Health Science Reports最新文献

Purpose

To evaluate possible problems during pregnancy or delivery in women with pediatric bladder augmentation.

Methods

Eleven of 59 women, who had undergone bladder augmentation in our pediatric hospital during 1990–2019, had given birth in our hospital district afterwards and their obstetrical records were evaluated.

Results

Median age at first delivery was 32 years (range 26–42). Six patients had myelomeningocele, two had bladder exstrophy and the remainder had VATER association, epispadias or traumatic paraplegia with vesicovaginal fistula. The patients had altogether 18 children (all singletons). Catheterizations were performed through continent stoma in six cases and through urethra in five cases. None of the patients needed an indwelling catheter before delivery. Antibiotic prophylaxis was initially in use during two pregnancies. Symptomatic urinary tract infections (UTIs) developed for five mothers in 11 pregnancies without prophylaxis and prophylaxis was continued after UTI in these cases. Three of the five mothers with UTI were treated with intravenous antibiotics due to pseudomonas infection (three infections) or pyelonephritis (one).

Two patients with myelomeningocele delivered vaginally (one woman three times and one woman once). In the remaining 14 cases a cesarean section (CS) was performed (two urgent and one emergency CS). A urologist was present in seven CSs. Some difficulties accessing the uterus were reported in seven surgeries. There were 10-term, three late-preterm and one very preterm delivery. In four cases the information on gestational age was unavailable. Six newborns had respiratory problems, two had severe asphyxia. One newborn had myelomeningocele like her mother.

Conclusions

Risk for UTIs during pregnancy is high in bladder augmentation patients, hence prophylactic antibiotics are justified. A multidisciplinary team should be involved in the planning of delivery. When indicated for obstetrical or urological reasons, an elective cesarean section with a urologist present may be the most rational option for many, although vaginal delivery is possible in selected patients.

Background

Lassa fever (LF) is a viral hemorrhagic illness endemic in Nigeria and other West African countries. In recent years, the number of reported cases of LF in Nigeria has increased. In this study, we discussed the epidemiology of LF, the phylogenomics of the LF virus, issues associated with the increased cases of LF, and recommendations for tackling the future occurrence of LF in Nigeria.

Methods

Epidemiology data on LF were obtained from the Nigeria Centre for Disease Control database and analyzed using Microsoft Excel software. About 59 partial and complete sequences consisting of both small and large segments of the LF virus were retrieved from the National Center for Biotechnology Information from 1969 to 2013 to study the evolutionary relationship of the LF virus in Nigeria.

Results

Nigeria has been shown to have the highest prevalence of Lassa fever among African countries, with seasonal occurrence in both wet and dry seasons. Furthermore, the phylogenetic analysis of the LF virus showed a great relationship with several outbreaks of LF in Nigeria and other African countries.

Conclusion

To combat the increasing cases of LF in Nigeria, there is a need to increase the molecular diagnosis capacity in Nigeria, improve public health awareness about the disease in rural and urban settlements, integrate a surveillance system through the One Health lens, and support LF vaccine research in Africa.

Background

Persons with disabilities (PWD) are often marginalized and face barriers to accessing health services. This study aimed to examine the COVID-19 vaccine uptake and its predictors among PWDs in the Ashanti region of Ghana, where about 17% of the population has some form of disability.

Methods

A cross-sectional survey was conducted among 402 PWDs in two districts of the Ashanti Region of Ghana from December 2021 to March 2022. Data were collected using a pretested structured questionnaire and analyzed using descriptive (frequencies and percentages) and inferential statistics (binary logistic regression).

Results

The majority (68.7%) of the respondents had received the COVID-19 vaccine. The vaccine uptake was significantly higher among PWDs with visual impairments (aOR = 1.81; 95% CI = 1.07–3.09; p = 0.028), older age groups (aOR = 4.95; 95% CI = 1.86–13.21; p = 0.001 for those aged 60 and above), those with junior high school level of education (aOR = 2.21; 95% CI = 1.05–4.64; p = 0.036), and those who were employed (aOR = 2.07; 95% CI = 1.07–3.99; p = 0.031), compared to their respective reference groups.

