Specialist Hospital Research Articles

Association of Nosocomial Burns and Bacterial Colonization in Iraqi Patients

Burn injury is a prevalent and severe form of trauma, posing a significant global public health concern. This study included isolating causative agents involved in nosocomial burns in Iraqi patients. 65 swabs from burn wounds were collected aseptically from a specialty hospital in Baghdad city. The swabs were cultured on routinely used culture media prepared in the laboratory and diagnosed using conventional biochemical tests, and the VITEK-2 compact system validated their findings. The findings revealed that 47 (72.3%) isolates had growth, and the remaining 27.7% of the swabs did not grow. Pseudomonas aeruginosa was the predominant species bacteria isolated in percent (43%), followed by Staphylococcus aureus in percent (26%), Corynebacterium spp. (11%), Proteus vulgaris (6%), whereas "Escherichia coli, Enterococcus faecalis, and Serratia marcescens" isolated in similar percent (4%), and Klebsiella spp. in the lowest percent (2%). Moreover, antibiotic susceptibility testing was also done using VITEK-2 compact system against Amoxiclav, Ticarcillin, Ceftriaxone, Imipenem, Gentamicin, Amikacin, Tetracycline, Doxycycline, Ciprofloxacin, and Erythromycin.

Segmentectomy for ground glass-dominant invasive lung cancer with tumour diameter of 2–3 cm: protocol for a single-arm, multicentre, phase III trial (ECTOP1012)

IntroductionPrevious studies demonstrated that wedge resection is sufficient for ground glass-dominant lung adenocarcinoma (LUAD) with tumour diameter ≤2 cm, however, the optimal surgical type for ground glass-dominant LUAD with tumour...

Evaluating patient-reported adherence and outcomes in specialty disease states: A dual-site initiative.

Patient-reported outcomes (PROs) are often used by clinicians to evaluate patient response to specialty medications used to treat multiple sclerosis (MS) and rheumatologic conditions. Identifying associations among PROs and patient characteristics could inform patient-centered treatment monitoring. To examine the association among patient characteristics and PROs, including patient-reported adherence (defined as no missed doses), medication tolerance, patient perceived effectiveness, and health care resource utilization (HCRU; defined as emergency department visits or hospitalizations), for patients prescribed specialty medications in 2 health system specialty pharmacies. A dual-center, retrospective review of monthly medication assessments completed by Vanderbilt Specialty Pharmacy and University of Illinois Hospital and Health Sciences System specialty pharmacy was conducted. Patients were included if they received at least 3 fills of a specialty medication from rheumatology or MS clinics from October 2019 to March 2022, excluding patients with more than a 30-day supply. Primary outcomes were the PROs of patient-reported adherence, medication tolerability, perceived effectiveness, and HCRU. For each of the 2 primary outcomes (adherence and tolerability), a mixed-effects logistic regression model was used to test for associations with age, sex, race, clinic, site, and the other PROs. A total of 61,926 assessments were completed from 3,677 patients (Site 1 = 3,346; 91.0% and Site 2 = 331; 9.0%). Patients were predominantly White (75.6%) and female (71.7%) with a median age of 50 years (IQR = 37-61). Assessments most frequently originated from rheumatology (76.0%). Nonadherence was reported 4.0% of the time, with the most common explanations being forgetfulness (33.1%) and medication being held because of a procedure or illness (29.5%). Most responses indicated perceived effectiveness as good/excellent (93.9%), with 98.5% of responses indicating no issues with tolerability. Patients who reported tolerability issues were 2.5 times more likely to report a missed dose (95% CI = 1.87-3.23, P < 0.001). An effectiveness rating of fair was associated with a 61% increase in the odds of a missed dose compared with a rating of good/excellent (95% CI = 1.33-1.94). Patients filling rheumatology or MS specialty medications within health system specialty pharmacies reported high rates of medication effectiveness and adherence and low rates of issues with tolerability and HCRU. Patients who report tolerability issues or lower perceived effectiveness may benefit from additional monitoring to prevent nonadherence.

