bluuebunny/crossref_metadata_2025 huggingface dataset:
The Challenges of Iranian Female Nurses Caring for Male Patients: A Qualitative Study
Authors: Alinejad Mofrad Samaneh , Nasiri Ahmad , Green Heidi
Published: July 2024

Background:

Caring is a multidimensional concept with many factors that can affect its quality such as caring for the opposite sex. This study aims to explore the experiences of Iranian female nurses caring for male patients.

Materials and Methods:

A descriptive qualitative study was conducted via conventional content analysis and purposeful sampling. Seventeen female nurses including staff and head nurses participated. Unstructured, face-to-face, in-depth interviews were conducted from June to December 2019 in Iran. The interviews were recorded by an MP4 player. When no new codes were extracted from the interview the data saturation was achieved. All interviews were immediately transcribed verbatim and were analyzed via Graneheim and Lundman’s conventional content analysis guidelines.

Results:

Four themes emerged from the data: 1) women nurses’ concerns about caring for men, 2) women nurses’ unpleasant feelings while caring for men, 3) Ignoring women nurses’ dignity, and 4) efforts to avoid unpleasant situations.

Conclusions:

Female nurses in Iran are faced with multidimensional challenges when providing care to men. Not only can these challenges decrease the quality of nursing care for male patients, but also make the hospital a stressful environment for female nurses and may lead to them leaving the work.
Exploring Knowledge, Safety Practices, and Anxiety Level among Women of Reproductive Age During COVID-19 Outbreak: A Cross-Sectional Study
Authors: Hamdan-Mansour Ayman M. , Alenezi Atallah , Soliman Hanan F. A. , Amasha Hadayat A. , Ali Amira M. , Alhowaymel Fahad M. , Abaoud AbdulAziz F. , Mahadeen Alia I. , Aboushady Reda M. N.
Published: July 2024

Background:

The global outbreak of coronavirus disease 2019 (COVID-19) and its consequences compromise the health of Women of Reproductive Age (WRA). The aim of this study was to assess the level of knowledge, safety practices, and anxiety levels among WRA during COVID-19 outbreaks.

Materials and Methods:

A cross-sectional, correlational design was used to recruit a convenience sample of 453 WRA in Saudi Arabia. Data were collected using an electronic self-administered questionnaire of Spielberger state-trait anxiety and an adapted authors-developed knowledge and practices scale using an extensive literature review. Data were collected between September and December 2020 targeting all women in the country. Pearson correlation coefficient has been used to test correlation utilizing the Statistical Package for the Social Sciences (SPSS) 25.

Results:

The mean score of anxiety was 46.0 (13.40). Women have a high mean score of knowledge (24.50, standard deviation (SD) = 3.40) while having a low mean score of practices (19.70, SD = 3.10) indicating inappropriate practices. A significant difference was found in anxiety (t479= 2.52,p= .012) and knowledge (t479= −1.98,p= .048) between pregnant and non-pregnant women, while no statistically significant difference was found in relation to practices. The mean score of anxiety was higher among pregnant women than non-pregnant women, while a slightly higher mean score of knowledge was observed for non-pregnant women compared to pregnant ones.

Conclusions:

Although women had good knowledge about safety precautions, their practices did not indicate that. There is a need to educate women about safety practices and interventions that buffer their anxiety levels.
Performing median arcuate ligament release surgery in celiac artery compression syndrome: Insights from a tertiary care hospital
Authors: Antony Ajil , Ravindran Santhosh Kumar , Jayan N. P. , Yadukrishna S. , Sebastian Robbins , Kumar Akshay , Shyamkumar Shwetha
Published: July 2024

Background:

Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery (CA) compression syndrome, is a rare condition characterized by persistent post-meal or post-exercise abdominal discomfort, often more pronounced during expiration. Additional symptoms include nausea, vomiting, and weight loss.

Aims and Objectives:

To document the clinical presentation, diagnostic process, and treatment outcomes of seven patients diagnosed with MALS and to evaluate the effectiveness of surgical release of the median arcuate ligament (MAL) over a follow-up period of at least six months.

Materials and Methods:

The study included seven patients diagnosed with MALS from 2019 to 2021. Diagnosis was based on the presence of chronic abdominal pain and associated symptoms, absence of alternative diagnoses after various clinical assessments, and angiographic evidence of CA compression. The primary treatment involved surgical decompression of the CA by releasing the MAL through either open or laparoscopic techniques.

Results:

All seven patients underwent successful surgical release of the MAL. The patients were followed up for at least six months post-surgery. The study evaluated the persistence of symptoms and the need for additional interventions such as revascularization techniques.

Conclusion:

Surgical release of the MAL is the primary treatment for MALS, providing relief for many patients. However, long-term follow-up is essential as some patients may continue to experience symptoms post-surgery, necessitating further interventions.
Safety and perioperative outcomes of uniportal versus multiportal video-assisted thoracoscopic surgery
Authors: Alanwar Mohamed , Elsharawy Mamdouh , Brik Alaa , Ahmady Islam , Shemais Dina Said
Published: July 2024

Introduction:

Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently become an alternative approach for many minimally invasive thoracic procedures, but although its surgical effectiveness has been proven, still its feasibility and safety are debated and unclear. the objective of this study was to compare the safety and perioperative outcomes of U-VATS versus multiportal VATS (M-VATS).

