SAGE Open Medicine最新文献

Title: Traumatic brain injury outcomes and mortality predictors in Eastern India: A prospective observational cohort study.

Objective: To evaluate clinical outcomes and identify predictors of mortality in patients with traumatic brain injury treated at a tertiary trauma centre in Eastern India.

Methods: This was a single-centre prospective observational cohort study conducted at AIIMS, Patna, Bihar, Eastern India, over 18 months (July 2023-January 2025). A total of 383 consecutive patients with traumatic brain injury were enrolled based on predefined inclusion and exclusion criteria. Demographic, clinical, radiological, and management variables were recorded. Functional outcomes were assessed at discharge, 3 months, 6 months months using the Glasgow Outcome Scale-Extended. Logistic regression was used to identify independent predictors of mortality and poor functional outcome.

Results: The mean age was 34.4 ± 15.2 years, and most patients were male (68.9%). Road traffic accidents were the leading cause of injury (68.9%). Based on admission Glasgow Coma Scale, 53.3% had mild, 20.1% moderate, and 26.6% severe traumatic brain injury. Mortality was 23.5% at discharge and 24.5% at 6 months, with 95.7% of deaths occurring within the first month. Favourable outcomes (Glasgow Outcome Scale-Extended 6-8) were observed in 66.1% at 3 months and 70.8% at 6 months. Severe traumatic brain injury was significantly associated with 6-month mortality (p < 0.001) and poor outcomes (p < 0.001). Radiological features associated with mortality included intraventricular haemorrhage (p = 0.011), midline shift (p = 0.019), third ventricle obliteration (p = 0.023), sulcal effacement (p = 0.028), and cisternal collapse (p = 0.017). Multivariate analysis confirmed older age, lower Glasgow Coma Scale, abnormal pupillary reflex, intraventricular haemorrhage, and sulcal effacement as independent predictors of 6-month mortality. Among management strategies, burr-hole surgery yielded the best functional recovery (93.3%), while craniectomy was associated with the highest mortality (45.0%).

Conclusions: Traumatic brain injury in Eastern India predominantly affects young males in road traffic accidents. While functional recovery appeared to improve between discharge and 6 months, severe injuries and specific radiological features may be associated with increased mortality. Burr-hole surgery and craniotomy may be linked to more favourable outcomes compared with craniectomy. Strengthening trauma systems and timely surgical interventions may help improve outcomes in resource-limited settings.

Background: Postoperative nausea and vomiting is a prevalent complication during the postoperative phase. Numerous factors affect postoperative nausea and vomiting, which can be categorized into patient-related, anesthesia-related, and surgery-related factors. The management of postoperative nausea and vomiting is multifaceted and consists of both prophylactic and therapeutic approaches.

Objectives: This study aimed to investigate the attitudes and behaviors of anesthesiologists regarding the prophylaxis and treatment of postoperative nausea and vomiting, while also raising awareness of current practices and gaps in adherence to guideline-based management.

Methods: This prospective observational study involved the online administration of a web-based questionnaire comprising 17 questions to physicians actively working in anesthesiology and reanimation clinics. The first five questions pertained to demographic data, while the remaining 12 questions assessed anesthesiologists' attitudes and behaviors regarding the prophylaxis and treatment of postoperative nausea and vomiting.

Results: The rate of missing to conduct postoperative nausea and vomiting risk assessments and not providing prophylaxis (n = 67) was 33.5%, whereas the rate of administering prophylaxis with a single agent to each patient without risk assessment (n = 85) was 42.5%. Among the anesthesiologists who participated in the study, the awareness rate regarding the prophylaxis and treatment of postoperative nausea and vomiting was found to be 90.0%.

Conclusions: This study demonstrates that, in current clinical practice, postoperative nausea and vomiting risk assessment and prophylaxis remain an overlooked complication. A clear gap exists between awareness and evidence-based practice in postoperative nausea and vomiting management. Therefore, the most appropriate prophylaxis and treatment strategies should be identified on a patient-specific basis. These findings highlight the need for structured risk assessment and guideline-based prophylaxis strategies to optimize patient outcomes.

