Department Of General Hospital Research Articles

Compliance with the flexible endoscope handling procedure at the Endoscopy Department of the Central Highlands General Hospital, in 2021.

The study was conducted to describe the current situation in the implementation of the flexible endoscope handling procedure at the Endoscopy Department of the Central Highlands General Hospital, in 2021. Methods: A cross-sectional descriptive study, using quantitative research on 295 opportunities to perform the processing procedure of the flexible endoscopic through observation using a checklist built on the tube handling guidelines flexible endoscope of the Ministry of Health. Findings: Results showed that the overall correct implementation rate for the whole process is 85.8%. The incorrect steps are step 1 (pre-clean), step 2 (tube removal), step 3 (leak check), step 5 (tube test), step 7 (coating and drying) with the ratios are 2.8%; 1.7%; 8.1%; 4.1%; 6.4% respectively. Conclusion: The overall correct performance rate for the entire flexible endoscopic procedure at the Endoscopy department of the Central Highlands General Hospital in 2021 is 85.8%. There are still flaws in the implementation of the process. From this situation, the hospital as well as the Department of Endoscopy have solutions to improve compliance with the procedure for handling flexible endoscopes. Keywords: Compliance with the procedure, flexible endoscope, endoscope handling.

Drug utilisation evaluation in patients with osteoarthritis in tertiary care hospital

Background: The principle aim of our study is to assess the prescribing pattern of drugs used in treatment of osteoarthritis patients. Methods: A prospective and empirical study was carried out at department of orthopaedics-Shadan teaching and general hospital, for 6 months.Results: During the study period, a total 120 patients were enrolled, of which 57% were females, 43% were males and common age group was ≥60 years. It was found that 56% of OA patient have history of trauma and 62% of obese individual contribute to occurrence of OA. It was found that subjects developed comorbidities like CV disorders which is 36%. It was found that 63% have OA for a duration of >2 years, 56% had no knowledge about their medications, 59% have co-morbidity, 61% have treatment complexity. NSAID’s, calcium, vitamin D3, glucosamine and chondroitin sulphate were the most frequently prescribed drugs in OA accounting for 50%. It was reported that 55% were adherent to OA medication, adherence to physical activity was 64%, adherence to weight loss was 62%.Conclusions: Our study manifest that majority of the patients had duration of >2 years of OA. The reasons for the uncontrolled pain was due to absence of awareness about osteoarthritis-related difficulties, drugs, low calcium diet, increased stress, obesity, and advanced age. Continuous health education, patient counselling, information about medication adherence and satisfaction at follow-ups is essential to avoid the problems.

Quality of Life in Patients With Tongue Cancer After Surgical Treatment: A 12-Month Prospective Study.

Aim of the studyThe project assessed the quality of life in post-operative patients with tongue cancer at three-month intervals in the first year after the operation.Material and methodsA longitudinal prospective cohort study was conducted in the oral and maxillofacial department of a large public general hospital in northern Greece. Fifty-six patients out of a total of 156 with oral cancer were chosen for the study, who completed distinct quality-of-life surveys (EORTC QLQ-C30, and QLQ Head & Neck Module FACT-G).ResultsTumor size correlated negatively with various EORTC QLQ-C30 scores, such as role functioning (p = 0.004) and cognitive functioning (p = 0.007), in the third evaluation. Tumor size correlated positively with subscale problems such as social eating (p = 0.001) and weight loss (p = 0.004) in the QLQ Head & Neck Module. The role functioning subscale (p = 0.003), the pain subscale (p = 0.001), and the speech issues QLQ Head & Neck module subscale (p = 0.003) adversely correlated with cancer stage. Patients who received flap reconstruction significantly differed from those who did not, on the EORTC QLQ-C30 cognitive functioning (U = 139.0, p = 0.006), dyspnea (U = 391.5, p = 0.006), and diarrhea (U = 425.0, p = 0.007) subscales during the third evaluation. Differences were also found in the QLQ-H&N35 subscale of sticky saliva (U = 391.0, p = 0.006).Patients with flap reconstruction did not significantly differ from those with immediate closure after one year. Differences concerned the EORTC QLQ-C30 subscales of cognitive functioning, dyspnea, and diarrhea, and the QLQ Head & Neck Module subscale of sticky saliva on the third assessment. No statistically significant correlations were observed between tumor size and cancer stage in the fourth assessment, but the grade of cancer positively correlated with the EORTC QLQ-C30 subscale of constipation (p = 0.000).ConclusionsOur study suggests that quality of life is impaired in patients with tongue cancer who have undergone surgical interventions, particularly within the first month post-operation. However, quality of life is fully restored one year after the surgical excision. Future studies should explore early interventions to help healthcare providers better treat this unique group of patients.

