Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis.

BACKGROUND: Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE: We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN: A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING: A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS: Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES: Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS: A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION: Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.

Gestational glucose intolerance among pregnant women at the Cape Coast Teaching Hospital.

BACKGROUND: Malaria in pregnancy can have adverse outcomes if untreated. Both malaria and pregnancy are associated with insulin resistance and diabetes. Although malaria is treated prophylactically with gestational diabetes mellitus (GDM) screened for in pregnancy as part a routine antenatal care, their impacts have not been examined in terms of other forms of dysglycaemia. This cross-sectional study examined insulin resistance and its relationship with dysglycaemia and malaria among pregnant women in the Cape Coast Teaching Hospital (CCTH). METHODS: Using a structured questionnaire, demographic and clinical information were obtained from 252 pregnant women aged 18-42 years. Weight and height were measured for computation of body mass index (BMI). Measurement of insulin, lipid profile and glucose were taken under fasting conditions followed by oral glucose tolerant test. Insulin resistance and beta-cell function were assessed by the homeostatic model as malaria was diagnosed by microscopy. RESULTS: The respective prevalence of GDM, gestational glucose intolerance (GGI) and insulin resistance were 0.8% (2/252), 19.44% (49/252) and 56.75% (143/252). No malaria parasite or dyslipidaemia was detected in any of the participants. Apart from BMI that increased across trimesters, no other measured parameter differed among the participants. Junior High School (JHS) education compared with no formal education increased the odds (AOR: 2.53; CI: 1.12-5.71; P = 0.03) but 2nd trimester of pregnancy compared to the 1st decreased the odds (AOR: 0.32; CI: 0.12-0.81; P = 0.02) of having insulin resistance in the entire sample. In a sub-group analysis across trimesters, pregnant women with JHS education in their 3rd trimester had increased odds (AOR: 4.41; CI: 1.25-15.62; P = 0.02) of having insulin resistance. CONCLUSION: Prevalence of GDM and GGI were 0.8% and 19.44% respectively. The odds of insulin resistance increased in pregnant women with JHS education in the 3rd trimester. Appropriate measures are needed to assuage the diabetogenic risk posed by GGI in our setting.

Experiences from a COVID-19 vaccination center at a tertiary care teaching hospital in Delhi, India: Challenges and solutions.

India began its nationwide coronavirus disease 2019 (COVID-19) vaccination program on January 16, 2021, in a phased manner. In this paper, we have discussed our experience at one of the COVID-19 vaccination centers in the country and have identified a few of the major challenges and their implications. The guidelines for COVID-19 vaccination in the country were changing frequently, leading to ambiguity among the beneficiaries. Co-WIN software, used for program implementation, had some glitches, which caused dissatisfaction among the service providers and beneficiaries. Vaccine hesitancy and eagerness caused low vaccine uptake initially and overcrowding at vaccination centers later. Some of the vaccination centers had the potential to become hot spots for further spread of the virus due to insufficient infrastructure. The disparity in access to vaccines for the homeless and other vulnerable groups was another hurdle for adequate vaccination coverage. These challenges could have been addressed by pretesting the information technology platform, long-term planning with a vision for handling vaccine hesitancy and eagerness, strong communication systems, removing disparities in vaccine access, and maintaining uniformity in messages for frequently updating guidelines.

Is the QCI framework suited for monitoring outcomes and costs in a teaching hospital using value-based healthcare principles? A retrospective cohort study.

OBJECTIVES: The objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between health outcomes and healthcare utilisation costs. DESIGN: This is a retrospective cohort study. SETTING: A teaching hospital in Rotterdam, The Netherlands. PARTICIPANTS: The study was performed in two use cases. The bariatric population contained 856 patients of which 639 were diagnosed with morbid obesity body mass index (BMI) <45 and 217 were diagnosed with morbid obesity BMI ≥45. The breast cancer population contained 663 patients of which 455 received a lumpectomy and 208 a mastectomy. PRIMARY AND SECONDARY OUTCOME MEASURES: The quality cost indicator (QCI) was the primary measures and was defined asQCI = (resulting outcome * 100)/average total costs (per thousand Euros)where average total costs entail all healthcare utilisation costs with regard to the treatment of the primary diagnosis and follow-up care. Resulting outcome is the number of patients achieving textbook outcome (passing all health outcome indicators) divided by the total number of patients included in the care path. RESULTS: The breast cancer and bariatric population had the highest resulting outcome values in 2020 Q4, 0.93 and 0.73, respectively. The average total costs of the bariatric population remained stable (avg, €8833.55, min €8494.32, max €9164.26). The breast cancer population showed higher variance in costs (avg, €12 735.31 min €12 188.83, max €13 695.58). QCI values of both populations showed similar variance (0.3 and 0.8). Failing health outcome indicators was significantly related to higher hospital-based costs of care in both populations (p <0.01). CONCLUSIONS: The QCI framework is effective for monitoring changes in average total costs and relevant health outcomes on an institutional level. Health outcomes are associated with hospital-based costs of care.

