Articles

Prothrombin Time (PT), also called Quick’s Time (QT), is a coagulation test expressed in seconds, measured in the presence of tissue thromboplastin and calcium ions. Similarly, Activated Partial Thromboplastin Time (APTT) is measured in the presence of phospholipids, an activator, and calcium ions. These two tests are among the most commonly used in hemostasis. Their execution absolutely requires plasma samples used as quality controls, whether commercial or prepared locally (“pooled” in the laboratory).This descriptive study aimed to determine the stability duration of an in-house control pool for PT and APTT tests, prepared in the laboratory of the Hematology and Blood Bank service of the Yaoundé University Teaching Hospital, Cameroon.Plasma was collected after centrifugation, mixed, and then frozen at a temperature of -30 °C to preserve the coagulation factors, especially the most labile ones. The plasma pool was then aliquoted, stored at -30 °C protected from light in a domestic freezer, and kept for a period of two weeks. A portion of the pool was tested within four hours of collection: 30 PT and APTT analyses were performed.The assay was performed manually using the tube tilt method. The means obtained were 12.71 seconds for PT and 30.66 seconds for APTT. The acceptability limits (mean ± 2 standard deviations), calculated from the standard deviation, were 11.38 to 14.04 seconds for PT and 27.96 to 33.37 seconds for APTT.The plasma pool was then analyzed daily in duplicate. The average of the results for each day was plotted on a Levey-Jennings chart and interpreted according to Westgard rules. The results showed that the stability duration of the normal control pool is eight (8) days for PT and seven (7) days for APTT.In a context marked by a recurrent shortage of quality control reagents, for various logistical and economic reasons, these results offer a reliable alternative to commercial control samples, which are often expensive or unavailable. The use of locally prepared control pools could thus compensate for stock-outs of normal or pathological control reagents supplied by manufacturers.

Introduction: The document introduces the topic of medical termination of pregnancy (MTP) using misoprostol, a synthetic prostaglandin E1 analogue. It discusses the advantages and challenges of this method, and the research gap in the Gulf region and the Middle East. It also states the aim of the study, which is to evaluate the safety, efficacy, and acceptability of misoprostol for MTP in Bahrain. Methods: The document describes the study design, data source, and inclusion criteria. It explains that the data was collected from the Hope system in King Hamad University Hospital and included women in the first and second trimester of pregnancy who were undergoing MTP as per the FIGO protocol. It also mentions the statistical analysis that was used to compare the outcomes of different regimens, dosages, and routes of administration of misoprostol. Results: The document reports the main findings of the study, such as the success and failure rates of MTP, the association between previous deliveries and MTP outcomes, the optimal number and route of misoprostol doses, the length of hospital stay, and the incidence of complications. It also presents some figures to illustrate the results. Discussion: The document interprets the results and compares them with previous studies. It highlights the high efficacy of the sublingual route of misoprostol but also acknowledges the side effects and limitations of this route. It suggests that two doses of 600mcg or 800mcg of misoprostol are sufficient for MTP. It also identifies the strengths and weaknesses of the study and proposes some future directions for research. Conclusion: The document concludes that the study provides a better understanding of the outcomes of misoprostol for MTP in a controlled environment. It asserts that misoprostol is a safe and effective option for women seeking abortion in the first and second trimester, especially in low-resource settings. It also emphasizes the need for evidence-based guidelines and counseling for misoprostol use.

Introduction: Cervical cancer remains one of the most common malignancies affecting women worldwide, with over 600,000 patients globally every year, and is a leading cause of cancer-related mortality in women. Although there have been advancements in both screening and prevention, radiation therapy, with or without chemotherapy, is the standard of care for treating locally advanced cervical cancer. Radiation typically consists of two methods, external beam radiation therapy (EBRT) and brachytherapy, which have both evolved in their own respective ways technologically and for patient accessibility. This article aims to review the different cervical cancer brachytherapy techniques, such as intracavitary and interstitial approaches, including their advantages and drawbacks.Methods: Resources on PubMed between the years 2000 and 2024 were reviewed based on their relevance to the approaches of brachytherapy. Articles were found through the use of key terms and Boolean operators such as ("cervical cancer,” AND “brachytherapy," OR “high dose rate brachytherapy,”) OR (“intracavitary,” OR “interstitial brachytherapy,” OR “hybrid brachytherapy,”). Discussion: Three techniques of brachytherapy are de: intracavitary brachytherapy (ICBT), interstitial brachytherapy (ISBT), and hybrid intracavitary/interstitial brachytherapy (HBT).Conclusion: Brachytherapy is a vital part of definitive cervical cancer treatment. While ICBT remains the standard of care for most cervical cancers, ISBT and HBT approaches remain important treatment options. HBT has been shown to address variances in patient anatomy and tumor geometry, resulting in better tumor dose coverage and improved outcomes through minimizing toxicity.