Patients and Methods:

This was a comparative follow-up randomised controlled clinical trial, carried out on 36 randomly selected eligible patients, and fulfilling the inclusion and exclusion criteria for VATS, they were assigned randomly into two groups: Study Group I including 18 patients undergoing U-VATS with conventional treatment using standard chest tube drainage and Control Group II including 18 patients undergoing M-VATS) with the same conventional treatment using standard chest tube drainage and served as a comparable control group.

Results:

Patients in the U-VATS Group 1 had faster operation time, and with reduced blood loss, pleural drainage and post-operative hospitalisation, they also experienced lower average post-operative pain score on comparison with those in M-VATS Group II (P < 0.001), respectively. For either group, there were no hospital deaths or infections. There was no noticeable difference between the two groups in terms of the number of resected lymph nodes or the rates of intraoperative or post-operative complications (P > 0.05).

Conclusion:

U-VATS is feasible and safe in eligible selected patients with favourable short-term perioperative outcomes (operative time, duration of pleural drainage, post-operative pain, early ambulation, duration of hospital stay as well as the risk of perioperative complications), and it can be considered the preferred approach in minimally invasive thoracic procedures that open up for the possibility of fast-track thoracic surgeries.
Enhancing Mental Health With PHILOI: A Comprehensive Analysis of Mood Music and Chatbot Module
Authors: Kumavat Kavita , Gatagat D. , Wakode K. , Gundawar S. , Jain V.
Published: July 2024

The project aim was to develop an app that would enable the recording and monitoring of behaviour related to specific aspects of wellness, as well as support those aspects of wellness that are entertainment-related. Our main goal was to envision and develop an app with the well-being of users in mind. People’s moods can be improved upon or changed by music, with music and mental health tightly intertwined. Music is frequently used to complement or change an individual’s mood. While there are advantages to mood-appropriate music, it may cause us to remain in a depressed, angry, or nervous state. A survey was conducted to examine these aspects. After performing a lot of research and interviews in this area, we found 68% of those surveyed listen to music according to their mood or to change their mood. This inspired us to build an application that not only plays music but also recommends songs to users, eliminating the daily nuisance of selecting the right music, which can waste valuable time. As mental balance is an essential component of healthy existence in today's hectic world, to enhance the practicality of our app, as icing on the cake, we included an AI chatbot that not only converses with the user but also provides them with suitable advice on their concerns.
Genuine pro-$p$ Iwahori–Hecke algebras, Gelfand–Graev representations, and some applications
Authors: Gao Fan , Gurevich Nadya , Karasiewicz Edmund
Published: July 2024

We study the Iwahori-component of the Gelfand–Graev representation of a central cover of a split linear reductive group and utilize our results for three applications. In fact, it is advantageous to begin at the pro-

p

level. Thus to begin we study the structure of a genuine pro-

p

Iwahori–Hecke algebra, establishing a Bernstein presentation. With this structure theory we first describe the pro-

p

part of the Gelfand–Graev representation and then the more subtle Iwahori part. For the first application we relate the Gelfand–Graev representation to the metaplectic representation of Sahi–Stokman–Venkateswaran, which conceptually realizes the Chinta–Gunnells action from the theory of Weyl group multiple Dirichlet series. For the second we compute the Whittaker dimension of the constituents of regular unramified principal series representations; for the third we do the same for unitary unramified principal series representations.
Case Report: Dengue Fever Progressing to Acute Liver Failure and Hepatic Encephalopathy
Authors: Yadav Vaibhav , Pawar Akash , Meena Mahadev , Dandasena Tarini Prasad , Singh Prachi
Published: July 2024

Dengue fever is an important arboviral disease that significantly impacts the disease burden among populations residing in tropical regions. Dengue infection is known to have a broad spectrum of clinical manifestations, which range from fatal, life-threatening shock, encephalitis, and myocarditis to asymptomatic illness. Mild hepatic dysfunction with deranged hepatic laboratory parameters is a known entity with dengue fever. However, dengue presenting as acute liver failure associated with hepatic encephalopathy without shock or signs of plasma leakage is rare. Therefore, we are reporting the case of a young male with dengue fever presented as acute liver failure from a tertiary care center in central India to spread awareness among healthcare professionals worldwide regarding unusual presentations of dengue fever and consideration of dengue fever as a differential diagnosis in patients presenting with acute liver failure, especially in endemic regions.
Diagnostic Prediction Model for Tuberculous Meningitis: An Individual Participant Data Meta-Analysis
Authors: Stadelman-Behar Anna M. , Tiffin Nicki , Ellis Jayne , Creswell Fiona V. , Ssebambulidde Kenneth , Nuwagira Edwin , Richards Lauren , Lutje Vittoria , Hristea Adriana , Jipa Raluca Elena , Vidal José E. , Azevedo Renata G. S. , Monteiro de Almeida Sérgio , Kussen Gislene Botão , Nogueira Keite , Gualberto Felipe Augusto Souza , Metcalf Tatiana , Heemskerk Anna Dorothee , Dendane Tarek , Khalid Abidi , Ali Zeggwagh Amine , Bateman Kathleen , Siebert Uwe , Rochau Ursula , van Laarhoven Arjan , van Crevel Reinout , Ganiem Ahmad Rizal , Dian Sofiati , Jarvis Joseph , Donovan Joseph , Nguyen Thuy Thuong Thuong , Thwaites Guy E. , Bahr Nathan C. , Meya David B. , Boulware David R. , Boyles Tom H.
Published: July 2024