Nurses' Working Experiences of Their Provision of Cross-Cultural Services to Tibetan Patients With Kashin-Beck Disease: A Qualitative Study.

Limited qualitative studies exist on nurses' experience in terms of communicating with and caring for patients with endemic diseases. The purpose of this study was to describe the working experiences of nurses caring for Tibetan patients with Kashin-Beck disease in China. A qualitative design was used in this study. Sixteen nurses who worked in the orthopedics department of a large tertiary general hospital in Wuhan, China, constituting a purposive sample, were interviewed face-to-face using semi-structured guided questions. Three major themes and nine subthemes were identified. Major themes included the challenge in cross-cultural nursing, stress adjustment in cross-cultural nursing, and reshaping competencies in cross-cultural nursing. This study revealed that nurses encountered multifaceted challenges when caring for Tibetan patients with Kashin-Beck disease. In a multiethnic society, communication and language skills, cultural competency and cultural sensitivity, and diverse training methods to improve cross-cultural knowledge could increase ethnic minority patient satisfaction with cross-cultural care.

Hospital intranet system is major barrier to paediatric clinical guideline use a cross-sectional single-centre survey of NHS doctors and nurses

Across clinical specialties, the use of clinical guidelines is integral to maintaining patient safety, reducing variation in clinical practice and optimising patient care. Identifying specific barriers to the effective use of guidelines within individual healthcare settings allows for the implementation of effective strategies to overcome them, and ultimately improvements in patient care. Here, we report a single-centre survey of paediatric doctors and nurses, which formed part of a quality improvement project within the Acute Paediatrics Department of an NHS district general hospital. The primary aim of the study was to explore the perspective and resource barriers paediatrics healthcare staff experience when using local and national clinical guidelines. The secondary aim of the study was to examine the impact of the Covid-19 pandemic on local and national clinical guideline use. We found that local and national guidelines are frequently used by paediatric doctors and nurses, and that they have positive perceptions of guidelines, overall. However, the NHS Trust's Intranet system was identified as a direct barrier to the use of local paediatric clinical guidelines. Staff throughout the UK in the NHS rely on their Intranet system in order to access local guidelines. Our results provide an impetus for interventions within this NHS Trust, and in the many other NHS Trusts with similar Intranet systems, to increase clinical guideline use and, ultimately, improve patient care.

Nhiễm giun lươn và một số yếu tố liên quan ở bệnh nhân điều trị nội trú tại Khoa Nội tổng quát, Bệnh viện Đa khoa khu vực Củ Chi, 2021

Human strongyloidiasis – the disease is caused by Strongyloides stercoralis infection, is one of the neglected parasitic diseases, but is an important health problem in immunodepression patients due to its autoinfection cycle and lead to hyperinfection. In currently, there were not many adequate studies on this major in patients who were treated inside hospital. A cross-sectional descriptive study and convenient sampling of all patients being treated as inpatients at the hospital. Stool samples were collected and tested for Strongyloides stercoralis infection by direct smear and modified Harada Mori culture. Study of 330 cases of inpatients treated at the general internal medicine department of Cu Chi general hospital showed that: the prevalence of Strongyloides spp infection was 8.5%. In which, direct smear technique only detected 7.0%, lower than the culture technique. Patients over 60 years old, prolonged use of corticosteroids, farmer and frequent contact with soil directly increased Strongyloides spp infection risk 4.1; 3.0; 4.5 and 5.1 times in order. Sex, education level, unhygienic latrines using, and the percentage of eosinophils were not related with Strongyloides spp infection.

