Till March Research Articles

Sex differences in the associations of water, coffee and tea consumption with cardiovascular diseases: a prospective cohort study

BackgroundWater, coffee and tea are the primary sources of daily hydration. However, the sex-specific relationship between these beverages and cardiovascular disease (CVD) among remains unclear.MethodsIn total, 210,239 men and 251,383 women from the UK Biobank were included. The consumption of water, coffee and tea were self-reported. CVDs, including coronary heart disease (CHD), stroke and heart failure (HF) were followed till March 1st, 2023. Sex-specific Cox models were utilized to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations.ResultsDuring a median follow-up of 8.7 years, 11,098 (2.40%) participants developed new-onset HF, 33,426 (7.24%) participants developed new-onset CHD, and 9,706 (2.10%) participants developed new-onset stroke. After adjustments, higher water consumption was generally associated with reduced risk of CVDs among both men and women. In contrast, heavy coffee consumption (particularly ≥6 cups/day) was associated with a greater risk of HF [1.16 (1.03–1.31) in men vs. 1.25 (1.12–1.40) in women], a greater risk of CHD [1.27 (1.18–1.36) in men vs. 1.21 (1.14–1.29) in women] and a greater risk of stroke [1.13 (0.99–1.29) in men vs. 1.20 (1.03–1.31) in women]. Similarly, heavy tea consumption was associated with an increased risk of HF (men: HR 1.19 [1.08–1.31]; women: HR 1.12 [1.02–1.23]) and CHD (men: HR 1.12 [1.05–1.18]; women: HR 1.18 [1.12–1.24]).ConclusionOur study revealed that water consumption was associated with a lower risk of CVDs, with a lower risk of CVDs, while heavy coffee or tea consumption was linked to a higher risk. Notably, coffee and tea consumption partially attenuated the protective association of water intake with CVDs. Furthermore, significant sex differences were observed in the associations between coffee or tea consumption and CHD incidence.

P-364. Outbreak of bla-OXA-48 in the eastern part of Singapore

Abstract Background Changi General hospital (CGH) is a 1000 bed acute hospital that mainly serves the general population in the eastern region of Singapore and community. At the beginning of October 2023 till March 2024, we observed an increase in the number of the Carbapenemase producing Enterobacteriaceae (CP-CRE) bla-OXA-48 cases from the routine long-stayer inpatient surveillance screening in several wards. Methods Standard outbreak protocols are executed, including enhanced environmental testing and disinfection, inpatient contact tracing, and Box-PCR typing of Klebsiella pneumoniae spp. isolates. Results 68% (n = 226) of the bla-OXA-48 are identified from the outbreak wards, of which 15% (n = 33) cases is likely due to the additional beds added in the outbreak wards, reported an OR of 3.6 times (p-value: 0.007, 95%CI: 1.3 – 9.0) of being colonized by bla-OXA-48 CP-CRE compared to the non-outbreak wards. Patients from the outbreak wards have 2.7 times higher odds of requiring significantly more nursing care compared to the non-outbreak wards (p-value: 0.009, 95%CI: 1.3 – 5.7). The limited space to manoeuvre during nursing care, especially during diaper changing for the bed bound patients which is 61% (n = 139) of bla-OXA-48 CP-CRE cases in the outbreak wards. Among the bedbound patients, the odds of being colonized with bla-OXA-48 CP-CRE is 5.6 times (p-value: 0.008, 95%CI: 1.3 – 24.7) in the outbreak wards compared to the non-outbreak wards due to possible surface contamination when the curtains are drawn during the diaper changing or through accidental contact with the adjacent beds by the healthcare workers. The microbiological typing suggests 2 common types are circulating between patients in the outbreak wards in 79% (n = 58) of the samples tested. 3% (n = 194) of the environmental samples are positive for bla-OXA-48 detected in the toilet and drains, used only by ambulating patients during their hospitalization. No incidences (n = 75) of community onset of bla-OXA-48 CP-CRE is reported form a point prevalence survey (PPS). Conclusion Hence, bla-OXA-48 CP-CRE transmission is more likely from healthcare worker transmission. Ensuring adequate spacing between hospital beds is crucial to facilitate the work of healthcare staff, allowing them to move freely and efficiently while providing care. Disclosures All Authors: No reported disclosures

Clinical efficacy of photobiomodulation therapy in dental implant stability and crestal bone loss in implants placed in healed sites: a systematic review and meta-analysis of randomized clinical trials.