No accurate and rapid diagnostic test exists for tuberculous meningitis (TBM), leading to delayed diagnosis. We leveraged data from multiple studies to improve the predictive performance of diagnostic models across different populations, settings, and subgroups to develop a new predictive tool for TBM diagnosis. We conducted a systematic review to analyze eligible datasets with individual-level participant data (IPD). We imputed missing data and explored three approaches: stepwise logistic regression, classification and regression tree (CART), and random forest regression. We evaluated performance using calibration plots and C-statistics via internal–external cross-validation. We included 3,761 individual participants from 14 studies and nine countries. A total of 1,240 (33%) participants had “definite” (30%) or “probable” (3%) TBM by case definition. Important predictive variables included cerebrospinal fluid (CSF) glucose, blood glucose, CSF white cell count, CSF differential, cryptococcal antigen, HIV status, and fever presence. Internal validation showed that performance varied considerably between IPD datasets with C-statistic values between 0.60 and 0.89. In external validation, CART performed the worst (C = 0.82), and logistic regression and random forest had the same accuracy (C = 0.91). We developed a mobile app for TBM clinical prediction that accounted for heterogeneity and improved diagnostic performance (https://tbmcalc.github.io/tbmcalc). Further external validation is needed.
Evaluation of the International Task Force for Disease Eradication: A Review of Past Deliberations
Authors: Sadiq Shanze , Kajani Ursula A. , Travers Anyess R. , Hopkins Donald R. , Richards Frank , Ijaz Kashef
Published: July 2024

The International Task Force for Disease Eradication (ITFDE) was formed at The Carter Center in 1988. Its primary purpose is to review activities and provide recommendations related to programs focused on eradication. The ITFDE also considers opportunities for disease elimination and improved control. Over the last two decades, the ITFDE has held 33 meetings, discussed 22 diseases, and made 244 recommendations. This report aims to analyze the patterns in recommendations made by the ITFDE between 2001 and 2022 and assess the ITFDE’s role, impacts, and successes in advancing elimination and eradication efforts for selected diseases. Using a thematic analysis, recommendation categories were crafted, followed by a scoping review to determine evidence of implementation for each recommendation. Categories of recommendations included research (24%), leadership (20%), medical (17%), advocacy (11%), collaboration (13%), development (8%), and financial (8%). We determined that 123 (50.4%) ITFDE recommendations were implemented in some form. Notably, the ITFDE has helped raise the profile of neglected tropical diseases. Four salient outcomes include 1) the identification of the potential eradicability of lymphatic filariasis (1993), 2) the recognition of the critical need for improved treatments of human African trypanosomiasis (2002), 3) a recommendation for the elimination of lymphatic filariasis and malaria from Hispaniola (2006), and 4) recommendations for effective and safe ways to avoid disruption of elimination and eradication programs during the COVID-19 pandemic (2020). This review of the ITFDE will help to devise new approaches to monitor its impact in the future.
Etiologies of Infectious Keratitis in Malawi
Authors: Kalua Khumbo , Misanjo Esther S. , Lietman Thomas M. , Ruder Kevin , Zhong Lina , Chen Cindi , Liu YuHeng , Yu Danny , Abraham Thomas , Wu Nathaniel , Yan Daisy , Hinterwirth Armin , Doan Thuy , Seitzman Gerami D.
Published: July 2024

Infectious keratitis is a leading cause of corneal blindness worldwide with little information known about causative etiologies in Malawi, Africa. This area is resource-limited with ophthalmologist and microbiology services. The Department of Ophthalmology at the Kamuzu College of Health Sciences in Blantyre, Malawi, is a participating site of an international corneal ulcer consortium, capriCORN (Comprehensive Analysis of Pathogens, Resistomes, and Inflammatory-markers in the CORNea). In this study, 50 patients with corneal ulcers were swabbed for pathogen identification using RNA-sequencing. Corneal trauma was reported in 41% and 19% of the patients worked in agriculture. A pathogen was identified in 58% of the cases. Fungal pathogens predominated, followed by viruses and bacteria. Aspergillus, Fusarium, HSV-1, and Gardnerella were the most common pathogens detected. 50% of patients reported treatment with an antibiotic before presentation. Pathogens unusual for infectious keratitis, such as Subramaniula asteroids, Aureobasidium pullulans, and Gardnerella vaginalis, were also detected.
Environment Spectra and Corrosivity Monitoring Using Electrochemical and Electrical Resistance Sensors
Authors:   HM-1 Integrated Vehicle Health Management Committee
Published: July 2024

This SAE Aerospace Information Report (AIR) provides guidance on using environmental, electrochemical, and electrical resistance measurements to monitor environment spectra and corrosivity of service environments, focusing on parameters of interest, existing measurement platforms, deployment requirements, and data processing techniques. The sensors and monitoring systems provide discrete time-based records of (1) environmental parameters such as temperature, humidity, and contaminants; (2) measures of alloy corrosion of the sensor; and (3) protective coating performance of the sensor. These systems provide measurements of environmental parameters, sensor material corrosion rate, and sensor coating condition for use in assessing the risk of atmospheric corrosion of a structure. Time-based records of environment spectra and corrosivity can help determine the likelihood of corrosion to assess the risk of corrosion damage of the host structure for managed assets and aid in establishing maintenance intervals and processes.

