Tertiary Care Setting Research Articles

Health-Related Quality of Life Assessment for Liver Cirrhosis Patients at a Tertiary Care Hospital in Karachi, Pakistan.

Background The global health challenge of cirrhosis affects millions of individuals. Still, there is a notable lack of research on the health-related quality of life (HRQOL) of cirrhosis patients, especially in specific regions. This study aims to assess the impact of cirrhosis onHRQOL, including factors influencing it in a tertiary care setting in Pakistan. Methodology A cross-sectional study was conducted on a cohort of 115 patients diagnosed with cirrhosis, confirmed on imaging. HRQOL was measured using the short-form 36 (SF-36) survey. Furthermore, socioeconomic factors and self-rated health perceptions regarding HRQOL were recorded. Factors Influencing HRQOL domains in liver cirrhosis patients were also analyzed. Results Among 115 liver cirrhosis patients, 63.5% (N=73) were aged 40-60 years, and 73.9% (N=85) lived primarily in urban areas. HRQOLassessments highlighted moderate disability in physical functioning (62.6 ± 26.5) and notable impacts on mental health, emotional well-being, and bodily pain. Statistical analysis demonstrated the complexity of factors influencing HRQOL. Physical functioning was significantly associated with a higher Child-Turcotte-Pugh class, diabetes mellitus, hypertension, smoking status, and family monthly income (p-value < 0.05). While the duration of liver cirrhosis showed a significant association with bodily pain (p < 0.05). Additionally, residence status with social well-being (p-value = 0.01), and family monthly income with vitality (p-value < 0.05). Conclusion Our study in Pakistan highlights significant impacts on the HRQOLof liver cirrhosis patients, affecting physical function, mental health, emotional well-being, and bodily pain. Factors influencing HRQOL include liver disease severity, comorbidities, and socio-economic status.Recommendations include educational programs and specialized nursing care to address diverse challenges.The findings stress the importance of a personalized approach to patient care, urging urgent, targeted efforts to improve the health-related standard of life for cirrhotic patients.

Depression care integration in tuberculosis services: A feasibility assessment in Pakistan.

The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses. The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan. Mixed-method study. Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique. A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility. There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system. To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.

Antimicrobial Susceptibility Patterns of Salmonella Typhi and Salmonella Paratyphi in Tertiary Care Hospitals

Background: Salmonella typhi and Salmonella paratyphi are significant causes of enteric fever, posing substantial public health challenges globally. Monitoring their antimicrobial susceptibility patterns is crucial for guiding treatment strategies and combating antimicrobial resistance, particularly in tertiary care hospitals where severe cases are managed. Aim: To determine the antibiogram profile of Salmonella typhi and Salmonella paratyphi isolated from blood cultures of paediatrics patients presenting in Lady Reading Hospital Peshawar. Methodology: The study examined the prevalence, clinical characteristics, and antibiotic susceptibility patterns of Salmonella typhi and Salmonella paratyphi infections among 530 participants aged 13 to 18 years presenting in Lady Reading Hospital Peshawar. Over the course of two years using a prospective observational cohort design. Recruitment, clinical evaluations, and laboratory validation using accepted methods were all part of the data gathering process. Testing for antibiotic susceptibility was done, and statistical analysis was done using SPSS version 28. Both informed consent and ethical approval were obtained. Results: The research included 530 instances of enteric fever, of which 318 cases (or 60%) were due to Salmonella typhi and 212 cases (or 40%) to Salmonella Paratyphi. There were 40.25% female cases and 59.75% male cases among them. The age group of 15–16 years old accounted for the largest percentage of cases (38.68%), followed by 13–14 years old (33.02%) and 17–18 years old (28.30%). Different patterns emerged from antimicrobial susceptibility tests; drugs such as ampicillin (66.04%), azithromycin (74.26%), cefixime (87.47%), ceftriaxone (92.77%), chloramphenicol (91.51%), ciprofloxacin (92.40%), and co-trimoxazole (55.03%) showed substantial susceptibility rates. Compared to Salmonella typhi, Salmonella paratyphi showed notably greater sensitivity rates for azithromycin (94.47%) and ceftriaxone (95.45%). Practical implication: This research provided the community with important advantages and practical consequences. The study helps healthcare professionals choose efficient treatment plans by identifying the antibiotic susceptibility patterns of Salmonella typhi and Salmonella paratyphi, particularly in tertiary care facilities. Conclusion: This study highlights the importance of continuous surveillance and species-specific treatment strategies to combat antimicrobial resistance and improve patient outcomes in enteric fever, particularly in tertiary care settings. Keywords:Antimicrobial susceptibility, Salmonella typhi, Salmonella Paratyphi, Tertiary care hospitals