Evaluation of Two Readings for the QuicGM Aspergillus Lateral Flow Assay in a Group of Immunocompromised Patients in Iraq

Background: Aspergillus spp. causes a wide range of diseases called Invasive Aspergillosis (IA) which is a fatal illness that affects a variety of immunocompromised people worldwide. Objective: Using the lateral flow test for the detection of Galactomannan antigen in immunocompromised patients suspected to have IA. Patients and Methods: This study was conducted on 72 patients, whose samples (serum, Bronchoalveolar lavage, Blood) were collected from the Hematology-Oncology Unit at Baghdad Teaching Hospital and Pediatric Welfare Hospital, and ICU in Ghazi AL-Hariri Surgical Specialties Hospital, and Bone Marrow Transplantation Center in period between November 2022 to February 2023. Patients’ blood and sputum were sent for fungal culture to confirm the diagnosis in most cases. Results: QuicGM Aspergillus Lateral Flow Assay was conducted on 72 patients, of whom 34 () were positive and 38 (52.7) were negative (P-value of 0.001 and 0.5) respectively. This screening aimed at detecting IA. One week later, the second confirmative result was obtained from 24 patients to determine the response to antifungal drugs or recovery from neutropenia on which 15 readings were negative and nine were positive. Out of 48 single readings, 25 were positive and 23 were negative. All for 72 members of the control group gave negative results. This study is the first in Iraq to use this assay. Conclusion: QuicGM Aspergillus Lateral Flow Assay was found to be reliable, sensitive, and specific, and proved to be a very good guide for the early diagnosis of IA in immunocompromised patients and in monitoring treatment outcomes and follow-up.

Career plateau, Abusive Supervision, and their Relation to Nurses' Intention to Quit at Mansoura Medical Specialty Hospital

Career plateau, Abusive Supervision, and their Relation to Nurses' Intention to Quit at Mansoura Medical Specialty Hospital

Investigating the Use of Simulated Patient Ratings in Objective Structured Clinical Examinations to Enhance Undergraduate Medical Assessments in Riyadh, Saudi Arabia.

Objective structured clinical examinations (OSCE) are the gold standard of clinical assessment, and are used to conduct undergraduate family medicine clinical assessment at King Faisal Specialist Hospital and Research Centre (KFSHRC). Some studies have suggested that simulated patient (SP) ratings could provide a better measure of empathy and communication skills than physician scores. The objective of this study is to further explore the effectiveness of simulated patient (SP) ratings inundergraduate OSCE assessments. The research employed a mixed-method approach. Three OSCE assessments for final-year students were selected. Both physicians and SPsevaluated each student, providing global ratings across four domains. The quantitative aspect involved comparing physician and SP scores and assessing correlation. The qualitative aspect involved interviewing SPs to establish what student behaviours led to higher or lower scores. Moderate correlation was found between physician ratings and SP ratings (r=0.53, p<0.01). Internal consistency of the SP ratings was lower than physician scores. SPs considered themselves to be patient advocates and were keen to give formative feedback. The ability of the trainee to truly listen was a major concern. Scoring for SPs was relatively holistic in nature. The results demonstrate that SP scores have slightly weaker reliability but are still relevant and offer a completely different perspective, enriching the assessment data. Assessment should take patientor SP perspectives into account, and not rely solely on the expert physician. Changing the assessment methods will lead to necessary changes in student approach to the OSCE and improve authenticity and validity.

Diagnostic evaluation of patients with epileptic spasms in the era of next-generation sequencing.

