Prevalence and Associations of Night Eating Syndrome Among Medical Students in Saudi Arabia

Background

Medical students often experience elevated stress levels and disrupted sleep patterns, increasing the risk of developing Night Eating Syndrome (NES). Depression is prevalent among medical students, further emphasizing the need for investigation. This study aims to explore the occurrence of NES and its associated factors, primarily focusing on depression, among medical students at a university in Jeddah, Saudi Arabia.

Methods

In this cross-sectional study involving medical students, participants completed a self-administered questionnaire covering sociodemographic details, the Night Eating Syndrome Questionnaire (NEQ) with 14 items, and the Patient Health Questionnaire-2 (PHQ-2) for depression screening.

Results

The study involved 300 medical students, reflecting a diverse sample with an average age of 21.4 ± 1.9 years and a well-balanced distribution across academic years. Notably, 41 participants (13.7%) were identified as obese. Depression, as determined by PHQ-2 scores exceeding 3, was prevalent in 159 students (53.0%). A multivariable logistic regression analysis uncovered a significant independent association, revealing that being a second-year medical student was linked to depressive health conditions (odds ratio [OR]: 3.53, 95% confidence interval [CI]: 1.24-10.10, p = 0.02). Exploring NES, 22 students (7.3%) scored above the NEQ threshold of 25, indicating its presence. Intriguingly, multivariable logistic regression illustrated that the sole independent factor associated with NES was the presence of depression (OR: 4.4, CI: 1.4-13.2, p = 0.01).

Conclusion

The overall prevalence of NES was 7.3%, and it was found to be associated with depression in medical students. Additionally, being a second-year medical student was independently associated with depression. These findings underscore the importance of addressing mental health issues, including NES and depression, in medical students, particularly during the early stages of their training.

Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates

Objective

This study aimed to identify factors that should be focused on by the antimicrobial stewardship team for treating patients with sepsis, by investigating the mortality of patients with sepsis within 30 days and the mortality-related factors in our hospital over a 10-year period from the perspective of appropriate antimicrobial use.

Methods

Factors associated with 30-day mortality were investigated using hierarchical multiple logistic regression in 1406 patients with pathogen-identified sepsis in Hirosaki University Hospital. These factors were clinical data, microbiological data, antimicrobials used in empiric and definitive therapies, presence/absence of ineffective use, underdosing as evaluated using Monte Carlo simulation, and practice of de-escalation.

Results

The ineffective use of antimicrobials in empiric therapy and the underdosing and ineffective use in definitive therapy were significantly associated with 30-day mortality (odds ratio [OR] = 2.70, 3.72, and 3.65, respectively). Multiple blood culture sampling was inversely associated with these inappropriate antimicrobial uses. Every year, the 30-day mortality rate has been decreasing, in line with the increase in multiple blood culture sampling and de-escalation; the inappropriate use of antimicrobials has also decreased.

Conclusion

Multiple blood culture sampling, proper choice of antimicrobial, and using an adequate dose in definitive therapy could decrease the 30-day mortality rate in patients with sepsis and these factors could be supported by the antimicrobial stewardship team.

Serum 3-Hydroxybutyrate is Expected to Serve as One of the Supportive Diagnostic Markers of Persistent Idiopathic Dentoalveolar Pain (PDAP)

Background

Persistent idiopathic dentoalveolar pain (PDAP), previously referred to as atypical odontalgia, is a chronic dental pain that occurs without signs of pathology. PDAP is considered a diagnosis of exclusion, and its definition is currently under refinement and remains ambiguous. The metabolite known as 3-hydroxybutyrate (3HB) has garnered significant interest as a potential indicator for both depression and chronic psychogenic pain. We investigated the characteristics of patients with PDAP and hypothesized that serum 3HB could support the diagnosis of PDAP.

Subjects and Methods

Forty-one patients with PDAP and 167 patients with odontogenic toothache were investigated regarding depression and anxiety scales in addition to the general dental evaluation. Blood tests including high-sensitivity CRP, HbA1c, and 3HB were performed for all patients. Associations between PDAP and patients' varying characteristics were investigated using hierarchical multivariate logistic regression analyses.

Results

There were more females, current smokers, patients with orofacial pain (such as temporomandibular joint pain, glossalgia, and headache), and people with elevated 3HB levels among patients with PDAP than among control participants. Multivariate logistic regression analyses predicting patients with PDAP identified the female sex (odds ratio [OR]: 4.16), current smoking (OR: 14.9), glossalgia (OR: 19.8) a high CES-D score (≥16) (OR: 5.98), and elevated serum 3HB (≥80 μmol/L) (OR: 18.4) factors significantly associated with PDAP.

Conclusion

Our results demonstrated that serum 3HB levels could be elevated in patients with PDAP compared to other types of odontogenic pain, although 3HB was not specific to PDAP. Based on our findings, five factors - female sex, current smoking, depressive tendencies, chronic orofacial pains, and high serum 3HB levels - could be useful for diagnosing PDAP.

Anxiety and Depression in Patients with Alopecia Areata in Eskisehir, Turkey

Background

Conflicting results have emerged in studies conducted to reveal the relationship between alopecia areata (AA) and depression and anxiety. The comorbidity of depression and anxiety in patients with patchy AA who applied to a tertiary care center will be investigated and compared with a healthy control group.

Methods

This study included 86 patients with AA and 85 healthy volunteers. The patients and controls completed Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BDI).

