University Health Sciences Research Articles

Assessment and evaluation of attitudes, knowledge, and barriers to evidence-based practice among Fatima college of health sciences educators, UAE

Evidence-based practices are widely acknowledged as important in improving healthcare quality and achieving excellence in patient care. It is necessary to teach students how to implement evidence-based practice in clinical. Health sciences educators' awareness of evidence-based practice plays an essential role in implementing this concept in practice which will be reflected in the student's performance and enhance patient care in the future. This study aimed to assess attitudes, beliefs, knowledge, and behaviour regarding evidence-based practice among allied healthcare educators of Fatima College of Health Science (FCHS). This is a cross-sectional survey study. The survey was distributed among 165 healthcare professional educators in nursing, radiography and medical imaging, physiotherapy, paramedics, psychology, pharmacy, and general requirements departments at the four campuses of the Fatima College of Health Sciences: Al-Dhafra, Abu-Dhabi, Al-Ain, and Ajman. The response rate was 33.3% (n=55). The result showed that the most preferred source of information for educators was electronic research engines 55% (n=30). The data obtained indicated that approximately 95% (n=52) of educators believe that Evidence-Based Practice (EBP) improves patient care, enhances outcomes, and supports sound clinical decision-making. Additionally, 91% of educators agree that the concept of EBP should be incorporated into all college programs. However, the primary barrier to implementing EBP is identified as a lack of time. The study revealed a positive attitude toward EBP among FCHS educators but highlighted the need for more knowledge-sharing opportunities. Time constraints were the main challenge.

Susceptibility pattern of Ceftazidime-Avibactam against multi drug resistant gram-negative rods

This study was conducted to evaluate the susceptibility pattern of ceftazidime avibactam against multi drug resistant gram negative rods. This prospective study cross sectional study conducted in Microbiology Section of Dow Diagnostic Reference and Research Laboratory, Dow University of Health Sciences, Karachi, Pakistan. Identification of isolates was done in accordance with the standard bacteriological technique, and were distinguished based on gram staining, colony morphology and biochemical tests. Antibiotic susceptibility testing (AST) was performed on Muller-Hinton agar by Kirby-Bauer Disk Diffusion method in accordance with the Clinical Laboratory Standard Institute (CLSI) guidelines. Good sensitivity of Lactose fermenters (Escherichia coli, Klebsiella pneumoniae and Enterobacter) were observed against Ceftazidime avibactam. Pseudomonas aeruginosa exhibited 42% resistance in all clinical samples. Proteus species and Serratia have shown high resistance in our study. Our observations showed the persistence of high ceftazidime avibactam activity against pathogenic and multi drug resistant strains of Enterobacterales and Non lactose fermenting bacteria.

Evaluation of risk factors for postpartum cerebral venous sinus thrombosis, a multicenter retrospective observational study.

The postpartum period is a well-defined risk factor for cerebral venous sinus thrombosis (CVST). However, it is unclear which patients are at risk for CVST in the postpartum period. Thus, determining some CVST risk factors in postpartum patients may be useful for preventing the disorder in this population. Previous studies have shown that preeclampsia (PE) is a risk factor for pulmonary thromboembolism and deep vein thrombosis, but whether it is related to postpartum CVST has not yet been evaluated. This study aimed to determine if this relationship exists. This study was a case-control study of retrospectively screened patients diagnosed with CVST between 2018 and 2023 at the Uludağ University Faculty of Medicine Department of Neurology, the Eskişehir Osmangazi University Faculty of Medicine and the Bursa City Hospital Health Sciences University Department of Neurology. All of the women who delivered between 2018 and 2023 at the Uludağ University Faculty of Medicine Department of Obstetrics and Gynaecology were included in the control group. In total, 57 out of 322 cases and 4299 out of 4452 controls were included in this study. A nonsignificant relationship was found between CVST and spinal anesthesia, but a significant relationship was found between PE and stillbirth. Women with PE who had recently delivered were found to be at increased risk of developing CVST. The primary limitation of this study is that it was retrospective, and the control group was hospital-based. We recommend that these findings be confirmed by multicenter prospective international studies.

