Search results for: medical interpreting

Authors: Isabel Cristina Ortiz Trujillo, Lina Maria Martinez Sanchez, Felipe Hernández Restrepo, Daniel Gallego Gonzalez, Natalia Vargas Grisales, Camilo Andrés Agudelo Vélez

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Chorioamnionitis, is a pregnancy infection, causes different fetal and maternal symptoms. Streptococcus agalactiae present in the normal vaginal microflora of some women, favouring its abnormal multiplication during pregnancy, causing perinatal morbidity and mortality. Objective. Describe the clinical and epidemiological profile of the patients with diagnosis of clinical chorioanmionitis. Methodology. Descriptive, cross-sectional study. The population was patients with diagnosis of clinical chorioanmionitis. The information was taken from the medical records. The research was approved by the Ethics Committee. We used the program SPSS ® version 17.0 (SPSS Inc; Chicago, Illinois, USA) for the information analysis, descriptive statistics were used. Results. 78 patients in total with clinical chorioamnionitis, with a mean age of 26.3 ±5, 8 years old, the 69.2% primigravid women. 2.6% of women had positive culture for Streptococcus agalactiae in urine sample during current pregnancy and 30.7% had received some kind of antibiotics during current pregnancy. The 57.7% had 37 to 40 weeks of gestation in the current pregnancy it was calculated more frequently by ultrasound (66.7% in first quarter, 11.5% in the second and 1.9% in the third). In a 60.3% way of termination of pregnancy was vaginal and a 35.9 percent were caesarean section. Among the women in the study, a 30.8% had premature rupture of membranes. Conclusion. The chorioamnionitis continues to be an important cause of antibiotic use during pregnancy or labour and the decision to do a caesarean, with highest percentage in pregnancies-preterm and preterm premature rupture of membranes.

Keywords: chorioamnionitis, Streptococcus agalactiae, pregnancy complications, infectious

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Authors: Nafdha Thajudeen

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Hijamah therapy is one of the leading alternative & complementary modalities in the World. It is a kind of detoxification, rejuvenation, and blood purification method. It comes under Ilaj bil Tadbeer (Regimental therapy) in the Unani medical system. In diabetes, hands and foot care in people is very important because of slow blood circulation, where blood sometimes is not able to fully penetrate the capillaries. Hijamah therapy works upon the following two principles- Tanqiyae Mawad (Evacuation of morbid humor) and Imalae Mawad (Diversion of humor). The aim of this study was to find out the effectiveness of hijamah therapy on the numbness of legs in a diabetic patient. This case study was carried out in Ayurvedic Research Hospital (Non-Communicable Diseases), Ninthavur, Sri Lanka. A 63 years old female diabetic patient came to the clinic with the complain of numbness in both feet for one year. The treatment history of the patient revealed that she had taken western medicine for her complaints for 7 months. In her first visit, wet cupping was done on local and distal points. The patient said there was a remarkable improvement; internal medicines were given to keep the sugar level in normal with some external applications. Every week, wet cupping was done on the same points, with repeating the same medicines. Foot numbness was fully cured within one month. The finding of this study shows that the complaint of numbness in the diabetic patient was treated with hijamah therapy with internal & external medicine. This case study can be concluded as hijamah therapy is very effective in treating diabetic numbness. This single case study may be the entrance for future clinical studies

Keywords: Hijamah therapy, Ilaj bil thadbeer, diabetes, numbness

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Authors: Donatien Niragira

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The progress of technology creates new expectations for patients. The world of deafness is no exception. In recent years, there have been considerable advances in the field of technologies aimed at assisting failing hearing. According to the usual medical vocabulary, hearing aids are actually orthotics. They do not replace an organ but compensate for a functional impairment. The Amplifier Hearing amplification is useful for a large number of people with hearing loss. Hearing aids restore speech audibility. However, their benefits vary depending on the quality of residual hearing. The hearing aid is not a "cure" for deafness. It cannot correct all affected hearing abilities. It should be considered as an aid to communication. The urge to judge from the audiogram alone should be resisted here, as audiometry only indicates the ability to detect non-verbal sounds. To prevent hearing aids from ending up in the drawer, it is important to ensure that the patient's disability situations justify the use of this type of orthosis. If the problems of receptive Pre-fitting counseling are crucial: the person with hearing loss must be informed of the advantages and disadvantages of amplification in his or her case. Their expectations must be realistic. They also need to be aware that the adaptation process requires a good deal of patience and perseverance. They should be informed about the various models and types of hearing aids, including all the aesthetic, functional and financial considerations. If the person's motivation "survives" pre-fitting counseling, we are in the presence of a good candidate for amplification. In addition to its relevance, it shows that the results found in this study significantly improve the quality of audibility in the patient, from where this technology must be made accessible everywhere in the world.