Surveillance of resected metastatic colorectal cancer utilizing circulating DNA.

214 Background: There is limited data to guide surveillance in patients with metastatic colorectal cancer (CRC) who have had curative resection using circulating tumor DNA (ctDNA) in addition to labs and imaging studies. Minimal residual disease (MRD) assays utilize circulating tumor DNA (ctDNA) for the purposes of monitoring for early recurrence and predicting therapeutic response. In this study, we aim to investigate the utility of ctDNA monitoring in the setting of resected metastatic CRC. Methods: Patients were identified through retrospective search at a tertiary care and several satellite settings to identify patients with metastatic CRC who had undergone curative resection and later had ctDNA monitoring (using Signatera assay). IRB approval was obtained for the study. We recorded demographic information (sex, race, age at diagnosis), disease characteristics (stage at diagnosis, site of primary cancer, site of metastasis), treatment regimens, clinical outcomes (recurrence, survival) and follow-up data. Our primary outcome was to evaluate the rate of recurrence in patients with metastatic CRC who had curative resection in two different population, ctDNA positive or ctDNA negative, post-surgery. Results: We identified 35 patients with a median age of 55 years (range 31 – 82) at the time of metastatic diagnosis. In this study cohort, 20 (57%) were female; 23 (66%) were white, and 10 (29%) were African American. 22 (63%) patients had left-sided primary tumors and the remaining (47%) had right-sided primary tumors. At the time of presentation, 23 (66%) patients had synchronous metastases and 12 (34%) developed metachronous metastases. ctDNA positivity was reported in 21 (60%) pts post-curative therapy. Median time from curative therapy to ctDNA positivity was 62 days. 22 (63%) pts experienced recurrence of disease post-curative resection. Median time to recurrence after ctDNA test was first positive was 6.6 months. Among 21 patients in ctDNA positive group, 19 (86%) developed recurrences and among 14 ctDNA negative patients, only 3 (21%) developed recurrences (p-value &lt;0.01). Recurrence free survival was significantly shorter in patients who were ctDNA positive post surgery (Median RFS: 7.17 months, 95% CI: 4.4-18.0 months) compared to those who were ctDNA negative (Median RFS: 30.8 months; 95% CI: 12.6-NR) (p-value=0.005). Conclusions: In patients with metastatic CRC who underwent curative resection ctDNA may have utility in predicting disease recurrence at both academic and community sites. Larger studies are needed for validation of ctDNA as an adjunct test for surveillance in broader population.

Variations in Hospital Admissions of Non-Communicable Disease Patients Before and During The COVID-19 Pandemic (A Tertiary Care Setting, January 2018-June 2021).

This study aimed to analyze the variations (if any) in hospital admissions of patients with any of the five common non-communicable diseases (NCDs), based on secondary analysis of electronic health records of patients admitted to Hacettepe University Hospitals at least once, from January 1, 2018 through June 15, 2021. Data were recruited from hospital's electronic health records on patients with diagnoses of ischemic heart disease, hypertension, diabetes, cancer, and chronic obstructive pulmonary disease, using relevant ICD-10 codes. Compared to the corresponding time span in the pre-pandemic period, the number of hospital admissions of patients with selected five NCDs significantly decreased during the pandemic, with an official start in Turkey on March 11, 2020. Number of total-, out-patient-, and in-patient admissions of NCD patients were significantly lower in the pandemic period compared to the expected values in time series analysis, controlling for patient characteristics, and seasonality. Study findings suggest that there has been a prominent impediment in NCD patients' access to, and/or use of health care services over the pandemic, which might evolve to higher admission rates, severity and fatality of such patients in the upcoming years. Further studies are warranted for confirmation of our findings in other care settings, with individual-based data on care compensation through settings other than regular admission sites (if any), and/or the reasons for under-use of services.