Comparison of ease of endotracheal intubation with fixed height pillow versus pillow height attained by alignment of external auditory meatus to sternal notch

Background: Endotracheal intubation is considered to be the “Gold Standard” for airway management during the administration of general anesthesia and in critical care setting because of its advantages, which allows delivery of anesthetic gases and oxygen through positive pressure ventilation without inflation of stomach, permits access to tracheobronchial tree for pulmonary hence minimizing the risk of gastric content aspiration, and improves surgical access to head and neck. The major determinants of easy tracheal intubation are optimal laryngoscopy and a good visualization of the glottis. Aims and Objectives: The aims and objectives of the study are to seek the optimal pillow height that gives the best direct laryngoscopic view and can be recommended as the starting head position before direct laryngoscopy in adults. Materials and Methods: The present study was conducted in a prospective randomized comparative manner in the Department of Anaesthesiology and Critical Care, Pt. B.D. Sharma University of Health Sciences, Rohtak after obtaining approval from the institutional ethical committee (approval number: No. BREC/Th/20/Anaesth.../034). Patients included were scheduled for elective surgery under general anesthesia requiring endotracheal intubation. The inclusion criteria were patients aged 18–50 years of either sex of ASA I and II. Results: A total of 50 subjects, 25 in each group, were included in the final analysis. Following observations and results were drawn from the present prospective and randomized study using appropriate statistical tests. The various observations were out of 50 patients in the study population, and the mean age in years of patients in Group 1 was 38.48±11.77 years and 39.36±11.64 years in Group 2. Conclusion: To conclude, alignment of external auditory meatus to sternal notch offers better conditions for endotracheal intubation than conventionally used sniffing position when assessed in terms of Cormack–Lehane grading and time taken for laryngoscopy and intubation.

Building and sustaining a laparoscopic simulation curriculum in Dar es Salaam, Tanzania

PurposeAlthough laparoscopy has transformed surgical care in high-income countries, access remains limited in Africa. This calls for tailored laparoscopic education in such contexts to enable the training necessary to expand laparoscopic surgery. We aimed to describe the implementation, evaluation, and sustainability of a laparoscopic simulation lab in Dar es Salaam, Tanzania.MethodsWe founded a laparoscopic simulation lab at Muhimbili University of Health and Allied Sciences (MUHAS) and implemented a simulation curriculum. We conducted a prospective curricular evaluation focusing on both process and outcome metrics.ResultsWe established laparoscopic simulation training at MUHAS. This entailed securing a dedicated space, equipping the laboratory, and training a lab manager to be a simulation educator. Fifty-one participants completed 1,909 h of laparoscopic training at the simulation lab and received 3,940 individual pieces of online feedback. Analysis of task completion times and performance showed improvement in all tasks in pre-test task videos compared to final task videos. Nine of 20 graduates responding to a questionnaire (45%) actively performed laparoscopic surgery within their institutions. Among these respondents, all felt that participating in LAPP was very helpful or essential to their practice.ConclusionsWe implemented a laparoscopic curriculum at a new simulation lab in Tanzania. Residents, fellows, and faculty from across Tanzania dedicated substantial time and effort over more than 18 months to complete the curriculum, improve their laparoscopic skills, and change their operative practices. This report may serve as a blueprint for those looking to implement, evaluate, and sustain curricula in similar settings.

Study Of Characteristics Of Victims And Alleged Accused In Cases Of Deaths Due To Homicide

