Search results for: chronic knee pain

Authors: Lindsay Fink, Sarha Smith-Moyo, Leanne W. Charlesworth

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In recent years, the number of individuals experiencing homelessness has increased in the United States. This paper analyzes 2019 data from 16 different emergency shelters in Monroe County, located in Upstate New York. The data were collected through the County’s Homeless Management Information System (HMIS), and individuals were de-identified and de-duplicated for analysis. The purpose of this study is to explore the basic characteristics of the homeless population in Monroe County, and the dynamics of shelter use. The results of this study showed gender as a significant factor when analyzing the relationship between demographic variables and recorded reasons for shelter entry. Results also indicated that age and ethnicity did not significantly influence odds of re-entering a shelter, but did significantly influence reasons for shelter entry. Overall, the most common recorded cause of shelter entry in 2019 in the examined county was eviction by primary tenant. Recommendations to better address recurrent shelter entry and potential chronic homelessness include more consideration for the diversity existing within the homeless population, and the dynamics leading to shelter stays, including enhanced funding and training for shelter staff, as well as expanded access to permanent supportive housing programs.

Keywords: chronic homelessness, homeless shelter stays, permanent supportive housing, shelter population dynamics

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Authors: Sadam Elayah

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Background: One of the most critical competencies in advanced dentistry is alveolar ridge preservation after exodontia. The aim of this clinical trial was to assess the impact of autologous concentrated growth factor (CGF) as a socket-filling material and its ridge preservation properties following the lower third molar extraction. Materials and Methods: A total of 60 sides of 30 participants who had completely symmetrical bilateral impacted lower third molars were enrolled. The short-term outcome variables were wound healing, swelling and pain, clinically assessed at different time intervals (1st, 3rd & 7th days). While the long-term outcome variables were bone height & width, bone density and socket surface area in the coronal section. Cone beam computed tomography images were obtained immediately after surgery and three months after surgery as a temporal measure. Randomization was achieved by opaque, sealed envelopes. Follow-up data were compared to baseline using Paired & Unpaired t-tests. Results: The wound healing index was significantly better in the test sides (P =0.001). Regarding the facial swelling, the test sides had significantly fewer values than the control sides, particularly on the 1st (1.01±.57 vs 1.55 ±.56) and 3rd days (1.42±0.8 vs 2.63±1.2) postoperatively. Nonetheless, the swelling disappeared within the 7th day on both sides. The pain scores of the visual analog scale were not a statistically significant difference between both sides on the 1st day; meanwhile, the pain scores were significantly lower on the test sides compared with the control sides, especially on the 3rd (P=0.001) and 7th days (P˂0.001) postoperatively. Regarding long-term outcomes, CGF sites had higher values in height and width when compared to Control sites (Buccal wall 32.9±3.5 vs 29.4±4.3 mm, Lingual wall 25.4±3.5 vs 23.1±4 mm, and Alveolar bone width 21.07±1.55vs19.53±1.90 mm) respectively. Bone density showed significantly higher values in CGF sites than in control sites (Coronal half 200±127.3 vs -84.1±121.3, Apical half 406.5±103 vs 64.2±158.6) respectively. There was a significant difference between both sites in reducing periodontal pockets. Conclusion: CGF application following surgical extraction provides an easy, low-cost, and efficient option for alveolar ridge preservation. Thus, dentists may encourage using CGF during dental extractions, particularly when alveolar ridge preservation is required.

Keywords: platelet, extraction, impacted teeth, alveolar ridge, regeneration, CGF

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Authors: Mohammad Abdullah Almalki

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Background: Despite the frequent usage of ankle arthroscopy, there is limited medical literature regarding its indications, patterns of admissions, surgical outcomes, and associated complicated at Saudi Arabia. Hence, this study would highlight the surgical outcomes of such surgical approach that will assist orthopedic surgeons to detect which surgical procedure needs to be done as well as to help them regarding their diagnostic workups. Methods: At the Orthopedic Division of King Abdul‑Aziz Medical City in Riyadh and through a cross‑sectional design and convenient sampling techniques, the present study had recruited 20 subjects who fulfill the inclusion and exclusion criteria between 2016 and 2018. Data collection was carried out by a questionnaire designed and revised by an expert panel of health professionals. Results: Twenty patients were reviewed (11M and 9F) with an average age of 40.1 ± 12.2. Only 30% of the patients (5M, 1F) have no comorbidity, but 70% of patients (7M, 8F) were having at least one comorbidity. The most common indications were osteochondritis dissecans (n = 7, 35%), ankle fracture without dislocation (n = 4, 20%), and tibiotalar impingement (n = 3, 15%). Patients recorded pain in all cases (100%). The top four symptoms after pain were instability (30%, n = 6), muscle weakness (15%, n = 3) swelling (15%, n = 3), and stiffness (5%, n = 1). Two‑third of cases reached to their full healthy status and toe‑touch weight‑bearing was seen in two patients (10%). Conclusion: Ankle arthroscopy improved the rehabilitation rates in our tertiary care center. In addition, the surgical outcomes are favorable in our hospital since it has a very short length of stay, unexpended surgery, and fewest physiotherapy sessions.

Keywords: ankle, arthroscopy, indications, patterns

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Authors: G. Shiha, S. Seif, W. Samir, K. Zalata

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Prospective Validation of the FibroTest Score in assessing Liver Fibrosis in Hepatitis C Infection with Genotype 4 FibroTest (FT) is non-invasive score of liver fibrosis that combines the quantitative results of 5 serum biochemical markers (alpha-2-macroglobulin, haptoglobin, apolipoprotein A1, gamma glutamyl transpeptidase (GGT) and bilirubin) and adjusted with the patient's age and sex in a patented algorithm to generate a measure of fibrosis. FT has been validated in patients with chronic hepatitis C (CHC) (Halfon et al., Gastroenterol. Clin Biol.( 2008), 32 6suppl 1, 22-39). The validation of fibro test ( FT) in genotype IV is not well studied. Our aim was to evaluate the performance of FibroTest in an independent prospective cohort of hepatitis C patients with genotype 4. Subject was 122 patients with CHC. All liver biopsies were scored using METAVIR system. Our fibrosis score(FT) were measured, and the performance of the cut-off score were done using ROC curve. Among patients with advanced fibrosis, the FT was identically matched with the liver biopsy in 18.6%, overestimated the stage of fibrosis in 44.2% and underestimated the stage of fibrosis in 37.7% of cases. Also in patients with no/mild fibrosis, identical matching was detected in 39.2% of cases with overestimation in 48.1% and underestimation in 12.7%. So, the overall results of the test were identical matching, overestimation and underestimation in 32%, 46.7% and 21.3% respectively. Using ROC curve it was found that (FT) at the cut-off point of 0.555 could discriminate early from advanced stages of fibrosis with an area under ROC curve (AUC) of 0.72, sensitivity of 65%, specificity of 69%, PPV of 68%, NPV of 66% and accuracy of 67%. As FibroTest Score overestimates the stage of advanced fibrosis, it should not be considered as a reliable surrogate for liver biopsy in hepatitis C infection with genotype 4.

