Neha Mundotiya*, Mukesh Choudhary, Saurabh Jaiswal and Umema Ahmad
Published on: 19th July, 2023
Soil-mixed bodily fluids are the most common kind of evidence at outdoor crime scenes. This biological evidence contains DNA, which is a key component of forensic science’s ability to prove an accused person’s guilt because it connects the victim and suspect to the crime scene and aids in identifying the offender and victim. The yield of DNA is significantly influenced by factors including temperature, humidity, storage environment, time since deposition, etc. DNA degradation is caused by a variety of microbes, bacteria, humic acid, and other substances present in soil. Nowadays for DNA extraction, a variety of commercial DNA extraction kits was used now. This paper’s objective is to compare the efficiency of ten different commercial kits used to extract mixed DNA samples. It has been observed that samples stored at a low temperature (-20 °C) are the best for soil blood mixture samples. Compared to samples paired with other types of soil (silt, clay, and marshland), sand soil had the largest production of DNA using the QIAmp investigator kit (Qiagen). Blood Miniprep kit extractions were mostly inhibited, the control that amplified confirms that this kit was the worst in terms of DNA extraction potency. The samples with fewer dirt particles had a much greater yield of DNA.
Pooja Sharma, Anita Tahlan*, Anshu Palta and Monica Gupta
Published on: 24th July, 2023
Background: The COVID-19 pandemic has resulted in significant burdens globally. Healthcare workers (HCWs), at the heart of the unparalleled crisis of COVID-19, face challenges treating patients and doing testing for COVID-19: reducing the spread of infection; developing suitable short-term strategies; and formulating long-term plans. We aimed to assess the psychological impact of COVID-19 on Laboratory health staff. Material and methods: Between February - March 2021, 72 laboratory staff workers of a tertiary care teaching hospital were invited to fill out a questionnaire regarding concerns and worries about the novel coronavirus pandemic, along with a coping scoring system and General health questionnaire level (GHQ-12) survey. Results: Out of 72 laboratory health staff who completed the survey questionnaire, 10 were faculty members, 17 were residents (including senior residents, junior residents, and demonstrators), 39 were lab technicians, followed by 4 were attendants and 2 were data operators. Laboratory staff workers with an age group range from 30 years - 60 years had a higher level of depression symptoms than respondents with 20 years - 29 years of age. Similarly, the symptoms of anxiety were noted to be significantly higher among female respondents and respondents with age >30yrs. The most frequent concern was transmitting the infection to family than to themselves only. A considerable number of laboratory staff workers utilized online psychological resources to deal with their psychological distress.Conclusion: The findings of this survey recognize the various problems faced by laboratory health workers during the period of COVID-19 which affect their working ability. Therefore, in the future, we have to implement such strategies that enhance the performance of laboratory workers, boost their energy level, and encourage them to take care of themselves, in times of such crisis.
Georgina George Balyorugulu, Emmanuela Ambrose, Patrick S Ngoya, Yusuf S Jamnagerwalla, Iddi S Buri, Primrose Songoro and Protas D Komba
Published on: 28th July, 2023
Background: Stroke occurs in 11% of patients with SCA before 20 years of age. In Northwestern Tanzania, the prevalence of stroke among children living with SCA under the age 15 years is 16.9%, of which might be attributed to the absence of routine screening for the risk of stroke by using Transcranial Doppler Ultrasound (TCD). Screening with TCD allows preventive measures such as chronic blood transfusion to be done which has led to the reduction of stroke by 92%.Methods: This was a prospective analytical cross sectional study which enrolled 267 SCA children aged 2 to 16 years attending Bugando Medical Centre Pediatric Sickle Cell Clinic from July 2019 to June 2020. Assessment of factors associated with elevated TCD included a clinical history of stroke in sibling, death in sibling, temperature, oxygen saturation in room air, blood pressure, hemoglobin level and total white blood cell count. TCD was done by accessing transtemporal window and recording the highest time average mean of maximum velocity (TAMMV) of major vessels mainly, middle cerebral artery (MCA) and distal internal carotid artery (dICA).Results: The median age of enrolled was 6.6 (IQR: 4-9) years. The prevalence of elevated TCD (> 170 cm/s)was found to be 21% (56/267). By multivariate logistic regression, low oxygen saturation in room air, p - value = 0.037, OR 1.08 [95% CI 1.00-1.17] and low hemoglobin level, p - value = 0.001, OR 1.76 [95% CI 1.26-2.45] were statistically significantly associated with elevated TCD among children living with SCA.Conclusion: The high prevalence of elevated TCD velocity, with low hemoglobin and low oxygen saturation in room air as associated factors under multivariate logistic regression, warrants routine TCD screening for children with SCA aged 2 to 16 years.
Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies is an expression of the causal agent in the grafted tissue, are characteristic of chromoblastomycosis. Considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface.The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, coconut and babassu harvesters, lumberjacks, and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, clothes, etc.), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case due to multiple simultaneous inoculations on the back after the patient suffered an accidental fall while working on his farm. The diagnosis was established by direct mycological examination, histopathological examination, culture, microculture, and MALDI-TOF MS analysis that identified the agent of the Fonsecaea pedrosoi.
Laurence Fruteau de Lacos, Andréanne Blanchette, Kadija Perreault, Raoul Daoust, Jacques Lee, Jeffrey J Perry, Marcel Émond, Eddy Lang and Nathalie Veillette and Marie-Josée Sirois*
Published on: 1st August, 2023
Background: Around 75% of seniors seeking treatment for injuries in Emergency Departments (ED) are discharged home with minor injuries that put them at risk of functional decline in the following months. Objectives: To 1) describe seniors’ characteristics using or not physiotherapy services following ED visits for minor injuries and 2) examine their functional status according to physiotherapy use. Methods: Secondary data analyses of the Canadian Emergency Team Initiative cohort study. Participants were 65 years and older, discharged home after consulting EDs for minor injuries and assessed three times: ED, 3- and 6-months. Physiotherapy use was recorded as yes/no. Functional status was measured using the Older American Resources Scale (OARS). Multivariate linear regressions were used to examine change in OARS scores over time, accounting for confounders. Results: Among the 2169 participants, 565 (26%) received physiotherapy, and 1604 (74%) did not. Physiotherapy users were more likely females (71% vs. 64%), more educated, and less cognitively impaired. The overall change in OARS at 6 months was -0.31/28 points (95% CI: -0.55; -0.28) with no difference across groups after adjustment. Subgroup analyses among frail seniors showed that physiotherapy users maintained their function while non-users lost clinically significant function (-0.02 vs. -1.26/28 points, p = 0.03). Among the severely injured (Injury Severity Scale ≥ 5), physiotherapy users’ results were higher by almost 1/28 points (p = 0.03) compared to non-users. Conclusion: These results suggest that among seniors discharged home after consulting the ED for minor injuries, the frail and severely injured may benefit from being systematically referred to physiotherapy services.
Adnan Yaqoob*, Rafat Jan and Salma Rattani and Santosh Kumar
Published on: 4th August, 2023
Introduction: Nursing theories are critical as they drive nursing education, practice, and research. Neuman Systems Model (NSM) considers a person a complete system with integrated psychological, physiological, spiritual, social, and developmental components. Nurses give their patients physical, emotional, and psychological assistance and are subjected to mental and physical pressure due to these responsibilities, impacting their health, psychological well-being, and interpersonal relationships. This paper aims to perform a concept analysis of stressors proposed in NSM about lines of defense and the level of preventive interventions that can affect a person’s well-being. Further, this paper discusses knowledge generation through NSM’s applicability to preventing exhaustion and burnout among nurses. Methodology: This theoretical attempt is carried out using the theory analysis approach suggested by Walker and Avant (2019).Discussion: Nursing is a career that requires a great deal of dedication and personal engagement. Nurses are subjected to recurrent stresses due to technological advances and rising demands. Burnout occurs when nurses get discouraged and have less compassion for the patients due to recurrent burdens. Stress and burnout are two of the most common reasons for nurses to quit hospitals. The NSM is concerned with stresses that may affect a person’s health and well-being (prediction). Nurses assist patients at the most vulnerable and challenging times, such as surgical procedures, traumas and personal and physical losses.Conclusion: The NSM enables the investigation of preventative and protective treatments. Because of the model’s flexibility, it may be used in a wide range of nursing situations. Administrative, hospitals, clinics, and other nurses can benefit from this paradigm. Evaluating the many distinct elements contributing to burnout is also feasible. The model’s client factors of physiological, sociocultural, developmental, and spiritual characteristics are used to achieve this. Viewing the individual as an open system that responds to environmental stimuli encourages the existence of stressors that might lead to burnout.