Aims and Objectives: Homicide is a cruel act of mankind. It reveals one of the darkest sides of the society. Homicidal crimes represent a reasonable proxy for all different kinds of violent crimes in general. In this modern world violent crimes are being executed professionally. Such criminal activities follow peculiar socio-demographic profiles of victims and the accused involved. The study aimed to find out the different characteristics of victims and perpetrators i.e. alleged accused in homicidal deaths Materials and Methods: The present prospective study was carried out on 179 homicidal deaths at the Department of Forensic Medicine and Toxicology of Indira Gandhi Government Medical College, Nagpur over a period from January 2013 to October 2014. The Institutional and Maharashtra University of Health Sciences, Nashik ethical committee approved the study protocol. Observation and Results: Male victims were most commonly attacked by acquaintances (argument, quarrel, momentary rage) in 33 (18.44%) cases followed by friends in 28 (15.64%) whereas females by their husbands or In-laws in 13 (7.26%) cases. No victim-assailant relationship could be traced in 73 (40.78%) cases. 64 (35.75%) victims were attacked by a single assailant of which 47 (26.26%) were males and 17 (9.50%) were females followed by by two assailants at a time in 21 (11.73%) cases 16 (8.94%) males and 5 (2.79%) females. Incidences where more than five assailants were involved included only male victims in 7 (3.91%) cases. The numbers of assailants were unknown in 68 (37.99%) cases. Maximum homicidal attacks occurred at or near the victim's house in 54 (30.17%) cases out of which 32 (17.88%) were males and 22 (12.29%) females followed by incidences occurring on the road or streetside in 48 (26.82%) cases. Male victims were commonly attacked on the road or streetside in 45 (25.14%) followed by 32 (17.88%) cases at victims' houses. In contrast, females were commonly attacked at the victim’s house in 22 (12.29%) cases followed by roadside attacks in 03 (1.68%) cases. The main motive behind the homicidal attack was quarrels in 47 (26.26%) cases followed by enmity or revenge in 46 (25.70%). Males were common victims due to quarrel 29 (16.20%) and enmity 24 (13.40%). Cases of sexual assault or illicit sexual relationships were the principal motive behind homicidal attacks on females. Sharp and pointed weapons were most commonly used in executing homicidal attacks in 56 (31.28%) cases followed by hard and blunt in 51(28.49%) cases. Combined blunt and sharp weapons were used in 11(5.03%) cases. Sharp weapons commonly used were knife 37 (20.67%), gupti 18 (10.05%) and axe in 9 (5.02%) cases. Hard and blunt weapons commonly used in this area were stones 29 (16.20%), bricks 15 (8.37%), bamboo sticks 12 (6.70%), iron rods 11 (6.14%), etc. Maximum victims 125 (69.83%) died at the place of homicidal assault or on their way to the hospital. Out of 54 hospitalized victims, 35 (19.55%) died within the first 24 hours. Blunt weapon injuries were common in spot-dead victims whereas sharp weapons were in admitted cases who died later during treatment. In all these cases, stomach contents, blood, and other routine viscera were sent to the forensic science laboratory for chemical analysis. Conclusions: Males outnumbered females in all aspects of Homicidal deaths. Overall specific pattern was observed which could help police investigating authorities in tracing out characteristics of victims and assailants in homicidal deaths reported shortly.

Nasal carriage of MRSA among clinically affiliated undergraduate students at the College of Health and Medical Sciences, Haramaya University, Ethiopia

Medical and health science students are among the demographics most at risk from Methicillin-resistant Staphylococcus aureus (MRSA), which is a serious hazard to public health. The main reservoir for MRSA is the nasal cavity, and colonization of this area can raise the risk of infection and transmission in healthcare settings. This study aimed to assess the nasal carriage rate of MRSA among clinically affiliated students at Haramaya University, College of Health and Medicine Sciences, Ethiopia, from July to August 2022. An institution-based cross-sectional study of 250 study participants was conducted using a stratified random sampling methods. The data were collected via structured questionnaires. Nasal swabs were cultured on mannitol salt agar and blood agar at 37 °C for 24 h. Staphylococcus aureus was identified using catalase and coagulase tests. The MRSA was screened using the cefoxitin disk diffusion method on Muller Hinton agar. The data were entered and analyzed by SPSS version 25. Pearson’s chi-square test was performed to predict associations between variables. A p value less than 0.05 was regarded as statistically significant. The nasal carriage rate of S. aureus was 8% (95% CI: 4.6-11.3%). The Nasal carriage rate of MRSA was 4.8% (95% CI: 2.1-7.4%). Overall, 4.8% of all the students were identified as MRSA carriers. MRSA carriage was high among medical students (33.3%). Nose-picking habit (X2 = 16.7, P = 0.001) and dormitory occupancy (X2 = 3.6, P = 0.045) were significantly associated with the MRSA rate. All the MRSA strains were resistant to penicillin and ampicillin. However, all the MRSA strains were susceptible to chloramphenicol and clindamycin. This study revealed that MRSA is a threat due to significant resistance. Nasal carriage is associated with nose picking and dorm occupancy. Encourage practices such as avoiding nose picking and maintaining personal cleanliness. Regular cleaning and disinfection of shared spaces can reduce the presence of MRSA.

