Standardized Data Collection Form Research Articles

Clinical Insights and Outcomes in Community-Acquired Acute Bacterial Meningitis versus Postoperative Bacterial Meningitis.

To compare the demographics, clinical characteristics, and in-hospital mortality rates between community-acquired bacterial meningitis cases and postoperative bacterial meningitis. Analytical study. Place and Duration of the Study: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye, from 2016 to 2022. A total of 153 patients diagnosed with bacterial meningitis were included and categorised into two groups: 95 (62.1%) with community-acquired bacterial meningitis (CABM) and 58 (37.9%) with postoperative bacterial meningitis (POBM). Demographics, clinical features, laboratory, paraclinical findings, treatments, and outcomes of the cases were compared. Data were retrieved using a standard data collection form from the electronic medical records. A substantial portion (58.8%) of all patients had comorbidities. Fever was the common symptom in all groups. Headache, neck stiffness, nausea, and vomiting were more often observed in the CABM group (p <0.001). Upon admission, the CABM exhibited higher levels of white blood cell count, C-reactive protein, and procalcitonin (p = 0.017, p = 0.004, p = 0.007, respectively). Overall 33.1% had positive cerebrospinal fluid cultures. The overall mortality rate was 26.8%. POBM was associated with longer hospital and intensive care unit (ICU) stays (p <0.001). Shorter treatment durations, lower Glasgow coma scale scores (GCS), higher Charlson Comorbidity Index values, and elevated markers of inflammation were related to mortality. This study illuminates the differences in clinical presentations and outcomes between community-acquired and postoperative bacterial meningitis. It also suggests that factors such as lower GCS scores, comorbidities, and elevated inflammation markers at the last follow-up may be associated with unfavourable clinical outcomes in bacterial meningitis. Postoperative meningitis, Central nervous system infection, Cerebrospinal fluid, Antibiotics.

Is It Safe to Correct Iron Deficiency Anemia with Intravenous Iron in Pregnancy? a Systematic Review and Meta-Analysis

Background: Iron deficiency anemia is common among pregnant patients. There is lack of consensus on the approach to management of iron deficiency anemia in pregnancy and controversy remains surrounding the risks associated with its correction. Previous systematic reviews have examined the effectiveness of various management strategies for iron deficiency anemia in pregnancy; however, severe adverse maternal and neonatal effects have not been systematically described. The aim of this systematic review and meta-analysis was to evaluate for adverse maternal and neonatal effects with intravenous (IV) versus oral iron in pregnancy. Methods: A comprehensive search in MEDLINE, Embase, and CENTRAL from database inception to January 2024 was performed. Articles were eligible for inclusion if they were 1) randomized controlled trials or cohort studies; 2) included pregnant individuals with iron deficiency anemia; 3) comparing patients who received IV iron with those who received oral iron and 4) examining for severe adverse effects in mothers and neonates. IV iron formulations with known safety concerns such as high molecular weight iron dextran were excluded. The primary outcome was preterm birth. Secondary outcomes included neonatal outcomes (e.g., intrauterine growth restriction (IUGR), Apgar scores, admission to the neonatal intensive care unit, stillbirths and neonatal deaths) and maternal outcomes (e.g., red blood cell (RBC) transfusions, postpartum hemorrhage, maternal intensive care unit admission, hysterectomy, unplanned C-section, postpartum depression and maternal death). Data from included studies were extracted by two reviewers independently and in-duplicate, using a standardized data collection form. Disagreements were adjudicated by a third reviewer. Risk of bias assessments were conducted using standard study design specific tools. Inverse variance random effect meta-analyses were used to pool effect estimates using RevMan 5.4. Results: A total of 1,568 citations were initially obtained of which 28 studies met inclusion criteria and 24 were randomized controlled trials. In total, 3,402 pregnant patients received IV iron and 3,640 pregnant patients received oral iron. All studies administered IV iron or oral iron within the second or third trimester of pregnancy. The most frequently reported IV iron formulations were iron sucrose and ferric carboxymaltose. The most frequently reported oral iron formulation was ferrous sulphate. There was no difference in risk of premature birth between IV and oral iron formulation groups (risk ratio (RR): 0.98, 95% Cl: 0.83 to 1.15, p=0.78, I2=0%). Rates of IUGR (RR:0.88, 95% Cl: 0.74 to 1.03, p=0.12, I2=0%), stillbirths (RR:0.93, 95% Cl: 0.56 to 1.52, p=0.76, I2=0%) and neonatal deaths (RR: 0.72, 0.45 to 1.17, p=0.19, I2=0%) were also similar between IV and oral formulation groups. Rates of adverse maternal outcomes (RBC transfusion (RR:1.00, 95% Cl: 0.57 to 1.76, p=1.00, I2=17%), postpartum hemorrhage (RR: 0.92, 95% Cl: 0.62 to 1.35, p=0.65, I2=0%), unplanned C-sections (RR: 1.33, 95% Cl: 0.99 to 1.78, p=0.06, I2=0%)) were also similar between formulation groups. No studies examined for differences in rates of postpartum depression. Meta-analyses could not be generated for Apgar score &amp;lt;7 at 5 minutes, admissions to the neonatal intensive care unit, maternal admissions to the intensive care unit and maternal death due to an insufficient number of studies reporting these outcomes. Conclusions: This systematic review and meta-analysis found no difference in risk of adverse neonatal nor maternal outcomes for IV iron compared with oral iron when used to treat iron deficiency anemia of pregnancy. This suggests that IV iron should not be avoided in pregnancy for fear of severe adverse neonatal or maternal events, and provided if deemed clinically appropriate.

