Optimization of Multiplex-PCR Technique To Determine Azf Deletions in infertility Male Patients

Background

To optimize the multiplex polymerase chain reaction (M-PCR) technique to diagnose microdeletions of azoospermia factors (AZF) on the Y chromosome and initially apply the technique to diagnose male patients with sperm density less than 5×106 million sperm/mL was assigned to do a test to check for AZF microdeletions on the Y chromosome.

Methods

Based on the positive control samples which belong to male subjects who have had 2 healthy children without any assisted reproductive technologies, the M-PCR method was developed to detect simultaneously and accurately AZF microdeletions on 32 male patients with sperm densities below 5×106 million sperm/mL of semen at the Department of Biology and Medical Genetics - Vietnam Military Medical University.

Results

Successful optimization of the M-PCR technique including 7 reactions arranged according to each AZFabc region using 24 STS/gene on the Y chromosome. Initial application to diagnose AZF deletion on 32 azoospermic and oligospermic men reveals that AZFa deletion accounts for 6.25% (2/32); deletion of all 3 regions AZFa,b,c with 18.75% (6/32 cases); The combined deletion rate of AZFb,c is highest, accounting for 56.24% (18/32 patients).

Conclusion

Successfully optimized the M-PCR technique in identifying AZF microdeletions using 24 sequence tagged sites (STS)/gene for azoospermic and oligozoospermic men. The M-PCR technique has great potential in the application of AZF deletion diagnosis.

Plasmodium Vivax as a Causative Agent for Cerebral Malaria in a Group of Adults at Mizan Tepi Teaching Hospital: Case Series

In 2022, there were 249 million cases of malaria globally, resulting in 608,000 deaths. The majority of cases and deaths occurred in the WHO (World Health Organization) African Region. A study in our region found that, out of 263,476 individuals, 148,734 had P. falciparum, 106,946 had P. vivax, and 7,796 had mixed infections. The prevalence of P. falciparum (Plasmodium falciparum) was 8.97% and P. vivax (Plasmodium Vivax) was 7.94%. Although there have been a few reported cases of cerebral malaria caused by P. vivax, there is currently no comprehensive analysis of such cases. All the cases that have been reported so far involved individuals living in malaria-endemic areas, who presented with symptoms characteristic of cerebral malaria. Cerebral malaria was diagnosed based on the clinical algorithm which WHO used except we used P. vivax instead of P. falciparum The diagnosis of these cases was confirmed through thin blood film examination and Rapid Diagnostic Tests (RDTs). Therefore, this report aims to provide additional data on the occurrence of P. vivax as a cause of cerebral malaria. It also recommends further studies to reassess the current clinical case definition of cerebral malaria mainly in endemic areas as it affects patient treatment outcome.

Does Nipple-Ward Positive Margin Contribute to a Higher Rate of Re-Excision Procedures After a Lumpectomy with Pathology-Confirmed Positive Margins? A Retrospective Study

Background

Positive margins on lumpectomy specimens are associated with a twofold increased risk of local breast tumor recurrence. Prior literature has demonstrated various techniques and modalities for assessing margin status to reduce re-excision rates. However, there is paucity of literature analyzing which margin contributes to the highest re-excision rates. Therefore, the primary aim of the study was to investigate whether the nipple-ward margins resulted in a higher rate of re-excision in our patient population.

Methods

 A retrospective chart review was performed on patients who had re-excision surgery. Nipple-ward margin was identified by correlating radiological and pathological reports. A cut-off of more than 25% was used to demonstrate correlation between nipple-ward margin and re-excision rate.

Results

A total of 98 patients' data were analyzed, with 41 (41.8%), 14 (14.3%), 5 (5.1%), and 38 (38.8%) diagnosed with DCIS, IDC, ILC, and mixed pathology on their margins, respectively. Overall, 48% (n=47) of the positive margins were nipple-ward, with 44.7% (n=21) reporting DCIS. Upon stratification, 45 (45.9%) cases were single-margin positive, with 26 (57.8%) being nipple-ward. Furthermore, the remaining 53 (54.1%) patients had multiple positive margins, with 21 (39.6.7%) nipple-ward cases.

Conclusion

Positive nipple-ward margins significantly contribute to a higher re-excision rate p < 0.001; 48% of re-excision surgeries had positive nipple-ward margins, and 57.8% of positive single-margin cases were nipple-ward. Taking an additional shave during initial lumpectomy decreases re-excision rates. However, planning a lumpectomy procedure with a more elliptical rather than a spherical resection with additional cavity shave (ie, larger volume) in the nipple-ward direction and minimizing the remaining cavity shaves so the total volume resected remains unchanged. Nevertheless, future studies with larger sample sizes are required to bolster our findings.

Generalized Asymptomatic Nodulo-Ulcerative Lesions Without Systemic Symptoms in a Secondary Syphilis Patient Co-Infected with HIV

Syphilis is a sexually-transmitted disease with various clinical stages. Secondary syphilis manifestations may mimic other skin lesions. Patient co-infected with Human Immunodeficiency Virus (HIV), with CD4 cell counts of 200-499 cells/mm3, often manifests an atypical cutaneous lesion, which may also occur as nodular or ulcerative lesions. Generalized nodulo-ulcerative lesions without systemic symptoms in secondary syphilis patients with HIV co-infection are rarely reported. A 22-year-old man presented with generalized asymptomatic multiple erythematous papules and plaques with scales, as well as nodular and nodulo-ulcerative lesions on the trunk, both arms, and both legs. His lesions spread progressively without the presence of any prodromal symptoms or adenopathy. He was previously diagnosed with HIV and is currently on antiretroviral medications, with a CD4 cell count of 388 cells/μL. His venereal disease research laboratories (VDRL) result was reactive (titer of 1:256). His Treponema pallidum hemagglutination assay (TPHA) result was also reactive (titer of 1:10,240). A skin biopsy was performed from the nodulo-ulcerative lesion on his back. Hematoxylin-eosin staining revealed a hyperplastic epidermis, a massive influx of plasma cells, and lymphocyte infiltration into the deep dermis, especially in the peri-adnexal, peri-vascular, and peri-muscular regions. The patient was diagnosed with secondary syphilis with HIV co-infection. He had no previous history of drug allergy. A single dose of 2.4 million units of benzathine penicillin G was administered. Almost all the lesions became hyperpigmented macules after two weeks and resolved completely after one month. His VDRL titer declined to 1:32 after three months. The various atypical lesions of secondary syphilis may lead to misdiagnosis and delayed treatment. The presence of multiple asymptomatic nodulo-ulcerative lesion without prodromal symptoms may indicate the presence of secondary syphilis, notably in patients co-infected with HIV. Therefore, knowledge of atypical cutaneous manifestations of secondary syphilis is warranted in order to treat patients accordingly.

The Experiences of Nursing Managers in Implementing Palliative Care in Long-Term Care Facilities

Purpose

The purpose of this study was to explore the experiences of nursing managers in implementing palliative care in long-term care facilities and to provide recommendations for managers who plan to introduce palliative care into their facilities.

