Miracle-dz/UniFAR-FTUs huggingface dataset:
A Comparison of the Characteristics of Maternal Near-Misses and Maternal Deaths in Enugu, Southeast Nigeria: A 3-Year Prospective Study

Background Maternal near-misses, also known as severe acute maternal morbidity, have become globally recognized as an appropriate indicator of obstetric care. Women experiencing maternal near-misses are more in number than maternal deaths, and can provide more specific and detailed evidence, as the patient herself can be a leading source of useful information. Objective To determine the frequency of maternal near-misses and maternal deaths in the University of Nigeria Teaching Hospital in Ituku-Ozalla, Enugu, document the primary determinant factor that caused these, and compare cases of maternal near-miss and maternal deaths. Methods This was a 3-year prospective study of all women admitted for delivery or within 42 days of delivery or termination of pregnancy at the hospital. Data were collected prospectively in consecutive patients in a pro forma manner and entered into SPSS version 17 for Windows. Results There was a total of 2,236 deliveries, of which 88 had severe maternal outcomes. Of the latter, 60 were maternal near-misses, while 28 suffered maternal death. The maternal near-miss:mortality ratio was found to be 2.14. The maternal mortality ratio here was 1,252 per 100,000. All the 88 women that had severe maternal outcomes lived at least 5 km from the hospital. The leading organ-system dysfunction in this study was cardiovascular, manifesting as shock and cardiac arrest, and respiratory, manifesting as gasping and cyanosis. Leading complications were severe hemorrhage, anemia, and hypertensive disorders. The pattern of complications was similar in both near-misses and maternal deaths, but cases of hypertensive disorders and exploratory laparotomy as an intervention for those with organ dysfunction were noted to be higher in near-miss cases, and differences were statistically significant. Conclusion It was concluded that despite numerous similarities in the characteristics of patients who had had maternal near-misses or died, our study points out that those who succumb to death are often <40 years of age, poorly educated, unemployed, usually present as unbooked emergencies from a distance >5 km and suffer maternal death within 24 hours of presentation.
The evaluation of geriatric patients who presented with trauma to the emergency department

Introduction Geriatric patients are subject to traumas more frequently due to age-related physiopathological changes. The objective of the study was to evaluate the demographic properties of geriatric patients who presented with trauma to the emergency department in addition to establishing the course of the diagnosis and treatment. Material and methods Nine hundred and twelve geriatric patients who presented with trauma to the emergency department during one year were included in this retrospective study. Cause of the presentation, demographic properties, diseases, medications, sites of trauma, departments of consultations, departments that the patients were admitted to, discharge, mortality and morbidity rates were obtained from the folders of the subjects. The subjects were assigned to age groups 65–79 years old and over 80 years old. Results 60.4% (n = 551) of the 912 subjects were female, 39.6% (n = 361) were male and the mean age of the subjects was 77.16 (65–100). Falls were the most common cause (80.3%) of traumas, and the most frequently affected parts of the body were the extremities. The over 80 group was the most frequently consulted group (p = 0.01) and women were admitted more often to the hospital (p = 0.03). Of the patients who presented with trauma, 28.9% (n = 264) were hospitalized and 2% (n = 18) died. The most common causes of death of patients were femur fractures and intracranial hemorrhages. Conclusions Due to high mortality and morbidity, this geriatric patient group deserves a multidisciplinary approach beginning with the emergency departments.
Incidence of Drug Related Problems in Outpatient Setting: A Review Article

