Tertiary Level Hospital Research Articles

Abstract Su1205: The Effect of Targeted Temperature Management on Five-Year Mortality in Comatose Out-of-Hospital Cardiac Arrest Survivors: A Real-World Experience

Background: Hypothermia-Induced Targeted Temperature Management (TTM) is a neuroprotective treatment after the return of spontaneous circulation (ROSC) in comatose survivors of out-of-hospital cardiac arrest (OHCA). However, its effectiveness in all patient subpopulations is debated. While short-term survival has been well studied, the impact of TTM on long-term survival is still unknown. Methods: In a prospective cohort study, 98 comatose survivors of non-traumatic OHCA were recruited from four tertiary-level hospitals in Buffalo, Western New York and followed up for five years. Patients with active cancer, infection, cardiac pathology or surgery in three-month prior to presentation, were excluded. Cardiac arrest characteristics, demographics, comorbidities, and therapeutic interventions were recorded. According to TTM protocols, a target body temperature of 33°C was reached and maintained for 24 hours using either an intravascular cooling catheter or a surface cooling system. This was followed by gradual controlled rewarming over 12-24 hours to normothermia. Factors associated with the receipt of TTM were determined. The effect of TTM on five-year survival was studied using cox-regression analysis. Results: Among comatose patients with mean age of 60.1±14.9 years, 49% received TTM. Females were significantly less likely to receive TTM (35.1% vs 59.3%, p=0.021). In TTM group, the time to ROSC was significantly longer: median [IQR] 14.5 mins (5-19.7) vs 20 mins (12-27), p=0.018. TTM group was more likely to have a history of coronary artery disease (CAD) (12.5% vs 35.4%, p=0.009). Overall, 5-year mortality did not differ significantly between TTM vs. non-TTM: 72.9% vs 66.0%, (HR: 1.134, 95% CI: 0.705-1.826, p=0.603) in univariate and multivariate Cox-regression analysis (Table 1). Conclusion: While females are less likely to receive TTM treatment, TTM is more likely to be used in patients with a longer time to ROSC and a history of CAD. The overall five-year survival remains high in both treatment groups in all eligible patients, as well as in shockable and non-shockable rhythm groups studied separately. Larger cohort studies are needed to determine the patients who may benefit most from TTM.

Pressure Injuries and the Waterlow Subscales in the Intensive Care Unit: A Multicentre Study.

Pressure injuries (PIs) impose a significant burden on patients in the intensive care unit (ICU) and the healthcare system. Assessing the risk of developing PIs is crucial for prevention. However, it is unclear whether all subscales of the Waterlow scale can be used to assess PIs risk in ICU. To assess whether all subscales of the Waterlow scale can predict PIs risk in ICU. Multicentre prospective study. A total of 18,503 patients from ICUs in 40 tertiary-level hospitals in Gansu province of China were enrolled from April 2021 to August 2023. The incidence and characteristics of PIs were recorded. Univariate Cox regression analyses were performed for each subscale as a predictor of PIs development, followed by multivariate Cox regression with covariates for each subscale separately. Out of 17,720 patients included, the incidence of PIs was 1.1%. Multivariate analysis revealed skin type (HR: 1.468, 95% CI: 1.229, 1.758), sex (HR: 0.655, 95% CI: 0.472, 0.908), advanced age (HR: 1.263, 95% CI: 1.106, 1.442), continence (HR: 1.245, 95% CI: 1.052, 1.473), tissue malnutrition (HR: 1.070, 95% CI: 1.007, 1.136) and neurological deficit (HR: 1.153, 95% CI: 1.062, 1.251) were independently predictive of PIs development for all participants. Skin type (HR: 2.326, 95% CI: 1.153, 3.010) (HR: 2.217, 95% CI: 1.804, 2.573) independently predicted PIs occurrence for high-risk and very high-risk group, respectively, while sex (HR: 0.634, 95% CI: 0.431, 0.931) and age (HR: 1.269, 95% CI: 1.083, 1.487) predicted PIs development for very high-risk group. This study found that not all subscales of the Waterlow scale are associated with the PIs development in patients in ICU, highlighting the importance of the skin type subscale in predicting PI risk across all patient groups. Nurses need to focus on patient's skin and related (moisture, pain and pressure) conditions and take measures to promote skin health and avoid the occurrence of PI. None.

Concordance between clinical diagnoses and autopsies anatomopathological findings at a tertiary-level university hospital.