Implementation of a quality improvement initiative for standardising essential newborn care in a teaching public hospital in rural central India.

OBJECTIVE: Our aim was to refine the essential newborn care practices by employing the multidisciplinary peer team-led quality improvement (QI) projects. DESIGN: In 2017, concerning the same, the department focused on early initiation of breast feeding, prevention of hypothermia within an hour of life and rational usage of antibiotics among babies admitted to neonatal intensive care unit (NICU). Baseline data reported the rate of initiation of breast feeding, hypothermia and antibiotic exposure rate as 35%, 78% and 75%, respectively. Root causes were analysed and a series of Plan-Do-Study-Act cycles were conducted to test the changes. The process of change was studied through run charts (whereas control charts were used for study purpose). RESULT: After the implementation of the QI projects, the rate of initiation of breast feeding was found to be improved from 35% to 90%, the incidence of hypothermia got reduced from 78% to 10% and the antibiotic exposure rate declined from 75% to 20%. Along with the improvement in indicators related to essential newborn care, down the stream we found a decrease in the percentage of culture-positive sepsis rate in the NICU. CONCLUSION: Peer team-led QI initiatives in a resource-limited setting proved beneficial in improving essential newborn care practices.

Assessment of average glandular dose in mammography practice of a teaching hospital in Ghana.

Introduction: above the age of 40, women are advised to begin breast examinations and screenings for early detection of breast cancer. The average glandular dose (AGD) provides dosimetric information about the quantity of radiation received by the mammary glands during mammographic exposures. There is, therefore, the need to analyse the radiation dose received by patients presenting for mammography examinations. Methods: a retrospective cross-sectional design was carried out on the data of 663 participants, conveniently sampled between the months of July 2021 and June 2022. Paired T-test was used to compare imaging parameters for cranio-caudal (CC), medio-lateral (ML), automatic exposure control (AEC), manual exposure control (MEC), and left and right breast. Pearson´s correlation was used to test for relationship between imaging parameters and AGD. Results: the mean AGD per exposure was 1.9 ± 0.7 mGy for CC projections and 2.3 ± 1.2 mGy for ML projections. The mean AGD per examination for the study was 4.1 ± 1.4 mGy. A positive correlation was found between AGD per examination and exposure factors (tube loading and tube voltage), compressed breast thickness, and compression force. Patient age had no statistically significant relationship with the AGD per examination. Conclusion: average glandular dose (AGD) was consistent with other findings in literature studies. It was also observed that MEC yielded lower AGD per exposure values than AEC. There was no significant difference in the mean AGD per exposure for left and right breasts.

Knowledge and management practices of infant teething symptoms among mothers in a tertiary facility in Ghana.

Introduction: teething is a natural process that all infants go through, and most toddlers obtain their first tooth around six months. However, misconceptions about teething and its remedies are still prevalent. The study assessed the knowledge and management practices of infant teething symptoms among mothers whose children were admitted to the Pediatric ward of Tamale Teaching Hospital. Methods: the study adopted a prospective descriptive cross-sectional design with a quantitative data collection method. A total of 251 mothers were selected using a convenient sampling strategy, and a structured questionnaire was used for data collection. Results: the study found that 79.7% and 20.3% of respondents had good and poor knowledge of teething, respectively. Also, 65.3% and 34.7% of the mothers had good and poor practices, respectively, in the management of teething symptoms. Marital status (p= 0.029) and type of ward (p= 0.020) were significantly associated with mothers' knowledge of teething. Furthermore, mothers less than 30 years of age (OR, 2.07; 95% CI: 1.19-3.57; p= 0.009) and mothers with formal education (OR, 2.22; 95% CI: 1.22-3.81; p= 0.004) were more likely to have good management practices for teething symptoms. Conclusion: most mothers have a good understanding of child teething, but they do not think delayed eruptions indicate systemic disease. They identified taking the child to the hospital during teething symptoms and administering Paracetamol to relieve the symptoms as standard practices. However, more education is needed to differentiate between teething signs and other ailments and to prevent substandard first aid practices during teething.

