Search results for: patients with stroke

Authors: C. Iitake, K. Iitake

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Background and Aims: The number of diabetic patients based on obesity is increasing drastically in Asia. Since most patients have multiple complications, if one medicine can treat those at the same time, it would contribute to financial savings and patients’ compliance. A Japanese-made DPP-4 inhibitor, Anagliptin is only sold in Japan and South Korea. It is said to have its unique aspect of lowering LDL-cholesterol (LDL-C) levels together with lowering blood glucose. We have assessed 63 patients in our faculty to investigate this fact clinically and statistically. Method: Patients with type 2 diabetes who has been treated with Anagliptin for the first time was investigated changes in HbA1c, fasting and random blood glucose and LDL-C levels from the baseline at 1 month, 6 months and 1 year. Results: 29 patients (46.1%) were given DPP-4 inhibitors for the first time (original group), and 34 patients (53.9%) were using other DPP-4 inhibitors before Anagliptin (exchanged group). The change in HbA1c and fasting glucose from the baseline were -2.0% (P < 0.001) and -38.3mg/dl (P < 0.01) respectively with original group, -0.5% (P < 0.01) and -29.4mg/dl (P < 0.01) respectively with exchanged group. 23 patients (36.5%) were using statins or fibrates and 28 patients (44.4%) were using none, and its LDL-C change were -8.1mg/dl (P = 0.2582) and -10.1mg/dl(P < 0.05) respectively. 16 patients(25%) with LDL-C level ≥ 140mg/dl, change were -21.7mg/dl(P < 0.05). LDL-C change did not have a correlation coefficient (=-0.03238) with change in HbA1c and was not affected by other diabetic drugs. Conclusion: These findings indicate that Anagliptin is a potential treatment option for type 2 diabetes complicated by hyperlipidemia.

Keywords: DPP-4 inhibitors, anagliptin, LDL-cholesterol, type 2 diabetes

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Authors: Jennifer Reese, Josh Biber, Howard Weeks, Rachel Hess

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Aim: The Edinburgh Postnatal Depression Screen (EPDS) is a mental health screening for pregnant women that has been widely used over the last 30 years. This screen is typically given in clinic on paper to patients throughout pregnancy and postpartum. The screen helps identify patients who may be at risk for pregnancy related depression or postpartum depression. In early 2016, University of Utah Health implemented an electronic version of the EPDS as well as the PROMIS Depression v1.0 instrument for all pregnant and postpartum patients. We asked patients both instruments to understand coverage of patients identified as at risk for each instrument. Methods: The EPDS is currently administered as part of our PRO template for pregnant and postpartum women. We also administer the PROMIS Depression as part of a standard PRO assessment to all patients. Patients are asked to complete an assessment no more often than every eight weeks. PRO assessments are either completed at home or in clinic with a tablet computer. Patients with a PROMIS score of ≥ 65 or a EPDS score of ≥ 10 were identified as at risk for depression Results: From April 2016 to April 2017, 1,330 unique patients were screened at University of Utah Health in OBGYN clinics with both the EPDS and PROMIS depression instrument on the same day. There were 28 (2.1%) patients were identified as at risk for depression using the PROMIS depression screen, while 262 (19.7%) patients were identified as at risk for postpartum depression using the EPDS screen. Overall, 27 (2%) patients were identified as at risk on both instruments. Conclusion: The EPDS identified a higher percent (19.7%) of patients at risk for depression when compared to the PROMIS depression (2.1%). Ninety-six percent of patients who screened positive on the PROMIS depression screen also screened positive on the EPDS screen. Mental health is an important component to a patient’s overall wellbeing. We want to ensure all patients, particularly pregnant or post-partum women, receive screening and treatment when necessary. A combination of screenings may be necessary to provide the overall best care for patients and to identify the highest percentage of patients at risk.

Keywords: patient reported outcomes, mental health, maternal, depression

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Authors: Saira Baloch, Mohsin Ali Baloch

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Background: Malaria is a potentially life-threatening disease and also a major public health problem in Pakistan. Renal failure is an emerging problem correlated with morbidity and mortality, however can be diagnosed and treated in the early stages. Objectives: To elucidate the biochemical renal parameters in patients with falciparum malaria and comparison with healthy control subjects. Method: 80 patients, who were diagnosed to be affected by falciparum malaria. Detailed history, general physical and systemic examination and necessary pathological, biochemical renal laboratory parameters and investigations were done. Results: Among the 80 patients, 43 were males and 37 were females. All patients were infected with P. falciparum. All patients had increased serum creatinine and urea levels and urine output of less than 400 ml/day were categorized as suffering from renal failure. Conclusion: Patients infected with P. falciparum are at an increased risk of developing renal failure when compared to patients infected with other complications. P. vivax has massive potential to cause life threatening complications and even death. Further research is required to understand the exact pathogenesis of various complications encountered in vivax malaria.

Keywords: falciparum malaria, renal failure, biochemical parameters, pathogenesis

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Authors: D. Maneetham

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The developed exoskeleton device has to control joints between shoulder and arm. Exoskeleton device can help patients with hemiplegia upper so that the patient can help themselves in their daily life. Exoskeleton device includes a robot arm wear that looks like the movement is similar to the normal arm. Exoskeleton arm is powered by the motor through the cable with a control system that developed to control the movement of the joint of a robot arm. The arm will include the shoulder, the elbow, and the wrist. The control system is used Arduino Mega 2560 controller and the operation of the DC motor through the relay module. The control system can be divided into two modes such as the manual control with the joystick mode and automatically control with the movement of the head by Gyro sensor. The controller is also designed to move between the shoulder and the arm movement from their original location. Results have shown that the controller gave the best performance and all movements can be controlled.

