General medicine

s: Background & Aim: Hematopoietic system is another organ seriously affected by tuberculosis. The hematological changes sometimes act as useful factors providing a clue to diagnosis, assessing the prognosis, indicating the complication of underlying infection as well as therapy and response to therapy. Aim is to study the various hematological parameters in Z-N positive pulmonary tuberculosis patients. Methodology & Results: Present study was conducted on hematological parameters in pulmonary tuberculosis patients in the department of Pathology in MM institute of Medical Science and Research, Mullana, Ambala. The study was conducted for a period of one year from March 2013 to march 2014. Total numbers of 80 subjects were selected of Z-N positive and changes were compared with normal hematological parameters. The testing protocol was followed in the hospital laboratory. Result: showed decreased values of hemoglobin (Hb), red blood cell (RBC), packed cell volume (PCV), mean cell volu...

Background: Seizure is the most frequently observed symptom of neurological disorders and an important determinant of outcome during neonatal period. In clinical practice, it is prevalent and observed in neonates admitted to hospital in low-resources countries, but due to the paucity of studies in these regions, little is known about its pattern, clinical outcomes of hospitalization, and its predictors. Therefore, aims to evaluate seizure patterns, clinical outcomes, and its predictors among neonates admitted to the NICU of ACSH, Mekelle, and Tigray. Methods: A hospital-based cross-sectional study design was conducted among neonates with neonatal seizures admitted to NICU of Ayder Comprehensive Specialized Hospital. Data collection was done from record reviews. SPSS Version 25 was used. Descriptive statistics and bivariate logistic regressions where a p-value of <0.05 is considered statistically significant. Results: Out of 1622 NICU admissions, 155 (9.6%) were cases of neonatal seizure. The most frequently observed types of seizure in this study were subtle 70 (45.1%) and tonic 49 (31.6%) respectively. At the end of hospitalization 70.3% of neonates were discharged improved, 21.3% of neonates died and 8.4% of neonates had severe neurologic deficits. Poorly controlled seizures (AOR 4.8, 95% CI 2.6-9.2), prolonged duration of labor (AOR 4.3, 95% CI 2.2-8.8) and seizure onset <72 hours (AOR 3.7, 95% CI 1.6-8.5), respectively, were found to be independent predictors of poor neonatal outcome. Of all neonatal admissions, neonatal seizure was observed in close to 9.6%. The most frequently observed type of seizure was subtle. Of those admitted neonates, 30% had poor outcomes following the end of their hospitalization or when they leave against medical advice for lack of improvement). Poorly controlled seizures, prolonged duration of labor, and seizure onset <72 hours were independent predictors of poor neonatal outcomes.

Hospital-acquired infection (HAI) is a significant cause of increased morbidity and mortality amongst hospitalized patients and represents a considerable health and economic burden worldwide. However, evidence about HAI in pediatric ICU is limited. Objective: To identify the prevalence of hospital-acquired infection (HAI), clinical profile, and its risk factors for nosocomial infection in patients admitted to the pediatric intensive care unit (PICU). Methodology: From a two-year retrospective chart review admitted from 2019 to 2020 to the PICU, 223 patients were selected by systematic random sampling. Data were analyzed in SPSS version 23.0. P-values <0.05 were considered significant for all tests. Results: Forty-five (20.2%) patients developed nosocomial infection (NI). The median age was 4 years with 25-50th IQR of (0.6-9). About invasive procedures done, the most common was nasogastric tube (57%), followed by mechanical ventilation (17.9%) and urinary catheter (13.9%). The main focus of the infection was chest (53.3%), followed by bloodstream infection (22%) and gastrointestinal infection (9%). The odds of HAI were 3.3 times higher among under-five compared to those aged between 5 and 18 years (AOR: 3.3, 95% CI = 1.4-8.0, p = 0.008). The odds of HAI were also 4.1 times higher in those who stayed for more than two weeks compared to those who stayed in the pediatric ICU 2 to 14 days (AOR: 4.1, 95% CI = 2.0-8.6, p < 0.001). The mean duration of mechanical ventilation in those patients with and without NI was 1.65 days and 13.96 days, respectively (AOR = 3.46, 95% CI = 1.44-9.81, p = 0.02). Patients who started antibiotics at admission and patients who were on nasogastric tube feeding were also statistically significant risk factors for developing NI (AOR = 2.67, 95% CI = 1.37-9.64, p = 0.02; AOR = 2.45, 95% CI = 1.64-6.53, p = 0.03). The rate of infection in this study was higher compared to some developing countries. Younger age and prolonged length of hospital stay were found to be significant risk factors for HAI.

The coexistence of undernutrition, overweight, and obesity within the same households and populations is recognized as the Double Burden of Malnutrition (DBM). A paradigm shift thinking is needed to mitigate its impact. School adolescents are the most vulnerable groups to DBM. However, lived experiences and perceptions on prevention, causes, and consequences of DBM were not well studied. Therefore, this study aims to explore the lived experiences and perceptions of adolescents about the prevention, causes, and consequences of DBM in Ethiopia. Methods: A qualitative research method using phenomenology design was conducted among 20 purposively selected participants from private and government schools from June 3 to July 10, 2022. The further sampling process was guided by a saturation of ideas. In-depth and key informant interviews were conducted to collect the data. The most recent version of Open code 4.03 was utilized to generate meaningful codes, subthemes, and themes. The results were displayed using thematic analysis and respondents' well-spoken verbatims. The study explored the perceptions of adolescents on the causes, prevention, and consequences of DBM. The main causes of DBM identified were poor dietary and drinking habits, poor knowledge and attitude about nutrition, low financial income, unemployment, food insecurity, poor feeding culture, physical inactivity, poor food management, educational and school-related issues, nationalrelated issues, frequent use of ultra-processed foods, and frequent out of home eating. The majority of students were not aware of how DBM will affect their health and academic performance over the long run. The findings showed that despite school adolescents' variations in knowledge, lived experience, attitude, and perceptions, most of them have a poor understanding of the causes, consequences, and prevention mechanisms of the double burden of malnutrition. The results suggest the need for instituting double-duty interventions that have a double impact on the prevention of DBM.

