Search results for: patient death

Authors: Byeongju Choi, Sanggil Lee, Kyung-Eun Lee

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Introduction: In the republic of Korea, the number of workers in the beauty industry has been increasing. Because the prevalence of hepatitis B carriers in Korea is higher than in other countries, the risk of blood-borne infection including viral hepatitis B and C, among the workers by using the sharp and contaminated instruments during procedure can be expected among beauty salon workers. However, the health care policies for the workers to prevent the blood-borne infection are not established due to the lack of evidences. Moreover, the workers in hair and nail salon were mostly employed at small businesses, where national mandatory systems or policies for workers’ health management are not applied. In this study, the risk of the viral hepatitis B and C from the job experiencing the hair and nail procedures in the mortality was assessed. Method: We conducted a retrospective review of the job histories and causes of death in the female deaths from 2006-2016. 132,744 of female deaths who had one more job experiences during their lifetime were included in this study. Job histories were assessed using the employment insurance database in Korea Employment Information Service (KEIS) and the causes of death were in death statistics produced by Statistics Korea. Case group (n= 666) who died from viral hepatitis was classified the death having record involved in ‘B15-B19’ as a cause of deaths based on Korean Standard Classification of Diseases(KCD) with the deaths from other causes, control group (n=132,078). The group of the workers in the beauty service industry were defined as the employees who had ever worked in the industry coded as ‘9611’ based on Korea Standard Industry Classification (KSIC) and others were others. Other than job histories, birth year, marital status, education level were investigated from the death statistics. Multiple logistic regression analysis were used to assess the risk of deaths from viral hepatitis in the case and control group. Result: The number of the deaths having ever job experiences at the hair and nail salon was 255. After adjusting confounders of age, marital status and education, the odds ratio(OR) for deaths from viral hepatitis was quite high in the group having experiences with working in the beauty service industry with 3.14(95% confidence interval(CI) 1.00-9.87). Other associated factors with increasing the risk of deaths from viral hepatitis were low education level(OR=1.34, 95% CI 1.04-1.73), married women (OR=1.42, 95% CI 1.02-1.97). Conclusion: The risk of deaths from viral hepatitis were high in the workers in the beauty service industry but not statistically significant, which might attributed from the small number of workers in beauty service industry. It was likely that the number of workers in beauty service industry could be underestimated due to their temporary job position. Further studies evaluating the status and the incidence of viral infection among the workers with consideration of the vertical transmission would be required.

Keywords: beauty service, viral hepatitis, blood-borne infection, viral infection

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Authors: Gabrielle Pilliat

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The Supreme Court of Canada rendered unconstitutional the sections of the Canadian Criminal Code which prohibited the Physician-assisted suicide in February 2015. However, in 1993, the same Supreme Court of Canada ruled that Physician-assisted suicide should remain absolutely prohibited. In the light of these historical facts, we will explore how the Supreme Court of Canada was able to make two different decisions 20 years apart. To understand how Canada could rule so differently between 1993 and 2015 about Physician-assisted suicide, we will analyze the content of the Supreme Court of Canada decisions’ discourse of 1993 and of 2015. Our preliminary results indicate that A) the patient autonomy (or the personal choice) has taken over the idea of the preservation of life (or the sacred character of life) in 2015. B) That between 1993 and 2015, the physician is seen differently by the Judges; like an abusive murderer in 1993 and like an objective evaluator in 2015. C) That the patient is seen as a victim in 1993 and more like a hero in 2015.

Keywords: physician-assisted suicide, patient autonomy, choice, sacred character of life, dignity

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Authors: Merav Ben Natan, David Maman, Milana Avramov, Galina Shamilov, Yaron Berkovich

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Introduction: Patient satisfaction and the willingness to recommend a hospital are vital for improving healthcare quality. This study examines orthopedic patients to identify factors influencing their willingness to recommend the hospital. Aim: This study to explore the demographic and clinical variables affecting orthopedic patients' willingness to recommend the hospital and to understand the role of patient satisfaction in this context. Methods: A cross-sectional survey was conducted with 200 orthopedic patients hospitalized between July and December 2023 in north-central Israel. Data were analyzed to assess the impact of various factors on the willingness to recommend the hospital. Results: Age was positively associated with the willingness to recommend (OR=2.44), while the length of stay in the Emergency Department negatively impacted this willingness (OR=0.58). Satisfaction with hospital care had a positive effect on willingness to recommend (OR=1.96). Gender, comorbidities, and total hospital stay length did not significantly influence willingness to recommend. Conclusions: Satisfaction with hospital care and the length of Emergency Department stays are crucial factors affecting orthopedic patients' willingness to recommend the hospital. This underscores the need for strategies to improve patient experiences and address delays in the Emergency Department. The findings offer valuable insights for healthcare providers and policymakers.

Keywords: orthopedic patients, patient satisfaction, willingness to recommend, hospital recommendation

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Authors: Aniko Babits, Ahmad Daoud

