bluuebunny/crossref_metadata_2025 huggingface dataset:
Family Caregiver’s Attitudes and Preventive Measures toward Home-Quarantine Guidelines for COVID-19 Patients
Authors: Elsawy Manal M. , Abd El Koddous Rehab F. , Mousa Khadraa M.
Published: May 2024

Background

Home quarantine is an important way to stop the spread of coronavirus disease 2019 (COVID-19), and one of the key elements to control the transmission of COVID-19 is to decrease the source of infection and transmission to the community.

Aim

To assess the attitudes and preventive measures of the family caregivers toward home-quarantine guidelines for COVID-19-infected patients.

Design

A descriptive-exploratory design was used.

Setting

The study was conducted at Dar El Salam Family Health Center, Cairo Governorate.

Sample

A purposive sample of 140 family caregivers was included.

First tool

Family caregivers’ home quarantine attitude scale that has two parts. Part 1 Demographic data of the family caregivers and part 2: family caregiver’s attitudes. Second tool: Family caregivers’ reported home quarantine preventive measures.

Results

A positive attitude and good reported preventative measure scores were reported by more than two-thirds of family caregivers, whereas a minority had a negative attitude and fair reported preventive measure scores toward home-quarantine guidelines for COVID-19-infected patients. Family caregivers’ attitudes and reported preventative measures were positively correlated. A highly statistically significant positive correlation was found linking total attitude and reported preventative measure scores with the family caregiver’s place of residence, education, and having COVID-19. Total attitudes and reported preventative measure scores had a statistically significant positive correlation with monthly income.

Conclusion

More than two-thirds of family caregivers had positive attitude and good reported preventive measure scores toward home-quarantine guidelines for COVID-19-infected patients.

Recommendation

It is advised that a health education program be developed to encourage positive attitude and maintain safe practices toward home-quarantine guidelines for COVID-19-infected patients and family caregivers to avoid the spread of the infection.
Prevalence and associated risk factors of ectopic pregnancy among pregnant women at El-Galaa Teaching Hospital
Authors: Abdullah Noura M. , Elsayed Yousria A. , AbdElhalim Diaa A. , Abdelmonem Amel S.
Published: May 2024

Background

Ectopic pregnancy (EP) is a major contributing factor to the burden of maternal mortality and morbidity in the early half of pregnancy. The aim of study was to assess the prevalence of EP in women under study and determine the risk factors of EP in the study sample.

Design

A descriptive exploratory design was adopted in this study.

Sample

A convenience sample of 121 women who were diagnosed with EP were included, whereas those who were diagnosed with intrauterine pregnancies were excluded from the study.

Tool

A structured interviewing questionnaire was used to collect data related to sociodemographic characteristic, medical surgical, and obstetric history.

Results

The prevalence of EP in the current study was 0.52, 0.62, and 0.72% in 2018, 2019, and 2020, respectively. Risk factors of EP were grand multigravidity (55.2%), history of abortion (43.3%), history of pelvic inflammatory diseases (40%), history of abdominal and pelvic surgery (22.60%), history of infertility (19.1%), history of assisted reproductive technology usage (16.5%), failure of intrauterine devices (13.3%), history of previous EP (9.2%), and history of cesarean section deliveries more than three (5.8%) times sequentially.

Conclusion

EP is an increasingly common and potentially catastrophic condition. The prevalence of EP among women who present to emergency with first trimester bleeding or pain or both was matched with the worldwide prevalence. Risk factors of EP were seen in grand multigravida, abortion, and pelvic inflammatory disease, being the most common risk factors of EP.

Recommendations

Early diagnosis of an EP via detailed history, focusing on identification of risk factors for EP, will promote successful medical management, thus reducing surgical intervention and ultimately reducing maternal morbidity/mortality with preservation of future fertility.
Self-concept among school-age children with nephrotic syndrome
Authors: Khalil Shaimaa H. , Attia Azza A. , Mahmoud Naglaa F. , Abdelaziz Hanan E.
Published: May 2024

Background

Nephrotic syndrome (NS) is a major chronic renal problem among children. The psychological aspect is highly important because children with chronic diseases may have low self-concept and a distorted body image.

Aim

The aim was to assess self-concept among school-age children with NS.

Participants and methods

A descriptive exploratory research design was used. The study was conducted at the outpatient nephrology clinic and two Inpatient Medicine Units at Al-Mounira Pediatric, Cairo University Hospital. A purposive sample of 50 school-age children with NS (15 from inpatient and 35 from outpatient clinic) was recruited. A structured interview questionnaire and children’s self-concept scale were used.

Results

More than three-quarters of children aged 8 to less than 10 years had low self-concept. More than half of the children had learning difficulties and behavioral changes, whereas more than one-third had body changes and nearly half had problems with their parents. Regarding total self-concept, nearly three-quarters and more than half of the children had low self-concept regarding total school and family experiences, respectively, whereas less than three-quarters of the children had medium self-concept regarding total experiences with friends. Parenting problems, learning difficulties, and female sex were the major factors affecting children’s total self-concept.