A clinical autopsy is a fundamental diagnostic tool for confirming the diagnosis of diseases of public health interest. However, the clinical-pathological concordance has not been evaluated. To determine the concordance between clinical diagnoses and anatomopathological findings from autopsies conducted at a tertiary-level hospital institution. A descriptive, observational, cross-sectional, and retrospective study where we analyzed autopsy cases performed between 2015 and 2019. The variables studied were age, gender, origin, and clinical and anatomopathological diagnoses. The concordance degree was slight (κ = 0.30; 95% CI: 0.21-0.42), which coincides with internationally reported findings in healthcare institutions with a similar patient population and availability of diagnostic resources. The clinical-pathological discrepancy, as evidenced according to the Goldman et al. classification, then modified by Battle et al., was 57.3% (47/82), corresponding to major discrepancies, a value within the expected limits. The concordance between clinical diagnoses and anatomopathological findings in autopsies is slight, and the discrepancies are within the expected range. This study highlights the importance of improving clinical and syndromic diagnosis of public health interest.

Relationship between Abnormal CTG Findings and Perinatal Outcome

Background: Continuous monitoring of fetal well-being through cardiotocography (CTG) is a standard practice in antenatal care, aiming to detect and manage potential complications. However, interpreting CTG patterns requires expertise and understanding, especially in diverse clinical settings such as those in Bangladesh. Objective: To assess normal and abnormal CTG patterns and their implications for perinatal outcomes in a tertiary level hospital in Bangladesh. Methods: A cross sectional study was conducted on CTG recordings of pregnant women admitted to the antenatal unit of a tertiary level hospital in Bangladesh from January 2024 to June 2024. CTG pattern was abnormal based on established criteria. Perinatal outcomes including fetal distress, neonatal outcomes, and obstetric interventions were recorded and analyzed in relation to CTG findings. The aims of the study were to evaluate the abnormal cardiotocography (CTG) patterns during the antenatal period and their impact on perinatal outcomes at a tertiary level hospital in Bangladesh. Results: The incidence of fetal distress was significantly higher in cases with abnormal CTG patterns compared to normal patterns (p<0.05). Furthermore, neonatal outcomes such as Apgar scores <7 at 1 minute and 5 minutes were more prevalent in pregnancies with abnormal CTG patterns. Among the abnormal CTGs groups, who had more risk factors abnormal outcomes were more. Most of the patients in both the normal and abnormal CTGs groups were associated with DM. In abnormal CTGs groups pre-eclampsia, PROM Many pregnant women had other risk factors associated with DM. Conclusion: This study highlights the importance of accurately assessing CTG patterns in the antenatal period for predicting perinatal outcomes. The identification of abnormal CTG patterns can aid in timely interventions to prevent adverse outcomes for both the mother and the newborn.

Post-Vaccination COVID-19 Transmission among Healthcare Workers in a Tertiary Level Hospital in Nepal

Background and Aims: Frontline healthcare workers have faced an increased risk of contracting COVID-19 since the beginning of the pandemic. Nurses, in particular, faced a substantial risk compared to doctors, possibly due to their prolonged exposure to patients. Despite the vaccine coverage to healthcare workers before the second wave of the pandemic, breakthrough infection was unavoidable. Methods: This observational study was conducted at Shahid Gangalal National Heart Center, Kathmandu, Nepal, during the second wave of the COVID-19 pandemic. The study aimed to investigate COVID-19 infections among nursing staff, focusing on the number of infections, severity, the relationship between infections and time spent in the COVID ward, the comparison of infections among vaccinated and unvaccinated staff, and the effectiveness of infection control measures. Results: Among the 132 nursing staff, the overall positive rate after vaccination was 15.15%, with a breakthrough infection rate of 4.34%. Significant differences were observed in age and prior infection. However, no significant differences were observed among the type of family, education level, work experience, wards, total duty hours, level of PPE used, mask type, or mask reuse. Conclusion: Vaccines reduce the severity of infections but do not eliminate the risk, especially in high-exposure settings like healthcare facilities.

Comparison of Letrozole Versus Combination Letrozole and Clomiphene Citrate (CC) for Ovulation Induction in Sub Fertile Women with Polycystic Ovarian Syndrome (PCOS)-An Open Label Randomized Control Trial.