We recently indicated that patient age on its own is not a determinant of quality of allied health care received after an acute stroke. It has not been tested whether other non-age variables influence care decisions made by allied health professionals. This paper explores demographic and stroke-related variables that are putatively associated with the quality of care provided to acute stroke patients by allied health professionals. Methods: Data were retrospectively audited from 300 acute stroke patient records regarding allied health care. Compliance with each of 20 indicators of allied health care quality was established. The influence of various demographic and stroke-related variables on each performance indicator was examined. We undertook a series of analyses using univariate logistic regression models to establish the influence of these variables on care quality. Results: Patient age had a significant correlation with only one process indicator (early mobilization). Seven variables, including stroke severity and level of dependence, were associated with patient age. The majority of these age proxies had significant associations with process indicator compliance. Correlations between non-age variables, in particular stroke severity and comorbidity, suggest the potential for complex confounding relationships between non-age variables and quality of allied health care. Compliance with individual indicators of allied health care was significantly associated with variables other than patient age, and included stroke severity, previous independence, comorbidities, day of admission, stroke unit admission, and length of stay. The inter-relationships between these non-age variables suggest that their influence on quality of care is complex.

Use of procurement biopsies in deceased donor kidney acceptance is controversial. We analyzed Scientific Registry of Transplant Recipients data (n = 59,328 allografts, 2014-2018) to describe biopsy practices across US organ procurement organizations (OPOs) and examine relationships with discards, using hierarchical modeling to account for OPO and donor factors. Median odds ratios (MORs) provide medians of the odds that allografts with identical reported traits would be biopsied or discarded from two randomly drawn OPOs. Biopsies were obtained for 52.7% of kidneys. Biopsy use rose in a graded manner with kidney donor profile index (KDPI). Biopsy rates differed significantly among OPOs (22.8% to 77.5%), even after adjustment for KDPI and other donor factors. Discard rates also varied from 6.6% to 32.1% across OPOs. After adjustment for donor factors and OPO, biopsy was associated with more than 3 times the likelihood of discard (adjusted odds ratio ( 95%LCL aOR 95%UCL ), 3.29 3.51 3.76 ). This association was most pronounced for low-risk (KDPI <20) kidneys (aOR, 5.45 6.47 7.69 ), with minimal impact at KDPI >85 (aOR, 0.88 1.15 1.51 ). Adjusted MORs for kidney discard and biopsy were greatest for low-risk kidneys. Reducing the rate of unnecessary biopsy and improving the accuracy of pathologic findings in higher-KDPI organs may help reduce graft discard rates.

Objectives: To gather data and investigate if ownership and duration of using electronic devices determines the weight status in an urban Saudi school-aged child. Methods: A multicenter, cross-sectional study conducted in Riyadh, Saudi Arabia between December 2015 and March 2016. A total of 1023 child were randomly selected, aged 9.00 to 11.99 years. The participants were divided into 2 groups (normal weight and obese), and further stratified by gender. A self-paced questionnaire was used to collect sedentary behaviors data, in addition to the anthropometric measurements and body fat composition of the participants. Results: Hours spent watching TV/DVD/videos were not significantly different between the participating groups or both genders, be it during weekdays (p=0.75) or on weekends (p=0.93). Electronic device utilization hours were significantly different between the groups, specifically in boys. Obese children, particularly during weekdays, had higher utilization rates of tablets and mobile phones at p<0.01 in weekdays and weekends. The most popular electronic device owned was a tablet (67.1% among normal weight and 70.2% obese groups). This was followed by gaming consoles owned, predominantly by boys rather than girls. Ownership of a smartphone was significantly higher in the obese group p=0.01), especially in boys (p=0.01). Using modern electronic screen devices has begun to replace TV viewing. Excessive use of internet, and watching electronic screen devices, especially mobiles and tablets, have been associated with the increasing risk of obesity in urban Saudi school-aged child.

BACKGROUND: Autopsies are a crucial source of medical knowledge. Unfortunately, autopsy rates have decreased markedly in Switzerland and many other countries. Communication between clinicians and the deceased's sceptical relatives is crucial to obtain autopsy permission. This survey investigates the personal views of multimorbid patients and their relatives on autopsies. In addition, the study examines whether motivational interviewing of the decedent's relatives according to Miller and Rollnick can be used to increase autopsy rates. METHODS: At the Department of Medicine of the Kantonsspital Winterthur, Switzerland, the views of multimorbid patients and their relatives on autopsies were surveyed between 1 September 2014 and 31 December 2015 (14 months) using a standardised questionnaire. All physicians participated in a 1-hour tutorial on motivational interviewing. From November 2014 to October 2015, motivational interviewing was used to improve the communication between physicians and the decedent's relatives and to obtain autopsy permission. Autopsy rates before, during and after this intervention were compared. RESULTS: Questionnaires were completed by 135 multimorbid patients and 82 corresponding relatives. Views on autopsies were mostly positive. Before the intervention, there had been a steady decline in the number of autopsies ranging from 18.9% (412 deaths and 78 autopsies) in 2010, to 12.8% (489 deaths and 53 autopsies) in the 12-month period prior to the intervention. During the intervention (motivational interviewing of the decedents' relatives in asking for autopsy permission), 489 deaths occurred and 132 autopsies were performed (26.9%). This increase was highly statistically significant (p <0.0001). During the 12-month period after motivational interviewing was terminated, the autopsy rate dropped to 23.3% (statistically not significant; p = 0.174). INTERPRETATION: The positive views on autopsies expressed by multimorbid patients and their relatives contrasts with the low and steadily declining autopsy rates at our institution and in general. Motivational interviewing is an easy-to-learn and effective technique to increase autopsy rates. Physicians should be taught how to communicate better with grieving relatives when asking for autopsy consent.

