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Prior work has found incongruencies in injury information reported by crash and hospital records. However, no work has focused on child passengers. The objective of this study was to compare crash scene and hospital-reported injury information for crash-involved child passengers. This study also explored injury location and severity by child age and restraint type. Utilizing linked New Jersey data from 2017 through 2019, the authors identified crash-involved child passengers <13 years old and their injuries in crash and hospital reports. Then, they characterized the congruency of injury frequency, severity, and location, as well as the frequency of injuries by child age and restraint type. Analyses were conducted from December 2023 through February 2024. Of 84,060 crash-involved child passengers, crash reports documented 7,858 (9%) children with at least "possible" injuries, while 2,577 (3%) had at least one injury in hospital events. Crash report and hospital data were incongruent for both body region of injury and injury severity. The proportion of children injured increased as children's ages increased and as restraint type progressed. Crash reports overestimated the number of injured child passengers and misrepresented injury severity and locations. Child restraint systems mitigated a child's injury risk. Importantly, injury information documented on crash reports currently informs the allocation of traffic safety resources. These results highlight the importance of improving these reports' accuracy and underscore calls to link administrative datasets for public health efforts. [ABSTRACT FROM AUTHOR]

Antibiotics are frequently administered in the neonatal period and early infancy. Little is known about the long-term health consequences of early life antibiotic exposure. The objective is to investigate the association between neonatal and early life (0–6 months) antibiotic treatment and the development of atopic dermatitis, asthma and the use of inhaled corticosteroid medication later in childhood. We analyzed data obtained from hospital records and national registers in a cohort of 11,255 children. The association between early antibiotic exposure and the outcomes were analyzed using logistic regression. Confounding factors were included in the model. Neonatal antibiotic therapy for confirmed infection was associated with childhood atopic dermatitis (adjusted odds ratio 1.49; 95% confidence interval 1.15–1.94). Antibiotic therapy by six months of age was more common in children developing atopic dermatitis (adjusted odds ratio 1.38; 95% confidence interval 1.15–1.64), asthma (adjusted odds ratio 1.56; 95% confidence interval 1.32- 1.85) and inhaled corticosteroid medication use (adjusted odds ratio 1.88; 95% confidence interval 1.66–2.13). Conclusions: Neonatal antibiotic therapy for confirmed or clinically diagnosed infection is associated with increased risk of atopic dermatitis later in childhood. Antibiotic treatment before six months of age is associated with atopic dermatitis, asthma and inhaled corticosteroid use. What is known: • The use of antibiotics early in life has been associated with an increased risk of developing atopic dermatitis or asthma. • Confounding by indication or reverse causation may underlie the observed associations. What is new: • Our results demonstrate that neonatal antibiotic therapy for confirmed or clinically diagnosed infection was associated with increased risk of atopic dermatitis and antibiotic treatment before six months of age was associated with atopic dermatitis, asthma and inhaled corticosteroid use in analyses adjusted for confounding factors. [ABSTRACT FROM AUTHOR]

Background: Malaria remains a significant concern for children under five in malaria-endemic regions. Rwanda's successful efforts in malaria treatment reduced nationwide cases, but high mortality persists in the Eastern and Southern provinces. This study aimed to investigate the clinical features of severe malaria and to identify the death risk factors among under-five children in Eastern province Hospitals. Methods: This cross-sectional study assessed severe malaria-related mortality and associated factors among children aged under five years in hospitals of Eastern Province, Rwanda, from 2017 to 2021. Data were collected from hospital records, and descriptive statistics and logistic regression were used for data analysis. Results: Factors associated with severe malaria-related mortality included coma (aOR: 10, 95% CI: 1.2–82.5, p = 0.03), Vomiting (aOR: 5.2, 95% CI: 1.0–26.0, p = 0.04), four or more days of illness before consultation (aOR: 30.9, 95% CI: 8.7–109.9, p < 0.01). On the other hand, a low parasitaemia level (aOR: 0.01, 95% CI: 0.0–0.1, p < 0.01). Conclusion: In conclusion, coma, vomiting, and healthcare delays increased mortality in children with severe malaria. Prompt treatment, proper assessments, protocol adherence, and caregiver education on early symptom recognition are crucial for improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Status asthmaticus is a severe, life-threatening asthma exacerbation requiring urgent medical intervention. This study aims to examine its epidemiology in Timis County, Romania, over 11 years. Methods: A retrospective analysis was conducted using hospital records from 2013 to 2023, focusing on demographic, geospatial, and temporal distributions. Network analysis of the recorded comorbidities was used to identify phenotypic clusters among patients. Results: Females and older adults were disproportionately affected. Several triggers and geospatial patterns were identified. Five phenotypic clusters were determined: two in the T2-high endotype, two in T2-low, and a mixed one. Conclusions: The findings highlight the need for personalized asthma management strategies and public healthcare interventions in Timiș County, addressing specific demographic and geospatial factors. This study also provides a valuable reference for similar regions. [ABSTRACT FROM AUTHOR]

Background: Postoperative mortality might be influenced by postoperative care, vigilance, and competence to rescue. This study aims to describe the course of events preceding death in a high‐risk surgical cohort. Methods: We analyzed hospital records of patients who died within 30 days after surgery in 4 high volume hospitals using (1) reflective narrative thematic approach to identify recurring themes reflecting issues with conduct of care and (2) Global Trigger Tool to describe incidence, timing, and types of adverse events (AEs) leading to harm. Results: Preoperative predicted median risk of death in the studied group was 9%/13% according to SORT/P‐POSSUM, respectively. Nine recurring themes were identified. Prominent themes were "consensus concerning aim and/or risk with planned surgery," "level of (intraoperative) competence and monitoring," and in the postoperative period "level of care and vigilance" on signs of deterioration. We found a total of 303 AEs, with only three patients (5%) having no adverse events. Most common severity category was "I," that is "contributed to patient's death" (n = 110, 36% of all AEs). Of these, 60% were classified as preventable or probably preventable. The peak incidence of AEs was seen on the day of index surgery. Most common types of AEs were "failure of vital functions" (n = 79, 26%), followed by infections (n = 45, 15%). Conclusions: A high predicted risk of death and a peak of adverse events on the day of index surgery were detected. Identified themes reflect lack of documented multi‐professional consensus on how to handle prevalent perioperative risk, vigilance, and postoperative level of care. [ABSTRACT FROM AUTHOR]

Management of undernourished children depends only on wasting yet it can coexist with underweight and/or stunting. Among children admitted to hospital with acute illness, we determined the proportion with wasting coexisting with underweight and/or stunting and their risk factors. A retrospective review of hospital records of children 6‒59 months old admitted at Garissa County referral hospital, Kenya, from January 2017 to December 2019 was conducted. Using World Health Organization 2006 growth standards, undernutrition were defined: wasting as Weight‐for‐height Z‐score < −2, stunting Height‐for‐age Z‐score < −2 and underweight Weight‐for‐age Z‐score < −2. We studied wasting coexisting with underweight and/or stunting. Among 624 children recruited, 347 (56%) were males and 511 (82%) <24 months old. Diarrhoea 210 (34%) and pallor/anaemia 310 (50%) were the most frequent admission diagnosis. HIV infection was present among 8 (1.3%) children. Wasting, underweight and stunting were present among 595 (95%), 518 (83%) and 176 (28%) children respectively. 161 (26%), 506 (81%) and 161 (26%) children had wasting coexisting with stunting, underweight and both stunting and underweight respectively. In the multivariable regression, diarrhoea was positively associated with wasting coexisting with stunting (adjusted risk ratio [aRR = 2.96] [95% CI = 2.06‒4.23]) and anaemia with wasting coexisting with underweight (aRR = 1.23) (95% CI = 1.03‒1.47). Overall, 343 (55%) children were discharged alive, 67 (11%) absconded from the wards, 164 (26%) were transferred to another hospital and 50 (8.0%) died before discharge. The risk of inpatient death was 10.3%, 7.9%, 8.4% and 6.8% among children not wasted, wasted only, wasted & underweight, and wasted and underweight and stunted respectively (Chi‐square p = 0.60). The study reports an unacceptably high levels of undernourishment, including coexisting forms of undernutrition among hospitalised children. This highlights a public health priority for current nutrition therapeutic care and need of continuity of care among those children discharged alive in the community‐based management of acute malnutrition programmes. [ABSTRACT FROM AUTHOR]

