Search results for: dental patients

Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao

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This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.

Keywords: TPO antibody, subclinical hypothyroidism, anti nuclear antibody, thyroxin

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Authors: Cecília M. Antão, Paulo Jorge Nogueira

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Breast cancer (BC) is the first cause of cancer mortality among Portuguese women. This retrospective observational study aimed at identifying comorbidities associated with BC female patients admitted to Portuguese public hospitals (2010-2018), investigating the effect of comorbidities on BC mortality rate, and building a predictive model using logistic regression. Results showed that the BC mortality in Portugal decreased in this period and reached 4.37% in 2018. Adjusted odds ratio indicated that secondary malignant neoplasms of liver, of bone and bone marrow, congestive heart failure, and diabetes were associated with an increased chance of dying from breast cancer. Although the Lisbon district (the most populated area) accounted for the largest percentage of BC patients, the logistic regression model showed that, besides patient’s age, being resident in Bragança, Castelo Branco, or Porto districts was directly associated with an increase of the mortality rate.

Keywords: breast cancer, comorbidities, logistic regression, adjusted odds ratio

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Authors: O. J. Akinsola, Yinan Zheng, Rose Anorlu, F. T. Ogunsola, Lifang Hou, Robert Leo-Murphy

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Cervical Cancer (CC) is the 2nd most common cancer among women living in low and middle-income countries, with no associated symptoms during formative periods. With the advancement and innovative medical research, there are numerous preventive measures being utilized, but the incidence of cervical cancer cannot be truncated with the application of only screening tests. The mortality associated with this invasive cervical cancer can be nipped in the bud through the important role of early-stage detection. This study research selected an array of different top features selection techniques which was aimed at developing a model that could validly diagnose the risk factors of cervical cancer. A retrospective clinic-based cohort study was conducted on 178 HIV-associated cervical cancer patients in Lagos University teaching Hospital, Nigeria (U54 data repository) in April 2022. The outcome measure was the automated prediction of the HIV-associated cervical cancer cases, while the predictor variables include: demographic information, reproductive history, birth control, sexual history, cervical cancer screening history for invasive cervical cancer. The proposed technique was assessed with R and Python programming software to produce the model by utilizing the classification algorithms for the detection and diagnosis of cervical cancer disease. Four machine learning classification algorithms used are: the machine learning model was split into training and testing dataset into ratio 80:20. The numerical features were also standardized while hyperparameter tuning was carried out on the machine learning to train and test the data. Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), and K-Nearest Neighbor (KNN). Some fitting features were selected for the detection and diagnosis of cervical cancer diseases from selected characteristics in the dataset using the contribution of various selection methods for the classification cervical cancer into healthy or diseased status. The mean age of patients was 49.7±12.1 years, mean age at pregnancy was 23.3±5.5 years, mean age at first sexual experience was 19.4±3.2 years, while the mean BMI was 27.1±5.6 kg/m2. A larger percentage of the patients are Married (62.9%), while most of them have at least two sexual partners (72.5%). Age of patients (OR=1.065, p<0.001**), marital status (OR=0.375, p=0.011**), number of pregnancy live-births (OR=1.317, p=0.007**), and use of birth control pills (OR=0.291, p=0.015**) were found to be significantly associated with HIV-associated cervical cancer. On top ten 10 features (variables) considered in the analysis, RF claims the overall model performance, which include: accuracy of (72.0%), the precision of (84.6%), a recall of (84.6%) and F1-score of (74.0%) while LR has: an accuracy of (74.0%), precision of (70.0%), recall of (70.0%) and F1-score of (70.0%). The RF model identified 10 features predictive of developing cervical cancer. The age of patients was considered as the most important risk factor, followed by the number of pregnancy livebirths, marital status, and use of birth control pills, The study shows that data mining techniques could be used to identify women living with HIV at high risk of developing cervical cancer in Nigeria and other sub-Saharan African countries.

Keywords: associated cervical cancer, data mining, random forest, logistic regression

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Authors: Krishna Gopal Lageju

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On 25th April 2015, a 7.6 magnitude earthquake struck Gorkha district of Nepal, which resulted over 8,790 deaths and 22,300 injuries. In addition, almost one-third of the country’s healthcare service has been disrupted. A total of 1,211 health facilities became non-operational, due to 446 completely and other 765 partially damaged. Nearly 84 percent (375 out of 446) of the completely damaged health facilities are in the 14 most affected districts. As a result, the ability of health facilities to respond to health care needs has been harshly affected. In addition, 18 health workers lost their lives and 75 are injured, which added further challenges in the delivery of health services. Thus, to address the immediate health needs in the most devastated areas, Nepal Red Cross Society (NRCS) in coordination with IFRC and Nepal Government, 8 Field hospitals established with surgical capacities, where around 492 international Emergency Response Units (ERUs) Members are mobilized for 3 months period. More than 54,000 patients have been treated in the Red Cross operated field hospitals. Trauma cases accounted 9,180 (17%) of the total patients off which 1,285 (14%) are major surgical cases. Most of the case loads 44,830 (83%) are outpatients and 9,180 patients got inpatients service. Similarly, 112 births have been performed in the field hospitals. Inpatient mortality rate remained 1.5% (21 deaths), many of them are presented with critical injuries or illnesses. No outbreak has been seen during the ERU operation. Deployment of ERUs together with national health workers are very important to address the immediate health needs of the affected communities. This will ease for transition and handover of emergency service and equipments to local provider. Likewise, capacity building of local staff as on the job training on various clinical teachings would be another important issue to look at before phasing out such services.

