Search Results (38,329)

Background: In the present study, we aimed to investigate the association between (EORTC) QLQ-C30 scores and both preoperative somatometric parameters and postoperative outcomes in elderly patients undergoing elective surgery for resectable colorectal cancer. Methods: The 118 elderly consecutive patients who underwent colorectal surgery for cancer in a single university’s surgical department between 01/2018 and 12/2018 were prospectively enrolled in the present study. All patients with an age > 65 years, diagnosed with resectable colorectal cancer, without metastatic disease, that underwent elective surgery were included prospectively in the present study. Results: Regarding patients’ characteristics, a negative correlation between preoperative QLQ (pQLQ) score and age (p = 0.001) and a positive correlation between body mass index (BMI) and pQLQ score (p = 0.048) were observed. Furthermore, there was a statistically significant difference (p = 0.004) in the mean pQLQ score between patients with rectal or colon cancer. Moreover, assessing pQLQ score was a useful tool in terms of postoperative recovery. Negative correlations between the pQLQ score and time (days) of beginning oral feeding (p < 0.001) and length of hospital stay (p = 0.004) were found. The pQLQ score was statistically significantly lower (p = 0.005) in patients who had any postoperative complication; however, there was no difference in patients with major complications. Conclusions: Advanced age, colon cancer and decreased BMI were negatively associated with preoperative QLQ. The assessment of pQLQ in elderly patients with colorectal cancer can be a useful predictive tool for postoperative complications, length of hospital stay and postoperative rehabilitation. Full article

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21–1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02–1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03–1.33) and renal failure (OR = 1.63, 95% CI = 1.42–1.86), high fall risk (OR = 2.67, 95% CI = 2.30–3.10), and being bedridden (OR = 6.55, 95% CI = 5.48–7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15–2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally. Full article

Adult Acquired Buried Penis (AABP) is a morbid condition that often requires surgical intervention. This retrospective study of 46 patients who underwent AABP surgery from November 2017 to July 2023 evaluates surgical outcomes, functional outcomes, and patient-reported outcomes. The median follow-up (FU) was 46 months. Patients were categorized by surgical complexity using the Pariser classification, with 76.1% undergoing high-complexity procedures (Pariser ≥ III). Common comorbidities included obesity (58.7%), prior circumcision (52.2%), and hypertension (52.2%). The low-complexity group had a shorter hospital stay (p = 0.02). No other significant differences were noted between groups in terms of Body Mass Index, operative time, or FU. Sexual dysfunction (45.7%) and urinary issues (38.1%) were the main reasons for surgical consultation. Skin grafting was required in 63.0% of patients; partial graft loss was more common in full thicknes skin graft group (p = 0.04). Postoperative complications occurred in 32.6% of patients, 13.3% of which were classified severe (Clavien ≥ III). The median increase in stretched penile length was 2 cm. The recurrence rate was 21.7%. The 12-month recurrence-free survival rate was 89.1%. All groups saw significant improvements in urinary and sexual function post-surgery (p < 0.05), and high patient satisfaction was reported (90.3%). Despite the complication rate, AABP surgery significantly improves quality of life, with ongoing advancements in technique anticipated to enhance outcomes further. Full article

Background: This study investigates the association between depression and ischemic heart disease (IHD), conditions that often coexist and complicate patient management. Understanding the impact of demographic factors, risk factors, symptoms, and medical approaches in these patients is essential to develop effective clinical strategies. Objectives: The aim of this study is to investigate how demographic characteristics, risk factors, symptoms, and treatment methods differ between patients with depression alone and those with both depression and IHD. It seeks to identify how these factors influence patient outcomes, providing insights to improve management and treatment approaches for this complex patient group. Materials and Methods: This cross-sectional study included a sample of 332 patients diagnosed with depression, with a specific subgroup consisting of individuals who also had comorbid IHD. Statistical analyses were performed to compare the patients with depression, focusing on those with IHD. Data on demographic characteristics (e.g., gender, environment, social status), risk factors (e.g., hypertension, diabetes), symptom severity, and treatments (e.g., antidepressants, antipsychotics, anxiolytics, hypnotics) were analyzed. The study also evaluated the frequency of cardiac examinations and emergency hospitalizations. Results: Significant demographic differences were found between the two groups. Patients with both depression and IHD had higher rates of hypertension and diabetes mellitus and experienced more severe depressive symptoms, including reduced mood, energy, and activity levels. The treatment patterns were similar in terms of antidepressant use, but the IHD group had a higher use of antipsychotics, anxiolytics, and hypnotics. Additionally, these patients required more cardiac examinations and emergency hospitalizations. Conclusions: Comorbidity between depression and IHD presents complex clinical challenges, and it is crucial to implement an integrated management approach that addresses both mental and physical health. This study highlights the need for comprehensive therapeutic strategies to improve the quality of life and outcomes for patients with these coexisting conditions. Full article

