1st Month Research Articles

Taiwan National Health Insurance and Proportional Physician Fee of Psychiatrist in General Hospital during the COVID-19 pandemic : Case Report

IntroductionIn Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.ObjectivesThis study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.MethodsDemographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.Results Demographic data found PPF rises significantly over time (Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item (Figure 2) and psychiatric outpatient consultation fee for outpatient item (Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.Image:Image 2:Image 3:ConclusionsIn the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.Disclosure of InterestNone Declared

The effect of different therapeutic treatments on the frequency of postoperative hypocalcemia in patients with thyroidectomy.

Thyroid gland surgery and its surgical complications are situations that a surgeon frequently encounters in his daily practice. In our study, it was aimed to examine the effect of different treatment methods given to patients who underwent thyroidectomy on hypocalcemia. Three hundred and seventy-one patients who underwent thyroidectomy at Ondokuz Mayıs University Medical Faculty General Surgery clinic between December 2016 and January 2021 were retrospectively included in the study. Parameters such as surgery indications, fine needle aspiration biopsy results, preoperative serum calcium values, type of surgery, serum calcium values at postoperative 1st day and 1st month, postoperative hospital stay, drugs prescribed at discharge, histopathological diagnosis of the patient, and whether there was incidental parathyroidectomy or not were included. Mean age of 371 patients who underwent thyroidectomy was 49 (19-82) years. Total thyroidectomy was the most common type of thyroidectomy with 61% (n= 225) of the patients. There was a significant decrease in pre-op and post-op calcium values in all three types of surgery performed on the patients, and there was no significant difference between the different types of surgery. Post-operative day one and month one serum calcium values were significantly increased in all groups (p= .000). The increase in post-op serum calcium level was most common in the group using calcium carbonate + cholecalciferol + calcitriol. The use of post-op calcitriol in patients undergoing thyroidectomy seems to be quite effective in preventing the development of hypocalcemia.

Irreversible electroporation for prostate cancer using PSMA PET-CT.

To demonstrate the clinical usefulness of prostate-specific membrane antigen (PSMA) positron emission tomography (PET) computerized tomography (CT) for irreversible electroporation (IRE) in prostate cancer patients. From January to May 2021, 17 men were diagnosed with localized prostate cancer through preoperative mpMRI and [18F] florastamin PSMA PET-CT imaging, followed by transperineal MRI-ultrasound fusion-guided biopsy. The patients underwent IRE focal therapy at the target lesions under general anesthesia. To evaluate the treatment outcome, serum prostate-specific antigen (PSA) levels were followed up in the 1st, 3rd, 6th, 9th, 12th months, and mpMRI was taken in the 1st and 12th months, followed by MR fusion biopsy in the 12th month post-IRE. The mean age of the patients was 66.1±9.3 with a median PSA of 7.5ng/ml. After the treatment, PSA nadir was 4.06±3.4, and 11 (64.7%) achieved decline of PSA more than 50% from the baseline. Rate of negative biopsy for prostate cancer is 88% (15/17) at 12monthsMR fusion biopsy after the IRE treatment. Among the relapsed cases, 1 (6.9%) patient recurred at margin of treated area, and 1 (6.9%) patient was from outfield recurrence. When excluding initial four patients, none of the patients had cancer recur. When treating with IRE focal therapy, PSMA-PET CT is a potentially valuable diagnostic approach for localizing prostate cancer; it supports the detection of lesions with conventional mpMRI, enabling to perform the procedure more completely.

