bluuebunny/crossref_metadata_2025 huggingface dataset:
MEDICAL DEVICE MANAGEMENT BASED ON A PROCESS APPROACH
Authors: Artamonova Galina V. , Avramenko Olesya E. , Popsuiko Artem N. , Milinevskiy Nikolay I.
Published: July 2024

Highlights

Scientific novelty and practical significance of the presented work is seen in the relationship between the development of medical equipment management system and quality management in health care institutions and medical science. The application of the principles of international ISO 9001:2015 to the system of medical equipment management, which has its own special features in this industry makes the author’s approach unique. The role of the process approach in ensuring the sustainable functioning of medical equipment is shown in the study. The performance of the medical equipment management system based on the principles of international standard ISO 9001:2015 has been analyzed. The positive dynamics in terms of achieving the target performance indicators of this process in 2013–2021 is revealed.

Aim. To analyze the experience of applying the process approach in the management of medical equipment based on the principles of the international standard ISO 9001:2015.

Methods. The basis of the study was “Research Institute for Complex Issues of Cardiovascular Diseases” (NII KPSSZ). The object of the study is the quality management system of the Research Institute for Complex Issues of Cardiovascular Diseases. The subject of the study is the process of equipment and measuring instruments management. The main methods of this study were: system analysis, unity of historical and logical. The period of the study was 2013–2021.

Results. The process approach in medical device management is considered within the framework of the quality management system of NII KPSSZ. During the study period there was an increase in equipment units by 2.58 times (from 976 to 2520 units, respectively, 2013–2021), which led to an increase in scheduled maintenance (SM) by 4.25 times (due to the introduction of pre-checking maintenance). The relative number of repairs to the total amount of equipment in different years amounted to 33.4–54.3% or on average 40.3%, the increase in current repairs of medical equipment relative to 2013 in 2021 amounted to 2.68 times. There is a positive dynamic in terms of decrease in the number of comments and increase in the number of proposals to improve the process during 2013–2021.

Conclusion. The analysis of performance indicators in the period under the study indicates the determining role of the quality management system in ensuring the sustainability and stability of the medical equipment management system. The implementation of research tasks allowed the authors to form a holistic vision of the role of the process approach in solving the problem of finding effective organizational solutions that ensure the quality and safety of medical care. The presented experience can be replicated for any medical organization.
PROGNOSTIC SIGNIFICANCE OF ELECTROCARDIOGRAPHIC PARAMETERS ASSOCIATED WITH METABOLIC CHANGES IN THE MYOCARDIUM (LITERATURE REVIEW)
Authors: Kuzminykh Natalia A. , Ragino Yulia I.
Published: July 2024

Highlights

The main ECG parameters associated with cardiovascular mortality in metabolic cardiomyopathy are P-wave changes, QT prolongation, ECG signs of left ventricular hypertrophy, depression and ST segment elevation, T-wave changes. These simple ECG markers are valuable signs of an unfavorable prognosis in patients with myocardial metabolic disorders.

 

Abstract

Cardiovascular diseases (CVD) are the leading cause of death globally, one of the initial manifestations of these diseases are metabolic changes in the myocardium.   Risk stratification in a young population makes would make it possible to timely identify such conditions and prevent their development, as well as their further progression. Electrocardiography is an effective, reliable, accessible and inexpensive method used in clinical practice and research. The aim of this article was to review electrocardiographic (ECG) features associated with manifestations of myocardial metabolic disorders, the mechanisms underlying these associations, and to briefly describe the main research findings in this area and consider the implications for clinical practice. The material and methods were literature sources analyzing metabolic changes in the myocardium and their electrophysiological manifestations, the following databases were used to search for relevant articles: elibrary.ru, pubmed.ncbi.nlm.nih.gov, researchgate.net. The results of the analysis showed that the main changes in ECG parameters associated with cardiovascular mortality in metabolic cardiomyopathy are P-wave changes, QT prolongation, ECG signs of left ventricular hypertrophy, depression and ST segment elevation, T-wave changes. Thus, simple ECGs-markers remain valuable indicators of an adverse prognosis for patients with metabolic disorders of the myocardium.
Determination of stiffness and damping characteristics of the adaptive suspension system to develop the optimal control of the simulation bench
Authors: Godzhaev Zakhid A. , Senkevich Sergey E. , Malakhov Ivan S. , Ilchenko Ekaterina N. , Uyutov Sergey Y.
Published: July 2024