Keywords: auditives protheses, hearing, aids, no medicaly treatable deafnes

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Authors: P. Charipoor, M. Khani, H. Mahmoudi, E. Ghasemi, P. Akbartehrani, B. Shokri

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Cold air plasma could have a variety of effects on cells and living organisms and also shows good results in medical and cosmetic cases. Herein, plasma floating electrode dielectric barrier discharge (FEDBD) plasma was designed for mouse skin rejuvenation purposes. It is safe and easy to use in clinics, laboratories, and homes. The effects of this device were investigated on mouse skin. Vitamin C ointment in combination with plasma was also used as a new method to improve FEDBD results. In this study, 20 Wistar rats were evaluated in four groups. The first group received high-dose plasma, the second group received moderate-dose plasma (with vitamin C cream), the third group received low-dose plasma (with vitamin C cream) for 6 minutes, and the fourth group received only vitamin C cream. This process was done 3 times a week for 4 weeks. Skin temperature was monitored to evaluate the thermal effect of plasma. The presence of reactive species was also demonstrated using optical spectroscopy. Mechanical assays were performed to evaluate the effect of plasma and vitamin C on the mechanical strength of the tissue, which showed a positive effect of plasma on the treated tissue compared to the control group. Using pathological and biometric skin tests, an increase in collagen levels, epidermal thickness, and an increase in fibroblasts was observed in rat skin, as well as increased skin elasticity. This study showed the positive effect of using the FEDBD plasma device on the effective parameters in skin rejuvenation.

Keywords: plasma, skin rejuvenation, collagen, epidermal thickness

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Authors: Rania E. Ramadan

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Dental esthetics is subjective, can be reported by the dentist and not noticed by the patient. However, if there is any imperfection seen by both the dentist and the patient, it is considered as an unesthetic like white and/or brown spot lesions. Many patients nowadays have been concerned about dental esthetics. Esthetic rehabilitation of anterior teeth and even maxillary premolars aid a lot in patients’ satisfaction of their smile consequently, gaining positive psychological impact for the patients. Many cases need esthetic rehabilitation such as diastema closure, spaced teeth and masking discolored teeth. Dental fluorosis and enamel hypo calcification can be presented as white and/or brown spot lesions. There are many treatment options for the management of these spotted teeth. Treatment options range from bleaching, microabrasion, direct composite restorations, porcelain veneers, and complete coverage crowns. The selection of certain options depends on many factors: the patient’s age, socioeconomic status and the severity of the lesion. In this clinical report, a 22-year-old male patient has been presented to the Department of Prosthodontics in Alexandria University, Egypt. His chief complaint was, “I was unpleased by white and brown spots in my teeth and I want to close the space between the two maxillary central.” Upon medical history, clinical examination, diagnostic photographs, and digital smile design by Exocad software, lithium disilicate veneers were chosen as the treatment of choice in maxillary anterior and first premolars.

Keywords: flourosis, ceramic veneers, case report, diastema closure

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Authors: Saeed Wahass

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Objective: Obesity is epidemic, affecting all societies and cultures. Most serious medical illnesses are attributed to obesity. For this reason, all healthcare systems worldwide have focused on obesity for both intervention and prevention. However, there is scientific evidence supporting that obesity is treatable through implementing different modalities of interventions. They include biological interventions like medications and bariatric surgeries and behavioral interventions. It seems healthcare professionals may suggest the quick and the easiest interventions for obesity like surgery, ignoring other modesties that might require efforts from their sides and patients as well. Searching on the onset, progression and prevention, behavior plays a major role. As a result, psychological interventions have become increasingly core for intervention and prevention of obesity. They are effective and cost effective in dealing with obesity. Methods: A questionnaire describing the role of behavior on obesity and the way it can be prevented and treated was distributed to a group of health professionals who are dealing with obesity e.g. bariatric surgeons, bariatric physicians, psychologists, health educators, nurses and social workers. Results: 88% of healthcare professionals believed that behavior plays a major role on the onset and progression of obesity, 95% of them recognized that obesity can be prevented with consideration for behavior factors. A major proportion (87%) of the respondents see that psychological interventions are effective and cost effective in treating obesity. Conclusions: It optimistically appears that the majority of healthcare professionals believe that behavior is a key component in understanding, preventing and treating obesity. This outcome may help in developing specific training courses for healthcare professionals, who are dealing with obesity concerning the way they can treat patients behaviorally and, moreover, educating the community.

Keywords: behavior, obesity, healthcare provider, psychological interventions

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Authors: Yi-Fung Lin, Yuan-Mei Liao

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Background: Pain is common among patients with cancer and is also one of the most disturbing symptoms. As this suffering is subjective, if patients proactively participate in their pain self-management, pain could be alleviated effectively. However, not everyone can carry out self-management very well because human behavior is a product of the cognition process. In this process, we can see that "self-efficacy" plays an essential role in affecting human behaviors. Methods: We used the eight steps of concept analysis proposed by Walker and Avant to clarify the concept of “self-efficacy for cancer pain management.” A comprehensive literature review was conducted for relevant publications that were published during the period of 1977 to 2021. We used several keywords, including self-efficacy, self-management, concept analysis, conceptual framework, and cancer pain, to search the following databases: PubMed, CINAHL, Web of Science, and Embase. Results: We identified three defining attributes for the concept of self-efficacy for cancer pain management, including pain management abilities, confidence, and continuous pain monitoring, and recognized six skills related to pain management abilities: problem-solving, decision-making, resource utilization, forming partnerships between medical professionals and patients, planning actions, and self-regulation. Five antecedents for the concept of self-efficacy for cancer pain management were identified: pain experience, existing cancer pain, pain-related knowledge, a belief in pain management, and physical/mental state. Consequences related to self-efficacy for cancer pain management were achievement of pain self-management, well pain control, satisfying quality of life, and containing motivation. Conclusions: This analysis provides researchers with a clearer understanding of the concept of “self-efficacy for cancer pain management.” The findings presented here provide a foundation for future research and nursing interventions to enhance self-efficacy for cancer pain management.

