SAGE Open Medicine最新文献

Background: Postoperative atrial fibrillation occurs in 27% to 40% of patients after cardiac surgery. One cause of postoperative atrial fibrillation is pericardial effusion, which can be a significant source of inflammation. In this study, we investigated the effect of a drain placed in a posterior site to the heart to reduce pericardial effusion in the early postoperative period to prevent postoperative atrial fibrillation.

Methods: Participants were patients who underwent initial standby aortic valve replacement at Saga-Ken Medical Centre Koseikan from January 2010 to December 2021. Patients with a history of atrial fibrillation, complex surgery, or emergency surgery were excluded. The patients were divided into two groups: those with a posterior cardiac drain in addition to the usual intrapericardial and subpleural drains from September 2017 (group P) and those without posterior cardiac drain from January 2010 to August 2017 (group N). Multiple logistic regression analysis was performed to evaluate the usefulness of posterior cardiac drain.

Results: Of the 79 patients included the study, 40 were male and groups P and N comprised 27 and 52 patients, respectively. Of the 79 patients, 32 developed postoperative atrial fibrillation; among whom, 7/27 (25.9%) had posterior cardiac drain and 25/52 (48.1%) had no posterior cardiac drain (p = 0.09). When adjusted for body surface area, left ventricular end-diastolic and left atrial diameter, the incidence of postoperative atrial fibrillation was significantly lower in group P than in group N (adjusted odds ratio 0.270, 95% confidence interval 0.077-0.953, p = 0.042). Furthermore, no patient in the group P underwent postoperative thoracentesis in the subanalysis.

Conclusions: The results suggest that early postoperative reduction of pericardial effusion by posterior cardiac drain placement may reduce the incidence of postoperative atrial fibrillation.

Background: The ability of Pseudomonas aeruginosa to produce biofilm has established it as one of the most significant pathogens. The purpose of this study was to evaluate antimicrobial resistance and conduct a molecular investigation of the virulence genes PslB and PelD in Pseudomonas aeruginosa species isolated from patients.

Methodology: One hundred clinical isolates were collected from patients of different age groups who were hospitalized in Kermanshah and Sonqor hospitals. The isolates were obtained through culture on specific media, biochemical confirmatory tests, and gram staining for confirmation. Biofilm production was assessed using an indirect quantification method with crystal violet. Additionally, antibiotic resistance was determined through the disc various method following Clinical and Laboratory Standards Institute guidelines. Finally, the presence of genes related to PlsB and PelD in resistant strains was examined using The polymerase chain reaction (PCR).

Results: The results indicate that the highest resistance and lowest sensitivity were related to nitrofurantoin 100 μg, while the lowest resistance and highest sensitivity were related to cefepime 30 mg. Biofilm phenotypes were categorized as weak in 7% (n = 7) of isolates, medium in 13% (n = 13), and high in 80% (n = 80). The PslB and PelD genes were identified in 86% (n = 86) and 38% (n = 38) of isolates, respectively, while 4% (n = 4) did not possess either of these two genes. Additionally, a majority of the isolates exhibited multidrug-resistance (87%) due to their moderate-to-high biofilm formation.

Conclusion: All isolates were capable of producing biofilm. A significant association were between strains with the high biofilm and multidrug-resistance species (p < 0.05). Multidrug-resistance (78%) isolates included 28% (n = 28) of isolates that were PslB+ PelD+, 45% (n = 45) of isolates that were only PslB+, and 5 (n = 5) isolates that were only PelD+. A significant relationship was found between the presence of the PslB gene multidrug-resistance and high producer (p < 0.05).

Introduction: There were approximately 38 million human immune deficiency virus/acquired immune deficiency syndrome cases worldwide in 2019, of which 36.2 million were adult cases, of these 25.4 million had access to antiretroviral therapy. The desire to have children among human immune virus-infected people has significant implications for the transmission of the human immune virus. In many developing countries such as Ethiopia, where the prevalence of the human immune virus is high, the risk of human immune virus transmission to the baby is inevitable.

Objective: This study's objective is to evaluate fertility desire and associated factors among antiretroviral therapy users at South Gondar public hospitals, Northwest Ethiopia, 2022.