Epileptic spasms (ES) can be caused by a variety of etiologies. However, in almost half of cases, the etiology is unidentified. With the advent of next-generation sequencing (NGS), the recognition of genetic etiologies has increased. We retrospectively reviewed the medical records of patients with ES who were evaluated in the comprehensive epilepsy program at King Fahad Specialist Hospital Dammam between 2009 and 2022. Our data show that in 57.7% of patients with ES, the etiology was unidentified after a standard clinical evaluation and neuroimaging. Of these patients, n = 25 (35.2%) received a genetic diagnosis after some form of genetic testing, and 3.1% of patients from specialized metabolic work indicated the need for genetic testing to confirm the diagnosis. Karyotyping led to a diagnosis in 3.6% of patients, and chromosomal microarray led to a diagnosis in 7.1%. An NGS epilepsy gene panel (EP) was done for 45 patients, leading to a diagnosis in 24.4% (n = 11). Exome sequencing was done for 27 patients, including n = 14 with non-diagnostic panel testing; it led to a diagnosis in 37.3% (n = 10). Exome sequencing led to a diagnosis in 61.5% of patients without a previous panel test and in only two patients who had previously had a negative panel testing. In this article, we present the diagnostic evaluations of ES for a cohort of 123 patients and discuss the yield and priority of NGS for evaluating ES. Our findings suggest that exome sequencing has a higher diagnostic yield for determining the etiology of ES in patients for whom the etiology is still unclear after an appropriate clinical assessment and a brain MRI.

The Impact of the COVID-19 Pandemic on Ophthalmology Residency and Fellowship Training: A Retrospective Study.

Background The COVID-19 pandemic has negatively affected many aspects of the healthcare system. Many meta-analysis studies showed that surgical training and medical education have faced the most negative effects. Aim In this study, we aim to study the impact of the COVID-19 pandemic on residency and fellowship training in terms of clinical load, surgical exposure, medical education, and research opportunities. Methodology This retrospective study was conducted at King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia, to assess the effects of COVID-19 on the training program by comparing the years 2018 and 2019 before the COVID-19 pandemic to 2020 and 2021 after the COVID-19 pandemic. The sample was inclusive, including 117 KKESH graduates (residents and fellows in the surgical subspecialties) from 2018 to 2021. All the sample populations were included. The data was collected in a specifically designed form. All participants were ensured to have a full surgical logbook with no missing data in the documentation. Outpatient visits were collected through electronic records in the hospital registry. The teaching activities and grand rounds were collected through the residency and fellowship program. Results During 2018-2021, 18,669 surgeries were performed. The total number of surgeries performed was 3,980, 4,898, 4,813, and 4,978 in 2018, 2019, 2020, and 2021, respectively. There was a 23.1% (N = 918) increase in the number of surgeries done by trainees from 2018 to 2019, then a 1.7% (N = 85) reduction from 2019 to 2020, followed by an increase of 3.4% (N = 165) from 2020 to 2021. The mean number of surgeries performed by fellows showed a 25.2% (N = 1,042) increase from 2018 to 2019, a 7.3% (N = 107) reduction from 2019 to 2020, and a 15.1% (N = 550) increase (p = 0.018). In the case of residents, there was a 10.7% (N = 136) reduction from 2018 to 2019, a 2.1% (N = 24) increase from 2019 to 2020, and a 40% (N = 783) reduction in the total number of phacoemulsification surgeries (p < 0.001).In total, there was a 25.1% (N = 8,215) increase in the number of patients seen in outpatient clinics from 2019 to 2020. All activities were on-site during 2018 and 2019. A gradual shift occurred from on-site to virtual over 2020 and 2021 without any effect on the number. From 2019 to 2020, there was an increase in the number of papers submitted by the trainees. There was an increase of 25% (N = 10), 20% (N = 2), and 6.3% (N = 3) in the retrospective research, prospective research, and case reports, respectively. Conclusions The surgical exposure has not affected the fellows and residents of the hospital. However, the number of surgeries for the residents has been affected due to the stoppage of overseas surgical courses during the pandemic. The volume of the outpatient clinic has increased after the pandemic, which could be caused by the increased number of referrals to our tertiary hospital, mainly after the pandemic effect on other hospitals in the kingdom and the implementation of the virtual clinic and telephone call. Interestingly, research activity has also increased after the pandemic.

