Search results for: Tikur Anbesa specialized hospital

Authors: Amir Nazemi, Milad Ramezankhani, Marian Kӧrber, Abbas S. Milani

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The excellent strength to weight ratio of woven fabric composites, along with their high formability, is one of the primary design parameters defining their increased use in modern manufacturing processes, including those in aerospace and automotive. However, for emerging automated preform processes under the smart manufacturing paradigm, complex geometries of finished components continue to bring several challenges to the designers to cope with manufacturing defects on site. Wrinklinge. g. is a common defectoccurring during the forming process and handling of semi-finished textile composites. One of the main reasons for this defect is the weak bending stiffness of fibers in unconsolidated state, causing excessive relative motion between them. Further challenges are represented by the automated handling of large-area fiber blanks with specialized gripper systems. For fabric composites forming simulations, the finite element (FE)method is a longstanding tool usedfor prediction and mitigation of manufacturing defects. Such simulations are predominately meant, not only to predict the onset, growth, and shape of wrinkles but also to determine the best processing condition that can yield optimized positioning of the fibers upon forming (or robot handling in the automated processes case). However, the need for use of small-time steps via explicit FE codes, facing numerical instabilities, as well as large computational time, are among notable drawbacks of the current FEtools, hindering their extensive use as fast and yet efficient digital twins in industry. This paper presents a novel woven fabric simulation technique through the application of the material point method (MPM), which enables the use of much larger time steps, facing less numerical instabilities, hence the ability to run significantly faster and efficient simulationsfor fabric materials handling and forming processes. Therefore, this method has the ability to enhance the development of automated fiber handling and preform processes by calculating the physical interactions with the MPM fiber models and rigid tool components. This enables the designers to virtually develop, test, and optimize their processes based on either algorithmicor Machine Learning applications. As a preliminary case study, forming of a hemispherical plain weave is shown, and the results are compared to theFE simulations, as well as experiments.

Keywords: material point method, woven fabric composites, forming, material handling

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Authors: Muhammad Munir, Riffat Mehboob, Samina Naeem, Muhammad Salman, Shehryar Ahmed, Irshad Hussain Qureshi, Tahira Murtaza Cheema, Ashraf Sultan, Akmal Laeeq, Nakhshab Choudhry, Asad Aslam Khan, Fridoon Jawad Ahmad

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A dengue outbreak in Lahore, Pakistan during 2011 was unprecedented in terms of severity and magnitude. This research aims to determine the serotype distribution of dengue virus during this outbreak and classify the patients demographically. 5ml of venous blood was drawn aseptically from 166 patients with dengue-like signs to test for the virus between the months of August to November 2011. The samples were sent to the CDC, Atlanta, Georgia for the purpose of molecular assays to determine their serotype. RT-PCR protocol was performed targeting at the 4 dengue serotypes. Out of 166 cases, dengue infection was detected with RT-PCR in 95 cases, all infected with same serotype DEN-2. 75% of positive cases were males while 25% were females. Most positive patients were in the age range of 16-30 years. 33% positive cases had accompanying bleeding. This is first study during the 2011 dengue epidemic in Lahore that reports DEN-2 as the only prevalent serotype. It also indicates that more infected patients were males, adults, within age range of 16-30 years, peaked in the month of November, Dengue hemorrhagic fever (DHF) is manifested more in females, Ravi town was heavily hit by dengue virus infection.

Keywords: dengue, serotypes, Pakistan, DEN 2, Lahore, demography, serotype distrbution, 2011 epidemic

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Authors: Afolabi Joseph Fasoranti

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Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis. Tuberculosis is a major public health problem in Nigeria, being one of the ten leading causes of hospital admissions and a leading cause of death in adults, especially among the economically productive age group. This paper critically examined the importance of health education towards the eradication and prevention of tuberculosis in Nigeria. It was reviewed and discussed under the following subheadings; Global burden of tuberculosis in Nigeria, concept, definition and etiology of tuberculosis, Signs and symptoms of tuberculosis, diagnosis of tuberculosis, causative agent, modes of infection and incubation period, risk factors of pulmonary tuberculosis Dots and stop TB programmes in Nigeria Treatment and prevention of tuberculosis TB treatment strategies, Dealing with treatment problems in Nigeria Stigmatization against Tuberculosis Patients Health education as a tool for achieving free tuberculosis country. Emphasis for Tb control has been placed on the development of improved vaccines, diagnostic and treatment courses but less on health education and awareness. Although the need for these tools is indisputable, the obstacle facing the spread of TB go beyond technological. The findings of this study may stimulate health system policy makers, Government and non- governmental organizations, donor agencies and other stakeholders in planning and designing health education intervention programs on the control and eradication of tuberculosis. It therefore recommended that Government should implement health education as part of the DOTs, this will thus empower the tuberculosis patients on ways to live healthy, lifestyle, in doing this, they will recover fast and prevent them from spreading the disease.