Diagnostics for determining damage to a structure and prognostics for predicting the remaining useful life before reaching a critical corrosion damage threshold are not within the scope of this document. Also not within the scope of this document are other nondestructive evaluation tools or structural health monitoring (SHM) technologies that can directly assess corrosion-based damage. While this document is focused on air-vehicle environments, many of these topics would translate to other industries and systems without much modification.
Gender and Age Differences in Cardiac Size Parameters of Ghanaian Adults: Can One Parameter Fit All? Part Two
Authors: Edmund Kwakye Brakohiapa  , Benard Ohene Botwe  , Benjamin Dabo Sarkodie
Published: July 2024

BACKGROUND፡ The cardiothoracic ratio (CTR) is a radiographic parameter commonly used in assessing the size of the heart. This study evaluated the gender and age-based differences in the average cardiothoracic ratios, and transverse cardiac diameters (TCD) of adults in Ghana.METHOD: Plain chest radiography reports of 2004 patients (without known chest related diseases) generated by two radiologists with at least 15 years’ experience from July 2016 to June 2020 were retrospectively analyzed for this study. The CTR for each radiograph was calculated using the formula CTR (TCD÷TTD)×100, where TCD and TTD represent transverse cardiac diameters and transverse thoracic diameters, respectively. Data were analyzed with the statistical package for social sciences version 23. The independent t-test and One-way Analysis of Variance tests were used in the analyses.RESULTS: A total of 2004 patients’ chest x-rays were used in the analyses. The ages of the patients ranged from 20-86 years old with a mean of 39.4±14.04 years. The mean CTR for males was 46.6 ± 3.7% while that of females was 47.7±3.7%. The difference in the overall CTR among the gender groupings was statisticallysignificant (p = 0.001). There were statistically significant differences between the gender categories among patients in the following age groups: 30-39 (p=0.046), 40-49 (p=0.001), 50-59 (p=0.001) and 60-69 (p=0.001).CONCLUSION: The study reveals there are significant gender and age-related differences in cardiac size parameters obtainedfrom routine, frontal chest radiographs. These differences, if considered, may result in early and appropriate treatment of cardiac pathology in some age groups.
Exploring the Process of Spiritual Health of the Elderly Living in Nursing Homes: A Grounded Theory Study
Authors: Ali Jadidi  , Masoud Khodaveisi  , Efat Sadeghian  , Masoud Fallahi- Khoshknab
Published: July 2024

BACKGROUND፡ Spiritual health is one of the important dimensions of the elderly’s health, which plays an important role in other dimensions of their health. This study aimed to explain the process of spiritual health of the elderly living in nursing homes.METHODS: This grounded theory study was conducted in 4 nursing homes in the city of Arak Iran between October 2019 and September 2020. The participants were 24 elderly people living in nursing homes, two health care providers, one nurse and one family member, first selected through purposive sampling andthen, through theoretical sampling. The data were collected through semi-structured interviews and field notes. All the interviews were transcribed verbatim and analyzed based on Strauss and Corbin approach (2008).RESULTS: Six main categories were identified, including helplessness, inefficient supportive environment, spiritual distress, seeking support, relative improvement of spiritual health and factors affecting spiritual health, each of which explains a part of the whole process of spiritual health of the elderly living in nursing homes.CONCLUSION: Supporting the elderly living in nursing homes is necessary in order to meet their spiritual needs and preserve and promote their spiritual health.
Major Dietary Patterns Relationship with Severity of Coronary Artery Disease in Gaza-Strip, Palestine: A Cross-Sectional Study
Authors: Mohamed Kuhail  , Sakineh Shab-Bidar  , Mehdi Yaseri  , Kurosh Djafarian
Published: July 2024

BACKGROUND፡ The association of dietary patterns (DPs) linked to the severity of coronary artery disease (CAD) is little known. Therefore, this study aims to explore the relationship between major DPs and the severity of CAD.METHODS: This cross-sectional study was conducted among423 newly discovered CAD patients (both genders, aged 35-65 years), who underwent coronary angiography. The severity of CAD was assessed by the Gensini score. All patients were tested using a semi-quantitative food frequency questionnaire and other related data through face-to-face interviews. Factor analysis and logistic regression were applied by using SPSS version-24.RESULTS: By principal component analysis, two major DPs were identified: “Unhealthy” DP that characterized mainly by high intakes of sugar and sweets, soft drinks, salts, cooking oils, and processed meats, and “Healthy” DP that consisting high intakes of fruits, fish, poultry, vegetables, whole grains. After adjustment for confounding variables, the odds of severe CAD was significantly higher in the third (T3) and second (T2) tertile of the unhealthy pattern by 4.79 and 2.48 times more compared to the first tertile (T1) (OR 4.79; 95%CI 2.60, 8.83; P<0.001) and (OR 2.48; 95%CI 1.40, 4.39; P=0.002), respectively. However, the odds of CAD severity in the T3 and T2 of the healthy pattern was lowered by 0.24 and 0.38 times less compared to the T1 (OR 0.24; 95%CI 0.12, 0.47; P=0.002) and (OR 0.38; 95%CI 0.20, 0.73;P=0.006), respectively.CONCLUSION: The severity of CAD was significantly increased by the unhealthy dietary pattern, while decreased by adherence to the healthy pattern.
Antimicrobial Resistance Profile of Bacterial Isolates Identified from Surgical Site Infections at a Referral Hospital, Northwest Ethiopia
Authors: Samuel Abosse  , Chalachew Genet  , Awoke Derbie
Published: July 2024