Comparative humoral response of mRNA and inactivated vaccines against COVID-19 in healthy adults aged 60 years and older

A vaccine against coronavirus disease 2019 (COVID-19) is critically needed for older adults because of the increased morbidity and mortality rates. In this prospective study, we analysed the titre magnitude of the IgG antibodies directed against the SARS-CoV-2 Spike Protein S1 (S1-RBD) antigen in both CoronaVac and Pfizer-BioNTech groups. The samples were tested to detect antibodies that bind to the receptor-binding domain of the spike protein of SARS-CoV-2 using the Enzyme-Linked Immunosorbent Assay (ELISA) technique with SARS-CoV-2 IgG II Quant. The cut-off value was > 50 AU/mL. GraphPad Prism software was used. Statistical significance was defined at p < 0.05. The CoronaVac group (12 females, 13 males) had a mean age of 69.64 ± 1.38 years. The Pfizer-BioNTech group (13 males, 12 females) had a mean age of 72.36 ± 1.44 years. The anti- S1-RBD titre decrease rate from the 1st to the 3rd month for CoronaVac and Pfizer-BioNTech groups was 74.31% and 86.48%, respectively. There was no statistically significant difference in the antibody titre between the 1st month and 3rd month for the CoronaVac group. However, there was a significant difference between the 1st and 3rd month in the Pfizer-BioNTech group. In addition, there was no statistically significant difference in the genders between the 1st and 3rd month of the antibody titres for both the CoronaVac Pfizer-BioNTech group. The levels of anti-S1-RBD, the preliminary outcome data of our study, represents one piece of the puzzle of humoral response and duration of vaccination protection.

Efficacy of Burrhole Craniostomy in Chronic Subdural Hematoma. A Retrospective 9-Year Study

Objective: To demonstrate the effectiveness, possible complications, and difference of Burr-hole craniostomy surgical technique applied to patients diagnosed with chronic subdural hematoma from other surgical techniques. Methods: The surgical techniques and postoperative clinical and radiological details of 36 patients who were operated on with the diagnosis of chronic subdural hematoma in the Neurosurgery Clinic of Ordu University Training and Research Hospital between 01.01.2013 and 15.08.2022 were retrospectively analyzed. In all patients in the post-op period, control brain CT was taken within the first 24 hours and compared with the pre-op CT. Again, at the end of post-op 1st, 2nd week and 1st month, control brain CT was taken for all patients and GCS was compared with pre-op scores. After determining the post-op complications, the treatment and results of these complications were examined. Results: One patient who was operated on with Burr-Hole developed motor dysphasia in the post-op period, and intraparenchymal hemorrhage was detected in the post-op tomography of this patient. . Post-op clinical and radiological results of patients who underwent burr-hole craniostomy were significantly better than pre-op clinical and radiological results, and the recurrence rate was low, consistent with the literature. All drains placed in the subdural area after the burr hole opened during the operation were removed before discharge. Conclusions: Although the drainage of chronic subdural hematoma with bur-hole craniostomy has a higher recurrence rate compared to the craniotomy method, it has a lower complication rate and is a more easily applicable surgical technique. In our study, some important points about patients who underwent burrhole craniostomy for cSDH evacuation were highlighted. It was observed that our patients who underwent burrhole craniostomy had higher reoperation rates compared to our patients who underwent craniotomy. We think that the presence of residual hematoma in the controls performed with CT in the post-op period should not be the sole criterion for re-operation. We think that CT controls are sufficient if there is improvement in the neurological status of the patient and a better GCS score in the post-op follow-up.

XEN gel stent ® in the management of glaucoma: preliminary results of a tertiary center

Purpose: To analyze the efficacy and safety of a MIGS device (XEN gel stent ®) in the management of glaucoma in our tertiary center. Methods: Retrospective analysis of patients submitted to XEN ® implant alone or combined with cataract surgery. Patients with previous filtering surgeries were included. Intraocular pressure (IOP) was evaluated at 1st week, 1st, 3rd, 6th and 12th months after surgery. BCVA, RNFL thickness and number of antiglaucoma medications were evaluated 1 year after surgery. Early and late complications and need for an additional glaucoma surgery were recorded. Results: Thirty-four eyes from 28 patients were included. The main diagnosis was primary open angle glaucoma (POAG) (58.8%). IOP decreased from 20.5±4.9 mmHg to 15.4±4.1 mmHg 1 year after surgery (p&lt;0.001). There was also a decrease in the number of antiglaucoma medications, from 3.6±0.6 to 0.6±0.7 (p&lt;0.001). BCVA increased from 0.57±0.30 to 0.87±0.18 in the combined surgery group (p=0.03). RNFL thickness remained stable (p=0.558). Hypotony occurred in 2 eyes (5.9%). Two eyes (5.9%) needed another glaucoma surgery in the 1st year of follow-up. Conclusion: According to our results, XEN® alone or combined with phacoemulsification showed to be effective in IOP reduction, with few complications, as a primary surgery or even in eyes with previous filtering surgeries.

