Care Medical Center Research Articles

Problematic issues of the development of hospital-replacing technologies in surgery at the prehospital stage and ways to solve them

Introduction. One of the main trends in the development of the healthcare system in the Russian Federation is a shift in the emphasis of care from inpatient to outpatient. At the beginning of 2000, this trend in healthcare was confirmed by its development. However, the position on shifting the center of medical care from the inpatient to the outpatient level is currently not confirmed, in particular, in outpatient surgery.The purpose of the study: to analyze the work of day surgical hospitals and identify problematic issues in the development of hospital-replacement technologies in surgery at the prehospital stage and propose ways to solve them.Materials and methods. The research materials were our own developments based on the results of the work of day surgical hospitals in the outpatient surgery clinic of the Military Medical Academy of S.M. Kirov, as well as statistical data, scientific works and publications presented in periodicals by the most authoritative representatives of domestic medicine in the field of studying the development of hospital-replacement technologies (day surgical hospitals).Results. During the study, it was revealed that the number of surgical interventions performed at the prehospital stage has been progressively decreasing since 2005. The average bed occupancy per year in day hospitals of hospitals and clinics is lower than that of 24-hour hospital beds, which indicates the idleness of day hospital beds and their underutilization. There is a low turnover of day hospital beds. All this confirms the presence of problems and low efficiency of day hospitals. To solve problematic issues in the development of hospital-replacement technologies, the authors recommend establishing “normative indicators” for the work of day hospitals, determining the status of a day hospital bed, increasing bed turnover, establishing targeted funding for day hospitals, etc. To improve the system of providing inpatient replacement care at the prehospital stage, it is proposed to create a multidisciplinary center for inpatient replacement technologies. All clinics assigned to the multidisciplinary center for hospital-replacement technologies refer patients who cannot receive routine medical care in the clinic to the multidisciplinary center. The center selects patients who will receive care using hospital-replacement technologies. The remaining patients are sent to hospitals for treatment.Conclusion. In order to increase the efficiency of day hospitals, it is necessary to establish standard indicators for their work. It is necessary to increase the turnover of day hospital beds. It is advisable to organize targeted funding for all day hospitals. An option for optimizing the organization of inpatient replacement care at the outpatient stage is the creation of a multidisciplinary center for inpatient replacement technologies, which will prevent the “outflow” of outpatients to hospitals and increase the efficiency of using day hospital beds.

FREQUENCY OF INFECTIOUS AND NON-INFECTIOUS DISEASES DURING THE WAR IN UKRAINE BASED ON SOME PRIMARY MEDICAL CARE UNITS' DATA IN THE CHERNIVTSI REGION

Aim – to investigate the impact of the war in Ukraine and COVID-19 on the frequency of infectious (COVID-19, tuberculosis) and non-infectious diseases (hypertension (AH), diabetes mellitus (DM), obesity, thyroid pathology, chronic kidney disease (CKD)) according to data from primary health care units in Chernivtsi region..Material and methods. The statistical reports of Communal Non-commercial Enterprises (CNEs) "Kitsman Center of Primary Medical Care" of the Kitsman District Council and "City Polyclinic No. 1" of the Chernivtsi City Council for the years 2019-2023 with the number of observed population subject to medical care - 36,508 and 58,500, respectively, were analyzed.Results. During the COVID-19 pandemic (2021-2022), a surge in the incidence of tuberculosis was observed in separate communities, with an almost 7% increase per 100,000 residents in the Chernivtsi region as a whole (in 2022-2023), caused, in our opinion, by the war and an increased population migration. During the period of the COVID-19 pandemic and with the beginning of the full-scale invasion of the russian federation on the territory of Ukraine, a strict trend in the incidence of DM increase (mainly non-insulin-dependent) was established. The frequency of obesity in women increased as well by 17.5%, while in men, on the contrary, it decreased – by 17.42%. The frequency of diffuse goiter in the structure of thyroid diseases decreased by 3%, with a slight elevation in autoimmune thyroiditis.Conclusion. An obvious dependence of changes in the incidence of CKD and hypertension in linkage with the COVID-19 pandemic and the war in Ukraine was not established in the analyzed communities.

Effect of National Accreditation Board for Hospital-Recommended Trainings on Patient Care Standards: A Comparative Study Based on the National Quality Assurance Standards Guidelines in a Tertiary Health-care Institute.

