Advanced Healthcare Facilities Research Articles

Mobile Critical Care in Resource-Limited Settings: An Unmet Need.

Care of the critically ill in resource-limited areas, inside or outside the intensive care unit (ICU), is indispensable. Murthy and Adhikari noted that about 70% of patients in low-middle income (LMIC) areas could benefit from good critical care. Many patients in resource-limited settings still die before getting to the hospital. Investing in capacity building by strengthening and expanding ICU capability and training intensivists, critical care nurses, respiratory therapists, and other ICU staff is essential, but this process will take years. Also, having advanced healthcare facilities that are still far from remote areas will not do much to alleviate distance and mode of transportation as barriers to achieving good critical care. This paper discusses the importance of mobile critical care units (MCCUs) in supporting and enhancing existing emergency medical systems. MCCUs will be crucial in addressing critical delays in transportation and time to receive appropriate lifesaving critical care in remote areas. They are incredibly versatile and could be used to transfer severely ill patients to a higher level of care from the field, safely transfer critically ill patients between hospitals, and, sometimes, almost more importantly, provide standalone short-term critical care in regions where ICUs might be absent or immediately inaccessible. MCCUs should not be used as a substitute for primary care or to bypass readily available services at local healthcare centers. It is essential to rethink the traditional paradigm of 'prehospital care' and 'hospital care' and focus on improving the care of critically ill patients from the field to the hospital.

Connecting through public transport: accessibility to health and education in major African cities

ABSTRACT Transport matters for health and education outcomes, by ensuring physical access to crucial facilities. Using spatial modelling techniques and routable public transport service data, this study assesses the effectiveness of mostly semi fixed-route public transport systems in connecting people to advanced healthcare and education facilities in African cities. Uncovering significant pockets of ‘accessibility poverty’ – travel times above an acceptable level – it underscores the inequality in access within the cities, disproportionately affecting poor populations. Proximity of public transport to homes matters but has limited impact, due to how the routes, operated mainly by informal service providers, are allocated across the urban space and the low technical performance. The low ‘value added’ of public transport compared to walking helps explain the prevalence of foot travel. Tailored policy interventions – improving the public transport systems and, equally importantly, ensuring more equitable spatial distribution of advanced healthcare facilities – emerge as crucial strategies for addressing accessibility poverty.

Can the choice of resuscitation fluid in a patient with traumatic brain injury affect the outcome?

Madam, Traumatic brain injury (TBI) refers to non-congenital, non-degenerative damage to the brain caused by an external mechanical force which can lead to permanent or temporary impairment of cognitive, psychosocial, and physical functions, accompanied by a reduced or altered state of consciousness.1 TBI is the most frequently occurring among common neurological disorders and accounts for a significant public health challenge.2 TBI has a high prevalence worldwide in adolescent (15 to 18 years) and elderly (>65 years) groups with a reported incidence of 1.7 million cases in the US alone.3 Pakistan also has a high prevalence of TBI with approximately one-third of its population being affected by it mainly due to the high incidence of road traffic accidents.4 Patients with TBI often present with clinical features of shock especially when the mechanism of injury is associated with high-energy trauma like road traffic accidents. In such cases, there is an imminent need for fluid resuscitation which becomes more important in under-served areas where immediate neurosurgical care is not available. It is widely known that crystalloids are superior to colloids for the resuscitation of the patient in such settings.5 The ringer lactate solution is usually preferred over normal saline for resuscitation in non-TBI settings because of lower mortality but the same is not true in TBI settings in which normal saline has been reported with significantly lower mortality. This difference can be attributed to the fact that ringer lactate being a balanced crystalloid, is hypo-osmotic, and thus can increase the intracranial pressure as well as the incidence of hyponatremia in patients with TBI.6 Therefore, in TBI, normal saline should be the fluid of choice for resuscitation instead of ringer lactate solution. The choice of fluid for resuscitation is of paramount importance in TBI, especially in a country like Pakistan where advanced healthcare facilities for neurosurgical care are not available in every city and village. Hence, many patients get referred to tertiary care centers from primary and secondary care centers after initial resuscitation for further management. In such cases, the correct choice of resuscitation fluid can significantly help in improving the odds of survival till patient’s arrival at higher care facility, and thereby help in decreasing the overall mortality associated with TBI.

