Determinants of Outcomes in Convulsive Status Epilepticus: An Observational Study at a Tertiary Care Center in North India.

Objective Status epilepticus (SE) presents a critical neurological emergency associated with high morbidity and mortality rates worldwide. However, the determinants influencing outcomes in SE within specific regional contexts remain less explored, especially within North India. Understanding the factors influencing the prognosis of SE in this region is crucial for tailored therapeutic approaches and improved patient outcomes.  Materials and methods This observational study was conducted at Jawaharlal Nehru Medical College, Aligarh, India, from December 1, 2020, to November 31, 2022. Patients who presented with convulsive SE lasting more than five minutes or repetitive and discrete seizures with impaired consciousness between the interictal period for at least 30 minutes were included in the study. Their clinical and biochemical variables at presentation were assessed and correlated with the outcome. Results Out of the 110 patients included in the study, males represented 59.1% (n=65), outnumbering females, who comprised 40.9% (n=45). Favourable outcome was observed in 66.36% (n=73) of patients, and unfavourable outcome was observed in 33.63% (n=37). The mean time interval between seizure onset to the patient's arrival at the hospital was 5.30 ± 4.96 hours, and the mean time interval between seizure onset to the point of seizure control was 7.10 ± 6.38 hours. On analysing the factors associated with unfavourable outcome, the type of seizure at onset (p=0.021), Glasgow Coma Scale (GCS) of <=12 at presentation (p<0.001), presence of refractory seizure (p<0.001), presence of abnormal epileptiform discharges on electroencephalography (p=0.001), Status Epilepticus Severity Score (STESS) of >2 (p<0.001), serum lactate levels (p<0.001), duration of hospital stay (p=0.004), time interval between seizure onset to hospital arrival (p<0.001) and time interval between seizure onset to the point of seizure control (p<0.001) showed significant association. However, on analysing the independent risk factors of unfavourable outcome using multivariate logistic regression, only duration of hospital stay (p<0.001, odds ratio (OR): 1.205, 95% confidence interval (CI): 1.046-1.389), and GCS of less than or equal to 12 at presentation (p<0.001, OR: 12.354, 95% CI: 2.974-51.319) showed significant association. Conclusions Our study highlighted key clinical and time-related parameters influencing the outcome of convulsive SE. Understanding these factors is crucial for better treatment and improved patient outcomes. Further research is essential for refining interventions in this complex condition.

Correction: Article Title: Quarantine-related traumatic stress, views, and experiences during the first wave of Coronavirus pandemic: A mixed-methods study among adults in Saudi Arabia.

[This corrects the article DOI: 10.1371/journal.pone.0261967.].

Needle-Stick Injuries in Ophthalmic Practice.

Purpose: Needle-stick injuries (NSI) are a prominent route by which blood-borne infections are transmitted. The unique microsurgical nature of ophthalmic practice constitutes an additional risk to sustain injury. This study aimed to identify the epidemiological profile of needle-stick injuries in a tertiary eye center and to evaluate the implemented safety policy in preventing sharp injuries. Methods: This was a retrospective cross-sectional study of all sharp injuries that occurred at King Khalid Eye Specialist Hospital (KKESH). Data on all reported sharp injury incidents from 2013 to 2021 were collected. The mechanisms of injury, context, location, and type of prick were collected and analyzed. Also, this study involved an institution-based survey for all ophthalmic staff. Results: Two hundred and one sharp injury incidents were reported over 9 years. Physicians sustained 46.8% (n=94) of injuries, followed by nurses and ophthalmic technicians, 40.8% (n=82) and 7% (14); respectively. Operating and treatment rooms were the locations of 60.7% of incidents, whereas outpatient clinics and emergency rooms accounted for 19.4% and 13.4% of injuries, respectively. Conclusion: The current findings add to the growing body of literature on the importance of NSI prevention and reporting strategies. In the present study, sharp injuries were most commonly encountered by ophthalmic staff in the operating rooms. Continuous staff education on handling sharp instruments, encouraging anonymous reporting, and up-to-date revisions of guidelines and policies are of paramount importance to lessen the burden of sharp injuries.

Manipulative and body-based methods in chronic kidney disease patients: A systematic review of randomized controlled trials.