Methods

This study used semi-structured interviews and grounded theory methodology, with purposive sampling. A total of 11 long-term care facilities in eastern Taiwan that had implemented palliative care were selected, and 11 facility nursing managers participated in in-depth, face-to-face interviews.

Results

The introduction of palliative care in long-term care facilities can be divided into four stages: (1) the opportunity for change, (2) playing a supportive role, (3) a new collaboration model, and (4) facility transformation. The core category shared by the participants may be summed up as "the palliative care captain in the facility". It reflects the spirit of the successful implementation of palliative care by managers in long-term care facilities.

Conclusion

The study reveals that during the initial phases of implementing palliative care, the palliative care teams assume a crucial leadership role, while the facilities play a supportive role. At this stage, managers should focus on personnel training and addressing internal issues within the facilities to facilitate successful collaboration with the palliative care teams. In the later stages, the facilities transition from a supportive role to one of independence, marking a critical juncture for the facilities' potential stable development. During this period, managers are tasked not only with establishing the facilities' own palliative care team but also with facilitating the transformation of staff from learners to instructors. Finally, even after successful implementation, managers must contemplate how to innovate and set more ambitious goals.

The Evaluation of Serum Endocan, Interleukin-6, and CRP Levels Following Sleeve Gastrectomy

Background

The excessive accumulation of fat tissue in obesity is the source of chronic low-level inflammation and causes future dysmetabolic and cardiovascular disorders. Removal of this excessive fat tissue with the aid of bariatric surgery (BS) techniques, such as sleeve gastrectomy, may reverse adverse inflammatory outcomes. The aim of this study is to investigate the impact of sleeve gastrectomy on inflammatory markers, specifically endocan, IL-6, and CRP, in individuals with obesity.

Methods

Thirty-two patients with class 3 obesity and class 2 obesity + comorbidities were enrolled in the study. Clinical characteristics including age, comorbidity, body mass index (BMI), waist, and hip circumferences of the participants were noted before and 3 months after sleeve gastrectomy. Blood samples were collected during those periods to assess biochemical features such as serum endocan, interleukin-6 (IL-6), C-reactive peptide, fasting insulin, glycosylated hemoglobin A1c levels, and lipid panel. A statistical package program was used for the analysis of those parameters, and p<0.05 was accepted as significant at a 95.0% confidence interval.

Results

BMI reduced from 43.55±6.78 to 36.16±6.14 kg/m2 within 3 months following BS (p<0.001). Preoperative serum endocan, IL-6, and CRP levels were correlated with BMI, and in line with BMI reduction, their serum levels decreased after BS (p<0.05). HOMA-IR also reduced after BS, and both in the pre and post-BS periods correlated with BMI, IL-6, endocan, and CRP levels (p<0.05). The mean total body weight loss was 20.4% within 3 months post-BS.

Conclusion

BS techniques are effective in weight loss and reversing the inflammatory processes caused by obesity. Serum endocan, IL-6, and CRP levels are promising markers for describing obesity-related inflammation and objectively checking the alleviation of inflammation following BS.

Chronic Uterine Inversion in 54 Year Old Woman: Case Report

Introduction

Uterine inversion is a disease characterized by the folding of the uterine fundus into the uterine cavity or beyond the cervix. It is a rare complication following parturition. Acute uterine inversion presents immediately following vaginal delivery. Prevalence of acute uterine inversion is 1 in 20,000-50,000 cases. Chronic uterine inversion is a rare disease presentation in post-menopausal women. It is commonly associated with uterine pathology like leiomyoma, leiomyosarcoma, or endometrial polyps. It is very rare without associated factors. In the post-menopausal age group, the diagnosis is confirmed with high index of suspicion and physical examination. Typically, inverted uterine fundus is a leading point of protrusion but it could be the uterine cervix in uterine prolapse.

Case Presentation

A 54 year old woman came to our hospital with the complaint of a painless mass in her vagina of 3 years duration. Three years ago, she encountered a protrusion of mass through her vagina, which gradually grew in size over time. On physical examination, uterine fundus was the leading point of the mass and it protruded 7 cm below the hymenal ring. As a result, she was diagnosed with chronic uterine inversion and underwent an abdominal hysterectomy. She was discharged home improved. We report this case because of an unidentified factor eliciting the uterine inversion, late presentation of the disease and difficulty in surgical treatment.

Conclusion

Chronic uterine inversion is a rare disease presentation especially when there is no associated uterine pathology like leiomyoma. It is seen in a broad range of age groups, from reproductive to postmenopausal. A strong index of suspicion and physical examination are used to reach the diagnosis. Surgical technique should be anticipated to be difficult as it is a rare case, outside the experience of most surgeons.

Two Case Reports of Elastolytic Giant Cell Granuloma on the Palms

Elastolytic giant cell granuloma (EGCG) is a rare granulomatous reaction hypothesized to occur because of the altered antigenicity of elastic fibers, resulting in cellular immunological reactions. The hallmarks of EGCG include elastolysis, elastophagocytosis, and multinucleated giant cell infiltrations. EGCG was first described as an actinic granuloma or annular elastolytic giant cell granuloma that classically presents as centrifugally expanding annular plaques on sun-exposed areas. It was recently named EGCG due to reports of non-annular lesions in various sun-protected areas. Hand involvement has been described but is almost exclusively confined to the dorsal and lateral aspects of the hands. Herein, we report two cases of EGCG on the palms, an unusual site of presentation, that were successfully treated with topical, high-potency corticosteroids. EGCG should be included in the differential diagnosis in cases of annular skin lesions located on the marginal area of the palms.

Reconstruction After En Bloc Resection of a Distal Radius Tumor. An Updated and Concise Review

The distal radius is rarely affected by either primary or metastatic bone cancers. The most frequent tumors of the distal radius are giant cell tumors, which are benign tumors with the propensity to invade. En bloc excision of giant cell tumors of the distal radius achieves a low recurrence rate but compromises the wrist joint, necessitates a significant reconstruction, and has functional consequences. Reconstruction after en bloc resection of a distal radius bone tumor is challenging. Furthermore, orthopedic oncologists disagree on treating such long bone anomalies most effectively. The present article summarizes the various biological and non-biological reconstruction techniques performed after en bloc resection of a distal radius tumor, discusses the advantages and disadvantages of each reconstruction strategy, and summarizes several case studies and case reports.

Relationship Between Metacognitive Awareness of Undergraduate Students and Students' Academic Performance at Vietnam Military Medical University

Introduction

Metacognition plays an essential role in competency-based medical education. Metacognitive skills consist of knowledge and regulation metacognition. This study was conducted to investigate the metacognition of undergraduate students and its correlation with students' academic performance.

Methods

The metacognitive skills inventory comprised 52 binary-scale items administered to 202 Vietnam Military Medical University medical students. The entire semester and clinical results were used to measure their academic performance.

