Basic Demography Research Articles

The Management Outcome of Heart Failure Reduced Ejection Fraction with or without Angiotensin Receptor Neprilysin Inhibitor

INTRODUCTION: Heart failure is associated with recurrent admission, higher mortality and low quality of life. Angiotensin receptor neprilysin inhibitor (ARNI) is a novel agent that has been used for treating heart failure reduced ejection fraction (HFrEF) patients. Thus, it is interesting to evaluate the effect of ARNI on the reverse cardiac remodelling, rehospitalization, cardiac biomarker and quality of life in HFrEF patients. MATERIALS AND METHODS: A case controlled study was conducted to assess the treatment outcome of HFrEF with or without ARNI. During the study, the patients’ basic demography, co-morbidities, baseline echocardiography (ECHO) findings, NYHA classification, NT-pro BNP levels and KCCQ score were evaluated. The patients’ admission history within 90 days from initiation of ARNI or non ARNI were obtained retrospectively. A follow up ECHO was obtained after at least 3 months of intervention. RESULTS: A total of 81 patients were recruited in which 54 patients were on ARNI and 27 were on non ARNI treatment. There was a statistically significant improvement of ejection fraction, left ventricular internal diameter end diastole and systole, and left ventricular end-systolic volume in ARNI group. The NYHA class was also noted to improve after ARNI treatment. The NT-proBNP value was lower whereas the KCCQ score was higher in ARNI group compared to non ARNI group. CONCLUSION: HFrEF patients with ARNI treatment had better reverse cardiac remodelling effect, cardiac biomarker and quality of life compared to non ARNI treatment. Furthermore, patient received ARNI demonstrated improved heart failure classification after treatment

Effect of Smoking on the Progression and Severity of COVID-19 Infection among Adult Males in Sullia Taluk of Dakshina Kannada

Abstract Context: Coronavirus disease 2019 (COVID-19) primarily targets pulmonary epithelial cells, causing viral pneumonia and acute respiratory distress syndrome. It progresses more severely in chronic obstructive pulmonary disease patients. Aims: The aim of the study was to assess the effects of smoking on the progression of COVID-19 infection among adult males in Sullia Taluk, Dakshina Kannada. Subjects and Methods: A cross-sectional study was carried out among 230 male subjects, aged 18 years and above diagnosed with COVID-19 from the records of the general hospital, Sullia. Necessary data were collected using a validated questionnaire comprised of three parts, Part A recorded basic demography, Part B recorded details of smoking history, and Part C recorded details of COVID-19 symptomatology. Descriptive measures and Chi-square tests were conducted separately for each variable to determine the association between various determinants of smoking and COVID-19. P < 0.05 was considered statistically significant. Results: The response rate of the study was 68.7%. Among the studied population, 20.3% were smokers. Analysis revealed that loss of taste or smell (73.91%), cough (52.17%), difficulty in breathing (52.17%), persistent pain in the chest (21.73%), and running nose (13.16%) were significantly higher among smokers compared to their nonsmoking counterparts. Conclusions: Results of the study support the hypothesis that smoking has an effect on the progression and severity of COVID-19 infection.

Impact of Psychiatry Posting on Attitudes Toward Mental Illness: A Prospective Cohort Study of Medical Students From Three Universities.

Negative attitudes towards mental illness are known to exist among medical students in Nigeria. However, the effect of undergoing a rotation in psychiatry on their attitudes is uncertain. It aimed to determine the effect of psychiatry posting during medical training on medical students' attitudes toward mental illness and examine the association of posting-related and demographic factors with their attitudes. It is a prospective cohort study in which 187 medical students from three different universities were followed up during their psychiatry postings in two different posting sites. Questionnaires containing basic demography, posting-related variables, and the Community Attitude to Mental Illness (CAMI) scale were administered to all available students before and after the rotation in psychiatry. A paired t-test was applied to test the differences in the CAMI scores before and after posting, while ANOVA and hierarchical regression were utilized to determine the association of variables with the CAMI scores. There were significant differences between the pre-and post-rotation CAMI scores in CAMI's social restrictiveness (SR) and community mental health ideology (CMHI) domains, indicating improved attitudes. Demographic factors had no significant influence on the students' attitudes, but the length of posting, university of the students, and posting sites had varying impacts. Psychiatry rotation has a positive impact on students' attitudes toward mental illness in both posting sites, particularly in the domains of SR and CMHI. This underscores the importance of psychiatry training in medical education in changing the attitudes of future healthcare professionals.

