Search results for: early mobilisation in intensive care (ICU)

Authors: Jyoti Agrawal

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Introduction: Renal diseases in children and young adult can be difficult to diagnose early as it may present only with few symptoms, tends to have different course than adult and respond variously to different treatment. The pattern of renal disease in children is different from developing countries as compared to developed countries. Methods: This study was a hospital based prospective observational study carried from March, 2014 to February 2015 at BP Koirala institute of health sciences. Patients with renal disease, both inpatient and outpatient from birth to 14 years of age were enrolled in the study. The diagnosis of renal disease was be made on clinical and laboratory criteria. Results: Total of 120 patients were enrolled in our study which contributed to 3.74% % of total admission. The commonest feature of presentation was edema (75%), followed by fever (65%), hypertension (60%), decreased urine output (45%) and hematuria (25%). Most common diagnosis was acute glomerulonephritis (40%) followed by Nephrotic syndrome (25%) and urinary tract infection (25%). Renal biopsy was done for 10% of cases and most of them were steroid dependent nephrotic syndrome. 5% of our cases expired because of multiorgan dysfunction syndrome, sepsis and acute kidney injury. Conclusion: Renal disease contributes to a large part of hospital pediatric admission as well as mortality and morbidity to the children.

Keywords: glomerulonephritis, nephrotic syndrome, renal disease, urinary tract infection

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Authors: Khairi El Battawy, Monika Skalicki

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The present investigation has been done on pure Egyptian Arabian mares that reared in private horse studs. Fifty non-pregnant mares were selected and examined to classify them as either being reproductively healthy or subfertile mares including clinical endometritis, early embryonic death, granulosa cell tumor, repeat breeder (post-breeding endometritis), and anoestrus mares. The purpose of the study was to assess oxidative/antioxidant biochemical metabolites, lipogram, trace elements and reproductive hormones throughout reproductive conditions in mares during regular estrous, anestrum, early pregnancy, granulose cell tumor, ovulation failure, and endometritis. Results showed intensification of the free radical-dependent process in the blood of infertile mare, especially mares with endometritis. Ultrasonography as a diagnostic tool diagnosis of endometritis in mares was an important step as it revealed much information concerning infertility problem.

Keywords: endometritis, ovulation, oxidative, mare

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Authors: Ge Zhan

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Mobile health (mHealth) concerns the use of mobile technologies to deliver health care and improve wellness. In this paper, we ask the question of what are the drivers of positive consumer attitude toward mHealth programs. Answers to this question are important to consumer health, but existing marketing and health care service literature does not provide sufficient empirical conclusions on the use of mobile technologies for consumer health. This study aims to fill the knowledge gap by investigating mHealth use and consumer attitude. A content analysis was conducted with sample mHealth programs and online consumer reviews in Hong Kong, UK, US, and India. The research findings will contribute to marketing and health services literature.

Keywords: mobile health, consumer attitude, content analysis, online marketing

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Authors: Noor Abdelhamid, Donovan Nelson, Cara Prosser

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The architectural design process could be mapped out as a dialogue between designer and user that is constructed across multiple phases with the overarching goal of aligning design outcomes with user needs. Traditionally, this dialogue is bounded within a preliminary phase of determining factors that will direct the design intent, and a completion phase, of handing off the project to the client. Pre- and post-occupancy evaluations (P/POE’s) could provide an alternative process by extending this dialogue on both ends of the design process. The purpose of this research is to study the influence of systematic pre-occupancy data collection in achieving design goals by conducting post-occupancy evaluations of two case studies. In the context of this study, systematic pre-occupancy data collection is defined as the preliminary documentation of the existing conditions that helps portray stakeholders’ needs. When implemented, pre-occupancy occurs during the early phases of the architectural design process, utilizing the information to shape the design intent. Investigative POE’s are performed on two case studies with distinct early design approaches to understand how the current space is impacting user needs, establish design outcomes, and inform future strategies. The first case study underwent systematic pre-occupancy data collection and synthesis, while the other represents the traditional, uncoordinated practice of informally collecting data during an early design phase. POE’s target the dynamics between the building and its occupants by studying how spaces are serving the needs of the users. Data collection for this study consists of user surveys, audiovisual materials, and observations during regular site visits. Mixed methods of qualitative and quantitative analyses are synthesized to identify patterns in the data. The paper concludes by positioning value on both sides of the architectural design process: the integration of systematic pre-occupancy methods in the early phases and the reinforcement of a continued dialogue between building and design team after building completion.

