Rose Angina Questionnaire: Validation in emergency department to detect myocardial infarction in a tertiary hospital of eastern Nepal

Background: Rose Angina Questionnaire (RAQ) is a useful screening questionnaire for ischemic heart disease validated in different settings; however, its diagnostic ability to predict myocardial infarction (MI) in the emergency is less clear. Objectives: To find out the usefulness of RAQ to predict MI in patients presenting to the emergency. Methods: A cross-sectional study was conducted at the BP Koirala Institute of Health Sciences (BPKIHS), a teaching hospital in eastern Nepal from 1 January to 30 March 2017, after ethical clearance from the Institutional Review Committee. Informed consent was obtained from the patients for their anonymised information to be published in this study The samples were collected from 100 patients with chest pain aged 40 to 70 years presenting to the emergency. RAQ was applied and its performance to detect MI was compared with emergency and cardiologist diagnosis of MI. Sensitivity, specificity, positive predictive value and negative value were calculated along with descriptive analysis. Results: A total of 100 patients were analysed with the mean age of 63.78 years (SD 11.60) and male to female ratio of 1.94. RAQ detected 58 cases (63.8%) with emergency department (ED) diagnosis of MI (true positive) and identified 3 (33.3%) cases with non-MI (true negative). The true positive rate for RAQ to detect MI after cardiologist consultation was 71.6%. RAQ had a sensitivity of 84.91% (95% confidence interval (CI) 72.41% –93.25%) to detect positive troponin, 63.74% (52.99–73.56) to detect positive electrocardiogram (ECG) and 71.60% (95% CI 60.5% to 81.07%) to detect final diagnosis of MI. Conclusion: RAQ is a good screening tool to detect MI in the emergency that can be used in isolation or in combination with other diagnostic modalities to detect it early.

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Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v8i2.28839 ◽

2021 ◽

Vol 8 (2) ◽

pp. 105-111

Author(s):

Sunil Adhikari ◽

Suraj Rijal ◽

Darlene Rose House

Keyword(s):

Emergency Department ◽

Gastrointestinal Bleeding ◽

Variceal Bleeding ◽

Clinical Presentation ◽

Upper Gastrointestinal Bleeding ◽

Tertiary Hospital ◽

Clinical Profile ◽

Ulcer Bleeding ◽

Cross Sectional ◽

Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

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Recent trends of glucose-6-phosphate dehydrogenase deficiency among saudi population in Riyadh city

Bioscience Journal ◽

10.14393/bj-v35n6a2019-49357 ◽

2019 ◽

Vol 35 (6) ◽

Author(s):

Fatmah Said Abdullah Al Qahtany

Keyword(s):

Saudi Arabia ◽

G6pd Deficiency ◽

Descriptive Analysis ◽

Saudi Population ◽

Cross Sectional ◽

Female Ratio ◽

Mortality And Morbidity ◽

King Saud University ◽

Riyadh City ◽

Medical City

G6PD deficiency is associated with erythrocyte deficiency in the X-chromosome enzyme. It causes a hematologic syndrome called hemolytic anemia that connects G6PD deficiency with X-linked condition. In the Middle East, including Saudi Arabia, G6PD deficiency is the most dominant genetic blood disorders. It results in higher rates of mortality and morbidity due to its incurable long-lasting nature and prevalence of physical and psychological incapacities. In this study, an attempt was made to evaluate the prevalence of G6PD deficiency among the Saudi population in Riyadh city. A cross-sectional retrospective study was conducted at King Saud University Medical City in Riyadh, Saudi Arabia. The population of the study comprised randomly chosen males and females who visited the hospital from January 2017 to January 2018. Statistical analyses were performed using SPSS, and descriptive analysis was used to find the frequency of G6PD-deficient patients. Out of the 209 patients, 62.2% were males (n=130) and 37.8% were females (n=79). Twenty males and 6 females were found to have G6PD deficiency, with the male to female ratio being 1:3. Out of the total 130 male participants, 20 patients were found to be enzyme deficient and 6 patients of 79 female patients were found to be G6PD deficient. There were 38.4% (n=10) patients with G6PD level <4 units/gram hemoglobin, 26.9% (n=7) patients had G6PD levels of 4.1–7.0 units/gram hemoglobin, and 34.6% (n=9) patients had >7 units/gram hemoglobin. Among the G6PD patients, 23.07% patients were severely anemic, and 5 (19.2%) patients were reported to have high bilirubin. The present study revealed the G6PD prevalence to be 12.4% among the Saudi population; this value is significantly higher than that found in France, Spain, India, and Singapore. In the Saudi population, males are more vulnerable to G6PD-deficient than females. Hence, attention should be paid to G6PD-deficient patients while prescribing antimalarial medication. Such patients may be advised to avoid certain foods to minimize the risk of having hemolytic episodes.