Detection and resolution of Drug Related problems (DRPs) are one of the most important parts of Pharmaceutical care. As many as 4.6% of deaths in the United States may be the result of a DRPs, making DRP one of the top 5 leading causes of death. According to the high prevalence of DRPs in an outpatient setting, lack of information about this setting rather than inpatient setting and the importance of detection and resolution of them, reviewing the articles in this regard is necessary. In this review article, PubMed, Scopus, and Google scholar databases were used for finding the relevant studies about the prevalence of DRPs in an outpatient setting and ambulatory care services. In the past 20 years the incidence of drug-related drug problems in the ambulatory care unit has increased and it’s more important in the elderly patient due to pharmacokinetic changes and polypharmacy. Patients with cardiovascular diseases or diabetes mellitus and patients who require chronic pain management are important target groups for DRP Screening. The lack of medication counseling in ambulatory care and in pharmacy settings are an important cause of DRPs in an outpatient setting. According the knowledge about physiology, pharmacology and toxicology, pharmacokinetics and Pharmacotherapy, the most qualified health care provider for detection and management of DRPs in the outpatient setting is pharmacist Quality improvement programs in the base of pharmaceutical care, such as medication therapy management service should target DRPs, especially for patient groups using cardiovascular drugs, analgesics, hypoglycemic agent’s and anti-Seizure agents. J Pharm Care 2017; 5(3-4): 76-78. jpc.tums. ac.ir ► Please cite this paper as: Roshanzamiri S, Farrokhian A, Eslami K. Incidence of Drug Related Problems in Outpatient Setting: A Review Article. J Pharm Care 2017; 5(3-4): 76-78. medication (4,5). Research has shown annually more than 700000 patients are treated in emergency departments for DRPs (6). in 1994 more than 1 million patients in the ambulatory care setting experienced DRPs that need hospitalization, and that 4.7% of admissions were caused by medications (7). Ambulatory care patients run a significant risk of experiencing DRPs. A large proportion of these DRPs are preventable, and nearly half of the preventable DRPs require hospitalization (8). According to the high prevalence of DRPs in an outpatient setting, lack of information about this setting rather than inpatient setting and the importance of detection and resolution of them, reviewing the articles in this regard is necessary. Methods In this review article, PubMed, Scopus, and Google scholar databases were used for finding the relevant studies about the prevalence of DRPs in an outpatient setting and ambulatory care services.
Circulating Antimicrobial Peptide LL-37 Status in Type 1 Diabetes Mellitus and its Relation with Glycemic Control

Antimicrobial-peptides are important molecules of constitutive innate immunity. Though patients with diabetes mellitus are generally prone to infections, there is limited information on their antimicrobialpeptide status. We assessed the circulating LL-37 antimicrobial peptide (also referred as cathelicidin) levels in patients with type 1 diabetes mellitus and its relation with their glycemic status. The LL-37 mRNA expression was assessed in the peripheral blood mononuclear cells (PBMC) by quantitative RTPCR using AŸ-actin and cytochrome-C1 as the reference genes in 154 subjects (Type 1 diabetes, n=111 and healthy subjects, n=43). Â Serum LL-37 was quantii¬ed using sandwich-ELISA. Average HbA1c over last 2 years and current HbA1c were used to determine long-term and short-term glycemic status. LL-37 mRNA expression and serum LL-37 levels were correlated with the glycemic status. The LL-37 mRNA copies were comparable between type 1 diabetes and healthy subjects [median (IQR) = 6.7 (1.8â€“15.28) vs. 7.2 (2.23â€“21.86), respectively, P = 0.42]. There was no signii¬cant difference in serum LL-37 levels between the two groups [median (IQR) = 3.9 (2.88â€“7.52) vs. 5.0 (3.19â€“9.05) ng/ml, respectively, P = 0.52]. The LL-37 mRNA and its protein concentration showed no signii¬cant correlation with the average or current HbA1c values. The constitutive circulating antimicrobial peptide LL-37 status is not signii¬cantly altered in patients with type 1 diabetes mellitus and also not affected by their glycemic status.
Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) as a Diagnostic Method for Prostate Cancer