Keywords: architecture, design process, pre-occupancy data, post-occupancy evaluation

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Authors: Ahmed Shaboub, Yusuf Jasim Althawadi, Shadi Alaa Abdelaal, Mohamed Hussein Abdalla, Hatem Amr Elzahaby, Mohamed Mohamed, Hazem S. Ghaith, Ahmed Negida

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Objectives: We aimed to compare the safety and outcomes of the minimally invasive approaches versus conventional sternotomy procedures for aortic valve replacement. Methods: We conducted a PRISMA-compliant systematic review and meta-analysis. We ran an electronic search of PubMed, Cochrane CENTRAL, Scopus, and Web of Science to identify the relevant published studies. Data were extracted and pooled as standardized mean difference (SMD) or risk ratio (RR) using StataMP version 17 for macOS. Results: Forty-one studies with a total of 15,065 patients were included in this meta-analysis (minimally invasive approaches n=7231 vs. conventional sternotomy n=7834). The pooled effect size showed that minimally invasive approaches had lower mortality rate (RR 0.76, 95%CI [0.59 to 0.99]), intensive care unit and hospital stays (SMD -0.16 and -0.31, respectively), ventilation time (SMD -0.26, 95%CI [-0.38 to -0.15]), 24-h chest tube drainage (SMD -1.03, 95%CI [-1.53 to -0.53]), RBCs transfusion (RR 0.81, 95%CI [0.70 to 0.93]), wound infection (RR 0.66, 95%CI [0.47 to 0.92]) and acute renal failure (RR 0.65, 95%CI [0.46 to 0.93]). However, minimally invasive approaches had longer operative time, cross-clamp, and bypass times (SMD 0.47, 95%CI [0.22 to 0.72], SMD 0.27, 95%CI [0.07 to 0.48], and SMD 0.37, 95%CI [0.20 to 0.45], respectively). There were no differences between the two groups in blood loss, endocarditis, cardiac tamponade, stroke, arrhythmias, pneumonia, pneumothorax, bleeding reoperation, tracheostomy, hemodialysis, or myocardial infarction (all P>0.05). Conclusion: Current evidence showed higher safety and better operative outcomes with minimally invasive aortic valve replacement compared to the conventional approach. Future RCTs with long-term follow-ups are recommended.

Keywords: aortic replacement, minimally invasive, sternotomy, mini-sternotomy, aortic valve, meta analysis

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Authors: Walid A. Alkeridy, Arwa Aljasser, Khalid Mohammed Alayed, Saad Alsaad, Amani S. Alqahtani, Claire Ann Lim, Sultan H. Alamri, Doaa Zainhom Mekkawy, Mohammed Al-Sofiani

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Introduction: The history of publicly funded Home Health Care (HHC) service in Saudi Arabia dates back to 1991. The first HC program was launched to provide palliative home care services for patients with terminal cancer. Thereafter, more programs launched across Saudi Arabia most remarkably was launching the national program for HHC by the Ministry Of Health (MOH) in 2008. The national HHC MOH program is mainly providing long-term care home care services for over 40,000 Saudi citizens. The scope of the HHC service program provided by the Saudi MOH is quite diverse, ranging from basic nursing care to specialized care programs, e.g., home peritoneal dialysis, home ventilation, home infusion therapy, etc. Objectives: The primary aim of our study is to report the prevalence of chronic conditions among Saudi people receiving long-term HHC services. Secondary aims include identifying the predictors of mortality among individuals receiving long-term HHC services and studying the association between frailty and poor health outcomes among HHC users. Methods: We conducted a retrospective and cross-sectional data collection from participants receiving HHC services at King Saud University Medical City, Riyadh, Saudi Arabia. Data were collected from electronic health records (EHR), patient charts, and interviewing caregivers from the year 2019 to 2022. We assessed functional performance by Katz's activity of daily living and the Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). Mortality was assessed by reviewing the death certificates if patients were hospitalized through discharge status ascertainment from EHR. Results: The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. The following variables were statistically significant between deceased and alive individuals receiving HHC services; clinical frailty scale, the total number of comorbid conditions, and functional performance based on the KATZ activity of daily living scale and the BADLS. We found that the strongest predictors for mortality were pressure ulcers which had an odds ratio of 3.75 and p-value of < 0.0001, and the clinical frailty scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services. Moreover, we found a high rate of annual readmission for individuals enrolled in HHC, which requires further analysis to understand the possible contributing factors for the increased rate of hospital readmission and develop strategies to address them. Future studies should focus on designing quality improvement projects aimed at improving the quality of life for individuals receiving HHC services, especially those who have pressure ulcers at the end of life.

Keywords: homecare, Saudi, prevalence, chronic

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Authors: Himanshu Kumar Gupta

