Category: Nevin Manimala

J Adolesc Health. 2025 Jan 24:S1054-139X(24)00563-9. doi: 10.1016/j.jadohealth.2024.11.011. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of evidence examining clinician experiences with structured health-care transition (HCT) programs. Among HCT Learning Collaborative participants, this study describes clinician experiences with implementation of a structured HCT process: Got Transition’s 6 Core Elements.

METHODS: Representative members from 6 health systems designed a survey to collect clinician feedback regarding HCT and demographic and practice information. The survey included adapted Got Transition Current Assessment of HCT Activities Level 4 and Clinician Feedback surveys as well as the following factors: clinical role, care setting, status, time involved in HCT process implementation, presence of champion, and partnership between pediatric and adult systems. Surveys were distributed across pediatric and adult clinical settings to 855 clinicians involved in HCT process implementation efforts during August and September 2022. Statistical analysis was performed to identify relationships between key clinician demographic data and responses on the survey.

RESULTS: A total of 272 clinicians provided feedback (31% response rate) on implementing a structured HCT process. About two-thirds reported that fidelity to a structured HCT process was present. The 6 Core Elements most implemented processes included transition policy, tracking, and transition planning. The majority of clinicians agreed that a structured HCT process improves safety and quality of care, as well as both patient and clinician experiences. Time invested in HCT processes was significantly associated with securing senior leadership buy-in. Presence of an identifiable institutional HCT process improvement champion was significantly associated with positive clinician experiences.

DISCUSSION: Clinicians found positive benefits in providing a structured HCT process using the 6 Core Elements and having a champion in their health system. They acknowledge that added time and continued investment in practice-wide HCT processes are needed.

PMID:39864000 | DOI:10.1016/j.jadohealth.2024.11.011

J Perianesth Nurs. 2025 Jan 23:S1089-9472(24)00518-5. doi: 10.1016/j.jopan.2024.10.010. Online ahead of print.

ABSTRACT

PURPOSE: The aim in the present study was to evaluate the effects of chewing postoperative xylitol gum on gastrointestinal functional recovery after laparoscopic cholecystectomy.

DESIGN: A three-arm randomized controlled trial.

METHODS: After a baseline assessment, participants were randomly assigned in three groups. The random assignment was performed by using a computer program (Microsoft Excel 2016). Afterward, participants were categorized into three subgroups. Group 3 was the control group that consisted of participants who had no intervention for chewing gum (n = 25). Group 2 was xylitol-free gum chewing group (n = 25), whereas Group 1 was xylitol gum chewing group (n = 24). In later phases, the time to first postsurgical flatus, time to first bowel sound after surgery, time to first postsurgical defecation, time to first mobilization after surgery, and discharge time from hospital were recorded. Nausea and vomiting, which are among the postoperative symptoms, were also evaluated.

FINDINGS: The duration of the control group from the end of surgery to the flatulence and bowel sounds was statistically higher than the xylitol group and xylitol-free group (all P < .05). Also, first postoperative flatulence time of xylitol-free group was higher than the xylitol group (P < .05). The duration from the end of surgery to defecation was longer in the control group compared with the xylitol group and the xylitol-free group, with a statistically significant difference between the groups (P < .05). In this study, a statistically significant difference was observed in terms of the time to first postsurgical flatus, time to first bowel sound after surgery, and time to first postsurgical defecation (all P < .000). No significant difference was found between the xylitol group, xylitol-free group, and control group when discharge from hospital and mobilization times were analyzed (all of them are P > .05).

CONCLUSIONS: Chewing xylitol gum facilitates postoperative gastrointestinal recovery after laparoscopic cholecystectomy. Further studies are recommended to confirm these findings and investigate the underlying mechanisms.

PMID:39863997 | DOI:10.1016/j.jopan.2024.10.010

Psychiatr Pol. 2024 Oct 31;58(5):747-759. doi: 10.12740/PP/186721. Epub 2024 Oct 31.