Background: Prostate cancer is the second most common cancer among men in the world. Due to the slow growth of this cancer, its early detection can lead to definitive treatment and mortality reduction. Based on the lower diagnostic ability of conventional methods, imaging methods have been paid attention in recent years. Objectives: The aim of this study was to evaluate the value and accuracy of diffusion MRI in the prostate cancer as a diagnostic method. Methods: This was a descriptive cross-sectional study conducted in a 15-month period in patients with prostate cancer who had lower urinary tract symptoms, high PSA (higher than 4 ng/mL), or an abnormal finding in the digital rectum examination. The patients were evaluated by MRI of the whole prostate gland with T2 weighted and diffusion images. Patients’ conditions were determined by a urologist with standard 12-fold transrectal sonography-guided biopsy of the prostate. Then, by a histologic examination, healthy or cancerous tissues, Gleason score, and the positive blind numbers were determined by a pathologist. In the end, the results were compared. Results: We observed 80 patients among whom, 25 cases (31.2%) had malignancies in DW-MRI, including 22 cases that had a malignancy in biopsy and three cases whose biopsy indicated the benign pathology. MRI findings in 55 cases (68.7%) were benign (BPH, prostatitis) that in four cases, malignancy was seen in the biopsy. The sensitivity of DW-MRI was 84% and specificity was 94%, indicating a high diagnostic capability for DW-MRI. The positive and negative predictive values of DW-MRI for prostate cancer were 88% and 92%, respectively. We also observed that older age leads to the lower sensitivity of the MRI. Gleason score, PSA level, and tumor burden had a direct relationship with the accuracy of DW-MRI. However, prostate volume did not have a significant relationship with the detection of cancer in MRI. Conclusions: DW-MRI can be used for better diagnosis and staging of prostate cancer in patients with prostate lesions. Accordingly, it can upgrade cancer diagnosis in patients with negative biopsies and high suspicion of cancer.
Knowledge, Attitudes and Practices Related to Oral Health of Dental, Medical and Pharmacy Students at the University of Science and Technology in Yemen

Objective: This study aimed to evaluate the level of knowledge, attitudes and practices related to oral health of Dental, Medical and Pharmacy students at University of Science and Technology in Yemen. Subjects and Methods: A cross-sectional study with questionnaire survey was conducted on 300 students with an age ranged from 19 to 22 years. They were distributed equally and randomly according to gender, specialty and year of the studied academic programs. The target population was the 2nd and 3rd year’s pre-professional students. The obtained data were subjected to statistical analysis. Results: The highest rate of knowledge scores of the students related to oral health was (87%) with better response in Dental students (95%) than Medical and Pharmacy students (84% and 82% respectively). However, the lowest rate of them was (54.33%) with also better response in Dental students (64%) than Medical and Pharmacy students (52% and 47% respectively). Nearly 72% of them (93% Dental, 65% Medical and 58% Pharmacy) believed that regular visits to the dentist is necessary. Moreover, 56.33% of them (88% Dental, 43% Medical and 38% Pharmacy) showed that private clinic was voted as the preferred place of visit for dental treatment. Approximately 77% of them (86% Dental, 74% Medical and 71% Pharmacy) had visited a dentist at least once in their lifetime. About 61.67% of them (77% Dental, 56% Medical and 52% Pharmacy) brushed their teeth twice daily. Conclusion: It showed that knowledge, attitudes and practices related to oral health of female students were better than male students. Dental students had better knowledge, attitudes and practices related to oral health than medical and pharmacy students.
Incidence of Placenta Accreta and Its Complications in Cases of Previous Cesearean Sections with Placenta Praevia Anterior at El-Sayed Galal Hospital

