Ethiopian Journal of Health Sciences

Editorial message

2023-03-26T14:21:09+00:00

Editorial message

A Multiple-Center, Retrospective Study of Characteristics and Outcomes of Hospitalized COVID-19 Patients with Cardiovascular Disease in North Iran

2023-03-26T14:40:07+00:00

BACKGROUND: In this retrospective study, we investigated the outcomes and demographic characteristics of COVID-19 patients with and without a history of CVD.

METHODS: This large retrospective, multicenter study was performed on inpatients with suspected COVID-19 pneumonia who were admitted across four hospitals in Babol, Northern Iran.

Demographic data, clinical data, and cycle threshold value (Ct) results of Real Time PCR were obtained. Then, participants were divided into two groups: (1) cases with CVDs, (2) cases without CVDs.

RESULTS: A total of 11097 suspected COVID-19 cases with a mean ± SD age of 53 ±25.3 (range: 0 to 99) years were involved in the present study. Out of whom 4599 (41.4%) had a positive RT-PCR result. Of those, 1558 (33.9%) had underlying CVD. Patients with CVD had significantly more co-morbidities such as hypertension, kidney disease, and diabetes. Moreover, 187 (12%) and 281 (9.2%) of patients with and without CVD died, respectively. Also, mortality rate was significantly high among the three groups of Ct value in patients with CVD, with the highest mortality in those with Ct between 10 and 20 (Group A = 19.9%).

CONCLUSION: In summary, our results highlight that CVD is a major risk factor for hospitalization and the severe consequences of COVID-19. Death in CVD group is significantly higher compared to non-CVD. In addition, the results show that age-related diseases can be a serious risk factor for the severe consequences of COVID-19.

Breastfeeding Self-efficacy in COVID-19 Positive Postpartum Mothers in a Community Maternal Facility in South India: A Case Control Study

2023-03-26T14:52:05+00:00

BACKGROUND: Breastfeeding experiences have altered during the COVID-19 pandemic. Breastfeeding self-efficacy is a strong determinant of the breastfeeding behaviour of women. We aimed to study breastfeeding self-efficacy and assess the perceived factors for breastfeeding hindrance in COVID-19 positive mothers in the postpartum period.

METHOD: A facility based case-control study was conducted with 63 COVID-19 positive (cases) and 63 COVID-19 negative postnatal mothers (controls). A breastfeeding self-efficacy short form (BFSE SF) instrument measured Breastfeeding self-efficacy 24 to 48 hours post-delivery. Mothers who tested positive for COVID-19 were interviewed about perceived factors for breastfeeding hindrance. Data was analyzed by SPSS version 25. Descriptive statistics were used for maternal parameters. BFSE SF scores were compared by a t test.

RESULTS: The mean BFSE SF score of COVID-19 positive mothers was 53.14 which was significantly lower than the mean BFSE SF score of 56.52 of COVID-19 negative mothers (p=0.013). Mothers who had received postpartum breastfeeding advice had significantly higher BFSE SF mean scores (p= 0.031). Sixty-seven percentage of COVID-19 positive mothers reported fear of transmission of illness to the neonate as a hindering factor.

CONCLUSION: Breastfeeding self-efficacy scores were significantly lower in COVID- 19 positive mothers. Higher breastfeeding self-efficacy scores were observed in mothers who had received postpartum breastfeeding advice. The fear of transmission of the COVID-19 illness to the neonate was perceived as a breastfeeding hindering factor in most of the mothers. These observations imply the need for professional lactation support programs.

Emergency Nurses' Compliance with Standard Precautions during the COVID-19 Pandemic at Governmental Hospitals in Hail City, Kingdom of Saudi Arabia

2023-03-26T14:55:24+00:00

BACKGROUND: This study was conducted to assess nurses' compliance with standard precautions during COVID-19 pandemic at emergency departments, Hail city, Saudi Arabia.

