Search results for: hospital

Authors: Sara Herrero Jaén, José María Santamaría García, María Lourdes Jiménez Rodríguez, Jorge Luis Gómez González, Adriana Cercas Duque, Alexandra González Aguna

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Background: Health concept has evolved throughout history. The health level is determined by the own individual perception. It is a dynamic process over time so that you can see variations from one moment to the next. In this way, knowing the health of the patients you care for, will facilitate decision making in the treatment of care. Objective: To design a technological tool that calculates the people health level in a sequential way over time. Material and Methods: Deductive methodology through text analysis, extraction and logical knowledge formalization and education with expert group. Studying time: September 2015- actually. Results: A computational tool for the use of health personnel has been designed. It has 11 variables. Each variable can be given a value from 1 to 5, with 1 being the minimum value and 5 being the maximum value. By adding the result of the 11 variables we obtain a magnitude in a certain time, the health level of the person. The health calculator allows to represent people health level at a time, establishing temporal cuts being useful to determine the evolution of the individual over time. Conclusion: The Information and Communication Technologies (ICT) allow training and help in various disciplinary areas. It is important to highlight their relevance in the field of health. Based on the health formalization, care acts can be directed towards some of the propositional elements of the concept above. The care acts will modify the people health level. The health calculator allows the prioritization and prediction of different strategies of health care in hospital units.

Keywords: calculator, care, eHealth, health

Procedia PDF Downloads 237

Authors: Niall Fennessy, Charlotte Yin, Vineet Gorolay, Michael Chan, Ilias Drivas

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Background: The aim of this study was to evaluate the effect of manual aspiration of air from the pleural cavity in mitigating the need for chest drain placement after a CT-guided lung biopsy. Method: This is a single institution retrospective review of CT-guided lung biopsies performed on 799 patients between September 2013 and May 2021 in a major tertiary hospital. Percutaneous manual aspiration of air was performed in 104/306 patients (34%) with pneumothoraxes as a preventative measure. Simple and multivariate analysis was performed to identify independent risk factors (modifiable and nonmodifiable) for the success of manual aspiration in mitigating the need for chest drain insertion. Results: The overall incidence of pneumothorax was 37% (295/799). Chest drains were inserted for 81/295 (27%) of the pneumothoraxes, representing 81/799 (10%) of all CT-guided lung biopsies. Of patients with pneumothoraces, 104 (36%) underwent percutaneous aspiration via either the coaxial guide needle or an 18 or 20G intravenous catheter attached to a three-way stopcock and syringe. Amongst this group, 13 patients (13%) subsequently required chest drain insertion. The success of percutaneous aspiration in avoiding subsequent pleural drain insertion decreased with aspiration volume >500mL, radial pneumothorax depth >3cm, increased subpleural depth of the lesion, and the presence of background emphysema.

Keywords: computed tomography, lung biopsy, pneumothorax, manual aspiration, chest drainage

Procedia PDF Downloads 152

Authors: Ghada A. Gamea, Nabila A. Yaseen, Ahmed A. Othman, Ahmed S. Tawfik

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Infection with Toxoplasma gondii can cause serious complications in pregnant women, leading to abortion, stillbirth, and congenital anomalies in the fetus. Definitive diagnosis of T. gondii acute infection is therefore critical for the clinical management of a mother and her fetus. This study was conducted on 250 pregnant females in the first trimester who were inpatients or outpatients at Obstetrics and Gynaecology Department at Tanta University Hospital. Screening of the selected females was done for the detection of immunoglobulin (IgG and IgM), and all subjects were submitted to history taking through a questionnaire including personal data, risk factors for Toxoplasma, complaint and history of the present illness. Thirty-eight samples, including 18 IgM +ve and 20 IgM-ve cases were further investigated by the avidity and IgE ELISA tests. The seroprevalence of toxoplasmosis in pregnant women was (42.8%) based on the presence of IgG antibodies in their sera. Contact with cats and consumption of raw or undercooked meat are important risk factors that were associated with toxoplasmosis in pregnant women. By serology, it could be observed that in the IgM +ve group, only one case (5.6%) showed an acute pattern by using the avidity test, though 10 (55.6%) cases were found to be acute by the IgE assay. On the other hand, in the IgM –ve group, 3 (15%) showed low avidity, but none of them was positive by using the IgE assay. In conclusion, there is no single serological test that can be used to confirm whether T. gondii infection is recent or was acquired in the distant past. A panel of tests for detection of toxoplasmosis will certainly have higher discriminatory power than any test alone.

Keywords: diagnosis, serology, seroprevalence, toxoplasmosis

Procedia PDF Downloads 129

Authors: Samina Nazli, Nadia Qamar, Quratulain, Akasha, Saman Jamal

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Objective: The objective is to determine the frequency of iron deficiency anemia among children having febrile seizures. A descriptive Cross-Sectional Study was done in the Pediatric Unit of Allama Iqbal Memorial Teaching Hospital Sialkot from September 2020 to February 2021. Material & Methods: A total of 70 children were studied aged six months to 10 years, with either gender presenting with febrile seizures. All data of the patients was documented, including demographic data like age, gender, residential area, educational status, socioeconomic status and clinical findings at the time of presentation like fever, fits and duration of symptoms etc. Blood hemoglobin and ferritin levels were tested for each patient to evaluate iron deficiency anemia. Results: There were 65.7% male and 34.3% female cases in this study. The age range of the patients was 6 months to 10 years, with a mean age of 4.36 ± 2.71 years. Most of the children (60%) were below three years of age. Most children belonged to low and middle socioeconomic status with a frequency of 42.8% and 45.7%, respectively. Iron deficiency anemia was found in 38.6% of cases. The majority of the mothers were illiterate (65%). There were 44.3% cases from rural areas and 55.7% from urban areas. Conclusion: Iron deficiency anemia is a common problem among children with febrile seizures, younger than 03 years and belonging to rural areas. Illiterate mothers are an important risk factor for iron deficiency anemia in their children.