Conclusion

Self-concept regarding total school and family experiences was negatively affected than total friends’ experiences among school-age children with NS.

Recommendations

Psychological interventions should be available for children with NS along different disease stages to enhance their self-concept. Replication on a larger sample and different settings to generalize the results is needed.
Relation between decision-making styles among head nurses and their personality traits
Authors: Zaid Karima A. , Basiony Basiony M. , Adam Shimaa S.
Published: May 2024

Background

Decision-making styles differ from one head nurse to another one based on several factors and a variety of personality traits that collaboratively affect the proficiency of the decision.

Aim

This study aimed to assess the relation between decision-making styles among head nurses and their personality traits.

Design

A descriptive correlational research design was used in carrying out the current study.

Setting

This study was conducted at nine hospitals affiliated to the Ministry of Health at Beni-Suef governorate and included six central hospitals and three specialty hospitals.

Patients

A purposive sample of 137 head nurses was included as a study sample.

Data-collection tools

Three tools were used to carry out this study, namely (a) factors affecting decision-making questionnaire, (b) general decision-making style inventory, and (c) personality-trait questionnaire.

Results

The mean age of the study sample was 35.2±6.8. Majority (90.5%) of the head nurses had a low level of rational style, the highest mean was regarding psychoticism neuroticism trait (21.41±0.86). There was a statistically significant correlation between intuitive decision-making style of head nurses and their neuroticism traits. There was a statistically significant correlation between dependent decision-making style of head nurses and their psychoticism and lie traits.

Conclusion

There was a highly statistically significant correlation between spontaneous decision-making style of head nurses and their extraversion and neuroticism traits. Also, there was a highly statistically significant correlation between intuitive decision-making style of head nurses and their psychoticism trait.

Recommendations

Periodic training and evaluation of head nurses on decision-making skills and giving more attention for personality traits of head nurses and their effect on decision-making.
Pelvic inflammatory disease
Authors: Hasab Allah Magda F. , Abdelnaem Safaa A. , Mohammed Manar D. , Abdelrahim Amany H.
Published: May 2024

Background

Pelvic inflammatory disease (PID) is one of the most serious infections faced by women today. It is a common problem encountered in post natal, post abortions and family planning clinics.

Aim

To evaluate the effect of educational program on women awareness regarding postabortive preventive measures of PID.

Patients and methods

A quasi-experimental design was used to achieve the aim of the study, which was conducted at the outpatient clinics of Maternal and Child Minia University Hospital.

Sampling

A purposive sample of 100 women was recruited.

Tools

Three tools were used in the current study for data collection: tool 1, structured interviewing questionnaire; tool 2, knowledge assessment tool; and tool 3, self-reported practice assessment tool.

Results

Overall, 85% of women had poor level of knowledge regarding PID and its prevention at preeducational test; this improved at posteducational test to 90% of them having good level of knowledge about PID and its prevention. Moreover, 83% of women had unsatisfactory level of reported practices related to postabortion care at preeducational test; this improved at posteducational test to 88% of them having satisfactory level of reported postabortion care practices. There was a positive association between knowledge scores and reported practice scores of the women at posteducational program.

Conclusion

Application of health education program was significant in enhancing the knowledge and self-reported practices among women in postabortion period regarding preventive measures of PID.

Recommendations

More research studies are needed to increase women’s awareness regarding postabortive preventive measures of PID because there were few research studies in this field.
A nude mutant rat derived from Sprague Dawley-National Institute of Nutrition rat colony with normal thymus
Authors: Motha Satyavani , Patil Pradeep Bhatu , Ramavat Ravindar Naik , Myadara Srinivas , Qadri S. S. Y. H.
Published: May 2024

BACKGROUND:

A spontaneous mutant rat with a hairless phenotype and an intact thymus was discovered in a long-standing Sprague Dawley-National Institute of Nutrition (SD/NIN) rat colony at a national animal resource facility.

OBJECTIVE:

We conducted extensive phenotypic and biochemical analyses on this mutant strain to determine its suitability as a preclinical model for immunocompetent testing in noncommunicable disease research.

MATERIALS AND METHODS:

We subjected the mutant rats to strict and frequent phenotypic and genetic surveillance to accomplish this objective. The animals were assessed for food intake, body weight, blood cell profile, clinical chemistry, adipose tissue deposition, and bone mineral density (BMD) using total electrical body conductance (TOBEC) and dual-energy X-ray absorptiometry (DXA) analysis.

RESULTS:

Initially, only two hairless mutant rats, a male and a female, were born from a single dam in the SD/NIN rat strain. However, the results indicate that the mutant colony propagated from these unique pups displayed distinct phenotypic features and exhibited differences in feeding behavior, weight gain, and clinical biochemistry. The food conversion rate was significantly higher in nude females (2.8-fold) while 26% lower in nude males. Both sexes of nude rats had significantly higher triglycerides and lower glucose levels in females. However, glucose levels did not change in male nude rats. Furthermore, nude female and male rats had significantly lower fat (TOBEC) and bone mineral content (DXA). Nonetheless, BMD was only slightly lower (7%–8%) compared to the heterozygous groups.