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The Jaisalmer Basin is one of the parts of the Rajasthan basin in northwestern India. The presence of five major unconformities/hiatuses of varying span i.e. at the top of Archean basement, Cambrian, Jurassic, Cretaceous, and Eocene have created the foundation for constructing a sequence stratigraphic framework. Based on basin formative tectonic events and their impact on sedimentation processes three first-order sequences have been identified in Rajasthan Basin. These are Proterozoic-Early Cambrian rift sequence, Permian to Middle-Late Eocene shelf sequence and Pleistocene - Recent sequence related to Himalayan Orogeny. The Permian to Middle Eocene I order sequence is further subdivided into three-second order sequences i.e. Permian to Late Jurassic II order sequence, Early to Late Cretaceous II order sequence and Paleocene to Middle-Late Eocene II order sequence. In this study, Late Jurassic to Early Cretaceous sequence was identified and log-based interpretation of smaller order T-R cycles have been carried out. A log profile from eastern margin to western margin (up to Shahgarh depression) has been taken. The depositional environment penetrated by the wells interpreted from log signatures gave three major facies association. The blocky and coarsening upward (funnel shape), the blocky and fining upward (bell shape) and the erratic (zig-zag) facies representing distributary mouth bar, distributary channel and marine mud facies respectively. Late Jurassic Formation (Baisakhi-Bhadasar) and Early Cretaceous Formation (Pariwar) shows a lesser number of T-R cycles in shallower and higher number of T-R cycles in deeper bathymetry. Shallowest well has 3 T-R cycles in Baisakhi-Bhadasar and 2 T-R cycles in Pariwar, whereas deeper well has 4 T-R cycles in Baisakhi-Bhadasar and 8 T-R cycles in Pariwar Formation. The Maximum Flooding surfaces observed from the stratigraphy analysis indicate major shale break (high shale content). The study area is dominated by the alternation of shale and sand lithologies, which occurs in an approximate ratio of 70:30. A seismo-geological cross section has been prepared to understand the stratigraphic thickness variation and structural disposition of the strata. The formations are quite thick to the west, the thickness of which reduces as we traverse towards the east. The folded and the faulted strata indicated the compressional tectonics followed by the extensional tectonics. Our interpretation is supported with seismic up to second order sequence indicates - Late Jurassic sequence is a Highstand Systems Tract (Baisakhi - Bhadasar formations), and the Early Cretaceous sequence is Regressive to Lowstand System Tract (Pariwar Formation).

Keywords: Jaisalmer Basin, sequence stratigraphy, system tract, T-R cycle

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Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

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Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

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Authors: Mathew Nyashanu, George K. Kiggundu, Mandu S. Ekpenyong

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There is an increased number of young people engaging in early sexual relationships worldwide. Furthermore, statistics for early pregnancy among young people have also increased, especially in low and middle-income countries. This has health implications for both the parents and the baby. High uptake in family planning contraception among young people can reduce early pregnancy and subsequent negative health outcomes on the young parents and the baby. This study was set to explore the factors influencing the uptake of family planning contraceptive services among young people (18-24 years) at a community level in rural Budaka district, Uganda. The study utilised an explorative qualitative approach. The study found out that religion, partner resistance; perceived loss of libido, perceived barren, long waiting time and distance from the health facility, lack of privacy/confidentiality, excessive menstrual bleeding, cancer, and fear of having disabled babies, limited the utilisation of family planning contraceptive services while contraception as HIV prevention and child spacing encouraged young people to use family planning contraceptive services. There is a need for a culturally orientated community-based contraceptive health promotion approach to increase the uptake of family planning contraception services among young people.

Keywords: Young people, Family Planning, Contraceptives, Black sub-Sahara African

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Authors: Abdelrahman A. Ramzy, Bassel S. Abdallah, Mohamed E. Bahgat, Sarah M. Abdelkader, Sherif H. ElGohary

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Attention-Deficit/Hyperactivity Disorder (ADHD), epilepsy, and autism affect millions of children worldwide, many of which are undiagnosed despite the fact that all of these disorders are detectable in early childhood. Late diagnosis can cause severe problems due to the late treatment and to the misconceptions and lack of awareness as a whole towards these disorders. Moreover, electroencephalography (EEG) has played a vital role in the assessment of neural function in children. Therefore, quantitative EEG measurement will be utilized as a tool for use in the evaluation of patients who may have ADHD, epilepsy, and autism. We propose a screening tool that uses EEG signals and machine learning algorithms to detect these disorders at an early age in an automated manner. The proposed classifiers used with epilepsy as a step taken for the work done so far, provided an accuracy of approximately 97% using SVM, Naïve Bayes and Decision tree, while 98% using KNN, which gives hope for the work yet to be conducted.

Keywords: ADHD, autism, epilepsy, EEG, SVM

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Authors: C. Asarkaya, S. Z. Siretioglu Girgin

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Turkish migrants constitute the largest group among people with migration background living in Germany. Turkish women’s labor market participation is of significant importance for their social and economic integration to the German society. This paper thus aims to investigate their labor market positions. Turkish migrant women participate less in the labor market compared to men, and are responsible for most of the housework, child care, and elderly care. This is due to their traditional roles in the family, educational level, insufficient knowledge of German language, and insufficient professional experience. We strongly recommend that wide-reaching integration policies for women are formulated, so as to encourage participation of not only migrant women but also their husbands, fathers and/or brothers, and natives.