Laleye Flora Tinouade Founmilayo* and Fanou Fogny Nadia and Kayode Polycarpe
Published on: 10th August, 2023
In developing countries, malnutrition represents a public health problem, which affects many children under five, during their complementary feeding period. One way to overcome this problem is through the supplementation of complementary flours with locally available food resources, such as Moringa oleifera leaf (MOL). An experimental study was conducted from June through November 2019 in the southern-Benin, with moderately acutely malnourished (MAM) children, using a porridge made of a mixture of corn, malted sorghum, soybean, peanut, milk, and moringa leaf powder. A total of 150 MAM children aged 12-59 months were recruited and divided into two groups, an intervention group (48) and a control group (75). The intervention group received the test food, a porridge made of maize flour supplemented with Moringa oleifera leaf flour (MOL-flour), at least 5 times/week for 6 months. The control group, whose mothers received nutritional education sessions on food diversification as well as the different ways of preparing MOL meals. Sensory evaluation, anthropometric and dietary diversity data were collected. Z-scores Weight/Height, Weight/Age et Height/Age were determined before and right after the intervention. Results showed that 70% of the children and more than 75% of the mothers assessed the porridge as palatable. A significant average weight gain of 1.720 g (p < 0.005) was observed in the intervention group at the end of the experimentation, with a reduction of the prevalence of underweight by 1,33% (p > 0.05), and the number of acute Malnutrition children by 10,42% (p < 0.005).
During this period of time, mushroom experience changes in functional aspects and consumption areas. Due to its magnificent role in promoting health, it was considered one of the most healthy sources of food. Agaricus spp., Marcrolepoita spp., Auricularia spp, Armillaria spp, Pholoita, Hericium, Grifola spp, Flammulina, and Hypsizygus spp. are some most commonly consumed mushrooms in the world. They provide inexpensive means of nutritious and tasty food worldwide. However, ancient people are also very much aware of their holistic function towards health and that was why they used mushrooms for medicinal purposes in the past onwards. Mushroom plays an important role in the treatment of some lethal diseases like cancer, inflammation, autoimmune disorders, allergy, hypertension, arthritis, hyperglycemia, atherosclerosis, and many more. Meanwhile, researchers still focus on other functions of mushrooms in health science and also explore their anticancerous activity. However, many findings are left to be found in the future. This review paper throws light on the various important mushrooms and their functions related to human health, and also ongoing research towards treating some critical diseases.
Daniel Moore-Palhares, Murtuza Saifuddin, Ling Ho, Lin Lu, Archya Dasgupta, Martin Smoragiewicz, Irene Karam, Andrew Bayley, Arjun Sahgal, Ian Poon and Gregory J Czarnota*
Published on: 24th August, 2023
Background and aim: Preclinical in vitro and in vivo experiments suggest that radiation-induced tumour cell death can be enhanced 10- to 40-fold when combined with focused-ultrasound (FUS)-stimulated microbubbles (MB). The acoustic exposure of MB in the tumour volume causes vasculature perturbation, activation of the acid sphingomyelinase (ASMase) ceramide pathway, and resultant endothelial cell apoptosis. When the tumour is subsequently treated with radiation, there is increased endothelial cell death and anoxic tumour killing. Here we describe a first-in-human experience treating patients with magnetic resonance (MR)-guided FUS-stimulated MB (MRgFUS+MB) radiation enhancement.Case presentation: A head and neck cancer patient with recurrent disease underwent radiotherapy for 5 separate sites of locoregional disease followed by systemic therapy. The first consisted of a course of 45 Gy in 5 fractions alone, the second of 30 Gy in 5 fractions with hyperthermia, and the three others of 20-30 Gy in 5 fractions along with MRgFUS+MB treatment. The treatment methodology used an MR-coupled FUS-device operating at 500 KHz and 540 kPa peak negative pressure with an insonification time of 750 ms spread over 5 minutes to stimulate intravenously administered MB within tumour target. All sites treated with stimulated MB had a complete radiological response, and subsequently, the patient’s other cutaneous metastatic disease disappeared. The patient has been under surveillance for over two years without active treatment or disease progression.Discussion: MRgFUS+MB was well-tolerated with no reported treatment-related adverse events, which can be attributed to the capability of FUS to selectively stimulate MB within the tumour volume while sparing the surrounding normal tissue. Sustained local control at all target sites aligns with earlier preclinical findings suggesting the radiation enhancement potential of FUS+MB.Conclusion: MRgFUS+MB represents a novel and promising therapy for enhancing radiation efficacy and improving therapeutic index with potential improvements in disease control.
