SAGE Open Medicine最新文献

Introduction: The World Health Organization recommends the viral load test as the preferred method for monitoring responses to antiretroviral treatment; however, this test is not widely available in developing countries. Timely monitoring is crucial; early detection of virological failure can significantly improve health outcomes for these children and help prevent the development of drug resistance. Therefore, this study aims to contribute valuable insights into time to virological failure and its predictors among children with human immunodeficiency virus.

Methods: An institution-based retrospective follow-up study was conducted among 497 children who were enrolled for first-line antiretroviral treatment from January 1, 2017 to December 31, 2021 in Eastern Ethiopia public Hospitals. A standard pretested checklist was used to extract data. Data were entered using Epi-Data 4.6 and analyzed using STATA 16. Kaplan-Meier was used to estimate the cumulative probability of virological failure, and the log-rank test was used to compare failure curves. The Cox proportional hazard regression model was used to analyze the relationship between independent and outcome variables.

Results: The overall incidence rate of virological failure was 3.70/1000 person-month observations (95% confidence interval: 2.88-4.76). World Health Organization clinical stages 3 and 4 at the time of antiretroviral treatment beginning (adjusted hazard ratio: 2.38 (95% confidence interval: 1.34-4.26)), baseline cluster of differentiation 4 cells, type of T lymphocytes count below the threshold (adjusted hazard ratio: 3.65 (95% confidence interval: 2.12-6.30)), tuberculosis positive during the follow-up period (adjusted hazard ratio: 4.81 (95% confidence interval: 2.51-9.23)), and poor adherence to the antiretroviral treatment regimen (adjusted hazard ratio: 3.87 (95% confidence interval: 2.08-7.22)) were independent predictors of virological failure.

Conclusion: The incidence of virological failure in this area was significantly higher compared to nationally conducted studies in Ethiopia. Baseline World Health Organization clinical stages 3 and 4, baseline cluster of differentiation 4 cells, type of T lymphocytes level below the threshold, being tuberculosis infected during the follow-up, and poor adherence were identified as independent predictors of time to virological failure.

Drug-resistant frontal lobe epilepsy is a challenge in epilepsy surgery because it is the second most common epilepsy type after temporal lobe epilepsy. Additionally, the frontal lobe is the largest brain lobe, making the localization of epileptic foci difficult, thereby preventing necessary surgery and improving seizure control. This review discusses the epidemiology and aetiology of drug-resistant frontal lobe epilepsy, demonstrating that cortical developmental manifestations constitute the most common aetiology of epileptic focus. Additionally, we reviewed the anatomy and symptoms of frontal lobe seizures. The review discusses advances in the neurophysiological study, including magnetoencephalography and neuroimaging modalities, such as quantitative PET scans and 7T MRI, for lesion detection and outcome improvement in frontal lobe epilepsy surgery. Although 7T MRI is unavailable in many epilepsy centres, the imaging modality can increase the rate of lesion detection, particularly when its findings are confirmed using depth electrode implantation, along with the utilization of artificial intelligence and machine learning in interpreting the morphometric analysis of MRI and nuclear imaging.

Background: The midwifery-led continuum of care model is an approach where a single midwife or a team of midwives provides comprehensive care to a woman throughout pregnancy, childbirth, and the early postpartum period. This model of care has significantly improved maternal and newborn outcomes; however, it is primarily implemented in high-income countries.

Objectives: To evaluate the effect of the midwifery-led continuum of care model on maternal and neonatal health outcomes in general hospitals of the Sidama region in Ethiopia.

Methods: A prospective nonrandomized control trial was conducted from October 2023 to June 2024 in the Sidama region, Ethiopia. A systematic sampling technique was used to recruit 478 low-risk women in total for the intervention group and control group. Multivariable analysis for binary outcomes with the log link were conducted to estimate adjusted risk ratios Adjusted risk ratio (aRR) and 95% confidence intervals.

Results: Women in the intervention were significantly more likely to have spontaneous vaginal birth (aRR) of 1.21 (95% confidence interval 1.14-1.67), and less likely to have preterm birth aRR of 0.16 (95% confidence interval 0.11-0.57) in comparison with women and newborns who received shared care.

Conclusion: Women in the intervention group experience improved outcomes and seems to be a valuable strategy for improving pregnancy outcomes in low-resource settings. Further research should enhance the practical application of midwifery-led continuum of care for women facing social risk factors, and medical complications in low-resource settings.

Trial registration: PACTR202310532830947.

Website: https://pactr.samrc.ac.za/.

Objectives: Preeclampsia (PE) is a major contributor to maternal and foetal morbidity and mortality. Early identification of women at risk is crucial for timely intervention, yet a cost-effective and reliable screening tool remains unavailable. This study aimed to evaluate the role of platelet-related parameters-platelet count (PC), mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)-in predicting the development and severity of PE.

Methods: This prospective observational cohort study was conducted at AIIMS Patna between January and November 2021. Pregnant women enrolled before 14 weeks of gestation were followed throughout pregnancy. Platelet parameters were measured at three gestational intervals: 10 to 14 weeks, 24 to 28 weeks, and 32 to 36 weeks. Data were analysed using SPSS v22, employing chi-square tests, t-tests, and logistic regression.