The impact of limited English proficiency on oncological outcomes in the United States: A systematic review.

The increasing number of immigrants in the United States (U.S.) has resulted in more patients with limited English proficiency (LEP). LEP contributes to patient-provider language discordance, which may impact oncologic health outcomes. To assess the effects of LEP compared to English proficiency (EP) for oncological outcomes in adult cancer patients in the United States. We searched MEDLINE (Ovid), the Cochrane Library (Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials), PsycINFO, CINAHLand Scopus from data inception to 26 January2023. We also searched the reference lists and cited lists of included studies. Studies were limited to the UnitedStatesand the English language. We included retrospective and cross-sectional studies that analyzed one or more clinical outcomes (survival, readmission, length of stay, complicationsand discharge disposition) in LEP and EP cancer patients. Studies were eligible if they assessed cancer patients in the United Stateswho were 18 years and older. Using a piloted, standardized data collection form, two non-blinded, independent reviewers extracted data in duplicate from studies meeting our inclusion criteria. Reviewers resolved discrepancies through discussion. We then performed a qualitative assessment of the findings. We retrieved 2425 records from the database searches. We screened 1496 records by title and abstract and reviewed the full text of eight records. We retrieved 347 records from additional search methods and reviewed the full text of six records. We included 14 papers in total for analysis. The studies included 55,141 total patients and assessed outcomes in brain, oesophageal, head and neck, pancreaticand skin cancer. Our qualitative assessment demonstrated limited information on whether LEP impacted survival, complicationsand discharge disposition. We found no significant association between LEP and readmission or length of stay. Studies assessing the impact of LEP and EP on the health outcomes of cancer patients are sparse and inconsistent in the measurements of outcomes and data reporting. The inconclusiveness of our study indicates that further standardized research is needed to assess the impact of LEP on the outcomes of cancer patients in the United States.

Risk Factors of Sarcopenia in COPD Patients: A Meta-Analysis.

Sarcopenia is a common complication of COPD associated with an age-related reduction in skeletal muscle mass associated with decreased muscle strength and / or reduced mobility. The incidence of sarcopenia in patients with COPD is twice that of non-COPD patients and is associated with poor prognosis, this study aimed to investigate the influencing factors of sarcopenia in COPD patients. Selected studies from PubMed, Embase, Web of Science, Cochrane Library, Wanfang, Wanfang, CNKI, CBM, and Wanfang databases as of November 12023. Patients aged 18 were selected; data were then independently extracted by two reviewers using a standard data collection form. In total, 17 articles reporting on 5408 patients were included. Age (OR = 1.083; 95% CI, 1.024-1.145), ALB (OR = 0.752; 95% CI, 0.724-0.780), BMI(OR = 0.701; 95% CI, 0.586-0.838), smoking (OR = 1.859; 95% CI, 1.037-3.334), diabetes (OR = 1.361; 95% CI, 1.095-1.692), qi deficiency (OR = 9.883; 95% CI, 2.052, 47.593), GOLD C (OR =2.232; 95% CI, 1.866, 2.670) and GOLD D (OR = 2.195; 95% CI, 1.826-2.637) were factors affecting muscle loss in COPD patients. Sarcopenia is more prevalent in patients with COPD. Age, body mass index, smoking, diabetes mellitus, qi deficiency, ALB, and GOLD grade were the contributing factors for sarcopenia in patients with chronic obstructive pulmonary disease. In the future, medical staff should not only pay attention to the early screening of sarcopenia in high-risk groups, but also provide relevant prevention information.

A Major Gap Between the Knowledge and Practice of Mothers Towards Early Initiation and Exclusive Breastfeeding in Afghanistan in 2021.