Improving the clinical ability and quality of endocrinology department with diagnosis-related groups tool

BackgroundTo evaluate the use of the diagnosis-related groups (DRGs) tool to promote the diagnosis/treatment ability and quality of the endocrinology department under the new policy of grouping payment-related to disease diagnosis.MethodsWe compared the income structure of the endocrinology department in a 3a general hospital between the first half of 2019 and the same period in 2021. We also observed the changes in cost efficiency indexes (CEIs), time efficiency indexes (TEIs), case-mix index (CMI), number of DRGs, risk weight (RW) proportion, and surgery number in the inpatient department. Furthermore, the distribution of inpatients with diabetes of the whole hospital and the improvement of treatment efficiency indexes of the sub-specialty department were analyzed.ResultsIn the first half of 2021, compared with the same period of 2019, the total revenue of the endocrinology department decreased by 20.05%, the average hospitalization cost decreased by 11.72%, the CEI decreased from 1.31 to 1.06, and the TEI decreased from 0.74 to 0.64. Additionally, the number of DRGs increased from 162 to 176, the average CMI value increased from 0.80 to 0.84, and the proportion of RW 1–5 cases increased. Moreover, the number of surgical cases increased by 60.50%, minimally invasive surgery increased by 53.54%, grade 4 surgery increased by 66.67%, and the proportion of entering the clinical pathway increased from 77.76% to 86.64%. From May to August, 2021, the admission rate of endocrinology sub-specialty increased significantly, the number of DRGs showed an increasing trend, and the CEI and TEI decreased significantly. In the first half of 2021, inpatients with diabetes in the departments of rehabilitation, neurology, nephropathy, ophthalmology, and general administration accounted for 21.99–38.54%.ConclusionsThe DRGs tool can be used to improve the clinical diagnosis and treatment ability of the endocrinology department, as well as optimize the CEI, TEI, CMI, and RW values. It is an effective way to promote the development of the endocrinology department under the new DRGs payment policy, carry out blood glucose management in the hospital, build endocrinology sub-specialties, and improve surgical and operation capacity.

Effect of the Strategic Thinking, Problem Solving Skills, and Grit on the Disaster Triage Ability of Emergency Room Nurses.

In this descriptive study, we aimed to identify factors related to emergency room nurses’ disaster triage ability. A total of 166 nurses who worked for emergency departments of general hospitals completed a structured questionnaire consisting of the Disaster Triage Ability Scale (DTAS), the Strategic Thinking Scale (STS), the Problem-Solving Inventory (PSI), and the Original Grit Scale (Grit-O). The data were analyzed using SPSS/WIN 25.0 by means of descriptive statistics, t-test, one-way ANOVA, the Scheffé post hoc test, Pearson’s correlation coefficients, and stepwise multiple regression. Participants’ DTAS averaged 14.03 ± 4.28 (Range 0–20) and showed a statistically significant difference according to their experience of triage education (t = 2.26, p = 0.022) as a disaster triage-related attribute. There were significant correlations among DTAS and confidence in the PSI (r = 0.30, p < 0.001), the approach-avoidance style in the PSI (r = −0.28, p < 0.001), and futurism in the STS (r = 0.19, p = 0.019). The strongest predictor was confidence in the PSI; in addition, 14.1% of the DTAS was explained by confidence in the PSI, approach-avoidance in the PSI, and futurism in the STS. Emergency room nurses who received triage education showed a higher level of the DTAS and their DTAS could be explained by problem-solving skills and strategic thinking. Therefore, it is necessary to develop and implement triage education programs integrated with stress management to improve the approach-avoidance style to ensure better problem-solving skills and to utilize various training methods to enhance confidence to improve problem-solving skills and futurism as part of strategic thinking.