Alienation in the Teaching Hospital: How Physician Non-Greeting Behaviour Impacts Medical Students' Learning and Professional Identity Formation.

Introduction: Clinical workplaces offer unrivalled learning opportunities if students get pedagogic and affective support that enables them to confidently participate and learn from clinical activities. If physicians do not greet new students, the learners are deprived of signals of social respect and inclusion. This study explored how physicians' non-greeting behaviour may impact medical students' participation, learning, and professional identity formation in clinical placements. Methods: We analysed 16 senior Norwegian medical students' accounts of non-greeting behaviours among their physician supervisors in a reflexive thematic analysis of focus group interview data. Results: The main themes were: A) Descriptions of non-greeting. Not being met with conduct signalling rapport, such as eye contact, saying hello, using names, or introducing students at the workplace, was perceived as non-greeting, and occurred across clinical learning contexts. B) Effects on workplace integration. Non-greeting was experienced as a rejection that hurt students' social confidence, created distance from the physician group, and could cause avoidance of certain workplace activities or specific medical specialties. C) Impact on learning. Non-greeting triggered avoidance and passivity, reluctance to ask questions or seek help or feedback, and doubts about their suitability for a medical career. Conclusion: Medical students' accounts of being ignored or treated with disdain by physician superiors upon entering the workplace suggest that unintended depersonalising behaviour is ingrained in medical culture. Interaction rituals like brief eye contact, a nod, a "hello", or use of the student's name, can provide essential affective support that helps medical students thrive and learn in the clinic.

Unveilling genetic profiles and correlations of biofilm-associated genes, quorum sensing, and antibiotic resistance in Staphylococcus aureus isolated from a Malaysian Teaching Hospital.

BACKGROUND: Staphylococcus aureus is a notorious multidrug resistant pathogen prevalent in healthcare facilities worldwide. Unveiling the mechanisms underlying biofilm formation, quorum sensing and antibiotic resistance can help in developing more effective therapy for S. aureus infection. There is a scarcity of literature addressing the genetic profiles and correlations of biofilm-associated genes, quorum sensing, and antibiotic resistance among S. aureus isolates from Malaysia. METHODS: Biofilm and slime production of 68 methicillin-susceptible S. aureus (MSSA) and 54 methicillin-resistant (MRSA) isolates were determined using a a plate-based crystal violet assay and Congo Red agar method, respectively. The minimum inhibitory concentration values against 14 antibiotics were determined using VITEK® AST-GP67 cards and interpreted according to CLSI-M100 guidelines. Genetic profiling of 11 S. aureus biofilm-associated genes and agr/sar quorum sensing genes was performed using single or multiplex polymerase chain reaction (PCR) assays. RESULTS: In this study, 75.9% (n = 41) of MRSA and 83.8% (n = 57) of MSSA isolates showed strong biofilm-forming capabilities. Intermediate slime production was detected in approximately 70% of the isolates. Compared to MSSA, significantly higher resistance of clindamycin, erythromycin, and fluoroquinolones was noted among the MRSA isolates. The presence of intracellular adhesion A (icaA) gene was detected in all S. aureus isolates. All MSSA isolates harbored the laminin-binding protein (eno) gene, while all MRSA isolates harbored intracellular adhesion D (icaD), clumping factors A and B (clfA and clfB) genes. The presence of agrI and elastin-binding protein (ebpS) genes was significantly associated with biofilm production in MSSA and MRSA isolates, respectively. In addition, agrI gene was also significantly correlated with oxacillin, cefoxitin, and fluoroquinolone resistance. CONCLUSIONS: The high prevalence of biofilm and slime production among MSSA and MRSA isolates correlates well with the detection of a high prevalence of biofilm-associated genes and agr quorum sensing system. A significant association of agrI gene was found with cefoxitin, oxacillin, and fluoroquinolone resistance. A more focused approach targeting biofilm-associated and quorum sensing genes is important in developing new surveillance and treatment strategies against S. aureus biofilm infection.

Effect of Motivational Interviewing on Lifestyle Modification among Patients with Hypertension Attending the Family Medicine Clinics of ISTH, Irrua, Nigeria (Milmaph Study) - A Randomised Control Trial Study Protocol.

