Search results for: surgery outcome

Authors: Debalke Dale, Bezabh Geneta, Yohannes Amene, Yordanos Bergene, Mohammed Yimam

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Background: A drug therapy problem (DTP) is an event or circumstance that involves drug therapies that actually or potentially interfere with the desired outcome and requires professional judgment to resolve. Heart failure is an emerging worldwide threat whose prevalence and health loss burden constantly increase, especially in the young and in low-to-middle-income countries. There is a lack of population-based incidence and prevalence of heart failure (HF) studies in sub-Saharan African countries, including Ethiopia. Objective: The aim of this study was designed to assess drug therapy problems and associated factors among patients with HF in the medical ward of Arba Minch General Hospital(AGH), Ethiopia, from June 5 to August 20, 2022. Methods: A retrospective cross-sectional study was conducted among 180 patients with HF who were admitted to the medical ward of AGH. Data were collected from patients' cards by using questionnaires. The data were categorized and analyzed by using SPSS version 25.0 software, and data were presented in tables and words based on the nature of the data. Result: Out of the total, 85 (57.6%) were females, and 113 (75.3%) patients were aged over fifty years. Of the 150 study participants, 86 (57.3%) patients had at least one DTP identified, and a total of 116 DTPs were identified, which is 0.77 DTPs per patient. The most common types of DTP were unnecessary drug therapy (32%), followed by the need for additional drug therapy (36%), and dose too low (15%). Patients who used polypharmacy were 5.86 (AOR) times more likely to develop DTPs than those who did not (95% CI = 1.625–16.536, P = 0.005), and patients with more co-morbid conditions developed 3.68 (AOR) times more DTPs than those who had fewer co-morbidities (95% CI = 1.28–10.5, P = 0.015). Conclusion: The results of this study indicated that drug therapy problems were common among medical ward patients with heart failure. These problems are adversely affecting the treatment outcomes of patients, so it requires the special attention of healthcare professionals to optimize them.

Keywords: heart failure, drug therapy problems, Arba Minch general hospital, Ethiopia

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Authors: Dyna Ann C. Sevilles, Noel J. Belonguel, Jarungchai Anton S. Vatanagul, Mary Jeanne O. Flordelis, Grace G. Anota

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Guillain Barre syndrome is an acute inflammatory polyradiculoneuropathy causing progressive symmetrical weakness which can be debilitating to the patient. Early diagnosis is important especially in the acute phase when treatment favors good outcome and reduces the incidence of the need for mechanical ventilation. Electrodiagnostic studies aid in the evaluation of patients suspected with GBS. However, the characteristic electrical changes may not be evident until after several weeks. Thus, studies performed early in the course may give unclear results. The aim of this study is to associate the symptom onset of patients diagnosed with Guillain Barre syndrome with the EMG NCV results and determine the earliest time when there is evident findings supporting the diagnosis. This is a retrospective descriptive chart review study involving patients of >/= 18 years of age with GBS written on their charts in a Tertiaty hospital in Cebu City, Philippines from January 2000 to July 2014. Twenty patients showed electrodiagnostic findings suggestive of GBS. The mean day of illness when EMG NCV was carried out was 7 days. The earliest with suggestive findings was done on day 2 (10%) of illness. Moreover, the highest frequency with positive results was done on day 3 (20%) of illness. Based on the Dutch Guillain Barre Study group criteria, the most frequent variables noted were: prolonged distal motor latency in both median and ulnar nerves(65%) and both peroneal and tibial nerves (71%); and reduced CMAP in both median and ulnar nerves (65%) and both tibial and peroneal nerves (71%). The EMG NCV findings showed majority of demyelinating type (59%). Electrodiagnostic studies are helpful in aiding the physician in the diagnosis and treatment of the disease in the early stage. Based on this study, neurophysiologic evidence of GBS can be seen in as early as day 2 of clinical illness.

Keywords: Acute Inflammatory Demyelinating Polyneuropathy, electrophysiologic study, EMG NCV, Guillain Barre Syndrome

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Authors: Stephanie Boue, Nicolas Sierro, Julia Hoeng, Manuel C. Peitsch

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Systems biology relies on large numbers of data points and sophisticated methods to extract biologically meaningful signal and mechanistic understanding. For example, analyses of transcriptomics and proteomics data enable to gain insights into the molecular differences in tissues exposed to diverse stimuli or test items. Whereas the interpretation of endpoints specifically measuring a mechanism is relatively straightforward, the interpretation of big data is more complex and would benefit from comparing results obtained with diverse analysis methods. The sbv IMPROVER project was created to implement solutions to verify systems biology data, methods, and conclusions. Computational challenges leveraging the wisdom of the crowd allow benchmarking methods for specific tasks, such as signature extraction and/or samples classification. Four challenges have already been successfully conducted and confirmed that the aggregation of predictions often leads to better results than individual predictions and that methods perform best in specific contexts. Whenever the scientific question of interest does not have a gold standard, but may greatly benefit from the scientific community to come together and discuss their approaches and results, datathons are set up. The inaugural sbv IMPROVER datathon was held in Singapore on 23-24 September 2016. It allowed bioinformaticians and data scientists to consolidate their ideas and work on the most promising methods as teams, after having initially reflected on the problem on their own. The outcome is a set of visualization and analysis methods that will be shared with the scientific community via the Garuda platform, an open connectivity platform that provides a framework to navigate through different applications, databases and services in biology and medicine. We will present the results we obtained when analyzing data with our network-based method, and introduce a datathon that will take place in Japan to encourage the analysis of the same datasets with other methods to allow for the consolidation of conclusions.

