Hospital Outpatient Departments Research Articles

Complications of Ambulatory Procedures: Prevalence and Hospital Outpatient Department Variation.

Ambulatory procedures performed electively in hospital outpatient departments are of increasing complexity and constitute a growing share of total procedure volume. Despite their importance, little is known of the prevalence of complications from routine procedures once patients are discharged. This study utilizes a 100% Medicare Fee-for-Service claims data file for the years 2019-2022 to assess the relative frequency of hospital-based ambulatory procedures and 30-day patient postprocedure emergency room and hospitalization complication rates utilizing the Ambulatory Potentially Preventable Complication (AM-PPC) classification method. AM-PPC is a claims-based method designed to calculate comparative provider rates of complication exclusively for elective ambulatory procedures excluding procedures performed in hospital emergency departments. The authors calculated the mean rate of ambulatory complications by procedure across hospitals and then compared them for variation in hospital-specific procedure complication rates to the mean rate. About 2.1% of patients receiving a procedure performed in a hospital outpatient department had an emergency room or inpatient hospitalization visit within 30 days. Complication event rates varied widely across hospital outpatient departments and within specific procedures. Hip arthroplasty complication rates varied from 0.0% to 7.6% while those for upper genitourinary procedures varied from 1.7% to 14.2%. In conclusion, the complication rate for ambulatory procedures is seen to vary substantially across hospital outpatient departments for well-established, routine procedures. This study provides a baseline of complication rates for ambulatory procedures, which will be essential for future efforts to improve patient safety.

Differences in Negotiated Facility Fees for Otolaryngology Procedures at Ambulatory Surgery Centers and Hospitals.

While outpatient otolaryngology procedures have been increasingly performed at ambulatory surgery centers (ASCs), the cost differences compared to hospital outpatient departments (HOPDs) remain unclear. Utilizing newly available data collected from Turquoise Health's Rate Sense as required under the Transparency in Coverage rule, we assess, in this cross-sectional analysis, the differences in negotiated facility fees between ASCs and HOPDs for 20 common otolaryngologic procedures. Analyzing data from 4613 ASCs and 2382 hospitals, we found significantly higher facility fees at HOPDs, with a median relative price difference of +146% (P < .0001). This may be explained by greater infrastructure costs and market power differences between facilities. Our findings suggest that further shifting outpatient otolaryngology procedures toward ASCs could yield substantial cost reductions across health care systems. Additional research is needed to ensure safe and cost-effective patient selection for ASCs.

Mobile Phone Usage and Willingness to Use Mobile Phones to Support Medication Adherence and Receive Text Message Appointment Reminders in Older Outpatients With Type 2 Diabetes.

Information technology can be used to improve the management of non-communicable diseases, such as diabetes. This study aims to evaluate the willingness of older outpatients with type 2 diabetes to use mobile phones to support medication adherence and receive text message appointment reminders and investigated the factors associated with this willingness. This study was a cross-sectional study conducted at the outpatient department of Dong Da General Hospital. Participants aged 60 and over managed and treated for type 2 diabetes were asked about mobile phone usage. Data were also collected on sociodemographic information, diabetes characteristics, and medical history. In the 584 study participants recruited, the mean age was 73.2 (SD: 8.3) years. Approximately 80% patients with diabetes had medium or high treatment adherence and 52.4% had hemoglobin A1c (HbAlc) < 7.5%. In the multilevel logistic regression analysis, the following factors were significantly associated with willingness to using phones to support medication adherence: college, university, or higher level (odds ratio [OR] = 2.35, 95% confidence interval [CI] = 1.10, 4.99), current smoking (OR = 5.40, 95% CI = 1.01, 28.94), whether they had a mobile phone and type of phone (basic phone: OR = 2.47, 95% CI = 1.42, 4.30; smartphone: OR = 17.93, 95% CI = 8.81, 36.47) . The following factors were significantly associated with willingness to receive these appointment reminders via mobile phone: whether they had a mobile phone and type of phone (basic phone: OR = 2.79, 95% CI = 1.70, 4.59; smartphone: OR = 9.61, 95% CI = 4.61, 19.99) and HbA1c < 7.5 (OR = 0.65, 95% CI = 0.43, 0.99). Our study would suggest that there is potential value in using mobile phone to improve the management of diabetes in community living older people but this alone cannot be relied upon.