Keywords: trauma management, critical injuries, earthquake, health

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Authors: Biswabandhu Bankura, Srikanta Guria, Madhusudan Das

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Purpose: Thyroid peroxidase (TPO) is the key enzyme in the biosynthesis of thyroid hormones. We aimed to identify the spectrum of mutations in the TPO gene leading to hypothyroidism in the population of West Bengal to establish the genetic etiology of the disease. Methods: 200 hypothyroid patients (case) and their corresponding sex and age matched 200 normal individuals (control) were screened depending on their clinical manifestations. Genomic DNA was isolated from peripheral blood samples and TPO gene (Exon 7 to Exon 14) was amplified by PCR. The PCR products were subjected to sequencing to identify mutations. Results: Single nucleotide changes such as Glu 641 Lys, Asp 668 Asn, Thr 725 Pro, Asp 620 Asn, Ser 398 Thr, and Ala 373 Ser were found. Changes in the TPO were assayed in vitro to compare mutant and wild-type activities. Five mutants were enzymatically inactive in the guaiacol and iodide assays. This is a strong indication that the mutations are present at crucial positions of the TPO gene, resulting in inactivated TPO. Key Findings: The results of this study may help to develop a genetic screening protocol for goiter and hypothyroidism in the population of West Bengal.

Keywords: thyroid peroxidase, hypothyroidism, mutation, in vitro assay, transfection

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Authors: Biswabandhu Bankura, Srikanta Guria, Madhusudan Das

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Purpose: Thyroid peroxidase (TPO) is the key enzyme in the biosynthesis of thyroid hormones. We aimed to identify the spectrum of mutations in the TPO gene leading to hypothyroidism in the population of West Bengal to establish the genetic etiology of the disease. Methods: 200 hypothyroid patients (case) and their corresponding sex and age matched 200 normal individuals (control) were screened depending on their clinical manifestations. Genomic DNA was isolated from peripheral blood samples and TPO gene (Exon 7 to Exon 14) was amplified by PCR. The PCR products were subjected to sequencing to identify mutations. Results: Single nucleotide changes such as Glu 641 Lys, Asp 668 Asn, Thr 725 Pro, Asp 620 Asn, Ser 398 Thr, and Ala 373 Ser were found. Changes in the TPO were assayed in vitro to compare mutant and wild-type activities. Five mutants were enzymatically inactive in the guaiacol and iodide assays. This is a strong indication that the mutations are present at crucial positions of the TPO gene, resulting in inactivated TPO. Key Findings: The results of this study may help to develop a genetic screening protocol for goiter and hypothyroidism in the population of West Bengal.

Keywords: thyroid peroxidase, hypothyroidism, mutation, in vitro assay, transfection

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Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

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Bionaut Labs, LLC is developing a minimally invasive robotic microdevice designed to treat non-communicating hydrocephalus in both adult and pediatric patients. The device utilizes biocompatible microsurgical particles (Bionaut™) that are specifically designed to safely and reliably perform accurate fenestration(s) in the 3rd ventricle, aqueduct of Sylvius, and/or trapped intraventricular cysts of the brain in order to re-establish normal cerebrospinal fluid flow dynamics and thereby balance and/or normalize intra/intercompartmental pressure. The Bionaut™ is navigated to the target via CSF or brain tissue in a minimally invasive fashion with precise control using real-time imaging. Upon reaching the pre-defined anatomical target, the external driver allows for directing the specific microsurgical action defined to achieve the surgical goal. Notable features of the proposed protocol are i) Bionaut™ access to the intraventricular target follows a clinically validated endoscopy trajectory which may not be feasible via ‘traditional’ rigid endoscopy: ii) the treatment is microsurgical, there are no foreign materials left behind post-procedure; iii) Bionaut™ is an untethered device that is navigated through the subarachnoid and intraventricular compartments of the brain, following pre-designated non-linear trajectories as determined by the safest anatomical and physiological path; iv) Overall protocol involves minimally invasive delivery and post-operational retrieval of the surgical Bionaut™. The approach is expected to be suitable to treat pediatric patients 0-12 months old as well as adult patients with obstructive hydrocephalus who fail traditional shunts or are eligible for endoscopy. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebrospinal fluid, CSF, fenestration, hydrocephalus, micro-robot, microsurgery

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Authors: Juni C. Kim, Anna R. Robuck, Douglas I. Walker

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The human exposome, which includes chemical exposures over the lifetime and their effects, is now recognized as an important measure for understanding human health; however, the complexity of the data makes the identification of environmental chemicals challenging. The goal of our project was to establish a computational workflow for the improved identification of environmental pollutants containing chlorine or bromine. Using the “pattern. search” function available in the R package NonTarget, we wrote a multifunctional script that searches mass spectral clusters from untargeted gas-chromatography high-resolution mass spectrometry (GC-HRMS) for the presence of spectra consistent with chlorine and bromine-containing organic compounds. The “pattern. search” function was incorporated into a different function that allows the evaluation of clusters containing multiple analyte fragments, has multi-core support, and provides a simplified output identifying listing compounds containing chlorine and/or bromine. The new function was able to process 46,000 spectral clusters in under 8 seconds and identified over 150 potential halogenated spectra. We next applied our function to a deidentified dataset from patients diagnosed with primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and healthy controls. Twenty-two spectra corresponded to potential halogenated compounds in the PSC and PBC dataset, including six significantly different in PBC patients, while four differed in PSC patients. We have developed an improved algorithm for detecting halogenated compounds in GC-HRMS data, providing a strategy for prioritizing exposures in the study of human disease.

