Structured Data Collection Form Research Articles

Admission Cardiotocography and Neonatal Outcomes at a Tertiary Health Facility in Southwestern Nigeria

Background: Admission cardiotocography (CTG), a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward. Objective: This study assessed the association of admission CTG findings with neonatal outcome at a tertiary health facility. Materials and Methods: A prospective, observational study of 206 pregnant women who were admitted into the labor ward with singleton live pregnancies. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing, and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at P < 0.05. Results: The admission CTG findings were normal in 73.3%, suspicious in 13.6%, and pathological in 13.1% of the women. The occurrence of low birth weight, special care baby unit (SCBU) admission, asphyxiated neonates, neonatal death, and prolonged hospital admission was significantly more frequent among those with pathological admission CTG results compared with normal and suspicious results (P < 0.05). The incidence of vaginal delivery was more common when the CTG findings were normal, whereas all women with pathological CTG result had a cesarean delivery. Conclusion: Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score, SCBU admission, and prolonged hospital admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological.

Comparative Effectiveness of Proprioceptive Neuromuscular Facilitation Stretch Vs Spencer Muscle Energy Technique on Pain and Disability in Patients with Adhesive Capsulitis

Purpose: Adhesive capsulitis is a condition in which the tissues of the shoulder joint become tight and impede movement. It is characterized by gradual loss of both active and passive glenohumeral joint motion, resulting in fibrosis, scarring and contractures of the joint capsule. Patient with adhesive capsulitis usually have difficulty in performing overhead activities, as well as routine duties such as combing their hair, dressing themselves, and throwing a ball. The objective of this study was to determine the effectiveness of proprioceptive neuromuscular facilitation (PNF) stretch vs muscle energy technique (MET) on pain and disability in patients with adhesive capsulitis.
 Methodology: Study Design: This research employed a rigorous single-blinded randomized controlled trial design to investigate the comparative effectiveness of two manual therapy techniques in the management of adhesive capsulitis. The study was conducted in accordance with established ethical guidelines and principles. Participant Selection: A total of 30 participants, aged between 30 and 60 years, were recruited for this study. The selection process adhered to specific inclusion and exclusion criteria to ensure the homogeneity of the participant group. Inclusion criteria encompassed individuals in the 2nd and 3rd stages of adhesive capsulitis, both males and females, those with comorbid conditions such as diabetes and hypertension, and individuals experiencing painful restrictions in active and passive glenohumeral or periscapular motion. It was essential that participants had the ability to understand Punjabi or Urdu and were willing to participate. Exclusion criteria included individuals with a history of post-traumatic immobilization, cognitive impairment, previous surgery or arthroscopy, cervical pathology, neoplasm/tumor, or reflex sympathetic dystrophy. Informed Consent: Before the commencement of the study, informed consent was obtained from all participants. The participants were fully informed of the study's objectives, procedures, and potential risks and benefits. The rights of voluntary participation and the option to withdraw from the study at any time were emphasized. Participant data were anonymized and kept confidential throughout the research process to safeguard privacy. Randomization: To minimize bias, participants were randomly assigned to two distinct treatment groups, Group A and Group B. The randomization process was conducted using a computer-generated method, ensuring that each participant had an equal chance of being assigned to either group. Interventions: The study employed two distinct manual therapy techniques for the treatment of adhesive capsulitis. Group A received proprioceptive neuromuscular facilitation (PNF) stretching, while Group B underwent the Spencer muscle energy technique (MET). Both interventions were administered over a duration of one month. Baseline Treatment: In addition to the primary interventions, all participants received a hot pack as a baseline treatment. This standard treatment approach aimed to create a consistent baseline condition for all participants and to alleviate any discomfort. Data Collection: The collection of data was a crucial aspect of this study. Data were gathered through the utilization of structured data collection forms, designed to capture demographic information and adhere to the inclusion and exclusion criteria. Additionally, standardized assessment tools were used to quantify outcomes. The Shoulder Pain Assessment Disability Index (SPADI) was employed to evaluate both pain and functional disability, while the Numeric Rating Scale (NRS) was utilized to measure pain intensity.
 Findings: Statistical analysis was done by using statistical package for the social sciences (SPSS) version 28. The collected data was analyzed and presented using appropriate statistical techniques. The data were initially checked for normality using the Kolmogorov-Smirnov and Shapiro-Wilk tests. Non-parametric tests were employed due to the non-normal distribution of the data. Qualitative data were analyzed for frequency and percentage. Intra-group differences were examined using the Wilcoxon signed-rank t-test, while inter-group differences were assessed with the Mann Whitney U-test. Spencer mean Mets treatment group has lower mean ranks in total SPADI pain as compared to PNF study group.
 Conclusion: the study concluded that Spencer Mets has been more effective in reducing the pain of the patients as compared to PNF treatment. Healthcare professionals involved in the treatment of patients with adhesive capsulitis should consider the incorporation of Spencer MET as a viable option for pain management. The superior pain reduction observed in this study suggests that this technique may yield favorable results in real-world clinical settings. While this study offers valuable insights, further research is warranted to explore the long-term effects and potential differences in functional outcomes between Spencer MET and PNF treatment. Comparative studies with larger sample sizes and extended follow-up periods can provide a more comprehensive understanding of the benefits of these techniques.