CONCLUSIONS:

These findings indicate that the spontaneous mutant rat has the potential to serve as an immunopotent and modulatory testing system in pharmacokinetics/pharmacodynamics and toxicology, which can be further explored for therapeutic drug discovery.
Paxlovid
Authors: Niraj Niraj , Mahajan Sonia Shinde , Prakash Ajay , Sarma Phulen , Medhi Bikash
Published: May 2024

Coronavirus infection is a pandemic threat and the most dangerous disease of the 21st century. Despite the rigorous exertion of world-class researchers, there is no perfect cure for it. It has been seen in presently available studies that Paxlovid prevents the progression of diseases and reduces severity in patients tremendously who are at high risk of hospitalization and death. It is a safe oral antiviral drug and has the potential to treat infections from multiple corona variants including omicron which affects humans. Paxlovid is comparatively less expensive than other available effective medicines. Consequently, it reduces hospitalization and death and helps to plummet the economic burden on patients and the health-care system globally. This medicine is still under investigation, and numerous clinical trials are still underway. Its potential side effects are minor and well tolerated by research study participants. Studies show its benefits outweigh the risk, and it is an effective and good alternative for the treatment of coronavirus disease.
Extensive arm skin necrosis following administration of unfractionated heparin
Authors: Firouzabadi Dena , Petramfar Peyman , Mahmoudi Laleh
Published: May 2024

Unfractionated heparin (UH), a commonly used anticoagulant, can rarely cause skin necrosis following heparin-induced thrombocytopenia (HIT). A 38-year-old female, a case of chronic inflammatory demyelinating polyneuropathy (CIDP) admitted to the neurology ward, developed extensive skin necrosis following a change in UH dose at the exact site of UH injection. A sudden fall in the platelet count was observed within 48 h of increasing the UH dose. Necrosis of the outer layer of the skin along with clot formation and inflammation in the inner layers was detected after histopathological evaluation. UH was discontinued, and rivaroxaban was started for the patient as soon as the complication was detected. The patient was discharged in good condition after completing treatment for CIDP without any need for surgical removal of the necrotic tissue. Extensive skin necrosis, as a result of HIT, requires immediate discontinuation of UH and substitution of a nonheparin-based anticoagulation treatment.
Reporting of adverse events related to medical devices
Authors: Meher Bikash Ranjan , Dash Ashish
Published: May 2024

As frontline health workers, nursing professionals have a crucial role in reporting medical device-associated adverse events (MDAEs). A questionnaire-based study was carried out to evaluate the knowledge, attitude, and practice of senior nursing officers (SNOs), nursing officers (NOs), and nursing students (NSs) toward MDAE. The response rate of the survey was 84% (n = 134). The mean score of knowledge of SNOs, NOs, and NSs was 2.03 ± 0.92, 1.71 ± 0.96, and 1.52 ± 0.82, respectively (P = 0.9). A large proportion of study participants (97%) considered that the use of medical device could sometimes cause untoward occurrences and detecting and reporting those events will enhance the safety of patients. However, many of them (67%) have not reported it during clinical posting. The participants of this survey possessed limited knowledge of MDAE. However, their attitude toward MDAE was encouraging and a continuous training program may improve their knowledge regarding MDAE and enhance the reporting practice.
Long-lasting effect of belantamab mafodotin in heavily pretreated multiple myeloma
Authors: Gil-Sierra Manuel David , Briceño-Casado Maria Del Pilar , Julia-Luna Francisco Javier , Martinez-Moya Maria Dolores
Published: May 2024

Belantamab mafodotin (BLMF) is an interesting therapeutic alternative for multiple myeloma (MM) patients pretreated with immunomodulatory drugs, proteasome inhibitors, and anti-CD38 monoclonal antibodies. Scientific evidence on BLMF provides immature data about progression-free survival and overall survival by short follow-up of patients with poor prognoses. Cases with long follow-ups could provide additional information about BLMF. This case reports a patient with MM treated with BLMF who had received nine previous lines of therapy with a follow-up of 11 months. No complete response was obtained. However, no disease progression was observed and the patient was still alive at the end of this work. BLMF showed manageable adverse effects. Our patient presented advanced disease, good functional status at the beginning of BLMF treatment, and elevated levels of lactate dehydrogenase during BLMF therapy. The influence of these last two factors was not evaluated in clinical trials. This relationship should be assessed more deeply in future studies.
Efficacy and safety of levamisole in childhood nephrotic syndrome
Authors: Bhatt Girish Chandra , Patel Bhupeshwari , Das Rashmi Ranjan , Malik Shikha , Bitzan Martin , Mishra Nihar Ranjan
Published: May 2024

