A Case-Control of Patients with COVID-19 to Explore the Association of Previous Hospitalisation Use of Medication on the Mortality of COVID-19 Disease: A Propensity Score Matching Analysis

Data from several cohorts of coronavirus disease 2019 (COVID-19) suggest that the most common comorbidities for severe COVID-19 disease are the elderly, high blood pressure, and diabetes; however, it is not currently known whether the previous use of certain drugs help or hinder recovery. This study aims to explore the association of previous hospitalisation use of medication on the mortality of COVID-19 disease. A retrospective case-control from two hospitals in Madrid, Spain, included all patients aged 18 years or above hospitalised with a diagnosis of COVID-19. A Propensity Score matching (PSM) analysis was performed. Confounding variables were considered to be age, sex, and the number of comorbidities. Finally, 3712 patients were included. Of these, 687 (18.5%) patients died (cases). The 22,446 medicine trademarks used previous to admission were classified according to the ATC, obtaining 689 final drugs; all of them were included in PSM analysis. Eleven drugs displayed a reduction in mortality: azithromycin, bemiparine, budesonide-formoterol fumarate, cefuroxime, colchicine, enoxaparin, ipratropium bromide, loratadine, mepyramine theophylline acetate, oral rehydration salts, and salbutamol sulphate. Eight final drugs displayed an increase in mortality: acetylsalicylic acid, digoxin, folic acid, mirtazapine, linagliptin, enalapril, atorvastatin, and allopurinol. Medication associated with survival (anticoagulants, antihistamines, azithromycin, bronchodilators, cefuroxime, colchicine, and inhaled corticosteroids) may be candidates for future clinical trials. Drugs associated with mortality show an interaction with the underlying conditions.

The Prediction of Essential Medicines Demand: A Machine Learning Approach Using Consumption Data in Rwanda

Today’s global business trends are causing a significant and complex data revolution in the healthcare industry, culminating in the use of artificial intelligence and predictive modeling to improve health outcomes and performance. The dataset, which was referred to is based on consumption data from 2015 to 2019, included approximately 500 goods. Based on a series of data pre-processing activities, the top ten (10) essential medicines most used were chosen, namely cotrimoxazole 480 mg, amoxicillin 250 mg, paracetamol 500 mg, oral rehydration salts (O.R.S) sachet 20.5 g, chlorpheniramine 4 mg, nevirapine 200 mg, aminophylline 100 mg, artemether 20 mg + lumefantrine (AL) 120 mg, Cromoglycate ophthalmic. Our study concentrated on the application of machine learning (ML) to forecast future trends in the demand for essential drugs in Rwanda. The following models were created and applied: linear regression, artificial neural network, and random forest. The random forest was able to predict 10 selected medicines with an accuracy of 88 percent with the train set and 76 percent with the test set, and it can thus be used to forecast future demand based on past consumption data by inputting a month, year, district, and medicine name. According to our findings, the random Forest model performed well as a forecasting model for the demand for essential medicines. Finally, data-driven predictive modeling with machine learning (ML) could become the cornerstone of health supply chain planning and operational management.

Homeopathy for the treatment of gastrointestinal disorders in children

Background: Colic and diarrhea are among the most common gastrointestinal disorders in childhood, which manifest spontaneously and acute. The allopathic treatment consists, in most cases, in the administration of the association homatropine-dimethicone to relieve colic, and oral rehydration and loperamide in cases of diarrhea [1,2]. The ineffectiveness of the conventional treatment and the possible adverse effects they may cause have led to increase the demand from children’ parents for complementary and alternative therapies, and homeopathy can be one of the first choices in this disorders [3]. Aims: make a literature review evaluating the effectiveness of homeopathic treatment for colic and diarrhea in children, observing the relation between the main medicines prescribed in these disorders and their pathogenesis described in materia medica. Methodology: a literature research was performed applying electronic database, including Medline, HomeoIndex, BIREME, LILACS, PubMed, SciELO, and ScienceDirect in the period from September to December 2010. Results: Data found indicate that few studies are available in the literature to prove the effectiveness of homeopathic medicines for colic and diarrhea in children, but the applicability of this therapeutic modality seems to be useful, safe and low cost, which are important factors for less favored communities. Besides, studies concerning diarrhea are more frequent, not only because of its gravity, but also for the duration, which makes more adequate the monitoring, on the contrary to acute colic. The most cited medicines were Chamomilla, Nux vomica, Arsenicum album and Mercurius solubilis. Conclusions: Homeopathy can be an important source of colic and diarrhea relief. However, more investigations should be performed in order to show parents how valuable this kind of therapy can be to children and the whole family.

