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Ghana Medical Journal Sep 2023To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have undergone digital subtraction angiography (DSA) at a single centre in... (Observational Study)
Observational Study
OBJECTIVE
To document the location, size, and multiplicity of intracranial aneurysms in Ghanaians who have undergone digital subtraction angiography (DSA) at a single centre in Accra, Ghana.
DESIGN
We conducted a retrospective observational review of the medical records of all patients diagnosed with intracranial aneurysms on DSA.
SETTING
Patients' medical records at Euracare Advanced Diagnostic and Heart Centre were reviewed between March 2018 and March 2020.
PARTICIPANTS
Thirty-one patients were identified with various intracranial aneurysms (IAs) within the study period. Patients' ages, sex, and types of IAs were extracted using a checklist and analysed using Microsoft Excel for Windows 2016.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
The prevalence of types and distribution of intracranial aneurysms.
RESULTS
The age range of the patients was 26-76 years, with a mean age of 45.5±14.3 years. The mean age of men and women with IA was 45.5 ±15.9 years and 46.7 51.3±12.9 years, respectively. The most common IAs were located in the posterior communicating artery (PCOM) at 54.8% (95%CI: 36.0, 72.7), followed by the anterior communicating (ACOM), which constituted 32.3% (95%CI: 16.7, 51.4). The majority, 89.2% (33/37) of these aneurysms were less than 7mm in diameter. Single aneurysms were present in 25 (80.6%).
CONCLUSION
The most common IAs were found in the PCOM and ACOM, and IAs tend to rupture at a younger age and smaller size among the Ghanaian adults examined. Early detection and treatment of IAs less than 7mm in diameter is recommended.
FUNDING
None declared.
Topics: Humans; Intracranial Aneurysm; Ghana; Female; Male; Adult; Middle Aged; Retrospective Studies; Aged; Angiography, Digital Subtraction; Prevalence
PubMed: 38957670
DOI: 10.4314/gmj.v57i3.13 -
JAMIA Open Oct 2024Wrong-patient order entry (WPOE) is a potentially dangerous medical error. It remains unknown if patient photographs reduce WPOE in the pediatric inpatient population.
BACKGROUND
Wrong-patient order entry (WPOE) is a potentially dangerous medical error. It remains unknown if patient photographs reduce WPOE in the pediatric inpatient population.
MATERIALS AND METHODS
Order sessions from a single pediatric hospital system were examined for retract-and-reorder (RAR) events, a surrogate WPOE measure. We determined the association of patient photographs with the proportion of order sessions resulting in a RAR event, adjusted for patient, provider, and ordering context.
RESULTS
In multivariable analysis, the presence of a patient photo in the electronic health record was associated with 40% lower odds of a RAR event (aOR: 0.60, 95% CI: 0.48-0.75), while cardiac and ICU contexts had higher RAR frequency (aOR: 2.12, 95% CI: 1.69-2.67 and 2.05, 95% CI: 1.71-2.45, respectively).
DISCUSSION AND CONCLUSION
Patient photos were associated with lower odds of RAR events in the pediatric inpatient setting, while high acuity locations may be at higher risk. Patient photographs may reduce WPOE without interruptions.
PubMed: 38957593
DOI: 10.1093/jamiaopen/ooae042 -
Annals of Gastroenterological Surgery Jul 2024Operations for malignant diseases of the bile duct, pancreas, and esophagus are the most invasive gastroenterological surgeries. The frequency of complications after...
PURPOSE
Operations for malignant diseases of the bile duct, pancreas, and esophagus are the most invasive gastroenterological surgeries. The frequency of complications after these surgeries is high, which affects the postoperative course and mortality. In patients who undergo these types of surgeries, continuous monitoring of the perioperative central venous oxygen saturation (ScvO) is possible via a central venous catheter. We aimed to investigate the relationship between continuously monitored perioperative ScvO values and postoperative complications.
METHODS
The medical records of 115 patients who underwent highly invasive gastroenterological surgeries and ScvO monitoring from April 2012 to March 2014 were analyzed. Sixty patients met the inclusion criteria, and their ScvO levels were continuously monitored perioperatively. The relationship between ScvO levels and major postoperative complications, defined as Clavien-Dindo grade ≥ III, was examined using uni- and multivariate analysis.
