Nevin Manimala

Ann Afr Med. 2023 Jan-Mar;22(1):94-100. doi: 10.4103/aam.aam_178_21.

ABSTRACT

BACKGROUND: Epidemiological data on Hospital-Acquired Pneumonia (HAP) are scarce inside Intensive Care Units (ICUs).

AIM: This study aims to quantify the incidence of HAP, determine the predictors of HAP, calculate HAP-related mortality risk ratio as well as pinpoint the different risk factors contributing to mortality.

SUBJECTS AND METHODS: A prospective longitudinal study was conducted at a governmental hospital’s general ICUs over 12 months. We included adult patients admitted for at least 72 h before signs appear. We utilized a logistic regression model for fatality outcome and cox proportional hazard model for HAP outcome.

RESULTS: Of 356 patients, 133 patients developed Ventilated-Acquired Pneumonia (VAP), 76 patients with Non-Ventilated HAP (NV-HAP), as well as 147 patients did not acquire HAP. The incidence of HAP was 28 cases of HAP per 1000 person-days, as well as the mortality rate was 74 per 100 days, while the Attributable Risk Percentage (ARP) was 85%. This high fatality rate was clarified by independent predictors as reintubation (odds ratio [OR] = 8.99, P < 0.001), ICU duration ≥5 days (OR = 7.29, P = 0.02), HAP outcome (OR = 6.49, P = 0.001), diabetes mellitus (DM) (OR = 2.98, P = 0.004), APACHE II ≥17 (OR = 2.76, P = 0.004), as well as neurological diseases (OR = 2.20, P = 0.03). The most common independent HAP predictors were Pseudomonas aeruginosa (Hazard Ratio [HR] = 2.27, P < 0.001), Klebsiella pneumoniae (HR = 1.81, P = 0.003), tracheostomy (HR = 1.72, P = 0.04), and APACHE II ≥17 (HR = 1.54, P = 0.04).

CONCLUSION: High incidence rate of HAP was linked with P. aeruginosa, K. pneumoniae, tracheostomy, and APACHE II ≥17. Furthermore, a high mortality rate was strongly correlated with reintubation, duration in ICU ≥5 days, HAP outcome, DM, APACHE II ≥17, and neurological diseases.

PMID:36695229 | DOI:10.4103/aam.aam_178_21

Ann Afr Med. 2023 Jan-Mar;22(1):45-48. doi: 10.4103/aam.aam_211_21.

ABSTRACT

INTRODUCTION: Shoulder capsulitis (SC) is a common musculoskeletal complication in patients with diabetes. It can be particularly disabling. It is often overlooked by clinicians. The aim of this study is to evaluate the prevalence of retractile capsulitis and to identify the risk factors in a population of Moroccan diabetic patients.

MATERIALS AND METHODS: We realised a cross-sectional study including patients with diabetes mellitus (DM). We recorded the demographic and diabetic characteristics of our patients. SC and vascular complications were assessed by clinical and para-clinical investigations. The prevalence of SC was calculated. The factors associated with SC were evaluated by suitable statistical tests.

RESULTS: Three hundred and Sixty-five patients were included; 84.9% had Type 2 DM (T2DM). The mean age of the participants was 52.6 ± 13.6. Shoulder capsulitis was present in 12.6% of patients. In statistical analysis, age >50 years (P = 0.001), T2DM (P = 0.03), duration of progression >10 years (P = 0.03), dyslipidemia (P = 0.013) and macrovascular complications (P = 0.009) were associated with an increased frequency of SC.

CONCLUSION: This study shows that the prevalence of SC is higher in diabetic patients. Therefore, inclusion of this pathology in the global management of the diabetic patient is necessary.

PMID:36695221 | DOI:10.4103/aam.aam_211_21

Ann Afr Med. 2023 Jan-Mar;22(1):18-32. doi: 10.4103/aam.aam_223_21.

ABSTRACT

OBJECTIVE: The objective is to determine the prevalence of kidney disease (KD) risk factors and their knowledge among Nigerians aged 15-64 living in the Mainland and Island metropolitan districts of Lagos State, South West Nigeria.

MATERIALS AND METHODS: A total of 1171 respondents between 15 and 64 years of age were recruited for the measurements of prevalence and knowledge of KD risk factors using a structured questionnaire. Descriptive, bivariate, and logistic regression statistical analyses were employed.

RESULTS: The respondents’ mean age was 33.83 ± 11.54, with a male-to-female ratio of 0.54:0.46. Respondents without KD have lower knowledge of KD risk factors (38.26; 37.27‒39.25) than those with KD (45.00; 38.84‒50.16) with an overall knowledge score of 38.39 (37.41‒39.36). The prevalent risk factors include indiscriminate use of analgesics and frequent use of traditional remedies (P < 0.05). Knowledge predictors of KD risk factors among respondents were older age (≥30 years) (with KD-Adjusted Odds Ratio (AOR) 1.06: 95% confidence interval [CI]: 0.82‒1.98; without KD-AOR 2.10: 95% CI: 1.52‒2.25) and chronic ailments (with KD-AOR 1.51: 95% CI: 0.28‒2.93; without KD-AOR 3.03: 95% CI: 0.04‒7.49).