Background: We sought to estimate the prevalence and clinical characteristics of paroxysmal sympathetic hyperactivity (PSH) in childhood tuberculous meningitis. Methods: Hospital records of children (6 months to 14 years) with tuberculous meningitis were retrospectively analyzed from September 2019 through January 2022. In September 2019, the first case of paroxysmal sympathetic hyperactivity in tuberculous meningitis was identified in our division. Since then, all admitted children with tuberculous meningitis have been screened for paroxysmal sympathetic hyperactivity using the Paroxysmal Sympathetic Hyperactivity Assessment Measure (PSH-AM). Paroxysmal sympathetic hyperactivity is suspected when any of the following are present: recurrence of fever after initial defervescence, episodic posturing, dystonia, or unexplained tachycardia. Outcome at 3 months was prospectively scored according to the Pediatric Cerebral Performance Category score. Results: Forty-one hospital records of children with tuberculous meningitis were analyzed, and 6 of them had paroxysmal sympathetic hyperactivity (probable paroxysmal sympathetic hyperactivity, 5/6; possible paroxysmal sympathetic hyperactivity, 1/6). Paroxysmal sympathetic hyperactivity appeared after a mean duration of 17 weeks (range: 12-25 weeks) from the diagnosis of tuberculous meningitis in 4 of 6 children and at 4 weeks in 2 of 6 children. Children with tuberculous meningitis who developed paroxysmal sympathetic hyperactivity were younger (median age: 5 years) compared with the nonparoxysmal sympathetic hyperactivity tuberculous meningitis cohort (median age: 10 years). A high proportion of children who developed paroxysmal sympathetic hyperactivity had hydrocephalus at presentation (5 of 6 [83.3%] vs 12 of 35 [34.3%], P =.035). Hospital stay was significantly prolonged in children with probable paroxysmal sympathetic hyperactivity (mean: 71.2 ± 26.8 days) compared with tuberculous meningitis without paroxysmal sympathetic hyperactivity (mean: 20.8 ± 11.6 days; P <.0001). Conclusion: Paroxysmal sympathetic hyperactivity is a late complication of tuberculous meningitis observed in 14.6% cases and should be anticipated in children with reappearance of fever or neurologic worsening without any apparent cause. [ABSTRACT FROM AUTHOR]

Background: In both the elderly and children, pneumonia remains one of the leading causes of hospitalization. This study aimed to assess the impact of pneumonia-related hospitalizations in the population over 65 years of age in the Veneto Region. Methods: This retrospective study analyzed hospital discharge records for patients aged 65 and older who resided in the Veneto Region and had a diagnosis of pneumonia from 2007 to 2023. The hospitalizations were identified using specific ICD-9-CM codes for pneumonia as a discharge diagnosis. Hospitalization rates, mortality rates, the prevalence of complications and comorbidities, the length of stay, and associated costs were calculated by age and year. Results: From 2007 to 2023, there were 139,201 hospitalizations for pneumonia. Emergency admissions accounted for 92.1% of these cases, and only 2.0% had a specific diagnosis of pneumococcal pneumonia. The median length of stay was 10 days, and the median diagnosis-related group (DRG) tariff per hospitalization was EUR 3307. Excluding the pandemic years, the hospitalization rates remained stable at approximately 850 cases per 100,000 inhabitants before 2019. After 2022, the rates started to increase again. Overall, in the investigated period, the results showed a negative trend (average Annual Percentage Change (AAPC) of −1.931, p < 0.0001). However, when only considering the pre-pandemic years, the trend was stable, while a decline was observed starting in 2020 (AAPC of −19.697, p = 0.001). The overall discharge mortality rates ranged from 13% to 19.3% but were significantly higher in those over 85 years of age (20.6% compared with 6.5% and 12.0% in the 65–74 and 75–84 age groups, respectively). Conclusions: This study highlights the substantial burden of pneumonia in individuals over 65 years of age, showing the impacts on public health. [ABSTRACT FROM AUTHOR]

Background Acute kidney injury (AKI) is a significant challenge in healthcare. While there are considerable researches dedicated to AKI patients, a crucial factor in their renal function recovery, is often overlooked. Thus, our study aims to address this issue through the development of a machine learning model to predict restoration of kidney function in patients with AKI. Methods Our study encompassed data from 350,345 cases, derived from three hospitals. AKI was classified in accordance with the Kidney Disease: Improving Global Outcomes. Criteria for recovery were established as either a 33% decrease in serum creatinine levels at AKI onset, which was initially employed for the diagnosis of AKI. We employed various machine learning models, selecting 43 pertinent features for analysis. Results Our analysis contained 7,041 and 2,929 patients’ data from internal cohort and external cohort respectively. The Categorical Boosting Model demonstrated significant predictive accuracy, as evidenced by an internal area under the receiver operating characteristic (AUROC) of 0.7860, and an external AUROC score of 0.7316, thereby confirming its robustness in predictive performance. SHapley Additive exPlanations (SHAP) values were employed to explain key factors impacting recovery of renal function in AKI patients. Conclusion This study presented a machine learning approach for predicting renal function recovery in patients with AKI. The model performance was assessed across distinct hospital settings, which revealed its efficacy. Although the model exhibited favorable outcomes, the necessity for further enhancements and the incorporation of more diverse datasets is imperative for its application in real-world.

Background Astrovirus is a leading cause of acute gastroenteritis in children worldwide. However, few prospective studies have analyzed astrovirus in community-dwelling pediatric populations in low- and middle-income countries. Methods We assessed the incidence, risk factors, clinical characteristics, genotypes, viral coinfections, and time distribution of astrovirus gastroenteritis in 443 healthy Nicaraguan children born in 2017 to 2018 who were followed for 36 months. Children were recruited from hospitals and birth records in an economically diverse neighborhood of León city. Astrovirus-positive episodes and genotypes were identified from stool with reverse transcription quantitative polymerase chain reaction and Sanger sequencing. Results Of 1708 total specimens tested, 80 children (18%) experienced at least 1 astrovirus episode, and 9 experienced repeat episodes, mostly during the rainy season (May–October). Initial astrovirus episodes were not associated with a lowered risk against future episodes. In exploratory analyses, home toilets were associated with a lower risk of future astrovirus episodes (hazard ratio, 0.19; 95% CI,.04–.91). Human astrovirus 5 episodes, representing 15% of all typed episodes, were associated with longer diarrhea and more symptomatic rotavirus coinfections. Conclusions Astrovirus was a common cause of gastroenteritis in this cohort, and future studies should clarify the role of astrovirus genotype in clinical infection severity. [ABSTRACT FROM AUTHOR]

Objectives: Anti-melanoma differentiation associated gene 5 antibody (anti-MDA5 Ab)-positive dermatomyositis (DM) is a representative of rapidly progressive interstitial pneumonia. However, its association with thrombotic microangiopathy (TMA), characterized by thrombocytopenia, haemolytic anaemia, and organ dysfunction, has not been defined. This study aimed to elucidate the characteristics of anti-MDA5 Ab-positive DM accompanied by TMA. Methods: We reviewed our hospital records from November 2009 to September 2022. We included patients in accordance with the 2017 European League Against Rheumatism/American College of Rheumatology classification criteria and the criteria of Bohan and Peter. TMA was diagnosed according to the criteria for transplantation-associated TMA proposed by the International Working Group. Results: This study enrolled a total of 26 anti-MDA5 Ab-positive DM patients, four of whom developed TMA. The patients with TMA had an increased urine protein/creatinine ratio. In addition, these four of them showed significantly elevated levels of ferritin and anti-MDA5 Ab titers and were considered to have high disease activity; yet, all of them survived. Conclusions: Our study indicated that anti-MDA5 Ab-positive DM patients with hyperferritinemia, a high anti-MDA5 Ab titer, and an increased urine protein/creatinine ratio should be carefully managed, bearing in mind a complication of TMA. [ABSTRACT FROM AUTHOR]