Present evidence regarding the efficacy and safety of levamisole in childhood nephrotic syndrome (NS), particularly the steroid-sensitive NS (SSNS), is limited. We searched relevant databases such as PubMed/MEDLINE, Embase, Google Scholar, and Cochrane CENTRAL till June 30, 2020. We included 12 studies for evidence synthesis (5 were clinical trials that included 326 children). The proportion of children without relapses at 6–12 months was higher in the levamisole group as compared to steroids (relative risk [RR]: 5.9 [95% Confidence interval (CI): 0.13–264.8], I
2 = 85%). Levamisole as compared to the control increased the proportion of children without relapses at 6–12 months (RR: 3.55 [95% CI: 2.19–5.75], I
2 = 0%). The GRADE evidence was of “very-low certainty” except for the comparison of levamisole with control, the latter being of “moderate certainty.” To conclude, levamisole given to children with SSNS is beneficial in preventing relapses and achieving remission as compared to placebo or low-dose steroids. Good-quality trials are needed to provide a robust evidence in this regard. PROSPERO Registration number: CRD42018086247.
Evaluation of peripheral lymphocyte subsets in acne vulgaris patients before and after systemic isotretinoin treatment
Authors: Gunaydin Sibel Dogan , Tezcan Ilhan
Published: May 2024

OBJECTIVES:

Isotretinoin (ISO) is a retinoic acid-derived molecule which is very efficient in the treatment of acne vulgaris (AV). Little is known regarding alterating affects of systemic ISO on immune system.

SUBJECTS AND METHODS:

Thirty-two patients with moderate and severe AV with indications for systemic ISO treatment were recruited. The evaluation of peripheral blood lymphocyte subsets was made on treatment initiation and at the end of the therapy by flow cytometry.

RESULTS:

CD16/56+ natural killer (NK) cell levels were higher in patients with severe acne compared to moderate acne (P = 0.009). CD45RA+ (naive) cell levels decreased significantly after systemic ISO treatment; the mean percentage was 66.9 ± 6.5 which decreased to 63.9 ± 7.5 after treatment (P = 0.013). CD19+ cell levels were also significantly increased; mean percentage (%) and absolute cell counts were 8.0 ± 3.1 and 161.3 ± 7.36 cells/μl which increased to 10 ± 2.7 and 227.7 ± 108.7 cells/μl, at the end of treatment, respectively (P = 0.007,P= 0.011).

CONCLUSIONS:

NK cell count may be a parameter related to acne severity. Systemic ISO may have an inhibitory effect on naïve T cells. Finally, systemic ISO seems to stimulate mature B-cell proliferation.
Antitumor effects of polyphenol-rich extract of Euphoria longana seed by vascular endothelial growth factor and transforming growth factor-beta signaling inhibition in experimentally induced oral cancer in rats
Authors: Lagariya Labhu , Soni Kinal , Shah Jigna Samir
Published: May 2024

ETHNOPHARMACOLOGICAL RELEVANCE:

Oral cancers are found to have high risk in South Central Asia due to exposure of various risk factors. Euphoria longana Lam. (EL) has been traditionally used to relieve insomnia, prevent amnesia, and treat palpitation. In addition, EL has been reported to have anti-inflammatory, anti-cancer, and antioxidant activities. The investigation was aimed to evaluate the mechanism of action and antitumor activity of polyphenol-rich EL seeds extract against oral cancer induced by 4-Nitroquinoline-1-oxide (4-NQO).

MATERIALS AND METHODS:

Seven groups of Sprague–Dawley rats were formulated: normal animals, oral cancer induced with 4-NQO, EL-treated normal control, EL-treated disease control from 0-day, EL-treated disease control from 60 days, 5-fluorouracil (5-FU)-treated disease control from day 60, and combined EL- and 5-FU-treated disease control animals from day 60. The animal tongue was smeared with 0.5% 4-NQO at frequency of thrice a week for 12 weeks to induce oral cancer. At the end of treatment, excised tongues were used for biochemical and tumour-specific parameters along with histopathology assessment.

RESULTS:

Treatment with EL, 5-FU, and combination of both in diseased animals exhibited significant improvement in interleukin-6, vascular endothelial growth factor (VEGF), and Transforming growth factor beta (TGF-β) levels, antioxidant status together with histoarchitecture of the tongue tissue. In addition, the combination of both was slightly more effective than EL and 5-FU alone.

CONCLUSION:

Our data suggest antitumor activity of Euphoria longana Lam. Extract against 4-NQO induced oral cancer in rats, which could be attributed to alteration in the VEGF and TGF-β signaling axis.
A comparative study of intravenous low doses of dexmedetomidine, fentanyl, and magnesium sulfate for attenuation of hemodynamic response to endotracheal intubation
Authors: Shukla Sharmishtha , Kadni Reena R , Chakravarthy Joel J , Zachariah K Varghese
Published: May 2024

BACKGROUND:

Endotracheal intubation is an integral part of general anesthesia. The hemodynamic stress responses associated with it, though transient, are unpredictable and variable. In comparison with healthy individuals, those with comorbid health issues can have life-threatening complications with this sympathetic response. Hence, in this study, we compared the efficacy of intravenous low doses of dexmedetomidine, fentanyl, and magnesium sulfate (MgSO4) in reduction of the hemodynamic response to endotracheal intubation.