Influence of health-insurance on treatment outcome of childhood cancer in Western Kenya

BackgroundFew governments in low and middle-income countries (LMIC) have responded favourably to the international plea for Universal Health Coverage. Childhood cancer survival in LMIC is often below 20%. Limited health-insurance coverage may contribute to this poor survival. Our study explores the influence of health-insurance status on childhood cancer treatment outcomes in a Kenyan academic hospital.MethodsThis was a retrospective medical records review of all children diagnosed with cancer at Moi Teaching and Referral Hospital between 2010 and 2016. Socio-demographic and clinical data was collected using a structured data collection form. Fisher’s exact test, chi-squared test, Kaplan–Meier method, log-rank test and Cox proportional hazard model were used to evaluate relationships between treatment outcomes and patient characteristics. Study was approved by Institutional Research Ethics Committee.FindingsFrom 2010–2016, 879 children were newly diagnosed with cancer. Among 763 patients whose records were available, 28% abandoned treatment, 23% died and 17% had progressive/relapsed disease resulting in 32% event-free survival. In total 280 patients (37%) had health-insurance at diagnosis. After active enrolment during treatment, total health-insurance registration level reached 579 patients (76%). Treatment outcomes differed by health-insurance status (P < 0.001). The most likely treatment outcome in uninsured patients was death (49%), whereas in those with health-insurance at diagnosis and those who enrolled during treatment it was event-free survival (36% and 41% respectively). Overall survival (P < 0.001) and event-free survival (P < 0.001) were higher for insured versus uninsured patients. The hazard-ratio for treatment failure was 0.30 (95% CI:0.22–0.39; P < 0.001) for patients insured at diagnosis and 0.32 (95% CI:0.24–0.41; P < 0.001) for patients insured during treatment in relation to those without insurance.InterpretationOur study highlights the need for Universal Health Coverage in LMIC. Children without health-insurance had significantly lower survival. Childhood cancer treatment outcomes can be ameliorated by strategies that improve health-insurance access.

Prevalence and Risk Factors of Polypharmacy among Elderly Patients

Background: Medications play a key role in the treatment and prevention of disease. There are a variety of medical conditions and diseases that cannot be controlled treated or prevented solely by the use of one medication. This will mandate polypharmacy which is the use of more than one medication or a combination of drugs. Polypharmacy can cause many complications, the most important are drug-related problems that should be taken under consideration. Objectives: Our aim in this prospective cross-sectional study is to determine the prevalence of polypharmacy among selected elderly patients and to investigate the factors associated with polypharmacy use. The patient is considered to be exposed to polypharmacy if he is on five concurrent medications or more for the management of chronic diseases. Methods: Data collection was done by targeting elderly patients in the internal medicine ward of Azadi Hospital utilizing a structured data collection form which is specially designed to fit the goals of this study. Results: To estimate the prevalence of polypharmacy, the frequency and proportion (%) were presented. The Chi-square test was used to investigate the factors associated with polypharmacy. Significant p-value set at &lt; 0.05. Polypharmacy prevalence indicates that 27% (n= 53) of elderly patients were receiving more than five medications for chronic use. Heart diseases are the most common to be followed by hypertension and diabetes subsequently. Diabetes mellitus has shown the highest association with polypharmacy compared to the other factors. The Chi-square test result for this risk factor is χ2 = 6.76., df = 1, p &lt; 0.05. To be followed by heart diseases, and age. Other factors have no association with polypharmacy according to our current study results. Conclusion: An approach or care plan should be developed in all health care settings to decrease the exposure of elderly patients to poly-pharmacy. Reducing polypharmacy should focus on the groups that are most prone to it. According to our research results, elderly people and those who are being treated with drugs for cardiovascular disease, and diabetes are of high priority.