Validity and Reliability of the Korean Version of Gotland Male Depression Scale.

Despite lower depression rates in men than in women, men's suicide rates are significantly higher, suggesting potential gaps in depression screening. Rutz et al. developed the Gotland Male Depression Scale (GMDS), which includes symptoms commonly associated with male depression. This study was conducted to validate the Korean version of the GMDS (K-GMDS). The K-GMDS, Patient Health Questionnaire-9 (PHQ-9), and outpatient records of 233 new patients at the outpatient psychiatry department of Catholic University Hospital in Daegu from February and May 2022 were retrospectively reviewed. Internal consistency was measured using Cronbach's α, and external validity was tested by analyzing the scale's correlation with the PHQ-9. The screening capacity of the K-GMDS was tested based on the receiver operating characteristic (ROC) curve, sensitivity, specificity, and overall accuracy. Of 233 patients, 42.6% (n=98) were classified to the depression group. Cronbach's α was 0.92, and external validity was established with a Pearson's correlation coefficient of 0.83 between the total score of the K-GMDS and the PHQ-9. While there were no significant differences in the area under the ROC curve between the K-GMDS and the PHQ-9, the K-GMDS had better sensitivity, specificity, and overall accuracy in screening depressive symptoms among men compared to the PHQ-9. The K-GMDS exhibits satisfactory reliability and validity in psychiatric outpatient settings and outperforms the PHQ-9 in screening for depression among men. This study will be useful in developing male depression scales that are currently unavailable in South Korea.

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

This study aimed to uncover the patterns of Human papillomavirus (HPV) infection outcomes in women and assess the risk factors that may affect these outcomes. A 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. The 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 < 0.05). Among 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.

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.

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.

Sexual and reproductive health needs of women with severe mental illness in low- and middle-income countries: A scoping review.

This scoping review aimed to understand the extent and type of evidence in relation to sexual and reproductive health needs of women with severe mental illness (SMI) in low- and middle-income countries (LMIC) and to summarise those needs. Inclusion criteria were 1) focus on sexual and reproductive health needs 2) women or girls with SMI, professionals, caregivers of women with SMI and community members 3) study set in a LMIC 4) peer reviewed literature (no restriction on study date or design). Studies were identified from comprehensive searches of Medline, EMBASE, CINAHL and PsycINFO (to July 2023). The review included 100 papers. Most studies were cross-sectional and set in hospital outpatient departments. Only 20 of 140 LMIC countries were included in this review and only 15 studies were set-in low-income countries (LIC). Included studies often had multiple focus areas and were grouped by frequency of topic into categories of HIV (prevalence, risk behaviour and knowledge), other sexually transmitted infections (STIs), sexual function, contraception use and family planning, sexual violence, fertility, pregnancy and postpartum. Included studies indicated women with SMI have worse outcomes and worse sexual and reproductive health compared to both women without SMI and men with SMI. Women with SMI were shown to have higher rates of HIV and low levels of contraception knowledge and use, with little advice offered by professionals. This review highlights the need for a greater diversity of study methodology, robustness of ethical and consensual reporting when researching vulnerable populations and for further research on interventions and models of care aimed at addressing stigma, discrimination and improving the sexual and reproductive health of women with SMI. Future research should better represent the breadth of LMIC, investigate cultural adaptability of interventions and consider sexual health needs across the life course.

Emergence of Extended spectrum β-lactamase (ESBL) and carbapenemase producing Escherichia coli (E. coli) in mid-stream urine cultures of patients presenting in outpatient department of tertiary care hospital with uncomplicated cystitis (2016-2022): A retrospective analysis of Laboratory data.

