Department Of Hospital Research Articles

A Comprehensive Systematic Review of Etiology and Risk Factors of Surgical Site Infections

Introduction: Surgical wound infections (SWIs) remain a significant risk to patients due to their high morbidity and mortality rates. Moreover, they pose substantial economic challenges for both developing and developed countries. The global impact of these infections is staggering, with the World Health Organization (WHO) reporting that millions of patients worldwide are affected by hospital-acquired infections annually, with many succumbing to these infections. This study aims to analyze the incidence of surgical site infections (SSIs) based on the type of surgical intervention, identify the most frequent causes of these infections, and explore effective management strategies. The findings of this study will provide valuable insights into the prevention and management of SSIs, thereby enlightening the medical community and empowering them to improve patient outcomes. Material and Methods: This study, conducted with meticulous attention to detail, focuses on patients operated on in our clinic from January to October 2024. It will reflect the incidence of SSI according to the type of surgical intervention, the most frequent causes of these infections, and the way of their treatment. Results: From January 2023 to June 2024, 788 patients were hospitalized, and 408 were operated on in the Surgery Department of the Clinical Hospital of Tetovo. Three hundred fifty were male, and 438 were female. The ages of the patients included in the study ranged from 21 to 81. Most of the patients were operated on because of cholecystolithiasis, inguinal, ventral, and umbilical hernias, breast cancer, acute appendicitis, and neoplasia of the colon and ileus. From the total number of operated patients (408), the infection of operative wounds was recorded in 49, representing an incidence of 11.76 %. Conclusion: The findings of this study underscore the serious global implications of SSIs, including increased morbidity and mortality rates and the strain on healthcare budgets. Therefore, the prevention and reduction of these infections should be a priority for all countries, irrespective of their economic status.

Effect of Stress Management Training Based on Multimedia Software on the Stress Response of Nurses in Children's Wards of Iran University of Medical Sciences

Background and Objectives: The use of modern and technology-based educational methods can play a significant role in enhancing nurses' capabilities in stress management and improving their responses to stressful situations. Therefore, this study aims to determine the impact of stress management on the stress responses of nurses working in pediatric departments of educational hospitals affiliated Iran University of Medical Sciences through a multimedia software intervention. Methods: In this quasi-experimental study, a random sampling method was employed to select 102 nurses (51 individuals in the intervention group and 51 in the control group) working in general hospital departments. The inclusion criteria for evaluating the effectiveness of stress management training on the stress responses of nurses included having at least a bachelor’s degree, a minimum of 6 months of work experience in pediatric wards, no reported psychological disorders, and no use of psychiatric medications based on self-reports. Additionally, participants were required to have access to a computer capable of running DVDs and familiarity with its operation, with no prior experience or readiness to participate in a stress management workshop within the last 6 months. Conversely, the exclusion criteria were participant dissatisfaction, change of department, and hospital relocation. This assessment is shared in improving the skills and response to the stress of nurses in pediatric department of medical centers. To measure the stress responses, the Inventory Response Stress questionnaire was utilized, which was completed by both groups prior to the intervention. Subsequently, the educational content regarding stress management was provided to the intervention group for duration of 8 weeks. At the end of the eighth week, both groups completed the stress response questionnaire again. Data analysis was performed using SPSS version 22 software, with statistical tests including Fisher's exact test, Mann-Whitney U test, Kruskal-Wallis H test, and Analysis of Variance (ANOVA). Results: No significant difference was observed in the mean of stress response in the intervention (29.69 ± 23.66) and control (33.20 ± 27.95) groups before the intervention (p = 0.661). The average stress response score in the intervention group (19.65 ± 16.74) was significantly lower than the control group (32.67 ± 28.17) after the intervention (p < 0.001). Conclusion: These data demonstrated the positive effect of the stress management program on nurses' stress response who participated in this study.