To evaluate the effectiveness of Letrozole and Clomiphene (CC) combination versus Letrozole alone for ovulation induction in infertile women with PCOS. This was an open label randomized controlled trial conducted between September 2020 and March 2023 at a tertiary level hospital. Women with a diagnosis of infertility and PCOS were included. Participants were randomized in a 1:1 ratio, to either the combination of 2.5mg letrozole and 50mg Clomiphene Citrate (CC) daily or 2.5mg letrozole alone from 2nd to 6thday of menstrual cycle for up to three treatment cycles. The primary outcome was ovulation rate per cycle. The secondary outcomes included ovulation rate per woman randomised, cumulative pregnancy and live birth rates. A total of the 120 participants, 59 women in Letrozole and CC arm (intervention) and 61 women in the Letrozole alone arm (control) were recruited. The woman per cycle ovulation rate following Letrozole and CC combination versus Letrozole alone (71/92 (77.2%) vs. 52/83 (62.6%), RR 1.43, 95%CI 0.99 to 2.06) but was not statistically significant. A per ITT analysis, the clinical pregnancy rate per woman randomized (16/61(26.2%) vs. 13/59(22%), RR 1.12, 95%CI 0.76 to 1.64) and live birth rate per woman randomized (10/61(16.4%) vs 11/59(18.6%), RR 0.92, 095%CI 0.57 to 1.50) did not differ significantly between Letrozole and CC versus Letrozole group. There was no significant improvement in ovulation, clinical pregnancy, or live birth rates with a combination of letrozole and CC versus letrozole alone in per woman randomized with PCOS. Trial RegistrationThe trial was prospectively registered in the clinical trial registry of India (CTRI registration number CTRI/2020/07/026263), Registration dated: February 26, 2020.

Construction of a nomogram risk prediction model for depressive symptoms in elderly breast cancer patients

The primary objective of this study was to identify the factors associated with the development of depressive symptoms in elderly breast cancer (BC) patients and to construct a nomogram model for predicting these symptoms. We recruited 409 patients undergoing BC treatment in the breast departments of two tertiary-level hospitals in Jiangsu Province from November 2023 to April 2024 as our study cohort. Participants were categorized into depressed and non-depressed groups based on their clinical outcomes. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors for depression among BC patients. Multivariate analysis revealed that monthly income, pain score, family support score, and physical activity score significantly influenced the onset of depression in older BC patients (P < 0.05).The risk prediction model, constructed using these identified factors, demonstrated excellent discriminatory power, as evidenced by an area under the ROC curve (AUC) of 0.824. The maximum Youden index was 0.627, with a sensitivity of 90.60%, specificity of 72.10%, and a diagnostic threshold value of 1.501. The results of the Hosmer-Lemeshow goodness-of-fit test (χ² = 3.181, P = 0.923) indicated that the model fit the data well. The calibration curve for the model closely followed the ideal curve, suggesting a strong fit and high predictive accuracy. Our nomogram model exhibited superior predictive performance, enabling healthcare professionals to identify high-risk patients early and implement preventative measures to mitigate the development of depressive symptoms. This study is a cross-sectional study that lacks longitudinal data and has a small sample size. Future research could involve larger samples, multicenter studies, and prospective designs to build better clinical predictive models.

Dietary practices and associated factors among adult diabetic patients at academic tertiary-level hospitals in central Ethiopia: convergent mixed study

BackgroundDiabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide. Despite the existence of national strategies to prevent potential complications, DM-related morbidities and mortality continue to rise in Ethiopia. Although studies have been conducted regarding dietary practices among DM patients in the country, there is a lack of in-depth understanding of the situation.ObjectiveTo assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia in 2024.MethodsA concurrent mixed-methods study was conducted from January 01 to 30, 2024, involving 420 adult DM patients. Participants were selected using a simple random sampling technique for the quantitative study. A purposive sampling technique was used to select sixteen participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and in-depth interviews were conducted for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data.ResultOf 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (42.4%). Being female, residing in urban areas, having a family history of DM, and having good dietary knowledge were significantly associated with better dietary practices. From the qualitative analysis, two themes emerged "Living as before and not adhering to diabetic dietary recommendations" and "Barriers to adherence to effective eating practices."Conclusions and recommendationsLess than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

The effect of COVID-19 lockdown on admission rates in Maternity Hospital.

The COVID-19 pandemic had adverse health outcomes on individuals and communities. In this cross-sectional study we evaluated the admission rates in a tertiary-level hospital during the first wave of the pandemic (March 22, 2020 to August 31, 2020). We compared the indications for admission during the first wave of the pandemic to a control period prior to the lockdown (November 9, 2019 to March 22, 2020). Most hospital admissions during the curfew period were obstetric emergencies (46.88%), which were significantly higher than the control group (38.19%) p ≤ 0.0001. Among the obstetric emergencies, cases in active labor (65.63%) were dominant. Significant rises in car deliveries (2.46%, p ≤ 0.0001) and admissions during the second stage of labor (6.43%, p ≤ 0.001) were noted. There was also an increased rate of admissions for early pregnancy complications, induction of labor, elective obstetric cases, and medical obstetric cases. This study demonstrates that lockdown precautions implemented had a significant impact on the rate of admissions to Maternity Hospital. The data obtained may be a used to aid in designing robust policies for future pandemics to avoid adverse health outcomes.