BACKGROUND: Surgical wound infections (SWI) remain as a major source of postoperative illness that increases the time of hospital stay and health care related costs globally. On top of this, the emergence and spread of drug-resistant pathogens continue to challenge the proper management of surgical wound infections.METHODS: A hospital based cross-sectional study was conducted at Felege Hiwot Referral Hospital (FHRH). A total of 165 study participants were included. Socio-demographic data were collected using a pre-tested structured questionnaire. Isolates were identified by conventional bacteriological technique and antimicrobial susceptibility test was performed using the Kirby-Bauer disc diffusion method.RESULTS: Among 165 study participants, 98 (59.4%) were males. The overall prevalence of culture confirmed surgical wound infection was 115 (69.7%). A total of 125 bacteria isolates were identified among which, Staphylococcus aureus was predominant followed by Pseudomonas aeruginosa and Klebsiella species witha proportion of 31 (24.8%), 26 (20.8%) and 17 (13.6%), respectively. Majority (80.8%) of the isolates were found multidrug resistant (MDR). Dirty wound and duration of hospital stay were found significantly associated with culture confirmed surgical wound infections.CONCLUSIONS: S. aureus, P. aeruginosa and Klebsiella species were the most common isolates identified from surgical wound sites. Most of these pathogens were found MDR. Therefore, regular surveillance on the types of bacterial isolates and their drug resistance pattern should be considered.
Frequency of Beta-Lactamase Antibiotic Resistance Genes in Escherichia Coli and Klebsiella pneumoniae
Authors: Roghieh Golsha  , Maryam Montazeri  , Nazanin Razaghi  , Mina Einollah Zade
Published: July 2024

BACKGROUND፡ This cross-sectional study was performed on isolates of Klebsiella pneumoniae, and E.coli from clinical specimens of patients admitted to Sayyad Shirazi Hospital by census sampling method in 2019. Antibiogram testing was performed using the disk diffusion method as defined by the Clinical and Laboratory Standards Organization for performing this test. Finally, the abundance of genes was evaluated by PCR using specific primers. Frequency, percentage, mean±SD were used to describe the data. Chi-square and Fisher’s exact tests were used to compare the presence and absence of the studied genes alone and in the presence of each other.RESULT: This study was performed on 130 positive samples, isolated from 32 (24.6%) males and 98 (65.4%) females with a mean age of 43.78 ± 21.72. From the total number of 130 isolates, 84 (64.6%) consisted of E.coli, and 46 (35.4%) were Klebsiella. Most of the cultures were urine and vaginal (61.5%). The highest antibiotic resistance in isolates was cephalexin and cefazolin (67.9% in E.coli & 63% in Klebsiella). Colistin was identified as the most effective antibiotic (100%) in both. AMPC extendedspectrum β-lactamase genes were present in 40 (30.8%) isolates. The highest frequency about the gene pattern of AMPC positive β-lactamase bacteria was correlated to DHA, FOX, and CIT genes, while none of the samples contained the MOX β-lactamase gene. E.coli and Klebsiella beta-lactamase-producing AMPC isolates were also significantly correlated with antibiotic resistance to the cephalosporin class (P <0.05).CONCLUSION: This study indicated a high percentage of resistance to third and fourth generation cephalosporins. Hence, careful antibiogram tests and prevention of antibiotic overuse in infections caused by AMPC-producing organisms and screening of clinical samples for the resistance mentioned above genes and providing effective strategies to help diagnose and apply appropriate treatments and change antibiotic usage strategies can partially prevent the transmission of this resistance.
Fatal Left Ventricular Aneurysm in a 13 Years Old Male Child: A Case Report
Authors: Tsion Tilahun  , Elias Kedir  , Beza Eshetu
Published: July 2024

BACKGROUND፡ A pouch protruding from the free wall of the left ventricle may be either a congenital ventricular diverticulum or congenital ventricular aneurysm. Congenital ventricular aneurism is a ventricular protuberance which is a kinetic or dyskinetic and on histology is predominantly fibrous tissue with no organized myocardium. Common clinical presentations of congenital ventricular aneurism are arrhythmia, rupture and heart failure.CASE DETAIL: A 13 year old patient presented with shortness of breath, fever, orthopnea of two pillows and paroxysmal nocturnal dyspnea of one week duration. Echocardiography revealed cystic mass seen at the apex of the heart communicating with left ventricle, with communicating defect and flow on color Doppler study. CT scan showed ventricular aneurism at the apex. The patient was managed for heart failure and passed away after few hours’ of establishing diagnosis.CONCLUSION: Congenital ventricular aneurysm is a rare condition which needs careful diagnosis for subsequent management.
Trends in Operative Delivery in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A 5 years’ Retrospective Review
Authors: Yeshiwas Abebaw  , Eskinder Kebede
Published: July 2024

BACKGROUND፡ Operative vaginal delivery refers to the use of measures to accomplish vaginal delivery through the use of instruments, mainly obstetric forceps and vacuum cups. In developed countries, the rate of cesarean section is increasing for fear of vaginal delivery complications, including instrumental delivery. This study was done to explore trends of operative vaginal deliveries and their characteristicsMETHODS: A cross-sectional, facility-based retrospective study was conducted over a period of five years July 1, 2011, to June 30, 2016, using data collected from the labor ward logbook, patient charts. Data were coded, entered, using SPSS version 20 statistical software. Descriptive statistical analysis was used to describe and analyze the data into graphs and tables. RESULTS: The rates of operative vaginal delivery and cesarean section over the five-year study period were 11.9% and 30.4%, respectively. The trend in the operative vaginal delivery rate declined from 15.8% in July 2011 to 9.9% in June 2016, while it shows a noticeable rise in cesarean section rate 25.4% to 33.8%. The trend in the use of vacuum has shown a sharp decrease from 58% in the 1st year to 10.5% in the fifth year of the study period. There is a rise in the use of forceps from 42% of all operative vaginal delivery in the first year to 89.5% in the fifth yearCONCLUSION: This study shows that the rate of operative vaginal delivery has declined. The use of vacuum-assisted delivery has especially decreased compared to that of forceps-assisted delivery.
Comparison of Intravenous Ketamine with Intrathecal Meperidine in Prevention of Post-anesthetic Shivering after Spinal Anesthesia for Lower Limb Orthopedic Surgeries: A Double-blind Randomized Clinical Trial
Authors: Abdolmajid Gholinataj  , Afshin Gholipour Baradari  , Soheila Najafi  , Farshad Hasanzadeh Kiabi
Published: July 2024

