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Abstract : Lower respiratory tract infections (LRTIs) caused by the influenza virus are associated with significant mortality and morbidity. We sought to generate estimates of the burden and cost of influenza-associated LRTIs in Indonesia in 2017. Data from Indonesian influenza sentinel sites and hospitals not designated as sentinel sites, and published demographic data for Indonesia were used to estimate the incidence of LRTIs attributable to influenza by applying the Global Burden of Disease (GBD) methods. The cost of influenza LRTI associated illness, disability, and premature death was used to estimate the macroeconomic burden. Direct health care expenditures for ambulatory services and hospitalization were also calculated. We estimated that in 2017 1,285 episodes of LRTIs were attributable to influenza per 100,000 LRTI episodes (a total of 3,358,418 episodes). Of these, 121,305 (3.6%) were detected from ambulatory healthcare visits and 40,435 (1.2%) were hospitalizations. The case fatality rate was 0.122 per 100 cases, a total of 4,097 deaths. Total medical expenditure (out-patients and hospitalized patients) was estimated as 19,235,240 USD, and the DALYs lost were 223,506 years or 859.79 million USD. The total economic cost due to influenza in Indonesia in 2017 was estimated as 878.99 million USD. This study estimates a considerable burden of disease related to LRTIs due to influenza, associated with a substantial productivity loss and healthcare costs in Indonesia. Our results highlight the significant impact that influenza prevention strategy, such as immunization, could have on current health and economic loss in Indonesia.

Abstract : Bloodstream infections (BSIs), particularly in neonates, must be diagnosed and treated with great care. Blood cultures continue to be the gold standard for diagnosis and are one of the most frequent causes of morbidity and mortality in BSIs. This study aims to estimate the bacteriological profile in blood culture among neonates in the tertiary care NICU of western Uttar Pradesh. This is a retrospective study, done in tertiary care hospital. All the neonatal blood samples, received during the period of 1st December 2020 to 30th November 2022 are included in the study. All samples were incubated in BacT/Alert system. The positive blood culture was further plated on Blood Agar & MacConkey Agar. The growths were identified according to the standard guidelines and the antibiotic sensitivity was performed by Kirby–Bauer’s disc diffusion method. A total of 637 neonatal blood samples were received during the period of 1st December 2020 to 30th November 2022. Among them, 15.2% of blood cultures were positive by BacT/Alert blood culture system of sepsis in neonates, Out of these total 52.6% patients had a Gram-negative bacterial infection, and 47.4% patients had Gram-positive bacterial infection. Among these 97 blood culture-positive cases, CoNS were isolated in 29.9%, followed by Klebsiella species in 20.6% cases, 18.5% Escherichia coli, 15.5%. Staphylococcus aureus,6.2% Pseudomonas spp., 5.2% Acinetobacter spp, 2.1% Enterococcus spp and 1% Enterobacter & Citrobacter each respectively. Our study shows 15.2 % of positive blood cultures. Klebsiella species and E. coli were found to be more prevalent among gram-negative bacteria. Among gram-positivemost common organisms were CoNS and Staphylococcus aureus. So it is important to include good hygiene practices and standard protocol in paediatrics wards to minimize the chances of bacterial sepsis.

Abstract : This study aimed at investigating reasons behind failure of initiatives to reform medical curricula of Syrian universities. A qualitative study was undertaken, and data were collected through interviews with ten academic staff members from Syrian medical faculties in public universities. Inductive thematic analysis was performed to allow themes to emerge from the comments of the participants. Two researchers independently coded each interview using the Braun and Clarke model. QSR NVivo 11 software was used for statistical analysis. Three emerged themes that identify causes of failure to reform medical curricula were developed. Theme 1: personal reasons associated with circumstances of the academic member such as lack of technical and teamwork skills and lack of passion to participate in training program, and lack of inter-professional collaboration. Theme 2 was related to institutional reasons such as absence of clear strategy, rigidity of administrative regulations, interference of several authorities, and migration of medical members. Theme 3 was related to crisis impact such as economic sanctions that led to decreased mobility of staff, decreased number of capacity building programs that usually promote national and international collaboration and consequently enhance passion to improve the curricula. The study offers new insights into the challenges of medical curriculum reform in Syria and suggests strategies for overcoming these obstacles. Medical schools and educators should play and important role in reforming the medical curricula. Some of challenges that face academic members can be resolved.

Abstract : The purpose of this study is to explore the risk of developing low back pain among normal body mass index and overweight pregnant women. This study's respondents consisted of 74 pregnant women in Leuwiliang Sub District in Indonesia. Lower back pain was examined using the Oswestry Disability Index for Low Back Pain questionnaire. This parameter has also high testability and takes about 5 minutes for the patient to complete. The questions given by the interviewer consisted of 10 items asking the results were grouped into two categories: low back pain and no low back pain. Body Mass Index was counted from the height and weight, then the results of the height and weight are entered into the formula (BMI = body weight (kg)/height (m2). The results of BMI were divided into 3 categories BMI < 18,5 into less 18,5-23.0 into normal and >23,0 into overweight. Based on the results, pregnant women who had a body mass index in the overweight category experienced more complaints of lower back pain, there are 35 people with a percentage of (94.6%) compared to pregnant women who had a body mass index in the normal there are 2 people with a percentage (5.4%). From calculations using the Chi-Square test, the Odd Ratio (OR) value of the incidence of complaints of low back pain in the body mass index group during pregnancy was 7.4, where pregnant women with a body mass index in the overweight category were 7.4 times more likely to experience complaints of lower back pain than pregnant women with normal body mass index category. Pregnant women with a body mass index in the category of excessive weight have a higher risk of reporting lower back pain, which is statistically significant and represents the group of pregnant women with the highest percentage of a normal body mass index.

Abstract : Mechanical ventilation (MV) uses in neonates primarily aim to assist or replace spontaneous breathing completely, but prolonged use of MV has been associated with various injuries and increased mortality rates. Therefore, extubation must be planned as early as possible, but due to the lack of standardized guidelines, the decision on when to extubate is difficult to determine. The aim of this study is to find the factor that becomes a predictor of the successfulness of extubation among neonates. This study is an observational cross-sectional study was conducted at the neonatal intensive care units (NICU) in the Government General Hospital Haji Adam Malik in February-May 2022. The sample were neonates treated with MV. The sample will be divided into two groups, consisting of successful extubation and failed extubation group. Data were collected and analyzed, and a p-value <0.05 is considered a significant result. From 46 neonates, the mean age of the sample was 10.22 days with males predominant (56.5%). Successful extubation was found in 40 neonates (87%), and extubation failure only occur in 6 neonates (13%). There were statistical differences in FiO2, MAP, PIP, neutrophils, procalcitonin, pH, and SaO2 between the successfully extubated neonates when compared to fail extubated neonates (p < 0.05). The conclusion of this study is FiO2, PIP, MAP, neutrophils value, procalcitonin value, blood pH, and SaO2 can be considered reliable factors that can predict the likeliness of successful extubation.