Keywords: big data interpretation, datathon, systems toxicology, verification

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Authors: Mariana Mangas, Yaroslava Martins, M. Suárez, Célia Santos, Ana Matos Pires

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Baixo Alentejo is a region of Portugal characterized by an aging population, geographic isolation, social deprivation and a lack of medical staff. It is one of the most problematic regions in regards to mental health, particularly due to the factors mentioned. The aim of this study is a presentation of liaison psychiatry in Hospital José Joaquim Fernandes; a sample of the work done, the current situation and future perspectives. The aim is to present a retrospective study of internal psychiatric emergencies from January 1st, 2016 to August 31st, 2016. Liaison psychiatry of Department of Psychiatry and Mental Health (Psychiatry Service) of ULSBA includes the following activities: internal psychiatry emergencies, HIV consultation (comprised in the general consultation) and liaison psychology (oncology and pain), consisting of a total of 111 internal psychiatry emergencies during the identified period. Gender distribution was uniform. The most prevalent age group was 71-80 years, and 66,6% of patients were 60 years old and over. The majority of the emergency observations was requested by hospital services of medicine (56,8%) and surgery (24,3%). The most frequent reasons for admission were: respiratory disease (18,0%); tumors (15.3%); other surgical and orthopedic pathology (14,5%) and stroke (11,7%). The most frequent psychiatric diagnoses were: neurotic and organic depression (24,3%); delirium (26,1%) and adjustment reaction (14,5%). Major psychiatric pathology (schizophrenia and affective disorders) was found in 10,8%. Antidepressive medication was prescribed in 37,8% patients; antipsychotics in 34,2%. In 9.9% of the cases, no psychotropic drug was prescribed, and 5,4% of patients received psychologic support. Regarding hospital discharge, 42,4% of patients were referred to the general practitioner or to the medical specialist; 22,5% to outpatient gerontopsychiatry; 17,1% to psychiatric outpatient and 14,4% deceased. A future perspective is to start liaison in areas of HIV and psycho oncology in multidisciplinary approach and to improve collaboration with colleagues of other specialties for refining psychiatric referrals.

Keywords: psychiatry, liaison, internal emergency, psychiatric referral

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Authors: Mahmoud A. Amin, Essam Taman, Ahmed Omran, Mahmoud Shawky, Ahmed Mekawy, Abdallah M. Kotkat, Saber Younes, Nehad N. Ghonemy, Amin Saad, Ezz-Aleslam, Abdullah M. Elosh

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Introduction: TMJ is a one-of-a-kind, complicated synovial joint that helps with masticatory function by allowing the mandible to open and close the mouth. True ankylosis is a situation in which condylar movement is limited by a mechanical defect in the joint, whereas false ankylosis is a condition in which there is a restriction in mandibular movement due to muscular spasm myositis ossificans, and coronoid process hyperplasia. Ankylosis is characterized by the inability to open the mouth due to fusion of the TMJ condyle to the base of the skull as a result of trauma, infection, or systemic diseases such as rheumatoid arthritis (the most common) and psoraisis. Ankylosis causes facial asymmetry and affects the patient psychologically as well as speech, difficult mastication, poor oral hygiene, malocclusion, and other factors. TMJ is a technically challenging joint; hence TMJ ankylosis management is complicated. Case presentation: this case is a male patient 25 years old reported to our maxillofacial clinic in Damietta faculty of medicine, Al-Azhar University with the inability to open the mouth at all, with a history of difficulty of mouth breathing and eating foods, there was a history of falling from height at 2006, and the patient underwent corrective surgery before with no improvement because the ankylosis was relapsed short period after the previous operations with that done out of our hospital inter-incisor distant ZERO so, this condition need mandatory management. Clinical examination and radiological investigations were done after complete approval from the patient and his brother; tracheostomy was done for our patient before the operation. The patient entered the operation in our hospital and drastic improvement in mouth opening was noticed, helping to restore the physical psychological health of the patient.

Keywords: temporomandibular joint, TMJ, Ankylosis, mouth opening, physiotherapy, condylar plate

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Authors: Dona Pamoda W. Jayatunga, Veer Bala Gupta, Eugene Hone, Ralph N. Martins

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Being a neurodegenerative disorder, Alzheimer’s disease (AD) affects a majority of the elderly demented worldwide. The key risk factors for AD are age, metabolic syndrome, allele status of APOE gene, head injuries and lifestyle. The progressive nature of AD is characterized by symptoms of multiple cognitive deficits exacerbated over time, leading to death within a decade from clinical diagnosis. However, it is revealed that AD originates via a prodromal phase that spans from one to few decades before symptoms first manifest. The key pathological hallmarks of AD brains are deposition of amyloid beta (Aβ) plaques and neurofibrillary tangles (NFT). However, the yet unknown etiology of the disease fails to distinguish mitochondrial dysfunction between a cause or an outcome. The absence of early diagnosis tools and definite therapies for AD have permitted recruits of nutraceutical-based approaches aimed at reducing the risk of AD by modulating lifestyle or be used as preventive tools during AD prodromal state before widespread neurodegeneration begins. The objective of the present study was to investigate beneficial effects of luteolin, a plant-based flavone compound, against AD. The neuroprotective effects of luteolin on amyloid beta (Aβ) (1-42)-induced neurotoxicity was measured using cultured human neuroblastoma BE(2)-M17 cells. After exposure to 20μM Aβ (1-42) for 48 h, the neuroblastoma cells exhibited marked apoptotic death. Co-treatment of 20μM Aβ (1-42) with luteolin (0.5-5μM) significantly protected the cells against Aβ (1-42)-induced toxicity, as assessed by the MTS [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2(4sulfophenyl)-2H-tetrazolium, inner salt; MTS] reduction assay and the lactate dehydrogenase (LDH) cell death assay. The results suggest that luteolin prevents Aβ (1-42)-induced apoptotic neuronal death. However, further studies are underway to determine its protective mechanisms in AD including the activity against tau hyperphosphorylation and mitochondrial dysfunction.