A study to assess the efficacy of topical cyclosporine A 0.05% in the management of dry eye with meibomiam gland dysfunction

: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Meibomian Gland Dysfunction (MGD) is an abnormality of the meibomian gland that blocks the secretion of lipids. Without sufficient lipid production, tears evaporate quickly causing Dry Eye.MGD is associated with multiple pathological mechanisms including inflammation, microbial factors and lipid deficiencies. Topical Cyclosporine A (CsA) 0.05% is a calcineurin inhibitor that reduces inflammation by specifically inhibiting T‑cell activity, which reduces ocular surface inflammation and improves tear film dynamics. This was a prospective observational study done on 100 patients at the Department of Ophthalmology Basaveshwar teaching and general hospital, on patients of dry eyes due to meibomian gland dysfunction. Patients who were diagnosed with dry eyes due to meibomian gland dysfunction were invited to take part in the study. Patients were divided randomly into two groups of 50 patients each. This study, was explained in detail to them. An informed consent was obtained. Patients fulfilling the inclusion criteria were listed.All OSDI scores (symptom intensity, frequency and aggravation) revealed decreasing patterns throughout the observation period in both the groups. In single analysis, the cyclosporine A 0.05% group showed a significant improvement for each score at 3 months (p &amp;#60; 0.01, p = 0.01, p = 0.02, respectively). The mean TBUT after treatment in the group A (cyclosporine A group) increased to 12.36± 3.58(p&amp;#60;0.001) seconds, and in the group B (Control group) the TBUT score increased to 11.01±3.06 seconds. After 3 Months, there was statistically significant improvement in the mean Schirmer’s scores in both the treatment groups, however improvement was significantly greater in Cyclosporine A group. Prior to the treatment in group A (Cyclosporine A) mean Lissamine staining score was 2.73±0.15 and post treatment it reduced to 1.32±0.15 which was statistically significant (P&amp;#60;0.001). In group B (Control group) score before treatment was 2.46±0.15 and after treatment it reduced to 2.39±0.27 (p=0.11), not much difference was seen. : Findings from our study showed that there were significant improvements in the dry eye conditions due to defect in meibomian gland by treatment of topical Cyclosporine A 0.05% and sodium hyaluronate 0.1%.

"Emergency Room Evaluation and Recommendations" (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database.

Purpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The aim of this study is to examine the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [LR+], negative likelihood ratio [LR-] and area under the receiver operating characteristic curve [AUROC]) of the ER2 high-risk level and its “temporal disorientation” item alone to screen for major neurocognitive disorders in older ED visitors at the JGH.Methods: Based on a cross-sectional design, 999 older adults (age 84.9 ± 5.6, 65.1% female) visiting the ED of the JGH were selected from the ER2 database. ER2 was completed upon the patients' arrival at the ED. The outcomes were ER2's high-risk level, the answer to ER2's temporal disorientation item (present vs. absent), and the diagnosis of major neurocognitive disorders (yes vs. no) which was confirmed when it was present in a letter or other files signed by a physician.Results: The sensitivities of both ER2's high-risk level and temporal disorientation item were high (≥0.91). Specificity, the PPV, LR+, and AROC were higher for the temporal disorientation item compared to ER2's high-risk level, whereas a highest sensitivity, LR-, and NPV were obtained with the ER2 high-risk level. Both area under the receiver operating characteristic curves were high (0.71 for ER2's high-risk level and 0.82 for ER2 temporal disorientation item). The odds ratios (OR) of ER2's high-risk level and of temporal disorientation item for the diagnosis of major neurocognitive disorders were positive and significant with all OR above 18, the highest OR being reported for the temporal disorientation item in the unadjusted model [OR = 26.4 with 95% confidence interval (CI) = 17.7–39.3].Conclusion: Our results suggest that ER2 and especially its temporal disorientation item may be used to screen for major neurocognitive disorders in older ED users.