To determine the prevalence of antimicrobial resistance (AMR) in E. coli isolated from urine cultures of patients with uncomplicated cystitis in Pakistan. Another objective was to analyze and compare the resistance rates of E. coli to specific antibiotics, conducting a year-by-year evaluation of these rates to identify trends and changes over the past seven years. Retrospective analysis of susceptibility data of E. coli isolated from midstream urine culture samples of patients presenting in outpatient department with uncomplicated cystitis, from January 2016 to December 2022 in the section of Microbiology, Liaquat University of Medical and Health Sciences was done. All the demographic data, clinical information and susceptibility results were obtained from laboratory data base. All the cultures were performed on CLED agar and E. coli was identified using biochemical tests, susceptibility test was performed by disk diffusion method and clavulanate inhibition test for analysis of extended spectrum β-lactamase (ESBL) was performed. A total of 5169 patients with uncomplicated cystitis with no history of renal disease, pregnancy, hospitalization, catheterization and no elderly or pediatric population were included, 76% of which were of females. Mean age was 37 ±11 years Rising trends of resistance were observed in ampicillin (86.3%-95.3%), cotrimoxazole (12.8-48.6%), ciprofloxacin (57.3-81.6%) and low rates of resistance were seen in fosfomycin (0.57-2.96%), nitrofurantoin (0.72-2.96%) and amikacin (2.09-3.15%). Presence of ESBL and emerging resistance to ceftriaxone (15.7-48.7%), piperacillin/tazobactam (0-4.84%) and carbapenems (0-0.39%) was observed. The national guidelines offer an empirical treatment regimen for patients with uncomplicated cystitis. However, regional variations in antimicrobial resistance (AMR) complicate adherence to these guidelines. Our study supports the use of fosfomycin and nitrofurantoin in management of uncomplicated cystitis, However, ongoing annual regional surveillance is essential to keep clinicians informed about the latest trends in AMR.

Pharyngeal Microbiome in Atopic Dermatitis: A 16S rRNA Sequencing Study.

While recent studies have demonstrated the involvement of the skin and gut microbiome in the pathogenesis of atopic dermatitis (AD), the influence of pharyngeal microbiota on AD remains unclear. This study aims to explore disparities in the composition of pharyngeal flora among AD patients and their potential role in the pathogenesis of AD. Between March and May 2023, 30 patients with AD at the outpatient department of Jiangsu Provincial Traditional Chinese Medicine Hospital were recruited, along with 20 healthy subjects, underwent 16S rRNA sequencing on pharyngeal swabs. Pharyngeal taxonomic biomarkers of AD were identified using linear discriminant analysis effect size (LEfSe), and phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt2) was employed to predict potential functional metabolic pathways of bacteria with differential abundance. Significant variations were observed in the microbiota composition between the two study groups. The Pharynx of AD patients exhibited a notably higher relative abundance of Granulicatella, Pseudomonas, and Acinetobacter compared to healthy volunteers. Conversely, the relative abundance of Prevotella, Porphyromonas, Campylobacter, Lactobacillaceae, Treponema, Megasphaera, Selenomonas, and Oribacterium was lower in AD patients. According to the metabolic functional enrichment annotations predicted by PICRUSt2, bacteria with differential abundance may be involved in the pathogenesis of AD through two metabolic pathways, namely chondroitin sulfate degradation and chitin derivatives degradation. AD patients displayed distinctive microbiota profiles compared to healthy controls. These findings imply a pivotal role of pharyngeal microbiota in the pathogenesis of AD, offering novel perspectives for AD treatment strategies.