Keywords: cancer pain, concept analysis, self-efficacy, self-management

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Authors: Hao Cheng, Yingzhou Ni, Amr M. Bakry, Li Liang

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Functional foods containing bioactive nutrients offer benefits beyond basic nutrition and hence the possibility of delaying and preventing chronic diseases. However, many bioactive nutrients degrade rapidly under food processing and storage conditions. Encapsulation can be used to overcome these limitations. Food proteins have been widely used as carrier materials for the preparation of nano/micro-particles because of their ability to form gels and emulsions and to interact with polysaccharides. The mechanisms of interaction between bioactive nutrients and proteins must be understood in order to develop protein-based lipid-free delivery systems. Beta-lactoglobulin, a small globular protein in milk whey, exhibits an affinity to a wide range of compounds. Alfa-tocopherol, resveratrol and folic acid were respectively bound to the central cavity, the outer surface near Trp19–Arg124 and the hydrophobic pocket in the groove between the alfa-helix and the beta-barrel of the protein. Beta-lactoglobulin could thus bind the three bioactive nutrients simultaneously to form protein-multi-ligand complexes. Beta-casein, an intrinsically unstructured but major milk protein, could also interact with resveratrol and folic acid to form complexes. These results suggest the potential to develop milk-protein-based complex carrier systems for encapsulation of multiple bioactive nutrients for functional food application and also pharmaceutical and medical uses.

Keywords: milk protein, bioactive nutrient, interaction, protection

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Authors: Sachin Deshmukh

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Mind and body synchronization occurs through memory and sensation production. Sensations are the guiding language of subconscious mind for conscious mind to take a proper action. Mind-mechanism is based upon memories collected so far since intrauterine life. There are three universal triggers for memory creation; they are persons, situations and objects. Memory is created as sensations experienced by special senses. Based upon experiencing comfort or discomfort, the triggers are categorized as safe or unsafe triggers. A memory comprises of ‘safe or unsafe feeling for triggers, and actions taken for that feeling’. Memories for triggers are created slowly, thoughtfully and consciously by the conscious mind, and archived in the subconscious mind for future references. Later on, similar triggers can come in contact with the individual. Subconscious mind uses these stored feelings to decide whether these triggers are safe or unsafe. It produces comfort or discomfort sensations as emotions accordingly and reacts in the same way as has been recorded in memory. Speed of sensing and processing the triggers, and reacting by subconscious mind is that of the speed of bioelectricity. Hence, formula for human emotions has been designed in this paper as follows: Emotion (Stress or Peace) = Trigger (Person or Situation or object) x Mass of feelings (stressful or peaceful) associated with the Trigger x Speed of Light². We also establish modern medical scientific facts about relationship between reflex activity and memory. This research further develops the ‘Rational Memory Therapy’ focusing on therapeutic feelings conversion techniques, for stress prevention and management.

Keywords: memory, sensations, feelings, emotions, rational memory therapy

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Authors: Jarel Elgin Tolentino, Arby Denise Nera, Mary Rose Roco, Angela Vianca Aspa, Nikko Beltran, Else Dapat

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Drug resistance by cells has been the problem in the medical field for decades now. The use of medicinal plants as a source of creating powerful drugs has been nowadays recognized worldwide to treat such resistant diseases. In the present study, the potential for Diospyros philippinensis A. DC. to inhibit growth of both bacteria and cancer cell line was conducted. The leaf crude extracts were screened for the presence of phytochemicals and examined for potential bioactivities by employing several assays like Kirby-Bauer disc diffusion method, DPPH (2,2-diphenyl-1-picryl-hydrazyl-hydrate) assay and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium assay for the antibacterial, antioxidant and cytotoxic activities of the extract, respectively. Phytochemical test results of the extracts revealed the presence of alkaloids, flavonoids, saponins, phenols, quinones, cardiac glycosides, phlobatannins, carbohydrate, cardenolides and proteins. The leaf extracts were found to exhibit antibacterial activity against gram-positive bacteria, high antioxidant activity (99.22% ± 0.005) but did not show any sign of cytotoxicity towards HCT116 (ATCC CCL-247). The study therefore concludes that D. philippinensis A. DC. leaf extract can be a source of antibacterial and chemopreventive agents. This claim may be used as basis for future investigation.

Keywords: bioassay, medicinal plants, plant crude extracts, phytochemical screening

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Authors: Samar Rabah

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Background: Incense woods are special kind of trees called Agarwood, which characterized by good smelling odors and many medical benefits. Incense smoke is heavily used in Saudi Arabia although comprehensive studies of its effects on health are limited. The present study demonstrated lung ultrastructure changes of mice after exposure and cessation to Incense smoke. Eighty mice are divided equally into four groups, three groups are exposed to different concentrations of Incense smoke (2, 4 and 6 gm) for three months, while the fourth group is control one. At the end of each month, lungs of five animals from each group are gathered, while the last five animals from each group are kept for another 60 days without exposure to the Incense smoke to allow for recovery. Results: Transmission electron microscope investigations of all exposed groups showed hypertrophy and hyperplasia in Clara Cells and some an enlargement of the macrophage to the point that it fills a large part of the alveolar lumen. Scanning electron microscope marks presence of mucus materials attached to the epithelial bronchioles. After prevention of exposure to the Incense smoke for 60 days, necrosis and degeneration in some cells of epithelial bronchioles, fibrosis of peribronchial, thickening in alveolar walls and aggregation of lymphoid cells were demonstrated. Conclusion: Based on the above findings and other related studies (not published), we conclude that exposure to Incense smoke causes harmful effects due to sever changes in pulmonary ultrastructure, such effects do not disappear even when Incense smoke inhalation was stopped. Therefore, we recommend that Incense smoke should use only in open places to reduce its harms.