This systematic review and meta-analysis aimed to compare the effect of photobiomodulation (PBM) therapy on implant stability and crestal bone loss placed in healed sites. The present systematic review and meta-analysis were conducted according to PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two investigators carried out the electronic search of Pubmed, Google Scholar, and Ebscohost for published literature from 2012 till March 2024. Handsearch for articles relevant to the topic was also carried out along with references. Only randomized controlled trials were included for systematic review. The assessment quality was done using the revised JBI checklist (Joanna Biggs Institute). After screening and eligibility assessment, Qualitative analysis was envisaged for 15 studies on implant stability and crestal bone loss, followed by quantitative analysis of 8 studies on implant stability and only 2 studies for crestal bone loss. Meta-analysis showed that overall implant stability was significantly higher in the control group (P < 0.00001). Crestal bone loss showed a significant difference after the therapy when observed after six months of implant placement (P = 0.03). Heterogeneity was high with the random effects model for implant stability, while it was acceptable for crestal bone loss. However, more studies with similar parameters concerning implant stability and PBM characteristics are required for further subgroup analysis and to reach conclusive results.

Pregnancy Outcomes in Women with Low and Ultra-Low Ejection Fraction: A Retrospective Study in a Tertiary Care Center

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF &gt; 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF &gt; 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling.

The burden of lymphedema on quality of life.

Background: Due to a lack of validated methodologies, this study aimed to evaluate the quality of life (QoL) among individuals affected by lymphedema and to compare them with the general population and common diseases. Patients and methods: Patients were recruited from October 2023 till March 2024. The SF-36 and LYMQOL questionnaires were administered. The Robert Koch Institute provided data from the survey for secondary evaluations of the DEGS1 study. Descriptive analysis of the patient's data was conducted, followed by an analysis of risk factors, a comparison with common diseases and a pairs matched analyses with the general population based on the parameters sex, age and Body Mass Index (BMI). A p-value below 0.05 was considered significant. Results: Among the 273 patients, 18 had primary lymphedema and 255 had secondary lymphedema due to cancer history. Staging revealed 28 patients in stage I, 137 in stage II, and 75 in stage III. The majority of patients (83%) were female and mostly the lower extremity was affected. Age, International Society of Lymphology (ISL)-stage, and BMI were significantly correlated with reduced QoL in seven, six, and eleven out of thirteen subscales of the respective scores. The LYMQOL analysis revealed, that patients with upper limb lymphedema (ULL) demonstrated higher QoL compared to those with lower limb lymphedema (LLL). When compared to the general population, individuals with ULL exhibited reduced QoL in five out of eight SF-36 domains (p<0.05). Conversely, LLL patients showed decreased QoL across all eight SF-36 subscales (p<0.01). In comparison to diseases like myocardial infarction or malignant diseases, patients with lymphedema experience a significant, diminished QoL. Conclusions: By 2024, lymphedema patients continue to experience significantly lower QoL compared to the general population or common diseases in Germany. LLL patients exhibit a reduced QoL compared to individuals with ULL.

