Clinic Of General Hospital Research Articles

Behavioural and psychological symptoms of dementia in patients with Alzheimer\u2019s disease and family caregiver burden: a path analysis

BackgroundStudies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer’s disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden.MethodsPath analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation.ResultsMean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect.ConclusionsUnlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers’ burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers’ burden.

Haematological profile of children with malaria in Sorong, West Papua, Indonesia

BackgroundMalaria remains a major public health problem in Indonesian Papua, with children under five years of age being the most affected group. Haematological changes, such as cytopenia that occur during malaria infection have been suggested as potential predictors and can aid in the diagnosis of malaria. This study aimed to assess the haematological alterations associated with malaria infection in children presenting with signs and symptoms of malaria.MethodsA retrospective study was performed by collecting data from the medical records of malaria patients at Sorong Regional General Hospital, Sorong, West Papua, Indonesia, both from outpatient and inpatient clinics, from January 2014 until December 2017. The laboratory profile of children suffering from malaria was evaluated.ResultsOne hundred and eighty-two children aged 1 month to 18 years old were enrolled. The subjects were mostly male (112, 61.5%) with a mean age of 6.45 years (SD = 4.3 years). Children below 5 years of age suffered the most from malaria in this study (77, 42.3%). One hundred two subjects (56%) were infected with Plasmodium falciparum. Half of the enrolled subjects (50%) had haemoglobin level (Hb) between 5.1 and 10 gr/dL. A total of 41 children (53.2%) less than 5 years old suffered from P. falciparum infection. In the age group of 5–10 years, there were 34 children (57.6%) who suffered from P. falciparum, and in the age group > 10 years, 27 children (58.7%) suffered from P. falciparum infection. Only 4 subjects (5.2%) in the less than 5 years old age group had mixed malaria infection. Among eight predictors of the haematological profile, there were five predictors that were significantly associated with the diagnostic criteria, namely haemoglobin, haematocrit, leukocytes, platelets and monocytes (p < 0.05). Generally, clinical symptoms are not significantly associated with a malaria diagnosis, and only one variable showed a significant relationship, pale, with a P value of 0.001.ConclusionsChildren with malaria had changes in some haematological markers, with anaemia, low platelet count, white blood count, and lymphocyte count being the most important predictors of malaria infection in the study area. These markers could be used to raise suspicion of malaria in children living in high endemic areas, such as West Papua.

Application of Kaiser Model-Based Disaster Vulnerability Analysis in Pediatric Clinics of Tertiary General Hospitals

Application of Kaiser Model-Based Disaster Vulnerability Analysis in Pediatric Clinics of Tertiary General Hospitals

Prevalence and Factors Associated with Unintended Pregnancy among Women Attending Antenatal Clinic in General Hospital in Dodoma

Prevalence and Factors Associated with Unintended Pregnancy among Women Attending Antenatal Clinic in General Hospital in Dodoma

Crisis intervention for serious mental disorders. The example of the First Department of Psychiatry of Athens University

We describe the crisis management and resolution service for serious mental disorders established by the First Department of Psychiatry of the National and Kapodistrian University of Athens. The service is intended to meet patients' needs for adequate management of acute mental crisis without hospitalization, while implementing modern standards in mental care and considering existing restrictions in mental health resources and public expenditure. Last decade we witness an increase in demand for psychiatric beds in Psychiatric clinics of General Hospitals resulting in a drastic increase of auxiliary beds that becomes a serious problem in mental health provision. The shutdown of big psychiatric hospitals in the process of psychiatric reform, accompanied by a delay in the establishment of all the anticipated beds in general hospitals together with overloaded and insufficient network of mental health services in the community are the major determinants. Additionally, fiscal economic crisis of the last decade intensified even more the problem by diminishing funding for the recruitment of new personnel and drastically reducing allocated funding for new and old services. In 2016 we set up a crisis intervention service for serious mental disorders within the operational framework of the emergency psychiatric services of the Department of Psychiatry in Eginition Hospital in Athens. The crisis resolution team is composed by two psychiatrists, a psychiatric nurse, social workers, a psychologist, mental health volunteers, and mental health trainees/students. The patient enters the service through the emergency service when an indication for hospitalization is given by the emergency psychiatrist, followed by the clinical estimation of a member of our team. The therapeutic team convenes twice a week for the new entrants and for follow-up sessions with the participation of the patient and the family members whenever feasible. The rest of the therapeutic interventions take place during the week. The work 'with' the person and not 'to' the person encapsulates the philosophy of the service, which is characterized by a holistic treatment approach aiming to empower the individual strengths and sense of control of the patient for crisis resolution on the basis of a safe therapeutic milieu. Therapeutic interventions include family and supportive members, as well as community interventions. In summation, interventions consist of a) comprehensive evaluation (psychiatric/ physical) and therapeutic plan, b) psychopharmacological treatment, c) psychotherapeutic support for the patient and the family for management of the crisis, d) training for the management of future crises and e) referral to appropriate community services for follow up management and treatment. Treatment lasts approximately 6-8 weeks. Initial data of the evaluation study indicate clinical effectiveness and high levels of satisfaction for patients and family. Conclusively, crisis management and resolution services are feasible even in a time of heavy restrictions in recourses, and anticipated benefits are multiple for the economy, mental health provision, the public health system, patients and relatives alike.

