RESUMEN

Chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) have a syndemic relationship with shared risk factors and complex interplay between genetic, environmental, socioeconomic, and pathophysiological mechanisms. CVD is among the most common comorbidities in patients with COPD and vice versa. Patients with COPD, irrespective of their disease severity, are at increased risk of CVD morbidity and mortality, driven in part by COPD exacerbations. Despite these known interrelationships, CVD is underestimated and undertreated in patients with COPD. Similarly, COPD is an independent risk-enhancing factor for adverse cardiovascular (CV) events, yet it is not incorporated into current CV risk assessment tools, leading to under-recognition and undertreatment. There is a pressing need for systems change in COPD management to move beyond symptom control towards a comprehensive cardiopulmonary disease paradigm with proactive prevention of exacerbations and adverse cardiopulmonary outcomes and mortality. However, there is a dearth of evidence defining optimal cardiopulmonary care pathways. Fortunately, there is a precedent to support systems-level change in the field of diabetes, which evolved from glycemic control to comprehensive multi-organ risk assessment and management. Key elements included integrated multidisciplinary care, intensive risk factor management, coordination between primary and specialist care, care pathways and protocols, education and self management, and disease-modifying therapies. This commentary article draws parallels between the cardiometabolic and cardiopulmonary paradigms and makes a case for systems change towards multidisciplinary, integrated cardiopulmonary care, using the evolution in diabetes care as a potential framework.

RESUMEN

The management of medulloblastoma, a pediatric brain tumor, has evolved significantly with the advent of genomic subgrouping, yet morbidity and mortality remain high in LMICs like Pakistan due to inadequate multidisciplinary care infrastructure. This paper aims to establish evidence-based guidelines tailored to the constraints of such countries. An expert panel comprising neuro-oncologists, neurosurgeons, radiologists, radiation oncologists, neuropathologists, and pediatricians collaborated to develop these guidelines, considering the specific challenges of pediatric brain tumor care in Pakistan. The recommendations cover various aspects of medulloblastoma treatment, including pre-surgical workup, neurosurgery, neuropathology, chemotherapy, radiation therapy, and supportive care. They offer both minimum required and additional optional protocols for more advanced centers, ensuring comprehensive patient management with attention to complications and complexities encountered in Pakistan. The paper's consensus guidelines strive for uniformity in healthcare delivery and address significant gaps in diagnosis, treatment, and follow-up of pediatric medulloblastoma patients.

Asunto(s)

RESUMEN

INTRODUCTION: Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR). METHODS: We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: "Optimal GC" (HbA1c < 7%), "Sub-optimal GC" (HbA1c 7-8.4%), and "Poor GC" (HbA1c ≥ 8.5%) and their outcomes were compared. RESULTS: 514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented. CONCLUSION: In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.

RESUMEN

Introduction Acute coronary syndrome (ACS) and acute pulmonary embolism (PE) are life-threatening conditions with similar clinical presentations. As current diagnostic tools, such as computed tomography pulmonary angiography, for distinguishing between these two conditions are time-consuming and may not be available in all settings, we tried in this study to devise a diagnostic tool based on electrocardiography to distinguish between ACS and acute PE based on T wave features. Methods Medical records of patients with diagnoses of ACS and acute PE, who were referred to three hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from March 2019 to March 2021, were evaluated. One expert cardiologist read patients' electrocardiograms (ECGs). All ECGs were recorded at the standard 25 mm/s and 10 mm/mV. The sum of T wave inversion or TWI (mV) in consecutive leads, including anterior leads (V1, V2, V3, and V4), inferior leads (II, III, aVF), and lateral leads (I, aVL, V5, and V6) were calculated to estimate the cut-off points used to differentiate ACS versus acute PE. The receiver operating characteristic (ROC) curve was used to estimate the diagnostic accuracy of T wave changes. The Youden index was used to calculate the optimum cut-offs for sensitivity and specificity. Results Of 151 patients with a mean age of 55.44±12.88 years, 74 were in the acute PE and 77 were in the ACS groups. The results showed that the TWI sum in anterior leads >1.2 mV (P<0.001), in lateral leads >0.9 mV (P<0.001), in anterior-to-inferior leads ratio >12 (P<0.001), and V4/V1 leads ratio >4 (P<0.001) rules out acute PE. Anterior-to-lateral TWI ratio (AUC=0.807, sensitivity=70.3%, specificity=10%) was significantly distinctive among ACS and acute PE patients. Conclusion TWI sum in anterior leads >1.2 mV, in lateral leads >0.9 mV, in anterior-to-inferior leads ratio >12, and in V4/V1 leads ratio >4 rules out acute PE. The anterior-to-lateral TWI ratio obtained from patients' ECG was significantly distinctive among the patients and can be used as a screening tool.