Feto-Maternal Outcome of Moderate Anaemia in Term Pregnancy at DMCH

Background: Anaemia is a major public health problem throughout the world especially in developing countries and it is the most common nutritional deficiency disorder in the world. High prevalence of anaemia among pregnant women persists despite the availability of effective and low-cost interventions for prevention and treatment. Objective: The aim of this study was to evaluate the adverse maternal and fetal outcome in women diagnosed with moderate anaemia at term pregnancy. Methods: This Descriptive type of observational cross-sectional study was conducted in the department of Obstetrics &amp; Gynaecology, Dhaka Medical College Hospital; from 16th September 2021 to 15th March 2022. Samples were collected by purposive sampling. Sample size was 96. Detailed demographic data were collected from the hospital case records in structured data collection form. History, clinical examination, and investigations were done meticulously. Then all information were collected in data collection sheet. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data by number of SPSS version 24. Results: This study was attempted to observe the feto-maternal outcome of moderate anaemia. Among 96 study patients, majority (37.5%) were between 21-25 years age group. There was rural predominance with 66.56%. Socio-demographic data showed that 45.8% came from lower class and 40.6% from lower middle class. Majority patients (59.28%) were housewives. According to level of education, 42.64% had only school education followed by 37.44% had no education. Among the patients, 89.6% were Muslims and 9.4% were Hindus. Among the 53 multiparous women, 21 patients (39.62%) had no history of fetal loss, 16 patients (30.18%) had history of previous abortion &amp; 5 (9.43%) had previous ectopic pregnancies. According to the type of anaemia 81.12% had normocytic normochromic anaemia, 79.04% had Iron deficiency, 8.32 &amp; had folic acid ..

Pattern of Suicidal Deaths in Cases Coming to a Tertiary Center in Bangladesh

Background: Anaemia is a major public health problem throughout the world especially in developing countries and it is the most common nutritional deficiency disorder in the world. High prevalence of anaemia among pregnant women persists despite the availability of effective and low-cost interventions for prevention and treatment. Objective: The aim of this study was to evaluate the adverse maternal and fetal outcome in women diagnosed with moderate anaemia at term pregnancy. Methods: This Descriptive type of observational cross-sectional study was conducted in the department of Obstetrics &amp; Gynaecology, Dhaka Medical College Hospital; from 16th September 2021 to 15th March 2022. Samples were collected by purposive sampling. Sample size was 96. Detailed demographic data were collected from the hospital case records in structured data collection form. History, clinical examination, and investigations were done meticulously. Then all information were collected in data collection sheet. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data by number of SPSS version 24. Results: This study was attempted to observe the feto-maternal outcome of moderate anaemia. Among 96 study patients, majority (37.5%) were between 21-25 years age group. There was rural predominance with 66.56%. Socio-demographic data showed that 45.8% came from lower class and 40.6% from lower middle class. Majority patients (59.28%) were housewives. According to level of education, 42.64% had only school education followed by 37.44% had no education. Among the patients, 89.6% were Muslims and 9.4% were Hindus. Among the 53 multiparous women, 21 patients (39.62%) had no history of fetal loss, 16 patients (30.18%) had history of previous abortion &amp; 5 (9.43%) had previous ectopic pregnancies. According to the type of anaemia 81.12% had normocytic normochromic anaemia, 79.04% had Iron deficiency, 8.32 &amp; had folic acid def

Observation Study among Cured Cases of Pulmonary Tuberculosis: A Long-Term Study under the Revised National Tuberculosis Control Program

Background: Tuberculosis is one of the leading causes of mortality in India. The Revised National Tuberculosis Control Program (RNTCP) is a robust public health system to deal with Tuberculosis (TB) in India. Unless the treated patient comes back to the system with signs and symptoms of TB due to relapse or reinfection, there is no mechanism of follow-up or any method to know the relapse rate in the population. This study aimed to analysed trends in relapse tuberculosis cases and describe their associations with socio-demographic and clinical factors.Subjects dan Method: In this prospective cohort study, 750 selected sample size who were declared “Cured” in four randomly selected TB units of Gwalior district were followed up for 1–5 years through home visits by trained staff with structured data collection forms. Data Collection was done between January 2022 to June 2022 and afterwards analyzed using Microsoft excel spreadsheet.Results: The mean age of the index cases was Mean= 30.53; SD= 14.24 years, and there were 39 females and 64 males. At early stage (1-to-2-year posttreatment follow-up of 248 index cases) 199 (80.2%) were healthy and working without any symptoms of TB. Symptoms of TB were present in 49 (19.8%) cases. The after 2-year posttreatment TB Symptoms were present in 54 (19.3%) cases.Conclusion: Long-term follow-up of cured, new smear-positive TB cases reinforce the effectiveness of anti-TB treatment under the RNTCP as assessed by improved health outcomes in more than two-thirds of cases and posttreatment survival of 80.72% of index cases. Further investigation needed to continue such follow-up for all TB cases treated under the RNTCP for effective end-TB strategy. Keywords: tuberculosis treatment, follow-up, relapses, RNTCP Correspondence: Ramniwas Mahore. Department Of Community Medicine. G R Medical College Gwalior 474009 Madhya Pradesh, India. Email: Drmahore@gmail.com. Mobile: 9425334365.

GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe (GENERATE)

A cross-sectional survey GENERATE (GEospatial aNalysis of ExtRacorporeal membrane oxygenATion in Europe) initiated on behalf of the European chapter of the Extracorporeal Life Support Organization (EuroELSO), aims to provide a systematic, detailed description of contemporary Extracorporeal Life Support (ECLS) provision in Europe, map the spatial distribution of ECLS centers, and the accessibility of ECLS. Structured data collection forms were used to create a narrative description of ECLS provision in EuroELSO affiliated countries. This consisted of both center-specific data and relevant national infrastructure. Data was provided by a network of local and national representatives. Spatial accessibility analysis was conducted where appropriate geographical data were available. 281 centers from 37 countries affiliated to EuroELSO were included in the geospatial analysis and demonstrate heterogeneous patterns of ECLS provision. Accessibility of ECLS services within 1 hour of drive-time is available for 50% of the adult population in 8 of 37 countries (21.6%). This proportion is reached within 2hours in 21 of 37 countries (56.8%) and within 3hours in 24 of 37 countries (64.9%). For pediatric centers, accessibility is similar with 9 of 37 countries (24.3%) reached the covering of 50% of the population aged 0-14 within 1hour and 23 of 37 countries (62.2%) within 2hours and 3hours. ECLS services are accessible in most of the European countries, but their provision differs across the continent. There is still no solid evidence given regarding the optimal ECLS provision model. The spatial disparity in ECLS provision demonstrated in our analysis requires governments, healthcare professionals and policy makers to consider how to develop existing provision to accommodate the anticipated increase in need for time critical access to this advanced support modality.

Clinical features and outcome of human Mpox (Monkeypox) in Saudi Arabia: An observational study of travel-related cases

BackgroundThe 2022 Monkeypox virus (Mpox) outbreak had involved multiple countries around the globe. Here, we report clinical features and outcome of human Mpox of the first cases in Saudi Arabia. MethodsWe obtained records of confirmed Mpox cases in Saudi Arabia from the public electronic health information system, Health Electronic Surveillance Network (HESN) and the healthcare providers completed a de-identified structured clinical data collection form. ResultsThe reported seven cases were travel-related and all were males between 24 and 41 years of age (mean age + SD) was 30.14 (+ 6.69) years. Of the cases, three (43 %) had heterosexual contact and the others had other intimate encounters while traveling abroad. They presented with skin lesions (100 %), fever (86 %), and lymphadenopathy (71 %). The illness was mild to moderate, did not require antiviral medications, and lasted 7–15 days. The mean duration of skin rash (+ SD) was 10 (+ 2.68) days. Routine laboratory tests (CBC, BUN, serum electrolytes, and liver enzymes) were within normal limits, and initial screening for HIV was negative. Expanded contact tracing did not reveal secondary cases of Mpox in the community or the healthcare setting. ConclusionThe current study showed heterosexual transmission of Mpox and the clinical course was mild and non-complicated. Therefore, clinicians and public health professionals should consider Mpox among individuals presenting with skin rash especially in the context of the investigation of HIV and other sexually transmitted diseases.

Access to episodic primary care: a cross-sectional comparison of walk-in clinics and urgent primary care centers in British Columbia.

This study aimed to identify publicly reported access characteristics for episodic primary care in BC and provided a clinic-level comparison between walk-in clinics and UPCCs. Walk-in clinics are non-hospital-based primary care facilities that are designed to operate without appointments and provide increased healthcare access with extended hours. Urgent and Primary Care Centres (UPCCs) were introduced to British Columbia (BC) in 2018 as an additional primary care resource that provided urgent, but not emergent care during extended hours. This cross-sectional study used publicly available data from all walk-in clinics and UPCCs in BC. A structured data collection form was used to record access characteristics from clinic websites, including business hours, weekend availability, attachment to a longitudinal family practice, and provision of virtual services. In total, 268 clinics were included in the analysis (243 walk-in clinics, 25 UPCCs). Of those, 225 walk-in clinics (92.6%) and two UPCCs (8.0%) were attached to a longitudinal family practice. Only 153 (63%) walk-in clinics offered weekend services, compared to 24 (96%) of UPCCs. Walk-in clinics offered the majority (8,968.6/ 78.4%) of their service hours between 08:00 and 17:00, Monday to Friday. UPCCs offered the majority (889.3/ 53.7%) of their service hours after 17:00. Most walk-in clinics were associated with a longitudinal family practice and provided the majority of clinic services during typical business hours. More research that includes patient characteristics and care outcomes, analyzed at the clinic level, may be useful to support the optimization of episodic primary healthcare delivery.