A Comprehensive Study of Phenotypic and Genotypic Techniques to Detect Metallo-β-lactamases in Carbapenem-resistant Escherichia coli (E. coli) and Klebsiella pneumoniae (KP) Strains Derived through Numerous Clinical Specimens in Advanced Health care Facilities

In recent years, an increase in Escherichia coli and Klebsiella pneumoniae resistant to carbapenem was reported globally. Due to their high prevalence and extensive range of medical conditions, Escherichia coli and Klebsiella pneumoniae are both confirmed to be major public health concerns. Furthermore, carbapenem resistance restricts treatment options for individuals infected with these bacteria. Consequently, early detection of carbapenem resistance is essential for starting effective therapy, achieving successful management, and avoiding the infection from spreading further in the future. This study’s objective was to identify the phenotypic and genotypic identification of Metallo-β-lactamases (MBL) in carbapenem-resistant E. coli and K. pneumoniae in advanced healthcare facilities. Meropenem resistance was tested in E. coli and K. pneumoniae using the Kirby-Bauer disc diffusion technique. MBL was discovered using a combination of Disc diffusion testing and the Modified Hodge Test. The Polymerase Chain Reaction was used to determine the genotypes of the bla NDM-1 genes that express these enzymes. Out of 427 strains, including 223 E. coli and 204 K. pneumoniae, 35 (8.2%) consisted of carbapenem-resistant, and 29 (82.85%) showed phenotypically verified as metallo-beta-lactamase producers by using the Combined disc test and 20 (57.14%) using the Modified Hodge test. Polymerase Chain Reaction tests for genes detect those three different strains all showed the bla NDM-1 gene. Carbapenemase production and MBL can be recognized with the help of phenotypic combination disc and MHT tests in labs. Since both tests showed 100% concordance, laboratories may use the less expensive CDT instead of the MHT. The current study supports institutional antibiotic stewardship programmes to manage antibiotic use and prevent CRE worldwide.

Medicinal plants used as therapeutic medicine in the Himalayan region of Azad Jammu and Kashmir

• Medicinal plants have been playing an important role in traditional healing systems. • A total of 125 plant species used in herbal medicine were identified. • The herbaceous used life form is dominantly in herbal preparation. • The maximum ICF index value is calculated for liver and digestive problems. • Berberis lyceum and Thymus sarphylum (100% FL) are used for treating jaundice and joint pain respectively. The current research is the first quantitative ethno-botanical assessment of district Haveli in the Himalayan region, a remote and undiscovered territory of Azad Jammu & Kashmir (AJK). The people of the Himalayan region have a wealth of traditional knowledge that can be used to cure a variety of diseases. However, ethno-medicinal data must be recorded as soon as possible in order to preserve them and prevent extinction due to oral transmission, as well as to determine which remedies are still in use. Data was gathered from 70 informants (25 female and 45 male) through semi-structured interviews and group discussions. Informants were chosen at random or, in certain cases, using the snow-ball approach. To evaluate the gathered information, different ethnobotanical indices including UV, RFC, FL%, and ICF were used. Moreover, the information gathered in the current research work was contrasted with 22 different studies of aligned areas, including Pakistan. A total of 125 plant species used in herbal medicine were identified, which were distributed among 56 families and employed in 16 illness categories. Asteraceae (16 spp.) was the most used family in the area. The herbaceous life form was dominantly (66 spp., 53.65%) used in herbal preparation. The most commonly used part in herbal medicine was leaves (29.55%), and the most generally used method for preparing herbal recipes was extract (26.53%). The maximum ICF index value (0.92) was calculated for liver and digestive problems. The highest UV (0.92) was calculated for Berginia virgata. Olea ferruginea had the highest relative importance (100). Two plant species, Berberis lycium and Thymus surphylum, had 100% fidelity value. A high similarity was found with the study conducted on Devi Gali and Neelum valley with JI of 16.75 and 14.58. The plants with the highest levels of UV, RFC, RI, and FL would be examined for future pharmacological study in order to validate the findings and produce novel medications. Local residents have remained closer to nature due to their lack of communication with modern civilization. Despite the fact that they continued to employ medicinal plants in different herbal recipes, this tradition is on the verge of extinction since it is mostly retained by hakims, midwives, or the elderly people. The new generation is much less interested in traditional health practices due to advanced healthcare facilities and modern lifestyles.