Background: Social anxiety disorder is the most common anxiety disorder in children with burns, which require psychological treatments including storytelling. Therefore, this study was conducted with the aim of determining the effect of storytelling on the social anxiety of hospitalized children with burns.

Methods: In this clinical trial study, 52 people in two test and control groups were selected by random sampling. Storytelling education was conducted in 13 sessions for the intervention group. Data analysis was done using statistical tests by SPSS 22 software.

Results: A significant difference was observed between social anxiety before and after the intervention (p = 0.001). Accordingly, social anxiety and fear of negative evaluation have decreased after the intervention.

Conclusion: Based on this study's results, storytelling effectively reduces the social anxiety disorder of children with burns and reduces social anxiety at different childhood ages.

Background: Pediatric patients with critical illnesses often exhibit serum electrolyte disturbances, which significantly influence their clinical outcomes.

Methods: This prospective observational study included 534 pediatric patients (age range 1 month to 18 years) admitted to the pediatric intensive care unit of R.D. Gardi Medical College, Ujjain, from January 1, 2023 to April 30, 2024. The objective of the study was to study associations of disturbances in the levels of serum sodium, potassium, calcium, magnesium, and phosphorus with organ system involvement and child mortality, using multiple logistic regression models.

Results: Among the 534 patients, 325 (61%) were boys and 209 (39%) were girls, with a mean ± SD age of 5.17 ± 4.79 years. Most patients presented with fever (71%), fatigue (34%), and malaise (21%). A total of 1057 electrolyte abnormalities were recorded, with hypocalcemia (263 episodes, 25%) being the most common, followed by hypokalemia (192 episodes, 18%) and hyponatremia (172 episodes, 16%). A total of 173 episodes of severe hypocalcemia (S. calcium <6.5 mg/d), 21 episodes of severe hypernatremia (S. sodium >150 mEq/L) and 12 episodes of hypokalemia (S. potassium <2.5 mEq/L). All children with hypocalcemia had neurological symptoms. Hypokalemia was significantly associated with neurological (adjusted odds ratio 2.07), endocrine (adjusted odds ratio 2.26) and cardiovascular system (adjusted odds ratio 10.20) symptoms. Hyponatremia was significantly associated with symptoms of respiratory system (adjusted odds ratio 2.82) and gastrointestinal system (adjusted odds ratio 1.95). Hyperkalemia was significantly associated with symptoms of neurological (adjusted odds ratio 3.84), endocrine (adjusted odds ratio 2.24) and cardiovascular system (adjusted odds ratio 3.53). A total of 34 (6%) deaths were recorded and found to be associated mainly with hypokalemia (56%), hypocalcemia (44%), and hyponatremia (32%). Among these, hypokalemia (odds ratio: 2.43) and hypernatremia (odds ratio: 2.26) were significantly associated with mortality.

Conclusion: Electrolyte abnormalities were highly prevalent among children in the pediatric intensive care unit, with imbalances in the calcium, potassium, and sodium levels being the most common. Hypokalemia and hypernatremia were significantly and positively associated with mortality.

Background: Labor companions often lack clarity about their support roles during childbirth. Therefore, this study aims to analyze factors influencing companions' adherence to support roles during labor and childbirth.

Methods: A convergent parallel mixed-methods design was used to examine factors influencing companions' adherence to support roles from May to June 2024. Systematic random sampling selected 320 participants from the maternity ward. Data were collected via face-to-face exit interviews. Purposive sampling chose 24 labor companions for in-depth interviews. Adherence to support roles was measured using a four-point Likert scale, ranging from "not at all" to "all of the time." Ethical approval was obtained from the IRB at Jimma University, and support letters were secured for each study facility. Written consent was obtained from all participants.