Keywords: febrile seizure, iron deficiency anemia, illetrate mother, low scioeconomic status, febrile siezure

Procedia PDF Downloads 37

Authors: Darshani Premaratne, Afshin Kandampath Puthiyadath

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The Government of Qatar is taking active steps in improving quality of health care industry in the state of Qatar. In this initiative development and market introduction of Clinical Information System and Electronic Health Record (EHR) system are proved to be a highly challenging process. Along with an organization specialized on EHR system development and with the blessing of Health Ministry of Qatar the process of introduction of EHR system in Qatar healthcare industry was undertaken. Initially a market survey was carried out to understand the requirements. Secondly, the available government regulations, needs and possible upcoming regulations were carefully studied before deployment of resources for software development. Sufficient flexibility was allowed to cater for both the changes in the market and the regulations. As the first initiative a system that enables integration of referral network where referral clinic and laboratory system for all single doctor (and small scale) clinics was developed. Setting of isolated single doctor clinics all over the state to bring in to an integrated referral network along with a referral hospital need a coherent steering force and a solid top down framework. This paper discusses about the lessons learned in developing, in obtaining approval of the health ministry and in introduction to the industry of the single doctor referral network along with an EHR system. It was concluded that development of this nature required continues balance between the market requirements and upcoming regulations. Further accelerating the development based on the emerging needs, implementation based on the end user needs while tallying with the regulations, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and proper utilization of findings were equally found paramount in successful development of end product. Development of full scale Clinical Information System and EHR system are underway based on the lessons learned. The Government of Qatar is taking active steps in improving quality of health care industry in the state of Qatar. In this initiative development and market introduction of Clinical Information System and Electronic Health Record (EHR) system are proved to be a highly challenging process. Along with an organization specialized on EHR system development and with the blessing of Health Ministry of Qatar the process of introduction of EHR system in Qatar healthcare industry was undertaken. Initially a market survey was carried out to understand the requirements. Secondly the available government regulations, needs and possible upcoming regulations were carefully studied before deployment of resources for software development. Sufficient flexibility was allowed to cater for both the changes in the market and the regulations. As the first initiative a system that enables integration of referral network where referral clinic and laboratory system for all single doctor (and small scale) clinics was developed. Setting of isolated single doctor clinics all over the state to bring in to an integrated referral network along with a referral hospital need a coherent steering force and a solid top down framework. This paper discusses about the lessons learned in developing, in obtaining approval of the health ministry and in introduction to the industry of the single doctor referral network along with an EHR system. It was concluded that development of this nature required continues balance between the market requirements and upcoming regulations. Further accelerating the development based on the emerging needs, implementation based on the end user needs while tallying with the regulations, diffusion, and uptake of demand-driven and evidence-based products, tools, strategies, and proper utilization of findings were equally found paramount in successful development of end product. Development of full scale Clinical Information System and EHR system are underway based on the lessons learned.

Keywords: clinical information system, electronic health record, state regulations, integrated referral network of clinics

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Authors: Kristel Dame Bañez Sumagaysay, Marie Victoria Cruz-javier

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The current subject is a case of a 21 year-old woman at 29 1/7 weeks of gestation with Pre-B cell Acute Lymphoblastic Leukemia who was admitted to the coronary care unit (CCU) of the St. Luke’s Medical Center-Global City for Severe Acute Respiratory Distress Syndrome (ARDS) secondary to hospital-acquired pneumonia secondary to pneumocystis jiroveci; central line-associated bloodstream infection (E. aerogenes). She presented with chronic hypoxemia caused by Pulmonary edema, probably secondary to heart failure secondary to cardiomyopathy chemotherapy-induced. Due to worsening feto-maternal status, extracorporeal membrane oxygenation (ECMO) for respiratory support was instituted, and an elective cesarean section was done due to multiple maternal factors and deteriorating health status under total intravenous anesthesia assisted by veno-venous extracorporeal membrane oxygenation. She delivered a live preterm newborn male, APGAR Score: 1, 0, 0, birth weight 985 grams, birth length: 40.5cm, small for gestational age.