Laryngeal Abscess: A 34-Year Review

Abstract This study aimed to investigate the frequency, clinical-epidemiological characteristics, and management of laryngeal abscesses in our hospital setting. We included all patients treated for primary laryngeal abscesses in the Otorhinolaryngology Department of a tertiary hospital over a 34-year period. Patients with abscesses believed to have originated from adjacent regions were excluded. Thirteen patients with laryngeal abscesses were identified, with epiglottitis being the most common etiology (61%). Three patients were immunosuppressed. Four patients required urgent tracheotomy, and one underwent cricothyrotomy due to upper airway obstruction. All cases were drained under general anesthesia via a transoral route. Five patients required admission to the intensive care unit, and two experienced severe complications. There were no fatalities. Laryngeal abscesses are rare, with epiglottitis being the predominant cause. These cases pose a high risk of upper airway obstruction, highlighting the importance of early diagnosis and prompt treatment by a multidisciplinary team to prevent complications.

Care pathway for patients hospitalized with venous thromboembolism.

Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a potentially fatal disease with a multifactorial nature, impacting different medical and surgical specialties. Recently, new guidelines and direct oral anticoagulants facilitated early discharge for most DVT patients and non-severe PE patients. The aim of this study is to illustrate the distribution of VTE patients throughout the hospital and map their care pathway from Emergency Department (ED) to hospital discharge. This multicenter retrospective cross-sectional study included all hospitalized patients with a VTE code from 39 hospitals between 2018 and 2019. Data were analysed using JupyterLab, with subgroup analyses based on mode of entry, diagnosis location and thrombosis site. A total of 23,199 hospitalizations were analysed, involving 17,718 patients a median age 66 years [52-78] and man-to-women ratio 1.05. Among these, 10,747(46.3%) had PE and 4176(18.0%) had lower limb DVT. The ED was the primary entry point for 31.2% of cases, followed by gastroenterology, surgery, geriatrics, and internal medicine. Patients admitted through ED patients were most frequently transferred to internal medicine, cardiovascular and intensive care units (ICU). The median hospital stay was 9 days [4-21], with ICU stays being the longest (mean 15 days [8-27]). Notably, 1357 patients (18.8%) of VTE patients were discharged within 48 h of ED admission. This study is the first to portray the distribution and care pathways of VTE patients across hospital departments. Despite recent clinical guidelines, many patients still require inpatient management, highlighting the need for dedicated care pathway.

Injuries Among Pediatric Age Group Children Attending the Emergency Department of Maternity and Children Hospital, Buraidah City

Injuries Among Pediatric Age Group Children Attending the Emergency Department of Maternity and Children Hospital, Buraidah City

Two Cases of Maxillofacial Vascular Malformations Associated with Blue Rubber Bleb Nevus Syndrome And Literature Review

Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare systemic vascular malformation-related disorder that primarily affects the skin, gastrointestinal tract, and central nervous system. Approximately 55.9% of patients have lesions involving the oral and maxillofacial region. Due to the potential risks of gastrointestinal hemorrhage and intracerebral hemorrhage, it is crucial for dental practitioners to promptly identify and refer such cases to relevant departments to improve patient prognosis and enhance quality of life. This paper reports two cases of BRBNS associated with maxillofacial vascular malformations treated at the Oral and Maxillofacial Surgery Department of Henan Provincial People's Hospital. In conjunction with a literature review, this study discusses the clinical features, diagnosis, and treatment strategies of BRBNS, aiming to raise awareness among dental practitioners to avoid missed or incorrect diagnoses.

Association of Mobile Stroke Unit Care and Spending, Utilization, and Death in New York City.