Keywords: Incense smoke, lungs, ultrastructure of lungs, Agarwood

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Authors: Akeem Akinboro, Bala Alhaj Kegun

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Haemoglobinopathy is a genetic disorder that has the potentiality to cause death of individuals in whom both the alpha (α) and beta (β) globin chains of the haemoglobin molecule are defective due to mutations in their genes. The haemoglobin genotype variants among some residents of Niger state, Nigeria, were determined using the secondary data available at Bida, Minna and Kotangora general hospitals of the state. A total of 1,639 data, representing 434, 655 and 550, collected from the outside patients who visited the medical laboratory units of the three general hospitals, respectively, over five years period (2015-2020) were analyzed into gene frequency, sex and age to determine their haemoglobin genotypes status. More males (51.6 – 58.7%) than females (41.3 – 48.4%) visited the three hospitals during the period covered and most of the patients were between 11 - 20 years old. The frequency of HbA allele in the human population was 0.72, 0.65, 0.68 for Bida, Minna and Kotangora, respectively, while it was 0.25, 0.29 and 0.28 for HbS allele. The HbC allele was prevalent at 0.03, 0.06 and 0.05 among the human population in Bida, Minna and Kotangora cities of Niger state. In overall, the prevalence of HbA, HbS and HbC alleles in Niger state of Nigeria was 0.68, 0.28 and 0.05. Minna being the capital city of Niger state and the most populous among the three cities in the state seems to have influx of more people who are carriers of abnormal haemoglobin genotypes which has resulted to higher frequency of HbS and HbC than those of the other two cities in this study. These results show that the pattern of haemoglobin genotypes frequency of Kontagora could be a prediction for the whole of Niger state. It is therefore necessary and important to take screening of blood for haemoglobin genotype serious among intending couples to prevent and reduce the possibility of having increase in the number of people with abnormal haemoglobin genotypes in the state.

Keywords: haemoglobin, genotype, niger state, gene frequency, general hospitals

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Authors: Caroline Correia, Stefani Perna, John Gaughan, Elizabeth Cerceo

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Introduction: The COVID-19 pandemic has brought unprecedented changes to how hospitals function on a daily basis. Increased personal protective equipment (PPE) usage and measures to pre-package, separate, and decontaminate have the potential to increase the waste load. However, limiting non-essential surgeries drastically reduces operating room (OR) waste, and restricting visitation policies to contain outbreaks may help conserve resources. The impact of these policy changes with increased disposable PPE usage on hospital production of waste is unknown. Methods: Waste produced in pounds (lbs) was measured for January through June during both 2019 and 2020 through Stericycle in Cooper University Hospital in Camden, NJ. This timeframe was selected since the pandemic began in January 2020 in the US. The total waste produced during this time was 328,623 lbs in 2019 and 306,454 lbs in 2020. Using Poisson counts (α=.05), less waste was produced in 2020 (p < 0.001). The amount of sharps and regulated medical waste (grossly bloody items) were both significantly decreased as well (p < 0.0001, p=0.0002), and these account for 10-15% of the total waste produced. Discussion: Despite the increased usage of disposable PPE, overall hospital waste was decreased during the pandemic as compared to prior. As surgeries are estimated to be responsible for up to one-half of waste produced by hospitals, it is possible that constraint on elective procedures contributed to the decreased waste in all three categories; estimates of a 35% decrease in surgical volume would be expected to impact waste production. The effects of the pandemic on waste production should continue to be monitored to understand the environmental impact as health systems resume backlogged surgeries at a higher volume.

Keywords: COVID-19, hospital, surgery, waste

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Authors: Dylan Treger, Lujia Zhang, Xiaoxiao Jia, Jessica H. Hui, Munkh-Amgalan Gantumur, Mizhou Hui, Li Liu

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Hyaluronic acid (HA) is involved in wound healing via inflammation, granulation, and re-epithelialization mechanisms. The poor physical properties of natural high-molecular-weight polymers limit their direct use in the medical field. In this clinical study, we investigated whether the local injection of a tissue-permeable 35 kDa HA fragment (HA35) could favor the healing process in patients with chronic wounds accompanied by neuropathic pain. The HA35 fragments were freshly manufactured by degradation of high-molecular-weight HA with bovine testis-derived hyaluronidase PH20. Twenty patients in this study had nonhealing wounds and wound-related pain for more than 3 months. Freshly produced HA35 was locally injected into healthy skin immediately surrounding chronic wounds once a day for 10 days. Wound-associated pain and the degree of wound healing were evaluated. The injection of HA35 relieved the pain associated with chronic wounds in 24 hours. HA35 treatment significantly promoted the healing of chronic wounds, including expanded fresh granulation tissue on the wounds; reduced darkness or redness, dryness, and damaged areas on the surface of the skin surrounding the wounds; and decreased the size of the wound area. It can be concluded that the topical injection of tissue-permeable HA35 around chronic wounds has great potential to promote wound healing.