Variations in Symptomatology of Migraine Among Local Population of Pakistan

Introduction: Migraine is considered one of the most disabling neurological disorders worldwide. Migraine has recently been shown to effect population with a severe cascade of symptoms. With still a huge gap in understanding of pathogenesis of migraine, knowledge regarding migraine symptomatology is mandatory for effective diagnosis and treatment.&#x0D; Aims &amp; Objectives: To compare symptoms of migraine between two groups migraineurs (M) and migraineurs with high blood pressure (MBP).&#x0D; Place and duration of study: The study was conducted at Shaikh Zayed Postgraduate Medical Institute, Department of Physiology and Lahore General Hospital, from January 2015 to June 2015.&#x0D; Material &amp; Methods: It was a cross-sectional comparative study. The study population was 35 diagnosed migraine patients (M) and 29 migraine patients with high blood pressure (MBP). Patients were questioned about various migraine symptoms based on the standard criteria for diagnosing migraine and the responses were recorded in written on a predesigned proforma. Collected data was studied and interpreted by using SPSS 23 , p value ? 0.05 was taken as significant.&#x0D; Results: Symptoms of migraine were compared between two groups, migraineurs (M) and migraineurs with high blood pressure (MBP). The mean age of the patients was 25±7years in migraineurs (M) and 38±6 years in migraineurs with high blood pressure (MBP). The incidence of vomiting was significantly higher in patients who had both migraine and high BP, (p-value = 0.008). Collected data was studied and interpreted by using SPSS 23. The difference in the rest of the symptoms was nonsignificant between the two groups studied by using One Way Anova and T-test frequency and percentages. Chi- square test was applied using cross-tabulation to check the association of family history of migraine which was statistically non-significant.&#x0D; Conclusion: Migraine is a female dominant disorder mostly affecting people in their 30's. There was no significant difference in major diagnostic migraine symptoms in both groups. However, among minor diagnostic symptoms, the frequency of vomiting was higher in patients with migraine with high BP.

The effective therapeutic strategies to fight against COVID-19 in India

In December 2019, the global pandemic coronavirus infection (COVID-19) was first detected in Wuhan, Hubei Province, Central China. It is caused by coronavirus-2, which causes severe acute respiratory syndrome (SARS-CoV-2). This was declared by World Health Organization on 11 th March 2020. In India, the first case of COVID-19 infection was reported in Kerala on January 27,2020 of a 20 yr old female presented to an Emergency Department in General Hospital, Thrissur, Kerala. Since then, many government and health officials are trying hard to combat with this perniciousness novel coronavirus disease. It is known that coronavirus enters into human cells by the help of angiotensin-converting enzyme (ACE2) receptor. The infection starts in the cells of the respiratory mucosa and then spreads to the lungs' alveolar epithelial cells. The receptor facilitates in the binding and release of nucleocapsid into the cell by fusing the viral membrane with the host cell membrane. The virus subsequently replicates and produces viral RNAs and proteins using the host machinery. These are assembled into new viral particles called virions by budding into intracellular membranes. The release of new virus particles causes the host cells to die. This replication cycle study of the virus gives new insight for the development of potential drugs and vaccines for treatment of coronavirus disease. In the first wave of the pandemic, hydroxychloroquine, an antimalarial medicine, was shown to be effective for coronavirus patients, but it was no longer regarded therapeutic in the second wave of the Delta variant. Instead, another drug called Remdesivir became more prevalent in second wave. Although, the omicron variant showed milder effects with less death rate. In this review, therapeutic strategies including potential drugs and effective vaccines are to be discussed to fight effectively against the disease.

Prognostic Value of Long Corrected QT Interval on Electrocardiogram in Acute Organophosphate Poisoning: A Cohort Study