Showpiece City: How Architecture Made Dubai

Showpiece City: How Architecture Made Dubai

Enhancing artemisinin content in and delivery from Artemisia annua: a review of alternative, classical, and transgenic approaches

Main conclusionThis review analyses the most recent scientific research conducted for the purpose of enhancing artemisinin production. It may help to devise better artemisinin enhancement strategies, so that its production becomes cost effective and becomes available to masses.Malaria is a major threat to world population, particularly in South-East Asia and Africa, due to dearth of effective anti-malarial compounds, emergence of quinine resistant malarial strains, and lack of advanced healthcare facilities. Artemisinin, a sesquiterpene lactone obtained from Artemisia annua L., is the most potent drug against malaria and used in the formulation of artemisinin combination therapies (ACTs). Artemisinin is also effective against various types of cancers, many other microbes including viruses, parasites and bacteria. However, this specialty metabolite and its derivatives generally occur in low amounts in the source plant leading to its production scarcity. Considering the importance of this drug, researchers have been working worldwide to develop novel strategies to augment its production both in vivo and in vitro. Due to complex chemical structure, its chemical synthesis is quite expensive, so researchers need to devise synthetic protocols that are economically viable and also work on increasing the in-planta production of artemisinin by using various strategies like use of phytohormones, stress signals, bioinoculants, breeding and transgenic approaches. The focus of this review is to discuss these artemisinin enhancement strategies, understand mechanisms modulating its biosynthesis, and evaluate if roots play any role in artemisinin production. Furthermore, we also have a critical analysis of various assays used for artemisinin measurement. This may help to develop better artemisinin enhancement strategies which lead to decreased price of ACTs and increased profit to farmers.

Effect of COVID-19 on Lungs: Focusing on Prospective Malignant Phenotypes.

Simple SummaryAccording to the coronavirus virus resource center of Johns Hopkins Medicine, more than 75 million people are presently affected worldwide, including 1.7 million deaths due to severe acute respiratory syndrome since December 2019. Apart from the common symptoms similar to the common flu, a characteristic computed tomography (CT) feature i.e., Ground Glass Opacity (GGO) is highlighted in this article. GGOs have been observed in COVID-19 patients with severe symptoms including pneumonia in both lungs. It is important to reflect that GGO may indicate the onset of lung fibrosis and may be an indicative feature of high-risk subjects for developing lung cancer. In this article, the causes of the appearance of GGOs and their effects are mainly discussed, along with the brief immunopathogenesis of COVID-19 in comparison with other oncogenic viruses. In this pandemic situation, it is also important to consider the long-term effects of coronavirus infection and the ways to follow-up the patients who recovered from this disease.Currently, the healthcare management systems are shattered throughout the world, even in the developed nations due to the COVID-19 viral outbreak. A substantial number of patients infected with SARS-CoV2 develop acute respiratory distress syndrome (ARDS) and need advanced healthcare facilities, including invasive mechanical ventilation. Intracellular infiltration of the SARS-CoV2 virus particles into the epithelial cells in lungs are facilitated by the spike glycoprotein (S Protein) on the outer side of the virus envelope, a membrane protein ACE2 (angiotensin-converting enzyme 2) and two proteases (TMPRSS2 and Furin) in the host cell. This virus has unprecedented effects on the immune system and induces a sudden upregulation of the levels of different pro-inflammatory cytokines. This can be a cause for the onset of pulmonary fibrosis in the lungs. Existence of a high concentration of inflammatory cytokines and viral load can also lead to numerous pathophysiological conditions. Although it is well established that cancer patients are among the high-risk population due to COVID-19-associated mortality, it is still unknown whether survivors of COVID-19-infected subjects are at high-risk population for developing cancer and whether any biologic and clinical features exist in post-COVID-19 individuals that might be related to carcinogenesis.

Detection of Intravascular Hemolysis in Newborn InfantsUsing Urinary Carbonic Anhydrase I Immunoreactivity.

