UNASSIGNED: This study aimed to evaluate the aetiology, management and outcomes of convulsive status epilepticus (CSE) in children and highlight the factors influencing patient outcomes in such cases.
UNASSIGNED: In a retrospective study spanning the 2020-2023 period, 93 children with CSE treated at Sultan Qaboos University Hospital\'s emergency department (ED), high dependency unit (HDU) and intensive care unit (ICU) were analysed. The Modified Rankin Scale at discharge was used to determine CSE outcomes.
UNASSIGNED: Among the 93 children studied (mean age 4.84 ± 3.64 years), predominantly Omani (92.47%), 14 aetiologies were noted. Of them, acute symptomatic (37.7%) and febrile status (31.2%) were the primary causes of CSE. Diazepam was administered as the first-line treatment in 58 (67.44%) cases, with a median seizure duration of 45 minutes. Successful seizure control was achieved in 71 (76.34%) cases within 60 minutes. A return to baseline was observed in 55.9% of cases, while mortality and disability were noted in 5.38% and 38.7% of cases, respectively. For 17 cases, aetiology and duration significantly impacted patient outcomes (P <0.05).
UNASSIGNED: Acute symptomatic status is the most common aetiology of CSE. A longer duration of CSE is associated with higher mortality and neurological disability. Prompt and appropriate management of CSE is essential. Furthermore, identifying and treating the underlying cause of CSE is a crucial step in reducing its duration and improving patient outcomes.

BACKGROUND: Anaemia is a global public health issue that impacts individuals of all ages in both developed and developing countries. Anaemia is common in patients with diabetes mellitus; however, it is often undiagnosed and untreated. The main aim of this study was to assess the prevalence and associated factors of anaemia in patients with type 2 diabetes mellitus admitting to a medical unit at National Hospital Kandy.
METHODS: A descriptive, cross-sectional study was conducted in type 2 diabetes mellitus (T2DM) patients admitted to a medical ward at National Hospital Kandy (NHK). They were assessed with a pre-tested, interviewer-administered, structured questionnaire using consecutive sampling method. The data was entered and analyzed using SPSS 26.
RESULTS: Total 252 patients with diabetes were included. The prevalence of anaemia in patients with T2DM was 31.3%. The corresponding values for males and females were 34.2% and 65.8% respectively. Independent predictors for anaemia among diabetic patients were older age, female gender, poor glycemic control, diabetes duration > 5 years, diabetic nephropathy, retinopathy, neuropathy, stage ≥ 3 chronic kidney disease (CKD), ischaemic heart disease (IHD), peripheral vascular disease (PVD), diabetic foot ulcers (DFU) and usage of aspirin. These were significantly associated with the prevalence anemia among patients with type 2 diabetes mellitus. Multivariate logistic regression analysis revealed that female gender, age ≥ 65 years, diabetic duration > 5 years, poor glycaemic control, stage ≥ 3 CKD, diabetic nephropathy and retinopathy were associated with greater odds for the presence of anaemia.
CONCLUSIONS: We found that 31.3% T2DM patients in a medical ward at NHK had previously undiagnosed anaemia. Anaemia screening during diabetes diagnosis, maintaining glycaemic control and raising patient awareness can reduce anaemia prevalence, improve patient quality of life and potentially reduce microvascular complications.