Background: due to the increasing rate of cesarean delivery, there has been a 10-fold rise in the incidence of placenta accreta since the 1970. In a recent survey, placenta accreta was even found to become the leading cause of emergency peripartum hysterectomy which represented 40–60% of cases. Aim of the Work: the purpose of this study was to determine the incidence of placenta accreta and its complications in cases of previous cesarean sections with placenta praevia anterior at El-Sayed Galal Univerity Hospital. Patients and Methods: this prospective study was done at El-Sayed Galal Maternal Unevirsity Hospital during the period from March 2017 to March 2018 on 100 pregnant women diagnosed by ultrasound as placenta praevia or low lying placenta anterior with previous cesarean section, they were selected from Outpatient Clinic, Ultrasound Unit and women admitted in El-Sayed Galal Maternal University Hospital Departments. Results: the incidence of placenta accreta in cases of previous cesarean section with placenta praevia anterior were 63%. Risk factors of placenta accreta were: 1) Placenta praevia with prior cesarean section. All cases had placenta praevia and had at least one previous CS, 2) Increased maternal age (the mean age 32.60±5.018 years in cases of placenta accrete ), and 29.14±4.889 years in cases with normal placenta. 3) Multiparity [the median parity was 3 (range: 1-6). The ultrasonography and Doppler was suggestive of morbid adherence in 60 cases (95.2%)of cases approved with placenta accreta, with accuracy 96, sensiyivity 95.24, specificity 97.3, +ve predictive value 98.36, and -ve predictive value 92.31. The intraoperative data were:, - Cesarean hysterectomy performed in all cases of placenta accrete (63 cases), and 2 cases (5.4%) of normal placenta due to severe bleeding from placental ped and uterine atony. , - Bladder injury occured in 31 cases(49.2%) all of them approved placenta accreta, all of them do C.S hystrectomy and performed bladder repair. Bowel injury in 2 cases (3.2%) all of them have placenta accreta and C.S hysterectomy done. All cases of placenta accreta received intra operative blood transfusion. Uterine preserving procedures (Bakry balloon) done in one case after spontaneous separation of the placenta. The postoperative data were:, - ICU admission occurred in 40 cases (63.5%) of cases with placenta accrete, and in 2 cases (5.4%) of cases with normal placenta. 61 cases (96.8%) of cases with placenta accreta received postoperative blood transfusion. -No cases complicated with DIC or death. Conclusion: from the above our results showed that the incidence, risk factors and Feto-maternal outcome of management of Patients with placenta accreta at El-Sayed Galal University Maternity Hospital are comparable with those in the previous literatures.
Stress in Nursing University Students and Mental Health

Stress is a physiological response that impacts the cognitive, emotional, behavioral, and social components. It also involves the adaptation of the organism, the coping resources, and the environment. In young people, stress can be triggered by social interactions or school requirements. This chapter is a narrative review analyzing scientific bibliography from the main databases (NIH, Scielo, Redalyc) that explored the main stressors and their effects on nursing students. These stressors include the care of patients, assignments and workloads, academic evaluations, and negative or hostile social interactions. Data include the deleterious effects of stress in nursing students as anxiety, depression, inhibiting learning, and burnout, which negatively impact their academic development and health. Finally, some interventions to reduce the impact of stress are discussed. Conclusion: Stress responses in nursing students vary in duration and intensity during their academic training; final effects depend on the coping mechanisms, individual resources, and hos pital environment. The effects of stress on nursing students impact on academic perfor - mance but could also trigger several psychiatric disorders as depression or anxiety, as well as other associated problems such as sleep disorders, alcohol, and psychoactive drug consumption, which in the short and long term may affect the patient care.
Epidemiology of Esophageal Cancer (EC) In Oromia Region, Ethiopia 2016: A 4-Year Medical Record Review

