Incidence Geometry

IntroductionReports around the world indicate that COVID-19 pandemic may be contributing to an increase in the incidence of new onset diabetic ketoacidosis (DKA). This has yet to be studied in Africa. We aimed to compare the incidence trend of new onset DKA before and during the COVID-19 pandemic, with a focus on the type of diabetes mellitus (DM).Materials and methodsThis was a cross sectional analytical study, over a 4-year period, between March 2018 until February 2022 conducted in the referral center: diabetology department of university hospital Farhat Hached Sousse, Tunisia. The study population included patients hospitalized for new onset DKA divided in two groups: G1: before COVID-19 pandemic and G2: during COVID-19 pandemic. Patients younger than 14, new onset DM not presenting with DKA, other types of diabetes (monogenic, secondary or pancreatic diabetes) were not included. A statistical analysis of the monthly incidence trend was conducted using the Jointpoint software pr...

Hypnosis is a valuable technique for clinical intervention, and for the treatment of a wide variety of psychological and medical problems. Based on insufficient theoretical and practical knowledge on the application of exclusive hypnotic analgesia, without pharmacological anesthetics in exodontics, a quasi-experimental study was carried out, with the aim of modeling and validating a technique from neurophysiology and dentistry. A control group that received pharmacological anesthesia (lidocaine with epinephrine) was designated for exodontics, and another study or experimental group, which received hypnotic anesthesia exclusively. Patients were assigned to each group from the universe formed by those who attended the Elective Exodontics consultation of Polyclinic 3 Rene Vallejo Ortiz in the period from September 2015 to September 2017. For the case of the experimental group it was considered for the assignment that were hypertensive, or that presented absolute contraindication of pha...

Introduccion: la Psiconeuroinmunologia ha ofrecido claves para la comprension del impacto del estres psicosocial en las llamadas enfermedades psicosomaticas; entre estas ocupa un lugar importante el asma bronquial. En la presente investigacion se modela una intervencion hipnoterapeutica, dirigida a aportar recursos para el afrontamiento y la percepcion de los estresores. Objetivo: disenar y fundamentar un tipo de terapeutica intrahipnotica que contribuya al alivio de los sintomas y la prolongacion de los periodos intercrisis. Metodo: a partir de un metodo psicofisiologico, que controla los marcadores por etapas, y que aporta certeza sobre el estado de conciencia en que transcurre la terapia, se disenaron estrategias ancladas a sugestiones posthipnoticas, que mejoraran la percepcion de los estresores y el estilo de afrontamiento en los pacientes. Resultados: el paradigma Th1/Th2 ha sido central en la interpretacion de la expresion de las citocinas en respuesta al estres psicologico, ...

To study the incidence of the tubercle of Zuckerkandl (ZT) among Indian patients subjected to thyroid surgery at a tertiary care cancer centre and its relevance in localization of recurrent laryngeal nerve (RLN). Prospective study on 144 patients (48 males, 96 females) undergoing thyroidectomy (35 hemithyroidectomies, 109 total thyroidectomies) from September 1st 2010 -February 28th 2013. 144 specimen/253 lobes (129 right, 124 left) were evaluated. Findings were recorded by the same team to ensure consistency. Presence, shape, grade (Pelizzo's) of ZT and relationship to RLN were documented. ZT was identified in 90.5 % (n = 229), commoner on the right (n = 120) than on left (n = 109). ZT was Grade 0 in 9.5 %, Grade I in 28.9 %, Grade II in 50.5 % and Grade III in 11 % of cases. In all patients ZT was unilobed. Recurrent laryngeal nerve (RLN) was consistent in position and was posterior to ZT in all cases. There were no branches of the RLN above the ZT. The ZT is a useful guide in locating RLN. Surgeon should be aware about the incidence, shape, grade and relation to RLN which is different in the Indian population as compared to what has been reported globally.

Background: Rejection is an important adverse event after pediatric liver transplantation (LT). Aim: We aimed to study the incidence and risk factors for post-transplant rejection in pediatrics. Methods: The study included 40 pediatric patients underwent LT. All patients' records were reviewed. A wide range of potential risk factors for rejection, were recorded. Results: Rejection occurred in 13/40 (32.5%) of recipients. For the 13 rejecters, a total of 24 rejection attacks have occurred. 25% of which occurred during the 1st month post-LT. Acute rejection accounted for 54% of total rejection attacks, while chronic rejection occurred in 46%. LT for biliary atrasia (BA) was a significant risk factor for rejection. The means of transaminases levels were 268 ± 141 (IU/L) AST and 221 ± 119 (IU/L) ALT, biliary enzymes were 962 ± 687 (IU/L) for the ALKP and 485 ± 347 (IU/L) for the GGT, total BIL was 6.5 ± 7.1 (mg/dl), and FKL levels were 10.4 ± 5.6 (ng/ml) during the rejection attacks...

La diferencia en las muertes en menores de 5 años fue de 72% (IC 95%=62-81). Conclusiones. La vacunación contra rotavirus tiene un impacto favorable en la disminución de las tasas de diarrea en menores de 5 años, especialmente en menores de 1 año. Es una estrategia efectiva en la prevención de muertes por esta causa en poblaciones menores de 5 años.