METHODS: A cross-sectional study was conducted in the year 2021, at emergency departments of governmental hospitals in Hail city, Saudi Arabia. A total of 138 emergency nurses were selected using a census sampling method, and included in the current study. Of them, 56(40.6%) were from King Khalid Hospital, 35(25.4%) from King Salman Specialist Hospital, 28(20.3%) from Sharaf Urgent Care Hospital, and 19(13.8%) from Maternity and Child Hospital. The compliance with standard precautions scale was used, and socio-demographic characteristics were assessed using a structured questionnaire. Statistical analysis was performed using SPSS version 28.

RESULTS: A large percentage (71.0%) of the studied nurses were females, and (78.3%) were Saudi. The mean scores of compliances with standard precautions ranged from 3.1 to 3.9 out of 4. The overall compliance rate with all components of standards precautions was optimal (92.75%). Significant statistical differences were found in the mean scores of the “prevention of cross infection from person to person” with age; and between the mean scores of the “decontamination of spills and used article” with profession carrier P-values = 0.013, and 0.016, respectively.

CONCLUSION: The compliance with standard precautions by emergency nurses was optimal (more than 90%). The mean compliance scores with the standard precautions could be associated with age and professional category. Continuous training program to enhance compliance with standard precautions among emergency nurses with continuous follow up and evaluation are recommended.

The Predictors of Clinical Competence among Hospital Nurses: A Cross-Sectional Study in Hamadan, West Iran

2023-03-26T15:03:58+00:00

BACKGROUND: Nurses' clinical competence (CC) is critical in providing high-quality and safe nursing care. Assessment of nurses’ CC and its predictors is a key step to improve their CC and the quality of their services. The aim of this study was to determine the predictors of CC among hospital nurses in Iran.

METHODS: This analytical cross-sectional study was conducted from September 2020 to May 2021. Participants were purposively selected from four university hospitals in Hamadan, west of Iran. A demographic questionnaire and the 73-item Nurse Competence Scale were used for data collection. A total of 300 questionnaires were distributed and 270 questionnaires (response rate: 90%) were completed and returned to the researcher. Data were analyzed using the SPSS software (v. 16.0) and the one-way analysis of variance, the independent-sample t, the Mann-Whitney U, and the Kruskal-Wallis tests, the Pearson and the Spearman correlation analyses, and the linear regression analysis.

RESULTS: The mean score of CC was 40.28±8.6 (in the possible range of 0–100) and the highest and the lowest dimensional mean scores were for the situation management (56.13±11) and the ensuring quality (25.3±8.1) dimensions, respectively. The mean score of CC had significant relationship with age, work experience, and ward of working and these variables significantly predicted 77% of the variance of CC (adjusted R = 0.778, P<0.05).

CONCLUSION: According to the results of this study, age, work experience and ward of working weresignificant predictors of CC in hospital nurses. Nursing managers should employ strategies such as reducing nurses’ workload, improving their employment status, and providing them with quality in-service education in order to improve their CC and the quality of their services.

Decision to Delivery Interval, Perinatal Outcome and Factors Following Emergency Cesarean Section in Southern Ethiopia

2023-03-26T15:18:11+00:00

BACKGROUND: The interval between the decision for an emergency cesarean section and the delivery of the fetus should be made within 30 minutes. In a setting like Ethiopia, the recommendation of 30 minutes is unrealistic. Decision to delivery interval should, therefore, be considered as vital in improving perinatal outcomes. This study aimed to assess the decision to delivery interval, its perinatal outcomes, and associated factors.

METHODS: A facility-based cross-sectional study was employed, and a consecutive sampling technique was used. Both the questionnaire and the data extraction sheet were used, and data analysis was done using a statistical package for social science version 25 software. Binary logistic regression was used to assess the factors associated with decision to delivery interval. P-value < 0.05 level of significance with a 95% Confidence interval was considered statistically significant.

RESULTS: Decision-to-delivery interval below 30 minutes was observed in 21.3% of emergency cesarean sections. Category one (AOR=8.45, 95% CI, 4.66, 15.35), the presence of additional OR table (AOR=3.31, 95% CI, 1.42, 7.70), availability of materials and drugs (AOR=4.08, 95% CI, 1.3, 12.62) and night time (AOR=3.08, 95% CI, 1.04, 9.07) were factors significantly associated. The finding revealed that there was no statistically significant association between prolonged decisions to delivery interval with adverse perinatal outcomes.