Keywords: exposome, metabolome, computational metabolomics, high-resolution mass spectrometry, exposure, pollutants

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Authors: Sujeet Poudyal

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Introduction: After Holmium:yttrium-aluminum-garnet (Ho: YAG) laser has revolutionized the management of urolithiasis, the introduction of Thulium fibre laser (TFL) has already challenged Ho:YAG laser due to its multiple commendable properties. Nevertheless, there are only few studies comparing TFL and holmium laser in Retrograde Intrarenal Surgery(RIRS). Therefore, this study was carried out to compare the efficacy and safety of thulium fiber laser (TFL) and holmium laser in RIRS. Methods: This prospective comparative study, which included all patients undergoing laser lithotripsy (RIRS) for proximal ureteric calculus and nephrolithiasis from March 2022 to March 2023, consisted of 63 patients in Ho:YAG laser group and 65 patients in TFL group. Stone free rate, operative time, laser utilization time, energy used, and complications were analysed between the two groups. Results: Mean stone size was comparable in TFL (14.23±4.1 mm) and Ho:YAG (13.88±3.28 mm) group, p-0.48. Similarly, mean stone density in TFL (1269±262 HU) was comparable to Ho:YAG (1189±212 HU), p-0.48. There was significant difference in lasing time between TFL (12.69±7.41 mins) and Ho:YAG (20.44±14 mins), p-0.012). TFL group had operative time of 43.47± 16.8 mins which was shorter than Ho:YAG group (58±26.3 mins),p-0.005. Both TFL and Ho:YAG groups had comparable total energy used(11.4±6.2 vs 12±8 respectively, p-0.758). Stone free rate was 87%for TFL, whereas it was 79.5% for Ho:YAG, p-0.25). Two cases of sepsis and one ureteric stricture were encountered in TFL, whereas three cases suffered from sepsis apart from one ureteric stricture in Ho:YAG group, p-0.62). Conclusion: Thulium Fibre Laser has similar efficacy as Holmium: YAG Laser in terms of safety and stone free rate. However, due to better stone ablation rate in TFL, it can become the game changer in management of urolithiasis in the coming days.

Keywords: retrograde intrarenal surgery, thulium fibre laser, holmium:yttrium-aluminum-garnet (ho:yag) laser, nephrolithiasis

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Authors: Alieh Farshbaf

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Introduction: Current anti-retroviral drugs have some restrictions for treatment of HIV-1 infection. The efficacy of retroviral drugs is not same in different infected patients and the virus rebound from latent reservoirs after stopping them. Recently, the engineering of stem cells and gene therapy provide new approaches to eliminate some drug problems by induction of resistance to HIV-1. Literature review: Up to now, AIDS-restriction genes (ARGs) were suitable candidate for gene and cell therapies, such as cc-chemokine receptor-5 (CCR5). In this manner, CCR5 provide effective cure in Berlin and Boston patients by inducing of HIV-1 resistance with allogeneic stem cell transplantation. It is showed that Zinc Finger Nuclease (ZFN) could induce HIV-1 resistance in stem cells of infected patients by homologous recombination or non-end joining mechanism and eliminate virus loading after returning the modified cells. Then, gene modification by HIV restriction factors, as TRIM5, introduced another gene candidate for HIV by interfering in infection process. These gene modifications/editing provided by stem cell futures that improve treatment in refractory disease such as HIV-1. Conclusion: Although stem cell transplantation has some complications, but in compare to retro-viral drugs demonstrated effective cure by elimination of virus loading. On the other hand, gene therapy is cost-effective for an infected patient than retroviral drugs payment in a person life-long. The results of umbilical cord blood stem cell transplantation showed that gene and cell therapy will be applied easier than previous treatment of AIDS with high efficacy.

Keywords: stem cell, AIDS, gene modification, cell engineering

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Authors: Mathumalar Loganathan, Lina Syazana, Bryony Dean Franklin

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Background: The therapeutic benefit of self-administered medication for long-term use is limited by an average 50% non-adherence rate. Patient forgetfulness is a common factor in unintentional non-adherence. With a growing ageing population, strategies to improve self-administration of medication adherence are essential. Our aim was to review systematically the effects of interventions to optimise self-administration of medication. Method: Database searched were MEDLINE, EMBASE, PsynINFO, CINAHL from 1980 to 31 October 2013. Search terms included were ‘self-administration’, ‘self-care’, ‘medication adherence’, and ‘intervention’. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. Results: The search strategy retrieved 6 studies that met the inclusion and exclusion criteria. Three intervention strategies were identified: self-administration medication programme (SAMP), nursing education and medication packaging (pill calendar). A nursing education programme focused on improving patients’ behavioural self-management of drug prescribing. This was the most studied area and three studies highlighting an improvement in self-administration of medication. Conclusion: Results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, self-administration of medication programme seems to show most promise. A multi-faceted approach and clearer policy guideline are likely to be required to improve prescribing for these vulnerable patients. Mixed results were found for SAMP. Medication packaging (pill calendar) was evaluated in one study showing a significant improvement in self-administration of medication. A meta-analysis could not be performed due to heterogeneity in the outcome measures.

Keywords: self-administered medication, intervention, prescribing, older patients

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Authors: Yasuyuki Takahashi, Genta Hoshi, Kyoko Saito

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Objectives: The objective of this study was to evaluate the reproducibility of I-123-N-ω-fluoropropyl-2β-carbomethoxy-3β-(4- iodophenyl) nortropane (I-123 FP-CIT) SPECT by using specific binding ratio (SBR) in phantom studies and Parkinson’s Disease (PD) patients. Methods: We made striatum phantom originally and confirmed reproducibility. The phantom studies changed head position and accumulation of FP-CIT, each. And image processing confirms influence on SBR by 30 cases. 30 PD received a SPECT for 3 hours post injection of I-123 FP-CIT 167MBq. Results: SBR decreased in rotatory direction by the patient position by the phantom studies. And, SBR improved the influence after the attenuation and the scatter correction in the cases (y=0.99x+0.57 r2=0.83). However, Stage II recognized dispersion in SBR by low accumulation. Conclusion: Than the phantom studies that assumed the normal cases, the SPECT image after the attenuation and scatter correction had better reproducibility.