Experiencia clínica con medicamentos huérfanos para enfermedades raras metabólicas

IntroductionInborn errors of metabolism are a highly heterogeneous group of orphan diseases. Diet therapy and enzyme and coenzyme replacement are the most frequently used treatment. There are few patients and published studies about inborn errors of metabolism. The main objective of this study was to describe the effectiveness of orphan drugs in inborn errors of metabolism in paediatric patients. Material and MethodsRetrospective descriptive study of 24 months on patients diagnosed with inborn errors of metabolism during childhood and who attended the pharmacy clinic or Day-Care Unit of a 630-bed general hospital. ResultsThe study included 15 patients with a median age of 17.8 years and were treated with nine different drugs: sapropterin, sodium phenylbutyrate, miglustat, velaglucerase, sebelipase, idursulfase, 5-hydroxytryptophan, succinate, and riboflavin. Nine different inborn errors of metabolism were observed: phenylketonuria, defects of the urea cycle, Gaucher, Nieman-Pick, Hunter's disease, along with acid lipase deficiency, and mitochondrial diseases. Orphan drugs used for the treatment of inborn errors of metabolism accounted for 1.3% of hospital drug costs. Some orphan drugs achieved asymptomatic patients, but others just produced a modest symptomatic improvement. Most patients showed good tolerance to the treatment. ConclusionsOrphan drugs used in inborn errors of metabolism had an easy to manage toxicity profile, with many disparities in effectiveness. These drugs have a high economic impact. The cost-effectiveness ratio for orphan drugs is a controversial issue due to their high cost and the inconclusive clinical evidence.

301 - The diagnostic and treatment challenges of behavioral and psychological symptoms in Alzheimer’s disease; a qualitative study in memory clinic practice

Introduction:Behavioral and psychological symptoms in dementia (BPSD) have great impact on the daily lives of Alzheimer’s disease (AD) patients and their caregivers. Timely recognition and treatment of these symptoms may benefit quality of life, caregiver burden, and delay disease progression. In this qualitative study we examine the experiences of memory clinic physicians with the recognition and management of BPSD in early stages of AD.Methods:Semi-structured interviews were held with 8 physicians (5 neurologists, 3 geriatricians) employed at memory clinics of academic or general hospitals in the Netherlands. Two independent researchers coded verbatim transcripts of the interviews, followed by a consensus meeting on preliminary themes. In the upcoming months, additional interviews will be conducted until data saturation is reached.Results:Preliminary results indicate substantial variability in how memory clinic physicians recognize and diagnose BPSD in AD. Themes are: 1. Prevalence of BPSD in early stages of AD; e.g. ‘BPSD is more often present in late stages of AD […]’ vs. ‘I see this often, very often, I think these are the main problems people with AD face’). 2. Systematic assessment; some physicians consider it part of their clinical work-up to assess behavioral changes while other physicians do not touch upon BPSD. 3. Barriers for assessment; e.g. a lack of time, and not being able to observe BPSD occurring at home in a memory clinic setting. Treatment and management of BPSD in AD also differed greatly. Themes are 1. Treatment type; Two physicians discussed using a person-centered non-pharmacological approach, others refer patients with BPSD to daycare, a case manager or psychiatrist, or treat ‘problematic’ behaviors with psychotropic drugs. 2. Capabilities; some physicians experience managing BPSD in AD as very difficult, while others are confident about their capabilities. The majority suggests that collaboration with GPs or case managers may benefit treating these complex symptoms.Conclusion:There are remarkable differences in the recognition and management of BPSD in patients with AD visiting memory clinics in the Netherlands. Considering the potential benefit of early recognition and treatment, a first crucial step is discussing standardization of recognition and management of BPSD in memory clinics.