Keywords: 35 kDa hyaluronan fragment HA35, chronic wound, wound healing, tissue permeability

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Authors: Michael Dolgin, Oz Hamtzani, Talma Kushnir

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A literature review has shown that while parents of children with cancer experience increased levels of psychological distress associated with their child's medical condition, considerable variability in parental adjustment is evident. Of the factors that may account for this variability, little attention has been devoted to the simultaneous interaction of three coping constructs and their role in parental adjustment: (1) Coping techniques employed, (2) Repertoire of coping techniques, and (3) Flexibility in applying coping techniques. While these constructs have been studied individually in relation to adjustment in general, studies to date have not included them together within a single conceptual model and research design and evaluated them in a clinical population. The objective of the current study was to determine how these three coping technique constructs interact to impact parental adjustment to pediatric cancer. A cross-sectional sample of 145 parents of children in active cancer treatment completed standardized measures of coping techniques, repertoire, flexibility, and parental distress. A hierarchical multiple regression analysis demonstrated that 37% of the variance in parental distress was predicted by the use of avoidance-focused coping techniques [F(1,118)=69.843, p<.001], with an additional 3% predicted by coping repertoire [F(2,117)=7.63, p=.00] for a total of 40% variance explained. Coping flexibility was found to mediate the relationship between coping repertoire and parental distress. These findings suggest that coping techniques employed by parents (problem/emotion-focused vs. avoidance-focused), as well as coping repertoire, significantly impact parental adjustment. Flexibility in applying coping techniques within one’s coping repertoire further contributes to parental adjustment. Implications for further study and clinical intervention will be presented.

Keywords: coping techniques, repertoire, flexibility, adjustment

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Authors: Oscar Kallay

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Objective: This study compares the sustainability, financial implications, and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones. Methods: The observational study involves retrospective cataract surgery data collection at the Centre Médical de l'Alliance, Braine-L’alleud, Belgium, a tertiary eye care center. Information on cassette weight, quantities, and transport volume was obtained from routine procedures and purchasing records. The costs for each machine were calculated by reviewing the invoices received from the accounting department. Results: We found significant differences across comparisons. The reusable cassette machine, when compared to the single-use machine, used 306.7 kg less plastic (75.3% reduction), required 2,494 cubic meters less storage per 1000 surgeries (67.7% decrease), and cost €54.16 less per 10 procedures (16.9% reduction). The machine with daily reusable cassettes also exhibited a 7-minute priming time advantage for 10 procedures, reducing downtime between cases. Conclusions: Our findings underscore the benefits of adopting reusable cassette systems: reduced plastic consumption, storage volume, and priming time, as well as enhanced efficiency and cost savings. Healthcare professionals and institutions are encouraged to embrace environmentally conscious initiatives. The use of reusable cassette systems for cataract surgeries offers a pathway to sustainable practices.

Keywords: cataract, epidemiolog, surgery treatment, lens and zonules, public health

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Authors: Saira Mehnaz, Ali Jafar Abedi, Shazia Farooq Fazli, Sakeena Mushfiq, Zulfia Khan, M. Athar Ansari

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Introduction: Public health spending is a necessity in an underdeveloped country like India. The people are already suffering from poverty and that clubbed with out of pocket expenditure leads them to a very catastrophic situation, reducing the overall access to healthcare. Objectives: This study was designed to determine the usual source of medical care opted, the illness pattern, the expenditure incurred on illness and its source of procurement by the study population. It also intended to assess this expenditure as a determinant of access to health care. Methodology: Cities like Aligarh, which are classified as B grade cities in India are thought to be ripe sites for getting livelihood and hence are almost half filled with migrants living in urban slums. A cross sectional study was done to study the newer slum pockets. 3409 households with a population of 16,978 were studied with the help of pretested questionnaire; SPSS 20 was used for statistical analysis. Results and Conclusions: In our study, we found that almost all the households suffered from catastrophic health expenditure. The study population, which was already vulnerable owing to their low socio-economic and migrant status was further being forced with into poverty and indebtedness on account of expenditure on illness. This lead to a significant decrease in access to health. National health financing systems should be designed to protect households from financial catastrophe, by reducing out-of-pocket spending.

Keywords: access to healthcare, catastrophic health expenditure, new urban slums, out of pocket expenditure

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Authors: Bavneet Kaur Sidhu, Manoj Tiwari

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Global Developmental Delay (GDD) is a common pediatric condition. Etiologies of GDD might, however, differ in developing countries. In the last decade, sporadic families are being reported in various countries. As to the author’s best knowledge, many risk factors and their correlation with the prevalence of GDD have been studied but its statistical correlation has not been done. Thus we propose the present study by targeting the risk factor, prevalence and their statistical correlation with GDD. FMR1 gene was studied to confirm the disease and its penetrance. A complete questionnaire-based performance was designed for the statistical studies having a personal, past and present medical history along with their socio-economic status as well. Methods: We distributed the children’s age in 4 different age groups having 5-year intervals and applied structural equation modeling (SEM) techniques, Spearman’s rank correlation coefficient, Karl Pearson correlation coefficient, and chi-square test.Result: A total of 1100 families were enrolled for this study; among them, 330 were clinically and biologically confirmed (radiological studies) for the disease, 204 were males (61.8%), 126 were females (38.18%). We found that 27.87% were genetic and 72.12 were sporadic, out of 72.12 %, 43.277% cases from urban and 56.72% from the rural locality, the mothers' literacy rate was 32.12% and working women numbers were 41.21%. Conclusions: There is a significant association between mothers' age and GDD prevalence, which is also followed by mothers' literacy rate and mothers' occupation, whereas there was no association between fathers' age and GDD.