Comparison of Er,Cr:YSGG laser and diode laser in the treatment of gingival melanin pigmentation: a randomized clinical trial.

This investigation has aimed to compare the efficiency of clinical depigmentation and repigmentation rate of erbium chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) and diode lasers during a 1-year follow-up and to evaluate patient satisfaction. Twenty-two participants were divided into Er,Cr:YSGG laser and diode laser groups using computer-aided randomization. Dummett Oral Pigmentation Index (DOPI) and photographic assessment with ImageJ Software version 10.2 were performed at the preoperative period and postoperative 1st month, 6th month, and 12th month. Moreover, the study assessed intra- and postoperative intensities of pain and postoperative patient aesthetic satisfaction using the Visual Analog Scale in both groups. The median values of DOPI did not differ statistically between the groups according to time (p > 0.05). In the Er,Cr:YSGG group, the extension of repigmentation was less as compared to the diode group at 1-year follow-up (p = 0.045). In the Er,Cr:YSGG group, the patients felt less intraoperative pain and discomfort compared to the diode group (p = 0.007). No significant differences were found between the two groups in terms of patient aesthetic satisfaction at the 1st and 12th months. The findings indicate that diode and Er,Cr:YSGG lasers can be used safely in depigmentation treatment, while the Er,Cr:YSGG laser has been shown to have superiorities in pain management and patient comfort parameters. Clinical Trial No.: NCT05304624.

Kompleks renal tümörlerde uygulanan robot yardımlı laparoskopik nefron koruyucu cerrahide hemostatik ajan eşliğinde tek kat renorrafi uygulanabilir mi?

Objective: To compare outcomes of single- layer renorrhaphy suturing and hemostatic agent application with double-layer renorrhaphy among complex renal tumors. Material and Methods: 51 patients who underwent robotic partial nephrectomy due to complex renal tumors (PADUA score ≥10) between August 2017 and February 2021 were retrospectively enrolled. A double-layer renorrhaphy was applied in 36 patients (Group 1), and a single-layer renorrhaphy plus hemostatic agent FloSeal® (Baxter Medical, Fremont, CA) was applied in 15 patients (Group 2). Pre- and post-operative serum creatinine, glomerular filtration rate, hemoglobin levels, surgical and warm ischemia time, drainage, hospital stay duration, as well as complications were all evaluated. Results: Group 1 and Group 2 mean PADUA scores were 11 and 10.47, respectively. The mean preoperative, postoperative 1st day and 6th month serum creatinine were 1.02, 1.15 and 1.09 mg/dL in the Group 1 and were 0.93, 1.02 and 0.90 mg/dL in the Group 2, respectively. The mean preoperative, postoperative 1st day and 6th month glomerular filtration rates were 91.47, 77.31 and 81.90 mL/ min/1.73m2 in the Group 1 and were 92.07, 84.93 ve 90.73 mL/min/1.73m2 in the Group 2, respectively. Operation and warm ischemia time were 118min and 23min in the Group 1, and 101min and 13 min in the Group 2, respectively. There was no significant difference between groups in terms of drain removal time and hospital stay. Perioperative only Clavien I and II complications were observed with no recurrence during the follow-up. Conclusion: A single-layer of renorrhaphy plus hemostatic agent application can be safely applied in complex renal tumors with a PADUA score between 10-11 undergoing robotic partial nephrectomy. Keywords: robotic partial nephrectomy, nephron sparing surgery, renorrhaphy, complex renal tumor