Objective: Coronavirus disease 2019 (COVID-19) can cause intubation and ventilatory support due to respiratory failure, and extubation failure increases mortality risk. This study, therefore, aimed to explore the feasibility of using specific biochemical and ventilator parameters to predict survival status among COVID-19 patients by using machine learning. Methods: This study included COVID-19 patients from Taipei Medical University-affiliated hospitals from May 2021 to May 2022. Sequential data on specific biochemical and ventilator parameters from days 0–2, 3–5, and 6–7 were analyzed to explore differences between the surviving (successfully weaned off the ventilator) and non-surviving groups. These data were further used to establish separate survival prediction models using random forest (RF). Results: The surviving group exhibited significantly lower mean C-reactive protein (CRP) levels and mean potential of hydrogen ions levels (pH) levels on days 0–2 compared to the non-surviving group (CRP: non-surviving group: 13.16 ± 5.15 ng/mL, surviving group: 10.23 ± 5.15 ng/mL; pH: non-surviving group: 7.32 ± 0.07, survival group: 7.37 ± 0.07). Regarding the survival prediction performanace, the RF model trained solely with data from days 0–2 outperformed models trained with data from days 3–5 and 6–7. Subsequently, CRP, the partial pressure of carbon dioxide in arterial blood (PaCO₂), pH, and the arterial oxygen partial pressure to fractional inspired oxygen (P/F) ratio served as primary indicators in survival prediction in the day 0–2 model. Conclusions: The present developed models confirmed that early biochemical and ventilatory parameters—specifically, CRP levels, pH, PaCO₂, and P/F ratio—were key predictors of survival for COVID-19 patients. Assessed during the initial two days, these indicators effectively predicted the likelihood of successful weaning of from ventilators, emphasizing their importance in early management and improved outcomes in COVID-19-related respiratory failure. Full article

Background: Today, single-inhaler ICS/LAMA/LABA (SITT) COPD therapies are available. It is unclear whether they are more effective than multiple-device triple therapies (MITT) in improving COPD outcomes. Methods: We retrospectively considered patients on SITT/MITT in 2019/2020 who were prescribed >7 packages of ICS/LABA/LAMA or ICS/LAMA (+LAMA). The two treatments were compared concerning systemic corticosteroids, antibiotics, salbutamol, antifungal prescriptions, and number of emergency room visits/hospitalizations (ERV/Hs). We studied 292 MITT patients (Group A) during 2019, switching to SITT in 2020, and 366 subjects (Group B) who took SITT during 2019, and 206 MITT individuals (Group C) in 2020. Results: ICS/LABA + LAMA (MITT) package use was 8.2 ± 4.2 and 7.85 ± 4 in 2019, switching to 11.2 ± 3.2 when patients shifted to SITT in 2020 (p = 0.0001). Group A MITT package use was lower than in SITT patients in 2019 (9.31 ± 2.71, p = 0.0001; Group B). Throughout 2020, Group C (10.3 ± 6.1 packs) adherence to ICS/LABA was similar to SITT adherence in Group A (p = 0.270), whereas LAMA package use (9.1 ± 5) was lower (p = 0.0038). Patients using systemic corticosteroids/antibiotics were fewer in SITT in 2020, compared to the MITT results in 2019. Subjects with fewer ERV/Hs were observed with SITT rather than with MITT. Particularly, 13.8% of patients needed ≥2 ERV/Hs when treated with SITT, whereas 19.2% needed ≥2 ERV/Hs with MITT in 2019 (p = 0.08). Multivariate analysis, adjusted for all confounding factors including treatment adherence, showed that MITT (vs. SITT) can have an increased risk of at least one ERV/H (subjects receiving MITT during 2019 passing to SITT in 2020, OR: 1.718 [1.010–2.924], p = 0.046; Group A/MITT/2019 vs. Group B/SITT/2019, OR: 1.650 [0.973–3.153], p = 0.056; Group C/MITT/2020 vs. Group B/SITT/2019, OR: 1.908 [1.018–3.577], p = 0.044). Conclusions: SITT therapy may promote treatment adherence more effectively, therefore, reducing COPD exacerbations better than MITT. A possible synergistic effect of ICS/LABA/LAMA intake with a single device might be another cause of SITT’s greater efficacy. Full article