Prevalence of anti-leptospiral IgM and detection of pathogenic Leptospira species DNA in neonates presenting with clinical sepsis in Southwestern Uganda

BackgroundLeptospirosis is an emerging neglected zoonotic disease that presents with nonspecific signs/symptoms and it can be mistaken for other diseases. Owing to limited diagnostic capacity and unawareness, the data on human leptospirosis particularly in neonates are scarce in many sub-Saharan countries. It has been underreported hindering preventive and control measures in place. The study aimed at determining prevalence of leptospirosis as a cause of febrile illness in neonates using IgM ELISA and a quantitative real-time PCR (qPCR).MethodsThis was a descriptive cross-sectional study that included 103 neonatal sepsis cases whose parents/legal guardians gave informed consent. The data on demographic and clinical characteristics were collected using structured data collection form. EDTA whole blood sample was collected from the neonates by trained study nurses. From the samples, IgM ELISA was done using automated analyzers, DNA extracted and qPCR was performed using primers for LipL32, specific for the pathogenic leptospires.ResultsThe prevalence of anti-leptospiral IgM among the neonates as determined by ELISA was 4.3%, where all of them presented with lethargy and poor feeding. No pathogenic Leptospira species DNA was amplified by qPCR.ConclusionsEvidence of leptospirosis was demonstrated in neonatal sepsis cases in this study. The findings suggest considerations of leptospirosis in the differential diagnosis of neonates with sepsis. More data are needed on the real epidemiology, clinical features, and burden of leptospirosis in neonates. There is need to include intermediate pathogenic species of Leptospira in the diagnostic qPCR assays.

A Study of 309 Patients and at One Year Follow-Up for Depression after Traumatic Brain Injury.

Traumatic brain injury (TBI) is one the major causes of death and morbidity in developing countries, where depression is a common psychiatric condition among individuals with TBI. The objectives were to investigate the occurrence and severity of depression one-year post-TBI; the association between radiological findings and depression; and the risk factors. We report a cross-sectional study among adult patients who were hospitalized because of TBI in the past one year. A structured data collection form was used to collect patients' demographic data during TBI, while the Patient Health Questionnaire (PHQ)-9 questionnaire was administered to assess the level of depression at one-year post-TBI. Of the 309 patients in this study; 46.6%, 26.2%, and 27.2% had mild, moderate, and severe TBI, respectively. The overall rate of depression was 33.7%, where 22.3%, 8.7%, and 2.6% had mild, moderate, and moderately severe depression, respectively. There was a significant, positive correlation between severity of TBI and level of depression; rs (0.427), p < 0.0001. The risk factors for depression at one-year post-TBI are moderate-severe TBI (odds ratio [OR]: 3.75, 95% confidence interval [CI] 2.03-6.90, p < 0.00), being unmarried (OR: 2.67, 95% CI 1.51-4.72, p = 0.001), female gender (OR: 2.62, 95% CI 1.25-5.46, p = 0.011), alcohol consumption (OR: 2.38, 95% CI 1.12-5.06, p = 0.024) and frontal lobe injury (OR: 1.96, 95% CI 1.05-3.68, p = 0.035). Increasing severity of TBI is associated with worsening levels of depression. Patients with frontal lobe injury have the highest risk of depression, while diffuse injury is associated with occurrence of moderate and moderately severe depression.

Ultrasonographic Evaluation of Ulnar Neuropathy at the Elbow: A Systematic Review and Meta-Analysis

Background: Several studies have aimed to discuss the Ultrasonographic (US) findings in the assessment of ulnar neuropathy at elbow; however, the current data are widely heterogeneous and it seems necessary to summarize the original studies to reach a consensus. The goal of this study was to conduct a systematic review on the ultrasound measurements of ulnar nerve cross-sectional area at the elbow among patients with definite diagnosis of ulnar neuropathy.&#x0D; Methods: The global databases including Medline, Web of Science, Cochrane Library, Google Scholar, and Scopus were deeply evaluated for all eligible English studies. Among the 343 initially retrieved articles, 31 studies met the eligibility criteria and were published from 2000 April to 2019 December. After excluding the non-eligible articles, 18 manuscripts were systematically reviewed with the goal of assessing Cross-Sectional Area (CSA) at different levels regarding the elbow using different techniques and by various types of transducer ranged from 4-18 MHZ. Data extraction was independently performed by two reviewers on some structured data-collection forms.&#x0D; Results: The summary of following details were systematically reviewed for the included studies: technique of US measurement and type of transducer, as well as cut-off value and diagnostic capability of the ultrasonography. The collected data were analyzed in STATA software using random or fixed-effect models, as effect size measures such as raw or standardized mean differences (MD or SMD).&#x0D; Conclusion: In the current meta-analysis, it was proved that ultrasound could be a suitable device to diagnose ulnar neuropathy at elbow, with acceptable sensitivity (72.0-76.1%) and specificity (76.1-81.8%) values.

