Introduction: Ventilator-associated pneumonia (VAP), a common nosocomial infection, increases the length of hospitalization and the patient mortality rate. A ventilator care process "bundle", composed of peptic ulcer disease prophylaxis, deep vein thrombosis (DVT) prophylaxis, elevation of the head of the bed, and a sedation vacation, may decrease VAP rates. This cross-sectional descriptive study aimed to assess the knowledge, attitudes, and practical levels of intensive care unit (ICU) nurses toward VAP bundle. Methods: A four-part questionnaire was designed and distributed to the all-general ICU nurses (n=100) at Sina, Shohada and Imam Reza hospitals of Tabriz University of Medical Science in Iran, from November 2021 to November 2022, who intended to take part in this project and completed the questionnaire form completely. Analysis of variance (ANOVA) tests were used to compare ICU nurses’ knowledge, attitude, and practice levels. Results: 54% of nurses presented high knowledge, 64% had moderate practices, and 90% had a positive attitude toward VAP bundles. Nursing experience in ICU wards, level of education, and participation in infection control courses had a significant relation with the knowledge and practice levels (P<0.05), while only the education level showed significant association with positive attitude (P=0.007). Conclusion: ICU nurses demonstrated a high level of knowledge, a positive attitude, and a moderate level of practice regarding the VAP bundle.

Introduction: In the flipped class, students study the educational content before attending the class. They enter the classroom for cooperative learning, therefore, in this project, the effect of holding a critical care workshop in the flipped teaching method on the improvement of knowledge, and practical skills in medical students has been investigated. Methods: In this descriptive interventional study, the sample size was calculated to be 45 people in both groups. The educational content of critical care through the center’s website and virtual channels was provided to the intervention group a month ago, and then the students practiced and asked questions in the practical class under the supervision of the professor. The knowledge, and practical skills in the fields of intubation, ATLS, BLS, and ACLS were checked before and after the training through a questionnaire and OSCE test. Results: The acceptable amount of students’ awareness in doing critical care between two training and control groups after training and two months after training is statistically significant (P<0.001). The difference in the average skill score of students in critical care was statistically significant (P<0.001). Conclusion: Learning through interaction and discussion increases knowledge, improves skills and stability, and deepens learning in critical patient care education.

Introduction: India is committed to achieving the United Nations Sustainable Development Goals, aiming to eradicate human immunodeficiency virus (HIV) by 2030. India has 2.4 million people living with HIV. This study aims to identify gender gaps in internet access and their impact on comprehensive HIV knowledge. Methods: India’s National Family Health Survey-5 (NFHS-5) data, which is public and anonymised, is used for the study. The sample is divided into urban and rural men and women. Correlation coefficient analysis, linear regression analysis, and descriptive statistical analysis were performed. Results: National-level data on internet access show a greater number of men with internet access (total 57.1%, urban 72.5%, and rural 48.7%) than women (total 33.3%, urban 51.8%, and rural 24.6%). The descriptive analysis shows that in every region of India; men are more numerous compared to women with access to the internet and comprehensive knowledge of HIV. Linear regression analysis at a significance level of 0.05, when compared with the total women population (0.347), urban women (0.3529), and rural women (0.3963), with values for total men population (0.6051), urban men (0.4159), and rural men (0.5538) for the study variables, shows a significant gender difference. Correlation coefficient analysis at a significance level of 0.05 shows a linear association between the study variables. Conclusion: This study identified an urban-rural and gender disparity. As a result, differences were discovered in internet access and HIV awareness. Men have more access to the internet than women. Our findings revealed a clear link between internet access and HIV knowledge. Gender inequalities affect social variables such as access to technology, with men having greater access to the internet than women. Men, irrespective of cities or rural areas, have greater access to the internet than women, which may explain why they are more knowledgeable about HIV. Compared to rural women, urban women have better internet access, which could explain why urban women have a higher level of HIV knowledge. Gender inequality in information access has an impact on health outcomes.

Introduction: Magnetic resonance imaging (MRI) scans of the brain are used to identify signs of disease, enabling more precise diagnosis of brain-related conditions. Neurological disorders pose significant risks and can lead to the deterioration of normal bodily functions. Various strategies are employed to monitor anomalies. However, significant improvements are still required in diagnostic processes and in the detection of cerebral diseases. Methods: This method first involved preprocessing the image, followed by threshold-based segmentation. We used elastic net regression (ENR) due to its superior performance metrics compared to the approaches we evaluated for image classification. Results: This strategy yielded improved outcomes, with an accuracy of 98.7% and precision of 98.88%. The recall score was 98.75%, while the F1 score was 98.23%. Conclusion: In this study, the TSENR method was used to detect brain disease. Although many techniques are used to diagnose neurological disorders, not all of them are suitable for reliable evaluation. However, the implemented TSENR model provided a more accurate, sensitive, and predictive response. This technique can be applied to medical image analysis.

Introduction: Stroke is the third most common cause of death and most common debilitating neurological disease with balance disorder as one of its major clinical manifestations. The purpose of this study is to investigate the balance and related neurophysiological measurements in ischemic stroke patients. Methods: Stroke patients with 0 or 1 modified Rankin Scale (mRS) level and National Institutes of Health Stroke Scale (NIHSS) below 10 was involved in this study. Balance measuring device (BSS), Pittsburgh Sleep Quality Index (PSQI) Questionnaire, Vienna Test System (VTS), paraclinical measurements including transcranial Doppler and MRI were used to evaluate the condition. Results: In evaluation of 58 patients with acute stroke, the average score of the overall stability index was 3.38 ± 1.75. The left-right average was 8.93 ± 67.90 and front-back average was 7.58 ± 133.50. The mean reaction time was 659.64 ± 197.72 milliseconds, which was 17.31 in terms of percentage rank. Also, average movement time was 337.77 ± 146.44, which was equal to 9.18 in terms of percentage rank. Total score was 2.78 ± 4.27, its average percentile rank is 13.27 and time for correct answers was 6.70 ± 1.83, and average percentile rank is 22.50. Sleep quality score of the patients indicated low. Conclusion: Balance, reaction time, follow-up, and sleep disturbance among the studied stroke patients were significantly worse than the community average and in poor range. In addition, it was shown that several factors are effective in balance of stroke patients, and thus paying attention to those factors can be effective in improving the balance.