Keywords: 123I-FP-CIT, specific binding ratio, Parkinson’s disease

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Authors: Rosy Chaudhary, Pushpa Parajuli

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Background and Objectives: Informational support to family members has a significant potential for reducing this distress related to hospitalization of their patient into the critical care unit, enabling them to cope better and support the patient. The objective of the study is to assess family members’ perception of informational support, anxiety, satisfaction with care and to reveal the association with selected socio-demographic variables and to investigate the correlation between informational support, anxiety and satisfaction with care. Materials and Methods: A descriptive cross-sectional study was conducted in 39 family caregivers of patients admitted in critical care unit of BPKIHS(B.P. Koirala Institute of Health Sciences). Consecutive sampling technique was used wherein data was collected over duration of one month using interview schedule. Descriptive and inferential statistics were used. Results: The mean age of the respondents was 34.97 ± 10.64 and two third (66.70%) were male. Mean score for informational support was 25.72(SD = 5.66; theoretical range of 10 - 40). Mean anxiety was 10.41 (SD = 5.02; theoretical range of 7 - 21). Mean score for satisfaction with care was 40.77 (SD = 6.77; theoretical range of 14 - 64). A moderate positive correlation was found between informational support and satisfaction with care (r = 0.551, p < .001) and a moderate negative correlation was found between anxiety and satisfaction with care (r = -0.590; p = 0.000). No relationship was noted between informational support and anxiety. Conclusion: The informational support and satisfaction of the family caregivers with the care provided to their patients was satisfactory. More than three fourth of the family caregivers had anxiety; the factors associated being educational status of the caregivers, the family income and duration of visiting hours. There was positive correlation between informational support and satisfaction with care provided justifying the need for comprehensive information to the family caregivers by the health personnel. There was negative correlation between anxiety and satisfaction with care.

Keywords: anxiety, caregivers, critical care unit, informational support, family

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Authors: Gehan Labib Abuelenain, Azza Fahmi, Salma Awad Mahmoud

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Toxoplasmosis is a global parasitic disease caused by the protozoan Toxoplasma gondii (T. gondii), with a high infection rate that affects one third of the human population and results in severe implications in pregnant women, neonates, and immunocompromised patients. Anti-parasitic treatments and schemes available against toxoplasmosis have barely evolved over the last two decades. The available T. gondii therapeutics cannot completely eradicate tissue cysts produced by the parasite and are not well-tolerated by immunocompromised patients. This work aims to highlight new trends in Toxoplasma gondii diagnosis by providing a comprehensive overview of the field, summarizing recent findings, and discussing the new technological advancements in toxoplasma diagnosis and treatment. Advancements in therapeutics utilizing trends in molecular biophysics, such as biosensors, epigenetics, and artificial intelligence (AI), might provide solutions for disease management and prevention. These insights will provide tools to identify research gaps and proffer planning options for disease control.

Keywords: toxoplamosis, diagnosis, therapeutics, biosensors, AI

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Authors: Ephrem Mebratu Dagnew, Mohammed Biset Ayalew, Gizework Alemnew Mekonnen, Alehegn Bishaw Geremew, Ousman Abubeker Abdela

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Objective: To assess the prevalence of drug-related problems and associated factors among adult psychiatric inpatients. Method: Hospital-based multicenter cross-sectional observational study was conducted from April to July 2021 at five randomly selected hospitals in North-west Ethiopia. A total of 325 consecutively sampled patients participated in the study. Clinical pharmacists assessed the DRPs based on clinical judgment supported by updated evidence-based diseases guidelines. A Medscape drug-interactions checker was used to check drug-drug interactions. The results were summarized using descriptive statistics, including frequency, mean, and standard deviation. Odds ratio (OR) with 95% confidence interval were also computed for each variable for the corresponding P-value. The value of P ≤ 0.05 was considered statistically significant. Result : From the total of 325 study participants, more than half of them (52.9%) were females and the mean age ± (standard deviation) was 30.8±11.3 years. At least one drug-related problem was recorded from 60.9%, 95% CI (55.7-65.8) of study participants with a mean of 0.6±0.49 per patient. Need additional drug therapy was the most common DRP (22.8%), followed by non-adherence to medicine (20.6%) and adverse drug reactions (11%), respectively. Factors independently associated with drug-related problems were rural residence [AOR=1.96,95%CI:1.01-2.84, P-value=0.046], self-employed [AOR=6.0 ,95% CI: 1.0-36.9, P-value=0.035] and alcohol drinkers [AOR=6.40,95%CI:1.12-37.5, p-value=0.034]. Conclusion: The prevalence of drug-related problems among adult psychiatric patients admitted to psychiatric wards was high. Healthcare providers give more attention to tackling these problems. Being a rural residence, self-employed, and Alcohol drinkers were associated with drug-related problems.

Keywords: psychiatric patients, drug-relatedproblems, multicenter, Ethiopia

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Authors: Michelle Nighswander

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Suicide can be a tragic response to mental illness. It is difficult for people to disclose or discuss suicidal impulses. The stigma surrounding mental health can create a reluctance to seek help for mental illness. Patients may feel pressure to exhibit a socially desirable demeanor rather than reveal these issues, especially if they sense their healthcare provider is pressed for time or does not have an extensive history with their provider. Overcoming these barriers can be challenging. Although there are several validated depression and suicide risk instruments, varying processes used to administer these tools may impact the truthfulness of the responses. A literature review was conducted to find evidence of the impact of the environment on the accuracy of depression screening. Many investigations do not describe the environment and fewer studies use a comparison design. However, three studies demonstrated that computerized self-reporting might be more likely to elicit truthful and accurate responses due to increased privacy when responding compared to a face-to-face interview. These studies showed patients reported positive reactions to computerized screening for other stigmatizing health conditions such as alcohol use during pregnancy. Computerized self-screening for depression offers the possibility of more privacy and patient reflection, which could then send a targeted message of risk to the healthcare provider. This could potentially increase the accuracy while also increasing time efficiency for the clinic. Considering the persistent effects of mental health stigma, how these screening questions are posed can impact patients’ responses. This literature review analyzes trends in depression screening methodologies, the impact of setting on the results and how this may assist in overcoming one barrier caused by stigma.