Effect of Behavioral Intervention Education Program on Urinary Incontinence Among Elderly Patients at Assiut University Hospital

Abstract Urinary incontinence is considered a stigmatizing condition in most populations, especially elderly people which contributes to poor quality of life. Aim: Assess quality of life among elderly suffering from urinary incontinence and evaluate the effect of behavioral intervention on Quality of Life of urinary incontinence elderly patients. Subject and method: A quasi-experimental pre and post-test design was utilized. It involved 73 elderly participants selected by simple random sample from outpatient clinics in urology and general hospital at Assiut University Hospitals. Three tools were utilized. 1st tool: An interview questionnaire sheet for collection of demographic data, medical and urology history, 2nd tool: Questionnaire for Urinary Incontinence Diagnosis (QUID). 3 rd tool; International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). Studied participants were evaluated at baseline and after three months of program. Results: A statistically significant P=0.001 was found between pre and post-test among elderly in terms of mean scores obtained from QOL domain of the ICIQ-SF was 9.49±1.48 and 5.9±2.1, respectively. Conclusions: Behavioral intervention program are effective in reducing severity of urinary incontinence. Given the study results, it is recommended that expand of public education efforts through various channels about importance of behavioral intervention for appropriate management of urinary incontinence among elderly.

Environmental monitoring and infection control of fever clinics in general hospitals during COVID-19 pandemic

<p indent="0mm">The early stage of the COVID-19 epidemic happened to be the flu season. Since some symptoms of influenza and COVID-19 are similar, symptomatic patients flocked to fever clinics and emergency departments. Meanwhile, asymptomatic COVID-19 patients attending other departments in general hospitals made things worse. Lack of knowledge of the pathogen, absence of awareness and short of personal protective equipment all posed threat to healthcare workers as well as other patients. As SARS-CoV-2 can be spread via droplets, direct contacts and potentially aerosols, the indoor air environment of hospitals, especially fever clinics, must have strict measures to prevent hospital-acquired infection. Thirty-two sensors were deployed in the Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital (mentioned as Changgung Hospital hereinafter) from January 30, 2020, in order to monitor high-resolution real-time indoor environmental parameters at its fever clinic, isolation wards and other departments. One sensor monitors and records CO₂ concentration, PM_2.5 mass concentration, relative humidity, temperature and illuminance every <sc>5 minutes.</sc> Six sensors were located at the fever clinic, where all patients with fever and/or other COVID-19 related symptoms firstly attended after arriving at the hospital. The clinic has two parts, one for diagnosis and the other for quarantine. Three sensors were placed in doctor’s office, nursing station and waiting area in the diagnosis part, respectively. Natural ventilation was chosen to dilute the environment, as the flowrate of outdoor airflow was abundant in Beijing’s winter. Atmospheric CO₂ concentration surrounding Changgung Hospital was stable, and the rise of indoor CO₂ concentration was caused by human exhalation. During this pandemic, CO₂ concentration can be regarded as an indicator of room ventilation condition and hospital congestion, if all the people in hospital were regarded as potential infector of SARS-CoV-2. According to the usage pattern of the fever clinic, the maximum number of patients in each functional area was set as 4 for doctor’s office, 4 for nursing station and 11 for waiting area. According to the ventilation regulation of infectious disease hospital, the air change rate at fever clinics should be at least <sc>6 h^–1.</sc> In addition, the outdoor CO₂ concentration was assumed to be <sc>400 ppm.</sc> Based on these conditions, the upper limits of indoor CO₂ concentration were 902, 864 and <sc>867 ppm</sc> for doctor’s office, nursing station and waiting area at the Changgung Hospital’s fever clinic, respectively. Indoor CO₂ concentration exceeding these thresholds stands for poor ventilation or overcrowds. Fortunately, this didn’t happen during the monitoring period and indoor CO₂ concentration didn’t exceed <sc>609–711 ppm.</sc> In another word, natural ventilation was sufficient and effective in this specific case at the Changgung Hospital’s fever clinic. Moreover, together with environment disinfection and personal protective measures, good ventilation condition led to no COVID-19 hospital-acquired infection. To conclude, this article introduced a real-time environmental monitoring campaign at the Changgung Hospital’s fever clinic. Similar methodology can help assess ventilation conditions and risk of hospital-acquired infection at the fever clinic during and after COVID-19 pandemic. Once indoor CO₂ concentration exceeds the set thresholds, areas with high infection risk can be identified rapidly and timely, so that prevention measures can be taken in time.