Xpert MTB/RIF is recommended for the diagnosis of tuberculosis (TB) in children. We determined the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children. The characteristics of children influencing Xpert MTB/RIF positivity were explored. Children aged <15 years with symptoms suggestive of pulmonary TB were prospectively enrolled from 2013 to 2019. Two sputum/early morning gastric aspirate specimens were collected for examination by smear (fluorescence microscopy), Xpert MTB/RIF, and culture [Mycobacteria growth indicator tube (MGIT)/Lowenstein-Jensen (LJ) medium]. Diagnostic performance of Xpert MTB/RIF was evaluated using LJ and or MGIT culture positivity as the reference standard. Sensitivity, specificity with 95% confidence interval (CI) were calculated. Stratified analysis was done; P < .05 was considered statistically significant. Of the total 1727 enrolled children, 1674 (97%) with complete results for at least one sputum/gastric aspirate sample were analyzed. The sensitivity of Xpert MTB/RIF was 68.5% in sputum and 53.6% in gastric aspirate while the specificity was 99% for both. The sensitivity compared to smear was 68.5% vs. 33.7% (P < .001) and 53.6% vs. 14.5%; (P < .001) in sputum and gastric aspirate, respectively. The sensitivity of Xpert MTB/RIF was 23.9% with decision to treat as reference standard. Xpert MTB/RIF positivity was significantly influenced by sex, age, nutritional status, chest X-ray abnormality, TB infection status, and symptoms suggestive of TB. Xpert MTB/RIF as an upfront test compared to smear improves diagnosis of pulmonary TB in children yet the sensitivity is suboptimal. Newer TB diagnostic tools with improved sensitivity is warranted in children.
We evaluated the performance of Xpert MTB/RIF in the diagnosis of pulmonary TB in children and explored the characteristics influencing Xpert MTB/RIF positivity. Sputum and or early morning gastric aspirate specimen was collected from children aged <15 years with symptoms suggestive of pulmonary TB. This was examined by smear (fluorescence microscopy), Xpert MTB/RIF, and culture (Mycobacteria growth indicator tube (MGIT)/Lowenstein–Jensen (LJ) medium). Diagnostic performance of Xpert MTB/RIF was evaluated using LJ and or MGIT culture positivity as the reference standard. Of the total 1727 enrolled children, 1674 (97%) with complete results for at least one sputum/gastric aspirate sample were analyzed. The sensitivity of Xpert MTB/RIF was 68.5% in sputum and 53.6% in gastric aspirate which was higher than smear and the specificity was 99%. The sensitivity of Xpert MTB/RIF was 23.9% with decision to treat for TB as reference standard. The Xpert MTB/RIF positivity was influenced by sex, age, nutritional status, chest X-ray abnormality, TB infection status, and symptoms suggestive of TB. Xpert MTB/RIF as an upfront test compared to smear improves the diagnosis of pulmonary TB in children yet the sensitivity is suboptimal. Newer TB diagnostic tools with improved sensitivity is warranted in children.

OBJECTIVE: Although previous studies have described phenomenological diagnoses, they lacked description of aetiological spectrum in patients visiting movement disorders (MD) service. Herein, we classify the MD phenomenology and describe aetiology wise distribution of each phenomenology in patients visiting a tertiary care movement disorders service.
METHODS: Collected information included demographic profile (age of onset, age at presentation, gender, duration of illness before presentation), predominant MD phenomenology [such as parkinsonism, dystonia, ataxia, tremor, chorea, ballism, myoclonus, tics, stereotypy, restless legs syndrome (RLS) and others], diagnostic evaluations and detected aetiology.
RESULTS: This observational study included 1140 MD patients over a span of 5 years. The median (IQR) age of onset was 49 (35-60) years and age at presentation was 54 (40-65) years, with median duration of illness being 36 (18-72) months. Nearly two-third of patients were males (M:F=731:409). Parkinsonism (n=494, 43.3 %) was the most common MD phenomenology observed, followed by dystonia (n=219, 19.2 %), ataxia (n=125, 11 %), tremor (n=118, 10.4 %), myoclonus (n=73, 6.4 %), chorea (n=40, 3.5 %), spasticity (n=22, 1.9 %), tics (n=8, 0.7 %), and RLS (n=8, 0.7 %). Thirty-three (2.9 %) patients were grouped under miscellaneous MDs. Overall, neurodegenerative disorders (57.4 %) were the most common cause of MDs. Parkinson\'s disease, genetic dystonia, essential tremor, genetic ataxias, hemifacial spasm, and Huntington\'s disease were the most common aetiologies for parkinsonism, dystonia, tremor, ataxia, myoclonus, and chorea, respectively.
CONCLUSIONS: Parkinsonism was the most common phenomenology observed in MD patients, and was followed by dystonia, ataxia and tremor. Neurodegenerative disorders were the most common aetiology detected.

Objective of the study was to find the association of vitamin D receptor (VDR) polymorphisms (Fokl, Taql and Apal) with vitamin D levels in diabetic foot ulcer (DFU) patients in South India. In this case-control study, plasma vitamin D levels and VDR genotype frequencies of 70 cases (DFU patients) were compared with 70 diabetic (diabetes mellitus [DM] [non-DFU]) patients and 70 apparently healthy controls (HC) from South India. Plasma vitamin D levels were measured using the ELISA technique, and genotyping of VDR polymorphisms was carried out using real-time polymerase chain reaction. Logistic regression was used to find the association between DFU versus HC and DFU versus DM traits. Association analysis was performed based on additive, dominant and recessive models with age and gender as covariates. A 45.7% of DFU patients have sufficient vitamin D levels than 48.6% and 40% of DM patients and HC, respectively. Linkage disequilibrium analysis for DFU versus HC and DFU versus DM traits shows that single nucleotide polymorphisms (SNPs) Taq1 (rs731236) and Apal (rs7975232) are in strong linkage disequilibrium in DFU patients. The alleles and genotype frequencies were similar in all three groups. Although the additive model does not show statistical significance, age and sex correlate with the three SNPs (Fokl, Taql and Apal). No association was found between VDR gene polymorphisms and vitamin D levels in DFU patients in Southern India. On the other hand, age and sex correlate with the three SNPs.

