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Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal.

ABSTRACT: BACKGROUND:Despite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal. METHODS:This cross-sectional study was conducted between June 2015 and November 2015 at Tribhuvan University Teaching Hospital, a tertiary hospital in Kathmandu, Nepal. Children aged 3-60 months with a clinical diagnosis of pneumonia by a physician were enrolled in the study. Radiological pneumonia was identified and categorized as per World Health Organization guidelines by an experienced radiologist blinded to patient characteristics. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia. RESULTS:Out of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study. Among the enrolled patients, 61% had radiological pneumonia. Tachypnea had the highest sensitivity of 99%, while bronchial breathing had the highest specificity of 100%. During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia. Only hypoxemia remained an independent predictor when adjusted for all the factors. CONCLUSION:Tachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.

SUBMITTER: Shrestha S

PROVIDER: S-EPMC7377451 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal.

Shrestha Sandeep S Chaudhary Nagendra N Shrestha Saneep S Pathak Santosh S Sharma Arun A Shrestha Laxman L Kurmi Om P OP

PloS one 20200723 7

<h4>Background</h4>Despite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to ...[more]

PMID: 32702037

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Project description:BackgroundPatient satisfaction is one proxy indicator of the health care quality; however, enhancing patient satisfaction in low-income settings is very challenging due to the inadequacy of resources as well as low health literacy among patients. In this study, we assess patient satisfaction and its correlates in a tertiary public hospital in Nepal.MethodsWe conducted a cross sectional study at outpatient department of Bhaktapur Hospital of Nepal. To recruit participants for the study, we applied a systematic random sampling method. Our study used a validated Patient Satisfaction Questionnaire III (PSQ-III) developed by RAND Corporation including various contextual socio-demographic characteristics. We calculated mean score and percentages of satisfaction across seven dimensions of patient satisfaction. To determine the association between various dimensions of patient satisfaction and socio-demographic characteristics of the patient, we used a multi-ordinal logistic regression.ResultsAmong 204 patients, we observed a wide variation in patient satisfaction across seven dimensions. About 39% of patients were satisfied in the dimension of general satisfaction, 92% in interpersonal manner, and 45% in accessibility and convenience. Sociodemographic factors such as age (AOR: 6.42; CI: 1.30-35.05), gender (AOR: 2.81; CI: 1.41-5.74), and ethnicity (AOR: 0.26; CI: 0.08-0.77) were associated with general satisfaction of the patients. Other sociodemographic variables such as education, occupation, and religion were associated with a majority of the dimensions of patient satisfaction (p < 0.05). Age was found to be the strongest predictor of patient satisfaction in five out of seven dimensions.ConclusionsWe concluded that patient satisfaction varies across different dimensions. Therefore, targeted interventions that direct to improve the dimensions of patient satisfaction where the proportion of satisfaction is low are needed. Similar studies should be conducted regularly at different levels of health facilities across the country to capture a wider picture of patient satisfaction at various levels.

Project description:BackgroundMental illness is stigmatized in most of the communities and people with such illness are often subjected to defame. Stigma impairs an individual's and their caregiver's physical, social and emotional wellbeing, and health-seeking behavior. Sufficient literature on how often the caregivers of people with mental illness from low and middle-income countries are stigmatized and how they perceive people with mental illness is unavailable. In this study, we examined caregivers' attitude towards people with mental illness and perceived stigma.MethodsWe conducted face-to-face interviews with 170 caregivers in an outpatient clinic of a hospital in Nepal using a structured questionnaire. We calculated median and inter-quartile range of the attitude and perceived stigma scores. To assess the correlates, Kruskal Wallis H test and Mann Whitney U test were carried out.ResultsOverall median score for the domains: attitude (score range: 18-90) and perceived stigma (score range: 12-60) were 42 and 28 respectively, inter-quartile range being 8 each. Attitude score differed significantly by the sex of caregiver (p<0.05), educational status of caregiver (p<0.001), sex of patient (p<0.05) and type of mental illness (p<0.05). Perceived stigma score varied significantly by caregiver's sex (p<0.05), marital status (p<0.001), educational status (p<0.001), occupation (p<0.05), relation with the patient (p<0.005) and use of alternative treatment modalities (p<0.05).ConclusionSex of participant, educational status, sex of patient and type of mental illness were the correlates of attitude towards mental illness. Similarly, sex of participant, marital status, educational status, occupation, caregiver's relation with patient and use of alternative treatment modalities were correlates of perceived stigma. Findings of this study suggest that interventions targeting these high-risk populations might be beneficial to help build a positive attitude and overcome the perceived social stigma.