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Introduction: The beach chair position (BCP) is a good approach to almost all types of shoulder procedures. However, moving an anaesthetized patient from the supine to sitting position may pose a risk of cerebral hypoperfusion and potential cerebral ischaemia as a result of significant reductions in blood pressure and cardiac output. Hypocapnia in ventilated patients and impaired blood flow to the vertebral artery due to hyperextension, rotation, or tilt of the head may have an impact too. Co-morbidities that may increase the risk of cerebral ischaemia in the BCP include diabetes with autonomic neuropathy, cerebrovascular disease, cardiac disease, severe hypertension, generalized vascular disease, history of fainting, and febrile conditions. Beach chair surgery requires a careful anaesthetic and surgical management to optimize patient safety and minimize the risk of adverse outcomes. Methods: We describe the necessary steps for optimal patient positioning and the aims of intraoperative management, including anaesthetic techniques to ensure patient safety in the BCP. Results: Regardless of the anaesthetic technique, adequate patient positioning is paramount in the BCP. The key steps to BCP are aimed at optimizing surgical success and minimizing the risk of severe neurovascular complications. The primary aim of anaesthetic management is to maintain cardiac output and mean arterial pressure (MAP) to protect cerebral perfusion. Blood pressure management includes treating a fall in MAP of more than 25% from baseline or a MAP less than 70 mmHg. This can be achieved by using intravenous fluids or vasopressors. A number of anaesthetic techniques could also improve cerebral oxygenation, including avoidance of intermittent positive pressure ventilation (IPPV) with general anaesthesia (GA), using regional anaesthesia, maintaining normocapnia and normothermia, and the application of compression stockings. Conclusions: In summary, BCP is a reliable and effective position to perform shoulder procedures. Simple steps to patient positioning and careful anaesthetic management could maximize patient safety and avoid unwanted adverse outcomes in patients undergoing surgery in BCP.

Keywords: beach chair position, cerebral oxygenation, cerebral perfusion, sitting position

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Authors: Asit K. Sikary, O. P. Murty

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Adipocere formation is a modification of the process of putrefaction. It consists mainly of saturated fatty acids, formed by the post-mortem hydrolysis and hydrogenation of body fats with the help of bacterial enzymes in the presence of warmth, moisture and anaerobic bacteria. In temperate climate, it takes weeks to develop while in India it starts to begin within 4-5 days. In this study, we have collected cases with adipocere formation, which were from the South Delhi region (average room temperature 27-390C) and autopsied at our centre. Details of the circumstances of the death, cause and time of death, surrounding environment and demographic profile of the deceased were taken into account. Total 16 cases were included in this study. Adipocere formation was predominantly present over cheeks, shoulder, breast, flanks, buttocks, and thighs. Out of 16, 11 cases were found in a dry atmosphere, 5 cases were brought from the water. There were 5 cases in which adipocere formation was seen in less than 2 days, and among them, in 1 case, as early as one day. This study showed that adipocere formation can be seen as early as 1 day in a hot and humid environment.

Keywords: adipocere, drowning, hanging, humid environment, strangulation, subtropical climate

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Authors: Launcelot McGrath

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A comprehensive understanding of physiological data is a vital aid to the anaesthesiologist in monitoring and maintaining the well-being of a patient undergoing surgery. Bio signal analysis is one of the most important topics that researchers have tried to develop over the last century to understand numerous human diseases. Understanding which biological signals are most important during anaesthesia is critically important. It is important that the anaesthesiologist understand both the signals themselves and the limitations introduced by the processes of acquisition. In this article, we provide an overview of different types of biological signals as well as the mechanisms applied to acquire them.

Keywords: biological signals, signal acquisition, anaesthesiology, patient monitoring

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Authors: Amulya Srivatsa, Gayatri Prakash, Deeksha Sarda, Varshni Nandakumar, Duncan Salmon

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Delivery of Patient-Directed Wound Care Via Mobile Application-Based Qualitative Analysis Chronic wounds are difficult for patients to manage at-home due to their unpredictable healing process. These wounds are associated with increased morbidity and negatively affect physical and mental health. The solution is a mobile application that will have an algorithm-based checklist to determine the state of the wound based on different factors that vary from person to person. Once this information is gathered, the application will recommend a plan of care to the user and subsequent steps to be taken. The mobile application will allow users to perform a digital scan of the wound to extract quantitative information regarding wound width, length, and depth, which will then be uploaded to the EHR to notify the patient’s provider. This scan utilizes a photo taken by the user, who is prompted appropriately. Furthermore, users will enter demographic information and answer multiple choice and drop-down menus describing the wound state. The proposed solution can save patients from unnecessary trips to the hospital for chronic wound care. The next iteration of the application can incorporate AI to allow users to perform a digital scan of the wound to extract quantitative information regarding wound width, length, and depth, which can be shared with the patient’s provider to allow for more efficient treatment. Ultimately, this product can provide immediate and economical medical advice for patients that suffer from chronic wounds. Research Objectives: The application should be capable of qualitative analysis of a wound and recommend a plan of care to the user. Additionally, the results of the wound analysis should automatically upload to the patient’s EMR. Research Methodologies: The app has two components: the first is a checklist with tabs for varying factors that assists users in the assessment of their skin. Subsequently, the algorithm will create an at-home regimen for patients to follow to manage their wounds. Research Contributions: The app aims to return autonomy back to the patient and reduce the number of visits to a physician for chronic wound care. The app also serves to educate the patient on how best to care for their wounds.

Keywords: wound, app, qualitative, analysis, home, chronic

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Authors: Farid Risheq, M. Zaid Alrisheq, Shuaa Al-Sadoon, Karim Al-Faqih, Mays Abdulazeez