Results

The average BDI of the patient group was 13.45±8.59, while in the control group, it was 7.2±5.7 (p = 0.002). The average BAI of the patient group was 12.56±8.76, while in the control group, it was 6.01±5.87 (p = 0.019). Depression was detected in 30.2% (n = 26) of the patients and anxiety was detected in 19.8% (n = 17) of the patients. In the control group, the rate of depression was 5.9% (n = 5) and the rate of anxiety was 7.1% (n = 6). There was a statistically significant difference between the patients and the control group in terms of depression (p < 0.001) and anxiety (p < 0.001).

Conclusion

Depression and anxiety were more prevalent in patients with AA than in healthy volunteers. Dermatologists should keep in mind psychiatric diseases such as depression and anxiety that may accompany patients diagnosed with AA.

Changes in Oncological Surgical Principles Driven by Advances in Preoperative Treatments

From a surgical point of view, the development of preoperative oncological treatment has had a profound effect on the surgical treatment trends of cancer as well as on the outcomes of cancer patients. Consequently, these changes have challenged formerly entrenched oncological surgical principles. In our short report, we aimed to summarize the main shifts regarding the surgical principles of cancer treatment due to the development of preoperative oncological therapy in recent years. As a result of successful preoperative treatment, surgeons may perform less radical surgeries, the required free resection margin has been narrowed down to a few millimeters in dimension and preoperative treatment is justified in both definitely resectable tumors and in oligometastatic tumors as well. For prognosis assessment, the post-preoperative oncological treatment stage is now considered decisive, rather than the pretreatment stage as previously thought. Other changes include the introduction of the watch and wait strategy and the reverse order of treatment of the primary tumor and metastasis. Observing the continuously improving outcomes of cancer patients and the developments in oncological treatment modalities, a further expansion of the indication of preoperative treatments is to be expected.

Adherence to Antiretroviral Therapy and Associated Factors Among HIV-Infected Children in Public Health Institutions of Adwa, Axum, and Shire Towns of Tigray, Northern Ethiopia: A Cross-Sectional Study

Background

Antiretroviral therapy (ART) provision was among the major challenge of treatments. Maintaining the optimal level of adherence among children living with HIV/AIDS is a pivotal step towards achieving treatment success. However, there are limited studies on child's ART adherence. Therefore, this study aimed to assess the level of adherence to antiretroviral therapy and associated factors among HIV-infected children in health institutions of Adwa, Axum, and Shire towns, Tigray, Northern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among human immunodeficiency virus (HIV)-infected children in between February and April, 2016. A total of 255 children who were taking antiretroviral therapy in the randomly selected three health facilities from Adwa, Axum and Shire towns were included. Data were collected using pretested and structured questionnaires using a face-to-face interview. The collected data were entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. Bivariate and multivariate binary logistic regression models were used to determine the factors associated with adherence to antiretroviral therapy among HIV-infected children.

Results

A total of the 255 study participants were included in the study. The level of ART adherence among HIV-positive children was 212 (84.8%). Knowledge of caregivers about ART treatment (AOR = 2.78, 95% CI: 1.18, 6.53), occupational status (AOR = 4.78, 95% CI: 1.26, 18.91), appointment to ART less than two months (AOR = 3.05, 95% CI: 1.21, 7.70) and use of memory aids (AOR = 4.58, 95% CI: 1.73, 12.13) were independently associated with adherence to ART.

Conclusion

The level of adherence to antiretroviral therapy was low. Healthcare providers should reinforce adherence intervention and counseling sessions during follow-up and address the proper use of medication reminders to help children take their drugs appropriately.

Nurses Cultural Competence in Southwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Diversity is a challenge and an opportunity, resulting in a change toward providing services suited to clients' cultural needs and desires. Nurses working with culturally diverse populations face unique challenges because of the coexistence of diverse cultural and ethnic societies. Hence, the study's purpose has been to evaluate the current state of cultural competence and the factors that influence it among nurses in Southwest Ethiopia.

METHODS

From December 1 to December 30, 2021, nurses at eight public healthcare facilities in southwest Ethiopia were enrolled in a facility-based cross-sectional study. Participants were selected using a simple random sampling. A self-administered questionnaire was used to collect the data. Epi data 4.1 was used to enter the data, and SPSS version 26 was used for analysis. To identify factors associated with cultural competence, bivariate and multivariable linear regression analyses were performed. The significance level was set at p < 0.05.

RESULTS

Two hundred thirty-seven nurses took part in the study, yielding an 86.1% response rate. The mean age was 28.83 years (standard deviation = ±5.48). The mean cultural competence score among healthcare professionals was 1.95 ± 0.32. Marital status (p < 0.05) and the use of healthcare interpreters (p < 0.05) were significantly associated with cultural competence.

CONCLUSION

Nurses had a low level of cultural competence. Cultural competence varies according to a number of factors, including marital status and the use of healthcare interpreters. Nurses are better suited to focus on the ethnic diversity of their patients, which necessitates the provision of cultural competence training for nurses.

