Chest compression is the fundamental technique in cardiopulmonary resuscitation (CPR) in patients with cardiac arrest [1]. The quality and the early implementation of CPR are essential to improve the prognosis and the chances of restoring spontaneous circulation. In the literature, there are some articles about the poor quality of chest compression [2-4]. Therefore chest compression is as crucial as alerting the emergency services or early defibrillation in the survival chain. In accordance with the guidelines, chest compressions have to be performed continuously to improve the outcome [5]. However, the efficacy of manual chest compression diminishes over time with the fatigue of the provider (which appears within minutes of starting the procedure), and is impaired during transportation manoeuvres, which expose patients to unforeseen interruptions and a deterioration in the quality du massage in terms of power and rhythm. The efficacy of manual chest compression has been reported to fall by 20% per minute [6,7]. Mechanical chest compression overcome this problem of operator fatigue by ensuring constant efficacy in terms of both quality and quantity. Even though current data show no difference between manual chest compression and automated systems in terms of survival, haemodynamic studies in animal models have shown that mechanical techniques are more effective [8].

Allergen immunotherapy (AIT) is the unique curative treatment to help allergic patients to get over their allergies. With a personalized approach, AIT is the best example of precision medicine. After a century of intensive studies and innovative discoveries, allergists have in their hands many tools to orchestrate the best strategy to re-educate the hypersensitive immune systems that decrease the quality of life of their patients. This review describes both the historical and the promising acquisitions in this field, focusing the biochemical and Bioengineering tools that render an allergen more suitable for a secure, convenient and effective immunotherapy.

It is estimated that there are 36.9 million individuals living with HIV-1 from who 21.7 million patients receiving antiretroviral therapy (ART) [1,2]. ART has had a significant effect on the patients’ quality of life recently, however, its global coverage declines to 16-35% in low or middle income parts of Africa [3]. ART is unable to eliminate the virus from the infected individuals despite the fact of great impact on virus life cycle. There is no doubt that vaccination is considered as the most important medical strategy to prevent and suppress the infectious diseases. Nevertheless, there are many difficulties toward the cure or prevention of HIV-1 including the virus characteristics, lack of ideal animal model and funding [4-7].

Asthma is a complicated chronic disease of airway and airway inflammation, bronchoconstriction, cough, dyspnea and wheezing that are main symptoms of the asthma. Genetic, epigenetic and environmental agents are main factors in pathophysiology of the asthma. Direct and indirect healthcare costs and health-related quality of life in asthmatic patients require more and more attention. A main challenges of asthma control is environment and specially house and building [1].

Functional dyspepsia (FD) is a prevalent global health concern increasing with years. Inspired by the Traditional Chinese Medicine (TCM) liver-stomach disharmony syndrome in order to find a quick natural alternative treatment, a Ferula asafoetida-Silybum marianum (Asdamarin™) combined extract has been developed and proved its rapid efficiency and its safety with a 7-day randomized, double-blind, placebo-controlled pilot study (CTRI/2018/05/013993 dated 21/05/2018) conducted on 70 healthy human volunteers (aged 18–60 years) supplemented with 250 mg / twice a day of either a placebo or Asdamarin™. Subjects were evaluated from baseline to the end of the study (EOS) through changes in Gastrointestinal Symptom Rating Scale (GSRS), changes in Glasgow Dyspepsia Severity Score (GDSS) and changes in the short form of Nepean Dyspepsia Index (NDI-SF) for Quality of Life. Compared to the baseline a significant reduction (p < 0.001) of GDSS questionnaire score was noted in the Asdamarin™ group (from 5.66 ± 3.1 at baseline to 5.09 ± 2.8 at the End Of Study (EOS)) compared to placebo group (from 2.77 ± 1.3 baseline to 2.69 ± 1.3 EOS), a significant decrease (p < 0.001) of GSRS score noted in the Asdamarin™ group (from 32.11 ± 8.6 baseline to 19.11 ± 5.4 EOS) compared to the placebo group (from 25.23 ± 3.6 baseline to 23.2 ± 4.9 EOS), and a significant reduction (p < 0.001) of NDI-SF scoring was noted in the Asdamarin™ group (from 15.74 ± 4.1 baseline to 11.54 ± 2.1 EOS) compared to placebo group (from 12.54 ± 3.2 baseline to 11.63 ± 2.6 EOS). Asdamarin™ has been found safe and very well tolerated during the study.