Results: Companions' adherence to support roles during childbirth had an overall mean score of 1.39 (95% CI: 1.29-1.49) on the four-point Likert scale. Specifically, 27.5% of companions reported not at all, and 35.63% reported only a little support, while 17.19% reported providing support all of the time. Awareness among companions was associated with increased adherence to support roles (B = 0.238, p = 0.029). Nevertheless, companions with less prior experience (first time: B = -0.377, p = 0.001; second time: B = -0.280, p = 0.031) showed significantly lower adherence to support roles. The qualitative data also explored that, unclear role definition, unwelcoming approach of healthcare providers, and social-cultural factors were associated with minimal adherence to support roles.

Conclusion: A structured orientation session for companions is a vital recommendation to address hindering factors to their support roles. Such a session might equip them with techniques how to provide.

[This corrects the article DOI: 10.1177/20503121251358313.].

Objectives: This study aimed to develop and validate a nomogram prediction model for identifying the risk of early perforation (within 24 h) in patients with acute appendicitis, using objective clinical and imaging indicators.

Methods: A retrospective study was performed on 880 patients with acute appendicitis who underwent laparoscopic appendectomy within 24 h of symptom onset at the General Surgery Department of the Central Theater Command General Hospital between January 2011 and December 2022. Patients admitted from 2011 to 2020 were assigned to the modeling group (n = 616), and those from 2021 to 2022 to the validation group (n = 264). Based on postoperative pathology, patients were classified as having early or non-early perforated appendicitis. Independent risk factors for early perforation were identified using LASSO and multivariate logistic regression and were used to develop a predictive nomogram. Model performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC) for discrimination and the Hosmer-Lemeshow test for calibration.

Results: Appendiceal diameter, body temperature, white blood cell count, fibrinogen level, appendiceal fecalith, age, and diabetes mellitus were identified as independent predictors of early perforation in acute appendicitis within 24 h (p < 0.05). ROC analysis indicated that diameter (AUC = 0.673), temperature (AUC = 0.705), white blood cell (AUC = 0.713), fibrinogen (AUC = 0.742), and age (AUC = 0.759) had moderate predictive power. Incorporating fecalith and diabetes significantly enhanced model performance, yielding an AUC of 0.891.

Conclusion: The nomogram prediction model incorporating appendiceal diameter, body temperature, white blood cell count, fibrinogen level, appendiceal fecalith, age, and diabetes mellitus demonstrates clinical utility in estimating the probability of perforation within 24 h in patients with acute appendicitis.

Background: Sleep disorders and disturbances are a significant issue that affects occupational health and safety, yet their association with occupational injuries remains understudied. Therefore, this systematic review and meta-analysis aimed to investigates the association between sleep disturbance, sleep disorder, and occupational injuries among industry workers in Ethiopia.

Methods: Observational studies reporting occupational injury, sleep disturbance, and sleep disorder were considered in this study. A comprehensive search of electronic databases, including PubMed, Google Scholar, Semantic Scholar, HINARI, and ScienceDirect, and a Google manual search was conducted up to December 18, 2024. The recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting items. Data were extracted using a standard data extraction template and exported to STATA V 17 for analysis. The Joanna Briggs Institute quality assessment tool was used to determine the quality of the reviewed research articles. To estimate the pooled association, a random effects model was used. The Egger's regression test and the funnel plot were used to evaluate publication bias.

Results: This review included a total of 27 studies that met the inclusion criteria. The finding revealed that industrial workers who have sleep disorder and sleep disturbance had a 2.6 and 2.5-fold increased risk of experiencing occupational injuries than those without sleep disorder and disturbance, respectively. Subgroup analyses demonstrated that high heterogeneity exists among manufacturing and agricultural workers for sleep disorders and moderate heterogeneity among building and construction sectors for sleep disturbances. The leave-one-out sensitivity analysis showed the robustness of the results.

