Prognostic factors and models to predict pediatric sepsis mortality: A scoping review.

Introduction: Several scoring systems are available to assess the severity of sepsis in pediatric patients in diverse settings worldwide. This study investigates the quality and applicability of predictive models for determining pediatric sepsis mortality, especially in acute care and limited-resource settings. Data sources: Mortality prediction factors and models were searched in four databases using the following criteria: developed for pediatric health care, especially in acute settings, and with mortality as an outcome. Study selection: Two or more reviewers performed the study selection to ensure no bias occurred. Any disagreements were solved by consensus or by the decision of a third reviewer. Data extraction: The authors extracted the results and mapped the selected studies qualitatively to describe the prognostic properties of the risk factors and models proposed in the study. Data synthesis: The final analysis included 28 mortality prediction models. Their characteristics, analysis, and performance measures were summarized. Performance was described in terms of calibration and discrimination, including assessing for risk of bias and applicability. A modified version of the PRISM-III score based on physiologic criteria (PRISM-III-APS) increased its predictive value to 0.85-0.95. The vasoactive-inotropic score at 12 h had a strong independent association with death. Albumin had an excellent predictive value when combined with other variables. Lactate, a biomarker widely measured in patients with sepsis, was highly associated with mortality. The bioimpedance phase angle was not considered applicable in our setting. Measurement using more straightforward methods, such as mid-upper arm circumference, was feasible in numerous health care facilities. Conclusion: Leveraging prognostic models to predict mortality among pediatric patients with sepsis remains an important and well-recognized area of study. While much validation and development work remains to be done, available prognostic models could aid clinicians at the bedside of children with sepsis. Furthermore, mortality prediction models are essential and valuable tools for assessing the quality of care provided to critically ill pediatric patients.

Correlation of Depression and Illness Cognition in Coronary Artery Disease at Hasan Sadikin Hospital Bandung, Java, Indonesia

@#Introduction: The incidence of depression in coronary artery disease (CAD) is higher than in the general population. The factor is associated with depression is learned helplessness. Helplessness is one of the domains of illness cognition, which is someone’s preoccupation with unpleasant side effects of chronic disease related to daily functioning. Aim of this study was to determine the correlation between helplessness of illness cognition and symptoms of depression in CAD at Hasan Sadikin Hospital (RSHS), Bandung from November to December 2020. Method: The research method is a quantitative study with a cross-sectional design on CAD patients, male, and aged 55 years and over. Illness Cognition Questionnaire (ICQ) was used to assess illness cognition and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Results: This study involved 86 participants with a mean age of 62.4 ± 5.53 years, an average length of treatment of 3.4 ± 3.45 years, and 34 people (39.5%) had depressive symptoms. Of the 34 people who had depressive symptoms there were 4 persons (4.65%) with moderate depressive episodes and 1 person (1.16%) with major depressive episodes. The bivariate analysis using the rank Spearman correlation coefficient found that helplessness (r=0.337, p=0.001) had a significant relationship with depressive symptoms; whereas acceptance and perceived of benefit had no significant relationship with depression (r=-0.125, p=0.126,) and (r=0.035, p=0.374) respectively. Conclusion: This study concludes that depressive symptoms have a significant correlation with helplessness of illness cognition in CAD patient and there is a role of physician and cardiologist to help patients with these problems.

The relationship between service quality perceptions and the level of hospital accreditation.

BACKGROUND: The quality of health services has long received global attention. Consequently, safe and quality health services in hospitals have become the main hopes and goals of the community, health workers, managers, owners, and regulators. A common external strategy used globally involves recognizing the applied quality management system, specifically certification and accreditation. OBJECTIVE: Therefore, the purpose of this study is to determine the relationship between levels of quality perception and accreditation in hospitals based on several variables. METHODS: A total of 13 hospitals were examined in this cross-sectional study, while a questionnaire consisting of 24 validated items was used for data collection. Subsequently, the analysis was performed by utilizing descriptive statistics and chi-square techniques. RESULTS: From the results obtained, the patient assessment, drug use management, patient and family education, infection prevention and control, alongside facility management and safety variables, had a relationship with the level of hospital accreditation, while patient service did not. CONCLUSIONS: Therefore, each hospital is expected to improve its service quality and accreditation.

