Randomised controlled trial of home based motivational interviewing by midwives to help pregnant smokers quit or cut down

OBJECTIVE

To determine whether motivational interviewing--a behavioural therapy for addictions-provided at home by specially trained midwives helps pregnant smokers to quit.

DESIGN

Randomised controlled non-blinded trial analysed by intention to treat.

SETTING

Clinics attached to two maternity hospitals in Glasgow.

PARTICIPANTS

762/1684 pregnant women who were regular smokers at antenatal booking: 351 in intervention group and 411 in control group.

INTERVENTIONS

All women received standard health promotion information. Women in the intervention group were offered motivational interviewing at home. All interviews were recorded.

MAIN OUTCOME MEASURES

Self reported smoking cessation verified by plasma or salivary cotinine concentration.

RESULTS

17/351 (4.8%) women in the intervention group stopped smoking (according to self report and serum cotinine concentration < 13.7 ng/ml) compared with 19/411(4.6%) in the control group. Fifteen (4.2%) women in the intervention group cut down (self report and cotinine concentration less than half that at booking) compared with 26 (6.3%) in the control group. Fewer women in the intervention group reported smoking more (18 (5.1%) v 44 (10.7%); relative risk 0.48, 95% confidence interval 0.28 to 0.81). Birth weight did not differ significantly (mean 3078 g v 3048 g).

CONCLUSION

Good quality motivational interviewing did not significantly increase smoking cessation among pregnant women.

Complete Regression of Cutaneous B-Cell Lymphoma in a Renal Transplant Patient After Conversion From Cyclosporin to Sirolimus

Posttransplant lymphoproliferative disease remains a serious morbidity. Herein we have reported a case of complete regression of a biopsy-proven B-cell lymphoma that occurred in the posttransplant period. A 48-year-old man received a living donor renal transplant for end-stage renal disease due to undetermined etiology. His initial immunosuppression consisted of corticosteroid, mycophenolate mofetil, and cyclosporin. The patient developed severe pneumonia within the first 2 months after transplantation due to Acineotobacter, fungus, and cytomegalovirus infections. He experienced a complete recovery and was discharged for regional follow-up. Four months after discharge, he was referred again because of presence of two nodules on his trunk. A biopsy of the nodules revealed B-cell lymphoma. Cyclosporin was stopped and he was converted to sirolimus. The lesions regressed progressively and completely within 7 weeks. The patient remains well without clinical relapses at 19 months after conversion. Renal functions remained stable. We postulated that the antincoplastic properties of sirolimus may have played an active part in the positive outcome.

Donor Gender Balance in a Living-Related Kidney Transplantation Program in Oman

It has been observed in several Eastern and Western countries that there is a gender imbalance among kidney donors. In the international experience, approximately 65% of live kidney donors have been women. We retrospectively studied the distribution of female and male donors or recipients among living kidney transplantations performed from 1980 to 2005, namely 198 Omani recipients of living-related kidney transplantations. To examine cultural influences, transplantations performed or expatriates were excluded from the study. For the whole period, 98 out of 198 donors (49.5%) were women. The number of female recipients 75 of 198 (38%) versus males were 123 (62%) recipients. We then subdivided the period into three intervals: 1980 to 1990, 1991 to 2000, and 2001 to 2005. The numbers of female donors for these three periods were 29 of 64 (45%), 42 of 89 (47%), and 27 of 45 (60%), respectively. There was a persistent preponderance of male recipients ranging from 58% to 66% during these periods. We concluded that there was no gender imbalance for kidney donors. Nevertheless, there was a male preponderance in the recipient group.

Retinal injury as an early manifestation of posttransplant thrombotic microangiopathy: recovery with plasma exchanges and conversion to sirolimus--case report and review of the literature

Thrombotic microangiopathy (TMA) remains a serious event. We report a case of occurrence of TMA in the immediate postoperative period after a living-related renal transplantation. A distinguished feature of the case was major, early involvement of the retina with marked by decreased visual acuity along with thrombocytopenia and renal functional impairment. The syndrome was reversible with plasma exchange and conversion from tacrolimus to sirolimus. The patient's renal function is excellent at 11 months after transplantation. Decreased visual acuity and cotton wool exudates may be the first manifestation of posttransplant TMA.

Frontiers of Ovarian Cancer Therapy

Since the majority of patients with ovarian cancer present with advanced stages of disease, more effective systemic approaches are needed to add to the benefits of surgical staging and debulking. New combinations of taxoids with cisplatin have prolonged survival, and other chemotherapeutic agents are being evaluated. Immunotherapy, including intraperitoneal approaches with monoclonal antibodies, cellular therapies and vaccines, hormone therapy with well-known drugs such as tamoxifen, and gene therapy give promise for the future.