Keywords: extracorporeal membrane oxygenation, pre-b cell acute lymphoblastic leukemia, severe acute respiratory distress syndrome, ethical dilemmas

Procedia PDF Downloads 47

Authors: Sanjaya N. Munasinghe, R. Gnanasekeram, Dimuthu Tennakoon

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During the last few years there has been a dramatic increase in the number of motorcyclists in Sri Lankan roads and thus an increase of motorcycle accidents (MCAs) with a heavy death and casualty toll. Extremity injuries due to MCAs cause a heavy burden on government hospitals. However, data on MCA injuries are limited. This study tries to determine the relationship between extremity injuries with protective gears and clothing motorcycle riders were wearing at the time of the accident. Data were collected from 410 motorcycle riders and passengers involved with MCAs and admitted to orthopedic and emergency observation wards in Teaching Hospital Kurunegala with extremity injuries between 1st February 2015 and 31st July 2015 using an interviewer administered questioner. Data were analyzed using SPSS version 17.0. Distal radial fracture is the most common upper extremity injury (12%), and Tibial fracture is the most common and severe lower extremity injury (23%). Very few participants were wearing safety gloves (2%) and jackets (10%). Most of the participants were wearing slippers (66%), short sleeved upper clothing (96%) and light cloth trousers (49%). According to Chi-square test associations were found between footwear and foot injuries (p-value - 0.001, Cramer's v-value - 0.203) and safety jacket and upper extremity injuries (p-value - 0.002, Cramer's v-value - 0.177). The results indicate that using safety gear can minimize the number of injuries in MCA victims. Thus it is necessary to ensure that motorcycle riders and pillion riders use proper safety gear.

Keywords: extremity injuries, fractures, motorcycle accidents, safety gear

Procedia PDF Downloads 273

Authors: Alice W. Theuri, Anselimo O. Makokha, Florence M. Kyallo

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Type 2 diabetes mellitus (T2DM) is a serious metabolic disorder whose prevalence among adults has been increasing in the last decade. It is estimated that by 2030, the number of cases in Africa will almost double. Diet and lifestyle modifications are considered the cornerstone for the treatment and management of T2DM. Despite this, there is minimum literature assessing the dietary practices and glycemic control in a semi arid region context in Kenya. The objective of this study was to determine the dietary practices of adult T2DM patients attending Kitui out patient clinic in Kitui County. This was a cross sectional study design where every consenting second patient attending diabetic clinic was interviewed. A total of 138 T2DM patients were interviewed using a structured interview guide on socio-economic and dietary practices administered. The study was carried out in April and May 2017. There were more female (64%) than male (36%) in this study with majority being unemployed (38.4%). Forty seven percent (47.6%) had elevated HbA1c. Majority took three meals per day while DDS was 4.3 ± 1.09. The mean energy intake for men and women was 2823.8 ± 82.45 and 2766.3.30 ± 76.74 respectively. There was a non significant positive relationship (r= 131; P value = 0.124) between amount energy consumed and glycemic control. There were suboptimal dietary practices leading to poor glycemic control among T2DM patients attending diabetic clinic at Kitui District Hospital.

Keywords: adults, dietary practices, semi arid region, T2DM

Procedia PDF Downloads 121

Authors: Mehrdad Taghipour, Mina Rostami, Mahdi Eskandarlou

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Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, graft, scalp, partial thickness

Procedia PDF Downloads 68

Authors: Ligia Florio, João Mauricio Castaldelli-Maia

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Background: Food addiction (FA) emerged in the 1990s as a possible contributor to the increasing prevalence of obesity and overweight, in conjunction with changing food environments and mental health conditions. However, FA is not yet listed as one of the disorders in the DSM-5 and/or the ICD-11. Although there are controversies and debates in the literature about the classification and construct of FA, the most common approach to access it is the use of a research tool - the Yale Food Addiction Scale (YFAS) - which approximates the concept of FA to the concept diagnosis of dependence on psychoactive substances. There is a need to explore the dimensional phenotypes accessed by YFAS in different population groups for a better understanding and scientific support of FA diagnoses. Methods: The primary objective of this project was to investigate the construct validity of the FA concept by mYFAS 2.0 in individuals who underwent bariatric surgery (n = 100) at the Hospital Estadual Mário Covas since 2011. Statistical analyzes were conducted using the STATA software. In this sense, structural or factor validity was the type of construct validity investigated using exploratory factor analysis (EFA) and item response theory (IRT) techniques. Results: EFA showed that the one-dimensional model was the most parsimonious. The IRT showed that all criteria contributed to the latent structure, presenting discrimination values greater than 0.5, with most presenting values greater than 2. Conclusion: This study reinforces a FA dimension in patients who underwent bariatric surgery. Within this dimension, we identified the most severe and discriminating criteria for the diagnosis of FA.

Keywords: obesity, food addiction, bariatric surgery, regain

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Authors: H. Noureddine, P. Rao, R. Guru, A. Chandratreya

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The nice guidance for elective total knee replacements states that patients should be given mechanical thrombo-prophylaxis, and if no contraindications chemical thromboprophylaxis in the form of Dabigatran etexilate, Rivaroxiban, UFH, LMWH, or Fondaparinux sodium (CG92, 1.5.14, January 2010). In Practice administering oral agents has been the dominant practice as it reduces the nursing needs, and shortens hospital stay and is generally received better by patients. However, there are well documented associated bleeding risks, and their effects are difficult to reverse in case of major bleeding. Our experience with oral factor 10 inhibitors used for thromboprophylaxis was marked with several patients developing complications necessitating return to the theatre for wound washouts. This has led us to try a different protocol for thromboprophylaxis that we applied on our patients undergoing total and unicondylar knee replacements. We applied mechanical thromboprophylaxis in the form of intermittent pneumatic pressure devices, and chemical thromboprophylaxis in the form of a dose of prophylactic LMWH pre-op, then 150 mg of Aspirin to start 24 hours after the surgery and to continue for 6 weeks, alongside GI cover with PPIs or antihistamines. We also administered local anaesthetics intra-operatively in line with the ERAS protocol thus encouraging early mobilization. We have identified a cohort of 133 patients who underwent one of the aforementioned procedures in the same trust, and by the same surgeon, where this protocol was applied and examined their medical notes retrospectively with a mean follow-up period of 14 months, to identify the rate and percentage of patients who had thrombo-embolic events in the post-operative period.