Methods: A multicenter institutional-based cross-sectional study design was conducted among patients attending antiretrio viral therapy at South Gondar Zone public hospitals, from April 1 to May 30, 2022. A total of 551 study participants were selected using systematic random sampling. Data were collected through face-to-face interviews using a pretested, semi-structured questionnaire. The data were entered into Epi-Data version 4.6 and then exported to SPSS version 26 for analysis. Multivariable logistic regression analysis was performed to identify factors associated with the outcome variable, and adjusted odds ratios with 95% confidence intervals were calculated to determine the level of significance.

Result: The study included 551 participants with a 100% response rate. The prevalence of fertility desire among antiretroviral therapy users in South Gondar Zone public hospitals was 42.5% (95% confidence interval: 38.6, 46.8). Independent predictors of fertility desire included being a merchant (adjusted odds ratio = 0.06; 95% confidence interval: 0.01, 0.08), being a farmer (adjusted odds ratio = 0.21; 95% confidence interval: 0.09, 0.47), having no children (adjusted odds ratio = 20.04; 95% confidence interval: 4.7, 24.2), disclosing HIV status (adjusted odds ratio = 0.05; 95% confidence interval: 0.01, 0.30), and being diagnosed with HIV (adjusted odds ratio = 15.5; 95% confidence interval: 12.79, 20.54).

Conclusions: The prevalence of fertility desire among antiretroviral therapy users is found to be high. It is important to improve the existing Information, Education, and Communication interventions on fertility desire among antiretroviral therapy attendants at the individual and community levels.

A dysregulated host response to infection resulting in life-threatening organ dysfunction defines the onset of sepsis. Unfortunately, sepsis is common, costly, and deadly. The Surviving Sepsis Campaign publishes regularly updated, evidence-informed, detection, and treatment guidelines culminating in time-sensitive care "bundles." The goal of these bundles is to expedite sepsis recognition because it is widely held that early treatment is life-saving. Hospitals are mandated to publicly report their bundle compliance, and this will soon be tied to hospital reimbursement. For these reasons, hospitals are creating sepsis emergency response teams which are a form of a rapid response team consisting of dedicated medical professionals who evaluate patients with suspected sepsis and initiate therapy when appropriate. Evidence to date support sepsis emergency response teams as a mechanism to improve bundle compliance, and potentially, patient outcome. Nevertheless, some elements of bundled sepsis care are controversial (e.g., intravenous fluid administration) as some argue that mandated treatment precludes personalized care. Herein, we briefly describe general sepsis emergency response team structure, review evidence supporting sepsis emergency response teams to improve bundle compliance and patient outcome and report our unique experience incorporating point of care ultrasound-to guide intravenous fluid-into a nursing-led sepsis team. We propose that our sepsis emergency response team approach allays concern that sepsis care is either bundled or personalized. Instead, incorporating point of care ultrasound into a nursing-led sepsis emergency response team increases bundle compliance and individualizes care.

Background: Community-based health insurance is a voluntary scheme where community members pool resources to cover healthcare costs. Assessing beneficiary satisfaction with chronic disease management is crucial for the program's long-term viability. Therefore, this study aimed to assess determinants of satisfaction with community-based health insurance among beneficiaries with chronic diseases in selected public hospitals in the Hararghe Zones of Eastern Ethiopia.

Methods: An institution-based cross-sectional study was conducted among randomly selected 416 chronic disease beneficiaries of community-based health insurance from 30 July to 30 August 2023. Data were collected through a pre-tested and structured face-to-face interview questionnaire. The data were entered into Epi-Data 3.1 and then exported to STATA 17.0 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify determinants of satisfaction with community-based health insurance. Significance was set at a p-value < 0.05.