Comparative study of serum albumin, serum cholestrol and liver enzymes in individuals having senile cataract versus normal individuals

Abstract Background: One of the often-seen consequences of the aging process is the development of senile cataracts, a disease that affects one of our most precious gifts, that of sight. Many factors such as aging, changes in blood electrolyte levels, and possibly family history are involved in senile cataract formation. Changes in serum electrolyte levels can induce changes in aqueous electrolyte levels and affect lens metabolism and probably cataract formation. Aims: We aimed to measure the level of serum albumin, serum cholesterol, and liver enzymes in senile cataractous lens and normal crystalline lens. To analyze the correlation of serum albumin, serum cholesterol, and liver enzymes with cataractogenesis. Materials and Methods: This prospective case–control study was performed on 160 patients who presented to the Ophthalmology Outpatient Department of Jawaharlal Nehru Medical College and Hospital in collaboration with the Department of Biochemistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, over 2 years (from December 2016 to December 2018), study group comprised of 100 patients and the control group comprised of 60 patients. Statistical Package for Social Sciences software was used for data analysis. Results: The two groups were comparable concerning age. There were no significant statistical differences between the groups in terms of age. However, there was a statistically significant difference in intraocular pressure (IOP) and visual acuity (P &lt; 0.05) in IOP and a highly significant difference (P &lt; 0.001) in best corrected visual acuity (BCVA right eye), BCVA (left eye) between the study group and control group, though IOP was within the normal limit in both the groups. Conclusion: This study demonstrates that deranged liver enzymes have some role in cataract formation, and are associated with decreased serum albumin levels and it increases the chances of cortical cataract followed by nuclear cataract. Increased serum cholesterol levels are also associated with increased chances of mixed cataracts followed by cortical cataracts.

Pain Severity, Illness Appraisal and Pain Acceptance in Patients with Chronic Pain Conditions

The present study used a correlational research design to look into the association across pain severity (PS), illness appraisal (IA) and pain acceptance (PA) among individuals struggling with chronic pain. A purposive sample of 120 chronic pain patients from the Outpatient Departments of both private and government tertiary care hospitals of Lahore was obtained. The participants were asked to fill out a questionnaire booklet including a demographic questionnaire, West Haven Yale Multidimensional Pain Inventory, Revised Illness Perception Questionnaire, and Chronic Pain Acceptance Questionnaire. The findings revealed significant associations between pain severity, its subscales and pain acceptance. Timeline, consequences and emotional representations and pain acceptance; treatment control and illness coherence and pain acceptance showed negative correlation. Emotional representation predicted PA and pain willingness; Consequences, Timeline cyclic, affective distress and interference predicted both PA and Activity engagement; Treatment control and distracting responses were better predictors of pain willingness and negative responses was a better predictor for activity engagement. Independent sample t-test indicated that women tend to keep themselves busy with household chores whereas men tend to experience pain with more negative consequences. It was concluded that those who appraised their illness positively showed more acceptance towards their diagnosis and displaying better life regulation. Overall, it was concluded that pain acceptance plays a significant role in the lives of individuals with chronic pain. Hence, the results can be used to enhance empathy among clinical psychologists.

Relationship between gestational body mass index, blood pressure variability, and postpartum depression in pregnant women with pre-eclampsia.