The National Quality Assurance Standards (NQAS) have been developed keeping in specific requirements for public health facilities as well global best practices. Standards are primarily meant for providers to assess their quality for improvement through predefined standards and to bring up their facilities for certification. To study the effect of National Accreditation Board for Hospitals (NABH)-recommended training on patient care standards based on NQAS guidelines. The research was conducted at a tertiary-level teaching institute and medical care center in North India. The institute has multiple blocks, few have undergone training for NABH standards, and few have not due to administrative reasons. Only the NABH-trained blocks underwent accreditation process through NABH and provided an opportunity to study whether there is a difference in patient care standards between NABH-trained staff and nontrained staff. It was a checklist-based observational study. The evaluation covered seven key areas in intensive care unit (ICU) and wards in both NABH-trained and nontrained hospital blocks: patient rights, inputs, support services, clinical services, infection control, quality management, and outcome. The compliance percentage of ICU and wards was measured for NABH-trained and nontrained hospital blocks. NABH-trained blocks in both areas showed better compliance adhering to standards as compared to nontrained blocks for all seven key areas. The study findings indicate that NABH-recommended training showed positive impact on patient care standards as per the NQAS guidelines. The NABH-trained hospital block exhibited superior compliance with various domains including patient rights, inputs, support services, clinical services, infection control, and quality management.

Some Aspects of Public Health from the Point of View of the Work of Center for Primary Medical and Sanitary Care

Some Aspects of Public Health from the Point of View of the Work of Center for Primary Medical and Sanitary Care

A clinical comparative study on carbamylated haemoglobin as a surrogate marker to differentiate acute kidney injury from chronic kidney disease.

Carbamylated haemoglobin is the result of reaction of isocyanate with N-terminal valine residues of the α and β chains of haemoglobin. Carbamylated haemoglobin concentration is dependent on the degree and duration of uraemia and thus may potentially serve as a marker to differentiate acute kidney injury (AKI) and chronic kidney disease (CKD). A hospital-based prospective clinical comparative study was conducted in an urban tertiary medical care centre. Carbamylated haemoglobin was estimated in a total of 60 patients, 30 each of chronic kidney disease and acute kidney injury. The comparison of the carbamylated haemoglobin levels among the CKD and AKI groups was done using Mann-Whitney test. The mean value of carbamylated haemoglobin among the CKD group was 240.71 ± 75.64 μgVH/g, whereas among the AKI group, it was 67.15 ± 17.05 μgVH/g. These values are statistically significant with P < 0.001. Carbamylated haemoglobin values were elevated in relation to renal dysfunction, and it significantly correlated with chronicity of kidney disease. Mean CarHb among the CKD group was significantly high in comparison to the AKI group with statistical significance, with a P value of <0.001. It was significantly attributed in this study that carbamylated haemoglobin >100 μgVH/g is diagnostic of CKD and a value <100 μgVH/g is diagnostic of AKI. Thus, in this study, it can be concluded that carbamylated haemoglobin is a useful marker to differentiate AKI from CKD.

Bias in obtaining broad consent in a German general practice? - Preliminary results from a cross-sectional study.

The growing importance of collecting Broad Consent (BC) for research utilizing electronic health records in Germany has brought attention to the need for a deeper understanding of potential selection bias in the process. Since 2020, the BeoNet-Halle outpatient database has been collecting anonymous and pseudonymous patient data from primary care and specialty practices throughout Germany, with the practice being an integral part of this data collection effort. The primary objective of the pilot study is to explore potential socioeconomic discrepancies between patients who provided BC and the general practice population. This is a single-center, cross-sectional study. The study was performed with patients from one Medical Care Center including eight GPs. We categorized patients with at least one interaction with a general practitioner from March 2021 to January 2023 into two sets: patients who approved BC versus a randomly chosen representative sample (RS) of non-BC inquirers. We mailed a sociodemographic survey to both groups. A total of 561 patients were analyzed, with the BC group responding more actively (60.7%) than the RS group (29.7%). Age and gender were similar between the BC group and RS group. Being widowed, divorced, or unmarried and being neither open nor hostile toward research was associated with an increased likelihood of giving consent. Analysis of personality traits did not show any impact on giving consent. Overall, this study outlines that there is some bias between BC and RS. Possible associations in BC decisions that offer insights into complex decisions to participate in medical research are marital status, immigrant background, income, and age. Findings emphasize the potential of BC for outpatient research, warranting further investigation to optimize its application in the general practice setting.