Background: Ghana is a malaria-endemic country with the entire population at risk. The Northern region of the country recorded the highest malaria case fatality rate (CFR) for two consecutive years: 1.11% in 2013 and 1.07% in 2014. Even though the National Malaria Elimination Programme (NMEP) has achieved a reduction in malaria mortality, the existence of high case fatality in the Northern region was alarming. This study, therefore, aimed to determine the factors associated with malaria mortality in the northern region of Ghana to institute control measures. Methods: An unmatched case control study was conducted from July 2015 to August 2015. The study population consisted of patients admitted to health facilities for severe malaria in the Northern region of Ghana. A case was defined as a patient diagnosed with severe malaria at an eligible health facility who died as a result of malaria. A control was a patient diagnosed with severe malaria admitted to an eligible health facility who did not die. Health facilities that recorded CFRs of 1.0% and above were randomly sampled for this study, after which, 10 cases and 20 controls were recruited from each health facility. Information on cases and controls was then abstracted from hospital records using an electronically deployed abstraction tool. Continuous variables were expressed as means and medians, and categorical variables as frequencies and proportions. Multivariable logistic regression was used to assess the strength of the association between malaria mortality and factors predictive of malaria mortality. A p-value of < 0.05 was considered statistically significant. Results: In all, a total of 95 cases and 190 controls participated in this study. The median ages of cases and controls were 4.1 years (IQR = 21.6) and 5.7 years (IQR = 18.2), respectively. Fifty-four (56.8%) cases were females, while 93 (49.0%) of the controls were females. Factors associated with malaria mortality included: duration of hospital stay less than 24 h [aOR: 12.0, 95% CI (5.9–24.6)], severe pallor [aOR: 2.3, 95% CI (1.1–4.6)], children under 5 years [aOR: 2.8, 95% CI (1.4–5.6)], oral Artesunate/Amodiaquine administration [aOR: 0.4, 95% CI (0.2–0.9)] and sepsis as an additional diagnosis [aOR: 4.1, 95% CI (1.8–9.5)]. Conclusion: Predictors of malaria mortality in the Northern region include children under 5 years, severe pallor, sepsis as an additional diagnosis, and use of oral anti-malarial. Patients with severe pallor and sepsis as co-morbidities should receive proactive management. The NMEP and its partners should implement measures to strengthen the referral system, anaemia prevention and management, and retrain health workers on malaria case management. Malaria control interventions targeted at under five children in the region should be reviewed and enhanced. [ABSTRACT FROM AUTHOR]

Background: Strangulation in domestic violence cases represents a severe form of intimate partner violence, often overlooked and under-reported, with potential fatal outcomes. Methods: This cross-sectional study analyzed 130 domestic violence cases involving strangulation over a three-year period from 2020 to 2023 in a metropolitan area. Data were collected from hospital records, police reports, and forensic examinations. Results: The study found that the majority of the victims were females aged between 25 and 40 years. There was a significant association between the occurrence of strangulation and subsequent severe injuries or fatalities. Legal outcomes varied significantly based on the evidence collected during initial investigations. Conclusions: The findings underscore the critical need for immediate medical and forensic examination in suspected cases of strangulation in domestic violence, which could potentially improve legal outcomes and victim support. [ABSTRACT FROM AUTHOR]

Our aim was to investigate relative contributions of central and peripheral mechanisms to knee osteoarthritis (OA) diagnosis and their independent causal association with knee OA. We performed longitudinal analysis using data from UK-Biobank participants. Knee OA was defined using International Classification of Diseases manual 10 codes from participants' hospital records. Central mechanisms were proxied using multisite chronic pain (MCP) and peripheral mechanisms using body mass index (BMI). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated, and proportional risk contribution (PRC) was estimated from receiveroperator-characteristic (ROC) analysis. To estimate the causal effects, we performed 2-sample multivariable Mendelian Randomisation (MR) analysis. We selected genetic instruments from the largest Genome Wide Association Study of BMI (N 5 806,834) and MCP (N 5 387,649) and estimated the instruments genetic associations with knee OA in the largest available dataset (62,497 cases and 333,557 control subjects). The multivariable MR was performed using modified inverse-variance weighting methods. Of the 203,410 participants, 6% developed knee OA. Both MCP (OR 1.23, 95% CI; 1.21-1.24) and BMI (1.10, 95% CI; 1.10-1.11) were associated with knee OA diagnosis. The PRC was 6.9% (95% CI; 6.7%-7.1%) forMCPand 21.9% (95% CI; 21.4%-22.5%) for BMI; the combined PRC was 38.8% (95% CI; 37.9%-39.8%). Body mass index andMCPhad independent causal effects on knee OA (OR 1.76 [95% CI, 1.64-1.88] and 1.83 [95% CI, 1.54-2.16] per unit change, respectively). In conclusion, peripheral risk factors (eg, BMI) contribute more to the development of knee OA than central risk factors (eg, MCP). Peripheral and central factors are independently causal on knee OA. [ABSTRACT FROM AUTHOR]

Introduction: We investigated 2018 gestational diabetes mellitus (GDM) prevalence estimates in three surveillance systems (National Vital Statistics System, State Inpatient Database, and Pregnancy Risk Assessment Monitoring Survey). Methods: We calculated GDM prevalence for jurisdictions represented in each system; a subset of data was analyzed for people 18–39 years old in 22 jurisdictions present in all three systems to observe dataset-specific demographics and GDM prevalence using comparable categories. Results: GDM prevalence estimates varied widely by data system and within the data subset despite comparable demographics. Discussion: Understanding the differences between GDM surveillance data systems can help researchers better identify people and places at higher risk of GDM. Significance: What is Already Known on this Subject?: Gestational diabetes mellitus (GDM) prevalence varies by data system and population. Estimates of GDM prevalence are essential to inform prevention, identification, and management programs. What this Report Adds?: GDM prevalence estimates varied widely by data system (NVSS, SID, PRAMS) and participant demographics varied only slightly when a subset of comparable data were evaluated using jurisdictions available in all three systems (21 states and the District of Columbia). Understanding the differences between surveillance data systems can help researchers better identify people and places at higher risk of GDM. [ABSTRACT FROM AUTHOR]

Background: Post-operative oral defect is a common problem facing surgeons due to the scarcity of donor sites in the area. The submental flap or submental island pedicled flap (SIPF) offers an alternate approach in orofacial reconstruction, particularly in a setting where freeflap services are unavailable or comprises a big challenge for surgeons and patients. Methods: A retrospective cross-sectional study of patients with oral cavity cancers, who subjected to submental flap reconstruction. Both genders above 18 years were included. Patients with clinically positive neck nodes or who had preoperative radiotherapy were excluded. Hospital records were reviewed and data analyzed in order to assess the utility of submental flap in managing and reconstructing oral defect following excision of tumors at different subsites in a tertiary university hospital. Results: 26 patients were included 16 males and 10 females with age ranging from 38 to 67 years. Primary tumor sites were tongue (9), lower alveolar margin (7), buccal mucosa (6), and floor of mouth (4). All patients subjected to tumor excision and ipsilateral selective neck node dissection following flap creation. Total flap necrosis was evident in one patient, whereas partial flap dehiscence seen in two and infection in two other patients. Over follow up period with mean of 12 months there were 2 regional neck failures. Conclusions Submental flap is a reasonable and easy method to manage small oral cavity defect after resection of small tumors. [ABSTRACT FROM AUTHOR]

Healthcare knowledge management systems can mitigate hospitals' operational inefficiency. As a healthcare information technology, the electronic health record (EHR) receives much attention from medical institutions due to its considerable impact on operational cost performance. This paper focuses on EHR systems to address operational inefficiency by which patients pay more for health care services, and many U.S. hospitals are filing for bankruptcy. From the theoretical perspective of the practice-based view, this paper introduces a path to implement EHR systems for improving cost performance. The empirical investigation is archival data of 200 hospitals collected from the U.S. healthcare agencies. Findings contribute to prior work by hypothesizing moderating and mediating roles in EHR systems implementation. This paper introduces absorptive capacity and monitoring mechanisms as enablers of implementing EHR systems. The results showed that hospital monitoring strengthens the relationship between absorptive capacity and electronic health record systems implementation, which results in better operational cost performance. Theoretically, this study supports the long-term potential benefits of EHR adoption, and its findings are consistent with optimizing efficiency through data standardization and interoperability. From a practical perspective, this study supports hospitals' investments in evolving healthcare information technology systems through the development of a knowledge-based system employing EHR, particularly when hospitals are merging or need a financial strategic plan to control expenses. [ABSTRACT FROM AUTHOR]

Objective: We studied whether the use of hydroxychloroquine (HCQ) for COVID‐19 resulted in supply shortages for patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Methods: We used US claims data (IQVIA PHARMETRICS® Plus for Academics [PHARMETRICS]) and hospital electronic records from Spain (Institut Municipal d'Assistència Sanitària Information System [IMASIS]) to estimate monthly rates of HCQ use between January 2019 and March 2022, in the general population and in patients with RA and SLE. Methotrexate (MTX) use was estimated as a control. Results: More than 13.5 million individuals (13,311,811 PHARMETRICS, 207,646 IMASIS) were included in the general population cohort. RA and SLE cohorts enrolled 135,259 and 39,295 patients, respectively, in PHARMETRICS. Incidence of MTX and HCQ were stable before March 2020. On March 2020, the incidence of HCQ increased by 9‐ and 67‐fold in PHARMETRICS and IMASIS, respectively, and decreased in May 2020. Usage rates of HCQ went back to prepandemic trends in Spain but remained high in the United States, mimicking waves of COVID‐19. No significant changes in HCQ use were noted among patients with RA and SLE. MTX use rates decreased during HCQ approval period for COVID‐19 treatment. Conclusion: Use of HCQ increased dramatically in the general population in both Spain and the United States during March and April 2020. Whereas Spain returned to prepandemic rates after the first wave, use of HCQ remained high and followed waves of COVID‐19 in the United States. However, we found no evidence of general shortages in the use of HCQ for both RA and SLE in the United States. [ABSTRACT FROM AUTHOR]