Initiation of breastfeeding right after birth and exclusive breastfeeding for the first 6 months of life is highly recommended. In this survey, we assessed the knowledge and practice of ever-married women towards early initiation of breastfeeding and exclusive breastfeeding in the Nuristan province of Afghanistan. In a cross-sectional household survey, we enrolled 640 ever-married 15-49years women having a child aged 0-23months in the Parun district of Nuristan province from September to October 2021. Using a standardized data collection form and face-to-face interview, we measured self-reported demographic characteristics and the study outcomes (awareness and practice towards the initiation of breastfeeding within an hour of birth and exclusive breastfeeding for the first 6 months of life). We analyzed the data using survey methods and used bivariate and multiple Poisson regression to assess the covariates of the study outcomes. About 46.9% of ever-married women were 25-34years old, 67.5% never attended school, 30.4% were unemployed, and 86.4% had < $60 monthly income. Overall, 56.8% (95% CI 52.9-60.6) of the women had correct knowledge of the early initiation of breastfeeding, and 51.4% (95% CI 47.5-55.3) initiated breastfeeding early for their last baby. Also, 85.9% (95% CI 82.9-88.4) of the women had correct knowledge of exclusive breastfeeding, but only 32.6% (95% CI 29.1-36.4) exclusively breastfed their last baby for 6months after birth. After adjustment for covariates, women who were 45-49years old (Adjusted Prevalence Ratio [APR] = 1.26), Divorced/Separated (APR 1.68), ever attended school (APR 1.39), monthly income > $115 (APR 1.50) were more likely to start early breastfeeding. Moreover, women who were Divorced/Separated (APR 3.53) were more likely to exclusively breastfeed their babies for 6months after birth. Only over half of the women were aware of and initiated early breastfeeding. Although most women knew about exclusive breastfeeding, less than one-third exclusively breast their babies for 6months after birth. We found several contributing factors, such as age, marital status, education, and income that should be considered for targeted interventions.

Applicability of selected Brighton Collaboration case definitions in low-resource settings: A prospective hospital-based active surveillance in Addis Ababa, Ethiopia

IntroductionStandardizing case definitions for priority vaccine safety conditions facilitates uniform evaluation and consolidation of data obtained from different settings. The Brighton Collaboration case definitions (BCCD) were created to support this harmonization and enable classification from level 1 (most certain) to level 5 (not a case) of certainty. Assessing the performance of BCCD in practice is critical, particularly in resource-limited settings, where many new vaccines may be introduced without prior monitoring in high-income countries. We assessed the performance of BCCD in Addis Ababa, Ethiopia, as applicable to COVID-19 and other vaccines. MethodsActive surveillance was conducted at Tikur Anbessa Specialized Hospital, the largest referral hospital in Ethiopia. During June 1, 2022–May 31, 2023, three trained physicians prospectively identified patients eligible for COVID-19 vaccination (regardless of vaccine receipt) who presented with one or more of eleven pre-specified adverse events of special interest (AESI) from the emergency department and inpatient wards. Standardized data collection forms were used to capture patient information and assign level of certainty (LOC), regardless of vaccination status for COVID-19. We conducted descriptive analysis to characterize cases and the LOCs reached for each AESI. ResultsWe detected 203 AESI cases. The most detected conditions were thrombosis and thromboembolism (n = 100, 49 %) and generalized convulsions (n = 38, 19 %). Ninety-six percent of the cases were confirmed at levels 1–3 (n = 187) or level 5 (n = 9) LOC. Non-classifiable (level 4) cases were observed for pericarditis (n = 2), encephalitis (n = 2), myelitis (n = 2), and generalized convulsion (n = 1). ConclusionThe BCCD were successfully applied in > 95 % of cases in a large referral hospital in Ethiopia, with generalized convulsion, pericarditis, and encephalomyelitis as the exceptions. We recommend further evaluation in other low-resource settings, particularly in rural or non-referral hospitals, to gain additional insights into performance of these definitions for revision or adaptation, as needed.

Prevalence and factors associated with medication administration errors in the neonatal intensive care unit: A multicentre, nationwide direct observational study.