Background: Endometriosis is the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. Some women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. The aim of this study was to detect the incidence of endometriosis among symptomatic and asymptomatic cases of primary infertility in Tanta University Hospital over one year. Methods: This prospective observational study was conducted on 50 females aged between 20 and 35 years old, with unexplained infertility, symptoms of endometriosis and infertility for 1 or more years. Patients were divided into two equal groups: group (1): cases with unexplained infertility for 1 year or more and group (2): cases with symptoms of primary infertility and endometriosis for 1 year or more. Patients were subjected to the following: meticulous history taking (personal, obstetric and menstrual history, history of present illness, past history 'medical and surgical'), thorough clinical examination, routine laboratory investigations, imaging techniques (ultrasound and HSG) and laparoscopy for diagnosis of possible presence of endometriosis. Results: Endometrioma size was significantly higher in group 2 compared to group 1 (P value = 0.020). Stage 1 of endometriosis was significantly lower in group 2 compared to group 1 and Stage 2, 3 and 4 of endometriosis were significantly higher in group 2 compared to group 1 (P value =

Background: Endometriosis is the presence of endometrial-like tissue outside the uterus, which induces a chronic, inflammatory reaction. Some women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. The aim of this study was to detect the incidence of endometriosis among symptomatic and asymptomatic cases of primary infertility in Tanta University Hospital over one year. Methods: This prospective observational study was conducted on 50 females aged between 20 and 35 years old, with unexplained infertility, symptoms of endometriosis and infertility for 1 or more years. Patients were divided into two equal groups: group (1):  cases with unexplained infertility for 1 year or more and group (2):  cases with symptoms of primary infertility and endometriosis for 1 year or more. Patients were subjected to the following: meticulous history taking (personal, obstetric and menstrual history, history of present illness, past history 'medical ...

Background Cannabis use is associated with increased risk of later psychotic disorder but whether it affects incidence of the disorder remains unclear. We aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder. We included patients aged 18-64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We applied adjusted logistic regression models to the data to estimate which patterns of cannabis use carried the highest odds for psychotic disorder. Using Europe-wide and national data on the expected concentration of Δ⁹-tetrahydrocannabinol (THC) in the different types of cannabis available across the sites, we divided the types of cannabis used by participants into two categories: low potency (THC <10%) and high potency (THC ≥10%). Assuming causality, we calculated the population attributable fractions (PAFs) for the patterns of cannabis use associated with the highest odds of psychosis and the correlation between such patterns and the incidence rates for psychotic disorder across the study sites.

Laser interstitial thermal therapy (LITT) is a neurosurgical technique that has become increasingly popular in recent years due to its minimally invasive nature and ability to reduce the size of brain tumors. Advances in technology, such as magnetic resonance imaging thermometry and better laser probe design, have made LITT procedures more feasible and safe. Many studies have been conducted on using LITT to treat various conditions like tumors and epilepsy, but the specific uses for LITT are still evolving. In this article, we explain the basic principles of LITT, the process of performing the procedure, and both established and emerging applications for it. The effectiveness of LITT in treating recurrent glioblastoma (rGBM) is not yet established. This study aimed to systematically review and analyze existing literature to determine the outcomes of patients with rGBM who undergo LITT.

Objective To measure the impact on transmission of leishmaniasis of curtains impregnated with insecticide. Design Cluster randomised controlled trial: household interview survey, observational study of people's behaviour, entomological study with light trap captures of sandflies inside houses. Setting 14 urban sectors in Trujillo, Venezuela. Participants 2913 inhabitants of 569 houses. Intervention Sectors were paired according to their 12 month cumulative incidence of cutaneous leishmaniasis, one sector in each pair was randomly allocated to receive polyester curtains impregnated with lambdacyhalothrin (intervention group) while the other sector received curtains without insecticide or no curtains (control groups). After 12 months a follow up household survey was conducted. Main outcome measures Reduction in abundance of sandflies indoors and 12 month incidence of clinical cases of cutaneous leishmaniasis. Results Transmission of cutaneous leishmaniasis occurred mainly in the domestic setting, with the incidence over 12 months of 4%. The mean number of sandflies per trap per night was 16. After follow up the 12 month incidence of cutaneous leishmaniasis was 0% in the intervention group and 8% in the six pairs in the control group that received unimpregnated curtains (mean difference 8, 95% confidence interval 4.22 to 11.78; P=0.001). There were significantly fewer sandflies in the intervention group (2 v 15, mean difference 13 sandflies per trap; 9 to 17; P < 0.001). Conclusion Curtains impregnated with insecticide provide a high degree of protection against indoor transmission of cutaneous leishmaniasis.

A cohort of 235 subjects, who underwent radical prostatectomy from 1994 to 2002, completely continent at the 2-year follow up and with the last follow-up visit in 2009, was examined to assess incidence and risk factors of late-onset incontinence. Median follow up was 100 months, range 84-176. At the last follow-up visit, 209 (89%) maintained continence, and 26 (11%) became incontinent. Specifically 14 out of 26 (6%) used one pad and 12 (5%) used two or more pads daily. Incidence of age Ն65 years at radical prostatectomy was greater in the subgroup who developed late incontinence, 109/209 (52%) vs 19/26 (73%). Incidence of adjuvant or salvage radiotherapy, of hormonal manipulation and of extraprostatic disease was similar in the two subgroups. Univariate and multivariate analysis did not disclose any difference. Late-onset incontinence is to be expected in about 10% of subjects who became completely continent after radical prostatectomy. The cause is likely to be related to ageing. Patients should be informed about the long-term risk of becoming incontinent.