Transport by mobile stroke units (MSUs), which provide access to computed tomography scanning and intravenous blood pressure medications and thrombolytics, reduces time to treatment and may improve short-term functional outcomes for patients with acute stroke. The longer-term clinical and financial impacts remain incompletely understood. The aim of the study was to determine whether MSU care is associated with better health, utilization, and spending outcomes for patients with suspected acute stroke. This was a retrospective, observational study of Medicare patients transported by MSUs versus traditional ambulances in New York City, from October 2016 to December 2019. The study included 167 Medicare patients with suspected acute stroke transported by MSU and 2518 propensity score-matched controls. Primary outcomes included length of stay and discharge destination at the index hospitalization, as well as risk of repeat hospitalization, number of emergency department visits, total costs of care, and death at 1 year. Of 167 patients (mean age, 79.9 years; 56.3% women) transported by an MSU for suspected acute stroke, 61.1% had an ischemic stroke/transient ischemic attack, 7.8% had an intracerebral hemorrhage, and 31.1% had a stroke mimic or other diagnosis. Compared with propensity score-matched control patients, MSU patients were significantly more likely to receive tissue-type plasminogen activator (49.9% versus 9.4%; difference, 37.5 percentage points [95% CI, 30.2-45.6]; P<0.001) but experienced similar lengths of stay (5.9 versus 6.7 days, P=0.13) and were similarly likely to be discharged to a skilled nursing facility (15.6% versus 15.1%, P=0.86). At 1 year, MSU patients had a mortality rate of 21.6%, and control patients had a mortality rate of 28.4%, although the difference did not reach statistical significance (difference, 6.8 percentage points [95% CI, -13.3 to 0.3]; P=0.058). They had similar rates of any repeat hospitalization (24% versus 23.2%, P=0.82) and emergency department visits without hospitalization (14% versus 12%, P=0.86), and there were no significant differences in total spending or specific types of spending. In this study of patients presenting with suspected acute stroke in New York City, transport by MSUs, compared with traditional ambulances, was associated with a trend toward a lower mortality rate at 1 year. Prospective trials and replication in other regions are warranted.

Outbreak of Norovirus Infection in the Hematology Department of a Children's Multidisciplinary Hospital

Relevance. Noroviruses are currently considered the most common cause of sporadic cases and community-acquired outbreaks of acute gastroenteritis (AGE) worldwide [1]. However, outbreaks of healthcare-associated infections (HAI) are also often caused by norovirus etiology [2], including in the Russian Federation [3].Aim. Analysis of key aspects of prevention and anti-epidemic measures against norovirus infection (NVI) in the hematology department.Materials and methods. The following epidemiological research methods were used: descriptive (intensity, dynamics, spatial characteristics of the NVI outbreak); analytical – longitudinal cohort study of the epidemic process of HAI – assessment of hypotheses about the causes and conditions, risk factors and routes of transmission of norovirus among patients and caregivers in the oncohematology department of the children's multidisciplinary hospital.Results and discussion. An outbreak of acute norovirus gastroenteritis of an imported nature was identified in the oncohematology department of a children's multidisciplinary hospital in February 2023, an analysis of the spread of NVI was carried out: the presumed source and mechanism of transmission of norovirus infection was established; the chronology of the spread of norovirus among patients and their caregivers is shown, a list of anti-epidemic measures taken to stop the outbreak is presented, and the difficulties of verifying the epidemiological diagnosis of HAI are reflected (based on the efficiency of laboratory testing of material from patients).Conclusion. Based on the results of the activities carried out, recommendations were proposed for improving preventive and anti-epidemic measures for acute gastroenteritis (AGE) in children's oncohematology departments.

Clinical characteristics and prognostic analysis of patients with hydrocephalus after hypertensive cerebral haemorrhage: a retrospective case-control study.

To investigate the clinical characteristics of patients with hydrocephalus after hypertensive cerebral haemorrhage (HICH) and to analyse the relevant factors affecting the prognosis. A total of 500 patients with HICH admitted to the neurosurgery department of The First Hospital of Hebei Medical University between January 2020 and July 2024 were retrospectively analysed. The clinical data of the patients were collected, the occurrence of hydrocephalus within 3 months after discharge was followed up, and the patients were divided into the occurrence group and the non-occurrence group. Logistic regression analysis was applied to identify risk factors for hydrocephalus, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of these factors. Among 500 patients, 45 (9%) developed hydrocephalus, with an average age of 59.93 ± 14.20 years in the occurrence group and 61.76 ± 12.28 years in the non-occurrence group. Logistics univariate analysis showed that the brain haemorrhage location, cerebral hernia, haematoma volume and the Glasgow Coma Scale (GCS) score were the influencing factors for hydrocephalus after HICH (P < 0.05). The results of logistics multivariate analysis showed that cerebral hernia (odds ratio [OR] = 3.102, 95% CI: 1.315-7.204) and the GCS score (OR = 1.732. 95% CI: 1.102-2.401) were risk factors for the development of hydrocephalus after HICH (P < 0.05). The ROC curve analysis showed an area under the curve of 0.639 for cerebral hernia, 0.713 for the GCS score and 0.794 for their combination in predicting hydrocephalus. Cerebral hernia and the GCS score are independent influencing factors of hydrocephalus after HICH, and the combination of the two can better predict the formation of hydrocephalus.