Keywords: exoskeleton arm, hemiplegia upper, shoulder and arm, stroke

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Authors: A. Ibovi Mouondayi, S. Zaher, K. Nassar, S. Janani

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Introduction: Osteoarticular ultrasound has become an essential tool for the investigation and monitoring of osteoarticular pathologies for rheumatologists. It is performed in the clinic, cheap to access than other imaging technics. Important anatomical sites of inflammation in inflammatory diseases such as synovium, tendon sheath, and enthesis are easily identifiable on ultrasound. Objective: The objective of this study was to evaluate the importance of ultrasound for rheumatologists in the development of diagnoses of inflammatory rheumatism in cases of uncertain clinical presentation. Material and Methods: This is a retrospective study conducted in our department and carried out over a period of 30 months from January 2020 to June 2022. We included all patients with inflammatory arthralgia without clinical arthritis. Patients' data were collected through a patient operating system. Results: A total of 35 patients were identified, made up of 4 men and 31 women, with a sex ratio M/F of 0.12. The average age of the patients was 48.8 years, with extremes ranging from 17 years to 83 years. All patients had inflammatory polyarthralgia for an average of 9.3 years. Only two patients had suspicious synovitis on clinical examination. 91.43% of patients had a positive inflammatory assessment with an average CRP of 22.2 mg/L. Rheumatoid factor (RF) was present in 45.7% of patients and anti-CCP in 48.57%, with respective averages of 294.43 and 314.63 international units/mL. Radiographic lesions were found in 54% of patients. Osteoarticular ultrasound was performed in all these patients. Subclinical synovitis was found in 60% of patients, including 23% Doppler positive. Tenosynovitis was found in 11% of patients. Enthesitis was objectified in 3% of patients. Rheumatoid arthritis (RA) was retained in 40% of patients; psoriatic arthritis in 6% of patients, hydroxyapatite arthritis, and osteoarthritis in 3% each. Conclusion: Osteoarticular ultrasound has been an essential tool in the practice of rheumatology in recent years. It is for diagnostic purposes in chronic inflammatory rheumatism as well as in degenerative rheumatism and crystal induced arthropathies, but also essential in the follow-up of patients in rheumatology.

Keywords: ultrasound, skeletal, rheumatoid arthritis, arthralgia

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Authors: O. Yu Shchelkova, E. B. Usmanova

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Introduction: Last decades scientific research of quality of life (QoL) is developing fast worldwide. QoL concept pays attention to emotional experience of disease in patients, particularly to personal sense of possibility to satisfy actual needs and possibility of full social functioning in spite of disease limitations. QoL in oncological patients is studied intensively. Nevertheless, the issue of QoL in patients with bone tumors focused on psychological factors of QoL and relation to disease impact on QoL is not discussed. The aim of the study was to reveal the basic aspects and personality factors of QoL in patients with bone tumor. Results: Study participants were 139 patients with bone tumors. The diagnoses were osteosarcoma (n=42), giant cell tumor (n=32), chondrosarcoma (n=32), Ewing sarcoma (n=10) and bone metastases (n=23). The study revealed that patients with bone metastases assess their health significantly worse than other patients. Besides patients with osteosarcoma evaluate their general health higher than patients with giant cell tumors. Social functioning in patients with chondrosarcoma is higher than in patients with bone metastases and patients with giant cell tumor. Patients with chondrosarcoma have higher physical functioning and less restricted in daily activities than patients with bone metastases. Patients with bone metastases characterize their pain as more widespread than patients with primary bone tumors and have more functional restrictions due to bone incision. Moreover, the study revealed personality significant influence on QoL related to bone tumors. Such characteristics in structure of personality as high degree of self-consciousness, personal resources, cooperation and disposition to positive reappraisal in difficult situation correspond to higher QoL. Otherwise low personal resources and slight problem solving behaviour, low degree of self-consciousness and high social dependence correspond to decrease of QoL in patients with bone tumors. Conclusion: Patients with bone metastasis have lower QoL compared to patients with primary bone tumors. Patients with giant cell tumor have the worth quality of life among patients with primary bone tumors. Furthermore, the results revealed differences in QoL parameters associated with personality characteristics in patients with bone tumors. Such psychological factors as future goals, interest in life and emotional saturation, besides high degree of personal resources and cooperation influence on increasing QoL in patients with bone tumors.

Keywords: quality of life, psychological factors, bone tumor, personality

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Authors: Xuzhen Yang, Yan Shan, Yabo Ding, Keke DIao, Yanjun Zhang, Yijia Huang

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Purpose: Our aim is to understand the unique experiences of patients with peritoneal dialysis and how they deal with issues brought on by disease and dialysis. Patients and Methods: Semi-structured interview was designed to collect information, and inpatients with peritoneal dialysis in a university-based tertiary hospital in the central province of China were purposively chosen as interviewees. The content analysis method was used to analyze the data. Results: Nine patients participated in the study, and three themes and eight subthemes were generated. Conclusion: Patients using peritoneal dialysis encounter numerous challenges and problems in the process of disease and dialysis, and they took attempt to cope with them well to adapt to living with peritoneal dialysis.