Assessment of hospitalisation costs and their determinants among Covid-19 patients in South Central Ethiopia

BACKGROUND

The coronavirus disease 2019 (Covid-19) pandemic is a global public health problem. The Covid-19 pandemic has had a substantial impact on the economy of developing countries, including Ethiopia.This study aimed to determine the hospitalisation costs of Covid-19 and the factors associated with the high cost of hospitalisation in South Central Ethiopia.

METHODS

A retrospective cost analysis of Covid-19 patients hospitalised between July 2020 and July 2021 at Bokoji Hospital Covid-19 Treatment Centre was conducted using both the micro-costing and top-down approaches from the health system perspective. This analysis used cost data obtained from administrative reports, the financial reports of the treatment centre, procurement invoices and the Covid-19 standard treatment guidelines. The Student's t-test, Mann-Whitney U test or Kruskal-Wallis test was employed to test the difference between sociodemographic and clinical factors when appropriate.To identify the determinants of cost drivers in the study population, a generalised linear model with gamma distribution and log link with a stepwise algorithm were used.

RESULTS

A total of 692 Covid-19 patients were included in the costing analysis. In this study, the mean cost of Covid-19-infected patients with no symptoms was US$1,073.86, with mild symptoms US$1,100.74, with moderate symptoms US$1,394.74 and in severe-critically ill condition US$1,708.05.The overall mean cost was US$1,382.50(95% CI: 1,360.60-1,404.40) per treated episode.The highest mean cost was observed for personnel, accounting for 64.0% of the overall cost. Older age, pre-existing diseases, advanced disease severity at admission, admission to the intensive care unit, prolonged stay on treatment and intranasal oxygen support were strongly associated with higher costs.

CONCLUSIONS

This study found that the clinical management of Covid-19 patients incurred significant expenses to the health system. Factors such as older age, disease severity, presence of comorbidities, use of inhalation oxygen therapy and prolonged hospital stay were associated with higher hospitalisation costs.Therefore, the government should give priority to the elderly and those with comorbidities in the provision of vaccination to reduce the financial burden on health facilities and health systems in terms of resource utilisation.

Bilateral pseudocyst of the auricle

Pseudocyst of the auricle is characterized by asymptomatic swelling caused by an intracartilaginous fluid accumulation. If left untreated, permanent deformity of the pinna may occur. Many modalities of treatment have been reported. This article summarizes a 2 year retrospective study (2005-2007) performed in the Children Teaching Hospital in Bratislava. This study presents two children who had bilateral pseudocyst of the auricle, and who were treated with different types of surgical treatment and reviews the literature. Purpose of this study is to compare the effectiveness of the two different methods of surgical treatment. The recognition of the ideal way of surgical method of treatment may lead to standardized approach, which can result in successful repair of the auricle with no recurrence (Fig. 4, Ref 16). Full Text (Free, PDF) www.bmj.sk

Severe acute otitis media in children

Acute otitis media (AOM) is one of the most common infections in children. Recently it was noticed that there is a marked increase in relapse of severe acute otitis media in children. There is also an increase in number of hospitalized children due to severe AOM, with etiological agent resistant to antibiotics. There is a rise of infections, caused by highly resistant Streptococcus pneumoniae, too. Authors retrospectively reviewed children hospitalized at the Children's ENT Department in Children's University Hospital in Bratislava, from January 2005 to December 2006, due to severe acute otitis media. They mainly focused on etiological agent, antibiotics resistance as well as alternatives of treatment and prevention of severe AOM. During 2 years, there were 76 children aged from 4 months to 14 years hospitalized with severe AOM. The most frequent etiological agent was Streptococcus pneumoniae in 37 cases; this was almost in 70% of cases resistant to routine antibiotics. In 7 cases there was mastoiditis, and mastoidectomy or antrotomy had to be done in 6 cases. To establish a diagnosis and start appropriate treatment it is necessary to identify etiological agent and its sensitivity. An increasing bacterial resistance is forcing us to prescribe antibiotics rationally. When severe AOM occurs, tympanotomy and insertion of ventilation tubes, exceptionally mastoidectomy, is often required (Fig. 13, Tab. 3, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

Posterior Reversible Encephalopathy Syndrome Secondary to Cyclophosphamide

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological diagnosis defined as new onset seizures, headaches, impaired vision and consciousness. PRES is typically associated with hypertensive emergencies and pre-eclampsia but its association with autoimmune diseases is largely multifactorial with the combination of ongoing immunologic processes, sepsis and cytotoxic agents contributing to patient’s presentation. Cyclophosphamide induced PRES is rare and has been reported in cases of patients with renal failure and active autoimmune processes.