Keywords: global developmental delay, FMR1 gene, spearman’ rank correlation coefficient, structural equation modeling

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Authors: Ajay Agrawal, Pritha Basnet, Achala Thakur, Pappu Rizal, Rubina Rai

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Context: Rapid expulsion of fetus in intrauterine fetal death (IUFD) is usually requested without any medical grounds for it. So; an efficient, safe method for induction of labor (IOL) is required. Objective: To determine if pre-treatment with mifepristone followed by IOL with misoprostol in late IUFD is more efficacious. Methods: We conducted a randomized controlled trial in 100 patients. Group-A women received single oral dose of 200 mg mifepristone, followed by induction with vaginal misoprostol after 24-hour. Group-B women were induced only with vaginal misoprostol. In each group 5 dose of misoprostol was used 4 hourly. If first cycle was unsuccessful, after break of 12 hour, second course of misoprostol was started. The primary outcome was a measure of induction to delivery time and vaginal delivery within 24 hours. Secondary outcome was to measure need of oxytocin and complications. Results: Maternal age, parity and period of gestation were comparable between groups. Number of misoprostol dose needed in group A was significantly less than group B. Mann Whitney U test showed, women in group A had significantly earlier onset of labor, however total induction to delivery interval was not significant. In group-A, 85.7% delivered within 24 hours of first dose of misoprostol while in group-B 70% delivered within 24 hour (p=0.07). More women in Group B required oxytocin. Conclusion: Pretreatment with mifepristone before IOL following late IUFD is an effective and safe regimen. It appears to shorten the duration of induction to onset of labor.

Keywords: induction of labor, intrauterine fetal death, mifepristone, misoprostol

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Authors: Ibrahim Nadeem, Mohammed Rahman, Yasser Ad-Dab’Bagh, Mahmood Akhtar

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Depression is one of the most prevalent mental illnesses and is often associated with various other medical disorders. In this review, we aim to evaluate existing systematic reviews that investigate the use of probiotics as a treatment for depressive symptoms. Five online databases were searched for relevant studies up to December 2017. Systematic reviews that included randomized controlled trials assessing the efficacy of probiotics in the treatment of depressive symptoms were included. Seven systematic reviews met the inclusion criteria. Three of these reviews conducted meta-analyses, out of which, two found probiotics to significantly improve depressive symptoms in the sample population. Two meta-analyses conducted subgroup analysis based on health status, and both found probiotics to significantly decrease depressive symptoms in patients with major depressive disorder, but only one review found it to significantly decrease in healthy patients. Another subgroup analysis was conducted based on age, and found probiotics to produce significant effects on subjects under the age of 60, but close to no effect on patients over the age of 65. Out of the four reviews that conducted qualitative analysis, three reviews concluded that probiotics have the potential to be used as a treatment. Due to the differences in clinical trials, a definitive effect of probiotics on depressive symptoms cannot be concluded. Nonetheless, probiotics seem to produce a significant therapeutic effect for subjects with pre-existing depressive symptoms. Further studies are warranted for definitive conclusions.

Keywords: depression, gut-brain axis, gut microbiota, probiotic, psychobiotic

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Authors: Hannah Riva, Sarah Mazal, Jessica L. Marquez, Michael Rains

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A 70-year-old female with a Fitzpatrick skin phenotype II presented with a 13-year history of a scaly rash located on the left breast and bilateral pretibial regions. The patient’s past medical history was otherwise unremarkable, with the exception of surgery involving the left breast. Physical examination revealed infiltrative hyperpigmented scaly plaques and nodules located on the left breast and pretibial regions bilaterally. A negative systemic workup excluded organ involvement. A clinical diagnosis of cutaneous sarcoidosis was made. Prior treatments included triamcinolone 0.1% topical cream and clobetasol 0.05% ointment, which failed to show improvement. Full-body narrow-band UVB (NBUVB) treatment was performed on a tri-weekly basis for eight months. NBUVB dosage was slowly titrated from 300 mJ/cm2 to a final dose of 1800 mJ/cm2 to prevent discomfort and burning sensations. Throughout the duration of her treatment, the patient adhered to a regimen of clobetasol 0.05% topical ointment applied twice daily in two-week intervals. Improvement was noticed after two months, with continued improvement up to eight months. The patient is continuing NBUVB phototherapy treatments for maintenance. In our case, NBUVB phototherapy treatment demonstrated promising results with improvement after two months of treatment. Physicians should consider NBUVB phototherapy as an effective option for patients presenting with cutaneous sarcoidosis.