Keywords: computerized self-report, depression, mental health stigma, suicide risk

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: Liaquat Ali, Khurshid Natasha

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Low resource countries are not usually equipped with the organizational tools to implement health care for chronic diseases, and thus, providing effective diabetes care in such countries is a challenging task. Diabetic Association of Bangladesh (BADAS in Bengali acronym) has created a stimulating example to meet this challenge. Starting its journey in 1956 with 39 patients in a small tin shed clinic BADAS, and its affiliated associations now operate 90 hospitals and health centres all over the country. Together, these facilities provide integrated health care to about 1.5 million registered diabetic patients which constitute about 20% of the estimated diabetic population in the country. BADAS has also become a pioneer in health manpower generation in Bangladesh. Along with its affiliates, it now runs 3 Medical Colleges (to generate graduate physicians), 2 Nursing Institutes, and 2 Postgraduate Institutes which conduct 25 postgraduate courses (under the University of Dhaka) in various basic, clinical and public health disciplines. BADAS gives great emphasis on research, which encompasses basic, clinical as well as public health areas. BADAS is an ideal example of public-private partnership in health as most of its infrastructure has been created through government support but it is almost self-reliant in managing its revenue budget which approached approximately 40 million US dollar during 2010. BADAS raises resources by providing high-quality services to the people, both diabetic and non-diabetic. At the same time, BADAS has developed a cross financing model, to support diabetic patients in general and poor diabetic patients (identified through a social welfare network) in particular, through redistribution of the resources. Along with financial sustainability BADAS ensure organizational sustainability through a process of decentralization, community ownership, and democratic management. Presently a large scale pilot project (named as a Health Care Development Project or HCDP) is under implementation under BADAS umbrella with an objective to transform the diabetes care model to a health care model in general. It is expected to create further evidence on providing sustainable (with social safety net) health care delivery for diabetes, and other chronic illnesses as an integral part of general health care delivery in a resource constrained setting.

Keywords: Bangladesh, self sustain, health care, constrain

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Authors: C. Bel, J. Nevado, F. Ciceri, M. Ropacki, T. Hoffmann, P. Lapunzina, C. Buesa

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Background: The Phelan-McDermid syndrome (PMS) is a genetic disorder caused by the deletion of the terminal region of chromosome 22 or mutation of the SHANK3 gene. Shank3 disruption in mice leads to dysfunction of synaptic transmission, which can be restored by epigenetic regulation with both Lysine Specific Demethylase 1 (LSD1) inhibitors. PMS subjects result in a variable degree of intellectual disability, delay or absence of speech, autistic spectrum disorders symptoms, low muscle tone, motor delays and epilepsy. Vafidemstat is an LSD1 inhibitor in Phase II clinical development with a well-established and favorable safety profile, and data supporting the restoration of memory and cognition defects as well as reduction of agitation and aggression in several animal models and clinical studies. Therefore, vafidemstat has the potential to become a first-in-class precision medicine approach to treat PMS patients. Aims: The goal of this research is to perform an observational trial to psychometrically characterize individuals carrying deletions in SHANK3 and build a foundation for subsequent precision psychiatry clinical trials with vafidemstat. Methodology: This study is characterizing the clinical profile of 20 to 40 subjects, > 16-year-old, with genotypically confirmed PMS diagnosis. Subjects will complete a battery of neuropsychological scales, including the Repetitive Behavior Questionnaire (RBQ), Vineland Adaptive Behavior Scales, Escala de Observación para el Diagnostico del Autismo (Autism Diagnostic Observational Scale) (ADOS)-2, the Battelle Developmental Inventory and the Behavior Problems Inventory (BPI). Results: By March 2021, 19 patients have been enrolled. Unsupervised hierarchical clustering of the results obtained so far identifies 3 groups of patients, characterized by different profiles of cognitive and behavioral scores. The first cluster is characterized by low Battelle age, high ADOS and low Vineland, RBQ and BPI scores. Low Vineland, RBQ and BPI scores are also detected in the second cluster, which in contrast has high Battelle age and low ADOS scores. The third cluster is somewhat in the middle for the Battelle, Vineland and ADOS scores while displaying the highest levels of aggression (high BPI) and repeated behaviors (high RBQ). In line with the observation that female patients are generally affected by milder forms of autistic symptoms, no male patients are present in the second cluster. Dividing the results by gender highlights that male patients in the third cluster are characterized by a higher frequency of aggression, whereas female patients from the same cluster display a tendency toward higher repetitive behavior. Finally, statistically significant differences in deletion sizes are detected comparing the three clusters (also after correcting for gender), and deletion size appears to be positively correlated with ADOS and negatively correlated with Vineland A and C scores. No correlation is detected between deletion size and the BPI and RBQ scores. Conclusions: Precision medicine may open a new way to understand and treat Central Nervous System disorders. Epigenetic dysregulation has been proposed to be an important mechanism in the pathogenesis of schizophrenia and autism. Vafidemstat holds exciting therapeutic potential in PMS, and this study will provide data regarding the optimal endpoints for a future clinical study to explore vafidemstat ability to treat shank3-associated psychiatric disorders.