RESUMEN

Background: Prevention of diabetes in the general population can help reduce the incidence of tuberculosis. Hence it is necessary to document that diabetes is strongly associated with tuberculosis as a risk factor. Objective: To study if diabetes is associated with tuberculosis compared to controls. Materials and Methods: A community based case-control study was carried out. 215 newly diagnosed cases of tuberculosis on treatment for not more than three months were selected randomly from the randomly selected tuberculosis unit. 215 neighbourhood controls were selected. They were matched for the age group of ± 10 years and sex. Fasting blood sugar (FBS) was estimated using a glucometer. Results: Tobacco chewing, residence and family history of TB were significantly more in cases (P < 0.05). Mean BMI was significantly lower in cases compared to controls. The proportion of TB cases among the known cases of diabetes was 67% compared to 33% in controls, which was statistically significant. Mean FBS was significantly higher in cases compared to controls (P < 0.05). The odds of cases being diabetic was 2.456 times more than those of controls. On binary logistic regression, diabetes was an independent risk factor for tuberculosis. Other independent risk factors were tobacco chewing, and family history of TB. Conclusion: Family history of tuberculosis, and tobacco chewing were positively associated with tuberculosis whereas body mass index was negatively associated with tuberculosis. Diabetes was significantly associated with tuberculosis.

RESUMEN

Aging is a complex, multifactorial, and inevitable process, which begins before birth and continues throughout the life. Multimorbidity prevailing among the geriatric population is an important health challenge for most of the developing countries. To examine the effect of gender and increasing age on the survival of the geriatric population suffering from multimorbidity. A cross-sectional study was conducted among the geriatric population of the Jammu district, J and K, using multistage sampling procedure, and the analysis was conducted using the Kaplan-Meier method and survival analysis using software IBM SPSS version 24.0. Our study included 1150 study subjects, of whom 610 (53%) were males and 540 (47%) were females, respectively. It was indicated that the probability for the survival of the study population suffering from morbidity belonging to 60-64 years was higher than the survival of the geriatric population belonging to other age-groups or we can say that survival probability of the geriatric population suffering from morbidities decreases with the increase in age. Also, it was reported that probability for the survival of the female geriatric population suffering from morbidity was slightly higher than the survival of the male geriatric population. Gender had no significant effect on survival of the geriatric population suffering from morbidities, whereas baseline age had a significant effect on the survival of the geriatric population suffering from morbidities as their survival probability decreases with the increase in age.

RESUMEN

Background: Considering the concerns of obesity problems, Mumbai Police authorities had launched full-day residential "Healthy Living Training Program" in February 2019 for obese policemen. We studied the effectiveness of the program by assessing health profile of the participants, and change in anthropometric measurements and blood pressure readings. Methods and Materials: Permission from the concerned authorities and approval from the Institutional Ethics Committee (IEC) were taken. Health profiles of 143 policemen were assessed. Anthropometric measurements and blood pressure recordings were done on the first and the last day of the 28-day program. The data were coded and entered in password-protected Microsoft Excel. Paired t-test was applied to test statistically significant differences. The association of some of the variables with weight change was assessed by the Chi-square test for categorical variables. Results: The mean age of participants was 49.6 ± 5 years. The proportion of hypertensive, diabetics, vision problems, and bone and joint problems were 48.2%, 23.2%, 57.1%, and 46.4%, respectively. Only 70% of them had home-cooked food in the lunch. Daily, 50% of the participants do physical activity. There was statistically significant weight reduction (105.6 ± 12.1s vs. 103.3 ± 12 kg), body mass index (BMI) (36.3 ± 3.4 vs. 35.5 ± 3.3), waist circumference (110.8 ± 7.9 vs. 109.5 ± 7.9), and hip circumference (115.6 ± 8.1 vs. 106.8 ± 15.0) of the participants after 28 days of training program. Conclusion: "Healthy Living Training Program" was effective in reducing weight, blood pressure, BMI, and waist and hip circumference. The program benefitted the participants by inculcating healthy lifestyles and raising awareness of health issues.

