Medicine Unit Research Articles

Authentic Nursing Leadership and Safety Climate Across Hospital Settings During the COVID-19 Pandemic: A Cross-Sectional Study.

To analyse the relationship between authentic nursing leadership and safety climates across hospital settings during the COVID-19 pandemic. Authentic nursing leadership shapes the safety climate by fostering positive perceptions of workplace policies, processes, procedures and practices that influence how safety is prioritised and addressed within an organisation. A cross-sectional study. Our study was conducted from December 2021 to December 2022 in six Brazilian hospitals. Participants were nursing staff working in General Medicine Units, Intensive Care Units (ICU) and Emergency Departments (ED) who provided care to patients with COVID-19. The Authentic Leadership Questionnaire and the Safety Attitudes Questionnaire were used to measure nursing staff perceptions of authentic leadership and safety climates. Data were analysed using descriptive and inferential statistics. 391 nursing staff across six hospitals participated. Self-awareness significantly enhanced perceptions of the safety climates. Additionally, being a Registered Nurse and working in the ICU were positively associated with achieving safe climates in the working environment. In contrast, working in EDs was significantly negatively related to safety climates. The COVID-19 pandemic underscored a lack of authentic nursing leadership and unsafe climates. Therefore, it is critical to implement educational strategies that foster authentic leadership, particularly focusing on self-awareness, to promote more positive safety climates. Ensuring that leadership and safety climates are relationship-focused is critical to enhancing patient outcomes. Nursing staff's perceptions of authentic leadership and safety climates are important in making more informed decisions about patient management. Since self-awareness increases positive perceptions of safety climates, nursing staff should exercise it to guide their actions in facing future health crises. STROBE guidelines. Higher self-awareness in relationships with others is a predictor of safety climates and can lead to enhanced patient outcomes.

Comparison between Lavender and Chamomile Essential Oils for Pain and Anxiety Reduction during Amniocentesis in Second Trimester Pregnancy: A Randomized Controlled Trial

Objective: To investigate the effectiveness of aromatherapy using lavender and chamomile essential oils, to alleviate pain and reduce anxiety during the amniocentesis procedure in second trimester pregnancy. Materials and Methods: The present was a randomized controlled trial approved by the Human Research Ethics Committee of Thammasat University (MTU-EC-OB-1-023/66) and registered in the Thai Clinical Trials Registry on June 29, 2023 (TCTR20230629001). The present study was conducted at the Maternal and Fetal Medicine Unit, Thammasat University Hospital, Pathum Thani, Thailand between July and November 2023. The participants were pregnant women undergoing amniocentesis. Participants were randomly assigned into three groups, lavender, chamomile, and normal saline, which was the control group. Participants in each group were instructed to inhale the assigned scent, lavender, chamomile, or normal saline, for 15 minutes prior to the amniocentesis procedure. For each participant, a cotton swab containing four drops of the assigned scent was held 10 centimeters from the participant’s nose. Pain and anxiety were recorded using visual analog scale (VAS) and visual facial anxiety scale (VFAS). Expected pain and anxiety were recorded before amniocentesis (Te), immediate after procedure (T0), and at 15 and 30 minutes after the procedure (T15 and T30). Results: One hundred fifty participants were allocated into three groups. To ensure comparability, demographic characteristics were matched across the three groups. The present study revealed that both lavender and chamomile lowered pain more than the control at 15 minutes after amniocentesis (T15), and only lavender can reduce pain during the procedure (T0). Both lavender and chamomile reduced anxiety more than the control 15 minutes after amniocentesis (T15), and only chamomile continued to reduce anxiety 30 minutes post procedure (T30). Thus, lavender proved to be more effective in managing pain during the amniocentesis procedure, whereas chamomile offers a prolonged effect in reducing anxiety, lasting up to 30 minutes post-procedure. Conclusion: Aromatherapy effectively reduces pain and anxiety associated with amniocentesis. In the present study. Both lavender and chamomile reduced pain at 15 minutes after the procedure, but only lavender has efficacy in pain reduction during the procedure. Both lavender and chamomile reduced anxiety 15 minutes after the procedure, but only chamomile continued to reduce anxiety 30 minutes post procedure. However, when comparing lavender and chamomile, there was no statistically significant difference in efficacy of pain or anxiety reduction. Keywords: Lavender; Chamomile; Aromatherapy; Essential oil; Amniocentesis; Pain; Anxiety