Outcomes and associated factors of cervical human papillomavirus infection among 608 women in Shenzhen, China, 2018–2023

ObjectiveThis study aimed to uncover the patterns of Human papillomavirus (HPV) infection outcomes in women and assess the risk factors that may affect these outcomes.MethodsA retrospective study was conducted on 608 women who tested positive for HPV-DNA during their initial visit to the outpatient department of Shenzhen Longgang Central Hospital from 2018 to 2023 and who had subsequent HPV-DNA testing as part of their post-visit monitoring. The monitoring intervals were every 6 months. The rank sum test was used to analyze ranked data. The Kaplan–Meier method was used to analyze the turning negative time. Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using the Cox model to analyze independent risk factors.ResultsThe results showed that the median age was 40.00 years (interquartile 33.00–47.00 years), the total conversion rate of the HPV-negative patients was 38.98%, and the median conversion time of the HPV-negative patients was 8.95 months (interquartile 4.20–16.175 months). Age, infection status and type of health insurance were significantly correlated with HPV outcome (p &amp;lt; 0.05).ConclusionAmong women infected with HPV, the overall rate of negative HPV infection was 38.93%, and the duration of negative conversion was 8.95 months. The study revealed that age, HPV infection status, and type of medical insurance are independent predictors of the persistence of negative HPV test outcomes.

Enhancing chronic care pathways with Health Lean Management: a case study in a Spanish hospital

PurposeFacing the burden of chronic diseases has become a priority for health-care systems’ economic and social sustainability. To this end, this paper aims to focus on adopting Health Lean Management (HLM), a widely used managerial approach, to improve the performance and quality of care provided in chronic care pathways. HLM addresses not only efficiency and timeliness issues but also care effectiveness and integration. Indeed, the lack of continuity and co-ordination of care constitutes a major challenge for chronic pathways. This research provides an innovative contribution, by extending the implementation of HLM to chronic pathways developed across hospital and territorial care. Indeed, HLM scope typically regards hospital units and departments; hence, analysing the interaction between different levels of care represents a novelty from an academic and practical perspective.Design/methodology/approachWith the aim of understanding how to extend the adoption of HLM towards the territory, an action research project has been developed. In particular, an improvement project focused on breast cancer care pathways has been launched in a Spanish hospital. The research investigates which HLM activities, tools and practices need to be accomplished in this kind of project, grasping insights into emerging wastes. To this end, the HLM project followed the Define, Measure, Analyse, Improve and Control (DMAIC) cycle, supporting the project team in effectively conducting a preliminary context analysis, qualitative and quantitative data collection, the current state analysis and the countermeasure proposals.FindingsThe analysis conducted on the breast cancer care pathway highlighted major criticalities in managing the diagnosis of new patients. In particular, waiting times to obtain diagnostic imaging and breast specialist consultations highly impacted the care pathway effectiveness and efficiency. Specific wastes that caused these delays have been investigated, leading to the definition of specific countermeasures that could minimise the inefficiencies: an 85% reduction of the staging process lead time was estimated.Originality/valueThe achieved results contribute to enhancing the quality of care delivered to breast cancer patients. This paper enriches the theoretical knowledge about HLM, extending its typical field of application; provides practical support to health-care providers, managers and leaders with a case demonstrating how to develop HLM projects adopting the DMAIC cycle; and finally, it has valuable social implications, addressing the global threat of chronic disease.