Keywords: aspirin, heparin, knee arthroplasty, thromboprophylaxis

Procedia PDF Downloads 349

Authors: Sherif Sabri, Nael Samir, Mohamed Ali, Ahmed ElSakhawy

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Introduction: There is growing evidence to support the hypothesis that serum matrix metalloproteinase -9 in could be an early predictor of mortality in septic patients. Aim of the work: Study the relationship of matrix metalloproteinase 9 in patients with SIRS in comparison to septic patients in day 0 and day 2. Patients and Methods: This is a prospective observational study conducted on 40 adult critically ill patients staying more than 24 hours in ICU either surgical or medical department, El Fayoum General Hospital in the period from November 2014 to March 2015. Patients met at least two of the criteria for severe inflammatory response syndrome (SIRS). Diagnostic criteria include several clinical and laboratory findings of sepsis induced tissue hypoperfusion or organ dysfunction. Samples were grouped as drawn either at admission, or at day 2 after admission. Results: Patients were divided into two groups: The non-sepsis (SIRS) group, which included 15 (37.5%) patients with no later evidence of sepsis were enrolled as controls. The Sepsis group, which included 25 patients diagnosed to have SIRS with later evidence of sepsis with positive culture. Exploring serum level of MMP-9 in non-survivors and survivors, there was significant increase in non-survivors if compared to survivors at admission p-value 0.001 (mean value in survivors 4.4mg/dl±4.1mg/dl at admission versus mean value in non-survivors 11.9mg/dl±5.8mg/dl) and after two days of admission was also significant increase p-value 0.001 (mean value in survivors 10.9mg/dl ±9.4mg/dl versus mean value in non-survivors 22.6mg/dl±10.4). Conclusion: MMP-9 levels in septic patients have a beneficial role in ICU for high-risk stratification as it is an independent marker of mortality in severe sepsis.

Keywords: matrix metalloproteinase (MMP-9), sepsis, septic shock, systemic inflamatory response syndrome

Procedia PDF Downloads 208

Authors: Maryam Panahi

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Background: Adjuvants such as ketamine, promethazine, and paracetamol could bring up patient's satisfaction and control the harmful effects of opioids besides lessening their needed doses, as seen by the fentanyl/paracetamol and fentanyl/ketamine combination before. The current study is headed to compare paracetamol and ketamine, in addition to fentanyl, applied by infusion pumps in order to pain relief following major surgery. Materials and Methods: Through a double-blinded, randomized clinical trial, patients between18 and 65 with elective surgery for tight or leg fractures with ASA Class 1 and 2 referred to a university hospital in Arak, a town in the central region of Iran, were recruited and used infusion pump for their postoperative pain control. The participants were divided into cases and controls regarding using ketamine/fentanyl (KF) or paracetamol/fentanyl (PF) infusion pumps. Results: The mean pain score was a total of 3.87, with the highest value in KF (5.06) and the lowest in PF (4.50) immediately after finishing the surgery and getting conscious when started using an infusion pump. There was no statistical difference between the groups in this regard. Concerning the side effects of the applied medications, blood pressure and heart rate had no differences comparing the groups. Conclusion: This study showed that paracetamol used in infusion pumps could be brilliant in pain control after major surgeries like those done in lower extremities and joint replacement while lessening opioid use. Although paracetamol was more effective than ketamine in the current trial, more qualified studies at bigger sizes and in other fields of surgery besides orthopedic ones would be useful to support the effects if applicable

Keywords: infusion pump, Ketamine, Paracetamol, pain

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Authors: Al-Tammar M. Shahah

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Background and Objective: A novel pneumonia caused by coronavirus disease 2019 (COVID-19), which is spreading domestically and internationally, has been identified by the Chinese city of Wuhan since the end of December 2019. Limited studies examined the psychological experience such as anxiety, depression, and stress during Corona pandemic. Moreover, to the best of author's knowledge, there is no study to date has examined the psychological resilience and mental health during Corona pandemic in Kuwait. Therefore, the present research investigates the role of psychological resilience in predicting psychological distress among Kuwaiti adults during Corona pandemic. Method: Kuwaiti citizens (N = 735) completed an online survey, which includes four scales the Hospital Anxiety and Depression Scale HADS (anxiety and depression), the Connor-Davidson Resilience Scale (CD-RISC-25), and the Perceived Stress Scale (PSS). A cross-sectional correlational design was used. Results: A high level of stress was observed, with 59% reported moderate to severe stress. In contrast, low levels of anxiety and depression were observed; with 70% reporting no anxiety symptoms and 74% report no depression symptoms. Psychological resilience was negatively correlated with anxiety, depression, and stress, consistent with previous studies. As expected, resilience was found to account for significant variance in anxiety and stress after controlling for quarantine variables and demographic variables. Conclusion: The findings suggest that increasing psychological resilience might help reduce psychological distress after confronting with stressful live events in Kuwaiti citizen.