Keywords: tuberculosis, health education, panacea, Nigeria, prevention

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Authors: Davoud Maleki

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Today, education and investment in human capital is a long-term investment without which the economy will be stagnant Stayed. Higher education represents a type of investment in human resources by providing and improving knowledge, skills and Attitudes help economic development. Providing efficient human resources by increasing the efficiency and productivity of people and on the other hand with Expanding the boundaries of knowledge and technology and promoting technology such as the responsibility of training human resources and increasing productivity and efficiency in High specialized levels are the responsibility of universities. Therefore, the university plays an infrastructural role in economic development and growth because education by creating skills and expertise in people and improving their ability.In recent decades, Iran's higher education system has been faced with many problems, therefore, scholars have looked for it is to identify and validate the causal factors affecting the responsiveness and productivity of non-governmental universities. The data in the qualitative part is the result of semi-structured interviews with 25 senior and middle managers working in the units It was Islamic Azad University of Tehran province, which was selected by theoretical sampling method. In data analysis, stepwise method and Analytical techniques of Strauss and Corbin (1992) were used. After determining the central category (answering for the sake of the beneficiaries) and using it in order to bring the categories, expressions and ideas that express the relationships between the main categories and In the end, six main categories were identified as causal factors affecting the university's responsiveness and productivity.They are: 1- Scientism 2- Human resources 3- Creating motivation in the university 4- Development based on needs assessment 5- Teaching process and Learning 6- University quality evaluation. In order to validate the response model obtained from the qualitative stage, a questionnaire The questionnaire was prepared and the answers of 146 students of Master's degree and Doctorate of Islamic Azad University located in Tehran province were received. Quantitative data in the form of descriptive data analysis, first and second stage factor analysis using SPSS and Amos23 software were analyzed. The findings of the research indicated the relationship between the central category and the causal factors affecting the response The results of the model test in the quantitative stage confirmed the generality of the conceptual model.

Keywords: accountability, productivity, non-governmental, universities, foundation data theory

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Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

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Authors: Fatema Salman, Ridha Hammam, Fatima Khairallah, Fatima Aradi, Nafeesa Abdulla, Mohammed Alsafar

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Purpose: This study aims at measuring the extent of nurses’ knowledge and attitudes toward the use of physical restraints in different hospital wards at Salmaniya Medical Complex (SMC). Background: The habitual use of physical restraint is a widespread practice among nurses working in the clinical settings. Restraints inflict many deleterious consequences on patients physically and psychologically which in turn increases their morbidity and mortality risk and jeopardizes care quality. Nurses’ knowledge and attitudes toward physical restraints are crucial determinants of the persistence of this practice. Literature review: the evidence of lack of knowledge among nurses regarding the use of physical restraints is overwhelming in various clinical settings, especially in two main areas which are the negative consequences and the available alternatives to physical restraints. Studies explored nurses’ attitudes toward physical restraints yielded inconsistent findings. Equally comparable, some studies found that nurses hold positive attitudes toward the use of physical restraints while some others reported just the opposite. Methods: Self-administered knowledge and attitudes scales to 106 nurses working in the SMC. Findings: nurses hold the moderate level of knowledge about restraints (M=58%) with weak negative attitudes (M = -20%) toward using it. Significant moderately-strong negative correlation (r= -0.57, r2= 0.32, p= 0.000) was uncovered between nurses knowledge and their attitudes which provided an empirical explanation of this phenomenon (use of physical restraints). Recommendations: Induction of awareness program that especially focuses on the negative consequences and encourages the use of alternatives is an evident need. This effort necessarily should be adjoined with policy and procedure adjustments.

Keywords: attitudes, knowledge, nurses, restraints

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Authors: Ganesh Nivrutti Akhade

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This paper attempts to develop a reliable and valid instrument of measuring Healthcare service quality in India, and also analyses the impact of demographic factor of respondent on healthcare service quality. In this research paper , extant literature survey, discussion with stakeholder of healthcare system such as patients, patients relative, administrators of hospitals, clinics, professionals and expert interviews were used to develop a attributes of healthcare service quality dimensions. A pilot study was conducted with a sample of 31 healthcare patients of private sector, public sector ,trust hospital ,primary health care centers and clinics was surveyed in the Nagpur Metropolitan Area. At the end fifteen dimensions—reliability, assurance, responsiveness, tangibility, empathy, affordability, respect, and caring, Attitude of staff, Technical competence, Appropriateness, Safety, continuity, Effectiveness, Availability, Financial support. This fifteen-dimensional model was validated through a content validity and construct validity. The proposed research model shows acceptable fit indices. Impact of these dimensions on the Overall Healthcare Service Quality and customer satisfaction are analyzed using multiple regression technique. Findings indicate that all dimensions carry significant impact on the Overall Healthcare Service Quality perceptions and customer satisfaction. However, availability and effectiveness dimensions carry the maximum impact on the Overall healthcare Service Quality .

Keywords: healthcare, service quality, factor analysis (CFA), india, service quality dimensions

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Authors: H. N. S. Silva, S. N. Silva

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Introduction: The latest WHO data published in 2014 states that Sri Lanka has reached 2,773 of total deaths and over 14000 individuals’ sustained injuries due to RTAs each year. It was noticed in previous studies that policemen, three wheel drivers and also pedestrians were the first to respond to RTAs but the victim’s condition was aggravated due to unskilled attempts made by the responders while management of the victim’s wounds, moving and positioning of the victims and also mainly while transportation of the victims. Objective: To observe the practices of the urban public in Sri Lanka who are encountered with RTAs. Methods: A qualitative study was done to analyze public behavior seen on video recordings of scenes of accidents purposefully selected from social media, news websites, YouTube and Google. Results: The results showed that all individuals who tried to help during the RTA were middle aged men, who were mainly pedestrians, motorcyclists and policemen during that moment. Vast majority were very keen to actively help the victims to get to hospital as soon as possible and actively participated in providing 'aid'. But main problem was the first aid attempts were disorganized and uncoordinated. Even though all individuals knew how to control external bleeding, none of them was aware of spinal prevention techniques or management of limb injuries. Most of the transportation methods and transfer techniques used were inappropriate and more injury prone. Conclusions: The public actively engages in providing aid despite their inappropriate practices in giving first aid.