Mild hemolysis occurs physiologically in neonates, but more severe forms can lead to life-threatening anemia. Newborns in developing regions are particularly at-risk due to the higher incidence of triggers (protozoan infections, sepsis, certain genetic traits). In advanced healthcare facilities, hemolysis is monitored indirectly using resource-intensive methods that probe downstream ramifications. These approaches could potentially delay critical decisions in early-life care, and are not suitable for point-of-care testing. Rapid and cost-effective testing could be based on detecting red blood cell (RBC)-specific proteins, such as carbonic anhydrase I (CAI), in accessible fluids (e.g., urine). Urine was collected from 26 full-term male neonates and analyzed for CAI using immunoassays (ELISA, western blot) and proteomics (mass spectrometry). The cohort included a range of hemolytic states, including admissions with infection, ABO incompatibility, and receiving phototherapy. Data were paired with hemoglobin, serum bilirubin (SBR), and C-reactive protein (CRP) measurements. Urine from a control cohort (CRP < 20 mg/L, SBR < 125µmol/L) had no detectable CAI, in line with results from healthy adults. CAI excretion was elevated in neonates with raised SBR (>125 µmol/L), including those qualifying for phototherapy. Newborns with low SBR (<125 µmol/L) but elevated CRP (>20 mg/L) produced urine with strong CAI immunoreactivity. Proteomics showed that CAI was the most abundant RBC-specific protein in CAI-immunopositive samples, and did not associate with other RBC-derived peptides, indicating an intravascular hemolytic source followed by CAI-selective excretion. CAI is a direct biomarker of intravascular hemolysis that can be measured routinely in urine using non-invasive methods under minimal-laboratory conditions.

Evaluation of drug utilization in cardiovascular disease at a teaching and referral hospital in Northern Telangana.

OBJECTIVES:Cardiovascular disease (CVD) is the primary cause of death globally despite the advanced health-care facilities. Extensive disparity exists in pharmacotherapy pattern among CVD patients where rational drug use plays a pivotal role in promoting safety and efficacy. The study focused to evaluate drug utilization using the World Health Organization (WHO) prescribing indicators and defined daily dose (DDD) in patients admitted to a teaching/referral hospital in Northern Telangana.MATERIALS AND METHODS:A total of 1120 medical records were analyzed for drug utilization for a period of 7 months. Prescription pattern was assessed using the WHO prescribing indicators and DDD to measure individual drug utilization categorized under anatomical–therapeutic–chemical classification.RESULTS:Of the total admissions, 58.57% (55.19 ± 15.19 years) were male and 41.43% (56.64 ± 15.28 years) were female where coronary artery disease was the most common cause of admission followed by cardiomyopathy. Among prescribing indicators, percentage of drugs with generic names was least accounted with 26.86% and 18.95% during hospitalization and discharge, respectively. A mean of 11.55 (hospitalization) and 6.55 (discharge) drugs were prescribed per prescription. Antiplatelet (72.86%) and statin (80.62%) use was predominate during complete therapy. The DDD of furosemide (109.33) was found to be high, followed by atorvastatin (64.6), enalapril (58.44), aspirin (58.14) and clopidogrel (53.2).CONCLUSION:Polypharmacy and least use of generic name were observed in the study which may affect the rationality. The use of antiplatelets, statins, and angiotensin-converting enzyme-inhibitors was appropriate, but furosemide overuse is of major concern. Therefore, appropriate prescription writing improvises treatment compliance in the patients, which results in rationality.

Patterns of emergency department visits during Hajj period: Towards healthcare optimization in view of Saudi Arabia’s vision 2030

Objective:This study aimed to examine the pattern of emergency department (ED) visits by Hajj patients and determine the urgency of emergency visits at an advanced healthcare center.Methods:A retrospective review of medical records of Hajj patients visiting the ED at King Abdullah Medical City Makkah from September 1 to October 5, 2015 was conducted.Results:We considered 233 visits by 199 Hajj patients. Most diseases were cardiovascular related. Approximately half of the ED visits led to hospital admission, which were largely during the evening and nighttime. Potentially avoidable visits were significantly encountered during the daytime. Average bed occupation time in the ED was similar for both cases: those admitted to inpatient care and discharged from ED. Results from the Canadian Triage and Acuity Scale revealed that most patients were triaged with a score of III (48.4%) followed by a clinically better score of IV (32%); however, scores did not change significantly throughout the Hajj day.Conclusions:During Hajj, a significant proportion of patients who visited the ED at the ultimate healthcare facility were discharged within 24 hours, with a higher rate in the morning-afternoon period. Both admitted and discharged cases required equal levels of care. Therefore, an extension in working days at primary care centers and optimization of advanced healthcare facilities during Hajj is currently warranted.

