsThe overall DVT recurrence rate was alarmingly high and further complicated by PE, post thrombotic syndrome and chronic vein insufficiency, resulting in a 2.2% death rate. Major bleeding after DVT and PE remained high. Close monitoring should be performed for patients with advanced age, active cancer, bilateral DVT, retroviral infection, obesity and hypertension to prevent the recurrence of DVT and major bleeding.

Prognostic significance of the neutrophil to lymphocyte ratio in locally advanced breast cancer.

The present study aimed to clarify the prognostic role of the pre-treatment neutrophil-to-lymphocyte ratio (NLR) for the response to neoadjuvant chemotherapy (NAC) in locally advanced breast cancer (LABC). Due to conflicting results in currently available data, the specific focus of the present study was on evaluating the associations between the pre-treatment NLR and the rate of achieving a pathological complete response (pCR) and survival outcomes. For the present study, data from a cohort of 465 consecutive patients with LABC who underwent NAC at King Feisal Specialist Hospital and Research Center (Riyadh, Saudi Arabia) between 2005 and 2014 were obtained from a prospective BC database and analyzed. Patients were stratified into two groups based on an optimal NLR cut-off determined using the receiver operating characteristic curve. Logistic regression analyses were conducted to assess variables associated with pCR, and Cox regression analyses were used to assess variables associated with survival outcomes. The low pre-treatment NLR group (≤2.2) was found to exhibit a higher likelihood of achieving a pCR (odds ratio, 2.59; 95% CI, 1.52-4.38; P<0.001), along with higher 5-year disease-free survival (DFS) [75.8 vs. 64.9%; hazard ratio (HR), 0.69; 95% CI, 0.50-0.94; P=0.02] and 5-year overall survival (OS; 90.3 vs. 81.9; HR, 0.62; 95% CI, 0.39-0.98; P=0.04) rates compared with those in the high NLR group (>2.2). Sub-group analysis revealed that the observed significance in survival outcomes was driven by the triple-negative BC (TNBC) subgroup. Patients with residual TNBC disease and a high pre-treatment NLR were observed to have lower 5-year DFS (44.4 vs. 75.0%; P=0.02) and 5-year OS (55.9 vs. 84.5%; P=0.055) rates compared with those with residual TNBC disease and a low NLR. To conclude, data from the present study suggest that the pre-treatment NLR can serve as a viable independent prognostic factor for pCR following NAC in patients with LABC and for survival outcomes, particularly for patients with TNBC.

TB co-infection and associated factors among HIV patients attending highly active antiretroviral therapy in Saint Peter’s TB Specialized Hospital, Ethiopia: a five years retrospective study

TB co-infection and associated factors among HIV patients attending highly active antiretroviral therapy in Saint Peter’s TB Specialized Hospital, Ethiopia: a five years retrospective study

Anterior abdominal wall defects and their management outcomes in Tikur Anbessa Specialized Hospital, neonatal intensive care unit

AbstractIntroductionGastroschisis and omphalocele are common malformations of the anterior abdominal wall and can lead to significant morbidity and mortality in neonates. Despite advances in surgical care, these conditions remain challenging to manage effectively.ObjectiveThis retrospective institutional study aimed to assess the management outcomes of neonates with anterior abdominal wall defects, specifically gastroschisis and omphalocele, in the Neonatal Intensive Care Unit (NICU) of Tikur Anbessa Specialized Hospital (TASH) (Tertiary Hospital).MethodA retrospective review was conducted on cases of gastroschisis and omphalocele managed in the NICU of TASH from August 2018 to August 2022. Patient charts of neonates with omphalocele and gastroschisis were identified and retrieved from the NICU records. The collected data were analyzed using statistical software such as SPSS.ResultsThe study included a total of 50 neonates with abdominal wall defects, consisting of 39 cases of omphalocele and 11 cases of gastroschisis. Maternal age ranged from 18 to 40 years, with a mean age of 27.6 ± 4.5 years. Associated malformations were documented in 33.3% of omphalocele cases and 18.2% of gastroschisis cases. Cardiac anomalies were the most frequently associated malformation with omphalocele. Surgical intervention was performed in 27.3% of gastroschisis cases (3 out of 11) and 41% of omphalocele cases (16 out of 39). The postsurgery mortality rate was 12.5% for both major and minor omphaloceles, with 11 deaths occurring in gastroschisis cases. Sepsis was identified as the cause of death in all neonates who did not survive.ConclusionsThe study revealed a significantly higher mortality rate in gastroschisis cases compared to omphalocele cases. Sepsis was identified as the primary cause of death in the neonates. These findings underscore the importance of effective management strategies to prevent and manage sepsis in neonates with abdominal wall defects.