The Effect of an Individualized Informational Intervention on the Quality of Life, Adherence and Psychosocial Economic Status of Patients with COPD: A Research Protocol

Introduction: Chronic obstructive pulmonary disease (COPD) has a diverse negative impact on patients, affecting them both physically and mentally. Psychosocial factors such as anxiety, depression, social isolation, and financial stress have been found to be positively associated with more exacerbations, hospital readmissions, poor adherence to medication, and lower quality of life among patients with COPD. However, healthcare professionals, who have a crucial role in diagnosing and managing COPD, often overlook these psychosocial factors of the disease, despite growing evidence suggesting their crucial role in improving disease outcomes. Consequently, this study will evaluate the effectiveness of a personalized individualized informational intervention on the quality of life, adherence, and psychosocial economic status of patients with COPD in healthcare settings of Greece. Methods: A prospective, mixed-methods design will be used, incorporating both quantitative data through questionnaires, including the Short Form (SF-12), Clinical COPD Questionnaire (CCQ), Test of Adherence to Inhalers (TAI), Patient Health Questionnaire (PHQ-4), Multidimensional Scale of Perceived Social Support (MSPSS), and Financial Ability Scale (FAS), alongside qualitative data with questions exploring themes such as general health perception, treatment adherence, mental status, socioeconomic status, and disease management. Participants will consist of patients receiving care at primary healthcare facilities and respiratory hospital departments in Crete, Greece. The intervention will involve providing structured information on social, financial, and psychological support services, along with psychosocial counseling over a six-month period. The impact of the intervention will be measured using validated tools to assess health status, quality of life, treatment adherence, mental health, and socioeconomic status before and after the intervention. Conversely, qualitative interviews will be conducted to gain deeper insights into the impact of the intervention. Finally, when the analyses of both data types are finalized, they will be triangulated to achieve convergence. This procedure entails the creation of a figure or illustration that demonstrates the convergence or divergence of both data types. Conclusions: The findings of this study are expected to highlight the importance of integrating an individualized informational intervention into the management of COPD. Thus, this study could guide healthcare professionals and policymakers in improving COPD care and patient outcomes.

Genome-Wide DNA Methylation Confirms Oral Squamous Cell Carcinomas in Proliferative Verrucous Leukoplakia as a Distinct Oral Cancer Subtype: A Case–Control Study

Background/Objectives: Oral cancers in patients with proliferative verrucous leukoplakia (PVL-OSCC) exhibit different clinical and prognostic outcomes from those seen in conventional oral squamous cell carcinomas (cOSSCs). The aim of the present study is to compare the genome-wide DNA methylation signatures in fresh frozen tissues between oral squamous cell carcinomas in patients with PVL and cOSCC using the Illumina Infinium MethylationEPIC BeadChip. Methods: This case–control study was carried out at the Stomatology and Maxillofacial Surgery Department of the General University Hospital of Valencia. For the epigenomic study, unsupervised exploratory bioinformatic analyses were performed using principal component and heatmap analysis. Supervised differential methylation analyses were conducted using a rank-based regression model and a penalized logistic regression model to identify potential prognostic biomarkers. Results: The unsupervised analyses of the global methylation profiles did not allow us to differentiate between the distinct oral cancer groups. However, the two supervised analyses confirmed the existence of two oral carcinoma phenotypes. We identified 21 differentially methylated CpGs corresponding to 14 genes. Among them, three CpGs had not been previously assigned to any known gene, and the remaining were associated with genes unrelated to oral cancer. The AGL, WRB, and ARL15 genes were identified as potential prognostic biomarkers. Conclusions: This study emphasizes the significant role of epigenetic dysregulation in OSCC, particularly in cases preceded by PVL. We have provided data on differential methylation genes that could be involved in the molecular carcinogenesis of PVL-OSCC.