Maternal near-miss and mortality associated with being referred: a case control study in Luanda

Abstract Background Understanding of determinants of severe maternal morbidity is crucial for reducing Maternal Near Misses (MNM) and Maternal Deaths (MD). We aimed to assess whether being referred from lower level to tertiary-level hospitals is a determinant of MNM and MD in Luanda, capital of Angola. Methods A facility-based case control study was conducted (June-September 2022) at 2 referral hospitals in Luanda. Consecutive sampling for the cases (women admitted with life-threatening conditions) and systematic sampling for the controls (women admitted for vaginal delivery) was used. Cases were classified by the outcome at discharge: MD or MNM. Multivariate multinomial regression was conducted to assess whether being referred is associated with MNM and MD (controls as reference). Sociodemographic, clinical and obstetric factors and circumstances at admission related with MNM or MM (p-value &amp;lt;0.05) were included in the models. Reduced models (forward technic) were fitted for obtaining adjusted odds ratio (AOR) and respective 95% confidence interval (95%CI). Results Data from 331 cases (245 MNM and 86 MD) and 662 controls were analyzed and bivariate analysis revealed large differences between groups in regards to the sociodemographic, clinical and obstetric characteristics and circumstances of admission. The proportion of being transferred from another facility was 7.9%, 51.0% and 65.1% among controls, MNM and MD, respectively. After adjusting for pre-existing diseases during pregnancy, previous cesarean section and delay in seeking care, being referred from another facility increased the odds of MNM (AOR=10.97; 95%CI: 7.19-16.75) and MD (AOR=18.89; 95%CI: 10.50-33.89). Conclusions According to our findings, being referred from lower level facilities is a strong determinant of MNM and MD. Strategies for improving lower level of healthcare services and the referral system for pregnant women could have a positive impact on prevention of MNM and MD in our setting. Key messages • Awareness should be given to the conditions of maternal transfer from lower level to tertiary level hospitals in Angola. • Public health strategies should address the quality of maternal care at primary and secondary level hospitals, before maternal transfer, as well as, the maternal referral system in this setting.

Association Between Serum C-Reactive Protein (CRP) And D-Dimer Levels In Covid-19 Patients In A Tertiary Level Hospital, Khulna

Background: The novel corona virus disease 2019 (COVID-19) is major public health issue. It is the most significant global health challenge in the world. Biomarkers play a significant role to detect the severity of COVID-19 infection in the perspective of management of the patients. Aim and objective: We aimed to assess the association between the levels of C-Reactive Protein and D-dimer in COVID-19 patients. Methods: This cross-sectional study was conducted in the department of Pathology and department of Microbiology GMCH, Khulna. 152 patients with SARS-CoV-2 (COVID -19) positive patients were enrolled in this study. C-reactive protein and D-dimer levels are measured in the laboratory of Pathology department, GMCH, Khulna. All statistical computations were performed by using window-based computer software devised with Statistical Packages for Social Sciences (IBM SPSS Statistics 21 version). Results: In this study CRP level was found of mean value of 62.84± 44.64 mg/L with a range of 1.40-195.20 mg/L. It was normal in 21 (13.8%) patients and increased in in 131 patients (86.2 %). The mean value of D-dimer was 2.48 ± 02.20 mg/L with a range of 0.10-9.35 mg/L. D-dimer was normal in 26 (17.1%) patients, whereas it was increased in 126 patients (82.9 %). We performed Pearson’s correlation-coefficient (r) test to compare the association between the levels of CRP with D-dimer in COVID-19 positive patients. There was moderately positive and significant correlation (r = +0.647, p &lt;0.05) between the levels of CRP and D-dimer. Conclusion: There was statistically significant correlation between the levels of serum CRP with D-dimer in COVID-19 positive patients. These two biomarkers can be used to assess the severity in patients with COVID-19 positive with thrombotic disorder for reduction of morbidity and mortality of COVID positive patients. J Dhaka Med Coll. 2023; 32(1) : 57-62

Outcome of Endometriosis Treatment In Infertile Patients In A Tertiary Level Hospital