BACKGROUND: Optimization of the suspension system, its operating parameters, as well as active adjustment depending on the ground surface can significantly affect the fatigue resistance, improve comfort during operation ensuring smoothness of ride, reduce the pressure on ground, increase the overall energy efficiency of the mobile energy unit. Therefore, in this approach, there are theoretical calculations to find the optimal range for control of the simulation bench to study the parameters of the active suspension system.
AIM: Development of optimal operating conditions of the control system of the simulation bench, minimization of vibrations and oscillations, prediction of the system behavior in different conditions and modes of operation.
METHODS: The development of optimal control is based on the analysis of scientific works, including publications, scientific papers and other sources of information on the approaches to the development of optimal control of the performing device in the active suspension system for the most effective damping of vibrations arising from road unevenness. The method of theoretical calculation of three-factor experiment was used, the main dependencies were obtained.
RESULTS: The obtained equations have a high level of significance. Graphical representation makes it possible to make a qualitative assessment of the accuracy of the obtained equations. The equations make it possible to control the parameters of the adaptive suspension system with several criteria. Each criterion included in the equation influences on the function itself. In order to develop the optimal control, the obtained equations are applied in the software development.
CONCLUSION: The practical significance lies in the developed equations for the software concerning the optimal control of the simulation bench, the relationship between independent variables such as velocity, microprofile height and suspension stiffness has been established.
Factors affecting the intention to choose a marine ecotourism destination in Ba Ria-Vung Tau province, Vietnam
Authors: Khanh Pham Ngoc , Van Nguyen Thi , Cuong Ngo Anh
Published: July 2024

The objective of the article is to identify and evaluate the level of factors that influence the intention to choose a marine ecotourism destination and propose some management implications to help local government agencies and tourism businesses have appropriate policies and strategies to improve the quality of marine ecotourism and contribute to the development of the local tourism economy. Marine ecotourism is a form of nature-based tourism and sustainable marine tourism, associated with local cultural identity and community participation for sustainable development. Therefore, the author researched "factors affecting the intention to choose a marine ecotourism destination in Ba Ria-Vung Tau province, Vietnam." The study conducted data analysis based on 200 survey samples, processed with SPSS 23.0, software including assessing the reliability of the scales with Cronbach's Alpha test, exploratory factor analysis (EFA) with Barlett’s test and Kaiser-Meyer-Olkin (KMO); and regression analysis of factors affecting the intention to choose a marine ecotourism destination using F test and Sig significance level to test the hypotheses. The research results indicate that five factors, ranging from high to low in impact, influence the intention to choose a marine ecotourism destination: the source of destination information, travel motivation, ability to pay, the quality of information sources, and word-of-mouth on social networks.
Retelling Yassawi’s Hikmets: The impact on EFL students’ English-speaking performance and vocabulary size
Authors: Suleimenova Zhazira , Kenesbayeva Shynar , Tussupova Gulden , Saganayeva Gulnur , Kaliyeva Assel
Published: July 2024

This experimental study evaluates the effects of retelling Yassawi’s hikmets on the speaking performance and vocabulary size of English as a Foreign Language (EFL) learner. Sixty EFL students recruited from a university in Kazakhstan were asked to narrate monologues based on previously read hikmets of their choice during out-of-class meetings once a week over 10 weeks. The results reveal that this intervention significantly improved participants’ speech fluency, lexical complexity and vocabulary size as opposed to their counterparts who did not engage in the retelling experience. However, the analysis of covariance revealed that only fluency and lexical complexity showed significant differences after controlling for the pre-test scores of these variables and vocabulary size. It was also found that pre-test vocabulary size and fluency had a moderating influence on post-test fluency. In a nutshell, retelling hikmets brought about gains in learners’ vocabulary and speaking performance especially in terms of fluency. This evidence underscores the effectiveness of oral text reproduction exercises in improving the speaking abilities and vocabulary of EFL learners   even when the recited text is out-of-date and not really engaging. The findings advance our understanding of effective language teaching methods and offer practical guidance for EFL teachers, curriculum developers and researchers.
Audit report lag during the COVID-19 pandemic: A multi-country analysis
Authors: Alhebri Adeeb , Alkebsee Radwan , Al-Matari Ebrahim Mohammd , Azibi Jamel , Omer Adam Mohamed
Published: July 2024

This research investigates the impact of the COVID-19 pandemic on the promptness of audit reports. The COVID-19 epidemic has had a significant impact on several sectors, including accounting and auditing. The present study employed a dataset of 6652 multinational firms sourced from the Refinitiv Eikon and Datastream databases. We chose the year 2018 as the first reference point because there was no worldwide pandemic during that period. The global outbreak, which emerged in Wuhan, China, in December 2019, rapidly disseminated to many nations by March 2020. The regression analysis of a sample of 6652 worldwide enterprises indicates a positive correlation between the COVID-19 epidemic and the delay in issuing audit reports. This observation implies that the occurrence of such crises exacerbates the promptness of audit reports. Our study’s findings indicate that governments’ implementation of travel restrictions has a negative impact on the promptness of audit reports. Therefore, our results demonstrate resilience to endogeneity. Our findings add to the body of knowledge; this is the first study to look at how the COVID-19 epidemic has affected audit report latency globally. Second, while the promptness of audit reports is crucial for regulators and investors in a stable environment, it becomes even more crucial under unforeseen circumstances like the COVID-19 epidemic. Finally, the results of this study hold significant relevance for regulatory bodies and investors alike.
Examining the reliability and validity of measuring scales related to informatization and instructional leadership using the PLS-SEM approach
Authors: Li Wei , Lay Yoon Fah
Published: July 2024