CONCLUSION: Decision-to-delivery intervals were not achieved within the recommended time interval. The prolonged decision to delivery interval and adverse perinatal outcomes had no significant association. Providers and facilities should be better equipped in advance and ready for a rapid emergency cesarean section.

The Effectiveness of Mostafa Maged Technique in Closure of the Episiotomy during Vaginal Delivery

2023-03-26T17:37:52+00:00

BACKGROUND: This study is done to assess the effectiveness of Mostafa Maged technique in suturing the episiotomy.

METHODS: At the time of delivery, this technique will be applied to all women with episiotomy or perineal or vaginal tears. The technique employs absorbable vicryl threads with 75 mm round needles. Mostafa Maged technique includes the continuous suturing of the vaginal epithelium and the muscle layer. Evaluation of the perineal region within the next twenty-four hours prior to discharge searching for (edema-hematoma-septic wound - continence - ecchymosis - dyspareunia).

RESULTS: The current study included 50 patients. All patients had an episiotomy during delivery; 25 patients' episiotomies were sutured using Mostafa Maged technique, while the remaining patients' episiotomies were by regular traditional technique. Mostafa Maged technique has demonstrated efficacy in achieving adequate hemostasis and avoiding dead space formation during an episiotomy. It was found that 100 % of patients with Mostafa Maged technique have no dead space, and 95.8% of Mostafa Maged patients do not have vulval edema. The technique of Mostafa Maged has also proven effectiveness in achieving postoperative hemostasis. Unlike patients with regular maneuvers, 83.3% do not have dead space, and 83.3 % do not have vulval edema.

CONCLUSION: Mostafa Maged technique is a simple technique and easy to apply when suturing episiotomy. Mostafa Maged technique is significantly superior to conventional maneuvers in preventing bleeding at the episiotomy site and preventing formation of dead space so achieving good hemostasis; therefore, it is highly recommended. I recommend more studies on efficacy of Mostafa Maged maneuver on large sample of patients.

Effect of Intranasal Ketamine on Pain Intensity after Cesarean Section: A Single-Center, Double Blind, Randomized Controlled Trial

2023-03-26T17:43:18+00:00

BACKGROUND: Although intravenous or intramuscular opioids are widely used for managing postoperative pain after cesarean section (CS), their side effects are bothering and limit their use. The aim of this study was to determine the effect of intranasal ketamine on pain intensity after CS.

METHODS: In a single-center, double-blind, parallel-group, randomized controlled trial, a total of 120 patients who were scheduled for elective CS were randomly assigned into two groups. After birth, 1 mg of midazolam was administered to all patients. In addition, 1 mg/kg intranasal ketamine was administered to patients in the intervention group. For patients in control group, normal saline was administered intranasally as a placebo. The severity of pain and nausea in the two groups was evaluated after 15, 30 and 60 minutes, as well as 2, 6 and 12 hours after the initial administration of the medications.

RESULTS: The trend of changes in pain intensity was decreasing and these changes were statistically significant (time effect; P<0.001). The pain intensity in the placebo group was higher than the intervention and the observed difference was statistically significant, regardless of the time studied (group effect; P<0.001). In addition, it was shown that regardless of the study group, the trend of changes in nausea severity was decreasing and these changes were statistically significant (time effect; P<0.001). Regardless of the time studied, the severity of nausea in the placebo group was higher than the intervention group (group effect; P<0.001).

CONCLUSION: According to the results of this study, it seems that the using of intranasal ketamine (1 mg/kg), can be considered as an effective, well tolerated and safe method in reducing pain intensity as well as the need for postoperative opioid consumption after CS.

Spinal Anaesthesia for Urological Surgery: A Comparison of Isobaric Solutions of Levobupivacaine and Ropivacaine with Dexmedetomidine

2023-03-26T17:46:34+00:00

BACKGROUND: Subarachnoid block is used in most of urological surgeries and finding the best possible drug has always been a challenge. Bupivacaine’s pure enantiomers ropivacaine and levobupivacaine have lesser systemic toxicity. Isobaric solution has extra benefit of not affecting the intrathecal dispersion of drug. Dexmedetomidine when added intrathecally provides longer duration of analgesia and anaesthesia. Aim of this study is to compare onset, duration of the block with both the drugs along with their hemostability and postoperative analgesia.