MATERIALS AND METHODS:

This prospective randomized study compared three groups of dexmedetomidine (0.6 μg/kg) (Group D), fentanyl (2 μg/kg) (Group F), and MgSO4 30 mg/kg (Group M). A total of 105 American Society of Anesthesiologist's 1 and 2 patients were selected with 35 in each group. The hemodynamic variables recorded at baseline, during induction and intubation up to ten minutes were pulse rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure. The assessment of quantitative and qualitative data was done with the one-way ANOVAs, Student's t-test, and Chi-square test. Analysis of variance was done by post hoc tests.

RESULTS:

There were statistically significant differences that were observed with dexmedetomidine and fentanyl groups in respect to heart rate and blood pressure responses to laryngoscopy and intubation when compared to MgSO4. A significant attenuation of response from baseline values was also noted with dexmedetomidine and fentanyl groups.

CONCLUSION:

Efficacy of low doses of both dexmedetomidine and fentanyl was equipotent in attenuating response in comparison with MgSO4, and we conclude that dexmedetomidine can serve as an alternative to fentanyl.
Thalidomide and steroid in the management of erythema nodosum leprosum
Authors: Mishra S. R. P. K. , Samal Rajashree , Behera B
Published: May 2024

OBJECTIVE:

The objective of the study was to assess the efficacy and safety profiles of combined treatment of prednisolone with thalidomide (Gr-A) and prednisolone with clofazimine (Gr. B) in patients with erythema nodosum leprosum (ENL) or type 2 lepra reactions.

MATERIALS AND METHODS:

Efficacy of both regimens was assessed on the basis of clinical recovery of recurrent ENL measured by reaction severity score (RSS), Visual Analog Scale (VAS), and recurrence of type 2 lepra reaction. The causality assessment of adverse drug reactions was done using the WHO UMC causality assessment scale.

RESULTS:

The average age of patients with recurrent ENL was 42.8 years (male) and 51.8yrs (female) and had mean duration of leprosy and recurrent ENL 2.4 years and 2.09 years, respectively. 80% of nonrecurrence was observed in Gr-A versus 66% in Gr-B. Significant (P < 0.05) lower RSS and VAS was found in both the treatment groups as compared to pretreatment value. The reduction in RSS and VAS was statistically significant (P < 0.05) in Gr-A compared to Gr-B treatment.

CONCLUSION:

Thalidomide combination with steroid was found to be more efficacious than clofazimine combination with steroid in the treatment of ENL both the treatment regimens showed few tolerable side effects. Improved strategies for the treatment and management of these reactions need to be developed.
An idiosyncratic reaction of unilateral common peroneal nerve palsy associated with below desired therapeutic range of tacrolimus level in a patient postheart transplantation
Authors: Srivastava Ayush , Abhisek P Ansuman , Pradhan Shweta Supriya
Published: May 2024

Tacrolimus (TAC) is a very effective medication in routine use after solid organ transplantation. The potential, but infrequently reported neurological adverse effect of TAC is peripheral neuropathy (PN). This has rarely been reported in heart transplant patients. To the best of our knowledge, the data regarding mononeuropathy of common peroneal nerve presented with foot drop due to low whole blood trough TAC level are very limited in the early days postheart transplantation. An idiosyncratic reaction might be suspected in the early postoperative period, when the whole blood trough levels of TAC fall below or within the desired therapeutic range associated with any adverse events after ruling out other causes. We report a 21-year-old patient, who underwent heart transplantation after a suitable donor was identified, and presented with a new-onset right side foot drop on the 10th postoperative day. According to the WHO-Uppsala Monitoring Center causality assessment scale, the likely culprit agent is TAC. Rapid and progressive improvement of foot drop occurred after stopping it and changed over to cyclosporine.
Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers
Authors: Joshi R , Medhi B , Prakash A , Chandy S , Ranjalkar J , Bright H R , Basker J , Govindraj L , Chugh P K , Tripathi C D , Badyal D K , Balakrishnan S , Jhaj R , Shukla A K , Atal S , Najmi A , Banerjee A , Kamat S , Tripathi R K , Shetty Y C , Parmar U , Rege N , Dikshit H , Mishra H , Roy S S , Chatterjee S , Hazra A , Bhattacharya M , Das D , Trivedi N , Shah P , Chauhan J , Desai C , Gandhi A M , Patel P P , Shah S , Sheth S , Raveendran R , Mathaiyan J , Manikandan S , Jeevitha G , Gupta P , Sarangi S C , Yadav H N , Singh S , Kaushal S , Arora S , Gupta K , Jain S , Cherian J J , Chatterjee N S , Kaul R , Kshirsagar N A
Published: May 2024

OBJECTIVE:

The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates.

METHODS:

Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees.

RESULTS:

Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation.