BACKGROUND: Autopsies are a crucial source of medical knowledge. Unfortunately, autopsy rates have decreased markedly in Switzerland and many other countries. Communication between clinicians and the deceased's sceptical relatives is crucial to obtain autopsy permission. This survey investigates the personal views of multimorbid patients and their relatives on autopsies. In addition, the study examines whether motivational interviewing of the decedent's relatives according to Miller and Rollnick can be used to increase autopsy rates. METHODS: At the Department of Medicine of the Kantonsspital Winterthur, Switzerland, the views of multimorbid patients and their relatives on autopsies were surveyed between 1 September 2014 and 31 December 2015 (14 months) using a standardised questionnaire. All physicians participated in a 1-hour tutorial on motivational interviewing. From November 2014 to October 2015, motivational interviewing was used to improve the communication between physicians and the decedent's relatives and to obtain autopsy permission. Autopsy rates before, during and after this intervention were compared. RESULTS: Questionnaires were completed by 135 multimorbid patients and 82 corresponding relatives. Views on autopsies were mostly positive. Before the intervention, there had been a steady decline in the number of autopsies ranging from 18.9% (412 deaths and 78 autopsies) in 2010, to 12.8% (489 deaths and 53 autopsies) in the 12-month period prior to the intervention. During the intervention (motivational interviewing of the decedents' relatives in asking for autopsy permission), 489 deaths occurred and 132 autopsies were performed (26.9%). This increase was highly statistically significant (p <0.0001). During the 12-month period after motivational interviewing was terminated, the autopsy rate dropped to 23.3% (statistically not significant; p = 0.174). INTERPRETATION: The positive views on autopsies expressed by multimorbid patients and their relatives contrasts with the low and steadily declining autopsy rates at our institution and in general. Motivational interviewing is an easy-to-learn and effective technique to increase autopsy rates. Physicians should be taught how to communicate better with grieving relatives when asking for autopsy consent.

Background: Stroke is considered the second leading cause of death and the third leading cause of disability in the world. The incidence of stroke in Saudi Arabia is 43.8 per 100,000, due to the lack of knowledge and awareness of the population. This study intends to determine the level of stroke risk factor awareness among the Saudi population. Methods: A cross-sectional study was conducted in Saudi Arabia on 898 participants older than 18 years old. The validated online survey was randomly distributed and consisted of 20 questions in both English and Arabic languages to evaluate the level of awareness of stroke risk factors among the population. Results: A total of 898 participants completed the survey. The results showed that the median risk factor score was 5 (IQ 3-8) out of 14. A total of 2.2% could recognize all 14 risk factors. Personal history of hypertension was chosen as a risk factor by the majority of the participants (81.7%) followed by personal history of stroke (74.1%) and personal history of dyslipidemia (57.2%). This study showed that there is an insufficient level of stroke risk factor awareness in Saudi Arabia. More than half of the participants identified the term (stroke), while only 2.2% could recognize all 14 risk factors. Hence, public education is needed to identify people with stroke risk factors.

Background Treatment for chronic hepatitis C virus (HCV) has rapidly evolved to simple, well-tolerated, all-oral regimens of direct-acting antivirals (DAAs). There are few data on the epidemiology of HCV in American Indians/Alaska Natives (AI/ANs), a population disproportionately affected by HCV. Methods In this retrospective cohort study, all HCV-infected AI/AN patients treated with DAA therapies between January 1, 2014, and February 24, 2016, in specialty clinics or by primary care clinicians participating in Extension for Community Healthcare Outcomes (ECHO) were included. Demographic, clinical, and virologic data on all patients treated for HCV from pretreatment through sustained virologic response at 12 weeks (SVR12) were collected. Results Two hundred eighty patients were included; 71.1% of patients (n = 199) were infected with genotype 1 (GT1), 18.2% (n = 51) with GT2, and 10.7% with (n = 30) GT3. At baseline, 26.1% (n = 73) patients had cirrhosis and 22.6% (n = 56) had activ...

Background: As developing countries experience the epidemiologic transition to chronic diseases, morbidity and mortality from stroke is expected to rise. Stroke and other non-communicable diseases are increasing in Ethiopia but prospective data are scarce and there are not enough data regarding the characteristics, risk factors and mortality of stroke. Objective: Aimed at determining the risk factors, clinical profiles and treatment outcomes of stroke admissions in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia. Methods: This is a prospective cross-sectional study of all adult stroke patients admitted over consecutive 12 months period in medical ward and ICU of Ayder Comprehensive sSpecialized Hospital, northern Ethiopia. Medical residents through a pre-designed questionnaire collected data. Monovariate analysis, bivariate analysis and multivariate analysis to control for confounder variables were done using software SPSS version 26. P < 0.05 was considered statistically significant. Results: There were 272 stroke admissions to medical ward and ICU over the 1-year period. Stroke comprised 13.05% of total medical admissions. Ischemic stroke accounted for 62.9% of stroke admissions. Stroke in the young accounted for 14.7% of all stroke admissions. Hypertension was the most common risk factor identified, found in 51.8%. Diabetes mellitus and atrial fibrillation were the other common risk factors. The in-hospital mortality was 13.6%. The only independent predictor of mortality identified was presence of complications, AOR [95% CI] of 2.4 [1.4, 5.3], P-value of 0.028. Aspiration pneumonia was the most common complication. This study showed a high burden of stroke among medical admissions in northern Ethiopia. Being the most common risk factor for stroke, the high burden of undiagnosed and untreated hypertension needs special attention and efforts on community awareness should be enhanced. The relatively higher mortality illustrates the need to establish stroke centers to enhance the quality of stroke care.

The millions of peripheral intravenous catheters used each year are recommended for 72-96 h replacement in adults. This routine replacement increases health-care costs and staff workload and requires patients to undergo repeated invasive procedures. The effectiveness of the practice is not well established. Our hypothesis was that clinically indicated catheter replacement is of equal benefit to routine replacement. Methods This multicentre, randomised, non-blinded equivalence trial recruited adults (≥ 18 years) with an intravenous catheter of expected use longer than 4 days from three hospitals in Queensland,

Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role. Qualitative study in General Practice. UK primary care. A qualitative study - interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory. Qualitative study in General Practice. We conducted interviews, surveys...