Introduction: According to data available from National Poison Information Centre India, suicidal poisoning with household agents (organophosphates, carbamates etc.) is the most common modality of poisoning. There are reports suggesting relationship between prolonged corrected QT interval and the severity of Organophosphate (OP) poisoning. Corrected QT (QTc) interval is measured in 12 lead electrocardiograms taken on admission. Aim: To assess prognosis of acute organophosphate poisoning patients by studying association of corrected QT interval with its complications and mortality. Materials and Methods: The cohort study was conducted at Medicine Department of Medical College, Baroda and Sir Sayaji General Hospital, Vadodara, Gujarat, India, from December 2017 to November 2018. The study included 60 patients with a history of OP poisoning. The QTc interval in electrocardiogram was determined by using the Bazett formula. Prognostic importance of QTc interval was assessed by correlating it with Paradeniya Organophosphorus Poisoning Scale score, hospital stay, atropine requirement, requirement of ventilatory support and mortality. Data was analysed by using descriptive statistics and Chi-square test. Results: The organophosphate poisoning was seen more in younger age group, between 18-29 years (68.4%). The QTc prolongation was seen in 12, 80% of patients in moderate grade of Paradeniya Organophosphorus Poisoning Scale and in 9 (20%) patients among mild grade of Paradeniya Organophosphorus Poisoning Scale (p-value=0.0001). Amongst patients who needed hospital stay for more than 7 days, QTc prolongation was seen in 43% of patients, and in patients who needed hospital stay for less than 7 days QTc prolongation was seen in 9% of patients (p-value=0.0223). Statistically significant association was seen between atropine ampule requirement and QTc prolongation. Total 29 (48.3%) patients developed respiratory depression, and amongst them 19 (65.5%) had QTc prongation (p-value &lt;0.0001). Thirteen (22%) patients died and amongst them 12 (92.31%) had QTc prolngation. In those who survived (47,78%) only 9 (19.15%) had QTc prolongation (p-value &lt;0.0001). Conclusion: Prolonged QTc interval in electrocardiogram is a good prognostic indicator in patients with organophosphorus poisoning. Early identification of prolonged QTc interval and subsequent timely shifting of patients to Intensive Care Unit (ICU) and subsequent intensive management in a patient of OP poisoning would be of profound value at any level of health care setting for favourable outcomes.

Modified Alvarado score versus Tzanaki’s Score in diagnosing acute appendicitis: An observational study

Background: Appendix is a blind muscular tube derived from the midgut. During the embryogenic development, in the 6th week appendix and cecum appear as out pouching from midguts caudal limb. Acute appendicitis is one the most common diagnosis made whenever patient presents with right illac fossa pain and mostly encountered in young and middle-aged individuals. The diagnosis and management of acute appendicitis depend on clinical presentation, that is, clinical signs and symptoms. The most common presentations in these cases have abdominal pain along with fever, anorexia, nausea, and vomiting. Various Scoring systems are developed to diagnose acute appendicitis based mainly on the presenting signs and symptoms, but widely none of them are used as an uniform scoring system. Aims and Objectives: The purpose of this study was to assess effectiveness and comparison of modified Alvarado score and Tzanaki’s Score in the early diagnosis of acute appendicitis. Materials and Methods: A prospective observational study was done in department of General Surgery JLN Medical College Hospital, Ajmer which included 200 patients presenting with the signs and symptoms of acute appendicitis, clinically. During admission the patients were evaluated by Modified Alvarado score and Tzanaki’s Score and final surgical decision was taken by the treating surgeon. Finally, the scores were compared with the histopathological examination of the surgically operated specimen. Results: The sensitivity and specificity of Modified Alvarado Score was 84.26% and 72.7%, respectively, with a positive predictive value of 96.15% and negative predictive value of 36.3%. The sensitivity and specificity of Tzanaki’s score was 88.2% and 72.7%, respectively, with a positive predictive value of 96.31% and negative predictive value of 43.24%. The diagnostic accuracy of Alvarado score was 83% and that of Tzanaki’s score was 86.5%. Conclusions: Our study showed that Modified Alvarado scoring system is a simple tool with limited features for bedside diagnosis of acute appendicitis, but its effectiveness is not as good as that of Tzanaki’s scoring system.

A quality improvement project: Reducing the number of unnecessary plain abdominal radiographs performed in the emergency department of a London district general hospital.

Background:Inappropriate completion of abdominal radiographs results in unnecessary exposure to ionizing radiation. This quality improvement project aimed to reduce the number of inappropriate abdominal radiographs performed in the emergency department.Materials and methods:Abdominal radiograph request forms were analyzed with reference to the Royal College of Radiologists (RCR) iRefer guidance. A teaching session was then delivered to ED clinicians and posters were disseminated within the department. Post-intervention data collection followed.Results:Following the intervention, there was an increase in the proportion of abdominal radiographs meeting iRefer guidance, which was accompanied by an increased diagnostic yield of these investigations. There was a reduction in the number of requests post-intervention.Conclusions:Our interventions helped increase awareness of both the guidelines and radiation dose associated with each study. Routine education of the iRefer guidelines will help reduce inappropriate requests. This in turn will reduce unnecessary radiation exposure, whilst also reducing the financial burden.