Recently, many studies on the molecular activity of compounds have been carried out using simulations through computer programs or in silico simulations. Anthocyanins are one of the compounds that are often used as food coloring agents and can function as antioxidants to prevent blockage of blood vessels, as an anti-cancer that can prevent the development of cancer cells and tumors and have anti-inflammatory effects. The purpose of the research is to determine the stability of anthocyanins using molecular simulations and determine the best mixing sequence of ingredients to produce the most stable anthocyanin mixture. Based on the results of the simulations carried out, it can be proven that the final 3 sets (the modeled compound belonging to namely AP and AZ followed by a number based on the simulation order) selected are AP17, AP18, and AZ17. The AP17 set had the lowest potential energy at the end of molecular dynamics simulations, but molecular visualization showed structural instability indicated by the formation of gaps in the molecular conformation. The AP18 set had the second lowest potential energy at the end of molecular dynamics simulations and molecular visualization showed molecular conformation that tended to be stable during molecular simulations with no change in structure. The AZ17 set had the highest potential energy of the final 3 sets selected and molecular visualization showed a gap in the conformation at the beginning of the simulation, but over time the gap became denser, indicating that the molecule became more stable over time. Based on the research results, the AP18 set was chosen because it has relatively low potential energy and it can be proven that the structure visualization of this set tends to be more stable over time during molecular dynamics simulations.
The cosmetic industry is searching for new active ingredients from renewable natural sources to make more environmentally friendly and safe products. Botanical extract is a nearly limitless source of these new actives due to the current consumer demands as well as international regulations. Due to both their fragrant nature for the creation of fragrances and perfumes and the numerous advantageous properties of their individual components (EOCs), such as anti-inflammatory, antimicrobial, and antioxidant properties, essential oils (EOs) emerge as a very common natural ingredient in cosmetics and toiletries. Additionally, nowadays, the cosmetic industry includes EOs or different mixtures of their individual components (EOCs), either as active ingredients or as preservatives, in various product ranges (e.g., moisturizers, lotions, and cleansers in skin care cosmetics; conditioners, masks or anti-dandruff products in hair care products; lipsticks, or fragrances in perfumery). However, because each essential oil’s distinct chemical profile is linked to a different set of advantages, it is challenging to generalize about how they might be used in cosmetics and toiletries. Formulators frequently spend time looking for appropriate combinations of EOs or EOCs to achieve particular advantages in the finished products. The literature on the most recent developments in the use of EOs and EOCs in the production of cosmetic products is updated in this work’s review of the literature. Additionally, certain particular issues pertaining to the security of EOs and EOCs in cosmetics will be covered. It is expected that the information contained in this comprehensive review can be exploited by formulators in the design and optimization of cosmetic formulations containing EOs.