Keywords: empowerment, Germany, labor market, migration, Turkish, women

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Authors: Amardass Dhami, Clare Samuelson

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Background: Sickle cell disease (SCD) is a complex, multisystem condition that significantly impacts patients' quality of life, characterized by acute illness episodes, progressive organ damage, and reduced life expectancy. In the UK, over 13,000 individuals are affected, with South Yorkshire having the fifth highest prevalence, including approximately 800 patients. Retinal complications in SCD can manifest as either proliferative or non-proliferative disease, with proliferative changes being more prevalent. These retinal issues can cause significant morbidity, including visual loss and increased care requirements, underscoring the need for regular monitoring. An integrated approach was applied to ensure timely interventions, ultimately enhancing patient outcomes and reduce ‘did not attend’ rates. Aim: To assess the factors which may influence attendance to Haematology and Ophthalmology Clinics with attention towards levels of deprivation towards non-attendance. Method : A retrospective study on 84 eligible patients, from the regional tertiary Centre for Sickle Cell Care (Sheffield Teaching Hospital) from 2017 to 2023. The study focused on the incidence of sickle cell eye disease, specifically examining the outcomes of patients who attended the combined haematology and ophthalmology clinics. Patients who did not attend either clinic were excluded from the analysis to ensure a clear understanding of the combined clinic's impact. This data was then compared with the United Kingdom’s Index of Multiple Deprivation (IMD) datasets to assess if inequalities of care affected this population. Results: The study concluded that the effectiveness of combining haematology and ophthalmology clinics was reduced following the intervention. The DNA rates increased to 40% for the haematology clinic. Additionally, a significant proportion of the cohort was classified as residing in areas of deprivation, suggesting a possible link between socioeconomic factors and non-attendance rates Conclusion: These findings underscore the challenges of integrating care for SCD patients, particularly in relation to socioeconomic barriers. Despite the intent to streamline care and improve patient outcomes, the increase in DNA rates points to the need for further investigation into the underlying causes of non-attendance. Addressing these issues, especially in deprived areas, could enhance the effectiveness of combined clinics and ensure that patients receive the necessary monitoring and interventions for their eye health and overall well-being. Future strategies may need to focus on improving accessibility, outreach, and support for patients to mitigate the impact of socioeconomic factors on healthcare attendance.

Keywords: south yorkshire, sickle cell anemia, deprivation, factors, haematology

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Authors: Lindelwa Pepu

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Visual Arts and Visual Literacy are defined with distinction from one another. Visual Arts are known for art forms such as drawing, painting, and photography, just to name a few. At the same time, Visual Literacy is known for learning through images. The Visual Literacy phenomenon may be attributed to the use of images was first established for creating memories and enjoyment. As time evolved, images became the center and essential means of making contact between people. Gradually, images became a means for interpreting and understanding words through visuals, that being Visual Arts. The purpose of this study is to present the analogy of the two terms Visual Arts and Visual Literacy, which are defined and compared through early practicing visual artists as well as relevant researchers to reveal how they interrelate with one another. This is a qualitative study that uses an interpretive approach as it seeks to understand and explain the interest of the study. The results reveal correspondence of the analogy between the two terms through various writers of early and recent years. This study recommends the significance of the two terms and the role they play in relation to other fields of study.

Keywords: visual arts, visual literacy, pictures, images

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Authors: Ms Yaowaluck Ruampol

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The research on the development of using folk tales based on performance activities aimed to (1) study the development of speaking skill for early-childhood students, (2) evaluate the development of speaking skill before and after speaking activities. Ten students of Kindergarten level 2, who have enrolled in the subject of the research for speaking development of semester 2 in 2013, were purposively selected as the research cohort. The research tools were lesson plans for speaking activities and pre-posttest for speaking development that were approved for content validity and reliability (IOC=.66-1.00,0.967). The research found that the development of speaking skill of the research samples before using performance activities on folk tales in developing speaking skill was in the normal high level. Additionally, the results revealed that the preschoolers after applying speaking skill on performance activities also imaginatively created their speaking skill.

Keywords: speaking development, folk tales, performance activities, communication engineering

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Authors: Jamal Shokrzadehmadiyeh, Kambiz Kamkari, Shohreh Shokrzadeh

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According to the research topic, the purpose of the current paper is to research personality characteristics in adolescents under the care of the Tehran Juvenile Detention Centre, and a survey research method has been used. In this regard, through systematic random sampling, 120 people from the research population were selected as a sample, who were referred to Tehran Juvenile Detention Centre after the decision was reached by the court. Data collection was carried out by separate examination using NEO-PI-III personality inventory, and statistical analysis was done using a one-sample t-test. Finally, the results of the research revealed that the level of neuroticism is higher than the average level, the level of conscientiousness is lower than the average level, and the level of extraversion, agreeableness, and openness are at the average level.

Keywords: personality characteristics, adolescents, Juvenile Detention Center, Tehran city

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Authors: Tejasvi Parupudi, Mochen Li, Lakshya Mittal, Ignacio G. Camarillo, Raji Sundararajan

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With breast cancer becoming a global pandemic, it is very important to assess a woman’s risk profile accurately in a timely manner. Providing an estimate of the risk of developing breast cancer to a woman gives her an opportunity to consider options to decrease this risk. Women at low risk may be suggested yearly screenings whereas women with a high risk of developing breast cancer would be candidates for aggressive surveillance. Fortunately, there is a set of risk factors that are used to predict the probability of a woman being diagnosed with breast cancer in the future. Studying risk factors and understanding how they correlate to cancer is important for early diagnosis, prevention and reducing mortality rates. The effect of crucial risk factors among black and white women was compared in this study. The various risk factors analyzed include breast density, age, cancer in a first-degree relative, menopausal status, body mass index (BMI) and prior breast cancer diagnosis, etc. Breast density, age at first full-term birth and BMI were utilized in this study as important risk factors for the comparison of incidence rates between women of black and white races in the USA. Understanding the differences could lead to the development of solutions to reduce disparity in mortality rates among black women by improving overall access to care.