A data-driven approach to study temporal characteristics of COVID-19 infection and death Time Series for twelve countries across six continents

BackgroundIn this work, we implement a data-driven approach using an aggregation of several analytical methods to study the characteristics of COVID-19 daily infection and death time series and identify correlations and characteristic trends that can be corroborated to the time evolution of this disease. The datasets cover twelve distinct countries across six continents, from January 22, 2020 till March 1, 2022. This time span is partitioned into three windows: (1) pre-vaccine, (2) post-vaccine and pre-omicron (BA.1 variant), and (3) post-vaccine including post-omicron variant. This study enables deriving insights into intriguing questions related to the science of system dynamics pertaining to COVID-19 evolution.MethodsWe implement a set of several distinct analytical methods for: (a) statistical studies to estimate the skewness and kurtosis of the data distributions; (b) analyzing the stationarity properties of these time series using the Augmented Dickey-Fuller (ADF) tests; (c) examining co-integration properties for the non-stationary time series using the Phillips-Ouliaris (PO) tests; (d) calculating the Hurst exponent using the rescaled-range (R/S) analysis, along with the Detrended Fluctuation Analysis (DFA), for self-affinity studies of the evolving dynamical datasets.ResultsWe notably observe a significant asymmetry of distributions shows from skewness and the presence of heavy tails is noted from kurtosis. The daily infection and death data are, by and large, nonstationary, while their corresponding log return values render stationarity. The self-affinity studies through the Hurst exponents and DFA exhibit intriguing local changes over time. These changes can be attributed to the underlying dynamics of state transitions, especially from a random state to either mean-reversion or long-range memory/persistence states.ConclusionsWe conduct systematic studies covering a widely diverse time series datasets of the daily infections and deaths during the evolution of the COVID-19 pandemic. We demonstrate the merit of a multiple analytics frameworks through systematically laying down a methodological structure for analyses and quantitatively examining the evolution of the daily COVID-19 infection and death cases. This methodology builds a capability for tracking dynamically evolving states pertaining to critical problems.

EXPLORING THE IMPORTANCE OF DAILY REFLECTION WRITING AMONG UNDERGRADUATE MEDICAL STUDENTS: A CROSS-SECTIONAL STUDY

Objective: This study aimed to provide insights into the attitudes of medical students towards daily reflection writing and to explore the potential benefits of this practice for personal and professional development. The findings of this study could be used to inform medical education policy and practice, emphasising the need to integrate daily reflection writing into medical curricula. Methodology: 320 medical students (1st, 2nd, and 3rd year MBBS students) from Kabir Medical College Peshawar were included in the study from January 2023 till March 2023. Ethical approval was obtained from the Ethical Committee of Gandhara University. Two pre-tested questionnaires using a Likert scale were used. The questionnaire was self-administered, and content validity was ensured before conducting the research. Demographic information such as age, gender, and academic major was collected from participants. Descriptive and inferential analysis were applied using SPSS version 26.0. Results: The study found that most medical students positively perceived daily reflection writing. Almost half of the medical students (47.8%) found that writing in their logbooks improved their information retention, while 46.9% noticed positive changes in their learning approach. Additionally, nearly half of the participants (49.1%) reported being satisfied with the experience of daily reflection writing. These results highlight the potential benefits of integrating daily reflection writing in logbooks for medical students. Conclusion: The study highlights the need to integrate daily reflection writing into medical education curricula to foster critical thinking and self-awareness among medical students.

Neurological disorders in Pregnancy: Radiological insights and Obstetric implications.