Keywords: peritoneal dialysis, experience, patient, coping strategy

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Authors: John A. Morales, Guillermo Guidi, B. M. Keune

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Electric Power supply is a crucial topic for economic and social development. Power outages statistics show that discharges atmospherics are imperative phenomena to produce those outages. In this context, it is necessary to correctly detect when overhead line insulators are faulted. In this paper, an algorithm to detect if a lightning stroke generates or not permanent fault on insulator strings is proposed. On top of that, lightning stroke simulations developed by using the Alternative Transients Program, are used. Based on these insights, a novel approach is designed that depends on mother functions analysis corresponding to the given variance-covariance matrix. Signals registered at the insulator string are projected on corresponding axes by the means of Principal Component Analysis. By exploiting these new axes, it is possible to determine a flashover characteristic zone useful to a good insulation design. The proposed methodology for flashover detection extends the existing approaches for the analysis and study of lightning performance on transmission lines.

Keywords: mother function, outages, lightning, sensitivity analysis

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Authors: Marcin Szlachetka, Mateusz Paszko, Grzegorz Baranski

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This paper discusses the AVL EXCITE Designer simulation research into loads applied to main and crank bearings in the compression-ignition two-stroke engine. There was created a model of engine lubrication system which covers the part of this system related to particular nodes of a bearing system, i.e. a connection of main bearings in an engine block with a crankshaft, a connection of crank pins with a connecting rod. The analysis focused on the load given as a distribution of hydrodynamic oil film pressure corresponding different values of radial internal clearance. There was also studied the impact of gas force on minimal oil film thickness in main and crank bearings versus crankshaft rotational speed. Our model calculates oil film parameters, an oil film pressure distribution, an oil temperature change and dimensions of bearings as well as an oil temperature distribution on surfaces of bearing seats. Accordingly, it was possible to select, for example, a correct clearance for each of the node bearings. The research was performed for several values of engine crankshaft speed ranging from 800 RPM to 4000 RPM. Bearing oil pressure was changed according to engine speed ranging between 1 bar and 5 bar and an oil temperature of 90°C. The main bearing clearances made initially for the calculation and research were: 0.015 mm, 0.025 mm, 0.035 mm, 0.05 mm, 0.1 mm. The oil used for the research corresponded the SAE 5W-40 classification. The paper presents the selected research results referring to certain specific operating points and bearing radial internal clearances. Acknowledgement: This work has been realized in the cooperation with The Construction Office of WSK ‘PZL-KALISZ’ S.A. and is part of Grant Agreement No. POIR.01.02.00-00-0002/15 financed by the Polish National Centre for Research and Development.

Keywords: crank bearings, diesel engine, oil film, two-stroke engine

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Authors: Chi-Wen Huang, Hung-Chi Chen

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Total laryngectomy affects swallowing, speech functions and life quality in the head and neck cancer. Voice restoration plays an important role in social activities and communication. Several techniques have been developed for voice restoration and reported to improve the life quality. However, the rehabilitation program for voice reconstruction by using the ileocolon flap still unclear. A retrospective study was done, and the patients' data were drawn from the medical records between 2010 and 2016 who underwent voice reconstruction by ileocolon flap after laryngectomy. All of them were trained to swallow first; then, the voice rehabilitation was started. The outcome of voice was evaluated after 6 months using the 4-point scoring scale. In our result, 9.8% patients could give very clear voice so everyone could understand their speech, 61% patients could be understood well by families and friends, 20.2% patients could only talk with family, and 9% patients had difficulty to be understood. Moreover, the 57% patients did not need a second surgery, but in 43% patients voice was made clear by a second surgery. In this study, we demonstrated that the rehabilitation program after voice reconstruction with ileocolon flap for post-laryngectomy patients is important because the anatomical structure is different from the normal larynx.

Keywords: post-laryngectomy, ileocolon flap, rehabilitation, voice reconstruction

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Authors: Amna Imtiaz

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Aims: To correlate serum ferritin with left ventricular function in beta thalassemia major patients with increased transfusion dependence and to find out whether echocardiography can be used to assess pre clinical cardiac disease in these patients. Methods: The cross sectional study was conducted at Department of Pathology, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences, Islamabad. 60 patients of beta thalassemia major with increased transfusion dependence were enrolled in this study. Serum ferritin levels of all patients were measured by using indirect enzyme linked immunosorbent assay (ELISA). Echocardiography was performed on all patients by a consultant cardiologist by linking conventional echocardiography with tissue Doppler imaging. Ejection fraction and E/A ratio were measured in all patients to assess left ventricular systolic and diastolic function. Results: On the basis of serum ferritin level, patients were divided into three groups. Group I consisted of patients having serum ferritin level equal to or less than 2500 ng/ml. A total of 25 patients were placed in this group. Group II included patients having serum ferritin level between 2500 to 5000 ng/ml. A total of 22 patients were placed in this group. Group III included patients having serum ferritin level more than 5000 ng/ml. This group consisted of 13 patients. All patients having serum ferritin below 2500ng/ml had normal systolic function, and only 16% of the patients in this group had diastolic dysfunction as reflected by abnormal E/A ratio. In group II, 27% of the patients had systolic dysfunction reflected by subnormal ejection fraction while 40% of the patients had diastolic dysfunction. In group III, 62% of the patients had abnormal systolic and diastolic function. Pearson correlation was used to find a correlation between serum ferritin and left ventricular function. A strong negative correlation was found which is reflected by a p value of less than 0.05 which is significant. Chi square test is used to correlate serum ferritin with E/A ratio. P value came out to be less than 0.05 which is significant.

