Tertiary Health Research Articles

Comparative Assessment of Job Stress among Junior Doctors in Tertiary and Secondary Health Facilities in Benin City

Comparative Assessment of Job Stress among Junior Doctors in Tertiary and Secondary Health Facilities in Benin City

Clinical Correlation of Dengue Strains on the Basis of Seroprevalence in a Tertiary Care Hospital.

Dengue viruses are icosahedral in structure and contain a single-stranded positive- sense RNA sequence of 11kb inside their capsid protein, which belongs to Flaviviridae family, genera Flavivirus. DENV a vector dependent viral virus which presents a severe health danger worldwide. Objective: To study the different strains of dengue on the basis of serotypes Methods: A cross sectional study was conducted at a tertiary care hospital Lahore, Primary and Secondary Health Department Lahore. The blood samples of 103 patients were collected from non-random sampling technique to check out the data of different parameters such as WBC’s & Platelets through Complete Blood Count (CBC), NS1 from ELISA and nature of dengue strains through RT- PCR. Results: Of 103 positive dengue patients, there were n= 58 (33.63 ± 16.54) males and n=45 (40.64± 16.00) females. Data for the total patients is subjected to statistical differences by Paired t-test (*p<0.05). The overall percentage of dengue strains within the sample population was DENV-2 (96%), DENV-3 (2%), DENV-1 & DENV-2 (2% in females, nil in males) DENV-2 & DENV-3 (2% both in males and females). According to clinical parameters the correlation of ELISA results with WBC’s was significant (<0.0001) as well as ELISA and platelets of patients had no correlation with each other. Conclusions: Leukopenia and Thrombocytopenia is found particularly in DENV-2 strain as well as we found two different strains in two patients. So, our research work is helpful for the identification in genetic similarity of dengue strains.

Health systems\u2019 preparedness to provide post-abortion care: assessment of health facilities in Burkina Faso, Kenya and Nigeria

BackgroundIn many parts of sub-Saharan Africa, access to abortion is legally restricted, which partly contributes to high incidence of unsafe abortion. This may result in unsafe abortion-related complications that demand long hospital stays, treatment and attendance by skilled health providers. There is however, limited knowledge on the capacity of public health facilities to deliver post-abortion care (PAC), and the spread of PAC services in these settings. We describe and discuss the preparedness and capacity of public health facilities to deliver complete and quality PAC services in Burkina Faso, Kenya and Nigeria.MethodsA cross-sectional survey of primary, secondary and tertiary-level public health facilities was conducted between November 2018 and February 2019 in the three countries. Data on signal functions (including information on essential equipment and supplies, staffing and training among others) for measuring the ability of health facilities to provide post-abortion services were collected and analyzed.ResultsAcross the three countries, fewer primary health facilities (ranging from 6.3–12.1% in Kenya and Burkina Faso) had the capacity to deliver on all components of basic PAC services. Approximately one-third (26–43%) of referral facilities across Burkina Faso, Kenya and Nigeria could provide comprehensive PAC services. Lack of trained staff, absence of necessary equipment and lack of PAC commodities and supplies were a main reason for inability to deliver specific PAC services (such as surgical procedures for abortion complications, blood transfusion and post-PAC contraceptive counselling). Further, the lack of capacity to refer acute PAC cases to higher-level facilities was identified as a key weakness in provision of post-abortion care services.ConclusionsOur findings reveal considerable gaps and weaknesses in the delivery of basic and comprehensive PAC within the three countries, linked to both the legal and policy contexts for abortion as well as broad health system challenges in the countries. There is a need for increased investments by governments to strengthen the capacity of primary, secondary and tertiary public health facilities to deliver quality PAC services, in order to increase access to PAC and avert preventable maternal mortalities.

Managing oral health care and prevention: The experience of Aboriginal and Torres Strait Islanders living in a rural community in Queensland, Australia.