Keywords: autism, epigenetics, LSD1, personalized medicine

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Authors: Aya Gamal Khattab

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Chronic infection with the hepatitis C virus (HCV) is now the leading cause of liver-related morbidity and mortality; Currently, alanine aminotransferase ALT measurement is not only widely used in detecting the incidence, development, and prognosis of liver disease with obvious clinical symptoms, but also provides reference on screening the overall health status during health check-ups. Exercise is a low-cost, reliable and sustainable therapy for many chronic diseases. Low-volume high intensity interval training HIT is time efficient while also having wider application to different populations including people at risk for chronic inflammatory diseases. Purpose of this study was to investigate the effect of low volume high intensity interval training on ALT, AST in HCV patients. All practical work was done in outpatient physiotherapy clinic of Suez Canal Authority Hospitals. Forty patients both gender (27 male, 13 female), age ranged (40-60) years old submitted to low volume high intensity interval training on treadmill for two months three sessions per week. Each session consisting of five min warming up, two bouts for 10 min each bout consisting of 30 sec - 1 min of high intensity (75%-85%) HRmax then two to four min active recovery at intensity (40%-60%) HRmax, so the sum of high intensity intervals was one to two min for each session and four to eight min active recovery, and ends with five min cooling down. ALT and AST were measured before starting exercise session and 2 months later after finishing the total exercise sessions through blood samples. Results showed significant decrease in ALT, AST with improvement percentage (18.85%), (23.87%) in the study, so the study concluded that low volume high intensity interval training had a significant effect in lowering the level of circulating liver enzymes (ALT, AST) which means protection of hepatic cells and restoration of its function.

Keywords: alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatitis C (HCV), low volume high intensity interval training

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Authors: Dwi Endarti, Susi a Kristina, Rizki Noorizzati, Akbar E Nugraha, Fera Maharani, Kika a Putri, Asninda H Azizah, Sausanzahra Angganisaputri, Yunisa Yustikarini

Abstract:

Cost utility analysis is the most recommended pharmacoeconomic method since it allows widely comparison of cost-effectiveness results from different interventions. The method uses outcome of quality-adjusted life year (QALY) or disability-adjusted life year (DALY). Measurement of QALY requires the data of utility dan life years gained. Utility is measured with the instrument for quality of life measurement such as EQ-5D. Recently, the EQ-5D is available in two versions which are EQ-5D-3L and EQ-5D-5L. This study aimed to compare the EQ-5D-3L and EQ-5D-5L to examine the most suitable version for Indonesian population. This study was an observational study employing cross sectional approach. Data of quality of life measured with EQ-5D-3L and EQ-5D-5L were collected from several groups of population which were respondent with chronic diseases, respondent with acute diseases, and respondent from general population (without illness) in Yogyakarta Municipality, Indonesia. Convenience samples of hypertension patients (83), diabetes mellitus patients (80), and osteoarthritis patients (47), acute respiratory tract infection (81), cephalgia (43), dyspepsia (42), and respondent from general population (293) were recruited in this study. Responses on the 3L and 5L versions of EQ-5D were compared by examining the psychometric properties including agreement, internal consistency, ceiling effect, and convergent validity. Based on psychometric properties tests of EQ-5D-3L dan EQ-5D-5L, EQ-5D-5L tended to have better psychometric properties compared to EQ-5D-3L. Future studies for health related quality of life (HRQOL) measurements for pharmacoeconomic studies in Indonesia should apply EQ-5D-5L.

Keywords: EQ-5D, Health Related Quality of Life, Indonesian Population, Psychometric Properties

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Authors: Margaret Denise P. Del Rosario, Geraldine Alcantara

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Background: The declaration of the COVID-19 pandemic has impacted hospital visits of child abuse cases with less consults but more severe injuries. Objective: The study aims to identify the clinical profiles of patients seen in the hospital ng Makati Women and Children Protection Unit before and during the pandemic. Design: A cross-sectional analytic study design through review of records that underwent quantitative analysis. Results: 264 cases pre-pandemic and 208 cases during the pandemic were reviewed. Most reported cases were neglect comprising of 47% of the pre-pandemic cases and 68% of cases during the pandemic. Supervisory neglect was most commonly reported. An equal distribution between males and females were seen among victims and alleged perpetrators. The age group of both victims and alleged perpetrators during the pandemic was significantly younger compared to the pre-pandemic period. Children belonging to larger family groups were commonly encountered with most of them being the eldest amongst siblings. Alleged perpetrators were mostly secondary graduates for both time periods. A significant increase of cases during the pandemic occurred at home. More patients required hospitalization during the pandemic period with 37% compared to the 23% of admissions prior to the pandemic. Furthermore, a three-fold increase of injuries sustained during the pandemic required intensive care. Conclusion: The study reflects increased severity of injuries related to abuse during the pandemic compared to pre-pandemic times. A significant increase in injuries requiring intensive care were also seen despite less reported cases.

Keywords: child abuse, COVID-19, violence against children, WCPU, neglect

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Authors: Rammah Abdlbagi, Egmen Tazcan, Kiriti Tripathi, Vinayagam Sudhakar, Thomas Swallow, Aakash Pai

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Introduction and Objectives: MRI has an increasing role in the diagnosis and staging of prostate cancer. Multiparametric MRI includes multiple sequences, including T2 weighting, diffusion weighting, and dynamic contrast enhancement (DCE). Administration of DCE is expensive, time-consuming, and requires medical supervision due to the risk of anaphylaxis. Biparametric MRI (bpMRI), without DCE, overcomes many of these issues; however, there is conflicting data on its accuracy. Furthermore, data on the concordance between bpMRI lesion and pathology specimen, as well as the rates of cancer stage upgrading after surgery, is limited within the available literature. This study aims to examine the diagnostic test accuracy of bpMRI in the diagnosis of prostate cancer and radiological assessment of prostate cancer staging. Specifically, we aimed to evaluate the ability of bpMRI to accurately localise malignant lesions to better understand its accuracy and application in MRI-targeted biopsies. Materials and Methods: One hundred and forty patients who underwent bpMRI prior to radical prostatectomy (RP) were retrospectively reviewed from a single institution. Histological grade from the prostate biopsy was compared with surgical specimens from RP. Clinically significant prostate cancer (csPCa) was defined as Gleason grade group ≥2. bpMRI staging was compared with RP histology. Results: Overall sensitivity of bpMRI in diagnosing csPCa independent of location and staging was 98.87%. Of the 140 patients, 29 (20.71%) had their prostate biopsy histology upgraded at RP. 61 (43.57%) patients had csPca noted on RP specimens in areas that were not identified on the bpMRI. 55 (39.29%) had upstaging after RP from the original staging with bpMRI. Conclusions: Whilst the overall sensitivity of bpMRI in predicting any clinically significant cancer was good, there was notably poor concordance in the location of the tumour between bpMRI and eventual RP specimen. The results suggest that caution should be exercised when using bpMRI for targeted prostate biopsies and validates the continued role of systemic biopsies. Furthermore, a significant number of patients were upstaged at RP from their original staging with bpMRI. Based on these findings, bpMRI results should be interpreted with caution and can underestimate TNM stage, requiring careful consideration of treatment strategy.