RESUMEN

PURPOSE: Cytoreductive Surgery (CRS) ± Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is associated with a high incidence of postoperative morbidity. Our aim was to identify independent, potentially actionable perioperative predictors of major complications. METHODS: We reviewed patients who underwent CRS ± HIPEC from June 2020 to January 2022 at a high-volume center. Postoperative complications were categorized using the Comprehensive Complication Index, with the upper quartile defining major complications. Multivariate logistic analysis identified predictive and protective factors. RESULTS: Of 168 patients, 119 (70.8%) underwent HIPEC. Mean Comprehensive Complication Index was 12.6 (12.7) and upper quartile cut-off was 22.6. Medical complications were more frequent but less severe than surgical (63% vs 18%). Forty-six patients (27.4%) comprised the "major complications" group (mean CCI 30.1 vs 6.3). Multivariate logistic regression showed that heart disease (RR 1.9; 95% CI: 1.1 to 3.3), number of anastomoses (RR 2.4; 95% CI:1.3 to 4.6) and first 24-h fluid balance (RR 1.1; 95% CI: 1.1 to 1.2), were independently associated as risk factors for major complications, while opioid-free anesthesia (RR 0.6; 95% CI: 0.3 to 0.9) and high preoperative hemoglobin (RR 0.9; CI 95%: 0.9 to 0.9) were independent-protective factors. CONCLUSION: Preoperative heart diseases, number of anastomoses and first 24 h-fluid balance are independent risk factors for major postoperative complications, while high preoperative hemoglobin and opioid-free anesthesia are protective. Correction of anemia prior to surgery, avoiding positive fluid balance and incorporation of opioid-free anesthesia strategy are potential actionable measures to reduce postoperative morbidity.

RESUMEN

Background: Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependence in patients. Peer comparison has been demonstrated to impact providers' prescribing habits, though its effect on opioid prescribing has predominantly been studied in the emergency department setting. Objective: The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture of its implementation, and plans for future research on its effects. Methods: Using data generated by the author's enterprise vendor-based electronic health record, the enterprise analytics software, and expertise from a dedicated group of informaticists, physicians, and analysts, the authors developed an opioid scorecard that was released on a quarterly basis via email to all opioid prescribers at our institution. These scorecards compare providers' opioid prescribing habits on the basis of established metrics to those of their peers within their specialty throughout the enterprise. Results: At the time of this study's completion, 2034 providers have received at least 1 scorecard over a 5-quarter period ending in September 2021. Poisson regression demonstrated a 1.6% quarterly reduction in opioid prescribing, and chi-square analysis demonstrated pre-post reductions in the proportion of prescriptions longer than 5 days' duration and a morphine equivalent daily dose of >50. Conclusions: To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scale published in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hope to influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examining the effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing the progression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality.

Asunto(s)