A Pressure Injury Prevention (PIP) Quality Improvement Pilot Of Sub-Epidermal Moisture Scanning In Acute Care

The objective of this study was to evaluate the impact of Sub-epidermal Moisture (SEM) assessments, in conjunction with risk and skin assessments, on facility acquired pressure injuries and the current standard of care: pilot. One 33-bed acute care Medicine unit was purposefully selected to participate in the six-week pilot based on availability of baseline data, a structured pressure injury prevention team, and leadership approval. SEM assessments were completed, in conjunction with risk and skin assessments, based on inclusion/exclusion criteria. SEM assessment enhanced early and anatomy specific interventions and reduced facility-acquired pressure injuries by 100%. The addition of SEM contributed to higher quality care and an estimated annual cost savings of $426,903 Canadian dollars.

Drone-based medical delivery in the extreme conditions of Himalayan region: a feasibility study

IntroductionUnmanned aerial vehicles, or drones, have emerged as versatile tools across various sectors, including defence, agriculture, surveillance, mining, infrastructure, emergency response, transportation, geospatial mapping and notably medical supply delivery to...

Evaluation of Isolated Anti-HBc Positivity in Patients Considered for Hepatitis B Diagnosis: 8.5 Years of Data

Background: Hepatitis B virus (HBV) infection is a global health problem. Isolated anti-hepatitis B core (HBc) serologic pattern is the most common atypical serologic profile and is defined as positive anti-HBc and negative hepatitis B surface antigen (HBsAg) and anti-HBs. Objectives: This study aimed to determine the prevalence of isolated anti-HBc positivity in samples sent to the medical microbiology laboratory for the examination of hepatitis B indicators, to identify both anti-HBc IgM and HBV DNA positivity rates within this pattern, to examine the relationship of this atypical pattern with different clinics, and to contribute to the clinical data of our country. Methods: Between January 2015 and July 2023, the patients’ test results of HBsAg, anti-HBs, anti-HBc, anti-HBc IgM, and HBV DNA requested from blood samples were retrospectively scanned along with demographic data of these patients. Results: Isolated anti-HBc positivity was observed in 1941 (6.0%) patients. Hepatitis B virus DNA positivity was 8.4% and anti-HBc IgM positivity was 0.6% in patients with isolated anti-HBc positivity. In addition, isolated anti-HBc positivity increased by age, was more common in males, and in internal medicine units (gastroenterology, oncology, general internal medicine, etc.). Conclusions: Consequently, anti-HBc IgM and/or HBV DNA positivity within an isolated anti-HBc positive pattern shows the infectivity of the disease. For this reason, in the diagnosis of HBV, in addition to HBsAg and anti-HBs, anti-HBc also needs to be tested, and anti-HBc IgM and HBV DNA need to be checked in every patient with isolated anti-HBc positivity.

Mitigating adverse pregnancy and neonatal outcomes through expanded carrier screening in an oocyte donation programme