This study focuses on six variables that impact teachers' use of technology in their instructional leadership: usage expectancy (UE), social influence (SI), enabling circumstances (FC), behavioural intention (BI), computer self-efficacy (CSE) and blended teaching competency.   This study aimed to examine the reliability and validity of modified scales incorporating UE scales including the PE scale, EE scale, SI scale, FC scale, CSE scale, BTC scale, BI scale and TIIL scale. A total of 60 in-service university teachers participated in this research. The PLS-SEM approach was employed to examine the reliability and validity of all scales.  Composite reliability (CR) and Cronbach’s alpha determine internal consistency and reliability. Convergent validity was assessed by the outer loading and the average variance extracted (AVE). Assessment of discriminant validity was conducted by the Fornell-Larcker criterion, cross-loadings and Heterotrait-Monotrait Ratio (HTMT). After deleting nine items that were lower than .40, Cronbach’s alpha and CR values were all higher than .70. All scales’ item values fulfilled the criteria of AVE (>.50), Fornell-Larcker criterion, cross-loading and HTMT(<.90). Assessment results indicate that all modified scales have established validity and reliability for in-depth research. This research contributed to the PLS-SEM research technique, examined TIIL's influencing elements in the Chinese environment, enhanced the theoretical model of TIIL and provided useful assistance for the field's advancement.
Exploring the influence of emotions on sustaining purchase intentions through the online store in Indonesia
Authors: Sari Dewi Agustin Pratama , Berutu Meta Bara , Rahmi  , Dhinanty Raihanisa Dara , Ririh Kirana Rukmayuninda
Published: July 2024

This study explores the influence of emotions on sustaining purchase intentions through an online store in Indonesia. Application penetration in the mobile ecosystem has become popular as an online-to-offline (O2O) service that applies the convenience of online services to offline reality. Therefore, this study aims to develop a comprehensive model of online store image based on the continuous usage intention of consumers in online-to-offline meal applications. This study uses Pleasure, Arousal, and Dominance (PAD) theory as an adapted model of the organism stimuli, and response framework. The design of the study uses a quantitative research approach and adapts research instruments from previous research. This study focuses on five variables. It consists of Online Store Image, Pleasure, Arousal, Dominance, and continuous purchasing—the indicators obtained from previous studies. This study collected data in 2023, when the World Health Organization (WHO) revoked COVID-19 status. There are 260 responses collected. The result indicates that online store image affects pleasure, arousal, and dominance, as the emotions stimulated by this study show that pleasure and dominance emotions positively and significantly impact continuous purchase intention. The study’s practical implication suggests that the potential for boosting sustained purchasing intention exists when consumers experience feelings of happiness and sense of dominance. So, this study suggests the provider must increase their online presence to create an excellent online store’s image. If the online store’s image is good, consumers' pleasure, arousal, and dominance emotions will increase.
The role of external review in enhancing tax planning practices for investment agencies and companies in the sports sector and its impact on the Saudi economy
Authors: Hassan Ahmed K. , Alibrahim Mohammed S , Zahran Khaled M , Eldiasty Hatem Abd Elmonem Saleh , Al Ahmed Mustafa Issa Ali , Alhamdan Latifah Abdulaziz
Published: July 2024

The current study aimed to investigate the influence of an external audit on the achievement of tax planning practices in investment authorities and sporting companies, and to analyze its impact on the Saudi economy. We employed a descriptive method, specifically the survey method, to establish the objectives of this report. The participants represented the tax departments of the General Authority of Zakat and Income in addition to the responsible parties in the sports ministry, the ministry of investment, the sports authorities’ managers and the private companies, the commercial law and economic law experts, experts in sports law and sports management, and the sports law and sports management experts. They serve as members of the board of directors for various Saudi sporting organizations. The research used 350 participants as the sample frame, collecting data through the use of questionnaires. A consensus has been reached on tax avoidance approaches such as structure decisions and deductible costs that have been influenced by factors like disparate taxes and administrative weakness. It also demonstrated the enhanced application of external audit principles, leading to improved effectiveness and efficiency in tax planning. The research that was conducted has noted the need for external auditing to enhance financial and tax management and economically strengthen Saudi Arabia. The economic effects of such practices can be studied in future studies by expanding on the employment, investment, and economic growth dimensions of qualifications in the sports industry in the Kingdom of Saudi Arabia and adding financial and economic views.
Access to Megadoses of Vitamin D, Insufficient Knowledge of People and Poor Practice of Community Pharmacists, Made a Vicious Circle in the Direction to D Hypervitaminosis in Iran
Authors: Soleymani Saeed Mohammad , Esmaily Hadi
Published: July 2024

The Article Abstract is not available.
A Questionnaire Based Study to Assess the Antimicrobial Stewardship Practices in the Tertiary Care Hospitals in India
Authors: Mishra Prashant , Dhillon Harmanjot Singh , Vihan Sandeep , Bhargava Shashikant
Published: July 2024