Results: The mean age of the study participants was 48.10 ± 15.8 years. The study revealed that 55.1% (95% CI: 50.2%-59.8%) of beneficiaries with chronic diseases were satisfied with community-based health insurance. Beneficiaries aged over 55 years (AOR = 0.27; 95% CI: 0.08-0.91), experiencing delayed community-based health insurance opening times (AOR = 0.35; 95% CI: 0.17-0.73), preferring hospitals for future services (AOR = 4.13; 95% CI: 1.14-14.85), shorter waiting times (<60 min) (AOR = 8.8; 95% CI: 4.39-17.72), availability of drugs (AOR = 2.67; 95% CI: 1.30-5.45), availability of laboratory services (AOR = 5.5; 95% CI: 2.83-10.84), and knowledge of community-based health insurance benefit packages (AOR = 2.8; 95% CI: 1.47-5.43) were significant determinants associated with satisfaction to the community-based health insurance service.

Conclusion: About half of the community-based health insurance beneficiaries with chronic diseases were satisfied, indicating that a considerable number of them were dissatisfied with the services. The age of the participants, office opening time, waiting times, laboratory services, pharmacy services, and knowledge of community-based health insurance benefit packages were significant determinants of satisfaction with community-based health insurance schemes. Therefore, the government and other stakeholders need to enhance service quality, increase awareness, and address both supply and demand-side factors. These key strategies can lead to higher satisfaction with and ensure the sustainability of community-based health insurance schemes.

Background: Sedentary life is now considered among the main health risks globally among general population and pregnant women. Premature rupture of membranes is a serious pregnancy condition that is a main cause of newborn morbidity and death globally. There is very limited data about the effect of sedentary behavior during pregnancy on premature rupture of membranes.

Aim and objectives: The current study set out to evaluate the impact of sedentary behavior during pregnancy on premature rupture of the membranes in women older than 35.

Setting and methods: A cohort prospective study was done on 90 pregnant women at Kasr Al-Ainy Hospitals. Participants were met three times (once per trimester). Routine labs and examinations were done and physical activities and sedentary behavior were assessed using prenatal physical activity questionnaire at each visit then pregnant women were followed up till rupture of membranes happened.

Results: A statistically significant difference was observed in the kind and intensity of physical activity among pregnant individuals at the first, second, and third trimesters. Women who experienced premature rupture of membranes demonstrated significantly lower levels of physical activity (household or caregiving, occupational, and low physical activities) and they also showed signs of a more sedentary lifestyle.

Conclusion: Sedentary behavior during pregnancy had great effect on premature rupture of membranes in women above 35 years old. Sedentary participants were twice as likely to develop premature rupture of membranes in contrast to individuals who don't engage in sedentary behavior.

Background: Food aversion is one of the reasons for maternal undernutrition. Early screening for maternal undernutrition risk factors would improve the ability to recognize this problem and intervene early. Hence, this study was intended to identify the association of food aversion with maternal nutritional status.

Objectives: To assess food aversion and its association with pregnant women's nutritional status in Teticha Woreda, Sidama region, Ethiopia, March, 2022.

Methods: In Teticha Woreda, a mixed community-based comparative cross-sectional study was carried out from 1 March to 15 April 2022. Data were collected using an unstructured interview guide for qualitative data and a structured questionnaire for quantitative data. Epi-Data version 3.1 was used to enter quantitative data. Quantitative data were exported and cleaned and analyzed in SPSS version 20. For the quantitative data, descriptive statistics were calculated. To identify predictors of low nutritional status and control for confounders, multivariable logistic regression was utilized. Using Pearson's Chi-square test, the association between food aversion and the anthropometric status of pregnant women was examined.

Results: Maternal undernutrition was found in 109 (48.9%; 95% CI: 42.4%-55.4%) of pregnant women with food aversion and 69 (30.9%; 95% CI: 25.1%-37.2%) women without food aversion (mid-upper arm circumference 23 cm). A significant proportion of mothers 95 (42.6%) stated that food aversion stemmed from the taste or smell of the food. Some mothers avoided "Enset," while others avoided foods like cereal, milk, and coffee. In the Chi-square test, pregnant women who had food aversion had a higher likelihood of maternal undernutrition as compared to women who did not have food aversion (p-value of 0.000).

Conclusion: This study found higher magnitude of undernutrition among pregnant women who had food aversion as compared to their counterparts. Nutritional interventions, especially nutritional counseling focusing on food aversion, are essential to tackle maternal undernutrition.