METHODS: It is a Prospective Randomized Double-Blind Study. It includes 68 patients undergoing urological procedures under subarachnoid block. Group LD: Patients will receive 3.5 ml of Isobaric Levobupivacaine 0.5% + Dexmedetomidine 10 μg (0.1ml) Group RD: will receive 3.5ml of Isobaric Ropivacaine 0.5% + Dexmedetomidine 10 μg (0.1ml)

RESULTS: Time taken for onset of sensory and motor block is significantly more in ropivacaine while duration of block is more in levobupivacaine.

CONCLUSION: Addition of Dexmedetomidine to Isobaric Levobupivacaine significantly prolongs the duration of analgesia and anaesthesia compared to Ropivacaine and maintains stable hemodynamics. Ropivacaine is a suitable drug for day care whilst levobupivacaine is an excellent agent for longer surgeries. Dexmedetomidine is an effective non-opioid adjuvant which improves effectiveness of block without increasing the risk of side effects.

Pediatric Cardiac Surgery in Ethiopia: A Single Center Experience in a Developing Country

2023-03-26T17:52:10+00:00

BACKGROUND: In developing countries, the diagnosis of congenital heart diseases (CHD) is growing as the availability of echocardiography is increasing with most diagnoses made after birth. However, the access to pediatric surgery is still low and is mainly done by global surgical campaigns rather than local surgeons. Ethiopia has trained its local surgeons, and this is expected to improve the care of children with CHD. We aimed to evaluate the experience of local pediatric CHD surgery and its outcome in a single-center in Ethiopia.

METHODS: A hospital-based retrospective cohort study was done by including all patients with CHD and acquired heart disease in patients under the age of 18 operated at children’s cardiac center in Addis Ababa Ethiopia. We set in-hospital mortality, 30-day mortality, and the prevalence of complications including major complications after cardiac surgery as the primary outcomes.

RESULTS: A total of 76 children were operated. The mean age at the time of diagnosis and surgery was 4 (±5) and 7 (±5) years, respectively. Forty-one (54%) were female. Ninety five percent of the 76 operated children were with the diagnoses of congenital heart diseases while the rest (5%) with acquired heart disease. Of those with congenital heart disease, Patent ductus arteriosus (PDA) accounted for (33.3%), Ventricular septal defect (VSD) for 29.5% and Atrial Septal Defect (ASD) for 10% and Tetralogy of Fallot (TOF) for 5%. According to the RACS-1 category, 26 (35.1%) were in category 1, 33 (44.6%) were in category 2, 15 (20.3%) were in category 3 and none of the children were in category 4 and 5. In-hospital mortality was 2.6% whereas there was no patient who died within 30 days after discharge. Operative mortality was 2.6%.

CONCLUSION: Various types of lesions were treated in the hands of the local teams with VSD and PDA ligations as the commonest of all. The 30day mortality was within acceptable range and this outcome shows congenital and acquired heart diseases can be operated on in developing countries with good outcome despite the limited resources.

High Magnitude Advanced Colorectal Cancer at Diagnosis in Ethiopian Patients: Imaging Pattern and Associated Factors

2023-03-26T17:56:25+00:00

BACKGROUND: Colorectal cancer (CRC) is one of the most prevalent and incident cancers worldwide with an Increasing prevalence in a younger age in developing countries. The aim of the study was to determine the staging and imaging pattern of CRC at diagnosis.

METHODS: This is a descriptive cross-sectional study including all consecutive cases of CRC found in the departments of radiology and oncology during the study period from March 2016 - February 2017.

