Advanced Medical Research Articles

Effects of Cannabidiol on Intestinal Myofibroblast Fibrotic PathwaysPATHWAYS

Inflammatory bowel disease (IBD) includes two immune-mediated disorders, Crohn’s disease (CD) and ulcerative colitis (UC). IBD is characterized by recurrent and chronic inflammation of the gastrointestinal tract. IBD is lifelong, and there is no cure. There has been an interest in new advanced medications to decrease inflammation and manage symptoms. Many of these new medications are expensive and depress the immune system, leaving many patients looking for alternatives to current medical therapies. Some IBD patients use medical marijuana to relieve the symptoms of this disease, and cannabidiol (CBD) in particular shows potential for reducing inflammation. This study investigates the potential therapeutic effects of CBD on IBD by examining its impact on fibrotic pathways in human intestinal myofibroblast (InMyoFib) cells. Cultured InMyoFibs were pre-treated with CBD, followed by transforming growth factor-beta 1 (TGF-β1) to stimulate a pro-fibrotic phenotype and mimic human IBD in the lab. Expression of genes associated with fibrosis, inflammation, and cannabinoid signaling was measured by quantitative polymerase chain reaction (qPCR). Fibrotic protein expression in the culture media was analyzed using enzyme-linked immunosorbent assays (ELISA). CBD pre-treatment before TGF-β1 stimulation significantly reduced the expression of pro-fibrotic genes ACTA2, CCN2, COL1A1, and SERPINH1 compared to cells stimulated with TGF-β1 alone. Additionally, CBD increased the expression of inflammation-related genes IL6 and PTGS2 and the lipid metabolism gene PPARG, known to have anti-fibrotic properties. These findings suggest that CBD may modulate fibrotic and inflammatory signaling pathways, providing a potential therapeutic avenue for IBD treatment.

Technical efficiency analysis of advanced medical centers in Burkina Faso

IntroductionBurkina Faso faces many challenges in the health domain, with no real opportunity for an increase in public health expenditures. In Burkina Faso, as in all low-income countries, health spending efficiency is crucial. The objective of this paper is to assess the efficiency of Advanced Medical Centers (AMCs)—which correspond to district hospitals—in Burkina Faso over the 2017–2020 period and identify the factors that promote—or, on the contrary, limit—the efficiency of these health structures.MethodWe first assessed the efficiency level of the 45 AMCs running in the country between 2017 and 2020 using a bootstrap Data Envelopment Analysis (DEA) methodology. Inputs include the number of doctors, nurses, other medical staff, non-medical staff, and beds, while output variables correspond to the number of inpatients, surgeries, outpatients, and inpatient days. In a second step, determinants of AMC’s efficiency levels were explored using a double-bootstrap procedure. The roles of AMCs’ internal and environmental factors were both considered.ResultsWe found a mean efficiency score of 0.51 over the study period, indicating that AMCs could have almost doubled their healthcare production without needing additional resources. The size, education level, and health status of the covered population and the density of the healthcare supply in the district appeared to be the driving factors of AMCs’ efficiency.ConclusionOur results indicate that improving the efficiency of AMCs should be a high-level priority for the Burkinabe health policy. Resources could be reallocated across AMCs to increase the overall efficiency of the health system.

Healthcare Access for Patients With Inflammatory Bowel Disease in the United States: A Survey by the Crohn's & Colitis Foundation.

A prior survey disseminated in 2017 identified that healthcare access barriers exist and significantly affect patients with inflammatory bowel disease (IBD). We sought to identify, through an updated survey, the healthcare access barriers that patients continue to face, with a focus on socioeconomic factors and patient awareness of resources to navigate existing barriers. A 52-question online survey evaluating (1) access to healthcare professionals, medications, and procedures; (2) associated financial challenges; and (3) patient awareness of education and advocacy tools to navigate IBD care barriers, was disseminated through multiple channels to IBD patients and their caregivers. Of the 2281 completed responses, patients on advanced specialty medications, younger than 65 years of age, or on employer insurance experienced significantly greater issues with insurance barriers to accessing medications and coverage of medically necessary tests/treatments. Patients who live in areas of concentrated poverty were more likely to experience poor health outcomes when subjected to step therapy compared to patients who did not. Additionally, patients were more likely to experience one or more financial barriers or trade-offs if the patient used an advanced specialty medicine or lived in an area with concentrated poverty. While there have been significant and numerous advancements in IBD treatments, patients with IBD continue to experience barriers to healthcare access and treatment and financial struggles. Ongoing awareness and advocacy efforts focused on healthcare system reform and related policies to further minimize care disparities and barriers remain vital.