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Breast cancer is the most frequently diagnosed cancer worldwide, and a common cause of death among women. Various conventional anatomical imaging tools are utilized for diagnosis, histological assessment and TNM (Tumor, Node, Metastases) staging of breast cancer. Biopsy of sentinel lymph node is becoming an alternative to the axillary lymph node dissection. Advances in 18-Fluoro-Deoxi-Glucose Positron Emission Tomography/Computed Tomography (18FDG-PET/CT) imaging have facilitated breast cancer diagnosis utilizing biological trapping of 18FDG inside lesion cells, expressed as Standardized Uptake Value (SUVmax). Objective: To present the utility of 18FDG uptake PET/CT scans in detecting active extra lymph nodes and distant occult metastases for breast cancer staging. Subjects and Methods: Four female patients were presented with initially classified TNM stages of breast cancer based on conventional anatomical diagnostic techniques. 18FDG-PET/CT scans were performed one hour post 18FDG intra-venous injection of (300-370) MBq, and (7-8) bed/130sec. Transverse, sagittal, and coronal views; fused PET/CT and MIP modality were reconstructed for each patient. Results: A total of twenty four lesions in breast, extended lesions to lung, liver, bone and active extra lymph nodes were detected among patients. The initial TNM stage was significantly changed post 18FDG-PET/CT scan for each patient, as follows: Patient-1: Initial TNM-stage: T1N1M0-(stage I). Finding: Two lesions in right breast (3.2cm2, SUVmax=10.2), (1.8cm2, SUVmax=6.7), associated with metastases to two right axillary lymph nodes. Final TNM-stage: T1N2M0-(stage II). Patient-2: Initial TNM-stage: T2N2M0-(stage III). Finding: Right breast lesion (6.1cm2, SUVmax=15.2), associated with metastases to right internal mammary lymph node, two right axillary lymph nodes, and sclerotic lesions in right scapula. Final TNM-stage: T2N3M1-(stage IV). Patient-3: Initial TNM-stage: T2N0M1-(stage III). Finding: Left breast lesion (11.1cm2, SUVmax=18.8), associated with metastases to two lymph nodes in left hilum, and three lesions in both lungs. Final TNM-stage: T2N2M1-(stage IV). Patient-4: Initial TNM-stage: T4N1M1-(stage III). Finding: Four lesions in upper outer quadrant area of right breast (largest: 12.7cm2, SUVmax=18.6), in addition to one lesion in left breast (4.8cm2, SUVmax=7.1), associated with metastases to multiple lesions in liver (largest: 11.4cm2, SUV=8.0), and two bony-lytic lesions in left scapula and cervicle-1. No evidence of regional or distant lymph node involvement. Final TNM-stage: T4N0M2-(stage IV). Conclusions: Our results demonstrated that 18FDG-PET/CT scans had significantly changed the TNM stages of breast cancer patients. While the T factor was unchanged, N and M factors showed significant variations. A single session of PET/CT scan was effective in detecting active extra lymph nodes and distant occult metastases, which were not identified by conventional diagnostic techniques, and might advantageously replace bone scan, and contrast enhanced CT of chest, abdomen and pelvis. Applying 18FDG-PET/CT scan early in the investigation, might shorten diagnosis time, helps deciding adequate treatment protocol, and could improve patients’ quality of life and survival. Trapping of 18FDG in malignant lesion cells, after a PET/CT scan, increases the retention index (RI%) for a considerable time, which might help localize sentinel lymph node for biopsy using a hand held gamma probe detector. Future work is required to demonstrate its utility.

Keywords: axillary lymph nodes, breast cancer staging, fluorodeoxyglucose positron emission tomography/computed tomography, lymph nodes

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Authors: Chamseddine Barki, Salam Labidi, Hanen Boussi Rahmouni

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In this article, we present the principle and suitable methodology for the design of a medical ontology that highlights the radiological and dosimetric knowledge, applied in diagnostic radiology and radiation-therapy. Our ontology, which we named «Onto.Rap», is the subject of radiation protection in medical and radiology centers by providing a standardized regulatory oversight. Thanks to its added values of knowledge-sharing, reuse and the ease of maintenance, this ontology tends to solve many problems. Of which we name the confusion between radiological procedures a practitioner might face while performing a patient radiological exam. Adding to it, the difficulties they might have in interpreting applicable patient radioprotection standards. Here, the ontology, thanks to its concepts simplification and expressiveness capabilities, can ensure an efficient classification of radiological procedures. It also provides an explicit representation of the relations between the different components of the studied concept. In fact, an ontology based-radioprotection expert system, when used in radiological center, could implement systematic radioprotection best practices during patient exam and a regulatory compliance service auditing afterwards.

Keywords: knowledge, ontology, radiation protection, radiology

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Authors: Reem Alshiha, Tanzila Saba

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Physical rehabilitation is the process of helping people to recover and be able to go back to their former activities that have been delayed due to external factors such as car accidents, old age and victims of strokes (chronic diseases and accidents, and those related to sport activities).The cost of hiring a personal nurse or driving the patient to and from the hospital could be costly and time-consuming. Also, there are other factors to take into account such as forgetfulness, boredom and lack of motivation. In order to solve this dilemma, some experts came up with rehabilitation software to be used with Microsoft Kinect to help the patients and their families for in-home rehabilitation. In home rehabilitation software is becoming more and more popular, since it is more convenient for all parties affiliated with the patient. In contrast to the other costly market-based systems that have no portability, Microsoft’s Kinect is a portable motion sensor that reads body movements and interprets it. New software development has made rehabilitation games available to be used at home for the convenience of the patient. The game will benefit its users (rehabilitation patients) in saving time and money. There are many software's that are used with the Kinect for rehabilitation, but the software that is chosen in this research is Kinectotherapy. Kinectotherapy software is used for rehabilitation patients in Riyadh clinics to test its acceptance by patients and their physicians. In this study, we used Kinect because it was affordable, portable and easy to access in contrast to expensive market-based motion sensors. This paper explores the importance of in-home rehabilitation by using Kinect with Kinectotherapy software. The software targets both upper and lower limbs, but in this research, the main focus is on upper-limb functionality. However, the in-home rehabilitation is applicable to be used by all patients with motor disability, since the patient must have some self-reliance. The targeted subjects are patients with minor motor impairment that are somewhat independent in their mobility. The presented work is the first to consider the implementation of in-home rehabilitation with real-time feedback to the patient and physician. This research proposes the implementation of in-home rehabilitation in Riyadh, Saudi Arabia. The findings show that most of the patients are interested and motivated in using the in-home rehabilitation system in the future. The main value of the software application is due to these factors: improve patient engagement through stimulating rehabilitation, be a low cost rehabilitation tool and reduce the need for expensive one-to-one clinical contact. Rehabilitation is a crucial treatment that can improve the quality of life and confidence of the patient as well as their self-esteem.