BACKGROUND: Hypertension is a leading cause of morbidity and mortality globally. Over a quarter of patients with hypertension have uncontrolled hypertension. Lifestyle modification has been shown to improve blood pressure control, thus measures that would help patients with hypertension achieve positive lifestyle modification would improve BP control. The study aims to determine the effect of motivational interviews on lifestyle modification and blood pressure control among patients with hypertension attending the Family Medicine Clinics of Irrua Specialist Teaching Hospital (ISTH), Irrua, Nigeria. METHODS: The proposed study will be a randomised control trial (PACTR202301917477205). About 212 adults between 18 and 65 years with hypertension presenting to the Family Medicine Clinics of ISTH will be randomised into intervention and control groups. The intervention group will be given a motivational interview (MI) on lifestyle modification at the start of the study and monthly for 6 months in addition to standard care for the management of hypertension. The control group will be given standard care for the management of hypertension only without MI and seen monthly for 6 months. Both groups will be assessed at baseline and 6 months. At baseline, a qualitative technique will be used to determine the reason for not adopting lifestyle modification. STUDY OUTCOME: The primary outcome shall be lifestyle modification at 6 months while the secondary outcome shall be blood pressure control at 6 months. CONCLUSION: Findings from the study will provide cost-effective ways of blood pressure control and reduction in the disease burden of hypertension in Nigeria.

CONTEXTE: L'hypertension est l'une des principales causes de morbidité et de mortalité à l'échelle mondiale. Plus d'un quart des patients hypertendus ont une hypertension non contrôlée. La modification du mode de vie a été démontrée pour améliorer le contrôle de la pression artérielle, ainsi les mesures qui aideraient les patients hypertendus à réaliser une modification positive de leur mode de vie amélioreraient le contrôle de la PA. L'étude vise à déterminer l'effet des entretiens motivationnels sur la modification du mode de vie et le contrôle de la pression artérielle chez les patients hypertendus fréquentant les cliniques de médecine familiale de l'hôpital spécialisé d'enseignement d'Irrua (ISTH), Irrua, Nigeria. MÉTHODES: L'étude proposée sera un essai contrôlé randomisé (PACTR202301917477205). Environ 212 adultes âgés de 18 à 65 ans atteints d'hypertension se présentant aux cliniques de médecine familiale de l'ISTH seront randomisés en groupes d'intervention et de contrôle. Le groupe d'intervention recevra un entretien motivationnel (EM) sur la modification du mode de vie au début de l'étude et mensuellement pendant 6 mois en plus des soins standard pour la prise en charge de l'hypertension. Le groupe témoin recevra uniquement les soins standard pour la prise en charge de l'hypertension sans EM et sera vu mensuellement pendant 6 mois. Les deux groupes seront évalués au départ et à 6 mois. Au début, une technique qualitative sera utilisée pour déterminer la raison de la non-adoption de la modification du mode de vie. RÉSULTAT DE L'ÉTUDE: Le critère de jugement principal sera la modification du mode de vie à 6 mois, tandis que le critère de jugement secondaire sera le contrôle de la pression artérielle à 6 mois. CONCLUSION: Les résultats de l'étude fourniront des moyens rentables de contrôle de la pression artérielle et de réduction de la charge de morbidité de l'hypertension au Nigeria. MOTS-CLÉS: hypertension, entretien motivationnel, modification du mode de vie, contrôle de la pression artérielle, médecine familiale.