Susceptibility to hypertension based on MTHFR rs1801133 single nucleotide polymorphism and MTHFR promoter methylation.

The aetio-pathologenesis of hypertension is multifactorial, encompassing genetic, epigenetic, and environmental factors. The combined effect of genetic and epigenetic changes on hypertension is not known. We evaluated the independent and interactive association of MTHFR rs1801133 single nucleotide polymorphism (SNP) and MTHFR promoter methylation with hypertension among Taiwanese adults. We retrieved data including, MTHFR promoter methylation, MTHFR rs1801133 genotypes (CC, CT, and TT), basic demography, personal lifestyle habits, and disease history of 1,238 individuals from the Taiwan Biobank (TWB). The distributions of hypertension and MTHFR promoter methylation quartiles (β < 0.1338, 0.1338 ≤ β < 0.1385, 0.1385 ≤ β < 0.1423, and β ≥ 0.1423 corresponding to <Q1, Q1-Q2, Q2-Q3, and ≥Q3) among individuals with the rs1801133 genotypes (CC, CT, and TT) were significantly different (P < 0.05). The risk of hypertension was significantly higher among individuals with the TT genotype compared to the reference genotype (CC): odds ratio (OR); 95% confidence interval (CI) = 2.718; 1.503-4.914. The trend of the association of the CT and TT genotypes with hypertension was dose-dependent (P-trend = 0.0041). MTHFR promoter methylation (lower quartiles compared to ≥Q3) was not significantly associated with hypertension. However, its interaction with MTHFR rs1801133 was significant (P = 0.0323). After stratification by rs1801133 genotypes, lower MTHFR promoter methylation quartiles (<Q1, Q1-Q2, Q2-Q3) compared to ≥Q3 were significantly associated with a higher risk of hypertension among individuals carrying the CC genotype: ORs (95% CIs) = 3.225 (1.140-9.124), 4.177 (1.424-12.247), and 8.645 (2.513-29.739) for Q2-Q3, Q1-Q2, and <Q1, respectively. The trend test was significant (P-trend = 0.0009). Independently, rs1801133 TT was associated with a higher risk of hypertension, but methylation was not. Based on genotypes, lower methylation was dose-dependently associated with a higher risk of hypertension in individuals with the CC genotype. Our findings suggest that MTHFR rs1801133 and MTHFR promoter methylation could jointly influence hypertension susceptibility.

Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study

BackgroundPersistent anterior knee pain and subsequent patellofemoral joint (PFJ) osteoarthritis (OA) are common symptoms after anterior cruciate ligament reconstruction (ACLR). Quadriceps weakness and atrophy is also common after ACLR. This can be contributed by arthrogenic muscle inhibition and disuse, caused by joint swelling, pain, and inflammation after surgery. With quadriceps atrophy and weakness are associated with PFJ pain, this can cause further disuse exacerbating muscle atrophy. Herein, this study aims to identify early changes in musculoskeletal, functional and quality of health parameters for knee OA after 5 years of ACLR.MethodsPatients treated with arthroscopically assisted single-bundle ACLR using hamstrings graft for more than 5 years were identified and recruited from our clinic registry. Those with persistent anterior knee pain were invited back for our follow-up study. For all participants, basic clinical demography and standard knee X-ray were taken. Likewise, clinical history, symptomatology, and physical examination were performed to confirm isolated PFJ pain. Outcome measures including leg quadriceps quality using ultrasound, functional performance using pressure mat and pain using self-reported questionnaires (KOOS, Kujala and IKDC) were assessed. Interobserver reproducibility was assessed by two reviewers.ResultsA total of 19 patients with unilateral injury who had undergone ACLR 5-years ago with persistent anterior knee pain participated in this present study. Toward the muscle quality, thinner vastus medialis and more stiffness in vastus lateralis were found in post-ACLR knees (p < 0.05). Functionally, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb with increasing knee flexion. In accordance, rectus femoris muscle stiffness in the ACLR knee was significantly correlated with pain (p < 0.05).ConclusionIn this study, it was found that patients having higher degree of anterior knee pain were associated with higher vastus medialis muscle stiffness and thinner vastus lateralis muscle thickness. Similarly, patients with more anterior knee pain tended to shift more of their body weight towards the non-injured limb leading to an abnormal PFJ loading. Taken together, this current study helped to indicate that persistent quadriceps muscle weakness is potential contributing factor to the early development of PFJ pain.