ICU-Electroencephalogram Unit Improves Outcome in Status Epilepticus Patients: A Retrospective Before-After Study.

Continuous electroencephalogram (cEEG) monitoring is recommended for status epilepticus (SE) management in ICU but is still underused due to resource limitations and inconclusive evidence regarding its impact on outcome. Furthermore, the term "continuous monitoring" often implies continuous recording with variable intermittent review. The establishment of a dedicated ICU-electroencephalogram unit may fill this gap, allowing cEEG with nearly real-time review and multidisciplinary management collaboration. This study aimed to evaluate the effect of ICU-electroencephalogram unit establishing on SE outcome and management. Single-center retrospective before-after study. Neuro-ICU of a Swiss academic tertiary medical care center. Adult patients treated for nonhypoxic SE between November 1, 2015, and December 31, 2023. None. Data from all SE patients were assessed, comparing those treated before and after ICU-electroencephalogram unit introduction. Primary outcomes were return to premorbid neurologic function, ICU mortality, SE duration, and ICU SE management. Secondary outcomes were SE type and etiology. Two hundred seven SE patients were included, 149 (72%) before and 58 (38%) after ICU-electroencephalogram unit establishment. ICU-electroencephalogram unit introduction was associated with increased detection of nonconvulsive SE ( p = 0.003) and SE due to acute symptomatic etiology ( p = 0.019). Regression analysis considering age, comorbidities, SE etiology, and SE semeiology revealed a higher chance of returning to premorbid neurologic function ( p = 0.002), reduced SE duration ( p = 0.024), and a shift in SE management with increased use of antiseizure medications ( p = 0.007) after ICU-electroencephalogram unit introduction. Integrating neurology expertise in the ICU setting through the establishment of an ICU-electroencephalogram unit with nearly real-time cEEG review, shortened SE duration, and increased likelihood of returning to premorbid neurologic function, with an increased number of antiseizure medications used. Further studies are warranted to validate these findings and assess long-term prognosis.

Risk Analysis Index Frailty Score as a Predictor of Otolaryngology Surgical Outcomes.

The Risk Analysis Index (RAI) score is a screening tool to assess patient frailty. It has been shown to be predictive of postoperative outcomes and mortality in orthopedic, urologic, and neurosurgical patient populations. We sought to evaluate the predictive ability of RAI score for surgical outcomes in an otolaryngology patient population. Retrospective study. Academic tertiary medical center. A retrospective study was conducted of adult patients undergoing otolaryngology surgery at a tertiary medical care center over 21 months. Patients were sent electronic RAI survey questionnaires via direct messaging, which was completed prior to surgery. Endpoint data were analyzed, including demographics, RAI score, and patient outcome data. Univariate analysis, ROC curves, and predictive modeling were utilized. A total of 517 patients responded to the RAI questionnaire, resulting in a 59.6% response rate. Mean RAI score was 21.38 ± 11.83. Higher RAI scores were associated with increased 30-day readmissions (P < .0015), postoperative complications (P < .001), hospital length of stay (P < .001), and discharge with home health (P < .001). Predictive models for RAI score and postoperative outcomes were created, and a cutoff score of RAI = 30 was established to identify frail patients. We evaluated if RAI scoring predicted postoperative complications in an otolaryngology patient population. Increased RAI score is significantly associated with poorer surgical outcomes, including increased hospital length of stay, 30-day readmissions, and postoperative complications. We propose a predictive model with suggested RAI cutoff scoring for use in the otolaryngology surgical population.

A comparative study between first three waves of COVID-19 pandemic with respect to risk factors, initial clinic-demographic profile, severity and outcome

ABSTRACT Introduction: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results: Statistically significant (P &lt; 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P &lt; 0.01). The difference in mortality rates between patients with and without co-morbidity (P &lt; 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.