Hematological, clinical, cytogenetic and molecular profiles of confirmed chronic myeloid leukemia patients at presentation at a tertiary care teaching hospital in Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: In low-income countries there is insufficient evidence on hematological, clinical, cytogenetic and molecular profiles among new CML patients. Therefore, we performed this study among newly confirmed CML patients at Tikur Anbesa Specialized Hospital (TASH), Ethiopia. OBJECTIVE: To determine the hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at tertiary care teaching hospital in Addis Ababa, Ethiopia. METHODS: A facility-based cross-sectional study was conducted to evaluate hematological, clinical, cytogenetic and molecular profiles of confirmed CML patients at TASH from August 2021 to December 2022. A structured questionnaire was used to collect the patients' sociodemographic information, medical history and physical examination, and blood samples were also collected for hematological, cytogenetic and molecular tests. Descriptive statistics were used to analyze the sociodemographic, hematological, clinical, cytogenetic and molecular profiles of the study participants. RESULTS: A total of 251 confirmed new CML patients were recruited for the study. The majority of patients were male (151 [60.2%]; chronic (CP) CML, 213 [84.7%]; and had a median age of 36 years. The median (IQR) WBC, RBC, HGB and PLT counts were 217.7 (155.62-307.4) x103/µL, 3.2 (2.72-3.6) x106/µL, 9.3 (8.2-11) g/dl and 324 (211-499) x 103/µL, respectively. All patients had leukocytosis, and 92.8%, 95.6% and 99.2% of the patients developed anemia, hyperleukocytosis and neutrophilia, respectively. Fatigue, abdominal pain, splenomegaly and weight loss were the common signs and symptoms observed among CML patients. Approximately 86.1% of the study participants were Philadelphia chromosome positive (Ph+) according to fluorescence in situ hybridization (FISH). P210, the major breakpoint protein, transcript was detected by both qualitative polymerase chain reaction (PCR) and quantitative real time polymerase chain reaction (PCR). CONCLUSION: During presentation, most CML patients presented with hyperleukocytosis, neutrophilia and anemia at TASH, Addis Ababa. Fatigue, abdominal pain, splenomegaly and weight loss were the most common signs and symptoms observed in the CML patients. Most CML patients were diagnosed by FISH, and p120 was detected in all CML patients diagnosed by PCR. The majority of CML patients arrive at referral center with advanced signs and symptoms, so better to decentralize the service to peripheral health facilities.

Characterization of ß-lactamase and virulence genes in Pseudomonas aeruginosa isolated from clinical, environmental and poultry sources in Bangladesh.

The emergence and spread of multidrug-resistant pathogens like Pseudomonas aeruginosa are major concerns for public health worldwide. This study aimed to assess the prevalence of P. aeruginosa in clinical, environmental, and poultry sources in Bangladesh, along with their antibiotic susceptibility and the profiling of ß-lactamase and virulence genes using standard molecular and microbiology techniques. We collected 110 samples from five different locations, viz., BAU residential area (BAURA; n = 15), BAU Healthcare Center (BAUHCC; n = 20), BAU Veterinary Teaching Hospital (BAUVTH; n = 22), Poultry Market (PM; n = 30) and Mymensingh Medical College Hospital (MCCH; n = 23). After overnight enrichment in nutrient broth, 89 probable Pseudomonas isolates (80.90%) were screened through selective culture, gram-staining and biochemical tests. Using genus- and species-specific PCR, we confirmed 22 isolates (20.0%) as P. aeruginosa from these samples. Antibiogram profiling revealed that 100.0% P. aeruginosa isolates (n = 22) were multidrug-resistant isolates, showing resistance against Doripenem, Penicillin, Ceftazidime, Cefepime, and Imipenem. Furthermore, resistance to aztreonam was observed in 95.45% isolates. However, P. aeruginosa isolates showed a varying degree of sensitivity against Amikacin, Gentamicin, and Ciprofloxacin. The blaTEM gene was detected in 86.0% isolates, while blaCMY, blaSHV and blaOXA, were detected in 27.0%, 18.0% and 5.0% of the P. aeruginosa isolates, respectively. The algD gene was detected in 32.0% isolates, whereas lasB and exoA genes were identified in 9.0% and 5.0% P. aeruginosa isolates. However, none of the P. aeruginosa isolates harbored exoS gene. Hence, this study provides valuable and novel insights on the resistance and virulence of circulating P. aeruginosa within the clinical, environmental, and poultry environments of Bangladesh. These findings are crucial for understanding the emergence of ß-lactamase resistance in P. aeruginosa, highlighting its usefulness in the treatment and control of P. aeruginosa infections in both human and animal populations.

Measuring Local-Area Racial Segregation for Medicare Hospital Admissions.