Prevalence of Psoriatic Arthritis among Patients with Arthritis: Insights from a Tertiary Rheumatology Clinic in Bangladesh

Background: Psoriatic Arthritis (PsA) is a complex seronegative inflammatory arthritis associated with psoriasis, characterized by a wide range of clinical manifestations. This study aimed to explore the prevalence of PsA in arthritic patients along with associated demographic and clinical characteristics in a tertiary care setting in Bangladesh. Methods: This cross-sectional study was conducted at the Rheumatology Clinic of Dhaka Medical College Hospital over a period of 6 months from March 2018 to August 2018. A total of 600 arthritis patients underwent screening for PsA, with subsequent evaluations of confirmed cases based on the CASPAR criteria. Demographic and clinical characteristics were documented through face-to-face interviews and physical examination. For data collection, a pre-structured questionnaire was used. Disease activity was assessed using the DAPSA score. The study was conducted according to the ‘Declaration of Helsinki’. The statistical analysis was done with SPSS v-21. Results: The prevalence of PsA in arthritis patients was 5%. Age distribution of PsA showed a majority in between 30-39 years age group with a mean of 36.33±11.86 (SD). Slight female predominance was reported with a percentage of 53.3%. Almost three-fourths of study patients presented with a current diagnosis of psoriasis while the rest had a personal history or family history. A higher incidence (67.7%) of plaque psoriasis was observed followed by sebopsoriasis (20%) and for the rest of the patients, the type of psoriasis was unknown. The disease mostly involved multiple joints (90%), with ankle and metacarpal joints being the most commonly affected at 43.3% and 33.3%, respectively. Disease activity was high in the majority of the patients according to the DAPSA score, representing 53.34% of the patients, with the remainder exhibiting moderate to low disease activity. Conclusion: The study revealed a significant incidence of PsA among the arthritic population which indicates a pressing need for further extensive research on PsA across diverse populations. J MEDICINE 2024; 25: 35-40

Role of IL-6 as ‘core inflammatory marker’ in assessment of severity, response to therapy and predicting outcome in COVID-19 pneumonia: A single center experience of 2400 cases in tertiary care setting in India

Objectives: In coronavirus disease-19 (COVID-19) pneumonia, the role of various inflammatory markers including interleukin-6 (IL-6) was evolved in managing cases in indoor or critical care units worldwide. Apart from the role of IL-6 in predicting cytokine storms, the role in assessing post-COVID outcome is less studied. In the present study, we have analyzed the role in predicting ventilatory support requirement and final outcome in COVID-19 pneumonia. Material and Methods: A prospective, observational, and 12 weeks follow-up study included 2400 COVID-19 cases confirmed with reverse transcription-polymerase chain reaction. All cases were assessed with lung involvement documented and categorized on high-resolution computerized tomography (HRCT) thorax, oxygen saturation (SpO2), and IL-6 at entry point and follow-up. Covariates such as age, gender, and comorbidity; interventions such as oxygen use, bi-level positive airway pressure/non-invasive ventilation (BIPAP/NIV); and timings of ventilatory support and final outcome as with or without lung fibrosis as per computed tomography severity were recorded. Covariates were analyzed with initial and sequential IL-6 titer. Statistical analysis is done by Chi-square test. Results: The study of 2400 COVID-19 pneumonia cases, age (&lt;50 and &gt;50 years), gender, and comorbidity has a significant association with IL-6 titer (P &lt; 0.00001). HRCT severity score at entry point and duration of illness has a significant correlation with IL-6 level (P &lt; 0.00001). IL-6 titer has a significant association with SpO2 and BIPAP/NIV requirement during hospitalization (P &lt; 0.00001). Timing of BIPAP/NIV requirement during the course of hospitalization in the intensive care unit has a significant association with IL-6 titer (P &lt; 0.00001). Follow-up IL-6 titer during hospitalization as compared to entry point normal and abnormal IL-6 has a significant association in post-COVID lung fibrosis (P &lt; 0.00001). Follow-up IL-6 titer during hospitalization as compared to entry point abnormal IL-6 has a significant association in predicting cytokine storms irrespective of normal or abnormal IL-6 at entry point (P &lt; 0.0001). Conclusion: IL-6 titer has documented a very important role in triaging the COVID-19 pneumonia cases in indoor units, and guided treatments have shown improved outcomes. IL-6 titer is the “game changer” inflammatory marker not only in assessing the severity or predicting course during hospitalization but it has also helped in the utilizations of timely interventions required during hospitalizations. Sequential IL-6 titer has shown a significant role in predicting final radiological outcomes at 12 weeks.