The Role of Edmonton Frailty Scale in Determining the Postoperative Complications in Elderly: A Prospective Observational Study.

To explore the effect of Edmonton Frailty Index on the determination of postoperative complication and mortality rates in patients over 65 years of age. An observational study. Place and Duration of the Study: Department of Anaesthesiology and Reanimation, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkiye, from January to July 2021. Patients aged >65 years undergoing surgery were inducted. Frailty was defined as a multisystemic condition in which physical, physiological, and cognitive abilities are reduced. Demographic data, ASA, and Edmonton Frailty Test Score (EFS) were noted preoperatively. Subsequently, these patients were followed perioperatively and evaluated by Clavien-Dindo test (CDT) during the first month postoperatively. There was no statistically significant difference between genders, except EFS, which was higher in females than in males. EFS increased as age increased with a statistically significant positive correlation. The patients with the highest EFS underwent neurosurgical operations. There was a statistically significant and positive correlation between the length of hospital stay and EFS. EFS values increased as the ASA score increased and the positive correlation was statistically significant. The mild frality group had the highest CDT scores and were statistically significant. Frailty assessed by EFS has a statistically significant correlation with ASA and the CDT scores of the patients. EFS value was associated with length of hospital stay, unlike the ASA score. Both EFS and ASA were correlated with the CDT. Preoperative evaluation, especially in geriatric patients, is very important in determining postoperative complications, mortality, and length of hospital stay. Edmonton frailty index, Clavien-Dindo scoring, American society of anaesthesiologists.

Medical students’ perceptions of a community-engaged learning approach to community health in Ghana: the Students’ Community Engagement Programme (SCEP)

BackgroundRevitalizing primary health care requires that the health workforce, especially doctors, must appreciate the significance of the socio-cultural environment in health. To achieve this objective, training of medical students must emphasize greater understanding of the community and its role in health through community engagement using community-engaged learning. However, research on this learning method applied in a purely community engagement context is lacking. A medical school in Ghana adapted its fourth-year junior clerkship curriculum in Community Health to include a community-engagement programme. This study reports students’ perceptions of the said programme as a way of evaluating it and helping to improve upon its implementation.MethodsA cross-sectional survey using a Google form-based questionnaire with open- and closed-ended questions was conducted from May 2022 to December 2023 among 303 current and past medical students of the University of Health and Allied Sciences, Ghana who had experienced the said programme. Based on the first three levels of the Kirkpatrick’s four-level model of training evaluation, data was collected on participants’ socio-demographics, their assessment of the programme content and delivery, subsequent attitudinal changes and their application to practice. Descriptive statistics were performed on quantitative data and thematic content analysis done for responses to the open-ended questions.ResultsMore than half of participants were males (188/303). The mean (SD) participant age was 23.9 years (2.4). Over 90% indicated the programme was valuable to their training (277/297) and were satisfied with the facilitators (283/297) despite some anxieties expressed at the start of their clerkship. Participants noted that they acquired other skills including teamwork and leadership aside the reinforced academic content. At least 99% of participants noted they could conduct the processes of community entry and engagement with or without assistance.ConclusionAlthough there is room for improvement, the students’ community engagement programme may have some utility in the training of medical students to enable them better appreciate community interactions that influence health. Further research incorporating objective assessments of learning and behaviour change is needed to comprehensively assess the programme.