Importance: Considerable racial segregation exists in US hospitals that cannot be explained by where patients live. Approaches to measuring such segregation are limited. Objective: To measure how and where sorting of older Black patients to different hospitals occurs within the same health care market. Design, Setting, and Participants: This retrospective cross-sectional study used 2019 Medicare claims data linked to geographic data. Hospital zip code markets were based on driving time. The local hospital segregation (LHS) index was defined as the difference between the racial composition of a hospital's admissions and the racial composition of the hospital's market. Assessed admissions were among US Medicare fee-for-service enrollees aged 65 or older living in the 48 contiguous states with at least 1 hospitalization in 2019 at a hospital with at least 200 hospitalizations. Data were analyzed from November 2022 to January 2024. Exposure: Degree of residential segregation, ownership status, region, teaching hospital designation, and disproportionate share hospital status. Main Outcomes and Measures: The LHS index by hospital and a regional LHS index by hospital referral region. Results: In the sample of 1991 acute care hospitals, 4 870 252 patients (mean [SD] age, 77.7 [8.3] years; 2 822 006 [56.0%] female) were treated, including 11 435 American Indian or Alaska Native patients (0.2%), 129 376 Asian patients (2.6%), 597 564 Black patients (11.9%), 395 397 Hispanic patients (7.8), and 3 818 371 White patients (75.8%). In the sample, half of hospitalizations among Black patients occurred at 235 hospitals (11.8% of all hospitals); 878 hospitals (34.4%) exhibited a negative LHS score (ie, admitted fewer Black patients relative to their market area) while 1113 hospitals (45.0%) exhibited a positive LHS (ie, admitted more Black patients relative to their market area); of all hospitals, 79.4% exhibited racial admission patterns significantly different from their market. Hospital-level LHS was positively associated with government hospital status (coefficient, 0.24; 95% CI, 0.10 to 0.38), while New York, New York; Chicago, Illinois; and Detroit, Michigan, hospital referral regions exhibited the highest regional LHS measures, with hospital referral region LHS scores of 0.12, 0.16, and 0.21, respectively. Conclusions and Relevance: In this cross-sectional study, a novel measure of LHS was developed to quantify the extent to which hospitals were admitting a representative proportion of Black patients relative to their market areas. A better understanding of hospital choice within neighborhoods would help to reduce racial inequities in health outcomes.

Predictors of potential clinically harmful drug-drug interactions at the medical wards in the University of Benin Teaching Hospital, Benin City.

Drug-drug interactions are preventable causes of adverse events. Different factors have been recognized as important predictors of drug-drug interactions but few studies have addressed these predictors in patients admitted into medical wards of a tertiary hospital in Nigeria hence this study. This was a retrospective study conducted using case records of patients admitted into the medical wards between January 1 and December 31, 2020. Patients were selected using a systematic random sampling method. Socio-demographic details including age, gender, number of comorbidities, and number of medications prescribed and diagnosis were collected on days 1, 3, and at discharge. Potential drug-drug interactions were checked using Lexi-interact® software. Analysis was set at p < 0.05. A total of 430 case records were included in this study based on the inclusion criteria. Lexi-interact recorded a prevalence of (217) 50.5% on day 1, (146) 34.0% on day 3, and (290) 67.4% at discharge. A significant association (p < 0.05) was found between the potential drug-drug interactions (DDI) and an increased number of medicines prescribed on all the days of admission. Also, patients without certain infectious or parasitic diseases have reduced odds of developing DDI. There is a need for continuous monitoring of medications from admission to discharge especially in the elderly, those on multiple medications, certain infectious or parasitic diseases, and comorbidities as these impact on DDIs.

Knowledge and Attitude about Labor Epidural Analgesia among Pregnant Women Attending Antenatal Clinic.

BACKGROUND: Labour pain is one of the most painful experiences that a woman faces in her lifetime. There are various options for labour pain management. Epidural analgesia is the gold standard method for pain management during labour. In developing and under-developed countries there are many challenges to provide this service, a very important one being knowledge about epidural analgesia among the parturients and the physicians. METHODS: A prospective cross-sectional study was carried out among 384 pregnant women attending Antenatal clinic of a tertiary level teaching hospital using pretested structured questionnaire prepared by a team of anaesthesiologists and obstetricians. Non-probability purposive sampling technique was used. The data was analysed by using SPSS version 20.0. Descriptive and inferential statistical methods were used for analysis. RESULTS: Of the 384 pregnant women, only 29.4% had knowledge about some form of labour analgesia techniques and only 16% of the participants were aware of labour epidural analgesia. Also, only 6.2% were aware that epidural service is available at our hospital. Regarding acceptance, only 42.4% were willing to use epidural analgesia in their present pregnancy. CONCLUSIONS: The present study findings revealed that a significant number of participants had very limited knowledge about labour epidural analgesia and were also unaware of the availability of the service in our hospital. Educational programs need to be provided to all the pregnant women for enhancement of knowledge and awareness about epidural labour analgesia to increase its acceptability among them.

Diagnostic Accuracy of Fine Needle Aspiration Cytology as Compared to Histopathology in Parotid Gland Swelling.