CONCLUSION:

Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.
Successful management of delayed hyaluronidase hypersensitivity after subtenon's anesthesia during the COVID-19 pandemic
Authors: Gurnani Bharat , Kaur Kirandeep
Published: May 2024

Subtenon's block is commonly used to achieve akinesia, analgesia, and anesthesia for ophthalmic surgeries. This case study detailed a rare hypersensitivity report in a 65-year-old female who had underwent manual small incision cataract surgery under subtenon's anesthesia (STA) in the left eye. On postoperative day 1, she presented with acute onset proptosis, periorbital edema, conjunctival chemosis, and restriction of extraocular movements. The pupillary reaction and dilated fundus examination were normal. A differential diagnosis of orbital cellulitis, Mucormycosis, and hyaluronidase hypersensitivity (HH) was considered. Since the patient was afebrile, and pupillary reactions, ENT, neurological, and fundus examination were normal, the diagnosis was narrowed down to delayed HH. The patient was managed with a 1 cc IV injection of dexamethasone once a day for 3 days, along with routine postoperative drugs. As per detailed literature review, this is probably a second case report of delayed HH post-STA.
Erector Spinae Plane Block as a Potential Analgesic Option in Acute Pancreatitis
Authors: Khanuja Samiksha , Agarwal Jyotsna , Hussain Sana Yasmin , Batt Kharat Mohammad
Published: May 2024

Pain management in patients with acute pancreatitis (AP) is mostly dominated by intravenous opioids. Besides their side effects, opioids also prolong the intensive care unit stay of the patient. The ultrasound-guided erector spinae plane block (ESPB) is an established intervention for postoperative analgesia. It is now also being studied for providing pain relief in AP. A lower thoracic ESPB targets sympathetic nerve fibers in addition to the dorsal and ventral rami through local anesthetic spread to the paravertebral space to provide both visceral and somatic analgesia. It could be an effective adjuvant as a part of multimodal analgesia and may significantly reduce overall opioid usage. We describe a case of AP where significant pain relief was achieved after administering a single-shot ESPB.
Medical students’ dietary habits: Motivations and barriers to reaching health goals
Authors: Carcoana Allison O. Dumitriu , Tomlinson Stephanie , DeWaay Deborah , Izurieta Ricardo F.
Published: May 2024

ABSTRACT

Introduction:

It has been well reported that medical students do not follow healthy diets overall. Effectively guiding patients to change their health behavior is a crucial skill for primary care providers and family physicians. Our objective was to investigate medical students’ dietary decision-making, including the motivations and barriers that influence their dietary choices.

Methods:

A self-administered online questionnaire was conducted among preclinical students at one allopathic medical school in the United States. The survey was comprised of questions about students’ dietary goals, habits, and the barriers they face in reaching their nutritional ideals. Trends in the percentage of students who selected each survey answer choice were interpreted.

Results:

Of the 363 preclinical students provided with the optional survey, 71 (19.6%) chose to participate. The participants’ dietary decisions were predominately driven by convenience. Most students wanted to eat nutritiously to support their well-being but had been eating less healthily since starting medical school due to financial limitations and limited time. Approximately half (46.5%, 33/71) of the participants stated that they would buy the in-house food provided at the medical school campus more often if it better matched their dietary goals, but 36.6% (26/71) would only do so if the new foods were affordable compared to competitor’s prices.

Conclusion:

There is an opportunity to help medical students meet their dietary goals, which are negatively impacted by personal and structural academic barriers. Further research is needed on the obstacles that institutions face in offering healthy, affordable options to medical students.
Vaginal leiomyoma in a perimenopausal woman: A rare case report and review of the literature
Authors: Deepika  , Goyal Suresh , Garg Priyanka , Kanwat Jyoti , Kaur Navdeep
Published: May 2024

ABSTRACT

Vaginal leiomyomas, originating from the anterior vaginal wall, are exceedingly uncommon, with only around 300 reported cases documented in the literature to date. We present a rare case of a 50-year-old female who visited the outpatient department with complaints of abnormal uterine bleeding, and heaviness in abdomen with mass protrusion outside introitus since one year. Ultrasonography indicated adenomyosis of the uterus, with a suspected mass protruding through the posterior bladder or anterior vaginal wall. MRI imaging was conducted large polypoidal mass lesion is seen within the vaginal cavity two assymetrical round ends with close proximity to bladder and urethra with pedunculated submucosal uterine fibroid with adenomyotic changes . The provisional diagnosis of? vaginal leiomyoma along with pedunculated submucosal uterine fibroid with Adenomyosis made. Patient planned for Hysterectomy for submucosal leiomyoma with Adenomyosis and excision of vaginal mass via vaginal route. The size of vaginal mass was around size 5 * 6cm size enucleated, redundant vaginal wall excised and same sent for histopathology examination. The cut section of the vaginal mass showed whorled appearance .The Histopathology of vaginal mass showed Vaginal leiomyoma. Postoperative period was uneventful. The patient anatomy was restored and had no complaint of difficulty in urination and symptomatically improved.
Provider’s satisfaction with telemedicine services for tribals of Western Rajasthan: A qualitative analysis
Authors: Dwivedi Rakhi , Bohra Gopal , Bhardwaj Abhishek , Goel Akhil Dhanesh , Choudhary Bharat , Sharma Prem P. , Dwivedi Pradeep , Singh Surjit , Singh Pratibha , Singh Kuldeep
Published: May 2024

ABSTRACT

Background:

There are significant barriers to healthcare access in tribal areas, even though for every 834 people, there is one public physician (registered allopathic and AYUSH doctors). More than 86% of hospital visits occur in rural areas. Furthermore, the bulk of them travel long distances to reach hospitals. A telemedicine center was established in the aspirational tribal district of Sirohi, Rajasthan, to provide accessible quality health care.