Research questionHow frequent are adverse outcomes (AO) in an oocyte donation (OD) program and how many recessive conditions can be prevented with the implementation of expanded carrier screening (ECS)? DesignRetrospective observational study using data from OD cycles between January 2014 and December 2021 in the Reproductive Medicine Unit of a University Hospital in Spain.AO were studied in 4565 OD cycles and the number of high-risk assignations was identified in the OD program where ECS was applied to the oocyte donors and the recipient's male partner (or sperm donor, in cases of double donation). ResultsOut of 4565 OD cycles, 67 OD recipients (1.47%) reported an adverse obstetrical or neonatal outcome. Genetic aetiology was confirmed in 25 (37.3%) cases. The remaining 42 (62.7%) cases involved congenital malformations, neurodevelopmental disorders, and other conditions with unknown genetic origins.Moreover, 211 (4.6%,211/4565) high-risk assignations were identified due to both oocyte donors and recipient's male partners being carriers of the same autosomal recessive (AR) condition. This could have led to an additional 1,15% of children born with an AR condition (25%x4.6%). Additionally, 52 (2.8%,52/1875) oocyte donor candidates were carriers of X-linked (XL) conditions, which would have led to an additional 0.7% (25%x2.8%) of children born with an XL disorder.ECS implementation resulted in a 55.7% reduction in AO risk, decreasing the potential AO rate from a 3.32% rate (1.15%+0.7%+1.47%) to an actual incidence of 1.47%. ConclusionsECS reduces the probability that children born from OD could inherit recessive conditions screened. However, certain adverse outcomes remain unavoidable.

Accuracy of lung ultrasound performed with handheld ultrasound device in internal medicine: an observational study.

Lung ultrasound (LUS) is increasingly used in Internal Medicine to complement medical examination, documenting pleural and lung conditions. This study aimed to compare the accuracy of handheld ultrasound device (HHUSD) with high-end ultrasound device (HEUSD) in patients with heart failure or pneumonia, also including the assessment of costs and time-savings. In this observational study 72 patients (aged ≥ 18) admitted to Internal Medicine Unit for heart failure or pneumonia underwent LUS plus evaluation of inferior cava vein (ICV) when indicated, using both HHUSD and HEUSD. Each evaluation, independently performed by 2 different experienced operators, included B-lines number, pleural effusion, lung consolidations, ICV ectasia and its respiratory excursions. Concordance between HHUSD and HEUSD findings was 79.3% ± 17.7 (mean ± SD) for B-lines, 88.6% for pleural effusion, 82.3% for consolidations and 88.7% and 84.9% for ICV ectasia and its respiratory excursions respectively. BMI didn't significantly influence concordance between the two methods. Moreover, examination time (as mean ± SD) was shorter with HHUSD (8 ± 1.5min) compared to HEUSD (10 ± 2.5min). HHUSD demonstrated high accuracy in detecting B-lines, pleural effusions, lung consolidations and ICV evaluation when compared to HEUSD. Thus, HHUSD, not only is characterized by accessibility, portability, and easy handling due to its small size, but it also offers advantages in terms of saving costs and time, ultimately contributing to faster patient assessment compared to HEUSD.

Phenotype-to-Genotype Description of Prenatal Suspected and Postnatal Discovered Upper Limb Anomalies: A Retrospective Cohort Study.

To evaluate phenotype and genotype characteristics of fetuses and children with upper limb anomalies. Retrospective cohort study of a prenatal and postnatal cohort with upper limb anomalies from January 2007 to December 2021 in a Fetal Medicine Unit. Prenatally on ultrasound suspected upper limb anomalies, such as transverse and longitudinal reduction defects, polydactyly, and syndactyly, and postnatally identified children referred to the Congenital Hand Team were evaluated separately. The prenatal group included 199 pregnancies: 64 transverse and 19 longitudinal reduction defects, 103 polydactylies, and 13 cases with syndactyly. The majority of cases with longitudinal reduction defects (n=10, 52.6%), polydactyly (n=62, 60.2%), and syndactyly (n=10, 76.9%) were non-isolated, as opposed to transverse reduction defects, which were generally isolated (n=41, 64.1%). The postnatal cohort included 362 children with upper limb anomalies with 49 transverse and 22 longitudinal reduction defects, 226 polydactylies, and 65 syndactylies. Chromosomal or monogenic abnormalities were identified in 76/199 (38.2%) cases of the prenatal cohort and in 31/362 (8.6%) cases of the postnatal cohort. Prenatal identification of minor defects of the digits is a challenge, with more postnatal than prenatal cases. The majority of cases with isolated anomalies in both groups had no underlying chromosomal or monogenic cause, nor were they associated with a syndrome, as compared to the non-isolated cases. Conducting structural anomaly scans and genetic counseling are crucial to assess the risk of genetic abnormalities.

