collection

Introduction: Contraception is a method or device used to prevent pregnancy. In the first year of postpartum period around 65% of women are having unmet need of family planning. Post Placental Intrauterine Contraceptive Device is not only advantageous to the women and couples; even the service providers benefit from PPIUCD. PPIUCD insertion on the same delivery table saves time and separate clinical procedure is not required. Methodology: The Quantitiative Pre-Experimental One Group Pre and Post Test research design was used. 70 Antenatal mothers were selected by using Purposive Sampling Technique who fulfilled the inclusion criteria and who were available during the period of data collection at selected hospital, Puducherrry. Data was collected by using Structured Interview Schedule. Result: The Pre test mean score of Knowledge was 9.98 ± 2.38 and Post Test mean score of Knowledge was 14.91 ± 1.15. The calculated paired‘t’ value was (-20.82) found to be statistically significant at p < 0.001 level. The Pretest mean score of Attitude was 34.67 ± 5.67 and Post test mean score of Attitude was 44.27 ± 4.70. The calculated paired‘t’ value was (-17.25) found to be statistically significant at p < 0.001 level. The Pretest mean score of Acceptance was 0.11 ± 0.320 and Post Test mean score of Acceptance was 0.29 ± 0.455. The paired‘t’ value of t = -3.778 found to be statistically significant at p < 0.001 level. The Demographic and Obstetrical Variables like age at marriage, previous childbirth and decision maker of family about family planning have shown significant association with Post Test level of Knowledge, Attitude and Acceptance of PPIUCD at p < 0.05 and p < 0.001. Conclusion: The researcher concluded that Prenatal Intensive Counselling increases the mother’s Knowledge, Attitude and Acceptance of PPIUCD. So Prenatal Intensive Counselling on PPIUCD can be given to Antenatal Mothers during their antenatal visits to meet the unmet needs of family planning.

Over the last few years, antimicrobial shampoo therapy has been increasingly used to treat skin infections in order to reduce systemic use of antibiotics. This study was aimed to compare the In vitro bactericidal effect of a black currant oil based shampoo (S1) to a chlorhexidine 4% shampoo (S2) against methicillin-sensitive Staphylococcus pseudintermedius (MSSP), methicillin-resistant Staphylococcus pseudintermedius (MRSP), Staphylococcus aureus (SA), Escherichia coli (EC) and Pseudomonas aeruginosa (PA) isolates. A collection of 50 bacterial strains from skin swabs of dogs with superficial recurrent pyoderma was selected: 10 MSSP, 10 MRSP, 10 SA, 10 EC and 10 PA. The two shampoos were blindly tested in duplicate with a microdilution plate method, with scalar concentrations from 1:2 to 1: 256. The MBC was performed for each dilution. A linear regression was used to detect a statistically significance between the two shampoos. All isolates were completely killed at 1:2 up to 1:16 dilution of the two antiseptic products. At the 1:32 dilution the first bacterial growths were observed, in particular for 2 and 4 strains of MRSP by S1 and S2 respectively. The first lethal dilution for SA was at 1:64 for S1/S2 and only for S2 against SP. No significant difference was observed between the two shampoos according to the results of linear regression significant for: i) MRSP, PA and EC (p < 0.05); ii) MSSP and SA (p < 0.1). This study showed that both black currant oil based shampoo and chlorhexidine 4% shampoo have a similar In vitro bactericidal activity.

