Foundation Hospital Research Articles

Comparison of Disease Activity Indices in Patients of Rheumatoid Arthritis

Objective: To find out correlation between disease activity scores of Rheumatoid arthritis (RA), shedding light on significance of each disease activity score. Patients and methods: It is a cross sectional comparative study. The study was carried out at Rheumatology department, Fauji Foundation Hospital Rawalpindi, Pakistan over a period of six months. 240 patients (33 males, 203 females) aged [Formula: see text]18 years diagnosed as RA according to ACR 2010 criteria, were selected. We recorded demographics, details of RA, laboratory value (baseline chemistry, acute phase reactants, and RA serology), comorbidities, DAS 28 ESR, DAS 28 CRP, CDAI, SDAI and RAPID 3 of all the patients. Analysis was performed using Statistical Package for Social Sciences (SPSS) version 23. Pairwise correlation between the disease activity indices was assessed by Spearman’s log-rank analysis. Results: Median age of the study population was 53 years (range 20-87 years). Duration of RA in study population was 8 years (IQR= 4-15). Twenty-two patients (9.6%) had early RA, whereas 208 patients (90.4%) had established RA. ESR was raised in 163 (70.9%) of the RA patients. Methotrexate was the most common disease modifying drug, which was being used by 180(77.9%) patients. All the disease activity scores showed a significant correlation on bivariate spearman’s analysis. Although the strength of the correlation varied. Disease activity by DAS-28 ESR was most strongly correlated with CDAI. Disease activity assessment via RAPID-3 had the highest correlation with CDAI. There was a fair correlation of RAPID-3 with DAS-28 and a weak correlation with SDAI. Disease activity, as assessed by CDAI and SDAI had a moderate correlation with each other. Conclusion: While all disease activity indices demonstrate agreement in clinical use, CDAI and RAPID-3 offer suitable alternatives to DAS28 in resource-limited settings.

Post Banding Ulcer Haemorrhage: a Contributor to Morality in Patients with Liver Cirrhosis

Objectives: To evaluate the frequency, risk factors and mortality of post-banding bleeding in cirrhosis. Study Design: Retrospective longitudinal Study. Place and Duration of Study: Department of Medicine, Fauji Foundation Hospital, Rawalpindi Pakistan, from Feb to Jul 2021. Methodology: Esophageal variceal band ligation (EVBL) was done in 123 patients. The study cohort was divided into two groups: Group-1 without re-bleed and Group-2 with re-bleed. Blood chemistry, Child-Pugh and MELD score, including the indications of EVBL and risk factors, were also analysed. Regression analysis was performed. Results: Re-bleed occurred in 10.6% (n=13) of patients. The mean duration between ligation and re-bleed was 8.75±2.8 days. Oesophageal ulcers were the most common cause of re-bleeding (38.5%). Mortality rates among the two groups were 21.8 %( n=24) and 30.8 %( n=4), respectively. The model for end-stage liver disease score (OR 2.177, CI 1.069-4.43, p .03), APTT (OR 0.593, CI 0.397-0.887, p .01) and Sodium (OR 1.345, CI 1.07-1.69, p<0.01) were detected as the predictors of re-bleed. Conclusion: Although re-bleeding after banding occurs in a trivial number of patients, it contributes to mortality. Coagulopathy, high sodium and MELD score are major predictors.

Multiple Malignancies in Relation to Vitamin D Levels Among Women of Reproductive Age

The global burden of cancer, with deaths projected to increase from 7.6 million to 13.1 million by 2030, calls for urgent research into potential mitigating factors, such as Vitamin D levels. This study specifically addresses the correlation between Vitamin D and cancer prevalence among women of reproductive age, scrutinizing variables like age, socioeconomic background, and geographic location. Conducted at Fauji Foundation Hospital's Oncology department through detailed questionnaires, the study analyzes Vitamin D levels in newly diagnosed female cancer patients. While a significant direct association with cancer occurrence was not established, an alarming rate of Vitamin D deficiency and high obesity risk were noted. Furthermore, the study indicates an inverse relation between Vitamin D levels, sun exposure, and certain patient demographics. These findings underscore the necessity of considering environmental and lifestyle factors in cancer prevention strategies.