A Rapid Assessment of Knowledge, Attitudes and Practices of Mothers Admitted with Diarrhoea Suffering Children in West Urban Region of Unguja-Zanzibar

BackgroundThe knowledge, attitude and health practices of the mothers directly reflect on the health and vitality of the child in most of diarrhoea affected communities. The aim of the study was to determine the knowledge, attitude and practice of mothers and caregivers (house girls) towards diarrhoeal disease among children under-five in Unguja, Zanzibar Tanzania. MethodsA quantitative cross-sectional study using a rapid appraisal technique to assess the knowledge, attitudes and practice of mothers and caregivers admitted with children with diarrhoeal diseases was conducted in 23 hospitals of west urban region of Unguja, Zanzibar. ResultsA total of 102 mothers and caregivers were studied. From the respondents 97 (95%) had satisfactory level of knowledge on diarrhoea while 5 (5%) had unsatisfactory knowledge. A total of 52 (51%) rejected the use of Oral Rehydration Solution (ORS) at home due to taste and smell and 50 (49%) agreed its use. A total of 55 (54%) children were served by caregivers. Collectively mothers and caregivers were asked for their practice of drinking treated or boiling water where 47 (46%) reported not to practice. A total of 48 (47%) respondents reported hand washing after helping children with defecation while only 19 (19%) respondents reported washing hands before preparing food. ConclusionLimited use of water sanitation and hygiene (WASH) practices was observed among mothers and caregivers in the prevention and management of under-five children with diarrhoeal disease.

Clinical Characteristics And Prognosis of Vasovagal Syncope With Sinus Arrest In Children

The aim of this study was to analyze the clinical characteristics and prognosis of vasovagal syncope(VVS) with sinus arrest in children. From July 2017 to October 2020, cases of VVS with sinus arrest were recruited from patients diagnosed as VVS in our department. The clinical data, the results of the head-up tilt testing (HUTT), and follow-up information were analyzed. 223 patients were diagnosed as VVS during the time, and 10 cases of VVS with sinus arrest were recruited, who had a median age of 9.5 years（interquartile range: 6.8 to 10.4 years), a gender ratio of 1:1, and median sinus arrest time of 7.7s(range: 3.39 to 19s). These patients were given oral rehydration salts and orthostatic training, as well as 2 children treated with metoprolol and 5 children with sertraline hydrochloride. No child was implanted with pacemakers. During a median of 26 months of follow-up (interquartile range: 21 to 33 months), only one of the children had once syncope episode, three children had 1~4 times of prodromal symptoms. Conclusion The present research most crucial finding was that VVS patients with sinus arrest in children were younger than ordinary pediatric VVS patients. Oral rehydration salts(ORS) and autonomic nerve function exercise may improve clinical symptoms in children with VVS accompanied by sinus arrest. Pacemakers for VVS with sinus arrest in children should be cautious.

Role of Oral Zinc Supplementation in treatment of Acute Dehydrating Diarrhea in age 6 months to 5 years

Background: Oral Rehydration Salt (ORS) is the standard recommended treatment for acute dehydrating diarrhea but it has very little role in decreasing stool frequency and volume. Current studies recommend oral supplementation of zinc as an adjunct to ORS in treating acute dehydrating diarrhea of children especially those who are at risk of zinc deficiency and malnutrition. Aim: To determine the effect of oral zinc supplementation on duration of acute diarrhea and intake of ORS in children between 6 months and 5 years of age. Settings: Tehsil Head Quarters Hospital, Besham District Shangla, Khyber Pakhtunkhwa from October 2019 to September 2020. Methodology: The study was double blinded Randomized Control Clinical Trial in children aged between 6 months to 5 years of age. A total of 90 children were included in the study. In addition to rehydration, 45 children were given oral zinc (20mg daily) while 45 children were given placebo. Results: All 45(100%) patients in zinc group and 39(86.6%) patients in placebo group recovered after 5 days of treatment. Zinc group had significantly reduced duration of diarrhea (68.3±9.4 vs. 99.8±15.2 hours) and consumed less ORS solution (2.3±0.8 vs. 3.4±1.1 liters) as compared to placebo group. Conclusion: It is concluded from this study that oral zinc supplementation in addition to ORS in treating acute dehydrating diarrhea of children has better effect on the clinical course of disease. Key words: Diarrhea, ORS, Zinc, Dehydration.