Background and objectives: Current virtual care guidance lacks specialty-specific considerations. Neurological care is unique due to its reliance on physical examination and complex patient population. Our aim was to determine which factors impact virtual care suitability in neurology, virtual care adoption patterns, and satisfaction with virtual care among neurologists.

Methods: Surveys were sent to Ontario neurologists through a shared email from September to November 2021. The survey consisted of four parts: demographics, virtual care adoption patterns, factors influencing virtual care use, and physician satisfaction with virtual care.

Results: Sixty-six of 380 (17.4%) neurologists completed the survey. The pandemic resulted in a substantial increase in virtual care use, from 1.6% of all ambulatory visits in 2019 to 70.6% in 2020. Video teleconferencing was considered more appropriate across a broader range of presentations than phone visits, with both methods more suited to follow-ups. Neurologists were largely satisfied with virtual care except for the virtual neurological examination. The neurological presentations identified as least amenable to virtual consultation were movement disorders, limb weakness, gait/balance changes, and vision changes. Four presentations were felt to be most amenable to virtual care: sleep disorders, seizure, headache, and dizziness/syncope. Factors that were felt to reduce virtual care suitability included discussion of sensitive topics and acute presentations.

Conclusion: Neurologists were satisfied with virtual care as a means of providing outpatient care, though the specific reason for referral influenced perceived appropriateness. These results can inform the basis of the development of consensus guidelines for virtual care provision in neurology.

Introduction: Childhood-onset asthma is a chronic respiratory disease that profoundly impacts patients, their families, and healthcare systems. This study explores the lived experiences, challenges, and perceptions of mothers in managing asthma, controlling symptoms, and maintaining the quality of life for their children with asthma in Palestine.

Methods: A qualitative descriptive design through semi-structured interviews was used in this study. Purposive sampling was used to identify mothers who have children with severe uncontrolled asthma in the four public hospitals with pediatric units in the West Bank, Palestine. Mothers of children with scored below 15 on the asthma control test were included in the study. The data were analyzed using an analytical framework following a thematic analysis through the NVivo 11.

Results: A total of 20 mothers participated in interviews wherein they delineated the most important challenges negatively affecting asthma management from mothers' perspectives. These challenges encompassed frequent emergency room visits, improper medication administration practices, and limitations in physical activity. The mothers expressed concerns regarding asthma control, including anxieties concerning the chronicity of the illness, adverse effects of medications, and susceptibility to weather fluctuations. The main themes that emerged from the data included reduced quality of life for the child, parental responsibility for monitoring triggers, symptoms, and medications, challenges in asthma management, apprehensions regarding asthma control, and strategies for enhancing asthma management.

Conclusion: This study emphasizes the pressing need for targeted interventions to address asthma management, environmental triggers, and psychosocial disruptions related to asthma in children with asthma to enhance the quality of life and asthma control. This study highlights the importance of developing strategies that provide mothers with the appropriate information and tools to navigate the complexities of caring for a child with asthma.

Alcohol-associated hepatitis is an extreme form of alcohol-related liver disease associated with high short-term mortality. Currently, there are no authorized therapies for the treatment of severe alcohol-associated hepatitis. Important diagnostic steps for alcohol-associated hepatitis include recognizing the presence of an alcohol use disorder, distinguishing alcohol-related liver disease from metabolic-dysfunction-associated steatotic liver disease, ruling out alternative causes of acute hepatitis, confirming the diagnosis with validated criteria or a liver biopsy, and using the model for end-stage liver disease score to predict clinical outcome and initiate therapy. Due to the lack of other effective therapy options, corticosteroids continue to be used as initial treatment for patients with severe alcohol-associated hepatitis. Patients who do not improve while on steroid treatment and are ideal candidates should be considered for curative liver transplantation as soon as possible. Avoiding unnecessary and ineffective pharmacological and interventional therapy can help to keep costs down. If a patient is not a good candidate for a transplant or is rapidly deteriorating in health due to a condition such as acute or chronic liver failure, a salvage/bridge to transplant should be pursued through enrolment in a clinical trial program. The role of healthy donor stool transplant and targeted bacteriophage therapy seems promising, pending prospective controlled trials.