The urinary retention incidence after spinal anaesthesia with Lidocaine 2% and Bupivacaine 0.5%. Background and Goal of Study: Spinal anaesthesia is quick, cost-efficient, and safe, and is the ideal solution for some surgeries such as Chriptochidi, Herniy and Hydrocele. • Urinary retention after spinal anaesthesia has reported incidence between 0%-69% which is why successful micturition is still an important discharge criterion in many centers. • The purpose of this study was to measure the incidence of urinary retention and to identify the factors which affect the incidence of urinal retention after spinal anaesthesia with Lidocaine 2% and Bupivacaine 0.5%. Materials and methods: In this study are involved patients aged 18 to 65 years old. ASA I-II. • The patients underwent Chriptochidi, Hydrocele and Hernie repair surgeries. • Patients with prostate hyperplasia or urogenital pathologies (incontinence, cystoureteric reflux, know bladder retention) intraoperative blood loss>200 ml, pregnancy, alcohol or drug abuse, were excluded from the study. •An eco of the bladder was done to the patients before the surgery and was noticed that it was empty because the patients had urinated before entering the operation room. • Monitoring was standard with EKG, SaO2 and measurement of the blood pressure . • The subarachnoid space was punctured with a 26 G Whitacre needle at L2/L3 or L3/L4 with Lidocaine 2%-3ml (60mg) or Bupivacaine 0.5%-3ml(15mg). • Data were analyzed using Student's test and Fisher's exact test to detect significant differences among the groups. Correlations among outcome parameters and using Pearson's correlation test. • Linear and logistic uni-and multivariate regression analyses were performed to detect influencing and risk factors for catheterization A -P value of < 0.01 was deemed to be statistically significant. Results and discussion: Results: Number of patients was 90.87(96%) of them were males and 3 were females (4%). Mean age was 37(range 18-65 yr). •Mean (SD) duration of surgery was 60 min (range 45 min -120 min). • Patients received a mean (SD) of 780 ml (range 500ml -1500ml) Ringer's Lactate before and during surgery and 650ml (range 350 ml -1500 ml) after operation until micturition or urinary catheterization . • Use of Atropine was necessary in 20 of these patients. Retention was only noticed in men.Total i.v fluid administration was unexpectedly higher in patients who voided spontaneously in comparison with those who needed catheterization. • Urinary retention leading to catheterization was required in 24 patients(26%). • The incidence of urinary retention after spinal anaesthesia with Bupivacaine was significantly higher [(42%),17 of 40 patients] than Lidocaine[ (14%), 7 of 50] .(P<0.01). • Mean time (SD) between spinal puncture and urinary catheterization was 190 min(range 90-450min). •Mean time between spinal puncture and spontaneous micturition was significantly longer (240 min(SD60), range 60-450.P<0.0001) • Mean bladder volume was lower in patients able to micturate compared with those who required catheterization (P<0.08). Conclusion :We found an incidence of postoperative urinary retention of 26%. • The incidence of urinary retention after spinal anaesthesia with Bupivacaine was significantly higher (42%patients) than Lidocaine (14%, (P< 0.01

Background: Postoperative delirium is a common and deleterious complication in geriatric patients, and always has been associated with extent of day stay in hospital, and certainly more cost for the hospital as well. The delirium causes an increased mortality and an increasing of mental status deterioration characterized by reduction of environmental recognition as well as the disorder of alertness. The purpose of this study is to highlight the role of the presence of the patients' family in preventing postoperatore delirium in elderly patients in urology. This study is a prospective random double blinded study. Participants of this study are 456 patients older than 65 years old, while they were admitted to the urology department, between January 2010 December 2012. All patients are evaluated preoperatively on MMSE. The comparing value that was used for delirium was CAM. Patients that had been diagnosed and treated for psychiatric problems (Alzheimers, Dementia senile, Scysophrenia) were excluded from the study. Results: There was no difference between patients concerning the surgery type, anaesthesia, preoperatore comorbidity, hemodynamic changes. The difference between the two groups of patients was whether they met their family or not the two first days after the surgery. It is noticed that all patients who had contacts with their family after the surgery 306(100%) experienced no delirium, while 50 of the patients who did not have contacts with their family experienced delirium (33.3%) p<0.01. Having contact with their family the two first days after the surgery decreases significantly the incidence of postoperatore delirium in elderly patients in urology p<0.01.

Abstract -------- The increased average population age in Albania, and in the entire world, leads to increased number of patients that are elderly and that undergo surgery. The elderly concept is a dynamic concept which means that with the increase of the life expectancy the age that the person is considered elderly has changed as well. Delirium is a common complication on patients post anesthesia. Elderly population has a higher risk of delirium on post anesthesia, compare with other population. The purpose of this study is:To explore delirium, the risk factors and effect of delirium has on the length of the hospital stay and the financial burden of this complication.This study is conducted in “Mother Teresa”University Hospital Center in department of Anaesthezi-Reanimation and specifically on Urology section. This study is a prospective random bauble blinded study. Participants of this study are 1496 patients older than 65 years old, while they were admitted to the urology departm...