Pre-eclampsia has long been proven to be an independent risk factor for postpartum depression (PPD). Excessive increase in body mass index (BMI) during pregnancy is an important factor inducing pre-eclampsia. Increased blood pressure is the main symptom of patients with pre-eclampsia. However, whether there is a correlation between BMI and blood pressure variability during pregnancy and PPD occurrence in pregnant women with pre-eclampsia remains unclear. To investigate the relationship between BMI, blood pressure variability, and PPD in pregnant women with pre-eclampsia. Using a cross-sectional survey research, 201 pregnant women with pre-eclampsia who were treated and delivered in Suzhou Ninth People's Hospital from May 2016 to June 2024 were selected as this study's subjects. At 42 days after delivery, the subjects were re-examined in the hospital's outpatient department. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate whether PPD symptoms, divided the subjects into two groups: The PPD and non-PPD groups. We analyzed clinical data, changes in BMI during pregnancy, and blood pressure variability in the two groups. The Pearson method was used to test the correlation between BMI increase, blood pressure variability during pregnancy, and EPDS score in patients with pre-eclampsia. Logistic regression analysis was performed to explore whether increased BMI and blood pressure variability during pregnancy are influencing factors for PPD occurrence in patients with pre-eclampsia. Of the 201 pre-eclamptic women who underwent an outpatient review 42 days after delivery, 37 had PPD symptoms based on the EPDS scale evaluation, resulting in an incidence rate of 18.41% (37/201). The differences between the PPD and non-PPD groups in terms of age, educational level, place of residence, reproductive history, gestational age, mode of delivery, newborn gender, and newborn birth weight were not statistically significant (P > 0.05). The gestational BMI increase, 24-hour systolic blood pressure (SBP) variability, and 24-hour diastolic blood pressure (DBP) variability in the PPD group were significantly higher than those in the non-PPD group; the differences were statistically significant (P < 0.001). Pearson correlation analysis showed that BMI increase, SBP variability, and DBP variability during pregnancy correlated positively with the EPDS score of pregnant women with pre-eclampsia (r = 0.349, 0.336, and 0.241; P < 0.001). Logistic regression analysis showed that a high increase in BMI during pregnancy [odds ratio (OR) = 4.614, 95% confidence interval (CI): 1.749-12.170, P = 0.002], large variability in 24-hour SBP (OR = 2.910, 95%CI: 1.322-6.404, P = 0.008), and large variability in 24-hour DBP (OR = 2.347, 95%CI: 1.138-4.831, P = 0.021) were factors affecting PPD occurrence in patients with pre-eclampsia. Increased BMI and blood pressure variability during pregnancy can increase the risk of PPD in patients with pre-eclampsia. Strengthening pregnancy guidance and controlling fluctuations in BMI and blood pressure variability during pregnancy within a reasonable range can help reduce the risk of PPD in patients with pre-eclampsia.

Effect of Levothyroxine on Lipid Profile in Hypothyroid Patients Attending in a Tertiary Care Hospital

Background: Hypothyroidism is a common endocrine disorder in our country and is associated with many biochemical abnormalities.Clinical data suggest that levothyroxine replacement therapy has beneficial effect on lipid profile. Objective: The present study intends to find out the effect of levothyroxine replacement therapy on lipid profile in hypothyroid patients. Methods: A prospective analytical study was done in Endocrinology Outpatient Department of Dhaka Medical college and Hospital, Dhaka from January 2022 to December 2022. A total of 30 newly diagnosed hypothyroid patients were included according to selection criteria. The patient’s demographic, past, present history and relevant data needed for the study were collected by face-to-face interview by using structured questionnaire. Baseline data of serum free thyroxine (FT4), thyroid stimulating hormone (TSH), fasting lipid profile, Blood pressure and clinical features of hypothyroidism were recorded in a data collection form during first visit and after 3 months follow up. All patients were treated with tablet levothyroxine and dose was adjusted 4-6 weekly till patients were biochemically euthyroid. Results: 30 hypothyroid patients were followed up for 3 months. There was significant improvement in hypothyroid symptoms after thyroxine replacement. The mean age of the patient was 35.40±11.52 years. Mean FT4 level was significantly increased from 8.06±3.78 to 16.40±3.95(p&lt;0.001). There was significant reduction in mean TSH from 32.55±37.31 to 2.52±2.71(p&lt;0.001). Mean Total cholesterol, TG, LDL-C level was significantly decreased from 193.27±41.69, 173.33±63.71, 119.58±40.11 to 177.80±38.17, 155.87±58.25, 103.07±26.25 (p=0.022, 0.044, 0.042) respectively, but HDL has decreased from 45.04±13.14mg/dl to 43.11±10.78 mg/dl (p=0.415) though not significantly. Conclusion: Thyroxine replacement therapy improves lipid profiles and enhances quality of life. Levothyroxine directly reduces TC, LDL-C, and TG levels but not HDL-C. J Rang Med Col. September 2024; Vol. 9, No. 2: 61-66