Objective:

To understand providers’ attitudes and satisfaction with telemedicine services for tribal populations.

Materials and Methods:

This cross-sectional, mixed-method study enrolled consultants from various clinical departments of AIIMS Jodhpur (n = 23) who provide teleconsultations to the tribal population.

Result:

The mean score of the satisfactory index was 54.7 ± 22.04. The higher score is 87.4 regarding the ability to use the technology platform during teleconsultation. The lower score was 34.7 for video quality during teleconsultation at STHR. 91.3% found this a beneficial model for the tribal population. Consultants providing teleconsultations expressed that this model is a boon for tribal patients as a screening tool and will save time and money for improved accessibility.

Conclusion:

Positive indications of teleconsultation with a provider’s utility, acceptability, and satisfaction. Most marginalized people can efficiently access all levels of (primary, secondary, or tertiary) health care from experts through telemedicine, which will broaden outreach in hard-to-reach or inaccessible tribal or rural areas.
Factors influencing virtual collaborative care outcomes for depression and anxiety
Authors: Walker Chase , Little Virna , Joyner Jian , Fuller Steven , Green Brandn
Published: May 2024

ABSTRACT

Context and Aims:

In the United States, access to evidence-based behavioral health treatment remains limited, contributing to inadequate treatment for individuals with depression and anxiety disorders. The Collaborative care model (CoCM), the integration of behavioral healthcare into primary care, has been shown to be effective in addressing this issue, particularly when delivered virtually through telehealth platforms. While collaborative care has been shown to be effective, little has been studied to understand the impact of patient treatment factors on patient improvement. This study aims to analyze factors associated with patient improvement, measured by PHQ-9 and GAD-7 score changes, in patients with depression and anxiety disorders from Concert Health, a national behavioral medical group offering collaborative care across 18 states.

Methods and Material:

Stepwise logistic regression models were utilized to identify factors influencing patient improvement in standardized symptom screener scores (PHQ-9 and GAD-7). Relevant patient-level data, including demographics, clinical engagement, insurance type, clinical touchpoints, and other variables, were analyzed. Results are presented as odds ratios (ORs).

Results and Conclusions:

We find that increased clinical touchpoints were associated with improved outcomes in both depression (PHQ-9) and anxiety (GAD-7) populations. Commercial insurance was linked to a greater likelihood of improvement relative to Medicaid, and the use of C-SSRS suicide screeners had varied effects on patient outcomes depending on the diagnosis. The duration of time spent in appointments showed a nuanced impact, suggesting an optimal length for touchpoints. Psychiatric consults also impact patient outcomes in both populations. This study sheds light on factors influencing patient outcomes in virtual collaborative care for depression and anxiety disorders, which may be used to inform and motivate further research and allow providers to better optimize and understand the impacts of treatment choices in collaborative care settings.
The role of primary care in rare disorders: A qualitative study of parents and patients managing complex vascular anomalies
Authors: Kerr Anna M. , Bereitschaft Christine , Sisk Bryan
Published: May 2024

ABSTRACT

Background:

Patients with complex rare disorders often require the care of multiple specialists. Effective coordination between primary and specialty care is needed to ensure patients receive high-quality care. Previous research has documented the importance of primary care clinicians providing referrals to specialty care and the importance of specialists in helping patients reach a diagnosis. However, little is known about primary care clinicians’ roles in the ongoing care of patients with rare disorders. In the current study, we explored the role of primary care clinicians in the care of rare and complex vascular anomalies.

Materials and Methods:

Data were collected using semi-structured qualitative interviews with 34 parents and 25 adult patients recruited from advocacy groups for patients with complex vascular anomalies participated. We asked participants about their diagnosis, care experiences, and communication with clinicians. We used thematic analysis to identify themes illustrating the roles of primary care clinicians.

Results:

PCC roles were characterized by four behaviors. Supporting behaviors included learning more about vascular anomalies and asking participants about the care they received from specialists. Facilitating included providing referrals, ordering tests, and engaging in problem-solving. Interfering included failing to provide referrals or help participants coordinate care, ordering incorrect tests, or making inappropriate recommendations. Disregarding included focusing narrowly on primary care needs and not showing concern about the vascular anomaly.