To determine the prevalence of medication administration errors and identify factors associated with medication administration errors among neonates in the neonatal intensive care units. Prospective direct observational study. The study was conducted in the neonatal intensive care units of five public hospitals in Malaysia from April 2022 to March 2023. The preparation and administration of medications were observed using a standardized data collection form followed by chart review. After data collection, error identification was independently performed by two clinical pharmacists. Multivariable logistic regression was used to identify factors associated with medication administration errors. A total of 743 out of 1093 observed doses had at least one error, affecting 92.4% (157/170) neonates. The rate of medication administration errors was 68.0%. The top three most frequently occurring types of medication administration errors were wrong rate of administration (21.2%), wrong drug preparation (17.9%) and wrong dose (17.0%). Factors significantly associated with medication administration errors were medications administered intravenously, unavailability of a protocol, the number of prescribed medications, nursing experience, non-ventilated neonates and gestational age in weeks. Medication administration errors among neonates in the neonatal intensive care units are still common. The intravenous route of administration, absence of a protocol, younger gestational age, non-ventilated neonates, higher number of medications prescribed and increased years of nursing experience were significantly associated with medication administration errors. The findings of this study will enable the implementation of effective and sustainable interventions to target the factors identified in reducing medication administration errors among neonates in the neonatal intensive care unit. We adhered to the STROBE checklist. An expert panel consisting of healthcare professionals was involved in the identification of independent variables.

Availability of Pediatric Services and Equipment in Emergency Departments: A Multicenter Study in Resource-Limited Settings.

This study was conducted to assess the availability of equipment and supplies in the emergency departments of the hospitals in the West Bank of Palestine. This study was conducted in a cross-sectional design using a data collection form that was specifically developed for this study. The standardized data collection form contained a detailed list of all essential pediatric emergency equipment and supplies. This study was conducted in a total of 30 hospitals all across the West Bank of Palestine. The median number of patients visiting the emergency department per day was 115.0, the median number of patients admitted to the hospital per day was 14.5, and the median number of pediatric patients visiting the emergency department per day was 6.0. The median number of pediatricians in the hospital was 4.0, the median number of pediatricians in the emergency department was 1.0, the median number of nurses in the hospital was 75.0, and the median number of nurses in the emergency department was 8.5. Both governmental and private hospitals lacked the equipment and supplies needed for monitoring, gaining vascular access, airway management, resuscitation medications, cervical immobilization equipment, and other equipment and supplies. Decision and policymakers might use the findings reported in this study to allocate resources to restock and increase the availability of pediatric emergency equipment and supplies. More studies are still needed to compare the outcomes of patients before and after restocking and increasing the availability of pediatric emergency equipment and supplies.

Canadian colorectal cancer screening programs: How do they measure up using the International Agency for Research on Cancer criteria for organized screening?

Canada has one of the highest incidences of colorectal cancer (CRC) worldwide. CRC screening improves CRC outcomes and is cost-effective. This study compares Canadian CRC screening programs using essential elements of an organized screening program outlined by the International Agency for Research on Cancer (IARC). We collaborated with the Cancer Screening in 5 continents (CanScreen5) program, an initiative of IARC. Standardized data collection forms were sent to representatives of provincial and territorial CRC screening programs. Twenty-five questions were selected to reflect IARC's essential elements of an organized screening program. We performed a qualitative analysis of Canada's CRC screening programs and compared programs within Canada and internationally. CRC screening programs exist in 10 provinces and 2 territories. None of the programs in Canada met all the essential criteria of an organized screening program outlined by IARC. Three programs do not send invitations to participate in screening. Among those that do, 4 programs do not include a stool test kit in the invitations. While all provinces met the essential elements for leadership, governance, finance, and access to essential services, there was more heterogeneity in the domains of service delivery as well as information systems and quality assurance. There is considerable heterogeneity in the design of CRC screening programs in Canada and worldwide. Programs should strive to meet all the essential IARC criteria for organized screening if local resources allow, such as issuing invitations and implementing systems to track and compare outcomes to maximize screening program quality, effectiveness, and impact.

Exploring the Language Used to Describe Older Patients at Multidisciplinary Cancer Conferences.

Older adults with cancer often present with distinct complexities that complicate their care, yet the language used to discuss their management at multidisciplinary cancer conferences (MCCs) remains poorly understood. A mixed methods study was conducted at a tertiary cancer centre in Toronto, Canada, where MCCs spanning five tumour sites were attended over six months. For presentations pertaining to a patient aged 75 or older, a standardized data collection form was used to record their demographic, cancer-related, and non-cancer-related information, as well as the presenter's specialty and training level. Descriptive statistics and thematic analysis were employed to explore MCC depictions of older patients (n = 75). Frailty status was explicitly mentioned in 20.0% of presentations, but discussions more frequently referenced comorbidity burden (50.7%), age (33.3%), and projected treatment tolerance (30.7%) as surrogate measures. None of the presentations included mentions of formal geriatric assessment (GA) or validated frailty tools; instead, presenters tended to feature select GA domains and subjective descriptions of appearance ("looks to be fit") or overall health ("relatively healthy"). In general, MCCs appeared to rely on age-focused language that may perpetuate ageism. Further work is needed to investigate how frailty and geriatric considerations can be objectively incorporated into discussions in geriatric oncology.