BACKGROUND፡ Post-anesthetic shivering is one of the most common complications after anesthesia. Ketamine has been considered to be an effective treatment for post-anesthetic shivering, but the evidence for its therapeutic benefit after spinal anesthesia is limited. The aim of this study was to compare the effects of intravenous ketamine with intrathecal meperidine in the prevention of post-anesthetic shivering after spinal anesthesia for lower limb orthopedic surgeries.METHODS: In a double-blind randomized parallel-group clinical trial, a total of 150 patients scheduled for lower limb orthopedic surgeries under spinal anesthesia were selected and randomly divided into three equally sized groups of intravenous ketamine (0.5mg/kg), intrathecal meperidine (0.2mg/kg) or intravenous normal saline (as placebo). The intensity of shivering in patients were evaluated during surgery and after transfer into the post anesthesia care unit. Also, changes in patients' drowsiness, nausea, vomiting, pruritus, mean arterial pressure, heart rate, and arterial oxygen saturation (SPO2) during surgery and until the end of anesthesia were evaluated.RESULTS: In all times of evaluation (20, 60, 80, 100 and 120 minutes after onset of spinal anesthesia) patients in control group showed a greater intensity of shivering compared to other groups. However, patients who received intrathecal meperidine experienced significantly lower intensity of post anesthetic shivering (p<0.05). The results showed a significant mean arterial pressure and heart rates differences between the three groups, only on 20 and 60 minutes after initiation of spinal anesthesia. The incidence of nausea, vomiting, and pruritus was not significantly different in all three groups, although all patients who received ketamine experienced drowsiness after surgery (p<0.001).CONCLUSION: The results of the present study showed that, although both intrathecal meperidine and intravenous ketamine could effectively prevent postoperative shivering after spinal anesthesia in lower limb orthopedic surgeries, intrathecal meperidine was associated with more efficacy benefits and a lower frequency of side effects such as post-anesthesia drowsiness.
The Effect of Education Based on Kolb's Learning Style on Selfcare Behaviors of the Elderly with Type II Diabetes: A Randomized, Clinical Trial
Authors: Omolbanin Bagchegi  , Mahbubeh Tabatabaeichehr  , Hossein Lashkardoost  , Hamed Mortazavi
Published: July 2024

BACKGROUND፡ Individualized patient education can help older people with diabetes to improve their self-care behaviors and effectively manage their disease. Identifying patients' preferred learning style can be a useful way to optimize learning opportunities. The aim of this study was to investigate the effect of education based on Kolb's learning style on selfcare behaviors of older people with type II diabetes.METHODS: This randomized clinical trial was conducted on 62 older adults with type II diabetes referred to the diabetes center of Imam Reza Hospital in Bojnourd, Iran, from May to November 2020. Participants who met the inclusion criteria were randomly allocated into two groups of intervention (n=34) and control (n=28). Participants in intervention group received the educational intervention based on their learning style (described by Kolb as accommodating, diverging, converging and assimilating) in four 45 minutes-sessions (two sessions per week). In the control group, the same educational content was presented with a lecture and a booklet. Participants in both groups completed the self-care questionnaires before and one month after the intervention.RESULTS: The mean self-care scores of the older adult patients with type II diabetes based on Kolb's learning style after the educational intervention in the intervention and control groups were 58.15 (SD=10.71) and 44.7 (SD=12.12), respectively (P<0.001). Accommodating Kolb's learning stylebased education was most effective in improving self-care practice in older adult patients with type II diabetes (P<0.001).CONCLUSION: Education based on Kolb's learning style is effective in improving self-care behaviors of older people with type II diabetes. Therefore, it is suggested to consider Kolb's learning style in the educational process of older adults with type II diabetes to improve self-care practice in these patients.
Correlation of Clinical Features in Oral Submucous Fibrosis: A 9- Year Retrospective Study
Authors: Sneha R. Sharma  , Samiksha Chavan  , Freny R Karjodkar  , Kaustubh Sansare  , Bharathi S.  , Shivani Singh
Published: July 2024

