Record Form Research Articles

Non-alcoholic fatty liver disease among patients undergoing ultra-sonography abdomen and its associated factors in a tertiary care hospital, Kakinada

Background: Non-alcoholic fatty liver disease (NAFLD) presents a growing global health concern, characterized by the accumulation of hepatic lipids in the absence of significant alcohol consumption. Its prevalence has surged worldwide, including in India, where it has reached alarming levels. Despite its silent progression, NAFLD can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma. Objectives of the study to assess prevalence and its associated factors, which are essential for effective management and prevention strategies. Methods: An observational, analytical cross-sectional study was conducted in a tertiary care hospital in Kakinada, Andhra Pradesh, from June to July 2022. Among 100 subjects, chosen through the simple random sampling. Ethical approval was granted before conducting study. Data on demographics, lifestyle risk factors, anthropometry, and ultrasound findings were collected using a pretested and validated case record form. Statistical analysis was carried out using SPSS software, employing appropriate tests to explore associations between NAFLD and various variables. Results: Among 100 participants, the prevalence of NAFLD was found to be 41%. Significant associations were observed between NAFLD and variables such as BMI (p=0.034), waist-hip ratio (p=0.002), and history of diabetes mellitus (p=0.000). Lifestyle factors, including increased cooking oil consumption, were identified as significant risk factors. Conclusions: The study highlights the high prevalence of NAFLD among subjects undergoing ultrasound abdomen in Kakinada. Significant associations were observed with BMI, waist-hip ratio, and diabetes mellitus history. Promoting healthy behaviours is crucial for NAFLD prevention and management.

Interpreting Teaching STEM Education to Pre-service Elementary Teachers Through Online Course

Insufficient comprehension of integrated STEM learning has become one of the main difficulties for teachers in implementing STEM lessons at school due to lack of integrative STEM curriculum in teachers’ education programs. Therefore, the Elementary Teacher Education Program Universitas Pendidikan Indonesia in Purwakarta offers STEM Education for Elementary course as an optional course to support 21st-century education at the elementary school level. However, due to the continued Covid-19 pandemic, during the second semester of the academic year 2020/2021, all courses in our program were entirely carried out online. Through the descriptive analysis method, this paper details how the 16-weeks course was enacted online with a varied delivery form. Forty-two pre-service teachers enrolled in the course. Data on the course implementation were gathered in the form of video recordings of the lesson, while students’ perception of the course delivery was captured through a course evaluation questionnaire. Results imply that the course includes a theoretical and practical session with teaching simulations and engineering challenges to model STEM teaching and learning to develop pre-service teacher’s STEM pedagogical and content knowledge. In addition, course evaluation suggests that after enrolling in the course, the pre-service teacher has positive perceptions of the course delivery. Keywords: STEM education, pre-service elementary teachers, online course

Antimicrobial utilization pattern in indoor patients of obstetrics and gynecology ward of a tertiary care hospital

Background: Rational prescribing of antimicrobials is fundamentally necessary to reduce incidence of antimicrobial resistance. To evaluate the rationality of antimicrobial prescribing practices in patients admitted to obstetrics and gynecology ward of a tertiary care hospital using ICMR guidelines and to check how many drugs were prescribed from NLEMI. Methods: It was a prospective observational study. Study included newly admitted patients in obstetrics and gynecology ward receiving antimicrobial therapy. Drugs prescribed to the patients during their hospital stay were noted from case sheets in case record form. WHO core and economic indicators were used to analyze prescribing patterns. Medguideindia.com was referred for prices of drugs. Results: Average number of drugs prescribed for a patient admitted in the obstetrics and gynecology ward were 3.22 and 4.31 respectively. Percentage of drugs prescribed by their generic name were 37.11% and 39.42% in obstetrics and gynecology ward respectively. 26.85% and 34.14% of patients received drugs through parenteral route in obstetrics and gynecology wards respectively. All antimicrobials were prescribed from NLEMI. Conclusions: WHO recommends prescribing all drugs by their generic names. Average duration of antimicrobial treatment was higher than recommended average duration suggested by ICMR. ICMR recommends use of 2nd generation cephalosporins but in the present study 3rd generation cephalosporins were used. For rational use of antimicrobials and to reduce their cost it is recommended to prescribe antimicrobials by their generic names and reduce treatment duration by referring to ICMR Guidelines and NLEMI.