Background & objectives: Postoperative delirium is a frequent disorder in sick and elderly patients and has been associated with extended hospital stay and increased cost. The purpose of this study was to assess its etiology and incidence and the effectiveness of routine screening of vague postoperative delirium in the elderly using Confusion Assessment Method (CAM). We aimed to evaluate the risk factors and strategies for prevention and treatment as well as the impact of this psychiatric disorder on postoperative morbidity and mortality. We also assessed the economic impact of this disorder. Methodology: In this prospective, descriptive study, 640 patients, age 65 years or older, were included who underwent surgery at a urology clinic. All patients with a history of psychological problems and treated for these before admission were excluded from the study. Variables noted were: age, use of medications, signs and symptoms, biochemical and clinical balance, hemodynamic profile, and pre, intra and postoperative evaluation. Results: Postoperative delirium (POD) occurred in 166 (26%) out of 640 patients. Incidence was increased with increasing of age from 19% to 31%. POD was present in 27(26%) patients of the 65-70 year age group or in 4.2% of the total patients, in 74 (25%) patients of the 71-75 year age group or in 11.6% of the total patients, in 45 (26%) patients of the 76-80 year age group or in 7.0% of the total patients and in 20 (32%) patients of the >80 year age group or in 3.1% of the total patients. The association with many co-morbid conditions was not significant. The incidence of postoperative delirium with increasing age is significantly high. Further studies are required to relate it with physiologic changes in the brain due to preexistent or concomitant diseases, with blood biochemistry abnormalities, and with hormonal disturbances and with hemodynamic instability.

Objective. Women with gestational diabetes mellitus (GDM) are at increased risk to develop type 2 diabetes. This study aims to determine the incidence of postpartum diabetes and/or glucose intolerance among Filipino GDM patients who delivered at a tertiary hospital in Manila and to compare the risk factors present among these women. Methodology. 173 Filipino patients were included in this 3-year prospective cohort study. Demographics, clinical variables, and feto-maternal outcomes were recorded. 124 patients returned for follow-up and postpartum glycemic status was determined using 75g oral glucose tolerance test. Results. The incidence of diabetes and prediabetes postpartum was 7.3% and 34.7% respectively. Logistic regression analysis showed that multigravid patients (OR=2.84; 95% CI 1.20,6.70) and those with postpartum obesity (OR=2.84; 95% CI 1.20,6.70) are more likely to have prediabetes. Diagnosis of GDM at an earlier trimester increases the odds of having postpartum diabetes (OR=3.05; 95% CI 1.02,9.18). Also, if the body mass index falls under obese class II postpartum, the probability increases 115 times (95% ci 3.96,3357.83; p=0.006). Conclusion. The incidence of postpartum glucose intolerance among Filipino women with GDM is high. Clinicians should be more vigilant and strategies to implement compliance to postpartum glucose testing must be formulated to increase rates of follow-up testing among these women.

OBJECTIVE To describe the histological patterns, and to evaluate the long-term outcomes of non surgical treatment of nasopharyngeal carcinoma (NPC) in patients registered at Hadhramout National Cancer Centre (HNCC) in Mukalla City, in Hadhramout Province, Yemen. METHODS Non-randomized descriptive cancer registrybased study of patients with different WHO types of nasopharyngeal cancer and different non surgical treatment modality. Data was obtained from the medical records of patients seen and followed-up at HNCC. Data was collected using Can-Reg 10 computerized program and statistical analysis done using SPSS version-17 software program. RESULTS The study included 109 patients with NPC, males were 71(65.14%) and females were 38(34.86%), with a male to female ratio of 2:1. The mean age was 43 (range10-89 years). The majority of the patients were from Hadhramout 85(77.98%), while 24(22.2%) patients were from outside Hadhramout. The most common type of NPC seen according WHO classifica...

Background: Subacute Sclerosing Panencephalitis (SSPE) is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP), the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82-86% over those years. Results: Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/ year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were treated with isoprinosine and intraventricular interferon but died in less than three years from disease onset. One child did not have any treatment and died after seven years of illness. One child received intraventricular ribavirin and remains alive, but markedly impaired, nine years following diagnosis. The CPSP has demonstrated that Canadian paediatricians and paediatric neurologists may encounter cases of SSPE. This report highlights the clinical course of affected Canadian children and provides a review of the disease and its management.

Subacute Sclerosing Panencephalitis (SSPE) is so rare in developed countries with measles immunization programs that national active surveillance is now needed to capture sufficient number of cases for meaningful analysis of data. Through the Canadian Paediatric Surveillance Program (CPSP), the SSPE study was able to document a national incidence and determine the epidemiology of affected Canadian children. Between 1997 and 2000, the CPSP surveyed monthly 1978 to 2294 Canadian pediatricians and sub-specialists for SSPE cases. The response rate varied from 82-86% over those years. Altogether, four SSPE cases were reported to the CPSP: one case before, two during and one after the study period. The incidence of SSPE in Canadian children was 0.06/million children/year. Of the four cases, diagnosed between ages four and 17 years, three children had measles infection in infancy. All children showed a progressive course of dementia, loss of motor skills and epilepsy. Two children were tre...