To explore the radiological findings of neurological disorders in obstetrics patients, their obstetric and fetal outcome. The cross-sectional study was conducted at Lady Ready Hospital (LRH), Peshawar from June 2022 till March, 2023. Sixty two obstetric patients with neurological symptoms were included. Their clinical records were explored. MRI/MRV brain were performed in patients requiring brain imaging and followed till the end of pregnancy. Seizures were the commonest symptom found in 74.2% patients followed by hemiparesis; 8.1%. About 92% had never experienced hypertension and 62.3% had pregnancy-induced hypertension in current pregnancy. Twenty eight patients underwent MRI, revealing Dural sinus thrombosis (DST) in 42.9%, posterior reversible encephalopathy syndrome (PRES) in 17.9%, infarcts in 14.3% and hemorrhage in 7.1%. Normal baby was born in 69% patients; stillbirth, preterm birth and miscarriage were found in 25.9%, 3.2% and 1.6% respectively. Apgar scores of 7-10, 4-6 and 0-3 were found in 67.2%, 6.9% and 25.9% respectively. Fits were observed in 10.3% babies and 32.8% required neonatal intensive care unit (NICU) care. Fits and ischemic infarct were commoner in prenatal. DST and PRES were commoner in postnatal patients. All PRES patients presented with fits. DST patients presented with fits, headache, hemiparesis and altered consciousness. All PRES patients delivered normal alive babies. DST mothers delivered alive babies at term in 81.8%, dead pre-term baby and miscarriage in 9.1% each. Pregnancy-related neurological problems should be taken carefully and evaluated, since even seemingly insignificant symptoms like headaches may be signs of serious illnesses like PRES or DST.

Comparison of Pregnant Ladies with and without Antenatal Care Booking and its Effect on Maternal and Fetal outcome

Early Antenatal Care (ANC) introduction and frequent visits lead to favorable mother and fetal outcomes. Pregnant women who attend ANC experience much lower morbidity and mortality rates than those who do not. A cross-sectional study was conducted among women in an age group of 20-40 years who delivered at Jinnah International and Women and Children Hospital Abbottabad from March till August 2024. Women were selected through convenience sampling and interviewed through a self-structured questionnaire. 100 women were recruited with a mean age group of 20-40 years. Out of which 57% of the women received ANC while 43% did not. Antenatal care was significantly associated with better maternal and fetal outcome (p=0.015 and p=0.000) respectively. There was no statistical association between age (p=0.239) and mother’s education (p=0.128) on maternal outcome while iron/folic acid intake (p=0.000) and pregnancy complications (p=0.013) showed a positive association with maternal outcome. In the case of fetal outcome, decreased fetal movements (p=0.003) showed an association with poor outcome while time of delivery (p=0.015) and availability of transport (p=0.000) showed an association with poor fetal outcome. It was concluded that un-booked pregnant females are at a greater risk of adverse fetal and maternal outcomes due to poor antenatal care and late coming of subjects with complications that can result in higher fetal and maternal mortality and morbidity than booked females.

Heart Rate Variability During Weaning from Invasive Mechanical Ventilation: A Systematic Review.

Background: The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). Methods: The protocol of this systematic review was registered with PROSPERO (CRD42024485800). We searched PubMed and Scopus databases from inception till March 2023 to identify randomized controlled trials and observational studies investigating HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation. Our primary outcome was to investigate HRV changes occurring during the weaning from IMV. Results: Seven studies (n = 342 patients) were included in this review. All studies reported significant changes in at least one HRV parameter. The indices Low Frequency (LF), High Frequency (HF), and LF/HF ratio seem to be the most promising in predicting the outcome of weaning with reliability. Some HRV indices showed modification in response to different ventilator settings or modalities. Conclusions: Available data report HRV modifications during the process of weaning and suggest a promising role of some HRV indices in predicting weaning outcomes in critically ill patients. Point-of-care HRV monitoring systems might help to early detect patients at risk of weaning failure.

The Incidence of Palatal Fistula Postpalatoplasty in Children with Dental Caries: A Multi Centre Study