Home oxygen for moderate hypoxaemia in chronic obstructive pulmonary disease: a systematic review and meta-analysis

Long-term oxygen therapy (LTOT) improves survival in patients with chronic obstructive pulmonary disease (COPD) and severe hypoxaemia. However, the best method of management of moderate hypoxaemia not qualifying for LTOT (including isolated nocturnal desaturation) is uncertain. We examined the effect of home oxygen (either LTOT or nocturnal oxygen therapy) on overall survival in patients with COPD and moderate hypoxaemia. In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, CINHAL, and Web of Science from database inception to Jan 13, 2022, for parallel-group randomised trials of long-term or nocturnal oxygen in patients with COPD and moderate daytime hypoxaemia or isolated nocturnal desaturation, or both. Control groups received usual care or ambient air through sham concentrators (placebo) throughout the study period. The primary outcome of interest was 3-year mortality. Crossover trials and trials of oxygen in severe hypoxaemia were excluded. Two reviewers applied inclusion and exclusion criteria to titles and abstracts and screened the full-text articles and reference lists of relevant studies. Aggregate data were extracted manually in duplicate using structured data collection forms. Methodological quality was assessed using the Cochrane Risk of Bias tool. Random-effects meta-analysis was used to pool individual studies. We considered the minimal clinically important difference for home oxygen to be a relative risk reduction in mortality at 3-year follow-up of 30-40%. The meta-analysis is registered on PROSPERO, CRD42021225372. We identified 2192 studies and screened 1447 after removal of duplicates, of which 161 were subjected to full-text screening, and six were identified as being eligible for inclusion. These six randomised trials were published between 1992 and 2020 and the quality of evidence was high. In the primary meta-analysis (five trials; 1002 patients), we found the effect of home oxygen in reducing 3-year mortality to be small or absent (relative risk 0·91 [95% CI 0·72-1·16]; τ² = 0·00), hence the lower limit of the 95% CI did not meet the prespecified minimal clinically important difference. The results of our meta-analysis suggest that home oxygen probably makes little or no difference to 3-year mortality in patients with COPD and moderate hypoxaemia. The data do not support the widespread use of home oxygen in this patient population. None.

Ivabradine Induced Safety and Efficacy in Patients with Chronic Heart Failure: A Retrospective Study

Abstract: Background: Heart failure is a disabling condition affecting 26 million people worldwide. Progress in understanding of the pathogenesis of HF has led to new treatments, which include If channel inhibitor ivabradine, which acts selectively and specifically by inhibiting the cardiac pacemaker current If. The purpose of the study is to evaluate the safety and efficacy of ivabradine in HF patients. Materials and Methods: It was a retrospective, observational single-center study done in the Kottayam district of Kerala with a sample size of 391 patients with Chronic Heart Failure, and the data was collected from 2016-2020 using a structured data collection form. Various statistical tests were conducted using SPSS-version 16. Results: Among 391 patients with chronic heart failure 65.22% were males and the remaining were females. A significant reduction in heart rate was observed in patients taking Ivabradine compared to patients not taking Ivabradine. It also reduced the number of hospitalizations among patients. ADR was reported in 27 patients. A greater proportion of patients (188 patients) has been administered with Ivabradine 5mg BD. 128 patients were given 2.5mg BD,49 patients were prescribed with 5mg TID and only 26 patients were given 5 mg OD tablets. Conclusion: Ivabradine is the only agent shown to clinically lower the heart rate without negative inotropism on conduction and contractility. Increased heart rate produces an adverse impact on the myocardium. Ivabradine is an attractive, effective, and safe choice in patients with heart failure. Key words: Heart failure, Heart rate, Ivabradine, Standard therapy, Treatment outcome, Efficacy

Microbial Isolates and their Resistance Patterns at an Indian Teaching Hosptial - A Retrospective Study