Keywords: anxiety, corona, depression, psychological resilience, stress

Procedia PDF Downloads 90

Authors: Tia Morosin, Marie Shella De Robles

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Rectocele may be associated with symptoms of both obstructed defecation and faecal incontinence. Currently, numerous operative techniques exist to treat patients with rectocele; however, no single technique has emerged as the optimal approach in patients with post-partum faecal incontinence. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele for patients presenting with faecal incontinence as the predominant symptom. Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon. All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range 21 to 90 years). The median operating time and length of hospital stay were 2 hours and 7 days, respectively. Two patients developed urinary retention post-operatively, which required temporary bladder catheterization. One patient had wound dehiscence, which was managed by absorbent dressing applied by the patient and her carer. There was no operative mortality. In all patients with rectocele, there was a concomitant anal sphincter disruption. All patients had satisfactory improvement with regard to faecal incontinence on follow-up. This study suggests this method provides excellent anatomic and physiologic results with minimal morbidity. However, because none of the patients gained full continence postoperatively, pelvic floor rehabilitation might be also needed to achieve better sphincter function in patients with incontinence.

Keywords: anal sphincter defect, faecal incontinence, rectocele, transperineal repair

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Authors: Jean-Paul Kapuya Bulaba Nyembwe, John Omomoluwa Ogundiran, Manuel Carlos Gameiro da Silva

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Indoor environmental quality (IEQ) remains a global concern because it impacts people's comfort, health, performance, and general well-being. People spend a significant amount of time in buildings or while commuting, hence ensuring the minimal risk in indoor spaces by ensuring suitable IEQ. IEQ studies are limited regarding developing sub-Saharan countries, whereas there is also a huge risk and concern for the current population and geometric growth as many cities in the region will become mega-cities by 2040 (World Bank report). The absence of suitable IEQ regulations and energy poverty are reasons to assess the IEQ gaps for increased awareness of sustainable interventions to minimize the associated risk. This study evaluates the gaps and potential hazards that exist in the IEQ of sub-Saharan countries using empirical studies of hospital occupants and BRT bus passengers and drivers. The Surveys were conducted in 3 cities of the Democratic Republic of Congo and Lagos metropolis of Nigeria. The results suggest that gaps exist in IEQ for these regions. The gaps indicate existential risk to people’s health, comfort, and well-being. The inferential conclusions are that there is a need for further scientific studies, improvement in IEQ conditions, and ensuring suitable regulations for developing sub-Saharan countries.

Keywords: health hazards, hospitals indoor environmental quality, indoor spaces, occupants, sub-Saharan countries, vehicles

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Authors: Alasdair Warwick, Luna Dhir

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Aim: To ascertain the efficacy of overcorrecting minus lens therapy in intermittent distance exotropia. Methods: Retrospective audit of all intermittent distance exotropia patients seen in the Chelsea and Westminster Hospital pediatric eye clinic between 1st January 2014 and 1st March 2016. Change in LogMAR visual acuity, stereopsis, near and distance angles of deviation, as well as the proportions of patients converting to exophoria or undergoing strabismus surgery, were recorded. Results: 22 patients were identified, 45% male, mean age 5 years (range 0.6 to 18.5 years). The median overminus prescription was -1.0 dioptres (range -0.5 to -1.75 dioptres) and mean follow-up was 15 months (range 3 to 54 months). Visual acuity, near and distance angles of deviation improved but were not statistically significant: -0.15 LogMAR, -0.2 prism dioptres and -1.2 prism dioptres respectively (p>0.05). However, a significant change in stereopsis was observed: -74'' (p<0.01). 27% underwent strabismus surgery and 36% converted to exophoria whilst wearing their overminus prescription. Conclusions: Overcorrecting minus lens therapy is an effective therapy for intermittent distance exotropia. There was no deterioration in visual acuity and a significant improvement in stereopsis was seen in our cohort, with many patients converting to an exophoria. The proportion of patients requiring strabismus surgery was comparable to other studies. Further, follow-up is needed to ascertain long-term outcomes.

Keywords: exotropia, overcorrecting minus lens, refraction, strabismus

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Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares

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Introduction: Diabetes is a chronic health problem and a major risk factor of stroke. A number of therapeutic modalities exist for diabetes management. It’s still unknown whether the different oral hypoglycemic agents would ameliorate the detrimental effect of diabetes on stroke severity. The objective of this work is to assess the effect of pretreatment with oral hypoglycemic agents, insulin and their combination on stroke severity at presentation. Patients and Methods: Patients admitted to the King Abdullah University Hospital (KAUH)-Jordan with ischemic stroke between January 2015 and December 2016 were evaluated and their comorbid diseases, treatment on admission and their neurologic severity was assessed using the National Institute of Health Stroke Scale (NIHSS) were documented. Stroke severity was compared for non-diabetic patients and diabetic patients treated with different antidiabetic agents. Results: Data from 324 patients with acute stroke was documented. The median age of participants was 69 years. Diabetes was documented in about 50% of the patients. Multinomial regression analysis identified diabetes treatment status as an independent predictor of neurological severity of stroke (p=0.032). Patients treated with oral hypoglycemic agents had a significantly lower NIHSS as compared to nondiabetic patients and insulin treated patients (p < 0.02). The positive effect of oral hypoglycemic agents was blunted by insulin co-treatment. Insulin did not alter the severity of stroke as compared to non-diabetics. Conclusion: Oral hypoglycemic agents may reduce the severity of neurologic deficit of ischemic stroke and may have neuroprotective effect.