Dengue Early Warning System as Outbreak Prediction Tool: A Systematic Review

Early warning system (EWS) for vector-borne diseases is incredibly complex due to numerous factors originating from human, environmental, vector and the disease itself. Dengue EWS aims to collect data that leads to prompt decision-making processes that trigger disease intervention strategies to minimize the impact on a specific population. Dengue EWS may have a similar structural design, functions, and analytical approaches but different performance and ability to predict outbreaks. Hence, this review aims to summarise and discuss the evidence of different EWSs, their performance, and their ability to predict dengue outbreaks. A systematic literature search was performed of four primary databases: Scopus, Web of Science, Ovid MEDLINE, and EBSCOhost. Eligible articles were evaluated using a checklist for assessing the quality of the studies. A total of 17 studies were included in this systematic review. All EWS models demonstrated reasonably good predictive abilities to predict dengue outbreaks. However, the accuracy of their predictions varied greatly depending on the model used and the data quality. The reported sensitivity ranged from 50 to 100%, while specificity was 74 to 94.7%. A range between 70 to 96.3% was reported for prediction model accuracy and 43 to 86% for PPV. Overall, meteorological alarm indicators (temperatures and rainfall) were the most frequently used and displayed the best performing indicator. Other potential alarm indicators are entomology (female mosquito infection rate), epidemiology, population and socioeconomic factors. EWS is an essential tool to support district health managers and national health planners to mitigate or prevent disease outbreaks. This systematic review highlights the benefits of integrating several epidemiological tools focusing on incorporating climatic, environmental, epidemiological and socioeconomic factors to create an early warning system. The early warning system relies heavily on the country surveillance system. The lack of timely and high-quality data is critical for developing an effective EWS.

Magnitudes of Risk Factors of Venous Thromboembolism and Quality of Anticoagulant Therapy in Ethiopia: A Systematic Review

Background

Objective

Materials and Methods

Results

Conclusion

Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda

Background

In Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients.

Methods

This was a retroprospective cohort study involving patients with linked data in the Kampala cancer registry and medical records from hospitals in Uganda. Participants with a diagnosis of colorectal adenocarcinoma between 1st January 2008 and 31st December 2018 were included. Variables included patients’ demographic data, grade, stage and location of CRC, data on whether a patient was operated on, type of operation, treatment modalities and date of diagnosis. Our outcome variable was time to death after diagnosis. We computed and compared survival using the Log rank test and used Cox proportional hazards regression to determine factors associated with survival.

Results

A total of 247 patients were included in the study with a mean (SD) age of 53.3 (15.7) years and a female: male ratio of 1.14:1. The proportions of patients surviving at 1, 2 and 3 years were 65.2% (95% CI: 58.8–70.9), 42.0% (95% CI:35.6–48.3) and 33.3% (95% CI:27.3–39.4) respectively. In multivariate analysis, factors associated with increased mortality included clinical stage II (aHR = 2.44, 95% CI: 1.10–5.41, p=0.028), stage III (aHR=2.65, 95% CI: 1.31–5.39, p=0.007) and stage IV (aHR=5.47, 95% CI: 2.40–12.48, p<0.001). Curative surgery alone (aHR=0.63, 95% CI: 0.39–1.01, p=0.057) and curative surgery with chemotherapy (aHR=0.53, 95% CI: 0.32–0.88, p=0.015) were associated with a better survival.

Conclusion

The survival rate among CRC patients in Uganda is low. Advanced stage CRC accelerates mortality, while surgery alone or in combination with chemotherapy improves survival. Implementation of national screening programmes for early diagnosis of CRC and increasing surgery and oncology infrastructure is recommended to improve the CRC survival rate in the Ugandan population.

The Prevalence of Coagulopathy and Associated Factors Among Adult Type II Diabetes Mellitus Patients Attending the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

INTRODUCTION

Diabetes mellitus is a heterogeneous disorder of metabolism which results hyperglycemic-related atherothrombotic complications. These complications are the leading cause of death in diabetes mellitus patients. Therefore, this study was aimed to determine the prevalence of coagulopathy and associated factors among adult type II diabetes mellitus patients attending at University of Gondar comprehensive specialized hospital.

METHODS

A facility-based cross-sectional study was conducted among 357 study participants. A questionnaire and a data collection sheet were used to collect the sociodemographic and clinical data, respectively. About 6mL of venous blood samples were collected for coagulation tests and complete blood count. For prolonged coagulation tests, a mixing test was performed. Data were entered into EpiInfo and exported to SPSS for statistical analysis. Then, descriptive statistics were done. A binary and multivariable logistic regression model was used to identify the associated factors. P-value <0.05 was considered as statistically significant.

RESULTS

In this study, 357 study participants were included. Of them, 52.1% (186) and 80.7% (288) were females and urban residences, respectively. The prevalence of coagulopathy was 26.6% (95% CI: 22.1, 31.5%). Out of this, 12.3% and 8.7% showed shortened PT and aPTT, respectively. In addition, the prevalence of prolonged PT and aPTT were 5.6% and 3.9%, respectively. From the prolonged PT and aPTT, the prevalence of factor deficiency was 95% and 92.8%, respectively. Being female (AOR = 2.06; 95% CI: 1.11-3.85%), abnormal BMI (AOR = 1.94; 95% CI: 1.08-3.50), and educational status of high school (AOR = 0.26; 95% CI: 0.10-0.83%) were significantly associated with hypercoagulation.

CONCLUSION

Coagulopathy is an important public health problem among type II diabetes mellitus patients. Being female and having abnormal BMI were associated with hypercoagulation. Therefore, regular monitoring of coagulation parameters is vital to reduce the consequence of coagulopathy.

Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital

PURPOSE

The purpose of the study was to develop and implement an institution-specific trigger tool based on the Institute for Healthcare Improvement medication module trigger tool (IHI MMTT) in order to detect and monitor ADEs.

METHODS

We performed an investigator-driven, single-center study using retrospective and prospective patient data to develop ("development phase") and implement ("implementation phase") an efficient, institution-specific trigger tool based on the IHI MMTT. Complete medical data from 1008 patients hospitalized in 2018 were used in the development phase. ADEs were identified by chart review. The performance of two versions of the tool was assessed by comparing their sensitivities and specificities. Tool A employed only digitally extracted triggers ("e-trigger-tool") while Tool B employed an additional manually extracted trigger. The superior tool - taking efficiency into account - was applied prospectively to 19-22 randomly chosen charts per month for 26 months during the implementation phase.

RESULTS

In the development phase, 189 (19%) patients had ≥1 ADE (total 277 ADEs). The time needed to identify these ADEs was 15 minutes/chart. A total of 203 patients had ≥1 trigger (total 273 triggers - Tool B). The sensitivities and specificities of Tools A and B were 0.41 and 0.86, and 0.43 and 0.86, respectively. Tool A was more time-efficient than Tool B (4 vs 9 minutes/chart) and was therefore used in the implementation phase. During the 26-month implementation phase, 22 patients experienced trigger-identified ADEs and 529 did not. The median number of ADEs per 1000 patient days was 6 (range 0-13). Patients with at least one ADE had a mean hospital stay of 22.3 ± 19.7 days, compared to 8.0 ± 7.6 days for those without an ADE (p = 2.7×10-14).

CONCLUSION

We developed and implemented an e-trigger tool that was specific and moderately sensitive, gave consistent results and required minimal resources.

Factors Associated with Primary Postpartum Hemorrhage in Elderly Women Undergoing Repeated Cesarean Deliveries

Purpose

The aim of this study was to analyze the risk factors for primary postpartum hemorrhage in elderly parturients undergoing repeated cesarean delivery (PHEPWRCD).

Participants and Methods

The clinical data of 1675 elderly parturients who underwent repeated cesarean delivery in our hospital from May 2011 to March 2020 were retrospectively collected for analysis. The women were divided into a postpartum hemorrhage group (116 individuals) and a nonpostpartum hemorrhage group (1559 individuals). We analyzed the association of maternal age, maternal history, pregnancy complications, placenta and other factors with postpartum hemorrhage in elderly women who underwent repeated cesarean delivery and screened out independent risk factors by multivariate logistic regression analysis.

Results

The incidence rate of PHEPWRCD was 6.92% (116/1675). Using single-factor analysis of variance, we found that maternal age (p=0.012), the number of pregnancies (p=0.007), the number of cesarean deliveries (p<0.001), fetal position (p<0.001), fetal macrosomiaren (p<0.001), placental attachment position (p<0.001), placenta previa (p<0.001), and placental implantation (p<0.001) were significantly associated with PHEPWRCD. Multivariate logistic regression analysis showed that the number of cesarean deliveries (OR=2.457, 95% CI=1.453–4.540, P=0.013), placenta previa (OR=11.741, 95% CI=5.874–26.078, P<0.001), placenta implantation (OR=6.844, 95% CI=3.514–14.873, P<0.001), placental attachment position (OR=2.421, 95% CI=1.275–3.917, P=0.009) and fetal position (OR=5.722, 95% CI=3.817–16.577, P<0.001) were independent risk factors for PHEPWRCD.

Conclusion

This study found that the number of cesarean deliveries, placental attachment, placental previa, and placental implantation are independent risk factors for PHEPWRCD.

Cost-effectiveness of Tamoxifen, Aromatase Inhibitor, and Switch Therapy (Adjuvant Endocrine Therapy) for Breast Cancer in Hormone Receptor Positive Postmenopausal Women in India

Background

Breast cancer is the leading cause of cancer among women in India. Treatment with hormone therapy reduces recurrence. We undertook this cost-effectiveness study to ascertain the treatment option offering the best value for money.

Methods

The lifetime costs and health outcomes of using tamoxifen, AI and switch therapy were measured in a cohort of 50-year-old women with HR-positive early stage breast cancer. A Markov model of disease was developed using a societal perspective with a lifetime study horizon. Local, contralateral, and distant recurrence were modelled along with treatment related adverse effects. Primary data collected to obtain estimates of out-of-pocket expenditure (OOPE) and utility weights. Both health system cost and OOPE were included. The future costs and consequences were discounted at 3%. A probabilistic sensitivity analysis was used.

Results

The lifetime cost of hormone therapy with tamoxifen, AI and switch therapy was to be ₹1,472,037 (I$ 68,947), ₹1,306,794 (I$ 61,208) and ₹1,281,811 (I$ 60,038). The QALYs lived per patient receiving tamoxifen, AI and switch were 13.12, 13.42 and 13.32. tamoxifen was found to be more expensive and less effective. As compared to switch therapy, AI for five years incurred an incremental cost of ₹259,792 (I$12,168) per QALY gained. At the willingness to pay equals to per capita GDP of India, there is 55% probability of AI therapy to be cost-effective compared to switch therapy.

Conclusion

In postmenopausal women with HR-positive early-stage breast cancer, switch therapy is recommended for use on the basis of cost-effectiveness.