Background: Cleft lip and/or palate (CL&amp;/P) is the most common congenital craniofacial abnormality, affecting approximately 1 in every 700 newborns. Patients with cleft lip and/or palate (CL&amp;/P) generally display poor oral hygiene and a higher prevalence of caries. This may be due to the difficulty in achieving adequate plaque control associated with dental anomalies and defects from the lips and/or palate. Palatal fistula is a significant complication following cleft palate repair. It is the aim of this research to find correlation between palatal fistula and dental caries. Patient and Method: Patients with unilateral complete cleft palates admitted to the Cipto Mangunkusumo hospital, Adam Malik hospital within the period July 2012 till March 2013 were included in this study. All cases underwent modified two flap palatoplasty leaving lateral periosteum technique and follow-up were done in two weeks to see if there are any palatal fistula. Result: Thirty eight patients with unilateral cleft palate were enrolled in the study. Fifteen (39.5%) of them are boys and 23 (60.5%) are girls. Fifteen of the patients (41.7%) had dental caries, with six patients (40%) had palatal fistula in the follow up after palatoplasty, while there was none (0%) of the 21 (58.3%) patients that were found negative for dental caries developed a fistula. Conclusion: Dental caries is one of the important predisposing factors of palatal fistula in patients who undergo palatoplasty.

Prevalence of Substance Use among Students in The University of Kufa, 2023

Background: Substance use involves psychoactive drug consumption (both legal and illegal), including alcohol, tobacco, heroin, cocaine, and medically restricted drugs. It's a global public health issue, with over 275 million people (over 5% of the global population aged 15-64) using substances, with a 22% increase since 2010. In Iraq, substance use is a major concern, especially among males. This study aims to assess the prevalence of substance use among students in the University of Kufa, and to identify its associated factors. Methods: A cross-sectional study conducted in the University of Kufa during the period from February 15th till March 15th, 2023. Socio-demographic data was collected using a specially designed questionnaire and a total of (396) participants from four different colleges were randomly selected. Results: The study enrolled (396) participants with almost equal proportion from each of the included colleges. Mean age was (21.4 ± 2.2) years. More than half of the participants were females. Tobacco use was the most common used substance within recent year (19.9%) which was significantly higher among males (P-value &lt; 0.001). Pain killers use was the second most common (10.1%) with a significantly higher prevalence among females (P-value = 0.002). Conclusion: This study concludes that substance use is present among college students, mainly of tobacco and pain killers. Peer pressure was one of the important factors that influence substance use, especially among the vulnerable age group of 20-24 years.

One-Step Nucleic Acid Amplification Analysis of Sentinel Nodes in Endometrial Cancer Versus Ultrastaging: First Long-Term Follow-Up Data of Discordant Cases.

Endometrial cancer (EC) is the most common gynecological cancer worldwide and its incidence is rising. The cornerstone of its management is surgical treatment with nodal staging. A monocentric study investigating the potential of the molecular biology method of one-step nucleic acid amplification (OSNA) in sentinel lymph node (SLN) analysis was conducted at our institution between April 2016 and January 2018. Histopathological ultrastaging was used as the reference standard for SLN examination and OSNA as the index test. The aim of this study was to assess the long-term outcome of patients with discordant SLN and OSNA results. To our knowledge, this is the first study exploring this issue. Patients were followed in line with the current ESMO/ESGO/ESTRO recommendations. The institutional electronic database was retrospectively searched for patients' follow-up data from April 2016 till March 2023. Only patients who provided a written valid consent and had a positive OSNA and negative ultrastaging of their SLN analysis were included in the study. The primary endpoint was the retrospective analysis of their clinical outcome. Data from 58 patients enrolled into our previous study were reviewed and 12 discordant patients who met the inclusion criteria for this study were identified. The median follow-up was 83 months. Disease recurrence was detected in 3 (25%) patients, two of these were nodal and both patients died. One patient had a solitary lung metastasis which was surgically treated, and the patient was disease-free during the whole study period. The recurrence rate of patients included in the study was in the intermediate-high and high-risk group range, and hence, higher than expected based on ultrastaging results. Furthermore, benign epithelial inclusions do not seem to adversely affect OSNA SLN analysis in EC patients.