Project description:ObjectivesWe aimed to identify clinical, anamnestic, and sociodemographic characteristics associated with a positive swab for SARS-CoV2, and to provide a predictive score to identify at risk population in children aged 2-14 years attending school and tested for clinical symptoms of COVID-19.DesignCross sectional study.SettingOutpatient clinic of the IRCCS Burlo Garofolo, a maternal and child health tertiary care hospital and research centre in Italy.Data collection and analysisData were collected through a predefined form, filled out by parents, and gathered information on sociodemographic characteristics, and specific symptoms, which were analysed to determine their association with a positive SARS-CoV-2 swab. The regression coefficients of the variables included in the multivariate analysis were further used in the calculation of a predictive score of the positive or negative test.ResultsBetween September 20th and December 23rd 2020, from 1484 children included in the study, 127 (8.6%) tested positive. In the multivariate analysis, the variables retained by the model were the presence of contact with a cohabiting, non-cohabiting or unspecified symptomatic case (respectively OR 37.2, 95% CI 20.1-68.7; 5.1, 95% CI 2.7-9.6; 15.6, 95% CI 7.3-33.2); female sex (OR 1.49, 95% CI 1.0-2.3); age (6-10 years old: OR 3.2, 95% CI 1.7-6.1 p<0.001; >10 years old: OR 4.8, 95% CI 2.7-8.8 p<0.001); fever (OR 3.9, 95% CI 2.3-6.4); chills (OR 1.9, 95% CI 1.1-3.3); headache (OR 1.45, 95% CI 0.9-2.4); ageusia (OR 1.3, 95% CI 0.5-4.0); sore throat (OR 0.48, 95% CI 0.3-0.8); earache (OR 0.4, 95% CI 0.1-1.3); rhinorrhoea (OR 0.8, 95% CI 0.5-1.3); and diarrhoea (OR 0.52, 95% CI 0.2-1.1). The predictive score based on these variables generated 93% sensitivity and 99% negative predictive value.ConclusionsThe timely identification of SARS-CoV2 cases among children is useful to reduce the dissemination of the disease and its related burden. The predictive score may be adopted in a public health perspective to rapidly identify at risk children.

Project description:Background and objectivesPneumonia is the most common cause of death in children under five years of age. Epidemiological factors and the disease burden differ in developing and industrialized countries. The present study is a cross sectional observational study, carried out from August 2018 to August 2020 in Hindu Rao Hospital, to assess the prevalence of congenital heart disease (CHD) in patients with pneumonia in children up to 5 years. The main objectives of the study were to study the prevalence of congestive cardiac failure (CCF) in pneumonia with and without congenital heart disease.Material and methodsPatients under 5 years of age, presenting with pneumonia during August 2018 to July 2020 were enrolled for study. The bio-data of each patient was documented each patient was clinically evaluated thoroughly and findings noted. Pneumonia was diagnosed on typical history, physical findings, blood investigations and chest radiographic finding of pneumonia infiltrates in either one or both lung fields. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography, done by the cardiologist. Any congenital heart disease so found was noted. The type and size of the defects was documented. The ventricular septal defects were classified based on the site and size. The size of the patient ductus arteriosus was also determined. These measurements were taken to evaluate the impact of defect size on pneumonia. CCF was diagnosed when the patient fulfilled the clinical diagnostic criteria of heart failure. All the cases of pneumonia underwent transthoracic 2 Dimensional (2D) and Doppler echocardiography for diagnosis of any congenital heart disease.ResultsMean age of the children with pneumonia was 9.94 months with 77.5% of the cases below 1 year of age. Male predominance was seen with 56.3% males to 43.8% females. Prevalence of congenital heart disease among cases of pneumonia was 12.5% while that of congestive heart failure was 27.5%. Most common CHD observed was VSD (14 cases; 8.8%) followed by PDA, ASD and TGA (4; 2.5% and 3; 1.9% and 1; 0.6% cases respectively). A significant association was observed between presence of congenital heart disease and development of CCF.ConclusionOur study demonstrates that most patients with pneumonia or recurrent pneumonia are likely to have an underlying illness at the time of pneumonia. Recurrent ALRTI often occurred in children with history of congenital heart diseases (CHD) and is also associated with Congestive Cardiac Failure. Children with CHD are more vulnerable to recurrent respiratory tract infection.

