Three visionaries for HRT
Published on: 15th January, 2021
OCLC Number/Unique Identifier: 8897954469
When a woman consults a doctor about Hormone Replacement Therapy (HRT), the first concern is that there is an increased risk of breast cancer with HRT. And this sole reason might be the reason for refusing the offer of HRT. However, this practice has minimal basis and evidence to support it. Although HRT is an umbrella term, women who have no uterus receive oestrogen-only HRT or Estrogen Replacement therapy (ERT). No valid study has linked ERT with an increased risk of breast cancer [1,2].
Outcome of Patients Presenting with Peripartum Cardiomyopathy in a Tertiary Care Center of Nepal
Published on: 29th May, 2024
Purpose: Peripartum cardiomyopathy is a rare life-threatening cardiomyopathy of unknown etiology with significant maternal morbidity and mortality. It causes heart failure due to left ventricular systolic dysfunction with or without left ventricular dilatation in the last month of pregnancy up to 5 months postpartum in previously healthy women. We aimed to determine short-term outcomes of peripartum cardiomyopathy clinically as well as in terms of left ventricular systolic function and to study the clinical profile and associated risk factors.Patients and methods: A prospective observational study was carried out in the Department of Cardiology of Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Kathmandu, Nepal, from July 2018 to January 2022. All the patients with peripartum cardiomyopathy who presented to the department of cardiology were enrolled in the study and re-evaluated with echocardiography at 6 months.Results: A total of 68 women met the inclusion criteria. The mean age was 28.38 ± 5.5 years (range 19 to 44 years). The most common clinical presentation was dyspnea followed by lower limb edema. Six (8.8%) patients presented during the last month of pregnancy whereas 62 (91.2%) patients presented in the postpartum period. The mean left ventricular ejection fraction on presentation was 30.01 ± 8.54. A full recovery was observed among 60.29% at 6 months. The mortality rate was 4.41%.Conclusion: Timely diagnosis and management of peripartum cardiomyopathy with standard therapy for heart failure leads to better recovery of left ventricular systolic function.
Knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in Addis Ababa, Ethiopia: A cross-sectional study
Published on: 26th September, 2022
Background: Diabetes mellitus is a serious long-term condition with a major impact on the lives and well-being, of societies worldwide. Poor disposal practices of devices potentially result in personal injury and injuries to people in the household and the general community. This study aimed to assess the knowledge and self-reported practice of insulin injection device disposal and associated factors among diabetes patients in TASH, Addis Ababa, Ethiopia. Method: A cross-sectional study was conducted among 182 adults with diabetes. The study participants were selected through systematic random sampling. Data were collected from March/17/2020 - May/18/2020. Patients were interviewed using a structured questionnaire. Data were entered into Epi-data version 4. 6 and exported to SPSS version 25.0 for analysis. Bivariable and multivariable logistic regression with crude and adjusted odds ratios along with the 95% confidence interval was computed and interpreted accordingly. Good practice and adequate knowledge were defined based on median calculation; a result above the median value of good practice and adequate knowledge with a p - value < 0.05 was considered to declare a result as statistically significant.Results: About 54% of the participants had inadequate knowledge about safe insulin injection waste disposal. More than two-thirds (73%) of respondents had poor practice and 92.3% of respondents did not know how to dispose of lancets after use.Conclusion: This study revealed that the knowledge and practice of diabetic patients were inadequate and poor towards safe insulin injection waste disposal in the study area. Educating patients and awareness creation training on proper insulin injection device disposal should be considerable.
Results of a prospective strategy for focused Minimally Invasive Parathyroidectomy (MIP)
Published on: 3rd May, 2023
Neck exploration for primary HPT is the standard operation in which 4 parathyroid glands are identified and one abnormal parathyroid gland is removed. This is recommended for all patients with primary HPT. We hypothesized that most patients with primary HPT have a single abnormal parathyroid gland (adenoma) and parathyroid imaging studies will identify it and support a focused minimally invasive parathyroidectomy (MIP). This can be combined with ioPTH monitoring making bilateral exploration unnecessary. This paper reports a 93.4% success rate in 249 consecutive prospective patients with primary HPT over a 15-year period with a short operating time and few complications. The findings suggest that this alternate surgical MIP approach should be the procedure of choice for HPT patients.
Comparison of GFR measurement with [99mTc]-DTPA and clinical methods based on creatinine measurement, in patients over 80 years old
Published on: 28th September, 2022
OCLC Number/Unique Identifier: 9638982949
Introduction and aim: The most accurate way of measuring kidney function in GFR. Clinical formulas based on creatinine measurement may be inaccurate mainly in elderly patients (over 80 years of age). In this study we evaluated the accuracy of commonly used clinical formulas by comparing them with a direct measurement with [99mTc]-DTPA ([99mTc]-diethylene-triamine-peracetic acid) in a population of patients aged eighty and older.Material and methods: 47 patients (27 males and 20 females) with an average age of 81.9 ± 1.7 years, 80% already diagnosed with Chronic Kidney Disease (CKD), were investigated. Two plasma samples were collected between 60-90 and 165-190 minutes after the injection of [99mTc]-DTPA and GFR were calculated. Results: When comparing the GFR values obtained from the various formulae by creatinine levels with the GFR value obtained by measuring [99mTc]-DTPA residue, the following concordance values emerged: (1) MDRD: 55.3%, (2) Cockroft-Gault 55.3% (3) CKD-EPI 57.5% (4) BIS-1 51.1%Conclusion: Our data show a poor correlation between all clinical methods and [99mTc]-DTPA, which remains a gold standard for the direct measurement of GFR.