Background: Globally, Alzheimer’s disease (AD) affects millions of elderly individuals are affected with AD who suffer from decline in cognitive ability. However, immune system dysfunction has a role in AD pathogenesis. However, pharmacological therapeutic intervention for caring of ADis not available. Therefore there is a need to develop novel therapeutic modalities for AD individual care. Objective: The objective of the this trial was to detect immune system and quality of life (QOL) response following aerobic versus resisted exercise training among AD subjects. Methods: Fifty older with AD disease the range of age ranged was 61 to 73 years enrolled in the current study. However, smoking, liver, chest, renal, metabolic and cardiac dysfunction considered as exclusion criteria. Participants were randomly enrolled into group (A) who applied aerobic exercise intervention, while group (B) applied resisted exercise intervention for period of six months. Results: The SF-36 which measure QOL along with in the immunological parameters (CD3 count, CD4 count, CD8 count and CD4/CD8 ratio) showed significant improvement following aerobic and resisted exercise. However, comparing between both groups showed significant differences with greater significant improvement in all measured parameters following aerobic exercise training (p < 0.05). Conclusion: Aerobic exercise is the most appropriate exercise to improve immune system and quality of life among elderly Alzheimer’s.

Background: Skin diseases is a common worldwide problem. It affected every aspect of patients’ quality of life (QOL) mainly physically, socially and psychologically. Objectives: to assess the impact of skin disorders on patients’ quality of life and to identify factors associated with it. Methodology: This cross-sectional study was conducted in outpatient dermatology clinic of a tertiary hospital in Malaysia. A random sample of 145 patients with acne, psoriasis and atopic dermatitis (AD) were interviewed using DLQI questionnaire during their scheduled follow-up appointments at dermatology clinic. Main outcome measure: Self-reported patients’ QOL due to their skin diseases. Results and discussion: Out of three skin diseases psoriasis patients had the highest prevalence (39.3%) followed by AD (34.5%) and acne (26.2%). Patients’ QOL was highly influenced by their skin conditions especially on working/schooling domain. Furthermore, several factors were identified, namely age, working environment, concurrent skin diseases, usage of supplement for skin diseases and type of food as aggravating factors—that may influence patients’ QOL. QOL among females and younger adults was found to be more significantly influenced as compared to males and elderly. With respect to working environment, those who had both indoor and outdoor working environment showed the highest impact of their skin conditions on their QOL. Single patients were more influenced by their skin conditions when compared to those who are married, however it was not significant. Conclusion: Our findings revealed skin disease had negatively impacted individual QOL with different level of aspects. Among the three diseases, AD patients had the worst impact on QOL. Significant predictors of QOL did not relate solely to skin diseases but also other factors such as type of food and working environment.

Background: Alcoholism is a widespread problem in Kenya and is associated with severe impacts on health and quality of life of the individual. Physical activity is an affordable and sustainable adjunct treatment option for recuperating alcoholics; however its’ rarely used in rehabilitation of alcoholics in Kenya. Objective: This qualitative study sought to elicit facilitators and barriers that influence the practice of physical activity amongst recuperating alcoholics under rehabilitation. Methods: A focus group guide was utilized to gather views and perceptions of 15 alcoholics and 5 health professionals through focus group discussions. Constant comparative approach was used to analyze verbatim transcripts obtained from in-depth interviews. This analysis entailed three stages including open, axial and selective coding. Results: Recuperating alcoholics’ recognized various forms of physical activity to promote mental and physical health during their rehabilitation. Health professionals and significant others considerably supported the recuperating alcoholics to practice physical activity however physical activity facilities and facilitation was lacking in Asumbi rehabilitation center. Conclusions: The rehabilitation centres should have physical activity experts and facilities that can offer individualized physical activity services and support needed by the recuperating alcoholics.