RESUMEN

PURPOSE: This study explores the association of the American Society of Anesthesiologists (ASA) score with 90-day mortality in complicated mild traumatic brain injury (mTBI) patients, and in trauma patients without a TBI. METHODS: This retrospective study was conducted using a cohort of trauma patients treated at a level III trauma center in Stockholm, Sweden from January to December 2019. The primary endpoint was 90-day mortality. The population was identified using the Swedish Trauma registry. The Trauma and Injury Severity Score (TRISS) was used to estimate the likelihood of survival. Trauma patients without TBI (NTBI) were used for comparison. Data analysis was conducted using R software, and statistical analysis included univariate and multivariate logistic regression. RESULTS: A total of 244 TBI patients and 579 NTBI patients were included, with a 90-day mortality of 8.2% (n = 20) and 5.4% (n = 21), respectively. Deceased patients in both cohorts were generally older, with greater comorbidities and higher injury severity. Complicated mTBI constituted 97.5% of the TBI group. Age and an ASA score of 3 or higher were independently associated with increased mortality risk in the TBI group, with odds ratios of 1.04 (95% 1.00-1.09) and 3.44 (95% CI 1.10-13.41), respectively. Among NTBI patients, only age remained a significant mortality predictor. TRISS demonstrated limited predictive utility across both cohorts, yet a significant discrepancy was observed between the outcome groups within the NTBI cohort. CONCLUSION: This retrospective cohort study highlights a significant association between ASA score and 90-day mortality in elderly patients with complicated mTBI, something that could not be observed in comparative NTBI cohort. These findings suggest the benefit of incorporating ASA score into prognostic models to enhance the accuracy of outcome prediction models in these populations, though further research is warranted.

Asunto(s)

RESUMEN

BACKGROUND: Despite multiple calls for more inclusive studies, most clinical trial eligibility criteria remain too restrictive. Thrombectomy trials have been no exception. METHODS: We review the landmark trials that have shown the benefits of thrombectomy, their eligibility criteria, and consequences on clinical practice. We discuss the rationale behind various reasons for exclusions. We also examine the logical problem involved in using eligibility criteria as indications for treatment. RESULTS: Most thrombectomy trials have been too restrictive. This has been shown by a plethora of follow-up studies that have refuted most of the previously recommended trial eligibility restrictions. Meanwhile, the effect of clinical recommendations based on restrictive eligibility criteria is that treatment has been denied to the majority of patients who could have benefitted. Trial eligibility criteria cannot be used to make clinical decisions or recommendations unless, like any other medical diagnosis, they have been shown capable of reliably differentiating patients into those that will, and those that will not benefit from treatment. This goal can only be achieved with all-inclusive pragmatic trials. CONCLUSION: Restrictive eligibility criteria render clinical trials incapable of guiding medical decisions or recommendations.

RESUMEN

INTRODUCTION: Over the years, feasibility & safety of EEAs has become well established & the focus has now shifted to minimising the nasal morbidity. To this end, several modifications in nasal stage have been described that have focussed primarily on preservation of nasal mucosa on right side of nasal cavity (NC). However, the issue of nasal mucosal preservation on left side of NC has largely been ignored. In this paper, the author describes a modified technique that can eliminate mucosal damage in left NC. METHOD: In modified technique, trans-septal approach is utilised on left & endonasal on right side. A hemitransfixion incision is used to raise left submucosal tunnel. The mucosa of tunnel lies laterally in apposition with lateral nasal wall, thereby protecting it from injury by repeated passage of instruments. When tunnel mucosa is pushed back medially, left NC appears absolutely normal without any evidence of mucosal damage. RESULTS: Combined endonasal & trans-septal technique for nasal stage was performed in 51 patients with sellar/suprasellar lesions. Nonfunctional pituitary adenomas were the most common pathology (macroadenomas-n=14; Giant adenomas-n=10) followed by functional adenomas (acromegaly-n=10; prolactinomas- n=3; Cushings's disease- n=1), craniopharyngiomas (n=6), clival tumours (n=5), & tuberculum sella meningiomas (n=2). CONCLUSIONS: A combination of endonasal and trans-septal approaches utilises the advantages of both endoscopic & microscopic approaches sans the disadvantage of restricted space seen in microscopic approaches. It makes binostril approach least disruptive to left nasal mucosa & thus can reduce overall morbidity of EEAs.