Background: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). Methods: We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. Results: A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym². The median hospital postoperative length of stay was 2 days. Conclusions: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions. Full article

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36–40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38–50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67–65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85–87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55–10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO’s 2030 elimination goals. Full article

In the recent literature, numerous tools have been found that have been used to evaluate and improve the resilience of socio-technical systems such as hospitals. The Functional Resonance Analysis Method (FRAM) is certainly one of the most diffused, as it can provide information on the system structure and its components through a systemic analysis approach. FRAM has been successfully applied in different contexts. However, in the healthcare sector, only a few studies propose practical analyses that can support practitioners in systematically observing and analyzing events, both when things go right and when they go wrong. To reduce such a research gap, the current study focuses on the application of FRAM to two different case studies: (1) an accident that occurred in a hyperbaric oxygen therapy unit, and (2) the risk assessment of a magnetic resonance imaging unit. The results show the effectiveness of FRAM in detecting discrepancies and vulnerabilities in the practical management of these devices, providing valuable insights not only regarding the analysis of adverse events (i.e., retrospectively) but also concerning the improvement of safety procedures (i.e., prospectively). Full article

Background and Objective: The complexity of antiretroviral therapy (ART) regimens in people living with HIV (PLHIV) poses significant challenges for medication management, impacting adherence and overall health outcomes. The Medication Regimen Complexity Index (MRCI) is a tool that quantifies regimen complexity, yet its correlation with hospitalization rates and adverse drug reactions (ADRs) in PLHIV remains underexplored. Materials and Methods: This prospective study, which was conducted at a government-funded antiretroviral treatment center, investigated the relationships among MRCI scores, hospitalization due to ADRs, and the ADR rates in 285 PLHIV participants over 18 months. Results: The study revealed a significant association between higher baseline MRCI scores and hospitalization due to ADRs, with a threshold MRCI score of 8 indicating increased risk. There was no significant association between average MRCI scores and overall ADR rates or non-ADR-related hospitalizations. Conclusions: These findings emphasize the importance of monitoring medication regimen complexity in PLHIV, particularly in the context of preventing hospitalizations related to ADRs. Further research is needed to understand the multifactorial influences on ADR occurrence and to optimize ART regimens for better patient outcomes. Full article

Background/Objectives: Few studies have examined the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in acute care hospitals in Kazakhstan. This study aimed to address this gap by conducting a point-prevalence survey (PPS) of HAIs and AMU, as well as evaluating hospital antibiotic consumption via internationally recognized methodologies. Methods: PPS was conducted in four acute care hospitals in Kazakhstan on 11 May 2022, following the methodology of the European Center for Disease Prevention and Control, and included 701 patients. Antibiotic consumption in the same hospitals was assessed via the Global Antimicrobial Resistance and Use Surveillance System methodology. Results: HAIs were observed in 3.8% of patients (27/701), with intensive care unit wards accounting for 48.1% of these cases (13/27). Pseudomonas aeruginosa was the most frequently identified pathogen (5 out of 14 documented cases, 35.7%). Resistance to carbapenems was the most common resistance, followed by resistance to glycopeptides and third-generation cephalosporins. The rate of AMU was 38.2%, with an average of 1.37 antibiotics administered per patient. Surgical prophylaxis lasting more than one day was the most common indication for antimicrobial prescription (44.8%). Ceftriaxone and cefazolin are the most commonly used antibiotics. Conclusions: The results of this study are important for understanding the current situation in Kazakhstan and for informing national antimicrobial stewardship and infection control strategies. Full article

Respiratory syncytial virus (RSV) represents one of the most prevalent causes of lower respiratory tract infection in newborns and children by the time they are two years old, with a peak rate of hospitalization in those between two and three months of age and a high risk of morbidity and mortality, especially under the age of six months of life [...] Full article