Keywords: dermatology, sarcoidosis, phototherapy, ultraviolet

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Authors: Sadia Suri Kashif, Raheeda Fatima, Maqsood Ahmed Khan

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Purpose of the study: The objective of this research was to determine the perception of Pakistani physicians (whether primary care, specialists or residents) in Karachi, being one of the largest and highly populated cities of Pakistan, regarding clinical approaches towards diet, exercise, and therapy in obese patients. This research determines their understanding of obesity and employability of obesity management in their daily practices. Research methodology: This is a questionnaire-based survey. A minimum of 300 questionnaires (N=300) were distributed and filled by practicing physicians in a random selection of medical setups in Karachi. Randomly 246 physicians responded to the survey. The survey tested their views regarding weight management, importance of general awareness and their strategies to control weight. Results: In the first part of survey the physicians responded to almost 66% regarding the seriousness of obesity management with advising diet modification, physical exercise and decreasing calorie intake; 57% failed to employ Body Mass Index and Waist Hip Ratio as weight measurement tools in their daily practice; 50% disagreed on using pharmacotherapy as an option; 67% were not sure about the proper dosage and indication of anti-obesity medication while almost same disagreed on using surgical options for management of obesity; 83.3% physicians agreed on the increased obesity pandemic in Pakistan. Conclusion: The findings indicate that there is a gap between awareness and knowledge among Pakistani practicing physicians regarding pharmacotherapy for obesity. There is a need to frequently update latest guidelines to help manage this condition, which is becoming more prevalent in our country day by day. Physicians should be obligated to use updated knowledge for managing obesity.

Keywords: obesity, physicians, BMI, weight management, obesity awareness

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Sara Mercedes Barroso Pinzón, Antonio Javier Sanchéz Herencia, Begoña Ferrari, Álvaro Jesús Castro

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The current need for durable implants and bone substitutes characterised by biocompatibility, bioactivity and mechanical properties, without immunological rejection, is a major challenge for scientists. Hydroxyapatite (HAp) has been considered for decades as an ideal biomaterial for bone regeneration due to its chemical and crystallographic similarity to the mineral structure bioapatites. However, the lack of trace elements in the hydroxyapatite structure gives it very low mechanical and biological properties. In this sense, the objective of the research is to address the synthesis of hydroxyapatite with Mg from phosphate rock from sedimentary deposits in the central-eastern region of Colombia, taking advantage of the release of the species contained as natural precursors of Ca, P and Mg. The minerals present were studied, fluorapatite as the mineral of interest associated with mineralogical species of magnesium carbonates and quartz. The chemical and mineralogical composition was determined by X-ray fluorescence (XRF) and X-ray diffraction (XRD), scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX); as well as the evaluation of the surface physicochemical properties of zeta potential (PZC), with the aim of studying the surface behaviour of the microconstituents present in the phosphate rock and to elucidate the synergistic mechanism between the minerals and establish the optimum conditions for the wet concentration process. From the products obtained and characterised by XRD, XRF, SEM, FTIR, RAMAN, HAp-Mg biocomposite scaffolds are fabricated and the influence of Mg on the morphometric parameters, mechanical and biological properties of the designed materials is evaluated.

Keywords: phosphate rock, hydroxyapatite, magnesium, biomaterials

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Authors: Phang Moon Leng

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Automated Early Warning Scores is a newly developed clinical decision tool that is used to streamline and improve the process of obtaining a patient’s vital signs so a clinical decision can be made at an earlier stage to prevent the patient from further deterioration. This technology provides immediate update on the score and clinical decision to be taken based on the outcome. This paper aims to study the use of an automated early warning score system on whether the technology has assisted the hospital in early detection and escalation of clinical condition and improve patient outcome. The hospital adopted the Modified Early Warning Scores (MEWS) Scoring System and MEWS Clinical Response into Philips IntelliVue Guardian Automated Early Warning Score equipment and studied whether the process has been leaned, whether the use of technology improved the usage & experience of the nurses, and whether the technology has improved patient care and outcome. It was found the steps required to obtain vital signs has been significantly reduced and is used more frequently to obtain patient vital signs. The number of deaths, and length of stay has significantly decreased as clinical decisions can be made and escalated more quickly with the Automated EWS. The automated early warning score equipment has helped improve work efficiency by removing the need for documenting into patient’s EMR. The technology streamlines clinical decision-making and allows faster care and intervention to be carried out and improves overall patient outcome which translates to better care for patient.

Keywords: automated early warning score, clinical quality and safety, patient safety, medical technology

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Authors: A. Kulprasutidilok

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In order to address the social factors of elderly health care, researcher and community members have turned to more inclusive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received increased attention as the academic and public health communities struggle to address the persistent problems of disparities in the use of health care and health outcomes for several over the past decade. As Thailand becomes an ageing society, health services and proper care systems specifically for the elderly group need to be prepared and well established. The purpose of this assignment was to study the health problems and was to explore the process of community participation in elderly health care. Participants in this study were member of elderly group of Paisanee Ramintra 65 community in Bangkok, Thailand. The results indicated two important components of community participation process in elderly health care: 1) a process to develop community participation in elderly health care, and 2) outcomes resulting from such process. The development of community participation consisted of four processes. As for the outcomes of the community participation development process, they consisted of elderly in the community got jointly and formulated a group, which strengthened the project because of collaborative supervision among themselves. Moreover, inactive health care services have changed to being energetic and focus on health promotion rather than medical achievement and elderly association of community can perform health care activities for chronically illness through the achievement of this development; consequently, they increasingly gained access to physical, cognitive, and social activity.

Keywords: community-based participatory research, elderly, heath care, Thailand.