Sex differences implications in hippocampal volumetry during midlife

AbstractBackgroundSex differences in adult brain morphology are frequently reported. Hippocampal and medio‐temporal (MTL) cortices in women and men are frequently implicated in Alzheimer’s Disease (AD) pathology, and women are disproportionally more affected by AD than men. Modifications in these regions’ volumetry are described during aging and in pathology, but their specificities during midlife regarding sex are still debated. Also, the multifaceted interactions between sex and dementia risk factors in these brain areas are not fully established. The aim of this study is to precisely identify the differences between women and men in the volumetry of hippocampal and MTL subregions, as well as the moderation effects of risk factors for dementia such as hypertension (diastolic blood pressure), hypercholesterolemia, obesity (body mass index), physical inactivity, and inflammation (C‐Reactive Protein), on sex.MethodData from 210 cognitively healthy participants were analyzed (106 women; 104 men; age 40‐65). Automatic segmentation was performed to determine the volume of the bilateral anterior and posterior hippocampus, and of entorhinal, perirhinal (BA35 and BA36), and parahippocampal cortices (ASHS‐PMC‐T1 atlas). The total intracranial volume was obtained to calculate adjusted‐volumes for every participant. An analysis of covariance (ANCOVA) was performed to compare women and men subregions’ volumes, corrected for age. Linear regressions were performed to analyze the interactions between sex and dementia risk factors on the volumetry of these regions.ResultWomen and men were significantly different in the volume of the left (p &lt; .001) and right (p &lt; .001) hippocampus, on the right BA35 (p = .008), and on the left (p &lt; .001) and right (p &lt; .001) parahippocampal cortices. No significant interaction was highlighted between sex and risk factor variables.ConclusionBeyond basic demography, sex is essential to consider in research, as women and men appear to be inherently different in their brain morphometry, even from midlife. Volumetric differences in AD‐linked brain regions, regardless of potential dementia risk factors, may be an innocuous sex‐specific feature at the preclinical phase. In this regard, women’s vulnerability to AD may not occur until later in aging, potentially linked to hormonal decline.

Histopathological Profile of Central Nervous System Tumors in a Peripheral Tertiary Care Centre of West Bengal.

Introduction Central nervous system (CNS) tumor incidence is very low in comparison to other organ neoplasm. Recent increase in the incidence may be due to exposure of the population to various risk factors, genetic mutation, or improved diagnosis with advancement in diagnostic modalities. This study aims to observe the histopathological spectrum of CNS tumors with their clinical profile and basic demography at a single center in a peripheral region in West Bengal. Material and Methods A retrospective study was conducted in the department of pathology, Gouridevi Institute of Medical Sciences and Hospital (GIMSH), Durgapur, West Bengal, over a period of 2 years from October 2018 to September 2020 on CNS tumors. Basic demographic data, tumor site, and histopathological profile were obtained from medical records and further analyzed and graded according to the World Health Organization (WHO) classification. Result Among 42 cases of CNS tumors, 29 cases were from different regions of the brain and 13 cases were from the spinal cord, with a male to female ratio (1.21:1); the commonest age group was the sixth decade and most common tumor was meningioma, followed by astrocytic tumors. Conclusion The present study helps provide information regarding the burden of disease in our area. Despite the use of modern imaging techniques that help in the provisional diagnosis of disease, histological examination is the gold standard in diagnosis of varied types.

Risk factors associated with short-term complications in mandibular fractures: the MANTRA study-a Maxillofacial Trainee Research Collaborative (MTReC).

Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.