Refractive Outcome of Phacoemulsification Cataract Surgery in Rural Sabah Using Immersion Biometry.

BACKGROUND: A good refractive outcome after cataract surgery indicates adequate clinical service provision. Precise immersion biometry is critical to achieve the desired refractive outcome. While the immersion biometry results are good in the tertiary settings, it is of interest to explore the refractive outcome of cataract surgeries in a rural facility using the same technique. METHODS: A retrospective cross-sectional review was conducted on medical records of all cataract surgeries carried out in Hospital Keningau, Sabah. This study used all patients' medical records who had been assessed using immersion biometry pre-operatively, underwent phacoemulsification cataract surgery besides attending a post-operative refraction session within 90 days from the operation date. Clinical details were recorded in the form of standard proformas and analysed. The refractive outcome was evaluated using spherical equivalence (SE) and best-corrected visual acuity (BCVA). The percentage of cases with post-operative SE within ±1.00 diopter (D) and BCVA of '6/12 or better' were determined. The association between demographic factors and surgical-related factors with post-operative SE was evaluated using Fisher's exact test. RESULTS: Of 140 cataract surgeries, 113 fulfilled the inclusion criteria. The average patient age was 66.3 (SD = 10.9) years old. The technique was proven to replicate a good outcome of 84.1% of cases with post-operative SE within ±1.00 D while 90.3% of the cases achieved BCVA of '6/12 or better'. Age and ethnicity were found to be associated with post-operative SE. CONCLUSION: The study proves the reproducibility of good refractive outcome in a rural facility using immersion biometry. The findings provide a benchmark for performance surveillance in rural facilities.

The relationship between service quality perceptions and the level of hospital accreditation

Background: The quality of health services has long received global attention. Consequently, safe and quality health services in hospitals have become the main hopes and goals of the community, health workers, managers, owners, and regulators. A common external strategy used globally involves recognizing the applied quality management system, specifically certification and accreditation. Objective: Therefore, the purpose of this study is to determine the relationship between levels of quality perception and accreditation in hospitals based on several variables. Methods: A total of 13 hospitals were examined in this cross-sectional study, while a questionnaire consisting of 24 validated items was used for data collection. Subsequently, the analysis was performed by utilizing descriptive statistics and chi-square techniques. Results: From the results obtained, the patient assessment, drug use management, patient and family education, infection prevention and control, alongside facility management and safety variables, had a relationship with the level of hospital accreditation, while patient service did not. Conclusions: Therefore, each hospital is expected to improve its service quality and accreditation. (AU)

Diversity of Akanthomyces on moths (Lepidoptera) in Thailand.

Akanthomyces is a genus of invertebrate-pathogenic fungi from the family Cordycipitaceae (Ascomycota, Hypocreales). Its species occurs on two different types of hosts, spiders and insects, and in the latter case specifically Lepidoptera adults. Three new species of Akanthomyces, A. noctuidarum, A. pyralidarum, and A. tortricidarum occurring on adult moths from Thailand are proposed based on the differences of their morphological characteristics and molecular data. Phylogenetic analyses using a combined dataset, including the internal transcribed spacer regions, the large subunit of the ribosomal DNA, translation elongation factor 1-α, the largest subunit of RNA polymerase II, and the second largest subunit of RNA polymerase II, support the delimitation of these new species in Akanthomyces.

Distribution of Refractive Errors among Healthy Infants and Young Children between the Age of 6 to 36 Months in Kuala Lumpur, Malaysia-A Pilot Study.