ObjectiveTo understand the experience of rural Aboriginal and Torres Strait Islanders in engaging with oral health care services and programs in order to support the development of oral health services and prevention programs that better meet their needs.DesignThe study used a qualitative research design, which aims to describe participants' lived experience of engaging with oral health services and prevention programs in a rural Aboriginal and Torres Strait Islander community. Focus group discussions and in‐depth interviews were conducted with 27 participants. The 15 transcribed discussions were analysed using a 6‐step phenomenological process.SettingA rural community in Queensland, Australia, with a predominantly Aboriginal population.ParticipantsParticipants were purposively recruited from established health and community groups.Main outcomeSystem‐level barriers to accessing and engaging with oral health services and prevention influence how communities manage oral health and seek treatment.ResultsThe study identified 4 main themes describing the community's experience: service location and the efforts required to access oral health services; the financial burden of accessing oral health care and practising prevention; lack of confidence in oral health services; and the avoidance or delaying of accessing care for dental problems. Results confirmed a high burden of oral disease but limited attendance at an oral health facility and difficulties engaging in preventative oral health behaviours. Treatment seeking was usually instigated by the experience of pain and typically at a tertiary health facility.ConclusionAboriginal and Torres Strait Islanders in rural communities experience a high burden of oral disease but have limited engagement with oral health services. This is associated with system‐level barriers to accessing and engaging with oral health services and prevention.

Indications and risk factors for hospitalization in patients with primary Sjögren syndrome: experience from a tertiary center in Turkey.

ObjectiveIn this study, it was aimed to reveal the hospitalization reasons for patients diagnosed with primary Sjögren syndrome (pSS) and potentially associated factors in a tertiary health center.MethodOne hundred and sixty-three pSS patients who regularly attended their follow-ups between January 2010 and May 2021 were included in the study. These patients’ reasons for hospitalization, duration of hospitalization, and numbers of presenting to the hospital were recorded. The demographic, clinical and serological characteristics of the hospitalized and non-hospitalized patients were compared.ResultsHospitalization occurred in 22.7% of the patients, and the total number of hospitalizations was 79. The hospitalization incidence density rate was 6.21 per 100 patient-years. The most frequently encountered reason for hospitalizations was pSS-related organ involvement (44.3%). Infections (17.7%), malignancy (16.5%), endocrine, and various other reasons were the other indications for hospitalization. While male sex (p = 0.005), the presence of extra-glandular involvement (p < 0.001), and interstitial lung disease (p = 0.001) were more common in the hospitalized patients, anti-nuclear antibody positivity was less frequent (p = 0.032). The usage rate of hydroxychloroquine (p = 0.022) was lower in the hospitalized patients, whereas the use of glucocorticoids (p < 0.001) and azathioprine (p = 0.005) was more frequent. The multivariable analyses revealed a relationship between extra-glandular involvement (OR: 4.57 [1.05–19.84], p = 0.043), glucocorticoid use (OR: 3.23 [1.13–9.21], p = 0.028) and hospitalization.ConclusionpSS-related system involvement and infection accounted for the majority of hospitalizations of the pSS patients. The presence of extra-glandular involvement and glucocorticoid use were found to be associated with hospitalization.Key Points • pSS-related system involvement and infection accounted for the majority of hospitalizations of pSS patients.• The presence of extra-glandular involvement was found to be associated with hospitalization.

Trends in bacteriological spectrum and antibiotic susceptibility on blood culture in pediatric cardiac patients at a tertiary childcare health facility.