Background: Notwithstanding the momentous improvements in the nutritional status of children in sub-Saharan Africa, malnutrition continue to persist as a serious public health issue. Malnutrition often result from poor socioeconomic condition and infections, especially malaria and helminth infections. Majority of Ghanaian children live in poor rural areas endemic for malaria and helminths. Aim: To evaluate the burden of malnutrition and the influence of poor socioeconomic factors and parasitic infections among primary school children in the Volta Region of Ghana. Methods: A cross-sectional study in 3 districts of the Volta Region, involving 550 school children aged 6 to 14 years was conducted. Information on the demography, socioeconomic status, nutritional assessment were collected from the children. Their nutritional status were assessed using anthropometric methods, and analysed using the WHO Anthro-Plus software and expressed as height-for-age, BMI-for-age and weight-for-age. Ma...

Curcumin, commonly called diferuloyl methane, is a hydrophobic polyphone derived from the rhizome (turmeric) of the herb Curcuma longa. Turmeric has been used traditionally for many ailments because of its wide spectrum of pharmacological activities. Curcumin has been identified as the active principle of turmeric, which is useful in clinical setting because of its safety profile. Depression is the most common psychiatric disorder carrying high burden in terms of treatment costs and is currently ranked fourth in terms of global disease burden by the World Health Organization. Antidepressant therapy includes drugs having plenty of side effects which counterbalance the therapeutic benefit. Thus, it is worthwhile to look for antidepressant from plants with proven advantage and favorable benefit to risk ratio. So, there are tremendous researches going on curcumin to reveal the mechanism of action for its antidepressant effect. The present review summarizes the possible mechanisms involv...

There are a wide variety of disfiguring dermatological conditions whose pathologic substrate is represented by the unwanted deposition of collagen from dermal fibroblasts. Pirfenidone has demonstrated efficiency in the treatment of disordered collagen production when applied topically. Due to a similar mechanism of action, we also hypothesize that a similar medication, nintedanib, might have similar applications. We also propose that a liposomal technology may assist in the penetration of nintedanib and enhance its clinical effects.

In cases of atopy, IgE antibodies are formed in reaction to certain environmental factors like house dust mites, pollen, or even food allergens. Some studies have shown an association between atopic diseases and keratoconus. This study aims to determine the prevalence of atopy and its associated factors among keratoconus patients. A cross-sectional study was conducted among the Jazan population attending ophthalmology clinics regardless of their sex. Data collection started in August 2020 and finished in mid-June 2021. The sample was selected using the convenience sampling technique, and the total sample size was 83 participants. Data were collected via a questionnaire-based interview that contained 46 questions in the Arabic language. The data collected were analyzed using SPSS software. Results: Family history is the leading predisposing factor for keratoconus (P < 0.001). Also, eye rubbing was a significant (P < 0.015) trigger for keratoconus. However, other factors, including demographic factors such as gender and atopic conditions, did not have any significant association. Conclusion: A combination of genetic and environmental factors is the leading cause of the development of keratoconus; however, family history is the most influential factor, followed by eye rubbing.

The root morphology and canal configuration (RMCC) of mandibular and maxillary canines among Saudi population is systematically reviewed and compared with international studies in this research. Methods: This study was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The electronic databases of PubMed, Science Direct, Scopus, Wiley Library, Google website search, and Web of Science were searched. Only local and international cross-sectional, comparative, evaluation, and validation studies or case reports published between 2016 and 2022 that directly evaluated canine RMCC and assessed participants using cone beam computed tomography were included. Results: Forty-three studies that investigated RMCCs (17 local and 26 international) were involved in this review. The original Saudi research recorded that almost 100% of maxillary canines had one root and one canal, whereas 98.4% and 94.1% had one root and one canal in the mandibular arch. Vertucci's class I had the highest percentages in the maxillary and mandibular arches at 98.3% and 95.8%, respectively, followed by class III with 0.7% and 1.9% for the same arches, respectively. International studies recorded that 100% of maxillary canines had one canal and root; the percentages of the mandibular arch were 92.3 and 98% for single canal and root, respectively; and the highest percentage was obtained by Vertucci's class I (91.1%), followed by class III (4.7%). This review reports and confirmed the symmetry of the RMCCs of maxillary and mandibular canines between Saudi studies and other populations. Moreover, Vertucci's classes I and III were the most frequent RMCCs, and two-rooted canines in both arches were considerably less frequently than single-rooted ones.

The choice of the material base to which the material decomposition is performed in dual-energy computed tomography may affect the quality of reconstructed images. The aim of this work is to investigate how the commonly used bases (water, bone), (water, iodine) and (photoelectric effect, Compton scattering) affect the reconstructed linear attenuation coefficient in the case of the Alvarez–Macovski method. The performance of this method is also compared with the performance of the Dual-energy Iterative Reconstruction Algorithm (DIRA). In both cases, the study is performed using simulations. The results show that the Alvarez–Macovski method produced artefacts when iodine was present in the phantom together with human tissues since this method can only work with one doublet. It was shown that these artefacts could be avoided with DIRA using the (water, bone) doublet for tissues and the (water, iodine) doublet for the iodine solution.

Automatic segmentation of bones in computed tomography (CT) images is used for instance in beam hardening correction algorithms where it improves the accuracy of resulting CT numbers. Of special interest are pelvic bones, which—because of their strong attenuation—affect the accuracy of brachytherapy in this region. This work evaluated the performance of the JJ2016 algorithm with the performance of MK2014v2 and JS2018 algorithms; all these algorithms were developed by authors. Visual comparison, and, in the latter case, also Dice similarity coefficients derived from the ground truth were used. It was found that the 3D-based JJ2016 performed better than the 2D-based MK2014v2, mainly because of the more accurate hole filling that benefitted from information in adjacent slices. The neural network-based JS2018 outperformed both traditional algorithms. It was, however, limited to the resolution of 1283 owing to the limited amount of memory in the graphical processing unit (GPU).