Results

Medical students' total metacognitive awareness score was high (median 0.8). The median metacognitive knowledge score was significantly lower than the metacognitive regulation score (0.7 vs 0.8, respectively). The participants with a total metacognition score ≥0.8 had significantly higher academic results (full semester exam results of 7.4 and clinical exam of 7.5). The group of participants in the military, having sports habits and usually searching academic documents in English, had a higher proportion of total metacognitive awareness score ≥0.8 than the group without these above characteristics (with the percentages of 53.3%, 59%, and 64.3%, respectively; p < 0.05). The number of books read by participants with a total metacognitive awareness score ≥ 0.8 was significantly higher than those with a total metacognitive awareness score <0.8 (3.5 compared to 2.4 books).

Conclusion

Metacognitive awareness of Vietnam Military Medical University medical students was likely to be high. A high score of metacognitive awareness could predict high academic performance. Being a military student, playing sports, reading books, and searching English documents were predictors of better metacognitive awareness.

The Correlation Between Night Shift Work Schedules, Sleep Quality, and Depression Symptoms

Purpose

Poor sleep and depressive symptoms are two negative effects of night shift work on physical and mental health. This study evaluated the correlation between sleep quality and depression symptoms among nurses in Saudi Arabia. Specifically, we assessed depressive symptoms and sleep quality observed among nurses who worked night shifts and compared the outcomes with those who worked exclusively day shifts in hospital settings.

Patients and Methods

A total of 191 participants (55.5% men, 44.5% women) participated. The response rate was 63.6%. The hospital anxiety and depression scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression score and sleep quality, respectively.

Results

Nurses who worked night shifts had substantially higher PSQI ratings (p<0.05) than those who worked day shifts. In addition, there was a clear relationship between the HADS and PSQI scores. According to the binary logistic regression, longer working hours and inadequate sleep were both independently linked to depressive symptoms among nurses.

Conclusion

Poor sleep quality brought on by night shifts may explain why Saudi nurses who work night shifts experience higher rates of depression than those who work day shifts only.

Long Term Corneal Flattening After Corneal Crosslinking in Patients with Progressive Keratoconus

Purpose

We evaluate the long-term visual, refractive, and keratometric outcomes after corneal crosslinking (CXL) in patients with progressive keratoconus (KC) and the incidence of an extreme corneal flattening effect.

Settings

Oftalmosalud Institute of Eyes, Lima, Perú.

Design

Retrospective cohort study.

Methods

Forty-five eyes that underwent CXL with epithelial removal between June 2006 and September 2011. Data analysis was performed at preoperative evaluation, 1 year postoperatively, and at least 10 years or more postoperatively. Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and Scheimpflug (Pentacam) analysis. Progression was defined by an increase in steep keratometry (Ks) of 1.5D or greater between 2 examinations. Extreme flattening effect was defined as a decrease in K values equal to or greater than 5 diopters (D).

Results

Mean follow-up time was 11 ± 1.07 years (range 10-13 years). There was a significant improvement in Ks, UCVA, CDVA, and spherical equivalent at the last visit. The overall rate of progression was 2.22% (1/45). Extreme flattening was observed in 15.5% (7/45) of the eyes, and this was associated with a loss of CDVA in 4.44% (2/45) of the eyes. One eye with corneal flattening of 11.5 D lost 7 lines of CDVA and required corneal transplantation.

Conclusion

CXL is a safe and effective procedure to stop the progression of KC with a good overall long-term success rate. Extreme corneal flattening may be more common than commonly recognized, and severe corneal flattening associated with a decrease in CDVA may occur.

Prevalence of Thyroid Nodules and Associated Clinical Characteristics: Findings from a Large Sample of People Undergoing Health Checkups at a University Hospital in Vietnam

Background

Thyroid nodule is a common disorder normally detected by ultrasound. However, little is known about the population prevalence of thyroid nodules in a Vietnamese population. This study aimed to estimate the prevalence of thyroid nodules, its characteristics, and associated factors in a large number of people undergoing annual health checkups.

Methods

A retrospective, cross-sectional descriptive study was conducted, based on electronic medical records of people undergoing health checkups at the Health Checkup Department, University Medical Center at Ho Chi Minh City. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations.

Results

A total of 16,784 participants (mean age: 40.4 ± 12.7 years, 45.1% female) were included in this study. The overall prevalence of thyroid nodules was 48.4%. The mean diameter of nodules was 7.2 ± 5.8 mm. The prevalence of nodules with malignant characteristics was 36.9%. Women had a significantly higher prevalence of thyroid nodules than men (55.2% vs 42.9%, p<0.001). Advanced age, hypertension, and hyperglycemia were significantly associated with thyroid nodules in both genders. In men, significant factors also included increased body mass index. In women, these included increased total cholesterol and LDLc, hypertriglyceridemia, and hyperuricemia.

Conclusion

This study showed a high prevalence of TNs in Vietnamese people undergoing general health checkups. Importantly, the proportion of TNs with malignant risk was quite high. Therefore, screening for TNs should be added to annual health checkups to improve early detection of TNs, targeting those who have a high-risk profile based on factors identified in this study.

Risk Factors Associated with Methicillin Resistance in Hospitalized Newborn Infants with Staphylococcus aureus Infection

Background

An increasing number of infections due to methicillin-resistant Staphylococcus aureus (S. aureus) have been reported worldwide. To explore the risk factors associated with methicillin-resistance among the neonates with confirmed S. aureus infections and thereby to help selection of appropriate empirical antibiotics.

Methods

We compared a group of hospitalized neonates with culture confirmed methicillin-resistant S. aureus (MRSA) infections to a group with methicillin-sensitive S. aureus (MSSA) based on antimicrobial susceptibility reports. We used multivariable regression analysis to determine the risk factors for neonatal MRSA infections.

Results

There was no difference in the ratio of local to systemic infections or mortality between the two groups. However, the total hospitalization days and the medical care expenses in the MRSA group were significantly increased when compared to that of the MSSA group. Prior use of antibiotics for more than 48 hours was an independent risk factor for neonatal acquisition of MRSA infections, while exclusive breast milk feeding was a protective factor against MRSA infections.

Conclusion

Restrictions on antibiotic abuse and promotion of breast milk feeding may protect newborns from MRSA infections. Prior history of antibiotic use and exclusive breast milk feeding may be important factors to consider in the selection of appropriate empirical antibiotics for use in neonates prior to the availability of the results of antimicrobial susceptibility testing.