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CLINICAL STUDY OF POST COVID SYMPTOMS AFTER 1ST WAVE OF COVID 19, AT A TERTIARY HOSPITAL

10.36106/ijar/6101752 ◽

2021 ◽

pp. 51-53

Author(s):

Dilip Pandurang Patil

Keyword(s):

Chest Pain ◽

Tertiary Hospital ◽

Residual Effects ◽

Chronic Obstructive ◽

Age Group ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Female Ratio ◽

Raising Awareness ◽

Cognitive Disturbances

Background: Early reports suggest residual effects of SARS-CoV-2 infection, such as fatigue, dyspnea, chest pain, cognitive disturbances, arthralgia and decline in quality of life. In present study we aimed to evaluate post covid symptoms after 1st wave of COVID 19 in COVID 19 recovered patients at a tertiary hospital. Present study was Material and Methods: hospital based, descriptive, cross-sectional, questionnaire-based study conducted in Covid 19 positive patients (RT-PCR or Rapid Antigen positive patients) either hospital admitted or home isolation patients, recovered (either RTPCR negative or completed 14 days isolation and no symptoms) came to post covid OPD for follow up, were studied. In present study 101 post Results: COVID 19 recovered patients were studied. Most of patients were from age group 51-60 years (19.8 %) followed by age group 41-50 years (16.83 %). Male patients (65.35 %) were more than female patients (34.65%), male to female ratio was 1.9 :1. Majority of patients received treatment at hospital (75.25%) & were diagnosed by RTPCR (57.43%). Most of patients had recovered from COVID 61-90 days ago (28.71%) followed by 121-150 days ago (19.8%). During acute COVID-19 pneumonia was diagnosed in 36.63 % cases. Other characteristics were intensive care unit admission (14.85 %), oxygen supplementation (21.78 %), noninvasive ventilation (7.92 %) & mechanical ventilation (2.97 %). Pre-existing comorbidities noted were hypertension (12.87 %), thyroid disease (4.95 %), diabetes (3.96 %), chronic obstructive pulmonary disease (3.96 %), h/o kidney failure (1.98 %), active smoker (8.91 %) & former smoker (14.85 %). No regular physical activity was noted in 83.17 %. Post COVID symptoms noted in present study were cough (14.85 %), fatigue (13.86 %), Breathlessness (8.91 %), headaches (5.94 %), myalgia (3.96 %), palpitation (3.96 %), loss of smell sensation (3.96 %), muscle weakness (2.97 %), loss of taste sensation (2.97 %) & chest pain (1.98 %). Most of the Conclusion: COVID-19 survivors experienced mild post-recovery symptoms such as cough, fatigue, breathlessness, headache, myalgia & palpitation. Raising awareness, recognition, research, and multidisciplinary involvement will be considered the cornerstones to manage long-term sequelae of COVID-19 effectively.

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EFFECTIVE DOSE FOR RADIOLOGICAL PROCEDURES IN AN EMERGENCY DEPARTMENT: A CROSS-SECTIONAL STUDY

Radiation Protection Dosimetry ◽

10.1093/rpd/ncaa013 ◽

2020 ◽

Vol 189 (1) ◽

pp. 63-68

Author(s):

Maryam Naseri ◽

Mohammad Shahsavan ◽

Faeze Salahshour ◽

Soheil Peiman ◽

Seyed Farshad Allameh ◽

...