Knowledge, Awareness &amp; Practice (KAP) for COVID-19 in the Pakistani Nation

Objectives: The study aimed to examine COVID-19 knowledge among the general public in Pakistan, to review their attitudes and views regarding the fast epidemic. Study Design: Descriptive cross-sectional study. Duration of Study: June-July 2020. Methodology: A total of 679 respondents included. The questionnaires comprised of the following basic themes: basic demography, general &amp; basic clinical/medical knowledge, attitudes, awareness, perceptions as well as a sense of prevention regarding COVID-19. Results: The majority (75.5%) of the respondents were from Punjab province. Around half (54.5%) of the respondents had heard about the COVID-19 infection through different social media. The majority were 28.4% medical students. The majority of the respondents (80-95%) selected correct answers from the given choices for the questions related to some clinical knowledge. More than half of people (59-64%) think positively that COVID-19 will successfully be controlled and Pakistan will be successful in winning this battle of the pandemic. 61% were afraid of COVID-19 as it is highly contagious disease (37.7%). Around 60% always covered their noses and mouths while sneezing and coughing. Conclusion: The people must have a thorough understanding of COVID-19 to successfully execute COVID-19 prevention strategies. Although we found enough knowledge, favorable perspectives, and readiness to follow SOPs, we believe that additional preventative and cautious attitudes, as well as awareness, are needed. Keywords: COVID-19, Online Survey, KAP (Knowledge, Awareness &amp; Practice), Standard Operating Procedures (SOPs)

Food allergy in children with asthma and its correlation with level of asthma control.

BackgroundThere is paucity of regional data regarding food allergy among children with asthma.ObjectivesTo estimate the proportion of children with asthma who have food‐related respiratory symptoms and to correlate it with (a) skin prick test (SPT) results and (b) level of asthma control.MethodologyThis cross‐sectional study involved children with asthma, aged ≥6 years attending the childhood asthma clinic in a tertiary care hospital, in the southern part of India from July 2017 to July 2019. Basic demography and clinical details were recorded. In subjects with a history of food allergy, skin prick test (SPT) was done using AllergoSPT according to guidelines recommended by British Society of Allergy and Clinical Immunology (BSACI). Asthma control was assessed using asthma control test (ACT) and childhood ACT questionnaires.ResultsOf the total 305 children included, the most commonly reported allergen was banana (45%, n = 137). The predominant symptom reported was wheezing (54%). SPT was positive in 76 children (24.9%). Level of asthma control (P value < .01), family history of atopy (P value < .01), and age at introduction of complementary foods (P value < .01) were significantly associated with food allergy.ConclusionPresumed food allergy is seen in one‐fourth of children with asthma and significantly affects symptom control in them.

Hymenoptera heartaches -cardiac manifestation with hymenoptera stings, a retrospective study from a tertiary care hospital in South India.

Hymenoptera stings usually have a multitude of presentations from very subtle to life-threatening conditions. Various cardiac manifestations including Kounis syndrome often get missed due to lack of suspicion. The aim of the study was to describe the clinical profile of the cardiac etiologies associated with hymenoptera stings and review literature with focus on diagnosis and treatment strategies. A retrospective chart analysis was performed including all adult patients who had a hymenoptera sting during a two-year window (October 2018 - October 2020). Of these, patients with cardiac features were enrolled. A structured case record form was used to capture information like basic demography, clinical profile, and outcomes. Thirteen cases presented with hymenoptera stings of which six cases had cardiac presentation and were considered. The most common presentations were breathlessness and generalised itching with only one patient complaining of chest pain. All patients(with available data) had ECG changes suggestive of ischemia and associated raised troponin levels with 2D echo changes. The diagnoses considered included Kounis syndrome, hypersensitivity myocarditis, and Takotsubo cardiomyopathy. Patients were managed conservatively with one patient undergoing a coronary angiography. All patients were stable at discharge. Cardiac manifestations with hymenoptera stings although rare may complicate diagnosis and treatment.It should be borne in mind during assessment and standardised guidelines should be developed for ED treatment such as the one recommended in this study.

Clinical profile, outcomes and predictors of mortality in elderly patients admitted to the emergency medicine intensive care unit of a teaching hospital - A single-center registry.