Background: Despite the evidence of declining sperm counts worldwide and the increasing prevalence of male infertility, there has been limited documentation of the potential causes and risk factors for male infertility. With limited methods of primary treatment of male infertility, understanding the causes and risk factors will pinpoint specific lines of prevention. Objective: We reviewed published studies on causes and risk factors for male infertility and identify gaps in the literature enabling more focused research and innovations. Design/Setting: The study was a scoping review. The review included studies on the causes and risk factors of male infertility published in scientific/academic publications. It was not limited to any region or date. The following databases were searched: Cumulative Index to Nursing and Allied Health Literature, Wiley online, HINARI, Science Direct, PubMed/Medline, Google Scholar, African Journals Online, and the WHO Repository. In total, 1295 articles were identified. After removing 357 duplicates, 938 articles were screened, and 71 articles were identified for inclusion, while 60 articles met the inclusion criteria. Results: Four broad causes and risk factors of male infertility identified were 1) biological/physiological/genetic causes, 2) behavioral/lifestyle risk factors, 3) environmental factors, and 4) socio-demographic risk factors. However, no substantive results on actual causes under each category were identified, leaving gaps for further research and experimentation. The results indicate limited knowledge of the actual causes of male infertility in published studies. The gaps in knowledge that need to be bridged to enable a fuller understanding of the actual causes of male infertility were highlighted.

IntroductionSmoke-free policies have been introduced in prisons internationally. However, high rates of relapse to smoking after release from prison indicate that these policies typically result in short-term smoking cessation only. These high rates of relapse, combined with a lack of investment in relapse prevention, highlight a missed opportunity to improve the health of a population who smoke tobacco at two to six times the rate of the general population. This paper describes the rationale and design of a randomised controlled trial, testing the effectiveness of a caseworker-delivered intervention promoting smoking cessation among former smokers released from smoke-free prisons in Victoria, Australia.Methods and analysisThe multicomponent, brief intervention consists of behavioural counselling, provision of nicotine spray and referral to Quitline and primary care to promote use of government-subsidised smoking cessation pharmacotherapy. The intervention is embedded in routine ser...

Background: Pharmaceutical care is currently being implemented in Polish community pharmacies, but remains unsupported by state funding, limiting its widespread adoption. In Spain pharmacists there provide a wide range of pharmaceutical care services.
Objective: The aim of the work is to understand how other countries, such as Spain, have approached pharmaceutical care, which may offer potential strategies. Given this constant evolution and the challenges they face, a comprehensive review of current pharmaceutical care practices is necessary.
Methods: The study design was guided by Newman TV et al. Chosen review type was an umbrella review, which includes systematic reviews, narrative reviews, and meta-analyses concerning pharmacist-led interventions in the field of pharmaceutical care. Utilized PRISMA framework. Used the PubMed database, which includes MEDLINE-indexed articles. Search strategy initially identified 18,076 articles and abstracts. Articles were limited to English-language, free full-text systematic reviews or meta-analyses published between January 2019 and October 2024. The dataset was reduced to 3,016 articles. Ultimately, 13 articles were selected for final analysis.
Results: Given the identified lack of funding and training gaps, Poland must address workforce shortages, strengthen interdisciplinary trust, and ensure proper remuneration for pharmacists. Drawing on Spain’s experience, investing in pharmacist-led education and preventive services may significantly enhance care outcomes in community settings.
Conclusion: This review highlights key pharmaceutical services currently implemented in community pharmacies and identifies critical barriers that hinder their widespread adoption in Poland. The main tasks of pharmaceutical care are to reduce morbidity and mortality related to medications. These services are most often not provided due to the lack of additional remuneration for the pharmacist for their provision, which would serve as reimbursement for the cost of delivering these services. The results of this review will serve as a basis for developing future in-depth studies focused on the implementation and delivery of pharmaceutical care.

The lack of focus on the health status of shrimp cultivators by previous studies while the production of shrimp has been rising over the years after the introduction of the blue revolution in India. The present study estimated the burden of diseases among shrimp cultivators in India. Methods: Primary data were collected by using simple random sampling. The sample size was 357. The classification of diseases were made by using the international classification of diseases, tenth revision (ICD-10), version 2019. Disability-adjusted life years (DALY) were used to measure the health status of shrimp cultivators. DALY is the summation of the burden of disease from mortality and morbidity. Sensitive and uncertainty analysis was used by changing the value of the parameter and method, respectively. Results: The burden of disease among shrimp cultivators in 2020 ranges from 101.03 DALY based on equal age weightage, without discount rate, and potential life expectancy (DALY 0,0,PLE ) to 84.02 DALY based on unequal age weightage, discount rate, and standardized life expectancy (DALY 1,0.03,SLE ). The burden of disease per 100,000 shrimp cultivators was 28,477.74 DALY and 23,600.84 DALY when calculated by using DALY 0,0,PLE and DALY 1,0.03,SLE method, respectively. The higher burden of diseases from non-communicable diseases was followed by injury and communicable diseases for both methods. The disease burden from mortality was more than two-thirds of the total burden of disease and the rest from morbidity. The burden of disease among shrimp cultivators was sensitive to parameter changes because it changes between 92.10 DALY and 63.03 DALY with the change in the parameter. Uncertainty in the burden of disease among them was due to method variation, which ranges from 120.03 DALY to 74.06 DALY. The higher burden of non-communicable diseases, and the lower burden of communicable, and injuries per 100,000 shrimp cultivators compared to the national level in India.

As a philosophical position, pragmatism can be critiqued to distinguish truth only with methods that bring about desired results, predominantly with scientific enquiry. The article hopes to dismiss this oversimplification and propose that within mental health nursing, enquiry enlightened by pragmatism can be anchored to methods helping to tackle genuine human problems. Whilst pragmatists suggest one reality exists, fluctuating experiences and shifting beliefs about the world can inhabit within; hence, pragmatists propose reality has the potential to change. Moreover, pragmatism includes being cognisant of what works to whom reality concerns, making reality context‐driven, with a view to understand how actions shape experiences so what is generated has usefulness. Hence, it somewhat follows pragmatism can inform mental health nursing, after all, nursing is a discipline of action, and awareness is needed in how actions produce experiences that patients find helpful. Given the principl...