Uncorrected refractive error, especially myopia, in young children can cause permanent visual impairment in later life. However, data on the normative development of refractive error in this age group is limited, especially in Malaysia. The aim of this study was to determine the distribution of refractive error in a sample of infants and young children between the ages of 6 to 36 months in a prospective, cross-sectional study. Cycloplegic retinoscopy was conducted on both eyes of 151 children of mean age 18.09 ± 7.95 months. Mean spherical equivalent refractive error for the right and left eyes was +0.85 ± 0.97D and +0.86 ± 0.98D, respectively. The highest prevalence of refractive error was astigmatism (26%), followed by hyperopia (12.7%), myopia (1.3%) and anisometropia (0.7%). There was a reduction of hyperopic refractive error with increasing age. Myopia was seen to emerge at age 24 months. In conclusion, the prevalence of astigmatism and hyperopia in infants and young children was high, but that of myopia and anisometropia was low. There was a significant reduction in hyperopic refractive error towards emmetropia with increasing age. It is recommended that vision screening be conducted early to correct significant refractive error that may cause disruption to clear vision.

p63 cytoplasmic aberrance is associated with high prostate cancer stem cell expression.

INTRODUCTION: Prostate cancer in Indonesia is the 3rd ranking cancer among males and the 5th rank for their cancer mortality. Prognostic markers that can identify aggressive prostate cancer in early stages and help select appropriate therapy to finally reduce the mortality are therefore urgently needed. It has been suggested that stem cells in the prostate gland have a role in initiation, progression, and metastasis of cancer, although controversy continues to exist. Maintenance of normal stem cell or reserve cell populations in several epithelia including prostate has been shown to be regulated by p63 and alteration of p63 expression is considered to have an oncogenic role in prostate cancer. We hypothesize that the expression of cytoplasmic aberrance of p63 is associated with high ALDH1A1 expression as a cancer stem cell marker, thus leading to progression of prostate cancer. METHODS: Using a cross-sectional study during two years (2009-2010), a total of 79 paraffin embedded tissues of benign prostatic hyperplasia, PIN prostatic intraepithelial neoplasia, low and high Gleason score prostate cancer were investigated using immunohistochemistry. Associations between cytoplasmic p63 and ALDH1A1, as well as with pathological diagnosis, were analyzed by Chi-Square test using SPSS 15.0. Links of both markers with cell proliferation rate (KI-67) and apoptotic rate (cleaved caspase 3) were also analyzed by Kruskal-Wallis test. RESULTS: The mean age of patient at the diagnosis is 70.0 years. Cytoplasmic aberrance of p63 was associated with ALDH1A1 expression (p<0.001) and both were found to have significant relationships with pathological diagnosis (including Gleason score), (p=0.006 and p<0.001 respectively). Moreover, it was also found that higher levels of cytoplasmic p63 were significantly associated with the frequency of proliferating cells and cells undergoing apoptosis in prostate cancers (p=0.001 and p=0.016 respectively). CONCLUSION: p63 cytoplasmic aberrance is associated with high ALDH1A1 expression. These components are suggested to have an important role in prostate cancer progression and may be used as molecular markers.

Integration of methadone maintenance treatment and HIV care for injecting drug users: a cohort study in Bandung, Indonesia.

AIM: to know the effectiveness of antiretroviral treatment (ART) among methadone clients and patients who started ART outside the methadone program during the same period. METHODS: uptake of HIV testing and treatment were evaluated in a cohort of IDUs starting MMT. Effectiveness of anti-retroviral treatment (ART) was compared with matched 175 HIV-patients with a history of IDU outside MMT. RESULTS: overall, 223 patients were enrolled in MMT between May 2006 and January 2009, of whom 44% were tested for HIV, with an HIV prevalence of 73%. Screening of MMT clients was responsible for diagnosing HIV and starting ART in 31.9%, respectively 45.7%. Two year retention (100% vs 97.1%; p=0.23) and survival (93.9% vs 92.3%; p=0.76) during ART were not significantly different for 35 patients who combined ART with methadone, and the control group (n=175). Virological failure was found in one patient (3.7%) in MMT compared to 10.5% of the control group. CONCLUSION: providing HIV testing and treatment is a feasible and effective way to increase detection and treatment of HIV among clients enrolled in MMT. HIV- treatment integrated with methadone maintenance can be very effective. These results support wider application of integrated HIV care and opioid substitution.