Keywords: encountered, pedestrians, road traffic accidents, urban public

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Authors: Balaji Devanathan, Gokul G., Raveena Divya, Abhishek Yadav, Sudhir K. Gupta

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Background: Age estimation is a common problem in administrative settings, medico legal cases, and among athletes competing in different sports. Age estimation is a problem in medico legal problems that arise in hospitals when there has been a criminal abortion, when consenting to surgery or a general physical examination, when there has been infanticide, impotence, sterility, etc. Medical imaging progress has benefited forensic anthropology in various ways, most notably in the area of determining bone age. An efficient method for researching the epiphyseal union and other differences in the body's bones and joints is multi-slice computed tomography. There isn't a significant database on Indians available. So to obtain an Indian based database author has performed this original study. Methodologies: The appearance and fusion of ossification centre of sternoclavicular joint is evaluated, and grades were assigned accordingly. Using MSCT scans, we examined the relationship between the age of the deceased and alterations in the sternoclavicular joint during the appearance and union in 500 instances, 327 men and 173 females, in the age range of 0 to 25 years. Results: According to our research in both the male and female groups, the ossification centre for the medial end of the clavicle first appeared between the ages of 18.5 and 17.1 respectively. The age range of the partial union was 20.4 and 20.2 years old. The earliest age of complete fusion was 23 years for males and 22 years for females. For fusion of their sternebrae into one, age range is 11–24 years for females and 17–24 years. The fusion of the third and fourth sternebrae was completed by 11 years. The fusions of the first and second and second and third sternebrae occur by the age of 17 years. Furthermore, correlation and reliability were carried out which yielded significant results. Conclusion: With numerous exceptions, the projected values are consistent with a large number of the previously developed age charts. These variations may be caused by the ethnic or regional heterogeneity in the ossification pattern among the population under study. The pattern of bone maturation did not significantly differ between the sexes, according to the study. The study's age range was 0 to 25 years, and for obvious reasons, the majority of the occurrences occurred in the last five years, or between 20 and 25 years of age. This resulted in a comparatively smaller study population for the 12–18 age group, where age estimate is crucial because of current legal requirements. It will require specialized PMCT research in this age range to produce population standard charts for age estimate. The medial end of the clavicle is one of several ossification foci that are being thoroughly investigated since they are challenging to assess with a traditional X-ray examination. Combining the two has been shown to be a valid result when it comes to raising the age beyond eighteen.

Keywords: age estimation, sternoclavicular joint, medial clavicle, computed tomography

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Authors: Rasheed F. G., Hassan H. A., Shehu F. A., Mukhtar M. M., Muhammad Y. Y., Ibrahim S. S., Shehu D., Abdulsalam K., N. Abdullahi

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A cross sectional randomized, descriptive cross sectional study was conducted on the frequency of GSTT1 null alleles in patients diagnosed with type-2-diabetes mellitus (T2DM). A total of 40 patients with T2DM and 10 non-diabetic controls were included in the study. GSTT1 null-alleles genotyping was carried out using multiplex PCR amplification to amplify GSTT1 gene (460bp) while using β-globulin (250bp) as an internal control. The results showed that 55% of T2DM patients had BMI within reference limits, 13% are overweight. Additionally, patients with T2DM were found to have significantly higher (p<0.05) serum levels of glucose, total cholesterol, triglyceride and low density lipoprotein. Furthermore, the presence of null genotype of GSTT1 (deletion in GSTT1) was observed in 28% of diabetic patients. Subjects with GSTT1 deletion have significantly higher (p<0.05) levels of serum glucose, low-density lipoprotein and total cholesterol when compared with individuals without deletion (diabetic and non-diabetic). This results suggests that the deletion of GSTT1 gene might serve as a predisposing factor in the development of T2DM and dyslipideamia

Keywords: diabetes, glutathione-S-transferase, lipid profile, PCR, polymorphism.

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Authors: Nana Benma Osei

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Patient discharge can be a hectic process. Patients are sometimes sent to the wrong location or forgotten in lounges in the waiting room. This ends up compromising patient care because the delay in picking the patients can affect how they adhere to medication. Patients may fail to take their medication, and this will lead to negative outcomes. The situation highlights the demands of modern-day healthcare, and the use of technology can help in reducing such challenges and in enhancing the patient’s experience, leading to greater satisfaction with the care provided. The paper contains the proposed changes to a healthcare facility by introducing the clinical decision support system, which will be needed to improve coordination and communication during patient discharge. This will be done under Kurt Lewin’s Change Management Model, which recognizes the different phases in the change process. A pilot program is proposed initially before the program can be implemented in the entire organization. This allows for the identification of challenges and ways of managing them. The paper anticipates some of the possible challenges that may arise during implementation, and a multi-disciplinary approach is considered the most effective. Opposition to the change is likely to arise because staff members may lack information on how the changes will affect them and the skills they will need to learn to use the new system. Training will occur before the technology can be implemented. Every member will go for training, and adequate time is allocated for training purposes. A comparison of data will determine whether the project has succeeded.