Addressing reproductive healthcare disparities: strategies for achieving health equity
Published on: 8th May, 2023
Reproductive health care disparity is a significant public health issue that affects many populations. This disparity stems from various factors, including race, ethnicity, socioeconomic status, geographic location, and education level. Such inequality results in adverse health outcomes such as unintended pregnancy, infertility and sexually transmitted infections among certain populations. Therefore, addressing reproductive health care disparities requires increasing access to affordable and comprehensive reproductive health services, promoting culturally competent care, improving access to family planning services and addressing barriers to care. Furthermore, promoting comprehensive sexuality education and addressing the root causes of inequality are also crucial in eliminating reproductive health care disparities. By addressing these disparities, we can ensure that all individuals have equal access to quality reproductive health care and services, leading to improved health outcomes for everyone.
Experience in optimizing the accessibility of services for tuberculosis in the Republic of Tajikistan
Published on: 13th October, 2022
OCLC Number/Unique Identifier: 9652747316
Many researchers in their publications on tuberculosis (TB) in high-burden countries recommended the integrated work of different ministries and departments with the involvement of non-governmental public associations, volunteers, and activists, including former patients [1-8].
State of the science in diabetic foot: subjective screening vs. objective diabetic neuropathy examination in primary care
Published on: 14th October, 2022
Among the conditioning factors of Diabetic Foot (DF), neuropathy is considered the main factor, arteriopathy the aggravating factor, and foot deformities the triggering factor. The preventive interventions for DF and its complications are distributed by levels of care. At the higher level, hospital care focuses on reducing DF amputations. At the lower level, Primary Care (PC) and Podiatry, focused on preventing DF. PC is considered the ideal place to identify the conditioning factors of DF. In this area, prevention follows the recommendations of the International Working Group on Diabetic Foot (IWGDF) by screening neuropathy focused on the sensitive or insensitive foot. The American Diabetes Association (ADA) a recommends person-centered assessment of neuropathy by clinical examination of symptoms and signs testing sensory, motor, and autonomic neuropathy. This controversy lead us to investigate which methodology (screening or clinical examination) could be more accurate in identifying the conditioning factors of DF in a group of people recruited in the TERMOPIEDI study. Neuropathy was assessed following the definition of diabetic neuropathy, the Young MJ diagnostic criteria, and the Toronto Council diagnostic category. These results allowed us to know the applicability of this procedure in PC within nursing competencies, detecting a greater number of patients with neuropathy compared to the screening method. People with neuropathy presented higher plantar temperature, concluding that neuropathy interferes with foot thermoregulation.
A study on the determination of sex using lip print patterns among indigenes of Akwa Ibom State, Nigeria
Published on: 28th January, 2022
OCLC Number/Unique Identifier: 9406521878
The lip print pattern is the characteristic pattern of the wrinkles and grooves present on the labial mucosa. This study evaluated the determination of sex among indigenes of Akwa Ibom State, Nigeria using lip print patterns. 100 subjects (50 males and 50 females), aged 18-25 years participated in the study. With written consent, lip prints were collected from the subjects. Samples were analyzed using Suzuki and Tsuchihashi classification of lip prints. The lip samples were analyzed as a whole and then divided into six portions Right Upper Portions, Middle Upper Portion, Left Upper Portion, Right Lower Portion, Middle Lower Portion and Left Lower Portion and analyzed differently. Data were analyzed using the Chi-square test and T - test analysis. The result shows that the most prevalent lip print in males considering the lip as a whole is Type I (29%) while that of the females is Type I’ (32%). In six portions, there was a significant difference (p < 0.05) between the lip print patterns in male and female subjects in the Right Upper Portion (25.960), Left Upper Portion (15.455) and Middle Left Portion (19.948) suggesting that these portions can be effectively used for sex determination among these indigenes. There was no significant difference (p > 0.05) between the thickness of lip in males and in females but, the lower lip was significantly thicker (p < 0.01) than the upper lip in both gender. Results also showed that the length of lips in males was significantly longer (p < 0.01) than that of females. This study, therefore, concludes that determination of sex among indigenes of Akwa Ibom State using lip length and lip print patterns in specific portions of Right Upper Portion, Left Upper Portion and Middle Left Portion can be effectively done.
Post-operative agranulocytosis caused by intravenous cefazolin: A case report with a discussion of the pathogenesis
Published on: 18th February, 2022
A case of post-operative agranulocytosis which occurred in a 66-year-old woman following surgery for endometrial carcinoma is reported. The agranulocytosis had a rapid onset, being detected on the first post-operative day. The causative agent, cefazolin was given to the patient intraoperatively. The agranulocytosis persisted until the 22nd postoperative day. A bone marrow biopsy performed on post-operative day four showed a left-shifted myeloid maturation pattern but not a maturation arrest. The pathogenesis of drug-induced neutropenia/agranulocytosis is discussed. It is postulated that reversible binding of cefazolin to albumin accounts for the prolonged duration of agranulocytosis.
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