Keywords: diabetes, stroke, neuroprotection, oral hypoglycemic agents

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Authors: Helen Nelly Naiga, Christopher Garimoi Orach

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Introduction: Long-acting reversible contraceptive (LARC) methods are highly effective. However, LARC use in Uganda is low (13%). We assessed the factors associated with the use of long-acting reversible contraceptives among women of reproductive age (15-49 yrs) in Jinja District. Methods: We conducted a facility-based cross-sectional study. A total of 314 women aged 15–49 years attending public health facilities (1 hospital and 3 health center IV) in Jinja district, were randomly selected. A total of 6 key informants and 6 in-depth interviews were conducted. Logistic regression analysis was conducted using Stata version 14. Qualitative data were analysed using thematic analysis. Results: The study found that 40.45% of the respondents had ever used LARC. The commonest LARC method used was implanting (38.22%). The factors significantly associated with use of LARC were employment (AOR =2.91; 95% CI (1.05-8.08), access to LARC methods (AOR =4.48; 95% CI (1.24-16.21), husband support (AOR =4.90; 95% CI (1.56-15.41), and experience of no side effects (AOR =3.48; 95% CI (1.00-12.19). Conclusion and recommendations: The study showed that 4 in 10 women of reproductive age in Jinja District were using LARC. The factors associated with LARC use were employment, husband support, access to LARC methods, and the lack of side effects. There is a need to strengthen client education, improve accessibility to LARC methods at all levels of health centers, improve male partner’s decision-making in LARC use and manage the side effects effectively.

Keywords: family planning, implants, intrauterine device, long-acting reversible contraceptives (LARC)

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Authors: Patricia O. Carvalho, Marcia C. F. Messias, Salvador Sanchez Vinces, Caroline F. A. Gatinoni, Vitor P. Iordanu, Carlos A. R. Martinez

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Lipidomics methods are widely used in the identification and validation of disease-specific biomarkers and therapy response evaluation. The present study aimed to identify a panel of potential lipid biomarkers to evaluate response to neoadjuvant chemoradiotherapy in rectal adenocarcinoma (RAC). Liquid chromatography–mass spectrometry (LC-MS)-based untargeted lipidomic was used to profile human serum samples from patients with clinical stage T2 or T3 resectable RAC, after and before chemoradiotherapy treatment. A total of 28 blood plasma samples were collected from 14 patients with RAC who recruited at the São Francisco University Hospital (HUSF/USF). The study was approved by the ethics committee (CAAE 14958819.8.0000.5514). Univariate and multivariate statistical analyses were applied to explore dysregulated metabolic pathways using untargeted lipidic profiling and data mining approaches. A total of 36 statistically significant altered lipids were identified and the subsequent partial least-squares discriminant analysis model was both cross validated (R2, Q2) and permutated. Lisophosphatidyl-choline (LPC) plasmalogens containing palmitoleic and oleic acids, with high variable importance in projection score, showed a tendency to be lower after completion of chemoradiotherapy. Chemoradiotherapy seems to change plasmanyl-phospholipids levels, indicating that these lipids play an important role in the RAC pathogenesis.

Keywords: lipidomics, neoadjuvant chemoradiotherapy, plasmalogens, rectal adenocarcinoma

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Authors: Chen-Yu Tsai, Wen-Te Liu, Chen-Chen Lo, Kang Lo, Yin-Tzu Lin

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Background: Driving drowsiness related to insufficient or disordered sleep accounts for a major percentage of vehicular accidents. Sleep deprivation is the primary reason related to low sleep efficiency. Nevertheless, the mechanism of sleep deprivation induces driving fatigue to remain unclear. Objective: The objective of this study is to associate the relationship between insufficient sleep efficiency and driving fatigue. Methodologies: The physical condition while driving was obtained from the questionnaires to classify the state of driving fatigue. Sleep efficiency was quantified as the polysomnography (PSG), and the sleep stages were sentenced by the reregistered Technologist during examination in a hospital in New Taipei City (Taiwan). The independent T-test was used to investigate the correlation between sleep efficiency, sleep stages ratio, and driving drowsiness. Results: There were 880 subjects recruited in this study, who had been done polysomnography for evaluating severity for obstructive sleep apnea syndrome (OSAS) as well as completed the driver condition questionnaire. Four-hundred-eighty-four subjects (55%) were classified as fatigue group, and 396 subjects (45%) were served as the control group. The ratio of stage three sleep (N3) (0.032 ± 0.056) in fatigue group were significantly lower than the control group (p < 0.01). The significantly higher value of snoring index (242.14 ± 205.51 /hours) was observed in the fatigue group (p < 0.01). Conclusion: We observe the considerable correlation between deep sleep reduce and driving drowsiness. To avoid drowsy driving, the sleep deprivation, and the snoring events during the sleeping time should be monitored and alleviated.