O01 Epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacterales infections: experience from a large tertiary care centre in a developing country

Abstract Background Carbapenem-resistant (CR) Enterobacterales (CREs) are a significant source of healthcare-associated infections. These bacteria are difficult to treat and have a high mortality rate due to high rates of antibiotic resistance. These pathogens are also linked to major outbreaks in healthcare institutions, especially those with limited resources in infection prevention and control. Objectives To describe the epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country. Methods This was a retrospective cross-sectional study that included 218 patients admitted to An-Najah National University Hospital between 1 January 2021, and 31 May 2022. The target population was all patients with CRE infection or colonization in the hospital setting. Results Of the 218 patients, 135 had CR Klebsiella pneumoniae (61.9%) and 83 had CR Escherichia coli (38.1%). Of these, 135 were male (61.9%) and 83 were female (38.1%), with a median age of 51 years (IQR 24–64). Malignancy was a common comorbidity in 36.7% of the patients. Approximately 18.3% of CRE patients were obtained from patients upon admission to the emergency department, the largest percentage among departments. Most CRE pathogens were isolated from rectal swabs, accounting for 61.3%. Among the 218 patients, colistin was the most widely used antimicrobial agent (13.3%). CR E. coli showed resistance to amikacin in 23.8% of the pathogens tested and 85.7% for trimethoprim/sulfamethoxazole compared with CR K. pneumoniae, for which the resistance to trimethoprim/sulfamethoxazole was 74.1%, while for amikacin it was 64.2%. Regarding meropenem MIC, 85.7% of CR E. coli were greater than 16 mg/L compared with 84% of CR K. pneumoniae isolates. Conclusions This study found that CREs are frequently reported in this tertiary care setting, implying the presence of selective pressure and transmission associated with healthcare setting. The antibiotics tested showed a variety of resistance rates, with CR K. pneumoniae being more prevalent than CR E. coli and exhibiting an extremely high resistance pattern to the available therapeutic options.

Assessing Quality of Life: A Comparative Study among Patients with Schizophrenia, Bipolar Affective Disorder, and Healthy Control in a South Indian Tertiary Care Setting

Aim: To assess and compare the quality of life (QOL) of patients with schizophrenia, bipolar affective disorder (BPAD) patients and healthy control.&#x0D; Methods: This is an observational study carried out in MVJ Medical College and Research Hospital, Bengaluru, India. The WHOQOL-BREF questionnaire was administered to 139 patients with schizophrenia and 139 patients with BPAD that were diagnosed according to the ICD-10 diagnostic criteria, as well as 139 healthy subjects all of whom gave their informed consent. The data were analyzed using SAS 9.2 software.&#x0D; Results: On comparing the three groups, the schizophrenia group scored the least in the physical (53.51±19.36), psychological (51.32±21.37) and environmental health domains (55.59±17.78). The QOL of the BPAD group was comparable to that of the healthy control group and significantly better as compared to that of the schizophrenia group (P&lt;0.0001).&#x0D; Conclusion: The study shows that patients with schizophrenia had significantly lower QOL than patients with BPAD and healthy subjects. Our study emphasizes the significance of addressing psychiatric patients' overall health and QOL in addition to symptom management.