Ways of coping mediate the relationship between self-efficacy for managing HIV and acceptance of illness among people living with HIV.

The purpose of this study was to examine the relationship between self-efficacy for managing HIV and acceptance of illness and to identify the potential mediation effect of active coping and passive coping on this relationship. The study used a cross-sectional survey. A sample of 555 people living with HIV were recruited from September-December 2018 in the HIV clinic of a tertiary general hospital in Changsha, China. Survey data were collected through face-to-face interviews that included measures of sociodemographic and HIV-related clinical characteristics, Acceptance of Illness Scale, the Simplified Coping Style Questionnaire and the Self-efficacy for Managing Chronic Disease Scale. Step-by-step linear regression models combined with bootstrap testing were used to test the relationships when controlling for gender and HIV diagnosis duration. Self-efficacy was positively related to acceptance of illness and this relationship was partially mediated by both active coping and passive coping. Acceptance of illness increased by 0.175 for every point increase in self-efficacy indirectly through active coping, while acceptance of illness decreased by 0.034 for every point increase in self-efficacy via passive coping. The findings highlighted the importance of self-efficacy for managing HIV and ways of coping, especially active coping, for illness acceptance. The findings suggested that interventions that improve confidence in managing HIV and active coping may enhance the illness acceptance of people living with HIV.

Correlation between P-Wave Terminal Force V1 (PTFV1) from 12-Lead ECG and Left Ventricular Diastolic Dysfunction in Patients Diagnosed With Hypertension

Background: Patients diagnosed with hypertension will deteriorate into hypertensive heart disease which is characterized by diastolic dysfunction first followed by systolic dysfunction later in the course of the disease. Diastolic dysfunction of the left ventricle causes an increase in LVEDP as well as in the dimension of the left atrium. P-Wave Terminal Force V1 (PTFV1) which is derived from 12 lead ECG could help diagnose diastolic dysfunction in centers where echocardiography is not available. The purpose of this study was to determine the correlation of PTFV1 on the 12-lead Electrocardiography with diastolic dysfunction in patients diagnosed with hypertension in the outpatient clinic of Cardiac Center Adam Malik General Hospital in Medan.&#x0D; Methods: This is a cross-sectional study conducted from March 2019 until August 2019. Patients with hypertension who met the inclusion criteria were examined electrocardiographically to obtain PTFV1 value. Then echocardiography examination was then performed to assess the grades of diastolic dysfunction and other parameters. Analysis of correlation between PTFV1 values and diastolic dysfunction was then conducted.&#x0D; Results: From the clinical characteristics, there is no difference regarding age, sex , and risk factorsbetween the three diastolic dysfunction groups, while echocardiography characteristic shows more reduced EF in grade III diastolic dysfunction (36.5±7.7). Significant differences in PTFV1 are found among diastolic dysfunction groups. Grade I diastolic dysfunction has PTFV1 value of 23.8 mm.ms, grade II diastolic dysfunction has PTFV1 value of 34.1 mm.ms, and grade III diastolic dysfunction has PTFV1 value of 52.1 mm.ms, Significance of p value is &lt;0.001. There is a strong correlation between PTFV1 and diastolic dysfunction grade (r = 0.63 (P &lt;0.001)). Cut off point of PTFV1 &gt; 29.8 mm.ms can discriminate patients who have increased LAP with a sensitivity of 84% and specificity of 71%.&#x0D; Conclusions: PTFV1 is a simple screening tool which is widely available and correlate well with left ventricular diastolic dysfunction in patients with hypertension, which makes it a good alternative tool especially in areas where echocardiography is not readily available.

Relationship between periodontal disease and male infertility: A case-control study.