Introduction: Prevalence of endometriosis is 6-10% in reproductive-age females. Around 25-35% of infertile women may be affected by endometriosis. Modalities of treatment for infertile patients depends on the stage of the disease. It starts from ovulation inducing drug to advanced ART. The objective of this study was to assess the outcome of surgical treatment in infertile, endometriosis patients. Materials and Methods: It was an observational study, which was conducted at Reproductive Endocrinology and infertility Unit, Dhaka Medical College. Total 144 patients were included during July 2018 to July 2021, aged 20-40 yrs. All the demographic variables, clinical and sonographic findings, and hormonal assessment were done. Then, staging was done by clinical pelvic assessment, and ultrasonographic findings. Patients who had ovarian endometrioma, more than 4 cm, were selected for laparoscopic surgery. In patients whose endometrioma was less than 4 cm, or had no ovarian endometrioma, were selected for ovulation induction with or without prior GnRH agonist therapy. Further infertility management were planned according to ovarian reserve, tubal patency, and male factor. Result: Mean age of the patients were 28.30±4.95 yrs. 75.0% patients had primary infertility. Dysmenorrhea was the most common symptom (86.96%), followed by chronic pelvic pain (81.16%). Bilaterality of endometrioma was associated with decreased serum AMH. Laparoscopic surgery was the mainstay of treatment, Cystectomy was done in 58% patients. Conservative treatment was done in remaining patients. Fertility enhancing treatment was done by ovulation inducing drug -letrozole, GnRH agonist, followed by controlled ovarian stimulation and followed by IUI. IVF was advised for fertility management in 26patients (18.06%). Conclusion: Endometriosis is not only associated with decreased ovarian reserve but also responsible for diminished response to ovarian stimulation. So, it is a great challenge to obtain successful fertility treatment for this group of patients. J Dhaka Med Coll. 2023; 32(1) : 9-15

Misoprostol as Oral Solution or Oral Tablet for Induction of Labour (MISOBEST): A Randomised Controlled Non-Inferiority Trial.

To assess if off-label oral solution of misoprostol compared with licensed oral tablet of misoprostol approved for induction of labour (IOL) is as efficient in resulting in vaginal delivery within 24 h, using a non-inferiority design. Prospective, randomised, non-inferiority, open-label, blinded endpoint trial. Two tertiary level hospitals, Stockholm, Sweden, January 2022 to May 2023. In all, 874 women, without previous caesarean section, with an unripe cervix and a singleton, cephalic foetus at 37 + 0 to 42 + 0 gestational weeks, with a normal cardiotocography, planned for IOL were included. Women were randomised 1:1 to intervention (25 μg oral solution of misoprostol) or control (25 μg oral tablet of misoprostol) two-hourly for a maximum of eight doses. Subsequent methods of induction followed clinical practice. The primary outcome was vaginal delivery within 24 h tested using non-inferiority testing procedures at a non-inferiority margin of 5 percentage points. Secondary efficacy outcomes were tested for superiority of either treatment. Analyses were by intention-to-treat. There were 207 (47.4%) vaginal deliveries within 24 h for women receiving oral solution and 192 (43.9%) vaginal deliveries within 24 h for women receiving oral tablet, establishing non-inferiority with an absolute risk difference of 3.4% (95% CI -3.2% to 10.0%). Women receiving oral solution required fewer doses to reach active labour than women receiving oral tablet (5.7 vs. 6.1, p = 0.007). There were no significant differences for other secondary or safety outcomes. Off-label oral solution of misoprostol was non-inferior to the licensed oral tablet regarding efficacy of IOL defined as vaginal delivery within 24 h. Clinicaltrials.gov identifier: NCT05424445.

Factors Influencing Surgical Outcome of Patients with Traumatic Acute Subdural Hematoma

