Teaching Hospital Research Articles

A sarcopenia screening test predicts mortality among hospitalized cancer patients.

This study investigated the ability of a sarcopenia screening test to predict mortality among cancer inpatients. We conducted a prospective study of patients admitted to the oncology ward of a teaching hospital in southern Taiwan. Over a 5-month period, 82 patients were enrolled for evaluation and were followed for 3 years. All participants received a comprehensive assessment at the time of admission, including Eastern Cooperative Oncology Group (ECOG) performance status, cognitive ability, nutrition index, body mass index, and short physical performance battery (SPPB). Age, ECOG performance status, dementia, SPPB score, and albumin level were associated with sarcopenia. Of the enrolled participants, 53 (64.6%) were diagnosed with sarcopenia. Patients with sarcopenia were associated with worse overall survival (OS) than patients without sarcopenia (28.8% vs. 82%, p = 0.01). Metastasis (hazard ratio [HR]: 5.166; 95% confidence interval [CI]: 1.358-19.656) and albumin level (HR: 4.346; 95% CI: 1.493-12.654) were independent and significant predictors of OS for the whole study population. Age was a predictor of 2-year all-cause mortality among patients aged ≥65 years but not among those aged <65 years (OS: 25.6% vs. 100%, p = 0.04). To summarize, the sarcopenia screening results were found to predict OS and all-cause mortality and may be helpful for patient stratification during in-hospital care.

Should Obtaining Informed Consent Be Considered an Entrustable Professional Activity? Insights From Whether and How Attendings Entrust Surgical Trainees.

Because residents are frequently delegated the task of obtaining consent early in their training, the American Association of Medical Colleges describes "obtaining informed consent" as a core entrustable professional activity (EPA) for medical school graduates. However, prior studies demonstrated that residents frequently perform this task without receiving formal instruction or assessment of competency. This study sought to understand how attending physicians decide to delegate obtaining informed consent for surgical procedures to trainees. The authors conducted a survey of attending surgeons at a university-based health care system of 6 affiliated teaching hospitals (October-December 2020) to collect data about current entrustment practices and attendings' knowledge, experience, and attitudes surrounding the informed consent process. Summary statistics and bivariate analyses were applied. Eighty-five attending surgeons participated (response rate, 49.4%) from diverse specialties, practice types, and years in practice. Fifty-eight of 85 (68.2%) stated they "never" granted responsibility for the consent conversation to a trainee, and 74/81 (91.4%) reported they typically repeated their own consent conversation whenever a trainee already obtained consent. The most common reasons they retained responsibility for consent were ethical duty (69/82, 84.1%) and the patient relationship (65/82, 79.3%), while less than half (40/82, 48.8%) described concerns about trainee competency. Reflecting on hypothetical clinical scenarios, increased resident competency did not correspond with increased entrustment ( P = .27-.62). Nearly all respondents (83/85, 97.7%) believed residents should receive formal training; however, only 41/85 (48.2%) felt additional training and assessment of residents might change their current entrustment practices. Attendings view informed consent as an ethical and professional obligation that typically cannot be entrusted to trainees. This practice is discordant with previous literature studying residents' perspectives. Furthermore, resident competency does not play a predominant role in this decision, calling into question whether informed consent can be considered an EPA.

Reigniting Intensive Care Unit Liberation.

The Society of Critical Care Medicine has established guidelines to manage pain, sedation, delirium, immobility, family participation, and sleep disruption in the intensive care unit, a set of interventions known as the intensive care unit liberation (ABCDEF) bundle. Adherence to these guidelines has shown positive results. In the intensive care units of a level I trauma academic teaching hospital in central Texas, the rate of bedside nursing staff adherence to the ABCDEF bundle was only 67.1% in January 2022. The aim of this quality improvement project was to improve adherence to the bundle. Knowledge gaps were found to be the driver of the low adherence rate. Two primary needs were identified: (1) education on the elements of the ABCDEF bundle and (2) increased awareness and recognition of incomplete and incorrect documentation. Interventions included focused education on intensive care unit liberation. From February to June 2022, overall adherence to the ABCDEF bundle increased from 67.1% to 95.3%, ventilator use decreased by approximately 10%, and restraint use dropped by about 9%. The incidence of delirium increased, but this increase was due to incorrect patient assessment before the interventions. The results of this project are consistent with literature demonstrating that a multifaceted approach to improving ABCDEF bundle adherence can produce sustainable improvement in patient outcomes. This report may help other organizations facing similar challenges improve adherence to the bundle in a postpandemic environment.