CONCLUSION: The study revealed a lower knowledge of KD risk factors exists in respondents without KD, but the prevalence of risk factors was higher among both cohorts of respondents. Therefore, concerted efforts should be made to sensitize strategic public health programs to expand accurate and adequate awareness and understanding of KD risk factors and their implications for well-being, and to possibly avoid the risk of the disease later in life.

PMID:36695218 | DOI:10.4103/aam.aam_223_21

Ann Afr Med. 2023 Jan-Mar;22(1):11-17. doi: 10.4103/aam.aam_241_21.

ABSTRACT

BACKGROUND: One of the commonest and most frequently said, quoted and understood by even the least educated elements of our society is the neurological symptom of headache. The commonly diagnosed and studied headaches are Migraine and Tension type headache [TTH]. Headache has the power to reduce the very essence of a peaceful life and produce a disability in a person.

AIMS AND OBJECTIVES: The aim of our study is to approach the subject with view of correlation of quality of sleep with the disability associated with migraine and compare it to TTH.

MATERIALS AND METHODS: For the same a cross-sectional study design was adopted and a consecutive sampling procedure was adopted. The sample was subjected to basic socio-demography, VAS, PSQI and HDI. Statistical analysis was done on the collected data.

RESULTS: Based on scales the results were evaluated using appropriate statistical methods. It was observed that there was a higher female preponderance in both migraine and TTH, there was severe disability associated and both headaches cause poor sleep quality.

CONCLUSION: The current study concludes that headache is a debilitating illness which causes significant disability to a person.

PMID:36695217 | DOI:10.4103/aam.aam_241_21

Urol J. 2023 Jan 25. doi: 10.22037/uj.v20i.7418. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the impact of the skin-to-stone distance in the supine and prone positions on the outcome of shockwave lithotripsy of kidney stones.

METHODS: In a prospective randomized clinical trial study, 81 patients that candidates for shockwave lithotripsy (SWL) of kidney stones were randomly divided into two groups to perform SWL in the prone position (40 patients) or conventional supine position (41 patients). Demographic data, stone characteristics, skin-to-stone distances (SSD) in CT, SSD during SWL with an ultrasound probe in prone and supine positions, total shock wave rate, total energy (kilovolt), visual analog scale (VAS), complications (Clavien-Dindo scale system), and SWL success rate evaluated in two intervention and control groups. All statistical analysis was performed by independent T-test, Chi-Square test, Fisher exact test, paired T-test, and SPSS 22.0 software for windows. Results: There were no significant differences between demographic characteristics, SWL sessions, the median number of SWLs, the median SWL time, median total energy, VAS, and complications in the two groups. The SFR was numerically higher in the prone SWL group than in the supine SWL group (80% vs. 73.2%) but was not significantly different (p-value: 0.468). Also, the inline ultrasound (US) measuring of the SSD in the prone position was significantly different from US SSD measures in the supine position in the two groups (p-values=0.001 and 0.024). The mean SSD was lower in the US measurement during the SWL process that measured in supine and prone position than the CT measurement (73.5 vs. 101.1), which means the routine SSD measured by CT scan is higher than SSD in the US probe measurement during SWL.

CONCLUSION: The prone position SWL modification could be effective in obese patients with a BMI of more than 30 and increase the stone-free rate (p-value=0.039) with a similar safety profile and comparable VAS score. It seems the SSD measured by the ultrasound is a more accurate dynamic measurement during the SWL and needs to define the SSD according to the SSD calculation by the US probe of the therapy head. SFR was numerically higher in the prone compared with the supine treatment groups.

PMID:36695211 | DOI:10.22037/uj.v20i.7418

Hypertension. 2023 Jan 25. doi: 10.1161/HYPERTENSIONAHA.122.20061. Online ahead of print.

ABSTRACT

BACKGROUND: With rapid socioeconomic development and transition, associations between socioeconomic status (SES) and hypertension remained uncertain in China. We aimed to examine the health effects of SES on hypertension incidence and explore the sex differences among Chinese adults.

METHODS: We included 53 891 participants without hypertension from the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) project. SES was evaluated by education level, occupation prestige, and household monthly per capita income, and categorized into low, medium, and high groups. Hazard ratios and their 95% CIs were calculated using Cox proportional hazards regression models.

RESULTS: Compared with high SES, participants with medium SES (hazard ratio, 1.142 [95% CI, 1.068-1.220]) or low SES (hazard ratio, 1.166 [95% CI, 1.096-1.241]) had increased risks of incident hypertension in multivariate analyses. Interactions between SES and sex on hypertension were observed, with more pronounced adverse effects of lower SES among females. The corresponding hazard ratios (95% CIs) for low SES group were 1.270 (1.155-1.397) for females and 1.086 (0.999-1.181) for males. Effects of occupation prestige on hypertension were the strongest among SES factors.

CONCLUSIONS: Our study provided the compelling evidence from China that lower SES was associated with incident hypertension and females were more susceptible. These findings will have substantial implications on future hypertension prevention and management, especially among females. Sex-specific approaches are warranted to reduce socioeconomic disparities.