Assessment of clinical pharmacist interventions using a web-based application in a Saudi Arabian Tertiary Hospital.

Medication-related problems are a top concern of clinical pharmacists. Medication-related problems can cause patient harm and increase the number of visits, hospital admissions, and length of hospital stay. The objective was to assess clinical pharmacy medication-related problem-related interventions in a tertiary care setting. A retrospective cohort study was conducted at King Fahad Armed Forces Hospital in Jeddah (Saudi Arabia) between June 2021 and June 2022. The data were extracted monthly from a new web-based Microsoft Excel application documenting medication-related problems during any stage of the medication use process. A total of 5310 medication-related problem-related interventions in 1494 patients were performed. The departments associated with the highest frequency of medication-related problem-related interventions were the critical care unit (26.9%), intensive care unit (23.8%), anticoagulation clinic (17.1%), medical ward (11.3%), and nephrology unit (6.8%). The most common type of medication-related problem-related interventions included inappropriate dosage regimens (25.6%), monitoring drug effect or therapeutic drug monitoring (24.4%), requirement of additional drug therapy (21.9%), and inappropriate drug selection (14.1%). The proposed interventions were accepted by physicians in 97% of the incidents. The most frequent medication classes associated with medication-related problem-related interventions were cardiovascular agents (47.6%), antimicrobial agents (27.2%), and nutrition and blood substitute agents (11.4%). The most frequent medication groups associated with medication-related problem-related interventions were anticoagulants (25.6%) and antibiotics (25.2%). The current findings characterize the medication-related problem-related interventions addressed in clinical pharmacy at a tertiary care setting. The high rate of physician acceptance emphasizes the integral patient safety role of clinical pharmacy services.

Prevalence and Characteristics of Medicinal Cannabis Use among Chronic Pain Patients; A Post- Legalization Study in a Tertiary Care Setting in Thailand

Objective: Cannabinoid products have been applied for numerous medical conditions, including chronic pain. Thailand was the first country in South East Asia to legalize medical cannabinoids. This study aims to explore prevalence, characters, attitude, side effects of medical cannabinoid use, and pain-related outcome among the chronic cancer and non-cancer pain population at Siriraj Hospital. Materials and Methods: 200 chronic cancer pain and 670 chronic noncancer pain patients were collected by questionnaires and interviews. Data included demographic data, clinical diagnosis, pain treatment, knowledge, attitude, pattern of use, side effects and quality of life of cannabinoid extracts. Results: Prevalence of active cannabis user was 15% in chronic cancer pain and 3.1% in noncancer pain. Oil extract sublingual was the most common form. Pain control was the most common initial reason for usage. No serious side effects were reported. Common side effects were dry oral mucosa, drowsiness, and headache. The most common source was obtained from friends. 36% of the patients believed they had enough understanding of medical cannabis, while 68.5% agreed that it is appropriate to use in Thailand. In cancer patients, the Edmonton Symptom Assessment System (ESAS) subscale for lack of appetite, anxiety, and subscale for a brief pain inventory (BPI) for enjoyment of life were higher among active users. In patients with noncancer pain, only the mood subscale BPI was lower among active users. Conclusion: Medical cannabis usage is common compared with general population in Thai patients with chronic pain and may be associated with increased pain interference and cancer-related symptoms. Nonmedical license prescription and nonmedical license cannabis products were common in Thailand.

Perceptions of the COVID-19 Vaccine and Willingness to Receive Vaccination among Health Workers in Nigeria: A Cross-sectional Study.