Keywords: fibrotest, chronic Hepatitis C, genotype 4, liver biopsy

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Authors: Rajendra Kanojia

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Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could potential risk to damage the popliteus tendon especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side, one side requires resection in 3° external rotation (group A) and other side femoral component with inbuilt external roation (group B). We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B.

Keywords: popliteaus tendon injury, TKA, orthopaedic surgery, biomechanics and clinical applications

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Authors: Denise Ben-Porath, Tracy Masterson

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In the past, individuals who struggled with and sought treatment for mental health difficulties were stigmatized. However, the current generation holds more open attitudes around mental health issues. Indeed, public figures such as Demi Lovato, Naomi Osaka, and Simone Biles have taken to social media to break the silence around mental health, discussing their own struggles and the benefits of treatment. Thus, there is considerable reason to believe that this generation would hold fewer stigmatizing attitudes toward mental health difficulties and treatment compared to previous ones. In this study, we explored possible changes in stigma on mental health diagnosis and treatment seeking behavior between two generations: Gen Z, the current generation, and Gen X, those born between 1965-1980. It was hypothesized that Gen Z would hold less stigmatizing views on mental illness than Gen X. To examine possible changes in stigma attitudes between these two generations, we conducted a cross-generational cohort design by using the same methodology employed 20 years ago from the Ben-Porath (2002) study. Thus, participants were randomly assigned to read one of the following four case vignettes employed in the Ben-Porath (2002) study: (a) “Tom” who has received psychotherapy due to depression (b) “Tom” who has been depressed but received no psychological help, (c) “Tom” who has received medical treatment due to a back pain, or (d) “Tom” who had a back pain but did not receive medical attention. After reading the vignette, participants rated “Tom” on various personality dimensions using the IFQ Questionnaire and answered questions about their frequency of social media use and willingness to seek mental health treatment on a scale from 1-10. Identical to the results 20 years prior, a significant main effect was found for diagnosis with “Tom” being viewed in more negative terms when he was described as having depression vs. a medical condition (back pain) [F (1, 376) = 126.53, p < .001]. However, in the study conducted 20 years earlier, a significant interaction was found between diagnosis and help-seeking behavior [F (1, 376) = 8.28, p < .005]. Specifically, “Tom” was viewed in the most negative terms when described as depressed and seeking treatment. Alternatively, the current study failed to find a significant interaction between depression and help seeking behavior. These findings suggest that while individuals who hold a mental health diagnosis may still be stigmatized as they were 20 years prior, seeking treatment for mental health issues may be less so. Findings are discussed in the context of social media use and its impact on destigmatization.

Keywords: stigma, mental illness, help-seeking, social media

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Authors: Rana Praween Kumar

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Preterm-low birth weight delivery is a major cause of infant morbidity and mortality in developing countries and has been linked to poor periodontal health during pregnancy. Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory oral diseases. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. This study is intended to investigate predisposing and enabling factors as determinants of oral health indicators in pregnancy as well as the association between periodontal problems during pregnancy with age and socio economic status of the individual. A community –based prospective cohort study will be conducted in Jamshedpur, Jharkhand, India among pregnant women using completed interviews and a full mouth oral clinical examination using the CPITN (Community Periodontal Index of Treatment Need) and OHI-S (Simplified Oral Hygiene) indices with adequate sample size and informed consent to the patient following proper inclusion and exclusion criteria. Multiple logistic regression analyses will be used to identify independent determinants of periodontal problems and use of dental services during pregnancy. Analysis of covariance (ANCOVA) will be used to investigate the relationship between periodontal problems with the age and socioeconomic status. The result will help in proper monitoring of periodontal health during pregnancy encouraging the delivery of healthy child and the maintenance of proper health of the mother.

Keywords: infant, periodontal problems, pregnancy, pre-term-low birth weight delivery

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Authors: Hailemariam Getachew, John Sandi, Isata Dumbuya, Patricia Efe.Azikiwe, Evaline Nginge, Moses Mugisha, Eseoghene Dase, Foday Mandaray, Grace Moore

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Enhanced recovery after cesarean section (ERAC) is a standardized peri- operative care program that comprises the multidisciplinary team's collective efforts working in collaboration throughout the peri-operative period with the principal goal to improve quality of surgical care, decrease surgical related complications, and increasing patient satisfaction. Objective: The main objective of this project is to improve the implementation of enhanced recovery after cesarean section at Koidu Government hospital. Identified gap: Even though the hospital is providing comprehensive maternal and child care service, there are gaps in the implementation of ERAC. According to our survey, we found that there is low (13.3%) utilization of WHO surgical safety checklist, only limited (15.9%) patients get opioid free analgesia, pain was not recorded as a vital sign, there is no standardized checklist for hand over to and from Post Anesthesia care Unit(PACU). Furthermore, there is inconsistent evidence based post-operative care and there is no local consensus protocol and guideline as well. Implementation plan: we aimed at designing standardized protocol, checklist and guideline, provide training, build staff capacity, document pain as vital sign, perform regional analgesia, and provide evidence based post-operative care, monitoring and evaluation. Result: Data from 389 cesarean mothers showed that, Utilization of the WHO surgical safety check list found to be 95%, and pain assessment and documentation was done for all surgical patients. Oral feeding, ambulation and catheter removal was performed as per the ERAC standard for all patients. Postoperative complications drastically decreased from 13.6% to 8.1%. While, the rate of readmission was kept below 1%. Furthermore, the duration of hospital stay decreased from 4.64 days to 3.12 days. Conclusion The successful implementation of ERAC protocols demonstrates through this Quality Improvement Project that, the effectiveness of the protocols in improving recovery and patient outcome following cesarean section.