Approximately 10-12 million new syphilis infections occur annually worldwide, including in pregnant women. This study identified the factors associated with syphilis in pregnant women admitted to a tertiary maternity ward in the State of Paraná, Brazil. This is an ambispective, paired case-control study (1:2 ratio) conducted from September 2020 to October 2021. Pregnant patients (n = 93) admitted to the maternity ward, who were tested with the Venereal Disease Research Laboratory (VDRL) and rapid reagent test, were compared with 186 controls, matched by age and period of hospital admission. Sociodemographic, behavioral, prenatal, and maternity healthcare information was collected through interviews. The data were analyzed using binary logistic regression. Results showed that race/skin color other than white (OR: 2.12; 95%CI: 1.19-3.80; p < 0.001), having more than one sexual partner (OR: 3.69; 95%CI: 1.70-8.00; p = 0.001), being a former smoker (OR: 2.07; 95%CI: 1.07-4.01; p = 0.030) and a current smoker (OR: 4.31; 95%CI: 1.55-11.98; p = 0.005), as well as having a history of sexually transmitted infections (OR: 10.87; 95%CI: 4.04-29.27; p < 0.0.01) were risk factors for gestational syphilis. In summary, the study indicated that sociodemographic, behavioral, and healthcare-related variables were associated with gestational syphilis. Therefore, practitioners could benefit from incorporating these factors to deliver evidence-based treatment for gestational syphilis.

BACKGROUND: Hearing loss has not been thoroughly investigated as a comorbidity in larger cohorts with neurofibromatosis type 1 (NF1).
METHODS: Available audiometric data were reviewed from patients with NF1 seen at a tertiary pediatric hospital to assess prevalence and risk factors for hearing loss.
RESULTS: Of 1172 patients with NF1 seen between 2010 and 2022, 90 had available audiometric data and 48 of 90 patients (53%) had one or more audiogram revealing hearing loss. Those not referred to audiology were presumed to have normal hearing, resulting in a conservative hearing loss estimate of 4% for children and young adults with NF1. Of 90 patients with audiograms, 29 (32%) had conductive loss (CHL), 15 (17%) had sensorineural loss (SNHL), and 3 (3%) had mixed hearing loss. Hearing loss type was undetermined for one patient. For children with CHL, six had permanent CHL secondary to plexiform neurofibroma, 19 CHL were transient due to active middle ear dysfunction, and four CHL cases were indeterminate in etiology. For three children with SNHL or mixed hearing loss, etiology included history of ototoxic chemotherapy and/or family history of SNHL. In the 16 patients with SNHL or mixed hearing loss with more than one audiogram over time, progressive hearing decline was noted in eight of 16, and 26 of 178 hearing thresholds (15%) progressed.
CONCLUSIONS: Our findings suggest that audiometric evaluations should be considered for at least a subset of children with NF1, given the higher-than-expected rate of hearing loss in patients with NF1 compared with the general population.

OBJECTIVE: COVID-19 Omicron subvariants typically cause milder disease than previous strains, yet many patients were still admitted to hospital for acute care. We audited reasons for and details of admissions to identify opportunities to reduce hospitalisations.
METHODS: We reviewed all admitted patients who tested positive for SARS-CoV-2 from 1st December 2022 to 30th January 2023.
RESULTS: Of 600 patients with a positive COVID-19 polymerase chain reaction, 222(37%) were considered incidental diagnoses. Reasons for admission for symptomatic COVID-19 (375 patients, 63%) included worsening symptoms (226, 60%), exacerbation of comorbidities (89, 24%), and difficulty managing at home (38, 10%). Almost half were classified as a mild infection (175, 47%). Of the 231 patients aged over 70 years, only 55 (24%) had prior antiviral therapy, and 90 (39%) had 4+ vaccine doses. Patients speaking language other than English and having country of birth other than Australia were significantly associated with lower vaccination rates and not having antivirals prior to admission.
CONCLUSIONS: One-third of COVID-19 hospital admissions were incidental, and half were for mild disease. Many patients had not received appropriate vaccination or antivirals in the community.
CONCLUSIONS: Improving uptake of vaccinations and antivirals, and increasing community support, with a focus on people from culturally and linguistically diverse backgrounds, may reduce the burden of COVID-19 on hospitals.