Development Guidelines for Executive Function (EF) Skills in Early Childhood: Needs Assessment in Nonthaburi Kindergartens

Executive function skills are crucial for children in the 21st century, serving as indicators of their readiness for learning. Children with well-developed executive function skills can effectively accomplish various tasks, solve problems using diverse strategies, and collaborate with others happily. This research aims to: 1. Identify the necessity for fostering executive function skills among early childhood students in Nonthaburi Province. 2. Analyze the causes underlying the necessity to promote executive function skills in early childhood students. 3. Propose strategies to enhance executive function skills in early childhood students. The research consists of two phases. Phase 1 involves identifying the necessity for developing executive function skills among early childhood students, with a sample group comprising 12 volunteer kindergarten teachers randomly selected from 12 classrooms and 328 early childhood students aged 5 to 5 years 11 months (162 boys and 166 girls). The research instrument used is the MU.EF-101 assessment. Data analysis involves calculating the mean and standard deviation of T-scores for working memory, inhibitory control, and shift/cognitive flexibility. Phase 2 analyzes the causes of necessity and proposes strategies to promote executive function skills in early childhood students. The data sources for this phase are 12 teachers, and the research instruments include fishbone diagram recording forms and group discussion recording forms. Findings suggest that parental involvement is crucial in training children to perform tasks independently and in teaching children patience. Additionally, teachers should analyze children's behaviors to plan appropriate learning activities based on their context. Teachers must encourage children to think and make decisions independently, encourage when mistakes occur, and ensure the availability of suitable tools and toys that promote the development of executive function skills in early childhood students, which teachers or parents can conveniently utilize.

Prospective with historical control, case-matched cohort study of the tertiary survey beneficial in critically severe trauma patients

Background The tertiary survey is an evaluation process conducted after the primary and secondary surveys. It aims to identify missed injuries. This research aims to study the benefits of tertiary surveys in severely traumatized patients. Methods This prospective with historical control, case-matched cohort was conducted on critically-ill trauma patients who were admitted to the surgical intensive care unit (SICU) of Thammasat University Hospital. The study compared the period before and after the implementation of the tertiary survey. Tertiary survey record form was used in all severely traumatized patients with Injury Severity Score (ISS) > 15 within the first 24 hours and before discharge from SICU between August 2022 and February 2023. The comparison data were retrieved from electronic medical records of patients admitted to SICU with ISS > 15 between April 2020 and July 2022. Results We identified 55 type II missed injuries in 39 of 100 cases prior to implementation and 1 type II missed injury after implementation. Type II missed injury decreased from 31% to 4%, and the missed injury detection rate was 56% after implementing the tertiary survey. However, there is no statistically significant difference in morbidity and mortality rates from missed injuries before and after implementation. Conclusions Using tertiary surveys can reduce missed injury rates and increase missed injury detection rates. This research highlights the importance of implementing tertiary surveys as a routine part of trauma evaluation to improve patient care. However, there is no effect on the outcomes, which may require more sample size. Clinical Trials Registry (reference number TCTR20230625001).

The Clinical Impact of the Pulmonary Embolism Severity Index on the Length of Hospital Stay of Patients with Pulmonary Embolism: A Randomized Controlled Trial.

The Pulmonary Embolism Severity Index (PESI) is an extensively validated prognostic score, but impact analyses of the PESI on management strategies, outcomes and health care costs are lacking. Our aim was to assess whether the adoption of the PESI for patients admitted to an internal medicine ward has the potential to safely reduce the length of hospital stay (LOS). We carried out a multicenter randomized controlled trial, enrolling consecutive adult outpatients diagnosed with acute PE and admitted to an internal medicine ward. Within 48 h after diagnosis, the treating physicians were randomized, for every patient, to calculate and report the PESI in the clinical record form on top of the standard of care (experimental arm) or to continue routine clinical practice (standard of care). The ClinicalTrials.gov identifier is NCT03002467. This study was prematurely stopped due to slow recruitment. A total of 118 patients were enrolled at six internal medicine units from 2016 to 2019. The treating physicians were randomized to the use of the PESI for 59 patients or to the standard of care for 59 patients. No difference in the median LOS was found between the experimental arm (8, IQR 6-12) and the standard-of-care arm (8, IQR 6-12) (p = 0.63). A pre-specified secondary analysis showed that the LOS was significantly shorter among the patients who were treated with DOACs (median of 8 days, IQR 5-11) compared to VKAs or heparin (median of 9 days, IQR 7-12) (p = 0.04). The formal calculation of the PESI in the patients already admitted to internal medicine units did not impact the length of hospital stay.