Purpose: Percutaneous abscess drainage (PAD) is the first-line approach for abscess in Crohn’s disease (CD) since it procrastinates or avoids surgery especially in postoperative abscesses [within 30 days post-operative (p.o.)]. We retrospectively evaluated the effectiveness, complications and outcome after PAD in postoperative and spontaneous abscesses and factors influencing the outcomes. Methods: We performed PAD in 91 abscesses, 45 (49,5%) postoperative and 46 (50,5%) spontaneous. We defined the overall success (OS) as clinical (CS) and technical success (TS) when imaging documented the resolution of the abscess with no surgery within 30 days. Conversely, patients without abscess at the time of surgery, were considered as TS but clinical failure (CF). We also analyzed the overall failure (OF) defined as CF with or without technical failure (TF). Overall technical success (OTS) was OS plus TS. Complications were classified as major and minor according to the Interventional Radiology Criteria. Results: In postoperative abscesses we found 91% OS, 9% OF, no TF and 100% OTS. In spontaneous abscesses we found 33% OS, 67% OF, 6.4% TF, 95,6% OTS. A total abscess resolution was achieved in 97,8% of patients. No major complication occurred; only 1 case of minor complication. Factors statistically influencing the outcome were postoperative vs spontaneous collections (OF: 9% vs. 67%, p < 0.0001), multiloculated vs uniloculated collections (OF: 38% vs. 1%, p < 0.0001) and upper abdominal vs lower location (OF: 13% vs. 25%, p <0.05). Conclusion: Our data confirms the safety and effectiveness of PAD even in cases needing surgery within 30 days; most remarkable, PAD allows avoidance of early reoperation in almost all the patients with postoperative abscess.

Background: Beta 2- micro globulin (β2-MG) is involved in human malignancies. Increased synthesis and release of β2-MG, as indicated by elevated serum, plasma, or urine β2-MG concentration, occurs in several malignant diseases. Objective: The study was designed to assess the role of serum Beta2- micro globulin in the support of the diagnosis of different types of pediatric malignancies. Subjects and Methods: This case - control study was carried out on 137 children and adolescents with newly diagnosed pre-treated malignant diseases who were admitted to pediatric oncology center at Basra Children’s Specialty Hospital, their ages ranged from 3 months to 15 years, during the period from the 1st of November 2014 till the end of October 2015, 71 were males and 66 were females and 148 healthy children and adolescents (83 were males and 65 were females) matched for age and sex regarded as control group. Cases and control characteristics were assessed from data collection by special questionnaire. All patients and control group were investigated for Beta2- microglobulin by the enzyme-linked immunosorbent assay. Results: The study had revealed that level of Beta2-microglobulin was significantly higher in patients with malignancy in comparison to control group, P value < 0.001.Also the serum Beta2- microglobulin level for both hematological malignancies and solid malignancies was assessed and it was found that significantly higher percentage of elevated serum Beta2- microglobulin level was present in patients with hematological malignancies in comparison to solid malignancies, P value <0.01.The study also had revealed that there was a significant correlation between the initial white blood cells count ≥ 50000 cells/ml and abnormal serum Beta2- microglobulin level, P value < 0.01,but there was no significant differences in serum Beta2- microglobulin level in relation to risk groups and immunophynotypes of acute lymphoblastic leukemia ,morphological subtypes of acute myloid leukemia, stages of each type of lymphoma (Hodgkin lymphoma and non-Hodgkin lymphoma) and the histopathological subtypes of non-Hodgkin lymphomas. After subjecting variables (specific to acute lymphoblastic leukemia) to logistic regression analysis, the significant independent risk factor that associated with abnormal serum Beta2- microglobulin level was high initial white blood cells count (≥50000 cells/ml). Conclusion: Serum Beta2- microglobulin level is significantly higher in patients with hematological malignancies and high initial white blood cells count(≥50000cells/ml) .From this study, serum Beta2- microglobulin could be recommended in the initial work up for diagnosis of childhood malignancy.