RESULTS
Thirty patients developed major postoperative complications. The adequate cut-off value derived from receiver operating curves of the postoperative average ScvO levels for predicting major complications was 75%. Multivariate analysis revealed that low average postoperative ScvO levels ( = 0.016) and blood loss ≥ 1000 mL ( = 0.039) were significant predictors of major postoperative complications.
CONCLUSIONS
Low perioperative ScvO values were associated with an increased risk of major postoperative complications. Continuous ScvO monitoring will help prevent postoperative complications.
PubMed: 38957557
DOI: 10.1002/ags3.12768 -
JBMR Plus Aug 2024This retrospective study investigates the prevalence of atypical femoral fractures (AFFs) among patients admitted with hip and shaft fractures at a tertiary referral...
This retrospective study investigates the prevalence of atypical femoral fractures (AFFs) among patients admitted with hip and shaft fractures at a tertiary referral center in Beirut, Lebanon. We analyzed electronic medical records and radiology studies of patients aged above 40 admitted with hip and shaft fractures between January 2006 and December 2019. Fractures were confirmed by ICD9 or ICD10 codes. All cases were reviewed by radiologists, and AFFs were identified according to the 2013 revised ASBMR criteria. We identified 1366 hip and shaft fracture patients, of which 14 female patients had 19 AFFs. This represents a prevalence of 1.0% among all hip and shaft fractures patients and 1.7% among all female hip and shaft fracture patients. Bilateral AFFs were found in 5 of the 14 patients. Patients with AFF tended to be younger, with a mean age of 74.3 (±8.6) yr compared to 78.0 (±10.6) for patients with non-AFF fractures. A total of 36% of AFF patients had a prior history of non-traumatic fracture at first admission. A high percentage of patients with AFFs reported intake of proton pump inhibitors (42.9%) and glucocorticoids (21.4%). Bisphosphonate exposure was noted in 64.3% of AFF patients. None of the AFF patients were active smokers or consumed alcohol regularly. BMD assessments were available for 7 AFF patients, indicating osteoporosis in 4 and osteopenia in 3 cases. Hip axis length measurements showed no significant difference between AFF patients ( = 7) and sex and age-matched controls ( = 21). The study underlines the prevalence and characteristics of AFFs in Lebanon, which is consistent with the numbers reported in the literature (0.32%-5%). A larger prospective study that includes hospitals across the nation is needed to gain a more comprehensive view of the prevalence of AFFs in the Lebanese population.
PubMed: 38957400
DOI: 10.1093/jbmrpl/ziae069 -
Frontiers in Pharmacology 2024Natural products are widely used for primary insomnia (PI). This systematic review with trial sequential analysis (TSA) aimed to summarize evidence pertaining to the...
Natural products are widely used for primary insomnia (PI). This systematic review with trial sequential analysis (TSA) aimed to summarize evidence pertaining to the effectiveness and safety of Zao Ren An Shen (ZRAS) prescription, a commercial Chinese polyherbal preparation, for treating PI. Controlled clinical trials appraising ZRAS compared to controls or as an add-on treatment were systematically searched across seven databases until January 2024. Cochrane ROB 2.0 and ROBINS-I tools were adopted to determine risk of bias. Quality of evidence was assessed using the GRADE framework. We analyzed 22 studies, involving 2,142 participants. The effect of ZRAS in reducing Pittsburgh Sleep Quality Index scores was found to be comparable to benzodiazepines [ = 0.39, 95% (-0.12, 0.91), = 0.13] and superior to Z-drugs [ = -1.31, 95% (-2.37, -0.24), = 0.02]. The addition of ZRAS to hypnotics more significantly reduced polysomnographically-recorded sleep onset latency [ = -4.44 min, 95% (-7.98, -0.91), = 0.01] and number of awakenings [ = -0.89 times, 95% (-1.67, -0.10), = 0.03], and increased total sleep time [ = 40.72 min, 95% (25.14, 56.30), < 0.01], with fewer adverse events than hypnotics alone. TSA validated the robustness of these quantitative synthesis results. However, the quality of evidence ranged from very low to low. The limited data available for follow-up did not support meta-synthesis. While ZRAS prescription shows promising effectiveness in treating PI, the overall quality of evidence is limited. Rigorously-designed randomized control trials are warranted to confirm the short-term efficacy of ZRAS and explore its medium-to-long-term efficacy. (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=471497), identifier (CRD42023471497).