Keywords: beta thalassemia major, left ventricular function, serum ferritin, transfusion dependence

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Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

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Introduction: Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease of unknown cause. Concomitant autoimmune disorders have been described in 30–50% of patients with AIH. The aim of our study is to determine the prevalence and the type of autoimmune disorders associated with AIH. Material and Methods: It is a retrospective study over a period of 16 years (2000-2015) including all patients followed for AIH. The diagnosis of AHI was based on the criteria of the revised International AIH group scoring system (IAIHG). Results: Twenty-for patients (21 women and 3 men) followed for AIH were collected. The mean age was 39 years (17-65 years). Among these patients, 11 patients(45.8%) had at least one autoimmune disease associated to AIH. These diseases were Hashimoto's thyroiditis (n = 5), Gougerot Sjogren syndrome (n=5), Primary biliary cirrhosis (n=2), Primitive sclerosant Cholangitis (n=1), Addison disease (n = 1) and systemic sclerosis (n=1). Patients were treated with corticosteroids alone or with azathioprine associated to the specific treatment of associated diseases with complete remission of AIH in 90% of cases and clinical improvement of other diseases. Conclusion: In our study, the prevalence of autoimmune diseases in AIH patients was 45.8%. These diseases were dominated by autoimmune thyroiditis and Gougerot Sjogren syndrome. The investigation of autoimmune diseases in autoimmune hepatitis must be systematic because of their frequency and the importance of adequate management.

Keywords: autoimmune diseases, autoimmune hepatitis, autoimmune thyroiditis, gougerot sjogren syndrome

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Authors: Wanlapa Kunsongkeit

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When a person gets sick, he or she goes to hospital for the treatment. In the case of severe illness, there might be no hope for some patients to recover. In this state, the patients will face anxiety and fear. These feelings make the patients suffer in mind until the time of death or called bad death. These feeling also directly effect to family members who are loved ones and significant persons of the patients. They can help the dying patients to have good death. From literature reviews, many studies focused on good death in patients and nurses. Little is known about good death in family member. Therefore, the qualitative research based on Heideggerian phenomenology aimed to describe good death as perceived by the critically ill patients’ family members. Five informants who were the critically ill patients’ family members at hospital in Chonburi were purposively selected. Data were collected by in-depth interview, observation and critical reflection during January, 2014 to March, 2014 . Cohen, Kahn and Steeves’s (2000) steps guided data analysis. Trustworthiness was maintained throughout the study following Lincoln and Guba’s guidelines. Four themes were emerged, which were no suffering, acceptance of imminent death, preparing for death, and being with the family. This findings provide deep understanding of good death as perceived by the critically ill patients’ family members. It can be basic information for nurses to provide good death nursing care and further explore for development of knowledge regarding good death nursing care.

Keywords: good death, family member, critically ill patient, phenomenology

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Authors: Alaa Mostafa, Samuel Dagogo-Jack, Vivian Thieu, Maria Yu, Nan Zhang, Dara Schuster, Luis-Emilio Garcia-Perez

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Dulaglutide (DU), a once-weekly glucagon-like peptide-1 receptor agonist, was studied in the AWARD clinical trial program in adult patients with type 2 diabetes (T2D) and demonstrated significant hemoglobin A1c (A1c) reduction and potential for weight loss. To evaluate the efficacy and safety of DU 1.5 mg and DU 0.75 mg in patients with T2D by baseline A1c <8.5% or ≥8.5%, a post-hoc analysis was conducted on AWARD-1 to -6 and -8 at 6 months. Across 7 studies, 55% to 82% of the DU-treated patients had a baseline A1c <8.5%, and 18% to 45% had a baseline A1c ≥8.5%. The ranges of A1c reductions with baseline A1c <8.5% and ≥8.5%, respectively, were: DU 1.5 mg: -0.67% to -1.25% and -1.22% to -2.37%; DU 0.75 mg: -0.53% to -1.07% and -1.37% to -2.19%. The A1c reduction from the pooled analysis was greater in patients with baseline A1c ≥8.5% than patients with baseline A1c <8.5%, respectively: DU 1.5 mg: -1.86% and -1.02%; DU 0.75 mg: -1.75% and -0.83%. DU treatments were well tolerated among baseline A1c subgroups. Across the AWARD program, DU 1.5 mg and DU 0.75 mg demonstrated significant A1c reduction in both subgroups with an acceptable safety profile. Compared to patients with baseline A1c <8.5%, patients with baseline A1c ≥8.5% had greater A1c reduction. Disclosures: This study was supported and conducted by Eli Lilly and Company, Indianapolis, IN, USA.

Keywords: A1c reduction, dulaglutide, type 2 diabetes, weight loss

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Authors: Emrah Caylak

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The aim of this study is to investigate the effect of iron therapy on oxidative stress, ghrelin, and nesfatin-1 levels in patients with iron deficiency anemia (IDA). Thirty patients who applied to Internal Medicine Clinic and were diagnosed with IDA and also 30 healthy individuals as a control were included in the study. The samples were collected from IDA patients before and after treatment. Differences in serum MDA, TAC, and plasma ghrelin, nesfatin-1 were analyzed among the three groups. Serum MDA and TAC levels were found higher and lower in IDA patients before the treatment group compared to the controls (p < 0.05). After the iron therapy, plasma acylated ghrelin and nesfatin-1 levels in IDA patients were found higher in IDA patients before the treatment group and controls (p < 0.05). Plasma ghrelin and nesfatin-1 levels increase with iron treatment in IDA patients. The iron therapy induces the synthesis of ghrelin and nesfatin-1 in human body, thus causes increased appetite and food intake.