PMID:36695186 | DOI:10.1161/HYPERTENSIONAHA.122.20061

Circulation. 2023 Jan 25. doi: 10.1161/CIR.0000000000001123. Online ahead of print.

ABSTRACT

BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS: The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year’s worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains.

RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

PMID:36695182 | DOI:10.1161/CIR.0000000000001123

Phys Sportsmed. 2023 Jan 25. doi: 10.1080/00913847.2023.2170684. Online ahead of print.

ABSTRACT

OBJECTIVES: : Hamstring injuries are the most common muscle injuries in team sports. The aims of this study were to describe the epidemiology of hamstring muscle injuries in the professional and amateur sport sections of a multi-sport club (blinded for reviewers) and to determine any potential correlation between return-to-play (RTP) and injury location, severity of connective tissue damage, age, sex, and athlete’s level of competition.

METHODS: : This descriptive epidemiological study with data collected from September 2007 to September 2017 stored in the (blinded for reviewers) database. The study included non-contact hamstring injuries sustained during training or competition.

RESULTS: : A total of 538 hamstring injuries were reported in the club’s database, of which 240 were structurally verified by imaging as hamstring injuries. The overall incidence for the 17 sports studied was 1.29 structurally verified hamstring injuries per 100 athletes per year. The muscle most commonly involved in hamstring injuries was the biceps femoris, and the connective tissue most frequently involved was the myofascial. There was no evidence of a statistically significant association between age and RTP after injury, and no statistically significant difference between sex and RTP. However, the time loss by professionals was shorter than for amateurs, and proximal hamstring injuries took longer RTP than distal ones.

CONCLUSION: In the 17 sports practiced at multi-sport club, the incidence of hamstring injury was 1.29 per 100 athletes per year. Players from sports in which high speed sprinting and kicking are necessary, and amateurs, were at higher risk of suffering a hamstring injury. In addition, proximally located hamstring injuries involving tendinous connective tissue showed the longest RTP time. Age did not seem to have any influence on RTP. Documenting location and the exact tissue involved in hamstring injuries may be beneficial for determining the prognosis and RTP.

PMID:36695100 | DOI:10.1080/00913847.2023.2170684

Glob Health Action. 2023 Dec 31;16(1):2160543. doi: 10.1080/16549716.2022.2160543.

ABSTRACT

BACKGROUND: Peer-led education interventions are assumed to be an effective means of increasing contraceptive utilization and demand in adolescents. However evidence is lacking on whether peer-led education is effective in promoting the demand for and use of contraceptives in adolescent girls, especially in resource-limited settings.

OBJECTIVE: The present study evaluated the effectiveness of peer-led education interventions in improving contraceptive use, unmet needs, and demand among sexually active secondary school adolescent girls in Gedeo Zone, South Ethiopia.

METHODS: A single-blinded cluster randomised controlled trial study was performed in six randomly selected secondary schools in the Gedeo Zone, southern Ethiopia. A total of 224 participants were recruited and randomly assigned to the intervention and control groups. The intervention group received peer-led education intervention for six months. A pre-tested and validated questionnaire was used to measure contraceptive use, unmet need, and contraceptive demand. A generalised estimating equation (GEE) model was used to examine the effectiveness of the intervention.

RESULT: After six months of intervention, the Differences-in-difference in contraceptive use, unmet need, and contraceptive demand between the intervention and control groups were 25.1%, 7.4%, and 17.7%, respectively. There was a statistically significant difference in contraceptive use [AOR = 8.7, 95% CI: (3.66, 20.83), unmet need for contraceptives [AOR = 6.2, 95% CI: (1.61, 24.36)] and contraceptive demand [AOR = 6.1, 95% CI: (2.43, 15.11)] between the intervention and control groups.

CONCLUSIONS: School-based peer education intervention effectively improved contraceptive use and unmet needs in a low-resource setting and created demand in sexually active adolescent girls. These results support the potential utility of this approach in similar settings for the promotion of contraception use and demand.

PMID:36695098 | DOI:10.1080/16549716.2022.2160543

Subst Use Misuse. 2023 Jan 25:1-5. doi: 10.1080/10826084.2023.2170184. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care.

METHODS: Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes in healthcare engagement including completed in-person and telemedicine outpatient visits and telephone encounters 30 days before and after phone receipt. We used descriptive statistics, where appropriate, and paired t-tests to assess the change in healthcare engagement measures.

RESULTS: Patients were predominantly male (64%) and white (62%) with high rates of homelessness (81%) and opioid use disorder (89%). When comparing 30 days before to 30 days after phone receipt, there was a significant increased change in number of telemedicine visits by 0.3 (95% CL [0.1,0.4], p < 0.001) and telephone encounters by 0.2 (95% CL [0.1,0.3], p = 0.004). There was no statistically significant change in in-person outpatient visits observed.

CONCLUSIONS: Pre-paid phone distribution to patients with SUD was associated with an increased healthcare engagement including telemedicine visits and encounters.

PMID:36695079 | DOI:10.1080/10826084.2023.2170184