Background: Due to emergence of antimicrobial-resistant healthcare associated infections (HAIs), the implementation of antimicrobial stewardship programs (AMSP) is the need of hour at institutional and national levels. We conducted an assessment of the current status of infrastructure, manpower, and education and training (E&T) in relation to Antimicrobial Stewardship (AMS) in the tertiary care hospitals of India.
Methods: Healthcare professionals from 30 tertiary care hospitals in North-western India (public & private) were invited to participate in online survey from Nov 2022 to Apr 2023 by sending a pre-designed questionnaire about the current existing antimicrobial stewardship (AMS) practices at their hospitals through email. The answers received on various parameters of AMS were analyzed using descriptive statistics.
Results: 72 healthcare professionals from 30 hospitals responded to the survey. 63% of the respondents had received education and training (E&T) on AMS during undergraduate or postgraduate training. 65% had not received any E&T at induction to the hospital. The positive responses were 36%, 47% and 33% for leadership support, accountability and availability of drug expertise in form of pharmacologist/pharmacist respectively. A policy to support optimal antibiotic use was present in 25% of respondents. Broad interventions to improve antibiotic use were scored as 28%, 7% and 6% for antibiotic time out, pre-authorization and prospective audit with feedback respectively.
Conclusion: The findings reveal the enablers and barriers to implementation of antimicrobial stewardship and highlighted the need for establishing a framework for stricter implementation and monitoring of antimicrobial stewardship in Indian tertiary care hospitals. Few key areas which require immediate attention are: need for government level endorsement and leadership support of antimicrobial stewardship (AMS) activities; lack of AMS programs in hospitals; and lack of undergraduate/ postgraduate/at induction education and training in AMS for staff.
Clinical Pharmacy Services in a Neurosurgical Intensive Care Unit in Iran: A Focus on a Comprehensive Medication Management Model
Authors: Andarzbakhsh Kamyab , Mohebbi Niayesh , Rezazadeh Amir , Gholami Kheirollah , Abrishami Ramin
Published: July 2024

Background: Critically ill patients treated in the intensive care unit (ICU) are at risk of drug-related problems (DRPs), clinical pharmacists are specifically trained in pharmacotherapy evaluations with the abilities to identify and manage drug-related complications. This study aims to identify areas where clinical pharmacists can be effective in the ICU. The primary outcomes of this study were determining the clinical aspect of clinical pharmacists in the ICU, type, and number of clinical pharmacist interventions.
Methods: This was a prospective, interventional study in a teaching hospital in Iran. A clinical pharmacist was dedicated to implement comprehensive medication management (CMM); All Pharmacotherapy Problems were categorized.
Results: During the monitoring of 162 patients by the clinical pharmacist, 1524 interventions were conducted. The most frequent pharmacotherapy-related problems identified were drug selection (33.3%), dose adjustment (17.3%), and fluid and electrolyte management (12.9%).
Conclusion: Clinical pharmacists’ interventions could reduce the rate of DRPs by pharmacotherapy evaluation and may have important role in many aspects of patient’s management.
Efficacy and Safety of Rivaroxaban versus Warfarin in Patients with Coronary Endarterectomy: A Cross Sectional Study
Authors: Shahbazi Foroud , Heydarpour Fatemeh , Badrbani Matin , Azizi Mohammad , Kamari Amir , Bahremand Mostafa , Shojaei Lida
Published: July 2024

Background: Coronary endarterectomy is an adjunctive treatment to coronary artery bypass grafting (CABG) in patients with multiple coronary involvements. The aim of the present study was to compare the efficacy and safety of the rivaroxaban versus warfarin in patients undergoing CABG endarterectomy in a prospective observational study
Methods: All the patients who had undergone CABG endarterectomy and had received rivaroxaban or warfarin during the period from January2019 until August 2021 were included in the study. Need for salvage CABG, major bleeding, and thromboembolic events were considered as primary outcomes. The secondary outcomes included all-cause mortality and minor bleeding. All patients were followed for at least six months after their hospital discharge.
Results: Out of the 73 patients recruited during the 18 months, 45 received rivaroxaban and the remaining people received warfarin along with at least one antiplatelet. During the follow-up, no salvage CABG was performed. The minor bleeding was comparable between the two groups (31.96 versus 13.27; p=0.21). There was no significant difference between warfarin and rivaroxaban in terms of major bleeding and thromboembolic events (p=0.38 and >0.99, respectively). The all-cause mortality rate was similar between the two groups (p>0.99).
Conclusion: In this preliminary real-word study, rivaroxaban was comparable to warfarin in terms of efficacy and safety in the patients undergoing CABG endarterectomy. Further larger studies are needed to clarify safety and efficacy of such approach.
Survey on the Oxidative Stress Status and the Role of Antioxidants in Acute Myeloid Leukemia Therapy
Authors: Mosa Azzam Abdulsattar , Ali Ghorbat Saleh , Selamoglu Zeliha
Published: July 2024

Acute myeloid leukemia (AML) is a heterogeneous disease with multiple mutations in hematopoietic stem cells characterized by abnormality increases in immature or dysfunctional white blood cells. The precise mechanisms of AML development have not been clear but there are many factors increase to developing leukemia such as familial history of leukemia, elderly, life style, genetics and some chronic disease like diabetic. Multiple mutilations happen in the hematopoietic stem cells, acquire some form of genetic instability lead to improve expression of some protein kinase and transduction protein following that increase ROS formation, which is associated with increased DNA damage. Nowadays, the use antioxidant drugs are growingly accepted in universal due to their safety and efficiency to diminish the adverse effects of free radicals and treatment of the many diseases such as cancer. In this article, we discussed the correlation between acute myeloid leukemia incidence and the oxidant biomarkers (oxidative stress), and more focusing on the great role of antioxidant biomarkers, whether the non-enzymatic or the enzymatic in the protection of the cells against harmful effects of free radicals in the acute myeloid leukemia patients.
A Case Series of Eight Mucormycosis Patients during SARS-CoV-2 –Pandemic
Authors: Karbasforooshan Hedyieh , Zarei Batool , Jannati Mahdi , Elahabadi Ghazaleh , Elyasi Sepideh , Heydari Ali Akbar
Published: July 2024