Keywords: cesarean delivery, enhanced recovery, quality improvement, patient outcome

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Authors: Kai Way Li, Lang Gan

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Slip &Fall are common in Taiwan. They could result in injuries and even fatalities. Official statistics indicate that more than 15% of all occupational incidences were slip/fall related. All the workers in Taiwan are required by the law to join the worker’s insurance program administered by the Bureau of Labor Insurance (BLI). The BLI is a government agency under the supervision of the Ministry of Labor. Workers claim with the BLI for insurance compensations when they suffer fatalities or injuries at work. Injuries statistics based on worker’s compensation claims were rarely studied. The objective of this study was to quantify the injury statistics and financial cost due to slip-fall incidences based on the BLI compensation records. Compensation records in the BLI during 2007 to 2013 were retrieved. All the original application forms, approval opinions, results for worker’s compensations were in hardcopy and were stored in the BLI warehouses. Xerox copies of the claims, excluding the personal information of the applicants (or the victim if passed away), were obtained. The content in the filing forms were coded in an Excel worksheet for further analyses. Descriptive statistics were performed to analyze the data. There were a total of 35,024 claims including 82 deaths, 878 disabilities, and 34,064 injuries/illnesses which were slip/fall related. It was found that the average losses for the death cases were 40 months. The total dollar amount for these cases paid was 86,913,195 NTD. For the disability cases, the average losses were 367.36 days. The total dollar amount for these cases paid was almost 2.6 times of those for the death cases (233,324,004 NTD). For the injury/illness cases, the average losses for the illness cases were 58.78 days. The total dollar amount for these cases paid was approximately 13 times of those of the death cases (1134,850,821 NTD). For the applicants/victims, 52.3% were males. There were more males than females for the deaths, disability, and injury/illness cases. Most (57.8%) of the female victims were between 45 to 59 years old. Most of the male victims (62.6%) were, on the other hand, between 25 to 39 years old. Most of the victims were in manufacturing industry (26.41%), next the construction industry (22.20%), and next the retail industry (13.69%). For the fatality cases, head injury was the main problem for immediate or eventual death (74.4%). For the disability case, foot (17.46%) and knee (9.05%) injuries were the leading problems. The compensation claims other than fatality and disability were mainly associated with injuries of the foot (18%), hand (12.87%), knee (10.42%), back (8.83%), and shoulder (6.77%). The slip/fall cases studied indicate that the ratios among the death, disability, and injury/illness counts were 1:10:415. The ratios of dollar amount paid by the BLI for the three categories were 1:2.6:13. Such results indicate the significance of slip-fall incidences resulting in different severity. Such information should be incorporated in to slip-fall prevention program in industry.

Keywords: epidemiology, slip and fall, social burden, workers’ compensation

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Authors: Jamie R. Chua, Christina Irene D. Mejia, Regina P. Berba

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Disseminated tuberculosis is an infectious disease caused by Mycobacterium tuberculosis involving two or more non-contiguous sites identified through bacteriologic confirmation or clinical diagnosis. Over the five year period included in the study, the UP-PGH TB DOTS clinic had total of 3,967 referrals, and the prevalence of disseminated tuberculosis is 1% (68/3967). The mean age was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. 67% (52 patients) had no predisposing comorbid illness or immune disorder. The most common presenting symptoms were abdominal pain (19%), back pain (13%), abdominal enlargement (11%) and mass (10.2%). Anemia, leukocytosis, hypoalbuminemia, and high-normal serum calcium were common biochemical and hematologic findings. Around 36% (25) of patients were diagnosed clinically with disseminated tuberculosis despite lacking bacteriologic evidence of multi-organ involvement. The lungs (86%) is still the most commonly involved site, followed by intestinal (22%), vertebral/Pott’s (27%), and pelvic/genital (19%). The mean time from presentation to initiation of therapy was 22 days (SD 32.7). Only 18 patients (29.3%) were properly recorded to have been referred to local TB DOTs facilities. Of the 68 patients, only 16% (11 patients) continued follow-up at PGH, and all had documented treatment completion. Treatment outcomes of the remaining were unknown. Due to the variety of involved sites, a high index of suspicion is required. Knowledge on clinical features, common radiographic findings, and histopathologic characteristics of disseminated TB is important as bacteriologic evidence of infection is not always apparent.

Keywords: disseminated tuberculosis, Mycobacterium tuberculosis, miliary tuberculosis, tuberculosis

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Authors: Min Jee Lee, Young Sun Park, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Jae Ho Lee, Yoon Seon Lee, Kyung Soo Lim, Won Young Kim

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Background: Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is crucial, especially in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. Objectives: This study investigated the clinical features of patients of STEMI concomitant with AAS that may lead to the diagnostic clue. Method: Between 1 January 2010 and 31 December 2014, 22 patients who were the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma and ruptured thoracic aneurysm) in our emergency department were reviewed. Among these, we excluded 10 patients who were transferred from other hospital and 4 patients with non-STEMI, leaving a total of 8 patients of STEMI concomitant with AAS for analysis. Result: The mean age of study patients was 57.5±16.31 years and five patients were Standford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and two patients had in inferior leads. Most of the patients had acute onset, severe chest pain but no patients had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had D-dimer elevation. Aortic regurgitation or regional wall motion abnormality was founded in four patients. However, widened mediastinum was seen in all study patients. Conclusion: When patients with STEMI have elevated D-dimer and widened mediastinum, concomitant AAS may have to be suspected.

Keywords: aortic dissection, myocardial infarction, ST-segment, d-dimer

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Authors: Rihab Gamaoun, Cynthia El Hage, Laura Ruiz, Erin Prosk, Antonio Vigano

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Introduction: Santé Cannabis (SC), a Canadian medical cannabis-specialized group of clinics based in Montreal and in the province of Québec, has served more than 5000 patients seeking cannabis-based treatment prescription for medical indications over the past five years. Within a research frame, data on the use of medical cannabis products from all the above patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to gather information on the profiles of both patients and prescribed medical cannabis products at SC clinics and to assess the safety of medical cannabis among Canadian patients. Methods: Using a retrospective analysis of the database, records of 2585 patients who were prescribed medical cannabis products for therapeutic purposes between 01-November 2017 and 04-September 2019 were included. Patients’ demographics, primary diagnosis, route of administration, and chemovars recorded at the initial visits were investigated. Results: At baseline: 9% of SC patients were female, with a mean age of 57 (SD= 15.8, range= [18-96]); Cannabis products were prescribed mainly for patients with a diagnosis of chronic pain (65.9% of patients), cancer (9.4%), neurological disorders (6.5%), mood disorders (5.8 %) and inflammatory diseases (4.1%). Route of administration and chemovars of prescribed cannabis products were the following: 96% of patients received cannabis oil (51% CBD rich, 42.5% CBD:THC); 32.1% dried cannabis (21.3% CBD:THC, 7.4% THC rich, 3.4 CBD rich), and 2.1% oral spray cannabis (1.1% CBD:THC, 0.8% CBD rich, 0.2% THC rich). Most patients were prescribed simultaneously, a combination of products with different administration routes and chemovars. Safety analysis is undergoing. Conclusion: Our results provided initial information on the profile of medical cannabis products prescribed in a Canadian population and the experienced adverse events over the past three years. The Santé Cannabis database represents a unique opportunity for comparing clinical practices in prescribing and titrating cannabis-based medications across different centers. Ultimately real-world data, including information about safety and effectiveness, will help to create standardized and validated guidelines for choosing dose, route of administration, and chemovars types for the cannabis-based medication in different diseases and indications.