RESUMEN

PURPOSE: To provide risk estimations for vaginal morbidity with regard to vaginal dilation (summarizing the use of dilators and/or sexual activity) in locally advanced cervical cancer patients (LACC) treated with definitive radiochemotherapy and image-guided adaptive brachytherapy (IGABT) within the prospective, multi-institutional EMBRACE-I study. MATERIAL/METHODS: Physician-assessed vaginal morbidity (CTCAEv3.0), use of vaginal dilators and patient-reported sexual activity (EORTC-CX24) were prospectively assessed at baseline and during regular follow-up. Frequency analysis for vaginal dilation was performed in a sub-cohort of patients with ≥3 follow-ups. Regular dilation was defined if reported in ≥50% of follow-ups, no/infrequent dilation if reported in <50%. Actuarial estimates were calculated with Kaplan-Meier method; comparisons evaluated with the log-rank test. Univariate and multivariable Cox proportional hazard regression were used to evaluate risk factors for vaginal stenosis G≥2. RESULTS: The EMBRACE-I study included a total of 1416 patients (2008-2015); 882 were evaluated in the present report with a median follow-up of 60 months. Of those, 565 (64%) reported regular dilation. This was associated with a significantly lower 5-year risk of vaginal stenosis G≥2 compared to no/infrequent dilation (23% vs. 37%, p≤0.001). This univariate finding was confirmed by multivariable analysis, after adjusting for other risk factors (HR=0.630, p=0.001). Regular vaginal dilation was also associated with a significantly higher risk for vaginal dryness G≥1 (72% vs. 67%, p=0.028) and bleeding G≥1 (61% vs. 34%, p≤0.001). CONCLUSION: Vaginal stenosis represents irreversible fibrotic changes that can cause pain during gynecological examination and dyspareunia in LACC survivors. Regular vaginal dilation (defined as the use of dilators and/or sexual activity) is associated with a significantly lower risk for G≥2 vaginal stenosis, suggesting a potential improvement of vaginal patency. It is also associated with a significantly higher risk for mild G≥1 dryness and bleeding (no higher risk for G≥2), which both can be clinically managed.