Keywords: patient discharge, clinical decision support system, communication, collaboration

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Authors: Igor Pejic

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The main focus of this research will be on analyzing correlative links between terrorism as an asymmetrical threat and the consequences it leaves on conventional security forces. The methodology behind the research will include qualitative research methods focusing on comparative analysis of books, scientific papers, documents and other sources, in order to deduce, explore and formulate the results of the research. With the coming of the 21^st century and the rising multi-polar, new world threats quickly emerged. The realistic approach in international relations deems that relations among nations are in a constant state of anarchy since there are no definitive rules and the distribution of power varies widely. International relations are further characterized by egoistic and self-orientated human nature, anarchy or absence of a higher government, security and lack of morality. The asymmetry of power is also reflected on countries' security capabilities and its abilities to project power. With the coming of the new millennia and the rising multi-polar world order, the asymmetry of power can be also added as an important trait of the global society which consequently brought new threats. Among various others, terrorism is probably the most well-known, well-based and well-spread asymmetric threat. In today's global political arena, terrorism is used by state and non-state actors to fulfill their political agendas. Terrorism is used as an all-inclusive tool for regime change, subversion or a revolution. Although the nature of terrorist groups is somewhat inconsistent, terrorism as a security and social phenomenon has a one constant which is reflected in its political dimension. The state's security apparatus, which was embodied in the form of conventional armed forces, is now becoming fragile, unable to tackle new threats and to a certain extent outdated. Conventional security forces were designed to defend or engage an exterior threat which is more or less symmetric and visible. On the other hand, terrorism as an asymmetrical threat is a part of hybrid, special or asymmetric warfare in which specialized units, institutions or facilities represent the primary pillars of security. In today's global society, terrorism is probably the most acute problem which can paralyze entire countries and their political systems. This problem, however, cannot be engaged on an open field of battle, but rather it requires a different approach in which conventional armed forces cannot be used traditionally and their role must be adjusted. The research will try to shed light on the phenomena of modern day terrorism and to prove its correlation with the state conventional armed forces. States are obliged to adjust their security apparatus to the new realism of global society and terrorism as an asymmetrical threat which is a side-product of the unbalanced world.

Keywords: asymmetrical warfare, conventional forces, security, terrorism

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Authors: N. J. Nawarathna, N. R. Kmarasinghe, D. Chandrasekara, B. M. R. S. Balasooriya, R. A. A. Shaminda, R. J. K. Senevirathne

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Introduction: Thyroid malignancy associated with hyperthyroidism is considered rare. Retrospective studies have shown the incidence of thyroid malignancy in hyperthyroid patients to be low (0.7-8.5%). To assess the clinical relevance of this association, thyroid status in a cohort of patients with thyroid malignancy were analyzed. Method: Thyroid malignancies diagnosed histologically in 56 patients, over a 18 month period beginning from April 2013, in a single surgical unit at Teaching Hospital Kandy were included. Preoperative patient details and progression of thyroid status were asessed with Thyroid Stimulating Hormone, free Thyroxin and free Triiodothyronine levels. Results: Amongst 56 patients Papillary carcinoma was diagnosed in 44(78.6%), follicular carcinomas in 7(12.5%) and 5(8.9%) with medullary and anaplastic carcinomas. 12(21.4%) were males and 44(78.6%) were females. 20(35.7%) were less than 40years, 29(51.8%) were between 40 to 59years and 7(12.5%) were above 59years. Cross tabulation of Type of carcinoma with Gender revealed likelihood ratio of 6.908, Significance p = 0.032. Biochemically 12(21.4%) were hyperthyroid. Out of them 5(41.7%) had primary hyperthyroidism and 7(58.3%) had secondary hyperthyroidism. Mean age of euthyroid patients was 43.77years (SD 10.574) and hyperthyroid patients was 53.25years(SD 16.057). Independent Samples Test t is -2.446, two tailed significance p =0.018. When cross tabulate thyroid status with Age group Likelihood Ratio was 9.640, Significance p = 0.008. Conclusion: Papillary carcinoma is seen more among females. Among the patients with thyroid carcinomas, those with biochemically proven hyperthyroidism were more among the older age group than those who were euthyroid. Hence careful evaluation of elderly hyperthyroid patients to select the most suitable therapeutic approach is justified.

Keywords: age, hyperthyroidism, thyroid malignancy, thyroid status

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

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

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

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Authors: Abdelrahman Abdelrahman, Lawrence Nip, Seun Ikotun, Iman Satar, Anur Miah

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Introduction: Incision and drainage of an abscess is a common procedure performed by the general surgeon. Pus swabs are often obtained routinely for MC&S.Our study aimed to investigate whether swabs taken at our local institution had any impact on the overall management plan for uncomplicated abscesses. Methods: We retrospectively assessed all patients presenting to University Hospital Lewisham with an abscess between October 2020 – April 2021. Exclusion criteria were recurrent abscesses, patients admitted with sepsis, known inflammatory bowel disease, immunocompromised, and those managed non-operatively. Results: We identified 131 patients who met the inclusion criteria. Two thirds were performed in theatre under general anaesthetic and the other one third under local. 63% of patients had a pus swab collected. Of these, 96% were not followed up by the requesting doctor, and there was no further patient contact. In the other 4%, the organisms cultured were flagged as atypical such as MRSA. In these cases, microbiology advice was that if the patient was clinically well and adequate drainage was achieved, then no furtherantibiotics were required. All patients were discharged before any microbiology results had come back with no subsequent change in the management plan. Average cost of pus swab = £10.10 – potentially cost saving of £1656.4 annually. Conclusion: Our study reveals that the majority of pus swabs taken from uncomplicated abscessesare not followed up by requesting doctor with no impact on the overall management plan. We, therefore, do not recommend the routine use of pus swabs for uncomplicated abscesses.