Keywords: medical cannabis, real-world data, safety, pharmacovigilance

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Authors: Nahida Sultana

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Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year. The hepatitis C virus is a blood-borne virus, and most infections occur through exposure to blood from unsafe injection practices, unsafe health care, unscreened blood transfusion, injection drug use, and sexual practices that lead to exposure to blood. Hepatitis C virus (HCV) causes chronic infections that mainly affect the liver leading to liver diseases. This study aimed to determine whether there is any significant association between HCV transmission risk factors in relation to genotypes in HCV-infected Bangladeshi patients. After quantification of HCV viral load, 36 samples were randomly selected for HCV genotyping and risk factor measurement. A greater proportion of genotype 1 (p > 0.05) patients (40%) underwent blood transfusion compared to patients (22.6%) with genotype 3 infections. More genotype 1 patient underwent surgery and invasive procedures (20%), and rather than those with genotype 3 patients (16.1%). The history of IDUs (25.8%) and sexual exposure (3.2%) are only prevalent in genotype 3 patients and absent in patients with genotype 1 (p >0.05). There was no significant statistical difference found in HCV transmission risk factors (blood transfusion, IDUs, Surgery& interventions, sexual transmission) between patients infected with genotypes 1 and 3. In HCV infection, genotype may have no relation to transmission risk factors among Bangladeshi patients.

Keywords: HCV genotype, alanine aminotransferase (ALT), HCV viral load, IDUs

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Authors: Rachel Thomas Tharmabalan

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The growing unease over the matter of food security in the world is the result of a maturing realization that the genetic base of most human caloric intake from plants is dangerously narrow. Malaysia’s tropical rainforests have the potential to contribute to diet diversification and provide a source of nutrient-rich food as the Orang Asli communities in Malaysia have relied almost entirely on the jungle for food, fodder, medicine and fuel antithetical to what is happening today. This segregation of the Orang Asli from traditional lands and resources leads to severe loss of knowledge of biodiversity. In order to preserve these wild edibles, four different types of vegetables that are frequently consumed by the Orang Asli which consists of Rebu, Meranti, Saya and Pama were selected. These vegetables were then analysed to determine its proximate and mineral content to help ascertain claims and reaffirm the impact it can play in ensuring food and nutrition security, in addition to combating chronic diseases. From the results obtained, the Meranti had the highest crude fiber, iron and calcium content. Other minerals such as potassium, magnesium and copper were also found in varying content. These wild edibles could also contribute to education and bring awareness to younger generations as well as urban populations to start consuming more of these in their daily life as it could prevent various chronic diseases in Malaysia.

Keywords: food and nutrition security, Orang Asli, underutilized plants, wild edible food systems

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Authors: Hansraj Riteesh Bookun, Cassandra Monique Hidajat

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This pilot study investigated the efficacy of a newly designed shoe which will act as an intermittent pneumatic compression device to augment venous flow in the lower limb. The aim was to assess the degree with which a wearable intermittent compression device can increase the venous flow in the popliteal vein. Background: Deep venous thrombosis and chronic venous insufficiency are relatively common problems with significant morbidity and mortality. While mechanical and chemical thromboprophylaxis measures are in place in hospital environments (in the form of TED stockings, intermittent pneumatic compression devices, analgesia, antiplatelet and anticoagulant agents), there are limited options in a community setting. Additionally, many individuals are poorly tolerant of graduated compression stockings due to the difficulty in putting them on, their constant tightness and increased associated discomfort in warm weather. These factors may hinder the management of their chronic venous insufficiency. Method: The device is lightweight, easy to wear and comfortable, with a self-contained power source. It features a Bluetooth transmitter and can be controlled with a smartphone. It is externally almost indistinguishable from a normal shoe. During activation, two bladders are inflated -one overlying the metatarsal heads and the second at the pedal arch. The resulting cyclical increase in pressure squeezes blood into the deep venous system. This will decrease periods of stasis and potentially reduce the risk of deep venous thrombosis. The shoe was fitted to 2 healthy participants and the peak systolic velocity of flow in the popliteal vein was measured during and prior to intermittent compression phases. Assessments of total flow volume were also performed. All haemodynamic assessments were performed with ultrasound by a licensed sonographer. Results: Mean peak systolic velocity of 3.5 cm/s with standard deviation of 1.3 cm/s were obtained. There was a three fold increase in mean peak systolic velocity and five fold increase in total flow volume. Conclusion: The device augments venous flow in the leg significantly. This may contribute to lowered thromboembolic risk during periods of prolonged travel or immobility. This device may also serve as an adjunct in the treatment of chronic venous insufficiency. The study will be replicated on a larger scale in a multi—centre trial.

Keywords: venous, intermittent compression, shoe, wearable device

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Authors: Lian Wu, Mervyn Merrilees

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Chronic Obstructive Pulmonary Disease (COPD) is a worldwide problem, characterized by irreversible and progressive airflow obstruction. In New Zealand, it is currently the 4th commonest cause of death and exacerbations of COPD are a frequent cause of admission to hospital. Serum levels of Clara cell secretory protein-16 (CC-16) are believed to represent Clara cell toxicity. More recently, CC-16 has been found to be associated with smoker COPD. It is produced almost exclusively by non-ciliated Clara cells in the airways, and its primary function is to protect the lungs against oxidative stress and carcinogenesis. After acute exposure to cigarette smoke, serum levels of CC-16 become elevated. CC16 is a potent natural immune-suppressor and anti-inflammatory agent. In vitro, CC16 inhibits both monocyte and polymorphonuclear neutrophils chemotaxis and phagocytosis. CC16 also inhibits fibroblast chemotaxis. However, the role of CC-16 in non-smoking related COPD is still not clear. In this study, we investigated serum CC-16 levels in non-smoking related COPD. Methods: We compared non-smoker patients with COPD (FEV1<60% of predicted, FEV1/FVC <0.7, n=100) and individuals with normal lung function FEV1≥ 80% of predicted and FEV1/FVC≥ 0.7, n=80). All subjects had no smoking history. CC-16 was measured by ELISA. Results and conclusion: Serum CC-16 levels are reduced in individuals with non-smoking related COPD, and there is a weak correlation with disease severity in non-smoking related COPD group compared to non-smoker controls.