Objectives:To report trends in bacteriological spectrum and antibiotic susceptibility on blood culture in admitted pediatric cardiac patients at a Tertiary Childcare Health Facility.Methods:This cross-sectional observational study was conducted at the Department of Pediatric Cardiology, The Children’s Hospital and Institute of Child Health, Multan from January 2018 to December 2020. We included admitted children of both genders aged one day to 12 years and whose blood sample was sent for blood culture analysis. Gram staining was used to identify isolated organisms. Distribution of types of strains, bacterial isolates and antimicrobial sensitivity/resistance were recorded.Results:During the study period, a total of 772 blood samples were sent for blood culture analysis, out of which, 154 (19.9%) turned out to be positive. Mean age was noted to be 1.12±2.3 years. Gram negative rods were the most frequently noted strains found among 69 (44.8%) cases. A total of 131 strains were found to have bacterial isolates. Salmonella typhi was the commonest bacterial agent noted in 30 (19.4%) cases while Coagulase Negative Staphylococcus in 18 (11.7%) and acinetobacter baumannii in 16 (10.4%).Conclusion:Blood culture positivity rate was found to be 19.9%. Gram negative rods were the most frequently noted strains. Salmonella typhi, Coagulase Negative Staphylococcus and Acinetobacter baumannii were found to be the commonest bacterial isolates responsible. Routinely used antibiotics like Ciprofloxacin, Cefotaxime, Ceftizadime and Ampicillin were found to have high rates of resistance against most commonly found bacterial isolates.

Abstract 9474: Clinical and Epidemiologic Characterization of Infective Endocarditis in a Predominant Hispanic Community of the United States - Mexico Border

Introduction: We aimed to characterize the clinical, epidemiological and echocardiographic features of infective endocarditis (IE) in the United States (US)-Mexico border population. Methods: A retrospective cohort design of all patients with diagnosis of IE in a tertiary university health system in El Paso, Texas. The primary outcome was a composite of death, stroke, other embolic events or heart failure. Patients were risk-stratified using the Simplified Risk Score Calculation (scores &gt;=5 were considered high risk). Kaplan-Meier method was used to evaluate time to outcome which was subsequently compared between groups by Wilcoxon log-rank test and a priori multivariable proportional hazard model. Results: Final analytic sample was 155 patients with a median follow-up of 2.21 years. Prosthetic valve IE composed 10.3% of our patients. The most prevalent organism was S. aureus (35.5%), followed by streptococcus species (20.0%). Echocardiographic features of severe endocarditis (indication of surgery) were present in 123 patients (79.5%). Surgical treatment occurred in 23.2% of patients, and the median time to surgery was 12 days. A total of 53% of patients were in the high-risk score category and these patients were more likely to have a conservative, medical treatment compared to those with a low to intermediate risk score (62.2% vs 37.8%, p&lt;0.01). The composite outcome was met by 47.5% of our cohort. Median time to event was 69 days. In multivariable analysis, factors associated with increased risk of the composite outcome were high-risk score category (HR 2.6, 95%CI 1.6-4.3, p&lt;0.01), Medicaid (HR 3.2, 95%CI 1.6-6.2, p&lt;0.01) and uninsured status (HR 2.3, 95%CI 1.3-4.3, p&lt;0.01). Conclusion: In a predominant Hispanic community of the US-Mexico border, high-risk IE patients were more likely to experience the composite outcome, and less likely to get surgical treatment. In multivariable analysis, uninsured patients had a significant higher risk of readmission, embolic events, heart failure or death.

Abstract 10839: Two-year Follow-up Of Patients With Chronic Ischemic Heart Disease In A Specialized Center In Brazil