Keywords: big data, breast cancer, risk factors, incidence rates, mortality, race

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Authors: Anantdeep Kaur, Sharanjeet Singh

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Early childhood education and assessment of children is a very essential tool that helps them in their growth and development. Techniques should be developed, and tools should be created in this field as it is a very important learning phase of life. Some information and sources are included for student assessment to provide a record of growth in all developmental areas cognitive, physical, Language, social-emotional, and approaches to learning. As an early childhood educator, it is very important to identify children who need special support and counseling to improve them because they are not mentally mature to discuss with the teacher their problems and needs. It is the duty and responsibility of the educator to assess children from their body language, behavior, and their routine actions about their skills that can be improved and which can take them forward in their future life. And also, children should be assessed with their weaker points because this is the right time to correct them, and they be improved with certain methods and tools by working on them constantly. Observing children regularly with all their facets of development, including intellectual, linguistic, social-emotional, and physical development. Every day, a physical education class should be regulated to check their physical growth activities, which can help to assess their physical activeness and motor abilities. When they are outside on the playgrounds, it is very important to instill environmental understanding among them so that they should know that they are very part of this nature, and it will help them to be one with the universe rather than feeling themselves individually. This technique assists them in living their childhood full of energy all the time. All types of assessments have unique purposes. It is important first to determine what should be measured, then find the program that best assesses those.

Keywords: special needs, motor ability, environmental understanding, physical development

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Authors: Rohit Kothari

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Background: Leprosyis a chronic granulomatous diseasecaused by Mycobacterium leprae (M. Lepra). Reactions may interrupt its usual chronic course.Type-1 (T1R)and type-2 lepra reaction(T2R) are acute events and signifytype-IV and type-III hypersensitivity responses, respectively. Various chemokines like CCL3, 5, 11, and CCL24 may be increased during the course of leprosy or during reactions and may serve as markers of early diagnosis, response to therapy, and prognosis. Objective: To find correlation of CCL3, 5, 11, and CCL24 in leprosy patients on multidrug therapy and their family contacts after ruling out active disease during leprosy treatment and during periods of lepra reactions. Methodology: This randomized control trial was conducted in 50 clinico-histopathologically diagnosed cases of leprosy in a tertiary care hospital in Bengaluru, India. 50 of their family contacts were adequately examined and investigated should the need be to rule out active disease. The two study-groups comprised of leprosy cases, and the age, sex, and area of residence matched healthy contactswho were given single-dose rifampicin prophylaxis, respectively. Blood samples were taken at baseline, six months, and after one yearin both the groups (on completion of MDT in leprosy cases)and also during periods of reaction if occurred in leprosy cases. Results: Our study found that at baseline, CCL5, 11, and 24 were higher in leprosy cases as compared to the healthy contacts, and the difference was statistically significant.CCL3 was also found to be higherat baseline in leprosy cases, however, the difference was not statistically significant. At six months and one year, the levels of CCL 5, 11, and 24 reduced, and the difference was statistically significant in leprosy cases, whereas it remained almost static in all the healthy contacts. Twenty patients of leprosy developed lepra reaction during the course of one year, and during reaction, the increase in CCL11 and 24 was statistically significant from baseline, whereas CCL3 and 5 did not rise significantly. One of the healthy contacts developed signs of leprosy in the form of hypopigmented numb patch and was clinico-histopathologically, and CCL11 and 24 were found to be higher with a statistically significant difference from the baseline values. Conclusion: CCL5, 11, and 24 are sensitive markers of diagnosing leprosy, response to MDT, and prognosis and are not increased in healthy contacts. CCL11 and 24 are sensitive markers of lepra reactions and may serve as one of the early diagnostic modalities for identifying lepra reaction and also leprosy in healthy contacts. To the best of our knowledge, this is the first study to evaluate these biomarkers in leprosy cases and their healthy contacts with a follow-up of upto one year with one of them developing the disease, and the same was confirmed based on these biomarkers as well.