Prevalence of bacterial pathogens in children with acute respiratory infection in Addis Ababa

A study was conducted in the Ethio-Swedish Children's Hospital and different schools and kindergartens in Addis Ababa to determine the prevalence of bacterial agents that are associated with acute respiratory infection in children from 1998-1999. A total of 883 subjects were studied, out of which 77% were cases from the Ethio-Swedish Children's Hospital and 23% were controls from different schools and kindergartens. From each case and control throat and nasopharyngeal specimens were collected. Culture and different biochemical tests were used to isolate the potential bacterial pathogens. Clinical findings like cough, difficult breathing and fever were correlated with laboratory findings. S. pneumoniae and H. influenzae type b were the most commonly isolated bacteria in both throat and nasopharyngeal specimens; 74% and 70% in the cases and 2% and 5% in the control groups, respectively. This paper discusses the association between throat and nasopharyngeal carriership of bacteria and acute respiratory infection in children in Addis Ababa.

Sarcocystis cruzi in Egyptian slaughtered cattle (Bos taurus): epidemiology, morphology and molecular description of the findings

Background

Sarcocystis spp. are one of the most common foodborne tissue cyst-forming coccidia with a public health and veterinary concern.

Aims

The existing study aimed to rectify the epidemiological profile of Sarcocystis spp. infection in the cattle carcasses as well as to explore the structure and phylogenetic features of Sarcocystis spp. isolates.

Methods

A total of 292 cattle carcasses were checked for the existence of sarcocysts using light microscopy (LM) via muscle squash (MS) and peptic digestion (PD) analysis from January 2020 to December 2020. Individual sarcocysts from different cattle tissues were selected for morphologic characterization and DNA extraction. Each sarcocyst's 18S rDNA gene was amplified, sequenced, and analyzed.

Results

Overall, 92.5% (270/292) of cattle tissue samples contained microscopic thin walled sarcocysts and were exclusively found in esophagus by light microscopy. A statistically insignificant relationship exists between the prevalence of infection and age groups, gender of cattle, and the seasonal dynamics (P>0.05). Sarcocysts ultrastructural features were completely discussed. Sequencing of 18S rDNA Sarcocystis gene confirmed S. cruzi (identity 99-100%), which was the first molecular identification of the current isolate in the study region.

Conclusion

The current survey initially provides a brief account of knowledge about the epidemiology of Sarcocystis spp. infecting cattle and it is considered a starting point for the development of health awareness and efficient preventive schemes for this zoonotic protozoan parasite.

EVALUTION OF UNILATERAL ELECTRO-CONVULSIVE THERAPY (A double blind study)

A double blind study of one hundred twenty patients ( ninety schizophrenics and thirty depressives )-who were divided equally into three groups, who received either (a) bilateral ECT or (b) unilateral application of electrodes on non-dominant hemisphere or (c) unilateral on dominant hemisphere was conducted. The three groups were compared regarding efficacy of the therapy, effects on memory, speed of recovery from each shock session and lastly changes in the electro-encephalogram.It was found that all the three techniques were more or less equal in therapeutic efficacy. There was no significant difference between them in the speed of recovery, nor in the EEG changes. Only difference was that in the field of memory, unilateral non-dominant group showed significant improvement in the 'immediate verbal recall' component of memory in particular. Results have been discussed in view of the current literature on the subject.

Willingness to pay for Social Health Insurance and associated factors among Public Civil Servants in Ethiopia: A systematic review and meta-analysis

BACKGROUND

The provision of equitable and accessible healthcare is one of the goals of universal health coverage. However, due to high out-of-pocket payments, people in the world lack sufficient health services, especially in developing countries. Thus, many low and middle-income countries introduced different prepayment mechanisms to reduce large out-of-pocket payments and overcome financial barriers to accessing health care. Though many studies were conducted on willingness to pay for social health insurance in Ethiopia, there is no aggregated data at the national level. Therefore, this systematic review and meta-analysis aimed to estimate the pooled magnitude of willingness to pay for social health insurance and its associated factors among public servants in Ethiopia.