Introduction: Incidence of cardiovascular events in patients with chronic ischemic heart disease (CIHD) may vary significantly between regions. Although populous, Brazil is often underrepresented in international registries. Objective: This study aimed to describe the quality of care and 2-year incidence of cardiovascular events and prognostic factors in CIHD patients in a tertiary public health care center in Brazil. Methods: Patients with CIHD, denoted as previous revascularization, myocardial infarction (MI) or stenosis &gt; 50% in at least one epicardial coronary artery, were enrolled and followed for at least 2 years. Main endpoint was the composite of MI, stroke or death. We also evaluated prescription, symptoms and laboratory records. Results: 625 patients with mean age 65 (±9.6) years, 33.3% women, were included. Previous MI was present in 59.8%, CABG in 26.8%, and percutaneous coronary intervention in 40.6%. Diabetes was prevalent in 48.6%, high blood pressure in 83.1%, and chronic kidney disease (creatinine clearance &lt; 60 mL/min) in 34.7%. Residual coronary anatomy was known in 266 patients, of whom 29.3% had multivessel disease, and 11.7% had lesion in the left main artery. At a median follow-up (FU) of 881 days, we recorded 37 events of primary composite endpoint, with 2-year estimate event incidence of 7.05%. Age (HR per 10 years 1.61, 95%CI 1.32-1.97), stroke (3.65, 1.48-9.00) and LDL-cholesterol (1.23, 1.14-1.33) were the main prognostic factors in multivariate analysis. The participants experienced relief of angina symptoms based on Canadian Cardiovascular Society (CCS) scale (baseline vs. FU respectively): 65.7% vs. 81.7% were asymptomatic, 13 vs. 7.2% CCS1, 17.1 vs. 8.3% CCS2, 4.2 vs. 2.9% CCS3 or 4 (p &lt; 0.001). Analysis of therapeutic goals identified better quality of medication prescription, defined as the use of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus statin and any antithrombotic agent: 65.8% vs. 73.6% (p&lt;0.001) comparing baseline with FU. On the other hand, there was no improvement in LDL or blood pressure control. Conclusion: This study shows that CIHD patients had a 2-year incidence of the primary composite endpoint of 7.05%, LDL was the main modifiable risk factor of worse prognosis.

120 The Experience of Housing Need Amongst Families Caring for Children with Medical Complexity: A Qualitative Study

Abstract Primary Subject area Complex Care Background Caregivers of children with medical complexity (CMC) face many financial, social and emotional stressors related to their child’s medical condition(s). Previous research has demonstrated that financial stress among this population can have an impact on their housing situation. Families of CMC may face other unique housing challenges such as disability accommodations in the home and housing space and layout. Objectives The primary aim of this study was to explore families’ perspectives and experiences of housing need, and its relationship to their child’s health status as it pertains to CMC. Design/Methods We conducted a qualitative study using semi-structured interviews to identify themes surrounding families of CMC’s experiences of housing need. Parents of CMC were recruited through purposive sampling from the Complex Care Program at a tertiary pediatric health sciences centre. Recruitment ceased when thematic saturation was reached, as determined by consensus of the research team. Interviews were recorded, transcribed verbatim, coded, and analyzed using thematic analysis. Results Twenty parents completed the interview, of whom 89% were mothers and 42% identified a non-English language as their first language. Two major themes and five subthemes (in parentheses) were identified: 1) the impact of health on housing (housing preferences, housing possibilities, housing outcome as a trade-off) and 2) the impact of housing on health (health of the caregiver, health of the child). Some parents reported that their child’s medical needs resulted in specific preferences regarding the location and layout of their home. Parents also indicated that their caregiving role often affected their income and home ownership status, which in turn, affected their housing possibilities. Thus, the housing situation (location and layout of the home) was often the result of a trade-off between the parent’s housing preferences and possibilities. Conclusion Housing is a recognized social determinant of health. We found that among CMC, health also appears to be a significant determinant of housing as families reported that the health of their child impacted their housing preferences and the options available to them (possibilities). To support the health of CMC and their families, policies targeting improved access to subsidized housing, improved sources of funding and regulations allowing families who rent to make accessibility changes are vital. Future research should investigate the impact of household income on housing need and identify interventions to support appropriate housing for CMC.