Towards an interdisciplinary formalization of soundscapes.

Soundscapes have been studied by researchers from various disciplines, each with different perspectives, approaches, and terminologies. Consequently, the research field determines the actual concept of a specific soundscape with the associated components and also affects the definition itself. This complicates interdisciplinary communication and comparison of results, especially when research areas are involved which are not directly focused on soundscapes. For this reason, we present a formalization that aims to be independent of the concepts from the various disciplines, with the goal of being able to capture the heterogeneous data structure in one layered model. Our model consists of time-dependent sound sources and geodata that influence the acoustic composition of a soundscape represented by our sensor function. Using a case study, we present the application of our formalization by classifying land use types. For this we analyze soundscapes in the form of recordings from different devices at 23 different locations using three-dimensional convolutional neural networks and frequency correlation matrices. In our results, we present that soundscapes can be grouped into classes, but the given land use categories do not have to correspond to them.

In-Depth Analysis of Diet Diary and Urine pH Measurements Improved Food Diet Reporting in Postmenopausal Women with RUTI.

We proceeded with an in-depth review of diet diaries for nutrient analysis from a cohort of women suffering from uncomplicated recurrent urinary tract infection (RUTI) to validate the accuracy of our current food diet record (FDR) form and evaluate possible domains of improvement. As part of an IRB-approved study, this previously published cohort of NHANES-comparable women was analyzed for consistency of the nutrient intake over 3 days, the influence of the time between meals and urine pH, the effect of nutrient intake over interval time between meals, and seasonal and before/during the COVID-19 pandemic changes. Intrarater reliability for nutrient analysis and intrapatient variability for urine pH were computed to test for consistency. Intrarater reliability for diet analysis was 91% accurate for foods and beverage matching and nutrient analysis. Mean standard deviation of urine pH readings within study participants was 0.4 (95% CI: 0.4, 0.5). An association was noted between total calories and fat consumed at breakfast and an increase in time to lunch. Calories consumed were unaffected across seasons or during the COVID-19 pandemic. Water intake during summer was significantly lower than that during fall and winter (both, p < 0.001). The patients who reported drinking water had a significantly lower average urine pH than women who did not report drinking water (5.8 vs. 6.2; p = 0.026). In this cohort of postmenopausal women with RUTIs, in-depth analysis of our current FDR findings led to several actionable items, which will improve our current food diet self-reporting process by our patients.

Conceptual framework and responding approach of treatment burden of type 2 diabetes mellitus: A video recording-based qualitative analysis

BackgroundPatients with type 2 diabetes mellitus (T2DM) frequently face a considerable treatment burden. Research on the specific treatment burden associated with T2DM is still in its early stages both in China and worldwide. ObjectiveBased on video recordings of clinical diagnostic and therapeutic scenarios, this study aims to summarize the conceptual framework of treatment burden related to T2DM among patients in China Mainland and explore proactive coping strategies of general practitioners (GPs). MethodsThe researchers conducted a retrospective qualitative analysis using video records that filmed during 2018-2019 from general practice training clinics of a standardized training base in Guangdong Province of China. This analysis was integrated with the existing conceptual framework of treatment burden, employing qualitative research methods such as observational record forms, field notes, coding extraction and thematic analysis. ResultsFrom 25 video records, 49 instances of doctor-patient communication related to the treatment burden of T2DM were selected and analyzed. All six themes from the original conceptual framework were explored. Additionally, the researchers identified two additional thematic items (medical information burden and drug-induced hypoglycemia). The finding led to the development of a modified conceptual framework for the treatment burden of T2DM, encompassing seven observable dimensions: financial burden, medication burden, medical management burden, lifestyle change burden, healthcare system burden, time/travel burden, and medical information burden. Each sub-theme's definition was expanded accordingly. The consultation process analysis indicated that trained GPs can actively respond to treatment burdens (medication burden, medical information burden, time/travel burden, lifestyle change burden) using skills such as patient education, enhanced communication, shared decision-making and motivational interviewing. ConclusionThe study constructs a modified conceptual framework for the treatment burden of T2DM. By integrating the identification of conceptual dimensions in clinical diagnosis and treatment, it explores how Chinese GPs can use doctor-patient communication skills to proactively address specific treatment burdens of T2DM patients.