Introduction: Vertigo is a common clinical complaint with various underlying causes, making a clear understanding of patient characteristics essential for accurate diagnosis and management. This study aimed to investigate the age distribution, sex, medical history, and neurological symptoms in patients with vertigo. Methods: We collected data from 100 patients with complaints of vertigo who were referred to Ali Ibn Abi Taleb Hospital. Inclusion criteria included: 1) Age between 18 and 80 years, 2) A definitive diagnosis of true vertigo, and 3) Completion of the informed consent form. The collected information encompassed demographic characteristics, paraclinical evidence, and specifics of the vertigo. Statistical analysis was performed using descriptive statistics (frequency) and inferential statistics (chi-square test) within a 95% confidence interval. Results: Of the patients, 84% were diagnosed with peripheral vertigo, 63% were women, and 39% were aged between 45 and 65 years. A significant relationship was found between the type of vertigo and paraclinical evidence (P<0.000), and history of stroke (P=0.001). However, there was no significant relationship between the type of vertigo and history of head trauma and transient ischemic attack (TIA) (P>0.05). Additionally, no correlation was observed between vertigo and symptoms such as nausea, vomiting, auditory issues, or other neurological symptoms. Conclusion: The findings of this study show that the occurrence of central vertigo increases as people age. Most patients with abnormal paraclinical evidence were diagnosed with central vertigo, and many patients with a history of stroke experienced central vertigo. Therefore, it is important for physicians treating vertigo to provide appropriate management, carefully review patients’ medical histories and symptoms, and use paraclinical findings when needed.

Introduction: Although the prevalence of thyroid tumor is about 7% in the general population, the malignancy rate is approximately 5% among thyroid tumors. This emphasizes the need for effective preoperative diagnostic methods for proper patient management. Methods: A descriptive cross-sectional study was conducted at Colombo South Teaching Hospital and the Department of Pathology, University of Sri Jayewardenepura, Sri Lanka. Patients with radiologically suspected malignant thyroid nodules (n=107) were enrolled. fine needle aspiration cytology (FNAC) was performed under ultrasound scan (USS) guidance by an experienced consultant radiologist. Direct smears and cell block preparations were prepared from FNAC specimens. Smears were reviewed by two independent pathologists. USS and FNAC findings were reported according to Thyroid Imaging Reporting and Data System (TIRADS) system and Bethesda system, respectively. Descriptive statistics were expressed as frequencies and percentages. Diagnostic performance of USS and FNAC was assessed using receiver operating characteristic (ROC) curve. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Results: The Majority (79.4%) were females. Age ranged from 15 to 76 years (47.3±12.89). Malignant risk prediction of 77% was observed in TIRADS system. Malignant risk of 17.9%, 37.5%, and 87.5% were reported respectively for TIRADS 4a, 4b, 4c categories while TIRADS 5 reports a risk of 60.0%. Sensitivity, specificity, NPV, and PPV of FNAC were 88.9%, 87.5%, 96%, and 70% respectively compared with the histology results. Conclusion: Bethesda system cytology reporting and radiologic TIRADS classification are important preoperative diagnostic tools for identifying suspicious thyroid nodules in resource-limited setting. FNAC was a better diagnostic test compared to USS for evaluating thyroid nodules.

Introduction: Non-smoking chronic obstructive pulmonary disease (COPD) is one of the major contributors among total COPD cases in low- and middle-income countries. This study aimed to investigate pulmonary functions and estimate systemic and airway inflammatory and oxidative stress markers in serum and exhaled breath condensate (EBC) of cigarette-smoking COPD and biomass smoke-exposed COPD patients, comparing them with healthy smokers and healthy non-smokers. Methods: A total of 45 participants were enrolled: smoker COPD (n=10), biomass smoke-exposed COPD (n=10), smoker control (n=10), and non-smoker control (n=15). Pulmonary function tests, including spirometry and impulse oscillometry, were performed. Inflammatory and oxidative stress marker levels in both serum and EBC were estimated. Results: Spirometric parameters, including slow vital capacity (SVC), forced expiratory volume at 1st second (FEV1), forced vital capacity (FVC), and FEV1/FVC were significantly less in COPD groups (smoker/biomass) as compared to controls. Smoker COPD had less FEV1/FVC than biomass-exposed COPD. COPD groups (smoker/biomass) exhibited significant impairment in lung mechanics, characterized by increased peripheral airway resistance (R5-R20), reactance at 5 Hz (X5), and resonant frequency (Fres), indicating involvement of peripheral airways. However, no significant change in lung mechanics exists between smokers’ COPD and biomass-exposed COPD. Among the oxidative stress markers, 8-isoprostane and nitrotyrosine-3 (NT3) levels in EBC were significantly higher in smoker-COPD compared to biomass-exposed COPD and non-smoker controls, respectively. Conclusion: Significant pulmonary function impairment was observed in both smoker COPD and biomass smoke-exposed COPD. Inflammatory and oxidative stress markers are more deranged in smoker COPD than in biomass smoke-exposed COPD and healthy controls.