A Comparison of Caregiver Burden for Different Types of Dementia: An 18-Month Retrospective Cohort Study

BackgroundThis study aimed to elucidate the influence of dementia etiologies on the degree of caregiver burden and determine which factors predict a high caregiving burden.MethodsThis 18-month retrospective cohort study enrolled 630 patients and their caregivers from the Dementia Center of Changhua Christian Hospital. The care team performed face-to-face interviews every 6 months, for 18 months from when a diagnosis of dementia was made. The primary outcome was the change in Zarit Burden Interview (ZBI) scores. Generalized estimating equations were used for the longitudinal data analysis.ResultsParticipants with Lewy body disease (LBD) had a significantly higher caregiving burden compared with those with Alzheimer's disease (AD) (β = 3.83 ± 1.47, Wald = 6.79, p = 0.009) after adjusting for patient and caregiver features. Caregivers of mixed-type dementia and frontotemporal dementia (FTD) experienced a greater burden than caregivers of AD, at 6- and 18-month follow-up. Patients with more severe dementia, neuropsychiatric symptoms, being cared for by more than two caregivers, or utilizing social resources were associated with higher ZBI scores; the depressive mood of caregiver also predicted higher ZBI scores.ConclusionThis longitudinal study demonstrated that caregiver burden was influenced by the underlying dementia etiology of patients. The dementia care team should provide personalized education and transfer patients and caregivers to appropriate resources, especially for high-risk populations.

Reliability of a Trapezium Miniplate with Endoscope-Assisted Internal Fixation in Mandibular Subcondylar Fractures: A Three-Dimensional Analysis

This study aimed to evaluate the reliability of a trapezium plate for open reduction and internal fixation (ORIF) of mandibular subcondylar fractures with the simultaneous use of an endoscope. We selected and retrospectively studied 18 patients (12 males and 6 females) with unilateral mandibular subcondylar fractures who visited the Wonju Severance Christian Hospital. The mean age of the patients was 43.43 ± 15.76 years. Patients underwent ORIF with trapezium miniplate application through an intraoral incision under general anesthesia. The clinical and radiographic findings of the fractured side were compared with those of the non-operated side at 6 months follow-up. All occlusions became stable, and transient functional disturbances disappeared within 6 months of periodic follow-up. Functional mandibular movement recovered within the normal range, with an average mouth opening of 41.5 mm, protrusion of 7.5 mm, and lateral excursion of 7 mm at 6 months. Radiographic controls and statistical analysis confirmed a decent anatomical reduction in all 18 cases. In conclusion, the use of a trapezium miniplate with endoscope-assisted ORIF in mandibular subcondylar fractures can be useful for fixation and functional recovery.

OUTCOME AND ASSOCIATED FACTORS AMONG ROAD TRAFFIC ACCIDENT VICTIMS AT WOLAITA SODDO CHRISTIAN HOSPITAL, WOLAITA SODDO, SOUTH ETHIOPIA 2020, INSTITUTION-BASED CROSS-SECTIONAL STUDY.

ABSTRACT Background In today's world road traffic accident victims is treated as a major epidemic of non-communicable disease. Road traffic accidents caused numerous family tragedies such as serious economic loss to the community and the death of young people. The problem is more severe in low and middle-income countries. In Ethiopia, the largest proportion of series injuries comes from road traffic accidents and become major causes of death in the emergency room. Despite this, only a little is known about treatment outcomes of road traffic accident victims and its associated factors in Ethiopia. Method An institution-based Cross-sectional study design was conducted at Wolaita Soddo Christian hospital with a sample of 400 road traffic accidents. The medical record was selected using a systematic sampling method. Data was entered using Epi-data version 4.1 and was exported to and analyzed using SPSS version 23. A multivariable logistic regression model was used to assess the association between the independent variables and dependent variables. RESULT The overall death rate was 9.5%. Being out of hospital catchment area [AOR= 2.16, 95% CI= (1.01-4.70)] presence of co-morbid condition [AOR= 6.77 95% CI= (2.44-18.81)] lack of first aid help [AOR= 2.77 95% CI= (1.17-6.52)] and severity of the injury [AOR= 3.85 95% CI= (1.50-9.89)] were found to be significantly associated with outcome of road traffic accident victims. Conclusion The study shows that the death rate from road traffic accidents was high. Therefore, designing strategies to decrease death from road traffic accidents by giving great emphasis to road traffic accident victims with co-morbid conditions and severe injury and focusing on the availability and accessibility of pre-hospital care service. Keywords: Outcome, road traffic accident, Wolaita Soddo Christian hospital, Ethiopia