Keywords: Aβ (1-42)-induced toxicity, Alzheimer’s disease, luteolin, neuroblastoma cells

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Authors: Ibrahim Aliyu Isah, Mohd Mansor Ismail, Salim Hassan, Norsida Bint Man

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Global and National contributions of Extension Agents in income derive through stingless beekeeping production as acknowledged globally as a new source of wealth creation, which contributes significantly to the positive, sustainable economic growth of Malaysia. A common specie, Trigona itama, production through effective utilization of highly competent agents of extension services led to high increase of output that guaranteed high income and sustainability to farmers throughout the study areas. A study on impacts of extension services on stingless bee production and its profitability and sustainability in both Peninsular Malaysia and East (Sarawak) Malaysia was conducted with the following objectives: (i) to examined various impacts of extension services on sustainability as variables in enhancing stingless beekeeping production for positive profitability. (ii) to determine the profitability and sustainability of stingless beekeeping production in the study area through transfer of technology and human resources development. The study covers a sample of beekeepers in ten states of Peninsular Malaysia and Sarawak. The sample size of 87 respondents were selected out of the population and 54 of filled questionnaires were retrieved. Capital budgeting analysis was carried out and economic performance was evaluated. Data collected was analysed using SPSS version 23.0. Correlation and Regression analyses were used. The capital budgeting analysis and government incentive schemes was incorporated in the applied projection of stingless bee farms. The result of Net Present Value (NPV) is determined as an accepted projection to the financial appraisal. The NPV in the study indicated positive outcome of production that can generate positive income and indicated efficient yield of investment and Profitability index (PI). In summary, it is possible for the extension services to increase output and hence increase profit which is sustainable for growth and development of agricultural sector in Malaysia.

Keywords: extension services, impacts, profitability and sustainability, Sarawak and peninsular Malaysia, trigona itama production

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Authors: Camila Plaza, Stefan Felder

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In October 2014, the TARMED reform was implemented in Switzerland. In an effort to even out the financial standing of general practitioners (including pediatricians) relative to that of specialists in the outpatient sector, the reform tackled two aspects: on the one hand, GPs would be able to bill an additional 9 CHF per patient, once per consult per day. This is referred to as the surcharge position. As a second measure, it reduced the fees for certain technical services targeted to specialists (e.g., imaging, surgical technical procedures, etc.). Given the fee-for-service reimbursement system in Switzerland, we predict that physicians reacted to the economic incentives of the reform by increasing the consults per patient and decreasing the average amount of time per consult. Within this framework, our treatment group is formed by GPs and our control group by those specialists who were not affected by the reform. Using monthly insurance claims panel data aggregated at the physician praxis level (provided by SASIS AG), for the period of January 2013-December 2015, we run difference in difference panel data models with physician and time fixed effects in order to test for the causal effects of the reform. We account for seasonality, and control for physician characteristics such as age, gender, specialty, and physician experience. Furthermore, we run the models on subgroups of physicians within our sample so as to account for heterogeneity and treatment intensities. Preliminary results support our hypothesis. We find evidence of an increase in consults per patients and a decrease in time per consult. Robustness checks do not significantly alter the results for our outcome variable of consults per patient. However, we do find a smaller effect of the reform for time per consult. Thus, the results of this paper could provide policymakers a better understanding of physician behavior and their sensitivity to financial incentives of reforms (both past and future) under the current reimbursement system.

Keywords: difference in differences, financial incentives, health reform, physician behavior

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Authors: Cecil Blake, Tolu Kayode-Adedeji, Innocent Chiluwa, Charles Iruonagbe

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National, regional and international security threats have dominated the twenty-first century thus far. Insurgencies that utilize “terrorism” as their primary strategy pose the most serious threat to global security. States in turn adopt terrorist strategies to resist and even defeat insurgents who invoke the legitimacy of statehood to justify their action. In short, the era is dominated by the use of terror tactics by state and non-state actors. Globally, there is a powerful network of groups involved in insurgencies using Islam as the bastion for their cause. In Africa, there are Boko Haram, Al Shabaab and Al Qaeda in the Maghreb representing Islamic groups utilizing terror strategies and tactics to prosecute their wars. The task at hand is to discover and to use multiple ways of handling the present security threats, including novel approaches to policy formulation, implementation, monitoring and evaluation that would pay significant attention to the important role of culture and communication strategies germane for discursive means of conflict resolution. In other to achieve this, the proposed research would address inter alia, root causes of insurgences that predicate their mission on Islamic tenets particularly in Africa; discursive and non-discursive counter-terrorism approaches fashioned by African governments, continental supra-national and regional organizations, recruitment strategies by major non-sate actors in Africa that rely solely on terrorist strategies and tactics and sources of finances for the groups under study. A major anticipated outcome of this research is a contribution to answers that would lead to the much needed stability required for development in African countries experiencing insurgencies carried out by the use of patterned terror strategies and tactics. The nature of the research requires the use of triangulation as the methodological tool.

Keywords: counter-terrorism, discourse, Nigeria, security, terrorism

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Authors: Muntanavadee Maytapattana

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This research aims to study the effects of the Parent Training Program for Obesity Reduction (PTPOR) on child waist circumference and health behaviors of pre-school children at the Samut-Songkhram kindergarten school, Samut-Songkhram province, Thailand. The objective of this research is to evaluate the effectiveness of the PTPOR on child waist circumference and health behaviors of the pre-school children. The conceptual framework of this study is developed on the basis of the Ecological Systems Theory (EST), not only do the individual factors such as child characteristics and child risk factors contribute to the child’s weight status, but also other factors such as parenting style and family characteristics, as well as community and demographic factors. This research is a quasi-experimental study. Participants were pre-school overweight and obese children and their parents. Forty-one parent-child dyads were recruited into the program. Parents participated in two sessions including an educational session and a group discussion session. Research methodology uses Paired-Samples t-test to determine the difference between groups in the mean scores of the outcome variables of the children and parents. The research results show that there was significant difference between child waist circumferences mean score at the baseline and finishing the program at the 0.01 level (p = 0.001), mean score of the child waist circumference was decrease after finishing the program. And there was no significant difference between child exercise health behaviors mean score at the baseline and finishing the program at the 0.05 level; however, mean score of the child exercise behavior was increase after finishing the program. Meanwhile, there was significant difference between child dietary health behavior mean score at the baseline and finishing the program at the 0.01 level (p = 0.001), mean score of the child dietary was increase after finishing the program.