Introducing the Needs in Recovery Assessment (NiRA) into clinical practice: protocol for a pilot study investigating the formal and systematic assessment of clinical and social needs experienced by service users at a tertiary, metropolitan mental health service

BackgroundThe Needs in Recovery Assessment (NiRA) is a newly developed needs assessment tool, designed to identify the needs of people recovering from mental illness. This tool has been evaluated outside of the clinical context for validity and reliability. The aim of this study is to introduce the NiRA into clinical practice and to evaluate the value of the NiRA as an adjunct to service delivery from the perspectives of stakeholders and to evaluate the barriers and facilitators of embedding the NiRA in a mental health service.MethodsThe establishment of the NiRA in a tertiary mental health unit over a 6-month period will be evaluated using a multi-methods approach. Quantitative data will be collected using the NiRA itself and the Recovery Self-Assessment (RSA). Face-to-face interviews with service users and clinicians will be conducted following the initial completion of the NiRA, with a follow-up interview for service users on discharge from the service. Regular informal follow-up with clinicians throughout the study will support the introduction of the NiRA. Descriptive statistics will be used to analyse quantitative data, and descriptive qualitative methods will be used to analyse data from interviews.DiscussionAligning mental health services with recovery-oriented frameworks of care is imperative. The NiRA is a tool that has been designed in accordance with recovery principles and may assist services to be more recovery-oriented. If the NiRA is able to achieve the aims and objectives of this project, a larger implementation study will be conducted.Trial registrationAustralian and New Zealand Clinical Trial Registry (ANZCTR), ACTRN12621000316808

Analyzing of implementation maternal audit program in community health center: a qualitative study

Background: Maternal audits are part of quality control that is routinely carried out and aims as an essential learning material in evaluating maternal services in an area so that the expected outcome is a decrease in maternal mortality in an area. The maternal audit program that is carried out will undoubtedly benefit health facilities that provide services in the maternal sector, such as primary, secondary, and tertiary health facilities.Methods: This study used a qualitative case study method with a purposive sampling technique. The data collection technique was carried out by interviewed using the in-depth interview method, and triangulation was carried out using observation and document review.Results: The community health center has contributed to implementing maternal audits, starting from the data collection process, participating in district audit forums, and implementing the recommendations. Four factors influence the implementation of the maternal audit program at the community health center in reducing maternal mortality, namely the knowledge of health workers, the involvement of health workers in the community health center in the audit process, the recommendations for the results of the audit process and the implementation of follow-up on the results of the audit recommendations at the community health center.Conclusions: The maternal audit program can reduce maternal mortality and improve the maternal and child service system at the community health center level, although there are still several obstacles in implementing the recommendations of the audit results.

Evaluation of the Mortality and Morbidity of Premature Infants During a Five-Year Period in the Neonatal Intensive Care Unit.

BackgroundPremature birth is the most important cause of perinatal mortality and morbidity. This study aimed to evaluate mortality and morbidity in premature infants over a five-year period at a university hospital providing tertiary intensive care health services.MethodologyAll premature infants born alive at ≤37 gestational weeks and hospitalized in neonatal intensive care units were included in the study. Data such as maternal and perinatal characteristics, characteristics of the newborn, respiratory and related problems, neonatal morbidities, and causes of death were retrieved retrospectively from file records.ResultsA total of 1,780 patients (53.7% male and 46.3% female) were included in the study. High-risk pregnancy was present in 55% of women. Respiratory distress syndrome (RDS) developed in 50.4% of the patients, intracranial hemorrhage in 8.4%, and necrotizing enterocolitis in 5.6%. Mortality was observed in 20.9% of the patients. The most frequent cause of death was RDS and related complications (11.8%), and 66.4% of mortality occurred during the early neonatal period, that is, the first 24 hours of life.ConclusionsHigh-risk pregnancies were significantly associated with neonatal morbidity and mortality. Therefore, the management of maternal health factors should be the priority for controlling neonatal mortality.