Termination of Pregnancy: Misoprostol Versus Prostaglandin E2

Objective: To compare the efficacy of vaginal Misoprostol and vaginal prostaglandin E2 in termination of pregnancy.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of Obstetrics & Gynecology, Fauji Foundation Hospital, Islamabad, Pakistan, from Apr to Oct 2021.
 Methodology: After taking informed consent, a total of 80 women between the age of 20-40 years were included in the study for termination of pregnancy. Molar or ectopic pregnancy, signs of septic abortion, Chronic Liver Disease, and bleeding disorders were excluded. In group A, a 200µgm tablet of Misoprostol was inserted intravaginal every 6 hours, a total of 4 doses, while in group B patients, a PGE2 3 mg tablet was inserted intravaginal, a total of 4 doses. All patients in both groups were evaluated after 24 hours, at which efficacy was noted. 
 Results: The mean age of women in Group-A was 27.18±3.81 years, and in Group-B was 27.18±4.96 years. The mean gestational age in Group-A was 11.83±3.24 weeks, and in Group-B was 12.20±3.30 weeks. In this study, efficacy (complete expulsion of the fetus within 24 hours of medication) was seen in 37 (92.50%) women in Group-A (Vaginal Misoprostol) and 29 (72.50%) women in Group-B (Vaginal prostaglandin E2) with a p-value of 0.019.
 Conclusion: This study concluded that the efficacy of vaginal Misoprostol is better in termination of pregnancy as compared to vaginal prostaglandin E2.

Efficacy of Oral Methotrexate in the treatment of Plaque Psoriasis in a local population

Background: Plaque psoriasis constitutes around 90% of psoriasis prevalent in the world. It’s medically introduced as well demarcated erythematous plaques with coarse silvery scales predominantly involving extensor surfaces of the knees, elbows, sacrum, scalp, nails and sites of injury. Methotrexate has been widely used to treat psoriasis and associated arthritis, it is mainly used to treat plaque psoriasis in patients not responding to topical therapy. Systemic therapy is required for patients who don’t respond to topical or where there is extensive disease. These include photochemotherapy, ciclosporin, biological agents.2,9 Various studies show methotrexate as an efficient drug to treat plaque psoriasis by reducing inflammation, and reducing cell proliferation by exerting its immunosuppressant effect. Objective: To determine the safety and efficacy of methotrexate in treating plaque psoriasis. Materials and Methods: The interventional descriptive single-arm pre and post-study was conducted in the department of dermatology Fauji Foundation Hospital Rawalpindi from August 2018 to January 2021. This research was approved by the ethical review committee of the hospital. One hundred forty two patients between 15 to 60 years of age suffering from plaque type psoriasis with PASI score of >8 were included in the study after taking the informed consent. Oral methotrexate in a dose of 10 mg/week was given for 8 weeks to patients from dermatology outdoor and Indoor. (PASI 6 or greater).Baseline blood counts, blood urea nitrogen, serum creatinine, electrolytes, alkaline phosphatase, alanine aminotransferase and chest Xray to rule out latent tuberculosis. They all got cured through a methotrexate dosage of 10mg that was adjusted between 5 mg to 25 mg based on individual conditions. Outcomes were measured as Psoriasis Area Severity Index PASI and Disease Activity Score DAS 28 for patients having psoriatic arthritis. Results: Of all the participants 116(81.1%) were female and 26 (18.2%) were male whereas mean age of participants was 41.6 years. The mean pretreatment and post treatment PASI score shows significant drop from baseline (13.01+6.02) to eight weeks post treatment (5.4+3.2) which is statistically significant (P=<0.05). The change in percentage of PASI from baseline was analyzed by the Wilcoxon signed ranks test after 8 weeks (t=17.29) ie PASI 75 was achieved in more than 50% of participants. There was a marked improvement in the DAS28 score of participants having Psoriatic arthritis. Regarding Psoriatic arthritis, Table 6 shows that 26 out of 29 (96.29%) patients had moderate Psoriatic arthritis with DAS 28 score of less than 5 while 1(3.7%) patient had mild and 2(7.4%) had severe joint disease of greater than 5.1 DAS 28 score before methotrexate treatment. However majority ie 17/29 (62.9%) achieved complete remission in joint disease after 8 weeks of methotrexate treatment while a small number 2/29 (7.4%) still had DAS 28 score of upto 5.1 or moderate remission while none had high score of DAS28 of greater than 5.1 after 8 weeks. Conclusion: The outcome of this study has shown that the effective way to treat plaque psoriasis is through methotrexate which is efficient in treating coexisting psoriatic arthritis which is one of the important commodities associated with plaque psoriasis

Paper waste from instructions for use brochures in cataract surgery implant packaging in Europe and the United States.