Test Item Writing Competence Among Oman College of Health Sciences Nurse Faculty

<i>Background</i>: The demand for nursing faculty to deliver high-quality teaching and assessment has surged, emphasizing the need for accurate learning assessment through effective testing and outcome measurement. Yet, the literature reveals that many nursing faculty are underprepared in measurement and evaluation, lacking essential competencies in test development and often failing to follow established guidelines. While both teacher-made tests (TMT) and standardized test scores are used to inform nursing faculty what the students have learned, the validity and reliability of TMT remain a significant concern. This study, guided by Social Justice Theory, assessed nursing faculty competencies in TMT development within Oman’s College of Health Sciences, evaluating the fairness and effectiveness of these assessments based on content coverage, difficulty level, and test validity and reliability. <i>Methodology</i>: Descriptive statistics were used to portray the sample; Pearson's correlation was used to determine the relationship between TMT and committee-designed standardized end-of-semester final examinations (CDESFE). <i>Results</i>: Results showed a strong positive correlation between student scores on teacher-made tests (TMT) (<I>M</I> = 23.95, <I>SD</I> = 4.74) and committee-designed standardized exams (CDESFE) (<I>M</I> = 31.99, <I>SD </I>= 6.22), <i>r</i> (1672) =.613, <i>p</i> <.001. MANOVA analysis indicated no significant differences between TMT and CDESFE regarding best-practice guidelines and item analysis (Wilk’s Ʌ =.93, <I>F</I> (2, 21) =.78, <i>p</i> =.47, partial <i>ŋ<sup>2</sup></i> =.69). Multiple regression analysis further demonstrated that both TMT and CDESFE scores significantly predict students' overall academic achievement (<I>F</I> (2, 1671) = 2241, <i>p</i> <.001, <I>R²</I> =.73), underscoring the predictive value of both testing methods for student success. <i>Conclusion</i>: With a gap in how nurse faculty implement TMT, there are potential negative consequences on students’ progress towards licensure examination. This study contributes to nursing science and education through objective, efficient, fair, and equitable assessment measures in the classroom setting. These findings may also transfer to the clinical setting, where nursing students, staff, and faculty are assessed during and after educational sessions and workshops.

Strategy To Increase The Competence Of Practical Supervisors In The Learning Process Of Midwifery Students

Higher education has the function of developing the ability in order to educate the life of the nation in accordance with the vision, mission and goals of Higher Education. In producing competent and competitive graduates, every university must adjust to the national standards of education that have been set. The scope of the national standard of education, the standard of educators and Educational Personnel states that, educators must have academic qualifications and competencies as learning agents, be physically and spiritually healthy, and have the ability to realize the goals of National Education. As vocational education, in the core curriculum of Diploma III Midwifery Education, the percentage of practical learning experience is set at 60 %. Competent practice mentors will contribute to producing midwifery graduates who can be used to become midwifery professionals. In order to improve the competence of the practice supervisor, one of them is the development of skills through education and training. This study aims to describe the management of education and training as improving the competence of practice supervisors in the College of Health Sciences. Improvement of the competence of the practice supervisor through the practice supervisor learning training is carried out through several stages, namely 1) analysis of the needs of the practice supervisor Learning Training, 2) design and planning of the practice supervisor Learning Training, 3) curriculum development of the practice supervisor learning training, 4) implementation of the practice supervisor learning training, 5) evaluation of the practice supervisor learning training, 6) obstacles and carrying capacity of the practice supervisor learning training. To achieve this goal, the research was conducted using a qualitative approach with a case study method on STIKes Abdi Nusantara and STIKes BPI. Data were collected using in-depth interviews, observations, and documentation studies. The data of this study were checked for correctness, reliability through triangulation process. The results showed that the process of implementation of the teaching and learning practice supervisor in the College studied went well. Education and training provided to the practice supervisor contributes positively to the competence of the practice supervisor.

Digital Resource Investment Patterns in Health Science College Libraries: A Budget Analysis

Digital Resource Investment Patterns in Health Science College Libraries: A Budget Analysis

Evaluation of Left Ventricular Systolic Functions of Patients with Exaggerated High Blood Pressure Response to Treadmill Exercise Test with Two-Dimensional Longitudinal Strain Imaging.