Study on Clinical Features, Detection of Risk Factors and Causes of Anaemia in Children in a Tertiary Care Hospital of Bangladesh

Background: Anaemia is a common childhood health problem. Among the causes of anaemia besides the nutritional anaemia congenital hemoglobin disorder such as thalassemia and haemoglobinopathies has a great role which can be combated by increasing awareness in the population. Objective: To detect clinical features, common causes, risk factors of childhood anaemia and to make awareness among the population to prevent the deadly effects of anaemia in children as well as in the society. Methodology: A cross-sectional study was carried out at outpatient department of Delta Medical College and Hospital over a period of 3 years. Children aged between 6 months to eighteen years who visited outdoor for acute illness and were clinically pale and CBC supporting the condition were included. Children with malignancy and haemorrhagic diseases were excluded from the study. Total 200 cases were collected. Results: Among 200 cases 62.5% were male. Most vulnerable age group was 6 months to 2 years (63%). Most common cause of anaemia was iron deficiency anaemia (64.5%). Congenital haemoglobin disorder was the second most common cause (28%). Among haemoglobinopathies Hb E trait contributes (82.35%). Most common presentation of anaemic children was frequent attack of RTI. Low protein diet was the most common risk factor for iron deficiency anaemia. Under five years, males were more affected but thereafter females were more affected than male children. Among 200 cases only 32(15%) cases were malnourished. Most of the cases were term baby. Among inherited cases only one care giver had knowledge about thalassemia. Most cases came from lower middle class family (65%). Most common morphologic variant of anaemia was microcytic hypochromic anaemia (99%). RBC count was normal in iron deficiency anaemia. Conclusion: Besides iron deficiency anaemia, haemoglobinopathies and thalassemia have a great contribution in childhood anaemia. Family education, increased awareness, screening out of thalassemia and haemoglobinopathies carrier can combat this heath problem in children and can reduce social burden. Bangladesh J Child Health 2023; Vol 47 (2) : 89-94

COMPARATIVE EFFECTS OF VIRTUAL REALITY AND FRENKEL’S EXERCISES ON BALANCE, GAIT AND QUALITY OF LIFE IN PATIENTS WITH STROKE

Background: Stroke is a leading cause of disability and mortality worldwide, often resulting in significant motor deficits, including gait and balance impairments. Rehabilitation interventions, such as virtual reality and Frenkel’s exercises, are widely employed to improve motor function and quality of life in stroke patients. These techniques focus on enhancing neuromuscular control, coordination, and functional independence during the recovery process. Despite their established benefits, direct comparative evidence between these two modalities remains limited. Objective: To compare the effects of virtual reality and Frenkel’s exercises on balance, gait, and quality of life in stroke patients. Methods: A randomized clinical trial was conducted at the outpatient department of Islam Central Hospital, Sialkot, with a sample of 36 stroke patients selected through non-probability convenience sampling. Participants were randomly divided into two groups: Group A (virtual reality) and Group B (Frenkel’s exercises), each comprising 18 participants. Balance, gait, and quality of life were evaluated using the Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, and Stroke-Specific Quality of Life (SS-QOL) assessment, respectively. Each intervention was administered three times weekly for 30 minutes per session over six weeks. Data normality was assessed, and parametric tests, including paired and independent sample t-tests, were used for statistical analysis. A p-value of &lt;0.05 was considered significant. Results: Group A showed a significant improvement in BBS scores (35.81 ± 4.34 to 45.38 ± 3.32, p &lt; 0.001) and SS-QOL scores (124.56 ± 19.59 to 209.06 ± 10.18, p &lt; 0.001). Group B also demonstrated significant improvements, with BBS scores increasing from 35.50 ± 4.38 to 41.94 ± 2.64 (p &lt; 0.001) and SS-QOL scores rising from 129.94 ± 17.19 to 188.94 ± 11.17 (p &lt; 0.001). TUG test results revealed greater improvement in Group B (21.69 ± 2.89 to 13.81 ± 2.56, p &lt; 0.001) compared to Group A (21.69 ± 2.77 to 16.69 ± 2.63, p &lt; 0.001). Between-group analysis demonstrated that virtual reality was superior for balance and quality of life (BBS: p = 0.003; SS-QOL: p &lt; 0.001), while Frenkel’s exercises showed a greater effect on gait (TUG: p = 0.004). Conclusion: Virtual reality training significantly improved balance and quality of life in stroke patients, whereas Frenkel’s exercises were more effective in enhancing gait. These findings highlight the complementary benefits of both modalities in stroke rehabilitation, providing valuable insight for individualized patient care.