To assess the extent of paper waste generated per year by instructions for use (IFUs) brochures included in intraocular lens (IOL) packaging in Europe and the U.S. Rothschild Foundation Hospital, Paris, France; Royal Free London NHS Foundation Trust; Center for Sight, London, United Kingdom. Experimental study. A sample of IOLs were collected and each IFU was weighed. In addition, the cumulative weight of these brochures used in cataract surgeries performed annually in Europe and the U.S. was estimated, and the potential annual paper conservation that could be achieved if all manufacturers adopted electronic IFUs (e-IFUs) in Europe and the U.S. was determined. The mean and standard deviation of the weight for overall IFUs, classic IFUs, and e-IFUs were 17.6 ± 13.8 g, 23.5 ± 13.2 g, and 2.9 ± 1.9 g, respectively. The estimated cumulative weight of paper generated from the IFUs accompanying implants used in European and U.S. cataract surgeries is 153 tons. If all manufacturers transition to e-IFUs, the cumulative weight saved would be 128 tons (-84%), equivalent to 120 tons of carbon dioxide equivalent and the preservation of more than 2000 trees annually. The classic IFUs in IOL packaging result in a significant amount of paper waste annually. Therefore, there is an urgent need for a rapid transition to e-IFU technology. The adoption of e-IFUs has already been authorized in Europe and the U.S., and it is crucial to expedite this process.

Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study

Adjuvant breast radiotherapy as a standard component of breast-conserving treatment for early cancer can overtreat many women. Breast MRI is the most sensitive modality to assess local tumour burden. The aim of this study was to determine whether a combination of MRI and pathology findings can identify women with truly localised breast cancer who can safely avoid radiotherapy. PROSPECT is a prospective, multicentre, two-arm, non-randomised trial of radiotherapy omission in patients selected using preoperative MRI and postoperative tumour pathology. It is being conducted at four academic hospitals in Australia. Women aged 50 years or older with cT1N0 non-triple-negative breast cancer were eligible. Those with apparently unifocal cancer had breast-conserving surgery (BCS) and, if pT1N0 or N1mi, had radiotherapy omitted (group 1). Standard treatment including excision of MRI-detected additional cancers was offered to the others (group 2). All were recommended systemic therapy. The primary outcome was ipsilateral invasive recurrence rate (IIRR) at 5 years in group 1. Primary analysis occurred after the 100th group 1 patient reached 5 years follow-up. Quality-adjusted life-years (QALYs) and cost-effectiveness of the PROSPECT pathway were analysed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000810011). Between May 17, 2011, and May 6, 2019, 443 patients with breast cancer underwent MRI. Median age was 63·0 years. MRI detected 61 malignant occult lesions separate from the index cancer in 48 patients (11%). Of 201 group 1 patients who had BCS without radiotherapy, the IIRR at 5 years was 1·0% (upper 95% CI 5·4%). In group 1, one local recurrence occurred at 4·5 years and a second at 7·5 years. In group 2, nine patients had mastectomy (2% of total cohort), and the 5-year IIRR was 1·7% (upper 95% CI 6·1%). The only distant metastasis in the entire cohort was genetically distinct from the index cancer. The PROSPECT pathway increased QALYs by 0·019 (95% CI 0·008-0·029) and saved AU$1980 (95% CI 1396-2528) or £953 (672-1216) per patient. PROSPECT suggests that women with unifocal breast cancer on MRI and favourable pathology can safely omit radiotherapy. Breast Cancer Trials, National Breast Cancer Foundation, Cancer Council Victoria, the Royal Melbourne Hospital Foundation, and the Breast Cancer Research Foundation.