Keywords: driving drowsiness, sleep deprivation, stage three sleep, snoring index

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Authors: Kalyan Koganti

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Background: In India, platelet transfusions are given to large no. of patients suffering from dengue due to the fear of bleeding especially when the platelet counts are low. Though many patients do not bleed when the platelet count falls to less than 20,000, certain patients bleed even if the platelet counts are more than 20,000 without any comorbid condition (like gastrointestinal ulcer) in the past. This fear has led to huge amounts of unnecessary platelet transfusions which cause significant economic burden to low and middle-income countries like India and also sometimes these transfusions end with transfusion-related adverse reactions. Objective: To identify the role of Activated Partial Thromboplastin Time (APTT) in comparison with thrombocytoenia as an indicator to assess the real need of platelet transfusions. Method: A prospective study was conducted at a hospital in South India which included 176 admitted cases of dengue confirmed by immunochromatography. APTT was performed in all these patients along with platelet count. Cut off values of > 60 seconds for APTT and < 20,000 for platelet count were considered to assess the bleeding manifestations. Results: Among the total 176 patients, 56 patients had bleeding manifestations like malena, hematuria, bleeding gums etc. APTT > 60 seconds had a sensitivity and specificity of 93% and 90% respectively in identifying bleeding manifestations where as platelet count of < 20,000 had a sensitivity and specificity of 64% and 73% respectively. Conclusion: Elevated APTT levels can be considered as an indicator to assess the need of platelet transfusion in dengue. As there is a significant variation among patients who bleed with respect to platelet count, APTT can be considered to avoid unnecessary transfusions.

Keywords: activated partial thromboplastin time, dengue, platelet transfusion, thrombocytopenia

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Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

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Background/Purpose: Previous preclinical and clinical data suggest that increased lymphocytic infiltration would be associated with good prognosis and benefit from immunogenic chemotherapy especially in triple-negative breast cancer (TNBC). We investigated a single-center experience of TNBC and relationship with lymphocytic infiltration. Methods: From January 2004 to December 2012, at the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, we retrospectively reviewed 897 breast cancer patients-clinical outcomes, clinicopathological characteristics, breast cancer subtypes. And we reviewed lymphocytic infiltration of TNBC specimens by two pathologists. Statistical analysis of risk factors associated with recurrence was performed. Results: A total of 897 patients, 76 were TNBC (8.47%). Mean age of TNBC patients were 50.95 (SD10.42) years, mean follow-up periods was 40.06 months. We reviewed 49 slides, and there were 8 recurrent breast cancer patients (16.32%), and 4 patients were expired (8.16%). There were 9 lymphocytic predominant breast cancers (LPBC)-carcinomas with either intratumoral lymphocytes in >60% of tumor cell nests. 1 patient of LPBC was recurred and 8 were not. In multivariate logistic regression, the odds ratio of lymphocytic infiltration was 0.59 (p=0.643). Conclusion: In a single-center experience of TNBC, the lymphocytic infiltration in tumor cell nest might be a good trend on the prognosis but there was not statistically significant.

Keywords: tumor-infiltrating lymphocytes, triple negative breast cancer, medical and health sciences

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Authors: Lucia Salvioni, Pietro Giorgio Lovaglio, Valerio Leoni, Miriam Colombo, Luisa Fiandra

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The involvement of plasmatic surfactant protein-D (SP-D) in pulmonary diseases has been long investigated, and over the last two years, more interest has been directed to determine its role as a marker of COVID-19. In this direction, several studies aimed to correlate pulmonary surfactant proteins with the clinical manifestations of the virus indicated SP-D as a prognostic biomarker of COVID-19 pneumonia severity. The present work has performed a retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio (Lombardia, Italy) with the aim to assess differences in the hematic SP-D concentrations among COVID-19 patients and healthy donors and the role of SP-D as a prognostic marker of severity and/or of mortality risk. The obtained results showed a significant difference in the mean of log SP-D levels between COVID-19 patients and healthy donors, so as between dead and survived patients. SP-D values were significantly higher for both hospitalized COVID-19 and dead patients, with threshold values of 150 and 250 ng/mL, respectively. SP-D levels at admission and increasing differences among follow-up and admission values resulted in the strongest significant risk factors of mortality. Therefore, this study demonstrated the role of SP-D as a predictive marker of SARS-CoV-2 infection and its outcome. A significant correlation of SP-D with patient mortality indicated that it is also a prognostic factor in terms of mortality, and its early detection should be considered to design adequate preventive treatments for COVID-19 patients.

Keywords: SARS-CoV-2 infection, COVID-19, surfactant protein-D (SP-D), mortality, biomarker

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Authors: Dana Mohammed, Fatemah Abdullah, Hawraa Ali, Najat Al-Shaer, Rawan Al-Awadhi, , Magdy Helal

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We study the patient service performance at the emergency department of a major Kuwaiti public hospital, using discrete simulation and lean concepts. In addition to the common problems in such health care systems (over crowdedness, facilities planning and usage, scheduling and staffing, capacity planning) the emergency department suffered from several cultural and patient behavioural issues. Those contributed significantly to the system problems and constituted major obstacles in maintaining the performance in control. This led to overly long waiting times and the potential of delaying providing help to critical cases. We utilized the visual management tools to mitigate the impact of the patients’ behaviours and attitudes and improve the logistics inside the system. In addition a proposal is made to automate the date collection and communication within the department using RFID-based barcoding system. Discrete event simulation models were developed as decision support systems; to study the operational problems and assess achieved improvements. The simulation analysis resulted in cutting the patient delays to about 35% of their current values by reallocating and rescheduling the medical staff. Combined with the application of the visual management concepts, this provided the basis to improving patient service without any major investments.