Keywords: COPD, CC-16, ELISA, non-smoking-related COPD

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Authors: Oanthata Jester Sealetsa, Richie Moalosi

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Musculoskeletal Disorders (MSDs) are reported to be amongst the leading contributing factors of low productivity in many industries across the world, and the most affected being New Emerging Economies (NEC) such as Botswana. This is due to lack of expertise and resources to deal with existing ergonomics challenges. This study was aimed to evaluate occupational postures and the prevalence of musculoskeletal disorders among diamond polishers in a diamond company in Botswana. A case study was conducted with about 106 diamond polishers in Gaborone, Botswana. A case study was chosen because it can investigate and explore an issue thoroughly and deeply, and record behaviour over time so changes in behaviour can be identified. The Corlett and Bishop Body Map was used to determine frequency of MSDs symptoms in different body parts of the workers. This was then followed by the use of the Rapid Entire Body Assessment (REBA) to evaluate the occupational postural risks of MSDs. Descriptive statistics, chi square, and logistic regression were used for data analysis. The results of the study reveal that workers experienced pain in the upper back, lower back, shoulders, neck, and wrists with the most pain reported in the upper back (44.6%) and lower back (44.2%). However, the mean REBA score of 6.07 suggests that sawing, bruiting and polishing were the most dangerous processes in diamond polishing. The study recommends that a redesign of the diamond polishing workstations is necessary to accommodate the anthropometry characteristic of Batswana (people from Botswana) to prevent the development of MSDs.

Keywords: assessment, Botswana, diamond polishing, ergonomics, musculoskeletal disorders, occupational postural risks

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Authors: D. S. Mohale, A. P. Dewani, A. S.tripathi, A. V. Chandewar

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Present work demonstrates the applicability of high-performance liquid chromatography (HPLC) with UV-Vis detection for the quantification of malondialdehyde as malondialdehyde-thiobarbituric acid complex (MDA-TBA) in-vivo in rats. The HPLC method for MDA-TBA was achieved by isocratic mode on a reverse-phase C18 column (250mm×4.6mm) at a flow rate of 1.0mLmin−1 followed by detection at 532 nm. The chromatographic conditions were optimized by varying the concentration and pH of water followed by changes in percentage of organic phase optimal mobile phase consisted of mixture of water (0.2% triethylamine pH adjusted to 2.3 by ortho-phosphoric acid) and acetonitrile in ratio (80:20v/v). The retention time of MDA-TBA complex was 3.7 min. The developed method was sensitive as limit of detection and quantification (LOD and LOQ) for MDA-TBA complex were (standard deviation and slope of calibration curve) 110 ng/ml and 363 ng/ml respectively. Calibration studies were done by spiking MDA into rat plasma at concentrations ranging from 500 to 1000 ng/ml. The precision of developed method measured in terms of relative standard deviations for intra-day and inter-day studies was 1.6–5.0% and 1.9–3.6% respectively. The HPLC method was applied for monitoring MDA levels in rats subjected to chronic treatment of levofloxacin (LEV) (5mg/kg/day) for 21 days. Results were compared by findings in control group rats. Mean peak areas of both study groups was subjected for statistical treatment to unpaired student t-test to find p-values. The p value was <0.001 indicating significant results and suggesting increased MDA levels in rats subjected to chronic treatment of LEV of 21 days.

Keywords: malondialdehyde-thiobarbituric acid complex, levofloxacin, HPLC, oxidative stress

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Authors: Guebli Abdelkader, Zerf Mohammed, Mekkades Moulay Idriss, BenGoua Ali, Atouti Nouredinne, Habchi Nawel

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The paper aims to show the influence of angles in the results of triple jump. Whereas our background confirms that a series of motions are characterized by complex angles in the properties phase (hop, step, and jump) as a combination of the pushed phase on ultimate phases in the result. For the purpose, our results are obtained from the National Athletics Championship 2013, which was filmed and analysis by the software kinovea. Based on the statistical analysis we confirm: there is a positive relationship between angle of the leg, hip angle, angle of the trunk in the collision during (hop, step, and jump), and there is a negative correlation to the angle of the knee relationship in a collision during.

Keywords: kinematics variables, the triple jump, the finale results, digital achievement

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Authors: Akulov M. A., Orlova O. R., Zaharov V. O., Tomskij A. A.

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Introduction: One of the common postoperative complications of posterior cranial fossa (PCF) and cerebello-pontine angle tumor treatment is a facial nerve palsy, which leads to multiple and resistant to treatment impairments of mimic muscles structure and functions. After 4-6 months after facial nerve palsy with insufficient therapeutic intervention patients develop a postparalythic syndrome, which includes such symptoms as mimic muscle insufficiency, mimic muscle contractures, synkinesis and spontaneous muscular twitching. A novel method of treatment is the use of a recent local neuromuscular blocking agent– botulinum toxin A (BTA). Experience of BTA treatment enables an assumption that it can be successfully used in late facial nerve palsy complications to significantly increase quality of life of patients. Study aim. To evaluate the efficacy of botulinum toxin A (BTA) (Xeomin) treatment in patients with late facial nerve palsy complications. Patients and Methods: 31 patients aged 27-59 years 6 months after facial nerve palsy development were evaluated. All patients received conventional treatment, including massage, movement therapy etc. Facial nerve palsy developed after acoustic nerve tumor resection in 23 (74,2%) patients, petroclival meningioma resection – in 8 (25,8%) patients. The first group included 17 (54,8%) patients, receiving BT-therapy; the second group – 14 (45,2%) patients continuing conventional treatment. BT-injections were performed in synkinesis or contracture points 1-2 U on injured site and 2-4 U on healthy side (for symmetry). Facial nerve function was evaluated on 2 and 4 months of therapy according to House-Brackman scale. Pain syndrome alleviation was assessed on VAS. Results: At baseline all patients in the first and second groups demonstrated аpostparalytic syndrome. We observed a significant improvement in patients receiving BTA after only one month of treatment. Mean VAS score at baseline was 80,4±18,7 and 77,9±18,2 in the first and second group, respectively. In the first group after one month of treatment we observed a significant decrease of pain syndrome – mean VAS score was 44,7±10,2 (р<0,01), whereas in the second group VAS score was as high as 61,8±9,4 points (p>0,05). By the 3d month of treatment pain syndrome intensity continued to decrease in both groups, but, the first group demonstrated significantly better results; mean score was 8,2±3,1 and 31,8±4,6 in the first and second group, respectively (р<0,01). Total House-Brackman score at baseline was 3,67±0,16 in the first group and 3,74±0,19 in the second group. Treatment resulted in a significant symptom improvement in the first group, with no improvement in the second group. After 4 months of treatment House-Brockman score in the first group was 3,1-fold lower, than in the second group (р<0,05). Conclusion: Botulinum toxin injections decrease postparalytic syndrome symptoms in patients with facial nerve palsy.