Spontaneous Spinal Epidural Hematoma Mimicking Stroke and Its Outcome post Intravenous Thrombolysis

<b><i>Background and Purpose:</i></b> Spontaneous spinal epidural hematoma (SSEH) is a rare neurological emergency. Its presentation, depending on location of hematoma, could mimic stroke. While intravenous thrombolysis (IVT) is recommended to commence as early as possible in case of acute ischemic stroke, it is likely that it could be given to SSEH patients. We aimed to examine the prevalence, outcome, and prognosis of such patients. <b><i>Methods:</i></b> We have retrospectively screened all patients given IVT from January 2008 to March 2021 admitted to United Christian Hospital, a tertiary hospital in Hong Kong. We reviewed the final diagnosis of all patients and included cases diagnosed with SSEH. Their clinical and radiological features, treatment, and outcome were analyzed. We further performed a literature review to search for all cases with SSEH given IVT and review their clinical features and outcome. <b><i>Results:</i></b> Out of a total of 940 patients over the 12-year span, 2 patients were diagnosed with SSEH, accounting for 0.21% of cases. From our literature search, to date, there are only 10 cases that had been reported from 5 case reports where IVT was given to SSEH patients. Of the 12 cases, all presented with hemiparesis and 9 with pain. Of those with neck pain, 3 with initial computed tomography angiogram done showed SSEH which was missed initially. Eight were treated surgically and 4 conservatively. All recovered with no major disability. <b><i>Conclusions:</i></b> Though a rare disease, awareness toward SSEH presenting as stroke mimic should be raised.

Impact on patients with oral squamous cell carcinoma in different anatomical subsites: a single-center study in Taiwan

The incidence of oral cavity squamous cell carcinoma (OSCC) is particularly high in South Asia. According to the National Comprehensive Cancer Network, OSCC can arise in several subsites. We investigated survival rates and the clinical and pathological characteristics of OSCC in different anatomical subsites in the Taiwanese population. We retrospectively analyzed data for 3010 patients with OSCC treated at the Changhua Christian Hospital. Subsequently, we compared clinical and pathological features of OSCC in different subsites. Pathological T4 stage OSCCs occurred in the alveolar ridge and retromolar trigone in 56.4% and 43.7% of cases, respectively. More than 25% of patients with tongue OSCC and 23.4% of those with retromolar OSCC had lymph node metastasis. The prognosis was worst for hard palate OSCC (hazard ratio 1.848; p < 0.001) and alveolar ridge OSCC (hazard ratio 1.220; p = 0.017). Retromolar OSCC recurred most often and tongue OSCC second most often. The risk for cancer-related mortality was highest for hard palate OSCC, followed by alveolar ridge and retromolar OSCC. We found distinct differences in survival among the different subsites of OSCC. Our findings may also help prompt future investigations of OSCC in different subsites in Taiwanese patients.

The Effect of Suture-Mediated Closure Device on Hemostasis in Patients after Transfemoral Cardiac Procedures - an Evidence-Based Practice

Patients who used manual compression after transfemoral cardiac procedures could suffer from several problems. The suture-mediated closure device may be proven as an effective alternative, offering earlier sheath removal, and potentially a reduction in vascular complications. The aim of this study was to discover empirical bases and clinical application of suture-mediated closure devices on hemostasis in patients after transfemoral cardiac procedures. This study was applied on evidence-based practice in the clinical setting. The search process for evidence-based practices used 3 databases such as MEDLINE, PubMed, and Web of Science, obtaining 14 studies published between 2000 and 2016. The studies selected were assessed by two reviewers for their methodological quality and level of evidence prior to inclusion in the review. Research subjects were patients at the age of ≥ 20 years old who suffered from coronary artery disease and required transfemoral cardiac procedures. This study was implemented in a Medical Intensive Care Unit, Changhua Christian Hospital. The hemostasis status was evaluated based on two categories of, bleeding or not bleeding. Six patients were included in this study. Most of the patients were male with average age of 69.33 ± 11.70 years old. Hypertension, diabetes mellitus, and hyperlipidemia were their common history of diseases. Based on the evaluation outcome, five patients showed hemostasis status and only one patient had bleeding after the compression procedures. This study concludes that the suture-mediated closure device is effective for patients after transfemoral cardiac procedures to reach hemostasis status quickly based on clinical evaluation.