Background: Traumatic acute subdural hematoma (ASDH) is a catastrophic devastating component of brain injury in neurosurgical arena. Due to its significant mortality rate, potential for functional disability and disastrous consequence of complications, it is considered as a challenge for neurosurgeons worldwide. Consequently, precise recognition of predictive outcome factors is crucial for appropriate neurosurgical management and prognostication for patients with traumatic ASDH. Aims: The study aimed to determine the demographic, clinical, radiological and therapeutic factors associated with the surgical outcomes in patients with traumatic acute subdural hematoma (ASDH) who managed surgically in the Neurosurgery Department at a tertiary level hospital in Bangladesh. Materials and Methods: This prospective observational study included 40 radiologically diagnosed cases of traumatic ASDH age more than 18 years who were admitted and operated in the Department of Neurosurgery of Chittagong Medical College Hospital from May 2022 to April 2023. Data regarding demographic, clinical, radiographic, surgical procedure and findings were recorded. Three months mortality rate with clinical outcome was assessed by Glasgow Outcome Scale (GOS) score and analyzed. The outcome was divided into favorable outcomes (GOS score &gt;3) and unfavorable outcomes (GOS score d”3). Results: The median age of the patients was 45 years (range: 19-82 years), and there was a male predominance (82.5%) with a male to female ratio of 4.7:1. Road traffic accident (RTA) was the most common cause of trauma (65%), followed by fall from height (15%), and physical assault (12.5%). Craniotomy was done in 16 (40%) patients and other 24 (60%) patients had decompressive craniectomy. Overall, 21 (52.5%) patients had good outcome and other 19 (47.5%) had poor outcome, and three months mortality rate was 42.5%. Regression analysis revealed that, increasing age [Odds ratio (OR): 1.12, 95% Confidence interval CI: 1.02-1.22. p=0.014], preoperative GCS of d”8 (OR: 13.98, 95% CI:1.22-160.00, p=0.034), and presence of Anisocoria with non-reacting pupil (OR; 17.99, 95% CI: 1.32-244.08, p=0.030) were independently associated with poor outcome. Conclusions: This study identified higher age, preoperative low GCS score and pupillary abnormality as the independent predictors for 3-months poor outcome in patients who underwent surgical treatment for traumatic ASDH Bang. J Neurosurgery 2024; 13(2): 140-148

Surgical Outcome of Tumors of Spinal cord, Nerve roots, Meninges, and Vertebral column – Our Experience in Tertiary level Hospital

Background: Spinal cord tumors can result in dramatic neurological and functional disabilities in the patients. We aimed to know the different types of spinal tumors and the correlation between clinical presentation and pathological findings and compare the outcomes of these tumors postoperatively. Methods: A total of 410 patients were included in the retrospective study group. The duration of the study was January 2016 to October 2022 (82 months). After a thorough clinical evaluation, patients were subjected to magnetic resonance imaging (MRI) and then surgery. They were described based on age, sex, location of the tumor, type of the tumor, symptoms, histopathological type, surgical resection, and complications. Results: The study included 229 (56%) males and 181 (44%) females and their ages ranged from 6 years to 74 years. Out of the 410 patients, 203(49.51%) had intradural extramedullary, 121(29.51%) had extradural and 86(20.98%) had intradural intramedullary spinal tumors. A predilection towards the thoracic region (39.50%) and cervical region (28.40%). Lumbar region (20.10%) and Sacral region (4.10%), Cervicodorsal region (1.40%), Dorsolumbar region (3.00%), and Craniovertebral junction (3.50%) were seen. The tumors were excised completely in 72.68% of the patients while neartotal resection was done in 17.82%, subtotal resection in 7.32%, and only biopsy in 2.2% of patients. Histopathologically most of the tumors were Schwannoma (38.78%), then Meningioma (11.71%), Ependymoma (11.70%), Astrocytoma (10.98%), and others were found. There was significant improvement (33.66%) in the modified McCormicks score at discharge follow-up. Conclusions: Intradural extramedullary is the most common spinal cord tumor. The majority of the cases presented with sensorimotor symptoms and pain is the predominant clinical complaint. Spinal cord tumors are most commonly observed in the 2nd to 4th decade of life with a gradual decline in the incidence towards the extremes of age group. Surgery is the definitive treatment and the aim of the surgery is gross total resection Bang. J Neurosurgery 2024; 13(2): 112-120

Level of Awareness of Breast Cancer Among Adult Female in a Tertiary Level Hospital

Background: Breast cancer is the leading and most prevalent form of cancer among the women in Bangladesh. The aim of the study was to assess the level of awareness of the breast cancer among adult female. Methods: A descriptive cross-sectional study was conducted among 103 adult females in Out Patient Departments (OPDs) of Combined Military Hospital (CMH), Dhaka during July to December 2013. Data were collected purposively by face-to-face interview with a semi-structured questionnaire. Results: A total of 103 adult females participated in the study with the mean (±SD) age was 36.26±12.70. Majority 39(37.9%) of the respondents were in age group 29-39. Most 82(79.6%) of the participants were married, 90(87.4%) were housewives, 31(30.1%) were HSC qualified. Maximum 31(88.35%) respondents had average knowledge on breast cancer. Education and occupational status was found significantly associated with level of knowledge of the respondents. Conclusion: The overall knowledge of the respondents was found average. As it is a major health burden in women and incidence is very high in Bangladesh concern authority should take necessary action to adopt measures to increase the awareness on breast cancer. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 14-21