Background: In this study, we aimed to investigate the role of prognostic factors on breast cancer survival in Iran. Methods: This study was carried out using data from 500 participants with breast cancer. Data were gathered from medical records of patients referring to four breast cancer research centers in Esfahan, Iran, between 1990 – 2000. Age at diagnosis (year), size of tumor, Involve lymph nodes, tumor grade, and family history and married were the prognosis factors considered in this study. A Cox model was used. Results: The median follow-up period was 29.71 months with the interquartile range of 19-61 months. During the follow-up period, 57 (10%) patients died from breast. The Cox model showed that number of lymph nodes involved, and the tumor size and grade tumor are the prognostic factors survival in breast cancer. Conclusion: This study, confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and timely treatment could lead to longer life and increased quality of life for patients.

Objective: Colorectal cancer is one of the most commonly occurring cancers in men and women worldwide as well as one of the most common causes of death from cancer. It has a higher prevalence in men than women. The treatment of colorectal cancer (surgically or through chemotherapy) severely affects both patients and their families. The objective of the study was to identify cases of colorectal cancer, evaluate their demographic and clinical data, and identify any statistical relationship. Methods: This is a retrospective study. The data were collected through the revision of cancer patients’ files in the Chemotherapy Center at Vlore Regional Hospital, Vlore, Albania. The analysis included files from 2015-March 2019. A total of 72 patients’ files with colorectal cancer were analyzed. Result: Mean age of patients 66.36 ± SD10.99 years old, range 38-86. Most of the patients were male (n = 45) and with colon cancer type (n = 44). 19 patients had treatment with surgery, radiation, and chemotherapy. 56.34% of patients with colorectal cancer are still alive. The results of the study are the same as the global trend in terms of age, gender, type of cancer but not in terms of years of survival, which appear lower. Conclusion: The study suggests that in demographic terms patients with colorectal cancer have no difference from world trend. There was also a marked lack of documentation regarding the clinical data of patients. The complete and accurate documentation of cases with colorectal cancer is recommended to develop quality models of nursing care as well as to design effective promotional and preventive campaigns for colorectal cancer.

Sexual addiction is a growing reality. The acknowledgment of this disorder requires to identify vulnerability factors. Besides, it would improve the management and treatment of these people. We used a cross-sectional study with a sample of voluntary subjects recruited online anonymously. A prepared questionnaire explored the general and clinical data of the sample. The psychometric scales used were: Carnes Sexual Addiction Screening Test, the French Big Five Inventory for personality dimensions and the Rosenberg Scale for self-esteem. Five hundred and ten individuals were included. 38 people (8%) had sexual addiction. 68 people (13%) had attenuated symptoms of sexual addiction. The average age of the group with sexual addiction was 30.8 years with a male predominance. The majority had a higher academic level, was single (39.5%) and are working (73.7%). Our study revealed that self-esteem was below average in 73.7% of people with sexual addiction. Concerning personality dimensions, individuals with sexual addiction had higher scores in Neuroticism. The analytic study showed that four variables were statistically correlated with sexual addiction: male sex; low self-esteem; a large N dimension and a low C and E dimension. The concept of sexual addiction, still poorly defined, is beginning to be recognized. The need for more research is required to identify the factors of vulnerability with the aim of developing the preventive axis and improving the quality of life.