Background: It is difficult to determine the prevalence/incidence of EC without an established functional national cancer registry, which helps to demarcate the population at-risk and monitor cancer trends over time. The review of medical records can help to identify areas in a country with high number of diagnosed EC cases and help set public health priorities. Aim: To describe EC hospital case series during a period of 4 years at the main cancer treatment center in Ethiopia and two hospitals in the EC high-risk zones in the Oromia region, concentrating on residents of Oromia region and to offer recommendations for public health officials. Methods: All EC malignancy data from the period 2013-2016 were collected by reviewing patient charts at the selected hospitals: Tikur Anbessa Teaching hospital (TATH) in Addis Ababa, Adama General and Medical Teaching Hospital (AGMTH) and Adama Referral and Medical Teaching Hospital (ARMTH). Cases with insufficient residence information and residents of other regions were excluded from the summary. The number of EC cases is presented by age, sex and site as well as method of diagnosis. Data were expressed as percentages (%). Statistical analysis was done using SPSS 20 software. Results: Over the study period, a total of 669 EC cases who resided in Oromia region were identified in the selected hospitals out of 2211 registered in the referral surgical departments of hospitals in the study, with insignificant difference by sex. A total of 457 (68%) were residents from high risk Arsi/Bale zones and the rest 212 (32%) from other zones of the region. The mean age at diagnosis was 52.4 years with the majority of cases in the age range 45-69 years. A total of 34 (5%) EC cases were younger at diagnosis (15-29 years). A total of 258 (38.5%) cases were identified at TATH, 305 (46%) from AGHMT/ARHMT and 106 (16%) cases from both TATH/AGHMT. Data were gathered from patient charts at endoscopy departments 227 (34%), endoscopy and pathology departments 246 (37%) and all other sources (ie surgical department) 196 (29%). Most patients complained dysphagia for solids 664 (99%) and weight loss 352 (53%). Cases were histopathology proven (256, 38%), identified through endoscopy investigation (385, 58%) or radiology (28, 4%). Squamous cell carcinoma was the predominant histology type with 160 cases (62.5%) of those histologically proven. Among the total of 420 cases whose risk factor history was recorded, 401 (97%) had a previous history of digestive disease, 49% reported hot beverage consumption and 34% persistent heart burn. Conclusion: Two thirds of EC incident cases came from Arsi and Bale zones with decreasing trends over the period considered. Such trends warrant in depth investigation for possible reasons and future study to investigate local based risk factors associated with the disease.
Identification of Gardnerella vaginalis and Atopobium vaginae in Women With Bacterial Vaginosis in Northern Iran

Background Bacterial vaginosis is the most common lower genital tract infection among women of reproductive age. Its causative agent is often the bacterium Gardnerella vaginalis, which exists in synergism with other mostly anaerobic bacteria such as Atopobium vaginae, Mobiluncus curtisii, and Megasphaera type I. Methods A total of 211 women, who referred to obstetrics and gynecology clinics in Rasht City for suspected vaginal infections, were tested for possible bacterial vaginosis. The presence of G. vaginalis and A. vaginae was verified by 5 different laboratory methods based on the Amsel criteria. These methods included determination of pH, whiff test, and observation of clue cells in a direct smear. Polymerase chain reaction using specific primers was performed on the extracted DNA from the vaginal specimens. Results Sixty cases of bacterial vaginosis, of the 211 women tested for suspected vaginal infections, were confirmed using Amsel criteria. In 44% (29/66) and 29% (19/66) of these bacterial vaginosis cases, the presence of G. vaginalis and A. vaginae was confirmed by polymerase chain reaction, respectively. Conclusions Gardnerella vaginalis had a very high prevalence in the 18- to 35-year-old women suffering from bacterial vaginosis in this region of Iran. Presumably, these cases were recommended for appropriate treatment, but the wider issue is about prevention in this age group and appropriate public health messages to raise awareness.
Exploring Self-Management Practices Among Patients with Diabetes in Government Hospitals in the Upper West Region of Ghana

Diabetes mellitus is a chronic progressive metabolic disorder characterized by hyperglycaemia mainly due to absolute or relative deficiency of insulin hormone. The study aimed at exploring the level of self-management practices among diabetes patients receiving care in public hospitals in the Upper West Region of Ghana. The research was a cross-sectional survey adopting stratified sampling technique to select 201 respondents. A questionnaire was used in the study for data collection with a reliability coefficient of 0.8. The data was analyzed using the SPSS version 21. Adherence to proper self-management practices was high with a mean percentage of 64.7%. Demographic factors of diabetes patients did not have any effect on their Self-Management Practices (p>0.05). There were differences in Self-Management practices among group of diabetes patients receiving care at different hospitals (p<0.05). In conclusion, most diabetes patients in the Upper West Region adhered correctly to self-management practices. However, they needed to improve upon the management on monitoring of blood sugar level and foot care. There was a difference in self-management practices of diabetes patients who received care at Wa and Lawra. It was also found that sex, gender, district of location, occupation, and income among others did not have influence on self-management practice.