Keywords: anemia, oxidative stress, ghrelin, nesfatin-1

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Authors: Marina Kljaković-Gašpić Batinjan, Tea Petrović, Frano Vučković, Irzal Hadžibegović, Barbara Radovani, Ivana Jurin, Lovorka Đerek, Eva Huljev, Alemka Markotić, Ivica Lukšić, Irena Trbojević-Akmačić, Gordan Lauc, Ivan Gudelj, Rok Čivljak

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Immunoglobulin G has essential role in defense against infectious diseases, but its role cannot be fully recognized without understanding of changes in its N-glycans attached to the Fc domain. We analyzed and compared total IgG glycome in plasma samples of patients with influenza, patients with COVID-19 and healthy controls. We found similarities in IgG glycosylation changes in COVID-19 survivors and influenza patients that could be the consequence of adequate immune response to enveloped viruses, while observed changes in deceased COVID-19 patients may indicate its deviation.

Keywords: COVID-19, glycosylation, immunoglobulin G, influenza, pneumonia, viral infection

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Authors: Artitaya Sabangbal, Darawan Augsornwan, Palakorn Surakunprapha, Lalida Petphai

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Background: Srinagarind Hospital Ward 3C has about 180 cases of patients with head and neck cancer per year. Almost all of these patients suffer with pain, fatigue, low self image, swallowing problem and when the tumor is larger they will have breathing problem. Many of them have complication after operation such as pressure sore, pneumonia, deep vein thrombosis. Nursing activity is very important to prevent the complication especially promoting patients early ambulation. The objective of this study was to develop early ambulation protocol for patients with head and neck cancer undergoing operation. Method: this study is one part of nursing system development in patients undergoing operation in Ward 3C. It is a participation action research divided into 3 phases Phase 1 Situation review: In this phase we review the clinical outcomes, process of care, from document such as nurses note and interview nurses, patients and family about early ambulation. Phase 2 Searching nursing intervention about early ambulation from previous study then establish protocol . This phase we have picture package of early ambulation. Phase 3 implementation and evaluation. Result: Patients with head and neck cancer after operation can follow early ambulation protocol 100%, 85 % of patients can follow protocol within 2 days after operation and 100% can follow protocol within 3 days. No complications occur. Patients satisfaction in very good level is 58% and in good level is 42% Length of hospital stay is 6 days in patients with wide excision and 16 day in patients with flap coverage. Conclusion: The early ambulation protocol is appropriate for patients with head and neck cancer who undergo operation. This can restore physical health, reduce complication and increase patients satisfaction.

Keywords: nursing system, early ambulation, head and neck cancer, operation

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Authors: Peri Harish Kumar, Sai Sharan Dwarka, Tajbinder Singh Bains, Suneet John Joseph, Chaitanya Kiran, Sambhu Dutta, Sarah Makram, Mohamed Sayed Zaazouee, Alaa Ahmed Elshanbary

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Objective: To identify cancer and non-cancer causes of death in hepatocellular carcinoma (HCC) patients over different time periods after diagnosis and to compare the mortality risk of each cause in HCC patients with the general population. Methods: In this retrospective cohort study, data of 67,637 HCC patients from 1975 to 2016 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We investigated the association between different causes of death and the following variables: age, race, tumor stage at diagnosis, and treatment (surgery, chemotherapy, and radiotherapy); each according to the periods of <1 year, 1-5 years, 5-10 years, and >10 years following the diagnosis. Standardized mortality ratios (SMRs) and their 95% confidence intervals (CIs) were calculated for cancer and non-cancer deaths in each of the mentioned periods following diagnosis. Results: Data of 67,637 patients, of whom 50,571 patients died during the follow-up period, were analyzed. Most deaths were due to HCC itself (35,535, 70.3%), followed by other cancers (3,983, 7.9%). Common causes of non-cancer mortality included infectious and parasitic diseases including HIV (2,823 patients, SMR=105.68, 95% CI: 101.82-109.65), chronic liver disease (2,719 patients, SMR=76.56, 95% CI: 73.71,79.5), and heart diseases (1,265 patients, SMR=2.26, 95% CI: 2.14-2.39), with higher mortality risk in HCC patients than in the general population. Conclusion: Cancers stand for most deaths in patients with HCC. Besides, infectious, and parasitic diseases including HIV represent the commonest non-cancer cause of mortality.

Keywords: hepatocellular carcinoma, seer, causes of death, mortality

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Authors: Tiffany Wicks

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Queer patients can face issues with self-advocating due to the factors of implicit provider bias, lack of tools and resources to self-advocate, and lack of comfortability in self-advocating based on prior experiences. In this study, five participants who identify as queer discussed their interactions with their healthcare providers. This exploratory study revealed that there is a need for healthcare provider education to reduce implicit bias and judgments about queer patients. There is also an important need for peer advocates in order to further inform healthcare promotion and decision-making before and during provider visits in an effort for a better outcome. Through this exploration, queer patients voiced their experiences and concerns to inform a need for change in healthcare collaboration between providers and patients in the queer community.