Economic Evaluation of COVID-19 Immunization Strategies: A Systematic Review and Narrative Synthesis.

This study aimed to systematically assess global economic evaluation studies on COVID-19 vaccination, offer valuable insights for future economic evaluations, and assist policymakers in making evidence-based decisions regarding the implementation of COVID-19 vaccination. Searches were performed from January 2020 to September 2023 across seven English databases (PubMed, Web of Science, MEDLINE, EBSCO, KCL-Korean Journal Dataset, SciELO Citation Index, and Derwent Innovations Index) and three Chinese databases (Wanfang Data, China Science and Technology Journal, and CNKI). Rigorous inclusion and exclusion criteria were applied. Data were extracted from eligible studies usinga standardized data collection form, with the reporting quality of these studies assessed using the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). Of the 40 studies included in the final review, the overall reporting quality was good, evidenced by a mean score of 22.6 (ranging from 10.5 to 28). Given the significant heterogeneity in fundamental aspects among the studies reviewed, a narrative synthesis was conducted. Most of these studies adopted a health system or societal perspective. They predominantly utilized a composite model, merging dynamic and static methods, within short to medium-term time horizons to simulate various vaccination strategies. The research strategies varied among studies, investigating different doses, dosages, brands, mechanisms, efficacies, vaccination coverage rates, deployment speeds, and priority target groups. Three pivotal parameters notably influenced the evaluation results: the vaccine's effectiveness, its cost, and the basic reproductive number (R0). Despite variations in model structures, baseline parameters, and assumptions utilized, all studies identified a general trend that COVID-19 vaccination is cost-effective compared to no vaccination or intervention. The current review confirmed that COVID-19 vaccination is a cost-effective alternative in preventing and controlling COVID-19. In addition, it highlights the profound impact of variables such as dose size, target population, vaccine efficacy, speed of vaccination, and diversity of vaccine brands and mechanisms on cost effectiveness, and also proposes practical and effective strategies for improving COVID-19 vaccination campaigns from the perspective of economic evaluation.

An evaluation of a speech and language therapy eating, drinking and swallowing service for adults with intellectual disability

PurposeThis study aims to evaluate the quality of a speech and language therapy (SLT) swallow service provided to adults with intellectual disability (ID) by exploring the process and outcome factors; to explore the process of what is done to and for the patient including identifying dysphagia, choking and pneumonia risk, typical interventions and management; examine clinical outcomes; and explore the relationship of outcomes with risk factors, satisfaction with the service and the impact of the service on the number of choking incidents and admissions to acute hospital with swallow concerns.Design/methodology/approachThere were three specific work packages: (1) collecting and scrutinising patient data from the clinical record for adults with ID referred to the SLT swallow service over a six-month period. The researcher created aims, defined the limits to achieve the aims, designed a standardised data collection form, set out where data was in the clinical record, piloted, set limits for collection and trained reviewers; (2) gathering experience and satisfaction surveys from patients, caregivers and referrers over the six-month study period; and (3) monitoring choking adverse incident reports and hospital admission with swallow concerns for the whole ID population.FindingsChoking and hospital admission were the main reasons for referral, and pneumonia risk significantly predicted dysphagia impairment. The research highlighted common dysphagia risk factors, interventions and recommendations for this population. The SLT swallow service is a quality service that is highly valued by patients, their caregivers and referrers. The service achieves significant clinical improvements, helps identify dysphagia and provides management to reduce associated risks.Research limitations/implicationsThis study found common dysphagia risk factors, interventions and recommendations; it also found that the therapy outcome measures/Royal College of Speech and Language Therapy online outcome tool was a meaningful outcome measure, and that pneumonia risk significantly predicted dysphagia impairment, all of which could inform the identified dysphagia research priorities for this population.Practical implicationsNaming usual care in treatment and recommendations could help ensure a fair service and could help form quality indicators. People with ID, their caregivers and staff generated valuable ideas for improvement, and further involvement work could create a logic model for the service. Other future work could explore the use of screening tools, increase multidisciplinary team working, improve access to instrumental assessments, raise awareness of swallowing and promote important oral health and medication reviews. By using this information to shape quality improvement work and policies, one can work toward addressing high health-related inequalities and preventable deaths associated with dysphagia in this vulnerable population.Social implicationsIt may be useful to raise awareness that adults with ID age earlier and that one should not exclude them from older people’s services because of an age threshold, often set higher than their life expectancy. This study highlighted a possible inequality of access issue for adults with ID who do not have direct care or day care staff. There is a need to increase access to awareness training so caregivers and general practitioners can recognise swallow difficulties and know how to make a referral for a swallow assessment.Originality/valueOverall, the evaluation of the swallow service to adults with ID suggests that SLT have a quality service for adults with ID that is highly valued and provides significant clinical improvements. By building on these strengths, SLT could extend the reach, influence and impact of their services to help those adults with ID who have emerging swallow difficulties or who do not access the service.