To compare the prevalence of chronic periodontitis between men who had semen abnormalities and those who had normozoospermia through a case-control study. Male patients who visited the assisted reproduction clinic of a large general hospital and were diagnosed with semen abnormalities were included in the case group. The control group was composed of patients of the same clinic with normozoospermia. The semen analysis included sperm concentration, count and progressive and total motility, which were measured in the laboratory. A questionnaire and clinical periodontal examination were conducted for all participants. Logistic regression was performed to explore the relationship between chronic periodontitis and male infertility. A total of 192 participants were included: 63 participants (32.8%) had some type of semen abnormality (case group), while 129 participants (67.2%) had normozoospermia (control group). The case group had a significantly higher prevalence of moderate/severe periodontitis than the control group (33.3% vs. 17.8%, p=.012). The logistic regression showed that participants who had moderate/severe periodontitis had a greater chance of having semen abnormalities after adjusting for other confounding factors (OR=3.377, p=.005). Periodontitis is associated with semen abnormalities and sperm motility in men.

Epidemiology of macrolide-resistant Mycoplasma pneumoniae by age distribution in Japan

IntroductionMycoplasma pneumoniae (M. pneumoniae) is the major pathogen involved in community-acquired pneumonia in all age groups. Resistance to macrolides, the first-line treatment for M. pneumoniae infection, is a major global public health concern. However, studies evaluating macrolide-resistant M. pneumoniae infection simultaneously in all ages are limited. This study aimed to determine the prevalence and clinical characteristics of macrolide-resistant M. pneumoniae infection in terms of age distribution. MethodsWe enrolled 292 patients in Tokyo, Japan, who visited Eiju General Hospital or Zama Children's Clinic in 2015–2016. Patients were tested using real-time PCR for M. pneumoniae DNA. PCR-positive patients (n = 151) were further selected and sequentially divided into preschool-aged children (≤5 years, n = 31), school-aged children (6–15 years, n = 101), adolescents (16–19 years, n = 5), and adults (≥20 years, n = 14). We then analyzed the M. pneumoniae infection clinical characteristics, prevalence of macrolide-resistant infection, and 23S rRNA domain V resistance-associated mutation status. ResultsWe found insignificant differences in the prevalence of macrolide-resistant M. pneumoniae infection among all groups, clinical characteristics, and resistance-associated mutation status in patients with macrolide-resistant M. pneumoniae infection. We also found statistically higher prevalence of mutation-positive (n = 85) M. pneumoniae in patients previously treated with macrolide compared to the mutation-negative group (n = 66); 63.8% vs 11.1% (p < 0.001), respectively. ConclusionsWe found no significant differences in both clinical characteristics and prevalence of macrolide-resistant M. pneumoniae infection among all ages. Also, previous macrolide treatment contributes to drug-resistance.

Awareness and practices regarding dental health among pregnant women attending antenatal clinics in Sri Jayewardenepura General Hospital, Sri Lanka

Dental health is an important aspect of health. Further, teeth related dilemmas are common in pregnancy and thus have influences on the growing fetus. The study was conducted to assess awareness and practices regarding dental health among pregnant women, who attended the antenatal clinic at Sri Jayewardenepura General Hospital, Sri Lanka in 2018. A descriptive cross-sectional study was conducted with the participation of randomly selected 150 pregnant women who attended antenatal clinic, by using pre-tested interviewer administered questionnaire. Knowledge and practices scores were developed based on the maximum and minimum marks allocated for each section. Pearson Chi-square test was performed to determine the associations. Of the participants, 70% (n=105) were aware regarding the fact that hormonal imbalances during pregnancy may affect their dental health. However, only 21.3% (n=32) had awareness regarding the fact that frequent vomiting during pregnancy period is a risk factor for dental erosion. Further, 56.7% (n=85) of the participants were knowledgeable regarding the influence of mother's dental health on their growing fetus. Most frequent source of knowledge regarding the importance of dental health during pregnancy was the family doctor (40%, n=60) in participants, 54% (n=81) had good knowledge regarding dental health during pregnancy. Regarding overall level of dental care practices, only 33.3% (n=50) had good dental care practices. Age (p=0.02), level of education (p=0.01) and monthly income (p=0.01) showed a significant association with dental care knowledge while, the level of education (p=0.01) showed significant association with dental care practices among participants. Although more than half of the participants had good knowledge regarding dental health, less than one fourth of individuals were following proper dental practices. This study emphasizes the importance of conducting health education programmes to reduce the knowledge practice gap and to highlight the importance of dental care practices during pregnancy for better health outcome towards mother and baby. Keywords: Awareness, Practice, Dental health, Pregnant women, Patriarchy