Aim:Emergency intensive care of the elderly is often complicated and multifaceted. Understanding the clinical profile of elderly patients admitted in an emergency department-intensive care unit (ED-ICU) is crucial in planning health policies in geriatric emergency medicine. Thus, the aim of the study was to create a local registry of elderly people utilizing the ED-ICU services and to understand the rate and predictors of mortality.Methods:A retrospective chart analysis was performed including all patients aged ≥60 years who had an ED-ICU admission during a 6-month period (August 2018–January 2019). A structured case record form was used to capture information such as basic demography, clinical profile, and outcomes.Results:Total number of records considered for final analysis were 503. Mortality was seen in 21.07% (n = 106/503). The most common presenting complaint and cause of death was breathing difficulty (n = 48/503; 29.42%) and pneumonia (n = 41/106; 38.67%), repectively. The significant predictors of mortality [adjusted odds ratio; 95% confidence intervals; P value] were hypertension (2.195; 1.255, 3.840; 0.006), chronic liver disease (CLD) (4.324; 1.170, 15.979; 0.028), malignancy (2.854; 1.045, 7.796; 0.041), requiring noninvasive ventilation (NIV) (2.618; 1.449, 4.730; 0.001), requiring intubation (6.638; 3.705, 11.894; <0.001), and requiring vasopressors (3.583; 1.985, 6.465; <0.001).Conlusion:Approximately one in every five elderly patients getting admitted in ED-ICU died, and respiratory illness was the common diagnosis leading to death. Those with comorbidities such as hypertension, CLD, or malignancy and those requiring NIV, intubation, or vasopressors had higher mortality.

Comparison of the accuracy of clinical prediction of survival and palliative prognostic index for patients with head and neck squamous cell carcinoma in the end-of-life setting

ObjectiveIn the end-of-life stage of head and neck squamous cell carcinoma (HNSCC), predicting survival is essential to determine treatment procedure and place of care. Several reports have compared actual survival (AS) and clinical prediction of survival (CPS), a subjective prognostic prediction by attending physicians. However, specific studies focusing on patients with HNSCC are limited. Likewise, a comparison of the accuracy of CPS and palliative prognostic index (PPI), a prognostic tool using subjective assessment, has not been sufficiently investigated. This study aimed to clarify the correlation between AS and CPS/PPI and compare the accuracy of CPS and PPI in end-stage HNSCC. MethodsThis retrospective study included patients with HNSCC in the end-of-life setting. Patients were recruited from the National Hospital Organization Shikoku Cancer Center between April 2011 and March 2019. Data on basic demography and clinical parameters when patients decided to start end-of-life care at the head and neck oncology division were collected. We examined the correlation between AS and CPS using Spearman's correlation coefficients. The area under the receiver operating characteristic curve of CPS and PPI for 30-day survival prediction were compared for predictive accuracy. ResultsAmong 98 eligible patients, 59 patients were enrolled in this study and analyzed. Of the 59 patients, CPS and PPI were calculated for 30 patients, whereas, only the PPI was calculated for 29 patients. The median AS and CPS were 35 (IQR: 9–73) days and 30 (IQR: 7–83) days, respectively. CPS and PPI (30 cases) were moderately correlated (r = 0.72, p<0.01). AS and CPS/PPI (30 cases) were significantly correlated (p<0.01) and showed a strong correlation (r = 0.86 and 0.80, respectively). In the 30-day survival prediction, the AUROCs of CPS and PPI (30 cases) were 0.967 (95%CI: 0.919–1) and 0.884 (95%CI: 0.767–1), respectively. Both CPS and PPI (30 cases) showed high accuracy in predicting the 30-day prognosis, with no significant difference (p = 0.077). The AUROC of PPI (59 cases) was 0.840 (95%CI: 0.711–0.969). ConclusionsAS and CPS/PPI showed significant correlations. The high accuracy of CPS may have been influenced by the fact that multiple head and neck cancer specialists at a comprehensive cancer center estimated CPS. Both CPS and PPI showed high prognostic accuracy in predicting 30-day survival. This suggests that PPI is useful in centers among physicians and healthcare workers unfamiliar with head and neck cancer.