Migrations in Latin America: the corridor to the American dream is a public health problem

Introduction Migrant movements have tripled, and it is evident throughout the Americas. On the way to North America, people come from South America, the Caribbean, mainly Haiti, Cuba, Asia, and Africa. People migrate for work, study, humanitarian situations, poverty, violence in their territories, lifestyle change, or family reunification. Objetive The aim of this study is to assess the impact of most frequent infectious conditions of the population exposed to migratory movement through the Américas. Materials and Methods The present review focuses on the leading infectious diseases migrants acquired during the arduous journey through the tropical areas. Official migration web sides, journals, and scientific journals were used to get information. Results Some infectious diseases have reemerged in transit countries used by migrants, and the increase in migratory phenomena, triggered cases of HIV/AIDS, Tuberculosis, arbovirosis, Malaria, and hepatitis, among others. Conclusions Migrants suffer infectious diseases as they pass the countries to the USA; besides, they suffer violence and even sexual assault. The receiving countries should establish public policies to regularize the access of migrants to health services, which include preventive programs and easily accessible vaccination plans. Some of the pathologies suffered by migrants are preventable, although there are groups of populations in extreme social conditions and with compromised nutritional status. The need to establish a primary medical care center to apply an innovative border and transnational protocols for infectious diseases for migrant populations is highlighted.

Second opinion for pulmonary and pleural cytology is valuable for patient care

IntroductionThoracic cytology can be challenging due to limited procured material or overlapping morphology between benign and malignant entities. In such cases, expert consultation might be sought. This study aimed to characterize all pulmonary and pleural cytology consult cases submitted to our practice and provide recommendations on approaching difficult cases. Materials and MethodsAll thoracic (pulmonary and pleural) cytology cases submitted for expert consultation to the University of Michigan (MLabs) from 2013 to mid-2022 were reviewed. Cases where cytology was only part of a hematopathology or surgical pathology consult were excluded. Patient demographics, specimen location, procedure performed, referring diagnosis, and our diagnoses were recorded for each case. Diagnoses were categorized according to the Papanicolaou Society of Cytopathology recommendations for pulmonary and effusion cytology. Discordant diagnoses were stratified as major or minor. Data was analyzed using Chi-Square analysis and logistic models. ResultsWe received 784 thoracic cytology consult cases, including 530 exfoliative samples and 307 fine needle aspirations (FNAs). The most common anatomic locations sampled were the bronchial wall (n=194, 23%), lung nodule (n=322, 38%), and pleura (n=296, 35%). 413 cases had a diagnostic discrepancy (48.3%), with 274 (66%) minor and 139 (34%) major discrepancies. By location, pleural effusion specimens had the highest probability of a discrepant diagnosis (p=0.003). By specimen type, FNA samples were significantly more likely to have a discrepant diagnosis (p=0.06). ConclusionNearly half of the thoracic cytology cases submitted for expert second opinion had diagnostic discrepancies. Consequently, consulting a tertiary medical care center with cytopathology expertise for challenging thoracic cytology diagnoses is beneficial.

Training of Medical Assistants in Ophthalmology: Survey of a Sample of Large Ophthalmic Centers

The shortage of specialists in SHI-accredited medical care is increasingly affecting medical assistants (MFA) in medical practices and Medical Care Center (MVZ). Training can mitigate the associated problems in the future, but currently only 42% of practices provide training. A survey of a sample of large ophthalmic centers was conducted to test the hypothesis that larger practices and MVZs provide disproportionate training. In addition, an interaction between ownership (physician-owned (äE); third-party owned (F)) and training engagement was evaluated. In a questionnaire-based complete survey (2022) of large ophthalmic centers of different ownerships organized in a network, the training rate by main operating site (HBS), the number of MFA trainees (MFA-A) per HBS, staffing problems and planned change in training commitment were collected. The distribution measures of the quantitative data were analyzed overall and separately by sponsoring organization and tested for significance.Results were compared to data from a representative survey (2020/2021) of all practices and MVZs. In order to determine the proportion of all ophthalmic MFA-A accounted for by the sample, their total number was determined in an extrapolation. The training rate of the total of 100 HBS of the 14 surveyed centers (11 äE, 3 F) of the sample was 82% (äE: 93%, F: 79%), which was higher than the representative survey (41%). In the sample, there were on average 5.9 MFA-A per HBS (äE: 5.6, F: 7.1), in the comparative survey 1.5. 50% of the centers in the sample reported staffing problems, 25% wanted to expand their training commitment; the comparative values of the representative survey were 11% for both parameters. Stratified by sponsorship, neither training rate nor MFA-A per HBS showed significant differences. According to projections, there were nearly 1,966 MFA-A working in ophthalmology in 2021, of which 19.5% were at centers in the study population. Of all the MFA-A in the sample, 71% were at the significantly larger centers by number of HBS owned by third-party. The survey confirms the positive correlation between the size of practices and MVZ and commitment to training. There are no significant differences according to the ownership of organization.