Rapidly rising antibiotic resistance is a challenge to comprehensive patient care in all branches of medical science. A retrospective observational study was conducted to determine the antimicrobial resistance patterns in a tertiary care hospital for six months. The data was collected from laboratory test reports and patient case files using a structured data collection form. A total of 200 cases having a positive culture report were included in the study. Of these, 186 cases were identified to have gram-negative infections, and 14 had gram-positive infections. Escherichia coli (E. Coli) (47%) was the predominant isolate among gram-negative organisms, followed by Klebsiella (24.5%), Pseudomonas (7.55%), Enterobacter (6.5%), and Citrobacter (4.5%). All Gram-positive organisms E.coli, Klebsiella, Pseudomonas, Enterobacter have shown maximum resistance of 92.55%, 95.91%, 93.33%, and 76.92%, respectively, Ampicillin. E.coli has shown the least resistance to carbapenems (7.44%). Klebsiella demonstrated minimum reistance of 10.2% to cefotaxime, cefazolin and levofloxacin. Pseudomonas was completely sensitive to piperacillin-tazobactam. Enterobacter showed least resistance to gentamicin (3.07%) and piperacillin-tazobactam (3.07%). The primary gram-positive isolate, Enterococcus spp. (5.5%) mainly was resistant to ciprofloxacin (90.90%), followed by levofloxacin (81.81%), tetracycline (81.81%), and gentamicin (72.72%). E. coli was the most resistant organism in the present study. The study results would contribute to the development of an antibiogram at the study site.

Mucor Mycosis Associated with COVID-19: A Case Series at a Tertiary Care Center in India

Background: COVID-19 patients across the globe have been reporting several post-COVID health conditions such as respiratory, vascular, cardiac and renal complications and opportunistic infections; the most common of which has been fungal infections. Objective: The objective of our study was to identify socio-demographic characteristics, risk factors, clinical parameters, site of involvement and outcome of patients with COVID-19 associated Mucor Mycosis (CAM) at a tertiary care centre in Rewa (Madhya Pradesh, India), Materials and Methods: This was a prospective observational study, conducted between 1st May to 30th June 2021; including 40 patients who had Mucor Mycosis with recent or active COVID-19. The data was collected using a structured data collection form by trained interviewers who were already working in Mucor Mycosis Ward. Results: The overall mean and median age of the patients was 50.8 years and 52.5 years respectively, with majority of the males (72.5%). Of total, 47.5% patients had active COVID-19, whereas 50% had recent COVID-19 infection. Twenty-two patients (55%) had co-morbidities, among whom the majority had underlying diabetes mellitus (50%). History of Oxygen supplementation and use of steroids was found in 75% and 45% of the patients respectively. History of self-consumption of decoction (Kadha) and self-administration of inhalation drugs was found among 22 (80%) and 8 (20%) patients respectively. Twnty-one patients (52.5%) had gone through operative procedure/ intervention and 11 (27.5%) patients received conservative treatment. In terms of outcome, 20 patients (50%) had been successfully discharged, followed by 14 deaths (35%), 3 referrals (7.5%) to the higher centres and 3 readmissions (7.5%). Conclusion: Addictions and Indian traditional therapies might have played crucial role in occurrence of CAM. In addition, although Oxygen supplementation and steroid consumption have been life-saving against COVID-19, yet might be responsible for acute surge in CAM cases.

Troponin Levels and the Severity of COVID-19 Pneumonia.

IntroductionIn late 2019, a novel coronavirus was identified as the pathogen responsible for a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. Elevated cardiac troponin is a marker of myocardial injury, which is commonly seen in hospitalized patients with COVID-19 due to unclear reasons. The frequency of elevated troponin levels in patients with COVID-19 is variable and is reported in up to 7-36% of patients. The troponin level may be associated with the severity of COVID-19, and mild cases of COVID-19 tend to have a normal troponin level. This study aims to determine the frequency of patients with COVID-19 who had elevated troponin levels on presentation to the ED and determine the factors associated with elevated troponin levels. Additionally, the study aims to identify the association of elevated troponin and the outcome of COVID-19.MethodologyA retrospective study wherein the factors associated with elevated troponin levels in COVID-19 pneumonia were evaluated. The study was conducted in King Fahd Hospital of the Imam Abdulrahman Bin Faisal University. The Hospital Information System was used to identify all visits to the ED from March 2020 to November 2020 for patients who tested positive for SARS-CoV-2. In addition, a structured data collection form was used to collect data from the electronic health records. The data collection was conducted by emergency medicine physicians who were given a detailed explanation of the purpose of the study and had training and supervision by the principal investigator.ResultsThe study involved 214 patients who presented to the ED and had positive results on the SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test and had troponin-I levels measured. Patients with elevated troponin levels were more likely to require supplementary oxygen compared with those with normal troponin levels (88.0 vs. 58.5%; P < 0.01). In total, 36 (76.6%) patients with elevated troponin levels required admission to the ICU compared with 58 (45.0%) patients with normal troponin levels (P < 0.01). Multivariable binary logistic regression analysis was used to identify the predictors of elevated troponin levels on presentation. The model revealed that being admitted in the ICU was the single independent predictor (P = 0.02).ConclusionThe study demonstrated that the troponin level on presentation to the ED was a viable independent prognostic factor in COVID-19 pneumonia. However, further studies are needed to investigate targeted therapeutic interventions among patients with elevated troponin levels, such as cardioprotective therapies like corticosteroids, immunosuppressants, antivirals, or immunoglobulins.