RESULTS: A total of 132 CRC cases were studied with M: F = 2.4:1, mean age of 46yrs and 67.4% </= 50yrs. Left-sided tumors were associated with rectal bleeding (p = 0.001) and bowel habit change (p =0.045) whereas right-side tumors were associated with weight loss ( p = 0.02) and abdominal pain ( p = 0.004). 84.5% of CRC presented at an advanced stage, and 32% had distant metastasis. Young age was associated with the advanced stage (P=0.006) whereas family history was associated with the lower stage (P=0.008). Distance metastasis was associated with Colonic lesions (P=0.003) and emergent presentation (P=0.008). Asymmetric wall thickening with luminal narrowing was significantly associated with left side tumor (95% vs 21.4%) whereas large mass with necrosis was significantly associated with right side tumor (50% vs 5%) (P= 0.004),

CONCLUSION: CRC is presented at a younger age and at an advanced stage. The majority of CRCs were left-sided and rectal. Increasing the index of suspicion for CRC in patients with rectal bleeding and, bowel habit change is recommended.

Laryngeal Cancer Imaging Patterns and Agreement with Laryngoscopy Findings at Tikur Anbessa Specialized Hospital: A Retrospective Study

2023-03-26T18:00:41+00:00

BACKGROUNS: Head and neck cancer is the commonest cancer among male patients and the third commonest cancer in females at Tikur Anbessa Specialized Hospital from 1998 to 2010.

METHODS: A retrospective cross-sectional study of 90 patients with laryngeal mass who came to oncology and radiology departments at Tikur Anbessa specialized hospital from 2016 to 2019. Medical records were reviewed for clinical data, history, laryngoscope exam and computed tomography (CT) reports. The agreement between imaging and laryngoscope examination were analyzed.

RESULTS: The mean age of presentation was 51.5 years ±14 (SD). The primary patient complaint was hoarseness of voice 77(85.6%) followed by shortness of breath in 28(31.1%). Among 34 cases for which risk factors were indicated, 23 (67.6%) had cigarette smoking. Out of the 79 cases with laryngeal subsites described, 38 (48.1%) were transglottic, 27 (34.2%) were glottic and 12 (15.2%) were supraglottic. Extra-laryngeal spread was seen in 46(51.1%) patients and 42(46.7) were stage IVA. Out of 90 patients only 38(42.2%) patients had laryngoscope findings.

CONCLUSION: Transglottic involvement with extra-laryngeal spread was common with advanced stage at presentation.

Ultrasound Measurement of Foetal Kidney Length during Healthy Pregnancy: Relationship with Gestational Age

2023-03-26T18:11:04+00:00

BACKGROUND: Foetal kidney length (FKL) measurements and comparisons to normal charts can be used to assess the development of the foetal kidneys throughout the entire course of pregnancy. This study was designed to assess FKL between 20 – 40 weeks’ gestation, establish reference ranges for FKL and determine the relationship between FKL and gestational age (GA) in normal pregnancy.

METHODS: This descriptive, cross-sectional study was conducted between March-August 2022, at the Obstetric Units and Radiology Departments of the two tertiary health facilities, one secondary facility and one radio-diagnostic facility in Bayelsa State, Southern Nigeria. Transabdominal ultrasound scan was used to evaluate the foetal kidneys. The relationship between foetal kidney dimensions and GA was explored using Pearson's correlation analysis. Linear regression analysis was done to define the relationship between GA and mean kidney length (MKL). A nomogram predicting GA from MKL was constructed. Level of significance was set at p<0.05.

RESULTS: There was a very strong significant correlation between foetal renal dimensions and GA. The correlation coefficient between GA and mean FKL, width and anteroposterior diameter were 0.89 (p=0.001), 0.87 (p=0.001) and 0.82 (p=0.001), respectively. A unit change in mean FKL corresponded to a 79% change in GA (ɼ2), showing a very strong association between mean FKL and GA. The regression equation: GA = 9.87 + 5.91 x MKL, was derived for estimation of GA for a given MKL.

CONCLUSION: Our study revealed a significant relationship between FKL and GA. The FKL can therefore be reliably used to estimate GA.

Lactate for Predicting the Prognosis of Multi-Drug Poisoned Patients

2023-03-26T19:07:29+00:00

BACKGROUND: We aimed to compare serum lactate levels of multi-drug poisoned patients to determine whether knowing the level may help emergency clinicians in predicting the patients’ prognoses.