Keywords: PTPOR, child waist circumference, child health behaviors, pre-school children

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Authors: Kathryn L. Duncan, Charles A. Kuntz, James O. Simcock

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A surgical approach to the cranium for treatment of frontal lobe and olfactory bulb neoplasia in dogs is described in this report, which provided excellent access for visualisation and removal of gross neoplastic tissue. An 8-year-old spayed female Shih Tzu crossbreed dog (dog 1) and a 13-year-old neutered male Miniature Fox Terrier (dog 2) were evaluated for removal of neoplasms involving both the frontal lobe and olfactory bulb. Both dogs presented with abnormal neurological clinical signs, decreased menace responses, and behavioural changes. Additionally, dog 2 presented with compulsive circling and generalized tonic-clonic seizure activity. Computed tomography was performed in both dogs, and MRI was also performed in dog 1. Imaging was consistent with frontal lobe and olfactory bulb neoplasia. A transorbital frontal bone craniectomy, with orbital ligament desmotomy and ventrolateral retraction of the globe, was performed in both cases without complication. Dog 1 had a focal area of lysis in the frontal bone adjacent to the neoplasm in the frontal lobe. The presence of the bone defect provided part of the impetus for this approach, as it would permit resection of the lytic bone. In addition, the neoplasms would be surgically accessible without encountering interposed brain parenchyma, reducing the risk of iatrogenic injury. Both dogs were discharged from the hospital within 72 hours post-operatively, both with normal mentation. Case 1 had a histopathologic diagnosis of malignant anaplastic neoplasm. The tumour recurred 101d postoperatively, and the patient was euthanized. Case 2 was diagnosed with a meningioma and was neurologically normal at 294d postoperatively. This transorbital surgical approach allowed successful removal of the intracranial frontal lobe and olfactory bulb neoplasms in 2 dogs. This approach should be considered for dogs with lateralized frontal lobe and olfactory bulb neoplasms that are closely associated with the suborbital region of the frontal bone.

Keywords: neurosurgery, small animal surgery, surgical oncology, veterinary neurology

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Authors: Ambrish Tiwari, Sudhasini Panda, Archana Singh, Kalpana Luthra, S. K. Sharma

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Introduction: On the basis of available literature we know that various host factors play a role in outcome of Tuberculosis (TB) infection by modulating innate immunity. One such factor is Inducible Nitric Oxide Synthase enzyme (iNOS) which help in the production of Nitric Oxide (NO), an antimicrobial agent. Expression of iNOS is in control of various host factors in which Vitamin D along with its nuclear receptor Vitamin D receptor (VDR) is one of them. Vitamin D along with its receptor also produces cathelicidin (antimicrobicidal agent). With this background, we attempted to investigate the levels of Vitamin D and NO along with their associated molecules in tuberculosis patients and household contacts as compared to healthy controls and assess the implication of these findings in susceptibility to tuberculosis (TB). Study subjects and methods: 100 active TB patients, 75 household contacts, and 70 healthy controls were taken. VDR and iNOS mRNA levels were studied using real-time PCR. Serum VDR, cathelicidin, iNOS levels were measured using ELISA. Serum Vitamin D levels were measured in serum samples using chemiluminescence based immunoassay. NO was measured using colorimetry based kit. Results: VDR and iNOS mRNA levels were found to be lower in active TB group compared to household contacts and healthy controls (P=0.0001 and 0.005 respectively). The serum levels of Vitamin D were also found to be lower in active TB group as compared to healthy controls (P =0.001). Levels of cathelicidin and NO was higher in patient group as compared to other groups (p=0.01 and 0.5 respectively). However, the expression of VDR and iNOS and levels of vitamin D was significantly (P < 0.05) higher in household contacts compared to both active TB and healthy control groups. Inference: Higher levels of Vitamin D along with VDR and iNOS expression in household contacts as compared to patients suggest that vitamin D might have a protective role against TB which prevents activation of the disease. From our data, we can conclude that decreased vitamin D levels could be implicated in disease progression and we can use cathelicidin and NO as a biomarker for early diagnosis of pulmonary tuberculosis.

Keywords: vitamin D, VDR, iNOS, tuberculosis

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Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Jeounghee Kim

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Objective: To describe the incidence of complication, according to the stage of Traumatic Spinal Cord Injury (TSCI) which was treated at Asan Medical Center (AMC), Korea. Hereafter, it should be developed in nursing management protocol of traumatic SCI. Methods. Retrospectively reviewed hospital records about the patients who were admitted AMC Patients with traumatic spinal cord injury until January 2005 and December 2016 were analyzed (n=97). AMC is a single institution of 2,700 beds where patients with trauma and severe trauma can be treated. Patients who were admitted to the emergency room due to spinal cord injury and who underwent intensive care unit, general ward, and rehabilitation ward. To identify long-term complications, we excluded patients who were operated on to other hospitals after surgery. Complications such as respiratory(pneumonia, atelectasis, pulmonary embolism, and others), cardiovascular (hypotension), urinary (autonomic dysreflexia, urinary tract infection (UTI), neurogenic bladder, and others), and skin systems (pressure ulcers) from the time of admission were examined through medical records and images. Results: SCI was graded according to ASIA scale. The initial grade was checked at admission. (grade A 55(56.7%), grade B 14(14.4)%, grade C 11(11.3%), grade D 15(15.5%), and grade E 2(2.1%). The grade was rechecked when the patient was discharged after treatment. (grade A 43(44.3%), grade B 15(15.5%), grade C 12(12.4%), grade D 21(21.6%), and grade E 6(6.2%). The most common complication after SCI was UTI 24cases (mean 36.5day), sore 24cases (40.5day), and Pneumonia which was 23 cases after 10days averagely. The other complications after SCI were neuropathic pain 19 cases, surgical site infection 4 cases. 53.6% of patient who had SCI were educated about intermittent catheterization at discharge from hospital. The mean hospital stay of all SCI patients was 61days. Conclusion: The Complications after traumatic SCI were developed at various stages from acute phase to chronic phase. Nurses need to understand fully the time-course of complication in traumatic SCI to provide evidence-based practice.