Keyword(s):

Emergency Department ◽

Ct Scan ◽

Effective Dose ◽

Final Diagnosis ◽

Cross Sectional Study ◽

Sectional Study ◽

Exposure Risk ◽

Cross Sectional ◽

Higher Ed ◽

Radiological Procedures

Abstract The extent of radiation exposure in emergency settings is not well documented; here, the corresponding effective dose (ED) is provided. In 500 patients admitted in row to the emergency department, ED was compared in patients according to complaints and their visiting physicians. Out of all, 220 patients aged 43.5 ± 22.2 years (admission: 2.0 ± 1.6 days) had at least an imaging. The main reasons for admission were trauma (10.5%) and then orthopedic problems (8.6%). EDs from CT and radiography were 1.66 ± 3.59 and 0.71 ± 1.67 mSv, respectively (from all 2.29 ± 4.12). Patients with abdominal (5.8 ± 5.2 mSv; p < 0.002) and pelvic (12.0 ± 6.3 mSv; p < 0.007) complaints received higher ED from CT and radiography and, also, patients visited by surgeons (7.94 ± 6.9 mSv). CT scan was the main source for ED to patients. Irrespective of the final diagnosis, patients with abdominopelvic complaints and those visited by surgeons are at higher exposure risk.

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Performance of Fineneedle Aspiration Cytology of the Breast. Clinical Experience in Ravenna (Italy)

Tumori Journal ◽

10.1177/030089169307900609 ◽

1993 ◽

Vol 79 (6) ◽

pp. 413-417

Author(s):

Lauro Bucchi ◽

Patrizia Schincaglia ◽

Giangiuseppe Melandri ◽

Nori Morini ◽

Carlo Naldoni ◽

...

Keyword(s):

Predictive Value ◽

Breast Cancer Case ◽

True Positive Rate ◽

Cancer Case ◽

Breast Lesions ◽

Additional Contribution ◽

True Positive ◽

Aspiration Cytology ◽

True Negative ◽

Positive Rate

Aims and background Fineneedle aspiration cytology (FNAC) is a routine test in the evaluation of breast lesions. We assessed the diagnostic accuracy of mammography (MG), physical examination (PE), ultrasonography (US) and FNAC in 1064 histologically confirmed breast lesions (638 malignant, 426 benign) observed consecutively at the Cancer Prevention Center of Ravenna (Italy). Methods The performance of each test and the additional contribution of FNAC were determined. Results FNAC was done in 69.6 % of cancers and 39.7 % of benign lesions (P = 0.00000), the frequency of aspiration being significantly associated with severity at MG, PE, and US. For FNAC, the true positive rate was 95.1 % and the true negative rate 67.4 %. Only one breast cancer case was detected by FNAC alone (additional true positive rate 0.2 %). The positive predictive value of FNAC in the absence of other abnormalities was 5 %. The negative predictive value of a benign report at MG, PE, US and FNAC was 100 %. Conclusions All breast lesions should be evaluated by all available techniques, especially FNAC, and open biopsy should be avoided for those reported as benign at all tests.

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The Validity of the Tool “statcheck” in Discovering Statistical Reporting Inconsistencies

10.31234/osf.io/tcxaj ◽

2017 ◽

Cited By ~ 3

Author(s):

Michele B. Nuijten ◽

Marcel A. L. M. van Assen ◽

Chris Hubertus Joseph Hartgerink ◽

Sacha Epskamp ◽

Jelte M. Wicherts

Keyword(s):

Multiple Testing ◽

Degrees Of Freedom ◽

R Package ◽

True Positive Rate ◽

P Value ◽

True Positive ◽

Test Statistic ◽

True Negative ◽

True Negative Rate ◽

Positive Rate

The R package “statcheck” (Epskamp & Nuijten, 2016) is a tool to extract statistical results from articles and check whether the reported p-value matches the accompanying test statistic and degrees of freedom. A previous study showed high interrater reliabilities (between .76 and .89) between statcheck and manual coding of inconsistencies (.76 - .89; Nuijten, Hartgerink, Van Assen, Epskamp, & Wicherts, 2016). Here we present an additional, detailed study of the validity of statcheck. In Study 1, we calculated its sensitivity and specificity. We found that statcheck’s sensitivity (true positive rate) and specificity (true negative rate) were high: between 85.3% and 100%, and between 96.0% and 100%, respectively, depending on the assumptions and settings. The overall accuracy of statcheck ranged from 96.2% to 99.9%. In Study 2, we investigated statcheck’s ability to deal with statistical corrections for multiple testing or violations of assumptions in articles. We found that the prevalence of corrections for multiple testing or violations of assumptions in psychology was higher than we initially estimated in Nuijten et al. (2016). Although we found numerous reporting inconsistencies in results corrected for violations of the sphericity assumption, we demonstrate that inconsistencies associated with statistical corrections are not what is causing the high estimates of the prevalence of statistical reporting inconsistencies in psychology.