Keywords: queer, LGBT, patient, self-advocacy, healthcare

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Authors: Safa Safdar

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Breast cancer is a type of cancer which is developed by the formation of a tumor on the breast. This tumor invades and causes different electrolyte imbalance. The present study was designed to measure the serum calcium and inorganic phosphorous levels and to check the frequency of hypercalcemia and hypophosphatemia in breast cancer patients. Serum calcium and phosphorous levels of fifty breast cancer women of 18-70 years of age group and fifty healthy women of same age group were measured by using semi-automated chemistry analyzer ( Humalyzer 3000, Human, Germany ). Significant variation in these levels was observed. The mean calcium value in BC patients was higher 9.398 mg/dl as compared to controls which were 8.694 mg/dl. Whereas the mean value of inorganic phosphorus level was lower 4.060 mg/dl in BC patients as compared to controls having 4.456 mg/dl. In this study, the frequency of hypercalcemia in Breast cancer patients was 10% i.e. only 10 out of 50 Breast cancer patients were suffering from hypercalcemia. Whereas the frequency of hypophosphatemia in this study was only 2 % i.e. only 1 out of 50 patients was suffering from hypophosphatemia. Thus it is concluded that there is a significant change in serum calcium and inorganic phosphorous levels in Breast cancer patients as the disease progresses. So, this study will be helpful for the clinicians to maintain serum calcium and phosphorous levels in Breast cancer patients and also preventing them from further complications.

Keywords: serum analysis, calcium, inorganic phosphorus, hpercalcemia hypophosphatemia

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Authors: Ranitha Guna Selvi D, Ramakrishnan R, Mohideen Abdul Kader

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Purpose: To study the role of Vision centers in managing preventable blindness through refractive error correction in Rural South India. Methods: A retrospective analysis of patients attending 15 Vision centers in Rural South India from a period of January 2021 to December 2021 was done. Medical records of 10,85,81 patients both new and reviewed, 79,562 newly registered patients and 29,019 review patient’s from15 Vision centers were included for data analysis. All the patients registered at the vision center underwent basic eye examination, including visual acuity, IOP measurement, Slit-lamp examination, retinoscopy, Fundus examination etc. Results: A total of 1,08,581 patients were included in the study. Of the total 1,08,581 patients, 79,562 were newly registered patients at Vision center and 29,019 were review patients. Males were 52,201(48.1%) and Females were 56,308(51.9) among them. The mean age of all examined patients was 41.03 ± 20.9 years (Standard deviation) and ranged from 01 – 113 years. Presenting mean visual acuity was 0.31 ± 0.5 in the right eye and 0.31 ± 0.4 in the left eye. Of the 1,08,581 patients 22,770 patients had refractive error in right eye and 22,721 patients had uncorrected refractive error in left eye. Glass prescription was given to 17,178 (15.8%) patients. 8,109 (7.5%) patients were referred to the base hospital for specialty clinic expert opinion or for cataract surgery. Conclusion: Vision center utilizing teleconsultation for comprehensive eye screening unit is a very effective tool in reducing the avoidable visual impairment caused due to uncorrected refractive error. Vision Centre model is believed to be efficient as it facilitates early detection and management of uncorrected refractive errors.

Keywords: refractive error, uncorrected refractive error, vision center, vision technician, teleconsultation

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Authors: Wan Shan Chiang, Charn Ting Wang, Wei-Chih Kan, Hui-Chen Huang

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Dialysis patients have risk in Zoster virus because of low immune. Valacyclovir (product name: Valtex) 500mg/tab, an anti-zoster virus medicine, is digested in kidney and it has side-effect of nervous system in patients with malfunction kidneys. Although the clinical basis of the proposed administration, we found that patients still have side effects. So we want to explore the appropriate dose of peritoneal dialysis patients. We read small samples of case reports and analyze 8 cases in our hospital, some patients’ Kt/v, match the standard of dialysis, and still go to the toilet, they still have side effect seriously with 500mg portion. The solution to this includes stopping medicine, reduction of medicine, increase of liquid change and timely hemodialysis and all of them speed up the recovery. The safety of medication needs extra attention of medical care employee. If they can tell the doctor if the patient has urine or not in his or her Kt/v, the doctor can prescribe the medicine accordingly. About the limitation, due to the lack of cases and related pharmacokinetics numbers. Therefore, for peritoneal patients, we think 500mg/48hoursis the saves. We also want to remind pharmaceuticals to revise the portion taken by patients, so that the doctor may judge the use.

Keywords: herpes zoster, Valacyclovir, peritoneal dialysis, health education

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Authors: Anthony Bawa, Konstantinos Banitsas

Abstract:

Rheumatism is a muscular disorder that affects the muscles of the upper and lower limbs. This condition could potentially progress to impair the movement of patients. This study aims to investigate the hip muscular imbalance in patients with chronic rheumatism. A clinical trial involving a total of 15 participants, made up of 10 patients and 5 control subjects, took place in KATH Hospital between August and September. Participants recruited for the study were of age 54 ± 8years, weight 65± 8kg, and height 176 ± 8cm. Muscle signals were recorded from the rectus femoris, and vastus lateralis on the right and left hip of participants. The parameters used in determining the hip muscular imbalances were the maximum voluntary contraction (MVC%), the mean difference, and hip muscle fatigue levels. The mean signals were compared using a t-test, and the metrics for muscle fatigue assessment were based on the root mean square (RMS), mean absolute value (MAV) and mean frequency (MEF), which were computed between the hip muscles of participants. The results indicated that there were significant imbalances in the muscle coactivity between the right and left hip muscles of patients. The patients’ MVC values were observed to be above 10% when compared with control subjects. Furthermore, the mean difference was seen to be higher with p > 0.002 among patients, which indicated clear differences in the hip muscle contraction activities. The findings indicate significant hip muscular imbalances for patients with rheumatism compared with control subjects. Information about the imbalances among patients will be useful for clinicians in designing therapeutic muscle-strengthening exercises.