According to the World Health Organization definition, palliative care is an approach aimed at increasing the quality of life of patients and their relatives by addressing physical, psychosocial and spiritual needs and treating conditions early, such as pain while they are coming to terms with a life-threatening disease [1]. Palliative care services have started a rapid progress in developed countries such as Scandinavian countries, England and Canada since the beginning of 1990 [2]. Although palliative care cares for any patient who is in need of care, whether bed-bound or unable to look after themselves, one of the main area of interest is of course oncological patients and their relatives. Patients with advanced cancer, frequent sufferings from physical and psychological symptoms - primarily pain, reduced functional capacity, and reduced quality of life are in the scope of palliative care protocol [3]. The most common end-of-life symptoms and signs in palliative cancer patients are pain, anorexia, nausea, cachexia, weakness, dyspnea, ascites, anxiety, agitation, delirium, confusion and pressure sores. In order to achieve quality and continuous care in case management, a family doctor, specific branch specialist, nurse, dietician, psychologist, cleric, etc. should work together in a multidisciplinary approach and clinical guidelines and care protocols should be implemented [4]. However, it should be kept in mind that increasing the medication dose may not always be beneficial to the oncological patients in palliative services. The goal should always be maximum benefit with minimal tests and treatment. Palliative care does not aim to accelerate or postpone death; but it has many benefits in cancer patients and their relatives including the integration of the psychosocial and spiritual aspects of patient care into physical care, providing support for patients to live as active as possible until the last moment, improving the quality of life and the disease process, providing help and support in the grieving process [1,5]. Providing good care to advanced cancer patients requires that caregivers are educated and supported about their patients’ physical, psychological and social care needs. Balancing the physical and emotional needs of the caregivers will reduce the stress they experience, as well as increase the quality of life of their patients [6,7]. Professionalism in palliative care comes into play right at this point. There is no consensus in the medical world about by whom, when and to whom palliative care should be given. In this regard, the conflicts of opinion between specific branches such as anesthesia, internal medicine and neurology are inevitable. We think that the team leader should be a family physician or a palliative care specialist. The reason for this is the family medicine’s principles of core competencies including biopsycosocial, holistic, comprehensive approach and equal distance to specific branches. Of course when the palliative care specialist is the team leader the patient’s own family doctor still provides invaluable service because of his intimate and long-term knowledge about the patients. One key difference in some countries is that no distinction is being made between palliative and hospice care. Neither the insurance companies nor the state demands such classification because it doesn’t serve any practical purpose at the moment. However, in due time such distinction will be inevitable as one of the cost-cutting measure. Medical oncology will have to report about the expected survival of the cancer patients and it will further increase their workload given the exponential increase in cancer cases.

Introduction: The problem of protecting and strengthening the mental health of the population is the most important task of ensuring the socio-economic well-being of the Komi Republic (RK) as an integral part of the Russian Federation (RF), since it is a key resource for the development of a subarctic region. The aim of the work: was to characterize diseases of the mental sphere revealed by the psychiatrist at contingent of patients of the consultative outpatient admission at the 1State Autonomous Health Agency of the Republic of Komi “Consultative and Diagnostic Center of the Republic of Komi” (SAHA RK “CDC”) of the subarctic territory. Materials and methods: The analysis of a continuous sample of 6255 patients of the psychiatrist of the consultative department in 2015-2017 was carried out. on the basis of medical records. Analysis methods included: analytical and statistical. The control group consisted of a continuous sample of 5,356 psychiatric patients in 2010–2012. The depth of the study was 8 years. Discussion: Trends in changes in demographic indicators, including gender and age, in the structure of patients of a psychiatrist in an outpatient consultative procedure are considered. Indicators of the identified pathology of the mental sphere, including the first identified and pathology in patients suffering from epilepsy in comparison with the control group are given. Attention is paid to the organizational and methodological work of an outpatient counseling psychiatrist on the targeted identification by internists of signs of mental pathology in patients referred to a diagnostic center with somatic diseases. Priorities for the improvement of specialized advisory (including psychiatric) assistance to the population of the RK and ensuring its quality were identified. Conclusions: 1. The psychiatrist of the advisory department in 2015-2017. 6255 people were accepted (889 more than in the control group of 2010-2012). The increase was 16.78%. Primary patients account for 64.38% of the total number of people who applied to a psychiatrist (4027 people). 2. In the structure of the psychiatric pathology of the outpatient psychiatric appointment, the proportion of organic, including symptomatic, mental disorders (F00-F09) is 47.9±0.6%; neurotic, stress-related and somatoform disorders (F40-F49) - 39.6±0.6%; mental and behavioral disorders associated with the use of psychoactive substances (F10-F19) - 3.5±0.2%; mood disorders (affective disorders) (F30-F39) - 2.8±0.2%. 3. The most frequently detected pathologies in patients with epilepsy are: 1) Mild cognitive impairment; 2) Personality disorders; 3) Organic emotionally labile (asthenic) disorders. Their share annually accounts for 71.5%-75.8% of all types of nosological forms. The fourth and fifth ranking places are taken by: 4) Organic anxiety disorders; 5) Non-psychotic depressive disorders. Rarely diagnoses are established: “Organic Amnesia Syndrome” and “Dementia”. 4. Organic, including symptomatic, mental disorders prevail in the structure of newly discovered mental disorders; neurotic, stress-related and somatoform disorders (up to 87.7%). Mental and behavioral disorders associated with the use of psychoactive substances and mood disorders (affective disorders) do not exceed 8.4%.