Distance follow-up by a remote medical care centre improves adherence to CPAP in patients with obstructive sleep apnoea over the short and long term.

Adherence to continuous positive air pressure (CPAP) in patients with obstructive sleep apnoea (OSA) has remained invariably low over the last decades. Remote monitoring of the nocturnal CPAP treatment, within telemedicine (TM)-based follow-up programs, in these patients has been suggested as a potential tool to improve adherence and release the workload of sleep units. The aim of this study was therefore to assess whether a follow-up program carried out by a Remote Medical Care Centre (RMCC), outside the sleep unit, improves adherence to CPAP in the short and long term in patients with OSA. In this pilot protocol, we enrolled 37 patients starting CPAP in our Sleep Centre (SC). After three months of standard care in our SC, patients initiated a six-month remote follow-up carried out by the RMCC, functioning as an intermediary between patients and SC. Monthly reports and indication for face-to-face visits were sent to the SC for six months. After this period patients returned to usual care for one year. Results were compared with those obtained in 38 patients (controls) followed with usual care over the same time range. Mean nightly use of CPAP increased from 3.2 ± 2.4 h pre-RMCC to 5.2 ± 1.9 h post-RMCC (p < 0.0001). Nights/month of CPAP use improved from 19.8 ± 9.2 to 25.2 ± 2.5 (p < 0.05) and nights/month with CPAP use >4 h from 12.5 ± 10 to 21.03 ± 8.9 (p < 0.05). This improvement remained stable after 12 months from the return of patients to usual care. No significant changes in CPAP use were observed in controls over the time. A six-month follow-up through a remote facility can significantly improve adherence to CPAP in the short and long term. This pilot study provides a solid base for the design of multicentre randomized trials focusing on new models which are able to increase the long-term efficacy of TM programs.

Results of application of the IRIS dental implants with the surface modified by the method of plasma electrolytic oxidation

Surface modifications of dental implants to provide optimal conditions for osseointegration remains an urgent task in modern dental implantology. A few publications demonstrate that the surface of the dental implants modified by plasma electrolytic oxidation (PEO) possess a combination of several important features that promote osteointegration: optimal micro roughness within 1-7 microns, high chemical purity, and mechanical strength [8,20].The aim. To evaluate the clinical efficacy of IRIS implants with a new surface modified by the PEO method (hereinafter referred to as IRIS PEO).Materials and methods. Based on the Patrice Lumumba RUDN Medical Center and the Center of Medical Care for Dental Diseases, FGBU «Central Clinical Hospital with Polyclinic» of the Presidential Affairs Department of the Russian Federation, 60 patients aged 27 to 52 years with partial tooth loss were examined and treated. The patients received 1 IRIS-PEO implant each on the upper or lower jaw. All implants were placed with the force from 35 to 50 N/cm2, with gingiva shapers. Prosthetics were performed after 2 months on the lower jaw and after 4 months on the upper jaw. Before taking impressions, the stability of implants was measured using the Penguin RFA (Integration Diagnostic Sweden AB, Sweden). One year after prosthetics, the neck resorption of the implants was evaluated.Results. Because of the treatment, all prosthetic constructions met the functional and aesthetic requirements. The stability indices of implants in ISQ units on the upper jaw averaged 75±3.4, on the lower jaw 79±2.4. Bone resorption in the implants’ neck area 1 year after the end of the treatment was not observed. The pilot clinical study of the IRIS-PEO implants allowed to optimize the terms of rehabilitation and to obtain high functional and esthetic result in the treatment of patients with tooth loss.Conclusions. Pilot clinical implementation of the implants of the IRIS system with the surface modified by plasma electrolytic oxidation demonstrated the possibility of open management of the implants with the gingiva shaper, to carry out prosthetics in 2 months on the lower jaw and 4 months on the upper jaw. No neck resorption was observed one year after prosthetics.