Keywords: x-box, rehabilitation, physical therapy, rehabilitation software, kinect

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Authors: Esam Roshdy, Saleh AlRashdi, Turki Alharbi, Rawan Eskandarani, Zurina Cabilo

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Introduction/ background: Consultation in the Emergency Department constitute a major part of the work flow every day. Any delay in the consultation process have a major impact on the length of stay and patient disposition and thus affect the total waiting time of patients in the ED. King Fahad medical City in Riyadh City, Saudi Arabia is considered a major Tertiary hospital where there is high flow of patients of different categories visiting the ED. The importance of decreasing consultation time and decision for final disposition of patients was recognized and interpreted in this project to find ways to improve the patient flow in the department and thus the total patient disposition and outcome. Aim / Objectives: 1. To monitor the time of consultation for patients in the Emergency department and its impact on the length of stay of patients in the ED. 2. To detect and assess the problems that lead to long consultation times in the ED, and reach a targeted time of 2 hours for final disposition of patients, according to recognized international and our institutional consultation policy, to reach the final goal of decreasing total length of stay and thus improve the patient flow in the ED. Methods: Data was collected retrospectively for a 92 charts of consultations done in the ED over 2 month’s period. The data was analyzed to get the median of Total Consultation Time. A survey was conducted among all ED staff to determine the level of knowledge about the total consultation time and the compliance to the institutional policy target of 2 hours. A second Data sample of 168 chart was collected after awareness campaign and education of all ED staff about the importance of reaching the target consultation time and compliance to the institutional policy. Results: We have found that there is room for improvement in our overall consultation time. This was found to be more frequent with certain specialties. Our surveys have showed that many ED staff are not familiar or not compliant with our consultation policy which was not clear for everyone. Post-intervention data have showed that awareness of the importance to decrease the total consultation time and compliance alone to the targeted goal have had a huge impact on overall improvement and decreasing the time of final decision and disposition of the patient and the overall patient length of stay in the ED. Conclusion: Working on improving Consultation time in the Emergency Department is a major factor in improving overall length of stay and patient flow. This improvement helps in the overall patient disposition and satisfaction. Plan: As a continuation of our project we are planning to focus on the conflict of admission cases where more than one specialty is involved in the care of patients. We are planning to collect data on the time it takes to resolve and reach final disposition of those patients, and its impact on the length of stay and our department flow and the overall patient outcome and satisfaction.

Keywords: consultation time, impact, length of stay, in the ED

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Authors: Fanniyah Anis, Bram Kilapong

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Myocardial reperfusion injury is defined as the cellular damage that results from a period of ischemia, followed by the reestablishment of the blood supply to the infarcted tissue. Ventricular tachycardia is one of the most commonly encountered reperfusion arrhythmia as one of the types of myocardial perfusion injury. Prompt and early treatment can reduce mortality, despite limited resources of the hospital in high risk patients with history of triple vessel disease. Case report, Male 53 years old has been diagnosed with NSTEMI with 3VD and comorbid disease of Hypertension and has undergone revascularization management with Percutaneous coronary intervention. Ventricular tachycardia leading to cardiac arrest occurred right after the stent was inserted. Resuscitation was performed for almost 2 hours until spontaneous circulation returned. Patient admitted in ICU with refractory cardiac shock despite using combination of ionotropic and vasopressor agents under standard non-invasive monitoring due to the limitation of the hospital. Angiography was performed again 5 hours later to exclude other possibilities of blockage of coronary arteries and conclude diagnosis of myocardial reperfusion injury. Patient continually managed with combination of antiplatelet agents and maintenance dose of anti-arrhythmia agents. The handling of the patient was to focus more on supportive and preventive from further deteriorating of the condition. Patient showed clinically improvement and regained consciousness within 24 hours. Patient was successfully discharged from ICU within 3 days without any neurological sequela and was discharge from hospital after 3 days observation in general ward. Limited Resource of hospital did not refrain the physician from attaining a good outcome for this myocardial reperfusion injury case and angiography alone can be used to confirm the diagnosis of myocardial reperfusion injury.

Keywords: limited resources hospital, myocardial reperfusion injury, prolonged resuscitation, refractory cardiogenic shock, reperfusion arrhythmia, revascularization, triple-vessel disease

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Authors: Andriana Purnama, Reno Rudiman, Kezia Christy

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Anal stenosis which develops due to anoderm scarring usually caused by secondary to surgical trauma, has become common, causing significant decrease patient’s quality of life. Even though mild anal stenosis was treated with non-surgical treatment, but surgical reconstruction in unavoidable for moderate to severe anal stenosis that cause distressing, severe anal pain and inability to defecate. In our study, we intend to share our result with the use of diamond flap in treatment of anal stenosis. This case report illustrates a 57-year-old male patient who presented with difficulty and discomfort in defecation caused by anal stenosis after 2 years of open hemorrhoidectomy surgery. At physical examination, there was requirement of forceful dilatation when the index finger was inserted or precisely 6mm as measured by hegar dilator (moderate anal stenosis). Blood test result was within normal limits. The patient underwent anal repair and diamond flap where the scar tissue at 6 and 9 o’clock directions was excised and diamond graft was incised carefully while paying attention to the vascular supply. Finally, the graft was fixated without any tension to the anal canal, resulting in diameter of 2 cm after operation. After 2 days post operation, the patient was in stable condition, without any complication, and discharged. There was no abnormality concerning the stool. Ten days after the operation, diamond flap was in normal condition and without any complication. He was scheduled for futher follow up at the Digestive Surgery Department. Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when performed in experienced hands. Diamond flap was one of the options for the anal stenosis treatment with less complication.