Cutaneous Metastases from Thymic Carcinoma Primary Tumor: A Rare Case

Cutaneous metastases (CM) are neoplastic lesions of the skin originating from a primary tumor elsewhere. CM originating from primary thymic carcinoma is rare, and its incidence remains uncertain. A case of CM from thymic carcinoma in a 57-year-old man was reported. The patient complained about lumps on the skin of the chest, right shoulder and neck that appeared eleven months before the diagnosis of thymic carcinoma was established. Physical examination revealed tumors on the chest, right shoulder and neck. Histopathological examination results were consistent with CM. An immunohistochemical (IHC) examination was performed to determine the primary tumor, with a positive result for CK7. The diagnosis of thymic carcinoma was established based on the results of enhanced chest CT-scan and immunohistochemistry on lymph node biopsies. The patient was treated with a chemotherapy regimen of cyclophosphamide, doxorubicin, and carboplatin scheduled for six cycles. However, the patient did not survive his third cycle of chemotherapy. Establishing the diagnosis and managing CM are challenging for clinicians. This requires careful historical and physical examination, supported by histopathological examination and specific immunohistochemical marker in accordance with the suspected tumor.

Clinical Importance of aCGH in Genetic Counselling of Children with Psychomotor Retardation

Introduction

The X and Y chromosomes are responsible for the determination and differentiation of the gonads, and their numerical and structural abnormalities may cause the abnormal development of secondary sex characteristics. The presence of abnormalities concerning X chromosome can also contribute to many genetically heterogeneous diseases associated with cognitive impairment and intellectual disability.

Purpose

This study shows the effect of aberrations of the maternal X chromosome on the abnormal development of the child.

Patients and Methods

Ten women aged 26 to 40 years were consulted in genetic counselling clinic and subsequently subjected to cytogenetic and molecular tests due to abnormal psychomotor development of their children, in whom structural aberrations of the X chromosome had been detected.

Results

Two women were diagnosed with changes in karyotype: 46,X,der(X)t(X;Y)(p22.3;q11.2) in one and 46,X,inv(X)(p21.2q13). Five women were diagnosed with microduplications in the short arm of the X chromosome; dupXp22.31 in one, and in four women dupXp22.33. The remaining three women were diagnosed with duplication in the long arm of the X chromosome; dupXq25 in one and dupXq26.3 in two women.

Conclusion

Genetic analysis of the X chromosome, based on cytogenetic and molecular methods of the highest available resolution, is extremely important in women with reproductive failure. These methods allow establishing accurately the breakpoints and rearrangements in chromosomes, and assessment of the copy number variation (CNV) can explain phenotypic variability with apparently similar aberrations. A more precise characterization of the alterations is necessary for the correct genetic diagnosis, as well as determination of the carrier status and genetic risk in family members.

Evaluation of Potential Drug Interactions with AiDKlinik® in a Random Population Sample

Purpose

Undesirable drug interactions are frequent, they endanger the success of therapy, and they lead to adverse drug reactions. The present study aimed to evaluate statistically potentially drug interactions in a locally circumscribed, random sample population.

Patients and Methods

In a random sample population of 264 patients taking medications, we performed analyses with the drug information system AiDKlinik^®. Statistical analysis was performed using SAS version 9.4.

Results

Statistically potentially drug interactions were recorded in 82/264 (31.1%) subjects, including 39/82 (47.56%) men, and 43/82 (52.43%) women (χ²= 0.081; p = 0.776). The average number of potential possible interactions detected per person was 1.60 ± 1.21. The regression model with the variables age, body-mass-index and number of long-term-medications shows a significant association between the number of long-term medications taken and the number of moderately severe and severe reactions to drug interactions (F(3.239) = 28.67, p < 0.0001; (t(239) 8.28; p < 0.0001)). After backward elimination, the regression model showed a significant interaction with the number of long-term medications (t (240) = 8.73, p < 0.0001) and body-mass-index (t (240) = 2.02, p = 0.0442). In descriptive analysis, the highest percentages of potential drug interactions occurred in 42/82 (51.22%) subjects with body mass indices (BMIs) >25 kg/m² and in 28/82 (34.15%) subjects aged 61–70 years.

Conclusion

Number of long-term medications use, age, and obesity may lead to increased drug–drug interactions in a random population sample.

Patient-Reported Outcomes in Rheumatoid Arthritis: A Key Consideration for Evaluating Biosimilar Uptake?

Purpose

This review aims to provide an overview of the impact of TNFis biosimilars, with marketing authorization, in patient-reported outcome measures (PROMs) scores and explore how PROMs endpoints might add value in biosimilars uptake in RA patients.

Patients and Methods

A comprehensive search of Medline, Scopus, Lilacs, and CINAHL databases was performed for papers published between January 2012 and December 2021. For inclusion, studies had to be prospective, published in a peer-reviewed journal, published in English or Spanish language; studies using PROMs as an outcome measure. After screening title and abstracts and assessing the remaining full texts fulfilling the inclusion criteria, 31 papers were used in this narrative review.

Results

PROMs were used as secondary outcomes in included studies. The most frequently employed domains to assess biosimilar efficacy include physical function, patient global assessment (PtGA), health-related quality of life (HRQoL), and fatigue. The results of randomized clinical trials uniformly showed that mean change in PROMs scores is comparable between biosimilar and reference biologic treatment groups. However, open-label and real-world studies revealed high rates of discontinuation of therapy, mainly for subjective worsening of disease activity or non-specific adverse events. Even without objective clinical evidence of inflammation, patients who are considered to have active disease (higher scores on PtGA) have higher discontinuation rates of biosimilars. The available information suggests that the nocebo effect is the most likely cause for the discontinuation of biosimilars.

Conclusion

There is scarce literature surrounding the impact of biosimilars in PROMs, especially in open-label studies. In real-life studies, biosimilars have a higher discontinuation rate than reference products. TNFis biosimilars treatment efficacy in RA depends on disease activity and other factors such as PtGA and fatigue. The nocebo effect is the best explanation for biosimilar’s discontinuation.

Bupivacaine for Root Canal Treatment – Practitioner Behaviors and Patient Perspectives: Survey Studies

Introduction and Objectives

Local anesthesia is essential in dentistry in providing intraoperative analgesia and anesthesia. However, knowledge related to its use for management of post-operative pain is limited. Perioperative pain management is especially important for root canal treatment (ie, endodontic therapy), performed by endodontists. In this study, we sought to better understand endodontists’ attitudes regarding the use of long-lasting anesthetic, namely 0.5% bupivacaine HCl with 1:200,000 epinephrine, for the management of post-endodontic pain. Additionally, we aimed to understand the perspectives of dental patients about receiving longer lasting anesthesia for endodontic therapy and to determine factors that affect their anesthetic preferences within the orofacial region.

Methods

An email invitation to participate in an anonymous online survey was sent to members of the American Association of Endodontists. Also, 82 patients attending an in-person visit to an endodontic clinic were recruited to the study.

Results

Data from 474 endodontic practitioners and 82 patients included in analysis. Among practitioners, the majority reported to either never (33.31%) or rarely (34.84%) using bupivacaine. Most chose “I don’t think I need it” (47%) and “patient discomfort because of longer duration of soft tissue anesthesia” (30.81%) as reasons for not preferring the use of bupivacaine. Of the practitioners who reported at least rare use, most chose bupivacaine for post-operative pain management (78.02%). Conversely, 52% of patients reported that they were likely/most likely to request long-lasting anesthetics for post-operative pain control.