Keywords: botulinum toxin, facial nerve palsy, postparalytic syndrome, synkinesis

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Authors: Jan F. Talts, Amit Saxena, Kåre Engkilde

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Chemotherapy-induced peripheral neuropathy (CIPN) is one of the most frequent side effects caused by anti-neoplastic agents, with a prevalence from 19 % to 85 %. Clinically, CIPN is a mostly sensory neuropathy leading to pain and to motor and autonomic changes. Due to its high prevalence among cancer patients, CIPN constitutes a major problem for both cancer patients and survivors, especially because currently, there is no single effective method of preventing CIPN. Hearing loss is the most common form of sensory impairment in humans and can be caused by ototoxic chemical compounds such as chemotherapy (platinum-based antineoplastic agents).In rodents, single or repeated cisplatin injections induce peripheral neuropathy and hearing impairment mimicking human disorder, allowing studying the efficacy of new pharmacological candidates in chemotherapy-induced hearing loss and peripheral neuropathy. RNA sequencing data from full term amniotic fluid (TAF) mesenchymal stemcell (MSC) clones was used to identify neural-specific markers present on TAF-MSC. Several prospective neural markers were tested by flow cytometry on cultured TAF-MSC. One of these markers was used for cell-sorting using Tyto MACSQuant cell sorter, and the neural marker positive cell population was expanded for several passages to the final therapeutic product stage. Peripheral neuropathy and hearing loss was induced in mice by administration of cisplatin in three week-long cycles. The efficacy of neural-specific TAF-MSC in treating hearing loss and pain perception was evaluated by administration of three injections of 3 million cells/kg by intravenous route or three injections of 3 million cells/kg by intra-arterial route after each cisplatin cycle treatment. Auditory brainstem responses (ABR) are electric potentials recorded from scalp electrodes, and the first ABR wave represents the summed activity of the auditory nerve fibers contacting the inner hair cells. For ABR studies, mice were anesthetized, then earphones were placed in the left ear of each mouse, an active electrode was placed in the vertex of the skull, a reference electrode under the skin of the mastoid bone, and a ground electrode in the neck skin. The stimuli consisted of tone pips of five frequencies (2, 4, 6, 12, 16, and 24 kHz) at various sound levels (from 0 to 90 dB) ranging to cover the mouse auditory frequency range. The von Frey test was used to assess the onset and maintenance of mechanical allodynia over time. Mice were placed in clear plexiglass cages on an elevated mesh floor and tested after 30 min of habituation. Mechanical paw withdrawal threshold was examined using an electronic von Frey anesthesiometer. Cisplatin groups treated with three injections of 3 million cells/kg by intravenous route and three injections of 3 million cells/kg by intra-arterial route after each cisplatin cycle treatment presented, a significant increase of hearing acuity characterized by a decrease of ABR threshold and a decrease of neuropathic pain characterized by an increase of von Frey paw withdrawal threshold compared to controls only receiving cisplatin. This study shows that treatment with MSCselected for neural specificity presents significant positive efficacy on the chemotherapy-induced neuropathic pain and the chemotherapy-induced hearing loss.

Keywords: mesenchymal stem cell, peripheral neuropathy, amniotic fluid, regenerative medicine

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Authors: Mukesh K., Siddiqui A. K., Abbas H., Gupta R.

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Background: General Anesthesia is a standard for breast onco-surgery. The issue of postoperative pain and the occurrence of nausea and vomiting has prompted the quest for a superior methodology with fewer complications. Over the recent couple of years, paravertebral block (PVB) has acquired huge fame either in combination with GA or alone for anesthetic management. In this study, we aim to evaluate the efficacy of morphine and clonidine as an adjunct to ropivacaine in a paravertebral block in breast cancer patients undergoing modified radical mastectomy. Methods: In this study, total 90 patients were divided into three groups (30 each) on the basis of computer-generated randomization. Group C (Control): Paravertebral block with 0.25% ropivacaine (19ml) and 1 ml saline; Group M- Paravertebral block with 0.25% ropivacaine(19ml) + 20 microgram/kg body weight morphine; Group N: Paravertebral block with 0.25% ropivacaine(19ml) +1.0 microgram/kg body weight clonidine. The postoperative pain intensity was recorded using the visual analog scale (VAS) and Sedation was observed by the Ramsay Sedation score (RSS). Results: The VAS was similar at 0hr, 2hr and 4 hr in the postoperative period among all the groups. There was a significant (p=0.003) difference in VAS from 6 hr to 20 hr in the postoperative period among the groups. A significant (p<0.05) difference was observed among the groups at 8 hr to 20 hr). The first requirement of analgesia was significantly (p=0.001) higher in Group N (7.70±1.74) than in Group C (4.43±1.43) and Group M (7.33±2.21). Conclusion: The morphine in the paravertebral block provides better postoperative analgesia. The consumption of rescue analgesia was significantly reduced in the morphine group as compared to the clonidine group. The procedure also proved to be safe as no complication was encountered in the paravertebral block in our study.

Keywords: ropivacaine, morphine, clonidine, paravertebral block

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Authors: Jaylo Abalos, Sophia Zamora

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BACKGROUND: Various gastrointestinal (GI) symptoms, including diarrhea, nausea/vomiting and abdominal pain, have been reported in patients with Coronavirus disease 2019 (COVID-19). In this context, the presence of GI symptoms is variably associated with poor clinical outcomes in COVID-19. We aim to determine the outcomes of hospitalized COVID-19 patients with gastrointestinal symptoms. METHODOLOGY: This is a retrospective cohort study that used medical records of admitted COVID-19 patients from March 2020- March 2021 in a tertiary hospital in Pangasinan. Data records were evaluated for the presence of gastrointestinal manifestations, including diarrhea, nausea, vomiting and abdominal pain at the time of admission. Comparison between cases or COVID-19 patients presenting with GI manifestations to controls or COVID-19 patients without GI manifestation was made. RESULTS: Four hundred three patients were included in the study. Of these, 22.3% presented with gastrointestinal symptoms, while 77.7% comprised the study controls. Diarrhea was the most common GI symptom (10.4%). No statistically significant difference was observed in comorbidities and laboratory findings. Mortality was the primary outcome of the study that did not reach statistical significance between cases and controls (13.33% vs. 16.30%, p =0.621). There were also no significant differences observed in the secondary outcomes, mean length of stay, (14 [12-18 days] in cases vs 14 [12- 17.5 days] in controls, p = 0.716) and need for mechanical ventilation (12.22% vs 16.93%, p = 0.329). CONCLUSION: The results of the study revealed no association of the GI symptoms to poor outcomes, including a high rate of mortality, prolonged length of stay and increased need for mechanical ventilation.