Adetunji OMONIJO*, Paul OLOWOYO, Azeez Oyemomi IBRAHIM, Segun Matthew AGBOOLA, Oluwaserimi Adewumi AJETUNMOBI, Temitope Moronkeji OLANREWAJU and Adejumoke Oluwatosin OMONIJO
Published on: 19th September, 2023
Background: Spirituality has been strongly associated with good blood pressure control as it forms a strong coping mechanism in hypertensive patients. This hospital-based cross-sectional study was done to determine the relationship between spirituality and blood pressure control among adult hypertensive patients in rural Southwestern Nigeria to achieve good blood pressure control.Method: The selection was done by systematic random sampling technique. Socio-demographic and clinical information were obtained through semi-structured interviewer-administered questionnaires. The level of spirituality was assessed using the Spiritual Perspective Scale. Data were analysed using the Statistical Package for Social Sciences version 20.0. Statistical significance was set at p ≤ 0.05.Results: The mean age of the respondents was 61.1 ± 11.1 years. More than half (52.6%) had a high level of spirituality and more than two-thirds (67.1%) of respondents had controlled blood pressure. Respondents with a high level of spirituality were 4.76 times more likely to have good blood pressure control {p < 0.001, 95% CI (1.05-14.99)} than those with a low level of spirituality. Conclusion: Proper understanding and effective utilization of this relationship will assist health professionals and researchers in the appropriate integration of this concept into patients’ holistic care with the aim of achieving better blood pressure control among hypertensive patients.
Zahra Kmira*, Sassi Nedia, Ben Yahia Noura, Ben Sayed Nesrine, Greisha Ahmed, Mootameri Wided, Bouteraa Walid, Zaier Monia, Ben Youssef Yosra, Brahem Nejia, Haifa Regaieg and Khelif Abderrahim
Published on: 20th September, 2023
Introduction: Factor VII (FVII) deficiency, a rare bleeding disorder, can manifest as an autosomal recessive congenital or an acquired coagulopathy. Acquired FVII deficiency, although infrequently reported, presents unique challenges in understanding its mechanisms and identifying underlying causes. Case presentation: We present a case of acquired FVII deficiency discovered in a 23-year-old female patient with no apparent underlying disease. The patient exhibited spontaneous ecchymosis and gingival hemorrhage, along with low FVII activity and isolated prolongation of prothrombin time. Extensive laboratory investigations excluded liver dysfunction, familial deficiency, vitamin K deficiency, and inhibitory antibodies. Prompt treatment with Fresh Frozen Plasma (FFP) and bypassing agents resulted in a favorable response and resolution of hematomas. Conclusion: Acquired FVII deficiency was identified with bleeding symptoms in association with prolonged prothrombin time and a low level of FVII activity. In literature, this deficiency has been associated with various conditions such as sepsis, aplastic anemia, stem cell transplantation, and neoplasms, although approximately 14% of cases remain idiopathic. Clinical outcomes remain generally poor, with limited complete remissions reported.
Nikolaos Ntertsos, George Christantoniou, Krystallia Kyrka, Persefoni Pezirkianidou, Vasileios Bikos, Papadaki Konstantina and Theodora Tsiouda*
Published on: 25th September, 2023
As the introduction of immune checkpoint inhibitors in the treatment of various cancers is now proven to be already acquired knowledge, so does a new challenge arise for clinicians; the understanding, diagnosis, and management of the rarest adverse effects of immunotherapy. We present a case of type-1 diabetes Mellitus (T1DM) in a patient with non-small cell lung carcinoma (NSCLC) treated with pembrolizumab. Following ten cycles of treatment, our patient was diagnosed with T1DM after being admitted for diabetic ketoacidosis and stayed hospitalized in the ICU. Later, they continued treatment with insulin, having shown disease response to pembrolizumab, and resumed immunotherapy while on insulin. Immunotherapy-induced T1DM can sometimes occur with PD1/PD-L1 blockage therapies. It has a rapid onset, is characterized by insulin deficiency due to the autoimmune destruction of beta-cells, and usually presents itself with diabetic ketoacidosis. Unlike most of the other adverse effects of immunotherapy, glucocorticoids don’t seem to be of therapeutic value, and insulin substitution is required. Regular glucose monitoring can be key to early diagnosis and prevention of hospitalization.