Background: Intestinal obstruction (IO) is defined as a partial or complete blockage of the bowel that results in the failure of intestinal contents to pass through. It is a common cause of emergency surgical problems. IO has been the leading cause of acute abdomen in several African countries. Objective: To assess surgical management outcome of intestinal obstruction by IESO professionals and its associated factors of intestinal obstruction in surgically treated patients at South Wollo zone. Method: A cross-sectional study was done on 216 patients ‘the data was collected from medical cards of the patient by using a pretested data abstraction format. Three nurses were involved in the process of data collection. The collected data was cleaned, coded and analyzed by SPSS version 23 statistical package. First descriptive statics was done for categorical and analyzed using frequencies and percentage. Multivariable logistic regression models was used to determine the association factors on the management outcome of intestinal obstruction when p - value < 0.05 and the strength of statistical association was measured by adjusting odds ratio and 95% confidence interval. Statistical significance was taken at p - value < 0.05. Results: From all study participants about 177 (82%) of them had good surgical outcome. Study participants who were managed by 1-3 years of work experience of IESO {(p = 0.004, AOR (95% CI) = 7.2[1.89, 27.68]}, preoperatively diagnosed as small bowel obstruction {(p = 0.001, AOR (95% CI) = 4.5[1.91, 10.40], Surgery conducted at day time {(p = 0.03, AOR (95% CI) = 2.8[1.06, 7.16]} had shown positive association with management outcome of intestinal obstruction conducted by IESO professionals. Conclusion and recommendation: Majority patients with intestinal obstruction had good surgical outcome done by IESO professionals. Year of experience of IESO Workers, preoperative diagnosis and time of surgery of the respondents had shown positive association for the occurrence of chronic liver disease whereas. In this study we can conclude that surgeries of intestinal obstruction conducted by IESO professionals are as good as intestinal obstruction surgeries conducted by physicians so there is a need to train more IESO professionals to deliver decentralized surgical service for rural areas.

Background: There is a huge gap in the U.S. health care system when it comes to the prevention of substance abuse and addiction, specifically involving adolescents. It has been determined through literature review that parents in Utah are not informed about/knowledgeable of/aware of the current usage of alcohol/drugs in the adolescent population in this area or the inherent risks involved with consumption/use/misuse/abuse/addiction. Aim: The overarching aim of the doctoral project was to prevent Utah County middle school students from harmful alcohol and drug consumption by involving parents in prevention efforts. The prevention goals of this project included: increased parental knowledge of the brain disease of addiction, warning signs of adolescent drug use, what to do if their child is already using, and increased parental self-efficacy on communicating with teens on this subject. Design: For parents to be productively involved, barriers were broken down through education. The DNP student completed a 15-minute presentation at five separate parent meetings that took place annually during middle school registration at Lehi Jr High. Population: The education was for parents, foster parents, guardians, etc. of first-year middle school students only; an estimated 420 participants were in attendance. Data collection and analysis: A pre-and post- combined self-efficacy and knowledge test was given to the attendees. Data was gathered from 117 appropriately completed tests and analyzed using a paired t-test. The results were studied to evaluate effectiveness of the program relating to parental self-efficacy and knowledge. Findings: The presentation ultimately increased parental self-efficacy and knowledge (p-value <0.01) which in turn increases protective factors and decreases risk factors associated with adolescent substance abuse. Conclusions: The DNP project was successful, and the results assisted in the refinement of the presentation for sharing on a mass level to all Jr. High schools in Utah County, Utah.

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. 

Introduction: In accordance with the requirements for the preparation of a report, a physician must provide information on scientific research in the following sections to obtain a qualification category of a specialist: 6. Scientific and practical work (participation in scientific and practical conferences, medical scientific societies, presentations, publications); 11.2. List of publications of the attested in scientific journals and collections, abstracts and 11.3. List of speeches at international, all-Russian and republican conferences. Material and methods: The analysis of 5 qualification works of a psychiatrist (1997, 2002, 2008, 2013 and 2018) for the scientific component as part of the mandatory requirements for the processing of documents when they are submitted to the Attestation Commission on the assignment of a qualifying medical category in psychiatry . The depth of the study was 24 years. When working on the material, the following methodical approaches were used: system, complex, dynamic, normative, quantitative and situational. Methods of analysis included: historical, analytical and comparison. For the analysis, methods were used: groupings, absolute values, continuous and selective observations. Results: The psychiatrist GAUZ “KDC” independently or in co-authorship published 223 scientific and educational-methodical publications (total volume of 182.65 conventional author’s sheets), including 90 scientific (39.81) and 143 educational-methodical (142.84) works, in including one monograph and eight textbooks (two of them with the stamp of the Ministry of Education of the Russian Federation). In the e-library (www.e-library.ru) of the Russian Scientific Citation Index (RINC): publications - 31; citations - 123; Hirsch index - 3, publications in the journals of the VAK - 13. (https://elibrary.ru/author). Discussion: The scientific work of a practicing outpatient psychiatrist is assessed both quantitatively and qualitatively, the integral indicator of the psychiatrist’s own participation in each publication of 0.78 conventional printed sheets can be considered as a serious personal contribution to scientific research. In the regulatory framework of indicators and requirements for registration of the report there is no synchronization in the daily work of a practical doctor, his job duties with the statements of the report. When concluding an employment contract with the employer, there is no mention in it that the doctor should engage in scientific work, and it is an integral part of his functional duties and qualification requirements. The scientific work does not mention the “Unified qualification directory of positions of managers, specialists and employees, the section “Qualification characteristics of the positions of employees in the field of health care” for a psychiatrist. Conclusion: The attitude to the Administrative Regulations on the provision of a public service for assigning a qualification category to specialists engaged in medical and pharmaceutical activities should be reviewed in terms of synchronization with the duties of a doctor. The Regulation on the compulsory conduct of scientific research should be introduced, substantiated and provided by the employer or be excluded from the administrative regulations as an independent section and be exclusively recommendatory in nature. Publications of physicians in scientific journals and collections, theses of reports should motivate their interest, and within the limits of the possibilities of the medical institution to have reasonable financial support, fixed in the employment contract. An example of a practical doctor who speaks at international, all-Russian or republican congresses, congresses and conferences is an important indicator of his professional growth, an incentive for the disclosure and development of the potential of the medical institution team and the result of proper administrative and organizational-methodological guidance. The scientific work and publications of a psychiatrist’s practical doctor should be a weighty additional argument in favor of a positive decision on awarding the qualification category he has declared.