Impact of anemia on exercise capacity in patients with chronic obstructive pulmonary disease.

Objective: This study aimed to assess the impact of anaemia on exercise capacity in Chronic Obstructive Pulmonary Disease (COPD) patients by comparing the six-minute walk distance (6MWD) between anaemic and non-anaemic individuals. Study Design: Cross-sectional study. Setting: Department of Pulmonology, Khyber Teaching Hospital, Peshawar. Period: November 15, 2019 until May 14, 2020. Methods: This study included 162 COPD patients aged 40 to 70 years. Exclusion criteria encompassed any lung pathology other than COPD, malignancy, cardiac pathology, or conditions affecting hemoglobin levels. The 6MWD test was utilized to evaluate exercise capacity. Data analysis utilized SPSS Version 25.0, with descriptive statistics employed to summarize the demographic and clinical characteristics of the study population. A significance level of ≤0.05 was used to determine statistical significance. Results: The mean age of participants was 62.07 years, with a mean hemoglobin level of 12.63 gm/dl. The average 6MWD was 234.78 meters. Among the subjects, 40.74% were male. Anaemic patients had a significantly lower 6MWD (190.99 ± 95.44 meters) compared to non-anaemic patients (278.58 ± 100.17 meters; p ≤ 0.001). There were no significant differences in COPD duration, age, body mass index, or smoking status between the two groups. Conclusions: Anaemic COPD patients demonstrated a significantly reduced exercise capacity, covering approximately two-thirds of the distance non-anaemic patients did on the 6MWD test. These findings suggest that early diagnosis and management of anaemia in COPD patients could potentially improve their exercise tolerance and overall quality of life.

The endoscopy department can alert to complications associated with peripheral venous catheters in patients admitted to a tertiary teaching hospital

The endoscopy department can alert to complications associated with peripheral venous catheters in patients admitted to a tertiary teaching hospital

The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients.

Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting? While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group. Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective. A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation. The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up. Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births. The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias. The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients. The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose. ClinicalTrials.gov NCT04151485. 5 November 2019. 15 December 2019.

Role of emotions in change and change management in an emergency department: a qualitative study

BackgroundChanges in emergency departments are frequently implemented to improve efficiency and reduce costs. However, staff acceptance and adoption are crucial for the intended success of changes.ObjectivesThis study explored staff perceptions...

Nursing Informatics Competency among Nurses at a Teaching Hospital in Malaysia

Nursing informatics merges nursing science with information and analytical sciences to identify, describe, manage, and disseminate nursing data, information, knowledge, and wisdom. Identifying nurses’ informatics competency will help improve information technology utilisation in clinical practice. The aim of this study was to assess basic competency in nursing informatics and related factors influencing nurses working in a university teaching hospital. Thus, a cross-sectional study was conducted. A stratified random sampling of the total population of 1,136 nurses with sample size of 316 nurses participated in this study. The data was collected using a self-reported questionnaire utilising the Nursing Informatics Competency Assessment Tool (NICAT) reaching targeted sample by convenient approach. The results of this study showed that 85% (n = 269) nurses were competent in nursing informatics competency. There was a significant relationship between basic nursing informatics competency and sociodemographic of age (t = 4.194, p = 0.000), gender (t = –2.558, p = 0.011), educational level (F [2,313] = 5.094, p = 0.007) and working discipline (F [6,309] = 8.309, p = 0.000). There was also a significant relationship between basic nursing informatics competency and working experience (ρ = –0.231, n = 316, p = 0.000). However, the study is based on self-reporting and does not measure the actual performance of nursing informatics competency. Overall, the findings indicated the need for improvement in nursing informatics by exposure or awareness for potential age group and particular clinical setting for training and educational of nursing informatics.