ABSTRACT

In 2024, we observe the fortieth anniversary of the publication, where, for the first time, the term of Seasonal Affective Disorder (SAD) was used. Presently, SAD is regarded as a special category of mood disorder. In the American Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), the seasonality makes a specifier, “with seasonal pattern”, both for recurrent depression or Major Depressive Disorder (MDD), and for Bipolar Disorder (BD). The most spectacular phenomenon among SAD is winter depression. Its symptomatology is mostly similar to atypical depression, characterized by excessive sleepiness and carbohydrate craving. SAD can pertain up to one fifth of persons with MDD or BD and is more frequent in women. SAD can be considered as an extreme expression of the central nervous system (CNS) changes related to circannual rhythm of lighting. The seasonal changes of the CNS function apply to the secretion of melatonin, the neurotransmitters dopamine and serotonin and the hypothalamic-pituitary-adrenal axis. In the circadian and circannual processes, a significant role is played by so-called “clock genes”. SAD may be a legacy of Homo neanderthalensis. In winter depression, the therapeutic effect is obtained by an exposition to bright light (bright light therapy – BLT) as well as to blue light or using the method of dawn simulation. The therapeutic effect of phototherapy has also been ascertained in non-seasonal depression. As a counterpoint to this mechanism, promising trials have been undertaken in manic states by light restriction using blue light blocking glasses.

PMID:39863986 | DOI:10.12740/PP/186721

West Afr J Med. 2024 Sep 30;41(9):972-975.

ABSTRACT

BACKGROUND: The vital statistics in the third world countries are poor and have witnessed minimal improvement over the years with childhood mortality in Nigeria remaining one of the highest among the developing countries despite various child survival programmes. Child survival strategies can only be efficient if the major reasons for morbidity are known. The objective of this retrospective study was to review the patterns of childhood mortality at the emergency room of the Federal Teaching Hospital, Ido-Ekiti (FETHI).

MATERIALS AND METHODS: This study was conducted at the Children Emergency room of FETHI. Admission, discharge records and the case notes of the patients who died from September 2017 to October 2022 at the emergency units were retrospectively reviewed to extract the data on the age, sex, diagnosis, and duration of stay on admission before demise. A p-value of <0.05 was accepted as statistically significant.

RESULTS: There was a total of 2503 admissions with a M: F ratio of 1.25:1. The mortality rate was 3.9%. Age at demise was independent of the sex of the patients with a p-value of 0.33. More deaths occurred within six to 72 hours on admission and 68% of deaths in the EPU were U-5. Sepsis and malaria were the leading causes of death.

CONCLUSIONS: The high incidence of mortality among under-5 largely from preventable causes of death stresses the need to strengthen the existing childhood preventive measures.

PMID:39863983

West Afr J Med. 2024 Sep 30;41(9):966-971.

ABSTRACT

INTRODUCTION: Prostate cancer (PCa) is the commonest urologic cancer worldwide and the leading cause of male cancer deaths in Nigeria. In Nigeria, orchidectomy remains the primary androgen deprivation therapy. Dihydrotestosterone (DHT) is the active prostatic androgen, but its relationship with PCa severity has not been extensively studied in Africa.

OBJECTIVES: This study assessed the relationship between serum levels of DHT (pre- and post-orchidectomy) and serum prostate specific antigen (PSA), as well as Gleason scores.

METHODS: Patients undergoing orchidectomy for histologically confirmed prostate adenocarcinoma were studied. Serum PSA and DHT levels were assessed before orchidectomy, and 6 weeks afterwards. This was correlated with their Gleason scores. Data was analyzed using the IBM SPSS Statistics version 20. P < 0.05 was considered significant.