Occupational health services in Poland during the COVID-19 pandemic.

This publication analyses the activities of physicians and occupational medicine units in Poland during this period. The analysis of the number of physicians and units of occupational medicine and the preventive and judicial activities they carried out was based on the MZ-35 and MZ-35A statistical forms, which constitute mandatory medical reporting. In Poland, during the pandemic, the number of physicians authorized to perform preventive examinations of employees decreased by 9.3% (6597 in 2019 vs. 5984 physicians in 2022). At the same time, the number of basic units of the occupational medicine where preventive examinations of employees decreased from 5974 to 5534 (by 7.4%). The average number of preventive examinations performed annually on employees throughout the pandemic decreased by 9.4% from 5 429 808 (in 2015-2019) to 4 923 161 (in 2020-2023). In the first 2 years of the pandemic, the share of decisions on health contraindications to perform professional activities in the position indicated in the referral increased slightly. During the pandemic, there was also a significant decrease in the number of visits carried out by occupational medicine physicians, both to entire workplaces (by 46%) and to individual positions (by 49%). During the COVID-19 pandemic, occupational medicine physicians reported almost 3 times more suspected occupational diseases than in previous years (an average of 1736 reports per year compared to 673 reports in 2015-2019). The most reports were recorded in 2020 (N = 2183). The COVID-19 pandemic has significantly impacted the preventive activities performed by occupational medicine physicians. Reducing the number of mandatory medical examinations of employees during the pandemic could have led to the construction of a health debt of the working population, both in terms of limiting the unfavourable impact of working conditions and worsening the chances of early detection of lifestyle diseases. Int J Occup Med Environ Health. 2024;37(5).

Serum Albumin Alters [18F]FDG Activity in the Liver and Blood Pool

Abstract Objective This study aims to investigate the correlation between the 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) activity of the liver and blood pool, and the serum albumin. Methods A retrospective analysis was conducted on adult patients who underwent [18F]FDG positron emission tomography/computed tomography at the Nuclear Medicine Unit of a hospital in Hong Kong between January 1, 2023, and March 31, 2023. The mean standardized uptake value normalized to lean body mass (SULmean) was measured in the liver and blood pool. Pearson's correlation analyses between the SULmean of reference regions and serum albumin were performed. Multiple linear regression was used to analyze the effects of serum albumin and other parameters as the independent predictors on SULmean of the reference regions. Results A total of 146 patients were included, with their SULmean of the liver and blood pool showing significantly positive correlations with serum albumin (r = 0.393, p < 0.001 and r = 0.207, p = 0.012, respectively). Multiple linear regression analyses confirmed serum albumin as an independent variable on SULmean of the liver and blood pool (p < 0.001 and p = 0.014, respectively). Conclusion Serum albumin alters [18F]FDG biodistribution in the liver and blood pool. The decrease in liver background activity in patients with low serum albumin may produce a higher false-positive rate of lesion detection, particularly when there is a drop of serum albumin in serial scans. Nuclear medicine physicians should be cautious of image interpretation.

Long Term Ventilation in Pediatric Central Apnea: Etiologies and Therapeutic Approach over a Decade.