Leukopenia and thrombocytopenia in dengue patients presenting in the emergency department of a tertiary center in Nepal: a cross-sectional study

IntroductionDengue viruses cause either symptomatic infections or asymptomatic seroconversion. Symptomatic dengue has a wide clinical spectrum ranging from self-limiting infection to severe manifestations, mostly characterized by plasma leakage with or without hemorrhage. World Health Organization classification in 2009 classified dengue into dengue without warning signs, dengue with warning signs, and severe dengue. This study aimed to determine patient characteristics and hematological parameters (leukopenia, and thrombocytopenia) in patients with dengue infection in the emergency department of a tertiary center.MethodsA cross-sectional study was conducted among 252 patients with dengue confirmed by serological testing against dengue-specific nonstructural protein 1 (NS1) antigen and immunoglobulin M (IgM) by enzyme-linked immunosorbent assay from September to November 2022 who presented in the emergency department of a tertiary hospital in Nepal after ethical approval was obtained. Dengue was categorized according to the World Health Organization 2009 classification. Hematological parameters were recorded by reviewing patients’ laboratory records. Data analysis was done using descriptive statistical parameters and a chi-square test.ResultsDengue without warning signs was present in 166 (65.87%) patients, while dengue with warning signs and severe dengue was present in 68 (26.89%) and 18 (7.14%) patients, respectively. Leukopenia (< 4000 cells/mm3) was present among 163 (64.68%) patients. The lowest recorded leukocyte count was 1440. Similarly, thrombocytopenia (< 150000 cells/mm3) was present among 102 patients (40.48%). The lowest recorded platelet count was 26,000 cells/mm3. A significant association was found between the severity of dengue infection and leukopenia (χ2 13.268, p-value 0.001) and thrombocytopenia (χ2 43.924, p value < 0.001).ConclusionsMonitoring of warning signs and clinical parameters is important for identifying the progression of dengue infection to the critical phase. Leukopenia and thrombocytopenia are present among many dengue-infected patients presenting in the emergency department. The severity of the disease will usually only be apparent around defervescence, which often coincides with the onset of the critical phase. Leukopenia and thrombocytopenia could indicate progression to severe disease during emergency department admission.

Pattern of skin diseases in patients attending pediatric outdoor patient of a Tertiary Care Hospital of Bahawalpur, Pakistan.

Objective: To determine the pattern of skin diseases among patients visiting the Pediatric outpatient department of tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Outpatient, Combined Military Hospital, Bahawalpur, Pakistan. Period: August 2023 to February 2024. Methods: Children up to age of 12 years, attending the outpatient department for skin disorders were included in the study. Consultants with Postgraduate qualifications in Pediatrics made the diagnosis &amp; consultations from Dermatology department were also obtained. Results: A total of 300 patients were included in the study, consisting of 60% males and 40% females, with a mean age of 2.29 years (± 1.19 years). The age group distribution indicated that 34% of participants (n=102) were under 1 year of age, while 27.3% (n=82) were between the ages of 6 to 10 years. Infectious diseases and infestations were the most prevalent skin conditions, affecting 66.36% of participants. This was followed by eczema (n=46,15.33%), hypersensitivity (n=22,7.33%), and disorders of sweat and sebaceous glands (n=23,7.66). Among the infections, bacterial infections were the most common (23%), followed by fungal infections (18.33%) and viral infections (6.3%). Conclusion: Infections and infestations together constituted 66.36% of the cases. Bacterial infections, along with scabies and fungal infections were the most common disorders observed followed by eczematous disorders. Education regarding good hygiene and proper care can eventually help.

Endoscopic Sphenopalatine Artery Cauterization Under Local Anesthesia for Posterior Epistaxis: A Prospective Cohort Study of its Tolerability and Efficacy.

To assess the tolerability and efficacy of endoscopic sphenopalatine artery cauterization (ESPAC) under local anesthesia (LA) in managing posterior epistaxis. It was a prospective, cohort study, conducted in the Otorhinolaryngology Department of a tertiary-level hospital. Patients aged 18 years or above with posterior epistaxis who underwent ESPAC under LA were included. The tolerability of the procedure was reflected by the intraoperative pain measured using an 11-point numerical rating scale while the rebleed rate up to three months postoperatively denoted its efficacy. A total of 35 patients, 23 males and 12 females, aged 31 to 86 years (mean 57.42 ± 12.94) were included. Five out of 35 (14.2%) patients needed additional procedures besides ESPAC; 82.8% (29/35) had pterygopalatine fossa (PPF) block before ESPAC. The numerical rating scale reflecting the intraoperative pain ranged from 1 to 7 with a mean of 3.6 (± 1.7). The mean score was slightly higher in females than in males. Similarly, those who did not receive PPF block had a higher mean score than those who received it; however, the differences were not statistically significant. Meanwhile, the mean score was the same (3.6) irrespective of any additional procedure besides ESPAC. Amongst the 30 patients who completed the three-month follow-up, two patients rebled, so the overall success rate amounted to 93.3% in three months. Based on the outcome of this study, ESPAC under LA for posterior epistaxis is well tolerated and is as efficacious as under general anesthesia.