Conclusions:

The results reveal opportunities to improve primary care for patients with vascular anomalies. Disregarding and interfering behaviors furthered the division between primary and specialty care for patients with vascular anomalies and prevented patients from receiving comprehensive primary care. Supporting and facilitating behaviors convey genuine interest in the care of the vascular anomaly and a commitment to helping the patient and parent.
An evidence based immunohistochemical panel for diagnosing oral lymphoma along with a case series
Authors: Aneesh V. M , Carvalho Karla M. , Dhupar Anita , Spadigam Anita
Published: May 2024

ABSTRACT

Oral lymphomas are rare and present a diagnostic challenge. Immunophenotyping is essential to decipher their biology and identify therapeutic targets. Histopathology can prove to be diagnostically difficult to type these lesions, and hence, immunohistochemistry (IHC) proves useful in deciphering their biology. Here, we present an evidence-based approach using a novel immunohistochemical marker panel to diagnose oral lymphomas by discussing four unique cases.
Hematological manifestation of Pediatric Systemic Lupus Erythematosus (SLE) – A single centered cross-sectional study
Authors: Hassan Md Rakibul , Hossain Ashik , Mahata Joyanti , Srivastava Vartika , Sarkar Sougata
Published: May 2024

ABSTRACT

Introduction:

Systemic lupus erythematosus (SLE), the commonest type of lupus, is an autoimmune multisystemic disorder that can affect any organ system of the body, especially blood vessels and connective tissues, causing widespread inflammation. Pediatric onset of SLE is a rare condition with more hematological involvement.

Aim:

This study was undertaken to observe various hematological abnormalities and their association with various autoantibodies present in pediatric SLE in Eastern India.

Methodology:

It was a single-centered, cross-sectional, observational, hospital-based study conducted in the Department of Pediatric Medicine in collaboration with the Department of Rheumatology in IPGME and R and SSKM Hospital, Kolkata. The duration of the study was 1.5 years, and a total of 30 children up to 12 years of age of either gender were enrolled. Study participants were evaluated for various parameters like demographic, hematological (anemia, neutropenia, leucopenia, lymphopenia, and thrombocytopenia), biochemical (CRP, Lactate dehydrogenase (LDH), and bilirubin), autoantibodies (anti-dsDNA, anti-Ro 52, and anti-Ribonucleoprotein [RNP]), and SLE related pathologies (Cutaneous, nephritis, serositis).

Results:

In the present study, most of the participants had arthritis, muscle pain (86.66%), and hematological involvement (80%). Among cytopenias, anemia was the commonest. dsDNA autoantibody was positive in most of the patients (83%), and about one-third suffered from autoimmune hemolytic anemia (AIHA). No association was observed between autoantibodies and various hematological manifestations.

Conclusion:

It can be concluded from the present study that anemia is the most common cytopenia in pediatric SLE, but there is no association between autoantibodies and these cytopenias. However, study on larger population may give better results.
Antibiotic resistance of enteropathogenic bacteria in a teaching hospital in North Khuzestan during a three-year period
Authors: Deihim Behnaz , Masoudipour Parisa
Published: May 2024

ABSTRACT

Introduction:

Gastrointestinal infections affect many people annually. The most common bacterial agents involved in these infections are enteropathogenic bacteria and in the continuation of using broad-spectrum antibiotics, Clostridium difficile-associated diarrhea is involved, especially in hospitalized patients. The aim of the present study was to investigate the pattern of antibiotic resistance among enteropathogenic bacteria.

Materials and Methods:

In this cross-sectional study, 163 samples of patients with diarrhea in Dezful Ganjavian Hospital were examined. The samples were cultured in MacConkey, Hektoen enteric agar and GN broth, and cycloserine cefoxitin fructose agar media and incubated under standard conditions. In order to identify enteropathogenic bacteria, biochemical tests and serological confirmatory tests were used. Antibiotic resistance pattern of the isolates was investigated by Kirby–Bauer disk diffusion susceptibility test.

Results:

The frequency of pathogenic bacteria includes 41.1% of Shigella flexneri, followed by 41.1% of S. sonnei, 6.7% of Enteropathogenic E. coli, 5.5% of Salmonella enterica Serogroup B, and 5.5% of Shigella dysenteriae. The results revealed a total of 46 patients with orders regarding C. difficile culture, no C. difficile was isolated from the samples. The studied isolates showed the highest resistance to trimethoprim-sulfamethoxazole, and ceftriaxone (88.3%), and the most effective antibiotic in the treatment of patients was ciprofloxacin with 86% sensitivity.

Conclusion:

Susceptibility to antibiotics was different among the isolates, which shows that the early identification of the infection agent and the selection of the correct antibiotic treatment are effective in improving the gastrointestinal infection and preventing the spread of the infection.
Regulation and participation of the private sector in the pursuit of universal health coverage: Challenges and strategies for health systems
Authors: Zanga Rosendo
Published: May 2024

ABSTRACT

The 1978 Alma Ata Declaration established recommendations for health systems, which significantly impacted low-income countries. These guidelines marked improvements in access to health, coverage and financial equity, especially in Latin American countries.

Objectives:

This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs).

Methods:

The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC.

Results:

The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.