Correction of electrolyte balance in surgical patients with urgent surgical interventions

Annotation. Acute appendicitis is one of the most common acute pathologies of the abdominal cavity, which requires immediate surgical intervention and can lead to water-electrolyte imbalance. The aim of the study was to investigate the clinical significance of electrolyte imbalance in patients operated on for acute appendicitis and their correction. We examined 20 urgent surgical patients who were part of the control group and received “traditional” postoperative therapy and 23 patients of the study group who received oral rehydration therapy in the postoperative period to correct water-electrolyte disorders. To analyze the results of the study, profile analysis was used as a modification of multidimensional covariance analysis with repeated measurements. As can be seen from the results of testing the hypothesis of normalization of homeostasis due to the use of oral rehydration therapy schemes, the hypothesis was confirmed with a threshold significance of p=0.0642. The only significant effect of the rate of normalization of potassium concentration in blood plasma is the appointment of oral rehydration therapy with p=0.045. Also, the appointment of oral rehydration therapy is a significant effect of the rate of normalization of sodium and glucose in plasma (normalization of plasma glucose is significantly better in the dynamics of younger patients (p=0.045)). Thus, normalization of potassium and glucose, which correlates with the patient's age, was better in patients receiving oral rehydration mixture in the postoperative period than in patients receiving “traditional” postoperative therapy. Oral rehydration therapy is an acceptable alternative to infusion therapy in patients undergoing surgery for acute appendicitis in the postoperative period.

Impact of the Liberian National Community Health Assistant Program on Childhood Illness Treatment in Grand Bassa County, Liberia: A Difference-in-Differences Analysis of Population-Based Data

Liberia launched its National Community Health Assistant Program in 2016, which seeks to ensure that all people living 5 kilometers or farther from a health facility have access to trained, supplied, supervised, and paid community health workers (CHWs). This study aims to evaluate the impact of the national program following implementation in Grand Bassa County in 2018 using data from population-based surveys. We measured before-to-after changes in childhood treatment from qualified providers in a portion of the county that implemented in a first phase compared to those which had not yet implemented. We also assessed changes in whether children received oral rehydration therapy for diarrhea and malaria rapid diagnostic tests if they had a fever by a qualified provider (facility based or CHW). For these analyses, we used a difference-in-differences approach and adjusted for potential confounding using inverse probability of treatment weighting. We also assessed changes in the source from which care was received and examined changes by key dimensions of equity (distance from health facilities, maternal education, and household wealth). We found that treatment of childhood illness by a qualified provider increased by 60.3 percentage points (95%CI 44.7-76.0) more in intervention than comparison areas. Difference-in-differences for oral rehydration therapy and malaria rapid diagnostic tests were 37.6 (95%CI 19.5-55.8) and 38.5 (95%CI 19.9-57.0) percentage points, respectively. In intervention areas, treatment by a CHW increased from 0 to 81.6% and care from unqualified providers dropped. Increases in treatment by a qualified provider did not vary significantly by household wealth, remoteness, or maternal education. This evaluation found evidence that the Liberian National Community Health Assistant Program has increased access to effective treatment in rural Grand Bassa County. Improvements were approximately equal across three measured dimensions of marginalization.

Medical Experiences from a Consular Repatriation and Evacuation Operation from Afghanistan in August 2021: A Field Report

Following the Taliban influx in August 2021, several Western countries repatriated nationals and evacuated others from Kabul Airport in Afghanistan. This report aimed to describe medical experiences from the consular repatriation and evacuation operation. Memos from personal conversations with seven professionals involved in these operations formed the basis for this report. Minor trauma, gastrointestinal symptoms, dehydration, fever, and mental distress were common. Bandages, oral rehydration solution, and the administration of paracetamol were needed, in addition to medical evaluation of acuity. In consular repatriation and humanitarian evacuations, medical attendance should be prioritized to manage medical needs of individuals being evacuated, but also from a public health perspective. The medical needs covered a broad specter of infection disease symptoms, trauma, and mental health problems among patients of all ages. Since the nature of consular repatriations and evacuations can be challenging from safety and infrastructural aspects, general medical emergency awareness with an ability to effectively evaluate and manage both somatic and mental health emergencies on the ground and in the air, among both children and adults, is needed.

Rotavirus

Rotavirus is a double-stranded RNA virus that causes vomiting and diarrhea among children under 5 years. The main cause of mortality from rotavirus gastroenteritis (RVGE) is dehydration if not corrected appropriately with oral rehydration salts (ORS). Though the prevalence of RVGE is similar across countries and socio-economic groups, the higher mortality in Sub-Saharan Africa and South Asia is presumably due to poor awareness and poor health system responsiveness rather than poor hygiene. Enzyme immunoassays are the most commonly used tools for diagnosis of RVGE from stool samples. ORS and zinc remain the mainstay of treatment. Water, sanitation and hygiene measures did not appear to be very effective leaving vaccination among young children as the primary means of prevention. 4 WHO prequalified live attenuated, oral vaccines are available with different efficacy in high- versus low-mortality countries. There is a high degree of protection in countries with low RV mortality, and lower protection in countries with high RV morbidity and more fatalities. Rotavirus vaccines were associated with intussusception, though larger trials failed to establish increased risk in vaccinated groups compared to placebo recipients.