IMPLEMENTATION OF HOSPITAL INPATIENT ROOM DESIGN THAT SUPPORTS THE HEALING PROCESS

Hospitals as health facilities need to be supported in all aspects. The healing factors obtained from health services do not stand alone but must be supported by physical health facilities to make the healing process more comprehensive. Many rules must be applied in hospitals and many aspects must be taken into account when designing a hospital, so designers must understand how to design according to standard rules and also aspects of user needs because healing is carried out through the physical and psychological aspects of the patient to encourage a more effective healing process. With the various facilities in hospitals, the role of inpatient rooms is often not a priority compared to service-based health facilities such as the emergency room, operating room, ICU room, and hemodialysis room which are important priorities. Even though the healing process takes the longest time in the inpatient room. It is felt that the current arrangement of inpatient rooms does not support the healing process. Therefore, this paper aims to guide designing inpatient rooms that truly meet the behavioral needs of residents so that it is hoped to create an inpatient room that encourages healing (healing environment). The method applied is descriptive qualitative by studying it based on the theory of architectural behavior architectural psychology, namely a Healing Environment that is suitable for hospitals through analysis of behavior that produces a need for space elements. Observe the condition of the inpatient room and the expected behavior of the occupants. The results of the analysis of inpatient rooms will be in the form of guidelines for designing inpatient rooms comprehensively. How to choose colors, choose finishing materials, furniture, and other necessary elements. The author hopes that this article can be used by all parties who will design, renovate, or carry out further research regarding inpatient room design. For designers, hospital owners, and hospital management throughout Indonesia, so whatever hospital class, location, government-owned, private, or foundation can apply hospital room design well.keywords: inpatient room, Healing Environment, Interior Design

Macular oedema secondary to rhegmatogenous retinal detachment repair: risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant.

To assess the risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant (Ozurdex®) of patients with macular oedema (MO) secondary to rhegmatogenous retinal detachment repair (RRDR). This was a retrospective, consecutive cohort study conducted in patients who underwent RRDR between January 2014 and December 2020 in the Rothschild Foundation Hospital and experienced postoperative MO (POMO) with a follow-up of at least 18 months. Of the 1152 patients screened, 36 eyes (3.1%) experienced POMO. The mean follow-up duration was 45.2 months (18.0-80.5 months). Twenty-five eyes (69.4%) were resistant to first-line therapy and received at least one Ozurdex® injection (mean number: 2.7 [1-12]). The multivariate analysis showed an increased risk of resistance in patients who underwent perfluorocarbon liquid (PFCL)-assisted drainage (adjusted odds ratio: 8.65; 95% confidence interval: 1.97-15.33; p = 0.01). Significant differences in best-corrected visual acuity and central macular thickness were found between before Ozurdex® injection and the last follow-up visit: from 0.57 ± 0.47 LogMAR to 0.34 ± 0.32 LogMAR (p = 0.02) and from 483.0 ± 124.0 µm to 354.6 ± 96.5 µm (p = 0.001), respectively. The absence of serous retinal detachment and the presence of hyperreflective foci at baseline were associated with a higher resistance and a poorer response to Ozurdex®. Two patients (8%) experienced hypertony, that was well controlled with hypotonic drops. MO secondary to RRDR is challenging. Ozurdex® could be reasonably proposed as first-line treatment, at least when MO occurs following PFCL-assisted drainage, given the favourable long-term benefit/risk ratio.

Members of the genus Aeromonas are gram negative, non-spore forming, zoonotic bacteria that are widely distributed in aquatic environment. They affect both man and animals causing diseases such as gastroenteritis, peritonitis, endocarditis, pneumonia and ocular infections. The aim of this study