Background: Studies have long documented the presence of malaria and typhoid fever in sub-Saharan Africa (SSA). However, studies on these diseases have primarily concentrated on rural settings, neglecting the potential impact on urban areas. This knowledge gap hinders effective surveillance and intervention strategies. To bridge this gap, this study investigated the prevalence of malaria and typhoid co-infections in an urban environment. Methods: This study, conducted at Lead City University Hospital in Ibadan, Nigeria (West Africa's largest metropolis), analysed medical records of over 3195 patients seen between April and June 2023. Descriptive statistics and chi-square tests were used to understand how these co-infections were distributed across different age and gender groups. Results: The prevalence of co-infection peaked in May (9.7%), followed by June (8.9%) and April (5.7%). Notably, children aged 6–12 years exhibited the highest co-infection rate (18.5%), while those under five had the lowest (6.3%). Gender analysis indicated a slight difference, with 8.8% of females and 7.1% of males co-infected. Malaria prevalence was highest at the beginning of the rainy season and significantly decreased over time. Conversely, typhoid fever displayed the opposite trend, increasing with the rainy season. Children under five years old were most susceptible to malaria, while typhoid fever predominantly affected adults over 25 years old, with prevalence decreasing significantly with age. Conclusion: This study sheds light on the previously overlooked risk of malaria and typhoid co-infections in urban settings. These findings highlight the need for enhanced surveillance and targeted public health interventions, particularly for vulnerable groups like young children during peak transmission seasons. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions This study aimed to determine adherence with follow‐up from the New Zealand pre‐school vision screening programme. The study also examined associations between pre‐school vision screening outcomes and cognitive measures assessed at the 54‐month follow‐up in the Growing Up in New Zealand study cohort.A cross‐sectional retrospective record review of pre‐school vision screening outcomes and hospital ophthalmology records with linkage to Growing Up in New Zealand cohort study data.Of 176 children referred from vision screening, 21.6% did not attend a referral appointment. Of 138 children who attended a referral appointment, 21.0% did not attend one or more follow‐up appointments. Ethnic differences were observed in attendance at referral appointments (attended Māori 13%, Pacific 22.5%, European/Other 64.5%; not attended Māori 26.3%, Pacific 28.9%, European/Other 44.7%; P = 0.04) and follow‐up appointments (attended Māori 11.9%, Pacific 15.6%, European/Other 72.5%; not attended Māori 17.2%, Pacific 48.3%, European/Other 34.5%; P = 0.001). Vision screening outcome was significantly associated with letter naming fluency scores (P = 0.01) but not name and numbers scores (P = 0.05).Non‐attendance at referral and follow‐up appointments limits the efficacy of vision screening, particularly for children of Māori and Pacific ethnicity. Children referred from vision screening achieve lower scores on letter naming fluency, a key predictor of reading ability in later childhood. Equity‐based improvements are required to ensure that all children referred from vision screening receive appropriate follow‐up eye care. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of fistula in patients undergoing primary cleft palate repair. Study Design: Descriptive Case Series study. Setting: Burns and Plastic Surgery Center, HMC, Peshawar. Period: February 2023 to December 2023. Methods: Patient of both genders males and females undergoing primary cleft palate repair were included in the study with age ranging from 9 to 18 months age excluding patients with comorbids and syndromic patients. Non-probability consecutive sampling was adopted. The data was acquired from patients and hospital record and analyzed with statistical package for social sciences (SPSS). Results: Our study shows that among 169 patients, mean age was 10 months with SD ± 5.11. 100(59%) patients were male and 69(41%) patients were female. More over 3(2%) patients had fistula while 166(98%) patients didn't had fistula. Conclusion: In this study we observed an internationally acceptable frequency of post-palatal repair fistula for primary cleft palate in our study population. [ABSTRACT FROM AUTHOR]

Background: Corona virus diseases-19 (COVID-19) infection has shown many complications in all organ systems, like thyroid gland, during the acute phase and in the post-COVID-19 period. The aim of this study was to find the risk of hypo-functioning thyroid gland during post COVID- 19 period as a chronic complication for possible follow up and management implications. Methods: This combined retrospective-prospective study was conducted over a period of nine months at tertiary care hospitals, Ayub Medical Complex Abbottabad and King Abdullah Hospital, Mansehra. Through non-probability convenient sampling technique, data was collected from 160 records at the hospitals. Confirmed cases of COVID-19, after their consent, were measured for thyroid hormones at two, four and eight weeks. Data was analyzed using Chi-square test. p-value less than 0.05 was considered as significant. Results: Out of 160 study participants, majority 102 (63.75%) were males and 58 (36.25%) were females with mean age of study population of 47.41±14.29 years. The frequency of hypothyroidism decreased over eight weeks from 8 (38.09%) to 6 (28.57%). While subclinical hypothyroidism decreased from 14 (36.89%) to 12 (30.76%). There was a very highly significant (p= 0.0001) association between proportions of hypothyroidism, Euthyroid Sick Syndrome and Subclinical hypothyroidism, and proportions of euthyroid patients in post COVID-19 period over eight weeks. Conclusion: Subclinical hypothyroidism, overt hypothyroidism, Euthyroid Sick Syndrome, and thyrotoxicosis are manifestations of hypo functioning thyroid gland. There is a need to monitor patients over a period of as short as two weeks to two months and beyond for possible detection of these complications of COVID-19 for appropriate management. [ABSTRACT FROM AUTHOR]

Suicide is a major cause of death in today's world. The pattern of suicidal deaths in a particular area points not only to the quality of living but also the social and mental makeup of the population. AIM AND OBJECTIVES: 1. To ascertain suicidal death patterns in and around Madurai. 2. To analyse the data with respect to demographics presentation, methods used for committing suicide. 3. To find out the underlying factors that led to Suicide. METHODOLOGY: The study was conducted at Govt. Rajaji Hospital mortuary, Madurai which covers almost entire district for medicolegal autopsies. The study period was from 01/01/2021 to 31/12/2021 which amounts to one year study. The study design comprised of thoroughly scrutinised information gathered from autopsy related documents, history of relatives of the deceased, hospital records, concerned investigating officers and laboratory report of viscera and other relevant details available in our department. Suicide notes if any were also included. Data was analysed using standard statistical method. RESULTS: Out of 986 cases of suicidal deaths majority of the cases were Male belonging to the age group 21-30 years followed by age group 31-40years. Poisoning and Hanging were the most common methods employed. Most of the victims were of lower socioeconomic class belonging to rural background. Economic instability and family conflict were the most common cause that led to suicides. CONCLUSION: Suicidal deaths are preventable by the combined effort of the Government agencies, adaption of healthy lifestyle, counselling facilities and change in the mindset of the people to adapt to all difficult situations in life. [ABSTRACT FROM AUTHOR]

Background: In patients with symptomatic mitral PVL, successful transcatheter reduction of the PVL to less than mild is associated with significant improvement in short- and midterm survival. Objectives: In this study, we present our single-centre, same operators' experience on percutaneous paravalvular leak closure with techniques and outcomes. Methods: In this retrospective observational designed study, we retrieved hospital records of patients with a surgical history of mechanical or biological prosthetic valve replacement and who subsequently underwent transcatheter mitral paravalvular leak closure (TMPLC). All procedures were performed by the same operators. Results: A total of 45 patients with 58 PVDs underwent TMPLC using 60 devices. All patients had moderate or severe mitral paravalvular regurgitation associated with symptomatic HF (15.6%), clinically significant haemolytic anaemia (57.8%) or both (26.7%). The technical success rate was 91.4%, with 53 defects successfully occluded. The clinical success rate was 75.6%. Among the clinical success parameters, the preprocedural median ejection fraction increased from 45% (35–55) to 50% (40–55) (p =.04). Mitral gradients decreased from max/mean 18/8 mmHg to max/mean 16/7 mmHg; p =.02). Haemoglobin levels increased from 9.9 (8.5–11.1) to 11.1 (3–13); p =.003. LDH levels decreased from 875 (556–1125) to 435 (314–579); p: <.001. All-cause 30-day and in-hospital mortality rates were the same at 8.9%. Conclusion: This single-centre study with a limited number of patients confirmed that TMPLC is a safe and effective procedure to improve symptoms and severity of PVL. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self‐reported survey data, or data on hospital‐recorded infections only, resulting in gaps in data collection.This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011–2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital‐diagnosed prenatal infections and receipt of infection‐related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6‐8 week or 27‐30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross‐motor‐skills, hearing‐communication, vision‐social‐awareness, personal‐social, emotional‐behavioural‐attention and speech‐language‐communication) and (b) the trimester(s) in which infections occurred.After confounder/covariate adjustment, hospital‐diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19–1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07–1.67) and 3 (OR: 1.33; 95% CI: 1.21–1.47), that is the trimesters in which foetal brain myelination occurs. Infection‐related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98–1.08), but were associated with slightly increased odds of concerns specifically related to personal‐social (OR: 1.12; 95% CI: 1.03–1.22) and emotional‐behavioural‐attention (OR: 1.15; 95% CI: 1.08–1.22) development.Prenatal infections, particularly those which are hospital‐diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established. [ABSTRACT FROM AUTHOR]