BACKGROUND: Oral Submucous Fibrosis is a chronic debilitating disease and potentially malignant disorder of the oral cavity known in medical literature for a long time. The study aims to correlate the clinical staging of Oral Submucous Fibrosis with various clinical findings of the oral mucosa like hyperpigmentation, erosions, ulcerations, VAS score, tongue protrusion, and cheek flexibility.METHODS: A retrospective observational study was undertaken and records of 1267 clinically diagnosed cases of OSMF were included in the study. Clinical grading was done as per criteria by Lai DR et al. The observations were tabulated and subjected to statistical analysis using SPSS software.RESULTS: In our study, the incidence of hyperpigmentation, erosions, and ulcerations was higher in Group C OSMF. Visual analog scores in the range of 5-6 was noted in 40.9% of the total subjects, out of which 36.2% belonged to Group C OSMF. Tongue protrusion of less than 25 mm was seen in 10.65% of the subjects. Cheek flexibility of less than 0.6 cm was seen in 19.62% of the subjects, most of which belonged to Group D.CONCLUSION- In our study, we found an increase in the occurrence and severity of symptoms with an increase in grades of OSMF, but this increase was not observed to be consistent. Hence classification based on a single clinical entity cannot be sufficient and correlations to other clinical findings should be studied over a large population and a multi-tier classification could be proposed in the future.
Universal Health Coverage Policy and Progress towards the Attainment of Universal Sexual and Reproductive Health and Rights Services in Ethiopia
Authors: Yifru Berhan  , Mahbub Ali  , Awoke Tassew  , Akiyo Nonogaki
Published: July 2024

Critical interpretive analysis of literature review was applied to shed light on the status of universal access to Sexual and Reproductive Health and Rights (SRHR) and the progress towards Universal Health Coverage (UHC) in Ethiopia. Special emphasis was given to the determinations of the Ethiopian health policy frameworks to include comprehensive SRHR services in the UHC benefit package. Clinical services for pregnant women and newborn, abortion care, family planning, Female Genital Mutilation (FGM) complication treatment, Comprehensive Sexuality Education (CSE), and sexual health services are included in the national cost exempted services, but the latter three are not yet included in the health programs with defined objective and work plan. Capital intensive Sexual and Reproductive Health (SRH) services (such as infertility and reproductive cancers diagnosis and treatment) are not included in the UHC benefit package. Over the last two decades, a substantive progress is made in family planning service and maternal and child health, probably because they were taken as Millennium Development Goals (MDGs) indicators and have got better financial protection and political commitment. In order to include other SRHR services in the benefit package in due course and attain universal SRHR services without financial hardship in the Primary Health Care (PHC) setting, the domestic financing should be endorsed as a driving force. To make the multi-sectoral efforts towards achieving UHC and sustainable development goals (SDGs) complete, building resilient health systems through the humanitarian-development nexus for health systems strengthening in fragile setting should be equally prioritized, thereby leaving no one behind underserved.
Quality Assessment of Services in Primary Healthcare in Iran: A Systematic Review and Meta-analysis
Authors: Hojjat Rahmani  , Raheleh Maleki  , Mahboubeh Khaton Ghanbari  , Masoud Behzadifar
Published: July 2024

BACKGROUND: Primary healthcare (PHC) plays an important role in achieving universal health coverage (UHC). The SERVQUAL instrument is the tool for evaluating the quality of services in the health sector. The main purpose of this study is to evaluate the quality of services provided in PHC in Iran using the SERVQUAL instrument.MATERIALS AND METHOD: We searched eight databases from January 2000 to September 2021. We analyzed the mean of various SERVQUAL instrument items using the DerSimonian-Laird approach via a random model with 95% confidence interval. Also, we used I2 to evaluate the heterogeneity of the studies.RESULTS: Finally, 17 studies were chosen for analysis in the present study. There were 8,767 study participants, out of which 8,237 were female and 530 were male. The mean dimensions of perception were as follows: Tangibles = 3.71, reliability = 4, responsiveness = 3.79, assurance = 3.83, and empathy = 3.86. For the expectation, the mean dimension were: Tangibles = 4.46, reliability = 4.46, responsiveness = 4.36, assurance = 4.36, and empathy = 4.36 respectively. The total gap quality between perception and expectation was -0.53.CONCLUSION: All dimensions of quality based on SERVQUAL were negative, and the quality of service in PHC is not satisfactory. Therefore, policymakers must adopt serious and effective programs to improve services in this area. We also recommend that quality management of services in PHC in Iran should move toward comprehensive optimization in all areas, and quality in this area should be a priority.
Assessing the Complications of Monopolar Transurethral Resection of the Prostate (M-TURP) Using Clavien-Dindo Complications Grading System
Authors: Lijalem Mekonnen Geremew  , Samuel Amare Gelaw  , Andualem Deneke Beyene
Published: July 2024

BACKGROUND: Benign prostatic hyperplasia (BPH) is one of the most common diseases of ageing men, which increase starting from age 40. Monopolar transurethral resection of the prostate (M-TURP) is the gold standard surgical treatment for BPH between 30 to 80cc. This study is designed to assess complications of TURP based on the Clavien-Dindo post-op complication grading system.METHODS: A descriptive prospective study of prevalence of complications of M-TURP from May1, 2019 to April 30, 2021 in Tikur Anbessa Specialized Hospital. In this study, 174 patients were assessed pre-operatively, intra-operatively and postoperatively. All BPH patients with bothersome LUTS, bladder stone, recurrent UTI, recurrent acute urinary retention (AUR), renal insufficiency, or failed medical therapy had undergone TURP. We collected it by revising patient’s icare/charts and cell phone call.RESULTS: About 174 patients were studied with mean age were 63 years. Intra op complications were noticed in seventeen (9.8%) patients, the most common one was prostate capsule perforation seen in 9 (5.2%) cases followed by severe bleeding in 3(1.7%) patients which needs transfusion and urethral injury. Urinary tract infections developed in eleven (7.8%) of patients. Bulbar urethral stricture and bladder neck contracture developed in 9 (5.2%) and 3 (1.7%) patients each, respectively. Re TURP was done for 7 (4%) of patients.CONCLUSION: In this study, the overall complication rate of TURP with Clavien-Dindo grading system was 29.3%. Around 96% of the complications were Clavien-Dindo grade I, II and III; managed conservatively or with minimally invasive surgery. This shows M-TURP is a relatively safe procedure.
Antibacterial Effects of Artemisia afra Leaf Crude Extract Against Some Selected Multi-Antibiotic Resistant Clinical Pathogens
Authors: Alemtsehay Beyene Haile  , Tamene Milkessa Jiru
Published: July 2024