Risks for bicycle-related injuries in Al Ain city, United Arab Emirates: An observational study.

Traffic-related injuries are a serious health problem. Traffic safety is a priority reflected in the United Nations Sustainable Development Goals. Data on current hazards for bicycle-related injuries from the United Arab Emirates are lacking. The aim of our observational study was to assess the behavior of bicyclists on the roads in Al Ain City, United Arab Emirates and compare our current results with a previous study from 2004.We adapted and tested a structured data collection form. Different sectors of Al Ain were randomly selected to cover the whole city during different times. Bicyclists were observed without direct contact.Out of 1129 bicyclists, 97.6% were males and 13.2% children. 39.4% were cycling on main roads with high-density traffic, 33.1% were cycling against the traffic, 39.3% were cycling at night, and 96.8% of them were not using lights. Only 2.1% of the bicyclists used helmets. A higher proportion of female than male cyclists used helmets (25.9% vs 1.5%; P < .001, Fisher exact test). There was an increase in cycling with the traffic (P < .001) and in use of helmets (P < .025) compared with the previous study.Unsafe practices of bicyclists and low use of helmets despite legislation persist in Al Ain. There is a need to raise bicycle safety awareness and improve enforcement of bicycle helmet legislation. This should be directed toward expatriate workers, children, parents, and maids. Environmental changes, namely building separate bicycle lanes, can increase safety for cycling.

Biochemical parameters of mild, moderate &amp; severe COVID-19 patients

Background and objectives: Coronavirus disease 2019 (COVID-19) is affecting millions of people world-wide. It is caused by the severe acute respiratory syndrome corona virus 2(SARS-CoV-2). The laboratory findings are very important to assess the progress of the disease. The present study is aimed to discuss the biochemical parameters among mild, moderate and severe COVID-19 patients. Materials and methods: A cross sectional study were conducted in the Department of Physiology, Dhaka Medical College, Dhaka from January 2020 to December 2020. After obtaining ethical clearance, a total of 100 real time-polymerase chain reaction (RT-PCR) COVID-19 positive patients were selected from Dhaka Medical College Hospital. With all aseptic precautions, 10 ml of venous blood was collected from ante-cubital vein. D-dimer, prothrombin time, C-reactive protein (CRP), lactate dehydrogenase (LDH), serum ferritin, random blood glucose (RBG), serum creatinine, serum glutamic-pyruvic-transaminase (SGPT) and serum albumin measured in the Department of Laboratory Medicine, Dhaka Medical College Hospital, Dhaka. CRP was measured by Immunoturbidimetric method, serum ferritin was estimated by Chemiluminescent microparticle immunoassay. STA-neoplastine CI plus used with STA-R analyzer was used for determination of prothrombin time. D-dimer was estimated by Immunofluorescence Assay method. Serum LDH is measured by Dimention clinical chemistry system, serum albumin is measured by bromocresol purple dye binding method, serum creatinine is measured by Jaffe alkaline picrate method and serum SGPT is measured by colourmetric (IFCC 1980) method and RBG is measured by enzymatic colorimetric method (GOD-PAP). Data were recorded in a pre-designed structured data collection form. For statistical analysis, ANOVA followed by Bonferroni test, Chi square test, Spearman’s rho correlation coefficient test was performed as applicable using SPSS for windows version 25.0. Results: By analyzing biochemical parameters of mild, moderate and severe RT-PCR positive 100 COVID-19 patients revealed evaluation of biochemical parameters shows severity of the disease was significantly associated with CRP, SGPT, S. Creatinine, LDH, Ferritin, D-dimer &amp; Prothrombin time. No significant association was found with RBG &amp; S. Albumin. Bonferroni correction following ANOVA was performed to compare between each group. Spearman’s correlation reveals statistically significant strong positive correlation with CRP, Ferritin &amp; D-dimer, moderate positive correlation with S. Creatinine, LDH and mild positive correlation with SGPT &amp; Prothrombin time. Conclusion: This study showed D-dimer, prothrombin time, CRP, LDH, ferritin, serum creatinine and SGPT are significantly associated with the severity of the illness that is higher in severe group in comparison to mild and moderate groups. So, comprehensive analysis of the biochemical parameters will be very helpful for early identification &amp; better management of severe disease.