Основные особенности медицинской эвакуации железнодорожным транспортом раненных в современном вооруженном конфликте

Summary. The purpose of the study is based on the analysis of medical documentation and the work experience of medical specialists of the Center for Air Ambulance and Emergency Medical Care (CAS and EMS) of the Federal State Budgetary Institution “State Research Center – Federal Medical Biophysical Center named after A.I.Burnazyan” FMBA of Russia for medical evacuation by rail (MEZHT) of the wounded to determine the main features of medical evacuation measures (MEM) and the structure of the contingent evacuated during armed conflicts. Materials and methods of research. Research materials – primary medical documentation of 8 flights of a temporary military medical train (VVSP) of the Russian Ministry of Defense. Study period: July–August 2023. The study used methods of mathematical analysis and direct observation. Research results and their analysis. Currently, temporary military ambulance trains evacuate mainly walking and low-mobility lightly wounded patients, which is due both to the lack of operational need for long-distance MET for this category of patients due to the stable operation of air ambulances, and to the not entirely satisfactory conditions for placing seriously wounded bedridden patients in the air ambulance. Currently, the Air Forces operate in accordance with the scheme of routing the wounded from the zone of armed conflict to medical treatment organizations (HMO) in the rear of the country. At the same time, the existing difficulties in MEVT of bedridden, seriously wounded patients, including those in intensive care, require improvement of railway ambulance transport. In the author’s opinion, the most rational option for such an improvement in modern conditions is the further development of schemes for modifying passenger cars to meet the needs of the MEZhT of the seriously wounded and sick.

Final conclusions of the own investigations of combined antihypertensive treatment on clinical state in patients with arterial hypertension without and with diabetes mellitus: use of own materials in education in nation. and Engl. languages at pre- and po

General practice – family medicine department. Object of investigation – patients with confirmed diagnosis of arterial hypertension without and with diabetes mellitus of second type, which were under observation at the primary medical care centers. &#x0D; The aim of the investigation was the study of efficiency of the combined (calcium channel blocker – amlodipin besilat and angiotensin II receptor antagonist – valsartan) antihypertensive treatment in patients with arterial hypertension combined with diabetes mellitus from the start of the treatment in the practice of primary care physician.&#x0D; Methods of the investigation included physical examination, general clinical, instrumental and laboratory methods, monitoring of side effects.&#x0D; As a result it was found, that combined antihypertensive treatment (amlodipin and valsartan) is effective and safe in patients with arterial hypertension and diabetes mellitus of 2 type, which helps to reach the target level of arterial pressure in 72 % of patients and can be recommended from the beginning of the treatment in the practice of family physician. Maximal effect of the treatment in patients with arterial hypertension of II-III degree and diabetes mellitus of 2 type was observed only at 12th week of treatment. At combined antihypertensive treatment (amlodipin and valsartan) they observed tendency to the reduction of left ventricle hypertrophy. Despite the rate and percentage of the reaching of target arterial pressure were lower in the group of patients, which have diabetes mellitus of 2 type, it is necessary to recommend more active modification of the way of life in the named group of patients. It was found reduction of heart and vascular risks in the group of patients with arterial hypertension II–III degree with diabetes mellitus 2 type. This makes the basis for more active modification of life style and using from the start of the treatment combined antihypertensive therapy immediately. Consider all found results using from the start of the treatment combined antihypertensive therapy immediately by the primary care physician is proved for patients with arterial hypertension combined with diabetes mellitus.&#x0D; Accumulated materials (including theoretical reviews, demonstrative poster reports etc.) are used at training of interns in speciality «general practice – family medicine», during practical classes for higher courses education in national and English languages

Skin Diseases in Patients With Primary Psychiatric Conditions in Northern India: A Cross-Sectional Study.