RESULTS: Fifty-three patients completed the study. The mean age was 69.3 ± 6.9 years. Pre- and post-orchidectomy serum PSA ranged from 11.30 to 562.00 ng/ml and 0.01ng/mL to 245.00 ng/mL respectively. Pre- and post-orchidectomy DHT ranged from 6.91ng/mL to 4,996.38 ng/mL and 6.56 ng/mL to 2,575.03 ng/mL respectively. Up to 40% still had normal DHT post-orchidectomy. There was a positive but statistically insignificant correlation between pre-orchidectomy serum PSA and DHT (r = 0.089, p = 0.527). There was however a direct and significant relationship between pre-orchidectomy serum DHT and Gleason scores (p = 0.042).

CONCLUSION: This study showed a relationship between preorchidectomy serum DHT and Gleason scores. Assessing DHT in patients with high Gleason scores could influence hormonal manipulation.

PMID:39863964

West Afr J Med. 2024 Sep 30;41(9):959-965.

ABSTRACT

BACKGROUND: This study estimated the cost of providing free maternal and child health (MCH) services at the primary health centre (PHC) level in southeast Nigeria. The costs of providing an essential benefit package of maternal and child health (MCH) services are unknown. Such information is required for optimal resource allocation decisions and for replicating similar programmes in different settings.

METHODS: The full and unit costs of providing a thin benefit package of MCH services in all the 418 PHC centers in Imo State, southeast Nigeria were computed using an ingredient and activity costing approach from a provider perspective. Data on costs were collected both retrospectively and cross-sectionally. Data on service utilisation by mothers and children under five years were collected from the PHC attendance registers.

RESULTS: The total cost was $27,710,009.00, whilst the unit costs for delivering combined MCH services in 418 PHCs were $37.2. However, for just child health services, the unit cost was $13.7 per child, whilst the unit cost of providing just maternal health services was $42.7 per pregnant woman. Personnel costs contributed 84.6% of the total cost.

CONCLUSION: The findings will guide the design and scale-up of a similar programme towards the achievement of universal health coverage of MCH services.

PMID:39863959

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S369-S380. doi: 10.3855/jidc.19897.

ABSTRACT

INTRODUCTION: The present study aimed to explore the epidemiologic threats and factors associated with the coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) epidemic that emerged in Egypt during the second COVID-19 wave. The study also aimed to explore the diagnostic features and the role of surgical interventions of CAM on the outcome of the disease in a central referral hospital.

METHODOLOGY: The study included 64 CAM patients from a referral hospital for CAM and a similar number of matched controls from COVID-19 patients who did not develop CAM.

RESULTS: The most frequent factors among CAM patients were the use of corticosteroids, older age, and diabetes. CAM patients presented with facial pain (98.4%), black coloring on nasal endoscopy examination (87.5%), orbital invasion (70.3%), and loss of vision (68.8%). Despite treatment, CAM led to the death of 30 patients and 34 patients survived until the end of the study. CAM patients with death outcomes had orbital invasion, disturbed consciousness level, referral to intensive care units, and invasive mechanical ventilation. The patients who survived received more surgical interventions than dead patients, including functional endoscopic sinus surgery (FESS) and maxillofacial surgery.

CONCLUSIONS: CAM treatment requires complex, time-consuming, and expensive diagnostic approaches. Therefore, preventative measures should focus on early source control, strict glycemic control, and limiting steroids to COVID-19 patients especially older patients (> 40 years). Early antifungal treatment and surgical techniques such as FESS and necrotic tissue debridement were associated with better prognosis, indicating the efficiency of multidisciplinary medical and surgical teams.

PMID:39863956 | DOI:10.3855/jidc.19897

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S344-S352. doi: 10.3855/jidc.19019.

ABSTRACT

INTRODUCTION: Antimicrobial resistance (AMR) is a major public health challenge globally. This study aimed to analyze the antibacterial consumption (ATBc), and the incidence of multidrug-resistant organisms (MDRO), focusing on pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE group), in a Brazilian tertiary care hospital.

METHODOLOGY: The ATBc was measured by defined daily doses (DDD) calculated per 1000 patient days. The incidence of MDRO was collected from the hospital infection control committee specialized reports. Changes in ATBc and MDRO incidence over time were explained by the compound annual growth rate (CAGR) represented by the average yearly change as a proportion (%) of consumption in the starting year. This was a time series study using data collected retrospectively from January 2015 to December 2021.