RESUMEN

In this paper, we have provided more insights on the relationship between under five morbidity in Nigeria and some background characteristics using a Poisson regression model and the most recent 2018 NDHS data on Acute Respiratory Infection (ARI), diarrhoea and fever. Some of our results are that children 36-47 months old have the highest risk of ARI [OR = 1.45; CI (1.31,1.60)] while children less than 6 months old have the lowest risk of ARI [OR = 0.14; CI (0.11,0.17)]. The prevalence of diarrhoea is generally high among children under 48-59 months old but highest among children 6-11 months old [OR = 4.34; CI (3.69,5.09)]. Compared to children 48-59 months old, children in all other age categories except 24-34 months old have a high risk of fever [OR = 0.95; CI (0.73,1.24)]. ARI is more prevalent among female children [OR = 8.88; CI (8.02,9.82)] while diarrhoea [OR = 21.75; (19.10,24.76)] and fever [OR = 4.78; CI (4.31,5.32)] are more prevalent among male children. Children in urban areas are more likely to suffer ARI [OR = 9.49; CI (8.31,10.85)] while children in rural areas are more likely to suffer both diarrhoea [OR = 21.75; CI (19.10,24.76)] and fever [OR = 4.90; CI (4.26,5.63)]. Children in the South-South have the highest risk of ARI [OR = 4.03; CI (3.65,4.454)] while children in the North Central have the lowest risk of ARI [OR = 1.55; CI (1.38,1.74)] and highest risk of diarrhoea [OR = 3.34; CI (2.30,5.11)]. Children in the Northeast have the highest risk of fever [OR = 1.30; CI (1.14,1.48)]. In the Northcentral region, Kogi state has the highest prevalence of fever [OR = 2.27; CI (1.62,3.17)], while Benue state has the lowest [OR = 0.35; CI (0.20,0.60)]. Children in Abuja state face similar risks of fever and diarrhoea [OR = 0.84; CI (0.55,1.27)], with the risk of diarrhoea in Abuja being comparable to that in Plateau state [OR = 1.57; CI (0.92,2.70)]. Nasarawa state records the highest incidence of diarrhoea in the Northcentral [OR = 5.12; CI (3.03,8.65)], whereas Kogi state reports the lowest [OR = 0.29; CI (0.16,0.53)]. In the Northeast, Borno state has the highest rate of fever [OR = 3.28; CI (2.80,3.84)], and Bauchi state the lowest [OR = 0.38; CI (0.29,0.50)]. In Adamawa state, the risks of fever and diarrhoea are nearly equivalent [OR = 1.17; CI (0.97,1.41)], and the risk of fever there is similar to that in Taraba state [OR = 0.92; CI (0.75,1.12)]. Diarrhoea is most prevalent in Yobe state [OR = 3.17; CI (2.37,4.23)] and least prevalent in Borno state [OR = 0.26; CI (0.20,0.33)]. In the Northwest, the risk of fever is similarly high in Zamfara and Kebbi states [OR = 1.04; CI (0.93,1.17)], with Kastina state showing the lowest risk [OR = 0.39; CI (0.34,0.46)]. Children in Zamfara state experience notably different risks of fever and diarrhoea [OR = 0.07; CI (0.05,0.10)]. Kaduna state reports the highest incidence of diarrhoea [OR = 21.88; CI (15.54,30.82)], while Kano state has the lowest [OR = 2.50; CI (1.73,3.63)]. In the Southeast, Imo state leads in fever incidence [OR = 8.20; CI (5.61,11.98)], while Anambra state has the lowest [OR = 0.40; CI (0.21,0.78)]. In Abia state, the risk of fever is comparable to that in Enugu state [OR = 1.03; CI (0.63,1.71)], but the risks of fever and diarrhoea in Abia differ significantly [OR = 2.67; CI (1.75,4.06)]. Abia state also has the highest diarrhoea rate in the Southeast [OR = 2.67; CI (1.75,4.06)], with Ebonyi state having the lowest [OR = 0.05; CI (0.03,0.09)]. In the South-South region, Bayelsa and Edo states have similar risks of fever [OR = 1.28; CI (0.84,1.95)], with Akwa Ibom state reporting the highest fever rate [OR = 4.62; CI (3.27,6.52)] and Delta state the lowest [OR = 0.08; CI (0.02,0.25)]. Children in Bayelsa state face distinctly different risks of fever and diarrhoea [OR = 0.56; CI (0.34,0.95)]. Rivers state shows the highest incidence of diarrhoea in the South-South [OR = 10.50; CI (4.78,23.06)], while Akwa Ibom state has the lowest [OR = 0.30; CI (0.15,0.57)]. In the Southwest, Lagos and Osun states have similar risks of fever [OR = 1.00; CI (0.59,1.69)], with Ogun state experiencing the highest incidence [OR = 3.47; CI (2.28,5.28)] and Oyo state the lowest [OR = 0.18; CI (0.07,0.46)]. In Lagos state, the risks of fever and diarrhoea are comparable [OR = 0.96; CI (0.57,1.64)], and the risk of diarrhoea is similar to those in Ekiti, Ogun, and Ondo states. Oyo state has the highest diarrhoea rate in the Southwest [OR = 10.99; CI (3.81,31.67)], with Ogun state reporting the lowest [OR = 0.77; CI (0.42,1.42)]. Children of mothers with more than secondary education are significantly less likely to suffer ARI [OR = 0.35; CI (0.29,0.42)], whereas children of mothers without any education run a higher risk of diarrhoea [OR = 2.12; CI (1.89,2.38)] and fever [OR = 2.61; CI (2.34,2.91)]. Our analysis also indicated that household wealth quintile is a significant determinant of morbidity. The results in this paper could help the government and non-governmental agencies to focus and target intervention programs for ARI, diarrhoea and fever on the most vulnerable and risky under five groups and populations in Nigeria.