BACKGROUND: and purpose: Among chronic kidney disease (CKD) patients, manipulative and body-based methods (MBM) have demonstrated efficacy in improving symptoms such as fatigue. This review aims to summarize the efficacy and safety of MBM among CKD patients. METHODS: A systematic review was performed in PubMed, Embase, Scopus, CINAHL, CENTRAL and PsycInfo. Randomised controlled trials (RCTs) which evaluated the use of MBM among adult CKD patients were included. The grading of recommendations, assessment, development, and evaluation (GRADE) approach was used to determine the risk of bias and certainty of evidence. The efficacy of each MBM was determined by reduction in symptom severity scores. All adverse reactions were documented. RESULTS: Of 8529 articles screened, 55 RCTs were included. Acupressure (n = 23), massage therapy (n = 17), reflexology (n = 6) and acupuncture (n = 5) were the most studied MBMs. Acupressure and reflexology were shown to reduce sleep disturbance and fatigue by 6.2-50.0% and 9.1-37.7% respectively. For uremic pruritus, acupressure and acupuncture reduced symptoms by 34.5-77.7% and 56.5-60.2% respectively. Common adverse reactions associated with acupressure included intradialytic hypotension (20.4%) and dizziness (11.1%) while that of acupuncture included elbow soreness (7.5%) and bleeding (7.5%). No adverse effects were reported for massage therapy, moxibustion, reflexology and yoga therapy. CONCLUSION: Acupressure, reflexology and massage therapies were the most well-studied MBMs which have demonstrated efficacy in alleviating sleep disturbance, fatigue and uremic pruritus symptoms in CKD patients.

Quarantine-related traumatic stress, views, and experiences during the first wave of Coronavirus pandemic: A mixed-methods study among adults in Saudi Arabia.

PURPOSE: Mental health is a significant problem following exposure to a traumatic event. This study aimed to examine quarantine-related experiences, traumatic stress, and coping strategies among adults quarantined in Saudi Arabia due to coronavirus disease 2019 (COVID-19) exposure or travel history. METHODS: Individuals aged ≥ 18 years who were quarantined in Saudi Arabia due to COVID-19 exposure or travel history were included. We used a sequential mixed methods design, using an online survey followed by in-depth individual telephonic interviews. The Impact of Event Scale-Revised (IES-R) was used to measure post-traumatic stress disorder (PTSD) symptoms after the quarantine. To identify factors associated with significant symptoms (IES-R score ≥ 33), prevalence ratios (PR) with 95% confidence intervals were computed using Poisson regression with robust error variance. In the next phase, a subset of the participants (n = 26) were interviewed to elicit their quarantine-related experiences and coping responses. Major themes and subthemes were identified. RESULTS: Of the 111 adults who completed the survey, 32 (28.8% [95% CI, 21.1-38.0%]) had significant PTSD symptoms (IES-R score ≥ 33) and 27 (24.3% [95% CI, 17.2-33.3%]) had severe symptoms (IES-R score > 37). Marital status was the only variable that was significantly associated with significant PTSD symptoms (P = 0.028). Significant symptoms were twice as prevalent in married adults than among other marital groups (PR 2.00, 95% CI, 1.08-3.72). Participants reported negative emotions such as overwhelming fear, helplessness, anxiety, and disgust. Participants utilized both problem-centered coping (e.g., use of social support) and emotion-centered coping (e.g., use of positive diversionary activities) during the quarantine period. CONCLUSION: PTSD symptoms were present in one out of every four quarantined persons. The quarantine experience is viewed negatively. These findings highlight the need for increased awareness about stress-related disorders among quarantined individuals. Efforts are needed to detect and manage these symptoms early while making the quarantine experience more satisfying for the involved individuals and groups.

Impact of influenza vaccine in reduction of incidence and severity of influenza-like illness.

BACKGROUND: Vaccination is useful for protection against seasonal influenza but has a low uptake. Evidence of a protective effect of influenza vaccine among Arab populations would be a useful tool for advocacy. AIMS: To evaluate the impact of vaccine in reducing the incidence and severity of influenza-like illness among health staff of a tertiary care eye hospital in Saudi Arabia. METHODS: This retrospective cohort study was conducted in 2018-2019. Hospital staff were divided into vaccinated and unvaccinated groups. Influenza-like illness episodes and their severity were compared between the groups and influenza-like illness rate before and after vaccination was reviewed in the vaccinated group. RESULTS: The uptake of flu vaccine among 1180 health staff was 41%. There were 28 (9.3%) and 51 (17%) persons with influenza-like illness in the vaccinated (n = 300) and nonvaccinated (n = 300) groups, respectively. The nonvaccinated group had a significantly higher rate of influenza-like illness than the vaccinated group had. Vaccination, young age and absence of comorbidity were independent protectors against influenza-like illness. CONCLUSIONS: Influenza vaccine confers significant protection and reduces the incidence and severity of influenza-like illness. However, this was a retrospective review of health data; therefore, the association of vaccine with outcomes should be considered as a weak form of evidence. The low uptake of influenza vaccine in hospital staff and their dependents is a matter of concern and should be addressed by greater awareness and education. This evidence can be used to improve overall vaccine coverage.

Prevalence and determinants of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus carrier among staff of a tertiary eye hospital in Saudi Arabia.