Comparison of maternal and foetal outcomes between adolescent and adult pregnancies; a descriptive cross sectional study

Introduction: Adolescent pregnancy is a global issue and the trend is increasing specially in South East Asia. Pregnancies at a younger age have major maternal and fetal health consequences. The aim of this study was to compare selected maternal and fetal outcomes of adolescent pregnancies with its adult counterpart in atertiary care center. Methods: A hospital based descriptive study was conducted at Teaching Hospital Mahamodara (THM), Galle. One hundred adolescent mothers (10-19 years) were compared with 100 adult mothers (20 -35 years) who had singleton uncomplicated pregnancy. Pre-tested interviewer administered questionnaire was used as the tool to collect data on basic demography, perinatal, maternal outcomes and mode of delivery. Chi-squared test and t-test were used to compare data and presented as proportions, mean (SD), with 95% CI. Results: Mean (SD) age at delivery of adolescent and adult mothers were 18 (0.2) and 27 (0.8) years respectively. Of the adolescent mothers 16% were unmarried. More adolescent mothers had anaemia compared to adults (38% vs. 32%), but the difference was not statistically significant (p=0.37). Adolescent mothers had higher pre term delivery rate compared to adult mothers (23% vs.15%) but the difference was not statistically significant (p=0.18). There were no significant differences in birth weight (2.77 vs. 2.82; p=0.5) rate of admissions to premature baby unit (6% vs. 7%; p=0.8) and mean APGAR scores (9.9 vs 9.8; p=0.3) between the two groups. A significantly greater proportion of vaginal deliveries were carried out in adolescents compared to adults (75% vs. 55%; p= 0.003). Conclusions: Adolescent mothers underwent a significantly larger proportion of vaginal deliveries compared to adults. Though not significant, anaemia and preterm deliveries were higher than in their adult counter-parts. There was no significant difference between the two groups for the selected perinatal outcomes.

Care of children with type 1 diabetes mellitus in school- An interventional study.

Paucity of data from India on care of children with Type 1 diabetes in schools. Aims: To study assess the knowledge, attitude, practices and fear of Type 1 diabetes in school teachers and to assess the impact of an educational model on the fear of teachers and care of children in Type 1 DM at school hours. A community based study, involving school teachers and the intervention being educating them about diabetes conducted. Data pertaining to basic demography, attitude of teachers towards diabetic children, Hypoglycemia fear factor survey- parent version with worries domain and preparedness of school was collected. An education program was conducted on diabetes care in children. Immediately and after three months, the proforma details and HFSP-W scores reassessed. Forty two teachers (mean age: 38.7±5.4; M:F ratio 2:40) participated in the study. Post intervention, a higher willingness to have the diabetic child in class (100 vs. 57.1%; p>0.05), better support in daily care (100 vs. 92%; p>0.05), participation in sports activities (100 vs. 7.1%; p<0.05) observed. HFSP-W scores were 38.8±4.5 (pre-intervention), 22.5±4.3 (immediate post intervention) and 29.5±3.2 (at 3months) (p<0.05). To study the determinants of improvement in HFSP-W a regression analysis was performed: presence of glucometer the most likely determining factor (T=1.999, p=0.05). There is a significant element of fear in the minds of teachers towards hypoglycemia which improves with a structured education program.

Commentary on the Simulation Tool Developed by Imperial College, London for 137 Low- and Middle-Income Countries Using Nigeria a As a Case Study

The MRC centre for Global Infectious Disease Analysis at Imperial College have created a COVID-19 simulation for 130 Low and Middle countries available at covidsim.org. The simulation shows an epidemic trajectory and healthcare demand pattern for selected countries based on logic that is said to be a venture between Imperial College, London and a private firm, Bio Nano Consulting, The Jameel Group and is research funded by the Wellcome Trust and UK Aid from the UK government. The commentary focusses on the results that pertain to Nigeria, the country on interest of the authors. Although the simulation looks at mortality outcomes based on interventions and healthcare demand and supply situation, the emphasis of the commentary was on number for infections and associated mortality as displayed by the simulation. The inputs and the outputs of the model were critiqued. A result of the model was that a population far in excess of the country’s population is expected to be infected, and the simulated deaths associated with these numbers of infected people were considered excessive, improbable and unreasonable. Suggestions were made to improve the simulated outputs, and a conclusion of the adjusted model involving calibrating the model for actual results envisaged thus far and adjusting for the population that is expected to be infected based on the basic reproduction number, herd immunity and age demography resulted in a much lower estimate of mortality. This resulted in a reduction of simulated deaths from 989,475 deaths from the original model to 19,719 deaths in the adjusted model.