Objectives: Ghana's quest to reduce neonatal mortality, in hospital facilities and communities, continues to be a nightmare. The pursuit of achieving healthy lives and well-being for neonates as enshrined in Sustainable Development Goal three lingered in challenging hospital facilities and communities. Notwithstanding that, there have been increasing efforts in that direction. This study examines the contributing factors that hinder the fight against neonatal mortality in all hospital facilities in the Sunyani and Sunyani West Municipal Assemblies in Bono Region, Ghana. Methods: The study utilized neonatal mortality data consisting of neonatal deaths, structural facility related variables, medical human resources, types of hospital facilities and natal care. The data was collected longitudinally from 2014 to 2019. These variables were analysed using the negative binomial hurdle regression (NBH) model to determine factors that contribute to this menace at the facility level. Cause-specific deaths were obtained to determine the leading causes of neonatal deaths within health facilities in the two municipal assemblies. Results: The study established that the leading causes of neonatal mortality in these districts are birth asphyxia (46%), premature birth (33%), neonatal sepsis (11%) and neonatal jaundice (7%). The NBH showed that neonatal mortality in hospital facilities depend on the number of incubators, monitoring equipment, hand washing facilities, CPAPb machines, radiant warmers, physiotherapy machines, midwives, paediatric doctors and paediatric nurses in the hospital facility. Conclusions: Early management of neonatal sepsis, birth asphyxia, premature birth and neonatal infections is required to reduce neonatal deaths. The government and all stakeholders in the health sector should provide all hospital facilities with the essential equipment and the medical human resources necessary to eradicate the menace. This will make the realization of Sustainable Development Goal three, which calls for healthy lives and well-being for all, a reality. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The United Nations has set a target to reduce global maternal deaths to less than 70 per 100,000 live births by 2030. However, despite high rates of institutional deliveries in Karnataka, a state in southern India, maternal mortality remains a significant challenge. This study aims to analyse a 10-year period of pregnancy-related deaths in a healthcare centre in Karnataka to identify the causes and avoidable factors contributing to maternal mortality. Material and Methods: A comprehensive review of records from 2009 to 2018 was conducted, gathering data on socio-demographic features, obstetric and medical history, referral details, duration of hospital stay until death, cause of death, organ dysfunction at admission and avoidable factors contributing to maternal death by inputs from expert committee. The percentages of incidences of causes were determined and analysed using binary logistic regression. Results:One hundred nine maternal deaths were reported during the study period. The majority of these deaths occurred in rural areas, with infections and obstetric haemorrhage being the primary causes. A significant number of deaths occurred within 24 hours of admission, including during the postpartum period, with approximately one-fourth of cases being critically ill and nearly half of the cases had multiorgan dysfunction. Delay in seeking health services (42.8%) and failure to recognize early features of infection (36.3%) emerged as a common contributing factor tomaternal deathss. The presence of any delay in receiving obstetric care (odds ratio [OD]= 3.31), referral status (OD= 3.20), and rural residence (OD=3.06) were significant factors contributing to instability at the time of admission. Conclusions: This study underscores the urgent need to address preventable factors contributing to maternal deaths in Karnataka. Strategies should focus on reducing delays in seeking care, improving recognition and management of infection during pregnancy and enhancing access to emergency obstetric services, particularly for women in rural areas. [ABSTRACT FROM AUTHOR]

Copyright of Ege Journal of Medicine is the property of Ege University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Primary objective of the study was to determine the association between the TI-RADS system of thyroid lesion evaluation on ultrasound and the cytological findings of thyroid lesions by FNAC (graded as per the Bethesda system). The secondary objective was to study the outcome of high TI-RADS and high Bethesda grades in terms of malignant potential determined by histopathological examination. Materials and Methods: A multi-centric retrospective hospital-based study was done for all patients who underwent sonography for evaluation of thyroid lesions and subsequently fine needle aspiration cytology (FNAC) from 2018 to 2021 at two hospitals in two different states of India. Clinical and radiological data were obtained from hospital records. The data hence obtained was subjected to statistical analysis. The outcome of high-grade TIRADS and Bethesda scores in terms of malignant potential (confirmed by histopathology) was also evaluated. Results: A total of 249 patients fulfilled the inclusion criteria. 129 patients (51.8%) were in 36-55 year age group with female predominance. The majority of cases in the study belonged to TI-RADS 3 category (33.73%) on sonography and Bethesda Grade III (28.91%) after cytological analysis. Out of 72 Bethesda grade III cases, 59 (81.9%) had TI-RADS 3 score. Similarly, out of 67 Bethesda Grade IV cases, 55 (82%) had TI-RADS 4 scores showing maximum concordance. The accuracy of TIRADS 4 and 5 lesions and Bethesda grade 4-6 lesions in detecting malignancy confirmed on HPE was 67.9 and 73.6%. Discussion: Our study done on 249 patients from varying demographic profiles showed that the correlation between sonography and cytological findings of thyroid lesions was statistically significant. Both diagnostic modalities helped to correctly determine the severity of the lesions, and malignant potential and enabled grading into clinically relevant groups that decided the further management as per laid down guidelines. Conclusion: The concurrent use of ACR-TIRADS on sonography coupled with the Bethesda system of cytological evaluation for thyroid nodules is clinically appropriate in ascertaining the RoM (Risk of malignancy) in a thyroid nodule. [ABSTRACT FROM AUTHOR]

Background and purpose: After a diagnosis of ectopic pregnancy there are two choices for treatment: medical treatment with methotrexate and surgical treatment. It seems that medical treatment, has had acceptable success compared to surgery and lacks the complications of surgery. Nowadays, due to the progress achieved in the early diagnosis of ectopic pregnancy, a large number of patients are candidates for medical treatment. This study is conducted to evaluate the effective factors of medical treatment Response with methotrexate in ectopic pregnancies. Materials and methods: In this case-control study, the information related to patients who were diagnosed with ectopic pregnancy and were treated with methotrexate from March 2016 to March 2021 in Imam Khomeini Hospital in Sari was examined using hospital records by census method. In total, 160 patients out of 623 patients met the inclusion criteria and were studied. In the checklist prepared for each patient, the patient's age, number of gravity and parity and abortion, previous history of infertility, contraceptive method, presence of clinical symptoms (such as abdominal pain-vaginal bleeding-amenorrhea), History of using recent assisted reproductive methods, type of treatment regimen used (Single/Multiple Dose), serum beta human chorionic gonadotropin (BHCG) level before and after starting treatment, number of previous ectopic pregnancy, gestational age based on the last Menstruation, transvaginal ultrasound results(including the presence of the yolk sac & fetal heart rate & hematosalpinx - location and size of the ectopic mass-endometrial thickness) were recorded for each patient separately, The patients were divided into two categories: success and failure of treatment and the effect of different factors on the result of medical treatment with methotrexate was investigated. The collected data were entered into SPSS 26 software and qualitative variables were analyzed with the Chi-Square test. The normality of the distribution of quantitative variables was measured by the One-Sample Kolmogorov-Smirnov test, an independent t-test was used to examine quantitative variables with normal distribution, and the Mann-Whitney test was used for quantitative variables with non-normal distribution. Results: 160 patients were included in this study, 108 of patients (67.5%) were successfully treated and 52 patients (32.5%) faced treatment failure. In this study, the type of treatment regimen (P=0.001), Serum Beta Human Chorionic Gonadotropin (BHCG) level before treatment(P=0.000), BHCG level after treatment (P=0.000), the presence of fetal heart rate (P=0.002) and yolk sac (P=0.046) are factors affecting the response to methotrexate treatment in ectopic pregnancy. The presence of hematosalpinx, size of the ectopic mass, endometrial thickness, history of infertility and recent assisted reproductive procedures, presence of clinical symptoms, contraceptive method, gestational age, history of ectopic pregnancy, number of gravidity and parity, and abortion have no effect on the results of medical treatment with methotrexate. Conclusion: Based on the results obtained, Single Dose regimen of methotrexate treatment is associated with greater treatment success than a multiple-dose regimen and also high serum BHCG levels before and after the treatment, the presence of fetal heart rate and yolk sac in transvaginal ultrasound are factors to increase the probability of failure of medical treatment of ectopic pregnancy with methotrexate. [ABSTRACT FROM AUTHOR]