Keywords: simulation, visual management, health care system, patient

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Authors: Pitchaporn Purngpiputtrakul, Suttasinee Petsakul, Sunisa Chatmongkolchart

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Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope visualization and neck flexion with lateral neck pressure techniques. This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Using GlideScope visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion, while neck flexion with lateral neck pressure technique had fewer complications and was less time-consuming.

Keywords: anaesthesia, nasogastric tube, GlideScope, intubation

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Authors: S. M. P Manjula, Ishara Amarathunga, Aryan Nath Koura, Jaideepraj Rao

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Background: Laparoscopic D2 Gastrectomy for non metastatic advanced Gastric cancer (AGC) has become a controversial topic as there are confronting ideas from experts in the field. Lack of consensus are mainly due to non feasibility of the dissection and safety and efficacy. Method: Data from all D2 Gastrectomies performed (both Subtotal and Total Gastrectomies) in our unit from 2009 December to 2013 December were retrospectively analysed. Computor database was prospectively maintained. Pathological stage two A (iiA) and above considered advanced Gastric cancers, who underwent curative intent D2 Gastrectomy were included for analysis(n=46). Four patients excluded from the study as peritoneal fluid cytology came positive for cancer cells and one patient exempted as microscopic resection margin positive(R1) after curative resection. Thirty day morbidity and mortality, operative time, lymph nodes harvest and survival (disease free and overall) analyzed. Results: Complete curative resection achieved in 40 patients. Mean age of the study population was 62.2 (32-88) and male to female ratio was 23: 17. Thirty day mortality (1/40) and morbidity (6/40). Average operative time 203.7 minutes (185- 400) and average lymphnodes harvest was 40.5 (18-91). Disease free survival of the AGC in this study population was 16.75 months (1-49). Average hospital stay was 6.8 days (3-31). Conclusion: Laparoscopic dissection is effective feasible and safe in AGC.

Keywords: laparoscopy, advanced gastric cancer, safety, efficacy

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Authors: Sudheer Moorkoth, Leslie Edward Lewis, Pragna Rao

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Newborn screening (NBS) is a part of routine newborn care in many countries worldwide to detect early any rare treatable conditions and inborn errors of metabolism (IEM). India has not started this program yet. In an attempt to understand the challenges in implementing a national newborn screening program in India, we initiated a pilot newborn screening project funded by the Government of Canada. Along with initiating the newborn screening at Kasturba Hospital, Manipal in South India, for screening six disorders (Congenital Hypothyroidism(CH), Congenital Adrenal Hyperplasia (CAH), Galactosemia, Biotinidase deficiency, Glucose-6-Phosphate Dehydrogenase deficiency (G-6PD) and Phenylketonurea), we also studied the awareness of various stakeholders on the newborn screening. In a period of nine months from August 2017 to March 2018 we could screen 1915 newborns (999 male and 916 female). The result showed that there were seven babies screened positive. This interim result points to an incidence rate of 1 in 270 children for these rare disorders collectively. This includes three confirmed cases of CH, two cases of G-6PD deficiency, and one case each for Galctosemia and CAH. A questionnaire based study to understand the awareness among various stakeholders revealed that there is little awareness among parents, adolescents and anganwadi workers (public health worker). The interim data points to the need for a national newborn screening programme in India. There is also an immediate need to undertake large-scale awareness programme to create knowledge on NBS among the various stakeholders.

Keywords: awareness, inborn errors of metabolism (IEM), newborn screening, rare disease

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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: Gbenga Martins, Christopher J. Olowookere, Lateef Bamidele, Kehinde O. Olatunji

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The aims of this research are to measure the scattered dose rate during an X-ray examination in an X-ray room, compare the scattered dose rate with exposure parameters based on the body region examined, and examine the X-ray examination done with an over couch tube. The research was carried out using Gamma Scout software installation on the computer system (Laptop) to record the radiation counts, pulse rate, and dose rate. The measurement was employed by placing the detector at 900 to the incident X-ray. Proforma was used for the collection of patients’ data such as age, sex, examination type, and initial diagnosis. Data such as focus skin distance (FSD), body mass index (BMI), body thickness of the patients, the beam output (kVp) were collected at Obafemi Awolowo University, Ile-Ife, Western Nigeria. Total number of 136 patients was considered during this research. Dose rate range between 14.21 and 86.78 µSv/h for the plain abdominal region, 85.70 and 2.86 µSv/h for the lumbosacral region,1.3 µSv/yr and 3.6 µSv/yr in the pelvis region, 2.71 µSv/yr and 28.88 µSv/yr for leg region, 3.06 µSv/yr and 29.98 µSv/yr in hand region. The results of this study were compared with those of other studies carried out in other countries. The findings of this study indicated that the number of exposure parameters selected for each diagnostic examination contributed to the dose rate recorded. Therefore, these results call for a quality assurance program (QAP) in diagnostic X-ray units in Nigerian hospitals.

Keywords: X-radiation, exposure parameters, dose rate, pulse rate, number of counts, tube current, tube potential, diagnostic examination, scattered radiation

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