Keywords: spinal cord injury, complication, nursing, rehabilitation

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Authors: Anne N. Heirman, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Michiel W.M. van den Brekel

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Background: Due to the rising incidence of oropharyngeal squamous cell cancer (OPSCC), many patients are challenged with choosing between transoral(robotic) surgery and radiotherapy, with equal survival and oncological outcomes. Also, functional outcomes are of little difference over the years. With this study, the wants and needs of patients and caregivers are identified to develop a comprehensible patient decision aid (PDA). Methods: The development of this PDA is based on the International Patient Decision Aid Standards criteria. In phase 1, relevant literature was reviewed and compared to current counseling papers. We interviewed ten post-treatment patients and ten doctors from four head and neck centers in the Netherlands, which were transcribed verbatim and analyzed. With these results, the first draft of the PDA was developed. Phase 2 beholds testing the first draft for comprehensibility and usability. Phase 3 beholds testing for feasibility. After this phase, the final version of the PDA was developed. Results: All doctors and patients agreed a PDA was needed. Phase 1 showed that 50% of patients felt well-informed after standard care and 35% missed information about treatment possibilities. Side effects and functional outcomes were rated as the most important for decision-making. With this information, the first version was developed. Doctors and patients stated (phase 2) that they were satisfied with the comprehensibility and usability, but there was too much text. The PDA underwent text reduction revisions and got more graphics. After revisions, all doctors found the PDA feasible and would contribute to regular counseling. Patients were satisfied with the results and wished they would have seen it before their treatment. Conclusion: Decision-making for OPSCC should focus on differences in side-effects and functional outcomes. Patients and doctors found the PDA to be of great value. Future research will explore the benefits of the PDA in clinical practice.

Keywords: head-and-neck oncology, oropharyngeal cancer, patient decision aid, development, shared decision making

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Authors: James Ladzekpo

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Background: The urgent need to identify new pharmacological targets for diabetes treatment and prevention has been amplified by the disease's extensive impact on individuals and healthcare systems. A deeper insight into the biological underpinnings of diabetes is crucial for the creation of therapeutic strategies aimed at these biological processes. Current predictive models based on genetic variations fall short of accurately forecasting diabetes. Objectives: Our study aims to pinpoint key epigenetic factors that predispose individuals to diabetes. These factors will inform the development of an advanced predictive model that estimates diabetes risk from genetic profiles, utilizing state-of-the-art statistical and data mining methods. Methodology: We have implemented a recursive feature elimination with cross-validation using the support vector machine (SVM) approach for refined feature selection. Building on this, we developed six machine learning models, including logistic regression, k-Nearest Neighbors (k-NN), Naive Bayes, Random Forest, Gradient Boosting, and Multilayer Perceptron Neural Network, to evaluate their performance. Findings: The Gradient Boosting Classifier excelled, achieving a median recall of 92.17% and outstanding metrics such as area under the receiver operating characteristics curve (AUC) with a median of 68%, alongside median accuracy and precision scores of 76%. Through our machine learning analysis, we identified 31 genes significantly associated with diabetes traits, highlighting their potential as biomarkers and targets for diabetes management strategies. Conclusion: Particularly noteworthy were the Gradient Boosting Classifier and Multilayer Perceptron Neural Network, which demonstrated potential in diabetes outcome prediction. We recommend future investigations to incorporate larger cohorts and a wider array of predictive variables to enhance the models' predictive capabilities.

Keywords: diabetes, machine learning, prediction, biomarkers

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Authors: AliAkbar Hafezi, Jalal Taherian, Jamshid Abedi, Mahsa Elahi, Behnam Kadkhodaei

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Background: Soft tissue sarcomas (STS) are generally treated with a combination of limb preservation surgery and radiation therapy. Today, preoperative radiation therapy is considered for accurate treatment volume and smaller field size. Therefore, this study was performed to compare preoperative with postoperative radiation therapy in patients with extremity STS. Methods: In this non-randomized clinical trial, patients with localized extremity STS referred to the orthopedic clinics in Iran from 2021 to 2023 were studied. Patients were randomly divided into two groups: preoperative and postoperative radiation therapy. The two groups of patients were compared in terms of acute (wound dehiscence and infection) and late (limb edema, subcutaneous fibrosis, and joint stiffness) complications and their severity, as well as local recurrence and other one-year outcomes. Results: A total of 80 patients with localized extremity STS were evaluated in two treatment groups. The groups were matched in terms of age, sex, history of diabetes mellitus, hypertension, smoking, involved side, involved extremity, lesion location, and tumor histopathology. The acute complications of treatment in the two groups of patients did not differ significantly (P > 0.05). Of the late complications, only joint stiffness between the two groups had significant statistical differences (P < 0.001). The severity of all three late complications in the postoperative radiation therapy group was significantly higher (P < 0.05). There was no significant difference between the two groups in terms of the rate of local recurrence of other one-year outcomes (P > 0.05). Conclusion: This study showed that in patients with localized extremity STS, the two therapeutic approaches of adjuvant and neoadjuvant radiation therapy did not differ significantly in terms of local recurrence and distant metastasis during the one-year follow-up period and due to fewer late complications in preoperative radiotherapy group, this treatment approach can be a better choice than postoperative radiation therapy.