Background: The proposal that MALDI-ToF mass spectrometry could be used as a direct, rapid and affordable diagnostic tool in clinical laboratory medicine has moved from a theoretical possibility to a reality for Microbiology. Several studies have proposed the application of this technology in obstetric and gynaecological evaluation of patients. In particular, we have proposed that the adoption of MALDI-ToF mass spectrometry in examination of maternal pregnancy urine samples for the detection of Downs syndrome. Methods: A retrospective collection of 20 Down Syndrome and 100 non-aneuploid pregnancy urines at 12 to 14 weeks gestation, collected in 2007-2008 from high risk pregnancy cohorts, were examined by MALDI-ToF mass spectrometry in the mass/charge range between 1000 and 100000 m/z. Normalisation of spectral data was defined using mass bins of 100 m/z expressed as a percentage of the total ion count of the mass spectra from 2000 to 11000 m/z. Of the ninety 100 m/z bins, forty-six were identified as m/z bins at which statistically significant differences in spectra occurred between Downs and control/non-aneuploid samples. Based on the differences and variance, for values at these bins, weighted scores of the probability of being Downs were assigned. Comparative algorithms consisting of various mass bins were tested for ability to distinguish Down syndrome from non-aneuploid pregnancy. Results: Although various algorithms could distinguish Downs from non-aneuploid controls, it was found that gestational age was a confounding factor and that if separated into gestational age matched cohorts the ability to distinguish the groups improved dramatically e.g. whilst a 19 bins algorithm separated 100% of Downs from non-aneuploid pregnancies for a 9% false positive rate in the mixed gestational ages group; a two bin algorithm distinguished 100% of Downs for a 6% false positive rate for the 12 weeks gestational age pregnancies. Conclusion: Normalised MALDI-ToF mass spectra, at 2000 to 11000 m/z, of maternal urine gives rise to gestational age specific screening tests algorithms for Downs’s syndrome.