EFFECTIVENESS OF POSTURAL THERAPY IN INFANTS WITH FREQUENT INTESTINAL COLIC

Infantile colic is a general term used to describe excessive crying, abdominal pain, and discomfort in the first months of life, and it causes stress for parents and concern for clinicians. Colic in babies is common all over the world. The Rome criteria offer diagnostic criteria for functional gastrointestinal symptoms but do not discuss their treatment. Manipulative treatments are considered effective interventions to reduce the severity of symptoms.The aim of the study. To evaluate the effectiveness of postural therapy in infants with intestinal colic.Methods. The current prospective cohort study used data from a mother-child cohort. 37 "mother-child" pairs (age of babies from 2 weeks to 4 months) were under observation. Two observation groups were created by the method of simple randomization: Group I - 17 infants who received traditional therapy (preparations based on simethicone, prokinetics, enzymes, antispasmodics, in case of significant flatulence, a gas removal tube or microenema was used), Group II - 20 infants who received postural therapy.To reveal the statistical difference between indicators in groups distributed normally, the Student's t-criterion of reliability was used, the degree of significance - r. The probability of the difference between relative values was determined by the Fisher's angular transformation method (Рφ).The research design and all the methods used in this study were reviewed and approved by the bioethics commission of the Bukovinian State Medical University (protocol No. 8, dated 02/17/2023).The study was carried out as part of the research work «Early diagnosis, treatment and prevention of combined pathology of the gastrointestinal tract and thyroid gland in children» (state registration number 0116U002937, implementation period 02.2016-11.2022).Results of the study. In 81.1% of babies, colic started after the 2nd week of life, in 18.9% - after the 1st month of life. The average age of onset of symptoms was 1.1 ± 0.1 months. Initially, colic occurred less often (1-2 times a week) and lasted up to 15 minutes, with age, their frequency and duration increased. We identified the main risk factors for the development of colic in babies: younger age of parents (F = 0.529, p = 0.001), mother's smoking (F = 0.498, p = 0.01), hypodynamia of the mother during pregnancy (F = 0.511, p = 0 .02), positive history of the father regarding functional diseases of the gastrointestinal tract (F = 0.788, p= 0.004), positive history of the mother regarding functional diseases of the gastrointestinal tract (F = 0.489, p= 0.01), food allergy in the mother (Ф = 0.476, p = 0.02), food allergy in the father (F = 0.329, p = 0.05), early (up to 3 months) transfer of the child to mixed or artificial feeding (F = 0.324, p = 0.05), hypoxic-ischemic CNS damage (F = 0.467, p = 0.05), body weight at birth &lt;2900 g (F = 0.531, p = 0.01). The dynamics of symptoms in children of both observation groups was almost the same, with the exception of such signs of colic as flatulence and grunting, which disappeared faster by 2.7±0.6 days in children who were on postural therapy. The frequency of colic attacks also decreased. Positive dynamics of body weight gain were noted in infants of both groups.Conclusions.1. The average age of onset of intestinal colic symptoms in infants was 1.1 ± 0.1 months.2. The relationship between the age of the parents, the mother's smoking and the mother's hypodynamia during pregnancy, a positive history of the parents regarding functional diseases of the gastrointestinal tract, hypoxic-ischemic lesions of the central nervous system and a birth weight of less than 2900 g and intestinal colic in infants was established.3. The use of postural therapy in infants with intestinal colic is an effective method of their treatment, which is confirmed by the positive dynamics of symptoms, a decrease in the frequency and duration of colic attacks, a sufficient increase in body weight and does not require the cost of medication.

Comparison of Clinical Efficacy of Glass Ionomer-based Sealant using ART Protocol and Resin-based Sealant on Primary Molars in Children.