IJCM_365A: A prospective study on the safety and clinical efficacy of rabies monoclonal antibodies for post exposure prophylaxis in suspected animal exposures at the anti rabies clinic of KIMS Hospital and Research Centre, Bangalore

Background: Rabies immunoglobulins will provide timely passive immunity after exposure to suspected rabid animals along with thorough wound wash and full course of anti-rabies vaccination. The products include human derived RIG (HRIG) and equine derived RIG (ERIG), both having certain constraints for usage. In contrast, monoclonal antibodies (mAbs) produced by recombinant technology, have shown superiority in availability, safety and purity. Therefore, RmAb are an alternative to RIG for passive immunity component of post exposure prophylaxis (PEP). Only two products i.e., RabiShield (single human mAb) &amp; Twinrab (cocktail of two mAbs) have been merchandised in Indian market. WHO has recommended monitoring the clinical use and outcomes of RmAb products for rabies PEP Objective: To assess the safety and clinical efficacy of presently available rabies monoclonal antibodies for post exposure prophylaxis Methodology: All the patients with category III exposure visiting the study site and consenting for the study were included. The details pertaining to socio demographic profile, details of biting animal, characteristics of bite wound, wound wash, details of active &amp; passive immunization and details of adverse events following PEP were collected using a case record form. All the study subjects were followed up for the occurrence of any delayed reactions and further upto six months to know the clinical efficacy of PEP. Results: The present study included 475 animal bite victims. Among them 41.2 % were children, 49.6% were adults and 9.01 % were elderly. The ADEs among Rabishield and TwinRab were 3.18 % &amp; 2.12 % respectively and the difference among them were not statistically significant. ADEs among all the patients receiving both RmAbs were mild and subsided without any complications. All the study subjects were healthy and alive after six months after PEP confirming clinical efficacy. Conclusion: The presently available RmAbs are safe and clinically effective in preventing rabies in suspected exposures

Developing Hots-Based Communicative Language Teaching (CLT) to Improve Students’ Speaking Skill in Foreign Language Learning

This study aims at finding the significant difference in students’ speaking skill after being taught by using HOTS-based communicative language teaching. A quantitative study in the form of a quasi-experimental design was conducted which involved 27 students from the tenth grade in SMKN 1 Pugung, Tanggamus. The data were collected through pre-test &amp; post-test. The data were collected in form of recording. The data were analyzed using paired sample test and independent sample t-test. The findings showed that 1) there was a significant improvement in students’ speaking skill after being taught by using HOTS-based communicative language teaching. The mean in the speaking pre-test is 65.52 while the post-test is 78.30, with a value of sig. (2-tailed) is 0.000 and it was lower than 0.05. 2). In conclusion, HOTS-based communicative language teaching is appropriate for improving the student’s speaking skills since the student can be more active, and creative, and comprehend the language used.

Clinical and biological landscape of constitutional mismatch-repair deficiency syndrome: an International Replication Repair Deficiency Consortium cohort study