BACKGROUND፡ Due to improper use of antibiotics, some pathogenic bacteria that cause serious and deadly infections have become resistant to commonly used broad spectrum antibiotics. This antibiotic resistance has become major global healthcare problem. Therefore, there is an urgent need to develop novel antibacterial agents; hence, much attention has been made on medicinal plants such as Artemisia afra. Thus, the current study was aimed to evaluate the antibacterial activity of ethanolic, methanolic and n-hexane extracts of this plant leaf against four multi-antibiotic resistant clinical pathogens.METHODS: Crude extracts from A.afra leaf were prepared using ethanol, methanol and n-hexane and the antibacterial effect of each extract was tested against Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. In addition, minimum inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC) were evaluated.RESULTS: Among the crude extracts, the highest zone of inhibition (25.33±0.58mm) was recorded against E. coli when methanolic extract was applied. On the other hand, the lowest inhibition was exhibited when n-hexane extract was applied against S.aureus (5.67±1.56 mm). Concerning MIC values of the different extracts, varied results were obtained. MIC value of 6.25mg/mL was recorded when methanolic extract was applied against all clinical pathogens. Moreover, both methanolic and ethanolic extracts showed MBC value of 12.5mg/mL against the four clinical pathogens. However, the methanolic extract gave MBC value of 6.25mg/mL against E. coli.CONCLUSION: From this study, it can be concluded that it is possible to develop and formulate of new, efficacious, less toxic and inexpensive herbal medicine from A.afra leaf extract that act against multi-antibiotic resistant clinical pathogens.
Factors Associated with ICU Mortality at Hawassa University Comprehensive Specialized Hospital (HUCSH)
Authors: Abdi Bati Wotiye  , Emnet Tesfaye Shimber  , Biniyam A. Ayele
Published: July 2024

BACKGROUND: Providing acute care to critically ill patients in intensive care unit (ICU) is a global necessity, regardless of health system capacity. The objectives of the present study were to assess the reasons for admission and clinical outcomes of adult patients admitted to general ICU at Hawassa University Comprehensive Specialized Hospital (HUCSH).METHODS: A retrospective study based on a record review of logbook and charts of 310 adult patients admitted to general ICU of HUCSH between April 2012 and April 2017. Both descriptive analysis and inferential statistics were used.RESULTS: The average age was 41 ± 17.9 years (range: 18-100 years). Males accounted 51.6%. The average duration of stay in the ICU was 5.3 ± 6.7 days (range 1- 49 days). Cardiovascular disorders were the commonest cause of admission, accounted for 22.9%, followed by neurological disorders (17.7%), and trauma related illnesses (13.9%). Among 310 adults admitted during the study period, 23.1% required mechanical ventilator support; and 5.3% developed Hospital acquired infection. In-patient mortality rate was 45.8%. In multivariate analysis, the presences of aspiration pneumonia, and need for ventilator support, acute kidney injury, hospital acquired infection, and short ICU stays were associated with ICU mortality.CONCLUSION: The present study indicates high prevalence of ICU mortality among adults admitted to HUCSH during the study period. ICU mortality was associated with the presences of renal failure, hospital acquired infections, aspiration pneumonia and the need for mechanical ventilator.
Establishing a Self-sustaining Emergency Medicine Point-of-Care Ultrasound Curriculum in an Academic Teaching Hospital in Ethiopia
Authors: Anne Aspler  , Fraser Kegel  , Temesgen Beyene  , Tigist Zewdu  , Berhanu Tesfaye  , Alexandra McKnight  , Eileen Cheung  , Jennifer Bryan  , Claire Acton
Published: July 2024

BACKGROUND: Point-of-care ultrasound (POCUS) training has become a standard component of Canadian emergency medicine (EM) residency programs. In resource-limited contexts, including Ethiopia, there is a critical shortage of local clinicians who can perform and teach POCUS. Our aim was to establish an introductory POCUS rotation within the EM residency program at Addis Ababa University (AAU) through The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAACEM).METHODS: Through stakeholder engagement, the authors completed a quality improvement initiative and conducted a survey of AAU EM faculty and residents to understand which POCUS scans should be included in a core residency POCUS curriculum, "POCUS1".RESULTS: 17 residents completed the POCUS1 program and 16 residents completed the written survey. Focused assessment with sonography for trauma, inferior vena cava, and lung (pneumothorax, pleural effusions, and interstitial syndrome) were identified as core introductory topics. Seventeen residents completed the initial POCUS1 program. Three program graduates were supported to become “POCUS1 Master Instructors” to continue the program during the SARS-CoV-2 global pandemic.CONCLUSION: The authors identified the highest yield POCUS scans through a written survey, successfully introduced a sustainable core POCUS curriculum at AAU for EM residents, and graduated three master instructors for curriculum continuation. We outline the structure and materials for implementation of POCUS programs for EM trainees and staff in similar low- and middle-income countries.