An exaggerated hypertensive response (EHR) during exercise is linked to increased cardiovascular risk and mortality. This study aims to assess structural and functional cardiac changes, along with subclinical myocardial damage, using transthoracic echocardiography (ECHO) and 2D longitudinal strain analysis in patients showing a hypertensive response to treadmill exercise. Patients without known chronic diseases, presenting to the Cardiology Department at Health Sciences University Gülhane Training and Research Hospital, were divided into 2 groups based on their blood pressure response during treadmill exercise: exaggerated hypertensive response (EHR, n = 42) and normal response (control, n = 44). Left ventricular longitudinal strain was assessed using transthoracic echocardiography, and global longitudinal strain (GLS) was calculated as the average from all segments. Data analysis was performed using SPSS 26. No significant differences were found between the groups regarding baseline demographic and laboratory parameters (P > .05 for all). However, the EHR group exhibited significantly higher interventricular septum thickness, mitral A velocity, and mitral annulus velocity (a'), while mitral annulus velocity (e') was significantly lower (P < .05 for all). Additionally, left ventricular (LV) mass index, left atrial volume index, mitral E/e' ratio, deceleration time, and relative wall thickness (RWT) were higher in the EHR group, while the mitral E/A ratio was lower (P < .05 for all). The GLS was also significantly lower in the EHR group (P < .05). Left ventricular geometry parameters, such as LV mass index and RWT, and GLS findings indicating subclinical cardiac damage, were significantly altered in the EHR group, suggesting a higher risk of LV hypertrophy and myocardial dysfunction.

Mediating role of gut microbiota on Baduanjin for cognitive function in community-dwelling older adults with mild cognitive impairment: a study protocol for a cluster randomised controlled trial

IntroductionThe gut microbiome plays an important role in maintaining both cognitive and physical functions in older adults, and gut dysbiosis is an important pathophysiological mechanism of mild cognitive impairment (MCI)...

Ektacytometric examination of red blood cells’ morphodynamical features in diabetic nephropathy patients

Abstract Objectives Diabetic nephropathy (DN), the primary cause of end-stage renal disease, is associated with chronic hyperglycemia and elevated blood pressure. This study investigates the correlation between DN and changes in hemorheology, which involves blood flow properties. Methods At the University of Health Sciences in Istanbul, Türkiye, erythrocyte deformability, aggregation, and viscosity were measured using advanced ektacytometry (Lorrca® Maxsis) on blood samples from 31 healthy individuals, 41 diabetic patients, and 45 patients with diabetic nephropathy from University of Health Sciences Haydarpasa Numune Training and Research Hospital. All hematocrit values were standardized to 40 %. Results Deformability of red blood cells (RBCs), indicated by the elongation index at shear stresses from 0 to 30 Pa, significantly decreased in the diabetic nephropathy group compared to diabetic patients without nephropathy and healthy controls (mean min-max SD: 0.650 (0.63–0.67) vs. 0.659 (0.64–0.68) and 0.642 (0.62–0.66), respectively; p&lt;0.01). RBC aggregation significantly increased in the diabetic nephropathy group (mean min-max SD: 77.52 (57.84–90.7) vs. 69.96 (53.13–80.53) in controls; p&lt;0.01), and plasma viscosity was also higher (mean min-max SD: 1.48 (1.27–2.02) mPa·s vs. 1.34 (1.22–1.72) mPa·s in controls; p&lt;0.001). Conclusions Our findings demonstrate marked hemorheological changes in diabetic nephropathy patients. These changes suggest that evaluating RBC deformability, aggregation, and viscosity is critical for developing therapeutic strategies aimed at reducing vascular complications and preventing tissue damage in diabetics.

DNMT1 rs2228611, rs2228612 and DNMT3A rs2276598, rs752208 Polymorphisms and Their Association with Breast Cancer Phenotype and Prognosis.