The present in vivo study aims to evaluate and compare the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity glass ionomer (GI) (Equia Forte, GC India, Patancheru, Telangana, India) using atraumatic restorative treatment (ART) sealant protocol in primary molars. The design of the study was a clinical, prospective split-mouth study. A total of 100 contralateral primary molars were selected and divided into two groups. In group I, children received Equia Forte, and in group II, children received Clinpro Sealant. The follow-up examinations were performed in the 1st and 6th months. Simonsen's criteria were used to check for retention. International Caries Assessment and Detection System II (ICDAS II) criteria were used to check for dental caries. The data obtained were subjected to statistical analysis. At 6 months, there was no statistically significant difference between the groups with regard to retention and caries preventive effect. High-viscosity GI sealants can be applied using the ART protocol and provide an alternative to resin-based sealants. There is a limited number of studies on the performance of ART sealants in primary molars. Thus, the clinical efficacy and survival rate of resin-based composite sealant (Clinpro Sealant, 3M ESPE, Irvine, California, United States of America) with high viscosity GI (Equia Forte, GC India, Patancheru, Telangana, India) using ART sealant protocol in primary molars were evaluated. The research concluded that high-viscosity GI sealants using ART protocol are effective sealants in primary molars. Kaverikana K, Vojjala B, Subramaniam P. Comparison of Clinical Efficacy of Glass Ionomer-based Sealant using ART Protocol and Resin-based Sealant on Primary Molars in Children. Int J Clin Pediatr Dent 2022;15(6):724-728.

Is There Any Association Between Triglyceride–Glucose Index and Graft Function in Kidney Transplant Recipients?

BackgroundAlthough previous studies have illustrated the relationship between chronic kidney disease, coronary artery disease, erectile dysfunction, and the triglyceride–glucose index (TyGi), the relationship between this index and postoperative graft function in patients undergoing renal transplantation has yet to be investigated. In the present study, we aimed to reveal the association between the TyGi and renal graft outcomes in patients who underwent renal transplantation. MethodsWe retrospectively collected data on living and cadaveric kidney donor recipients between May 2019 and April 2022. The recipients’ age, sex, body mass index, preoperative fasting glucose and triglyceride levels, TyGi, estimated glomerular filtration rate (eGFR), and serum creatinine measurement data were recorded. The patients were divided into 2 groups according to their GFR values (group 1: GFR <60 mL/min/1.73 m2; group 2: GFR ≥60 mL/min/1.73 m2). Follow-up serum creatinine–eGFR levels and TyGi measurements were compared between the recipients in group 1 and group 2. ResultsThe mean TyGi measurements of the recipients were 8.79 ± 0.64 in group 1 and 8.83 ± 0.72 in group 2. There was no statistically significant difference in terms of the TyGi measurements between the 2 groups (P >. 05). No statistically significant correlation was found between the recipients’ creatinine, eGFR, and TyGi at 1st, 6th, and 12th postoperative months (P > .05). ConclusionsWe believe that the relationship between the TyGi and renal graft function can be more clearly understood in prospective studies that include a higher number of patients and a longer follow-up period.

Efficacy of Submucosal Diathermy of Inferior Turbinate in Patients with Chronic Rhinosinusitis Undergoing Functional Endoscopic Sinus Surgery.

To assess the efficacy of submucosal diathermy (SMD) in Chronic rhinosinusitis and inferior turbinate hypertrophy undergoing Functional Endoscopic Sinus Surgery. We conducted a Randomized Prospective study in patients undergoing Functional Endoscopic Sinus surgery for Chronic Rhinosinusitis in a tertiary care centre in South India for a period of 2 years. Patients were divided into two groups, Group A underwent FESS and Group B underwent FESS with SMD. The outcome was evaluated using nasal endoscopy score (NES), modified SNOT score and Modified Lund Kennedy scores. A total of 80 patients were included in this study.40 patients were allotted in each group. Male: Female ratio was 48:32. The age distribution ranged from 19 to 44 years with a mean of 29.55 ± 6.90 yrs. Mean NES scores, Modified SNOT and Modified Lund -kennedy scores were estimated pre-operatively and during 1st, 2nd and 3rd month of post-operative periods. The mean pre-operative sores were comparable in both the groups except NES score, which was higher in group B. Both the groups showed significant improvement in post-operative period. Inter group comparison showed significant difference in all scores with group B having better results when compared to group A. This study proves that FESS combined with SMD improves the postoperative clinical outcomes when compared with FESS without turbinate reduction. We conclude that SMD is a simple, mucosal preserving technique with almost no complications and can be safely done along with FESS to improve the outcomes .