Validation of the 2023 International Diagnostic Criteria for MOGAD in a Selected Cohort of Adults and Children.

To test the performance of the 2023 myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) criteria in adults and children with inflammatory demyelinating conditions who were tested for MOG antibodies (Abs). This was a retrospective study of patients tested for MOG-Abs from 2018 to 2022 in 2 specialist hospitals. The inclusion criteria comprised ≥1 attendance in an adult or pediatric demyelinating disease clinic and complete clinical and MRI records. The final clinical diagnosis of MOGAD, made by the treating neurologist, was taken as the benchmark against which the new criteria were tested. The international MOGAD diagnostic criteria were applied retrospectively; they stipulate at least 1 clinical or MRI supporting feature for MOGAD diagnosis in positive fixed MOG cell-based assay without a titer. The performance MOG-Ab testing alone for MOGAD diagnosis was also assessed and compared with that of MOGAD criteria using the McNemar test. Of the 1,879 patients tested for MOG-Abs, 539 (135 pediatric and 404 adults) met the inclusion criteria. A clinical diagnosis of MOGAD was made in 86/539 (16%) patients (37 adults, 49 children), with a median follow-up of 3.6 years. The MOGAD diagnostic criteria had sensitivity of 96.5% (adults 91.9%, children 100%), specificity of 98.9% (adults 98.8%, children 98.9%), positive predictive value of 94.3% (adults 89.4%, children 98%), negative predictive value of 99.3% (adults 99.2%, children 100%), and accuracy of 98.5% (adults 98.3%, children 99.2%). When compared with MOG-Ab testing alone, a difference was seen only in adults: a significantly higher specificity (98.9% vs 95.6%, p = 0.0005) and nonstatistically significant lower sensitivity (91.9% vs 100%, p = 0.08). The international MOGAD diagnostic criteria exhibit high performance in selected patients with inflammatory demyelinating diseases (who had a high pretest probability of having MOGAD) compared with best clinical judgment; their performance was better in children than in adults. In adults, the MOGAD criteria led to an improvement in specificity and positive predictive value when compared with MOG-Ab testing alone, suggesting that the requirement of at least 1 clinical or MRI supporting feature is important. Future work should address the generalizability of the diagnostic criteria to cohorts of greater clinical diversity seen within neurologic settings.

Determinants of virological failure among HIV clients on second-line antiretroviral treatment at Felege-hiwot and University of Gondar comprehensive specialized hospitals in the Amhara Region, Northwest Ethiopia: A case-control study.