Constitutional mismatch repair deficiency (CMMRD) syndrome is a rare and aggressive cancer predisposition syndrome. Because a scarcity of data on this condition contributes to management challenges and poor outcomes, we aimed to describe the clinical spectrum, cancer biology, and impact of genetics on patient survival in CMMRD. In this cohort study, we collected cross-sectional and longitudinal data on all patients with CMMRD, with no age limits, registered with the International Replication Repair Deficiency Consortium (IRRDC) across more than 50 countries. Clinical data were extracted from the IRRDC database, medical records, and physician-completed case record forms. The primary objective was to describe the clinical features, cancer spectrum, and biology of the condition. Secondary objectives included estimations of cancer incidence and of the impact of the specific mismatch-repair gene and genotype on cancer onset and survival, including after cancer surveillance and immunotherapy interventions. We analysed data from 201 patients (103 males, 98 females) enrolled between June 5, 2007 and Sept 9, 2022. Median age at diagnosis of CMMRD or a related cancer was 8·9 years (IQR 5·9-12·6), and median follow-up from diagnosis was 7·2 years (3·6-14·8). Endogamy among minorities and closed communities contributed to high homozygosity within countries with low consanguinity. Frequent dermatological manifestations (117 [93%] of 126 patients with complete data) led to a clinical overlap with neurofibromatosis type 1 (35 [28%] of 126). 339 cancers were reported in 194 (97%) of 201 patients. The cumulative cancer incidence by age 18 years was 90% (95% CI 80-99). Median time between cancer diagnoses for patients with more than one cancer was 1·9 years (IQR 0·8-3·9). Neoplasms developed in 15 organs and included early-onset adult cancers. CNS tumours were the most frequent (173 [51%] cancers), followed by gastrointestinal (75 [22%]), haematological (61 [18%]), and other cancer types (30 [9%]). Patients with CNS tumours had the poorest overall survival rates (39% [95% CI 30-52] at 10 years from diagnosis; log-rank p<0·0001 across four cancer types), followed by those with haematological cancers (67% [55-82]), gastrointestinal cancers (89% [81-97]), and other solid tumours (96% [88-100]). All cancers showed high mutation and microsatellite indel burdens, and pathognomonic mutational signatures. MLH1 or MSH2 variants caused earlier cancer onset than PMS2 or MSH6 variants, and inferior survival (overall survival at age 15 years 63% [95% CI 55-73] for PMS2, 49% [35-68] for MSH6, 19% [6-66] for MLH1, and 0% for MSH2; p<0·0001). Frameshift or truncating variants within the same gene caused earlier cancers and inferior outcomes compared with missense variants (p<0·0001). The greater deleterious effects of MLH1 and MSH2 variants as compared with PMS2 and MSH6 variants persisted despite overall improvements in survival after surveillance or immune checkpoint inhibitor interventions. The very high cancer burden and unique genomic landscape of CMMRD highlight the benefit of comprehensive assays in timely diagnosis and precision approaches toward surveillance and immunotherapy. These data will guide the clinical management of children and patients who survive into adulthood with CMMRD. The Canadian Institutes for Health Research, Stand Up to Cancer, Children's Oncology Group National Cancer Institute Community Oncology Research Program, Canadian Cancer Society, Brain Canada, The V Foundation for Cancer Research, BioCanRx, Harry and Agnieszka Hall, Meagan's Walk, BRAINchild Canada, The LivWise Foundation, St Baldrick Foundation, Hold'em for Life, and Garron Family Cancer Center.

Outcomes after surgery for children in Africa (ASOS-Paeds): a 14-day prospective observational cohort study

Safe anaesthesia and surgery are a public health imperative. There are few data describing outcomes for children undergoing anaesthesia and surgery in Africa. We aimed to get robust epidemiological data to describe patient care and outcomes for children undergoing anaesthesia and surgery in hospitals in Africa. This study was a 14-day, international, prospective, observational cohort study of children (aged <18 years) undergoing surgery in Africa. We recruited as many hospitals as possible across all levels of care (first, second, and third) providing surgical treatment. Each hospital recruited all eligible children for a 14-day period commencing on the date chosen by each participating hospital within the study recruitment period from Jan 15 to Dec 23, 2022. Data were collected prospectively for consecutive patients on paper case record forms. The primary outcome was in-hospital postoperative complications within 30 days of surgery and the secondary outcome was in-hospital mortality within 30 days after surgery. We also collected hospital-level data describing equipment, facilities, and protocols available. This study is registered with ClinicalTrials.gov, NCT05061407. We recruited 8625 children from 249 hospitals in 31 African countries. The mean age was 6·1 (SD 4·9) years, with 5675 (66·0%) of 8600 children being male. Most children (6110 [71·2%] of 8579 patients) were from category 1 of the American Society of Anesthesiologists Physical Status score undergoing elective surgery (5325 [61·9%] of 8604 patients). Postoperative complications occurred in 1532 (18·0%) of 8515 children, predominated by infections (971 [11·4%] of 8538 children). Deaths occurred in 199 (2·3%) of 8596 patients, 169 (84·9%) of 199 patients following emergency surgeries. Deaths following postoperative complications occurred in 166 (10·8%) of 1530 complications. Operating rooms were reported as safe for anaesthesia and surgery for neonates (121 [54·3%] of 223 hospitals), infants (147 [65·9%] of 223 hospitals), and children younger than 6 years (188 [84·3%] of 223 hospitals). Outcomes following anaesthesia and surgery for children in Africa are poor, with complication rates up to four-fold higher (18% vs 4·4-14%) and mortality rates 11-fold higher than high-income countries in a crude, unadjusted comparison (23·15 deaths vs 2·18 deaths per 1000 children). To improve surgical outcomes for children in Africa, we need health system strengthening, provision of safe environments for anaesthesia and surgery, and strategies to address the high rate of failure to rescue. Jan Pretorius Research Fund of the South African Society of Anaesthesiologists and Association of Anesthesiologists of Uganda.