Background: Antidepressant therapy is the most adopted treatment option for depression. The evaluation of cognitive effects related to antidepressant drug use is important for better selection of antidepressant drugs that leads to improved cognitive performance and patient health related quality of life. Aim: The aim of the present study was to evaluate the effects of antidepressant drugs on cognition and memory among patients of depression in Pakistan. Method: A descriptive cross-sectional study design was used. A pre-validated data collection tool Mini Mental State Examination was used. The sample size was calculated to be 382 with 95% confidence interval and 5% level of error. The data was cleaned, coded and analyzed statistically using spss 21. Chi-Square test (p ≥ 0.05) was used to find association among different variables. Results: The results showed that out of 382 respondents, 7.3% (n=28) were being prescribed amytryptyline and among them 46% (n=13) had questionably significant cognitive impairment and 53% (n=15) had mild cognitive impairment. On the other hand out of 23% (n=89) patients on escitalopram monotherapy, 85% (n=76) had impairment of questionably significant impairment and only 13.4% (n=12) had mild impairment. Area of residence and medication therapy were significant variables (p<0.05) that can affect cognition and memory among patients of depression. Conclusion: The results of present study concluded cognitive impairment of questionably significant nature among patients of depression in Pakistan. For the better management of depression, it is recommended that anti-depressant drug therapy should be tailored according to individual patient requirements. 

Background: Polycystic ovary disease (PCOD) is an endocrine disorder. It leads to menstrual disturbances, infertility, obesity and dermatological manifestations such as hirsutism and acne which leads to impaired health-related quality of life (QOL). Aims: To evaluate the perceived health related QOL in patients with PCOD treated with ethinyl oestradiol (35µg)/cyproterone acetate (2 mg) (EE/CPA) and ethinyl oestradiol (20 µg)/ desogestrel (0.15mg) (EE/DES) alone and in combination with low-dose metformin. Methods: A total of 117 patients with PCOD diagnosed according to Rotterdam Consensus Criteria 2003 with a hirsutism score of 8 or more according to modified Ferriman-Gallway Score (mFGS) were randomised to receive one of four drug combinations (arm A – EE/CPA, arm B- EE/DES, arm C- EE/CPA plus metformin, arm D- EE/DES plus metformin). The outcomes assessed were body mass index (BMI), hirsutism (using mFGS) and health-related QOL (Polycystic Ovary Syndrome Health- Related quality of life Questionnaire (PCOSQ) and a Visual Analog Scale (VAS) score) at baseline and 12 months after treatment. Results: PCOSQ score in relation to the hirsutism, emotions, menstruation, obesity, infertility and VAS score in relation to hirsutism and obesity had improved at the end of 12 months (p< 0.001) in all treatment arms. There was no difference between treatment arms in all measured outcomes at baseline and at the end of 12 months. Conclusion: Treatment with EE/CPA and EE/DES is associated with an improvement in perceived QOL in patients with PCOD. The addition of low-dose metformin did not have a significant benefit.

Psychological phenomena of the doctor-patient relationship influence the therapeutic process. Among these phenomena are the transference (the emotions of the patient towards the doctor), and the countertransference (the emotional reactions of the doctor towards the patient). Doctor and patient are within an interactive relationship in a conscious and unconscious way: the patient is influenced by the doctor, and vice versa. Doctor is solely responsible for the control of transference and countertransference, since patients do not have a conscious perception of these phenomena. In general medicine the transference/countertransference have connotations of placebo effect and nocebo. The challenge of the doctor-patient relationship for the doctor is to realize the transference and countertransference phenomena and use them to achieve placebo effects and minimize the nocebo, and also respecting the needs of both parties, so that to improve the quality of clinical practice. Under these conditions, transference and countertransference are auxiliary resources of unparalleled value.