BACKGROUND: The diagnosis of parotid swelling is challenging and investigations like imaging and needle aspiration cytology are helpful. The objective of this study was to determine the diagnostic accuracy of fine needle aspiration cytology (FNAC) as compared to the histopathology in parotid gland swelling. METHODS: It was a descriptive cross sectional study carried out in the Department of ENT-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu by reviewing the medical record charts of the patients who had undergone surgery for parotid lesions during the study period of seven and half years. All patients whose fine needle aspiration cytology and histopathology reports were available were included in the study. The data were presented as mean, standard deviation, ratio and percentages. Microsoft excel was used for data analysis. RESULTS: There were 75 patients included in the study. The age ranged from nine years to 78 years and the mean age being 38.3 17.42 years. The male to female ratio was 1:1.78. The concordance rate between fine needle aspiration cytology and histopathology was 82.7%. The sensitivity and specificity of the fine needle aspiration cytology were 80% and 95% respectively. Similarly, the positive predictive and negative predictive values were 84% and 93% respectively. The diagnostic accuracy of the fine needle aspiration cytology was 91% for the parotid swelling in our study. CONCLUSIONS: The diagnostic accuracy of fine needle aspiration cytology for parotid swellings in our study was excellent. The result of fine needle aspiration cytology is helpful in deciding management plan for parotid lesions.

Sexual Dysfunctions among Diabetic and Non-diabetic People Attending in Tribhuvan University Teaching Hospital, Kathmandu Nepal.

BACKGROUND: Sexual dysfunctions including erectile dysfunction among men, a widespread sexual health issue, pose challenges to sexual satisfaction. This cross-sectional study aimed to assess the prevalence and determinants of sexual dysfunctions in both diabetic and non-diabetic individuals aged 30-70. METHODS: A study at Tribhuvan University Teaching Hospital in Kathmandu, Nepal, surveyed 350 participants (176 men, 174 women), aged 30-70, with 52.6% having diabetes. The structured interviews and validated questionnaires like IIEF-5 for men and FSFI-6 for women to assess the prevalence and factors associated with erectile dysfunction were used. Statistical tools were employed to measure the associations of different variables with Sexual dysfunctions. RESULTS: Overall, the prevalence of sexual dysfunction was 73.7% (95% CI: 72.4- 73.7) with higher rates in men 83.9% (95% CI: 83.1- 84.7) than women 63.6% (95% CI: 62.0 - 65.2). Individuals with diabetes experienced an 81.5% prevalence of sexual dysfunction (95% CI: 80.6-82.4), whereas non-diabetic individuals exhibited a 65.1% prevalence (95% CI: 63.5-66.7). In the diabetic male population, the prevalence of sexual dysfunction was 97.5% (95% CI: 97.4-97.6), while diabetic females had a prevalence of 68.9% (95% CI: 67.5-70.3). Among non-diabetic men, the percentage of erectile dysfunction was 72% (95% CI: 70.7-73.3), and among non-diabetic women, sexual dysfunction remained 56.2% (95% CI: 54.4-58.0). Among individuals with diabetes, those who used tobacco exhibited a sexual dysfunction prevalence of 93.8% (95% CI: 93.5-94.1), while non-tobacco users had a prevalence of 74.8% (95% CI: 73.6-76.0). In non-diabetic individuals, obesity was associated with a higher prevalence of sexual dysfunctions, reaching 84.6% (95% CI: 83.8-84.6). High blood pressure showed a strong association with sexual dysfunctions in both diabetic (83% with 95% CI: 81.9-83.4) and non-diabetic (70% with 95% CI: 67.7-70.1) groups. Individuals with diabetes for more than five years had a higher rate of sexual dysfunction as 87.8% (95% CI: 86.6-89.0) with 100% in men and 79% in women. However, there was no significant difference in the prevalence of sexual dysfunctions related to obesity and alcohol consumption between diabetics and non-diabetics. CONCLUSIONS: The research highlights a noteworthy association of sexual dysfunctions with individuals with diabetes, male sex, tobacco use, and hypertension. The observed high prevalence of sexual dysfunctions in both diabetic and non diabetic people is a public health concern, emphasizing the need for culturally tailored approaches to address the sexual health of the affected individuals.

COVID-19 surveillance in a bone marrow transplantation unit: experience from a Brazilian tertiary-care teaching hospital.