Keywords: chemokine profile, healthy contacts, leprosy, lepra reactions

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Authors: Meryem Saban Guler, Saniye Bilici

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Malnutrition is a problem that significantly affects patients with cancer throughout the course of their illness, and it may be present from the moment of diagnosis until the end of treatment. We searched electronic databases using key terms such as ‘malnutrition in cancer patients’ or ‘nutritional status in cancer’ or ‘nutritional screening tools’ etc. Decline in nutritional status and continuing weight loss are associated with an increase in number and severity of complications, impaired quality of life and decreased survival rate. Nutrition is an important factor in the treatment and progression of cancer. Cancer patients are particularly susceptible to nutritional depletion due to the combined effects of the malignant disease and its treatment. With increasing incidence of cancer, identification and management of nutritional deficiencies are needed. Early identification of malnutrition, is substantial to minimize or prevent undesirable outcomes throughout clinical course. In determining the nutritional status; food consumption status, anthropometric methods, laboratory tests, clinical symptoms, psychosocial data are used. First-line strategies must include routine screening and identification of inpatients or outpatients at nutritional risk with the use of a simple and standardized screening tool. There is agreement among international nutrition organizations and accredited health care organizations that routine nutritional screening should be a standard procedure for every patient admitted to a hospital. There are f management of all cancer patients therefore routine nutritional screening with validated tools can identify cancer patients at risk.

Keywords: cancer, malnutrition, nutrition, nutritional screening

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Authors: Olusegun D. Badewa, E. K. Tsado, A. S. Gana, K. D. Tolorunse, R. U. Okechukwu, P. Iluebbey, S. Ibrahim

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Farmers are faced with varying production challenges ranging from unstable weather due to climate change, low yield, malnutrition, cattle invasion, and bush fires that have always affected their livelihood. Research effort must therefore be centered on improving farmers’ livelihood, nutrition, and health by providing early bulking biofortified cassava varieties that could be harvested earlier with reasonable root yield and thereby preventing long stay of the crop on their farmland. This study evaluated cassava genotypes at different harvesting months of 3, 6, 9, and 12 months after planting in order to evaluate their bulking rate at different agroecology of Mokwa and Ubiaja. Data were collected on fresh storage root yield, Harvest index, and Dry matter content. It was shown from the study that traits FSRY, HI, and DM were significant for genotype and months after planting and variable among the genotype while location had no effect on the yield traits. Early bulking genotypes were not high yielding and showed discontinuity at some point across the months. The retrogression in yield performance across months had no effect on the highest yielding. Also, for all the genotypes and across evaluated months, FSRY reduces at 9 MAP due to a reduction in dry matter content during the same month, and the best performing genotype was the genotype IBA90581, followed by IBA120036, IBA130896, and IBA980581 while the least performing was genotype IBA130818.

Keywords: early bulking, dry mater, harvest index, high yielding, root yield

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Authors: Yaser Meeralam, Walaa Alharthi, Hadeel Ashi, Alaa Bakhsh, Kholood Aljabri, Ebtihal Bin Salim

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Background:Basidiobolusranrum causes one of the rare fungal diseases that infects mainly immunocompetent individuals. Gastrointestinal Basidiobolomycosis (GIB) is a rare and uncommon form of this fungal infection. It’s still ambiguous how this fungus is reaching the gastrointestinal tract leading to Gastrointestinal Basidiobolomycosis. Objective: To summarize the clinical features, imaging, and histopathological of patients diagnosed with GIB in our institution. Patients and methods: A series of five cases of patients who diagnosed by basidiobolomycosis in King Abdullah Medical City, Makkah, Saudi Arabia, which reviewed by latest literature related to diagnosis and treatment. Results: Most of the patients were externally evaluated and were initially misdiagnosed. Some of them were suspected of colonic malignancy, other presumed to have hepatic hemangioma and fistulizing crohn’s disease. The definitive diagnosis is often based on histopathological examination and fungal culture of the surgically resected mass. An optimum standardized treatment of basidiobolomycosis has not yet been established. Conclusion: Deeper knowledge of clinical characteristics, diagnosis, and treatment of basidiobolomycosis will allow early initiating of treatment with a subsequent positive impact on the patients’ outcome. More studies are needed to establish a definite treatment.

Keywords: gastrointestinal infection, crohn's mimics, malignancy mimics, fungal infection

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Authors: Antonia Harold-Barry, Eugene Dempsey

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Background: The objective is to examine the survival and outcome of infants born under 26 weeks gestation in an Irish tertiary maternity hospital from 2007-2016 and to describe the survival and neurodevelopmental outcomes of these extremely preterm infants. Method: The population is 132 infants born at 23, 24, and 25 weeks in Cork University Maternity Hospital from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayley scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions, and comparisons between data from 2007-2011 and 2012-2016. Results: Overall survival rate was 63%. Of the surviving babies, 61% had Bayley scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks, and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival, with 50% of babies at 23 weeks, 58% at 24 weeks, and 89% at 25 weeks. Corresponding figures for 2007-2011 are 20%, 39%, and 75%. Gestational age and incidence of periventricular leukomalacia were statistically significant, with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025, as did gestational age and birth weight. A comparison of the two cohorts (2007-2011 and 2012-2016) with the administration of antenatal steroids showed a statistically significant p-value of 0.044. Conclusion: There is less morbidity and mortality in infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past ten years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents about the potential outcomes of extreme prematurity and policy regarding the management of extreme prematurity.

Keywords: extreme of viability, neurodevelopmental outcome, periventricular leukomalacia, prematurity

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Authors: Naseem M. Twaissi

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Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.

Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry

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Authors: Ya-Ping Chang

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Starting from the early stages of pregnancy, parents begin to form hopes and dreams about the future of their child. They will think about the appearance and personality of their child and may even develop many expectations. The patient in this study experienced a successful pregnancy following multiple attempts at artificial insemination. However, due to arrested embryonic development, and based on the physician’s evaluation, a caesarean section was performed at week 25. However, the baby suffered from infections and subsequently died from multiple organ failures. This study collected and analyzed objective and subjective data through observation, interviews, recording, and interactions with the patient. The following nursing issues of the patient were identified: anxiety, anticipatory grief, and adjustment disorder. The psychology of caring as proposed in Watson’s theory was applied to address these nursing issues. Comprehensive and continuous care was provided to the patient on the basis of mutual trust and individual nursing guidelines in order to alleviate the patient’s anxiety, help her to cope with grief, and prepare her for the eventual death of her child. The author helped the patient to say goodbye to her child and accept the child’s death calmly, such that she had no regrets about the experience. This nursing experience may serve as a reference to nurses managing similar cases in the future.

Keywords: dying baby, mother, grief, Watson’s theory

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Authors: Zahra BehboodiI-Moghadam, Zohre Khalajinia, Ali Reza Nikbakht Nasrabadi, Minoo Mohraz

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The purpose of our study was to explore and describe the experiences of pregnant women with HIV in Iran. A qualitative exploratory study with conventional content analysis was used. Twelve pregnant women with HIV who referred to perinatal care at the Imam Khomeini Hospital Behavioral Diseases Consultation: Center in Tehran were recruited to participate in in-depth interviews. The average age of the participants was 32.5 years. Four main themes were extracted from the data: “fear and hope, “stigma and discrimination, “marital life stability” and “trust”. The findings reveal the pregnant women living with HIV are vulnerable and need professional support. Improving the knowledge of healthcare professionals especially midwifes on pregnancy complications for women with HIV is crucial in order to provide high-quality care to pregnant women with HIV-positive.

Keywords: HIV, pregnancy, content analysis, experiences, Iran, qualitative research

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Authors: Anthony J. Kondracki, Bonzo Reddick, Jennifer L. Barkin

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Background: Many pregnancies in the United States are affected each year with the most common sexually transmitted infections (STIs), including Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Treponema pallidum (TP, syphilis), and the rate of congenital syphilis has reached a 20-year high. We sought to estimate the prevalence of CT, NG, and TP in pregnancy and the risk of preterm birth (PTB) (<37 weeks gestation) and low birthweight (LBW) (<2500g) deliveries according to utilization of prenatal care (PNC) during the COVID-19 pandemic. Methods: This study was based on the 2020 National Center for Health Statistics (NCHS) Natality File restricted to singleton births (N=3,512,858). We estimated the prevalence of CT, NG, TP, PTBand LBW across timing and the number of prenatal care (PNC) visits attended. In multivariable logistic regression models, adjusted odds ratios of PTB and LBW were assessed according to STIs and PNC status. E-values, based on effect size estimates and the lower bound of the 95% confidence intervals (CIs) of the association, examined the potential impact of unmeasured confounding. Results: CT (1.8%) was most prevalent in pregnancy, followed by NG (0.3%) and TP (0.1%). The strongest predictors of PTB and LBW were maternal NG (12.2% and 12.1%, respectively), late initiation/no PNC (8.5% and 7.6%, respectively), and ≤10 prenatal visits (13.1% and 10.3%, respectively). The odds of PTB and LBW were 2.5- to 3-fold greater for each STI in women who received ≤10 compared to >10 prenatal visits. E-values demonstrated the minimum strength of potential unmeasured confounding necessary to explain away observed associations. Conclusions: Timely initiation and receipt of recommended number of prenatal visits benefits screening and treatment of all women for STIs, including NG to substantially reduce infant morbidity and mortality related to PTB and LBW among infants born during the COVID-19 pandemic.

Keywords: COVID-19 pandemic, sexually transmitted infections, preterm birth, low birthweight, prenatal care

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Authors: Manisha Singh, Padam Simkhada