Keywords: anal stenosis, diamond flap, post hemorrhoidectomy, anal repair

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Authors: Elisavet Arsenaki

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Paracetamol overdose is associated with significant and possibly permanent consequences including hepatotoxicity, acute and chronic liver failure, and death. This quality improvement project explores the prevalence of accidental iatrogenic paracetamol overdose in hospital patients with a low body weight, defined as <50kg and assesses the impact of educational posters in trying to reduce it. The study included all adult inpatients on the admissions ward, a short stay ward for patients requiring 12-72 hour treatment, and consisted of three cycles. Each cycle consisted of 3 days of data collection in a given month (data collection for cycle 1 occurred in January 2022, February 2022 for cycle 2 and March 2022 for cycle 3). All patients given paracetamol had their prescribed dose checked against their charted weight to identify the percentage of adult inpatients <50kg who were prescribed 1g of paracetamol instead of 500mg. In the first cycle of the audit, data were collected from 83 patients who were prescribed paracetamol on the admissions ward. Subsequently, four A4 educational posters were displayed across the ward, on two separate occasions and with a one-month interval in between each poster display. The aim of this was to remind prescribing doctors of their responsibility to check patient body weight prior to prescribing paracetamol. Data were collected again one week after each round of poster display, from 72 and 70 patients respectively. Over the 3 cycles with a cumulative 225 patients, 15 weighed <50kg (6.67%) and of those, 5 were incorrectly prescribed 1g of paracetamol, yielding a 33.3% prevalence of accidental iatrogenic paracetamol overdose in adult inpatients. In cycle 1 of the project, 3 out of 6 adult patients weighing <50kg were overdosed on paracetamol, meaning that 50% of low weight patients were prescribed the wrong dose of paracetamol for their weight. In the second data collection cycle, 1 out of 5 <50kg patients were overdosed (20%) and in the third cycle, 1 out of 4 (25%). The use of educational posters resulted in a lower prevalence of accidental iatrogenic paracetamol overdose in low body weight adult inpatients. However, the differences observed were statistically insignificant (p value 0.993 and 0.995 respectively). Educational posters did not induce a significant decrease in the prevalence of accidental iatrogenic paracetamol overdose. More robust strategies need to be employed to further decrease paracetamol overdose in patients weighing <50kg.

Keywords: iatrogenic, overdose, paracetamol, patient, safety

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Authors: En Hyung Kim

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Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Although treatment is not necessary, many patients with facial PUL seek medical help for cosmetic reasons. There is no established standard treatment for PUL. Conventional lasers may cause postinflammatory hyperpigmentation because keratinocytes are injured during the process. Also scarring, long downtime and pain are important issues. Case: A 19-year-old patient with facial PUL was treated with 1064-nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (QS Nd:YAG) laser. The patient was treated at one-week intervals starting with a spot size of 6 mm, a fluence of 2.5 J/cm2 and a pulse rate of 10 Hz with 1-2 passes of slow sliding technique with approximately 5-15 % overlap. The fluence was elevated to 3 J/cm2 after the 4th session according to treatment response and patient tolerance. After 10 treatment sessions the lesions were remarkably improved. Discussion: Although the exact mechanism by which low fluence 1,064-nm QS Nd:YAG laser improves pigmentary lesions is unclear, the term ‘subcellular selective photothermolysis’ and ‘melanocyte apoptosis and replacement’ have been proposed. If appropriate measures are taken to monitor patient response during and after the procedure, low fluence 1064-nm QS Nd:YAG laser may achieve good cosmetic result in the treatment of PUL with a very safe and effective profile.

Keywords: laser toning, low fluence, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, partial unilateral lentiginosis

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Authors: Kim Lytle, Tim Talty, Alan Michaels, Jeff Reed

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Implantable medical devices (IMDs) are medically necessary devices embedded in the human body that monitor chronic disorders or automatically deliver therapies. Most IMDs have wireless capabilities that allow them to share data with an offboard programming device to help medical providers monitor the patient’s health while giving the patient more insight into their condition. However, serious security concerns have arisen as researchers demonstrated these devices could be hacked to obtain sensitive information or harm the patient. Cooperative jamming can be used to prevent privileged information leaks by maintaining an adequate signal-to-noise ratio at the intended receiver while minimizing signal power elsewhere. This paper uses ray tracing to demonstrate how a low number of friendly nodes abiding by Bluetooth Low Energy (BLE) transmission regulations can enhance IMD communication security in an office environment, which in turn may inform how companies and individuals can protect their proprietary and personal information.

Keywords: implantable biomedical devices, communication system security, array signal processing, ray tracing

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Authors: Faruk Emir, Simel Ayyıldız, Cem Şahin

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Behçet’s disease or Behçet’s syndrome is a chronic and multi-systemic inflammatory disease of unknown cause. This syndrome often presents with mucous membrane ulceration and ocular problems. As a systemic disease Behcet includes triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. Nearly all patients present with some form of painful oral mucocutaneous ulcerations in the form of aphthous ulcers. The aim of the treatment plan for Behçet’s Disease patients is to eliminate oral problems and increase the patient comfort.This clinical report represents the prosthodontic rehabilitation of Behcet’s disease patients mandibular total edentulism with the use of implant supported prosthesis that planned on custom abutments and bar retainers via CAD/CAM technology and patient satisfaction has been achieved in function and aesthetics.