Reflective practice in action: an account of psychotherapists’ experiences in group-work training

ABSTRACT The importance of reflective practice in psychotherapy has long been acknowledged. However, there is a paucity of work that elucidates the process of reflection in the context of therapist development. The current study employs reflexive action research for a supervised group-work in a tertiary mental health hospital carried out by two trainee therapists. Group-work intervention was chosen because it was viewed as a cost-effective method given the client-clinician ratio. It also provided a richer context to boost reflective practices in various interactions- with the participants, the supervisor and the co-facilitator. Reflective notes and discussions among trainees, supervisor, as well as verbatim feedback from clients were the sources of information. The paper describes this process of reflection as well as the critical events in the process that posed a challenge for the therapists and opportunities for reflection in these interactions during the course of therapy. The paper, with its reflective stance, has implications for promoting and documenting reflective practice in psychotherapy training using different methods and modalities.

Demographic Variables, Co morbidities and Clinical Presentation of Spontaneous Intracerebral Hemorrhage (ICH) in a tertiary Care Hospital in Bangladesh: A Cross Sectional Study

Spontaneous intracerebral hemorrhage (ICH) has remained the least treatable form of stroke despite recent improvements in medical treatment. Treatment usually supportive and medical such as ventilatory support, blood pressure reduction, osmotherapy, fever control, seizure control and nutritional support and treatment of co morbidconditions. This study was carried out to see demographic variability, clinical presentation, causes and outcome of spontaneous intracerebral hemorrhage. Methods and Materials: This was a cross sectional observational prospective in study on 50 spontaneous ICH patients admitted in Medicine department of Khulna Medical College Hospital from November 2020 to April, 2021. Result: The study showed that spontaneous ICH was most common in between 41-70 years. Their age frequency were 14 (28%) in 41-50 years, 15 (30%) in 51-60 years, 12 (24%) in 61-70 years, 5 (10%) in 71- 80 years and 4 (8%) in more than 81 years age group. Among the patients, 64% (32) were male and 36% (18) were female. Headache, vomiting and seizure was present in 28, 27 and 8 patients respectively. Diabetes mellitus was present in 22% (11) of patients and absent in 78% (39) patients. Range of blood pressure at presentation –&lt;140/90 in 24%(12), Systolic BP:140-159/Diastolic BP:90-99 (mm Hg) in 10%(5), Systolic BP:160-179/Diastolic BP:100-109 (mm Hg) in 22%(11),Systolic BP:180 or more/Diastolic BP:110 or more (mm Hg) in 44%(22) patients. Dyslipidemia was present in 30% (15) &amp; absent in 70% (35) patients. Glasgow Coma Scale Score was 8 or less in 42% (21) and 9 or more in 58% (29) patients. Conclusion: Spontaneous ICH is common in Indian subcontinent. As our study showed that death occur due to ICH itself, associated co morbidities or complications, facilities for stroke care unit, high dependency unit and Intensive care unit is required in tertiary care health settings. Keyword: Spontaneous; Intracerebral Hemorrhage; Osmotherapy; Seizure; Glasgow Coma Scale

Outcomes for Indigenous Children in Care Presenting at a Specialist Child and Youth Mental Health Service

ABSTRACT Limited evaluation research has been conducted on the effectiveness of mental health services and intervention provided to Indigenous children and young people (C&YP) in care. The primary objective of the study was to examine the difference in functioning and mental health outcomes of C&YP in care at a specialist mental health service for Indigenous and non-Indigenous C&YP. Of the total 259 C&YP included in this study, 38.2% (N = 99) were Indigenous. Two measures were used to examine C&YP’s mental health and functioning. Indigenous consumers showed a significantly greater improvement in antisocial behaviour, emotional symptoms, and peer relationships compared to non-Indigenous consumers at discharge from the program. The findings of this study provide support for the program’s therapeutic intent to be a culturally supportive tertiary level mental health service for vulnerable C&YP in care. IMPLICATIONS Equivalent outcomes for Indigenous and non-Indigenous consumers provide support for the program’s intent to be a culturally supportive and safe tertiary level mental health service for vulnerable children and young people in care. Further research is needed to determine the key components of cultural consultation that are advantageous for consumers, care providers, and their families.