Efficacy of Adjuvant Yoga Therapy for Cognition in Schizophrenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: It is well-known that negative and cognitive symptoms in schizophrenia are challenging to treat with conventional psychotropics. Hence, various mind–body interventions like yoga have been brought into the modern scientific realm to investigate for possible benefits. Although several studies have been done using yoga as an intervention for cognition in schizophrenia, the results have been inconclusive. In this study, we systematically reviewed and performed meta-analyses of the eligible studies to investigate the efficacy of yoga as adjuvant therapy for cognition in the schizophrenia population. Methodology: After registration of the protocol in PROSPERO (CRD42024504319), electronic databases such as PubMed, MEDLINE, PsycINFO, Scopus, Cochrane Library, ClinicalTrials.gov, and gray literature were searched for randomized controlled trials from their date of inception till March 2024, with appropriate search terms. Covidence and Microsoft Excel for data extraction, Cochrane tool for risk of bias assessment version 2, and RevMan version 5.4.1 for data analysis were used. Results: Of 182 studies found through database search, five articles were included for systematic review and two for the meta-analysis, with a pooled sample size of 76 patients. A systematic review of five articles showed high risk in two articles and low risk in three articles. Meta-analysis showed no significant effect of yoga on cognition (standardized mean difference 0.17, 95% confidence interval: −0.28 to 0.63, P = 0.46). Conclusion: The results of the meta-analysis should be interpreted with caution owing to the low power, small sample size, methodological limitations in the included studies, and hence high likelihood of type II error. There is a need for more studies with rigorous methodology involving yoga for cognition in schizophrenia.

Study of rotavirus genotypes G and P in one Egyptian center-cross-sectional study

BackgroundRotavirus-associated gastroenteritis is a common health problem in children, different variations of rotavirus genotypes differ according to geographic locations and the practice of wide-scale vaccination. Therefore, the present study aimed to detect both the G and P genotypes of rotavirus in children ≤ 5 years old in one center in Egypt as a cross-sectional study, to correlate the genotypes with various demographic and clinical data in infected children and to evaluate the common mixed genotypes G and P in infected children.MethodThe cross-sectional study included children with acute gastroenteritis ≤ 5 years old from January 2023 till March 2024 recruited from Mansoura University Children’s Hospital, Egypt based upon laboratory diagnosis by exclusion of bacterial and protozoa pathogens. The stool samples were obtained from each child and subjected to detection of rotavirus antigen by enzyme-linked immunosorbent assay (ELISA) followed by genotypes identification of G and P genotypes by nested polymerase chain reaction (PCR).ResultA nested PCR study for rotavirus genotypes revealed that G1 was the most common genotype (24.7%) followed by G2 (21.1%), G3 (20%), G9 (20%), and G4 (14.1%). The genotyping of the P genotype revealed that P9 was the commonest genotype (24.7%), followed by P4 (21.2%), P10 (20%), P8 (17.6%) and P6 (16.5%). The commonest combined genotypes of G and P were G1P4 (85.7%), G3P8(88.2%), followed by G2P6 (77.8%) and G9P9(76.5%) and G4P9 (66.7%) followed by G4P10 (33.3%), G9P10(23.5%), G2P10(22.2%), G1P10 (14.3%), G3P10(11.8%). The distribution was significant (P = 0.001). The positive rotavirus antigen was more frequently detected in females (55.3%) than males (44.7%, Odd ratio 0.2, 95% CI 0.22–0.71, P = 0.001). There was a significant association between the summer season and positive rotavirus antigen (P = 0.001) and rural residence of the patients (Odd ratio 6,9 95%CI 3,5-13.5, P = 0.001). The significant associated clinical sign with positive rotavirus antigen was fever (Odd ratio 3,3, 95%CI 1,8-6.05, P = 0.001). The genotypes G and P were significantly associated with positive rotavirus antigen as all cases positive by antigen had been detected by nested PCR with the commonest genotypes G4 (24.7%, P = 0.001) and genotype P9 (24.7%, P = 0.001).ConclusionThe present study highlights the common genotypes of rotavirus at one center in Egypt, G1, G2, and G3 were the commonest G genotypes. As regard genotype P the commonest genotypes were P9, P4, and P10. The commonest combined genotypes were G1P4, G3P8, G2P6. There was no effect of the practice of rotavirus vaccination at limited rates at private health sections as the rotavirus is still a major pathogen of acute gastroenteritis in children. There is a need for the inclusion of rotavirus vaccination in the national program of children vaccination in Egypt.