Prevalence, Antibiotic Resistant Pattern and Genotypic Detection of Acinetobacter baumannii Isolated from Different Clinical Specimens of Patients Admitted at a Tertiary Care Hospital in Bangladesh

Background: Acinetobacter baumannii infection treatment has become a clinical challenge due to the increasing resistance of the bacteria to different classes of antimicrobial agents and it needs to be identified before exposure to patients. Objective: This study aimed to determine the prevalence of Acinetobacter baumannii with its antibiotic-resistant patterns. Methodology: The study was a cross-sectional study that was done from 1st January 2019 to 31st December 2019 at the Microbiology Department of Dhaka Medical College. Clinical samples including endotracheal aspirates, blood, urine, sputum, wound swabs, and pus were collected from the patients from the intensive care unit, burn unit, general wards, and outpatient department of Dhaka Medical College and Hospital. Acinetobacter baumannii organisms were identified by biochemical tests and Gram staining, and the resistance pattern was determined by using the disc diffusion method for all antibiotics except for colistin, which was determined by minimum inhibitory concentration. Results: Among 500 clinical samples, 13.31% Acinetobacter baumannii were identified. Most of these showed resistance to fluoroquinolones, carbapenem, amikacin, the extended spectrum of cephalosporin, β-lactam, and β-lactamase inhibitors. However, the least resistant drug was tigecycline (8.88%). About 62.22% MDR, 28.89% A. baumannii were identified. Conclusion: Acinetobacter baumannii is showing increasing resistance to colistin and tigecycline. Bangladesh Journal of Medical Microbiology, January 2024;18(1):37-43

EFFECTS OF SLUMP NEURAL MOBILIZATION FOR THE TREATMENT OF CHRONIC RADICULAR LOW BACK PAIN

Background: Low back pain is a prevalent global health issue affecting individuals across all age groups, impacting their physical, mental, and social well-being. It is a significant concern in both developed and underdeveloped countries and a leading cause of disability worldwide. Chronic radicular low back pain, characterized by radiating discomfort due to neural irritation, demands effective therapeutic interventions to alleviate symptoms and improve quality of life. Objective: This study aimed to evaluate the effects of slump neural mobilization in conjunction with baseline treatments for managing chronic radicular low back pain. Methods: A randomized clinical trial was conducted in outpatient departments of multiple hospitals, enrolling 20 participants who met the inclusion and exclusion criteria. Participants were randomly allocated into two groups, with 10 in each group. Group A received slump neural mobilization combined with proprioceptive neuromuscular facilitation rhythmic stabilization and hot pack therapy. Group B received rhythmic stabilization techniques and hot pack therapy alone. Interventions were provided three times per week for five weeks. Pain intensity was assessed at baseline, the second week, and the fifth week using the Numeric Pain Rating Scale. Statistical analyses included the Mann-Whitney test for between-group comparisons and the Friedman test for within-group comparisons. Results: Between-group analysis revealed significant reductions in pain levels, with p-values of 0.018 at baseline and 0.02 at the fifth week, while results at the second week were not significant (p = 0.173). Within-group analysis using the Friedman test demonstrated statistically significant reductions in pain for both groups, with p = 0.000. In the treatment group, mean pain scores decreased from 5.70 at baseline to 3.90 at the second week and 1.40 at the fifth week, while the control group showed reductions from 4.20 at baseline to 3.30 at the second week and 2.90 at the fifth week. Conclusion: The study concluded that slump neural mobilization, when combined with baseline treatments, significantly reduced pain levels in patients with chronic radicular low back pain. These findings support its incorporation as an effective non-invasive intervention in physical therapy.