Conclusion

Bupivacaine is rarely used as a post-operative pain management strategy for endodontic therapy. Specifically, bupivacaine is not preferred not because of adverse events, toxicity, or slow onset concerns, but rather, because of longer duration of soft tissue anesthesia. However, our data suggest that patients may be willing to receive long-lasting anesthesia. Further patient-centered research should investigate the use of long-lasting anesthetic agents for management of post-endodontic pain.

Antibiotic Profile of Pathogenic Bacteria Isolated from Postsurgical Site Infections in Public Hospitals in Northern Jordan

Background

Surgical site infections are hospital-acquired, vary from one hospital to another, and can cause significant postoperative morbidity, mortality, and prolonged hospital stay.

Objective

The main aim of the study was to identify the bacterial pathogens associated with surgical site infections and their antibiotic susceptibility in a public hospital in northern Jordan.

Methods

Postsurgical wound samples were collected and processed in a microbiology laboratory using standard microbiological techniques. Antibiotic susceptibility tests were performed using 13 antibiotics covering the gram-positive and gram-negative bacteria using the disc diffusion test.

Results

The bacterial species that were identified in this study include Escherichia coli 8 (29%), Pseudomonas aeruginosa 3 (11%), Proteus mirabilis 1 (3.5%), Klebsiella pneumoniae 4 (14%), Salmonella enterica 2 (7%), Staphylococcus aureus 8 (29%), Staphylococcus epidermidis 1 (3.5%), and Streptococcus pyogenes 1 (4%). The antibiotic profiles of these bacteria showed high resistance. The MAR indices showed that 17 of 28 bacteria isolated were above 0.2 indicating high resistance.

Conclusion

Resistant bacteria are becoming more dominant in wound infections with a high prevalence of multidrug resistant isolates. Hospital disinfection and treatment protocols regarding the use of antibiotics should be practiced vigorously and monitored regularly to combat resistance.

Preoperative Correction of Low Hemoglobin Levels Can Reduce 1-Year All-Cause Mortality in Osteoporotic Hip Fracture Patients: A Retrospective Observational Study

Purpose

Osteoporotic hip fracture surgery is associated with a risk of morbidity and mortality. Admission hemoglobin levels <10 g/dL have been documented as a strong predictor of mortality risk. This study aimed to investigate the mortality outcome between osteoporotic hip fracture patients who had preoperative hemoglobin levels raised to ≥10 g/dL and those with hemoglobin levels were <10 g/dL.

Patients and Methods

This 5-year retrospective observational study included 226 participants with osteoporotic hip fractures that required surgery and who had admission hemoglobin levels <10 g/dL. Patients were categorized into two groups: those with corrected preoperative hemoglobin ≥10 g/dL and those with either corrected or uncorrected preoperative hemoglobin <10 g/dL. Outcomes were analyzed using Cox proportional hazard regression adjusted for confounders. Results are presented as hazard ratio (HR) and 95% confidence interval (95% CI).

Results

Among 226 the patients, the overall mortality rate was 17.25% (n=39/226) of the 226 patients, 93 (41.15%) had their hemoglobin levels raised to ≥10 g/dL by red blood cell transfusion. Multivariable analysis after adjustment for confounders showed a 50% lower incidence of mortality among patients with preoperative hemoglobin levels ≥10 g/dL than among those with hemoglobin levels <10 g/dL (HR 0.50, 95% CI (0.25–0.99), p=0.048).

Conclusion

In osteoporotic hip fracture patients with admission hemoglobin <10g/dL, raising preoperative hemoglobin levels to ≥10 g/dL can significantly reduce the risk of mortality. Testing for and correction of low preoperative hemoglobin levels is of value in hip surgery patients.

Hypertrophic Scar Following Excisional Surgery and Full-Thickness Skin Grafting Due to Rhinophyma Treated with 1064 nm Q-Switched Neodymium:Yttrium Aluminum Garnet Laser

Rhinophyma is characterized by progressive enlargement of the nasal skin, which is considered to be an advanced stage of phymatous rosacea. Esthetic disfigurement makes surgical treatment necessary for this condition. Hypertrophic scars are the consequence of alterations in the skin’s healing process following surgical interventions. Laser may be the treatment of choice in hypertrophic scars. We reported a case of hypertrophic scars following excisional surgery and full-thickness skin grafting due to rhinophyma in an 18-year-old male who was consulted from the Department of Plastic Surgery and Reconstruction. The 1064 nanometer (nm) Q-switched Neodymium: Yttrium Aluminum Garnet (QS Nd:YAG) with 4 mm spot size, 1.5 J/cm2 and 1 Hz was applied to the hypertrophic scars for three sessions within one month interval. Clinical improvement was observed as indicated by the patient’s Vancouver scar scale score and spectrophotometry result, and no side effects were found. Nd:YAG laser is a non-ablative device that targets hemoglobin, water, and melanin. Any thermal effects on dermal tissue containing blood vessels could result in reduced blood flow through the capillaries in the dermal papillae. QS Nd:YAG-induced selective photothermolysis was responsible for collagen breakdown and reduced collagen production in hypertrophic scars. The 1064 nm QS Nd:YAG laser gave good results in this case although more treatment sessions may be recommended and a longer follow-up is necessary in order to assess the stability of the result.

Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial

BACKGROUND

Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores.

PARTICIPANTS AND METHODS

This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time.

RESULTS

A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the labor duration (165 vs 333 minutes, p < 0.001), improved vital signs, which resulted in higher APGAR scores, and increased maternal satisfaction.

CONCLUSION

The labor unit management could consider adopting BRM as one of the non-pharmacological analgesia for healthy women in labor.

TRIAL REGISTRATION

ISRCTN87414969, registered 3 May 2019.

Development and Validation of a Risk Nomogram Model for Predicting Contrast-Induced Acute Kidney Injury in Patients with Non-ST-Elevation Acute Coronary Syndrome Undergoing Primary Percutaneous Coronary Intervention

Objective

To establish a nomogram model to predict the risk of contrast-induced acute kidney injury (CI-AKI) by analyzing the risk factors of CI-AKI and to evaluate its effectiveness.

Methods

Retrospectively analyze the clinical data of non-ST-elevation acute coronary syndrome (NSTE-ACS) patients who underwent percutaneous coronary intervention (PCI) in our cardiology department from September 2018 to June 2021. Of these, patients who underwent PCI in an earlier period formed the training cohort (70%; n = 809) for nomogram development, and those who underwent PCI thereafter formed the validation cohort (30%; n = 347) to confirm the model’s performance. The independent risk factors of CI-AKI were determined by LASSO regression and multivariable logistic regression analysis. By using R software from which nomogram models were subsequently generated. The nomogram was developed and evaluated based on discrimination, calibration, and clinical efficacy using the concordance statistic (C-statistic), calibration plot, and decision curve analysis (DCA), respectively.