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Authors: Y. Y. Babanyara, B. A. Gana, T. Garba, M. A. Batari

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Proper management of dental waste is a crucial issue for maintaining human health and the environment. The waste generated in the dental clinics has the potential for spreading infections and causing diseases, so improper disposal of these dental wastes can cause harm to the dentist, the people in immediate vicinity of the dentist, waste handlers, general public and the environment through production of toxins or as by-products of the destruction process. Staff that provide dental healthcare ought to be aware of the proper handling and the system of management of dental waste used by different dental hospitals. The method of investigation adopted in the paper involved a desk study in which documents and records relating to dental waste handling were studied to obtain background information on existing dental waste management in Nigeria other countries of the world are also mentioned as examples. Additionally, information on generation, handling, segregation, risk associated during handling and treatment of dental medical waste were sought in order to determine the best method for safe disposal. This article provides dentists with the information they need to properly dispose of mercury and amalgam waste, and provides suggestions for managing the other wastes that result from the day-to-day activities of a dental office such as: used X-ray fixers and developers; cleaners for X-ray developer systems; lead foils, shields and aprons; chemiclave/chemical sterilant solutions; disinfectants, cleaners, and other chemicals; and, general office waste. Additionally, this study may be beneficial for authorities and researchers of developing countries to work towards improving their present dental waste management system.

Keywords: clinic, dental, disposal, environment, waste management

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Authors: Getachew Adugna

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Background: Chronic energy malnutrition and human immune deficiency virus among pregnant women are highly prevalent in Sub-Saharan Africa, and they are interrelated in a vicious cycle. However, the prevalence of chronic energy malnutrition and its determinant factors among human immune deficiency virus-positive pregnant women is not well studied in Ethiopia and Addis Ababa in particular. Objective: To determine the prevalence & associated factors of chronic energy malnutrition among human immune deficiency virus-positive pregnant women in health centres of Addis Ababa Ethiopia. Methods: An institution-based cross-sectional study was conducted and a systematic random sampling technique was used to select study subjects. A total of 253 study subjects were enrolled in the study—a structured and pre-tested questionnaire collected sociodemographic, maternal health-related, and nutritional-related variables. MUAC measurements were taken and medical charts were reviewed. Bi-variable and multi-variable logistic regression analyses were used to assess the effect of different factors on chronic energy malnutrition. Result: The overall prevalence of chronic energy malnutrition was 32.0%. It was significantly associated with dietary counselling (AOR: 0.062; 95%CI: 0.007, 0.549), CD4 level (AOR: 0.219; 95%CI: 0.025, 1.908), and clinical stage (AOR: 0.127; 95%CI: 0.053, 0.305). Conclusions: The prevalence of chronic energy malnutrition among Human Immune deficiency virus-infected pregnant women in Addis Ababa was high and Nutritional Intervention should be an integral part of the HIV care program.

Keywords: chronic energy malnutrition, HIV, MUAC, Addis Ababa

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Authors: Luay Alsalmi

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Background: Facial filler is the most common type of cosmetic surgery next to botox. Permanent filler is preferred nowadays due to the low cost brought about by non-recurring injection appointments. However, such fillers pose a higher risk for complications, with even greater adverse effects when the procedure is done using unknown dermal filler injections. AIM: This study aimed to establish an algorithm to categorize and manage patients that receive permanent fillers. Materials and Methods: Twelve participants were presented to the service through emergency or as outpatient from November 2015 to May 2021. Demographics such as age, sex, date of injection, time of onset, and types of complications were collected. After examination, all cases were managed based on an algorithm established. FACE-Q was used to measure overall satisfaction and psychological well-being. Results: The algorithm to diagnose and manage these patients effectively with a high satisfaction rate was established in this study. All participants were non-smoker females with no known medical comorbidities. The algorithm presented determined the treatment plan when faced with complications. Results revealed high appearance-related psychosocial distress was observed prior to surgery, while it significantly dropped after surgery. FACE-Q was able to establish evidence of satisfactory ratings among patients prior to and after surgery. Conclusion: This treatment algorithm can guide the surgeon in formulating a suitable plan with fewer complications and a high satisfaction rate.

Keywords: facial filler, FACE-Q, psycho-social stress, botox, treatment algorithm

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Authors: Marzieh Yassin, Fereshteh Navaee, Javad Sarrafzadeh, Reza Salehi

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Introduction: Myofascial trigger point (MTrP) is one of the most common sources of musculoskeletal pain. Approximately 30-85% of the patients with musculoskeletal pains would experience MTrP in their life. The prevalence of MTrP has reported in the patients seen in a general orthopedic clinic, general medical clinic and specialty pain management centers, 21%, 30% and 93% respectively. Nowadays, dry needling is suggested as a standard treatment for MTrPs. The purpose of the present study was to examine the effectiveness of dry needling with stretching upper trapezius muscle on pain and pain pressure threshold in participants with active myofascial trigger point. Methods: Thirty participants with an active myofascial trigger point of the upper trapezius muscle were randomly divided into two groups: dry needling with passive stretch (n=15) and passive stretch alone (n=15). They received 5 sessions of the treatments for three weeks. The outcomes were pain intensity and pain pressure threshold that were assessed with visual analogue scale and algometer respectively. Results: Significant improvement in pain and pain pressure threshold was observed in both groups (P=0.0001) after the treatment. Also, the results showed a significant difference in measurements between two groups (P<0.05). Conclusion: Dry needling with passive stretch can be more effective on pain and pain pressure threshold than passive stretching alone in short term in participants with active myofascial trigger points.

Keywords: dry needling, myofascial pain syndrome, myofascial trigger point, stretching

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