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Etiologies of neonatal cholestasis at a tertiary hospital in Bangladesh

Paediatrica Indonesiana ◽

10.14238/pi60.2.2020.66-70 ◽

2020 ◽

Vol 60 (2) ◽

pp. 66-70

Author(s):

Md. Benzamin ◽

Mukesh Khadga ◽

Fahmida Begum ◽

Md. Rukunuzzaman ◽

Md. Wahiduzzaman Mazumder ◽

...

Keyword(s):

Biliary Atresia ◽

Parvovirus B19 ◽

Final Diagnosis ◽

Tertiary Hospital ◽

Neonatal Cholestasis ◽

Lipid Storage Disease ◽

Female Ratio ◽

Varicella Zoster ◽

Male Female Ratio ◽

Torch Infection

Background Neonatal cholestasis is an important etiology of chronic liver disease in young children. It has a varied etiology. There is considerable delay in presentation and diagnosis of neonatal cholestasis in Bangladesh. Lack of awareness and knowledge among the pediatricians regarding etiological diagnosis and outcome of neonatal cholestasis is the reasons for poor outcome in major portion of cases in Bangladesh. Objective To evaluate the etiological spectrum of neonatal cholestasis. Methods This retrospective study was conducted at the Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. We reviewed medical records of children who were diagnosed with neonatal cholestasis. Complete diagnostic profiles of every cases with age of presentation, male-female ratio and final diagnosis were analyzed. Results A total of 114 children with neonatal cholestasis were evaluated. Subjects’ male-female ratio was 1.92: 1.0, and mean age at hospitalization was 92.7 (SD 39.5) days. Biliary atresia was the most common etiology (47.4%), followed by idiopathic neonatal hepatitis/INH (21.9%). Other identified etiologies were, toxoplasmosis, others (syphilis, varicella-zoster, parvovirus b19), rubella, cytomegalovirus (CMV), and herpes/TORCH infection (8.61%), progressive familial intrahepatic cholestasis/PFIC (4.4%), galactosemia (4.4%), choledochal cyst (3.5%), sepsis (1.8%), urinary tract infection/UTI (1.8%), hypothyroidism (1.8%), lipid storage disease/Niemann-Pick disease (0.9%), non-syndromic paucity of interlobular bile ducts (2.67%), and Caroli’s disease (0.9%). Conclusion In Bangladesh, neonatal cholestasis cases are most often due to obstructive causes, particularly biliary atresia. Idiopathic (INH), infectious (primarily TORCH), metabolic, and endocrine causes followed in terms of frequency.

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Risk Factor Profile Of Young Adults With Acute Myocardial Infarction: A Preliminary Finding

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.913 ◽

2018 ◽

Vol 17 (1) ◽

Author(s):

Mohd Zhafri Mohd Razib ◽

Azarisman Shah M.Shah ◽

Jamalludin A.Rahman ◽

Aszrin Abdullah ◽

Aida N.S M.Shah ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Young Adults ◽