Introduction: Rural populations often experience disparities in health and access to and quality of healthcare. Such disparities may differ among subpopulations. Community outreach events provide an opportunity for rural residents to receive health services and education at reduced or no cost. This project builds on our previous experience with community health fairs by providing health events that target specific underserved subpopulations (rural youth, Latinas, and men). Methods: Our first event provided free sports physicals to area students. The second provided free health screenings to men during an annual agricultural event (Bean Day). The third was a cardiovascular health event for Latinas that featured free or reduced cost health screenings and other health-related and culturally appropriate activities. Results: Thirty-five students received sports physicals, enabling them to participate in sports. Twenty-two Bean Day participants, primarily men, received health screenings; four were hypertensive, three were overweight, and 12 were obese. Over 100 women attended Latina Red Dress and received health services and education. For many in these subpopulations, events such as this provide the only healthcare they receive. During all three events, participants received education regarding any health issues of concern and referrals to local health clinics when appropriate (e.g. hypertension, high glucose levels). Conclusion: Community health events such as these provide culturally appropriate and economical means to deliver health services and education, enabling participants to identify and address any health concerns. Targeting events for underserved subpopulations helped engage them in their healthcare. These findings support the need for effective education and intervention efforts to address physical and mental health concerns in this rural area. This was our first contact with these particular populations whom we know need intervention to receive health care. Moving forward through 2020 and beyond we will have future health fairs in the same groups in order to assess if the health fairs are indeed impacting health of these children, men and minority women. 

Introduction: Intense Pulsed Light (IPL) is the therapeutic tool implemented in the treatment of dry eye, characterized by the emission of waves of 500-1200nm in the region of the upper and lower eyelids. Dry eye is a recurring complaint in ophthalmology offices and has an impact on the patient’s quality of life. It results from dysfunction of the meibomian glands, duct obstruction, and quantitative and qualitative changes in glandular secretion. It is manifested by dryness and irritation, foreign body sensation, burning, tearing, and eye fatigue. The available treatments are short term palliative with unsatisfactory results.

Background: The present study was conducted to study the donor profile and to assess the trends of cornea donation. Methodology: This was conducted as a hospital based cross sectional study at a tertiary care centre in Central India for a period of 5 years. Data was retrieved from 70 patients from eye bank who filled form of eye donation at Eye bank of our institution. Sociodemographic profile of donors, cause of death and time since death was recorded. Source of information regarding corneal donation and reason for not willing to donate the cornea for research purpose was recorded from the filled form. Further cornea enucleated were subjected to serology and their utilization for various purposes were recorded in questionnaire. Results: The present study retrieved data from a total of 70 donor forms with mean age of 65.84 ± 18.4 years. Cornea obtained from younger patients were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/training purpose and the observed difference was statistically significant (p < 0.01). The corneas retrieved and utilized immediately after death were significantly used for optical or therapeutic purposes (p < 0.05). Conclusion: The present highlights the donor profile and trends of corneal donation at the tertiary care facility of Central India. It was observed that though the younger population and older population both are aware regarding corneal donation but still they are less aware on purpose for which cornea can be utilized. Quality of donor cornea is better when death to enucleation time interval was less.

Background: A cracked tooth may be challenging for dentists because it may present with varied intensities, may be asymptomatic, and may still not be clinically visible. The transilumination method can facilitate diagnosis and ensure appropriate treatment in such cases. The aim of the present article was to report a clinical case of an anterior cracked tooth with a nonesthetic class IV restoration. Clinical considerations: A 22-year-old male patient with chief complaint of esthetics of upper front tooth reported a history of dental trauma. Transilumination with a dental curing light unit was used to examine the region. The tooth 11 was diagnosed with several cracks and a nonesthetic class IV restoration. For repair, the universal adhesive system Scotchbond Universal was applied without previous acid etching, followed by the application of Filtek Z350 of color type B2 (for body) above the old restoration, taking care to slightly overlap the fracture line with the composite and to not extend the composite until the incisal margin. Subsequently, a thin layer of Filtek Z350 of color type B2 (for enamel) was applied over the bevel until the incisal margin, and the tooth shape was carved. Conclusion: This case report demonstrates simplified diagnosis of an anterior cracked tooth with transilumination; following repair, the esthetic quality of the restoration was considered satisfactory and approved by the patient.