Keywords: gastrointestinal symptoms, COVID-19, outcomes, mortality, length of stay

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Authors: Tasneem Halawani, Yamen Khateeb

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With customers’ ever-increasing expectations for fast services provisioning for all their business needs, information technology (IT) organizations, as business partners, have to cope with this demanding environment and deliver their services in the most effective and efficient way. The purpose of this paper is to identify optimization and automation opportunities for the top requested IT services in a heterogenic digital environment and widely spread customer base. In collaboration with systems, processes, and subject matter experts (SMEs), the processes in scope were approached by analyzing four-year related historical data, identifying and surveying stakeholders, modeling the as-is processes, and studying systems integration/automation capabilities. This effort resulted in identifying several pain areas, including standardization, unnecessary customer and IT involvement, manual steps, systems integration, and performance measurement. These pain areas were addressed by standardizing the top five requested IT services, eliminating/automating 43 steps, and utilizing a single platform for end-to-end process execution. In conclusion, the optimization of IT service request processes in a heterogenic digital environment and widely spread customer base is challenging, yet achievable without compromising the service quality and customers’ added value. Further studies can focus on measuring the value of the eliminated/automated process steps to quantify the enhancement impact. Moreover, a similar approach can be utilized to optimize other IT service requests, with a focus on business criticality.

Keywords: automation, customer value, heterogenic, integration, IT services, optimization, processes

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Authors: A. Alzahrani, G. Arnold, W. Wang

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Background: Stroke commonly occurs in middle-aged and elderly populations, and the diagnosis of early stroke is still difficult. Patients who have suffered a stroke have different balance and gait patterns from healthy people. Advanced techniques of motion analysis have been routinely used in the clinical assessment of cerebral palsy. However, so far, little research has been done on the direct diagnosis of early stroke patients using motion analysis. Objectives: The aim of this study was to investigate whether patients with stroke have different balance and gait from healthy people and which biomechanical parameters could be used to predict and diagnose potential patients who are at a potential risk to stroke. Methods: Thirteen patients with stroke were recruited as subjects whose gait and balance was analysed. Twenty normal subjects at the matched age participated in this study as a control group. All subjects’ gait and balance were collected using Vicon Nexus® to obtain the gait parameters, kinetic, and kinematic parameters of the hip, knee, and ankle joints in three planes of both limbs. Participants stood on force platforms to perform a single leg balance test. Then, they were asked to walk along a 10 m walkway at their comfortable speed. Participants performed 6 trials of single-leg balance for each side and 10 trials of walking. From the recorded trials, three good ones were analysed using the Vicon Plug-in-Gait model to obtain gait parameters, e.g., walking speed, cadence, stride length, and joint parameters, e.g., joint angle, force, moments, etc. Result: The temporal-spatial variables of Stroke subjects were compared with the healthy subjects; it was found that there was a significant difference (p < 0.05) between the groups. The step length, speed, cadence were lower in stroke subjects as compared to the healthy groups. The stroke patients group showed significantly decreased in gait speed (mean and SD: 0.85 ± 0.33 m/s), cadence ( 96.71 ± 16.14 step/min), and step length (0.509 ± 017 m) in compared to healthy people group whereas the gait speed was 1.2 ± 0.11 m/s, cadence 112 ± 8.33 step/min, and step length 0.648 ± 0.43 m. Moreover, it was observed that patients with stroke have significant differences in the ankle, hip, and knee joints’ kinematics in the sagittal and coronal planes. Also, the result showed that there was a significant difference between groups in the single-leg balance test, e.g., maintaining single-leg stance time in the stroke patients showed shorter duration (5.97 ± 6.36 s) in compared to healthy people group (14.36 ± 10.20 s). Conclusion: Our result showed that there are significantly differences between stroke patients and healthy subjects in the various aspects of gait analysis and balance test, as a consequences of these findings some of the biomechanical parameters such as joints kinematics, gait parameters, and single-leg stance balance test could be used in clinical practice to predict and diagnose potential patients who are at a high risk of further stroke.

Keywords: gait analysis, kinetics, kinematics, single-leg stance, Stroke

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Authors: Bill D. Geis

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Even with significantly increased spending, suicide rates continue to climb—with alarming increases among traditionally low-risk groups. This has caused clinicians and researchers to call for a complete rethinking of all assumptions about suicide prevention, assessment, and intervention. A form of therapy--Internal Family Systems Therapy--affords tremendous promise in sustained diminishment of lethal suicide risk. Though a form of therapy that is most familiar to trauma therapists, Internal Family Systems Therapy, involving direct work with suicidal parts, is a promising therapy for meaningful and sustained reduction in suicide deaths. Developed by Richard Schwartz, Internal Family Systems Therapy proposes that we are all influenced greatly by internal parts, frozen by development adversities, and these often-contradictory parts contribute invisibly to mood, distress, and behavior. In making research videos of patients from our database and discussing their suicide attempts, it is clear that many persons who attempt suicide are in altered states at the time of their attempt and influenced by factors other than conscious intent. Suicide intervention using this therapy involves direct work with suicidal parts and other interacting parts that generate distress and despair. Internal Family Systems theory posits that deep experiences of pain, fear, aloneness, and distress are defended by a range of different parts that attempt to contain these experiences of pain through various internal activities that unwittingly push forward inhibition, fear, self-doubt, hopelessness, desires to cut and engage in destructive behavior, addictive behavior, and even suicidal actions. These suicidal parts are often created (and “frozen”) at young ages, and these very young parts do not understand the consequences of this influence. Experience suggests that suicidal parts can create impulsive risk behind the scenes when pain is high and emotional support reduced—with significant crisis potential. This understanding of latent suicide risk is consistent with many of our video accounts of serious suicidal acts—compiled in a database of 1104 subjects. Since 2016, consent has been obtained and records kept of 23 highly suicidal patients, with initial Intention-to-Die ratings (0= no intent, 10 = conviction to die) between 5 and 10. In 67% of these cases using IFST parts-work intervention, these highly suicidal patients’ risk was reduced to 0-1, and 83% of cases were reduced to 4 or lower. There were no suicide deaths. Case illustrations will be offered.