Keywords: biparametric MRI, Ca prostate, staging, post prostatectomy histology

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Authors: Saimir Heta, Ilma Robo, Vera Ostreni, Glorja Demika, Sonila Kapaj

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Suturing, as a procedure of joining the lips of the lembo or wound, is important at the beginning of the healing process. This procedure helps to pass the healing process from the procedure per secundam to the stages of healing per primam, thus logically reducing the healing time of the wound. The element that remains in the individual selection of the dentist applying the suture is the selection of the suture material. At a moment when some types of sutures are offered for use, some elements should be considered in the selection of the suture depending on the constituent material, the cross-section of the suture elements, and whether it collects bacteria in the "pits" created by the material. The presence of bacteria is a source of infection and possible delay in the healing of the sutured wound. Conclusion: The marketing of suture types offers a variety of materials, from which the selection of the most suitable suture type for specific application cases is a personal indication of the dental surgeon, based on professional experiences and knowledge in the field.

Keywords: suture, suture material, types of sutures, clinical application

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Authors: Liaqat Ali, Ehsan, Muhammad Shahzad, Nasir Orakzai

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Introduction: Internal optical urethrotomy is the main stay treatment modality in management of urethral stricture. Being minimal invasive with less morbidity, it is commonly performed and favored procedure by urologists across the globe. Although short-term success rate of optical urethrotomy is promising but long-term efficacy of IOU is questionable with high recurrence rate in different studies. Numerous techniques had been adopted to reduce the recurrence after IOU like prolong catheterization and self-clean intermittent catheterization with varying success. Mitomycin C has anti-fibroblast and anti-collagen properties and has been used in trabeculectomy, myringotomy and after keloid scar excision in contemporary surgical practice. Present study according to the best of our knowledge is a pioneer pilot study in Pakistan to determine the efficacy of Mitomycin C in preventing recurrence of urethral stricture after internal optical urethrotomy. Objective: To determine the efficacy of Mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy. Methods: It is a randomized control trial conducted in department of urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from March 2011 till December 2013. After approval of hospital ethical committee, we included maximum of 2 cm anterior urethral stricture irrespective of etiology. Total of 140 patients were equally divided into two groups by lottery method. Group A (Case) comprising of 70 patients in whom Mitomycin C 0.1% was injected sub mucosal in stricture area at 1,11,6 and 12 O clock position using straight working channel paediatric cystoscope after conventional optical urethrotomy. Group B (Control) 70 patients in whom only optical urethrotomy was performed. SCIC was not offered in both the groups. All the patients were regularly followed on a monthly basis for 3 months then three monthly for remaining 9 months. Recurrence was diagnosed by using diagnostic tools of retrograde urethrogram and flexible urethroscopy in selected cased. Data was collected on structured Proforma and was analyzed on SPSS. Result: The mean age in Group A was 33 ±1.5 years and Group B was 35 years. External trauma was leading cause of urethral stricture in both groups 46 (65%) Group A and 50 (71.4%) Group B. In Group A. Iatrogenic urethral trauma was 2nd etiological factor in both groups. 18(25%) Group A while 15( 21.4%) in Group B. At the end of 1 year, At the end of one year, recurrence of urethral stricture was recorded in 11 (15.71%) patient in Mitomycin C Group A and it was recorded in 27 (38.5 %) patients in group B. Significant difference p=0.001 was found in favour of group A Mitomycin group. Conclusion: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C is found highly effective in preventing recurrence of urethral stricture after IOU.

Keywords: urethral stricture, mitomycine, internal optical urethrotomy, medical and health sciences

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Authors: R. Botrugno, S Basyuni, G. Nugent, I. Jenkyn, A. Ferro, H. Bennett, C. Hjalmarsson, J. Chu, V. Santhanam

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This trainee led randomised controlled trial (RCT) aims to assess various outcomes for resorbable versus non-resorbable sutures for traumatic lacerations to the face. Within this trial of resorbable versus non-resorbable sutures for traumatic lacerations of the face (TORNFace), patient recruitment was facilitated by trainees who were employed at an NHS University Teaching Hospital in the United Kingdom. The trainees received appropriate training prior to recruiting patients for the trial. This included the completion of a national research e-learning module and face-to-face training that was provided locally. The locally delivered training provided an understanding of the eligibility criteria for the trial and the consent process. Existing trainee skills were utilised involving clinical photography to record baseline data and delivering the intervention based on the treatment arm selected. Eligible patients who required primary closure of traumatic lacerations of the face were randomised into one of two treatment arms. These comprised of resorbable (vicryl rapide) or non-resorbable sutures (ethilon). Primarily the cosmetic outcome was assessed. Secondary outcomes included: complications rates, health care economics, and patient-reported outcomes. Remote follow-up of recruited patients utilised photographs of the facial laceration which had received the intervention. These took place at 1 week, 3 months and 6 months post-intervention. This study aims to demonstrate an example of trainee-led research within the specialty of oral and maxillofacial surgery. The available data for the randomised controlled trial will also be presented.