Iron and Antioxidant Status in Malaria Patients Attending Public Specialist Hospital, Kano State, Nigeria

Iron and Antioxidant Status in Malaria Patients Attending Public Specialist Hospital, Kano State, Nigeria

Patterns and Risk Factors of Traumatic Brain Injuries in Pediatric Patients Visiting the Emergency Room in Saudi Arabia: A Cross-sectional Analysis

Abstract Introduction: Traumatic brain injuries (TBIs) in pediatric patients are a pressing public health concern, with limited data in the Saudi Arabian context. This study aimed to identify patterns, risk factors, and clinical outcomes associated with TBIs among pediatric patients visiting emergency rooms in Saudi Arabia. Methods: A cross-sectional analytical study was conducted, involving 1,030 pediatric patients admitted to emergency departments of King Fahad Hospital in Hofuf, Almoosa Hospital in Hofuf, King Fahad Hospital in Dammam, King Fahad Hospital in Madina, King Faisal Hospital in Alahsa, King Faisal Specialist Hospital in Riyadh, and King Abdulaziz University Hospital in Jeddah. The age of the patients was predominantly within the range of 18–24 years, constituting 58.5% of the total sample. Data were collected through standardized questionnaires and analyzed using Chi-square tests and descriptive statistics. Results: Falls were the predominant cause of TBIs, accounting for 69.8% of cases. No significant correlation was found between age and TBI severity (P = 0.072). However, the cause of TBI significantly influenced clinical outcomes (P &lt; 0.05). Conclusion: While age did not significantly impact the severity of TBIs, the cause of the injury played a critical role in clinical outcomes. These findings provide a foundation for targeted preventive measures and interventions.

Impact of Pre- and Post-therapeutic Exercises in Sarcopenia and Pain in Liver Transplant Patients.

Sarcopenia, a state considered by the loss of muscle function and mass, is progressively recognized as a common complication of advanced cirrhosis and is related to negative clinical consequences. Liver transplantation (LT) is one of the options in the treatment of cirrhosis. This study aimed to evaluate the impact of exercise in newly developed (ND) sarcopenia through measurement of the psoas major muscle at the level of the third lumbar vertebra by abdominal computed tomography (CT) images in liver transplant patients. This analytical case-control longitudinal study was conducted on patients aged between 16 and 70 years at King Fahad Specialist Hospital (KFSH-D) in Dammam, Saudi Arabia. The patients were divided into two groups:an intervention group consisting of liver transplant patients (LTx, n=26) and a control group consisting of end-stage liver disease patients (ESLD, n=23) who were not candidates for LT. All participants were treated with a therapeutic exercise program through three phases. The first phase included pre-operative exercises, the second phase included early post-operative exercises, and the last phase included late post-operative exercises. CT scan of the psoas major muscle was performed pre- and post-LT to assess sarcopenia. Pain was measured with a numerical pain scale before and after exercise to evaluate the impact of exercise on pain. Psoas muscle index (PMI) for post-therapeutic exercises in the control and liver transplant groups showed significant differences for both male and female patients compared with the normal range (p<0.05). The liver transplant group showed a significant difference in mean weight loss, body mass index (BMI), and numerical pain rating scale (NPRS) observed on post-therapeutic exercises compared to baseline data. Conclusion: By and large, the finding revealed a substantial impact of therapeutic exercise on patient outcomes in terms of anthropometric characteristics, abdominal pain, handgrip strength (HGS), and PMI. The mean PMI at post-therapeutic exercises showed a significant increase by measuring the psoas major muscle at the level of the third lumbar vertebra by abdominal CT, which may indicate the extent of improvement and recovery from the ND sarcopenia in LTx.The results emphasize the potential advantages of pre- and post-therapeutic exercise in LTx, including enhancements in muscle strength and mass, as well as pain management associated with liver function and general health. Optimizing patient outcomes and promoting a more comprehensive approach to liver disease treatment may be achieved by including exercise activities in pre- and post-LT care procedures.

Medication-Related Hospital Admission Among Patients Admitted to the Emergency Ward at the University of Gondar, North West Ethiopia: A Cross Sectional Study.

