Porto biomedical journal最新文献

Background: Around 59,000 rabies deaths still occur annually. According to WHO, India accounts for 36% of the global deaths due to rabies and 65% of the deaths due to rabies in the Southeast Asia region. India, being highly endemic for rabies, has the largest number of animal bites in the World. So, this study will identify the high-risk areas for dog bites in India through geospatial analysis for better outcomes.

Objectives: To analyze the trends in dog bite cases in India from 2018 to 2023 and to identify the high-risk areas using geospatial analysis.

Methods: A retrospective analysis was conducted using open government data on dog bite cases across Indian states and union territories from 2018 to 2023. A geospatial analysis was done year-wise to identify high-risk areas for dog bites.

Results: Dog bite cases peaked in 2018 (7.57 million), followed by a steady decline until 2022 (2.18 million), with an increase in 2023 (2.76 million). Uttar Pradesh, Bihar, and Maharashtra consistently reported the highest burden.

Conclusions: While India has made progress in dog bite reduction through vaccination and sterilization programs, the increase in 2023 highlights the need for sustained efforts. Strengthening surveillance, improving public awareness, and ensuring widespread access to rabies prophylaxis are crucial for long-term control. Future research should focus on socioenvironmental determinants and intervention effectiveness to refine public health strategies.

Background: To assess the prevalence and indications for the use of benzodiazepines (BZDs) in patients admitted to an acute geriatric unit and to evaluate changes in their prescriptions.

Methods: BZD indications were investigated using computerized clinical records. Changes in BZD prescriptions were assessed at the time of discharge.

Results: Among the 165 patients included (mean age: 86.7 years, 71.5% women), 60 (36.4%) were taking BZD on admission, 58.3% of which were considered inappropriate. At discharge, BZD discontinuation was observed in 11.7% and dose reduction was initiated in 18.3%.

Conclusions: Most patients using BZD had no clear medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction in a third of patients.

Background: Patients with aortic stenosis undergoing noncardiac surgery pose a dilemma to physicians as they are at an increased risk for complications. This study aims to investigate the effect of aortic stenosis on mortality and other complications in patients with pancreatic cancer undergoing pancreaticoduodenectomy.

Methods: We investigated patients with pancreatic cancer undergoing pancreaticoduodenectomy between 2016 and 2019 using the National Inpatient Sample database. The study population was divided based on the presence or absence of aortic stenosis. Multivariate logistic regression analyses were performed to determine factors associated with in-hospital mortality and other complications.

Results: Of the 16,150 patients with pancreatic cancer who underwent pancreaticoduodenectomy, 165 patients were diagnosed with aortic stenosis. The mean age of patients with aortic stenosis was significantly higher. Patients with aortic stenosis had a significantly higher in-hospital mortality, occurrence of cardiac arrest, and ICU admission compared with patients without aortic stenosis. There was no difference in mechanical ventilation, hospital charges, and length of stay between the two groups.

Conclusions: Aortic stenosis was found to be associated with higher in-hospital mortality and worse outcomes in patients with pancreatic cancer undergoing pancreaticoduodenectomy. Preoperative risk stratification and a multidisciplinary approach to perioperative management, among other measures, should be considered to improve outcomes.

Background: The demand for skill development in the surgical field is critical to achieve the best functional and aesthetic patient results. Therefore, the use of simulation models has become necessary and integrated in training, holding substantial importance in skin reconstruction in the head. These models, while varying for realism and training applications, offer a low-stress, safe, and replicable environment for interns and residents to enhance their surgical technique.

Objective: The aim of this review was to analyze the various head simulators designed for skin flap and skin graft training. The anatomical representation, selected materials, manufacturing process, and validation approaches were examined to provide an overview of the characteristics of the models. In addition, their impact on training was assessed, categorizing the outcome as positive, negative, or with no effect, based on the findings of the reviewed studies.

Methods: Published literature on PubMed and Scopus was gathered through relevant keywords and phrases related to dermatological facial surgery simulators. A narrative synthesis was conducted based on the reporting guidelines of the synthesis without meta-analysis method. The head models were evaluated with overall performance as the primary outcome and confidence, planning and design, and execution as the secondary outcomes.

Results: Thirteen studies on head models for skin procedures were identified between 2004 and 2023. All the simulators reviewed demonstrated variability for supported techniques, composition, manufacturing methods, anatomical detail, and validation approach. Eleven studies demonstrated that the models improved at least one of the selected outcomes. No model was targeted for skin graft reconstruction. Furthermore, none of the models integrated objective feedback mechanisms.

Conclusions: Simulation was proved to enhance the surgical training of dermatological reconstructions in the head, despite variations in realism, complexity and production process. Future efforts should prioritize higher anatomical accuracy, cost-efficiency, and integration of feedback mechanisms to improve the educational value of these tools.

Aim of the study: Hypothermia as the major clinical feature at emergency admission poses a low-frequency yet complex and life-threatening challenge. Limited knowledge about its morbidity, mortality, and influencing factors contributes to the absence of standardized guidelines for rewarming treatments. This retrospective study, the first of its kind in Portugal, aims to fill this gap by examining hypothermic patients in a temperate climate, exploring rewarming treatments, mortality factors, and complications.

Methods: Conducted at the Emergency Department of Centro Hospitalar Vila Nova de Gaia/Espinho, the study spanned from January 2008 to December 2020. Sixty-two patients with body temperatures below 35ºC were included. Data collection focused on patient background, clinical presentation, hypothermia mechanism, reperfusion treatment, and laboratory results. Clinical infection was defined based on symptoms and imaging findings.