Introduction: The disease outbreak of COVID-19 has had a great clinical and microbiological impact in the last few months. In the preanalytical phase, the collection a sample from of a respiratory tract at the adequate moment and from the correct anatomical site is essential for a rapid and precise molecular diagnosis with a false negative rate of less than 20%. Materials and methods: We conducted a descriptive study of COVID-19 disease with a persistently negative RT-PCR test in patients seen at the National Institute of Respiratory Diseases (INER) in Mexico City in the period of March through May of 2020. 38 patients were registered with negative RT-PCR test obtained through nasopharyngeal and oropharyngeal swabbing. We evaluated the distribution of data with the Shapiro-Wilk test of normality. The non-parametric data are reported with median. The nominal and ordinal variables are presented as percentages. Results: The average age of our cohort was 46 years and 52.63% were male (n = 20). Diabetes Mellitus was documented in 34.21% (n = 13) of the patients, Systemic Hypertension in 21.05% (n = 8), Obesity in 31.57% (n = 12) and Overweight in 42.10% (n = 16). Exposure to tobacco smoke was reported in 47.36% (n = 18) of the patients. The median initial saturation of oxygen was 87% at room air. The severity of the disease on admission was: mild 71.05% (n = 27), moderate 21.05% (n = 8) and severe or critical in 7.89% (n = 3) of the cases respectively. 63.15% (n = 24) sought medical care after 6 or more days with symptoms. Lymphopenia was documented in 78.94% (n = 30). Median LDH at the time of admission was 300, being elevated in 63.15% (n = 24) of the cases. The initial tomographic imaging of the chest revealed predominantly ground glass pattern in 81.57% (n = 31) and predominantly consolidation in 18.42% (n = 7). The registered mortality was 15.78% (n = 6). Conclusion: Patients with COVID-19 and a persistently negative RT-PCR test with fatal outcomes did not differ from the rest of the COVID-19 population since they present with the same risk factors shared by the rest of patients like lymphopenia, comorbidities, elevation of D-Dimer and DHL on admission as well as a tomographic COVID-19 score of severe illness, however we could suggest that the percentage of patients with a mild form of the disease is higher in those with a persistently negative RT-PCR test.

Background: Colorectal cancer progresses without any symptoms early on, or those clinical symptoms are very discrete and so are undetected for long periods of time. The case reported is an unusual presentation of colorectal cancer. Case Report: A 60 year old man presented with right sided abdominal swelling. On examination, a well-defined, firm, tender swelling was noted. Computed tomography confirmed the presence of a mass arising from the right colon with infiltration of the right lateral abdominal wall and adjacent collection. An exploratory laparotomy with drainage of the subcutaneous abscess, resection of ascending colon, and ileotransverse colon anastomosis was performed. Conclusion: A differential diagnosis of carcinoma colon should be considered when an elderly patient presents with abdominal wall abscess accompanied by altered bowel habits or per rectal bleeding, even if there are no other significant clinical symptoms and a thorough investigative work up is required to confirm the diagnosis, to avoid untimely delay in treatment, and reduce mortality.

Pyogenic liver abscess (PLA) is a life-threatening infection that may develop as a result of an underlying hepatobiliary disease. A possible complication of PLA is metastatic spread, resulting in distant seeding of infection in other organs, and occasionally in the epidural space. Spinal epidural abscess (SEA) is a rare infection with severe potential complications. We describe a 71-year-old patient who presented with ascending cholangitis that was complicated by micro PLA, with a subsequent Escherichia coli bacteremia and metastatic SEA. An emergent surgical intervention with laminotomy and drainage of the epidural collection was performed. The patient was treated with a prolonged antibiotic regimen, with uneventful recovery and no neurologic sequelae. To our knowledge, this is the first reported case of a SEA following E. coli PLA.

Research is the process of searching for knowledge. It is systematic search pertinent information on specific topic of interest. It is a careful investigation or inquiry especially through search for new facts in any branch of knowledge [1]. It is a scientific way of getting answers for research questions and testing hypothesis. The research question is based on uncertainty about something in the population. This can be formulated by searching different literatures from index and non index journals, books, internet, and different unpublished research work etc. A good research question should follow the FINER criteria i.e. Feasible, Interesting, Novel, Ethical and Relevant [2].

Acute pancreatitis is commonly diagnosed clinically, with its classical presentation of upper abdominal pain, backed by raised serum levels of enzymes amylase and lipase. However, unusual presentation of this common surgical emergency as a psoas abscess is a rare finding which can lead to missed diagnosis with a fatal outcome. We present here two such cases of acute necrotising pancreatitis masquerading as psoas abscess, with no classical clinical symptoms and only mildly raised levels of serum amylase and lipase. The region of pancreas involved by necrosis influenced the site of presentation of the psoas abscess. In the first case, acute necrotising pancreatitis involving head and neck of pancreas presented as psoas abscess presenting in the right lumbar region, while the left side collection due to pancreatitis involving body and tail of pancreas manifested as an abscess in left flank. While evaluating the aetiology of a psoas abscess, a differential diagnosis of necrotizing pancreatitis should be kept as a possibility.