Emergency Medical Care Provided by North Shore Rescue Advanced Medical Providers.

The North Shore Rescue (NSR) Advanced Medical Provider (AMP) program is composed of physicians and nurses based in North Vancouver who attend high acuity medical search and rescue (SAR) callouts in British Columbia, Canada. This study aimed to analyze the medical care provided by AMPs with appropriate comparisons to non-AMP callouts. A retrospective review of all NSR callouts from January 1, 2018, to December 31, 2022, was conducted. The analysis included AMP involvement, rescue logistics, subject demographics, activity, primary cause, provisional diagnosis, treatments, medical decision-making, and extraction means. National Advisory Committee for Aeronautics (NACA) scores were assigned by physicians to evaluate medical acuity as well as under-triage and over-triage. Of the 767 NSR callouts over the 5-year span, 283 (37%) were medical, and of these, 35% (n = 99) involved AMPs. Seventy-five percent of AMP rescues involved traumatic injuries, and 31% involved nontraumatic medical illnesses. The mean NACA score for AMP callouts was significantly higher than non-AMP callouts (3.1 ± 1.3 vs 1.9 ± 1.3, p < .00001). Medications were administered in 40% of AMP rescues, procedures were performed in 54%, and 37% involved advanced medical decision-making. Over-triage occurred in 33% of AMP callouts, with under-triage in 10%. The AMP program provides a useful service when advanced medical care in wilderness environments is needed. AMPs coordinate appropriate medical response and ensure safe, comfortable, and efficient transport to definitive care. The NSR AMP program may act as a model for the development of similar programs by other SAR teams.

Domestic researchers who have made important contributions to the study of digestive system diseases: images in art. Nina Fedorivna Deyneko

Nina Fedorivna Deyneko is a Doctor of Medical Sciences, Professor, an honored worker of science and technology of Ukraine, an outstanding health care worker, a labor veteran, and an academician of the International Academy of Sciences in apiphytotherapy and beekeeping. Under Prof. N. F. Deyneko’s supervision, 86 clinical residents, including 34 foreign ones, and postgraduate students were taught during her tenure at the Kharkiv departments of therapy and gastroenterology. Additionally, 25 candidate dissertations and one doctorate thesis were defended. She served as the head of the Kharkiv Medical Institute’s state examination commission for 15 years, founded and presided over the Kharkiv Medical Society of Gastroenterologists for 20 years, was a member of the All‑Union Society of Gastroenterologists’ Presidium of the Board for more than 20 years, and worked as the deputy chairman of the board of the Ukrainian Republican Society of Gastroenterologists. More than 200 research publications, four monographs, textbooks, and copyright certificates have been produced by Nina Fedorivna. Kharkiv Railway Clinical Hospital №1 became the clinical base of the Department of Gastroenterology of the Ukrainian Institute for Advanced Medical Studies, which was headed by Professor Nina Fedorivna Deyneko. Contemporary diagnostic equipment made it possible to perform diagnosis and treatment of patients with pathologies of the gastrointestinal, liver, biliary and pancreatic pathologies. The goal of methodological and pedagogical work was to optimize the educational process by using modern techniques for tracking students’ practical skills and initial, intermediate, and final levels of learning. Four‑ and three‑ month specialty cycles, as well as pre‑certification and theme improvement in the field of gastroenterology, were implemented during the first five years of the department’s existence. In addition to receiving 20 copyright certificates and publishing over 300 research papers, department staff members have also developed 62 rationalization recommendations that have been put into practice in the healthcare industry. The staff of the department participated in many scientific forums, including those conducted abroad.