COMPARISON OF EFFICACY OF TAMSULOSIN, ALFUZOSIN, AND SILODOSIN IN THE MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA

Objectives: This study was done to determine the efficacy of alpha-1 adrenoceptor blockers such as tamsulosin, alfuzosin, and silodosin in patients with the lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) over 6 months by assessing change in international prostate symptom score (IPSS), quality of life scale for urinary symptoms (Bother score), and improvement in peak urine flow rate (Qmax) from baseline. We also tried to identify any adverse drug reactions (ADRs) caused by these drugs. Methods: A prospective observational study was conducted in 291 patients with LUTS secondary to BPH attending urology outpatient department of a tertiary care center for 1 year. Ninety-seven patients in each group received tamsulosin, alfuzosin, or silodosin once daily. IPSS, Qmax, and the quality of life scale for urinary symptoms by Bother score were assessed at 1st, 3rd, and 6th month of treatment period. ADR was noted and recorded in ADR reporting form. Results: IPSS, mean bother score, and mean Qmax showed significant improvement from the baseline in each follow-up visit at 1, 3, and 6 months for all the three groups, but maximum was for alfuzosin and was found to be statistically significant (p&lt;0.001). Two patients developed adverse drug reaction during the study; asthenia in tamsulosin group and hypotension in Silodosin group. Conclusion: Patients on alfuzosin showed maximum improvement in the values of IPSS, Bother score, and Qmax in BPH patients as compared to tamsulosin and silodosin. Alfuzosin would be a better choice in the treatment of LUTS due to BPH.

Oral Cavity Beta-Defensin Levels Are Regulated Differently during Radiotherapy in Head and Neck Cancer Patients

Background: Human beta-defensins (hBDs) are small cationic peptides of the epithelium with broad antimicrobial and immune response-regulatory activities. hBDs are also related to oncogenesis, and their secretion profiles are affected by radiotherapy treatment. The present study aimed to investigate the oral cavity hBD 1-3 levels in head and neck cancer patients and its relation to radiotherapy treatment. Methods: Sixteen head and neck cancer patients (all with a history of smoking) were included in this study. Periodontal parameters were measured before radiotherapy, and medical information was collected from registries. Oral rinses of the patients were collected before radiotherapy; on the 1st, 3rd, and 6th weeks of radiotherapy; and the 1st month following the end of radiotherapy. hBD 1–3 levels were measured using ELISA. Results: Oral hBD-1 levels increased during radiotherapy at week 6 (p = 0.019). hBD-1 levels returned to pretreatment levels after the end of radiotherapy. No significant change was detected for hBD-2 or hBD-3 levels during or after radiotherapy. Conclusions: The constant expression of hBD-1, which is distinct from the infection and inflammation-dependent expression profiles of hBD-2 and hBD-3, may explain why this peptide is the only one affected by radiotherapy.

Lip Mesotherapy with Dexpanthenol as a Novel Approach to Prevent Isotretinoin-Associated Cheilitis.

Isotretinoin (ISO)-associated cheilitis is the most common side effect and the most common reason for discontinuation of ongoing therapy. So, various lip balms are also routinely recommended for all patients. We aimed to investigate the effectiveness of local intradermal injections (mesotherapy) of dexpanthenol into the lips to prevent ISO-associated cheilitis. This pilot study was conducted on patients over the age of 18 using ISO (about 0.5 mg/kg/day). All patients were prescribed only hamamelis virginiana distillate in ointment form as a lip balm. In the mesotherapy group (n=28), 0.1 ml of dexpanthenol was injected into each lip tubercle (4 points total) to the submucosal level. The patients in the control group (n=26) used only the ointment. "ISO cheilitis grading scale (ICGS)" was used in the evaluation of ISO-associated cheilitis. The patients were followed for 2 months. Although there was an increase in ICGS scores in the mesotherapy group compared to the baseline, no statistically significant change was observed after treatment (p=0.545). However, in the control group, there was a statistically significant increase in ICGS scores in the 1st and 2nd months compared to the baseline (p<0.001). Lip balms were needed significantly less frequently in the mesotherapy group compared to the control, both in the 1st and 2nd months (p=0.006, p=0.045; respectively). Lip mesotherapy with dexpanthenol will be a useful option for preventing ISO-associated cheilitis because of its easy application, cost-effectiveness, low complication risk, and high patient satisfaction.