Oral cavity Squamous Cell Carcinoma (OCSCC) is a common form of head and neck cancer throughout the developed and developing world. However, the etiology of OCSCC is still unclear. Here, we explored the extent to which tobacco use, Human Papillomavirus (HPV) infection and genetic and transcriptomic changes contributed to the oncogenesis of OCSCC. In a prospective observational study, we analysed fresh tissue biopsies from 45 OCSCC collected from 51 subjects presenting with OCSCC to the Brisbane Head and Neck Clinics between 2013 and 2015. Exploration of the genetic and transcriptomic landscape of the biopsies were performed using RNA sequencing (RNA-seq) and whole exome sequencing. HPV associated tumours were determined using p16 staining of histological sections and RNA sequencing. Patient demographics including tumor location within the oral cavity, and history of tobacco and alcohol use were correlated with genomic and transcriptomics analyses. About 4.5% of OCSCC were HPV associated. The most frequent mutations in the OCSCC samples were in the TP53 and CDKN2A genes, but no association of specific mutations with HPV or tobacco use was observed. Using weighted gene co-expression network analysis to explore the RNA-seq data, tumors from participants with a history of tobacco use showed a significant trend towards increased mammalian target of Rapamycin (mTOR) signaling and decreased mitochondrial respiration. In conclusion, HPV was shown to be an uncommon association with OCSCC and changes in TP53 transcriptional regulation, mTOR signaling and mitochondrial function were associated with a history of tobacco use. Larger data sets will be required to enable detection of differences which may help with development of personalized therapeutics in the future.

IntroductionThe population is ageing, with increasing health and supportive care needs. For older people, complex chronic health conditions and frailty can lead to a cascade of repeated hospitalisations and further decline. Existing solutions are fragmented and not person centred. The proposed Being Your Best programme integrates care across hospital and community settings to address symptoms of frailty.Methods and analysisA multicentre pragmatic mixed methods study aiming to recruit 80 community-dwelling patients aged ≥65 years recently discharged from hospital. Being Your Best is a codesigned 6-month programme that provides referral and linkage with existing services comprising four modules to prevent or mitigate symptoms of physical, nutritional, cognitive and social frailty. Feasibility will be assessed in terms of recruitment, acceptability of the intervention to participants and level of retention in the programme. Changes in frailty (Modified Reported Edmonton Frail Scale), c...

Objective. We compared the diagnostic potential of using correlation coefficient images versus elastograms from 2-dimensional (2D) freehand elastography to characterize breast cysts. Methods. In this preliminary study, which was approved by the Institutional Review Board and compliant with the Health Insurance Portability and Accountability Act, we imaged 4 consecutive human subjects (4 cysts, 1 biopsy-verified benign breast parenchyma) with freehand 2D elastography. Data were processed offline with conventional 2D phase-sensitive speckle-tracking algorithms. The correlation coefficient in the cyst and surrounding tissue was calculated, and appearances of the cysts in the correlation coefficient images and elastograms were compared. Results. The correlation coefficient in the cysts was considerably lower (14%-37%) than in the surrounding tissue because of the lack of sufficient speckle in the cysts, as well as the prominence of random noise, reverberations, and clutter, which decorrelated quickly. Thus, the cysts were visible in all correlation coefficient images. In contrast, the elastograms associated with these cysts each had different elastographic patterns. The solid mass in this study did not have the same high decorrelation rate as the cysts, having a correlation coefficient only 2.1% lower than that of surrounding tissue. Conclusions. Correlation coefficient images may produce a more direct, reliable, and consistent method for characterizing cysts than elastograms.

Samuel Hahnemann, in his Organon of Medicine, provides a precise and revolutionary concept of cure that transcends mere suppression of disease. According to him, the highest mission of the physician is "to restore the sick to health, to cure, as it is termed" (Aphorism 1). Cure, as defined by Hahnemann, is "the rapid, gentle and permanent restoration of health, or removal and annihilation of the disease in its whole extent, in the shortest, most reliable and most harmless way" (Aphorism 2). The essence of cure lies in correcting the dynamic disturbance of the vital force rather than targeting local symptoms or pathological changes. This is possible only through the law of similars similia similibus curentur where a medicine producing similar symptoms in a healthy person cures those in the diseased (Aphorism 26). Hahnemann strictly differentiated true cure from palliative or suppressive measures (Aphorisms 60-69), which may relieve symptoms but ultimately deepen the malady. For a genuine cure, Hahnemann prescribed certain conditions: 1) The remedy must be selected according to the totality of symptoms and similarity (Aphorisms 7, 153). 2) The medicine must be given in the minimum dose sufficient to stimulate the vital force without causing unnecessary aggravation (Aphorism 275). 3) The remedy must be capable of producing a permanent restoration, with symptoms disappearing in a definite order generally from within outward, above downward, and from more vital to less vital organs (later known as Hering's Law of Cure). 4) The cure should proceed without significant harm or long-term weakness to the patient. Thus, Hahnemann's concept of cure emphasizes an individualized, dynamic, and holistic process, aiming at permanent health restoration. His philosophy established homoeopathy as a rational, scientific, and humane system of medicine.

Transgenic crops that express insecticide genes from Bacillus thuringiensis (Bt) are used worldwide against moth and beetle pests. Because these engineered plants can kill over 95% of susceptible larvae, they can rapidly select for resistance. Here, we use a model for a pyramid two-toxin Bt crop to explore the consequences of spatio-temporal variation in the area of Bt crop and non-Bt refuge habitat. We show that variability over time in the proportion of suitable non-Bt breeding habitat, Q, or in the total area of Bt and suitable non-Bt habitat, K, can increase the overall rate of resistance evolution by causing short-term surges of intense selection. These surges can be exacerbated when temporal variation in Q and/or K cause high larval densities in refuges that increase density-dependent mortality; this will give resistant larvae in Bt fields a relative advantage over susceptible larvae that largely depend on refuges. We address the effects of spatio-temporal variation in a manag...