METHODS: The patients were divided into two groups according to the number of kinds of drugs taken (Group 1: patients took 2 kinds of drugs; Group 2: patients took 3 or more kinds of drugs). The groups’ initial venous lactate levels, lactate levels before discharge, lengths of stay in the emergency department, hospitalisation units, clinics, and outcomes were recorded on the study form. These findings of the patient groups were then compared.

RESULTS: When we evaluated the first lactate levels and lengths of stay in the emergency department, we found that 72% of the patients with initial lactate levels ≥13.5 mg/dL stayed more than 12 hours in the emergency department. Twenty-five (30.86%) patients in the second group stayed ≥12 hours in the emergency department, and their mean initial serum lactate level was significantly related (p=0.02, AUC=071). The mean initial serum lactate levels of both groups were positively related with their lengths of stay in the emergency department. The mean initial lactate levels of patients who stayed ≥12 hours and those who stayed <12 hours in the second group were statistically significant, and the mean lactate level of the patients who stayed ≥12 hours in the second group was lower.

CONCLUSION: Serum lactate levels may be helpful in determining a patient’s length of stay in the emergency department in the case of multi-drug poisoning.

Lost to Follow-Up among Tuberculosis Patients during the Public-Private Mix Era in Rural Area of Indonesia

2023-03-26T19:24:35+00:00

BACKGROUND: Indonesia’s national Tuberculosis (TB) strategy is public-private mix (PPM). The PPM aims to treat patients who have lost sight during TB treatment as these patients are TB carriers and at risk of transmitting TB. The purpose of this study was to identify predictive factors for loss to follow-up (LFTU) among TB patients receiving treatment when the PPM was at place in Indonesia.

METHODS: The design of this study was a retrospective cohort study. The data used in this study was sourced from the Tuberculosis Information System (SITB) of Semarang which was recorded routinely during 2020-2021. Univariate analysis, crosstabulation, and logistic regression were performed on 3434 TB patients meeting the minimum variables.

RESULTS: The participation of health facilities in reporting TB during the PPM era in Semarang reached 97.6% consisting of 37 primary healthcare center (100%), 8 public hospitals (100%), 19 private hospitals (90.5%), and a community-based pulmonary health center (100%). The regression analysis reveal that the predictive factors of LTFU-TB during the PPM are the year of diagnosis (AOR=1.541; p-value=<0.001; 95% CI=1.228-1.934), referral status (AOR=1.562, p-value=0.007; 95% CI=1.130-2160), healthcare and social security insurance ownership (AOR=1.638; p-value=<0.001; 95% CI=1.263-2.124), drugs source (AOR=4.667; p-value=0.035; 95% CI=1.117-19.489).

CONCLUSIONS: The PPM strategy in dealing with LTFU patients should focus on TB patients without Healthcare and Social Security Insurance and who receive TB treatment rather than program drugs.

Trachoma Prevention Practice and Associated Factors in Rural Lemo District, Southern Ethiopia, 2021

2023-03-26T19:33:00+00:00

BACKGROUND: Trachoma is a leading cause of preventable blindness. It is more prevalent in areas where there is poor personal and environmental sanitation. Implementing a SAFE strategy will reduce the incidence of trachoma. The purpose of this study was to look into trachoma prevention practices and associated factors in rural Lemo, South Ethiopian communities.

METHODS: We conducted a community-based cross-sectional study in the rural Lemo district of south Ethiopia, covering 552 households, from July 1 - July 30, 2021. We used a multistage sampling technique. Seven Kebeles were selected using a simple random sampling method. Then, a systematic random sampling procedure with a five-interval size was applied to select the households.

Our study assessed the association between the outcome variable and explanatory variables using binary and multivariate logistic regressions. The adjusted odds ratio was calculated, and variables with a p-value below 0.05 at the 95% confidence interval (CI) were considered statistically significant.