Risk Factor ◽

Preliminary Finding ◽

Cross Sectional ◽

Risk Factor Profile ◽

Common Risk Factors

Introduction: Acute myocardial infarction (AMI) is a major cause of death around the world. There are limited studies of risk factor profile in young adults with AMI. This study aimed to assess the risk factor profile of young adults with AMI at the emergency department of Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang. This is a preliminary result of young adults (age between 18 to 45 years old) who presented to the emergency department of HTAA. Materials and Methods: This cross-sectional study was conducted in HTAA from the 31st July 2017 to the 11th June 2018 involving 709 patients who were diagnosed with AMI. Seventy seven patients were less than 45 years old. However, only 55 were recruited for analysis who fulfilled the inclusion and exclusion criteria. Results: The prevalence of young adults with AMI was 10.9% with mean age of 38.8 ± 5.1 years old and 96.4% were male. Eighty percent of the patients were Malay followed by 10.9% Chinese and 9.1% were Indian. 83.6% were married while 14.5% were unmarried and 1.8% were divorcees. Majority of patients (81.8%) had income less than RM4000. The common risk factors of young adults with AMI presented to HTAA was smoking (80%) followed by increased waist circumference (54.5%), obesity (52.7%), hypertension (40%), hypercholesterolaemia (27.2%), family history of ischaemic heart disease (27.2%), and diabetes mellitus (21.8%). Conclusion: AMI in young adults almost exclusively occurs in male. Smoking and obesity were the most common risk factors in young adults with AMI in HTAA.

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ACUTE MYOCARDIAL INFARCTION

The Professional Medical Journal ◽

10.29309/tpmj/18.4912 ◽

2018 ◽

Vol 25 (10) ◽

pp. 1450-1457

Author(s):

Rana Muhammad Suhail Khan ◽

Sabeen Farhan ◽

Fahad Aman Khan

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Homocysteine Level ◽

Cross Sectional ◽

Female Ratio ◽

Level Data ◽

Total Homocysteine ◽

Coronary Care ◽

Male To Female ◽

Conventional Risk Factors

Objectives: To determine the frequency of elevated homocysteine level inpatients presenting with acute myocardial infarction. Design: Cross-sectional. Place andDuration: Coronary Care Unit of Allied hospital Faisalabad, from 25-11-09- to 24-05-2010.Material and Methods: A total of 164 patients fulfilling the inclusion criteria were selected.Demographic details, history and examination findings of the patients were recorded. Bloodsample were collected in fasting state for estimation of plasma glucose, serum LDL, serumcholesterol and serum total homocysteine level. Data Analysis: Descriptive statistics like meanwith standard deviation were applied on age. Frequency of elevated homocysteine levels wascalculated in acute myocardial infarction with other conventional risk factors for coronary arterydisease. Male to female ratio was calculated. Frequency of elevated homocysteine levels wascalculated in acute myocardial infarction. Results: Out of 164, 53.9% (n=88) were male patientsand 76 46.08% (n=76) were females. Average age was 60.90±10.19. Among conventionalrisk factors, the frequency of elevated homocysteine levels was high (82%) in smokers. Thefrequency of elevated homocysteine levels was 55% in acute myocardial infarction and it was61% in males and 39% in females respectively. The frequency of elevated homocysteine levelswas highest (73%) among age group between 40-50 years. Conclusion: Frequency of elevatedhomocysteine levels was high among the patients with acute myocardial infarction. Moderateelevated homocysteine levels were associated with smoking.

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Aetiopathological and demographic profile of diabetic foot: a prospective cross sectional study from a tertiary hospital in South India

International Surgery Journal ◽

10.18203/2349-2902.isj20171132 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1305

Author(s):

Ragesh Kalikottu Valappil ◽

Sheena Krishnan ◽

Siddharth Matad ◽

Shameej Kinakool Vayalipath

Keyword(s):

Glycemic Control ◽

Diabetic Foot ◽

Foot Ulcer ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Poor Glycemic Control ◽

Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

History Of

Background: Diabetes mellitus is a chronic disorder affecting large segment of population and is a major public health problem.Methods: A prospective cross sectional study of 150 patients conducted in the Department of Surgery at Government Medical College, Kozhikode, Kerala, IndiaResults: Maximum numbers of patients were in the age group of 60-69. Male to female ratio is 3.04:1.50% had duration of diabetes <10 years and 50% had duration ≥10. years. 81 (54%) patients had neuropathy, 53 (35.3%) had PVD, 41 (27.3%) had history of prior foot ulcer, 70 (46.7%) had poor glycemic control (RBS >200 mg/dl) at the time of admission and 44 (29.3%) had history of smoking.Conclusions: Most important risk factors for diabetic foot ulcers were neuropathy (54%), poor glycemic control (46.7%) and PVD (35.3%), diabetic foot requires a comprehensive management.

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