The Effect of Pulmonary Rehabilitation on Pain, Respiratory Functions and Activities of Daily Living in COVID-19 Patients

Abstract Introduction: Coronavirus disease 2019 (COVID-19) requires a multidisciplinary approach owing to its multisystem involvement. Pulmonary rehabilitation may be required in patients with COVID-19. In our study, we aimed to examine the effect of the pulmonary rehabilitation program applied after the acute period of back pain in patients with severe pulmonary involvement, dyspnea and health profiles of the patients. Method: In our retrospectively planned study, 50 patients with advanced pulmonary involvement who were treated for COVID-19 and discharged from the hospital and who were diagnosed with shortness of breath, back pain and difficulties in daily living activities in the 1st month chest diseases polyclinic controls and who were given a pulmonary rehabilitation program for a period of 1 month were included in our study. Before and 1 month after the pulmonary rehabilitation program, back pain was evaluated with the VAS, respiratory functions were evaluated with the Modified Medical Research Council Scale, and activities of daily living were evaluated with the Notthingham scale. Results: A statistically significant difference was found between the beginning and the end of the pulmonary rehabilitation program in the Modified Medical Research Council Scale scores (p

Compare the Role of 5% Phenol in Almond Oil and Injection Sodium Tetradecyl Sulfate in the Treatment of Rectal Prolapse

Objective: To compare the role of 5% Phenol in Almond oil and Injection Sodium Tetradecyl Sulfate in the treatment of rectal prolapse. Methods and material: This study was conducted at Pediatric Surgery Department, Mayo Hospital Lahore. A total of 100 patients were included in the study and randomly divided into 2 groups. In Group-A patients were given 5% Phenol in Almond Oil and in Group-B patients were given Sodium Tetradecyl Sulfate. Patients were followed up at 1st post operative day and at 1st post operative month to see recurrence or any other complications (bleeding, perirectal inflammation, urinary retention, ischiorectal abscess, and necrosis of the rectal mucosa) in cases in both treatment groups. Results: In Group-A mean age was 5.63±3.34 years and in Group-B mean age of children was 7.16±2.80 years. In Group-A 46 and in Group-B 39 children were included.. There was significant association between treatment groups and outcome on 1st postoperative day reduction (P &lt; 0.05). In Group-A 5 and in Group-B 1 child had bleeding PR after postoperative day. No statistically significant association was present between treatment groups and bleeding PR after POD (P &gt; 0.05). In Group-A 49 and in Group-B 44 children had achieved reduction when observed at one month follow up time period. In Group-A reduction was achieved in greater number of patients as compared to that of Group-B patients (P &lt; 0.05). Practical implication: Current study will bring a revolution in the awareness of community amoung rectal prolapse problem and treating it successfully with the knowledge provided with the current literature. The role of 5% Phenol in Almond oil and Injection Sodium Tetradecyl Sulfate is well shown which proven to be a good treatement in Rectal prolapse. Conclusion: We conclude that 5% Phenol almond oil is more effective than Sodium Tetradecyl Sulfate in treating rectal prolepses. i.e., after the one-month follow-up, the post-operative decrease was 98% vs. 88 percent. Keywords: Rectal submucosa, ischiorectal abscess, ulceration, polyps, inflammation, idiopathic rectal prolapse,Etiology.