AYURVEDIC APPROACH IN THE MANAGEMENT OF STYE: A CASE REPORT

Stye is an infection of the sebaceous glands of Zeis located at the base of the eyelashes or the apocrine glands of Moll. Stye can be correlated to Anjananamika in Ayurveda. Signs and symptoms such as a boil with a red (Tamra varna) appearance and burning and pricking sensations around the eyelid (Vartma pradesha) will be present. Additionally, the condition is marked by mild pain with a soft, swollen eyelid (Mridvimandaruja). The treatment in Ayurveda involves various therapies like Swedana (hot compress), Nishpidana (applying pressure to drain pus), Bhedana (incision), Pratisarana (rubbing medicaments on the eyelids) and Anjana (collyrium). The main objective of this study is to assess the efficacy of Bidalaka (local application) and Ashchyotana (eye drops) along with oral medicines in treating the disease Anjananamika. A 26-year-old female patient presented at the Shalakya Tantra outpatient department of Jeevan Jyoti Ayurveda Medical College and Hospital, Aligarh, with complaints of multiple swelling in the right eyelid for eight days, pain and redness. Upon examination, the right eyelid showed oedema along the entire edge, with an abscess at the apanga desha (outer canthus). Based on these clinical signs and symptoms, the patient was diagnosed with Anjananamika and treated with Kriyakalpas tailored to the roga Bala-condition's severity. After a week of treatment, the symptoms entirely resolved, emphasising the effectiveness of the Ayurvedic approach in managing Anjananamika.

Development and validation of a metabolic syndrome and its components to predict the efficacy of neoadjuvant chemotherapy in breast cancer: An observational, single-center, cohort study.

To assess whether metabolic syndrome can be used as a reference index to evaluate the efficacy of neoadjuvant chemotherapy treatment for breast cancer (BC). Seventy cases of female BC patients who received neoadjuvant chemotherapy treatment and surgical treatment at the Glandular Surgery Department of Hebei Provincial People's Hospital from January 2021 to December 2023 were retrospectively collected, and clinical data such as puncture pathology were recorded. The clinical data were analyzed by 1-way analysis using the χ2 test, and further multifactorial logistic regression analysis was performed for statistically significant differences. The independent risk factor metabolic syndrome (MetS) and its components were plotted in the receiver operating characteristic curve (ROC) curve and baseline graph by R Studio 4.41 software, and the meaningful components were plotted in the column graph by lasso regression analysis for internal validation, and the quality of the model was evaluated by the ROC curve and calibration graph, and then the clinical decision curve analysis was used to evaluate the clinical effectiveness of the model. The neoadjuvant efficacy was statistically associated with whether the patient was first diagnosed between 45 and 55 years of age, estrogen receptors (ER), progesterone receptors (PR) expression status, Her-2 expression status, and whether the patient had MetS, as determined by univariate analysis through χ2 (P < .05). On multifactorial binary logistic regression analysis, ER, PR status, Her-2 status, and the presence of MetS were statistically significant (P < .05) for the efficacy of neoadjuvant chemotherapy. Patients with MetS were less likely to achieve complete pathological remission than those without MetS. MetS and its components were analyzed by lasso regression analysis with RStudio 4.41 software to conclude that hypertension, hyperglycemia, and high-density lipoprotein were all correlates affecting the pathologic complete response (pCR), and a column-line graph was plotted, with a C-index of 0.76, indicating a good predictive efficacy. ER, PR status, Her-2 status and the presence of MetS are independent predictors for assessing the efficacy of neoadjuvant chemotherapy in BC, and MetS can be used as a predictor of the efficacy of neoadjuvant chemotherapy. Clinical references are provided.