The outbreak of opportunistic fungal infections such as mucormycosis has been a critical issue following coronavirus disease 19 (COVID-19). Mucormycosis is happened by the fungal group Mucorales and commonly affects immunocompromised patients. To date, COVID-19-associated mucormycosis (CAM) is being reported in several countries. It should be noted that CAM has been started in patients approximately within two to three weeks after the onset of COVID-19. However, here, in one case, fungal symptoms appeared after just one week. In patients with mucormycosis due to this enigmatic infection, the sinuses were most commonly affected, followed by the orbit, nose, and finally the brain. All cases received glucocorticoids as a part of viral therapy. Diabetes mellitus (DM) was reported in all but one case in which COVID-19 was detected, without complications, and this may be the sole predisposing agent. Therefore, in this manuscript, we reported eight cases of COVID-19-induced mucormycosis. Although one case experienced evacuation of the right eye, others discharge with promising outcomes after receiving surgical debridement and proper anti-fungal treatment including, amphotericin B, caspofungin, and posaconazole.
Early Outpatient Administration of Remdesivir Shortens Recovery Time in Patients with Mild to Moderate COVID-19
Authors: Hajimaghsoudi Majid , Saghafi Fatemeh , Shorabi Mahya , Mirzaei Samaneh , Moharami Mehrnaz , Daryaei Negin , Hoseinzade Farahnaz , Jalili Farzad , Rezaei Hamid Reza , Rameshi Yekta , Jelodar Mohsen Gholinataj
Published: July 2024

Background: During COVID-19, healthcare systems in underdeveloped nations had significant challenges and were unlikely to offer the necessary care. It appears that a new, reliable healthcare model that prevents hospitalization is necessary to reduce the pressure that COVID-19 is putting on healthcare systems and patients. More particularly, as Remdesivir's use as an outpatient treatment for mild to severe SARS-CoV-2 infection has rarely been examined; we aimed to investigate in-depth comprehension of the effects of Remdesivir in these cases.
Methods: In our two-month cross-sectional study, non-hospitalized patients with mild to moderate COVID-19 who were referred to the hospital for up to 5 days of Remdesivir treatment received 200 mg of Remdesivir intravenously on day 1, followed by 100 mg of Remdesivir once daily for the subsequent 4 days. Patients were divided into groups based on the time of starting Remdesivir treatment after the appearance of symptoms: group 1 less than and equal to 7 days, and group 2 more than 7 days. Two groups were evaluated for a correlation between Remdesivir administration time and clinical symptoms on days 1 and 14 (follow-up visits).
Results: The study enrolled 273 eligible patients with a mean age of 47.5 years, of whom 112 were males and 125 were females. Results showed that patients who received Remdesivir in the first 7 days had less dyspnea (P-value<0.0001) and lung involvement (P-value<0.0001) than those who received it after 7 days at the end of the study. Patients who came later to receive Remdesivir also showed higher fatigue, AST, and ALT levels on the first day.
Conclusions: Among patients with moderate COVID-19, those who received a 5-day course of Remdesivir within 7 days of the onset of symptoms had a statistically significant difference in clinical status compared with those who received their treatments later. However, the size of this finding has uncertain clinical importance.
The Evaluation of Remdesivir Utilization Pattern and Its Correlation with Clinical Indicators in Hospitalized Patients During COVID-19 Pandemic; A Retrospective Cross-sectional Study
Authors: Soroush Yasaman , Esmailyi Hadi , Ghalandari Nasibeh
Published: July 2024

Background: In 2019 COVID became the cause of a pandemic, with approximately 500,000 deaths in six months worldwide. Remdesivir, the first drug approved by the U.S. Food and Drug Administration (FDA) for COVID-19 treatment, gained attention from numerous medical centers worldwide. The consecutive waves of COVID-19 peaks in Iran, coupled with the lack of widespread vaccination, and high consumption leading to a shortage of remdesivir in the country, prompted an investigation into the usage patterns of remdesivir and its correlation with clinical indicators in hospitalized patients.
Methods: A retrospective cross-sectional study was conducted using 390 patients' electronic records in seven different hospitals. Electronic records were reviewed and information was extracted under four categories: demographic data, lab test results at admission, medication information, and lab test results after completing treatment. Patients were classified into three time periods based on the date of their first remdesivir injection. Outcomes were defined as final clinical status and length of stay in hospital.
Results: A total of 390 patients were enrolled, with 198 females and 192 males. The longest hospital stay was 88 days, with an average of 7.5 days. A total of 1,979 doses of remdesivir were prescribed, with 224 doses being in accordance with the national protocol, 22 doses exceeding the protocol, and 144 doses below the protocol. The overall average dose consumption was 5.07 for each patient.
Conclusion: Overall pattern of remdesivir utilization in the hospitals evaluated in this study (affiliated with Shahid Beheshti University of Medical Sciences) has been reasonable and in accordance with national protocols for COVID-19 infection.
Retrospective Observational Analysis of Tocilizumab Outcomes in COVID-19 Patients at a Tertiary Care Hospital
Authors: Aringale Vrushali , Daswani Bharti , Fernandes Madeline
Published: July 2024