Knowledge and Awareness on Swine Origin Influenza A(H1N1) Among Health Care Providers and Civil Employees in a Tertiary Level Hospital, Dhaka Bangladesh

Background: Swine Origin Influenza A(H1N1) viruses create yearly epidemics and rarely pandemics that cost millions of lives worldwide. Health care providers and civil employees at hospital can help in prevention of transmission of influenza by acquiring knowledge and awareness. Methods: A descriptive cross-sectional study was conducted at Combined Military Hospital Dhaka from July to December 2023. Total 213 participants were interviewed that comprises doctors, nurses, medical assistants and civil employees. Purposive sampling technique was used to collect data. Face to face interview was done through a pre-tested semi-structured questionnaire. Data were analysed by using Statistical Package for the Social Sciences (SPSS) version 25.0. Informed consent were obtained from the respondents addressing proper ethical issues. Results: In this study out of total participants 70.4% had previously heard about H1N1 influenza A. Total 38% participants said that internet was found as major source of information. Among the participants 64.3% told fever was common symptom and use of facemask at duty hour was consented by 33.8% as an important means for prevention. Maximum (66.3%) civil employees do not know about washing hand after contact as a preventive procedure leading to spread of infection. Maintaining distance as preventive measures observed by 13.6% participants. Moreover, all participants were aware of transmission through droplet infection except civil employees. In the present study, 50% doctors and 38.1% nurses had knowledge that drug Oseltamivir is very effective against swine Influenza A(H1N1). Remarkable differences were identified among doctors, nurses, medical assistants and civil employees regarding knowledge of quarantine and availability of vaccine. RT-PCR laboratory test is the confirmatory method to defect swine influenza A(H1N1) were exactly known by 9.9% participants, while 70.9% participants don't know the confirm diagnostic method. Conclusion: Knowledge and awareness regarding swine influenza A(H1N1) was low among study participants. For controlling epidemic or even pandemic, awareness by mass media is important. Remarkable gap observed regarding knowledge and awareness about swine influenza A(H1N1) among the health care providers and civil employees, needs to be addressed by proper training and motivation. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 1-7

The prevalence and related factors of compassion fatigue among nursing interns: a cross-sectional study

BackgroundCompassion fatigue is common among nurses and can lead to decreased motivation, impaired physical and mental health, and turnover. Nursing interns often face environments the same as professional nurses, yet their compassion fatigue has received less attention. Therefore, this study aims to assess the prevalence and related factors of compassion fatigue among nursing interns.MethodsThis was a cross-sectional study involving 221 nursing interns in 2 tertiary-level hospitals in Shanghai, China. A general information questionnaire was formulated to investigate the demographic characteristics and internship-related factors of nursing interns. Compassion fatigue was assessed using the Professional Quality of Life Scale [compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS)]. Psychological resilience, empathy, and perceived stress were evaluated by the Connor-Davidson Resilience Scale, Jefferson Scales of Empathy, and Perceived Stress Scale, respectively. Personality traits were assessed using the extroversion/introversion subscale of the Eysenck Personality Inventory. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson’s correlation analysis, and multiple linear regressions were used to determine the predictors of the main research variables.ResultsThe prevalence of mild, moderate, and severe compassion fatigue in 221 nursing interns (mean age 21 years, 202 [91.4%] females) was 10.4%, 46.6%, and 43.0%, respectively, and their mean scores for CS, BO, and STS were 29.75 ± 6.39, 28.72 ± 4.78, and 28.51 ± 7.51, respectively. Psychological resilience and empathy were the strongest protective factors for CS and BO, respectively (p < 0.001), and the number of night shifts monthly was the most significant positive independent predictor of STS (p = 0.001). Additionally, male gender negatively predicted CS (p = 0.009). Younger age and extended daily working hours were associated with elevated levels of both BO and STS (p < 0.05). Clinical nursing teachers with intermediate or senior titles, as well as departments of pediatrics and obstetrics had a positive effect on STS (p < 0.05), while internship time had a negative effect on STS (p = 0.005). Furthermore, the variables of perceived stress, personality traits, and choice of nursing profession did not exhibit statistical significance in the multivariate analysis. Related factors predicted 14.2%, 26.2%, and 23.9% of the variance in the model of CS, BO and STS, respectively (all P < 0.001).ConclusionThe compassion fatigue of nursing interns was more serious, especially for nursing interns who were male and younger, and who had shorter internship time, departments of pediatrics and obstetrics, and clinical nursing teachers with intermediate or senior titles. Nursing educators can improve the psychological resilience and empathy of nursing interns by offering relevant psychological courses according to the different stages of internship, as well as rationalizing their daily working hours and the frequency of night shifts to improve the compassion fatigue of nursing interns.Registration NumberChiCTR2400081968.