Keywords: Behçet’s disease, CAD/CAM, custom-made manufacturing, titanium milled bar retainer

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Authors: Maria L. G. Lourenço, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, João C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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The neonatal mortality rates in dogs are considered high, varying between 5.7 and 21.2% around the world, and the causes of the deaths are often unknown. Data regarding canine neonatal mortality are scarce in Brazil. This study aims at describing the neonatal mortality rates in dogs, as well as the main causes of death. The study included 152 litters and 669 neonates admitted to the São Paulo State University (UNESP) Veterinary Hospital, Botucatu, São Paulo, Brazil between January 2018 and September 2019. The overall mortality rate was 16.7% (112/669), with 40% (61/152) of the litters presenting at least one case of stillbirth or neonatal mortality. The rate of stillbirths was 7.7% (51/669), while the neonatal mortality rate was 9% (61/669). The early mortality rate (0 to 2 days) was 13.7% (92/669), accounting for 82.1% (92/112) of all deaths. The late mortality rate (3 to 30 days) was 2.7% (18/669), accounting for 16% (18/112) of all deaths. Infection was the causa mortis in 51.8% (58/112) of the newborns, of which 30.3% (34/112) were caused by bacterial sepsis, and 21.4% (24/112) were caused by other bacterial, viral or parasite infections. Other causes of death included congenital malformations (15.2%, 17/112), of which 5.3% (6/112) happened through euthanasia due to malformations incompatible with life; asphyxia/hypoxia by dystocia (9.8%, 11/112); wasting syndrome in debilitated newborns (6.2%, 7/112); aspiration pneumonia (3.6%, 4/112); agalactia (2.7%, 3/112); trauma (1.8%, 2/112); administration of contraceptives to the mother (1.8%, 2/112) and unknown causes (7.1%, 8/112). The neonatal mortality rate was considered high, but they may be even higher in locations without adequate care for the mothers and neonates. Therefore, prenatal examinations and early neonatal care are of utmost importance for the survival of these patients.

Keywords: neonate dogs, puppies, mortality rate, neonatal death

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Authors: Neha Singh, Anuj Ranjan, Tanu Jindal

Abstract:

Over the last decade, the exponential growth of mobile communication has been accompanied by a parallel increase in density of electromagnetic fields (EMF). The continued expansion of mobile phone usage raises important questions as EMF, especially radio frequency (RF), have long been suspected of having biological effects. In the present experiments, we studied the effects of RF-EMF on cell death (apoptosis) and DNA damage of a well- tested biological model, Drosophila melanogaster exposed to 2400 MHz frequency for different time duration i.e. 2 hrs, 4 hrs, 6 hrs,8 hrs, 10 hrs, and 12 hrs each day for five continuous days in ambient temperature and humidity conditions inside an exposure chamber. The flies were grouped into control, sham-exposed, and exposed with 100 flies in each group. In this study, well-known techniques like Comet Assay and TUNEL (Terminal deoxynucleotide transferase dUTP Nick End Labeling) Assay were used to detect DNA damage and for apoptosis studies, respectively. Experiments results showed DNA damage in the brain cells of Drosophila which increases as the duration of exposure increases when observed under the observed when we compared results of control, sham-exposed, and exposed group which indicates that EMF radiation-induced stress in the organism that leads to DNA damage and cell death. The process of apoptosis and mutation follows similar pathway for all eukaryotic cells; therefore, studying apoptosis and genotoxicity in Drosophila makes similar relevance for human beings as well.

Keywords: cell death, apoptosis, Comet Assay, DNA damage, Drosophila, electromagnetic fields, EMF, radio frequency, RF, TUNEL assay

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Authors: Dursun Kalebaşi

Abstract:

When we examine the history of mankind (from the past up to the present), we see that millions of people died because of the wars. Especially, since the beginning of 19th century, the increase of the human death rate is caused mostly by the regional conflicts and natural disasters rather than the wars. From that point of view, the biggest threat humanity face today is temperature increase and climate change that started to emerge in recent years. When we take into account the natural disasters on one hand and refuges that flee from regional conflicts on the other, it stands out as a dramatic situation because of the huge human losses. In this context, most of the countries started to give more importance to Search and Rescue (SAR) operations to stop the loss of lives or decrease the death rate. This article will tell about the SAR activities in Turkey since 2000 and discuss the Turkey’s contributions to Rescue Missions after the natural disasters in different parts of the world. Moreover, there will be some new highlights to a more habitable and more peaceful world through the SAR missions.

Keywords: search and rescue, natural disasters, migration and world peace, Turkish army forces

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Authors: Pratima Tatke, Archana Avhad, Bhanu Duggal, Meeta Rajivlochan, Sujata Saunik, Pradip Vyas, Nidhi Pandey, Aditee Dalvi, Jyothi Subramanian

Abstract:

Background: Smoking is well established risk factor for the development and progression of coronary artery disease. It is strongly related to morbidity and mortality from cardiovascular causes. The aim of this study is to observe effect of smoking status on percutaneous coronary intervention(PCI) after 1 year. Methods: 2527 patients who underwent PCI at different hospital of Maharashtra(India) from 2012 to 2015 under the health insurance scheme which is launched by Health department, Government of Maharashtra for below poverty line(BPL) families which covers cardiology. Informed consent of patients was taken .They were followed by telephonic survey after 6months to 1year of PCI . Outcomes of interest included myocardial infarction, restenosis, cardiac rehospitalization, death, and a composite of events after PCI. Made group of two non smokers-1861 and smokers (including patients who quit at time of PCI )-659. Results: Statistical Analysis using Pearson’s chi square test revealed that there was trend seen of increasing incidence of death, Myocardial infarction and Restenosis in smokers than non smokers .Smokers had a greater death risk compared to nonsmoker; 5.7% and 5.1% respectively p=0.518. Also Repeat procedures (2.1% vs. 1.5% p=0.222), breathlessness (17.8% vs. 18.20% p=0.1) and Myocardial Infarction (7.3% vs. 10%) high in smoker than non smokers. Conclusion: Major adverse cardiovascular events (MACE) were observed even after successful PCI in smokers. Patients undergoing percutaneous coronary intervention should be encouraged to stop smoking.