Lead distribution in rice plant leaves planted in Sukawening Village, Jatinangor District, West Bandung Regency, West Java

Lead is harmful when its amounts in food are higher than the optimum. Plants with high levels of lead may trigger the generation of reactive oxygen species and eventually cell death. Our study aimed to assess lead distribution in rice plant leaves planted in Sukawening Village, Jatinangor District, West Bandung Regency, West Java. The rice plant leaves were collected each month until 4 months. The samples were dried and underwent wet destruction. Visible spectrophotometry with the addition of xylenol orange was employed to identify the lead metal in the samples, followed by a standard addition photometric titration method. Our results indicated that lead was identified in the samples since the plant was 1 month old as proven by the Pb-xylenol orange peak at 580 nm. The level of lead in the rice plant leaves were: 1st month (0.4118 mg/kg); 2nd month (0.5232 mg/kg); 3rd month (0.6206 mg/kg); and 4th month (0.5264 mg/kg). We concluded that the lead level in the rice plants is in the range of that required by the Verdict of the Director General of the National Agency of Drug and Food Control No. 03725/B/SK/89 about the Maximum Limit of Heavy Metal Contamination in Food.

Effects of bloom’s mastery learning model based on CBRN preparedness program on learning skills of nursing students: A randomized controlled trial

BackgroundExposure to chemical, biological, radiological and nuclear (CBRN) threats and hazards can have fatal or disabling consequences. One of the most risky groups in terms of secondary contamination in CBRN exposure is healthcare workers. Nurses need to have several competencies to be able to respond correctly to people exposed to CBRN agents and to protect themselves from secondary contamination. AimThis study aimed to investigate the effectiveness of a Bloom’s Mastery Learning Model-based Chemical, Biological, Radiological, Nuclear Threat and Hazards Preparedness Program for nursing students (MLM-CBRN Preparedness Program) as a means for improving knowledge, attitudes, self-efficacy and skills. DesignA parallel-group trial design was used. MethodsA total of 104 4th-year nursing students were randomized into intervention and control groups. The data from the participants were collected before the intervention, immediately after the intervention and in the 1st and 3rd months after the intervention. ResultsAfter the intervention, a significant difference was observed between the groups in terms of knowledge, attitude and self-efficacy scores. It was seen that there was a significant difference between the pre-intervention measurement (1st measurement) and the 2nd, 3rd and 4th measurements (Table 2). This was due to the increasing scores of the intervention group (p < 0.05). ConclusionsIt shows that the MLM-CBRN Preparedness Program is effective in increasing the knowledge, attitude, self-efficacy and skill development of student nurses about CBRN threats and dangers.

Prognostic value of choroidal vascular index in determining response to intravitreal dexamethasone implant treatment used in refractory diabetic macular edema

To investigate the effect of intravitreal dexamethasone (IVD) implant injection, which was used in the treatment of DME, on CVI and to investigate whether CVI can be used as a prognostic marker in the treatment of anti-VEGF resistant DME. A retrospective observational and comparative study. Twenty-five eyes of 25 patients with refractory diabetic macular edema who underwent intravitreal dexamethasone (IVD) implant and 50 eyes of 50 healthy patients were included in the study. Central macular thickness (CMT), subfoveal choroidal thickness (SFCT), luminal choroidal area (LCA), total choroidal area (TCA), stromal choroidal area (SCA), and choroidal vascularity index (CVI) were measured on optical coherence tomography. There was no significant difference between the groups in terms of age and gender. When the pre-treatment values in the IVD group were compared with the healthy group, LCA and SCA values were higher, and CVI ratios were lower in the IVD group compared to the control group. When baseline, 1st, and 3rd months after injection were compared, it was determined that there was a significant decrease in CMT and LCA. There was no statistically significant difference in SFCT, TCA, and CVI. There was a significant negative correlation between baseline CVI and 3rd month CMT after IVD (rho: - 0.643, p: 0.001). It was observed that the baseline and 1st month LCA values were significantly higher than the 3rd month. The choroidal vascular structure may be affected by IVD treatment. CVI may also have value as a prognostic marker in monitoring the response to treatment.