Keywords: laceration, suture, trauma, trial

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Authors: Merav Ben Natan, Yaniv Steinfeld, Sara Badash, Galina Shmilov, Milena Abramov, Danny Epstein, Yaniv Yonai, Eyal Berbalek, Yaron Berkovich

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Introduction: Postoperative pain management is crucial for effective rehabilitation, with the Visual Analog Scale (VAS) being a common tool for assessing pain intensity due to its sensitivity and accuracy. However, challenges such as misunderstanding of instructions and discrepancies in pain reporting can affect its reliability. Additionally, the mandatory use of face masks during the COVID-19 pandemic may impair nonverbal and verbal communication, potentially impacting pain assessment and overall care quality. Aims: This study examines the association between the type of mask worn by health care professionals and the assessment of pain intensity in patients after orthopedic surgery using the visual analog scale (VAS). Design: A nonrandomized controlled trial was conducted among 176 patients hospitalized in an orthopedic department of a hospital located in northern-central Israel from January to March 2021. Methods: In the intervention group (n = 83), pain assessment using the VAS was performed by a healthcare professional wearing a transparent face mask, while in the control group (n = 93), pain assessment was performed by a healthcare professional wearing a standard nontransparent face mask. The initial assessment was performed by a nurse, and 15 minutes later, an additional assessment was performed by a physician. Results: Healthcare professionals wearing a standard non-transparent mask obtained higher VAS scores than healthcare professionals wearing a transparent mask. In addition, nurses obtained lower VAS scores than physicians. The discrepancy in VAS scores between nurses and physicians was found in 50% of cases. This discrepancy was more prevalent among female patients, patients after knee replacement or spinal surgery, and when health care professionals were wearing a standard nontransparent mask. Conclusions: This study supports the use of transparent face masks by healthcare professionals in an orthopedic department, particularly by nurses. In addition, this study supports the assumption of problems involving the reliability of VAS.

Keywords: postoperative pain management, visual analog scale, face masks, orthopedic surgery

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Authors: Anandkumar S. Purohit

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Introduction: Amblyopia is a serious condition resulting in monocular impairment of vision. Although traditional treatment improves vision, we attempted the results of perceptual learning in this study. Methods: The prospective cohort study included all patients with amblyopia who were subjected to perceptual learning. The presenting data on vision, stereopsis, and contrast sensitivity were documented in a pretested online format, and the pre‑ and post‑treatment information was compared using descriptive, cross‑tabulation, and comparative methods on SPSS 22. Results: The cohort consisted of 47 patients (23 females and 24 males) with a mean age of 14.11 ± 7.13 years. A significant improvement was detected in visual acuity after the PL sessions, and the median follow‑up period was 17 days. Stereopsis improved significantly in all age groups. Conclusion: PL with hand-eye coordination is an effective method for managing amblyopia. This approach can improve vision in all age groups.

Keywords: amblyopia, perceptual learning, hand-eye coordination, visual acuity, stereopsis, contrast sensitivity, ophthalmology

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Authors: Godfrey Nsereko, Daniel Kadobera, Denis Okethwangu, Joyce Nguna, Alex Riolexus Ario

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Background: Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, northern Uganda, exceeding the action thresholds. We investigated to assess the outbreak’s magnitude, identify transmission risk factors, and recommend evidence-based control measures. Methods: We defined a malaria case as onset of fever in a resident of Nwoya District with a positive Rapid Diagnostic Test or microscopy for malaria P. falciparum from 1 February to 22 May 2018. We reviewed medical records in all health facilities of affected sub-counties to find cases. In a case-control study, we compared exposure risk factors between 107 case-persons and 107 asymptomatic controls matched by age and village. We conducted entomological assessment on vector-density and behavior. Results: We identified 3,879 case-persons (attack rate [AR]=6.5%) and 2 deaths (case-fatality rate=5.2/10,000). Females (AR=8.1%) were more affected than males (AR=4.7%). Of all age groups, the 5-18 year age group (AR=8.4%) was most affected. Heavy rain started on 4 March; a propagated outbreak began during the week of 2 April. In the case-control study, 55% (59/107) of case-patients and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% (27/107) of case-patients and 51% (55/107) of controls wore long-sleeve cloths during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 29% (31/107) of case-patients and 15% (16/107) of controls did not sleep under a long-lasting insecticide-treated net (LLIN) (ORM-H=2.3, 95%CI=1.1-4.9); 37% (40/107) of case-patients and 52% (56/107) of controls had ≥1 LLIN per 2 household members (ORM-H=0.54, 95%CI=0.30-0.97). Entomological assessment indicated active breeding sites; Anopheles gambiae sensu lato species were the predominant vector. Conclusion: Increased vector breeding sites after heavy rainfall, together with inadequate malaria preventive measures caused this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites.

Keywords: malaria outbreak, Plasmodium falciparum, global health security, Uganda

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Authors: Anita Yaghobi, Homayoun Ebrahimian

Abstract:

One of the important tools that can help orthopedic doctors for diagnose diseases is imaging scan. Imaging techniques can help physicians in see different parts of the body, including the bones, muscles, tendons, nerves, and cartilage. During CT scan, a patient must be in the same position from the start to the end of radiation treatment. Patient movements are usually monitored by the technologists through the closed circuit television (CCTV) during scan. If the patient makes a small movement, it is difficult to be noticed by them. In the present work, a simple patient movement monitoring device is fabricated to monitor the patient movement. It uses an electronic sensing device. It continuously monitors the patient’s position while the CT scan is in process. The device has been retrospectively tested on 51 patients whose movement and distance were measured. The results show that 25 patients moved 1 cm to 2.5 cm from their initial position during the CT scan. Hence, the device can potentially be used to control and monitor patient movement during CT scan and Radiography. In addition, an audible alarm situated at the control panel of the control room is provided with this device to alert the technologists. It is an inexpensive, compact device which can be used in any CT scan machine.

Keywords: CT scan, radiology, X Ray, unwanted movement

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