ANALYSIS OF INSTALLING HISTORY SUMMARY FORM IN AND OUT OF ADULT PATIENTS IN KINDERGARTEN HOSPITAL. IV KENCANA SERANG

Background: A summary form of admission and discharge history is a medical record form that is used to record a summary of the course of the disease from the time the patient enters until the patient leaves the hospital. Therefore, it is one of the forms that are immortalized, so it is necessary to design a design that is in accordance with the standards.Research Objectives: To identify the physical aspects, anatomical aspects, and aspects of the contents of the summary form of admission and discharge history of adult patients at the Kindergarten Hospital. IV Kencana Serang in 2022. Research Methodology: This study used descriptive research with observation and interview methods. The subjects in this study were medical record officers and the object in this study was a summary form of admission and discharge history of adult patients. The research instrument used observation sheets and interview guidelines. Research results: From the physical aspect, the material is HVS 75 gram paper, rectangular shape, HVS F4 paper size, the color of the paper is white with black ink writing. From the anatomical aspect, the heading in the form of the title of the form has been included, the subtitles are missing, the name of the hospital has been included, the hospital logo is not included, the revision number is not included. page numbers are included. Introduction in the form of the title of the form. Instruction in the form of * Adult and child patients. Body in the form of top margin (5 cm), bottom margin (2 cm), side margin (1.5 cm), back margin (1.5 cm). Spacing 1.15 spaces. Vertical and horizontal rules. Type Style Times New Roman with font size 11. The way of recording is done by handwriting. Close in the form of a clear name and signature has been included. From the aspect of content, the completeness of the data items is appropriate. Terminology / Terms in the form of diagnosis, complications, anesthesia, transfusion. Abbreviations in the form of Date, Goal, NRP, NIP, Kls, dr, Sp, Lk / Pr, Is / Kk / Kp / H / B, S / N / J / D. The symbol is the symbol * Adult and child patients. Suggestion: It is necessary to redesign the entry and exit history summary form for adult patients from the physical, anatomical and content aspects.

Frailty as a Key Predictor of Malnutrition among Older Adults with Swallowing Problems

Geriatric syndrome—frailty—has a more significant influence on the health of older, pre-frail and frail older adults who tend to have a poor nutritional status or develop severe malnutrition. Investigation of frailty and its association with malnutrition and swallowing problems is limited in older Thais. This cross-sectional study examined the association among frailty and other associated factors with malnutrition in older adults with swallowing problems. A purposive sampling method was employed to recruit 120 participants who met the specified inclusion criteria. Data were obtained from older adults who visited and received medical services at the rehabilitation department of a university hospital in Bangkok, Thailand, from July 2022 to February 2023. The instruments included the Demographic and Health Information Record Form, Mini Nutritional Assessment Short-Form - MNA® Elderly, Reported Edmonton Frail Scale-Thai Version, and Modified Barthel Activities of Daily Living Index. Data were analyzed using descriptive statistics and multiple logistic regression.The findings indicated that 82.5% of participants were frail, and approximately 30% and 80.0% presented with dependence and at-risk or malnutrition, respectively. Frailty, age, comorbidities, a history of aspiration, and activities of daily living could predict malnutrition, accounting for 71.7%. Significantly, frailty demonstrated a 4.47-fold increased risk of malnutrition, while dependence on activities of daily living had a 6.41-fold increased risk of malnutrition among this population. The findings of this study provide valuable insights for healthcare professionals, especially gerontological nurse practitioners, to raise awareness of the early detection of frailty, swallowing problems, and potential risks of malnutrition, together with promoting daily activity in older adults across settings. Implementing comprehensive management to improve swallowing and physical function in older adults at risk of frailty and malnutrition may enable gerontological nurse practitioners to strengthen professional care. By doing so, maintaining nutritional health among these populations can be achieved.