Members of the genus Aeromonas are gram negative, non-spore forming, zoonotic bacteria that are widely distributed in aquatic environment. They affect both man and animals causing diseases such as gastroenteritis, peritonitis, endocarditis, pneumonia and ocular infections. The aim of this study was to determine the prevalence of Aeromonas species among patients attending five hospitals in parts of plateau state. Eight hundred human stool samples were examined for the presence of Aeromonas species using the process of isolation, identification and characterization. Out of the 800 samples 65 (8.12%) were positive for Aeromonas. Among the hospitals screened, Jos University Teaching Hospital (Lamingo) has the highest prevalence of 15 (1.87%) followed by Our Lady of Apostle Hospital (Bukuru) with a prevalence of 14 (1.76%). The lowest percentage prevalence was recorded for the specimen collected from Faith Alive Foundation Hospital (Jos) 11 (1. 35%). The percentage prevalence of Aeromonas spp. among study population by gender showed that the female had a higher percentage prevalence of 37 (4.63%) of Aeromonas infection than the male with a prevalence of 28 (3.47%). The prevalence of Aeromonas species among study population by age distribution showed that the highest prevalence was among children below the ages of 1-10 years with a percentage prevalence of 22 (2.75%). There was a significantly higher (p<0.05) prevalence of the organism during the wet season (71%) than the dry season (29%). This study indicated that Aeromonas is prevalent in the study population, therefore enlightenment programs should be carried out by the Plateau state ministry of health to create awareness on the dangers of Aeromonas infections.

Abstract 13 — Comparison of Clinical and Serological Features in Juvenile and Adult-Onset Systemic Lupus Erythematosus

Background Systemic lupus erythematosus (SLE) has varying clinical and serological features in juvenile and adult-onset disease groups, depending on the ethnicity. Objectives: To compare the disease characteristics of patients with adult-onset (ASLE) and juvenile-onset systemic lupus erythematosus (JSLE). Methods It is a cross-sectional study, carried out at Rheumatology department Fauji Foundation Hospital. 184 SLE patients were included. They were divided into adult (n=152) and juvenile (n=32) group. The clinical and serological features at the time of disease onset were compared between the two groups. Statistical analysis was done using chi square and t-test. Results The mean age was 36.22 ± 11.48 in adults and 19.94 ± 7.17 in the juvenile group (t = 7.71, p<0.001). The duration of disease was 46.05 ± 45.74 months(adult) and 62.43 ± 84.00 months (juvenile). There was no significant difference in disease activity, SLE disease activity index (SLEDAI) was 13 in adult lupus patients and 14.5 in the juvenile, t-value=1.1 and p-value=0.39. Sicca symptoms were significant in the ASLE (p=0.004). Neuropsychiatric manifestations (p=0.03), thrombocytopenia (p=0.048) and low complement levels (0.02) were significantly higher in JSLE. Serological profiles did not differ significantly in the two groups. Conclusion The features of SLE differ in adult and juvenile patients. Neurological involvement and thrombocytopenia were more prevalent in JSLE, whereas sicca symptoms were more frequently found in ASLE.

Histomorphological Patterns of Focal Segmental Glomerulosclerosis and Their Clinical Correlation in Tertiary Care Hospitals in Bangladesh

Background: Being one of the commonest glomerular diseases in adults and a major etiology of the nephrotic syndrome, Focal Segmental Glomerulosclerosis (FSGS) gradually progresses towards end-stage renal disease (ESRD). According to pathogenesis, FSGS can be classified into primary or secondary ones and in both instances, histomorphological findings are nearly indistinguishable. Five histomorphological variants of primary as well as secondary focal segmental sclerosis have already been accepted, for instance, NOS (not otherwise specified), tip, cellular, perihilar, and collapsing variants. Nonetheless, primary FSGS is a diagnosis of exclusion and all the time, primary and secondary FSGS can not be distinguished discernibly. For this reason, correlation with clinical and biochemical parameters are extremely important. The present study was undertaken to identify various histomorphological patterns of FSGS by light microscopy and immunofluorescence study at tertiary care hospitals in Bangladesh as well as to correlate those patterns with clinical, biochemical parameters and additional histologic findings. Methods: This is an observational & cross sectional study which was conducted among 57 paraffin blocks of renal biopsy specimens of histologically confirmed FSGS cases including all age groups and both sexes, which were collected from department of Pathology, BSMMU & Kidney foundation hospital & research institute, Mirpur, Dhaka. Renal biopsies received for light microscopy only and biopsies that contained less than eight glomeruli were exluded from the study . Routine Haematoxylin & Eosin (H&E), Periodic Acid Schiff (PAS), Jones silver & Masson’s trichrome stains were used to evaluate renal biopsy specimens & histomorphological patterns of FSGS were identified. Data regarding clinical & biochemical parameters were collected from patient’s medical records. Statistical analyses were performed by SPSS-22. Result: In our study, it was observed that, among 57 biopsies, 35(61.4%) biopsies were diagnosed as NOS, 12(21.1%) biopsies as perihilar, 4(7.0%) biopsies as tip, 3(5.3%) biopsies as collapsing and 3(5.3%) biopsies as cellular variant. No clinical and biochemical parameters were significantly associated with these histomorphological patterns of FSGS. Regarding additional histologic features, thick walled blood vessels was significantly associated with histomorphological patterns. Conclusion: This study was conducted on only two tertiary level hospitals in Bangladesh, therefore, the result may not reflect the exact scenario of Bangladesh. It is the need of the moment to mention the histomorphological patterns of FSGS in renal histopathology reports. Moreover, logistic support is a necessity to institute nephro-pathology section in the pathology department of all the tertiary care hospitals in order to identify renal glomerular disease precisely. Sir Salimullah Med Coll J 2023; 31: 26-33