Lessons Learnt from Imaging Review of Interval Breast Cancers in a Single Center in the UK National Breast Screening Program.

False-negative mammograms are a part of any screening program and the National Breast Screening Program in the United Kingdom is no exception. Every year, 2.5 million women have screening mammograms in the United Kingdom. Around 8 per 1,000 women screened are diagnosed with a breast cancer and 3 per 1,000 women will present with an interval breast cancer following a negative screening mammogram and before their next mammogram. Robust quality standards have to be adhered to at every stage in the screening pathway in order to maintain the fine balance between detecting cancers early and avoiding unnecessary false-positive results. As part of this process, there is a mandatory requirement for screening units to review all breast cancers. We present a pictorial illustration of the lessons learnt from such a review in this essay. The cases described here are from one large breast screening unit in the North of England. In this unit, 30,000 to 40,000 women have a screening mammogram each year and these are all double read by human readers. All cases requiring recall and those where there is a disagreement between the first and second human reader go through a consensus/arbitration process involving a minimum of two human readers. Interval cancers are identified through a consistent process outlined by the screening program and are then subjected to a review by a minimum of two reviewers. In this process, the reviewers have access to the false-negative mammograms along with all priors that were available at the time of initial read. The reviewers make a decision on whether the initial mammogram is normal or abnormal without seeing the diagnostic mammogram with the interval cancer. They also categorize the density of the breast and describe the mammographic abnormality if there is any on a standardized interval cancer data collection form. Finally, they categorize the interval cancer into one of three types-"satisfactory," "satisfactory with learning points," or "unsatisfactory."

Prevalence of Heart Failure Patients Admitted in the Winter and Other Seasons in a Tertiary Care Hospital Bangladesh

Background: As a leading global cause of death and disability, heart failure places a significant strain on the healthcare system. It has been observed that in some countries, there is a seasonal increase in the number of people admitted to hospitals with heart failure during winter. However, there is a dearth of population-based statistics for Southeast Asia and Bangladesh. with regards to this subject. Objective: To determine the number of patients with heart failure admitted during the winter and other seasons in Bangladesh's tertiary care hospitals. Materials and Methods: This study used a cross-sectional, observational design. The study was carried out at the Cardiology Department of Dhaka Medical College Hospital (DMCH). The research took place over the course of a year, from April 2015 to March 2016. Patients with heart failure who are admitted to the DMCH's Cardiology Department constitute the study population. This study made use of a systematic sampling strategy. All 584 patients who visited the hospital's cardiology department were counted. Patients' demographics, medical histories, symptoms, and test results were recorded on a standard data collection form. The statistical software package SPSS 22.0 was used to analyze the data (Statistical Package for Social Science). Results: Heart failure patients were most prevalent in the 41 to 60 age group, with 74.3% being men and 25.7% being women. The winter season saw the largest number of patient admissions (n=207, 35.5%). Compared to other seasons, the winter had higher concentrations of all risk variables. It is statistically significant, with the exception of thyroid issues and dyslipidemia (p-values of &lt;0.222, &lt;0.001, &lt;0.001, &lt;0.001, and &lt;0.006). Conclusion: General practitioners might learn how to handle heart failure patients' responses to the cold and hone their abilities in this area. This research may also be useful for modifying the wintertime accessibility of hospital resources like emergency rooms.

A Prospective Observational Study on the Prescription Pattern of Anticancer Drugs and Adverse Reactions of Chemotherapy in Patients with Breast Cancer