A broad comparative genomics approach to understanding the pathogenicity of Complex I mutations

Disease caused by mutations of mitochondrial DNA (mtDNA) are highly variable in both presentation and penetrance. Over the last 30 years, clinical recognition of this group of diseases has increased. It has been suggested that haplogroup background could influence the penetrance and presentation of disease-causing mutations; however, to date there is only one well-established example of such an effect: the increased penetrance of two Complex I Leber's hereditary optic neuropathy mutations on a haplogroup J background. This paper conducts the most extensive investigation to date into the importance of haplogroup context in the pathogenicity of mtDNA mutations in Complex I. We searched for proven human point mutations across more than 900 metazoans finding human disease-causing mutations and potential masking variants. We found more than a half of human pathogenic variants as compensated pathogenic deviations (CPD) in at least in one animal species from our multiple sequence alignments. Some variants were found in many species, and some were even the most prevalent amino acids across our dataset. Variants were also found in other primates, and in such cases, we looked for non-human amino acids in sites with high probability to interact with the CPD in folded protein. Using this "local interactions" approach allowed us to find potential masking substitutions in other amino acid sites. We suggest that the masking variants might arise in humans, resulting in variability of mutation effect in our species.

Factors Associated with Pre- and Post-Educational Intervention Knowledge Levels of HPV and Cervical Cancer Among the Male and Female University Students, Northwest Ethiopia

BACKGROUND

Human papillomavirus (HPV) infections are sexually transmitted and most frequently associated with cervical cancer in women, but they are also a public health concern in men. There is rising evidence that HPV's role in other cancers, such as anal, vulva, vaginal, penis, head, and neck cancers. The present study aimed to understand the factors associated with HPV and cervical cancer knowledge levels of university students before and after an educational intervention.

METHODS

An Institutional-based cross-sectional study was conducted from October to November 2018. A total of 638 study participants were selected using a simple random multistage sampling technique. A pretested questionnaire was used, consolidated the data, and analyzed with SPSS version 23. Bivariate and multivariate logistic regression analyses were performed to identify which variables were associated with the knowledge levels.

RESULTS

Six hundred thirty-eight study participants with a 100% response rate, and the mean age was 21.07 years (±SD, 1.96). Initial awareness of various broad categories was 4.09, and after the intervention, it increased to 23.4, with an average increase of 19.31 at 99% CI, p≤0.001 significance level. Before the educational intervention, students with <21 years of age [6.16, 95% CI: (2.21-17.18)] and ≤2.5 CGPA [3.44, 95% CI: (1.51-7.81)] were less knowledgeable over other counterparts. After educational intervention, the year of study was significantly associated with increased knowledge of overall and different broad categories of cervical cancer and HPV. Year of study, 1st-year students [AOR: 0.27, 95% CI: (0.14-0.51)] over third years and above are less knowledgeable. First-year students and CGPA ≤2.5 were less improved awareness over others.

CONCLUSION

The educational intervention improved more than fourfold increase knowledge on cervical cancer and HPV, and the year of study was a key factor associated with overall improvement. This study suggests that educational intervention effectively strengthens our understanding of the spread of HPV and cervical cancer disease burden.

Coagulopathy in SARS-CoV-2 Infected Patients: Implication for the Management of COVID-19

COVID-19 disease has led to an extraordinary inclusive health crisis globally. Elevation of D-dimer is the major remarkable abnormal coagulation test in seriously ill COVID-19 patients. In nearly 50% of COVID-19 patients, the value of D-dimer was significantly enhancing. Recent literature indicated that COVID-19 patients were at higher risk of developing disseminated intravascular coagulation. Pro-inflammatory cytokines and chemokines are some of the factors leading to these conditions. The majority of COVID-19 patients showed a higher profile of pro-inflammatory cytokines and chemokines in severe clinical conditions. Tumor necrosis factor-α (TNF-α) and interleukins (ILs) elevated in COVID-19 infected patients. TNF-α, IL-6, and IL-1 are major cytokines vital for the inhibition of intrinsic anticoagulant pathways. COVID-19 becomes a higher complication with a significant effect on blood cell production and hemostasis cascades. Deep vein thrombosis and arterial thrombosis are common complications. Changes in hematological parameters are also frequently observed in COVID-19 patients. Especially, thrombocytopenia is an indicator for poor prognosis of the disease and is highly expected and aggravates the likelihood of death of SARS-CoV-2 infected individuals. Thrombopoiesis reduction in COVID-19 patients might be due to viral abuse of the bone marrow/the viral load may affect thrombopoietin production and function. In other ways, immune-inflammation-mediated destruction and increased consumption of platelets are also the possible proposed mechanisms for thrombocytopenia. Therefore, the counting of platelet cells is an easily accessible biomarker for disease monitoring. All SARS-CoV-2 infected patients should be admitted and identifying potential higher-risk patients. It is also obligatory to provide appropriate treatments with intensive care and strict follow-up. In addition, considerations of chronic diseases are essential for better prognosis and recovery. The current review discusses coagulopathy among SARS-CoV-2 infected individuals and its complication for the management of the disease.

Effect of Peer-Assisted Learning on Enhancing Clinical Research Skills Among Medical Students: Students' and Tutors' Perceptions

PURPOSE

Research methodology is an essential part of evidence-based medicine. Many educational programs include clinical research methodology within their curriculum. Moreover, students' preferences for learning methods are different than before, as they now prefer alternative methods, such as peer teaching. Peer-assisted learning enhances students' tutoring skills. Thus, the current study aimed to evaluate the effect of peer teaching on enhancing clinical research skills.