Developing COVID-19 Simulation Tool for Low and Middle-Income Countries: The Nigerian Case Study

The MRC centre for Global Infectious Disease Analysis at Imperial College has created a COVID-19 simulation for 130 Low and Middle countries available at covidsim.org. The simulation shows an epidemic trajectory and healthcare demand pattern for selected countries based on logic that is said to be a venture between Imperial College, London and a private firm, Bio Nano Consulting, The Jameel Group and is research funded by the Wellcome Trust and UK Aid from the UK government. The commentary focuses on the results that pertain to Nigeria, the country of interest of the authors. Although the simulation looks at mortality outcomes based on interventions and healthcare demand and supply situation, the emphasis of the commentary was on number for infections and associated mortality as displayed by the simulation. The inputs and the outputs of the model were critiqued. A result of the model was that a population far in excess of the country’s population is expected to be infected, and the simulated deaths associated with these numbers of infected people were considered excessive, improbable and unjustifiable. Suggestions were made to improve the simulated outputs, and a conclusion of the adjusted model involving calibrating the model for actual results envisaged thus far and adjusting for the population that is expected to be infected based on the basic reproduction number, herd immunity and age demography resulted in a much lower estimate of mortality. This resulted in a reduction of simulated deaths from 989,475 deaths from the original model to 19,719 deaths in the adjusted model.

Radiographers’ academic development in Sweden: Towards and after a doctoral degree

IntroductionRadiography is a young discipline and having radiographers with a doctoral degree is central for its development. Academic development of this field in Sweden has been evolving. This study explored the diagnostic radiographers’ prerequisites for doctoral studies, post-doctoral employment and research activities. MethodsData were collected through a questionnaire designed to give insight into doctoral radiographers’ qualification paths, funding, doctoral status, employment and basic demography. Sixteen radiographers participated. A conventional content analysis was used. ResultsThe median age at dissertation defence was 53 for doctorates and 60 for licentiates. This indicates that after receiving the doctorate, there is short time left in the profession, increasing the challenge to develop the field. Most doctorates were employed within educational establishments. Unfortunately, few had supervised doctoral students, but those employed within academia contributed significantly to academic research. ConclusionCompared to other Nordic countries, Sweden is at the forefront with a positive development in obtained high academic degrees. Nevertheless, there is an urgent need for post-doctorate radiographers in order to maintain the workforce to meet current and future demands. Radiographers with doctorates need to be consulted when planning research projects to establish a clear radiographic perspective. Swedish radiographers with a doctorate or licentiate have limited research time, indicating that Sweden may not invest enough in radiographic research. Implications for practiceThere is a need for more doctoral positions and doctorates radiographers to supervise doctoral students. Clinical departments should recognise the benefits of having radiographic clinical research.

Knowledge and practice amongst health care professionals regarding hand hygiene − are we on the right path in the current coronavirus disease 2019 pandemic?

Aim Hand washing is one of the most important practices for preventing nosocomial infections, especially in the current coronavirus disease 2019 pandemic. However, it is seen that hand hygiene has been replaced by just usage of hand sanitizers. We conducted a survey among health care professionals regarding their knowledge, attitude, and practice toward hand hygiene, with special focus on hand sanitizers.Patients and methods A cross-sectional survey was conducted among health care professionals using a structured and pretested questionnaire sent through e-mail. The study tool contained questions on basic demography, knowledge, and practice of hand hygiene.Results A total of 496 health care professionals completed the survey, the majority being physicians (60%). The correct response for components of hand hygiene was higher among nursing personnel (88.781%) followed by physicians (83.7%) and dentists (83.7%). Overall, 45% of the participants were not aware about the adverse effects of hand sanitizers.Conclusion There is an urgent need to educate both health care professionals and patients regarding various aspects of hand hygiene. Hand washing with soap and water should be encouraged where available.

Sri Lanka Elderly Study: Phase 1 (SLES:1) – A descriptive study of the health status and physiological parameters of institutionalized elderly in Colombo district: The protocol

The Journal of the Ceylon College of Physicians (JCCP) is a peer-reviewed, open access journal published bi-annually by the Ceylon College of Physicians (CCP) in the last week of June and December.The objective of the Journal is to promote good clinical practice and influence policy making across the medical world through publication of original research and peer reviewed articles on current issues and to foster responsible and balanced debate on issues that affect medicine and health care in Sri Lanka. Contributions to the JCCP reflect its national and multidisciplinary readership and include current thinking across a range of medical specialties.