Correlation between knowledge level, side effect severity, family support, and antiretroviral therapy adherence in HIV/AIDS patients in Greater Malang, East Java, Indonesia

Human Immunodeficiency Virus (HIV) is a virus that attacks and weakens the human immune system, leading to Acquired Immune Deficiency Syndrome (AIDS) symptoms. East Java is one of the provinces in Indonesia with a high HIV prevalence. Antiretroviral therapy (ART) is a critical approach to slow down the growth rate of HIV since no medicine has been found for HIV/AIDS patients. Therefore, high adherence to ART is necessary to reduce viral replication and prevent the development of resistance. This study aimed to investigate the correlation between knowledge level, side effect severity, family support, and ART adherence in HIV/AIDS patients. This observational analytic study with a cross-sectional design was conducted in September-October 2022 at the Netral Plus Indonesia Foundation and Malang Islamic Hospital. The study included 55 HIV/AIDS patients, and the Spearman correlation test was used to analyze the data. There was no significant relationship between knowledge level, side effects, and adherence to ART treatment (p = 0.959; p = 0.719). However, family support was found to be significantly related to adherence to ART treatment (p = 0.004). The findings of this study suggest that family support is a crucial factor in the adherence to ART treatment among HIV/AIDS patients.

COVID-19 Guidelines Adherence and Vaccine Acceptability Among Pregnant Women in Niger Foundation Hospital Enugu, South-Eastern Nigeria: A Mixed Method Study

Objectives: This study aimed to determine the acceptability of coronavirus disease 2019 (COVID-19) vaccines and adherence to the preventive protocol among pregnant antenatal attendees in Niger Foundations Hospital Enugu, South-Eastern Nigeria. Materials and Methods: Using a cross-sectional descriptive survey and in-depth interviews, we conducted a mixed method study from June to December 2021. We administered a structured questionnaire to 210 pregnant women to assess their knowledge and adherence to COVID-19 guidelines and interviewed 25 individuals. Quantitative and qualitative data were analyzed using SPSS v.28 and thematic analysis, respectively. Results: The participants’ age range was 20-43 years, with a mean of 29.9 (4.8) years. Most individuals (81.9%) had a university degree, 40.5% were skilled workers, and 73.3% had parity 0-1. They identified close contact (87.1%), respiratory distress (96.2%), and handwashing with soap (96.2%) as the commonest mode of transmission, symptom, and preventive strategy of COVID-19, respectively. Older women and individuals with higher parity had lower knowledge and adherence to COVID-19 precautions. Most participants rejected the vaccines due to fear of the side effects on themselves and the fetus. Conclusions: Although there was good adherence to COVID-19 protocols among the pregnant women in this study, vaccine acceptance/uptake rate was low. Education on vaccine advantages and correction of conspiracy theories are recommended.

Dysphagia and aspiration during a Parkinson's hospitalization: a care partner's perspective and recommendations for improving standards of care.