This retrospective study aimed to analyze the clinical characteristics, ventilatory strategies, and effectiveness of ventilation in pediatric patients with central apneas treated at the Sleep Medicine and Long-Term Ventilation Unit of the Bambino Gesù Children's Hospital in Rome from 2012 to 2022. Among all ventilated patients at our Center from January 2012 to December 2022, we retrospectively included children with a cAHI ≥ 1 events/h on baseline poly(somno)graphic study. Additional parameters assessed included the underlying disease, type of ventilation (non-invasive vs. invasive), age at ventilation onset, ventilation mode, and transcutaneous capnometry parameters. To assess the effectiveness of ventilation on central apneas, we compared the cAHI at baseline and on ventilation. Sixty-seven patients met the inclusion criteria for central apnea (cAHI > 1 events/h). Diagnoses included hypoxic-ischemic encephalopathy, 15 (22.4%); Ondine syndrome, 14 (20.9%); polymalformative syndrome, 10 (14.9%); Prader-Willi syndrome, 8 (11.9%); brain tumor, 6 (9.0%); Down syndrome, 4 (6.0%); ROHHAD syndrome, 2 (3.0%); other infrequent pathologies were, Arnold-Chiari II, primary central apnea, epilepsy, lisosomal diseases, hydrocephalus, myopathy, obesity, Rett Syndrome. Pressure-supported ventilation (PSV) was the most common mode used (45 out 67 patients, 67.2%), followed by pressure-controlled ventilation (PCV) (15 out 67 patients, 22.4%) and continuous positive airway pressure (CPAP) (7 out 67 patients, 10.4%). Statistically significant improvement (p < 0.05) in cAHI was observed in patients with polymalformative syndrome (3.5 vs. 0.3, p = 0.01), hypoxic-ischemic encephalopathy (3.1 vs. 0.1, p = < 0.01), and Prader-Willi syndrome (3.5 vs. 0.1, p = 0.03), while there was no significant improvementn in children with brain tumor (6.2 vs. 1.5, p = 0.21). Central apneas are present in children with various underlying pathologies. Ventilatory strategies tailored to the specific diagnosis and severity of central apneas yield significant improvements in cAHI. PSV was the preferred ventilation mode in this study and there was notable effectiveness across different diagnostic categories. PCV was employed in most severe cases. CPAP was exclusively used in patients with predominantly obstructive sleep apneas.

Detection of Elementary White Mucosal Lesions by an AI System: A Pilot Study

Aim: Accurately identifying primary lesions in oral medicine, particularly elementary white lesions, is a significant challenge, especially for trainee dentists. This study aimed to develop and evaluate a deep learning (DL) model for the detection and classification of elementary white mucosal lesions (EWMLs) using clinical images. Materials and Methods: A dataset was created by collecting photographs of various oral lesions, including oral leukoplakia, OLP plaque-like and reticular forms, OLL, oral candidiasis, and hyperkeratotic lesions from the Unit of Oral Medicine. The SentiSight.AI (Neurotechnology Co.®, Vilnius, Lithuania) AI platform was used for image labeling and model training. The dataset comprised 221 photos, divided into training (n = 179) and validation (n = 42) sets. Results: The model achieved an overall precision of 77.2%, sensitivity of 76.0%, F1 score of 74.4%, and mAP of 82.3%. Specific classes, such as condyloma and papilloma, demonstrated high performance, while others like leucoplakia showed room for improvement. Conclusions: The DL model showed promising results in detecting and classifying EWMLs, with significant potential for educational tools and clinical applications. Expanding the dataset and incorporating diverse image sources are essential for improving model accuracy and generalizability.

Identifying latent subgroups of primary head injury: an explorative latent class analysis on neuropathologically examined medico-legal autopsy cases.