Risk Estimation of Carcinogenic and Noncarcinogenic Diseases from Radiation for Medical X-ray Workers.

The objective of this paper is to construct a follow-up cohort of medical x-ray workers and analyze the risk estimates of radiation-induced carcinogenic and noncarcinogenic diseases induced by chronic low-dose ionizing radiation exposure in the follow-up cohort. A fixed cohort study was used. A total of 159 medical x-ray workers working in radiology departments of hospitals in Gansu Province from 1950 to 1980 were selected as the radiology group, and 149 medical workers in internal medicine, surgery, and other departments who had not engaged in radiology work at the same hospital were selected as the control group. A fifth follow-up survey was also conducted. Information on personal radiation exposure history, lifestyle and morbidity was collected for 310 medical x-ray workers and the control group. Malignant tumors and noncancerous diseases (cataracts, diabetes, aplastic anemia, hypertension, coronary heart disease, cerebral apoplexy, etc.) were used as endpoints to analyze the risk estimates of carcinogenic and noncancerous diseases caused by low-dose radiation. There were 14 patients with malignant tumors, 8 in the radiation group and 6 in the control group (RR=1.25); 11 cases of cataract, radiation group, 8 cases, control group, 3 cases, RR:2.50; 18 patients with diabetes mellitus, 12 in the radiation group and 6 in the control group (RR = 1.87); 25 hypertensive patients, 17 in the radiation group and 8 in the control group (RR = 1.99); 23 patients with CHD, 12 in the radiation group and 11 in the control group (RR = 1.02); and 15 cerebral apoplexy patients, 5 in the radiation group and 10 in the control group (RR=0.47).Compared with the control group, the differences were statistically significant (P<0.01). The risk factors for CR and noncarcinogenic diseases associated with low-dose radiation were cataracts (RR: 2.50) > hypertension (RR: 1.99) > diabetes (RR: 1.87) > malignancy (RR: 1.25) > CHD (RR: 1.02) > cerebral apoplexy (RR: 1.02). 0.47. Compared with those in the control group, medical x-ray workers had an increased risk of developing malignant tumors and cataracts, which may be related to occupational exposure to chronic low-dose ionizing radiation. Therefore, radiation workers should pay attention to the optimization of protection in radiation work practice. The incidences of hypertension and diabetes are increased, and the incidences of CHD are basically the same; in particular, the incidence of cerebral apoplexy is significantly reduced, indicating that cerebral apoplexy has a certain protective effect on medical x-ray workers.

Surgical audit of Neurosurgery Patients Admitted to a Tertiary Care Hospital in Terms of Record and Documentation

Objectives The aim of performing this audit is to observe and analyze record keeping and documentation of all the patients admitted to neurosurgery department in a tertiary care hospital in Peshawar Khyber Pakhtunkhwa Pakistan. Materials and Methods The audit cycle was conducted in a retrospective manner and data pertaining to all the admitted patients in neurosurgical department was collected from January 2018 to December 2022. A total of 1305 patients were enrolled in this audit admitted through OPD and emergency. The variables that were included in the audit cycle are the following: Name, age, gender, date of admission, medical record number (MR number), disease and the treatment given. Data was collected in a pre-designed proforma, added to Microsoft excel sheet and analyzed through SPSS software version 23.0. The data was described in the form of description, charts and tables. Results Out of 1305 patients enrolled in the study, we noticed that 1244 patient's (95%) names, 1079 (82.7%) hospital registration numbers, 1208 (99.5%) dates of admissions/discharges, 1252 (96%) genders and 99% of the diseases and procedures done were properly recorded. No record was available related to the address, contact numbers and occupations of the patients. Conclusion Despite having a few deficiencies, it is safe to conclude that most of the data pertaining to neurosurgery patients was properly recorded and kept in follow-up as shown by the results. We call attention to conducting audits on a regular basis that will further cover up the loopholes in data alimentation and improve our catalogue even further.