История организационно-управленческой деятельности советского микробиолога Зинаиды Виссарионовны Ермольевой

The study aims to reconstruct the organizational and managerial aspect in the scientific biography of Zinaida Vissarionovna Ermolyeva (1898-1974), a prominent Soviet microbiologist who produced the first Soviet antibiotic penicillin. The paper analyzes Ermolyeva’s work leading various scientific units and institutions: the Department of Microbial Biochemistry at the A. N. Bach Institute of Biochemistry, followed by the A. M. Gorky All-Union Institute of Experimental Medicine, the Institute of Biological Prophylaxis of Infections, and the Department of Microbiology at the Central Institute for Advanced Medical Training. The study is novel in that it is the first one to shed light on the role of Z. V. Ermolyeva as an organizer of science and a leader of a scientific team, based on the analysis of a number of unpublished documents from three federal archives. As a result of the study, Ermolyeva’s scientific-organizational activity has been reconstructed and it has been established that for half a century her professional activity was associated not only with research in the field of microbiology and medicine, but also with the successful organization of Soviet science within academic and educational institutions, where she managed to create cohesive teams of talented researchers who made a significant contribution to the development of Soviet microbiology and medicine.

Management of intensive care unit withdrawal syndrome

Intensive care unit (ICU) patients frequently develop physical and psychological dependence on analgesic and sedative medications, which can lead to Iatrogenic withdrawal syndrome (IWS) upon discontinuation or tapering. The incidence of IWS in adult ICU patients varies significantly, with reported rates ranging from 12% to 100%. Identified risk factors for IWS include advanced age, obesity, medication dosage, and duration of exposure. The clinical manifestations of IWS are varied and include increased excitability of the central nervous system, gastrointestinal disturbances, and sympathetic nervous system hyperactivity. Preventive and therapeutic strategies for IWS encompass individualized medication regimens, structured withdrawal protocols, and a combination of pharmacological and non-pharmacological interventions. This review emphasizes the critical need for heightened awareness and improved management strategies to mitigate the incidence of IWS in ICU patients.

Engineering Features From Advanced Medical Technology Initiative Submissions to Enable Predictive Modeling for Proposal Success.

The U.S. Army Telemedicine and Advanced Technology Research Center Advanced Medical Technology Initiative (AMTI) demonstrate key emerging technologies related to military medicine. AMTI invites researchers to submit proposals for short-term funding opportunities that support this goal. AMTI proposal selection is guided by a time-intensive peer review process, where proposals are rated on innovation, military relevance, metrics for success, and return on investment. Utilizing machine learning (ML) could assist in proposal evaluations by learning relationships between proposal performance and proposal features. This research explores the viability of artificial intelligence/ML for predicting proposal ratings given content-based proposal features. Although not meant to replace experts, a model-based approach to evaluating proposal quality could work alongside experts to provide a fast, minimally biased estimate of proposal performance. This article presents initial stages of a project aiming to use ML to prioritize research proposals. The initial steps included a literature review to identify potential features. Then, these features were extracted from a dataset consisting of past proposals submissions. The dataset includes 824 proposals submitted to the AMTI program from 2010 to 2022. The analysis will inform a discussion of anticipated next steps toward developing a ML model. The following features were created for future modeling: requested funds; word count by section; readability by section; citations and partners identified; and term frequency-inverse document frequency word vectors. This initial process identified the top ranked words (data, health, injury, device, treatment, technology, etc.) among the abstract, problem to be solved, military relevance, and metrics/outcomes text proposal fields. The analysis also evaluated the text fields for readability using the Flesch readability scale. Most proposals text fields were categorized as "college graduate," indicating a challenging readability level. Finally, citations and partners were reviewed as an indicator of proposal successfulness. This research was the first stage of a larger project to explore the use of ML to predict proposal ratings for the purpose of providing automated support to proposal reviewers and to reveal the preferences and values of AMTI proposal reviewers and other decision-makers. The result of this work will provide practical insights regarding the review process for the AMTI program. This will facilitate reduction in bias for AMTI innovators and a streamlined and subjective process for AMTI administrators, which benefits the military health system overall.