Traumatic brain injury (TBI) is a significant global health concern and frequently encountered in medico-legal autopsies. Previous studies suggest that certain TBI subtypes are more likely to co-occur than others. Therefore, we aimed to explore the potential of latent class analysis (LCA) to identify and characterize primary head injury combinations in neuropathologically examined medico-legal autopsy cases. The dataset comprised 78 cases from the Forensic Medicine Unit of the Finnish Institute for Health and Welfare over the period of 2016-2022. Data on background and circumstantial characteristics as well as primary and secondary head and brain injuries were collected from police documents, medical records, general autopsy reports and neuropathology reports. Latent class solutions with two to five classes were explored to identify clustering of primary head injuries among the sample. The dataset comprised 69.2% males and the median age was 49 years. In LCA, the solutions appeared reasonable, and each class appeared to represent a distinct TBI profile. The two-class solution was found to fit the present dataset best. Class 1 was characterized by older age, presence of an underlying CNS disease, and less diverse primary head injuries; these were interpreted as suggestive of lower traumatic forces. Class 2 was characterized by male sex and assaults as a prominent injury circumstance; subarachnoid and intracerebral/ventricular haemorrhages and contusions were classified exclusively into this class. In conclusion, this study identified two distinct subgroups of primary head injuries. Understanding typical injury combinations related to distinct circumstances could assist not only forensic pathologists but also clinicians treating TBI patients. However, the present latent class solution should not be interpreted as "ground truth", but instead further research is needed.

Sodium-glucose cotransporter 2 inhibition in patients with liver cirrhosis and diabetes: a possible role in ascites control?

The aim of this brief report is to evaluate sodium-glucose cotransporter 2 inhibitors (SGLT2-I) effects on patients with both refractory ascites and type 2 diabetes mellitus (T2D). We consecutively recruited all the diabetic patients with refractory ascites due to decompensated liver cirrhosis admitted between February and May 2023 at the Internal Medicine Unit of the University Hospital of Palermo. Clinical and laboratory data were collected after starting SGLT2-I therapy. SGLT2-I use was associated with a reduction/resolution of ascites and with an improvement in serum albumin and sodium levels and estimated glomerular filtration rate. SGLT2-I might represent a valid therapeutic option in the treatment of patients with refractory ascites and T2D, as already hypothesized by other research groups.

The effects of multimodal versus opioid-only analgesia on pain control and opioid exposure for inpatient acute pancreatitis: A retrospective cohort study.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Acute pancreatitis (AP) is a common gastrointestinal condition that carries a significant financial and physical burden for patients due to the painful presentation and frequent need for hospitalization. Treatment varies in the type and route of analgesic used. Unmanaged pain can lead to worsening health outcomes and prolonged admissions. Further research is needed to understand current practices for managing AP. This study was a retrospective, exploratory, single-center cohort study. Patients admitted to an internal medicine unit with AP from September 1, 2020, to December 31, 2021, were included. Our primary outcome was the change in pain scores during the first 24-hours after administration of the first pain-relieving medication. Secondary outcomes included change in pain scores within the first 12-hours, time to oral tolerance, characterization of analgesic orders, comparison of median pain scores by home analgesic usage, and specific inpatient opioid use. One hundred sixty-nine patients were screened, and 94 were included in the study. Forty-four patients were assigned to the multimodal cohort and 50 patients to the opioid-only cohort. Changes in pain scores per unit of time, assessed by a mixed-effects model, within the first 24 hours were -0.080 (SE, 0.018) in the multimodal cohort and -0.090 (SE, 0.014) in the opioid-only cohort (P = 0.780). Morphine milligram equivalents (MME) administered in the multimodal and opioid-only cohorts were 24.50 (interquartile range [IQR], 51.75) and 52.5 (IQR, 68.5) (P = 0.001), respectively. There was no significant difference in the change in pain scores between patients receiving multimodal therapy and those receiving opioids only. Significantly fewer MME were administered in the multimodal group, suggesting that multimodal therapy can be opioid-sparing in AP.