Availability of antidotes for drug poisonings and doctors’ perspectives thereof

Drug poisoning is an important area of study in South Africa as a treatable cause of mortality. While research has been conducted on poisoning, there is a paucity of literature on the availability of antidotes in South Africa. The objectives of this study were to assess the availability of antidotes in selected teaching hospitals in the Southern Gauteng City-Region and to explore doctors’ experiences of antidote supply. The availability of antidotes in the emergency departments (EDs) and pharmacies was assessed and recorded using a data sheet that was completed in person at each of the teaching hospitals. A questionnaire exploring experiences of antidote supply was distributed to 126 doctors working in the EDs. Our results indicate that N-acetylcysteine, atropine, diazepam, clonazepam, sodium bicarbonate, vitamin K, calcium gluconate, naloxone, ethanol, and pyridoxine were present in all EDs; activated charcoal was present in 80%; lorazepam, glycopyrrolate, and calcium chloride in 60%; freeze-dried plasma in 40%; glucagon and desferrioxamine in 20%; and fresh frozen plasma, hydroxocobalamin, sodium nitrite, sodium thiosulfate, sodium calcium edetate, and intralipid were not present in any of the EDs. Doctors reported organophosphate poisoning and paracetamol overdose as the most common drug poisonings (81.7% and 14.3% of 126 respondents, respectively). Most doctors experienced no supply issues for N-acetylcysteine, calcium gluconate, sodium bicarbonate, or pyridoxine (85.7%, 83.3%, 87.3%, and 75.4% of 126 respondents, respectively). The antidotes to the most common poisonings reported by doctors were present in all EDs. However, concerns were raised about consistency of supply, which will be an important avenue for further research.

Outcome of Left Anterior Descending Coronary Artery Ostial Lesions Treated with Drug-Eluting Stents

Patients with severe Left Main Stem (LMS) stenosis have very high risk of major cardiovascular events because of the extent of myocardium suffering ischemia. Coronary artery disease of left main stem is not very common but key cause of characteristic coronary artery disease. Such stenosis is usually treated with CABG which is the gold standard treatment. Objective: To determine the outcome of left anterior descending coronary artery ostial lesions stenting with drug-eluting stents. Methods: The descriptive case series was conducted at a teaching hospital in Lahore, from 01-08-2019 to 29-07-2020. After informed consent 113 patients were included in study; both genders and diagnosed cases of LAD ostial disease, keeping in view inclusion and exclusion criteria. Then patients were admitted in cardiology wards after recording demographic data. Next day, the patients underwent angioplasty under local anesthesia. After procedural success patients were followed-up there for 3 days to assess if there was repeat myocardial infarction or mortality within hospital stay. All information obtained was recorded on a standard performa. Quantitative and qualitative data were analyzed and outcome of the procedure was recorded. Results: In our study 104(92.04%) patients were male and 9(7.96%) patients were females. The Drug-Eluting Stents (DES) procedural success was found in 93.81% patients, post stenting MI observed in 6.4% patients and the mortality occurred in 2.7% patients. Conclusions: The left anterior descending coronary artery ostial lesions stenting with DES is effective and feasible procedure with good outcome.

Prognostic indicators for canine parvoviral enteritis in a Teaching Hospital in Italy: a retrospective study of 76 cases.

Potential prognostic indicators have been associated with decreased survival during canine parvoviral enteritis (CPE), such as body weight, sex, and clinicopathological parameters. Few studies reported the prognostic factors for CPE in Italy; therefore, the aim of this study was to identify prognostic factors associated with the survival of dogs admitted to the Veterinary Teaching Hospital of Perugia University, naturally infected with canine parvovirus. Seventy-six medical records of dogs with a definitive diagnosis of parvoviral infection admitted from 2017 to 2021 have been reviewed and included in the study. From medical records were extracted data on signalment, history, clinical examination, hematology, serum biochemistry, treatments, progression of clinical signs during hospitalization and outcome. The data have been subjected to univariate and multivariate statistical analysis. Our results showed winter season, male sex, dog ownership, small breed, normal sensory status, normal heart rate, normal hydration status, abdominal pain, increased capillary reperfusion time, and normal white blood cell count as positive prognostic factors. The survival model confirmed that parameters such as male sex, small breed, and ownership increased the survival rate during hospitalization. Data reported in the present study are partially in agreement with previous studies and added new information on the possible prognostic factors in dogs affected by CPE in Italy.