Keywords: coronary artery diseases, major adverse cardiovascular events, percutaneous coronary intervention, smoking

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Authors: M. Brockes, S. Beck, A. Sigaroudi, C. Brockes

Abstract:

Over the last years, telemedicine and telemonitoring have become a popular way of treatment, especially in other chronic diseases. Therefore this type of treatment methodology was also implemented in interstitial lung disease (ILD) patients. In January 2024, a new service for patients with interstitial lung disease (ILD) treated with Nintedanib was established, which contains daily telemonitoring (home spirometry, pulse oximetry, and daily level of activity), daily evaluation of parameters as well as a telemedical availability answered by doctors and telemedical specialists throughout 365 days per year. The main motivational points of this service are the early detection of first signs of exacerbations and/or other symptoms/complications as well as easier access to healthcare professionals. The evaluation of the patient’s quality of life and the subjective feeling of safetyness was measured through patient reported experience measurements (PREMs) and patient reported outcome measurements (PROMs). Patients were introduced to the telemedical and telemonitoring service six-months ago. Within this period, every sixty days, the questionnaires were conducted by the scientific employees. Due to the unlimited time frame of the long-term service the evaluation is not completed. The first analysis of patient reported experience measurements (PREMs) and patient reported outcome measurements (PROMs) have shown an increased positive effect on the patients' quality of life as well as an increased positive effect on the subjective feeling of safety at home, plus a reduction and avoidance of secondary damages (e.g., exacerbations, deterioration of typical interstitial lung disease ILD symptoms and pharmaceutical side effects). The first results have shown a tendency that the telemedical treatment combined with telemonitoring at home and the encouragement of patients to actively participate in their healthcare has a positive effect on the patient’s overall well-being and could be implemented as a complementation of the traditional standard of care.

Keywords: avoidance of secondary damages, interstitial lung disease, telemedicine and telemonitoring, subjective feeling of safety

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Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

Abstract:

Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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Authors: Anupuma Raina, Ajay Parkash

Abstract:

In forensic investigation, DNA analysis helps in the identification of a particular individual under investigation. A set of Short Tandem Repeats loci are widely used for individualization at a molecular level in forensic testing. STRs with tetrameric repeats of DNA are highly polymorphic and widely used for forensic DNA analysis. Identification of an individual became challenging for forensic examiners after Hematopoietic Stem Cell Transplantation. HSCT is a well-accepted and life-saving treatment to treat malignant and nonmalignant diseases. It involves the administration of healthy donor stem cells to replace the patient’s own unhealthy stem cells. A successful HSCT results in complete donor-derived cells in a patient’s hematopoiesis and hence have the capability to change the genetic makeup of the patient. Although an individual who has undergone HSCT and then committed a crime is a very rare situation, but not impossible. Keeping such a situation in mind, various biological samples like blood, buccal swab, and hair follicle were collected and studied after a certain interval of time after HSCT. Blood was collected from both the patient and the donor before the transplant. The DNA profile of both was analyzed using a short tandem repeat kit for autosomal chromosomes. Among all exhibits studied, only hair follicles were found to be the most suitable biological exhibit, as no donor DNA profile was observed for up to 90 days of study.

Keywords: chimerism, HSCT, STRs analysis, forensic identification

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Authors: Tianjiao Chu, Carla Rios Luci, Christy Maksoudian, Ara Sargsian, Bella B. Manshian, Stefaan J. Soenen

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Nanomaterials have gained high interest in their use as potent anticancer agents. Apart from delivering chemotherapeutic agents in order to reduce off-target effects, molecular agents have also been widely explored. The advances in our understanding of cell biology and cell death mechanisms1 has generated a broad library of potential therapeutic targets by siRNA, mRNA, or pDNA complexes. In the present study, we explore the ability of pDNA-polyplexes to induce tumor-specific necroptosis. This results in a cascade of effects, where immunogenic cell death potentiates anti-tumor immune responses and results in an influx of dendritic cells and cytotoxic T cells, rendering the tumor more amenable to immune checkpoint inhibition. This study aims to explore whether the induction of necroptosis in a subpopulation of tumor cells can be used to potentiate immune checkpoint inhibition studies.

Keywords: nanoparticle, MLKL, necroptosis, immunotherapy

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Authors: Olga Maksakova

Abstract:

A work with unconscious patients after acute brain damages besides special knowledge and practical skills of all the participants requires a very specific organization. A lot of said about team approach in neurorehabilitation, usually as for outpatient mode. Rehabilitologists deal with fixed patient problems or deficits (motion, speech, cognitive or emotional disorder). Team-building means superficial paradigm of management psychology. Linear mode of teamwork fits casual relationships there. Cases with deep altered states of consciousness (vegetative states, coma, and confusion) require non-linear mode of teamwork: recovery of consciousness might not be the goal due to phenomenon uncertainty. Rehabilitation team as Semi-open Complex System includes the patient as a part. Patient's response pattern becomes formed not only with brain deficits but questions-stimuli, context, and inquiring person. Teamwork is sourcing of phenomenology knowledge of patient's processes as Third-person approach is replaced with Second- and after First-person approaches. Here is a chance for real-time change. Patient’s contacts with his own body and outward things create a basement for restoration of consciousness. The most important condition is systematic feedbacks to any minimal movement or vegetative signal of the patient. Up to now, recovery work with the most severe contingent is carried out in the mode of passive physical interventions, while an effective rehabilitation team should include specially trained psychologists and psychotherapists. It is they who are able to create a network of feedbacks with the patient and inter-professional ones building up the team. Characteristics of ‘Team-Patient’ system (TPS) are energy, entropy, and complexity. Impairment of consciousness as the absence of linear contact appears together with a loss of essential functions (low energy), vegetative-visceral fits (excessive energy and low order), motor agitation (excessive energy and excessive order), etc. Techniques of teamwork are different in these cases for resulting optimization of the system condition. Directed regulation of the system complexity is one of the recovery tools. Different signs of awareness appear as a result of system self-organization. Joint meetings are an important part of teamwork. Regular or event-related discussions form the language of inter-professional communication, as well as the patient's shared mental model. Analysis of complex communication process in TPS may be useful for creation of the general theory of consciousness.