Background: Champions play a critical role in implementing technology within healthcare services. While prior studies have explored the presence and characteristics of champions, this review delves into the experiences of healthcare personnel holding champion roles, as well as the experiences of healthcare personnel interacting with them. By synthesizing existing knowledge, this review aims to inform decisions regarding the inclusion of champions as a strategy in technology implementation and guide healthcare personnel in these roles. Methods: A systematic mixed studies review, covering qualitative, quantitative, or mixed designs, was conducted from September 2022 to March 2023. The search spanned Medline, Embase, CINAHL, and Scopus, focusing on studies published from 2012 onwards. The review centered on health personnel serving as champions in technology implementation within healthcare services. Quality assessments utilized the Mixed Methods Appraisal Tool (MMAT). Results: From 1629 screened studies, 23 were included. The champion role was often examined within the broader context of technology implementation. Limited studies explicitly explored experiences related to the champion role from both champions' and health personnel's perspectives. Champions emerged as promoters of technology, supporting its adoption. Success factors included anchoring and selection processes, champions' expertise, and effective role performance. Discussion: The specific tasks and responsibilities assigned to champions differed across reviewed studies, highlighting that the role of champion is a broad one, dependent on the technology being implemented and the site implementing it. Findings indicated a correlation between champion experiences and organizational characteristics. The role's firm anchoring within the organization is crucial. Limited evidence suggests that volunteering, hiring newly graduated health personnel, and having multiple champions can facilitate technology implementation. Existing studies predominantly focused on client health records and hospitals, emphasizing the need for broader research across healthcare services. Conclusions: With a clear mandate, dedicated time, and proper training, health personnel in champion roles can significantly contribute professional, technological, and personal competencies to facilitate technology adoption within healthcare services. The review finds that the concept of champions is a broad one and finds varied definitions of the champion role concept. This underscores the importance of describing organizational characteristics, and highlights areas for future research to enhance technology implementation strategies in different healthcare settings with support of a champion. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence of incidental malignant pathology following a hysterectomy performed for benign reasons. Method: A descriptive cross-sectional study based on hospital records. Women who underwent hysterectomy for benign reasons at a general referral hospital between 2013 and 2021 were included. Women with obstetric hysterectomy were excluded. Measured variables: age, route of hysterectomy, type of hysterectomy, histopathological diagnosis of premalignant lesion or invasive cancer, type of cancer. Analysis: Descriptive, the prevalence of preneoplastic and neoplastic conditions was estimated for the overall period. Results: Of 816 clinical records, 674 cases (87 %) met the inclusion criteria and were ana-lyzed. The premenopausal population predominated. Twentysix cases of unex-pected malignant disease were identified, yielding a prevalence of 3.8 %, and 13 cases of premalignant pathology (1.9 %). The most common origin was the cervix (40 %), followed by the ovary (33 %). Conclusions: Patients undergoing hysterectomy for benign conditions should be informed about the risk of unexpected injury. The importance of performing, in our context an adequate preoperative approach to rule out cervix uteri and ovarian cancer is emphasized. Follow-up studies of patients with unanticipated cancer are required to determine their treatment and prognosis in the region. [ABSTRACT FROM AUTHOR]

Introduction: A febrile seizure is a convulsion in a child that's caused by a fever. Disruptions in the balance of serum electrolytes significantly contribute to the onset of these issues. This study aimed to investigate serum electrolyte abnormalities in hospitalized children experiencing fever and seizures. Methods: In this cross-sectional study, a census was conducted to examine all children hospitalized with fever and convulsions at Taleghani Hospital in Gorgan during the years 2013 and 2014. Demographic information, seizure type, recurrence, and test results of patients were gathered using a checklist developed from the data available in the patients' inpatient records and the hospital's information system. Spearman and Mann-Whitney correlation tests were performed using software for statistical analysis. Results: The study's results indicated that the average age of the patients was 22.6 ± 13.9 months, with 117 of them (54.7%) being boys. Fever and convulsions were classified as simple in 163 patients (76.2%), while 28 patients (13.1%) experienced recurrent convulsions. The findings revealed an inverse and significant relationship between age and serum levels of potassium, calcium, and magnesium; however, no such relationship was found between age and sodium serum levels. Additionally, there was no correlation between gender, type of fever and seizures, or the recurrence of seizures with serum levels of sodium, potassium, calcium, and magnesium. Conclusion: It appears that measuring serum electrolytes in children with fever and convulsions should be conducted on a case-by-case basis, guided by a physician's assessment. [ABSTRACT FROM AUTHOR]

Objective: Diagnosing mycosis fungoides (MF) poses a challenge both clinically and pathologically. In its early stages, MF may exhibit minimal changes, leading to potential misdiagnosis as benign inflammatory dermatoses. This study aimed to evaluate the clinicopathological features of cases where there is clinical suspicion of MF. Methods: A total of 254 consecutive patients with suspected MF were included in the study. Clinical findings and pathology reports were retrospectively obtained from hospital records, and the clinicopathological features were subjected to statistical analysis. Results: The median age of the study participants was 39.4 ± 19.2 years old (range: 0-85), with 52% being male. Clinical erythematous lesions were significantly more common among participants whose MF had been identified as the initial diagnosis based on clinical preliminary diagnoses (P = .02). Histomorphological MF diagnosis was statistically significant in clinically erythematous lesions, while histomorphological suspicion for MF group was more common in the clinical “other” group (P = .001, P = .03). Hyperchromasia, cytoplasmic halo, and atypical intraepidermal collections of lymphocytes were statistically more prevalent in histomorphological MF diagnoses (P < .001). Conclusion: Although the clinicopathological spectrum of MF diagnosis may vary across disease stages, our study demonstrates the importance of both clinical and pathological examination of erythematous lesions for MF. Compared to other pathological criteria for MF, changes in lymphocyte size and shape may have less significance in determining MF’s pathological suspicion. The best approach for diagnosing MF is to collate accurate data to avoid misdiagnosis. [ABSTRACT FROM AUTHOR]

Objective: Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS FNA/FNB) and potential endoscopic retrograde cholangiopancreatography (ERCP) for biliary decompression are indicated in patients with pancreatic cancer before initation of primary chemotherapy. This study aims to investigate the performance and safety of these two procedures in patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC). Methods: Endoscopy and pathology reports, and hospital records of consecutive patients with a radiological diagnosis of BRPC/LAPC included in a population based, protocol-driven study (NORPACT-2) were reviewed. Results: Of 251 patients, 223 (88.9%) underwent EUS-FNA/FNB, and 133 (53%) underwent ERCP. Repeated EUS attempts were performed in 33 (14.8%), eight (3.6%), and four (1.8%) patients. FNA was performed in 155 procedures, FNB in 30, and combined EUS-FNA/FNB in 83. Diagnostic accuracy was 86.1% for first EUS-FNA/FNB. The cumulative diagnostic accuracy for all attempts was 96%. False positive rate for malignancy was 0.9%. Of a total of 149 ERCP procedures, 122 (81.9%) were successful, and 27 (18.1%) were unsuccessful. Success rate of first ERCP attempt was 80.5% (107/133). Sixteen patients (12%) underwent a second attempt with a success rate of 93.8% (15 of 16). Combined EUS and ERCP was performed in 41 patients. Complications occurred in eight procedures (3%) after EUS-FNA/FNB, 23 procedures (15.3%) after ERCP, and four (9.8%) patients after combined EUS-FNA/FNB and ERCP. Conclusion: EUS-FNA/FNB and ERCP with biliary stenting in patients with BRPC/LAPC demonstrated acceptable performance and safety. Repeat procedures were performed with high success rates. Same session EUS-FNA/FNB and ERCP for biliary decompression is safe. [ABSTRACT FROM AUTHOR]