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Background: Although mental health policy has been adapted in Nepal since 1997, the implementation of the policy framework is yet to happen. The fact that mental health services are largely concentrated in urban areas more specific to treatment only provides a clear picture of the scarcity of mental health services in the country. The shreds of evidence from around the world, along with WHO’s (World Health Organization) Mental Health Gap Action Program (mhGAP) suggest that effective mental health services can be provided from Primary Health Care (PHC) centers through community-based programs without having to place a specialized health worker. However, the country is still facing the same challenges to date with very few psychiatrists and psychologists, but they are largely based in cities. Objectives: The main objectives of this study are; (a) to understand the perception of health workers at PHC on maternal mental health, and (b) to assess the availability of the mental health services at PHC to address maternal mental health. Methods: This study used a qualitative approach where an in-depth interview was conducted with the health workers at the primary level. “Mayadevi” rural municipality in Rupendehi District that comprised of 13 small villages, was chosen as the study site. A total 8 health institutions which covered all 13 sites were included where either the health post in- charge or health worker working in maternal and child health care was interviewed for the study. All the health posts in the study area were included in the study. The interviews were conducted in Nepali; later, they were translated in English, transcribed, and triangulated. NViVO was used for the analysis. Results: The findings show that most of the health workers understood what maternal mental health was and deemed it as a public health issue. They could explain the symptoms and knew what medication to prescribe if need be. However, the majority of them failed to name the screening tools in place for maternal mental health. Moreover, they hadn’t even seen one. None of the health care centers had any provision for screening mental health status. However, one of the centers prescribed medication when the patients displayed symptoms of depression. But they believed there were a significant number of hidden cases in the community due to the stigma around mental health and being a woman with mental health problem makes the situation even difficult. Nonetheless, the health workers understood the importance of having screening tools and acknowledged the need of training and support in order to provide the services from PHC. Conclusion: Community health workers can identify cases with mental health problems and prevent them from deteriorating further. But there is a need for robust training and support to build the capacity of the health workers. The screening tools on mental health needs to be encouraged to be used in the PHC levels. Furthermore, community-based culture-sensitive programs need to be initiated and implemented to mitigate the stigma related issues around mental health.

Keywords: maternal mental health, health care providers, screening, Nepal

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Authors: Ahmeda Ali, Mary Codd, Susan Brundage

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Importance: This research focuses on devising and improving Health Service Executive (HSE) policy and legislation and therefore improving patient trauma care and outcomes in Ireland. Objectives: The study measures components of the Trauma System in the district hospital setting of the Cavan/Monaghan Hospital Group (CMHG), HSE, Ireland, and uses the collected data to identify the strengths and weaknesses of the CMHG Trauma System organisation, to include governance, injury data, prevention and quality improvement, scene care and facility-based care, and rehabilitation. The information will be made available to local policy makers to provide objective situational analysis to assist in future trauma service planning and service provision. Design, setting and participants: From 28 April to May 28, 2016 a cross-sectional survey using World Health Organisation (WHO) Trauma System Assessment Tool (TSAT) was conducted among healthcare professionals directly involved in the level III trauma system of CMHG. Main outcomes: Identification of the strengths and weaknesses of the Trauma System of CMHG. Results: The participants who reported inadequate funding for pre hospital (62.3%) and facility based trauma care at CMHG (52.5%) were high. Thirty four (55.7%) respondents reported that a national trauma registry (TARN) exists but electronic health records are still not used in trauma care. Twenty one respondents (34.4%) reported that there are system wide protocols for determining patient destination and adequate, comprehensive legislation governing the use of ambulances was enforced, however, there is a lack of a reliable advisory service. Over 40% of the respondents reported uncertainty of the injury prevention programmes available in Ireland; as well as the allocated government funding for injury and violence prevention. Conclusions: The results of this study contributed to a comprehensive assessment of the trauma system organisation. The major findings of the study identified three fundamental areas: the inadequate funding at CMHG, the QI techniques and corrective strategies used, and the unfamiliarity of existing prevention strategies. The findings direct the need for further research to guide future development of the trauma system at CMHG (and in Ireland as a whole) in order to maximise best practice and to improve functional and life outcomes.

Keywords: trauma, education, management, system

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Authors: Xiaoyang Zhao, Kaiying Wang

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The choice of stocking density in poultry farming is a potential way for determining welfare level of poultry. However, it is difficult to measure stocking densities in poultry farming because of a lot of variables such as species, age and weight, feeding way, house structure and geographical location in different broiler houses. A method was proposed in this paper to measure the differences of young broilers reared under different stocking densities by sound analysis. Vocalisations of broilers were recorded and analysed under different stocking densities to identify the relationship between sounds and stocking densities. Recordings were made continuously for three-week-old chickens in order to evaluate the variation of sounds emitted by the animals at the beginning. The experimental trial was carried out in an indoor reared broiler farm; the audio recording procedures lasted for 5 days. Broilers were divided into 5 groups, stocking density treatments were 8/m², 10/m², 12/m² (96birds/pen), 14/m² and 16/m², all conditions including ventilation and feed conditions were kept same except from stocking densities in every group. The recordings and analysis of sounds of chickens were made noninvasively. Sound recordings were manually analysed and labelled using sound analysis software: GoldWave Digital Audio Editor. After sound acquisition process, the Mel Frequency Cepstrum Coefficients (MFCC) was extracted from sound data, and the Support Vector Machine (SVM) was used as an early detector and classifier. This preliminary study, conducted in an indoor reared broiler farm shows that this method can be used to classify sounds of chickens under different densities economically (only a cheap microphone and recorder can be used), the classification accuracy is 85.7%. This method can predict the optimum stocking density of broilers with the complement of animal welfare indicators, animal productive indicators and so on.

Keywords: broiler, stocking density, poultry farming, sound monitoring, Mel Frequency Cepstrum Coefficients (MFCC), Support Vector Machine (SVM)

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Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli

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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.

Keywords: consumer health, health informatics, hospital information system, universal medical record number

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