(1) Background and Aims: The seasonal factors influencing multiple sclerosis (MS) relapses remain elusive. This study aims to investigate the seasonal variation of MS relapses in Oman and compare it globally. (2) Subject and Methods: This retrospective study was conducted on N = 183 Omani MS patients treated at Sultan Qaboos University Hospital, a tertiary hospital in Muscat, Oman, over sixteen-year period (2007–2022). Demographic and clinical data of all MS patients were juxtaposed with the monthly weather data during this period, using descriptive and inferential statistical techniques. (3) Results: Among the N = 183 MS patients studied, 508 relapses were recorded during the study period. The average number of relapses per patient was 2.8 (range: 1–15). There were significant seasonal variations in MS relapse rate, with the highest prevalence in the winter months of January and February. However, no correlation was found between MS relapses and other climatic parameters (humidity, temperature, and rainfall). (4) Conclusion: The seasonal patterns of MS relapses in Oman differ from other parts of the world, which the local clinicians should take into account while diagnosing and making management decisions. The potential impact of climate change on the anomalous changes in the seasonality of MS relapses warrants further investigation. Full article

Tourism demand is critical for the hospitality industry and is influenced by a set of continuously changing factors. The tourism and hospitality industries play a critical role in many regions and countries, supporting the local economy, providing employment, and fostering economic and social development with effects across multiple industries. This study aims to analyse the nature of tourism and hotel demand through a thematic analysis. By conducting a review of the existing literature published over the period of 2018–2023, this research identifies overarching patterns, trends, and themes characterising the current research landscape. Research results reveal significant insights into market trends and strategic industry shifts. It particularly emphasises areas such as customer demand forecasting, technology integration, and sustainability, which are crucial for understanding demand fluctuations. The findings offer insights into the theoretical foundations of tourism and hotel demand and provide practical implications for industry stakeholders aiming to strategise effectively in a dynamic market. Full article

Background/Objectives: Proton pump inhibitors (PPIs) are amongst the most commonly prescribed classes of medication. However, inappropriate PPI use can lead to several adverse drug reactions (ADRs). Limited data exist on factors contributing to the risk of ADRs associated with PPI prescribing patterns in the Eastern Region of Saudi Arabia. This retrospective, cross-sectional study aimed to assess the prevalence and the pattern of PPI use and to identify factors contributing to the risk of ADRs. Methods: Data were collected from electronic medical records of patients at Al-Qateef Central Hospital from January 2020 to December 2021. The inclusion criteria included patients aged ≥40 years attending an outpatient medical care clinic. PPI prescribing patterns were categorized based on their dosage intensity into low-dose, medium-dose (MD), and high-dose (HD) categories. Binary and multinominal logistic regression models were used to determine the relationship between PPI prescribing patterns and use, categorized by MD or HD, and patient characteristics, adjusted for significant covariates. Results are presented as adjusted odds ratio (OR) with corresponding 95% confidence intervals (95% CI). Results: The study included 41,084 patients. The prevalence of PPI prescribing was 31%. PPI users were more frequently found to be females than males (52% vs. 50%, p = 0.013); they were also likely to be prescribed more medications (7 vs. 6, p < 0.001), but less likely to have gastritis-related diseases (34% vs. 32%, p < 0.001) compared to non-users. PPI HD users were more likely male (56% vs. 43%, p < 0.001), older (53 vs. 52 years, p < 0.001), and prescribed more medications (11.8 vs. 2.8, p < 0.001) compared to MD users. PPI usage was associated with concurrent use of antiplatelet drugs (OR = 1.08, 95% CI 1.01–1.15). An increasing number of prescribed medications was associated with HD usage (OR = 1.13, 95% CI 1.12–1.14), but negatively associated with MD usage (OR = 0.7 95% CI 0.69–0.71). Female gender was negatively associated with HD usage (OR = 0.85, 95% CI 0.79–0.91). Conclusions: Our findings indicate that 31% of the included cohort were prescribed PPI. Inappropriate PPI prescribing related to the drug’s omission is a concern as PPI non-users presented with valid indications such as gastritis. Male gender and increasing NPM were the common factors contributing to increased risk of PPI ADR. This study points to the importance of re-evaluating PPI use to ensure effective therapy with minimum risks of ADR. Full article