EVALUATION AND MANAGEMENT STRATEGIES FOR PATIENTS WITH BLUNT ABDOMINAL TRAUMA: A HOSPITAL-BASED STUDY

Introduction:Blunt trauma to the abdomen occurs due to forces that induce shearing, compression, or deceleration injuries, particularly affecting anatomical structures that are relatively immobile. The evaluation of abdominal injuries is challenging and often results in missed diagnoses due to the complexity of symptoms and the difficulty in identifying subtle signs of internal injury. Aims &amp; Objectives:To study the clinical presentation, evaluation, diagnostic investigations, and management strategies for various intra-abdominal organ injuries resulting from blunt trauma to the abdomen. Methods: - Following initial resuscitation and attainment of hemodynamic stability, all blunt abdominal trauma patients underwent meticulous clinical history-taking and comprehensive physical examination. Subsequent management decisions, whether operative or non-operative, were determined based on the integrated findings of clinical assessments and radiological evaluations. Results:Between August 2022 and August 2023, fifty (50) patients with blunt trauma to the abdomen were admitted to Basaveshwara Teaching and General Hospital, Kalaburagi. In this study, males predominated in the 21 to 30-year age group, which represented the most frequent demographic for abdominal blunt trauma. Traffic collisions were identified as the leading cause of abdominal blunt trauma. The spleen emerged as the organ most frequently affected. Of the patients, 28 underwent conservative management, while 22 required surgical intervention. Conclusion:In cases of blunt trauma to the abdomen, the early hours following injury are critically significant and represent a crucial window, often referred to as the golden period of trauma, associated with higher survival rates. Timely intervention andappropriate management during this phase have been shown to significantly decrease morbidity and mortality rates associated with blunt trauma abdomenandappropriate management during this phase have been shown to significantly decrease morbidity and mortality rates associated with blunt trauma abdomen.

Enhancing Nursing Staff Clinical Skills of Pain Assessment: Impact of the Educational Course

Objective: To assess the impact of a newly developed educational course in terms of improvement in post-test scores in clinical skills assessment of patients with patient-controlled intravenous analgesia (PCIA) and epidural analgesia using the Likert scale among nursing staff working in a tertiary care teaching hospital. Introduction: Nurses require certain clinical skills to assess patient’s pain adequately. This can be achieved through regular on-the-job training and educational workshops. This will enhance nurses’ clinical practice regarding pain assessment and improve pain treatment and patient satisfaction. Methods: After getting approval from the Institutional Review Committee an education course was developed and implemented. A total of 86 nursing staff attended the course. Teaching methodologies included online lectures, small group tutorials, and hands-on workshops using demonstrations of locally developed videos. Pain assessment skills were assessed at the start of the workshop and the end of the session using PCIA and Epidural Likert scale assessment forms on simulated patients in this experimental, pre-and post- (single-arm) study. Results: Eighty-six participants completed the course, of which 50 (58.1%) were female. In the clinical skill assessment of patients using PCIA, the mean difference in PCIA assessment scores of participants before and after the workshop was 13.88 (90.79%), which was statistically significant (p=&lt;0.001). In the epidural skills assessment, the mean difference in the score of participants before and after the workshop was 15.09 (79.47%), which was statistically significant (p=&lt;0.001). Conclusion: The educational course had a significant impact on increasing the understanding of pain assessment among nursing staff with statistically significant improvement in their clinical skills.

The surgical technique and protocol for dynamic sentinel node biopsy for penile cancer at a Southeast Asian regional hospital.

Lymph node status is a key prognostic factor in penile cancer. The European Association of Urology (EAU) recommends intermediate-risk (pT1a, Grade 2) or high-risk (pT1b or greater) penile cancer patients with clinically non-palpable inguinal lymph node (cN0) to undergo either an invasive bilateral modified inguinal lymph node dissection (ILND) or dynamic sentinel node biopsy (DSNB). DSNB has been reported to have acceptable false negative rates, and lower rates of long-term morbidity compared to ILND. We developed a protocol for DSNB at a regional hospital in Singapore that was adopted from St James's University Hospital, Leeds Teaching Hospitals Trust. Four patients with cN0 penile cancer underwent DSNB between November 2021 and October 2022 according to this protocol. Our surgical technique and protocol are described. The patients' oncological characteristics and their outcomes were evaluated. In this small case series, there was no complication attributable to the performance of DSNB, and there was no groin that was documented to be false negative over a median follow up of 15.5 months (range, 12 to 22 months). Using our protocol, 5 of 8 groins (62.5%) were able to avoid ILND in the cN0 setting. We recommend the adoption of DSNB for the surgical staging of inguinal lymph nodes for patients with intermediate to high-risk penile cancer and non-palpable inguinal nodes due to its significantly lower risks of long-term morbidity compared to ILND. Appropriate specialist training and a multi-disciplinary team is vital to ensure the success of the procedure.