PubMed: 38957383
DOI: 10.3389/fphar.2024.1376637 -
Journal of Rheumatic Diseases Jul 2024In this study, the association between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) at diagnosis and poor outcomes of atherosclerosis-related...
The monocyte-to-high-density lipoprotein-cholesterol ratio at diagnosis is associated with cerebrovascular accident during follow-up in patients with antineutrophil cytoplasmic antibody-associated vasculitis.
OBJECTIVE
In this study, the association between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) at diagnosis and poor outcomes of atherosclerosis-related antineutrophil cytoplasmic antibody-associated vasculitis (AAV) during follow-up in patients with AAV was investigated.
METHODS
This retrospective study included 138 patients diagnosed with AAV. Their comprehensive medical records were meticulously reviewed. All-cause mortality, cerebrovascular accident (CVA), and acute coronary syndrome (ACS) were evaluated as atherosclerosis-related poor outcomes of AAV. MHR was obtained by dividing monocyte counts (/mm3) by high-density lipoprotein cholesterol (mg/dL) levels.
RESULTS
The median age of the 138 patients was 58.3 years with 44 being male (31.9%). Among the 138 patients, 11 (8.0%) died, and 11 (8.0%) and 9 (6.5%) had CVA, and ACS, respectively. MHR at diagnosis was significantly correlated with the Birmingham vasculitis activity score, erythrocyte sedimentation rate, and C-reactive protein at diagnosis. Among the three poor outcomes of AAV, only CVA during follow-up was significantly associated with MHR at diagnosis, and thus, only CVA was considered an atherosclerosis-related poor outcome of AAV. In the multivariable Cox hazards model analysis, MHR (hazard ratio [HR] 1.195) and serum albumin (HR 0.203) at diagnosis were independently associated with CVA during follow-up. Additionally, patients with MHR at diagnosis ≥3.0 exhibited a significantly higher risk for CVA and lower cumulative CVA-free survival rate than those with MHR at diagnosis <3.0.
CONCLUSION
This study is the first to demonstrate clinical implications of MHR suggesting that MHR at diagnosis is significantly and independently associated with CVA during follow-up in patients with AAV.
PubMed: 38957360
DOI: 10.4078/jrd.2024.0001 -
Journal of Rheumatic Diseases Jul 2024Giant cell arteritis (GCA) is a large-vessel vasculitis that primarily affects elderly individuals. However, data regarding Korean patients with GCA are scarce owing to...
OBJECTIVE
Giant cell arteritis (GCA) is a large-vessel vasculitis that primarily affects elderly individuals. However, data regarding Korean patients with GCA are scarce owing to its extremely low prevalence in East Asia. This study aimed to investigate the clinical characteristics of Korean patients with GCA and their outcomes, focusing on relapse.
METHODS
The medical records of 27 patients with GCA treated at three tertiary hospitals between 2007 and 2022 were retrospectively reviewed.
RESULTS
Seventeen (63.0%) patients were females, and the median age at diagnosis was 75 years. Large vessel involvement (LVI) was detected in 12 (44.4%) patients, and polymyalgia rheumatica (PMR) was present in 14 (51.9%) patients. Twelve (44.4%) patients had fever at onset. The presence of LVI or concurrent PMR at diagnosis was associated with a longer time to normalization of the C-reactive protein level (p=0.039) or erythrocyte sedimentation rate (p=0.034). During follow-up (median 33.8 months), four (14.8%) patients experienced relapse. Kaplan-Meier analyses showed that relapse was associated with visual loss (p=0.008) and the absence of fever (p=0.004) at onset, but not with LVI or concurrent PMR.
CONCLUSION
Concurrent PMR and LVI were observed in approximately half of Korean patients with GCA, and the elapsed time to normalization of inflammatory markers in these patients was longer. The relapse rate in Korean GCA is lower than that in Western countries, and afebrile patients or patients with vision loss at onset have a higher risk of relapse, suggesting that physicians should carefully monitor patients with these characteristics.