Nursing stress and associated factors during covid-19 pandemic: findings of a cross-sectional study at tertiary hospitals in Bangladesh

Background: The COVID-19 epidemic has posed an unparalleled obstacle to healthcare systems worldwide. Particularly in the pandemic period, nursing is seen as a demanding profession with high standards. This study was conducted to assess the level of nursing stress and to identify the factors related to high nursing stress among nurses working in dedicated COVID-19 hospitals. Methods: The cross-sectional study was conducted from selected three dedicated COVID-19 public hospitals in Dhaka city of Bangladesh named Dhaka Medical College Hospital, Shaheed Suhrawardy Medical College, and Hospital, Dhaka North City Corporation dedicated COVID-19 hospital from 1st July 2021 to 30th June 2022. Total respondents were 368 who had working experience more than 6 months in above mentioned hospitals. Data were collected by face-to-face interview through pre-tested semi-structured questionnaire. Nursing stress was assessed by Nursing Stress Scale (NSS) and categorized as low (≤39), moderate (40-62), and high (&gt;62) stress score. Data analysis was carried out by using SPSS version 26. Results: The mean age of the respondents was 30.8±7.8 years, wherein highest number of respondents were in age group 20-30 years (50.3%). Among the respondents 86.7% were female, 83.4% were married and average monthly family income Tk. 53839±28587.7 taka. About 63% respondents had diploma degrees, 77.4% worked in different wards, and mean working hour per week was 51.9±5.6 hour. Overall, maximum 52.2% had moderate stress, while 39.4% had high stress and only 8.4% had low stress. Age &gt;30 years, male, marital status, working place, having senior citizen (&gt;60 years) and feeling stressed for isolation were the significant risk factors for having high stress level. Conclusion: Occupational health education, training programs, stress relieving programs, and motivational programs must be implemented in tertiary level hospitals. Special attention should be given on older aged married male nurses, having elderly family members and feeling stressed for isolation. JOPSOM 2023; 42(1):54-61

Comparison of 75 mg versus 150 mg aspirin for the prevention of preterm preeclampsia in high-risk women at a tertiary level hospital: study protocol for a randomized double-blind clinical trial

BackgroundHypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health, with substantial mortality and morbidity rates globally, particularly in developing countries. Pre-eclampsia (PE) accounts for a notable portion of maternal morbidity and mortality, with varied prevalence across regions within countries like India. Despite advancements, disparities in healthcare access persist, influencing outcomes. PE not only affects maternal health during pregnancy but also predisposes women to long-term cardiovascular complications, emphasizing the need for early screening and preventive measures.MethodsThis prospective randomized double-blind clinical trial aims to compare the efficacy and safety of 75 mg versus 150 mg aspirin for preventing preterm pre-eclampsia in high-risk women. Screen-positive women aged 18–45 years with singleton pregnancies between 12 and 16 weeks of gestational age will be enrolled. They will be randomized in a 1:1 ratio to receive either 75 mg or 150 mg of aspirin nightly until 37 weeks of pregnancy or earlier if preterm pre-eclampsia develops. Feto-maternal outcomes, including preterm pre-eclampsia incidence and neonatal and maternal complications, will be assessed. The sample size calculation based on expected proportions of preterm pre-eclampsia in both groups indicates a total of 370 participants (185 per group) accounting for 20% attrition.DiscussionThis prospective randomized double-blind clinical trial aims to compare the effectiveness and safety of two doses of aspirin (75 mg vs 150 mg) in preventing preterm pre-eclampsia in high-risk women. The potential implications of this study are significant, including the optimization of aspirin prophylaxis, the development of evidence-based guidelines, and comprehensive assessment of maternal and fetal outcomes. In conclusion, the results of this study have the potential to significantly impact clinical practice by enhancing maternal and perinatal health outcomes and contributing to evidence-based obstetric care.Trial registrationClinical Trials Registry-India CTRI/2023/12/060983. Trial was registered prospectively on 29 December 2023. Acknowledgement Number REF/2023/12/076358. https://acrobat.adobe.com/id/urn:aaid:sc:AP:15870322-f1f4-4460-900c-6e056ab83a44.