Almost all investigations of firstepisode schizophrenia uncover more male than female subjects. Two possible explanations for this observation are (1) first-episode investiga-Reprint requests should be sent to Dr. W.G. lacono, Dept. of Psychology, University of Minnesota,

RESUMO: Os autores relatam os resultados de 1000 colonoscopias realizadas no Serviço de Coloproctologia do Hospital das Forças Armadas, Brasília-DF. A indicação mais freqüente foi a alteração do hábito intestinal. As colonoscopias foram normais em 43,2% dos casos. Os pólipos colorretais e a doença diverticular foram as patologias de maior prevalência. A taxa de complicação foi de 0,4%, consistindo de três casos de perfuração de cólon e um caso de bacteremia após o exame. Quando exames de enema opaco de 176 pacientes foram comparados com os achados da colonoscopia, observaram-se 93 casos positivos verdadeiros, 32 negativos verdadeiros, 43 falsos-positivos, oito casos de falsosnegativos, resultando em sensibilidade de 92,07%, especificidade de 42,66%, valor preditivo positivo de 68,33%, valor preditivo negativo de 80% e acuidade diagnóstica de 71,02%. Os achados corroboram a eficiência e segurança da colonoscopia, em relação ao enema opaco, como procedimento fundamental no diagnóstico das patologias do intestino grosso.

Vaccination with Bacillus Calmette–Guérin (BCG) can be harmful to patients with combined primary immunodeficiencies. We report the outcome of BCG vaccination in a series of twelve patients affected by adenosine deaminase deficiency (ADA-SCID). BCG vaccination resulted in a very high incidence of complications due to uncontrolled replication of the mycobacterium. All patients who developed BCG-related disease were treated successfully and remained free from recurrence of disease. We recommend the prompt initiation of enzyme replacement therapy and secondary prophylaxis to reduce the risk of BCG-related complications in ADA-SCID patients.

Introduction: Hyponatremia is the most common electrolyte disorder in patients following surgical interventions (19-50%). Hospital acquired hyponatremia is often due to using hypotonic solution s and can be lethal. Materials and Methods: Between January and December 2014, 190 children (1 month to 12 years) who were admitted in the urology department of Children’s Hospital Medical Center for elective surgical procedures were enrolled in the study. The patients were randomly divided into two groups: group I received 50 mEq/L sodium and 20 mEq/L potassium in D/W 5% and group II received 154 mEq/l sodium and 20 mEq/L potassium in D/W 5% at the maintenance dose for a period of 6 hours following the operation. The patients did not have any oral fluid intake 6 hours postoperatively. The incidence of hyponatremia before and after maintenance IV fluid therapy was analyzed. Other characteristics of the patients such as age, gender, duration of hospitalization, other concomitant electrolyte di...

ObjectiveSingle cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19.MethodsGBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered.ResultsIncidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum scor...

During the last three decades, several myeloablative conditioning regimens have been used for AML allografts. In this review, we systematically examine the data from studies reporting on myeloablative conditioning regimens for AML allografts. High-dose busulfan combined with cyclophosphamide (BuCy) and cyclophosphamide in combination with total body irradiation (CyTBI) are the two most commonly used conditioning regimens for AML allografts. From the available data, there are no significant differences in survival with these two regimens. A small benefit of decreased relapse rate with CyTBI is counterbalanced by a nonsignificant increase in treatmentrelated mortality. The incidence of veno-occlusive disease is significantly higher in patients treated with BuCy. Therapeutic monitoring of busulfan was not reported in any of the studies comparing the regimens. Either of the regimens can be used for AML allografts, and the choice may ultimately depend on local availability and expertise. Further improvements may be possible from modifications of the standard regimens. Data from these latter studies seem to be encouraging, but are not based on comparative randomized trials.

"Background: Tuberculosis (TB) remains a major global health challenge, with Indonesia ranking among the top three countries with the highest TB burden in 2019. Information about the distribution of the tuberculosis (TB) incidence rate over time and space is necessary for the effective control of the disease. This study aimed to exam-ine the spatio-temporal trends of tuberculosis (TB) incidence rates in Makassar, South Sulawesi.
Methods: This Ecological study utilized aggregated TB cases data in Makassar City, from the Indonesian National Tuberculosis Information System (SITB). between January-December 2022 (3977 patients). Kulldorff’s space-time scan statistic, implemented using SaTScan, was applied to identify clusters of TB. In addition, Anselin’s Lo-cal Moran’s I, conducted in GeoDa, was utilized to further characterize tuberculosis hotspots and cold spots.
Results: The greatest Tuberculosis incidence rate was recorded in middle west area in Makassar during 2022. Kulldorf’s space-time scan statistic identified the most probable cluster in 60 villages in the mid-western region of Makassar from July to December 2022, with a relative risk (RR) of 1.50 (p-value <0.001) and secondary cluster (16 villages) was identified in the southern region of Makassar, with a RR of 1.41 (p = 0.0015). Some high-trend TB statistically significant clusters were found in the same places.
Conclusions: The TB cluster was located at Middle west Makassar. Prioritizing these clusters for resource alloca-tion could lead to more successful control and prevention of TB. Future studies should examine socioeconomic and environmental determinants to better explain TB clustering and guide comprehensive interventions."