Keywords: pus swabs, uncomplated abscess, Pus MCS, follow up of uncomplicated abscess

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Authors: Kyung Min Kwom, Young Joo Lee

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Purpose: Up to 90% of pancreatic cancer patient suffer from neuropathic pain. In palliative care setting, pain control in a pancreatic cancer patient is one of the major goals. Ketamine is a NMDA receptor antagonist effective in neuropathic pain. Also, there have been studies about opioid sparing effect of ketamine. This study was held in palliative care unit among pancreatic cancer patients to find out the factors related to ketamine use and the opioid sparing effect. Methods: Medical records of pancreatic cancer patients admitted to St. Mary’s hospital palliative care unit from 2013.1 to 2014.12 were reviewed. Patients were divided into two categories according to ketamine use. Also, opioid use before and after ketamine use was compared in ketamine group. Results: Compared to non ketamine use group, patients in ketamine group required a higher dose of opioid. Total opioid dose, daily opioid dose, number of daily rescue medication, daily average rescue dose were statistically significantly higher in ketamine group. Opioid requirement was increased after ketamine administration. Conclusion: In this study, ketamine group required more opioid. Ketamine is frequently considered in patients with severe pain, requiring high amount of opioid. Also, ketamine did not have an opioid sparing effect. Future studies about palliative use of ketamine in a larger number of patients are required.

Keywords: ketamine, opioid sparing, palliative care, pancreatic cancer

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Authors: Branimir Skoric

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Over the past two decades, number of international travels rose significantly in the United Kingdom and Worldwide in the shape of business travels and holiday travels as well. The fact that elderly people travel a lot, more than ever before increased the needs for medical evacuations (repatriations) back home if they fell ill abroad or had any kind of accident. This paper concerns medical evacuations of patients on the way back home to the United Kingdom (United Kingdom Residents) and their specific medical needs during short-haul or long-haul commercial scheduled flight and ground transportation to the final destination regardless whether it was hospital or usual place of residence. Particular medical need during medical evacuations is oxygen supply and it can be supplied via portable oxygen concentrator, pulse flow oxygenator or continuous free flow oxygenator depending on the main diagnosis and patient’s comorbidities. In this retrospective study, patients were divided into two groups. One group was consisted of patients suffering from cardio-respiratory diagnoses as primary illness. Another Group consisted of patients suffering from noncardiac illnesses who have other problems including any kind of physical injury. Needs for oxygen and type of supply were carefully considered in regards of duration of the flight, standard airline cabin pressure and results described in this retrospective study.

Keywords: commercial flight, elderly travellers, medical evacuations, oxygen

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Authors: Maria Malliarou, Efrossini Lyraraki, Pavlos Sarafis, Theodosios Paralikas, Styliani Kotrotsiou, Evangelia Kotrotsiou, Mairy Gouva

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Women with breast cancer have to adapt to physical malformations, side effects of chemotherapy, emotional insecurity, and changes in social roles. Inability to recognize the co-morbidity of psychiatric conditions can have an aggravating effect on patient compliance in therapeutic interventions, resulting in treatment delays and an impact on overall survival. The purpose of this study was to identify the quality of life of breast cancer patients undergoing external radiation therapy and to correlate it with depression and anxiety. Patients were asked to respond to an anonymous questionnaire with general demographic and clinical questions, followed by the EORTCQLQ-C30 questionnaire for assessing the quality of life of patients with breast cancer. Hospital Anxiety and Depression Scale (HADS) as well as the Depression, Anxiety and Stress Scale (DASS-21) was also administered. The statistical analysis of the data was done in IBM SPSS. Results indicated that the incidence of anxiety and depression in breast cancer patients is high both in HADS (37.5 % with mild to moderate depression and 62.5 % with significant to severe depression) and DASS - 21 (39.2 % mild to moderate depression and 60.8 % significant to severe) scales. The correlation of anxiety and depression with life quality was negative for HADS (r = -, 810, p = .000) as well as for DASS-21 (r = -, 682, p = .000). The psychological impact of breast cancer on patients is important. Its correlation with the quality of life may lead to better tolerance to treatment and better effectiveness of the therapeutic approach.