M Larissa Weirich*, Carolyn R Larkins, Wendy Y Craig, Emily Meserve, Terri Febbraro, Jason Lachance and Leslie S Bradford
Published on: 4th October, 2023
Objective: To explore the pathologic response rate to primary progesterone treatment in patients with Endometrial Intraepithelial Neoplasia (EIN) and early-stage endometrioid-type Endometrial Adenocarcinoma (EAC).Methods: Retrospective chart data were collected for patients with either EIN or EAC receiving primary progesterone treatment between 2015 and 2022. The presence of complete or partial response, time to response, and other demographic and treatment factors were recorded to determine independent predictors of response to progestin treatment.Results: In total, 112 women who were diagnosed with EIN or EAC were treated with upfront progestin therapy, of whom 79 had sufficient follow-up to assess response. Fifty patients (63%) responded, of whom 10 (20%) ultimately relapsed. Response was more robust among patients with EIN (79%, n = 33) compared with patients who had cancer (46%, n = 17). The median time to respond was 5.8 months overall. Diagnosis of EIN, younger age at diagnosis, and any pathologic evidence of progesterone effect were all predictors of treatment response. Younger patients had a significantly shorter time to partial or complete response with a median time to response of 5.9 months in patients ≤ 45 and 13.8 months in patients > 45. Conclusion: Our study demonstrated a lower overall response rate (63%) than reported in previous studies, especially for patients with cancer (46%). Younger patients had a significantly shorter time to respond than older patients. Pathologic progesterone effect observed at any time during treatment was a significant predictor of treatment response regardless of diagnosis and could serve as an early predictor of response to therapy.
Aim of study: In terms of treatment, it is essential to consider the correct use of preservatives and epoxy resin. Lumber pretreated with these substances can protect the wood from biodegradation or insect attack for exceeding three-year life expectation periods.Methods: To further increase durability and structural integrity, Posttreatment like painting or lamination on wood surfaces helps keep moisture out and carries a higher yield compared to traditional methods. In addition, chemical treatments to make timber resistant to fungal infestations as well has been gaining traction recently which makes it possible for lumber to be used in even more applications safely than ever before. Results: Thus, proper treatment plays a major role when considering the implications of using lumber as a resource both structurally and functionally over time. Conclusion: Lumber remains one of the most sought-after resources due to its versatility; likewise finding ways how impart maximum longevity necessitates research into new treatments available so that we can optimally exploit such abundant supplies without compromising the durable nature of good quality timber source.
Elsayed Elshamy*, Abdelbar Sharaf and Abdelhamid Shaheen
Published on: 10th October, 2023
Purpose: To compare between the two commonly used methods to deliver the fetus in emergency cesarean section with fully dilated cervix and impacted fetal head; vaginal push up of the fetal head and reverse breech extraction regarding safety and efficacy.Methods: A retrospective observational study was conducted 152 women underwent emergency CS with fully dilated cervix and impacted fetal head were divided into two groups; Group 1, vaginal push (n = 96) and Group2, reverse breech delivery (n = 56). Data variables were collected and analyzed to evaluate whether either method is more safe regarding maternal and fetal outcomes.Results: There was a significant higher percentage of extension of uterine incision in group 1 (p = 0.002). Also, there were significant higher mean values of operative time and operative blood loss in group 1 (p = 0.008 and 0.015; respectively). On the other hand, there was a significantly shorter uterotomy to delivery time in group 1 (p < 0.001). There was a significantly higher mean value of APGAR score at one minute in group 1 (p = 0.043) but no significant difference between the two groups regarding APGAR score at five minutes, atonic PPH, postoperative blood transfusion and hospital stay.Conclusion: Vaginal push technique was associated with significantly higher intraoperative maternal morbidity but postoperative maternal morbidity and fetal outcomes were comparable between both groups. Push method (after uterine incision) is still the preferable method and larger studies are required to assess the fetal safety with reverse breech extraction.