Results: The study revealed a diverse cohort, with an average age of 82 and a mortality rate of 33.9%. Clinical infection was prevalent in 51.6% of patients, mostly respiratory (59.4%). Rewarming treatments varied, and no specific method showed significant advantage. Complications included rhabdomyolysis, and late deaths were primarily attributed to infectious diseases, particularly pneumonia.

Conclusions: Taking into account its high mortality rate, accidental hypothermia, demands further research and multicenter data collection for evidence-based treatment strategies. Clinical infection emerged as a significant factor in mortality, prompting a call for increased attention to infectious disease identification and treatment during hypothermic episodes.

Background: Young people are disproportionately affected by human immunodeficiency virus (HIV) despite recent improvements in biomedical prevention strategies. Pre-exposure prophylaxis (PrEP) is an innovative prevention method that has shown significant promise in the fight against HIV. However, there is limited understanding of young people's knowledge and use of PrEP. This study assessed the knowledge, attitude, and uptake of PrEP among students in tertiary institutions in Calabar Metropolis, Nigeria.

Methods: This study used a cross-sectional descriptive design to assess the knowledge, attitude, and uptake of PrEP among 420 students who were recruited using a multistage sampling technique. A structured questionnaire was utilized to obtain relevant data from participants on PrEP. Data were exported to and analyzed using Statistical Product and Service Solution (SPSS) version 26 to produce descriptive and inferential statistics.

Results: Among respondents who have heard about PrEP (51.7%), more than half (58.1%) had a high level of knowledge of PrEP. Most of the respondents (84.3%) were willing to use PrEP in the future. PrEP use among the sexually active participants was poor, as only 13 (6%) have ever used it. Factors affecting the uptake of PrEP include lack of information on where and how to access PrEP (48.3%), lack of PrEP knowledge (46.5%), friend's disapproval (44.6%), unavailability (45%), fear of side effects (38.2%), and perception that PrEP could be expensive. Chi-square analysis showed that age (P = 0.033) and tribe (P < 0.001) were significantly associated with uptake of PrEP among participants.

Conclusion: This study highlights the need to address abysmal PrEP uptake among participants by improving awareness and knowledge and translating participants' willingness to use PrEP into service uptake. Equally critical is leveraging multifaceted approaches to tackle identified barriers mitigating the use of PrEP among this group, whose vulnerability to HIV infection remains high.

Background: Reducing stillbirth and infant mortality rates has become the primary focus of global public health initiatives to improve maternal and child health. This study aimed to investigate the temporal and spatial variations of stillbirth and infant mortality in Karnataka using the Civil Registration System (CRS) reports, examining trends from 1971 to 2022.

Methods: District-wise summaries of stillbirth and infant mortality rates from CRS reports were analyzed using geospatial techniques, including choropleth mapping and spatial autocorrelation, to assess their distribution across Karnataka districts for selected years (2001, 2010, and 2022).

Results: The findings reveal distinct temporal patterns in stillbirth rates over the study period, allowing for the identification of areas of concern. Dharwad district exhibited the highest stillbirth rate (16.67 per 1,000 total births), whereas Chamarajanagara reported highest infant mortality rate (21.88 infant deaths per 1,000 live births) in 2022. As per 2022 CRS reports, both stillbirth and infant mortality rates were highest in Dharwad, Gadag, Davangere, and Chitradurga districts. Spatial analysis techniques highlight clusters and disparities in stillbirth occurrences among different districts, providing valuable insights into regional variations.

Conclusions: This study highlights a declining trend in the number of stillbirths and reveals substantial spatial disparities in both stillbirth and infant mortality rates across Karnataka. The identification of high-burden districts such as Dharwad, Gadag, Davangere, and Chitradurga emphasizes the need for geographically targeted strategies to improve maternal and child health outcomes.

Background: Clostridium difficile (Clostridioides difficile) infection (CDI) is the most common nosocomial infection in the United States, with mortality rates approaching 25% within 2 months of diagnosis. While current guidelines focus on CDI management once systemic symptoms develop, limited research has explored early predictors of disease severity. Eosinophils play a key role in gut immunity, and prior studies suggest absolute eosinopenia may be associated with severe CDI. This study evaluates the relationship between initial emergency department eosinophil counts and in-hospital mortality, with secondary assessments of admission rates, length of hospital stay, vasopressor use, and the need for surgical intervention.

Methods: We conducted a retrospective cohort study across 3 hospitals from July 1, 2018, to September 1, 2019. Adult patients with a positive Clostridium difficile stool assay and a documented eosinophil count during their emergency department evaluation were included. Patients already on CDI treatment, those younger than 18 years, and those without eosinophil counts were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included admission rates, length of hospital stay, vasopressor use, and surgical intervention. Eosinophil counts were categorized 0.0 cells/μL (absolute eosinopenia) and >0.0 cells/μL. Odds ratios and relative risks were calculated with 95% confidence intervals.

Results: Among 326 patients, 56 had eosinophil counts of 0.0 cells/μL, while 270 had counts >0.0 cells/μL. Patients with eosinophil counts of 0.0 cells/μL had higher mortality (16% vs. 6%, OR: 2.98, 95% CI: 1.25-7.15), increased admission rates (87% vs. 57%, OR: 5.05, 95% CI: 2.23-11.41), and longer hospital stays (7.1 vs. 3.4 days, P < .001). No significant differences were observed in vasopressor use or surgical intervention.

Conclusions: An initial emergency department eosinophil count of 0.0 cells/μL is associated with increased mortality, admission rates, and prolonged hospital stays in CDI. Absolute eosinopenia may serve as an early prognostic marker for disease severity, warranting further prospective investigation.