Keywords: suicide, internal family systems therapy, crisis management, suicide prevention

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Authors: Rammah Abdlbagi, Similoluwa Biyi, Aakash Pai

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Introduction: Short-term ureteric stents are commonly placed after ureteroscopy procedures. The removal usually entails having a flexible cystoscopy, which entails a further invasive procedure. There are often delays in removing the stent as departments have limited cystoscopy availability. However, if stents with extraction strings are used, the patient or a clinician can remove them. The aim of the study is to assess the safety and effectiveness of the use of a stent with a string. Method: A retrospective, single-institution study was conducted over a three-month period. Twenty consecutive patients had ureteric stents with string insertion. Ten of the patients had a stent removal procedure previously with flexible cystoscopy. A validated questionnaire was used to assess outcomes. Primary outcomes included: dysuria, hematuria, urinary frequency, and disturbance of the patient’s daily activities. Secondary outcomes included pain experience during the stent removal. Result: Fifteen patients (75%) experienced hematuria and frequency. Two patients experienced pain and discomfort during the stent removal (10%). Two patients had experienced a disturbance in their daily activity (10%). All patients who had stent removal before using flexible cystoscopy preferred the removal of the stent using a string. None of the patients had stent displacement. The median stent dwell time was five days. Conclusion: Patient reported outcomes measures for the indwelling period of a stent with extraction string are equivalent to the published data on stents. Extraction strings mean that the stent dwell time can be reduced. The removal of the stent on extraction strings is more tolerable than the conventional stent.

Keywords: ureteric stent, string flexible cystoscopy, stent symptoms, validated questionnaire

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Authors: Pedro M. Abreu, Bruno R. Mendes

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The management of pharmacotherapy and the process of dispensing medicines is becoming critical in clinical pharmacy due to the increase of incidence and prevalence of chronic diseases, the complexity and customization of therapeutic regimens, the introduction of innovative and more expensive medicines, the unbalanced relation between expenditure and revenue as well as due to the lack of rationalization associated with medication use. For these reasons, co-payments emerged in Europe in the 70s and have been applied over the past few years in healthcare. Co-payments lead to a rationing and rationalization of user’s access under healthcare services and products, and simultaneously, to a qualification and improvement of the services and products for the end-user. This analysis, under hospital practices particularly and co-payment strategies in general, was carried out on all the European regions and identified four reference countries, that apply repeatedly this tool and with different approaches. The structure, content and adaptation of European co-payments were analyzed through 7 qualitative attributes and 19 performance indicators, and the results expressed in a scorecard, allowing to conclude that the German models (total score of 68,2% and 63,6% in both elected co-payments) can collect more compliance and effectiveness, the English models (total score of 50%) can be more accessible, and the French models (total score of 50%) can be more adequate to the socio-economic and legal framework. Other European models did not show the same quality and/or performance, so were not taken as a standard in the future design of co-payments strategies. In this sense, we can see in the co-payments a strategy not only to moderate the consumption of healthcare products and services, but especially to improve them, as well as a strategy to increment the value that the end-user assigns to these services and products, such as medicines.

Keywords: clinical pharmacy, co-payments, healthcare, medicines

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Authors: Daud Muhammad

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Introduction: Ankle radiographs are frequently requested in Emergency Departments (ED) for patients presenting with traumatic ankle pain. The Ottawa Ankle Rules (OAR) serve as a clinical guideline to determine the necessity of these radiographs, aiming to reduce unnecessary imaging. This audit was conducted to evaluate the adequacy of clinical information provided in radiograph requests in relation to the OAR. Methods: A retrospective analysis was performed on 50 consecutive ankle radiograph requests under ED clinicians' names for patients aged above 5 years, specifically excluding follow-up radiographs for known fractures. The study assessed whether the provided clinical information met the criteria outlined by the OAR. Results: The audit revealed that none of the 50 radiograph requests contained sufficient information to satisfy the Ottawa Ankle Rules. Furthermore, 10 out of the 50 radiographs (20%) identified fractures. Discussion: The findings indicate a significant lack of adherence to the OAR, suggesting potential overuse of radiography and unnecessary patient exposure to radiation. This non-compliance may also contribute to increased healthcare costs and resource utilization, as well as possible delays in diagnosis and treatment. Recommendations: To address these issues, the following recommendations are proposed: (1) Education and Training: Enhance awareness and training among ED clinicians regarding the OAR. (2) Standardised Request Forms: Implement changes to imaging request forms to mandate relevant information according to the OAR. (3) Scan Vetting: Promote awareness among radiographers to discuss the appropriateness of scan requests with clinicians. (4) Regular re-audits should be conducted to monitor improvements in compliance.

Keywords: Ottawa ankle rules, ankle radiographs, emergency department, traumatic pain

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Authors: Farjina Malek, Julie King, Niki Edwards

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Across the globe more than a billion people live with a disability and a further billion people, mostly carers, are indirectly impacted. While prevalence data is problematic, it is estimated that more than 15% of the population in Bangladesh live with a disability. Disability service infrastructure in Bangladesh is under-developed; and consequently, the onus of care falls on family, especially on mothers. Within the caring role, mothers encounter many challenging experiences which are not only due to the lack of support delivered through the Bangladeshi health care system but also related to the existence of stigma and perception around disability in the Bangladeshi society. Within this perception, the causes of disability are mostly associated with 'God’s will'; 'possession of ghosts on the disabled person'; and 'karma or the result of past sins of the family members especially the mothers'. These beliefs are likely to have a significant impact on the well-being of mothers and their caring experience of children with disability. This is an ongoing qualitative study which is conducting in-depth interviews with 30 mothers from five districts (Dhaka, Mymensingh, Manikganj, Tangail, and Gazipur) of Bangladesh with the aim to explore the impact of social perception and stigma around physical disability on the caring role of the mothers of children with physical disability. The major findings of this study show that the social perception around disability and the social expectation from a mother regarding her caring role have a huge impact on the well-being of mothers. Mothers are mostly expected to take their child on their lap to prove that they are ‘good mother’. These practices of lifting their children with physical disability and keeping them on the lap for a long time often cause chronic back pain of the mothers. Existing social beliefs consider disability as a ‘curse’ and punishment for the ‘sins’ of the family members, most often by the mother. Mothers are blamed if they give birth to ‘abnormal’ children. This social construction creates stigma, and thus, the caring responsibility of mothers become more challenging. It also encourages the family and mothers to hide their children from the society and to avoid seeking accessible disability services. The mothers also compromise their careers and social interaction as they have to stay with their children at home, and that has a significant impact on personal wellbeing, income, and empowerment of the mothers. The research is informed by intersectional theory and employed an interpretive phenomenological methodology to explore mothers’ experience of caring their children with physical disability, and the contribution and impact of key relationships within the family and the intersection with community and services.

Keywords: mother, family carer, physical disability, children, social stigma, key relationship

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