Background and Objectives: Breast cancer is a leading cause of cancer-related deaths globally. This study investigates the impact of genetic polymorphisms in DNA methyltransferases (DNMT1 and DNMT3A) on breast cancer pathomorphology and patient prognosis. Specifically, we focused on DNMT1 polymorphisms rs2228611 and rs2228612 and DNMT3A polymorphisms rs2276598 and rs752208. Materials and Methods: Conducted at the Institute of Oncology of the Lithuanian University of Health Sciences, this study included 201 Lithuanian women with early-stage breast cancer. DNA was extracted from peripheral blood samples, and genotyping for the specified polymorphisms was performed using the PCR-RFLP assay. Statistical analyses were applied to evaluate associations between polymorphisms and clinicopathological characteristics. Results: The non-carriers of the DNMT1 rs2228611 G allele were less likely to be diagnosed at an older age, while the DNMT3A rs752208 T allele was linked to lower-grade tumors. Survival analysis indicated a potential relationship between DNMT3A rs752208 and overall survival, although no significant findings were observed in progression-free or metastasis-free survival. Conclusions: This study suggests that the DNMT1 and DNMT3A polymorphisms may influence breast cancer pathomorphology and prognosis. The DNMT1 rs2228611 G allele may be associated with earlier onset, and the DNMT3A rs752208 T allele might correlate with less aggressive tumors. These findings underscore the potential of DNMT gene polymorphisms as prognostic biomarkers in breast cancer, warranting further investigation with larger sample sizes.

The Role of Hyperemesis Gravidarum in the First-Trimester as a Predictor of Intrahepatic Cholestasis of Pregnancy

Background: Intrahepatic cholestasis of pregnancy (ICP) and hyperemesis gravidarum (HEG) are pregnancy-specific liver diseases associated with significant fetal and maternal complications. Typically, HEG is diagnosed in the first trimester of pregnancy, and ICP in the third trimester of pregnancy. The aim of this study is to investigate whether primigravid women diagnosed with ICP between the 26th and 37th weeks of pregnancy were also diagnosed with HEG during the first trimester, and to evaluate whether the diagnosis of ICP can be predicted in pregnant women with a prior diagnosis of HEG. Methods: Our study is a retrospective analysis. A total of 4000 pregnant women, aged 18 to 45 years and between 26th and 37th weeks of gestation, who presented to the Gynecology and Obstetrics Clinic of the Health Sciences University, Istanbul Training and Research Hospital with complaints of pruritus between 01/07/2018 and 01/07/2023, were screened. 227 patients were diagnosed with ICP. Complete medical records and blood test results were available for 141 patients. 39 patients with a history of previous pregnancies and/or comorbidities, as well as 30 patients without available serum total bile acids (TBA) results, were excluded from the study. Of these, 72 pregnant women who met the inclusion criteria were enrolled in the study and grouped into primigravid women with and without a history of HEG in the first-trimester. Demographic characteristics, gestational age, detailed medical history, ultrasound findings, and biochemical parameters—including alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, bilirubin, and fasting bile acid (FBA) levels were statistically compared. Results: In our study, comparisons revealed no significant differences in AST, ALT, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and direct bilirubin levels (p &gt; 0.05) between the groups with and without a history of HEG diagnosed with cholestasis. In pregnant women diagnosed with cholestasis, the total bilirubin and indirect bilirubin levels were significantly lower (p &lt; 0.05) in the group with a history of HEG compared to the group without a history of HEG. In contrast, TBA levels were significantly higher (p &lt; 0.05) in the group with a history of HEG compared to the group without a history of HEG. Conclusions: This study found that primigravid women with ICP and a history of HEG had elevated TBA levels, while total and indirect bilirubin levels were reduced. This suggests that patients with a history of HEG should be closely monitored in later stages of pregnancy for the development of ICP and potential liver damage. However, larger and more comprehensive studies are needed to confirm these findings.

"Bridging The Gap" Medical Degree Preparatory Program (EMDP2) Military Students Provide Leadership and Mentorship to Classmates.