Malnutrisi dan anemia pada ibu hamil merupakan masalah gizi yang masih sulit diatasi di seluruh dunia. Malnutrisi dan anemia bukan hanya berdampak pada ibu, tetapi juga pada bayi yang dilahirkan. Tujuan penelitian ini adalah mengetahui pengaruh status gizi terhadap kejadian anemia pada ibu hamil di daerah endemis malaria kabupaten Pesawaran. Penelitian ini merupakan penelitian observasional analitik dengan menggunakan desain cross sectional. Penelitian dilakukan di kabupaten Pesawaran pada bulan Mei sampai November 2019. Sampel adalah 70 orang ibu hamil yang bersedia untuk berpartisipasi dalam proses penelitian dan tidak menderita penyakit keganasan, diabetes melitus dan TBC, yang diambil dengan teknik purposive sampling. Data anemia ibu hamil diukur dengan pemeriksaan kadar haemoglobin darah ibu dan data status gizi diperoleh dari pengukuran lingkar lengan atas. Data dianalisis secara univariat dan bivariat menggunakan Uji Chi Square. Hasil penelitian menunjukkan bahwa 32,9% responden menderita anemia dalam kehamilan, dan 22,9% memiliki status gizi malnutrisi. Hasil penelitian menunjukkan bahwa status gizi berpengaruh terhadap kejadian anemia ketika ibu hamil (p=0,02).

Diarrhea is one of the major health problem in Indonesia, it caused high amount children mortality. The immunity compounds in breastfeed gives diarrhea protection to the infants. Dietary allowance will influence the immunity. The aimed of this research is to know the relation of nutrition status and exclusive breastfeeding history with diarrhea in 6-12 months infants. This is an analytic observation research with cross sectional design. The subject are 94 infants with consecutive sampling method in November-Desember 2013. Data are analyzed in univariat and bivariat with chi square test. Bivariat analysis shows that there is a significant relation between exclusive breastfeeding and diarrhea. The infant that haven't breastfeeding history have 4,31 higer risk of diarrhea. There is a significant relation between the nutritional status and diarrhea. The infant that have less nutition status have 3,42 higher risk of diarrhea. From this research we can inferred that there is a relation between exclusive breastfeeding history and nutritional status with diarrhea.

High level of activity causes people prefer things that are instant, including in choosing food.Fast food is very easy to get and does not require a long time to be served.Most fast foods are high in calories, cholesterol, fat, and salt but low in fiber.This certainly affects the nutritional status where the incidence of malnutrition is more likely to be higher. Nutrition knowledge level of person also affects attitudes and behaviors in choosing foods. The purpose of this research is to know the relation of fast food eating habits, physical activity and nutrition knowledge with nutritional status of medical student of first year medical student of university of lampung 2013. This research is descriptive analytic research with cross sectional design. The number of respondents are 125 people. The results of this research showed that 58.4% of respondents are often eating fast food and 41.6% respondents are rarely. Physical activity brings about 42,4% have good physical activity and 57....

Background: Patients with acute neurologic illness often manifest findings suggestive of cardiac injury. Their proper interpretation is unclear. Accordingly, we conducted a blinded evaluation to assess the incidence of cardiac injury determined by elevations of cardiac troponin I (cTnI) in patients presenting within 24 hours of a neurologic event and to determine their short-and longterm prognostic effect. Methods: Blood samples for measurement of cTnI levels were obtained on hospital admission and daily for 3 days and were run by immunoassay. Extensive clinical evaluations including electrocardiograms and echocardiograms were obtained from all patients; daily follow-up evaluations were performed. The clinical electrocardiographic, echocardiographic, and biochemical data were analyzed independently by blinded observers. Results: Peak levels of cTnI were elevated (Ն0.4 µg/L) in 17 patients (19%) (mean ± SD, 2.5 ± 2.7 µg/L). All patients with elevated cTnI levels had clinical, electrocardiographic, or echocardiographic evidence of cardiac injury except those (n=5) with minor elevations. One-year mortality was 29% (23/80). Early death (Յ30 days) accounted for 44% of total mortality (n= 10) and was significantly higher in patients with elevated cTnI levels (Wilcoxon P = .01; odds ratio, 6.4). This difference was less marked by 1 year (Wilcoxon P =.07). Conclusions: There is a substantial prevalence of myocardial injury in patients with acute neurologic illness. Cardiac injury in this population, as in others, seems to adversely affect prognosis.

Objectives: Despite being a cheap, easy, and commonly used technique for screening early development of cervical cancer, collective evidence on the effect of visual inspection with acetic acid (VIA) for reducing cervical cancer mortality and incidence are conflicting. We conducted a systematic review and meta-analysis to determine the effectiveness of VIA screening on cervical cancer mortality and incidence. Methods: We searched PubMed, Embase, Cochrane library (Cochrane Database of Systematic Reviews & Cochrane Central Register of Controlled Trials), World Health Organization's (WHO) International Clinical Trials Registry Platform, and Google Scholar to identify studies conducted among women with no history of cervical cancer that assessed effectiveness of VIA on the cervical cancer mortality and incidence. Random effects model was used to estimate incident rate ratio and sensitivity analysis was conducted using Bayesian methods. Results: Of the included 4 studies, three were cluster randomized trials from India and one was quasi-experimental study done in Thailand. Duration of follow-up ranged from 7 to 12 years. Based on 3 trials, pooled rate-ratio for cervical cancer mortality and all-cause mortality was 0.68 (95% CI: 0.56-0.81, I 2 =0%) and 0.91 (0.85-0.97, I2=57%), respectively. Pooled rate-ratio of invasive cervical cancer was 0.94 (95% CI: 0.67 -1.30, I 2 =84%). Likewise, there was non-significant reduction in incidence of stage IB, >=stage II, and unknown stage cervical cancer. Conclusions: VIA screening may lead to reduction in cervical cancer and all-cause mortality in long run. However, the effectiveness of VIA in preventing invasive cervical cancer is inconclusive.