Keywords: soft tissue sarcoma, extremity, preoperative radiation therapy, postoperative radiation therapy

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Authors: Mitra Assadi, Md. Faan

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Background: Autism Spectrum Disorder (ASD) in a common neurodevelopmental disorder with limited pharmacological interventions. Transcranial Magnetic Stimulation (rTMS) has produced promising results in ASD, although there is no consensus regarding optimal targets or stimulation paradigms. A prevailing theory in ASD attributes the core deficits to dysfunction of the mirror neurons located in the inferior parietal lobule (IPL) and inferior frontal gyrus (IFG). Methods: Thus far, 11 subjects with ASD, 10 boys and 1 girl with the mean age of 13.36 years have completed the study by receiving 10 session of high frequency rTMS to the IPL. The subjects were randomized to receive stimulation on the left or right IPL and sham stimulation to the opposite side. The outcome measures included the Social Responsiveness Scale – Second Edition (SRS-2) and Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency task. Results: None of the 11 subjects experienced any adverse effects. The rTMS did not produce any improvement in verbal fluency, nor there was any statistically significant difference between the right versus left sided stimulation. Analysis of social awareness on SRS-2 (SRS-AWR) indicated a close to significant effect of the treatment with a small to medium effect size. After removing a single subject with Level 3 ASD, we demonstrated a close to significant improvement on SRS-AWR with a large effect size. The analysis of the data 3-month post TMS demonstrated return of the SRS-AWR values to baseline. Conclusion: This preliminary analysis of the 11 subjects who have completed our study thus far shows a favorable response to high frequency rTMS stimulation of the mirror neurons/IPL on social awareness. While the decay of the response noted during the 3-month follow-up may be considered a limitation of rTMS, the presence of the improvement, especially the effect size despite the small sample size, is indicative of the efficacy of this technique.

Keywords: rTMS, autism, scoial cognition, mirror neurons

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Authors: Erika Takidah, Salina Kassim

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Digital transformation has accelerated in the new millennium. It is reshaping the financial services industry from a traditional system to financial technology. Moreover, the number of financial inclusion rates in Indonesia is less than 60%. An innovative model needed to elucidate this national problem. On the other hand, the Islamic financial service industry and financial technology grow fast as a new aspire in economic development. An Islamic bank, takaful, Islamic microfinance, Islamic financial technology and Islamic social finance institution could collaborate to intensify the financial inclusion number in Indonesia. The primary motive of this paper is to examine the strategy of collaboration-based Islamic financial services to enhance financial inclusion in Indonesia, particularly facing the digital era. The fundamental findings for the main problems are the foundations and key ecosystems aspect involved in the development of collaboration-based Islamic financial services. By using the Interpretive Structural Model (ISM) approach, the core problems faced in the development of the models have lacked policy instruments guarding the collaboration-based Islamic financial services with fintech work process and availability of human resources for fintech. The core strategies or foundations that are needed in the framework of collaboration-based Islamic financial services are the ability to manage and analyze data in the big data era. For the aspects of the Ecosystem or actors involved in the development of this model, the important actor is government or regulator, educational institutions, and also existing industries (Islamic financial services). The outcome of the study designates that strategy collaboration of Islamic financial services institution supported by robust technology, a legal and regulatory commitment of the regulators and policymakers of the Islamic financial institutions, extensive public awareness of financial inclusion in Indonesia. The study limited itself to realize financial inclusion, particularly in Islamic finance development in Indonesia. The study will have an inference for the concerned professional bodies, regulators, policymakers, stakeholders, and practitioners of Islamic financial service institutions.

Keywords: collaboration, financial inclusion, Islamic financial services, Islamic fintech

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Authors: Nasir Ashraf, Sajid Rahid Ahmad, Adeel Ahmad

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Pakistan is a major tea consumer country and ranked as the third largest importer of tea worldwide. Out of all beverage consumed in Pakistan, tea is the one with most demand for which tea import is inevitable. Being an agrarian country, Pakistan should cultivate its own tea and save the millions of dollars cost from tea import. So the need is to identify the most suitable areas with favorable weather condition and suitable soils where tea can be planted. This research is conducted over District Mansehra and District Abbottabad in Khyber Pakhtoonkhwah Province of Pakistan where the most favorable conditions for tea cultivation already exist and National Tea Research Institute has done successful experiments to cultivate high quality tea. High tech approach is adopted to meet the objectives of this research by using the remotely sensed data i.e. Aster DEM, Landsat8 Imagery. The Remote Sensing data was processed in Erdas Imagine, Envi and further analyzed in ESRI ArcGIS spatial analyst for final results and representation of result data in map layouts. Integration of remote sensing data with GIS provided the perfect suitability analysis. The results showed that out of all study area, 13.4% area is highly suitable while 33.44% area is suitable for tea plantation. The result of this research is an impressive GIS based outcome and structured format of data for the agriculture planners and Tea growers. Identification of suitable tea growing areas by using remotely sensed data and GIS techniques is a pressing need for the country. Analysis of this research lets the planners to address variety of action plans in an economical and scientific manner which can lead tea production in Pakistan to meet demand. This geomatics based model and approach may be used to identify more areas for tea cultivation to meet our demand which we can reduce by planting our own tea, and our country can be independent in tea production.

Keywords: agrarian country, GIS, geoinformatics, suitability analysis, remote sensing

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Authors: Jasmin S. Nurkovic, Ljubisa Dj. Jovasevic, Zana C. Dolicanin, Zoran S. Bajin