Review Mechanisms for Advanced Medical Therapies in Japan and Thailand: A Proposal for the Use of Expert Clinical Benefit Assessments at Designated Institutions

AbstractAdvanced new therapies, such as stem cell and gene therapies and xenotransplantation, represent challenges for regulatory and ethical review. Major drug agencies, such as in the U.S., India, and Europe, have asserted regulatory authority and require ethics review by local ethics review committees, using the same strict requirements as those for standard drug approvals. In spite of this, unapproved and undocumented stem cell clinics flourish in all of these places, suggesting that current approaches do not offer patients sufficient protection. Japan has attempted another approach, requiring approvals at local levels for all regenerative medical procedures, and a faster approval of promising new interventions. The Japanese approach has, however, also been criticized as not striking a proper balance between early access and a proper assessment of safety and effectiveness. For smaller and less-resourced countries, such as Thailand, one major challenge is limited expertise to conduct the evaluation of these advanced new therapies. This article provides an overview of the issues facing regulators and proposes that countries should restrict the early adoption of advanced new therapies to specialized clinics with appropriate scientific and ethical expertise for review. Review in these institutions should focus on expert clinical benefit assessments for individual patients being offered such interventions, independently of whether they are offered as research or therapy.

Advance care planning and the ethical obligation of death literacy as a public health initiative in India.

This article highlights the importance of advance care planning (ACP) in good end-of-life care (EOLC). The judgement by the Supreme Court of India legalised Advance Medical Directives in 2018 and in January 2023, amended the procedure to make it easier. The article describes the advantages of ACP, the numerous ethical dilemmas at the end of life that it seeks to address and avoid, the latest legal procedure, the barriers, the need for awareness among healthcare providers, legal professionals as well as the public, and the need for legislation to translate the law into action. Educating citizens about their right to choose the kind of care they want at the end of life, including the right to refuse treatment, is the moral and ethical duty of all health professionals. Making death literacy and ACP a part of a public health initiative would be a major step towards meeting the obligations reflected in the World Health Organization guidelines and National Health Policy 2017, which envisage palliative care and EOLC as an integral part of Universal Health Coverage, requiring support from the government as well as the participation of civil society.

"What you Say Matters": Review of Clinical Outcome of Advanced Medical Directives Between Cancer and Non-cancer Patients in a Chinese Culture Society.

Advance medical directives (AMD) are statements made by individuals indicating the life-sustaining treatment that they would refuse in the future when they lost their mental capacity for medical decisions. While the proposal for the AMD legislation is ongoing locally in Hong Kong SAR, there are limited reviews on the clinical outcomes associated with it. To provide a comprehensive review on clinical outcomes of signed AMD. Retrospective, multi-center study, which includes AMD signed within five cluster hospitals. Records of signed AMD from 1st JAN 2020 to 31st DEC 2022 were retrieved from a central registry. Clinical information of each patient was obtained from the electronic patient record. 456 patients with documented AMD were included in the study. 91.6% of AMD were signed by palliative care (PC) team. Majority (74.6%) of the patients were accompanied by family members or friends when AMD were signed. The concordance rate between the AMD and the medical care received was 89.5%. No patient revoked their AMD. Cancer and non-cancer patients showed similar rates of AMD concordance, frequency of Accident & Emergency Department (AED) visits or acute ward admissions, duration of hospital stays in the 30days before death, and prevalence of receiving invasive or intensive treatments. Our study demonstrated that PC team currently plays a pivotal role in AMD completion, and AMD remains important in ensuring patients' care preferences are executed across different medical conditions. With the upcoming AMD legislation in Hong Kong SAR, adequate promotion and education should be launched.