Background: Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), was recommended for treatment of Covid-19 patients with a risk of cytokine storm but showed variable effect on outcome. The aim was to assess the association of outcome following tocilizumab administration with various physiological, pathological and pharmacological factor in Covid- 19 patients
Methods: Retrospective observational study from June 2020 to July 2020. All indoor Covid positive patients who received tocilizumab were included and relevant information was captured in the case record form. Data was analyzed to the study association of various physiological factors, comorbidities, severity of disease, laboratory parameters and co-administered drugs with the outcome following tocilizumab administration.
Results: Total 25 patients received tocilizumab during study period. Older age group (p=0.001), high NEWS score, hypertension (OR: 3.62; p=0.05) and hydroxychloroquine(HCQ) administration (OP=6.66; p=0.009) showed significant association with a worst outcome. Hypertension and hydroxychloroquine usage was analyzed after adjustment with NEWS score using MH adjusted analysis, which revealed a trend of worst outcome in HCQ recipients but the association was not significant with hypertension. High pre-treatment IL-6 (death 570.11+498.76; discharge110.31+ 49.68; p: 0.0011); high post-treatment ferritin level (death 1756.5+ 1622.03; discharge 711.71+ 421.23; p: 0.019) as well as post-tocilizumab rise in ferritin level was associated with worst outcome (p= 0.029).
Conclusion: Participants having higher cytokine level/or high NEWS score were unlikely to benefit from tocilizumab. Increased in ferritin level even after tocilizumab appeared to be an indicator of failure of treatment.
Delivery of Inhaled Medication in Children: Revisiting Pharmacological and Practical Issues for Better Health Outcome
Authors: Mishra Prashant
Published: July 2024

For safe and effective therapy of respiratory disorders in children, delivering the medication at the site of disease i.e. directly into the respiratory tract via aerosolized medication is critical. But, the anatomical and physiological differences in the respiratory tract of infants/children and adults make the delivery of aerosolized medication complicated. This review article gives an overview of the delivery of inhaled medication in children and discuss the pharmacological and specific clinically relevant aspects of medication delivery using nebulizers, pressurized metered dose inhalers (MDIs), and dry powder inhalers (DPIs) in children. As a physician, one should always keep in mind the various factors like properties of the device, aerosol particle, patient factors such as disease state, ventilatory pattern, and administration technique that can affect drug deposition via aerosol delivery devices.
Knowledge and Awareness of Disposal of Unused and Expired Medicines among Healthcare Professionals in Tertiary Care Hospital: A Brief Report
Authors: Nagothkar Sanjivani Krishna , Waghmare C. S. , Shirure Prashant Ashok , Bansode Amit , Mukadam Fehmi M. , Ali Dilara Parvin , Chavarkar Pranali Naresh
Published: July 2024

Background: The incidence and prevalence of diseases are increasing, which has resulted in a huge increase in the use of medications. However, when they were no longer required/remained unused due to various reasons, they had to be disposed of. Since the drugs are chemicals, their expiration date indicates the amount of time that the product is anticipated to remain stable. Consumption of expired drug can result in efficacy loss, safety concerns, potency loss.
Methods: This cross-sectional questionnaire-based study evaluated knowledge, attitude and practice of drug disposal among healthcare professionals especially junior residents in tertiary health care centre. The data were collected through a google form and expressed in percentage.
Results: Out of 200, a total of 133 participants have completed the survey, which includes 42% males and 58% females. A total of (97.7%) participants were aware that improper disposal of unused and expired medicines affects the environment and health. However, (97%) of the respondents answered that the drug take back programmes should be included in the communities.                                                                                  
Conclusion: Majority of the study participants reported that they have unused medications at home, and throwing them in the household garbage is the most common method of getting rid of them. It is important to educate people on the correct way to dispose of unused and expired medications, and a drug take-back program in communities could be the solution to this issue.
Third Nerve Palsy: Rare Adverse Event following Covid-19 Vaccination
Authors: Deshmukh Indira B , Burute Sheyas R , Pore Shraddha , Singh Atmik
Published: July 2024

Drugs Controller General of India (DCGI) in April 2022 approved the emergency use authorisation of Corbevax and Covaxin COVID 19 vaccines in children. Corbevax is a protein subunit COVID 19 vaccine developed by Texas Children's Hospital.  Third nerve palsy is rarely reported following protein sub- unit COVID vaccines. We report a case of a 13-year-old male who presented to a tertiary care hospital with complaints of   giddiness, headache, diplopia and drooping of left eye within one hour of receiving Corbevax vaccine in school. He was subsequently diagnosed with third nerve palsy and treated with corticosteroids and lubricant eye drops. He recovered fully and was discharged after four days. Causality assessment as per World Health Organization (WHO) guidelines for the causality assessment of Adverse Events Following Immunization (AEFI) was consistent. Protein sub unit vaccines can rarely cause third nerve palsy.
Exploring the use of music during ultramarathons using a think-aloud procedure
Authors: Bozianu Dominic , Jones Leighton
Published: July 2024