Asunto(s)

RESUMEN

Objective To identify the factors related to sleep duration in 3-month-old infants. Materials and Methods From 2021 to 2023, we conducted a cross-sectional study in the city of Araraquara, Brazil, involving 140 mothers and their respective 3-month-old infants. Maternal socioeconomic, demographic, obstetric, and nutritional characteristics, as well as nutritional and morbidity characteristics of the respective infants, were evaluated. Sleep duration was determined by the Brief Infant Sleep Questionnaire (BISQ). Multivariate linear regression analysis was used to assess the associations of maternal, newborn, and infant factors with sleep duration at three months. Results The nighttime sleep duration of the infants was of 9 hours. There were negative associations between nighttime sleep duration and prone sleep position ( p = 0.011), falling asleep between 8:30 pm and 11:00 pm ( p = 0.032), falling asleep after 11:00 pm ( p < 0.001), respiratory infection ( p = 0.011), dermatitis ( p = 0.002), and the presence of children under 9 years of age in the household ( p = 0.013). Discussion In the present study, factors such as infant morbidity, the presence of other children in the household, and sleeping habits were associated with a decrease in sleep duration in 3-month-old infants. Therefore, we emphasize the importance of early diagnosis of morbidity in the first months of life and of promoting healthy habits such as regulating the time to go to sleep, providing an adequate sleep environment, and other practices that help improve the quality and duration of sleep.

RESUMEN

BACKGROUND:  Acute encephalitis refers to the clinical diagnosis of children who have a sudden onset of symptoms and show evidence of inflammatory lesions in the brain. Timely diagnosis is crucial for both lifesaving measures and the preservation of brain functions. OBJECTIVE:  The objective of the study was to determine the clinical and etiological profile of acute viral encephalitis in children within a tertiary care hospital. METHODS:  This hospital-based cross-sectional study was conducted in the Pediatric Intensive Care Unit (PICU) at Dr. D. Y. Patil Medical College, Hospital, and Research Centre in Pune. The study included children aged one month to 12 years diagnosed with suspected viral encephalitis. Over 22 months, from August 2022 to June 2024, 35 children who met the inclusion criteria were enrolled. Data collection involved clinical examinations, laboratory investigations, and imaging studies, following informed consent from the parents or guardians. RESULTS: The study examined 35 patients with suspected acute encephalitis syndrome (AES) and found a male-to-female ratio of 3.4:1. Among the patients, 22 (62.85%) had a confirmed viral etiology, while 13 (37.17%) had an unknown etiology. The most common virus isolated was mumps, with school-age children most affected. The cases were concentrated in the Chikhali, Bhosari, Nigdi, and Chinchwad regions. Symptoms included fever, seizures, vomiting, and altered mental status. Low vaccination rates were observed, and the Glasgow Coma Scale (GCS) scores, shock incidence, and ventilation showed an association with mortality. Most patients required intensive care, antiedema measures, antibiotics, and antivirals. The mortality rate was 11.4%, with 17% of patients discharged with neurological sequelae. CONCLUSION: Causative agents such as mumps, herpes simplex virus (HSV), dengue, and many other viruses are now more prevalent than the Japanese encephalitis (JE) virus. Bad clinical course and fatal outcomes are observed in patients affected with rabies, HSV, and H1N1 influenza virus. Factors such as GCS scores, shock, and need for ventilation play a significant role in determining patient prognosis. Early detection and prompt treatment may aid in better outcomes for patients.

RESUMEN

AIM: To identify the most relevant factors with respect to the management of fracture-related infection (FRI) and to develop a comprehensive FRI classification that guides decision-making and allows scientific comparison. METHOD: An international group of FRI experts determined the preconditions, purpose, primary factors for inclusion, format and detailed description of the elements of an FRI classification through a consensus driven process. RESULTS: Three major elements were identified and grouped together in the FRI Classification: Fracture (F), Related patient factors (R) and Impairment of soft tissues (I). Each element was divided into five levels of complexity. Fractures can be healed (F1) or unhealed (F2-5). Patients may be fully healthy (R1) or have 4 levels of compromise, with and without end-organ damage (R2-5). Soft tissue condition ranges from well vascularized and easily closed (I1) to major skin defects requiring free flaps (I4). In all three elements, the fifth level (F5, R5 or I5) describes a patient who has an unreconstructible bone, soft tissue envelope or is not fit for surgery. CONCLUSION: The FRI classification, which is based on the three major elements Fracture (F), Related patient factors (R) and Impairment of soft tissues (I) is intended to guide decision-making and improve the quality of scientific reporting for FRIs in the future. The proposed classification is based on expert opinion and therefore an essential next step is clinical validation, in order to realize the ultimate goal of improving outcomes in the management of FRI.