COVID-19 vaccine hesitancy is a major barrier to vaccine uptake, and the achievement of herd immunity is required to reduce morbidity and mortality and protect the most vulnerable populations. In Nigeria, COVID-19 vaccine hesitancy has been high, and uptake remains very low. Healthcare workers (HCWs) in Nigeria can help support public health efforts to increase vaccine uptake. This study evaluates Nigerian HCWs' acceptance and intent to recommend the COVID-19 vaccine. Cross-sectional survey among 1,852 HCWs in primary, secondary, and tertiary care settings across Nigeria. Respondents included doctors, nurses, pharmacy workers, and clinical laboratory professionals who have direct clinical contact with patients in various healthcare settings. A 33-item questionnaire was used in the study, with two of the questions focused on the COVID-19 vaccine. The responses to the two questions were analyzed using Chi-square (c2) tests and independent t-tests to determine the acceptance of the vaccine. The majority of respondents were younger than 34 years (n = 1,227; 69.2%) and primarily worked in hospitals (n = 1,278; 72.0%). Among the respondents, 79.2% (n = 1,467) endorsed the COVID-19 vaccine as a critical tool in reducing the impact of the disease, and 76.2% (n = 1,412) will accept and recommend the vaccine to their patients. The younger HCWs were more likely to endorse and recommend the vaccine to their patients. There is a moderately high COVID-19 vaccine acceptance rate among HCWs surveyed in our study. The confidence of HCWs in its use and their willingness to recommend it to their patients can provide a potentially useful element in increasing acceptance by the larger population in Nigeria.

Heated and humidified high flow therapy (HHHFT) in extreme and very preterm neonates with respiratory distress syndrome (RDS): a retrospective cohort from a tertiary care setting in Pakistan

ObjectiveTo determine the role of heated humidified high flow therapy (HHHFT) as primary respiratory support in spontaneously breathing moderate-late, very and extreme preterm neonates with respiratory distress syndrome (RDS) at...

Epidemiology and clinical features of paroxysmal hemicrania: Asystematic review and meta-analysis.

To assess the prevalence or relative frequency of paroxysmal hemicrania and its clinical features in the adult general population and among adult patients evaluated for headache in tertiary care. Paroxysmal hemicrania is a rare trigeminal autonomic cephalalgia with characteristic attacks of headache, associated cranial autonomic symptoms and signs, and an absolute response to indomethacin. Its epidemiological burden remains unknown in both the adult general population and among adult patients evaluated for headache in a tertiary care setting. Moreover, the frequencies of the clinical features associated with paroxysmal hemicrania have not been well established. A literature search of PubMed and Embase was conducted from January 1, 1988, to January 20, 2023. Eligible for inclusion were observational studies reporting the point prevalence or relative frequency of paroxysmal hemicrania or its clinical features in the adult general population or among adult patients evaluated for headache in tertiary care. Two independent investigators (M.J.H. and J.G.L.) performed the title, abstract, and full-text article screening. Each included study's risk of bias was critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Estimates of prevalence or relative frequency were calculated using a random-effects meta-analysis. The between-study heterogeneity was assessed using the I2 statistic and further explored with meta-regression. This study was pre-registered on PROSPERO (identifier: CRD42023391127). A total of 17 clinic-based studies and one population-based study met the eligibility criteria. Importantly, an overall high risk of bias was observed across the eligible studies. The relative frequency of paroxysmal hemicrania was estimated to be 0.3% (95% CI, 0.2%-0.5%) among adult patients evaluated for headache in tertiary care with considerable heterogeneity (I2 = 76.4%). No cases with paroxysmal hemicrania were identified among 1,838 participants in a population-based sample. Moreover, the most prevalent cranial autonomic symptoms were lacrimation (77.3% [95% Cl, 62.7%-87.3%]), conjunctival injection (75.0% [95% Cl, 60.3%-85.6%]), and nasal congestion (47.7% [95% Cl, 33.6%-62.3%]). Our findings suggest that paroxysmal hemicrania is a rare disorder among adults evaluated for headache in tertiary care, while its prevalence in the general population remains unknown. Further studies focusing on the clinical features of paroxysmal hemicrania are warranted.