Academician of medicine Z.V. Ermolyeva and the Department of Microbiology of the Central Institute for Advanced Medical Training: the main directions of scientific research in the early 1970s

The very difficult geopolitical situation of recent years has once again confirmed the need for our state to focus on its internal and self-sufficient development in its development. The story of the coronavirus pandemic that swept the whole world has shown a fairly high level of domestic virology, and microbiology in general. But, undoubtedly, we are still far from the Soviet level of science development today. In this regard, it seems advisable to pay attention to the generalization of the Soviet experience in the development of biomedical sciences. We have made an attempt to analyze the development of Soviet microbiology through an analysis of the scientific and organizational activities of the domestic scientist, Academician of Medicine Zinaida Vissarionovna Ermolyeva, carried out by her at the Department of Microbiology of the Central Institute of Advanced Medical Training in the first half of the 1970s. The source base of the publication was unpublished documents of the federal archives (the Russian State Archive of Scientific and Technical Documentation and the Russian State Archive of Economics), most of which are being introduced into scientific circulation for the first time. The article examines the scientific activity of Z.V. Ermolyeva herself, as well as those research areas that were developed by teachers and research staff of the department headed by her.

Advancing Medical Education: Performance of Generative Artificial Intelligence Models on Otolaryngology Board Preparation Questions With Image Analysis Insights.

Objective To evaluate and compare the performance of Chat Generative Pre-Trained Transformer (ChatGPT), GPT-4, and Google Bard on United States otolaryngology board-style questions to scale their ability to act as an adjunctive study tool and resource for students and doctors. Methods A 1077 text question and 60 image-based questions from the otolaryngology board exam preparation tool BoardVitals were inputted into ChatGPT, GPT-4, and Google Bard. The questions were scaled true or false, depending on whether the artificial intelligence (AI) modality provided the correct response. Data analysis was performed in R Studio. Results GPT-4 scored the highest at 78.7% compared to ChatGPT and Bard at 55.3% and 61.7% (p<0.001), respectively. In terms of question difficulty, all three AI models performed best on easy questions (ChatGPT: 69.7%, GPT-4: 92.5%, and Bard: 76.4%) and worst on hard questions (ChatGPT: 42.3%, GPT-4: 61.3%, and Bard: 45.6%). Across all difficulty levels, GPT-4 did better than Bard and ChatGPT (p<0.0001). GPT-4 outperformed ChatGPT and Bard in all subspecialty sections, with significantly higher scores (p<0.05) on all sections except allergy (p>0.05). On image-based questions, GPT-4 performed better than Bard (56.7% vs 46.4%, p=0.368) and had better overall image interpretation capabilities. Conclusion This study showed that the GPT-4 model performed better than both ChatGPT and Bard on the United States otolaryngology board practice questions. Although the GPT-4 results were promising, AI should still be used with caution when being implemented in medical education or patient care settings.

Establishment of diagnostic reference level for routine CT scan examination in Sokoto state, Nigeria

Diagnostic Reference Levels (DRLs) are embedded into the optimization procedure to regulate CT dose and diagnostic quality. The purpose of this research was to establish the local DRLs and radiation dose exposure for CT scans at the Sokoto State Advanced Medical Diagnostic Center, Nigeria. 190 patients who had CT head, chest, and abdomen-pelvis scans were collected and evaluated for this study. It was established that the DRLs for CTDIvol for the head, thorax, and abdomen-pelvis were 48.2, 9.44, and 8.02, respectively with DLP DRLs in mGy.cm were 1044, 372, and 646. When comparing head CTs, our CTDIvol DRL is lower than many international standards, yet our DLP DRL is also below those of other nations. The chest CT DRL from Sokoto state is comparable to the DLP standards of some nations, although its CTDIvol is higher. The abdomen-pelvis CTDIvol DRLs are lower than those of the UK and US, thus necessitating the implementation of a controlled and optimized protocol in order to guarantee patient safety while maintaining image quality.