RESUMEN

BACKGROUND: Active-duty service women rely on the civilian sector for most abortion care due to limits on federal funding for abortion. Abortion is now banned in many states with large military presences. The Department of Defense has implemented policies to assist active-duty service women in accessing abortion, but there is debate to reverse this support. OBJECTIVE: Our goal was to compare the cost-effectiveness and incidence of adverse maternal and neonatal outcomes of a hypothetical cohort of active-duty service women living in abortion-restricted states comparing restricted abortion access (abortion not available cohort) to abortion available with Department of Defense travel support (abortion available cohort). STUDY DESIGN: We developed a decision tree model to compare abortion not available and abortion available cohorts for active-duty service women living in abortion-restricted states. Our cohorts were subdivided into normal pregnancies and those with a major fetal anomaly. Cost estimates, probabilities, and disability weights of various health conditions associated with abortion and pregnancy were obtained and derived from the literature. Effectiveness was expressed in disability-adjusted life years and the willingness to pay threshold was set to $100,000 per disability-adjusted life year gained or averted. We completed probabilistic sensitivity analyses with 10,000 simulations to test the robustness of our results. Secondary outcomes included numbers of stillbirths, neonatal deaths, neonatal intensive care unit admissions, maternal deaths, severe maternal morbidities, and first and second trimester abortions. RESULTS: The abortion not available cohort had a higher annual cost to the military ($299.1 million, 95% CI 239.2 - 386.6, vs. $226.0 million, 95% CI 181.9 - 288.5) and was associated with 203 more disability-adjusted life years compared to the abortion available cohort. The incremental cost effectiveness ratio was dominant for abortion available. Abortion not available resulted in an annual additional 7 stillbirths, 1 neonatal death, 112 neonatal intensive care unit admissions, 0.016 maternal deaths, 24 severe maternal morbidities, 27 less second trimester abortions, and 602 less first trimester abortions. Probabilistic sensitivity analysis revealed that the chance of the abortion available cohort being the more cost-effective strategy was greater than 95%. CONCLUSION: Limiting active-duty service women's access to abortion care increases costs to the military, even with costs of travel support, and increases adverse maternal and neonatal outcomes. This analysis provides important information for policymakers about economic and health burdens associated with barriers to abortion care in the military.

RESUMEN

Background The majority of complications and deaths related to childbirth are concentrated in developing and disadvantaged nations, where the rates are unacceptably elevated. These incidents predominantly occur in the vicinity during the intrapartum period and immediately after childbirth. The peripartum period is especially critical for expectant mothers, as it represents the time when a significant number of complications and deaths occur. This study aimed to develop, validate, and assess the efficacy of the maternal morbidity screening (MMS) tool for predicting peripartum morbidity. Methodology The study was conducted in two phases: Phase one involved developing, validating, and piloting the MMS tool, while Phase two focused on evaluating and comparing the MMS tool with the modified early obstetric warning system (MEOWS) chart for predicting peripartum morbidity. An observational analytical clinical study design was utilized. Result In Phase one, the MMS tool was developed and validated by subject experts, resulting in a reliability score of 0.90. Therefore, the tool was deemed reliable and valid. Phase two results revealed that obstetric morbidity in the maternal morbidity group was 66.66%, higher than the 32% observed with the MEOWS chart. The MMS tool demonstrated significantly higher sensitivity at 95.24%, specificity at 89.50%, and predictive value at 98.50%, yielding an overall accuracy of 90.50%. In comparison, the MEOWS chart exhibited a sensitivity of 70.51%, specificity of 86.81%, predictive value of 92.94%, and accuracy of 83.71%. Conclusion The occurrence of maternal morbidity in the trigger zone was significantly higher than in the non-trigger zone in the MMS tool. The MMS tool was significantly more effective as a predictor of peripartum morbidity compared to the MEOWS chart.