Ab. No. 104 Navigating Pediatric Rehabilitation in Tertiary Care: Understanding Parental Challenges and Enhancing Multidisciplinary Approaches

Introduction: This study investigates the intricate landscape of pediatric rehabilitation within an international tertiary healthcare context, shedding light on experiences of parents with children engaged in rehabilitation services. Most existing research on pediatric rehabilitation primarily focuses on barriers parents of specially-abled children face within home-to-hospital contexts. However, this study fills a crucial gap by exploring the challenges within tertiary care setups, specifically addressing communication barriers, bureaucratic hurdles, and service fragmentation. Methods: Participants were parents of disabled children who have used rehabilitation services in an international tertiary care facility for at least one year. The inclusion criteria pertain to individuals using services from three or more disciplines. Face-to-face semi-structured interviews with selected mothers were used in the study. Transcription in English ensured a complete understanding of the experiences. Following hermeneutic-phenomenological principles of naive reading, structural analysis, comprehensive reading, and critical reflection, responses were coded. Result: Hermeneutic-phenomenological analysis identified pervasive communication challenges, bureaucratic complexities, and service fragmentation as major themes. Empowered parents engaged in advocacy reported more positive experiences, emphasizing the pivotal role of parental empowerment. The discussion delves into the implications of the results, emphasizing the need for interventions to address communication barriers, streamline administrative processes, and foster multidisciplinary collaboration. It also highlights the significance of parental empowerment and advocates for a patient-centric approach to optimize pediatric rehabilitation. Conclusion: This study provides essential insights into the challenges parents face navigating pediatric rehabilitation in an international tertiary care setting. Addressing communication barriers, and bureaucratic complexities, and promoting parental empowerment are identified as pivotal for enhancing rehabilitation experiences. Implication: The study suggests ways to improve service integration and create a more patient-centric framework for paediatric rehabilitation in tertiary care settings for international healthcare systems. These implications are important for policymakers, healthcare providers, and researchers.

Comparative evaluation of traditional and molecular diagnostic methods for malaria: An analysis of performance.

As we edge closer to the eradication of malaria, several methods for detecting Plasmodium species have been developed, including peripheral blood smear examination (PBS), rapid diagnostic tests (RDTs), serological evaluations, fluorescent microscopy, polymerase chain reactions (PCRs), fluorescent in situ hybridization, and flow cytometry. The suitability of these tools for routine diagnosis requires evaluation, considering both their diagnostic accuracy and cost-effectiveness. Our study compared four diagnostic techniques for malaria: PBS, quantitative buffy coat (QBC), RDT, and PCR. We used PCR as the benchmark standard and statistically assessed the performance of PBS, QBC, and RDT against PCR in detecting malaria. Adopting a prospective observational approach, we collected blood samples from 117 patients exhibiting the symptoms suggestive of malaria. The findings from our study showed that PBS had a positivity rate of 93.4%, with a 95% confidence interval (CI) of 0.881-0.987, indicating reliable results for a similar population. The QBC assay demonstrated an elevated positivity rate of 96.7% with a solid 95% CI of 0.930-1.000. Although the RDT had a slightly lower rate of 92.4%, it still delivered dependable results, presenting a significant 95% CI of 0.868-0.980, ensuring a robust diagnostic performance compared to PCR. PCR is a reliable test when the identification of the specific species is inconclusive. Conversely, the commonly used PBS occasionally overlooks positive malaria cases due to the specialized skills needed for accurate reading. The cost-effective RDT is feasible for field operations without the need for expert knowledge. However, it fails to differentiate between old and new infections. Meanwhile, the QBC test, known for its sensitivity and speed, can be consistently employed for malaria diagnosis in a tertiary care settings.

Evaluating Antibiotic Treatment Guideline Adherence to Ongoing Antibiotic Stewardship in a Tertiary Care Setting: A Retrospective Observational Study.