BACKGROUND: \"Who will educate us\" lamented a School Principal after she took part in our study and education session. There is palpable low breast cancer (BC) literacy with rising incidence and disproportionate mortality rates.
METHODS: Breast Cancer Awareness Measure (BCAM) developed by Cancer Research UK was administered to 944 women. BCAM measures knowledge, age-related risk, and reported frequency of breast checking and other components. A woman is BC aware if she identified five or more nonlump symptoms, age-related risk, and reported breast checking once a week/month. At the end, each participant was given \"Be Breast Aware\" education; what/how to look for demonstrated on a model.
RESULTS: 2.8% health professionals. 3.1% BC survivors. 78.8% had lump knowledge and 55.3% had non-lump knowledge of BC, 10% had age-related risk knowledge. 24.3% check breasts once a week/month. 41.9% aware BC is common after 50 years. 14/944 (1.5%) had BC awareness. 59.9% had breast symptoms, but never consulted a doctor, 31.1% were embarrassed, and 29.4% were scared to consult. Nearly 43% heard of breast screening, 28.4% had mammography, 26.3% had ultrasound. About 44.1% knew family history risk. Those practicing breast checking looked for a size change (24.5%), nipple position (17.4%), discharge (22.1%), pain (32.5%), and lump (24.7%) in standing (17.8%), supine (8.5%) using finger pads (15.8%) fingertips (21.6%), using circular movements (16.4%), and pinching breast tissue (19.6%).
CONCLUSIONS: Health-care workers and BC survivors lack breast awareness which is alarming and indicates the need for BC awareness and post-BC treatment follow-up care education in these two groups and the general population. Some practice the wrong method (e.g., pinching tissue) of breast checking, which may lead to anxiety and unnecessary investigative costs. \"Be Breast Aware\" education based on the National Health Service 5-point plan given to 944 participants.
Résumé Introduction:‘Qui nous éduquera ?’ s’est lamentée une directrice d’école après avoir participé à notre séance d’étude et d’éducation. Il existe un faible niveau de connaissances sur le cancer du sein, avec une incidence croissante et des taux de mortalité disproportionnés.Méthodologie:La mesure de sensibilisation au cancer du sein (B-CAM) développée par Cancer Research UK a été administrée à 944 femmes. B-CAM mesure les connaissances, le risque lié à l’âge et la fréquence signalée de l’auto-examen des seins, ainsi que d’autres composants. Une femme est consciente du cancer du sein si elle a identifié au moins 5 symptômes non nodulaires, un risque lié à l’âge et si elle a signalé un auto-examen des seins une fois par semaine/mois. À la fin, chaque participante a reçu une éducation ‘Be Breast Aware’; comment auto-examiner les seins a été démontré sur un modèle.Résultats:2,8% de professionnels de santé. 3,1 % de survivantes du cancer du sein. 78,8 % avaient une connaissance des symptômes nodulaires et 55,3 % avaient une connaissance non nodulaire du cancer du sein, et 10 % avaient une connaissance des risques liés à l’âge. 24,3 % vérifient leurs seins une fois par semaine/mois. 41,9 % savent que le cancer du sein est courant après 50 ans. 14/944 (1,5 %) étaient sensibilisées au cancer du sein. 59,9% avaient des symptômes mammaires mais n’avaient jamais consulté de médecin, 31,1% étaient gênées, 29,4% avaient peur de consulter. 43 % ont entendu parler du dépistage du cancer du sein, 28,4 % de la mammographie, 26,3 % de l’échographie. 44,1 % connaissaient le risque lié aux antécédents familiaux. Ceux qui pratiquent l’auto-examen des seins ont examiné le changement de taille des seins (24,5 %), la position du mamelon (17,4 %), l’écoulement (22,1 %), la douleur (32,5 %) et la grosseur (24,7 %) en position debout (17,8 %) en décubitus dorsal (8,5 %) en utilisant le bout des doigts (15,8 %) le bout des doigts (21,6 %), en utilisant des mouvements circulaires (16,4 %) et en pinçant le tissu mammaire (19,6 %)Conclusion:les travailleurs de la santé et les survivantes du cancer du sein manquent de sensibilisation aux seins, ce qui est alarmant et indique la nécessité pour la sensibilisation au cancer du sein et l’éducation aux soins de suivi post-traitement dans ces deux groupes et la population générale. Certaines pratiquent une mauvaise méthode d’auto-examen des seins, ce qui peut entraîner de l’anxiété et des coûts d’investigation inutiles. Éducation ‘Be Breast Aware’ basée sur le plan en 5 points du NHS dispensé à 944 participantes.

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