Objective: We aimed at investigating prospective memory and its socio-demographic and neurocognitive correlates in nonpsychotic, first-degree relatives (FDRs) of patients with schizophrenia compared to patients with first episode schizophrenia (FES), and healthy controls (HCs). Methods: Forty-seven FES patients, 50 non-psychotic FDRs (23 offspring and 27 siblings) of patients with chronic schizophrenia (unrelated to the FES group) and 51 HCs were studied. The Chinese version of the Cambridge Prospective Memory Test (C-CAMPROMPT) was used to measure time-based prospective memory (TBPM) and event-based prospective memory (EBPM) performance. Other cognitive functions (involving respective memory and executive functions) were evaluated with standardized tests. Results: After controlling for basic demographic characteristics including age, gender and educational level, there was a significant difference between FDRs, FES and HCs with respect to both TBPM (F (2,142) = 10.4, p,0.001) and EBPM (F (2,142) = 10.8, p,0.001). Multiple linear regression analyses revealed that lower scores of the Hopkins Verbal Learning Test-Revised (HVLT-R) and the STROOP Word-Color Test (SWCT) contributed to TBPM impairment, while lower educational level and higher scores of the Color Trails Test-2 (CTT-2) contributed to EBPM deficit in FDRs. Conclusions: FDRs share similar but attenuated prospective memory impairments with schizophrenia patients, suggesting that prospective memory deficits may represent an endophenotype of schizophrenia.

I read with great interest the systematic review of meta-analysis assessing probiotics for the prevention of Clostridium difficile-associated diarrhea (CDAD) published in the International Journal of General Medicine. 1 These authors pooled 26 randomized controlled trials (RCTs) and concluded that Lactobacilli, mixtures, and Saccharomyces probiotics were effective in preventing CDAD. However, the meta-analysis by Lau and Chamberlain is flawed due to improper classification by the types of probiotics. It is important to recognize that the efficacy of probiotics for various diseases has been shown to be strain specific for each probiotic product, and thus the data should only be pooled for probiotics that are of the identical type. 2,3 In their analysis of probiotic subgroups by various species, the authors have inappropriately merged different types of Lactobacilli into one subgroup "Lactobacilli" and different types of mixtures into one group classified as "Mix". The Lactobacilli subgroup actually contains RCTs using six different types of Lactobacilli: Lactobacilli rhamnosus GG (three RCTs), one mixture of three Lactobacilli strains (Lactobacilli acidophilus CL1285, Lactobacilli casei LBC80R, and L. rhamnosus CLR2) (three RCTs), L. acidophilus (one RCT), one mixture of three strains of L. rhamnosus (E/n, Oxy, and Pen) (one RCT), L. casei Shirota (one RCT), and Lactobacilli plantarum 299v (one RCT). The Mix subgroup contains RCTs of five different types of strains, and only two trials evaluated the same type of probiotic mixture (L. acidophilus and Bifidobacterium bifidum). Only the Saccharomyces subgroup correctly pooled seven RCTs using the same strain of probiotic (Saccharomyces boulardii CNCM I-745). When these subgroups are pooled appropriately, as shown in Figure , only three types of probiotics have efficacy for the primary prevention of CDAD: S. boulardii (P=0.003) and two mixtures (BioK+, a mixture of three Lactobacilli strains 4 [P<0.001] and the mixture of L. acidophilus with B. bifidum [P=0.002]). L. rhamnosus GG did not significantly prevent CDAD (P=0.65), a finding that is not apparent in the meta-analysis presentation of Lau and Chamberlain. No other probiotic strains had a second confirmatory RCT, and hence it is inappropriate to pool these different strains together. Only by appropriately combining and pooling data using the same strain or strains of probiotics can practical clinical guidance be determined as to which specific probiotic strains can be used to prevent CDAD.

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. However, rectal GISTs represent only 5% of this category. We report a case of a rectal GIST treated with local excision after neoadjuvant therapy. Case presentation: A 41-year-old male patient presented with anal bleeding. Colonoscopy revealed a mass located 5 cm from the anal verge. Histological examination showed a GIST with immunohistochemical positivity for CD117 and CD34. Transanal local excision was performed after neoadjuvant therapy. Conclusion: Neoadjuvant immunotherapy for GISTs with unfavorable localization may facilitate local excision and avoid complications of more demanding operations.

The approach to clinical conundrums by an expert clinician is revealed through presentation of an actual patient's case in an approach typical of morning report. Similar to patient care, sequential pieces of information are provided to the clinician who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant.

Core Tip: Electronic Pediatrician (EPed) is the first and only physiopathology-based non-machine learning artificial intelligence (nml-AI) knowledge-based system (KBS) focused on general pediatrics and is the first and only Romanian pediatric KBS addressed to medical professionals. Furthermore, EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis, but also identifies possible physiopathological “clusters” that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically (until a final diagnosis is found), thus encouraging and developing the physiopathological reasoning of any clinician.

Introduction: Sexual dysfunction is a little-addressed condition in patients with rheumatoid arthritis. Aerobic exercises, including walking, can help alleviate this dysfunction. This study aimed to determine the effect of an 8-week aerobic walking program on sexual function ine patients with rheumatoid arthritis. Methodology: This clinical trial was conducted on 51 patients with rheumatoid arthritis. At first, patients were selected through nonprobability sampling. They were then allocated into intervention and control groups using block randomization. The walking intervention was performed based on the frequency-intensity-time-type principle forg 8 consecutive weeks. Rosen's Female Sexual Function Index was used for data collection before, immediately after, and 4 weeks after the intervention. Data collected were analyzed with SPSS 22 using descriptive and inferential statistics and 95% CI. Findings: Mean sexual function scores before, after, and 4 weeks after intervention were 17.66±4, 22.88±4.7, and 24.39±5.1 in the intervention group and 17. 60±4.24, 17.27±4.66, and 17.39±4.39 in the control group, respectively. Test results showed a significant intergroup difference in mean sexual function score (p<0.05). Conclusion: Based on our results, an 8-week aerobic walking program is recommended as an effective way to improve sexual function in women with rheumatoid arthritis.

Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS), a culture based alternative for microbial diversity studies, is an attractive tool to dereplicate large numbers of isolates to a smaller set of representatives for downstream characterization. In the present study, MALDI-TOF MS, combined with a database of reference spectra compiled in previous studies, was applied to identify 88 non-starter lactic acid bacteria (NSLAB) isolated from 18 samples of four different artisanal cheeses produced in the Island of Naxos, Greece, from raw sheep and goat milk without the addition of starters. Eighty-four isolates (95.5%) could be identified directly via MALDI-TOF MS. Lactobacillus brevis and Lactobacillus plantarum were the dominant species, followed by Lactococcus lactis, Leuconostoc mesenteroides Lactobacillus paracasei, Lactobacillus rhamnosus, Pediococcus pentosaceus and Enterococcus faecium. The remaining four isolates represented species present in the database; however, within-species diversity was insufficiently covered. Additionally, pheS sequencing was applied to confirm identification.

Diabetes has been termed one of the largest health emergencies of the 21 st century. The Diabetic Retinopathy is a leading cause of blindness that affects 34 million worldwide. Diabetic retinopathy is caused when high blood sugar damages blood vessels in the retina. Damaged blood vessels can swell & leak, causing blurry vision or stopping blood flow. Sometimes new blood vessels grow but they are not normal and can cause further vision problems. Diabetic retinopathy usually affects both eyes. The blindness as a result of diabetic retinopathy can be prevented by early detection and management. For this, patients need to be screened as per guidelines recommended by International Diabetes Federation. Patient awareness to Diabetic retinopathy is the key to early detection, prevention and further improvements in Diabetic retinopathy management as patients play an important role in their glycemic control and eye care. Managing diabetes by patient himself and getting regular eye examinations can help prevent vision problem and stop them from getting worse. The primary goal of this study is to assess the awareness about diabetic retinopathy in Indian urban and rural population. The present study was conducted on 451 subjects out of which 62.08% and 47.67% had knowledge of diabetes and Diabetic retinopathy respectively. Knowledge about Diabetes mellitus & Diabetic retinopathy was more in urban population as compared to rural. Compared with those who had no knowledge of Diabetic retinopathy, significant percentage of individuals with knowledge had the right attitude to go for regular eye examination and good practices for control of the disease.

Background. The mechanisms that link obesity and cancer development are not well-defined. Investigation of leptin and leptin receptor expressions may help define some of the mechanisms. These proteins are known for associating with the immune response, angiogenesis and, signalling pathways such as JAK2/STAT3, PI3K, and AKT pathways. Tissue proteins can be easily detected with immunohistochemistry (IHC), a technique widely used both in diagnostic and research laboratories. The identification of altered levels of leptin and leptin receptor proteins in tumour tissues may lead to targeted treatment for cancer. Objective. The objective of this study was to use IHC to compare leptin and leptin receptor expressions in clear cell renal cell carcinomas (ccRCC) in non-obese and obese patients to determine the association between these proteins with the clinicopathological features and prognosis of ccRCC. Patients and Methods. The study involved 60 patients who underwent nephrectomy of which 3...

Background and ObjectivesBlood Collection Agencies in several countries have implemented strategies to increase the number of plasmapheresis collections. Despite this, a sizable minority of plasma donors lapse from donation each year, with little research conducted on this topic. An understanding of the plasma donation experience from the perspective of lapsed donors, insights into why they stopped donating and their views on returning to donate may provide opportunities to intervene to increase the retention and reactivation of plasma donors.Materials and MethodsA qualitative approach was used in this study, with 17 lapsed plasma donors (no plasma donation for at least 13 months) interviewed. A purposive recruitment strategy was used to obtain a sample with diversity in gender (47% men), age (M = 36·2 years, SD = 13·6) and donation experience (M = 9·2 years, SD = 9·6). Semi‐structured, narrative interviews were conducted, with participants describing their plasma donation careers c...

The Editorial on pp. 96-100 'Dioxin -Contemporary and Future Challenges of Historical Legacies' describes background, aims and scope of this new series in ESPR which is dedicated to Prof. Dr. Otto Hutzinger on the occasion of his 75 th anniversary 4 .

Detection of endogenous anabolic androgenic steroids (EAAS) misuse is a major challenge in doping control analysis. Currently, a number of endogenous steroids, which constitute the steroid profile, are quantified using gas chromatography (GC). With this methodology, only the sum of the free and glucuronidated steroids is measured together. A dilute-and-shoot LC-MS method, which is compliant with the quality requirements for measuring EAAS established by the World Anti-Doping Agency (WADA), was developed and validated containing glucuronidated and sulfated steroids in order to gain some extra information and to expand the existing steroid profile. The developed method is, to the best of our knowledge, the first method to combine both steroid glucuronides and sulfates, which is compliant with the quality standards of the technical document on EAAS, established by WADA. The first advantage of this new steroid profile is the reduced sample preparation time, as it is a direct injection method of diluted urine. A second advantage is the ability of the used gradient to separate 5 α-androstane-3 α,17 β-diol-3-glucuronide (5 ααβdiol3G), 5 α-androstane-3 α,17 β-diol-17-glucuronide (5 ααβdiol17G), 5 β-androstane-3 α,17 β-diol-3-glucuronide (5 βαβdiol3G) and 5 β-androstane-3 α,17 β-diol-17-glucuronide (5 βαβdiol17G) allowing to gain specific information on these isomers, which cannot be accomplished in GC-MS screening due to hydrolysis. This steroid profile also contains free testosterone, 5 α-androstane-3,17-dione and 5 β-androstane-3,17-dione as markers of degradation. In total, 17 compounds and 10 isotopically labelled internal standards are included in this method.