Anti-NMDAR encephalitis has been associated with multiple antigenic triggers (i.e., ovarian teratomas, prodromal viral infections) but whether geographic, climatic, and environmental factors might influence disease risk has not been explored yet. We performed a systematic review and a meta-analysis of all published papers reporting the incidence of anti-NMDAR encephalitis in a definite country or region. We performed several multivariate spatial autocorrelation analyses to analyze the spatial variations in the incidence of anti-NMDA encephalitis depending on its geographical localization and temperature. Finally, we performed seasonal analyses in two original datasets from France and Greece and assessed the impact of temperature using an exposure-lag-response model in the French dataset. The reported incidence of anti-NMDAR encephalitis varied considerably among studies and countries, being higher in Oceania and South America (0.2 and 0.16 per 100,000 persons-year, respectively) com...

Objectives: Hip fractures mostly require surgical treatment and are associated with increased health-care costs and mortality rates. Patients with cirrhosis have low bone marrow density and inferior immune status which contribute to a higher fracture rate and higher surgical complication rate. This population-based study evaluated the prevalence, complication, and mortality rates due to hip fractures in cirrhotic patients. Methods: Taiwan National Health Insurance Research Database data were used. The study group included 117,129 patients with hip fractures diagnosed from 2004 to 2010, including 4048 patients with cirrhosis. The overall prevalence, morbidity, and mortality rates of the cirrhosis group with hip fractures were compared with the rates of a general group with hip fractures. Results: The cirrhosis group patients were younger than the general group patients (71.2 vs. 73.96 years, p &lt; 0.001). The annual incidence of hip fractures in the cirrhosis and general groups was ...

An obstetric ultrasound of a 38 years old woman with a dichorionic diamniotic twin pregnancy showed an increased nuchal translucency and absent nasal bone in one of the fetuses suggesting us an increased risk f or Down Sy ndrome (DS). This fetus was detected to hav e trisomy 21 (47, XX+21) by inv estigation of the amniocentesis material and was selectively undergone feticide process at 20 weeks of gestation. The other f etus (46, XX) was successf ully delivered at 36 weeks without any complications.

The majority of nosocomial infections in the hospital setting are found in intensive care units (ICUs). The present study was undertaken to determine the incidence, risk factors, causative microorganisms, and outcome of various ICU-acquired infections. The patients admitted to the ICU of a teaching hospital in North India were prospectively studied. Detailed history, clinical examination, acute physiology and chronic health evaluation score II, simplified acute physiology score II, sequential organ failure assessment score, and baseline investigations were recorded. Patients were assessed daily till 14th day for nosocomial infection as per Centers for Disease Control and Prevention (CDC) guidelines and were followed till death or discharge. Incidence, risk factors, and outcome parameters were calculated using Student t-test, Chi-square test, and stepwise multivariate logistic regression model. The overall incidence rate of ICU infections was 27.9%. The most common ICU-acquired infection was ventilator-associated pneumonia followed by catheter-related bloodstream infection and catheter-associated urinary tract infection. Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae were implicated in most of the infections. ICU length of stay (LOS) >7 days, neurological dysfunction, endotracheal intubation, ischemic heart disease, and use of antacids/H 2 blockers were significantly associated with ICU-acquired infections. The mortality rate was 32.8 and 28.8% in patients with and without ICU infections, respectively (p = 0.531). The ICU LOS (19.23 ± 12.79 days) was significantly higher in the ICU infections group (p <0.001). Conclusion: Ventilator-associated pneumonia was the most common nosocomial infection in our study. Gram-negative microorganisms were the predominant causative agents for various ICU-acquired infections. Mortality was not found to be affected but ICU LOS was significantly prolonged as a consequence of the development of ICU-acquired infection.

Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations. We conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens -once-daily tenofovir (TDF), combination tenofoviremtricitabine (TDF-FTC), or matching placebo -and followed monthly for up to 36 months. At enrollment, the HIV-1-seropositive partners were not eligible for antiretroviral therapy, according to national guidelines. All couples received standard HIV-1 treatment and prevention services. We enrolled 4758 couples, of whom 4747 were followed: 1584 randomly assigned to TDF, 1579 to TDF-FTC, and 1584 to placebo. For 62% of the couples followed, the HIV-1-seronegative partner was male. Among HIV-1-seropositive participants, the median CD4 count was 495 cells per cubic millimeter (interquartile range, 375 to 662). A total of 82 HIV-1 infections occurred in seronegative participants during the study, 17 in the TDF group (incidence, 0.65 per 100 person-years), 13 in the TDF-FTC group (incidence, 0.50 per 100 person-years), and 52 in the placebo group (incidence, 1.99 per 100 person-years), indicating a relative reduction of 67% in the incidence of HIV-1 with TDF (95% confidence interval [CI], 44 to 81; P<0.001) and of 75% with TDF-FTC (95% CI, 55 to 87; P<0.001). Protective effects of TDF-FTC and TDF alone against HIV-1 were not significantly different (P = 0.23), and both study medications significantly reduced the HIV-1 incidence among both men and women. The rate of serious adverse events was similar across the study groups. Eight participants receiving active treatment were found to have been infected with HIV-1 at baseline, and among these eight, antiretroviral resistance developed in two during the study. Oral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women. (Funded by the Bill and Melinda Gates Foundation; Partners PrEP ClinicalTrials.gov number, NCT00557245.