PARTICIPANTS AND METHODS

Peer-assisted learning was evaluated during a four-week online research methodology course designed for medical students at King Abdulaziz University. A total of 121 students' and 38 tutors' attitudes and perceptions of peer teaching were evaluated using a self-administered questionnaire. The effectiveness of peer teaching was assessed using pre- and post-course knowledge tests. Chi-square was used to assess the association of qualitative data, and Mann-Whitney U-test and Wilcoxon rank test were used as nonparametric tests for the variables that were not normally distributed.

RESULTS

The post-course knowledge score was significantly higher than the pre-test score. Students had a positive perception of peer-assisted learning. Over 90% of the students preferred peer-assisted learning to traditional teaching. Similarly, the tutors had significantly positive perceptions of peer-assisted teaching. Younger students who had higher post-test mean knowledge scores had a good perception of peer teaching.

CONCLUSION

The current study demonstrates students' and tutors' positive perceptions of peer-assisted learning as well as the effectiveness of peer learning. Medical schools should pay more attention to students and prepare them for peer-teacher roles.

Factors Influencing Response to Aflibercept in Diabetic Macular Oedema Patients in a Diverse North West London Population: A Real-World Study

BACKGROUND

Diabetic macular oedema (DMO) is the leading cause of sight impairment in working age populations in developed countries. Current first line treatment for centre-involving DMO involves intravitreal anti-VEGF but treatment response can be variable. In this retrospective, real world, multi-centre cohort study, we aim to identify ocular and systemic characteristics that correlate with anatomical and functional outcomes for treatment-naive DMO patients treated with intravitreal aflibercept.

METHODS

Retrospective multicentre cohort study of treatment-naive DMO patients initiated on aflibercept at three North West London hospitals between 2016 and 2018. Baseline systemic and ocular factors, best corrected visual acuity (BCVA) and central macular thickness (CMT) at 12 months were determined and statistically analysed.

RESULTS

A total of 270 eyes of 221 DMO patients met inclusion criteria. Mean age was 62.8 ± 12.1, mean baseline HbA1c was 67 ± 20 mmol/mol, and mean eGFR was 72 mL/min/1.7m2. Mean number of aflibercept injections at 12 months was 6.2. Better baseline BCVA, lower baseline CMT, and absence of epiretinal membrane (ERM) were associated with better BCVA at 12 months whilst lower baseline CMT and proliferative retinopathy status were associated with lower CMT at 12 months.

CONCLUSION

Our study is the largest real-world dataset examining factors influencing functional and anatomical response to aflibercept in DMO in the UK. Older age, lower baseline BCVA, higher baseline CMT and more severe diabetic retinopathy were associated with poorer visual acuity at 12 months and prioritisation of these patients within a pressured healthcare setting is recommended.

Trend Analysis and Forecasting the Spread of COVID-19 Pandemic in Ethiopia Using Box-Jenkins Modeling Procedure

INTRODUCTION

COVID-19, which causes severe acute respiratory syndrome, is spreading rapidly across the world, and the severity of this pandemic is rising in Ethiopia. The main objective of the study was to analyze the trend and forecast the spread of COVID-19 and to develop an appropriate statistical forecast model.

METHODOLOGY

Data on the daily spread between 13 March, 2020 and 31 August 2020 were collected for the development of the autoregressive integrated moving average (ARIMA) model. Stationarity testing, parameter testing and model diagnosis were performed. In addition, candidate models were obtained using autocorrelation function (ACF) and partial autocorrelation functions (PACF). Finally, the fitting, selection and prediction accuracy of the ARIMA models was evaluated using the RMSE and MAPE model selection criteria.

RESULTS

A total of 51,910 confirmed COVID-19 cases were reported from 13 March to 31 August 2020. The total recovered and death rates as of 31 August 2020 were 37.2% and 1.57%, respectively, with a high level of increase after the mid of August, 2020. In this study, ARIMA (0, 1, 5) and ARIMA (2, 1, 3) were finally confirmed as the optimal model for confirmed and recovered COVID-19 cases, respectively, based on lowest RMSE, MAPE and BIC values. The ARIMA model was also used to identify the COVID-19 trend and showed an increasing pattern on a daily basis in the number of confirmed and recovered cases. In addition, the 60-day forecast showed a steep upward trend in confirmed cases and recovered cases of COVID-19 in Ethiopia.

CONCLUSION

Forecasts show that confirmed and recovered COVID-19 cases in Ethiopia will increase on a daily basis for the next 60 days. The findings can be used as a decision-making tool to implement health interventions and reduce the spread of COVID-19 infection.

Patterns of Calcium- and Chloride-Ion Disorders and Predictors among Obese Outpatient Adults in Southern Ethiopia

BACKGROUND

Obesity is a condition characterized by abnormal or excess accumulation of fat in body tissue, which may impair health and result in electrolyte derangement. Hypercalcemia and hypochloremia are significant problems in obese patients, and can cause substantial morbidity and mortality. Determination of patterns of calcium and chloride may play a major role in the management of obese patients. Therefore, this study aimed to determine calcium and chloride disorders and their predictors among obese adults in the outpatient department at Wolkite University Specialized Hospital, southern Ethiopia from May to August 2020.