People with Parkinson's disease have a significantly increased incidence and risk of aspiration pneumonia when compared to those without. Aspiration pneumonia associated with dysphagia (swallowing issues), which is the leading cause of death among people with Parkinson's disease, accounting for 25% of Parkinson's deaths. There is relatively limited evidence of the most effective strategies to balance the competing needs of each Parkinson's patient as providers aim to prevent, diagnose, and manage dysphagia. Exacerbated, and in part caused, by the intricacies of dysphagia and Parkinson's disease, there is still limited understanding among hospital providers and the Parkinson's community regarding the most appropriate measures to prevent and manage dysphagia in Parkinson's disease. The Parkinson's Foundation Hospital Care Recommendations identified the prevention and management of dysphagia as a care standard necessary to eliminate harm and attain higher reliability in care. This article discusses key components of dysphagia management in the hospital, provides a case example to demonstrate the challenges that people with PD and their care partners experience in the hospital related to dysphagia, and offers recommendations on how to better manage dysphagia and involve care partners in PD hospital care.

A Study of Dialysis's Impact on the Mental Health of Renal Patients in Bangladesh

The treatment options that have an impact on quality of life include dialysis. This qualitative study aims to shed light on how hemodialysis patients see their experiences with depression and other psychological issues. End-stage renal illness is a global issue that affects many people in various nations and is treated with either transplantation or hemodialysis. The purpose of this study is to evaluate how hemodialysis would affect patients' psychological states and how these individuals will change in response to hemodialysis. A cross-sectional study of 120 people were chosen, 75 of whom were men and 45 of whom were women. Between December 2022 and March 2023, it was carried out at the kidney foundation hospital and research institute in Bangladesh. Information gathering based on patient interviews conducted by our research team and the unit at the kidney foundation hospital. Themes that emerged from the analysis point to hemodialysis, propensity was depression. Additionally, the results show that the majority of them have diabetic nephropathy and are in a terrible to moderate psychological state, as seen by their inability to communicate and their lack of response to family members' and doctors' instructions. Among all the patients 15% patients have got up with hepatitis and rest of time were clear from hepatitis.

Reliability and Validity of the COPE Index among Caregivers of Hemodialysis Patients in Pakistan

Objective: To assess the reliability and validity of the COPE (Carers of Older People in Europe) index tool among the caregivers of dialysis-dependent patients in Pakistan.Study Design: Cross-sectional study.Place and Duration of Study: The study was conducted at the Dialysis Unit of Pakistan Kidney Patients Association Rawalpindi, Bahria International Hospital Rawalpindi and Fauji Foundation Hospital Rawalpindi, Pakistan, from December 2018 to January 2019. Methods: A 15-item COPE index questionnaire was administered, and data were collected from 124 caregivers of patients undergoing regular hemodialysis. A Principal Component Analysis (PCA) was performed on all items of the COPE index to retain the underlying components. Further, Cronbach's alpha was used to assess the internal consistency of the retained component structure and loadings obtained from the PCA and the entire instrument separately.Results: The PCA analysis revealed that, with the context of this study, the COPE index had good internal consistency for the negative aspects of caregiving and social support (Cronbach's alpha scores were 0.864 and 0.781, respectively). For the positive impact items, a Cronbach's alpha score of 0.655 indicated modest internal consistency. Cronbach's alpha of 0.714 for the entire 15 items indicated that the COPE index had good overall internal consistency in our study population.Conclusion: The COPE index was found to be a valid tool for use in Pakistan to assess the caregiver experience, including both positive and negative aspects of caregiving.
 How to cite this: Nasim S, Lowe NM, Moran VH, Dillon S, Zaheer S, Philp I. Reliability and Validity of the COPE Index among Caregivers of Hemodialysis Patients in Pakistan. Life and Science. 2023; 4(4): 393-400. doi: http://doi.org/10.37185/LnS.1.1.351

A Study of Dialysis's Impact on the Mental Health of Renal Patients in Bangladesh

The treatment options that have an impact on quality of life include dialysis. This qualitative study aims to shed light on how hemodialysis patients see their experiences with depression and other psychological issues. End-stage renal illness is a global issue that affects many people in various nations and is treated with either transplantation or hemodialysis. The purpose of this study is to evaluate how hemodialysis would affect patients' psychological states and how these individuals will change in response to hemodialysis. A cross-sectional study of 120 people were chosen, 75 of whom were men and 45 of whom were women. Between December 2022 and March 2023, it was carried out at the kidney foundation hospital and research institute in Bangladesh. Information gathering based on patient interviews conducted by our research team and the unit at the kidney foundation hospital. Themes that emerged from the analysis point to hemodialysis, propensity was depression. Additionally, the results show that the majority of them have diabetic nephropathy and are in a terrible to moderate psychological state, as seen by their inability to communicate and their lack of response to family members' and doctors' instructions. Among all the patients 15% patients have got up with hepatitis and rest of time were clear from hepatitis.