The lack of adequate diverse representation (racially, socioeconomically, gender, second career applicants, student parents, etc.) within secondary education in the United States has proven to be a challenging and complex, multifaceted problem, and despite ongoing efforts, one that continues to remain unsolved. These disparities are well known and documented at all levels of education. The Uniformed Services University of Health Sciences is the nation's only fully federally funded medical school and capitalizes on the preexisting diversity and exceptional training already existing within the U.S. military's enlisted force through the Enlisted to Medical Degree Preparatory Program (EMDP2). This study aims to investigate how a novel program at a unique military medical school influences medical school class cohorts. This study used a traditional thematic qualitative analysis format. Thematic qualitative analysis is a method for identifying, analyzing, organizing, describing, and reporting themes found within survey responses. One hundred nine surveys via SurveyMonkey© were sent to EMDP2 students. Thirty-six surveys were returned for a response rate of 33%. Two co-investigators carefully read each participant response and coded independently line-by-line with constant comparison of each quote. NVivo© software was used to store the data as the counts progressed. After completion of data collection, results identified the following themes among survey responses being accepted, bridging the gap, feeling valued, gratitude, prior experiences, and professionalism. Students with prior military experience have a significant impact on our institutions medical school classes. These students provide mentorship and professionalism to their fellow classmates. This study helps educators understand the perspectives and challenges faced by prior-service medical students and appreciate how to use the prior experience of these unique prior-service members to benefit the entire class.

Prevalence of Vitamin D Deficiency in Patients with Autoimmune Thyroid Disorders at Tertiary Care Hospital, Karachi

Background &amp; Objective: Vitamin D deficiency is commonly observed in patients with autoimmune thyroid disorders, potentially influencing disease severity and management. This study aimed to ascertain the magnitude of vitamin D deficiency in those with autoimmune thyroid disorders (AITDs). Methodology: A cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan from February 2024 to June 2024. Patients who attended the outpatient department and were diagnosed with AITDs, such as autoimmune hypothyroidism and Grave's disease, based on positive anti-thyroid antibodies were included in the study. The 25-hydroxy vitamin D levels in these patients were then measured. Results: The study had 60 participants, with a mean age of 35.23 ± 9.934 years. The majority of participants had low vitamin D levels (28.3% had insufficient and 48.3% had deficient levels). Additionally, it was discovered that vitamin D status and AITDs were related, where a majority of individuals had low vitamin D levels (P-value = 0.014). Further, it was revealed that anti-TPO antibodies followed by the presence of anti-TG antibodies were more indicative of low vitamin D levels. Conclusion: The individuals with AITDs, specifically hypothyroidism had a noticeably higher prevalence of vitamin D deficiency followed by insufficiency.

Comparative Analysis of Effect of Lidocaine and Adrenaline Soaked Gauze Versus Normal Saline Soaked Gauze at Skin Graft Donor Site of Thigh: A Randomized Control Trial

Objective: To compare the hemostatic effect of Lidocaine and Adrenaline soaked gauze with normal saline soaked gauze at skin graft donor site of thigh. Study Design: Randomized control trial (Trial ID: NCT04344483). Place and Duration of Study: Plastic &amp; Reconstructive Surgery Department, Dow University of Health Sciences Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Jun to Oct 2020. Methodology: A randomized controlled trial was carried out on 60 Patients under treatment in burn surgery unit. Patients were randomly assigned to 2 groups. Patients in both groups at donor sites received subcutaneous infiltration for 10 minutes, either with 2% Lidocaine and 1:100,000 Adrenaline soaked gauze or with normal saline soaked gauze. Outcomes included intraoperative bleeding, number of dressings required in first 24 hours after surgery, post-operative pain in first 24 hours, systemic analgesia requirement after surgery within 24 hours and donor-site epithelization at 14th post-operatively. Statistical Package for Social Sciences version 25 was used to analyze the data. Results: out of 60 patients, the mean age was estimated as 36.58±12.42 years and 44(73.3%) patients were males while 16(26.7%) were females. Statistically significant difference was observed in number of dressings (p=0.001), mean pain score in first 24 hours (p=0.001), intra-operative bleeding (p=0.001) and systemic analgesia requirement in 24 hours of surgery (p=0.001) between both groups. Conclusion: In comparison to normal saline soaked gauze, the Lidocaine and Adrenaline soaked gauze was effective in terms of number of dressings, pain in first 24 hours, intra-operative