Background: Every hospital should conduct a periodic study of prescription patterns as a potential tool for determining the function of pharmaceuticals in society. Objective: The study’s primary goals were to evaluate prescription patterns and frequent adverse reactions in individuals undergoing breast cancer chemotherapy. Materials and methods: At the American Oncology Institute in Guntur, a prospective observational study was carried out. The breast cancer patients who met the inclusion criteria underwent a six-month period of purposive sampling in a daycare centre. Information about the patient’s demographics, recommended medications, and adverse responses was gathered using a standard data collection form. Results: The study included 230 patients with breast cancer who, according to the study, were found to be in the 50–60year age range. Of the 230 patients, 117 had left breast cancer and 113 had right breast cancer; 226 of the patients were female and 4 were male. The most frequently used chemotherapeutic agent was cyclophosphamide (26%), which was followed by docetaxel (19%) and Adriamycin (14%). Adriamycin + Cyclophosphamide was the most frequently suggested regimen, followed by Docetaxel + Carboplatin + Trastuzumab. The most often reported ADR was nausea, which was followed by alopecia, fatigue, vomiting, and skin rashes. Conclusion: The medication most frequently prescribed was cyclophosphamide. ADR incidence was highest when cyclophosphamide and Adriamycin were used. Despite receiving prophylactic antiemetic medication, the majority of patients experienced nausea and vomiting. This suggests that more steps should be taken to prevent emesis, as these adverse drug reactions (ADRs) associated with antineoplastic medicines are typically avoidable. Keywords: breast cancer, prescription medications, anti-cancer drugs, breast cancer therapy, adverse effects.

Gender-based stigma and the prevention and treatment of HIV/AIDS among older women: A scoping review protocol.

The population of women aged 50 years and older living with HIV is increasing. Older women face unique challenges in the prevention and management of HIV; however, they are often under engaged in HIV/AIDS research. One such challenge is gender-based stigma, which can be manifested through harmful gendered stereotypes, discrimination, prejudice, and sexism that could potentially hinder HIV care engagement among this population. We propose a scoping review to identify and synthesize evidence pertaining to how experiences of gender-based stigma impacts HIV prevention and care among older women. We will use the framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) to conduct this scoping review. We will search MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus for empirical literature published between January 1981 and the date of search commencement. Supplementary screening will be conducted using backwards citation chaining of the final list of included full-text articles. Two reviewers will independently screen all titles and abstracts for articles that meet the predetermined inclusion criteria. Two reviewers will also screen full-text articles and chart data using a standardized data collection form. We will synthesize the findings through tables, charts, and narrative summaries. We will also identify gaps in the current literature and provide recommendations for future research. Findings will be shared at conferences and submitted to a peer-reviewed publication. To our knowledge, this will be the first scoping review to examine gender-based stigma in relation to HIV prevention and care among older women. We anticipate that our results will be of interest to older women living with HIV, healthcare providers, policy makers, and community activists working to improve quality of life and care experiences for older women living with HIV.

Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis.

Halo sign on temporal artery ultrasound versus temporal artery biopsy for giant cell arteritis.

The COVID-19 Severity and Its Association with Intestinal Parasite Coinfection and Urine Biochemical Parameters among COVID-19-Confirmed Patients Admitted to Debre Markos University COVID-19 Center, Northwest Ethiopia.

Though most people with COVID-19 disease show asymptomatic to mild illness, a substantial number of patients are at high risk of developing severe disease and adverse outcomes with long COVID-19 and death. Even though some studies showed that previously existing infections with parasites amend the host's body defenses to increase resistance to infection with SARS-CoV-2, there is limited data in Ethiopia. This study is aimed at determining the COVID-19 disease severity and its association with intestinal parasite coinfection and urine biochemical parameters among COVID-19-confirmed patients admitted at Debre Markos University COVID-19 Center, 2021. A prospective cohort study was conducted on 136 RT-qPCR-confirmed COVID-19 patients admitted at Debre Markos University COVID-19 Center from January 1 to March 30, 2021. Sociodemographic and clinical data were collected by using standardized data collection forms. A urine biochemical test was performed using a dry urine dipstick kit and stool examination using direct wet mount microscopic examination and formalin-ether concentration method. The chi-square test, Fisher exact test, and ordinal logistic regression analysis were computed to assess association with outcome variables using Statistical Package for Social Science software (version 24). A total of 136 COVID-19-confirmed patients participated in this study. The median age of the participants was 48 years. The majority (86 (62.5%)) of them were male in sex. Of the 136 cases, 39 (28.7%) had died. Among the 136 patients, 22 (16.2%) were coinfected with intestinal parasites. COVID-19 patients who have intestinal parasite coinfection had lower odds of developing clinically severe COVID-19 compared to noninfected (AOR = 0.37; 95% CI = 0.147-0.944; P = 0.037). The majority (104 (76.5%)) of them have abnormal urine biochemical results. From the abnormal urine biochemical tests observed, the urine blood, glucose, and ketone tests were positive for 54 (39.7%), 36 (26.5%), and 30 (21.1%) patients, respectively. Among the 31 critical COVID-19 patients, 25 (80.6%) showed abnormal urine biochemical parameters. Age and comorbidity were significantly associated with COVID-19 severity (P < 0.05). Patients with old age and comorbidity had an increased risk of developing severe COVID-19 disease. Patients having SARS-CoV-2 and intestinal parasitic coinfections demonstrated mild COVID-19 disease severity. Abnormal urine biochemical results were common among critical COVID-19 patients. Thus, advanced study on the effect of the interaction among intestinal parasites on COVID-19 clinical severity and its mechanisms is essential.