FREQUENCY OF SARCOPENIA IN CIRRHOTIC PATIENTS DETERMINED ON ABDOMINAL COMPUTED TOMOGRAPHY

Background: Fibrosis of the liver progresses to cirrhosis resulting in hepatocellular dysfunction. Sarcopenia is an early sign of liver malfunction. Early detection of sarcopenia may provide a chance to cure or delay deterioration of liver function. This study aimed to detect sarcopenia on abdominal computed tomography (CT). Methods: This descriptive, cross-sectional study was carried out at the Department of Diagnostic Radiology, Fauji Foundation Hospital Rawalpindi from 1st October 2022 to 31st March 2023. All patients suffering from Hepatitis B or C referred for evaluation of complications were included in the study. After informed consent and examination, at LV3 level an axial CT image in abdominal window was assessed on each scan using Radiant® software. Muscles including internal and external obliques and transversus abdominus, rector spinae, quadratus lumborum, and psoas were identified and evaluated. A threshold of -29 to -150 HU, and -29 to 150 HU for fatty tissue and skeletal muscles respectively was used. Cross-sectional area of each muscle was calculated on the vitrea and skeletal muscle index was calculated. Cut-off value for men was taken as 52.4 Cm2/m2, and for women it was 38.5 Cm2/m2. Results: A total 120 chronic liver disease patients (21 males and 99 female) were studied. All (100%) men, and 82 (83.8%) women had sarcopenia. Conclusion: Sarcopenia was a common finding with male predominance in patients suffering from Hepatitis B and/or C. CT evaluation is an effective and non-invasive tool for evaluation of sarcopenia as an indicator of liver dysfunction. Pak J Physiol 2023;19(3):20–2

Novel deep learning approach to estimate rigid gas permeable contact lens base curve for keratoconus fitting

IntroductionRigid gas permeable contact lenses (RGP) are the most efficient means of providing optimal vision in keratoconus. RGP fitting can be challenging and time-consuming for ophthalmologists and patients. Deep learning predictive models could simplify this process. ObjectiveTo develop a deep learning model to predict the base curve (R0) of rigid gas permeable contact lenses for keratoconus patients. MethodsWe conducted a retrospective study at the Rothschild Foundation Hospital between June 2012 and April 2021. We included all keratoconus patients fitted with Menicon Rose K2® lenses. The data was divided into a training set to develop the model and a test set to evaluate the model's performance. We used a U-net architecture. The raw matrix of anterior axial curvature in millimeters was extracted from Scheimpflug examinations for each patient and used as input for the model. The mean absolute error (MAE) between the prediction and the prescribed R0 was calculated. Univariate and multivariate analyses were conducted to assess the model's errors. ResultsThree hundred fifty-eight eyes from 202 patients were included: 287 eyes were included in the training dataset, and 71 were included in the testing dataset. Our model's Pearson coefficient of determination (R2) was calculated at 0.83, compared to 0.75 for the manufacturer's recommendation (mean keratometry, Km). The mean square error of our model was calculated at 0.04, compared to 0.11 for Km. The predicted R0 MAE (0.16 ± 0.13) was statistically significantly different from the Km MAE (0.23 ± 0.23) (p = 0.02). In multivariate analysis, an apex center outside the central 5 mm region was the only factor significantly increasing the prediction absolute error. ConclusionOur deep learning approach demonstrated superior precision in predicting rigid gas permeable contact lens base curves for keratoconus patients compared to the manufacturer's recommendation. This approach has the potential to be particularly beneficial in complex fitting cases and can help reduce the time spent by ophthalmologists and patients during the process.