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Ruptured muscles and tendons very often must be repatriated by open operation in young persons. In young, muscles are ruptured more often than tendons, at the sane time in older persons are more exposed to rupture than muscles. Ruptured of the calcaneus are the most present of all ruptures. Sometime the rupture is complete, but very often the incomplete rupture can be noticed. During six years, from 2006 to 2012, we treated nineteen male patients and three female patients with the rupture of tendon Achilles. The youngest patient was aged thirty two, and the oldest was also managed sixty four. The youngest female patient was forty one and the oldest was forty six. One of our patients who was under corticosteroid treatment did not take any part in sport activities but she was, as she told us, going for a long walk, the same was with other two patients one man and one woman. We had nineteen male patients age 32 to 64 and three female patients age 41, 44 and 46. Conservative treatment by cast was applied in five patients and very good results were in three of them. In two patients surgical treatment failed in patient’s age 53 and 64. Only one of all patients treated by surgery had healing problems because of necrotic changes of the skin where incision was made. One of our female patients age 45 was under steroid treatment for almost 20 years because of asthmatic problems. We suggested her wearing boots with 8cm long heels by day and by night eight weeks. The final results were satisfactory and all the time she was able to work and to walk. It was the only case we had with bilateral tendon rupture. After eight weeks the cast is removed and psychiatric treatment started, patient is using crutches with partial weight bearing over a period of two weeks. Quite the same treatment conservative treatment, only the cast is not removed after two but after four weeks. Everyday activities after the surgical treatment started ten weeks and sport activities can start after fourteen to sixteen weeks. An increased activity of our patient without previous preparing for forces activity can result, as we already see, with tendon rupture. Treatment is very long and very often surgical. We find that surgical treatment resulted as safer and better solution for patients. We also had a patient with spontaneous rupture of tendon during longer walking but this patient was under prolonged corticosteroid treatment.

Keywords: tendon, Achilles, rupture, sport

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Authors: Arben Murtezani, Shefqet Mrasori, Vančo Spirov, Bukurije Rama, Oliver Dimitrovski, Visar Bunjaku

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Overview: Temporomandibular disorders (TMDs) are chronic musculoskeletal pain conditions. Clinical indicators of discomfort are related to the use of the joint stiffness during first motions after extended rest and restricted joint range of motion can cause substantial pain and disability. There is little evidence that physical therapy methods of management cause long-lasting reduction in signs and symptoms. Exercise programs premeditated to improve physical fitness have beneficial effects on chronic pain and disability of the musculoskeletal system. Objective: The aim of this study was to assess the effectiveness of physical therapy interventions in the management of temporomandibular disorders. Materials and Methods: A prospective comparative study with a 2-month follow-up period was conducted between April 2016 and June 2016 at the Physical Medicine and Rehabilitation Clinic in Prishtina. Forty six patients with TMDs, (more than three months duration of symptoms) were randomized into two groups: the TENS therapy group (n=24) and combination of active exercise and manual therapy group (n=22). The TENS therapy group patients were treated with twelve sessions of TENS. The treatment period of both groups was 3 weeks at an outpatient clinic. Following main outcome measures were evaluated: (1) pain at rest (2) pain at stress (3) impairment (4) mouth opening at base-line, before and after treatment and at 3 month follow-up. Results: Significant reduction in pain was observed in both treatment groups. In the TENS group 73% (16/22) achieved at least 80% improvement from baseline in TMJ pain at 2 months compared with 54% (13/24) in the exercise group (difference of 19%; 95% confidence interval 220 to 30%). Active and passive maximum mouth opening has been greater in the TENS group (p < 0.05). Conclusion: Exercise therapy in combination with TENS seems to be useful in the treatment of temporomandibular disorders.

Keywords: temporomandibular joint disorders, TENS, manual therapy, exercise

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Authors: Birgit Schmid, Brigitte Liebig, Susanne Burren, Maritza Le Breton, Martin Boehnel, Celestina Porta

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Internationalization of students is part of the agenda of many universities worldwide. Yet, how well do universities achieve to guarantee educational success for male and female students of migrant background? This contribution aims on analyzing the effects of the Swiss university environment on perceived educational outcome of migrant students from a gender sensitive perspective. Social selectivity and gender inequalities strongly influence students’ access and success at universities. However, the complex interaction between universities and their disciplinary environments, and educational success of migrant students of both sex remains rarely examined so far. Starting from an intersectional perspective and neo-institutional approaches on higher education organizations, this contribution addresses formal/informal factors in the university environment in its impact on male/female students’ perception of well-being, success and dropout motivation. The paper starts from a most recent Swiss online-survey of Bachelor-students in two Universities of Applied Science and a University of Education in Switzerland. It compares students’ perspectives in four large BA degree courses with different male/female ratio, i.e. educational science, technical/computer science, economy, and social work (N=9`608). Results highlight the complex interplay of gender, migrant background and further dimensions of social differentiation on students’ perception in these different fields of education. Further, they illustrate correlations between students’ perception of discriminatory contexts, poor ratings of social integration and study success, as well a higher rate of dropout ideas. The paper lines out, that formal aspects of internationalization are less important for successfully integrating male/female migrant students than informal university conditions, such as a culture of diversity, which has to become integral part of internationalization strategies.

Keywords: gender and migration, higher education, internationalization, success

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Authors: Pranita Shivankar, Arun Suryawanshi, Prabodhachandra Deshmukh, S. V. C. Kameswara Rao

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Many undesirable significant changes in landscapes and the regions in the vicinity of historically important structures occur as impacts due to anthropogenic activities over a period of time. A better understanding of such influences using recently developed satellite remote sensing techniques helps in planning the strategies for minimizing the negative impacts on the existing environment. In 1982, a fossilized hominid skull cap was discovered at a site located along the northern bank of the east-west flowing river Narmada in the village Hathnora. Close to the same site, the presence of Late Acheulian and Middle Palaeolithic tools have been discovered in the immediately overlying pebbly gravel, suggesting that the ‘Narmada skull’ may be from the Middle Pleistocene age. The reviews of recently carried out research studies relevant to hominid remains all over the world from Late Acheulian and Middle Palaeolithic sites suggest succession and contemporaneity of cultures there, enhancing the importance of Hathnora as a rare precious site. In this context, the maximum likelihood classification using digital interpretation techniques was carried out for this study area using the satellite imagery from Landsat ETM+ for the year 2006 and Landsat TM (OLI and TIRS) for the year 2016. The overall accuracy of Land Use Land Cover (LULC) classification of 2016 imagery was around 77.27% based on ground truth data. The significant reduction in the main river course and agricultural activities and increase in the built-up area observed in remote sensing data analysis are undoubtedly the outcome of human encroachments in the vicinity of the eminent heritage site.