PURPOSE: In this work, we aimed to describe the strategy of the weekly SARS-CoV-2 RT-PCR surveillance program that was implemented in our bone marrow transplantation (BMT) unit. METHODS: Our unit performed SARS-CoV-2 RT-PCR before admission and then weekly during hospitalization even if the patient was asymptomatic. From May 2021 to May 2022, we collected data from all patients that were admitted in the BMT unit to perform transplantation. The total of SARS-CoV-2 RT-PCR performed and the positive rate were described. RESULTS: During the study period, 65 patients were admitted for HSCT. A total of 414 SARS-CoV-2 RT-PCR were performed. Two cases were detected (positivity rate, 0.48%). After the positive test, both patients were isolated outside the BMT unit. CONCLUSION: We postulate that diagnosing these patients and isolating them outside the transplantation unit may have prevented secondary symptomatic cases.

Active surveillance of antimicrobial resistance in companion animals: A pilot study in a Spanish Veterinary Teaching Hospital.

The role of small animal veterinary hospitals in the onset and dissemination of antimicrobial-resistant organisms (AMROs) is still not clear, and the implementation of an internal surveillance systems is a cost-effective tool to better understand their impact. The aim of this study was to describe a pilot program of active surveillance in a Spanish Veterinary Teaching Hospital, developed to estimate the detection frequency of AMROs in the commensal flora of patients and in the environment. Surveillance was focused on Methicillin-resistant Staphylococci (MRS), third generation cephalosporins resistant gram-negative bacteria (3GCR-GNB), and carbapenems-resistant gram-negative bacteria (CR-GNB). Oral and perirectal swabs were collected in the same dogs and cats hospitalized > 48 h, at their admission and before their discharge. Out of 50 patients sampled, 24% (12/50) were carriers at admission of at least one of the three investigated AMROs. Twenty-eight percent of patients (14/50) acquired at least one AMRO during the hospital stay. MRS detection frequency at admission was 12% (6/50), while acquisition was 6% (3/50). 3GCR-GNB detection frequency was 14% at admission (7/50) and acquisition 22% (11/50), while CR-GNB detection frequency was 2% at admission (1/50) and acquisition 2% (1/50). Environmental surveillance (98 samples) showed a total detection frequency of 22.4% for MRS (22/98), 2% for 3GCR-GNB and CR-GNB (2/98). Clinical staff' shoe soles showed high detection frequency for MRS (50%). 3GCR Escherichia coli was the most isolated species in patients (n = 17). The results show how active surveillance can be used as a tool to assess the impact of AMROs in veterinary hospitals to subsequently build up tailored control plans based on specific issues.

Adult surgical admissions at a Botswana tertiary teaching hospital - spectrum, comorbidity profile, and outcomes.

BACKGROUND: Documentation on the spectrum, comorbidities, profile, and outcomes of adult surgical admissions in Botswana is limited. This information may guide manpower distribution for proposed rotations in the new general surgery training programmes. METHODS: The medical records of adult surgical admissions for a period of one year (August 2017 - July 2018) were reviewed retrospectively. Demographics, types of admissions, dates of admission and discharge, and known comorbidities were captured and the outcomes were analysed. RESULTS: Of the 2610 admissions the mean age was 44.4 years and 60.8% were male. Gastrointestinal tract (GIT), neurosurgical, and cardiothoracic admissions constituted 60.7%. Emergency admissions constituted 50.1%. Comorbidities were found in 45.6% of the admissions, and HIV-prevalence was 697/1822 (38.3%) among known HIV-status patients. Elective admissions underwent more surgical procedures, 776/1303 (59.6%), p = 0.001 (COR 1.9, 95% CI:1.7-2.3). A total of 220/2610 complications (8.4%) were documented, including 42/1355 (3.1%) superficial surgical site infections and 159/2610 deaths (6.1%). Hypertension and diabetes mellitus were associated with higher mortality, p = 0.002 (COR 1.8,95% CI:1.2-2.6) and p = 0.031 (COR 1.9, 95% CI:1.1-3.4) respectively. HIV-positive patients had longer hospital stays than HIV-negative patients, p = 0.001 (COR 1.03, 95% CI:1.02-1.04). HIV-positive admissions with CD4 count < 200 had significantly higher composite complication and mortality rate than those with ≥ 200, p = 0.002 (COR 3.03, 95% CI:1.52-6.04) and p = 0.001 (COR 4.34, 95% CI:2.08-9.05) respectively. CONCLUSION: Contributions of emergency and elective admissions were even. A higher burden of diseases was found in gastroenterology. The higher mortalities associated with hypertension, diabetes, and CD4 count < 200 warrant further study.