Keywords: anxiety, breast cancer, depression, quality of life

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Authors: Mohammad Nazri Mustafa, Sh Norliza Sy Salim, Pedram Hatami Abdullah

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Civil and structural assets normally have an average of more than 30 years of design life. Adding to this advantage, the assets are normally subjected to slow degradation process. Due to the fact that repair and strengthening work for these assets are normally not dependent on plant shut down, the maintenance and integrity restoration of these assets are mostly done based on “as required” and “run to failure” basis. However unlike other industries, the exposure in oil and gas environment is harsher as the result of corrosive soil and groundwater, chemical spill, frequent wetting and drying, icing and de-icing, steam and heat, etc. Due to this type of exposure and the increasing level of structural defects and rectification in line with the increasing age of plants, assets integrity assessment requires a more defined scope and procedures that needs to be based on risk and assets criticality. This leads to the establishment of risk based inspection and proactive maintenance procedure for civil and structural assets. To date there is hardly any procedure and guideline as far as integrity assessment and systematic inspection and maintenance of civil and structural assets (onshore) are concerned. Group Technical Solutions has developed a procedure and guideline that takes into consideration credible failure scenario, assets risk and criticality from process safety and structural engineering perspective, structural importance, modeling and analysis among others. Detailed inspection that includes destructive and non-destructive tests (DT & NDT) and structural monitoring is also being performed to quantify defects, assess severity and impact on integrity as well as identify the timeline for integrity restoration. Each defect and its credible failure scenario is assessed against the risk on people, environment, reputation and production loss. This technical paper is intended to share on the established procedure and guideline and their execution in oil & gas plants. In line with the overall roadmap, the procedure and guideline will form part of specialized solutions to increase production and to meet the “Operational Excellence” target while extending service life of civil and structural assets. As the result of implementation, the management of civil and structural assets is now more systematically done and the “fire-fighting” mode of maintenance is being gradually phased out and replaced by a proactive and preventive approach. This technical paper will also set the criteria and pose the challenge to the industry for innovative repair and strengthening methods for civil & structural assets in oil & gas environment, in line with safety, constructability and continuous modification and revamp of plant facilities to meet production demand.

Keywords: assets criticality, credible failure scenario, proactive and preventive maintenance, risk based inspection

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Authors: Marwa Al-Subhi, Eiman Al-Ajmi, Mallak Al-Maamari, Humood Al-Dhuhli, Srinivasa Rao

Abstract:

The orbit and its contents are affected by various pathologies and craniofacial anomalies. Sound knowledge of the normal orbital dimensions is clinically essential for successful surgical outcomes and also in the field of forensic anthropology. Racial, ethnic, and regional variations in the orbital dimensions have been reported. This study sought to determine the orbital dimensions of Omani subjects who had been referred for computed tomography (CT) images at a tertiary care hospital. A total of 273 patients’ CT images were evaluated retrospectively by using an electronic medical records database. The orbital dimensions were recorded using both axial and sagittal planes of CT images. The mean orbital index (OI) was found to be 83.25±4.83 and the prevalent orbital type was categorized as mesoseme. The mean orbital index was 83.34±5.05 and 83.16±4.57 in males and females, respectively, with their difference being statistically not significant (p=0.76). A statistically significant association was observed between the right and left orbits with regard to horizontal distance (p<0.05) and vertical distance (p<0.01) of orbit and OI (p<0.05). No significant difference between the OI and age groups was observed in both males and females. The mean interorbital distance and interzygomatic distance were found to be 19.45±1.52 mm and 95.59±4.08 mm, respectively. Both of these parameters were significantly higher in males (p<0.05). Results of the present study provide reference values of orbital dimensions in Omani subjects. The prevalent orbital type of Omani subjects is mesoseme, which is a hallmark of the white race.

Keywords: orbit, orbital index, mesoseme, ethnicity, variation

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Authors: Nazmul Haque, Syeda Tasnuva Maria

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Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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Authors: Mohammed Khamis Albalushi

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Background: Somatic symptoms disorders are usually comorbid with depressive disorders despite the fact that there is little evidence for effective treatment for it. Repetitive transcranial magnetic stimulation (rTMS) has been approved by the FDA for mildly resistant depression. From this point, we hypothesized that rTMS delivered over the prefrontal cortex (PFC) may be useful in somatic symptoms disorder. Therefore, in our case report, we want to shed light on the potential effectiveness of rTMS in somatic symptoms disorder. Case Report: A 65-year-old Omani female with multiple medical comorbidities on multiple medications. She presented complaining of multiple somatic complaints in the last 2 years after visiting multiple clinics and underwent several specialists’ examinations, investigations and procedures for somatic treatments; all of them were normal. Then patient was seen by a different psychiatric clinic; multiple anti-depressant and adjuvant anti-psychotic medications were tried, patient still did not improve. The patient was admitted to the hospital for observation and management. Initially, she was preoccupied with her somatic complaint and kept on Fluoxetine and Olanzapine along with that, topiramate was added, but still with minimal improvement. Then rTMS was added to her management plan following Intermittent theta burst (iTBS) rTMS protocol. After completing all sessions of rTMS, the patient was recovering from all her symptoms, and no complaints were reported from her. Conclusion: Our case highlights the importance of investigating more thoroughly in rTMS as a treatment option for Persistent Somatic symptoms Disorder.

Keywords: rTMS, somatic symptoms disorder, resistive cases, TMS

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Authors: Yuguang Gao, Qiang Yang, Yanpeng Zhang, Mingtao Deng

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To enhance the safety, quality and efficiency of healthcare services provided by surgical doctors, we propose a comprehensive approach to the performance evaluation of individual doctors by incorporating insights from performance data as well as views of different stakeholders in the hospital. Exploratory factor analysis was first performed on collective multidimensional performance data of surgical doctors, where key factors were extracted that encompass assessment of professional experience and service performance. A two-level indicator system was then constructed, for which we developed a weighted interval-valued spherical fuzzy analytic hierarchy process to analyze the relative importance of the indicators while handling subjectivity and disparity in the decision-making of multiple parties involved. Our analytical results reveal that, for the key factors identified as instrumental for evaluating surgical doctors’ performance, the overall importance of clinical workload and complexity of service are valued more than capacity of service and professional experience, while the efficiency of resource consumption ranks comparatively the lowest in importance. We also provide a retrospective case study to illustrate the effectiveness and robustness of our quantitative evaluation model by assigning meaningful performance ratings to individual doctors based on the weights developed through our approach.