Medication-related hospital admission (MRHA) is hospitalization due to drug-related problems. MRHAs have been reported to be on the rise in recent decades. This study was aimed at determining the prevalence, patterns, and predictors of MRHA among patients visiting the emergency ward of the University of Gondar comprehensive specialized hospital, Ethiopia. A cross-sectional study was conducted from June 1, 2022, to August 30, 2022 G.C. in the emergency ward at the University of Gondar Comprehensive Specialized Hospital. The AT-HARM 10 tool was used to collect data from participants who fulfilled the inclusion criteria. Data was entered into EpiData Manager 4.6.0.0 and was exported to Statistical Package for Social Sciences (SPSS) version 24 for analysis. Descriptive statistics were presented using frequency and percentage. Binary logistic regression was applied to identify factors associated with MRHAs with a 95% confidence level, and significance was declared at a p-value <0.05. The prevalence of MRHAs was 30.5% (95% CI = 27.7-36.4%). More than half (64.52%) of MRHAs were definitely preventable. The majority of MRHAs (48.39%) were severe. Non-compliance (41.12%), followed by untreated indication (26.61%) and adverse drug reaction (12.09%) were the most frequent causes of MRHAs. Renal impairment (AOR = 2.703, 95% CI: 1.29 to 5.663), chronic disease (AOR = 10.95, 95% CI: 4.691 to 25.559), history of traditional medication use (AOR = 2.089, 95% CI: 1.162 to 3.755), and history of hospitalization (AOR = 4.001, 95% CI: 1.98 to 8.089) were significantly associated with MRHAs. MRHAs were substantially prevalent. Most of the MRHAs were definitely preventable. Renal impairment, chronic disease, history of traditional medication use, and history of hospitalization were predictors of MRHAs. At the university hospital, health care providers should strive to prevent and manage MRHAs appropriately.

Postoperative hyperglycemia among adult non-diabetic surgical patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundPostoperative hyperglycemia is associated with morbidity and mortality in non-diabetic surgical patients. However, there is limited information on the extent and factors associated with postoperative hyperglycemia. This study assessed the magnitude and associated factors of postoperative hyperglycemia among non-diabetic adult patients who underwent elective surgery at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA facility-based cross-sectional study was conducted among 412 adult patients who underwent elective surgery at University of Gondar Comprehensive Specialized Hospital from April 14 to June 30, 2022 All consecutive postoperative non-diabetic elective surgical patients who were admitted to PACU during the data collection period and who fulfilled inclusion criteria were included in the study until the intended minimum sample size was achieved. And data were collected through interviews using a pretested semi-structured questionnaire. Postoperative hyperglycemia was defined as a blood glucose level of ≥ 140 mg/dl. Multivariable logistic regression was performed to identify the association between postoperative hyperglycemia and independent variables. Variables with a p-value less than 0.05 and a 95% confidence interval (CI) were considered statistically significant.ResultsA total of 405 patients’ data were evaluated with a response rate of 98.3%. The median (IQR) age was 40 (28-52) years. The prevalence of postoperative hyperglycemia was 34.1% (95% CI: 29.4–39.0). Factors significantly associated with postoperative hyperglycemia included being overweight (AOR = 5.45, 95% CI: 2.46-12.0), American Society of Anesthesiologists (ASA) classification II and III (AOR = 2.37, 95% CI: 1.17–4.79), postoperative low body temperature (AOR = 0.18, 95% CI: 0.069–0.48), blood loss ≥ 500 ml (AOR = 2.33, 95% CI: 1.27–4.27), long duration of surgery, mild pain (AOR = 5.17, 95% CI: 1.32–20.4), and moderate pain (AOR = 7.63, 95% CI: 1.811–32.20).Conclusion and recommendationOne-third of the study participants had postoperative hyperglycemia. Weight, ASA classification, postoperative body temperature, duration of surgery, intraoperative blood loss, and postoperative pain were identified as a modifiable risk factors. Maintaining normal body temperature throughout the procedure, treating postoperative pain, and monitoring and controlling blood glucose level in patients at risk of hyperglycemia is crucial.