Antimicrobial resistance (AMR) is widely regarded as an increasing threat to global public health. Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The present study aimed to assess physician's adherence to hospital antibiotic treatment guideline recommendations in Nepal and determine predictive variables with a significant association. This was a retrospective, monocentric observational review to investigate the adherence to endorsed guidelines using the medical records of adults admitted to the hospital with a diagnosis of urinary tract infection (UTI), pneumonia, or skin and soft tissue infection (SSTI) from January 2018 to December 2019. Of the 2,077 medical records that were reviewed (954 UTI, 754 pneumonia, and 369 SSTI), 354 (17%) met the study inclusion criteria, which included 87 UTI, 180 pneumonia, and 87 SSTI patients. Among eligible patients with antibiotic prescriptions, the following were adherent to guideline recommendations: 33 (37.9%) UTI, 78 (43.3%) pneumonia, and 23 (26.4%) SSTI. The overall extent of adherence to hospital antibiotic treatment guidelines for the use of antibiotics among adult inpatients diagnosed with these common infections was 37.9%. Patients who received ceftriaxone (OR = 2.09, 95% CI = 1.18-3.71, p=0.012) and levofloxacin (OR = 4.63, 95% CI = 1.30-16.53, p=0.018) had significantly higher adherence to treatment guidelines. This study revealed a low adherence rate despite the availability of updated guidelines for antibiotic prescriptions. The findings confer an urgent need to confront antibiotic prescription patterns in such tertiary care centers for tailored interventions to improve adherence to antibiotic guidelines.

Patterns and Management of Upper and Lower Limb Fractures in Pediatric Patients Presenting to the Pediatric Emergency Department at a Tertiary Care Hospital: A Retrospective Study in Riyadh, Saudi Arabia

Background: Pediatric fractures constitute a significant public health concern globally, with varying implications on healthcare systems and affected individuals. While global trends have been well-documented, research in Saudi Arabia, particularly within a tertiary care setting, continues to contribute significantly to the understanding of this issue. Methods: This retrospective chart review, conducted over a four-year period from 2019 to 2023, analyzed pediatric fracture cases at a major hospital in Riyadh, Saudi Arabia. The study included 286 children aged 14 years or younger presenting with new fractures. Data on demographics, fracture types, anatomical locations, and treatment modalities were extracted from electronic health records and analyzed using IBM SPSS Statistics Version 25. Results: The study found a higher incidence of fractures in males, particularly increasing after age 8, with radial, metatarsal, and humeral fractures being the most common. Radial fractures, especially distal radial fractures, were predominant, and the majority were treated with casts and backslabs. Metatarsal fractures were more prevalent in males, predominantly treated with backslabs, while humeral fractures were more common in females, mainly treated with backslabs and slings. Conclusion: This study provides essential insights into pediatric fracture patterns in a Saudi Arabian tertiary care setting, echoing global trends and underscoring the need for conservative treatment approaches. Future research should expand on long-term outcomes, broader demographic factors, and the impact of comorbidities to enhance pediatric fracture management and healthcare strategies.

Factors contributing in non-adherence to inhaler therapy among patients with obstructive airway diseases in a tertiary care setting

Medication adherence is crucial for managing respiratory conditions effectively. This study aimed to explore the multifaceted factors influencing medication adherence among patients with respiratory illnesses. A comprehensive analysis was conducted, focusing on patient demographics, characteristics, clinical factors, beliefs about medications, and reasons for irregular medication use. A cross-sectional design assessed medication adherence and beliefs in COPD patients through questionnaires. The study identified a middle-aged population (average age: 48.5 years) with high smoking prevalence, aligning with established COPD risk factors. Medication adherence scores indicated moderate levels (average ARMS score: 62.7), but with significant individual variation. Financial burden emerged as the primary barrier, with nearly 28% of participants reporting cost-related non-adherence, particularly impacting lower socioeconomic status (SES) patients. Social stigma regarding respiratory illness, a novel factor, influenced adherence, especially in urban areas (19.8% reported experiencing stigma). The study found a positive correlation between positive medication beliefs and adherence, highlighting the importance of fostering trust in treatment effectiveness. Additionally, a confirmed COPD diagnosis and specific inhaler devices (DPI, PMDI with spacer) were linked to improved adherence. This study identified significant factors impacting medication adherence in COPD, including financial constraints, social stigma, medication beliefs, and inhaler device type.

Self-esteem and psychosocial stress among the persons with substance use disorder attending a tertiary mental health care setting

Self-esteem and psychosocial stress among the persons with substance use disorder attending a tertiary mental health care setting