Role of CD4+ and CD8+ T Lymphocyte in the Onset of Stroke in People Living with HIV in Pointe-Noire

Objective: To determine the role of CD4+ and CD8+ T lymphocytes in the onset of stroke in people living with HIV. Methodology: This was a descriptive, cross-sectional study from January to July 2019, in the neurology department of loandjili general hospital, including any patient hospitalized for a first episode of stroke confirmed by brain scan. The study variables were: age, sex, CRP value, serum T cell CD4+, CD8+. The statistical analysis was carried out using the EPI info 7 software. Results: Twenty stroke patients were included. The relative frequency of HIV was 20%. The risk factors were potentiated by immunosuppression of CD4+ T cells. Sixty percent (60%) of the patients had a CD4+ count 3 and the mean CD4+ count was ±191/mm3. Stroke was the predominant mechanism of injury with a frequency of 70%, the only injury mechanism of stroke in patients with CD8+ T cell count > 800/mm3 (p = 0.04). Conclusion: Risk factors are potentiated by TCD4+ lymphocyte immunosupression, also CD8+ lymphocytes of immune system activation marker are a cardiovascular risk factor for living people with HIV.

A COMPARATIVE STUDY OF LIPID PROFILE IN CHRONIC ALCOHOLICS AND NON ALCOHOLICS IN TERTIARY HOSPITAL

BACKGROUND: Alcoholism is a signicant threat to public health in developed and developing countries. Over the last 30-40 years, alcohol consumption has increased in quantity and frequency. Alcohol use predisposes subjects to changes in lipid prole associated with coronary risk. AIM: 1] To study lipid prole in chronic alcoholics by measuring serum total cholesterol triglycerides, HDL, LDLand VLDL. 2]To compare lipid prole changes in chronic alcoholics and non-alcoholics MATERIALS AND METHODS: A Hospital-based cross-sectional study was conducted with patients attending the General Medicine department in Santhiram medical college and general hospital, of which 30 alcoholic and 30 non-alcoholic were taken into the present study. RESULTS: There was a signicant rise in TC, TGL, HDL, LDL and VLDL of chronic alcoholics compared with non-alcoholics with p-value 0.001, &lt;0.001, 0.004, 0.290, &lt;0.001, respectively. Lipid prole was compared among moderate and heavy drinkers and found increased levels of TC, TGL, LDL&amp; VLDL with p-value &lt;0.001, 0.001, 0.002 &amp; 0.001 respectively in heavy drinkers. There is a decrease in HDLcholesterol among heavy drinkers compared with moderate drinkers, p-value 0.011, which is signicant. But remains elevated compared to non-alcoholics. CONCLUSION: This study shows that alcohol intake increases lipid parameters. Moderate alcohol intake increases HDL cholesterol, whereas heavy alcohol consumption increases TC, TGL, LDL&amp; VLDLand decreases HDL.

Effectiveness of Pune shoulder rehab protocol on patients with frozen shoulder

Context: Frozen shoulder is a common condition which is seen in 2%–5% of the general population. It is a self-limiting condition which affects the range of motion of the patients in a capsular pattern. Aims: Although Pune Shoulder Rehabilitation Programme (PSRP) is being used for treating this condition still no study has been documented to find its efficacy as compared to conventional physiotherapy methods. Settings and Design: This was a quasi-experimental study and the study was done at Smt. Kashibai Navale General Hospital and Physiotherapy Outpatient Department, Pune. Institutional ethical clearance was taken on 7/8/2018 ref no. SKNCOPT/IEC/16/2018 before the commencement of this study. Subjects and Methods: Based on the study's inclusion criteria, 32 subjects were selected. The PSRP exercises were taught to each subject and given 10 repetitions with a hold of 10 s. For at least 45 min, each patient was treated. Patient's shoulder range of motion and visual analog scale were taken at the pretreatment, 2nd week, 4th week, and 6th week, respectively. Statistical Analysis Used: The data were analyzed using Primer software with a level of significance P < 0.05. Repeated measure ANOVA was used to compare the outcome measures within the group. Results: The findings showed that over the 6th-week protocol, statistically significant improvements were found in pain and shoulder range of motion. Conclusion: PSRP exercise protocol is effective in increasing the range of motion and decreasing the pain in the shoulder caused by frozen shoulder.