Conclusion: Sleep disorders and sleep disturbances increase the risk of occupational injuries. Therefore, integrated interventions tailored to the manufacturing, service-providing, building and construction, and agricultural workers context are required. Applying workplace policies, prioritizing mental health supportd to lessen the effects of sleep disturbances and disorders in service-providing industry sectors, and implementing thorough health and safety training, promoting better sleep hygiene practices to lower their risk of injury in agricultural workers, are advised.

Objective: Sexual and reproductive health services for disabled students are an important aspect of ensuring their overall well-being and empowerment. Therefore, the aim of this study was to assess the magnitude of risky sexual behavior and its associated factors among students with disabilities in higher academic institutions of Debre Markos city.

Methods: An institution-based cross-sectional study was conducted among 168 study subjects with disabilities in higher academic institutions in Debre Markos city. The data were collected from November 5, 2024 to January 25, 2025, by using interviewer-administered structured questionnaires. Training for data collectors was conducted to maintain the quality of the data. The data were analyzed using SPSS version 20 software. Descriptive statistics with both bivariable and multivariable logistic regression were performed to estimate the crude and adjusted odds ratio with a 95% confidence interval.

Results: The overall magnitude of risky sexual behavior among disabled students at higher academic institutions in Debre Markos city was 48 (28.6%). The mean (standard deviation) age of the participants was 24.7 (4.9), and 120 (71.4%) were male respondents. Sex (AOR = 0.125; 95% CI: 0.04-0.41), age group under 20 (AOR = 0.101; 95% CI: 0.02-0.59) and 21-24 years (AOR = 0.095; 95% CI: 0.03-0.31), religion (AOR = 0.132; 95% CI: 0.02-0.75), and place of residence (AOR = 4.129; 95% CI: 1.78-9.57) were significantly associated with risky sexual behavior.

Conclusion and recommendation: Considerable proportions of students were engaged in risky sexual behavior and have an association with sex, age, religion, and place of residence. Interventions are needed for those female disabled students, aged greater than 25 years, Muslim religion followers, and urban residents to reduce the risky sexual behavior.

Background: Kidney transplantation is the ideal treatment for patients with end-stage renal disease. However, this population has a higher risk of cancer. This highlights the importance of early screening to improve outcomes in the detection of neoplasms, associated risk factors, and prompt treatment in this population.

Objectives: The objective of this study is to determine the incidence and risk factors associated with post-transplant cancer.

Methods: This was a historical analytical cohort observational study that evaluated the incidence of cancer and associated risk factors in kidney transplant recipients in the Clínica Universitaria Colombia program between 2007 and 2022.

Result: A total of 555 patients were included, with a predominance of males (61.1%). An incidence of posttransplant cancer was documented in n = 79 (14%) patients at a follow-up of 84.7 months, with skin neoplasms in n = 33 (41.7%) of cases, followed by solid organ neoplasms n = 31 (39.2%). Associated risk factors identified were age at the time of transplantation being statistically significant (Hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.02-1.06), a history of cancer prior to kidney transplantation (HR: 3.62; 95% CI: 1.46-8.99), and diabetes mellitus (HR: 2.08; 95% CI: 1.24-3.49). A statistically significant relationship was documented as a protective factor for mammalian Target of Rapamicyn (mTOR) inhibitors and solid organ neoplasms with relative risk (RR) 0.414 (95% CI: 0.19-0.88). No increase of posttransplant lymphoproliferative disorder (PTLD) was found with co-stimulation signal inhibitor-based therapy.

Conclusions: In a Latin American kidney transplant cohort the incidence of post-transplant malignancy was found to be 14% in a median follow-up of 7 years. This study found that risk factors include age, history of cancer prior to transplantation, and diabetes mellitus. Use of mTOR pathway inhibitors was associated with a reduced risk of solid organ neoplasms. No increase in the frequency of PTLD was found in patients receiving costimulation signal inhibitors.