PubMed: 38957359
DOI: 10.4078/jrd.2024.0007 -
European Journal of Midwifery 2024When managing elective and emergency cesarean births in the same operating room, unpredictable variations in the start times of the cesareans can prolong fasting periods.
A retrospective study of pre-operative fasting times prior to elective or emergency cesarean birth in a large maternity hospital: Lessons to be learned to minimize the fasting time.
INTRODUCTION
When managing elective and emergency cesarean births in the same operating room, unpredictable variations in the start times of the cesareans can prolong fasting periods.
METHODS
The fasting times were retrospectively analyzed on 279 consecutive cesarean births at Helsinki University Women's Hospital, Finland, during January-February 2023. The fasting times were compared between the urgency groups and for elective cesareans according to their scheduled order on the operation list. The primary outcome was the difference in the fasting times for food and drink, while the secondary outcome was fasting for both food >12 h and fluids >4 h. The fasting times were compared by one-way ANOVA and chi-squared test, respectively. Dichotomous data are presented as unadjusted odds ratios (OR with 95% CI).
RESULTS
Increasing urgency was associated with shorter fasting times. Fasting times for elective cesareans increased with the scheduled order on the daily list. The mean fasting periods (SD) increased from 10.55 h (SD=1.57) to 14.75 h (SD=2.02) from the first to the third cesarean of the day (p<0.01). The unadjusted odds ratio (95% CI) for fasting of the scheduled cesareans to exceed 12 h for solid foods and 4 h for clear fluids was 6.53 (95% CI: 2.67-15.9, p<0.001), for the third and fourth cesareans compared to the first two cesareans of the day.
CONCLUSIONS
When elective and emergency cesareans are performed by the same team, the woman undergoing the third elective surgery of the day should be advised to have breakfast before 5 a.m. at home. While waiting for the operation, a carbohydrate drink should be offered to limit the fast.
PubMed: 38957355
DOI: 10.18332/ejm/188801 -
Ethiopian Journal of Health Sciences Jan 2024Globally, there were 241 million cases of malaria in 2020, with an estimated 627,000 deaths with Nigeria accounting for 27% of the global malaria cases. In sub-Saharan...
BACKGROUND
Globally, there were 241 million cases of malaria in 2020, with an estimated 627,000 deaths with Nigeria accounting for 27% of the global malaria cases. In sub-Saharan Africa, testing is low with only 28% of children with a fever receiving medical advice or a rapid diagnostic test in 2021. In Nigeria, there are documented reports of over-diagnosis and over-treatment of malaria in children. Therefore, this study examined the diagnosis of malaria at the Benue State University Teaching Hospital, Makurdi.
METHODS
A 5-year (2018-2022) retrospective study was carried out at the Emergency Pediatric Unit (EPU). Records of all children presenting to the EPU with an assessment of malaria were retrieved and reviewed. Data was analyzed using SPSS 23.
RESULTS
Out of 206 children reviewed, 128 (62.1%) were tested using either malaria RDT or microscopy while 78(37.9%) were not tested. Out of the number tested, 59(46.1%) were negative while 69(53.9%) tested positive, of which 14(20.3%) had uncomplicated malaria while 55(79.7%) had severe malaria. However, while 97.1% (n=67) of the positive cases were treated with IV artesunate, 69.5% (n=41) of those who tested negative and 88.5% (69) of those who were not tested also received IV artesunate. Moreover, while 85.5% (n=59) of those who tested positive received oral artemisinin-based combination therapy (ACT), 72.9% (n=43) of those who tested negative and 67.9% (53) of those who were not tested also received oral ACT.
CONCLUSION
There was over-diagnosis of malaria, and subsequently, over-treatment. Hence continued emphasis on parasitological confirmation of malaria before treatment is recommended.
Topics: Humans; Nigeria; Retrospective Studies; Child, Preschool; Hospitals, Teaching; Female; Male; Child; Antimalarials; Emergency Service, Hospital; Malaria; Infant; Artemisinins; Adolescent
PubMed: 38957335
DOI: 10.4314/ejhs.v34i1.5 -
Frontiers in Medicine 2024The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby...
BACKGROUND
The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality.
METHODS
In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk.
RESULTS
The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively.
CONCLUSION
The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.
PubMed: 38957300
DOI: 10.3389/fmed.2024.1419690