Results

The nomogram consisted of six variables: age >75, left ventricular ejection fraction, diabetes mellitus, fibrinogen-to-albumin ratio, high-sensitive C-reactive protein, and lymphocyte count. The C-index of the nomogram is 0.835 (95% CI: 0.800–0.871) in the training cohort and 0.767 (95% CI: 0.711–0.824) in the validation cohort, respectively. The calibration plots exhibited that the nomogram was in good agreement between prediction and observation in the training and validation cohorts. Decision curve analysis and clinical impact curve suggested that the predictive nomogram had clinical utility.

Conclusion

The nomogram model established has a good degree of differentiation and accuracy, which is intuitively and individually to screen high-risk groups and has a certain predictive value for the occurrence of CI-AKI in NSTE-ACS patients after PCI.

Assessment of the Influence of Physicians' Attire on Surgical Patients' Perception. Across-Sectional Study in Aabet Hospital, AddisAbeba, Ethiopia, 2021

BACKGROUND

In Ethiopia, physicians commonly wear formal attire, surgical scrubs, casual attire, or business attire during patient care, but there is no evidence to show which attire is preferred within the patients. So this study aims to assess the influence of physicians' attire on patients' perceptions.

METHODOLOGY

After ethical approval, a cross-sectional study was conducted with written informed consent; data were collected and checked for its completeness, later entered into SPSS version 25 for statistical analysis. Descriptive statistics was presented with frequency, percentage, tables, graphs, and texts based on the nature of the data. All the four attires were compared using the Friedman test and pair wise comparisons were conducted with Bonferroni correction for multiple comparisons, and Mann-Whitney U-test was used to know the preferred attire on patients' perception about physicians' skill, with 95% confidence and a p-value of less than 0.05 were considered as statistically significant.

RESULTS

In this study, out of the total respondents 66.7% are males and 71.9%, 50.3% of the respondents were degree or diploma holders, and aged 18-34 years respectively. Among participants' 77.1% and 55.9% preferred formal attire and surgical scrub respectively. For male surgeons, formal attire and surgical scrub have an equal preference in surgical patients (p<0.001), but business and casual attire have no statistically significant difference. The patients' preference in male formal physician attire in surgeon's confidence, willingness to discuss confidential information and safeties of the surgeon were 76.2%, 75.7%, and 70.5% respectively, and for female surgeons, formal attire on surgical patients' confidence in the surgeon, safety, and willingness to discuss confidential information were 74.9%, 73.8%, and 71.8% respectively.

CONCLUSION

Physician attire is one of the important factors that inspire surgical patient confidence, smartness, surgical skill, discussion of confidential information, and caring ability in physicians. Formal attire and surgical scrub were the most preferred physician's outfits.

Predictive Role of Targeted, Active Surveillance Cultures for Detection of Methicillin-Resistant Staphylococcus aureus

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) colonisation is an important source of healthcare-acquired infections. Reliable screening strategies for MRSA colonisation are essential for the timely implementation of infection control measures.

AIM

This study determined reliable MRSA screening sites to predict colonisation in resource-limited settings and estimated the impact of missed MRSA cases when shifting from multi- to single-site screening.

METHODOLOGY

A cross-sectional study was conducted in patients with positive MRSA surveillance cultures from the routinely screened sites (nasal, axillary, groin, and throat) from January 2009 to December 2019.

RESULTS

A total of 1906 screening tests were positive for MRSA cultures (n = 1345 patients). As a single site, the nasal cavity showed the highest MRSA detection, with a sensitivity of 66.8% (95% CI = 64-69) with 277.9 missed isolation days. Screening three or more anatomical sites detected 97-100% of MRSA cases, with 0-24.5 missed isolation days. Screening the axilla and groin separately or in combination showed a good clinical utility index (CUI) of >0.6 to <0.8, while an excellent CUI was obtained upon screening other site samples (>0.8). The combined nasal and throat cultures demonstrated a sensitivity of 93.2 (95% CI = 91-94) with 57.2 missed isolation days.

CONCLUSION

Multi-site screening is the optimal strategy for minimising MRSA exposure within a healthcare facility. For active MRSA surveillance, a combination of nasal and throat cultures can provide a practical approach in low-resource settings compared to nasal sampling alone.

Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review

The rising of global geriatric population has contributed to increased prevalence of dementia. Dementia is a neurodegenerative disease, which is characterized by progressive deterioration of cognitive functions, such as judgment, language, memory, attention and visuospatial ability. Dementia not only has profoundly devastating physical and psychological health outcomes, but it also poses a considerable healthcare expenditure and burdens. Acetylcholinesterase inhibitors (AChEIs), or so-called anti-dementia medications, have been developed to delay the progression of neurocognitive disorders and to decrease healthcare needs. AChEIs have been widely prescribed in clinical practice for the treatment of Alzheimer's disease, which account for 70% of dementia. The rising use of AChEIs results in increased adverse drug reactions (ADRs) such as cardiovascular and gastrointestinal adverse effects, resulting from overstimulation of peripheral cholinergic activity and muscarinic receptor activation. Changes in pharmacokinetics (PK), pharmacodynamics (PD) and pharmacogenetics (PGx), and occurrence of drug interactions are said to be major risk factors of ADRs of AChEIs in this population. To date, comprehensive reviews in ADRs of AChEIs have so far been scarcely studied. Therefore, we aimed to recapitulate and update the diverse aspects of AChEIs, including the mechanisms of action, characteristics and risk factors of ADRs, and preventive strategies of their ADRs. The collation of this knowledge is essential to facilitate efforts to reduce ADRs of AChEIs.

Overview of the Active Ingredients in Cosmetic Products for the Care of Skin That Has Been Exposed to Ionizing Radiation - Analysis of Their Effectiveness in Breast Cancer Radiotherapy

Treatment that uses ionizing radiation is one of the most common therapeutic methods in case of breast cancer. However, it often results in radiation dermatitis, which manifests itself, among others, as erythema, burning, itching and pain as well as dry or moist desquamation of the epidermis in the irradiated areas. The intensity of these symptoms significantly reduces the patient's quality of life, which could affect the effectiveness of the entire therapy. There are more and more cosmetic preparations on the market for daily care of skin that has been exposed to radiation. The composition of the active ingredients in these preparations is designed to support the protective functions of the skin, delay the occurrence of the side effects of ionizing radiation, reduce their intensity, and accelerate the regeneration of the irradiated areas. Unfortunately, there is little scientific evidence of the effectiveness of the active ingredients that are contained in these preparations. This paper presents a narrative review of the most commonly used ingredients and compares them with the current state of knowledge on their effectiveness in preventing radiodermatitis.

The Effect of Mesenchymal Stem Cell-Enriched Scaffolds on MMP-8 and TGF-β Levels of Vertebrae Postlaminoplasty in Rabbit Model

INTRODUCTION

Some laminoplasty procedures still have restenosis because of bony-bridging failure of the laminar hinge. The present study aimed to determine the effect of mesenchymal stem cell (MSC)-enriched scaffolds on vertebral regeneration after laminoplasty on the basis of the number of osteoblasts, matrix metalloproteinase-8 (MMP-8), and transforming growth factor-beta (TGF-β) levels.