The Effect of Combination Pranayama Yoga and Endurance Training Exercise on Peak Expiratory Flow (PEF) in Adult Asthmatic Patients

Pranayama Yoga can help improve breathing, and improve calm and also relieve stress. Endurance training can increase lung capacity, improve fitness, and relax the body. However, the combination of pranayama yoga and endurance exercises has never been done in asthma patients. The purpose of this study was to analyze the combination of pranayama yoga exercises and endurance exercises for Increased Peak Forced Expiration Flow. The design of this study was Quasy Experiment with a pretest-posttest control group design, the location of the study was in the pulmonary clinic of Universitas Airlangga Hospital and Haji General Hospital in Surabaya, East java. Respondents were selected by purposive sampling techniques in accordance with inclusion criteria with a total of 72 respondents. Peak Expiration Flow is measured from forced vital capacity or The peak expiratory flow (PEF) is the maximum flow obtained within the first 200 milliseconds of a forced expiratory maneuver after inhalation to total lung capacity (TLC). The intervention group was given a combination exercise by doing pranayama yoga and endurance exercise for 6 weeks, 2x per week, 51 minutes for each training session. Pranayama yoga combination exercises and endurance exercise using trainer instructors and modules. FPEF and asthma control were measured every week for 6 weeks. The results showed a significant difference in the level of FPEF and asthma control before and after 6 weeks of interventions combination of pranayama yoga and endurance exercise in the intervention group obtained significance values (p &lt;0.05) with p = 0.000 and asthma control in the intervention group (p &lt;0, 05) with p = 0.000 the results of the research shows that by practicing pranayama yoga and endurance exercise can improve FPEF and asthma control. Pranayama yoga and endurance exercise can be used as an complementary therapy in supporting pharmacological therapy to improve FPEF and control asthma.

Immunological Aspects of Patients Infested with Scabies in Thi-Qar Province, Southern Iraq

Scabies is skin disease of human and many mammalian hosts caused by the important obligate parasites Sarcoptes scabiei, lives and reproduces in epidermis ,resulting a significant human and animal morbidity. The current study aimed to determine the immunological responses in patients infested with scabies who attended a private clinic in Al-Hussein general hospital in Thi-Qar province. The total white blood cell count, differential counts (lymphocytes, monocytes, neutrophils, eosinophils and basophils), the serum levels of IL-5 and IL-13 in were evaluated in all patients with scabies and compared with non-infested healthy individuals as a control group. The present study showed significant increase on the mean of total WBC in patients infested with scabies when compared with control (P? 0.05). A significant differences (P? 0.05) were recorded in the absolute leukocytes counts for patient infested with scabies when compared with control group except that for monocytes and basophils which were non significant (P? 0.05) in our study. The results of study showed significant differences (P? 0.05) in the mean of IL-5 and IL-13 serum levels for the patient infested with scabies when compared with control.

Incidence of malaria parasites in human immuno-deficiency virus clients attending General Hospital Awo-Omamma, Imo State Nigeria

The incidence of malaria parasite in Human Immuno-deficiency Virus clients attending Awo-omamma General Hospital, Owerri Imo state Nigeria was studied. A total of 200 blood samples were collected; 150 samples were collected from sero-positive HIV clients while 50 samples were collected from sero-negative HIV clients which served as control samples. Out of this 200 clients 85(42.5%) were males while 65(32.5%) were females. The blood samples were analyzed using Malaria Rapid Test Kit for the presence of Plasmodium falciparum, using standard medical laboratory procedure. The result revealed an overall prevalence of 43 (28.7%) for HIV positive participants that tested positive to malaria parasite, 15 (17.6%) were male while 28 (43.1%) were female. Analysis based on age revealed that the highest prevalence was among those within the age group 30-39 years having 20 (10%) while those with the least prevalence were observed among those within the age group 20-29 years having 32 (16%). Analysis of malaria parasite based on CD4+ cell count among HIV clients revealed that 51(34%) had CD4+ cell count above 200cell/μl while 23 (15.3%) had CD4+cell count below 200cell\μl. This study has shown that there is a low prevalence of malaria parasite (Plasmodium falciparum) among HIV/AIDs clients with high CD4+ attending HIV clinic in Awo-omamma General Hospital, Imo state. It is recommended that more efforts be made to eradicate malaria completely as this will go a long way in reducing the rate of mortality among HIV clients.