Introduction: ultrarunning is a rapidly growing sport and is receiving increased attention in scientific literature. Ultrarunning is the act of running ultramarathons, defined as any distance over a marathon (42.2 km). Some ultramarathons are run over a set time e.g., 12 hours. Ultrarunners face many different challenges throughout their races, including injuries and pain, thoughts of quitting, and boredom (Holt et al., 2014, Sport Psych, 28, 22-35). The application of music during sports and exercise has been shown to be a powerful psychological and ergogenic aid, however, there is a dearth of studies exploring how music is applied in ultrarunning. Previous research around ultramarathons has typically used interviews or a range of scales to collect data (Watkins et al., 2022, Psych Sport Ex, 63, 102271). Think-Aloud (TA) procedures have been used in studies involving shorter distance running (Johnson et al., 2023, Int J Sport Ex Psych) but have not yet been applied to ultrarunning. Accordingly, the present study uses a TA approach to capture ultramarathoners’ thoughts and feelings during an event where they listen to music. Method: ten participants completed a two-stage training procedure of TA to conform with established procedures (McGreary et al., 2024, Sport Ex Perf Psych). The TA procedure permits recording of real-time thoughts. The first stage consists of two problems: a multiplication problem, and an anagram-based problem. The second stage involves thinking aloud for a short period while on a training run. Following the training, participants recorded their thoughts at six time points around their event: before the race, after 1 mile, at 30, 60, and 90% into the race, and within five minutes of race completion. Data Analysis: thematic analysis will be undertaken on the transcribed data and will follow standard procedures. Applications: TA has not been applied in ultrarunning previously and its use in the present study can offer evidence to its future feasibility for similar research. Findings of this study will inform the practical application of music around ultramarathon events, with insights offered for athletes and coaches. Moreover, recommendations will be made as to when music could be applied during an event to maximise its effects. These findings will be couched within contemporary conceptual frameworks for applying music in sport and exercise contexts and offer fresh insight into how these models could be expanded to consider ultra-endurance events more fully.
High vs. low glycaemic index pre-exercise feeding
Authors: Nicholls Tom , Fisher Lee , Broadbridge Heidi , Rowland Bethan , Blair Emma , Howe Matthew , Klaus Ellis , O’Donoghue Davey
Published: July 2024

Carbohydrates are proven to be the most important energy source to skeletal muscle during endurance exercise. However, the glucose that carbohydrates provide the muscle with can differ in how quickly they are digested and released into the bloodstream. High glycaemic index (GI) carbohydrates are released into the bloodstream in a rapid burst following digestion whereas low GI carbohydrates are released into the bloodstream at a constant rate after consumption. The effects of low and high GI carbohydrate consumption pre-exercise on endurance exercise performance are not comprehensively understood. Therefore, the aim of this study is to identify the impact of low vs high GI pre-exercise feeding on maximal effort endurance exercise performance. With institutional ethics approval, twelve physically active, healthy males aged 18-40 years attended the laboratory on four separate occasions. On the first occasion, participants underwent a V̇O2max test to identify their maximal aerobic capacity. The final three lab visits consisted of the participants undergoing trials under three differing conditions upon arrival in the fasted state (participants were instructed to not consume food or drink other than water 6 h before arrival). The trial entailed of 20 km cycling followed by 5 km running with 2 min rest in between. Upon arrival, the participants received a carbohydrate beverage, either 40 g high GI, 40 g low GI, or a placebo, 15 min before exercising. Before consumption of the beverage, before the onset of exercise, after each 5 km during the cycle and following the run, heart rate and RPE were recorded, and a finger prick blood sample was taken to analyse for blood glucose and blood lactate concentrations throughout the exercise bout. However, the primary performance indicator was the overall time to complete the trial (bike and run minus 2 min rest). The final order of mean completion time across conditions from fastest to slowest went low GI, high GI, placebo. There was no significant difference between the mean time to completion in the low GI and high GI conditions. However, the low GI condition resulted in a faster time to completion than the placebo condition (P = 0.02) as well as the high GI condition resulting in a faster time to completion than the placebo condition (P = 0.043). Therefore, this could demonstrate that the presence of any carbohydrate type is more influential on endurance exercise performance rather than the glycaemic index of such carbohydrates.
Team trust as a predictor of collective efficacy in female rugby players
Authors: Brown Kate E
Published: July 2024