Retrospective Cohort Study of Syphilis-Related Stillbirths in Winnipeg, Manitoba From 2017–2020

ObjectiveSyphilis-related stillbirths (SRSBs) disproportionately affect marginalized women with 11% of all local stillbirths having maternal syphilis as a contributory factor in 2020. This study describes the incidence and perinatal factors associated with SRSB. MethodsThis was a retrospective cohort study of all stillbirths occurring from 1 January 2017 to 31 December 2020, at a single tertiary-level referral hospital in Winnipeg, Manitoba. Cases that met criteria for SRSB were identified from hospital records and included in the final analysis. Maternal demographics, comorbidities, prenatal care attendance, sexually transmitted infection testing, treatment, and diagnostic investigations at time of stillbirth were collected from hospital charts using a standardized data collection form. Descriptive statistics were performed to present the results. ResultsThe proportion of SRSB increased over the period of study from 0%–11%. Eleven cases were identified as SRSB, with diagnosis occurring intrapartum in 7 cases and antenatally in 4 cases. Of the 4 antenatal cases, only 2 had identifiable treatment responses indicated by microbiological and pathology workup. Commonly identified risk factors for SRSB were homelessness, mental illness, substance use, sexually transmitted co-infections, and lack of prenatal care. ConclusionsCases of SRSB are rising in Winnipeg with 11% of all stillbirths having maternal syphilis as a contributory factor by 2020. SRSBs disproportionately affect marginalized women. The dramatic and rapid changes in the epidemiology of syphilis in Winnipeg are likely shared by other Canadian regions and warrant increased prevention strategies to improve outcomes.

Outcomes of Peripheral Nerve Blocks in Elderly Patients with Fragility Hip Fractures in the Philippine General Hospital: A 6-month Prospective Study.

Hip fractures among the elderly continue to be a serious public health concern. Hip fractures result in extremely painful injuries and given the higher risk of the elderly for complications, managing pain in this population can be challenging. This study aimed to describe the outcomes of peripheral nerve blocks on elderly patients with fragility hip fractures who will undergo elective or emergency hip surgery. A single-center prospective cohort study was conducted at the Philippine General Hospital from May 2022 to November 2022. Patients included were aged 60 years old and above with fragility hip fracture, for elective or emergency hip surgery, and with American Society of Anesthesiologists (ASA) Physical Status Score 1-3. Patients' baseline profile, intraoperative characteristics, and postoperative outcomes were collected using a standard data collection form. The data collector was blinded to the type of block performed. A total of 29 patients who underwent hip surgery were included in the study. Most (65.5%) had Subarachnoid block + Peripheral Nerve Block (SAB+PNB) while 24.1% had General Anesthesia + Peripheral Nerve Block (GA+PNB) and 10.3% had no Peripheral Nerve Block (PNB). The median Numerical Rating Scale (NRS) 30 minutes post block was similar (p=0.977) in those who had PNB blocks (GA+PNB = 0, SAB+PNB = 0). The median NRS at rest during Postoperative day 1 (POD1) was significantly highest (p=0.023) in the No PNB group (3) than in both GA+PNB (0) and SAB+PNB (0). In contrast, the median NRS at rest during POD2 was similar (p=0.713) in the three groups (GA+PNB = 0, SAB+PNB = 0, No PNB = 0). The median NRS at motion during POD1 was significantly highest (p=0.008) in the No PNB group (6) than in both GA+PNB (0) and SAB+PNB (1). Also, the median NRS at motion during POD2 was significantly highest (p=0.009) in No PNB group (4) than in both GA+PNB (0) and SAB+PNB (1). Median Morphine Milligram Equivalent (MME) of postoperative opioid was significantly higher in the No PNB group among the three groups (p=0.047). The median satisfaction score (p=0.210), median delirium score at POD2 (p=0.993), and median length of hospitalization (p=0.173) were all similar in the three groups. Peripheral nerve block is effective in elderly patients undergoing surgery for fragility hip fractures. It results in lower pain scores and can be administered with equal effectiveness either with general anesthesia or with subarachnoid block. Mortality rate, incidence of delirium, and hospital length of stay did not vary between those with and without peripheral nerve block.