Keywords: cultural succession, digital interpretation, Hathnora, Homo Sapiens, Late Acheulian, Middle Palaeolithic

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Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

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Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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Authors: Ratnakar Rao, Subair Khan, Hari Haran

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Posterior cruciate ligament (PCL) avulsion fractures is a rare condition and commonly mismanaged.Surgical reattachment has been shown to produce better result compared with conservative management.Only few techniques are reported in arthroscopic fixation of PCL Avulsion Fracture and they are complex.We describe a new technique in fixation of the PCL Avulsion fracture through a posterior trans septal portal using button fixation device (Mini Tight Rope). Eighteen patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. Standard Antero Medial Portal and Antero Lateral portals made and additional Postero Medial and Postero Lateral portals made and trans Septal portal established. Avulsion fracture identified, elevated, prepared. Reduction achieved using PCL Tibial guide (Arthrex) and fixation was achieved using Mini Tight Rope,Arthrex (2 buttons with a suture). Reduction confirmed using probe and Image intensifier. Postoperative assessment made clinically and radiologically. 15 patients had good to excellent results with no posterior sag or instability. The range of motion was normal. No complications were recorded per operatively. 2 patients had communition of the fragment while drilling, for one patient it was managed by suturing technique and the second patient PCL Reconstruction was done. One patient had persistent instability with poor outcome. Establishing trans septal portal helps in better visualization of the posterior compartment of the knee. Assessment of the bony fragment, preparation 0f the bone bed andit protects from injury to posterior neurovascular structures. Fixation using the button with suture (Mini Tight Rope) is stable and easily reproducible for PCL Avulsion fracture with single large fragment.

Keywords: PCL avulsion, arthroscopy, transeptal, minitight rope technique

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Authors: S. Haque, M. Kanapathy, E. Bollen, I. Younis, A. Mosahebi

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Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit.

Keywords: breast reconstruction, cost evaluation, infection, negative pressure wound therapy

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Authors: Piotr Muzyk, Beata Morawiec, Mariusz Opara, Andrzej Tomasik, Brygida Przywara-Chowaniec, Wojciech Jachec, Ewa Nowalany-Kozielska, Damian Kawecki

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Background: Coronary bifurcation is one of the most complex lesion in patients with coronary ar-tery disease. Provisional T-stenting is currently one of the recommended techniques. The aim was to assess optimal methods of treatment in the era of drug-eluting stents (DES). Methods: The regis-try consisted of data from 1916 patients treated with coronary percutaneous interventions (PCI) using either first- or second-generation DES. Patients with bifurcation lesion entered the analysis. Major adverse cardiac and cardiovascular events (MACCE) were assessed at one year of follow-up and comprised of death, acute myocardial infarction (AMI), repeated PCI (re-PCI) of target ves-sel and stroke. Results: Of 1916 registry patients, 204 patients (11%) were diagnosed with bifurcation lesion >50% and entered the analysis. The most commonly used technique was provi-sional T-stenting (141 patients, 69%). Optimization with kissing-balloons technique was performed in 45 patients (22%). In 59 patients (29%) second-generation DES was implanted, while in 112 pa-tients (55%), first-generation DES was used. In 33 patients (16%) both types of DES were used. The procedure success rate (TIMI 3 flow) was achieved in 98% of patients. In one-year follow-up, there were 39 MACCE (19%) (9 deaths, 17 AMI, 16 re-PCI and 5 strokes). Provisional T-stenting resulted in similar rate of MACCE to other techniques (16% vs. 5%, p=0.27) and similar occurrence of re-PCI (6% vs. 2%, p=0.78). The results of post-PCI kissing-balloon technique gave equal out-comes with 3% vs. 16% of MACCE in patients in whom no optimization technique was used (p=0.39). The type of implanted DES (second- vs. first-generation) had no influence on MACCE (4% vs 14%, respectively, p=0.12) and re-PCI (1.7% vs. 51% patients, respectively, p=0.28). Con-clusions: The treatment of bifurcation lesions with PCI represent high-risk procedures with high rate of MACCE. Stenting technique, optimization of PCI and the generation of implanted stent should be personalized for each case to balance risk of the procedure. In this setting, the operator experience might be the factor of better outcome, which should be further investigated.

Keywords: coronary bifurcation, drug eluting stents, long-term follow-up, percutaneous coronary interventions

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Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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Authors: Zahra R. Almansoor

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Background: Selective serotonin reuptake inhibitors (SSRI’s) and cognitive behavioural therapy (CBT) are the main treatment methods used for patients with obsessive compulsive disorder (OCD) under the National Institute of Health and Care Excellence (NICE) guidelines. Yet many patients are left with residual symptoms or remit, so several other therapeutic approaches have been explored. Objective: The objective was to systematically review the available literature regarding the treatment efficacy of current and potential approaches and diagnostic strategies. Method: First, studies were examined concerning diagnosis, prognosis, and influencing factors. Then, one reviewer conducted a systematic search of six databases using stringent search terms. Results of studies exploring the efficacy of treatment interventions were analysed and compared separately for adults and children. This review was limited to randomised controlled trials (RCT’s) conducted from 2016 onwards, and an improved Y-BOCS (Yale- Brown obsessive compulsive scale) score was the primary outcome measure. Results: Technology-based interventions including internet-based cognitive behavioural therapy (iCBT) were deemed as potentially effective. Discrepancy remains about the benefits of SSRI use past one year, but potential medication adjuncts include amantadine. Treatments such as association splitting and family and mindfulness strategies also have future potential. Conclusion: A range of potential therapies exist, either as treatment adjuncts to current interventions or as sole therapies. To further improve efficacy, it may be necessary to remodel the current NICE stepped-care model, especially regarding the potential use of lower intensity, cheaper treatments, including iCBT. Although many interventions show promise, further research is warranted to confirm this.

Keywords: family and group treatment, mindfulness strategies, novel treatment approaches, standard treatment, technology-based interventions

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