METHODS

This institution-based cross-sectional study was conducted on 250 obese adults attending the outpatient department from May to August 2020. Structured questionnaires through face-to-face interviews and participants' medical records were used to collect information on determinants related to calcium- and chloride-ion disturbances. Levels of serum calcium and chloride were measured using an ion-selective electrode analyzer. Bivariate and multivariate logistic regression analyses were done to identify determinants associated with calcium and chloride disorders. Using ORs and 95% CIs,P<0.05 was considered significant.

RESULTS

Among the 250 patients, 18% (95% CI 53.02-111) and 17.6% (95% CI 0.78-12) of study participants were hypochloremic and hypercalcemic, respectively. Age ≥50 years (AOR 3.58, 95% CI 2.57-11.10), diuretic use (AOR 2.35, 95% CI 1.31-4.23), and obesity (AOR, 6.82, 95% CI 2.26-14.62) were independent predictors of hypochloremia on multivariate logistic regression, and obesity (AOR 9.21, 95% CI 2.50-14.81), overweight (AOR 8.32, 95% CI 1.61-10.20) and physical inactivity (AOR 4.28, 95% CI 1.71-10.44) were predictors of hypercalcemia.

CONCLUSION

High burdens of hypochloremia (18%) and hypercalcemia (17.6%) were observed in these patients. Increased age, diuretic use, being overweight, and physical inactivity were predictors of electrolyte disorders. The findings of this study should be taken into consideration to implement preventive interventions on these predictors in obese patients. Promoting sufficient fruit and vegetable consumption and physical exercise and determination of serum-chloride and -calcium levels in adult overweight/obese patients are recommended to minimize the emergence of electrolyte disorders.

Gram-Negative Bacteria Isolates and Their Antibiotic-Resistance Patterns in Patients with Wound Infection in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia.

METHODS

Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses.

RESULTS

The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52-65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14-20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9-14%], Klebsiella pneumonia, 11% [95% CI: 9-13%], Proteus mirabilis, 8% [95% CI: 6-10%], Acinetobacter species, 4% [95% CI: 2-6%], Enterobacter species, 4% [95% CI: 3-5%], and Citrobacter species, 3% [95% CI: 2-4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66-86%], 84% [95% CI: 78-91%], 66% [95% CI:43-88%], 83% [95% CI:75-91%], 87% [95% CI:78-96%], 68% [95% CI:50-87%] and 71% [95% CI:46-96%], respectively.

CONCLUSION

There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.

Transition Patterns of Weight Status and Their Predictive Lipid Markers Among Chinese Adults: A Longitudinal Cohort Study Using the Multistate Markov Model

BACKGROUND

Obesity is well recognized as a risk factor for cardiometabolic diseases. The development of obesity is a dynamic process that can be described as a multistate process with an emphasis on transitions between weight states. However, it is still unclear what convenient biomarkers predict transitions between weight states. The aim of this study was to show the dynamic nature of weight status in adults stratified by age and sex and to explore blood markers of metabolic syndrome (MetS) that predict transitions between weight states.

METHODS

This study involved 9795 individuals aged 18 to 56 at study entry who underwent at least two health check-ups in the eight-year period of study in the health check-up centre of our institution. Weight, height and biochemical indices were measured at each check-up. The participants were divided into four groups based on age and sex (young male, middle-aged male, young female and middle-aged female groups). A multistate Markov model containing 3 states (healthy weight, overweight and obesity) was adopted to study the longitudinal weight data.

RESULTS

Young people were more likely to transit between weight states than middle-aged people, and middle-aged people were more resistant to recover from worse states. The mean sojourn time in obesity was greatest in the middle-aged male group (6.23 years), and the predicted rate of obesity beginning with healthy weight was greatest in the young male group (13.7%). In multivariate models, age group and triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels were significant for specific transitions in females, whereas age group and HDL levels were significant in males. In females, if HDL levels increased 1 mmol/L, the probability of progression from healthy weight to overweight decreased by 37.0% (HR= 0.63), and the probabilities of recovery (overweight to healthy weight and obesity to overweight) increased by 62.0% (HR= 1.62) and 1.23-fold (HR= 2.23), respectively. In males, if TG levels increased 1 mmol/L, the risk of progression from healthy weight to overweight increased by 24.0% (HR= 1.24). Each unit increase in HDL levels was associated with a 0.99-fold (HR= 1.99) increase in the chance of recovery from overweight to healthy weight and with a 0.37-fold (HR= 0.63) decrease in the risk of progression from healthy weight to overweight.

CONCLUSION

The weight status of young people was less stable than that of middle-aged people. Males were more likely to become overweight and more resistant to recover from worse states than females. Young males with healthy weight were more likely to develop obesity than other healthy weight groups. Blood lipid levels, especially HDL, were predictors of weight transitions in adults. Prevention and intervention measures should be applied early.

Artificial Flora Algorithm-Based Feature Selection with Gradient Boosted Tree Model for Diabetes Classification

PURPOSE

Classification of medical data is essential to determine diabetic treatment options; therefore, the objective of the study was to develop a model to classify the three diabetes type diagnoses according to multiple patient attributes.