Keywords: muscular, imbalances, rheumatism, Hip

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Authors: Mekroud Amel

Abstract:

Emergency departments are known for the workload, the variety of pathologies and the difficulties in their management with the continuous influx of patients The role of our service in the management of patients with two or three mild to moderate organ failures, involving several disciplines at the same time, as well as the effect of this management on the skills and efficiency of our team has been demonstrated Borderline cases between two or three or even more disciplines, with instability of a vital function, which have been successfully managed in the emergency room, the therapeutic procedures adopted, the consequences on the quality and level of care delivered by our team, as well as that the logistical consequences, and the pedagogical consequences are demonstrated. The consequences found are Positive on the emergency teams, in rare situations are negative Regarding clinical situations, it is the entanglement of hemodynamic distress with right, left or global participation, tamponade, low flow with acute pulmonary edema, and/or state of shock With respiratory distress with more or less profound hypoxemia, with haematosis disorder related to a bacterial or viral lung infection, pleurisy, pneumothorax, bronchoconstrictive crisis. With neurological disorders such as recent stroke, comatose state, or others With metabolic disorders such as hyperkalaemia renal insufficiency severe ionic disorders with accidents with anti vitamin K With or without septate effusion of one or more serous membranes with or without tamponade It’s a Retrospective, monocentric, descriptive study Period 05.01.2022 to 10.31.2022 the purpose of our work: Search for a statistically significant link between the type of moderate to severe pathology managed in the emergency room whose problems are multivisceral on the efficiency of the healthcare team and its level of care and optional care offered for patients Statistical Test used: Chi2 test to prove the significant link between the resolution of serious multidisciplinary cases in the emergency room and the effectiveness of the team in the management of complicated cases Search for a statistically significant link : The management of the most difficult clinical cases for organ specialties has given general practitioner emergency teams a great perspective and has been able to improve their efficiency in the face of emergencies received

Keywords: emergency care teams, management of patients with dysfunction of more than one organ, learning curve, quality of care

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Authors: Swati Bhasin, Ali Ahmed, Valence Xavier, Ben Liu

Abstract:

Aims: Diarrhea is a problem that is a frequent clinic referral to the gastroenterology and surgical team from the General practitioner. To establish a diagnosis, these patients undergo colonoscopy. The current practice at our district general hospital is to perform random left and right colonic biopsies. National guidelines issued by the British Society of Gastroenterology advise all patients presenting with chronic diarrhea should have an Ileoscopy as an indicator for colonoscopy completion. Our primary aim was to check if Terminal ileum (TI) biopsy is required to establish a diagnosis of inflammatory bowel disease (IBD). Methods: Data was collected retrospectively from November 2018 to November 2019. The target population were patients who underwent colonoscopies for diarrhea. Demographic data, endoscopic and histology findings of TI were assessed and analyzed. Results: 140 patients with a mean age of 57 years (19-84) underwent a colonoscopy (M: F; 1:2.3). 92 patients had random colonic biopsies taken and based on the histological results of these, 15 patients (16%) were diagnosed with IBD. The TI was successfully intubated in 40 patients, of which 32 patients had colonic biopsies taken as well. 8 patients did not have a colonic biopsy taken. Macroscopic abnormality in the TI was detected in 5 patients, all of whom were biopsied. Based on histological results of the biopsy, 3 patients (12%) were diagnosed with IBD. These 3 patients (100%) also had colonic biopsies taken simultaneously and showed inflammation. None of the patients had a diagnosis of IBD confirmed on TI intubation alone (where colonic biopsies were not done). None of the patients has a diagnosis of IBD confirmed on TI intubation alone (where colonic biopsies were negative). Conclusion: TI intubation is a highly-skilled, time-consuming procedure with a higher risk of perforation, which as per our study, has little additional diagnostic value in finding IBD for symptoms of diarrhea if colonic biopsies are taken. We propose that diarrhea is a colonic symptom; therefore, colonic biopsies are positive for inflammation if the diarrhea is secondary to IBD. We conclude that all of the IBDs can be diagnosed simply with colonic biopsies.

Keywords: biopsy, colon, IBD, terminal ileum

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Authors: Lakshmidevi Sreeramareddy, Komalpreet Kaur, Nane Pothier

Abstract:

For security purposes, it is important to detect passwords entered by unauthorized users. With traditional alphanumeric passwords, if the content of a password is acquired and correctly entered by an intruder, it is impossible to differentiate the password entered by the intruder from those entered by the authorized user because the password entries contain precisely the same character set. However, no two entries for the gesture-based passwords, even those entered by the person who created the password, will be identical. There are always variations between entries, such as the shape and length of each stroke, the location of each stroke, and the speed of drawing. It is possible that passwords entered by the unauthorized user contain higher levels of variations when compared with those entered by the authorized user (the creator). The difference in the levels of variations may provide cues to detect unauthorized entries. To test this hypothesis, we designed an empirical study, collected and analyzed the data with the help of machine-learning algorithms. The results of the study are significant.