Second-line HIV treatment failure has become increasing worldwide, mainly in sub-Sahara Africa including Ethiopia. Even though the problem becomes increasing, inadequate information was available about its magnitude and associated factors in the current study area. To assess the factors of second-line Anti-Retroviral Treatment virological failure among second-line ART users. Institutional-based unmatched case-control study design was conducted from September to December 2021 at Felege Hiowt and University of Gondar Comprehensive Specialized Hospitals; Amhara region, Northwest Ethiopia. A total of 216 patients (60 cases and 156 controls) were recruited by a simple random sampling technique with a 1:3 cases-to-controls ratio. Patients who had two viral load results >1000 copies/ml within a 3-month interval after taking ART drugs for at least 6 months were cases and those who had ≤1,000 copies/ mL were controls. The sample size was calculated by using Epi-Info version 7.2.4. Structured questionnaires were used to gather the required information. SPSS version 26 was used to summarize the findings. In bivariate logistic regression model, Variables with two-tailed P-value ≤ 0.25 at 95% confidence interval were transferred into multivariate binary logistic regression model and P value at ≤ 0.05 was set as statistically significant. Out of 216 patients recruited, 212 have participated with a response rate of 98.2%. From these participants, 117(55.2%) were males and 187(88.2%) were urban dwellers. Among the total respondents, 208(98.1%) had age > 24 years, 200(94.3) were at HIV clinical stage I, 72(34%) had poor ART adherence and 112(52.8) did not disclose their HIV status. Likewise, most of the patients 147(69.37) didn't use condoms. The associated factors were not disclosing HIV status (AOR = 3.4, 95% CI: 1.52-7.79), medium adherence (AOR = 3.7, 95% CI = 1.3-10.7), poor adherence level (AOR = 5.27, 95% CI: 2.2-12.5), not using condoms (AOR = 4.47, 95% CI: 1.63-12.2) and Viral load (>150 copies/ml) when switched to second-line ART (AOR = 3.56, 95% CI: 1.5-8). Non-disclosure, poor or medium adherence, not using condoms and high Viral load (>150 copes/ml) when switched to second-line ART were the main factors for second-line Anti-Retroviral Treatment virological failure. Disclosure about HIV status, using condoms and improving treatment adherence level are crucial to reduce second-line virological failure.

Impact of legal documentation requirements on physician practice using a regional specialty hospital as an example: an inventory

Doctors in German hospitals are critical of their working conditions. They complain about long working hours, inadequate remuneration for their work, poor training and development opportunities, and increasing time spent on administrative tasks. As these points of criticism are largely based on subjective perception, in the present study we documented in detail the workflows of physicians in a major regional hospital, determined the time taken for the workflows, and performed a statistical evaluation of the data. Nine doctors from the specialties of internal medicine, surgery, and anesthesia/intensive care medicine were observed during their shifts for a total period of 216 hours at an urban hospital in Germany. All of the tasks performed by the doctors were recorded in an observation protocol. The time spent daily on documentation by doctors of all specialties was on average 93.1 ± 23.4 minutes, accounting for 19.4 % of a doctor's working hours. The specialists who spent the longest period of time on documentation were internists (120.2 ± 15.0 minutes; 25 %). During an eight-hour working day, computers were used on average for 123.5 ± 44.4 minutes; surgeons spent the shortest period of time on computers (71.5 ± 16.6 minutes). The direct patient-related work time (excluding the time spent on operations) was considerably lower (33.8 + 22.7 minutes; 7 %) than thetime spent daily on documentation, increased to 80.7 ± 62.9 minutes when the time expended on actual surgical tasks was taken into account, and was then similar to the time spent on documentation (93.1 minutes). This pilot study was the first to determine, in real time, the work processes of doctors from different specialties at a German hospital. We noted a disparity between administrative and patient-related tasks in the in-patient setting. Legal and economic requirements exert a negative impact on medical care. We need to develop strategies for effective utilization of medical resources and for ensuring a high standard of medical care.