Effectiveness of combination use of intralesional steroid with 5-fluorouracil in the treatment of keloid patients

Background: Keloids are a common problem with significant recurrence rates despite intralesional steroid treatment and 5-fluorouracil in combination with triamcinolone may be superior to triamcinolone alone. Objectives: To evaluate the effectiveness of the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid. Methods: The study was a descriptive cross-sectional study and was conducted at the Department of Dermatology and Venereology, Khwaja Yunus Ali Medical College (KYAMC), Enayetpur, Sirajganj, from July 2020 to June 2021. A total of 100 patients with keloid were included in this study. These patients were subjected to history, clinical examination, and investigations. In all cases, informed written consent was taken from the Participants and a separate case record form was used during data collection. Collected data were analyzed by the statistical software IBM SPSS 25. Results: This study shows that the majority (68%) of patients belonged to the age group of 21-30 years. The mean age was 26.43±7.77 years. Regarding sex, 56% were females and 44% were males with a male-female ratio of 1.3:1. 52% of patients had a duration of lesion up to 1 year, 22% of patients had 1-2 years and 26% of patients had &gt;2 years. The most common site of keloid was the chest (38%), then face (32%), upper extremity (16%), shoulder (6%), back (4%). The most common presenting symptoms were pruritis (56%), then 38% were cosmetic disfigurement, 32% were skin discoloration, 28% were pain and 18% were restriction of movement. Trauma was the commonest factor seen in 34% of the patients followed by ear piercing (22%) and infection (20%). Other causes were spontaneous (10%), acne (6%), burns (6%), and post-surgical keloid (2%). 16 had a positive family history of the keloid disease. The majority (70%) had good outcomes followed by excellent outcomes in 22% and 8% had average outcomes. It was observed that most patients (88%) did not have any adverse effects. Only 12% had adverse effects seen as skin ulceration (6%), skin atrophy (4%) and telangiectasia (2%). Conclusion: This study revealed that the combination use of intralesional steroids with 5-fluorouracil in the treatment of keloid seems to offer the balanced benefit of faster and more efficacious response with fewer adverse effects. Treatment has to be individualized and can be combined with one or more modalities to aim for better efficacy and safety. Mediscope 2024;11(1): 41-47

The presence and burden of cognitive issues: discordance between the perception of neurologists and people living with multiple sclerosis.

Cognitive impairment is a common symptom of multiple sclerosis (MS) and occurs in more than 40% of people living with MS (plwMS). No real-world study has assessed the perception of neurologists and plwMS on cognitive issues. Using data from the 2011-2019 Adelphi MS Disease Specific Programme database, this real-world, retrospective, cross-sectional multi-cohort study included people aged ≥18 years with relapsing-remitting MS and secondary progressive MS from the United States, UK and the EU. Neurologists provided data on the patient record form for plwMS, with the same plwMS invited to voluntarily complete a patient self-completion form: a questionnaire about their experiences with MS. Of 25,374 plwMS, 4817 who provided information on cognitive and mood symptoms were included in the analysis. Of the plwMS, 68% and 59% reported feeling 'mentally fatigued' and having 'difficulty concentrating', respectively. Neurologists reported only 27% of plwMS as having 'difficulty concentrating' and 15% of plwMS as having 'short-/long-term memory problems'. Neurologists reported cognitive or mood symptoms as 'not experienced' by a higher percentage of participants with relapsing-remitting MS than secondary progressive MS. Of the plwMS who experienced 'difficulty concentrating', most had a concomitant feeling of being 'mentally fatigued' (52%), followed by 'feeling anxious or tense' (49%) and 'feeling depressed' (44%). In plwMS, caregivers reported 'difficulty concentrating' (16%) as the most common cognitive issue. A clear discordance was observed between neurologists and plwMS regarding the perception of the cognitive and neuropsychiatric issues. These results underline the under-perception of cognitive and emotional affective symptoms in plwMS during neurological consultations.