Amin Darroudi*, Ali Abbasi and Masoud Shayestehazar
Published on: 17th October, 2023
Introduction: Treatment failure and claims against physicians may have many negative consequences. Orthopedic surgeons have always been among the most used specialists. Therefore, the investigation of causes and the process of these claims can help reduce the negative effects of medical malpractice on physicians and society.Materials and methods: This retrospective study investigated all medical orthopedic negligence cases in Sari, Iran, from March 2015 to March 2020. Data were collected using a researcher-made checklist and analyzed in SPSS software (V-21).Results: Out of 57 finalized cases investigated in this study, surgeons were found liable in 23 (40%) cases. The mean ± SD age of patients was 41 ± 19.3. Moreover, the level of education had a positive correlation with the surgeon’s liability. The most common cause of complaint was reduced Range of motion (ROM) and the most common type of complained surgery was “open reduction & internal fixation” (ORIF). None of the surgeons were found liable due to surgical site infection or device failure. The mean ± SD time for the file processing was 11.1 ± 10.1 months. The mean indemnity payment was 320 million Iranian Rials (9.7% of indemnity for death in Iran).Conclusion: The most effective way to reduce medical complaint cases is to increase the knowledge and skill levels of physicians. The lack of a blinded arbitration system in both organizations could lead to bias in the case assessment process. Moreover, considering the long processing time of the claims, it is recommended that new technologies should be used to reduce the time and increase the accuracy of the final verdict. The absence of a ‘no-fault’ compensation program is a significant flaw in Iran violating patients’ rights. Also, more studies are needed to evaluate justice and equality in Iranian medical commissions.
Iratxe Gonzalez-Mendibil*, Eduardo García-Pascual, Ane Villanueva and Susana García-Gutiérrez
Published on: 24th October, 2023
Background: Clinical practice guidelines recommend monitoring the depth of anesthesia during endoscopic examination of the gastrointestinal tract using sedation scales, despite their subjective nature, while the use of the bispectral index, an objective measure, during sedation, remains controversial. The main objective of this study was to assess the ability of bispectral index monitoring to characterize the depth of anesthesia during endoscopy.Methods: We conducted a cross-sectional study to assess the performance of the bispectral index using data from a multicentre clinical trial with 180 patients undergoing scheduled colonoscopies. Sedation was monitored using the bispectral index and Ramsay Sedation Scale. Data on sedation were recorded at five-time points (t1 to t5) during the colonoscopy.Results: Bispectral values were significantly associated with Ramsay scores (rho, -0.73; p < 0.0001). In regression analysis, each unit increase in bispectral value was associated with a reduction in the risk of a high Ramsay score (> 3) at all points (OR 0.922; 95% CI: 0.865–0.979; p < 0.0001 at t1). Receiver operating characteristic curve analysis found areas under the curve of 0.8272 for a bispectral index cut-off for deep sedation of 69.76 (sensitivity, 95.35%; negative predictive value, 97.53%) when reaching the colic flexure (t2) and 0.8399 for a cut-off of 69.29 (sensitivity, 96.15%; negative predictive value, 98.81%) at the end of the colonoscopy (t5).Conclusion: Bispectral index monitoring enables objective real-time reliable assessment of sedation. It enables easy continuous monitoring with a very good performance for detecting deep sedation and correlates with a clinical scale routinely used in endoscopic procedures.
Zahra Zahid Piracha, Haider Ali, Noor ul Huda Rasheed, Umar Saeed*, Syed Shayan Gilani, Umer Ali Abbasi, Qasim Khan, Elyeen Noor and Seneen Noor
Published on: 13th October, 2023
Monkeypox is a rare zoonotic infection originating in the regions of Central and West Africa. The global threat has been arising since monkeypox is spreading outside of the endemic regions. Pakistan has recently exhausted health funds in a quarrel against SARS-CoV-2, by supplying expensive COVID-19 vaccines to the general public, free of cost. Pakistan’s government has remarkably contributed to lowering the suffering of COVID-19-affected patients by granting the Sehat Sahulat Programme and similar health initiatives to restrict viral propagation in the general public. However, despite all efforts the major constraints are a lack of international funds and limitations on the budget of healthcare systems and medical facilities. Newly emerged cases of monkeypox are very threatening to Pakistan’s economy and health. Therefore, it is very necessary that healthcare authorities take effective measures like surveillance, early identification, separation, monitoring of contacts, immunization, and public awareness in order to stop the spread of the virus and control monkeypox outbreaks.
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Nataliya Kitsera
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Zehra Guchan TOPCU
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