Role of Laparoscopy in Evaluation of Various Blunt Abdominal Trauma

Introduction with Objective: The aim of the present study was to assess the role of laparoscopy in evaluation of various Blunt abdominal trauma (BTA) in tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted from 21st June 2016 to 21st December 2017 among 50 abdominal blunt trauma patients attending at Casualty Block, Dhaka Medical College Hospital, Dhaka, after obtaining requisite consent from the patients attendant. Data were collected through the assessment and investigation report of abdominal blunt trauma patients in the Casualty Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the role of laparoscopy in evaluation of various blunt abdominal trauma. Results: Most of the patients were from 21-30 years (36%) of age group followed by 11-20 years (32%). The median age of this study population is 27 years. Of the study population, 84% (n=42) were male and 16% (n=8) were female. Male-female ratio was 84:16. In this study, 62% (n=31) of patients underwent only laparoscopy and 38% of patients (n=19%) underwent laparoscopy followed by laparotomy. Perforation of gas containing hollow viscus (94.73%) is responsible for conversion of laparoscopy into laparotomy in patients with blunt abdominal trauma. Among 50 patients 14 patients (28%) developed post operative complications. Rate of wound infection was higher laparoscopy followed by laparotomy (n=11). One patient developed post operative collection following laparoscopy. The accuracy rate is 100% in laparoscopic evaluation of BTA in this study. Conclusion: laparoscopy is a useful modality for evaluating and managing hemodynamically stable blunt abdominal trauma patients. Medicine Today 2024, Vol.36 (2): 95-98

Mastectomy in ten mares: indications, surgical technique, complications, and long-term outcome.

To describe the indications for and surgical technique of mastectomy of mares and to describe the outcome of 10 mares that underwent mastectomy in a retrospective case series. 10 mares having disease of one or both mammary glands. Medical records (1995 to 2022) from 2 university teaching hospitals were searched to identify mares that had undergone unilateral or bilateral mastectomy. Data regarding history, signalment, diagnostic tests, preoperative treatment, surgical procedure, and postoperative management were reviewed. Follow-up information was obtained by interviewing the owners by telephone. One (n = 4 mares) or both mammary glands (6 mares) were excised for the following reasons: chronic bacterial mastitis (4), neoplasia (3), lymphangiectasia (1), pythiosis (1), and lymphoid hamartoma (1). None of the mares experienced intraoperative complications. The surgical site was closed primarily in 2 mares and left unsutured in 8 mares. Both sutured wounds developed a seroma, and 1 dehisced. The owners reported that the surgical wound, whether sutured or unsutured, was healed within 3 months. All mares returned to use for their intended purpose, but 3 mares were euthanized 2 to 4 years after surgery due to progression of disease. One mare drowned 1 year after discharge. Mastectomy can be an effective treatment for mares suffering from disease of one or both mammary glands when the mare is refractory to medical treatment.

Epidemiological Features of Chronic Low-Back Pain

Introduction: Chronic low back pain (LBP) is a major cause of abstinence from work in the world. Objective: The aim of the present study was to assess the epidemiological features of chronic low back pain patients in tertiary care teaching hospital. Materials and Methods: A descriptive cross sectional study was conducted from January 2018 to June 2018 among 70 patients attending at Physical Medicine and Rehabilitation outpatient department of the Shaheed Suhrawardy Medical College and Hospital after obtaining requisite consent from the patients. Data were collected through interviewing of the patients. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the epidemiological features of chronic low back pain patients. Results: In a pool of 70 patients, most of the patients (n=34, 48.5%) belong to 31-40 year age group. In a pool of 70 patients, Male patients (52.85%) were more than the female patients (47.14%) at the Shaheed Suhrawardy Medical College and Hospital. In occupational status, most of the patients were Housewife (n=19, 27.14%) followed by service-holder (n=17, 24.28%). In a pool of 70 patients, most of the patients BMI were normal (n=49, 70%). Conclusion: Epidemiological features were characterized by male patients, as from the 31-40 years of life and housewife. Physical functional profile was primarily characterized by patients with normal BMI and overweight. Medicine Today 2024, Vol.36 (2): 107-109

Diagnostic utility of ultrasonography and fine needle aspiration cytology in the pre-operative assessment of suspicious thyroid nodules