Plasmid Curing of Bacteria Isolated from Upper Respiratory Tract Infections among Patients Attending Specialist Hospital Sokoto

Study’s Novelty/Excerpt This study focuses on curing plasmid-mediated antibiotic resistance in bacteria associated with upper respiratory tract infections in patients at Specialist Hospital Sokoto, an area previously underexplored in this context. It uniquely demonstrates the successful reversal of antibiotic resistance in Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa through plasmid curing experiments, highlighting the significant role of plasmids in resistance mechanisms. Additionally, the study underscores the potential for plasmid-mediated resistance to be transferred among bacterial populations, presenting a critical concern for antimicrobial resistance management in the region. Full Abstract Presences of resistant plasmids (R-plasmids) in microorganisms make the cells avert the effect of antibiotics and complicates chemotherapy of infections. This study aimed to cure the plasmid of antibiotic-resistant bacteria associated with upper respiratory tract infections among patients attending Specialist Hospital Sokoto by reassessing their susceptibility to antibiotics that were previously resistant. One hundred (100) throat swab samples were collected and analysed. The isolates were isolated and identified using standard methods (Gram staining, biochemical and serological tests). The susceptibility of the isolates to various beta-lactam antibiotics was evaluated, and resistant bacteria were subjected to plasmid curing experiments followed by further susceptibility testing to reassess their susceptibility to the erstwhile resistance. Bacteria isolated were Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa, with the frequency of occurrence of 20 (57.2%), 9 (25.7%), and 6 (17.1%), respectively. The result of antibiotic susceptibility tests before plasmid curing showed that Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa resisted Cloxacilline, Cefuroxime, Cloxacillin and Augmentin. Susceptibility results after curing showed that almost all bacteria have reverted to sensitivity to all antibiotics except Cloxacillin and Augmentin. This research implies that the resistance possessed by the bacterial isolates is plasmid-mediated and may easily be transferred to other non-resistant bacteria, which may lead to an alarming rate of antimicrobial resistance in the study area.

Diagnosis of Malaria among Children in Sokoto: A Comparison of Microscopy and Rapid Diagnostic Tests

Study’s Novelty/Excerpt This study compares the utility, sensitivity, specificity, and predictive values of microscopy with that of Rapid Diagnostic Tests (RDTs) in diagnosing malaria among children in Specialist Hospital Sokoto. The novelty lies in its focus on a specific pediatric population in a resource-limited setting, providing valuable data on the comparative effectiveness of these diagnostic methods in real-world clinical practice. The findings highlight the higher positivity rate of microscopy, advocating for its continued use alongside RDTs to ensure accurate malaria diagnosis and optimal patient care in similar environments. Full Abstract Malaria is a life-threatening disease primarily found in tropical countries, and it is the leading cause of morbidity and mortality among children. Diagnosis of malaria depends largely on clinical presentations and laboratory diagnosis. Microscopy is the gold standard for laboratory malaria diagnosis but requires adequate training and time compared to Rapid Diagnostic Tests (RDTs). The study compared the utility, sensitivity, specificity, and predictive values between microscopy and RDTs in diagnosing malaria among children accessing care in Specialist Hospital Sokoto. A total of 367 blood samples of consented children who met the study inclusion criteria were examined. All samples were screened for malaria using RDT thin and thick blood films. Of the 367 samples assessed, RDT was positive for 202 (55.0%) and negative for 165 (45.0%), while microscopy was positive for 235 (64.1%) and negative for 132 (35.9%), a non-statistically significant (χ2 = 0.090, P = 0.922) difference was observed when both positive tests were compared. The Rapid diagnostic tests (RDTs) showed a sensitivity of 85.95% and a specificity of 83.33%. This study confirms the higher positivity rate of microscopy to RDTs in diagnosing malaria. As such, RDTs are useful for rapid malaria diagnosis, especially in resource-limited settings; microscopy should be encouraged as much as possible for children to avoid missing any positive cases.

Prevalence of Human Papillomavirus Infection and its Association with the Risk of Cervical Cancer among Hiv-Positive Women in Plateau State, North-Central Nigeria