Background: Laparoscopic cholecystectomy (LC), is one of the most commonly performed surgical procedures worldwide, it is accepted as the gold standard in the treatment of symptomatic gallstones for its minimal invasiveness, less pain and early recovery. Purpose: To predict the difficulty of laparoscopic cholecystectomy in patients according to the recently published scoring system and select the difficult cases to be done by a senior surgeon. Patients: This is a prospective cohort study. This study took place Oct 6th University Hospital and Kasr El Aini Hospital, Cairo university; the study involved 120 patients admitted with calcular cholecystitis, arranged for laparoscopic cholecystectomy. Methods: Laparoscopic cholecystectomy after applying the scoring system. Results: In our study we found that age, sex and ultrasonographic data were significant predictive factors for assessment preoperatively difficult cases that will be operated upon. We found 14 patients above 50 years who scored to be difficult and very difficult were at outcome difficult, only three patients converted to open surgery over fifty. Conclusion: We can report that obese patient who were over fifty with history of previous upper abdominal surgery and ultrasonographic picture showed thick walled GB and pericholecystic collection had high risk of conversion. At this study scoring system was used for prediction of difficult laparoscopic cholecystectomy sensitivity was 93.75% and specificity was 52.94% of the scoring system at score 5 for prediction of easy or difficult laparoscopic cholecystectomy.

Introduction: Sepsis is an important cause of morbidity and mortality among neonates. Neonatal sepsis can alter the glucose level and both hypoglycemia and hyperglycemia may occur. A high or low blood glucose level may have a significant effect on the outcomes in patients of neonatal sepsis. Aims: The aim of the study to see the glycaemic status and its effect on outcome of neonatal sepsis. Material and Methods: This hospital based prospective observational cross-sectional study was conducted in Neonatal Intensive Care Unit in Universal College of Medical Sciences, a tertiary care hospital over a period of 4 months, from May 2019 to August 2019. A total of 220 Neonates suspected sepsis under the age of 28 days admitted in NICU, were studied and included in our study. Clinically suspected neonatal sepsis cases were enrolled in the study. Venous blood was collected before giving any intravenous fluid, dextrose or antibiotics and blood sugar, complete blood counts, CRP levels and blood culture were send to laboratory within half hour of collection. All patients included in this study were treated accordingly and followed up strictly. Blood glucose level and mortality of neonates having hypoglycemia, hyperglycemia were analyzed among CRP and culture positive patients. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage and comparison carried by Chi-square (χ2) test. Results: A total of 220 patients clinically diagnosed as neonatal sepsis were studied. 118 (53.6%) patients were found CRP positive and 56 (25.5%) patients were blood culture positive. Glycaemic status was analyzed among CRP and culture positive patients. Majority (55.9%) patients were found normoglycemic, 35.5% were found hypoglycemic and 8.6% were found hyperglycaemic in this study. 182 (82.73%) patients were cured and 38 (17.27%) died. Mortality was high in hypoglycaemic patients (34.4%) compared with normoglycaemic patients (9.82%), but the difference was not statistically significant (p > 0.05) between two groups, the mortality was high in hyperglycaemic patients (58.33%) compared with normoglycaemic patients (9.82%) and the difference was statistically significant (p < 0.05) between two groups. Conclusion: Alteration of glycaemic status occurred in septic newborn. Mortality is higher among the septic newborn with hyperglycemia. The present study found that majority of neonate with sepsis had high mortality rate when blood glucose level were either more than 145 mg/dl or less than 45 mg/dl. This signifies the importance of meticulous blood glucose estimation in cases of neonatal sepsis to improve mortality outcome.