METHODS

Laminoplasty procedure using the Hirabayashi technique was conducted at the lumbar level in 32 rabbits that were divided into four and three groups of the control (C) and treatment groups, respectively, with different types of laminoplasty spacer (T1, autograft; T2, scaffold; and T3, scaffold with MSCs). Histopathological studies were conducted to calculate the number of osteoblasts and enzyme-linked immunosorbent assay tests to detect MMP-8 and TGF-β 4 weeks after the surgery.

RESULTS

The results showed a significant decrease in MMP-8 level in the T3 group compared with that in the control group (p < 0.05). A significant difference exists between the average number of newly formed osteoblasts in the control group compared with that in the T3 group (p < 0.05) with a higher mean blood TGF-β level of all experimental groups compared with that of the control group (p = 0.58).

CONCLUSION

The significant decrease in MMP-8 levels, increase in TGF-β levels, and increased number of osteoblasts on MSC-seeded polylactic acid scaffolds could be useful to support the laminoplasty procedure to prevent restenosis because it was biocompatible and promoted the bone healing process.

Unicompartmental Knee Arthroplasty for Severe Osteoarthritis and Pseudarthrosis in a Patient with Neurofibromatosis

We describe the case of a 76-year-old Asian female patient who presented with severe pain and a valgus deformity of the right knee. Her past medical history included neurofibromatosis, which resulted in a severe anterior slope of the right knee, limb shortening, and congenital pseudarthrosis. She was diagnosed with severe anterolateral osteoarthritis and eburnation of the right knee that was treated surgically with a lateral unicompartmental knee arthroplasty (UKA). Bone and cartilage fragments were removed from the joint space and a UKA implant (Zimmer®) with dimensions of 29 mm × 50 mm was inserted. Perioperative imaging revealed that the procedure resulted in the correction of the valgus deformity. Pain was reduced and the patient was able to walk for 10 meters with support during the immediate postoperative period. One week post-surgery, the patient sustained an oblique tibial fracture that extended from the medial edge of the implant to the medial slope of the proximal tibia. This complication may have been attributed to large implant size or sagittal overcutting. The fracture was treated surgically with a rotated anterolateral locking plate (A.L.P.S®) inserted into the distal tibia. The patient was capable of ambulation at full weight load at two months after the second procedure. It is critical to recognize that there are no standard protocols that can be used to guide the treatment of neurofibromatosis-induced osteoarthritis. The specific preoperative condition of the individual patient plays a large role in determining the appropriate treatment option. In this case, the availability of custom-fitted UKA implants might have improved outlook, we understand that these devices are costly and may not be available at all hospitals. However, we strongly believe that the "gold standard" in these cases is patient-specific treatment that addresses the issues of the highest concern using the resources that are available at that time.

Antioxidants for the Treatment of Retinal Disease: Summary of Recent Evidence

Retinal tissue is prone to oxidant burden and oxidative stress secondary to the generation of reactive oxygen species from high metabolic demand. The formation of reactive oxygen species occurs primarily from the mitochondrial respiratory chain as well as several enzymatic and oxidation reactions that occur in the neurosensory retina and retinal pigment epithelium. This oxidative stress has been implicated in the pathogenesis of several retinal diseases and the role of antioxidants as a therapeutic treatment shows promise in slowing the progression of certain diseases. The aim of this narrative review is to describe the mechanisms of retinal oxidative stress and summarize the current available evidence for antioxidants as a treatment for vitreoretinal disorders.

Increased Incidence of Pediatric Diabetic Ketoacidosis After COVID-19: A Two-Center Retrospective Study in Korea

PURPOSE

We evaluated the clinical characteristics and severity of diabetic ketoacidosis (DKA) in children before and after the coronavirus disease 2019 (COVID-19) outbreak to identify its indirect effects on DKA incidence.

PATIENTS AND METHODS

This retrospective study included 19 children with DKA admitted to the emergency room (ER) in two centers in Jeonbuk province, Korea during the first 6 months of the year from 2017 to 2020. Data were collected on age, height, body weight, clinical symptoms, diabetic mellitus (DM) type, and laboratory findings. DKA severity was based on the presence of acute kidney injury, cerebrovascular accident, and altered mental status. The ratio of patients with DKA in all pediatric patients who visited the study ERs and in the Jeonbuk population was also determined.

RESULTS

There were no differences in anthropometric characteristics and complication rates between the pre-COVID-19 and COVID-19 periods; however, the rate of polydipsia was significantly higher in the COVID-19 period. All seven patients admitted during the COVID-19 pandemic (100%) had polydipsia and polyuria and were newly diagnosed with DM. The rate of pediatric patients with DKA admitted to the ER in 2020 (0.459%) was more than twice the mean rate of 0.206% for the four-year period. The incidence of DKA in the Jeonbuk population (0.00141%) also exceeded the mean rate (0.0009%).

CONCLUSION

The incidence of pediatric DKA might be higher due to the indirect effect of COVID-19 pandemic. Physicians should be aware of nonspecific symptoms related to DKA in children admitted to the ER.

Platelet Indices and Its Association with Microvascular Complications Among Type 2 Diabetes Mellitus Patients in Northeast Ethiopia: A Cross-Sectional Study

PURPOSE

Platelet indices have been shown to be associated with complications of diabetes mellitus (DM). However, the clinical relevance of platelet indices for assessing the risk of being microvascular complications among patients with DM is largely overlooked. Hence this study aimed to determine the association of platelet indices with microvascular complications among type 2 DM patients.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted among 352 type 2 DM patients from April 1 to May 30/2019 at Debre Berhan Referral Hospital. Data were collected by interview, physical measurements, document review, and laboratory tests. Then the data were entered into Epi-data manager-4.4.1.0 and exported into SPSS-25 for analysis. Platelet indices were compared between participants with and without microvascular complications using an independent t-test. A logistic regression model was used to assess the association between microvascular complications and platelet indices. All inferences were considered statistically significant at P<0.05.

RESULTS

One hundred seventeen (33.2%) of participants were suffering from at least one microvascular complications. The mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) were significantly increased in DM patients with complications as compared to without complications (13.57±2.17fl vs. 11.76±1.93fl), (16.57±2.49fl vs. 14.97±2.41fl) and (28.09±7.58% vs. 24.19±6.46%), respectively (all are P˂0.001). In multivariate logistic regression analysis, MPV (AOR=1.68, 95% CI: 1.37-2.05), PDW (AOR=1.37, 95% CI: 1.15-1.63), P-LCR (AOR=1.07, 95% CI: 1.01-1.14), age (AOR=1.07, 95% CI: 1.01-1.12), and duration of DM (AOR=1.31, 95% CI: 1.18-1.46) were significantly associated with the presence of microvascular complications.