Study’s Novelty/Excerpt This study investigates the prevalence and risk factors of HPV among HIV-infected women in Plateau State, Nigeria, highlighting a significant correlation between low CD4+ counts, high viral loads, and increased HPV infection rates. By utilizing comprehensive diagnostic methods including ELISA for HPV detection and cytology for cervical abnormalities, the research offers robust data linking immunosuppression and HPV-related cervical pathology in a high-risk population. The findings emphasize the urgent need for targeted interventions to improve sexual health behaviors and further research on how low immunity accelerates cervical cancer progression in both HIV-positive women and the broader population. Full Abstract Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI) associated with cervical, uterine, and anogenital cancers. Persistent infection with HPV is associated with abnormal cervical cells, which can develop into cervical cancer if left untreated. Human papillomaviruses are the first viruses to have been acknowledged to prompt carcinogenesis, and they are linked with cancers of the uterine cervix, anogenital tumours, and head and neck malignancies. A hospital-based study of HIV-infected women across the three senatorial zones of Plateau State, Nigeria, was conducted between November 2018 to November 2020. Ethical approval for the study was first obtained from the ethical committee of Plateau State Specialist Hospital Jos, and informed consent to participate in the research was also obtained from each participant. HIV status confirmation was first done through standard rapid test procedures, followed by cytology testing via the Pap smear procedure to detect any precancerous or malignant changes in the cervix. Subsequent detection of HPV utilized the ELISA procedure, while CD4+ cell count and viral load estimations were done using flow cytometry and nucleic acid amplification techniques, respectively. Questionnaires were administered to obtain information on cervical cancer risk factors and clinical presentations. The overall prevalence of HPV was 28% among HIV-infected women. More HPV infection (31.9%) occurred in women with low CD4+ count (0-200 cells/mm3), and also highest (50.0%) among women with the highest HIV viral load (&gt;100 copies/mL). The possible risk factors identified in this study include multiple sexual partnering, low condom usage, and coinfection with other STIs, among others. In conclusion, this study identified a high HPV prevalence, low CD4+ counts, and coinfection with other STIs among high-risk populations (HIV-infected women). We, therefore, recommend improved sexual behaviours and further research on the impact of low immunity on the rate of progression of cervical abnormality to cervical cancer, not just in HIV-positive women but in the general population.

Patterns of Spine Cases in a New Neurosurgery Centre in Southeast Nigeria

Background: The Imo State Specialist Hospital (IMSSH) commenced neurosurgical services in April 2021 and spine procedures in August 2021. The activities of the hospital with respect to surgical management of spine pathologies were audited. Aims: Our aims were to look at the pattern of spinal pathologies surgically managed in the hospital including their age and sex distribution, the pathologies and procedures performed as well as immediate post operative outcomes. Methods: The case files of all spine patients who had surgical procedures at IMSSH from August 2021 to April 2023 (21 months) were retrospectively reviewed. Results: Seventy-two spine patients had surgical procedures during the study period (an average of 3 – 4 spine procedures per month). The mean age of patients was 55.4±16.1 years with a male-to-female ratio of 7: 5. The mean age for male patients was 53.86±17.83 years while that of female patients was 57.5±13.2years. The peak age range at presentation was in the 7th (n=23, 31.9%) decade. The highest frequency of procedures was performed in the lumbar/ lumbosacral spine (56.9%), followed by cervical spine (29.1%), and thoracic/thoracolumbar spine (13.8%). Degenerative spine diseases (69.4%) accounted for the highest number of spine cases, followed by spinal trauma (20.8%) and Spinal tumours (6.9%). Mortality in the immediate post-operative period was 6.9% (n=5). Conclusion: The study showed a male preponderance for spinal surgeries among our spine patients, with most cases being of degenerative spine pathology. We hope this would be helpful in formulating policies for the growth of this new Neurosurgical Centre.

Seroprevalence of transfusion-transmitted infections among blood donors in Makkah, Saudi Arabia.