HPV test appears to be more effective in cervical cancer (CC) screening. However, the decision of its adoption as a primary screening method by substituting the established cytology lies in the evaluation of multiple criteria. Aim of this study is to evaluate the economic and clinical impact of HPV test as primary screening method for CC. A decision tree and a Markov model were developed to simulate the screening algorithm and the natural history of CC. Fourteen different screening strategies were evaluated, for women 25-65 years old. Clinical inputs were drawn from the HERMES study and cost inputs from the official price lists. In the absence of CC treatment cost data, the respective Spanish costs were used after being converted to 2017 Greek values. One-way and probabilistic sensitivity analyses were conducted. All screening strategies, that offer as primary screening method triennial HPV genotyping (simultaneous or reflex) alone or as co-testing with cytology appear to be more effective than all other strategies, with regards to both annual CC mortality, due to missed disease (-10.1), and CC incidence(-7.5) versus annual cytology (current practice). Of those, the strategy with HPV test with simultaneous 16/18 genotyping is the strategy that provides savings of 1.050 million euros annually. However, when the above strategy is offered quinquennially despite the fact that outcomes are decreased it remains more effective than current practice (-7.7 deaths and -1.3 incidence) and more savings per death averted (1.323 million) or incidence reduced (7.837 million) are realized.

The influence of the size and location of communities in relation to the different types of watercourse, the availability of a protected water supply, types of housing and the presence of other sanitary facilities on the prevalence of bilharziasis in the Egypt-49 project area has been studied. There is no direct relationship between the size of village and the prevalence of bilharziasis. Main drains and distributaries are potent sources of infection and, in terms of the total population exposed, distributaries play the most significant role in the transmission of infection. Of the other factors, the availability of a protected water supply seems to have the greatest effect on the prevalence. Although the presence of a latrine in the dwelling does not of itself influence the extent of schistosome infection, which is caught from polluted water, the installation of latrines assists in the cultivation of healthy habits, thereby lessening the prevalence not only of bilharziasis but also of certain other infections.

Background: The metabolic disorder Diabetes mellitus constitutes a steadily increasing global health problem which produces multiple complications during its progressive course. New epidemiological studies indicate that diabetes mellitus (DM) leads to hepatocellular carcinoma (HCC) development which ranks as the sixth most common cancer type and presents as one of the most frequent cancer-related fatalities. HCC development results from three main factors which link diabetes mellitus to the disease including insulin resistance, chronic inflammation, hyperglycemia and obesity. Methods: This evaluation will consider research from several populations using case-control studies and cohort studies as well as meta-analyses to explore the molecular pathways between DM and HCC while determining the impact of drinking alcohol and viral hepatitis risks to DM patients. Results: We will analyze how antidiabetic medications affect the risk of HCC development in the final part. The risk of developing HCC is doubled to tripled for subjects with diabetes mellitus according to epidemiologic research. The combination of high blood sugar levels creates inflammation alongside oxidative stress but elevated insulin levels coupled with long-running triggers of insulin-like growth factor 1 activity stimulates new liver cell growth. Some studies show that diabetes mellitus increases HCC development risk mainly when hepatitis B and C infections simultaneously occur. The independent risk factor status of diabetes mellitus exists for the development of HCC regardless of additional liver diseases. Conclusion: Current research remains limited about the HCC developmental effects of weight variations caused by antidiabetic medications alongside diabetes mellitus history.

Background: Hepatocellular carcinoma (HCC) ranks additional as the deadliest cancer, and around newly available literature proposes that the existence of chronic kidney illness may worsen the difficulty of important indicators like alpha-fetoprotein (AFP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and even platelet total. Methods: We confirmed a reflective cross-sectional study in three tertiary care centers which consisted of 255 patients with chronic liver bug (CLD) and had different degrees of renal meaningnormal, mild CKD, and simple CKD groups. Creatinine levels, eGFR, AFP, ALT, AST, and palates levels were gained and analyzed using ANOVA, correlation, and multivariate regression models. Results: There was a notable positive relationship between serum creatinine and AFP (r=0.62, p<0.001), whereby the most severely affected CKD patients had serum creatinine levels that were at least four-fold greater than those with normal renal functioning on AFP. With advancing CKD, ALT and AST levels gradually elevated while platelet counts markedly declined. Multivariate regression analysis showed that creatinine level independently predicted elevated AFP with the strongest relation amongst all age factors and liver damage proxies. Conclusion: The effects of chronic kidney disease (CKD) on hepatocellular carcinoma (HCC) biomarkers equal modifications cross with the wellknown benchmarks, cumulative the indicative difficulty. Considering the rising global prevalence of CKD and liver disease, it leftovers important to evaluate renal function as part of the HCC surveillance system to facilitate earlier diagnosis and enhance management.

Understanding spatial determinants, i.e., social, infrastructural, and environmental features of a place, which shape infectious disease is critically important for public health. We present an exploration of the spatial determinants of reported COVID-19 incidence across India’s 641 urban and rural districts, comparing two waves (2020–2021). Three key results emerge using three COVID-19 incidence metrics: cumulative incidence proportion (aggregate risk), cumulative temporal incidence rate, and severity ratio. First, in the same district, characteristics of COVID-19 incidences are similar across waves, with the second wave over four times more severe than the first. Second, after controlling for state-level effects, urbanization (urban population share), living standards, and population age emerge as positive determinants of both risk and rates across waves. Third, keeping all else constant, lower shares of workers working from home correlate with greater infection risk during the se...