Adherence to the Planetary Health Diet and Its Association with Diet Quality in the Young Adult Population of Türkiye: A Large Cross-Sectional Study.

To advance both human health and environmental sustainability, it's crucial to assess the adaptation to new dietary trends emerging in this field. This study aimed to explore the relationship between diet quality and the principles of planetary health diet in young adults studying at university. This cross-sectional study consisted of 945 young adults with a mean age of 20.1 ± 1.34 y (582 females, 363 males). A questionnaire form containing socio-demographic information (age, gender, education level), anthropometric measurements (body weight and height), and a 24 h dietary record form for three consecutive days was applied. The scores of the Planetary Health Diet Index (PHDI) and the Healthy Eating Index-2020 (HEI-2020) were calculated according to the dietary records. The mean total scores of the PHDI and HEI-2020 were 59.9 ± 14.16 and 54.2 ± 10.87, respectively. The association between the HEI-2020 score and the PHDI score was significant (p = 0.003). A one-unit increase in the unadjusted HEI-2020 score caused a 0.429 unit decrease in the PHDI score (95% CI: -0.709; -0.149). The findings underscore the imperative for targeted interventions and educational programs to enhance the PHDI and HEI-2020 scores, promoting individual well-being and environmental sustainability in the university.

Prevalence and predictors of postcholecystectomy syndrome in Nepalese patients after 1 week of laparoscopic cholecystectomy: a cross-sectional study

Postcholecystectomy syndrome (PCS) is persistent distressing symptoms which develops following a laparoscopic cholecystectomy (LC); in cases when the condition is severe, readmission may be necessary. However, research on the prevalence of PCS and potential factors associated with PCS in Nepalese patients is still limited. An observational point-prevalence, correlational predictive cross-sectional study was conducted to determine the prevalence of PCS and examine what predicting factors including preoperative anxiety, preoperative dyspepsia, smoking, alcohol consumption, and duration of preoperative symptoms are associated with PCS. A total of 127 eligible Nepalese patients who came for follow-up after 1 week of LC at outpatient department of surgery in one single university hospital, Kathmandu, Nepal, were recruited. A set of questionnaires consisting participants' information record form, Hospital Anxiety and Depression Scale (HADS), Leeds Dyspepsia Questionnaires (LDQ), Fagerstrom Test for Nicotine Dependence (FTND), and Alcohol Use Disorder Identification Test (AUDIT) was administered for data collection. The associations between influential factors and PCS were analyzed using Binary logistic regression. 43.3% of participants reported PCS after 1 week of surgery. The findings from logistic regression analysis affirmed that the patients with preoperative anxiety (OR = 6.38, 95%CI = 2.07–19.67, p < 0.01) and moderate to severe dyspepsia (OR = 4.01, 95%CI = 1.34–12.02, p < 0.05) held the likelihood to report PCS 6.38 and 4.01 times, respectively, greater than others. The implications from study results are that screening of anxiety and patients’ tailored interventions to reduce anxiety should be implemented preoperatively. An appropriate health education about persistence of PCS and self-management should be provided to those postoperative patients.

Traditional herbal medicine use doubled the risk of multi-organ dysfunction syndrome in children: A prospective cohort study.

Traditional herbal medicine (THM) is frequently used in pediatric populations in many low-income countries as a form of healthcare and has been associated with a range of adverse events, including liver toxicity, renal failure, and allergic reactions. Despite these concerns, its impact on multi-organ dysfunction syndrome (MODS) risk has not been thoroughly investigated. This study aimed to investigate the incidence and predictors of MODS in a pediatric intensive care unit (PICU) in Ethiopia, with a focus on the association between THM use and the risk of MODS. This was a single-center prospective cohort study conducted at a PICU in the university of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. The study enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS. A total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without. The Cox proportional hazards model identified renal disease (AHR = 6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR = 2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR = 1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR = 2.68 (95% CI: 1.77,4.07)) as predictors of MODS. The incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A more than twofold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.