Analysis of changes in the expression levels of peripheral blood immunoregulatory T Lymphocytes in children with bronchial asthma accompanied by recurrent infection.

Objectives:To investigate the changes in the expression levels of peripheral blood immunoregulatory T lymphocytes in children with bronchial asthma accompanied by recurrent infection.Methods:Eighty children with bronchial asthma admitted to the Third Outpatient Department of General Hospital of Northern Theater Command from January 2017 to January 2019 were retrospectively selected and divided into two groups according to whether they had recurrent infection: the asthma group (n=49) and the recurrent infection group (n=31). Another 40 children in the same age group who had a health checkup or a surgical hospital preoperative examination were selected as the control group. Peripheral venous blood of each group was taken to measure the expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+), and regulatory T cells (Treg) and helper T lymphocytes (Th1, Th2, Th17) in CD4+ subsets were detected at the same time. Moreover, Th1/Th2 values were calculated, and the levels of interleukin-4 (IL-4), interleukin-17 (IL-17), and interleukin-21 (IL-21) were measured.Results:The expression levels of CD3+ lymphocyte subsets were similar among the recurrent infection group, the asthma group, and the control group (P>0.05), and there were statistically significant differences in CD4+, CD8+ and CD4+/CD8+ lymphocyte subsets among the three groups (P<0.05). Statistically significant differences were observed in Treg, Th1, Th2, Th17 and Th1/Th2 values among the recurrent infection group, asthma group and control group (CD3+, CD4+, CD8+, CD4+/CD8+<0.05), and the expression levels of IL-4, IL-17 and IL-21 in the three groups also showed statistically significant differences (P<0.05).Conclusion:Bronchial asthma with recurrent infection may have a close bearing on the expression level of peripheral blood immunoregulatory T lymphocytes, and indirect examination of peripheral blood T lymphocyte level in children can be used clinically to determine the incidence of the disease, which is of high clinical application value.

Prevalence of Oral Candidiasis in Asthma and COPD Patients Using Inhaled Corticosteroids in the Philippine General Hospital Department of Out-patient Services.

Oral candidiasis (OC) is a well-known local side effect of inhaled corticosteroid (ICS) therapy in patients with asthma and chronic obstructive pulmonary disease (COPD). This study aimed to determine the prevalence of OC and its association with ICS-related factors in out-patient asthma and COPD patients of the Departments of Pulmonology and Pediatric Pulmonology of the Philippine General Hospital (PGH). This is a cross-sectional study conducted from October 2019 to January 2020. Data was collected through a two-part questionnaire accomplished by doctors and patients with asthma or COPD. A total of 67 patients were included in the study. Oral candidiasis was observed in 4 (5.97%) ICS users, and the prevalence was 1.65% to 14.59% (95% CI, SE: 0.028946). This study determined the prevalence of oral candidiasis in asthma and COPD patients and its association with ICS-related factors, including the dosage, medication, device, and duration of therapy. The prevalence of OC in ICS users in PGH cannot be interpreted as high or low due to the small number of respondents, but is consistent with OC prevalence found in related literature. Increased prevalence was observed in adult females with asthma under low dose ICS therapy with Fluticasone/Salmeterol DPI for more than a year. There was no statistically significant correlation among OC prevalence, age, sex, and components of ICS-therapy including dosage, medication, device, frequency, and duration of therapy. A large-scale study is recommended for more accurate assessment of OC prevalence in the population and to determine statistically significant associations among the factors. It is also recommended to quantifiably measure patient compliance, inhalation technique and instruction, and its association to OC prevalence. Findings may be used to strengthen patient education, preventive measures, and disease management to facilitate improved compliance and effective treatment outcomes.