CONCLUSION

MPV, PDW, and P-LCR were significantly higher among type 2 DM patients with microvascular complications. This indicates that platelet indices can be used as prognostic markers of vascular complications and can be used as simple and cost-effective parameters to predict microvascular complications particularly in patients with old age and long duration of DM.

Utilization of Integrated Community Case Management of Childhood Illnesses at Health Posts in Southern Ethiopia

PURPOSE

Even if strategic actions were undertaken to tackle common childhood illnesses, Ethiopia still stood as one of the six countries accounting for half of the global under-five deaths. So this study aimed to assess the utilization of integrated community case management during childhood illness at health posts in the study area.

METHODS

A community-based cross-sectional study was conducted using a multistage sampling technique that includes 633 sick under-five children with common childhood illnesses. The data was entered into EpiData 3.1 and exported to SPSS 20 for further analysis. Descriptive statistics, bivariate and multivariate logistic regression analyses were computed and adjusted odds ratio within 95% confidence interval was used to measure the statistical association between variables.

RESULTS

Out of the planned 633 participant, 624 caregivers underwent all the study components making the response rate 98.6%. The study indicated that only 10.6% of the sick children sought care from health posts. Income (AOR = 2.99, 95% CI: 1.37-6.53), previous service utilization (AOR = 6.66, 95% CI: 1.81-24.04), awareness of service availability (AOR = 4.74, 95% CI: 1.39-12.10), ownership of health insurance (AOR = 2.63, 95% CI: 1.45-4.76), distance (AOR = 5.23, 95% CI: 1.69-10.19) and type of illness (AOR = 2.97, 95% CI: 1.41-6.25) were the associated factors.

CONCLUSION

The low utilization of integrated community case management insights to focus on availing additional well-equipped health posts, creating community awareness on services at health posts and at what time the services are given to address the problem of the majority.

Miscarriage as a Complication of Hidradenitis Suppurativa of the Vulva

We present a rare case of severe chronic hidradenitis suppurativa (HS) Hurley (stage III) of the vulva complicated by disfiguring draining sinuses, multiple abscesses, and multiple nodules which resulted in miscarriage as a result of ascending infection.

<p>An Unusual and Rare Case of Generalized Multiple Epidermoid Cysts with a Giant Epidermoid Cyst</p>

Epidermoid cyst (EC) is a cyst containing keratin and its breakdown products, that is surrounded by an epidermoid wall. EC can occur in both men and women, especially in young- and middle-aged adults. The clinical features of EC include asymptomatic, well-demarcated, and skin-colored to yellowish subcutaneous or dermal nodules with a punctum on the middle of the lesion which can occur anywhere on the body. This type of cyst is usually solitary with diameter up to 5 cm, or rarely, there are multiple with diameters of more than 5 cm, which is classified as a giant EC. Here, we report a case of generalized multiple ECs with a giant EC on the left gluteal region of a 19-year-old male with complaints of asymptomatic skin-colored nodules with central punctum on the right temple, chest, back, and gluteal regions for five years. Correlation between the clinical and histopathological findings in the form of cysts containing keratin and lined by wall composed of stratified squamous epithelia established the diagnosis of EC. The patient underwent surgical procedures for the skin-colored nodules on the chest, back, and gluteal regions. He also received triamcinolone acetonide intralesional injection for the skin-colored nodule on the right temple. After four months of follow-up, there was no recurrence, and all the skin-colored nodules were completely removed. EC should always be considered when diagnosing a skin-colored nodule even if the manifestations are generalized multiple and giant nodules, as in our case, demonstrating a rare and unusual case of EC, to the best of our knowledge.

Prevalence of Anemia and Its Associated Factors Among Adult Diabetes Mellitus Patients at Debre Tabor General Hospital, Northcentral Ethiopia

BACKGROUND

Diabetes mellitus is a cluster of metabolic disorders which is characterized by hyperglycemia. The occurrence of anaemia is a significant public health problem among diabetic patients because of complication and dietary modifications. So, this study aimed to assess the magnitude of anaemia among adult diabetes mellitus patients in Debre Tabor General Hospital, Ethiopia.

METHODS

A cross-sectional study design was conducted. A simple random sampling technique was employed to collect data from 297 adult diabetic mellitus patients. After taking venous blood, the haemoglobin level was determined by using HemoCue 301 machine. Anaemia among diabetic patients was determined by using the haemoglobin level (<13.0g/dL for male and <12.0g/dL for female). Data were entered using EpiInfo version 7.2 and analyzed using SPSS version 21. The binary logistic regression model was used to explore the association of independent variables with anaemia. Finally, p-value <0.05 was used to declare the level of statistical significance.

RESULTS

The prevalence of anemia among diabetic patient was 29.81% (95% CI: 24.27, 35.35). Diabetic patients unable to read and write (AOR = 3.51, 95% CI: 1.40, 8.75), able to read and write (AOR = 9.76, 95% CI: 3.15, 30.24), ≥4 family size (AOR = 0.53, 95% CI: 0.29, 0.99), intake of flesh meat (AOR=0.19, 95% CI: 0.05, 0.74), and parasitic infections (AOR = 0.26, 95% CI: 0.07, 0.95) were more likely to develop anemia.

CONCLUSION

Anemia is a moderate public health problem among diabetic patients. Here, educational status, family size, intake of flesh meat, and intestinal parasite infections were the factors associated with the development of anaemia. So, working on these significant factors by health care providers during routine care is vital to prevent anaemia among diabetic patients.

Development of Obesity: The Driver and the Passenger

Obesity has reached epidemic proportions and is one of the greatest challenges for public health in the twenty-first century. The macronutrient composition of diets, in particular the amount and ratio of carbohydrates, fat and protein, have received considerable attention in recent decades due to its potential relevance to the development of obesity and weight loss. The effects of various macronutrients on body weight regulation are still under debate. High-carbohydrate diets, and particularly high-fat diets, have been blamed for the increase in the prevalence of obesity. This paper shows that neither fat nor carbohydrates are fattening per se. Mixed diets with substantial amounts of fat and high-glycemic carbohydrates, like current WDs, are required to promote weight gain and obesity. High-glycemic carbohydrates are the active partner (the "driver"), which promotes fat storage through its insulinogenic effect, while fat is the passive partner (the "passenger") on the way to obesity. Elevated insulin levels (postprandial, but more importantly due to hypersecretion and hyperinsulinemia) promote fat storage and play a key role in obesogenesis and the obesity epidemic. Furthermore, mixed diets high in high-glycemic carbohydrates and fat promote fetal programming, with long-term adverse impacts on the offspring, including insulin hypersecretion, (childhood) obesity and metabolic diseases. Maternal obesity and high weight gain during pregnancy have also been linked to deleterious effects on fetal programming. As the global obesity epidemic increasingly affects women of reproductive age, a significant percentage of fetuses will experience fetal programming with a tendency towards obesity - a self-reinforcing process that further fuels the epidemic. A change in lifestyle and diet composition is needed to prevent or limit the development of obesity and related diseases.