Conclusion

The study revealed a moderate level of COVID-19 vaccine uptake among PWDs in the Ashanti region, which may indicate some positive attitudes towards the prevention of the virus. However, there were disparities in the vaccine uptake by disability type, age, education, and employment status, which suggest the need for tailored interventions to address the specific needs and preferences of different subgroups of PWDs. The study also provides a basis for further research on the factors influencing COVID-19 vaccine acceptance among PWDs in Ghana and other similar settings. To enhance the vaccine coverage and equity among the marginalized groups in the region, more practical and inclusive strategies are needed to overcome the barriers and challenges faced by PWDs in accessing the COVID-19 vaccine.

Background and Aims

Butalbital is an acute headache medication commonly prescribed for tension-type headache (TTH), although discouraged by guidelines due to a risk of medication overuse headache (MOH). Considering spinal manipulative therapy (SMT) may reduce TTH frequency and intensity, we hypothesized adults with TTH receiving chiropractic SMT would be less likely to receive a butalbital prescription over 2 years versus matched controls not receiving SMT. We secondarily compared likelihood of MOH between cohorts.

Methods

We searched a United States medical records database of patients attending academic medical centers for adults with TTH, from 2013 to 2024, excluding those diagnosed with other headaches and seen in inpatient/emergency settings. We divided patients into two cohorts: (1) SMT and (2) non-SMT, using propensity matching to control for demographics and other variables associated with likelihood of butalbital prescription and MOH.

Results

Three thousand one hundred and sixteen patients remained per cohort after matching. The incidence of butalbital prescription was lower in the SMT cohort compared to the non-SMT cohort (SMT: 1.7%; non-SMT: 3.8%), yielding an RR (95% CI) of 0.46 (0.33–0.63; p < 0.001). The incidence of MOH was lower in the SMT cohort versus non-SMT cohort (SMT: 0.5%; non-SMT: 1.2%), yielding an RR (95% CI) of 0.44 (0.25–0.80; p < 0.001).

Conclusion

Adults receiving chiropractic SMT had a significantly lower likelihood of butalbital prescription and, tentatively, MOH compared to matched controls not receiving SMT. These findings support current guideline recommendations favoring SMT in TTH care, though future studies should replicate and compare these findings with other nonpharmacologic clinicians and interventions.

Background and Aims

Pathogenic microbial infections are closely related to the development and prognosis of esophageal cancer. The distribution and resistance of pathogens in different diseases are regional and gradually change over time. This study aimed to determine the distribution and drug resistance of pathogens isolated from patients with esophageal cancer and provide a reference for the rational use of antibiotics.

Methods

The results of strain identification and antimicrobial susceptibility testing of pathogens in patients with esophageal cancer from January 2013 to December 2022 at our hospital were retrospectively analyzed. SPSS Statistics 26.0 (IBM) and R software 4.3.1 were used for data analysis.

Results

In total, 2322 non-repetitive pathogens were isolated from 14,037 samples. Of all strains, 1713 (73.77%) were Gram-negative bacteria, 483 (20.80%) were Gram-positive bacteria, and 126 (5.43%) were fungi. The top 10 pathogens were Pseudomonas aeruginosa (19.81%), Stenotrophomonas maltophilia (12.88%), A. baumannii (9.91%), Klebsiella pneumoniae (9.82%), Staphylococcus aureus (7.54%), Candida albicans (3.92%), Staphylococcus epidermidis (3.19%), Escherichia coli (3.14%), Enterococcus faecalis (2.97%), and Serratia marcescens (2.15%). The isolation rate of S. maltophilia showed an upward trend (p < 0.05). The resistance rates of P. aeruginosa, S. maltophilia, A. baumannii, and Enterobacteriaceae bacteria to some common antibiotics showed a tendency to change (p < 0.05), and 2019 became a turning point to some extent. All common Gram-positive pathogens were sensitive to vancomycin, except for three Enterococcus spp. isolates that showed intrinsic resistance. The prevalence of MRSA was 65.14% (114/175) in this study. In addition, the resistance rates of MRSA and MSSA to moxifloxacin, ciprofloxacin, levofloxacin, erythromycin, clindamycin, and penicillin were significantly different (p < 0.001).

Conclusion

Pathogens are diverse in patients with esophageal cancer, with the most common being P. aeruginosa, followed by S. maltophilia. The pathogens exhibited different patterns of resistance. Antibiotics should be used rationally according to pathogen resistance patterns.