Location and accumulation of primary head injuries, and prevalence of secondary injuries among neuropathologically examined medico-legal autopsy cases – A comparative study of falls and assaults

Even though traumatic brain injury (TBI) is a major cause of death globally, detailed data on the location and accumulation of primary head injuries, and prevalence of secondary injuries in distinct injury circumstances such as falls and assaults is limited. This study aimed to highlight the differences in injury patterns between falls and assaults among neuropathologically examined medico-legal autopsy cases. Data were collected on a total of 128 cases from the Forensic Medicine Unit, Finnish Institute for Health and Welfare, between the years 2016 and 2022. All cases had suspected or confirmed acute head injuries and underwent a full neuropathological examination. Background and circumstantial variables, as well as the presence of head and brain injuries, were extracted from the medico-legal autopsy case files. Comparative analyses were conducted between assured falls (n = 26) and assaults (n = 23). Any primary head injury was observed in 57.0 % of the full sample; the most common primary injuries were scalp haemorrhage (47.7 %), subarachnoid haemorrhage (SAH) (24.2 %), and diffuse traumatic axonal injury (13.3 %). Assault cases showed a significantly higher prevalence of scalp haemorrhage (82.6 % vs. 46.2 %, p = 0.016) and SAH (52.2 % vs. 11.5 %, p = 0.004) compared to fall cases. In assault cases, the left hemisphere was clearly more frequently affected than the right one (91.3 % vs. 65.2 %). Of secondary injuries, brain oedema was more common in assaults than falls (47.8 % vs. 7.7 %, p = 0.003). In conclusion, this study highlights differences in head and brain injury patterns between falls and assaults. Scalp haemorrhage and SAH are more common in assaults than falls. Assaults appear to lead to a higher frequency and diversity of injuries, particularly in the left hemisphere.

Depression and anxiety in primary care patients with hemodialysis

Depression and anxiety affect with persistent sadness, low mood, fear and loss of interest in daily activities. Therefore, it is important to consider hemodialysis patients with psychological disorders in primary care. To analyze the presence of depression and anxiety with the Beck inventory in patients with hemodialysis in the Family Medicine Unit No. 1. A cross-sectional, analytical study was carried out with a type of convenience sampling. based on the inclusion criteria all patients on hemodialysis morning-afternoon shift and excluding all who do not wish to participate or intellectual disability, sample of 53 patients. Beck's anxiety and depression inventory instrument was applied, and the Pearson correlation coefficient was used to assess the degree of association. The sex with the greatest presence was male (57%) and the age range is 40-46 years with 22.6%, the relationship of patients with end-stage renal disease (ESRD) presented mild anxiety/depression, while patients with moderate anxiety presented intermittent depression, the level of anxiety was positively correlated with depression and anxiety (p = 0.877). ESRD decreases functional capacity, generating psychological disorders such as depression and anxiety, which is why joint management with psychology or psychiatry must be carried out.

Comparison of Second-Trimester Uterine Artery Doppler Indices between Pregnant Women with and without Prior Cesarean Delivery and Effect on Perinatal Outcomes

Objective: To evaluate the effects of prior cesarean delivery on second-trimester Uterine Artery (UtA) Doppler and its effect on perinatal outcomes. Materials and Methods: This study was conducted at the Maternal Fetal Medicine unit of Bhumibol Adulyadej Hospital, Thailand between June 2023 and January 2024. Healthy pregnant women aged between 18 and 45 years old were recruited and divided into prior (PCD) and non-prior cesarean delivery (non-PCD) groups. Both groups underwent UtA Doppler study from 18 to 24 weeks of gestation. UtA Doppler indices consisted of pulsatility index (UtA-PI), resistance index (UtA-RI) and systolic/diastolic ratio (S/D). Demographics, maternal and neonatal outcomes were collected. Results: Total of 416 participants were recruited and divided equally. The mean age of participants was 30.5 years old. Diabetes mellitus in pregnancy and hypertensive disorder were reported as 18.9 (79/416) and 5.5 (23/416) percent, respectively. From univariate analysis, subjects in the PCD group had higher UtA-PI, UtA-RI and UtA S/D than the non-PCD group with statistical significance. After multiple logistic regressions, only UtA-RI was greater in the PCD group with any statistical significance. The mean gestational age at delivery was 38.41 weeks. Prevalence of small for gestational age deliveries, preeclampsia, and preterm birth were 4.4 (17/376), 3.1 (12/376) and 10 percent (38/376), respectively. Maternal and neonatal outcomes of both groups were comparable. Number of cesarean deliveries, parity, miscarriage, and anterior placentation were not associated with UtA Doppler indices. Conclusion: UtA-RI of prior cesarean delivery participants were higher than non-prior cesarean delivery participants and not associated with maternal and neonatal adverse outcomes.