Blood donation is vital for healthcare; however, transfusion-transmitted infections (TTIs) pose a serious risk. This study investigated the seroprevalence of TTIs among Saudi blood donors. This retrospective study included male blood donors aged ≥ 18 years who donated blood at Al-Noor Specialist Hospital in Makkah from January 2017 to December 2022. The blood units were screened for hepatitis B surface antigen (HBsAg) and core antibodies (HBc-IgG), hepatitis C antibodies (HCV-Abs), syphilis, HIV-1 antigen/antibody (HIV-1 Ag/Ab), human T-lymphotropic virus 1, 2 (HTLV-1/2), and malaria. There were 40,287 donors with an average age of 44.33 ± 18.12 years, and 62.3% (n = 25103) were Saudis. The overall rate of TTIs seropositivity was 7.4% (n = 2953); HBc-IgG (6.1%; n = 2473) was the most common, followed by HCV-Abs (0.4%; n = 177), and syphilis (0.34%; n = 136). All cases were negative for malaria, whilst HIV and HTLV positive donors were 0.06% (n = 24) and 0.13% (n = 52), respectively. Syphilis was more prevalent among non-Saudis (0.24%; n = 83) than among Saudis (0.1%; n = 53), whereas anti-HBc antibodies seropositivity was significantly higher among Saudi (3.4%; n = 1373) than non-Saudi donors (2.7%; n = 1100). Hepatitis B virus was the most frequently detected bloodborne pathogen, followed by hepatitis C virus and syphilis. Hepatitis B virus was also more prevalent among Saudi donors, whilst expatriates had higher rates of syphilis. Additional prospective multicenter studies are needed to accurately determine the prevalence of TTIs in Saudi Arabia.

Leadership and Implementation of Total Quality Management: A Case Study of Employee Performance Improvement in Hospitals

This study aims to find out and analyze the influence of leadership on employee performance through the mediation of the implementation of Total Quality Management (TQM). The research design used is a survey research that takes samples from a population and uses questionnaires as a tool for collecting basic data. The research locations were carried out at Koja General Hospital, Sulianti Saroso Infectious Special Hospital, and TK II TNI AD M Ridwan Hospital. The number of population as well as the sample in this study is 240 people. To meet the assumptions and analysis models in this study, the Likert Scale was used. The analysis technique used in this study is path analysis using the Amos program. The results of the study show that leadership variables have a significant effect on the implementation of TQM, leadership has a significant effect on employee performance. Leadership has a significant effect on employee performance through the implementation of TQM.

Prevalence of Multi Drug Resistant Coagulase Negative Staphylococci among some Pregnant Women Attending Antenatal Clinic in Yola, Nigeria

Study’s Novelty/Excerpt This study presents findings on the prevalence and characterization of coagulase-negative staphylococci (CoNS) among pregnant women in public health facilities in Yola, revealing a significant prevalence rate of 26.97%. The research highlights the high susceptibility of CoNS to certain antibiotics and the alarming presence of multi-drug resistant and extended spectrum beta-lactamase (ESBL) producing strains. This underscores the necessity for routine screening of pregnant women for CoNS to prevent potential gestational complications, providing crucial data for public health interventions and antibiotic stewardship programs. Full Abstract Coagulase negative staphylococci have been reported to be a frequent agent of uncomplicated UTI in young sexually active women which can also lead to symptomatic infection, low birth weight (LBW) babies and preterm delivery. This study was undertaken to determine the prevalence and characterize coagulase negative staphylococci among pregnant women in public health facilities in Yola. A total of 250 urine samples were collected from pregnant women attending antenatal clinic at Specialist Hospital and Boshang Clinic and Maternity both in Yola. The samples were cultured on cysteine lactose electrolyte deficient medium and isolates characterized using phenotypic methods. The prevalence of coagulase negative staphylococci from this study was 26.97%, Staphylococcus aureus 16.29% and Escherichia coli 36.51%. The frequency of CoNS was highest among age group of 36-40 years and least among 16-20 years (12.5%). CONS isolated from this study demonstrated high susceptibility to pefloxacin, ciprofloxacin, erythromycin, ceftriaxone and streptomycin. Some isolates showed high resistance to ampiclox, cefuroxime and amoxicillin. About 83% of the isolates had multiple antibiotic resistant indexes greater than 0.2 with about 25% of the antibiotic resistance being plasmid mediated. Furthermore, phenotypic screening using the double disk synergy test showed that 20 (40%) of the isolates were extended spectrum beta lactamase (ESBL) producing. This study revealed the presence of multi-drug resistant and ESBL producing coagulase negative staphylococci among pregnant women in the study area. There is therefore the need for pregnant women to be screened for coagulase negative staphylococci to avoid complications during gestation period.