RESULTS: The study found that 59.6% (95% CI: 55.5%–63.7%) of participants had good trachoma prevention practices. Having a favorable attitude (odds ratio [AOR]: 1.91, 95% CI: 1.26-2.89), receiving health education (AOR: 2.16, 95% CI: 1.46-3.21), and obtaining water from a public pipe (AOR: 2.48, 95% CI: 1.09-5.66) were significantly associated with good trachoma prevention practice.

CONCLUSION: Fifty-nine percent of the participants had good prevention practices for trachoma. Health education, a favorable attitude, and a water source from public pipes were variables associated with good trachoma prevention practice. Improving water sources and disseminating health information are vital to increasing trachoma prevention practices.

Prevalence of Chlamydia trachomatis, Ureaplasma parvum and Mycoplasma genitalium in Infertile Couples and the Effect on Semen Parameters

2023-03-26T19:42:26+00:00

BACKGROUND: Chlamydia trachomatis, Ureaplasma parvum, and Mycoplasma genitalium are common sexually transmitted microorganisms. Our study aimed to determine the prevalence of C. trachomatis, U. parvum, and M. genitalium in infertile and fertile couples and the effect of these microorganisms on semen parameters.

MATERIALS AND METHODS: In this case-control study, samples were collected from 50 infertile couples and 50 fertile couples and were subjected to the routine semen analysis and Polymerase chain reaction (PCR).

RESULTS: C. trachomatis and U. parvum were detected in 5 (10%) and 6 (12%) of semen samples from infertile men. Also, out of 50 endocervical swabs from the infertile women, C. trachomatis and M. genitalium were detected in 7(14%) and 4 (8%) of swab specimens, respectively. In the control groups, all of the semen samples and endocervical swabs were negative. Also, in the group of infertile patients infected with C. trachomatis and U. parvum, sperm motility was lower than uninfected infertile men.

CONCLUSION: The results of this study showed that C. trachomatis, U. parvum, and M. genitalium are widespread among the infertile couples in Khuzestan Province (Southwest of Iran). Also, our results showed that these infections can decrease the quality of semen. For the prevention of the consequences of these infections, we suggest a screening program for infertile couples.

Ceftaroline Susceptibility among Isolates of MRSA: A Comparison of EUCAST and CLSI Breakpoints

2023-03-26T19:47:50+00:00

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important bacterial pathogen causing a number of community-acquired and nosocomial infections. Ceftaroline fosamil is a fifth generation cephalosporin, approved for the treatment of infections caused by MRSA. The main objective of this study was to estimate the susceptibility of ceftaroline among isolates of MRSA by using CLSI and EUCAST breakpoints.

MATERIALS AND METHODS: Fifty non-duplicate isolates of MRSA were included in the study. Ceftaroline susceptibility was done using E-strip test and interpreted using CLSI and EUCAST breakpoints.

RESULTS: Susceptible isolates were equal (42%) by both CLSI and EUCAST, while resistant isolates were more commonly seen in EUCAST (50%). Ceftaroline MIC ranged from 0.25- >32μg/ml. All the isolates were sensitive to Teicoplanin and Linezolid.

CONCLUSION: Resistant isolates were less (30%) while using the CLSI 2021 criteria probably due to the inclusion of SDD category. Our study showed that Fourteen isolates (28%) had Ceftaroline MIC >32μg/ml, which is an alarming finding. The high percentage of Ceftaroline resistant isolates in our study probably suggest a hospital spread of Ceftaroline resistant MRSA emphasizing the need for stringent infection control precautions.

Explaining the Concept of Self-Care Competence and Its Dimensions in Elderly Women with Knee Osteoarthritis in Iran: A Qualitative Study

2023-03-26T20:15:36+00:00

BACKGROUND: Chronic diseases, especially knee osteoarthritis, are more likely to occur among women with the increase in age. Self-care is an effective strategy for the management of disease in patients with knee osteoarthritis. Therefore, recognizing the dimensions of self-care competence in elderly women with knee osteoarthritis is particularly important for long-term management of the disease. The current study aimed to explain the concept and dimensions of self-care competence in elderly women with knee osteoarthritis.