Introduction and Background: The incidence of thyroid cancer in Sri Lanka has risen over the last two decades. According to current national cancer statistics, it has become the second commonest cancer in females. Ultrasonography and fine needle aspiration cytology (FNAC) are pre-operative investigations that are useful to assess the nature of thyroid nodules. Though, majority of thyroid nodules are benign, it is vital to identify the suspicious nodules pre-operatively, to decide the most appropriate treatment option.Aim of the study was to determine the diagnostic utility of ultrasonography and FNAC in the pre-operative assessment of suspicious thyroid nodules in the local setting.Methodology: A descriptive cross-sectional study conducted at the Colombo South Teaching hospital and Department of Pathology, University of Sri Jayewardenepura enrolling 135 patients with ultrasonically suspicious thyroid nodules. Ultrasound guided FNAC samples were collected from each patient for cytological assessment. TIRADS (Thyroid Imaging Reporting And Data System) classification was used for radiological assessment and the Bethesda system for cytological interpretation. Data was analyzed using the SPSS 23 software.Results: The age of enrolled patients ranged from 15-76 years with a mean age of 49.8. Majority of the patients were females (81%) while 19% were males. Eleven FNAC specimens were excluded from the study due to insufficient cellularity. Classification of the cases according to ultrasound findings showed that the majority of the patients 51.61% (n=64) belonged to TI-RADS 3 (mildly suspicious). Thirty nine (31.45%) patients had moderately suspicious nodules (TIRADS 4) and 21 cases (16.93%) were highly suspicious.Conclusion: TI-RADS 5 category had the highest sensitivity and 100% concordance between the cytology and ultrasonography results.

High prevalence of late presentation with advanced HIV disease and its predictors among newly diagnosed patients in Kumasi, Ghana

BackgroundLate presentation with advanced HIV disease (LP-AHD) remains a significant challenge to Human Immunodeficiency Virus (HIV) care, contributing to increased morbidity, mortality, and healthcare costs. Despite global efforts to enhance early diagnosis, a considerable proportion of individuals with HIV infection are unaware of being infected and therefore present late for HIV care. For the first time in Ghana, this study assessed the prevalence of LP-AHD and associated factors among people diagnosed with HIV (PDWH).MethodThis bi-center retrospective cross-sectional study included 315 PDWH at the Aniniwah Medical Centre and Komfo Anokye Teaching Hospital, both in Kumasi, Ghana. A well-structured questionnaire was used to collect data on sociodemographic, clinical, lifestyle and psychosocial factors from the study participants. Statistical analyses were done in SPSS version 26.0 and GraphPad Prism version 8.0 at significant p-value of < 0.05 and 95% confidence interval. Predictors of LP-AHD were assessed using binary logistic regression models.ResultsThis study observed that, 90 out of the 315 study PDWH (28.6%) reported late with advanced HIV disease (AHD). Participants within the age group of 36–45 years (adjusted Odds Ratio [aOR]: 0.32, 95% CI: 0.14–0.69; p = 0.004) showed a significantly decreased likelihood of LP-AHD. However, participants who perceived cost of HIV care to be high (aOR: 7.04, 95% CI: 1.31–37.91; p = 0.023), who were diagnosed based on clinical suspicion (aOR: 13.86, 95 CI: 1.83–104.80; p = 0.011), and missed opportunities for early diagnosis by clinicians (aOR: 2.47, 95% CI: 1.30–4.74; p = 0.006) were significantly associated with increased likelihood of LP-AHD.ConclusionThe prevalence of LP-AHD among PDWH in Ghana is high. Efforts to improve early initiation of HIV/AIDS care should focus on factors such as the high perceived costs of HIV care, diagnosis based on clinical suspicion, and missed opportunities for early diagnosis by physicians.

Adherence of Patients After Cholecystectomy for Diet

Background: Cholecystectomy often requires dietary and lifestyle adjustments, making adherence to educational programs crucial for optimal recovery. This study evaluated patients' compliance with a post-cholecystectomy educational program and examined how socio-demographic factors influenced adherence. This study aimed to evaluate patients' adherence to an educational program following cholecystectomy and to investigate the relationship between adherence and socio-demographic characteristics.Methods: A quasi-experimental design was employed at AL Imam Sadiq Teaching Hospital. Non-probability sampling was used to recruit 30 patients for the study group and 30 for the control group. A 9-item instrument was developed, and a panel of 11 experts established its validity. Descriptive and inferential statistical analyses were performed on the collected data.Results: The study found that socio-demographic factors play a significant role in patients' adherence to the educational program. The pretest adherence was (3.19) for the case group and (2.92) for the control group. Posttest adherence significantly improved to (5.78) for the case group and (3.13) for the control group. Notably, patients' employment status, educational level, and monthly income were found to significantly influence the effectiveness of the instructional program on nutritional adherence.Conclusion: The instructional program had a positive impact on patients who underwent cholecystectomy, effectively improving their nutritional adherence in both the case and control groups. This success underscores the potential of such programs in post-cholecystectomy patient care. The study recommends increasing patients' knowledge regarding nutritional adherence and explaining dietary recommendations through social media. Additionally, it suggests implementing the present program for all patients undergoing cholecystectomy.