Foot Care Education Among Patients With Diabetes Mellitus in China: A Cross-sectional Study.

To investigate the foot care knowledge and behavior of patients with diabetes to determine effect and current challenges of foot care education, as a basis to improve education and reduce diabetic foot complications. Quantitative, cross-sectional study. A convenience sampling method was used to recruit 200 patients with diabetes from the endocrinology clinic of a tertiary general hospital in Beijing between September 2014 and January 2015. Demographic and disease-related data, foot care education, foot risk stratification status, and knowledge and behavior (K&B) scores were collected using investigator-designed questionnaires. Of the 200 patients, 128 (64.0%) patients received routine diabetes education, and 73 (36.5%) received foot care education. The mean ± standard deviation (SD) for K&B scores were 63.76 ± 14.85, and 59.78 ± 11.17, respectively. The K&B scores of patients who received foot care education (69.54 ± 14.32 and 65.27 ± 11.90) were significantly higher than those who received diabetic education only (60.75 ± 15.27 and 57.54 ± 10.25) and those with no diabetic education (60.21 ± 13.37 and 55.94 ± 8.74) (P < .01). The K&B scores did not differ for patients based on diabetic foot risk strata (P > .05). The foot care K&B scores of patients with diabetes were low to moderate levels, particularly on items that pertained to self-foot examination, prompt treatment of foot problems, and regular foot inspection by professionals. Individuals with high risk of developing foot complications did not score higher on the K&B questionnaire. These data suggest there is need for improvement in instruction and patient uptake and application of knowledge. We recommend further study on the effectiveness of the delivery of foot care education based on foot risk stratification, and the implications of foot ulcer prevention in community settings.

PERCEIVED QUALITY OF TRANSITIONAL CARE BETWEEN PUBLIC HOSPITAL AND PUBLIC HEALTH CARE CLINIC IN NEGERI SEMBILAN, MALAYSIA: A PILOT STUDY

Quality of transitional care affects healthcare spending and service use. Poor transitional care is associated with adverse effects such as medication error and risk of unnecessary readmission. The objective of this study is to evaluate patients’ perception of quality of transitional care from a public tertiary hospital to a public health clinic in Negeri Sembilan. A cross-sectional study was conducted involving 307 respondents from the public health clinic following discharge from the hospital from July to September 2018.Patient’s perception of quality of transitional care was measured using the Care Transitional Measure (CTM 15®) questionnaire. The response rate for this study was 90.6%. The mean CTM-15® score was 73.1 (±13.03) out of a scale of 1 to 100. The mean scores for the various domains were: Critical understanding was 73.3 (±14.33), Preferences important was 71.9 (±14.99), Management preparation was 74.0 (±14.53), and Care plan 73.3 (±14.75). Multiple linear regression showed that age was a significant independent predictor for the CTM-15® scores where elderly patients had poorer scores than young adults (adjusted R2=0.104, p&lt;0.001).In conclusion, the perceived quality of transitional care between the public general hospital and health clinic was good but decreased with patient’s age. This could be due to complexity of the patient’s problems upon discharge.

Relationship of Vitamin D with Some Electrolytes in the Serum of People with Rheumatoid Arthritis in the City of Samarra

The study was conducted on 50 samples of 30 patients with rheumatoid arthritis. The samples were divided into 15 females, 15 males and 20 control group (healthy) without any disease. The sample was divided into 8 females and 12 males. 80 years) and collected samples from Samarra General Hospital and outpatient clinics of the city. The blood was then collected from the healthy and sick people and separated by centrifugation. Biochemical variables were measured (vitamin D, glutathione , Mallon dialdehyde , uric acid). The results of the current study showed a significant decrease in the level of vitamin D in the serum of people with rheumatoid arthritis compared to healthy people, and the results showed a significant decrease in the level of glutathione in the serum of people with rheumatoid arthritis compared to healthy people, with no significant differences in Level of Mallon dialdehyde. We also note a significant increase in the level of uric acid in the serum of people with rheumatoid arthritis compared to healthy people.