METHODS

Three different datasets are used to develop a novel medical data classification model. The proposed model involved preprocessing, artificial flora algorithm (AFA)-based feature selection, and gradient boosted tree (GBT)-based classification. Then, the processing occurred in two steps, namely, format conversion and data transformation. AFA was applied for selecting features, such as demographics, vital signs, laboratory tests, medications, from the patients' electronic health records. Lastly, the GBT-based classification model was applied for classifying the patients' cases to type I, type II, or gestational diabetes mellitus.

RESULTS

The effectiveness of the proposed AFA-GBT model was validated using three diabetes datasets to classify patient cases into one of the three different types of diabetes. The proposed model showed a maximum average precision of 91.64%, a recall of 97.46%, an accuracy of 99.93%, an F-score of 94.19%, and a kappa of 96.61%.

CONCLUSION

The AFA-GBT model could classify patient diagnoses into the three diabetes types efficiently.

Chemotherapy-Related Adverse Drug Reaction and Associated Factors Among Hospitalized Paediatric Cancer Patients at Hospitals in North-West Ethiopia

BACKGROUND

One of the prevalent treatment modalities for cancer is chemotherapy. Adverse drug reactions, however, are becoming the world's major public health problem. More than half (54.5 percent) of cancer patients need hospitalization for further management, in addition to the increased health-care costs of treatment. The aim of this study was to evaluate adverse drug reactions associated with chemotherapy and related factors in hospitalized paediatric cancer patients in Ethiopia's north-west hospitals.

METHODS

From July 1, 2017, to August 13, 2019, a cross-sectional study was carried out among 311 paediatric cancer patients at Gondar Comprehensive University, Specialized Hospital and Felegehiwot referral hospital. The data were entered into Epi Info version 7 and exported for further analysis to Statistical Product and Service Solutions (SPSS). To identify associated variables, both the bi-variate and multi-variate logistic regression analyses were computed. Variables with a P-value of less than 0.05 were considered statistically significant in the multivariate logistic regression analysis.

RESULTS

The overall adverse drug reaction in this study was 41.5 percent ((95% CI: 35.8-47.2%)). Patients who received concomitant medications were at higher risk of experiencing adverse drug reactions (AOR: 2.60 (95% CI: 1.54-4.40)), according to the multivariate logistic regression analysis. Similarly, there was a risk of developing adverse drug reactions in patients taking four or more chemotherapy agents (AOR: 2.67 (95% CI: 1.52-4.68)). In addition, regimens based on etoposide (AOR: 1.99 (95% CI: 0.93-4.27)), mercaptopurine (AOR: 3.91 (95% CI: 1.06-14.46)) and doxorubicin (AOR: 2.32 (95% CI: 1.30-4.15)) were at higher risk for adverse drug reactions in patients.

CONCLUSION

Adverse drug reactions developed in a significant proportion of the study patients (2 out of 5 patients). Therefore, for pediatric cancer patients on concomitant medications and for patients on etoposide, mercaptopurine and doxorubicin drug regimens, efficient prevention and management of adverse drug reactions should be sought.

Condom Utilization and Affecting Factors Among People Living with HIV/AIDS Attending ART Clinics in Addis Ababa, Ethiopia

BACKGROUND

Human immune deficiency virus or acquired immune deficiency syndrome (HIV/AIDS) has been a major public health problem globally as well as in Africa including Ethiopia. To prevent HIV effectively, condoms must be used regularly and consistently. When HIV positive individuals have sex without condom, they can easily transmit the vuirus to a seronegative partner. Condom utilization may be affected by various factors. Therefore, the findings from this study will give an opportunity to understand condom utilization and the barriers to condom use.

OBJECTIVE

To assess condom utilization and associated factors among people living with HIV/AIDS attending anti-retro viral treatment (ART) clinics in Addis Ababa, Ethiopia.

MATERIALS AND METHODS

An institution-based cross-sectional study was conducted among 677 people living with HIV/AIDS attending ART clinics in Addis Ababa from February 1, 2019 to March 30, 2019. The sampling technique was three-stage sampling and finally, the study participants were selected using a systematic random sampling technique. Data were coded, cleaned and entered in to EPIData version 3.4, and analyzed using SPSS version 23.0. The association between the dependent variable and independent variables was analyzed using binary logistic regression analysis at 5% level of significance.

RESULTS

About 677 HIV/AIDS patients receiving ART at health centers participated in the study. From the total participants, 306 (45.2%) utilized a condom in the last six months. Sex (adjusted odds ratio (AOR)=2.02; 95%CI=1.34-3.05), marital status (AOR=0.39; 95%CI=0.19-0.77 and (AOR=0.48; 95%CI=0.24-0.94), employment status (AOR=0.27; 95%CI=0.12-0.59), type of partner (AOR=0.15; 95%CI=0.05-0.48 and AOR=0.46; 95%CI=0.27-0.79), condom access (AOR=3.97; 95%CI=2.04-7.75), disclosure of HIV status (AOR=0.21; 95%CI=0.14-0.33) and attitude towards condoms (AOR=3.76; 95%CI=2.49-5.65) had significant association with condom utilization.

CONCLUSION

Condom utilization was found to be low among people living with HIV/AIDS attending ART clinics in Addis Ababa. This finding indicates that high concern shall be given to minimize the gap. Sex, marital status, employment status, disclosure of HIV status, condom access, type of partner and attitude towards condoms were significantly associated with condom utilization. Hence, continuous condom provision, promotion, demonstration, and awareness creation are vital.