Keywords: analytic hierarchy processes, factor analysis, fuzzy logic, performance evaluation

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Authors: Sonam Kelzang

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Background: Penetrating injuries as a result of traditional sports (Archery and Khuru) are commonly seen in Bhutan. To our knowledge, there is no study carried out looking into the data of penetrating injuries due to traditional sports. Aim: This is a retrospective analysis of cases of penetrating injuries as a result of traditional sports admitted to JDWNRH over the last 3 years to draw an inference on the pattern of injury and associated morbidity and mortality. Method: Data on penetrating injuries related to traditional sports (Archery and Khuru) were collected and reviewed over the period of 3 years. Assault cases were excluded. For each year we analysed age, sex, parts of the body affected, agent of injury and whether admission was required or not. Results: Out of the total 44 victims of penetrating injury by traditional sports (Archery and Khuru) between 2013 and 2015 (average of 15 cases of penetrating injuries per year). Eighty-five percent were male and 15% were female. Their age ranged from 4 yrs to 62 years. Sixty-one percent of the victims were in the working age group of 19-58 years; 30% of the victims were referred from various district hospitals; 38% of the victims needed admission; 42 % of the victims suffered injury to the head; and 54% of the injuries were caused by Khuru. Conclusion: Penetrating injuries due to traditional sports admitted to JDWNRH, Thimphu, remained same over the three years period despite safety regulations in place. Although there were no deaths during the last three years, morbidity still remains high.

Keywords: archery, Bhutan, Khuru, darts

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Authors: Nambiar Ritu, Ali Ban, Munawar Farida, Israell Imelda, T. Farouk Eman Rasheeda, Jangalgi Renuka, S. Boma Nellie

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Aim: To define the ultrasonographic endometrial thickness (USG ET) cutoff for evacuation of retained pieces of conception (ERPC). Background: Studies of conservative management of 1st trimester miscarriage have questioned the need for post miscarriage curettage. Therapeutic decision making with transvaginal scan post miscarriage endometrial thickness in patients clinically thought to be incomplete miscarriage is often not clear. Method: Retrospective analysis of all 1ST trimester ERPC at Al Rahba Hospital from June 2012 to July 2013 was done. Total of 164 patients underwent ERPC. All cases were reviewed for pre-operative USG ET and post ERPC histopathological examination. TVS was done to evaluate the maximum ET of the uterine cavity along the long axis of the uterus and features of retained products was noted. All cases without preoperative USG ET measurement were excluded from the study, therefore only 62 out of 164 cases were included in the study. The patients were divided into three groups: o Group A: have retained products within endometrial cavity. o Group B: endometrial thickness equal or more than 20 mm. o Group C: endometrial thickness equal or less than 19.9 mm. o Post ERPC product was sent for HPE and the results were compared. Transvaginal sonographic findings can be used as a deciding factor in the management of patients with 1st trimester miscarriage who need ERPC. Our proposed cutoff in clinically stable patients requiring ERPC is more than 20 mm.

Keywords: ERPC, histopathological examination, long axis of the uterus, USG ET

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Authors: Renee Moten

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Introduction: Knee pain becomes chronic because the therapy used focuses only on the symptoms of knee pain and not the causes of knee pain. Preventing knee injuries is not in the toolbox of the traditional practitioner. This research was done to show that we must reduce the inflammation (holistically), reduce the swelling and regain flexibility before considering any type of exercise. This method of performing the correct exercise stops the bowing of the knee, corrects the walking gait, and starts to relieve knee, hip, back, and shoulder pain. Method: The holistic method that is used to heal knees is called the Knee Pain Recipe. It’s a six step system that only uses alternative medicine methods to reduce, relieve and restore knee joint mobility. The system is low cost, with no hospital bills, no physical therapy, and no painkillers that can cause damage to the kidneys and liver. This method has been tested on 200 women with knee, back, hip, and shoulder pain. Results: All 200 women reduce their knee pain by 50%, some by as much as 90%. Learning about ankle and foot flexibility, along with understanding the kinetic chain, helps improve the walking gait, which takes the pressure off the knee, hip and back. The knee pain recipe also has helped to reduce the need for a cortisone injection, stem cell procedures, to take painkillers, and surgeries. What has also been noted in the research was that if the women's knees were too far gone, the Knee Pain Recipe helped prepare the women for knee replacement surgery. Conclusion: It is believed that the Knee Pain Recipe, when performed by men and women from around the world, will give them a holistic alternative to drugs, injections, and surgeries.