A measurement for evaluating the environmental quality of advanced healthcare facilities: Intelligent healthscape quality for medical staff

Healthcare facilities, where the newest medical technology based services are implemented by multiple stakeholders should be considered with a different point of view from other types of service buildings. However, there has been little effort to suggest the specific characteristics of advanced (technology-enhanced) healthcare facilities and moreover, most studies only discuss the patient's viewpoint. This study aims to suggest a theoretical background of Intelligent Healthscape Quality (IHQ) and determine evaluation measurements from the perspective of healthscape, which is a more integrated and contextual indicator than indoor environment quality (IEQ). Based on 36 items from the literature review, focus group interviews with 9 nurses, produced a 9 item optimized scale for the IHQ. Furthermore, a scale refinement, confirmation and validation procedure was implemented through the structural equation model. Finally, 5 dimensions (advanced technology, safety, ambience, layout accessibility, and sociality) with 17 factors were drawn and show that all dimensions and factors are reliable and valid measurements, both statistically and qualitatively. This construct includes not only traditional servicescape criteria but also newly proposed dimensions suitable for intelligent healthcare facilities. The results of the study support the robustness of the concept of intelligent healthscape quality as a multidimensional space that has a significant impact on medical staff satisfaction. Dimensionality of the intelligent healthscape as well as the scale development procedure of this study can contribute to analyze the quality of the built environment.

Evaluation of mobile phone addiction level and sleep quality in university students

To determine the mobile phone addiction level in university students, to examine several associated factors and to evaluate the relation between the addiction level and sleep quality. The study is a cross-sectional research conducted on the students of the Sakarya University between 01 November 2012 and 01 February 2013. The study group included 576 students. The Problematic Mobile Phone Use Scale was used for evaluating the mobile phone addiction level and the Pittsburgh Sleep Quality Index for assessing the sleep quality. Mann-Whitney U test, Kruskal-Wallis test and Spearman's Correlation Analysis were used for analyzing the data. The study group consisted of 296 (51.4%) females and 208 (48.6%) males. The mean age was 20.83 ± 1.90 years (min:17, max:28). The addiction level was determined to be higher in the second-year students, those with poor family income, those with type A personality, those whose age for first mobile phone is 13 and below and those whose duration of daily mobile phone use is above 5 hours (p < 0.05 for each). The sleep quality worsens with increasing mobile phone addiction level (p < 0.05). The sleep quality worsens with increasing addiction level. It was concluded that referring the students with suspected addiction to advanced healthcare facilities, performing occasional scans for early diagnosis and informing the students about controlled mobile phone use would be useful.

Implementation of foetal e-health monitoring system through biotelemetry

Continuous foetal monitoring of physiological signals is of particular importance for early detection of complexities related to the foetus or the mother's health. The available conventional methods of monitoring mostly perform off-line analysis and restrict the mobility of subjects within a hospital or a room. Hence, the aim of this paper is to develop a foetal e-health monitoring system using mobile phones and wireless sensors for providing advanced healthcare services in the home environment. The system is tested by recording the real-time Foetal Phonocardiography (fPCG) signals from 15 subjects with different gestational periods. The performance of the developed system is compared with the existing ultrasound based Doppler shift technique, ensuring an overall accuracy of 98% of the developed system. The developed framework is non-invasive, cost-effective and simple enough to be used in home care application. It offers advanced healthcare facilities even to the pregnant women living in rural areas and avoids their unnecessary visits at the healthcare centres.

Food consumption pattern for the population of the state of Kuwait based on food balance sheets

The population of Kuwait enjoys advanced healthcare facilities and an abundance of food. The life expectancy is 73.8 years, which is comparable with that of developed countries. However, nutrition-related diseases such as diabetes, obesity, high blood pressure, and heart disease have become serious health problems in Kuwait. Diabetes mellitus, asthma, and hereditary hemolytic anemia were reported to be the three leading causes of morbidity in governmental hospitals in 1993. A comprehensive overview of food import, export, and domestic production data for the period 1973- 1989 was conducted for 28 commodities, from which average per capita available food for consumption was calculated. Utilizing these data, a detailed analysis of the average energy, protein and nutrient supply was calculated. The data indicated that more than 75 percent of the energy supply comes from food groups of vegetable origin; animal products supplied 24 percent of the energy, whereas fats and oils contributed up to 15 percent of the energy supply. Comparing the recommended dietary allowances of the population with the nutrients available in the food supply, it was found that the food supply provided an excess of RDAs at a rate of 1.19 times of energy, 2.1 times of protein, 2.59 times of vitamin A, 1.37 times of thiamine, 1.39 times of riboflavin, 1.41 times of niacin, 2.52 times of vitamin C, 1.56 times of iron, and 1.10 times of calcium daily requirements. A detailed report on food available for consumption based on food balance sheet data is presented in this article, which gives contribution of various food groups to the dietary intake of the Kuwaiti population.