Results: Among 728 participants, 9.3% developed PE. Risk was significantly higher in primigravida women (p = 0.040), twin pregnancies (p = 0.027), and those with low educational status (p = 0.006). Significant differences were observed in PCT (p = 0.000) and NLR (p = 0.009) at 10 to 14 weeks, PCT (p = 0.034) at mid-trimester, and MPV (p = 0.005) at 32 to 36 weeks. Although MPV showed a consistent association with PE across trimesters, regression models did not achieve overall statistical significance.

Conclusion: Platelet indices, particularly PCT and NLR, demonstrated a significant association with PE in early pregnancy, while MPV was significantly elevated in late pregnancy. These findings suggest potential utility in risk stratification, though further studies are required to validate their predictive value before routine use in early screening.

Objective: This study aimed to evaluate the prevalence, location, and morphometric characteristics of the alveolar antral artery in an Iranian population using cone-beam computed tomography.

Materials and methods: A retrospective analysis was conducted on cone-beam computed tomography images of 322 patients acquired at Shiraz University of Medical Sciences between January 2015 and December 2022. The alveolar antral artery canal presence, mediolateral position (intrasinus, intraosseous, superficial), mediolateral coarse, and morphometry (distances to sinus floor and alveolar crest at the premolar and molar site, and diameter) were assessed. Statistical analysis was performed to identify significant differences based on age, gender, dental status, and side (p < 0.05).

Results: The overall prevalence of the alveolar antral artery was 92.2%, most commonly in an intrasinus position (51.3%). The most frequent course was the "in" type (32.4%). Median distances to the sinus floor ranged from 5.09 mm (first premolar) to 7.30 mm (second molar), while distances to the alveolar crest from 16.70 mm (second molar) to 24.65 mm (first premolar). Significant variations in alveolar antral artery canal dimensions and distances were observed based on tooth location, gender, age, and dental status.

Conclusion: This study demonstrates a high prevalence and significant anatomical variability of the alveolar antral artery canal in the Iranian population, and underscores the importance of preoperative cone-beam computed tomography imaging to minimize the risk of iatrogenic injury during posterior maxillary surgeries.

Objective: This study aimed to explore the lived experience of postnatal mothers receiving birth companionship care in the Katavi region.

Methods: A qualitative descriptive phenomenological approach was used to explore the experiences of eleven postnatal women who received birth companionship care during intrapartum. The study was conducted between May and June 2023, and postnatal women were conveniently sampled, with all participants providing their consent to participate. Data were collected through in-depth, semistructured interviews. The data were analyzed using thematic analysis, which involved the following steps: familiarizing oneself with the data, conducting preliminary coding, organizing themes, creating an initial coding template, refining the template, and applying it to the entire dataset.

Results: Six themes and twenty subthemes emerged in the current study. The main themes were (1) Choosing birth companions (BCs), (2) Mixed feelings about BCs, (3) Services offered by BCs, (4) Presence of BC during the intrapartum period, (5) Supportive infrastructure for birth companionship, (6) Challenges encountered with the presence of BCs.

Conclusion: The study found that women who had a BC during intrapartum experienced mixed feelings. Some participants acknowledged the significant role that BCs played throughout the process. In contrast, others expressed concerns about knowledge and privacy violations and opted not to have a BC present during childbirth. However, they consented to their presence during the first stage of labor. The women employed various methods to select their BCs, who assumed a range of responsibilities in providing care, both formally and informally. It is essential to enhance community awareness of the importance of BCs during labor and childbirth, as well as to provide them with training during the antenatal period to understand their roles better.

Background and objective: This study focuses on children aged 8-12 with cleft lip and palate, a critical period for surgical and orthodontic interventions that can significantly impact facial development and psychosocial well-being. Assessing the satisfaction and quality of life of patients and their parents during this stage can provide valuable insights to optimize care and support outcomes.

Methods: A cross-sectional study was conducted among parents and 32 patients with unilateral and bilateral complete cleft lip and palate who received continuous treatment at the Tawanchai Center during the year 2024. Data were collected using a general information questionnaire, the THAICLEFT quality of life Questionnaire, and a patient self-assessment. Data were analyzed using descriptive statistics, including percentage, mean, and standard deviation. Psychosocial satisfaction was compared using the Mann-Whitney U test.

Results: Among 32 participants, patients (68.75% male, mean age 10.38 ± 1.52 years) with predominantly unilateral cleft lip and palate (68.75%) reported high satisfaction across five psychosocial domains (mean 4.00 ± 1.26). Parents reported highest satisfaction with service quality (4.65 ± 0.52) and moderate-to-high satisfaction across medical, cost, and psychosocial domains (means 3.54-4.21). Family impact remained low (2.25 ± 1.71). Communication ability showed significant between group differences (p = 0.02).