Keywords: knee, surgery, healing, holistic

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Authors: Ravshan A. Ibadov, Sardor Kh. Ibragimov

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Objective. The aim of the study was to optimize the protocol of cardiopulmonary resuscitation (CPR) after cardiovascular surgical interventions. Methods. The experience of CPR conducted on patients after cardiovascular surgical interventions in the Department of Intensive Care and Resuscitation (DIR) of the Republican Specialized Scientific-Practical Medical Center of Surgery named after Academician V. Vakhidov is presented. The key to the new approach is the rapid elimination of reversible causes of cardiac arrest, followed by either defibrillation or electrical cardioversion (depending on the situation) before external heart compression, which may damage sternotomy. Careful use of adrenaline is emphasized due to the potential recurrence of hypertension, and timely resternotomy (within 5 minutes) is performed to ensure optimal cerebral perfusion through direct massage. Out of 32 patients, cardiac arrest in the form of asystole was observed in 16 (50%), with hypoxemia as the cause, while the remaining 16 (50%) experienced ventricular fibrillation caused by arrhythmogenic reactions. The age of the patients ranged from 6 to 60 years. All patients were evaluated before the operation using the ASA and EuroSCORE scales, falling into the moderate-risk group (3-5 points). CPR was conducted for cardiac activity restoration according to the American Heart Association and European Resuscitation Council guidelines (Ley SJ. Standards for Resuscitation After Cardiac Surgery. Critical Care Nurse. 2015;35(2):30-38). The duration of CPR ranged from 8 to 50 minutes. The ARASNE II scale was used to assess the severity of patients' conditions after CPR, and the Glasgow Coma Scale was employed to evaluate patients' consciousness after the restoration of cardiac activity and sedation withdrawal. Results. In all patients, immediate chest compressions of the necessary depth (4-5 cm) at a frequency of 100-120 compressions per minute were initiated upon detection of cardiac arrest. Regardless of the type of cardiac arrest, defibrillation with a manual defibrillator was performed 3-5 minutes later, and adrenaline was administered in doses ranging from 100 to 300 mcg. Persistent ventricular fibrillation was also treated with antiarrhythmic therapy (amiodarone, lidocaine). If necessary, infusion of inotropes and vasopressors was used, and for the prevention of brain edema and the restoration of adequate neurostatus within 1-3 days, sedation, a magnesium-lidocaine mixture, mechanical intranasal cooling of the brain stem, and neuroprotective drugs were employed. A coordinated effort by the resuscitation team and proper role allocation within the team were essential for effective cardiopulmonary resuscitation (CPR). All these measures contributed to the improvement of CPR outcomes. Conclusion. Successful CPR following cardiac surgical interventions involves interdisciplinary collaboration. The application of an optimized CPR standard leads to a reduction in mortality rates and favorable neurological outcomes.

Keywords: cardiac surgery, cardiac arrest, resuscitation, critically ill patients

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Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

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Authors: Hsin-Yi Lo, Huang-Ju Jiun, Yu-Chiao Chu

Abstract:

Hemodynamic monitoring is an important in the intensive care unit. Advances in medical technology in recent years, more diversification of intensive care equipment, there are many kinds of instruments available for monitoring of hemodynamics, Edwards Lifesciences Hemodynamic Monitoring (FloTrac) is one of them. The recent medical safety incidents in parameters were changed, nurses have not to notify doctor in time, therefore, it is hoped to analyze the current problems and find effective improvement strategies. In August 2021, the survey found that only 74.0% of FloTrac correctness of operation, reasons include lack of education, the operation manual is difficulty read, lack of audit mechanism, nurse doesn't know those numerical changes need to notify doctor, work busy omission, unfamiliar with operation and have many nursing records then omissions. Improvement methods include planning professional nurse education, formulate the secret arts of FloTrac, enacting an audit mechanism, establish FloTrac action learning, make「follow the sun」care map, hold simulated training and establish monitoring data automatically upload nursing records. After improvement, FloTrac correctness of operation increased to 98.8%. The results are good, implement to the ICU of the hospital.

Keywords: hemodynamic monitoring, edwards lifesciences hemodynamic monitoring, multiple strategies, intensive care

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Authors: R. M. Noah, N. M. Nasir, M. R. Jais, M. S. S. Wahab, M. H. Abdullah, A. S. S. Raj

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Infectious diseases are getting more difficult to treat due to the resistant strains of bacteria. Current generations of antibiotics are most likely ineffective against multi-drug resistant strains bacteria. Thus, there is an urgent need in search of natural antibiotics in particular from medicinal plants. One of the common medicinal plants, Melaleuca cajuputi, has been reported to possess antibacterial properties. The study was conducted to evaluate and justify the presence of antibacterial activity of Melaleuca cajuputi essential oil (EO) against the multi-drug resistant bacteria. Clinical isolates obtained from the teaching hospital were re-assessed to confirm the exact identity of the bacteria to be tested, namely methicillin-resistant staphylococcus aureus (MRSA), carbapenem-resistant enterobacteriaceae (CRE), and extended-spectrum beta-lactamases producer (ESBLs). A well diffusion method was done to observe the inhibition zones of the essential oil against the bacteria. Minimum inhibitory concentration (MIC) was determined using the microdilution method in 96-well flat microplate. The absorbance was measured using a microplate reader. Minimum bactericidal concentration (MBC) was performed using the agar medium method. The zones of inhibition produced by the EO against MRSA, CRE, and ESBL were comparable to that of generic antibiotics used, gentamicin and augmentin. The MIC and MBC results highlighted the antimicrobial efficacy of the EO. The outcome of this study indicated that the EO of Melaleuca cajuputi had antibacterial activity on the multi-drug resistant bacteria. This finding was eventually substantiated by electron microscopy work.

Keywords: melaleuca cajuputi, antibacterial, resistant bacteria, essential oil

Procedia PDF Downloads 122