Related COVID-19 and new Variant and treatment like vaccine it is relevant to deeply verify the immunologic implication and in a special way regarding the innate immune sensor system and the evasion of the immune system. This can be crucial to search for new strategies to fight this severe disease under a Toxicology-antidotes point of view. The rapid emergence of a new variant is under study by researchers because some of these show different responses to antibodies as reported in literature (vaccine efficacy?). In this article after a review part it is submitted a collection of hypothesis of solution to contrast COVID-19. Spread and mortality and project hypothesis. A new toxicological approach also in a viral respiratory disease can be a novelty to adequately fight this severe condition and this focusing not only towards specific immunity but also a specific measures. A toxicological approach in drug- vaccine like products designing makes it possible to get the clinical outcomes needed.

Managing municipal solid waste correctly is critical to the success of a society. Many regions and countries in the world are behind others in the context of solid waste management. In order to compare three such regions within this context, a meta-analysis was conducted in order to develop a decision matrix. Within this decision matrix, the United States, Europe, and Asia were compared to determine which region is managing municipal solid waste the best. This research design allowed for compiling information from many sources to increase the accuracy of data used in the justifications for the decision matrix. Purposive sampling was used to select and evaluate sources that discuss solid waste management to discern which region’s processes are most favorable in many parameters. The decision matrix consists of nine parameters: main management techniques; finances; landfill taxes; jobs created; waste generation; waste composition; waste storage, collection, and transportation; energy recovery; and environmental health. Each was scored on a scale from zero to ten, ten being the best score and zero being the worst. The final score from the decision matrix suggested that Europe had the most favorable municipal solid waste management (MSWM) system, and the United States had a notably close yet lower score. Asia had the lowest score that was hardly comparable to the other two regions.

Introduction: A patient satisfaction is considered as one of the desire outcomes of health care and it is directly related with utilization of health services. However, its level is falls at the fundamental level in developing countries including Ethiopia. Objective: To assess the level of patients’ satisfaction and its associated factors at Dessie Referral Hospital, Northeast Ethiopia Methods and Materials: An institutional based cross-sectional study design was employed from May 1 to June 1 2019. A total of 374 patients were selected by using systematic sampling technique and interviewer administer structured questionnaire was used to collect data. After data collection, the data were checked for its completeness and entered into Epi data version 3.1. The data were presented in frequency distribution tables and graphs. Both bivariable and multivariable logistic regression were applied to identify factors at a p < 0.05. Result: Among total study participants, 220 (58.8%) patients were satisfied with nursing care service. Patients who had particular nurse for nursing care were more likely satisfied than those who didn’t have particular nurse for nursing care (AOR = 2.01, 95% CI: 1.212 - 3.334). Patients who had other diseases in addition to current health problem were more likely satisfied (AOR = 0.45 & 95% CI: 0.196 - 1.031) compared with patients who had not. Conclusion: In this finding, the level of patients’ satisfaction towards nursing care was low. Having specific or particular nurse and presence of comorbid disease were factors associated with patients’ satisfaction towards nursing care. Health institutions should assign particular nurses for patients to improve their satisfaction and quality of care. In addition, nurses should give great attention to their patients who have co-morbid illnesses.

Objective: This descriptive study was conducted in order to determine body image perception and life satisfaction of individuals undergoing hemodialysis treatment. Material and methods: The population of the study consisted of individuals who were treated in hemodialysis units in the city center of Kırşehir. Patients. The study was conducted with 135 patients. Questionnaire, multidimensional body-self relations questionnaire, and satisfaction with life scale were used as data collection tool. Results: According to study results, total mean scores of MBSRQ were significantly low in individuals who were older than 65, illiterate, had an extended family, were unemployed, had low income, suffered from disease and underwent hemodialysis treatment for 10 years and longer, had arteriovenous fistula in vascular insertion site, had body mass index within the class of morbid obese, and had no planned transplantation. SWLS mean scores of individuals, who were in the age group of 25-34 years, high school graduate, employed, described their income status as very high, had CRF for 6-12 months, underwent hemodialysis for 6-12 months, were waiting for renal transplantation, were significantly high. As a result of the correlation analysis made between body image and life satisfaction, it was determined that there was a positive, quite significant correlation Conclusion: As a result, it was determined that hemodialysis patients were affected by body image and life satisfaction negatively due to many factors and the total score of body image scale was very low.