HPB SO39 - Incidence for the need of blood transfusion for Laparoscopic Cholecystectomy :Is a group and save always needed ?

Abstract Background Major bleeding is rare but among the most serious complications of laparoscopic surgery. As low as 1.3% of patient undergoing laparoscopic cholecystectomy may require a blood transfusion. We propose that not all patients undergoing laparoscopic cholecystectomy require a valid group and save sample, as the risk of bleeding is minimal. Method Health records of 458 patients who underwent cholecystectomy at our two hospital sites were reviewed for blood transfusion up to 30 days post-operatively. This review included elective and emergency procedures from January 2023 till March 2024. Demographics and surgical outcomes, including preoperative Haemoglobin (Hb) levels, need for transfusion, reason for transfusion and amount of units transfused were recorded. We analysed nominal values in proportions and percentages. Results Average pre-operative Hb levels were 13.38 g/dl. 7 patients required peri-operative blood transfusion. Three patients requiring transfusion had conversion to open cholecystectomy. Three patients requiring transfusion underwent emergency procedures. Time to transfusion ranged from 2 hours-5 days. All patients requiring transfusion were at our main hospital site (Watford General Hospital). Our yearly cost of ordering routine group and save sample throughout the audit period was £12,824 Conclusion Routine group and save is not required prior to Laparoscopic Cholecystectomy. In case transfusion is required sufficient time to process a group and save samples is present. High risk patients i.e those with known haematological malignancies, coagulopathy, concurrent use of blood thinner, higher ASA grades can be identified and selective blood grouping performed.

Abstract 4120716: Aspirin plus clopidogrel versus aspirin alone in patients with mild-to-moderate stroke: A systematic review and meta-analysis

Background: Studies have shown that dual antiplatelet therapy (DAPT) is superior to aspirin monotherapy in patients with minor stroke or transient ischemic attacks. However, there is limited evidence regarding the efficacy and safety of DAPT in mild-to-moderate stroke. Aims: We conducted a systematic review and meta-analysis to evaluate whether DAPT is superior to single antiplatelet among patients with mild to moderate ischemic stroke. Methods: PubMed/MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception till March 2024 for published randomized controlled trials (RCTs) and observational studies that compared aspirin plus clopidogrel versus aspirin monotherapy in patients with mild-to-moderate stroke. R version 4.3.2 was used to calculate risk ratios (RRs) with 95% confidence intervals (95% CIs). Results: A total of 4 studies reporting data for 15,173 patients were included. DAPT was associated with a reduced risk of early neurological deterioration (END) (RR: 0.55, 95% CI: 0.28 to 1.05, p = 0.07 Figure 1A) and recurrent ischemic stroke (RR: 0.65, 95% CI: 0.41 to 1.04, p = 0.07 Figure 1B) without reaching statistical significance. The risk of recurrent hemorrhagic stroke (RR: 0.94, 95% CI: 0.47 to 1.86, p = 0.86 Figure 2A), all-cause death (RR: 0.75, 95% CI: 0.52 to 1.08 Figure 2B), or myocardial infarction (RR: 0.83, 95% CI: 0.45 to 1.54 Figure 2C) was comparable across the two groups. DAPT was not associated with an increased risk of any bleeding event (RR: 0.70, 95% CI: 0.36 to 1.36 Figure 2D). Conclusion: DAPT possibly reduces the risk of END and recurrent ischemic stroke as compared to aspirin monotherapy in mild or moderate stroke without increasing the risk of bleeding events.

Comparative Efficacy of Postoperative Pain Management Techniques Following Costal Cartilage Harvest: A Systematic Review and Network Meta-analysis.