Background: We report a case of Peri-Partum Cardiomyopathy in a 28-year-old Primigravida, who came in labor and underwent a Caesarean Section in view of meconium-stained liquor, fetal distress. On day 4 post-partum, she complained of a sudden onset of shortness of breath, cough, and restlessness in the morning. The patient had no prior history of heart disease or respiratory disease. Patient developed sudden onset tachypnoea and tachycardia with bilateral crepitus. On further evaluation, she was diagnosed with Peripartum Cardiomyopathy. Results: The case was successfully managed by a multi-disciplinary team using dobutamine, diuretics, and Angiotensin receptor blockers. Conclusion: The case report aims to present a case of Peripartum cardiomyopathy with early diagnosis and successful management in a secondary care level hospital. Peripartum (postpartum) cardiomyopathy is the most common cardiomyopathy in pregnancy, defined as an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or after delivery, in the absence of any other cause of heart failure.  It is a diagnosis of exclusion, and the majority are diagnosed postpartum. Although the LV may not be dilated, the ejection fraction is nearly always reduced below 45%. Incidence of PPCM is 1:3000 to 1:15000 pregnancies. It is a major cause of morbidity and mortality if diagnosis gets delayed; therefore, early diagnosis and timely management can affect patients’ long-term prognosis. This case report aims to raise awareness in health professionals about the possibilities of PPCM and its symptoms, as in our case.

Purpose: To determine trends in breast imaging services utilization among privately and government-insured patients at a national radiology practice.Method: Monthly breast imaging volume data from January 2019 to September 2022 were analyzed across five insurance types: three commercial carriers (Com1-Com3), Medicaid, and Medicare. Primary analysis involved calculating quarterly volumes and standard errors of the mean, followed by a joinpoint regression to identify trend inflection points and quarterly percentage changes (QPC). In the secondary analysis, the entire period trend was obtained and measured as the average quarterly percentage change (AQPC).Results: Between 2019 Q1 and 2022 Q3, a total of 4,640,619 breast imaging services were accessed, including 2,034,833 2D screening mammograms, 1,640,689 screening digital breast tomosynthesis, 497,592 diagnostic mammograms, 452,549 breast ultrasounds, and 14,956 breast MRIs. AQPC values for imaging modalities varied across insurance types. Medicare and Medicaid patients showed the highest rates of utilization increases, particularly for modalities other than screening breast tomosynthesis, where private insurers dominated. Variations were observed between different commercial payors.Conclusion: Breast imaging utilization increased among patients insured by Medicare and Medicaid from 2019 to 2022, outpacing that of those with private insurance. These findings contrast previous research suggesting better access and utilization among privately insured individuals, highlighting increased access for government-insured patients in this study.

Suicide has become a major cause of human death during the last few decades. It is important to understand the dynamics of suicide and identify effective prevention strategies. In this work, bifurcation analysis and multi objective nonlinear model predictive control are performed on a suicide dynamics model. Bifurcation analysis is a powerful mathematical tool used to deal with the nonlinear dynamics of any process. Several factors must be considered, and multiple objectives must be met simultaneously. The MATLAB program MATCONT was used to perform the bifurcation analysis. The MNLMPC calculations were performed using the optimization language PYOMO in conjunction with the state-of-the-art global optimization solvers IPOPT and  BARON. The bifurcation analysis revealed the existence of limit and branch points. The MNLMC converged on the Utopia solution (best possible). The limit and branch points (which cause multiple steady-state solutions from a singular point) are very beneficial because they enable the Multi objective nonlinear model predictive control calculations to converge to the Utopia point (the best possible solution) in the model. It is proved (with computational validation) that the branch points were caused because of the existence of two distinct separable functions in one of the equations in the dynamic model. A theorem was developed to demonstrate this fact for any dynamic model.