Evaluating the metformin use on type 2 diabetes prevention in high-risk populations in primary care

ABSTRACT Purpose/Background: To identify the proportion of patients with prediabetes who have prescribed metformin and factors related to doing so as a preventive measure for diabetes in primary care at a Family Medicine Unit in northeastern Mexico. Methods: This retrospective observational study included 372 adults who met the criteria for prediabetes diagnosis according to the American Diabetes Association. Data was collected from medical records from January 2020 to December 2021. Possible associations between the variables of interest and the prescription of metformin were tested via hypothesis tests, furthermore, binary logistic regression was performed. Results: Nearly 85% of the patients met at least one criterion for receiving metformin according to ADA recommendations, but only 60% of them were prescribed this medication. Patients with metformin prescriptions differed from those without in aspects such as having a documented diagnosis of prediabetes in their medical records, a higher BMI, and higher glucose levels. Conclusions: Almost one out of two patients with a high risk of type 2 diabetes are not treated with metformin as a preventive measure. Factors associated with metformin prescription included a high BMI, elevated baseline glucose levels, and a prediabetes diagnosis in the medical record. These findings suggest the need for studies to evaluate physicians’ reasons for different treatments and implementation of recommendations for type 2 diabetes prevention in patients with prediabetes in primary health care.

Sex-related differences in vitamin D testing in the Veneto Region, Italy: a retrospective analysis from 2005 to 2016

SummaryA retrospective analysis was performed to evaluate the frequency of vitamin D blood testing in individuals from the Padua province, Veneto, Italy from 2005 to 2016. A significant increase in the frequency of vitamin D blood tests, particularly in females was observed and in individuals with severe vitamin D deficiency (Class I).PurposeVitamin D deficiency has been linked to negative health outcomes that extend beyond bone-related conditions. The frequency of vitamin D blood testing in residents from the Padua province, (Veneto, Italy) from 2005 to 2016 was evaluated.MethodsData were retrospectively retrieved from blood test databases (Laboratory Medicine Unit, Padua University Hospital) and information on number of vitamin D blood tests performed on residents from 2005 to 2016 was collected. Data were stratified by sex and ten birth cohorts from 1901 to 2016. Blood tests were classified into five vitamin D classes: I < 50 nmol/L, II 50–74.9 nmol/L, III 75–149 nmol/L, IV 150–250 nmol/L, and V > 250–1000 nmol/L. Blood test trends were analyzed as blood test rate and vitamin D class rate/resident population. Population analysis was analyzed by incidence rates and stratified by vitamin D class.Results293,013 vitamin D blood tests were conducted between 2005 and 2016 across 10 birth cohorts. Females accounted for 75% of tests and fewer were conducted in the youngest and oldest birth cohorts. Sex differences in vitamin D blood test frequency were observed; adjusted rates ranging from 1.7 to 35.6% for males and 8 to 81% for females from 2005 to 2016. Crude incidence rates (per 1000 from 2005 to 2016) varied from 1.5 to 10.8‰ for males and 7 to 19.4‰ for females. Crude blood test rates for vitamin D deficiency (Class I) increased from 1.1 to 9.9‰ in 2016 for males and 5 to 17.3‰ for females. Crude incidence rates (from 2005 to 2016) for Class I were 9.7–57.1‰ in males and 43.6–92.4‰ in females.ConclusionsThese findings highlight sex-related differences in vitamin D testing, providing valuable insight for healthcare planning.