The effect of exercise rehabilitation with exergames combined with ice therapy in the treatment of obese patients with gout: protocol for a clinical trial

BackgroundGout remains a leading cause of inflammatory arthritis worldwide, and the main risk factor for gout is persistent hyperuricemia. The clinical management of gout is mostly drug-based, and other treatment options are often ignored. This research proposal will explore whether exergames combined with ice therapy can help patients with gout to lose weight, relieve pain, improve the range of movement, improve quality of life, decrease uric acid level, decrease kinesiophobia and improve mental health of patients with gout.MethodsThis experiment will use a two-arm randomized controlled design. The study setting is at the Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia (USM). Obese patients with gout (N = 30) will be randomly assigned to the control group (receive an exergames intervention) and intervention group (receive an exergames intervention combined with ice therapy). The outcomes measurement will be conducted before (baseline) and after intervention (4 weeks). Then, it will be followed up at 12 weeks.DiscussionTo our knowledge, no study has investigated the effect of exergames and ice therapy among gout patients. This study is expected to demonstrate that exercise rehabilitation facilitated by exergames with ice therapy is more effective in gout management compared to a conventional rehabilitation intervention.Trial registrationChinese Clinical Trial Registry (ChiCTR2300070029). Registered on 31 March 2023.

Socio-demographic Characteristics and Clinical Profiles of Women Presented with Post-Caesarean Section Complications

Background: Post-caesarean section complications can occur in different Socio-demographic Characteristics with varied clinical profiles. Objective: The purpose of the present study was to see the socio-demographic characteristics and clinical profiles of women presented with post-caesarean section complications. Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecological at Dhaka Medical College and Hospital, Dhaka, Bangladesh from January 2013 to June 2013 for a period of six months. All women admitted with post caesarean section complications referred from different level of hospitals with the age group of more than or equal to 18 years were included as study population. All relevant data were recorded in a predesigned data collection sheet which included age, social status, economic condition and parity. Results: A total number of 50 women who were underwent caesarean section outside DMCH and admitted with post-caesarean section complications were included in this study. Maximum (40.0%) patients were within the age group of 21 to 25 years. Majority of the patients completed their primary and secondary level of education which was 16(32.0%) cases and 18(36.0%) cases respectively. Majority (56.0%) were multiparous. Primi was found in 20(40.0%) cases. Conclusion: In conclusion most the women are in younger age group with secondary and higher secondary education. Journal of Current and Advance Medical Research, July 2023;10(2):49-52

Detection of Breast Lumps with Fine Needle Aspiration Cytology: Experience of 50 Cases in Bangladesh

Background: Detection of breast lump is very crucial. Objective: This study was carried out to evaluate the effectiveness of FNAC as a diagnostic method for breast lump. Methodology: This cross sectional study was conducted among 50 women with breast lump at Popular Medical College Hospital, Dhaka, Dhaka Medical College Hospital and Ad-Din Barrister Rafique Ul Huq Hospital, Dhaka during the period of November 2021 to April 2022. This study was conducted using convenient type of non-probability sampling technique. Data were collected by face to face interview, clinical examination and findings of both cytological and histopathological examination. Results: The study revealed the most benign breast lesion (89.45%) were below the age of 40 years and most of the breast cancer (91.2%) were above the age of 40 years. The study showed that 29 cases (58.0%) were diagnosed as benign clinically but cytologically 30(60.0%) cases were benign. Clinically 14(27.0%) cases were malignant but cytologically 13(26.0%) cases malignant. Clinical diagnosis of 8(7.5%) cases were uncertain, whereas cytologically 2(4.0%) cases were suspicious of malignancy and 1(2.0%) case was atypical. The comparison study between cyological and final histopathological diagnosis showed that out of 28 benign lesions diagnosed cytologically among which only 2 cases were found malignant histologically like false negative 2 (7.20%). 13 malignant cases were diagnosed cytologically which were confirmed histologically like no false positive was found. The study found that sensitivity of FNAC 85.3% of the presence of breast cancer and specificity 100.0% for absence of breast cancer. They also showed that the negative predictive value of FNAC for benign breast lump was 93.5% and positive predictive value for malignant breast lump was 100.0% and the overall diagnostic accuracy was 95.40%. Conclusion: In conclusion, FNAC can be used as a diagnostic method in the management of breast lump which has reasonable sensitivity and specificity. Journal of Current and Advance Medical Research, July 2023;10(2):65-69