A study to assess the gynecological problems among adolescent girls attending gynecology out patient department in secondary care hospital in North East India

Background: Adolescence is a period of transition between childhood and adulthood. It is marked by enormous biological, physical and psychological changes. The young girls are embarrassed to discuss their gynecolgical problems and are hesitant to seek medical help, however their problems need to be identified and addressed. This study identifies the major health problems faced by adolescent girls.Methods: This research study was conducted at Baptist Christian hospital, Assam from Oct 2019 to Mar 2020. A total of 61 adolescent girls in the age group of 10 to 19 years attending gynecology out patient department of Baptist Christian hospital, Assam were included in this study.Results: Most of the girls who attended the OPD were between 17 to 19 years of age (54%). Maximum number (75%) of girls attain menarche at the mean age of 12.6 years. 55.7% of girls presented with menstrual disorders and the most common menstrual disorder was found to be menorrhagia (32%), followed by oligomenorrhea (29%).Conclusions: This study gives out that young girls must be taught to take care of their body and they must be made aware of their bodily changes during growing up years. Health education regarding menstrual hygiene, menstrual problems and reproductive health should be imparted to them.

Residual Stroke Risk in Patients with Atrial Fibrillation Treated with Non-Vitamin K Oral Anticoagulants: An 8-Year Retrospective Cohort Study

<b><i>Background:</i></b> Use of non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in non-valvular atrial fibrillation (NVAF) is common and significantly reduces stroke occurrence. Yet little is known about patients who have a stroke despite treatment. <b><i>Objective:</i></b> The aim of this work was to study the epidemiology of patients with stroke despite being treated with NOACs. <b><i>Methods:</i></b> We identified a cohort of patients with NVAF admitted to the United Christian Hospital for acute ischemic stroke (AIS) or transient ischemic attack (TIA) while on NOACs. The baseline characteristics, type of NOAC, compliance, duration of use, and dosage were reviewed. <b><i>Results:</i></b> Of 2,090 patients admitted for AIS/TIA from 2012 to 2019, 143 were on NOACs before the index episode. After excluding patients with non-compliance and incomplete data, 109 patients were included in the analysis; 65.1% were female and 79.8% were never smokers, with a mean age of 78 years. The mean CHA2DS2-VASc score was 5; 83.5% had hypertension, 59.3% had hyperlipidemia, and 30.3% had diabetes mellitus. Overall, 52.9% presented with lacunar syndrome, suggesting an atherosclerotic cause of stroke. However, their risk factor control was unexpectedly good; none had HbA1c &#x3e;7% and only 23.9% had a low-density lipoprotein cholesterol level higher than 2.6 mmol/L. <b><i>Conclusions:</i></b> Stroke developed in NVAF patients despite being on NOACs, with the majority being female, older, and hypertensive. Surprisingly, in general they had reasonable lipid and diabetic control.

CLINICAL CHARACTERISTICS OF PAEDIATRIC MEASLES PATIENTS AT MOJOWARNO CHRISTIAN HOSPITAL, JOMBANG, IN 2015-2016

Background: Measles is one of the main causes of child mortality. In 2016 there were 6,890 cases of measles with 4 patients died in Indonesia. There were 122 cases in Jombang, East Java in 2009. Aim: To describe the clinical characteristics of measles in children patients at Mojowarno Christian Hospital, Jombang, East Java. Methods: A cross sectional study using secondary data from medical records at Mojowarno Christian Hospital, Jombang, East Java, in 2015-2015. Demographic and clinical characteristics were described using tables. Results: There are 22 cases of measles in children, 3 of them had not taken measles vaccination. Most cases occurred in between 0 to 5 years old (59.1%). The proportion of measles were equal between male and female. There is a higher proportion of patients with normal nutrition status (59.1%) compared to other with malnutrition (40.9%). The most common symptoms and signs are fever (95.5%), cough (23.7%), and coryza (22.3%). The leukocyte examination mostly shows normal results for leukocyte (63.6%) and lymphocyte (50%). Conclusion: Most of the cases were presented with milder symptoms, signs and laboratory examination. There is a high prevalence of undernutrition among the subjects, which need further attention from local governments. In addition, there is a concerning high proportion of vaccinated children contracting the disease.

A Biblical Model for a Christian Hospital in India in the Time of COVID-19

The former director of a Christian hospital in Assam, India descries the biblical framework they use to address the COVID-19 threat using the first 6 chapters of Nehemiah.