Background: We aim to provide up-to-date real-world evidence on the persistence, adherence, healthcare resource utilization, and costs of multiple sclerosis (MS) by comparing ocrelizumab to other disease-modifying treatments (DMTs) and within different DMT sequences. Methods: We included 3371 people with MS who first received or switched DMT prescriptions from January 2018 to December 2022; they were identified through hospital discharge records, drug prescriptions, and exemption codes from the Campania Region (South Italy). We calculated persistence (time from the first prescription to discontinuation or switching to another DMT), adherence (proportion of days covered (PDC)), DMT costs, and MS hospital admissions and related costs. Results: The most frequently prescribed DMT was dimethyl fumarate (n = 815; age 38.90 ± 11.91 years; 69.5% females), followed by ocrelizumab (n = 682; age 46.46 ± 11.29 years; 56.3%); 28.8% of the patients treated with ocrelizumab were naïve to DMTs. Using ocrelizumab as a statistical reference, the risk of discontinuation was higher for other highly active (HR = 6.32; 95%CI = 3.16, 12.63; p < 0.01) and low-/medium-efficacy DMTs (HR = 10.10; 95%CI = 5.10, 19.77; p < 0.01); adherence was lower for other highly active DMTs (Coeff = −0.07; 95%CI = −0.10, −0.04; p < 0.01) and low-/medium-efficacy DMTs (Coeff = −0.16; 95%CI = −0.19, −0.14; p < 0.01). monthly DMT costs were higher for other highly active DMTs (Coeff = 77.45; 95%CI = 29.36, 125.53; p < 0.01) but lower for low-/medium-efficacy DMTs (Coeff = −772.31; 95%CI = −816.95, −727.66; p < 0.01). The hospital admissions and related costs of MS were similar between ocrelizumab, other highly active DMTs, and other low-/medium-efficacy DMTs, and with ocrelizumab as the first-line DMT after other highly active DMTs and after low-/medium-efficacy DMTs, which was possibly due to the low number of observations. Conclusions: From 2018 to 2022, ocrelizumab was among the most frequently prescribed DMTs, with 28.8% prescriptions to incident MS patients, confirming its relevance in clinical practice. Ocrelizumab was associated with the highest persistence and adherence, pointing towards its favorable benefit–risk profile. The costs of ocrelizumab were lower than those of other highly active DMTs. [ABSTRACT FROM AUTHOR]

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets. This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges. These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries. This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture. [ABSTRACT FROM AUTHOR]

Objective: To study the age at onset of relapsing–remitting multiple sclerosis (RRMS) during the past century. Methods: This is a population-based cohort study of persons diagnosed with RRMS in Hordaland, Møre, and Romsdal counties, Western Norway, from 1920 to 2022. Individual patient data were available and assessed from previously conducted prevalence and incidence studies in addition to hospital records up until October 31, 2022. Participants were categorized according to onset period and analyzed for temporal trends in age at onset, time from onset to diagnosis, and distribution of onset over time. Results: We identified 3364 persons with confirmed RRMS. The mean age at onset significantly increased (p < 0.001) throughout the study period, despite a decrease in time from symptom onset to diagnosis (p < 0.001). The proportion of persons with MS onset after 50 years of age increased from 2.6% before 1970 to 11.9% after 2010. We also found a trend toward a bimodal distribution of age at onset that peaked at around 30 years and 40–45 years of age in the latest period. Conclusion: Age at onset of MS significantly increased throughout the study period. This was mainly due to an increasing number of persons with MS, predominantly female, experiencing onset after 40–45 years of age. This bimodal distribution could indicate different susceptibility periods of MS or changes in exposure to risk factors during the observation period. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify the barriers and challenges in the adoption of the Electronic Health Record system in hospitals of Islamabad and to compare the barriers and challenges faced in adopting and running the electronic health record system in government and private hospitals of Islamabad. Method: This multicentric cross-sectional study was carried out among 210 respondents in four government and four private hospitals in Islamabad from June 2022 to November 2022. Out of 210, 160 respondents filled the questionnaire A structured questionnaire was distributed to the management, health professionals, and staff using the EHR system by simple random sampling. The data were analysed using SPSS version 26. An independent sample t-test was applied for a comparative analysis of challenges and barriers in government and private hospitals. Results: The response rate for the electronic health record system survey was 160 (76%). Of those responding, 85.75% and 72% reported using the EHR system regarding patient care in government and private hospitals, respectively. Around 42.5% and 83.75% of government and private hospitals have fully functional EHR systems, and 72% of government and 90% of private responses reported the use of computers as a major mode of patients’ data entry. A significant difference was found between government and private hospitals regarding social and legal barriers and lack of knowledge of the EHR system (p-value <0.05). Implementation of single modules and multi modules was a big challenge for the government and private hospitals, respectively (p-value <0.05). Conclusion: Government and private hospitals equally face the challenges and barriers to the implementation of the EHR system, with social and legal barriers being more prevalent in government hospitals and barriers and implementation of single modules and multimodule were a big challenge for the government and private hospitals. [ABSTRACT FROM AUTHOR]

Use of intravascular lithotripsy (IVL) for treating peri-stent calcification is increasing. However, this indication remains 'off-label'. We aimed to investigate the efficacy and clinical outcomes of in-stent IVL. Patients from five European centers who underwent in-stent IVL were included between 2019 and 2023. Demographic, clinical, procedural and follow-up data were collected from electronic hospital records. Angiographic and intracoronary imaging (ICI) data were analyzed in a centralized core-laboratory. Of 101 patients (71.2 ± 9.2 years), 56(55 %) received in-stent IVL for late stent failure (median 109 days post-PCI) due to calcific neoatherosclerosis or extra-stent calcification(late-IVL), while 45(45 %) underwent bail-out IVL due to stent infraexpasion (immediate-IVL). Both late-IVL and immediate-IVL significantly improved angiographic %diameter stenosis (73.7[59.6–89.8]% to 16.4 [10.4–26.9]%; p < 0.0001 and 28.6[22.5–43.3]% to 14.1[10.3–29.4]%;p < 0.0001, and minimum lumen area (MLA) (3.4 ± 1.2 to 8.6 ± 2.5 mm2; p < 0.002 and 5.4 ± 1.9 to 7.3 ± 1.9;p < 0.0001).Device(98 %) and procedural success(80 %) were high. MACE rates in-hospital (2 %), 30-days (3 %),6-months(5 %) and 1-year(7 %) were low and comparable in both groups. Acute diameter gain was lower in immediate-IVL (2.1 ± 0.7 mm vs. 0.5 ± 0.4 mm;p < 0.0001). This, however, was explained by significant differences in pre-IVL angiographic and ICI parameters (%diameter stenosis 73.7[59.6–89.8] vs. 28.6[22.5–43.3]%; p < 0.0001 and MLA (3.4 ± 1.2 vs 5.4 ± 1.9 mm2; p < 0.0001), whereas post-IVL percentage diameter stenosis (16.4(10.4–26.9) vs. 14.1(10.3–29.4); p = 0.914) and MLA (8.6 ± 2.5vs. 7.4 ± 1.9 mm2; p = 0.064) in late- and immediate-IVL were comparable. IVL in-stent due to peri-stent calcification is an effective strategy, both late and immediately after stent implantation. Overall, MACE rates at short- and mid-term were low and comparable in both groups, although clinical findings should be taken with caution. • IVL in-stent is an effective strategy, with high procedural success rate. • Similar results apply both for IVL late and immediately after stent implantation. • Overall, MACE rates at short- and mid-term were low. [ABSTRACT FROM AUTHOR]

To exist in relation to the State, it becomes necessary to be "counted," that is, to be part of the official statistics that underpin political and public action and control. In the case of individuals injured by firearms, not only are data not published, but there are no official statistics that reveal the number, context, and situation of gunshot victims, rendering these individuals invisible victims of a State that does not recognize them as citizens or victims, nor does it take responsibility for the failures in its function of monopolistic control over violence and the firearms that cause it. For this reason, the absence of statistics on individuals injured by firearms in Venezuela is addressed, highlighting the invisibility and neglect of these victims by the State. Hospital records were collected from three healthcare centers in Caracas, subsequently converted into statistical data to describe and bring visibility to the issue of individuals injured by bullets in this city. The analysis of the data reveals the lack of access to information, potential abuses by security forces, and the masculinization of armed violence. It is concluded by emphasizing the need to recognize these individuals as victims, demand their inclusion in public policies, and improve the conditions of care. Finally, the importance of having accurate statistics to effectively address armed violence and its consequences in Venezuelan society is underscored. [ABSTRACT FROM AUTHOR]

Quality disclosures regarding medical outcomes such as patient mortality are common healthcare policy instruments. Mixed evidence exists on whether quality disclosures improve outcomes for disclosed ailments. Moreover, disclosure policies can generate spillovers and impact ailments not targeted by the policy. We examine the effects of quality disclosure regulation on mortality improvements in disclosed and nondisclosed ailments. We use patient records for California hospitals for 1995–2014 and construct three groups of ailments: those that were the target of disclosure regulation, complementary ailments that were not the target of disclosure regulation but are medically related to the disclosed ailments, and medically unrelated ailments. Using a difference-in-differences design, we find that quality disclosure regulation is associated with declines in mortality risk of disclosed ailments ranging from 11.5% to 23%. Quality disclosure regulation is also associated with improvements for complementary ailments that are not the target of the disclosure policy. Such positive spillover effects yield an estimated 15.2% decline in mortality risk. Consistent with demand-side pressures driving improvements, market shares become sensitive to disclosed quality measures after disclosure regulation. Our findings of direct and spillover effects have implications for disclosure regulation. This paper was accepted by David Simchi-Levi, accounting. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4817. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to analyze the completeness of variables from Hospital-Based Cancer Registries of cases of prostate neoplasm in the Oncology Care Network of a Brazilian state between 2000 and 2020. Methods: an ecological time series study, based on secondary data on prostate cancer Hospital-Based Cancer Registries prostate. Data incompleteness was classified as excellent (50%), according to the percentage of lack of information. Results: there were 13,519 cases of prostate cancer in the Hospital-Based Cancer Registries analyzed. The variables “family history of cancer” (p