According to Bandura’s (1997) social cognitive theory, “the higher the sense of collective efficacy, the better the team performance”.  Bandura also states that collective efficacy is greater than the sum of its individual self-efficacies due to it being influenced by other cognitive factors, including trust (1986, 1997, J Cog Psychother, 13, 158-166). Therefore, the purpose of this study was to investigate the influence of team trust on the construct of collective efficacy within a sport context.  It is proposed that team trust is an important cognitive factor that may precede the relationship between collective efficacy and group performance.  With institute ethical approval (BREO:33249-A-Nov/2023-47988-1), 21 female college rugby players voluntarily completed the four factor Team Trust Scale (Costa & Anderson, 2011. Eur J Work Org Psych, 20, 119-154) and the five factor Collective Efficacy Questionnaire for Sport (Short, Sullivan. & Feltz, 2005, Meas Phys Ed Ex Sci, 9, 181-202) to measure the correlation between levels of team trust and collective efficacy and determine if team trust is indeed a valid predictor of collective efficacy. Linear regression analyses were conducted and correlation coefficients calculated using Pearson’s correlation. It was predicted that a positive correlation would be shown between the two constructs and that team trust is a significant predictor of collective efficacy. Assuming a positive hypothesis, the study recommends that rugby teams and interdependent sport teams, generally, should develop a high-quality environment of trust both on and off the pitch, given its relationship with collective efficacy and subsequent impact on performance. Relatively little research has been carried out into the effect of intrateam trust within sport and, therefore, this study serves to widen the exploration of this construct and its impact on other social constructs such as collective efficacy and their impact on team performance.
Does electronic cigarette use adversely affect cardiac autonomic function?
Authors: Phillips Olivia , Junejo Rehan T , Degens Hans , Mahmoud Ayman
Published: July 2024

Introduction: tobacco cigarette (TC) smoking is a predominant risk factor for cardiovascular disease and a leading preventable cause of death (Kondo et al., 2019, Circ J, 83, 1980-1985). Electronic Cigarette (EC) use has increased significantly in recent years (King et al., 2015, Nic Tob Res, 17, 219-227), mainly as it is considered a safer alternative to TC. A low heartrate variability (HRV) is an independent marker of adverse cardiovascular morbidity and all-cause mortality (Fang et al., 2020, Bio Res Nur, 22, 45-56). TC smokers have a lower HRV, and similar responses have now also been observed in EC smokers (Arastoo et al., 2020, Am J Physiol Heart Circ Physiol, 319, 262-270). However, the influence of cognitive / psychological stress on HRV in TC and EC users remains unexplored. As such, this study aims to assess the impact of cognitive stress on Time and Frequency domain measures of HRV. Methods: upon receiving ethical approval, HRV data was collected through electrocardiogram (ECG) recordings of healthy controls (HC), TC and EC smokers which were recorded using lead II ECG at 1000 Hz on LabChart during periods of rest (5 min) and cognitive stress (serial subtraction; 5 min). Time and frequency domain measures of HRV were assessed with LabChart. Data will be compared between groups using one-way analysis of variance (ANOVA) and two-way mixed methods ANOVA as appropriate. Conclusions: we hypothesise that EC smokers will present similar impaired autonomic function and reduced HRV as TC smokers during rest and cognitive stress in comparison to HC.
Using inertial measurement units to estimate ground reaction force and knee angular velocity during decelerations
Authors: Hitchens Luke , Verheul Jasper , Clifford-Pryer Bailey
Published: July 2024

Despite undergoing anterior cruciate ligament (ACL) reconstruction, athletes continue to present altered ground reaction force (GRF) and knee angular velocities (AV) for 6-24 months as they return to highly demanding tasks such as rapid decelerations (Schmitt et al., 2015, Med Sci Sports Ex, 47, 1426). In-field identification of GRF and knee AV during such deceleration tasks is challenging due to the laboratory restrictions of force platforms and 3D motion capture. Therefore, the use of inertial measurement units (IMU) has been suggested as an appropriate alternative to estimate such variables in the field (Pratt & Sigward, 2018. Sensors, 3460). The study aimed to establish whether IMU-derived measures can be used to estimate GRF and knee AV that are indicative of ACL injury risk during decelerations. Following ethical approval from the Cardiff Metropolitan Ethics Committee, ten male team-sport athletes performed five maximal decelerations at three approach speeds (100, 85, and 70% relative to maximal attainable speed), for a total of fifteen trials per athlete. GRF and kinematics were measured using four Kistler force platforms and Theia3D markerless motion capture. Pearson’s correlation coefficient was used to determine the relationship between IMeasureU Blue Trident IMUs mounted at the thigh or shank and vertical GRF, horizontal GRF, and knee AV during the first step of deceleration. A measure was considered field-viable if a very large significant correlation (r ≥ 0.7; P ≤ 0.05) was observed. At approach speeds of 85 and 70%, shank AV had a very large significant correlation (r = 0.79, 0.76; P = 0.001, 0.01, respectively) to vertical GRF, a moderate to large significant correlation to horizontal GRF (r = 0.46, 0.51; P = 0.04, 0.02, respectively), and a moderate significant correlation to knee AV (r =0.46, 0.40; P = 0.004, 0.02, respectively). At 100% approach speeds, shank AV had no significant correlation to GRF (r <0.3; P>0.05) and a moderate correlation to knee AV (r = 0.40; P = 0.02). This study was the first to find a strong association between shank AV and vertical GRF for whole-body decelerations at 85 and 70% approach speeds. This supports the use of IMUs in sport-specific settings (e.g., football pitches) to better quantify vertical GRF deficits during decelerations. This can further enhance in-field monitoring of GRF deficits and better assess athletes' readiness to return to sport following ACL reconstruction. However, alternative methods are required to accurately estimate horizontal GRFs and knee AV in the field.