Clinical efficacy of apatinib as a second-line treatment for advanced pancreatic cancer in a Chinese tertiary cancer health facility

Purpose: To study the effectiveness and safety of apatinib as second-line treatment for advanced pancreatic cancer (APC) in a Chinese tertiary cancer hospital.&#x0D; Methods: Two groups of APC patients who received treatment with single-agent or two-drug combination of gemcitabine-based first-line therapy (50 per group) in The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing were assessed. The study group received apatinib at or above the second line treatment, while the control group was treated with second-line chemotherapy, which was different from first-line single-drug chemotherapy. Patients received treatments until there was improvement in their conditions, or until adverse reactions became intolerable. Complete remission (CR), partial remission (PR), disease stabilization (SD), disease progression (PD), incidence of adverse reactions, and progression-free survival (PFS) of the patients were recorded.&#x0D; Results: The number of PR cases in APC patients who received apatinib as second-line therapy, and the number of PD patients were higher than the corresponding populations in the control group (p &lt; 0.05). Treatment effectiveness was significantly higher in study group patients than in control subjects (p &lt; 0.05). However, the incidence of adverse reactions was lower in the study group than in control group. Median PFS in the study group (5 months) was significantly higher than that of the control group (4.1 months, p &lt; 0.05).&#x0D; Conclusion: The clinical efficacy of apatinib as second-line treatment for advanced pancreatic cancer is higher than that of the single drug. Apatinib is associated with low incidence of adverse reactions which prolongs PFS. Thus, apatinib has potentials for the clinical management of pancreatic cancer.

#46: Changes in the hospital admission profile in a Peruvian National Tertiary Children’s Hospital during the First Year of Covid-19 Pandemic

Abstract Background During the first year of the current COVID-19 pandemic, health systems around the world have faced the challenge of maintaining health services for patients with non-communicable diseases, despite the logistical and personnel constraints. Despite SARS-CoV-2 infection is usually more benign in children, there is limited information about how this pandemic affected their healthcare at a population level. Methods We performed a cross sectional study at the Peruvian National Children′s Hospital San Borja, which is a 312-bed tertiary National referral health center, in Lima. We include all hospital admissions during 2020, with respect to the two previous years. We defined hospital admission as the permanence at the hospital for more than 24 hours irrespectively of patient′s initial destination (emergency observation unit, regular medical floor, or intensive care unit). We described demographic characteristics among hospitalized patients and compared them between 2018–19 and 2020 using standard descriptive tests. We use the International Classification of Diseases 10th (ICD-10) codes from the electronic patient registration system to ascertain three major non-communicable conditions: congenital cardiopathies, hematooncological disorders and burns non-communicable conditions. We set level for statistical significance at 0.05. Results There were 11635 patients admitted during 2018–19 period and 3480 patients admitted during 2020. The average daily hospital admission during 2018–19 was different compared to 2020 (15.9±6.1 vs. 9.6±6.0, p&amp;lt;0.001). There were also differences in the frequency of the gender (male 55.1% vs. 58.9%, p&amp;lt;0.001) and if the patient′s place of origin was outside Lima (49.0% vs. 41.1%, p&amp;lt;0.001). Among hospitalized patients, 3036 presented one of the three non-communicable conditions during the baseline period and 871 during 2020. There was a significant difference between the distribution of hospitalization among patients with one of the three non-communicable conditions (p&amp;lt;001), towards a decrease in hospitalizations due to congenital heart disease, and an increase in the hospitalizations due to burns. Conclusion During the first year of COVID-19 pandemic, there was a decrease in the number of hospitalizations of children with non-communicable conditions compared to the previous two years. It will be important to consider the implementation of public health policies aimed to increase accessibility to health care for children with non-communicable conditions during the coming months of the pandemic in Peru.

Ophthalmological knowledge of Family Health Network physicians working as first care providers in Brazil.