METHOD

Studies conducted before June 1, 2022, were retrieved from electronic databases (PubMed/Medline, Science Direct, African Journals Online, Google Scholar, and Web of Science) as well as from Universities' digital repositories. Data were extracted using a data extraction format prepared in Microsoft Excel and the analysis was performed using STATA 16 statistical software. The quality of the included studies was assessed using the Newcastle-Ottawa Scale for cross-sectional studies. To evaluate publication bias, a funnel plot, and Egger's regression test were utilized. The study's heterogeneity was determined using Cochrane Q test statistics and the I2 test. To determine the pooled effect size, odds ratio, and 95% confidence intervals across studies, the DerSimonian and Laird random-effects model was used. Subgroup analysis was conducted by region, sample size, and publication year. The influence of a single study on the whole estimate was determined via sensitivity analysis.

RESULT

To estimate the pooled magnitude of willingness to pay for the Social Health insurance scheme in Ethiopia, twenty articles with a total of 8744 participants were included in the review. The pooled magnitude of willingness to pay for Social Health Insurance in Ethiopia was 49.62% (95% CI: 36.41-62.82). Monthly salary (OR = 6.52; 95% CI:3.67,11.58), having the degree and above educational status (OR = 5.52; 95%CI:4.42,7.17), large family size(OR = 3.69; 95% CI:1.10,12.36), having the difficulty of paying the bill(OR = 3.24; 95%CI: 1.51, 6.96), good quality of services(OR = 4.20; 95%CI:1.97, 8.95), having favourable attitude (OR = 5.28; 95%CI:1.45, 19.18) and awareness of social health insurance scheme (OR = 3.09;95% CI:2.12,4.48) were statistically associated with willingness to pay for Social health insurance scheme.

CONCLUSIONS

In this review, the magnitude of willingness to pay for Social Health insurance was low among public Civil servants in Ethiopia. Willingness to pay for Social Health Insurance was significantly associated with monthly salary, educational status, family size, the difficulty of paying medical bills, quality of healthcare services, awareness, and attitude towards the Social Health Insurance program. Hence, it's recommended to conduct awareness creation through on-the-job training about Social Health Insurance benefit packages and principles to improve the willingness to pay among public servants.

AB0236 DOWN-TITRATION STRATEGY OF TUMOR NECROSIS FACTOR-INHIBITOR AGENTS FOR RHEUMATOID ARTHRITIS IN TUNISIA

Background:

Tumor necrosis factor (TNF) blocking agents are effective in treating rheumatoid arthritis, but they are associated with several adverse effects and high costs. Some studies have assessed the effectiveness of down-titration compared with continuation of standard dose.

Objectives:

The aim of our study is to assess dose tapering in Tunisia.

Methods:

A retrospective study including 170 rheumatoid arthritis patients treated by TNF blocker agent and with either low disease activity or remission (ACR/EULAR criteria). Two groups were compared, in the first group (G1) the interval of TNFi administration was extended, in the second group (G2) the standard dose and rhythm of administration were maintained.

Results:

The TNFi tapering group (G1) included 96 persons whereas the group having the same drug administration rhythm (G2) included 74 case. The baseline age of the down-dosing drug group was 56.6 ± 12.6 years versus 52.9 ± 11.6 years in the other group (p = 0.046) and the average disease duration were respectively 12.3 ± 7.2 years versus 11.2 ± 6 years (p = 0.346). Women represented 88.5% in G1 versus 93% in G2 (p = 0.298). Rheumatoid Factors and ACPA were positive respectively in (85.5% versus 83.8; p = 0.748) and (76.4% versus 67.8%; p= 0.309). Etanercept, adalimumab, certolizumab pegol and infliximab were respectively used in 84.4%, 9.4%, 4.2% and 2.1% cases (G1), whereas they were used in 48.6%, 16.2%, 27% and 8.1% cases in the second group (G2). In the TNFi down dosing group, methotrexate was associated to TNFi in 74% cases while 71.6% of patient received methotrexate in the standard rhythm of administration group (p = 0.734). Corticosteroids were used by 40.6% of patients in G1 vs. 56.8% of patients in G2 (p = 0.037). The average DAS28 at baseline was 5.91 ± 0.81 (G1) versus 5.95 ± 0.80 (G2) (p = 0.759). There was no statistically significant difference between the two groups for rates of TNFi withdrawal (p = 0.798). In fact, TNFi was interrupted due to inefficacy for 17 patients (17.7%) in the down-dosing group versus 12 patients (16.2%) in the other group.

Conclusion:

Our study add evidence that TNFi drugs tapering could be equivalent to maintenance strategy. This could be beneficial to decrease the risk of adverse effect or reduce costs. Further studies are needed to confirm those results and identify patients who could benefit of TNFi administration rhythm step-down.

Disclosure of Interests:

None declared