RESULTS: There was an increase in consumption of daptomycin and linezolid during the study period (39.4% and 27.7%, respectively), followed by polymyxins (9.8%). The MDRO of the ESKAPE group with the highest variation in the period were Staphylococcus spp (29.2%), Enterococcus spp (27.8%), and Acinetobacter spp (18.4%). Other MDROs, outside the ESKAPE group, such as Providencia sp (51.2%) and Clostridioides dificille (37.7%) had significant variation.

CONCLUSIONS: The coronavirus disease 2019 (COVID-19) pandemic may have reinforced the deterioration of the scenario of accelerating AMR increase. This warrants investigations of further surveillance data to assess the impact of the pandemic on AMR epidemiological trends.

PMID:39863953 | DOI:10.3855/jidc.19019

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S337-S343. doi: 10.3855/jidc.20182.

ABSTRACT

INTRODUCTION: The frequency of scabies and its relationship with the coronavirus disease 2019 (COVID-19) pandemic is a current scientific curiosity in Turkey and worldwide. The data presented in this article will help raise awareness of dermatologists in situations such as pandemic-induced quarantines where scabies can spread rapidly.

METHODOLOGY: This was a retrospective study to compare patients who presented with scabies and were evaluated during the COVID-19 pandemic, with those who presented before and after the pandemic, in terms of the diagnosis ratios. In addition, the recurrence rates were compared in terms of age, nationality, and the environment in which they lived.

RESULTS: The frequency of scabies was statistically significantly higher in the post-COVID period in all quarters of the year, with a higher rate of patients in the first and last quarters, which is typical of scabies patients. However, a significant difference in recurrence rates was not detected.

CONCLUSIONS: Several factors might be responsible for the increased frequency of scabies during the lockdown periods in Turkey. First, entire families, including relatives, had to live together in a crowded space. Second, there was a relative increase in doctor visits, in spite of the stay-at-home policy, owing to the overwhelming itchiness of scabies.

PMID:39863952 | DOI:10.3855/jidc.20182

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S331-S336. doi: 10.3855/jidc.19092.

ABSTRACT

INTRODUCTION: Acute kidney injury involves inflammation and intrinsic renal damage, and is a common complication of severe coronavirus disease 2019 (COVID-19). Baseline chronic kidney disease (CKD) confers an increased mortality risk. We determined the renal long-term outcomes of COVID-19 in patients with baseline CKD, and the risk factors prompting renal replacement therapy (RRT) initiation and mortality.

METHODOLOGY: We included 77 patients (median age was 67.1 ± 13.7 years) with a history of renal failure at baseline and recovery from COVID-19 at our institution, in a retrospective analysis from December 2020 to May 2021. Demographic, clinical, and laboratory data were compared between patients requiring RRT and those who did not. A correlogram analysis determined the risk factors for RRT. Survival analysis using the Kaplan-Meier method and Cox regression statistics assessed in-hospital mortality.

RESULTS: 70.1% of the patients had CKD. RRT initiation was higher in patients with known CKD (46.4%) than in those with no known CKD (28.5%). Those with diabetic nephropathy had a higher predisposition for RRT initiation compared to other CKD etiologies. Diabetics (42.3%) and hypertensive nephropathy (33%) were the most common etiologies in the general population. Blood urea nitrogen (BUN), creatinine, phosphorus, lactate dehydrogenase, and proteinuria were significantly higher; and platelets and calcium levels were lower; in patients requiring RRT. Decreased lymphocyte count negatively correlated with BUN levels.

CONCLUSIONS: Known CKD patients had a higher initiation rate of RRT, and laboratory features suggestive of kidney damage. However, RRT patients did not have an increased risk of mortality.

PMID:39863951 | DOI:10.3855/jidc.19092