First care providers working in the Brazilian Unified Health System are often physicians from the Family Health Program. Their knowledge on ophthalmology could indicate whether there is a need for training to decrease ophthalmological demands to secondary or tertiary health levels. A cross-sectional observational study based on an electronic questionnaire was conducted to evaluate the ophthalmological knowledge of Family Health Program physicians working at the VI Regional Health Department, Sao Paulo, Brazil. All Family Health Program physicians from this regional health department were invited, and the study included those who responded to the full questionnaire (115 physicians). The data were evaluated using descriptive analysis. There was no difference in the ophthalmological knowledge between sexes or in relation to undergraduate schools. Only 20% of the interviewees were specialized in Family and Community Medicine, which did not influence the number of correct answers. Only 22 (19.1%) physicians reported having enough knowledge about the main eye disorders, and 82 (71.3%) physicians considered themselves capable of treating ophthalmological emergencies. However, acute glaucoma was recognized by only 51 (44.3%) physicians, and eye perforations could only be handled by 65 (56.5%) of them. In addition, only 47 (40.9%) participants correctly answered that congenital cataracts should be operated right after diagnosis. Family Health Program physicians working as first care providers in the Health System in Brazil presented poor ophthalmological knowledge. Providing training on ophthalmology may improve the ophthalmological care at the primary level within SUS and reduce the case demands at other healthcare levels.

Epidemiology of Mycotic Infections: Experience From A Tertiary Care Center Of Uttarakhand, India

Introduction: The overall changing epidemiology of fungal infections in the current scenario isbecause of an increase in immunocompromised population including cancer patients, Humanimmunodeficiency virus (HIV)-infected patients, transplant receipts, and prolonged hospitalizationwith overuse of antimicrobial agents. These infections are challenging to diagnose and subsequentlymanage as their clinical symptomatology often mimics other common diseases like tuberculosis.Rapid diagnosis is limited and culture is often delayed due to slow growth rates of the causativeagents. Objective: This is a retrospective study to know the spectrum and burden of mycoticinfections in a tertiary care hospital. Methods: All samples collected from clinically suspected casesof fungal infections were sent to the Microbiology department over one year. The common specimensreceived were respiratory samples, scrapings from cornea, skin, and nail. All samples were firstobserved under direct microscopy using Potassium hydroxide (KOH) examination for the presence offungal elements and Gram stain for yeasts. India Ink examination was performed for sterile fluids.Fungal culture was done on Sabouraud's dextrose agar. Result: A total of 900 samples from variousdepartments were included, KOH examination was positive for 380 samples (42%) and fungalgrowth was obtained in 144 samples (16%). Rare fungi like Trichosporon dohaense (blood culture),Cladophialophora bantiana (brain abscess), Scedosporium apiospermum and Candida auris (bloodculture) were also isolated. Conclusion: Similar studies are needed to estimate the actual burden ofthe fungal infections in tertiary care health facilities, to help decrease the morbidity and mortalityassociated with underdiagnosed mycotic infections.

A study and evaluation of cutaneous adverse drug reaction in the patients attending dermatology department of tertiary care teaching hospital in Eastern Uttar Pradesh

Background: Cutaneous adverse drug reactions (CADRs) are most frequently reported type of ADRs and can be caused by variety of drugs. The clinical patterns of adverse cutaneous drug reactions and the drug responsible for them is changing every year due to the emergence of newer molecules and changing trends in the use of drugs.Methods: This was a prospective, cross-sectional and observational study done for a period of 6 months to evaluate the clinical pattern of CADRs and their causative drugs in the tertiary health care.Results: Over all 55 patients were detected with cutaneous adverse drug reaction. The majority of CADRs were in the age group of 18-35 years (63.46%). Fixed drug eruptions (FDE) being the most common adverse cutaneous drug reaction (34.68%) followed by maculopapular rash (23%), NSAIDs being the most common, followed by antimicrobial agents.Conclusions: Knowledge of these drug eruptions, the causative drugs are essential for the clinicians and implementing the ADRs reporting and monitoring system, one can promote drug safety and better patients care, among health care professionals.