OBJECTIVES: The objective of this study was to estimate the prevalence and risk factors of methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) carriers among staff of a tertiary eye hospital in Saudi Arabia. METHODS: This retrospective study was conducted in 2019. Nasal and axillary swabs of health-care staff were used to determine carriers of MRSA. Bacteria were identified by culture and sensitivity tests. These isolates were grouped as antibiotic resistant, sensitive, and others not in the S. aureus group. Demographics and other determinants were associated with carrier status. RESULTS: We evaluated the carrier status of 430 staff. There were 110 (24.9%; 95% confidence interval [CI]: 21.5, 29.7) S. aureus-positive staff, 21 (11.7%; 95% CI: 11.7, 26.4) of who carried the MRSA strain. Carrier status was significantly higher among physicians (31%) compared to nurses (22.5%) and other staff (5.7%) (P < 0.001). MRSA carrier status was significantly associated with >5 years of employment at the eye hospital (P = 0.02). MRSA was significantly associated with staff who were of Indian nationality (75%) compared to other nationalities (P = 0.04) and those who were at the hospital for <5-year stay compared more than 5 years at the hospital (P = 0.001). All carriers responded to decolonization treatment. CONCLUSIONS: The high prevalence of MRSA and relatively easy treat MRSA carriers points at the need for universal screening for MRSA carriers among eye health staff.

Vision Screening of Ophthalmic Nursing Staff in a Tertiary Eye Care Hospital: Outcomes and ocular healthcare-seeking behaviours.

OBJECTIVES: This study aimed to evaluate ocular healthcare-seeking behaviours and vision screening outcomes of nursing staff at a tertiary eye care hospital. METHODS: This study was conducted between April and September 2016 among all 500 nurses employed at the King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Data were collected on age, gender, use of visual aids, the presence of diabetes, a history of refractive surgery and date of last ocular health check-up. Participants were tested using a handheld Spot™ Vision Screener (Welch Allyn Inc., Skaneateles Falls, New York, USA). RESULTS: A total of 150 nurses participated in the study (response rate: 30.0%). The mean age was 41.2 ± 8.9 years old. Distance spectacles, reading spectacles and both types of spectacles were used by 37 (24.7%), 32 (21.3%) and 10 (6.7%) nurses, respectively. A total of 58 nurses (38.7%) failed the vision screening test. Visual defects were detected for the first time in 13 nurses (8.7%). With regards to regular eye checkups, 77 participants (51.3%) reported acceptable ocular healthcare-seeking behaviours; this factor was significantly associated with age and the use of visual aids (P <0.01 each). CONCLUSION: A high proportion of participants failed the vision screening tests and only half displayed good ocular healthcare-seeking behaviours. This is concerning as ophthalmic nurses are likely to face fewer barriers to eye care services than the general population.

Role of high-sensitivity C-reactive protein measurements in HIV patients.

As we herald into the 21st century, the quality of life and the repertoire of highly active antiretroviral therapy (HAART) have considerably improved. However, considerable work is still needed to educate the population about primary and secondary prevention modalities. Moreover, regular monitoring of immune response with patients on HAART with conventional biomarkers is still a problem in low resource settings which needs to be addressed. We aim to review high-sensitivity C-reactive protein as a potential biomarker in this regard.

Fiberoptic bronchoscopy, as a valuable diagnostic option in sputum negative pulmonary tuberculosis: A prospective study.

CONTEXT: World Health Organization recommends bacteriological confirmation of pulmonary tuberculosis (PTB) by the detection of acid-fast bacilli (AFB) in respiratory specimens. However about 40-60% of patients with PTB suspected clinically or radiologically may fail to produce sputum, or when it is available, AFB may be negative on repeated smear examination. These sputum smear negative patients and those who fail to produce any sputum can be diagnosed by flexible fiberoptic bronchoscopy. AIMS: Our study was an attempt to analyze the role of fiberoptic bronchoscopy in sputum smear negative PTB patients with respect to their association with clinical and radiological profile. MATERIALS AND METHODS: In this prospective, open label, observational study, 40 cases of sputum smear negative PTB were subjected to bronchoscopic examination after taking informed consent and samples like bronchial aspirate, bronchoalveolar lavage and post bronchoscopy sputum were collected. The data was analysed and the results were given in percentage. RESULTS: Out of the total 40 patients, overall diagnosis was confirmed in 24 (60%) patients. Of these 24 patients, 17 patients were confirmed for PTB whereas 7 had other diagnoses. CONCLUSION: The study concludes that fiberoptic bronchoscopy is a useful tool in diagnosing sputum smear negative PTB patients with respect to their association with clinical and radiological profile, and also identifies individuals at a higher risk for progression of disease, at an early stage despite not meeting routine bacteriological criteria for confirmation of PTB.