Diabetes Mellitus: A Global Health Concern Rising in Bangladesh

Abstract Not Available Journal of Current and Advance Medical Research, July 2023;10(2):47-48

Incidence of Polytrauma in the Casualty Emergency Department of a Tertiary Care Hospital in Dhaka City

Background: Polytrauma is a public health problem in every country. Objective: The purpose of the present study was to assess the incidence of Polytrauma in the Casualty Emergency Department of a tertiary care hospital in Dhaka city. Methodology: This cross-sectional study was carried out in the casualty of Emergency Department of Dhaka Medical College Hospital, Dhaka, Bangladesh. The patients who were admitted from January 2014 to December 2014 were included in this study. This study includes all the patients with polytrauma, most of whom underwent laparotomy or other types of surgery like suprapubic cystostomy, amputation, surgical toileting, chest drainage, but a small number was managed with non-operative approach. Immediately after admission, the patients were subjected to resuscitation, primary survey and history taking including pre-hospital retrieval. A tabulated sheet of questionnaire was given to all the patients and answer was taken by conversation and examination. Results: A total number of 100 patients were recruited for this study. The mean age with SD of the study population was 33.5±12.5 with the range of 3 to 67 years. The male female ratio is 7.33:1. The victims of polytrauma sustained their injury from different kinds of trauma. Out of hundred cases with polytrauma, road traffic accidents was the most common cause which included motor vehicle accident, pedestrian and motor cycle accident and resulted in a total of 63 casualty occupying 63% of the entire series. Polytrauma resulted fall from height occurred in 10 (10%) cases. Stab injury caused polytrauma in 5 (5%) cases. Conclusion: In conclusion majority of the study population is young adult with the predominance of male presented with road traffic accident. Journal of Current and Advance Medical Research, July 2023;10(2):60-64

Compare the Need of Additional Uterotonic Drugs for the Control of Post-Partum Hemorrhage after Caesarean Section

Background: Management of Post-Partum hemorrhage is very crucial among women after Caesarean Section. Objective: The purpose of the present study was to compare the need of additional uterotonic drugs for the control of post-partum hemorrhage among women after Caesarean Section. Methodology: This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2015 to December 2015 for a period of six months. Pregnant women diagnosed on the standard criteria admitted in BSMMU, Dhaka, Bangladesh were selected as study population by consecutive type of sampling. Randomization was performed according to computer generated simple random sampling method. An Uterotonic was an agent used to induce contraction or greater tonicity of the uterus. Then the patients were monitored per operatively and post operatively. All the information was recorded in data collection sheet. Main outcome variables were estimated blood loss. Results: A total number of 96 pregnant women were recruited for this study of which 48 cases were enrolled in group I and the rest of 48 case were enrolled in group II. The mean age with SD of the group I and group II were 24.4±4.7 years and 24.7±3.7 years. Before administration of drug, 44(91.7%) patients had well contracted uterus in group I and 41(85.4%) in group II. At 30 minutes after caesarean section, 48(100.0%) patients had well contracted uterine tone in group I and 47(97.9%) in group II. At 12 and 24 hours after caesarean section, 48(100.0%) patients had well contracted uterine tone in group I and group II respectively. The difference was not statistically significant (p&gt;0.05) between two groups. Four (8.3%) patients need additional utero tonic in group I and 7(14.6%) in group II. The difference was not statistically significant (p&gt;0.05) between two groups. In primary PPH of the study patients, it was observed that 2(4.2%) patients had primary PPH in group I and 6(12.5%) in group II. The difference was not statistically significant (p&gt;0.05) between two groups. Conclusion: In conclusion, additional uterotonic drugs are needed for the control of post-partum hemorrhage among women after Caesarean Section. Journal of Current and Advance Medical Research, July 2023;10(2):53-59