Objective: One of the vital problems after earthquakes that caused many deaths and injuries is crush syndrome due to traumatic muscle damage. The aim of this study was to determine the clinical course of patients with crush syndrome and identify factors that may be associated with crush syndrome. Methods: After the two earthquakes of 7.7 and 7.6 magnitude affecting 11 provinces with the epicentre in Kahramanmaraş on 6 February 2023, 319 patients over the age of 18 were admitted to our hospital between 6-14 February. 87 of 319 patients received inpatient follow-up and treatment. The age, gender, duration of stay in the rubble, province of residence, operation performed, duration of hospital stay, amount of fluid given in the first 24 hours, amount of urine output in the first 24 hours, body trauma sites, some laboratory parameters at the time of admission and during follow-up were retrospectively evaluated from the hospital records of all 43 patients diagnosed with crush syndrome among the inpatients between 6-28 February. Results: The age of the patients was 39±19.6 years, duration of stay under the cave-in(hours) 22.74±36.32, duration of hospitalization(days) 7.26±5.42, amount of fluid given in the first 24 hours(ml) 4954.18±3142, amount of urine output in the first 24 hours(ml) 2646.42±2262.65, admission creatinine(mg/dl) 1.59±2.25, admission creatine kinase(CK)(U/L) 11716.37±18520. 44.2% of the patients were female, 72.1% came from Kahramanmaraş province, 46.5% underwent surgical intervention, 67.4% had an admission CK above 1000 u/l, 14% received hemodialysis treatment and 51.2% had a duration of hospitalization longer than 21 days. The effect of other parameters on the duration of hospitalization and the time to reach the reference range of CK and correlation with laboratory parameters were analysed. Conclusion: As a result, it is thought that the parameters affecting the time to reach the CK reference range and the duration of hospitalization can be used to calculate and reduce the duration of hospitalization in prospective crush syndrome cases. [ABSTRACT FROM AUTHOR]

Introduction: Due to a systemic modification in Swedish emergency medical services (EMS) staffing in recent years, the nature of the Swedish EMS has changed. Transport to an emergency department (ED) is no longer the only option. Referrals and non-conveyance form a growing part of EMS assignments. Trauma is one of the most common causes of death and accounts for 17% of Swedish EMS assignments. The aim of this study was to describe the characteristics and clinical outcomes of non-conveyed trauma patients who were assessed, treated and triaged by the EMS to gain a better understanding of, and to optimise, transport and treatment decisions. Methods: The study had a descriptive, retrospective and epidemiologic design and was conducted by reviewing EMS and hospital records for 837 non-conveyed trauma patients in the southwest of Sweden in 2019. Results: Three in four non-conveyed trauma patients did not seek further medical care within 72 h following EMS assessment. The patients who were admitted to hospital later were often older, had suffered a fall and had a medical history. Half of all the incidents occurred in a domestic environment, and head trauma was the major complaint. Less than 1% of the studied patients died. Conclusion: Most of the non-conveyed trauma patients did not seek further medical care after being discharged at the scene. Falling was the most common trauma event, and for the older population, this meant a higher risk of hospital admission. The reasons for falls should therefore be investigated thoroughly prior to non-conveyance decisions. Future studies should focus on the reasons for non-conveyance and measure the morbidity and invalidity outcomes rather than mortality. [ABSTRACT FROM AUTHOR]

Intersectional social determinants including ethnicity are vital in health research. We curated a population-wide data resource of self-identified ethnicity data from over 60 million individuals in England primary care, linking it to hospital records. We assessed ethnicity data in terms of completeness, consistency, and granularity and found one in ten individuals do not have ethnicity information recorded in primary care. By linking to hospital records, ethnicity data were completed for 94% of individuals. By reconciling SNOMED-CT concepts and census-level categories into a consistent hierarchy, we organised more than 250 ethnicity sub-groups including and beyond "White", "Black", "Asian", "Mixed" and "Other, and found them to be distributed in proportions similar to the general population. This large observational dataset presents an algorithmic hierarchy to represent self-identified ethnicity data collected across heterogeneous healthcare settings. Accurate and easily accessible ethnicity data can lead to a better understanding of population diversity, which is important to address disparities and influence policy recommendations that can translate into better, fairer health for all. [ABSTRACT FROM AUTHOR]

Background: Mild fetal ventriculomegaly (VM) is a nonspecific finding common to several pathologies with varying prognosis and is, therefore, a challenge in fetal consultation. We aimed to perform a constant, detailed analysis of prenatal findings and postnatal outcomes in fetuses with early-onset and late-onset mild ventriculomegaly, and provide a new evidence basis and new perspective for prenatal counseling. Methods: This is a retrospective cohort study of women with a diagnosis of mild fetal VM between January 2018 and October 2020. The population was divided into two groups according to the gestational ages (GAs) at initial diagnosis: the early-onset group (diagnosed at/before 24+6 weeks) and the late-onset group (diagnosed after 24+6 weeks). Clinical data and pregnancy outcomes were obtained from hospital records. The children's neurodevelopment status was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3) and telephone interviews. Results: Our study cohort comprised 324 fetuses, out of which 94 (29%) were classified as early-onset group and 230 (71%) late-onset group. Early-onset group was more likely to have concurrent additional abnormalities, whereas in the late-onset group, isolated enlargement was more common (P = 0.01). Unilateral enlargement was more common in the late-onset group (P = 0.05), and symmetrical enlargement in the early-onset group (P < 0.01). In addition, early-onset mild VM cases were more likely to have intrauterine progression (P = 0.03), and many had a higher proportion of complex multisystem abnormalities. Compared with the late-onset group, the early-onset group was more often associated with congenital brain structure malformations. Approximately 11% of fetuses with mild VM had postnatal neurodevelopmental delay/disorders, and the risk was higher in the early-onset group (19.4% vs. 7.4%). Regression analysis showed that the GA at first diagnosis, non-isolated, and intrauterine progression significantly correlated with neurodevelopmental abnormalities. Conclusions: Early-onset and late-onset mild VM had significantly different ultrasound features and outcomes. Early-onset mild VM may have more complex potential abnormalities and are more likely to predict poor prognosis than the late-onset. [ABSTRACT FROM AUTHOR]

Background: Many hemodialysis (HD) patients report intradialytic symptoms, and take time to recover postdialysis. To improve quality of life, patient groups have highlighted the need to reduce postdialysis fatigue and other peridialytic symptoms. As compartmental shifts of fluid during dialysis have been proposed to cause peridialytic symptoms we investigated whether patients dialysing with higher ultrafiltration rates (UFR) reported more intradialytic symptoms and recovery times. Methods: We reviewed the hospital records of HD patients who completed a self‐reported intradialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous midweek pre‐ and postdialysis segmental bioimpedance measurements. Results: Six hundred and five patients returned the peridialytic symptom questionnaire with pre‐ and postdialysis bioimpedance measurements. The majority were male (64.8%), mean age 64.2 ± 15.6 years, duration of dialysis treatment 26.8 (10.7–59.2) months, 85% treated by hemodiafiltration and mean dialysate temperature 35.4 ± 0.4°C. We divided patients into terciles according to UFR adjusted for weight, and there was a greater fall in the ratio of extracellular water (ECW) to total body water (TBW) postdialysis in the nonfistula arm from the lower to middle to higher tercile (0.8 (0–1.54) vs. 1.28 (0.52–1.85) vs. 1.54 (0.78–2.52)), trunk (1.5 (0.74–2.27) vs. 1.53 (0.99–2.2) vs. 1.98 (1.18–2.66)), left leg (1.56 (0.49–2.25) vs. 1.77 (1.24–2.43) vs. 2.08 (1.18–2.95)), lower versus higher tercile p < 0.05. However, no differences in intradialytic symptoms or postdialysis recovery times between the UFR terciles were observed. Conclusion: There were no differences in self‐reported intradialytic symptoms or postdialysis recovery times with differing UFRs, despite changes in intracompartmental fluid shifts as measured by changes in ECW/TBW. [ABSTRACT FROM AUTHOR]