Background: Employee performance appraisal is essential for improving healthcare service delivery through systematic staff evaluation. In the health sector, effective appraisals support decision-making and professional development.Objective: This study aims to map and categorize existing employee performance appraisal methods in the health system using a scoping review approach.Methods: This scoping review was conducted using the JBI 2024 protocol. Articles published up to December 2024 were identified through four databases: PubMed, Scopus, Web of Science, and Google Scholar. The keywords used were “Personnel appraisal,” “Health workers,” and “Health workforce.” The inclusion criteria focused on studies assessing employee appraisal methods in health systems.Results: Of the 1,245 articles initially identified, 18 met the inclusion criteria. Appraisal methods were classified into traditional and modern categories. Traditional methods included ranking, critical incidents, and graphic rating scales. Modern approaches involved 360-degree feedback, Management by Objectives (MBO), and Behaviorally Anchored Rating Scales (BARS).Conclusion: No single appraisal method suits all healthcare environments. A hybrid approach tailored to organizational context and job roles is recommended. Emphasis should be placed on objective evaluation, customization, and the degree of scientific connection between the evaluator and the evaluated person to improve performance outcomes.

Depression, trauma, and anxiety disorders continue to be predominant causes of global disability, with typical therapies proving to be only marginally successful. Heart Rate Variability Biofeedback (HRVB) offers patients a self-regulation method that improves the flexibility of the autonomic nerve system via resonance breathing. Clinical research shows that training can significantly lower symptoms of sadness and PTSD, with improvements shown after 4 to 8 weeks. HRVB is inexpensive, non-invasive, and scalable, making it a promising supplementary therapy in psychiatry. Subsequent study ought to inform its incorporation into clinical protocols.

Sagittal split osteotomy (SSO) of the mandible is still an important part of orthognathic surgery, but “bad split” fractures that happen during the surgery are still a big problem. This report describes a rare case of bilateral bad split associated with highly compact mandibular bone (D1–D2 type) in a 53-year-old male undergoing mandibular advancement. The bone was too hard for the piezoelectric and rotary tools to work, and there was very little bleeding. This caused fractures in the cortex and lingual. Postoperative computed tomography confirmed the presence of highly dense bone, correlated with delayed healing and recurrence. Consistent pre-surgical CT scanning for an assessment of the density of the mandibular bone can provide essential information about the potential risk of the osteotomy procedure in the patient. Performing a careful bone quality and density examination pre-operatively will allow the surgeons to select the most appropriate instruments and surgical techniques that will fit the patient’s individual anatomy. Such a point escalates to being very significant when dealing with the geriatric population, as bone density increase can not only alter the fracture behavior but also the recovery process during and after surgery. The inclusion of regular CT-based bone density evaluations into the preoperative routine not only facilitates the anticipation of surgical difficulties but also results in safer and more efficient osteotomies.

Aims: The study was conducted from January to June 2023 to observe the prevalence of repeat breeding syndrome in cows, to isolate and identify the bacteria with their molecular confirmation, and antibiotic sensitivity in Bangladesh. Study design & Place and duration of study: The study was conducted under the supervision of the Department of Medicine, Surgery, and Obstetrics, Hajee Mohammad Danesh Science and Technology University, Dinajpur-5200. Some laboratory work was performed at the Microbiology Department of Pathology and Parasitology laboratory, HSTU, from January to June 2023.Methodology: A questionnaire was used to identify repeat breeding syndrome. Bacteria were isolated and identified from the cervical mucus of affected cows. For confirmation of the detected bacteria, PCR was used. The agar disc diffusion method was utilized to investigate the antibiotic sensitivity of the detected isolates against widely used antibiotics in vitro. Results: The prevalence of Repeat Breeding (RB) was 41.33%. The prevalence of E. coli was 40%, Staphylococcus aureus 40% and Klebsiella spp. 10%. Molecular detection of E. coli and Staphylococcus aureus was confirmed by using Eco 223 (F), Eco 455 (R), Sau 234(F), and Sau 1501(R) primers. The target genes were 16S and 23S rRNA, and the size of the product amplified at 232 bp and 1267 bp, respectively. According to the antibiogram profile, E. coli was resistant to ciprofloxacin, penicillin, tetracycline, amoxicillin, and erythromycin, but sensitive to ceftriaxone and gentamicin. While Staphylococcus aureus was resistant to ampicillin and erythromycin, it was sensitive to ciprofloxacin, ceftriaxone, and levofloxacin. It was also intermediately resistant to vancomycin and amoxicillin. Klebsiella spp. Showed resistance to ceftriaxone, penicillin, and amoxicillin, while remaining sensitive to ciprofloxacin, tetracycline, and intermediate resistance to erythromycin and gentamicin. Conclusion: This study concluded that E. coli, Staphylococcus aureus, and Klebsiella spp. are the most common bacteria causing repeat breeding syndrome in cows.