Keywords: authentication, gesture-based passwords, shoulder-surfing attacks, usability

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Authors: Merve Aydin, Mağfiret Kara Kaşikçi

Abstract:

Aim: To determine the perceptions of inpatients about care at Farabi Hospital in KTU. Material and Method: This research was conducted by using the universe known examples of formulas and probability selected by sampling method with 277 chosen patients in the hospital at least 14 days in other internal and surgical clinics except for pediatric, psychiatry, and intensive care unit services between January-March 2014 in KTU Farabi Hospital. The data was collected through the forms of nursing care perception scale of patients and defining characteristics of patients. In the evaluation of data, percentage, mean, Mann Whitney U, Student t and Kurskall Wallis tests were applied. Results: The average point the patients got in nursing care perception scale is 62.64±10.08’dir. 48.7 % of patients regard nursing care well and 36.8 % of them regard it very well. 19 % of the patients regard nursing care badly. When the age, sex, occupation, marital status, educational background, residential place, income level, hospitalization period, hospitalization clinic and having a hospital attendant were compared with nursing care perception average point, the difference among point averages was not found meaningful statistically (p > 0.05). The average point of nursing care perception was found greater in those having chronic disease (p < 0.05). Conclusion: The perception point of patients about nursing care is above the average according to the average of the lowest and highest points. The great majority of patients regard nursing care well or very well.

Keywords: hospital, patient, perception of nursing care, nursing care

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Authors: Mitra JahangirRad, Sheida Sodagar, Maryam Bahrami Hidaji

Abstract:

This study was conducted with the aim of comparing anxiety, stress, depression and attitude towards death among patients with breast cancer who have undergone mastectomy or breast-conserving surgery. The study method is causal-comparative. Statistical population was all patients with breast cancer referring to Medical Center of Panjom Azar Hospital in Gorgan or oncologists' offices in this city within eight months. They were selected using purposive sampling. Sample size of this study was 45 patients with breast cancer undergoing mastectomy and 70 patients under breast-conserving surgery. Measurement tools in this study were depression, anxiety, and stress scale (Dass-21) as well as Death Attitude Profile-Revised (DAPR). Results of this study in hypotheses investigation showed that anxiety, stress and depression among patients with breast cancer, undergoing mastectomy or breast-conserving surgery is significantly different. However, their attitudes towards death do not differ. From these findings, it can be concluded that although most patients with breast cancer encounter many psychological problems, patients undergoing mastectomy experience more anxiety, stress and depression relative to patients with breast-conserving surgery and it seems that they need more supportive therapy.

Keywords: anxiety, breast cancer, depression, death, mastectomy

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Authors: Ali Kassem, Esam Nada, Amro Abdelhamed, Shigeo Horie

Abstract:

Objective: Diabetes mellitus (DM) is associated with macrovascular complications, including coronary artery disease (CAD), and microvascular complications that contribute to the pathogenesis of erectile dysfunction (ED). On the other hand, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and mortality in diabetic and non-diabetic patients. Recently, Multidetector computed tomographic coronary angiography (MDCT-CA) has become a reliable non-invasive imaging modality for screening diabetic patients for SMI. We aim to evaluate the presence of SMI using (MDCT-CA) in patients with type 2DM having ED. Methods: This study evaluated 20 patients (mean age 61.45 ± 10.7 years), with DM and ED without any history of angina or angina equivalent. ED was tested with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erect meter. Results: Of twenty studied patients, coronary artery stenosis was detected in 13 (65%) patients in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Maximum coronary artery stenosis was positively correlated with age (P < 0.016,) and negatively correlated with EHS (P <04). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P <04). Conclusion: MDCT-CA is a useful tool to identify SMI in patients with diabetes mellitus and ED. One should consider the possibility of SMI especially in elderly patients with DM who have ED.

Keywords: diabetes mellitus, erectile dysfunction, microvascular, silent ischemia

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Authors: Amal Baalash, Shazia Mukaddam, M. Adel El-Sayed

Abstract:

Background: Several studies have suggested non-skeletal effects of vitamin D and linked its deficiency with features of many chronic conditions. In this study, We aimed to investigate the relationship between vitamin D levels and different components of the metabolic syndrome in male and female Saudi patients. Methods: the study population consisted of 111 patients with metabolic syndrome (71 females and 40 males) aged 37-63 years enrolled from patients attending the internal medicine outpatient clinics of King Fahad Medical City. The parameters for diagnosis of the metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) were measured, which included waist circumference, TG, HDL-C, Blood pressure and fasting blood glucose (FBS). The association between each parameter and serum 25-hydroxyvitamin D (25(OH) D) was studied in both male and female patients separately. Results: in male patients, 25(OH) D levels were inversely associated with FBS and TG and positively associated with HDL-C and diastolic blood pressure, With highest association with the HDL-C levels. On the other hand 25(OH) D, Showed no significant association with any of the measured metabolic syndrome parameters in female patients. Conclusion: in Saudi patients with metabolic syndrome, the association between the parameters of metabolic syndrome and the levels of 25 (OH) D is more pronounced in males rather than females.

Keywords: gender, metabolic syndrome, Saudi patients, vitamin D

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