Background and Aims

Due to the increasing use of imaging services, this study aimed to estimate the number of unnecessary imaging services, normal and abnormal imaging examinations, and their determinant factors.

Methods

This cross-sectional study was conducted at a district hospital in East Azerbaijan, Iran. Retrospective data were collected from the electronic medical records of patients referred to the Imaging Department between March and August 2022, using the Hospital Information System (HIS). Descriptive statistics and χ² tests were performed, followed by hierarchical logistic regression with AOR, 95% CI, using SPSS-24 for analysis.

Results

About 28% of imaging examinations with abnormal results and 21% of the examinations with normal results were unnecessary. The probability of ultrasound abnormal imaging results was 67% lower than computed tomography (CT) scan (CT-scan) (adjusted odds ratio (AOR) = 0.33 (0.212–0.50); p < 0.001). One year increase of patient age is associated with a 1% lower likelihood of having normal imaging (AOR = 0.99 (0.98–0.99); p < 0/001). Women were 20% less likely than men to have abnormal imaging results (AOR = 0.80 (0.65–0.98); p = 0.035). The probability of necessary imaging decreases by 1% for 1 year increase in patient age (p = 0.017), on the other hand, the probability of unnecessary chest radiography was 5% higher than a brain CT-scan imaging (AOR = 2.05 (1.19–3.51); p = 0.009).

Conclusions

Unnecessary imaging were more frequently performed on the older patients. Additionally, ultrasound was less likely than CT-scans to show abnormal findings, while chest radiography was more frequently deemed unnecessary compared to brain CT-scans. These insights highlight the need for age- and modality-specific guidelines to reduce unnecessary imaging and improve diagnostic efficiency.

Background and Aims

The diagnosis and management of soft tissue sarcoma (STS) in sub-Saharan Africa (SSA) present significant challenges. Positive outcomes in STS treatment include achieving negative margins, improved quality of life, and reduced recurrence rates, while negative outcomes involve incomplete resection, local recurrence, and surgical complications. This review aims to examine the current state of STS management in SSA, identify key challenges, and propose potential solutions to improve patient outcomes.

Methods

A comprehensive review of the literature using PubMed/MEDLINE, Google Scholar, and Scopus, focusing on English-language studies examining the management of STS in SSA. Inclusion criteria centered on studies reporting on surgical interventions, outcomes, and healthcare challenges in the region. Articles lacking sufficient data, non-English sources, conference abstracts, and duplicates were excluded.

Results

Findings highlight several obstacles in the management of STS in SSA, including limited multidisciplinary teams, inadequate healthcare infrastructure, financial constraints, and lack of standardized treatment protocols. Key themes such as diagnostic capacity and resource allocation were identified as significant barriers.

Conclusion

Improving STS outcomes in SSA requires investment in healthcare infrastructure, professional development, enhanced funding, and collaborative research. Addressing these gaps is crucial to achieving better surgical management and improving survival rates for patients with STS in SSA.

Background and Aims

There are still no useful biomarkers for the prognosis of esophageal squamous cell carcinoma (ESCC). In the prognosis of some kinds of cancer, soluble programmed death 1 (sPD-1) and programmed death ligand 1 (sPD-L1) have demonstrated statistical significance, but the prognostic value of serum sPD-L1 and sPD-1 remains unclear in ESCC.

Methods

Here, a meta-analysis was performed to estimate the prognostic value of sPD-L1 and sPD-1 in ESCC. To obtain eligible studies, we searched mainstream databases (PubMed, Cochrane, Embase, Web of Science, Wanfang Data, and CNKI), and the survival data including hazard ratios (HR) and its 95% confidence intervals (95% CI) from included literature were extracted.

Results

Six articles were included, including 645 patients with ESCC. The statistical result of this meta-analysis indicated that serum sPD-1 had no significant correlation with overall survival (OS) of patients with ESCC (p > 0.05). Patients with ESCC with high concentrations of serum sPD-L1 demonstrated a significantly poor prognosis (HR = 1.73, 95% CI: 1.42–2.11, p < 0.001).

Conclusion

Higher levels of serum sPD-L1 may predict poor OS in ESCC patients, which may be a promising and credible prognostic biomarker for esophageal cancer.