Conclusion: Parents reported high satisfaction in three domains, while patients showed high satisfaction in five psychosocial aspects. The findings from this study will be used to improve patient and family care, enhancing their overall quality of life.

Background: Existing evidence indicates an increasing burden of puerperal sepsis in sub-Saharan Africa. Across the world, due to a lack of self-care practice and less attention to puerperal sepsis, postpartum women are exposed to major disorders and life-threatening conditions, leading to a lower quality of life. Therefore, this study aimed to assess the knowledge of puerperal sepsis and self-care practices related to the prevention of puerperal sepsis.

Methods: A facility-based cross-sectional study was conducted among 422 postpartum women in Gurage zone public hospitals from July to August 2024. A systematic sampling technique was employed to get the representative sample. Bivariate and multivariable logistic regression were done to identify factors associated with outcome variables; a p-value <0.05 was considered statistically significant.

Result: In this study, the response rate was 98.8%. The overall good knowledge and self-care practice were found to be 40.8% (95% confidence interval (CI): 36, 46) and 29.3% (95% CI: 25, 34), respectively. Educational status (Adjusted odds ratio (AOR) = 1.13; 95% CI: 1.10, 2.85 and AOR = 2.1; 95% CI: 1.64, 5.43), occupation (AOR = 2.01; 95% CI: 1.2, 3.4), and antenatal care (ANC) contact (AOR = 1.3; 95% CI: 1.23, 2.97) were associated with knowledge of puerperal sepsis. Multiparous (AOR = 1.2; 95% CI: 1.04, 3.14), ANC contact (AOR = 1.27; 95% CI: 1.15, 2.81), and knowledge (AOR = 4.3; 95% CI: 2.14, 9.31) were factors associated with the self-care practice of puerperal sepsis prevention.

Conclusions: This finding showed that 70.7% of postpartum women lacked good self-care practices of puerperal sepsis prevention. Hence, counseling and enhancing their knowledge of self-care practices should be provided to women to increase their awareness regarding puerperal sepsis prevention and self-care.

Objectives: This study aimed to assess the prevalence of symptoms potentially related to central sensitisation (CS) in patients with spinal pain and explore its association with patient-reported treatment outcomes.

Methods: This study was designed as a single-centre prospective cohort study evaluating 496 patients undergoing surgical and non-surgical management for spinal pain between 2020 and 2023. Patients with symptoms lasting more than three months were assessed for symptoms associated with CS using the validated Central Sensitisation Inventory (CSI) before treatment. Treatment satisfaction was then assessed using a 5-point Likert scale. Complete data on patient demographics were available for 492 patients.

Results: The prevalence of a CSI score of 40+ was 49.9%. Non-surgical patients had a higher median CSI score (42, IQR: 32-49) compared to surgical patients (34.5, IQR: 24-48) (p = 0.001). A moderate negative correlation was found between CSI scores and Likert scores (r = -0.69, p < 0.001). Multiple regression analysis showed that both treatment type and CSI scoring significantly impacted satisfaction scores (p < 0.001). Logistic regression revealed that higher CSI scores (40+) decreased treatment satisfaction (OR = 0.09) (p < 0.001). Where post-treatment patient-reported outcome scores were available, the cohort of patients with CSI⩾40 compared to the <40 cohort had a lower proportion of patients who achieved minimum clinically important difference and patient acceptable symptom state for both Neck Disability Index and Oswestry Disability Index (p < 0.05).

Conclusions: Overall, high CSI scores were common in patients with chronic spinal pain and were significantly associated with treatment dissatisfaction. Higher CSI scores should be considered when selecting treatment and managing patient expectations.

Background: COVID-19 has instigated many challenges for all groups of society, but these problems have been more tangible and difficult for female heads of households. The purpose of the present study is to analyse the lived experience of Iranian female heads of households during the COVID-19 pandemic.

Methods: The present research was conducted with a qualitative approach and qualitative content analysis method on 40 female heads of households. Data collection was done through purposeful and snowball sampling and via face-to-face, semi-structured interviews from 1 September 2021 to 30 March 2022. Data management was done using MAXQDA-2018 software, and the analysis was done using the Graneheim and Lundman analysis method. Also, to increase the trustworthiness of the results, Guba and Lincoln's criteria were followed.

Results: A total of 180 codes, 2 main categories, and 11 subcategories include: (1) challenges and problems (formation of new family roles, work-related problems, new economic needs of the family, weakening of personal health, social problems, risky life, affecting family nutrition, fear of collapse); (2) opportunities (expansion of home entrepreneurship, availability of other family members, internet businesses) were extracted from the data analysis.

Conclusion: In general, based on the results, the COVID-19 pandemic, in addition to creating numerous personal, family, and social challenges for female heads of households, has also created positive and effective opportunities in their lives. Their resilience and willingness to make sacrifices become even more pronounced, especially during severe crises. Therefore, measures such as financial support from relevant organisations, easy access to necessary health services, and promoting their ability to manage situations in times of crisis through strengthening their resilience as a key strategy for coping with adversity can play a vital role in enhancing the health and quality of life of female heads of households and their children.