Investigating Anatomical Variations in Paranasal Sinuses: A Comprehensive Analysis through Retrospective CT among the Indigenous Population at Multi - Speciality Hospital, Shillong

Investigating Anatomical Variations in Paranasal Sinuses: A Comprehensive Analysis through Retrospective CT among the Indigenous Population at Multi - Speciality Hospital, Shillong

Prediction of diabetic retinopathy among type 2 diabetic patients in University of Gondar Comprehensive Specialized Hospital, 2006–2021: A prognostic model

BackgroundThere has been a paucity of evidence for the development of a prediction model for diabetic retinopathy (DR) in Ethiopia. Predicting the risk of developing DR based on the patient’s demographic, clinical, and behavioral data is helpful in resource-limited areas where regular screening for DR is not available and to guide practitioners estimate the future risk of their patients. MethodsA retrospective follow-up study was conducted at the University of Gondar (UoG) Comprehensive Specialized Hospital from January 2006 to May 2021 among 856 patients with type 2 diabetes (T2DM). Variables were selected using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. The data were validated by 10-fold cross-validation. Four ML techniques (naïve Bayes, K-nearest neighbor, decision tree, and logistic regression) were employed. The performance of each algorithm was measured, and logistic regression was a well-performing algorithm. After multivariable logistic regression and model reduction, a nomogram was developed to predict the individual risk of DR. ResultsLogistic regression was the best algorithm for predicting DR with an area under the curve of 92%, sensitivity of 87%, specificity of 83%, precision of 84%, F1-score of 85%, and accuracy of 85%. The logistic regression model selected seven predictors: total cholesterol, duration of diabetes, glycemic control, adherence to anti-diabetic medications, other microvascular complications of diabetes, sex, and hypertension. A nomogram was developed and deployed as a web-based application. A decision curve analysis showed that the model was useful in clinical practice and was better than treating all or none of the patients. ConclusionsThe model has excellent performance and a better net benefit to be utilized in clinical practice to show the future probability of having DR. Identifying those with a higher risk of DR helps in the early identification and intervention of DR.

A retrospective analysis of the clinical profile and factors associated with mortality and poor hospital outcomes in adult Guillain–Barre syndrome patients

Guillain–Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14–34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067–184.858; P < 0.010). At discharge, 55% had a good outcome, and 45% had a poor outcome, according to the Hughes Functional Disability Scale (HFDS). Mechanical ventilation (AOR 0.024, 95% CI 0.001–0.607) and a GBS disability score > 3 (AOR 0.106, 95% CI 0.024–0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions.

Symptomatic remission and its associated factors among patients with schizophrenia on risperidone or olanzapine at Amanuel mental specialized hospital, Addis Ababa, Ethiopia

BackgroundSchizophrenia is a debilitating condition that affects 1% of the global population. Understanding the prevalence and the factors predicting schizophrenia remission is crucial for healthcare providers. This study aimed to determine the prevalence of remission and factors affecting the remission. Cross-sectional study was conducted at the Amanuel Mental Specialized Hospital from 3 October, 2022, to 31 August, 2023, and included 271 participants. Remission was measured using Remission in Schizophrenia Working Group (RSWG) symptom severity-based criteria. Data analysis was done using SPSS V.25.ResultsThe mean age of participants was 34.2 with standard deviation (SD) of 10.5 years. Most were male (90%), unmarried (63.8%), lived with their relatives (91.9%), and were unemployed (56.5%). Fifty-two percent achieved symptomatic remission. Remission in patients with medication switched to SGAs increased by 1.9 times compared to patients without medication switch (AOR 1.9, 95% CI: 1.1, 1.2). Adherent patients had 2.7 times higher odds of symptomatic remission as compared to non-adherent patients (AOR 2.7, 95% CI: 1.5,4.9), and for each unit increase in body mass index (BMI), the odds of achieving symptomatic remission were increased by 13% (AOR 1.13, 95% CI: 1.04, 1.23). The odds of symptomatic remission decreased by 71% in patients experiencing moderate-to-severe side effects compared to their counterparts (AOR 0.29, 95% CI: 0.1, 0.6).ConclusionsOur study revealed a symptomatic remission was achieved in 141 (52%) of the subjects. There is a possibility to improve symptomatic remission with counseling on the importance of adherence, monitoring and managing side effects, and switching medication to either risperidone or olanzapine. Measuring remission using RSWG time-based criteria is recommended.