Metabolic Dysfunction and Alzheimer’s Disease Risks in African Americans

AbstractBackgroundMetabolic diseases like chronic Type 2 Diabetes Mellitus (T2DM) are now a serious global health concern In the United States. African Americans (AA) are being affected at a disproportionate rate with the condition compared to other ethnic groups, yet there are relatively few studies that have specifically focused on this group. Our previous findings have suggested that AA patients with T2DM had gene expression signals associated with Alzheimer’s Disease (AD). The current pilot study aimed to examine the amyloidogenic processing pathways (APP) and cholesterol biosynthesis‐related marker genes in the circulation of clinically identified T2DM AA patients in the Washington DC area.MethodA total of 12 confirmed T2DM AA patients and matched healthy controls were recruited from a regional hospital's outpatient departments, with sociodemographic and medical details obtained for analysis. Whole blood was collected in DNA/RNA Shield™ Blood Collection Tube for RNA extraction and isolation. The APP and cholesterol biosynthesis‐related gene expression patterns were examined using profiler array gene expression (qRT‐PCR). The affected pathways were identified using Ingenuity Pathway Analysis (IPA).ResultWe identified Amyloid Processing, Neuroinflammation Signaling, ERB4 Signaling, Interleukin signaling, and nNos signaling as the top canonical pathways. The top diseases and their functions were Metabolic disease, Neurological disease, Organismal Injury and Abnormalities, Psychological disorders, and cardiovascular diseases. APP, CDK5R1, PSENEN, and MAPT were the key genes that were differentially expressed (≥2‐fold change at p &lt;0.05) in APP pathways, with PHLPP2, IL33, APP, CRP, &amp; TAC1 as the top upstream regulators.ConclusionThe results suggest that T2DM may influence the risk of developing AD in AA patients. Further studies on larger multi‐ethnic populations would be of interest to validate and extend these findings. Information from such biochemical and genetic studies will be crucial to the development of therapeutic targets to assess future AD risks.

Impact of Re-Du-Ning enema treatment on the intestinal microflora in pediatric patients with hand, foot, and mouth disease.

Hand, foot, and mouth disease (HFMD) is a prevalent infectious condition in children. This study aimed to assess the regulatory effects of Re-Du-Ning on the intestinal microflora of pediatric patients with HFMD. Fecal samples were collected from children affected by HFMD, who were diagnosed at the traditional Chinese medicine pediatrics outpatient and emergency departments of Liuzhou Women and Children's Healthcare Hospital, as well as from healthy children undergoing physical examinations at the same hospital during the same period. DNA was extracted from these samples and subjected to 16S ribosome DNA amplicon sequencing. The sequenced data were categorized, quantified, and compared. Analyses involved creating relative abundance bar graphs, constructing unweighted pair-group method with arithmetic mean clustering trees, and generating heatmaps of clustering to evaluate the variations in abundance and diversity across different groups. The analysis of molecular variance and t-test were used to analyze structural differences in microbial flora between groups, and linear discriminant analysis was used to identify significant differences in microbial genera between the groups. A total of 67 fecal samples were collected from children with HFMD (13 in the intravenous group, 40 in the enema group) and from healthy children (14 in the healthy group). When compared with the healthy group, the intestinal microflora diversity and similarity were highest after enema treatment, although the microbial structure exhibited significant changes (weighted_unifrac, P<0.05). The composition of species relative abundance was comparable between the healthy group and the post-enema group. Re-Du-Ning enema treatment regulated the intestinal microflora in these children, significantly increasing the abundance of probiotics like Bifidobacteria and reducing the abundance of opportunistic pathogens like Enterobacter.