Keywords: rehabilitation team, urgent rehabilitation, severe brain damage, consciousness disorders, complex system theory

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Authors: Karthikeyan M., Paul M. J.

Abstract:

This case report discusses a 54-year-old woman from Salem, Tamilnadu, who presented with a rare case of papillary thyroid carcinoma (PTC), manifesting as a hypervascular mass in the left carotid sheath. The patient had a two-and-a-half-month history of non-progressive neck swelling, with symptoms including dysphagia and a choking sensation. Clinical examination and investigations such as FNAC and CECT revealed a large vascular mass in the left neck region, initially perplexing the diagnosis. The patient underwent total thyroidectomy and excision of the left carotid sheath mass. Histopathology confirmed PTC. Postoperatively, the patient received Iodine-131 ablation and showed good recovery with no recurrence. This case highlights the diagnostic challenge and atypical presentation of PTC as a vascular neck mass, emphasizing the importance of a comprehensive approach in evaluating thyroid and neck lesions.

Keywords: lateral neck vascular mass, lateral aberrant thyroid, thyroid vascular swelling, smooth post op recovery

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Authors: G. I. Onwuka, A. Danbaba, S. U. Gulumbe

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This study investigated of Infant Mortality Rate as observed at a general hospital in Kaduna-South, Kaduna State, North West Nigeria. The causes of infant Mortality were examined. The data used for this analysis were collected at the statistics unit of the Hospital. The analysis was carried out on the data using Multiple Linear regression Technique and this showed that there is linear relationship between the dependent variable (death) and the independent variables (malaria, measles, anaemia, and coronary heart disease). The resultant model also revealed that a unit increment in each of these diseases would result to a unit increment in death recorded, 98.7% of the total variation in mortality is explained by the given model. The highest number of mortality was recorded in July, 2005 and the lowest mortality recorded in October, 2009.Recommendations were however made based on the results of the study.

Keywords: infant mortality rate, multiple linear regression, diseases, serial correlation

Procedia PDF Downloads 323

Authors: Dylan Shiting Lu, Samson Okello, Anita Chunyan Wei, Daniel Xiao Li

Abstract:

Mammotome vacuum-assisted breast biopsy (MVB) introduced in 1995 can be used for the removal of benign breast lesions. Whether or not MVB is a better option compared to conventional open surgery is inconclusive. We aim to compare the clinical and patient-related outcomes between MVB and open surgery to remove benign breast tumors less than 5 cm in women. We searched English and Chinese electronic databases with the keywords of Mammotome, clinical trial (CT), vacuum-assisted breast biopsy for studies comparing MVB and open surgery until May 2021. We performed a systematic review and random-effects meta-analysis to compare incision size, operation time, intraoperative blood loss, healing time, scar length, patient satisfaction, postoperative hematoma rate, wound infection rate, postoperative ecchymosis, and postoperative sunken skin among those who have Mammotome and those who have surgery. Our analysis included nine randomized CTs with 1155 total patients (575 Mammotome, 580 surgery) and mean age 40.32 years (standard deviation 3.69). We found statistically significant favorable outcomes for Mammotome including blood loss (ml) [standardized mean difference SMD -5.03, 95%CI (-7.30, -2.76)], incision size (cm) [SMD -12.22, 95%CI (-17.40, -7.04)], operation time (min) [SMD -6.66, 95%CI (-9.01, -4.31)], scar length (cm) [SMD -7.06, 95%CI (-10.76, -3.36)], healing time (days) [SMD -6.57, 95%CI (-10.18, -2.95)], and patient satisfaction [relative risk RR 0.38, 95%CI (0.13, 1.08)]. In conclusion, Mammotome vacuum-assisted breast biopsy compared to open surgery shows better clinical and patient-related outcomes. Further studies should be done on whether or not MVB is a better option for benign breast tumors excision.

Keywords: clinical and patient outcomes, open surgery, Mammotome vacuum-assisted breast biopsy, meta-analysis

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Authors: A. Bruce Janati, Muhammad Umair Khan, Naif Alghassab, Ibrahim Alzeir, Assem Mahmoud, M. Sammour

Abstract:

Rationale: Lennox-Gastaut syndrome(LGS) is an electro-clinical syndrome composed of the triad of mental retardation, multiple seizure types, and the characteristic generalized slow spike-wave complexes in the EEG. In this article, we report on two patients with LGS whose brain MRI showed dysgenesis of corpus callosum(CC). We review the literature and stress the role of CC in the genesis of secondary bilateral synchrony(SBS). Method: This was a clinical study conducted at King Khalid Hospital. Results: The EEG was consistent with LGS in patient 1 and unilateral slow spike-wave complexes in patient 2. The MRI showed hypoplasia of the splenium of CC in patient 1, and global hypoplasia of CC combined with Joubert syndrome in patient 2. Conclusion: Based on the data, we proffer the following hypotheses: 1-Hypoplasia of CC interferes with functional integrity of this structure. 2-The genu of CC plays a pivotal role in the genesis of secondary bilateral synchrony. 3-Electrodecremental seizures in LGS emanate from pacemakers generated in the brain stem, in particular the mesencephalon projecting abnormal signals to the cortex via thalamic nuclei. 4-Unilateral slow spike-wave complexes in the context of mental retardation and multiple seizure types may represent a variant of LGS, justifying neuroimaging studies.

Keywords: EEG, Lennox-Gastaut syndrome, corpus callosum , MRI

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