METHODS: This qualitative study was conducted using a conventional content analysis method proposed by Graneheim and Landman, from March to November 2020 in Mashhad (one of the largest cities in Iran). A total of 19 participants including 11 elderly women with knee osteoarthritis, 4 first-degree relatives and 4 medical staff were selected by the purposive sampling. Data were collected through in-depth and semi-structured interviews which continued until data saturation was reached. The MAXQDA (Version 10) was used to organize, code, and manage the data.

FINDINGS: Three main themes including "symptom management", "personal growth" and "social cohesion" were emerged as the dimensions of self-care competence in elderly women with knee osteoarthritis.

CONCLUSION: Understanding the dimensions of self-care competence as one of the basic needs of the elderly women with knee osteoarthritis who live alone, is very important. Symptoms management, personal growth, and social cohesion as dimensions of self-care competence among this group of the elderly help to develop self-care competence interventions based on their needs.

Household Poverty-Wealth and Decision-Making Autonomy as Predictors of Reproductive and Maternal Health Services Utilization among Rural Women in Nigeria: Evidence from a National Survey

2023-03-26T20:16:14+00:00

BACKGROUND: Adequate reproductive and maternal healthcare services utilization are significant in reducing maternal deaths, however, the prevalence rate of contraceptive use remains low, with inadequate maternal health services utilization among rural women in Nigeria. This study examined the influence of household poverty-wealth and decision-making autonomy on reproductive and maternal health services utilization among rural women in Nigeria.

Methods: The study analyzed data from a weighted sample of 13,151 currently married and cohabiting rural women. Descriptive and analytical statistics including multivariate binary logistic regression were conducted using Stata software.

RESULTS: An overwhelming majority of rural women (90.8%) have not used modern contraceptive methods, with poor utilization of maternal health services. About 25% who delivered at home received skilled postnatal checks during the first 2 days after childbirth. Household poverty-wealth significantly reduced the likelihood of using modern contraceptives (aOR: 0.66, 95% CI: 0.52-0.84), having at least four ANC visits (aOR: 0.43, 95% CI: 0.36-0.51), delivering in a health facility (aOR: 0.35, 95% CI: 0.29-0.42) and receiving a skilled postnatal check (aOR: 0.36, 95% CI: 0.15-0.88). Women’s decision-making autonomy regarding their healthcare significantly increased the use of modern contraceptives and the number of ANC visits, while women’s autonomy on how their earnings are spent positively influenced the use of maternal healthcare services.

CONCLUSION: In conclusion, the use of reproductive and maternal health services among rural women was associated with household poverty-wealth and decision-making autonomy. Government should formulate more pragmatic policies that will create awareness and promote universal access to reproductive and maternal healthcare services.

Intraductal Carcinoma of the Parotid Gland as a Rare Neoplasm: A Case Report and Literature Review

2023-03-26T20:08:24+00:00

BACKGROUND: Intraductal carcinoma is a rare low grade neoplasm of salivary glands with an excellent prognosis. It most frequently occurs in the parotid gland. Ectopic localizations are quite rare.

METHODS: This case report describes a man in his 60’s who was referred to ear, nose and throat outpatient department with 1-month history of painless swelling of the right parotid region.

RESULTS: Ultrasound-guided fine-needle aspiration unveiled a cytologic specimen judged as “suspicious for malignancy” and patient underwent a partial superficial parotidectomy. Immunohistochemistry confirmed diagnosis of intraductal carcinoma of right parotid gland.

CONCLUSION: There are few reported cases concerning this clinical entity following thorough review of the literature and recent developments with reference to the contribution of cytology and histopathology will probably modify its classification and management.

A Novel Case Report of Severe Aplastic Anemia with COVID Infection

2023-03-26T20:13:46+00:00

Aplastic anemia is a rare disease of the hematopoietic system. Although some viral agents have been implicated, the association between COVID-19 and aplastic anemia is unclear. In this way, several cases of aplastic anemia have been reported following infection with COVID-19. Importantly, we reported a 16-year-old girl with severe aplastic anemia with no history of disease following an Omicron infection who did not respond well to treatment despite supportive treatment and immunosuppression.