Project description:BackgroundThe transmissibility and associated morbidity and mortality of severe acute respiratory syndrome-related coronavirus (SARS-Cov-2), have overwhelmed worldwide healthcare systems, resulting in an urgent need to understand this virus and its associated effects. The aim of our study was to identify patient symptoms, clinical characteristics, laboratory, and radiology findings that are associated with serious morbidity and mortality in COVID-19 patients.MethodsA cross sectional study was conducted in Jaber Al Ahmad Hospital, the designated COVID-19 center in Kuwait between August 1st, 2020 and January 31st, 2021. The main outcomes measured in this study were to identify variables associated with intensive care unit (ICU) admission, as proxy for serious morbidity, and in hospital mortality.ResultsTwo hundred and seventy-six patients were included in the study. Thirty-six (13%) patients were admitted to intensive care unit (ICU) and 33 (12%) patients expired. On multivariate analysis we found having elevated fibrinogen [OR 1.39, 95% CI 1.08-1.64, P = 0.04], low estimated glomerular filtration rate (eGFR) [OR 0.89, 95% CI 0.81-0.95, P = 0.02], and having bilateral patchy lung shadowing [OR 6.68, 95% CI 1.85-15.28, P < 0.01] to be significantly associated with increase odds of ICU admission. Elevated CRP [OR 1.25, 95% CI 1.10-1.98, P < 0.01], low eGFR [OR 0.95, 95% CI 0.90-0.99, P = 0.05] and having ischemic heart disease [OR 7.03, 95% CI 1.60-46.42, P = 0.04] were independently associated with increased odds of mortality.ConclusionCertain inflammatory and coagulopathy markers, and having certain lung radiological features, in addition to having medical comorbidities, specifically, ischemic heart disease and renal impairment are key predictors for serious morbidity and mortality in patients infected with COVID-19. These should be incorporated into medical institutes risk assessment tools used by physicians and policy makers to instigate, prioritize, and reprioritize care in patients with COVID-19 and instigate preventative strategy to reduce the impact of future outbreak.

Project description:BackgroundQuality of life is an important indicator of health and has multiple dimensions. It is adversely affected in patients with trauma history, and psychiatric disorders play an important role therein. Studies in trauma-affected populations focus mainly on the development of psychiatric disorders. Our study explored various aspects of quality of life in trauma patients in a clinical setting, mainly focusing on the association of psychiatric disorders on various domains of quality of life.MethodsOne hundred patients seeking help at the psychiatry outpatient of a tertiary hospital in Kathmandu, Nepal, and with history of trauma were interviewed using the World Health Organization Composite International Diagnostic Interview version 2.1 for trauma categorization. Post-traumatic stress disorder symptoms were assessed using the Post-Traumatic Stress Disorder Checklist-Civilian Version; while the level of anxiety and depression symptoms was assessed using the 25-item Hopkins Symptom Checklist-25. Quality of life was assessed using the World Health Organization Quality Of Life-Brief Version measure. Information on sociodemographic and trauma-related variables was collected using a semi-structured interview schedule. The associations between psychiatric disorders and quality of life domains were explored using bivariate analyses followed by multiple regressions.ResultsThe mean scores (standard deviations) for overall quality of life and health status perception were 2.79 (.87) and 2.35 (1.11), respectively. The mean scores for the physical, psychological, social and environmental domains were 12.31 (2.96), 11.46 (2.84), 12.79 (2.89), and 13.36 (1.79), respectively. Natural disaster was the only trauma variable significantly associated with overall quality of life, but not with other domains. Anxiety, depression and post-traumatic stress disorder were all significantly associated with various quality of life domains, where anxiety had the greatest number of associations.ConclusionQuality of life, overall and across domains, was affected in various ways based on the presence of psychiatric disorders such as anxiety, depression and post-traumatic stress disorder in patients with trauma. Our findings therefore emphasize the need to address these disorders in a systematic way to improve the patients' quality of life.

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Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal.

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Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal.

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