Efficient pain control is essential in reconstructive surgeries, particularly in procedures involving the harvest of costal cartilage. This study examines and compares different pain relief treatments using a network meta-analysis (NMA) to determine the most effective techniques for managing pain. We performed a systematic review and network meta-analysis (NMA) by scanning several databases such as PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu till March 18, 2024. The review analyzed randomized controlled trials and observational studies that evaluated the effectiveness of local anesthetics and multimodal analgesia techniques in treating postoperative pain following costal cartilage harvest. Primary outcomes were pain scores at 6-, 12-, 24-, and 48-h post-surgery, while secondary outcomes included the need for rescue analgesia and opioid-related adverse effects. Fourteen studies involving 935 participants were included. The analysis revealed that multimodal strategies, particularly 'Methylene Blue and Ropivacaine Intercostal Nerve Block (MB & Ropivacaine ICNB) combined with Patient-Controlled Analgesia (PCA),' were the most effective techniques to reduce pain scores across 6, 24, and 48-h time points. "Pre-operation SAPB & PSB + PCA" was most effective in reducing pain score at 12h and significantly decreased the need for rescue analgesia and opioid-related adverse effects. In contrast, traditional ICNB with single drug consistently showed the least efficacy. The results of our study strongly support the use of multimodal analgesic techniques instead of typical single medication ICNB for managing postoperative pain after costal cartilage harvest. These strategies not only provide superior pain control but also contribute to reducing the dependency on opioids, aligning with current clinical priorities to enhance recovery and minimize opioid-related risks. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Glycemic control and risk factors of mortality in patients with diabetes mellitus and COVID-19: A single center experience from Pakistan.

Objective: To highlight the effect of COVID-19 and DM on each other by studying glycemic control and risk factors for mortality. Study Design: Retrospective Observational Review. Setting: Sindh Institute of Urology and Transplantation Karachi Pakistan. Period: March 2020 till March 2021. Methods: Covid-19 diagnosed patients admitted were enrolled. They were divided into DM and non-DM. Demographics, clinical variables and outcome were compared. Glycemic control during hospitalization was noted. Fasting glucose level &gt;120 mg/dl, and random &gt;200 mg/dl were considered as poor glycemic control. Survivors and non- survivors among DM patients were compared. Results: A total of 366 patients were included, 113(30.87%) DM and 253(69.12%) non-DM. Mean age was higher in DM group (58yrs vs 49.6yrs p &lt;0.001). Significantly more patients with hypertension (p &lt;0.001) and ischemic heart disease (p=0.001) developed Covid-19 in DM group. There was no difference in mortality (p = 0.295). In DM patients, the significant risk factors for mortality were age &gt;60years, hypertension and chronic kidney disease. The mean high fasting and pre-dinner blood glucose levels at admission and day 5 were significantly associated with mortality. Conclusion: Diabetic patients with advanced age, hypertension and chronic kidney disease were associated with increased risk of death. More attention should be focused on dynamic monitoring and strict glycemic control as uncontrolled diabetes is associated with severe infection and mortality.

Blended Psychological Therapy for the Treatment of Psychological Disorders in Adult Patients: Systematic Review and Meta-Analysis.

Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models. We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure. PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=-1.1, 95% CI -0.6 to -1.6, P<.001, and z score=-4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=-0.1, 95% CI -0.3 to 0.05, P=.17, and z score=-1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=-0.75, 95% CI -0.56 to -0.95; anxiety: n=8, Cohen d=-0.9, 95% CI -0.6 to -1.2); fewer (≤6) face-to-face sessions (depression: n=9, Cohen d=-0.7, 95% CI -0.5 to -0.9; anxiety: n=7, Cohen d=-0.8, 95% CI -0.3 to -1.3); and a lower ratio (≤50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=-0.8, 95% CI -0.6 to -1.1; anxiety: n=4, Cohen d=-0.8, 95% CI 0.006 to -1.6). This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required. PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258977.