The relationship between skin diseases and psychiatric illnesses is bi-directional and is manifested as cause and effect. Psychiatric disorders such as stress, anxiety, and depression are seen to be instrumental in the development and progression of dermatological diseases on one hand, while on the other hand, cosmetic disfigurement caused by dermatological diseases is responsible for psychological distress in patients. The present study was conducted to investigate the spectrum of dermatological disorders in psychiatric patients to offer them holistic treatment andprovide them with a better quality of life. This cross-sectional, observational study wasconducted at a tertiary medical care center. A total of 170 psychiatric patients referred to the dermatology department for different dermatological manifestations were enrolled in the study. A demographic profile of the patients was done, and an association between dermatological diseases and psychiatric illnesses was done. Out of 170 study participants, 88 (51.8%) were females, and the rest (82, 48.2%) were males.A total of 13 major types of dermatological conditions were noted; among them, fungal infection (43, 25.3%) was the most common, followed by eczema (18, 10.6%), parasitic infestation (17, 10.0%), pigmentary disorder (13, 7.6%), acne (11, 6.5%), bacterial infection (11, 6.5%), pruritic disorder (11, 6.5%), hair disorder (9, 5.3%), drug reaction (9, 5.3%), papulosquamous disorder (7, 4.1%), and viral infection (6, 3.5%). Skin conditions other than the above-mentioned were present in 15 (8.8%) patients.The most common psychiatric illness in the present study was major depressive disorder (41, 24.1%), followed by generalized anxiety disorder (38, 22.4%) and psychosis not otherwise specified (34, 20.0%). Other psychiatric illnesses included in the study were bipolar affective disorder (22, 12.9%), schizophrenia (18, 10.6%), obsessive-compulsive disorder (12, 7.1%), and mixed anxiety depressive disorder (5, 2.9%). The findings of the present study depict that psychiatric patients with dermatological manifestations show a spectrum of dermatological conditions, primarily of infectious (fungal, parasitic, or viral) nature. This might be associated with a relatively poor hygienic status of psychiatric patients and thus their increased susceptibility to these disorders. Most of the time, the susceptibility to these skin conditions seemed to be opportunistic and unaffected by the type, duration, and level of control of psychiatric illness.

Body image perception and physical activity behavior among adult population: Application of trans-theoretical model of behavior change.

The human body changes during life, but research on how sociodemographic characteristics and physical activity (PA) related to all aspects of body image are still unclear and there is conflict in the relevant results. This study aims to examine gender-specific body image perception and physical activity in relation to BMI and sociodemographic characteristics among health employees who worked in health and medical care centers. The study was a population-based cross-sectional survey of 170 health employees (55 men and 115 women) in Binaloud, Iran. Participants completed a self-administered questionnaire, which consisted of a self-administered Multidimensional Body-Self Image Questionnaire (MBSRQ) and stages of change scales. The full version of Marcus-TTM based on the stages of physical activity changes was used based on 5 items related to regular physical activity behavior and intentions. There were no significant differences between men and women in total body image score, body area satisfaction, and attitude. Disease orientation (p = 0.02) and health orientation (p = 0.05) were the only significant differences between men and women. The number of children, level of education, BMI, and PA had a stronger influence on body image concerns and body dissatisfaction. PA and 7 of the 10 subclasses of MBSRQ (appearance evaluation, fitness evaluation, fitness orientation, health evaluation, health orientation, and illness orientation) showed a significant difference (P<0.05) between participants in the five TTM stages. The ideal body image and body satisfaction may differ by the number of children, level of education, gender, BMI, and PA. Evidence from this study supports that participants' stages of change affect their physical activity and body image perception. This result suggests a need for conducting work/home place intervention to promote adults' body image perception and body area satisfaction based on the usage-specific stage under consideration.

Lived Experience of Adult With Heart Failure at Tibebe Ghion Specialized Teaching Hospital Northwest Ethiopia, Qualitative Phenomenological Study.

Heart failure is major public health problem that affects many people worldwide. It affects all aspects of patients' lives, leading to extreme physical, social, and functional restriction and increasing psychological distress. The purpose of this study was to explore the lived experience of adult patient with heart failure at Tibebe Ghion Specialize Hospital, Ethiopia, 2022. Qualitative Phenomenological study design was conducted at Tibebe Ghion Specialized Referral Hospital, from November 10 to December 15, 2022. Heterogenous purposive sampling technique was used to select 11 study participants. Data were collected through in-depth interviews guides and observational checklist. The rigor and trustworthiness of the study were maintained by transferability, dependability, credibility, and conformability. Thematic analysis method was used for the development of codes and themes using ATLAS. ti.7 software for analysis. Five main themes and eleven subthemes were developed that explore the lived experience of adults with heart failure. Impact of heart failure on daily life, psychological and spiritual experiences, financial experiences, experiences related to hospital service, and challenges to getting treatment are major themes. Unavailability of medicine, lab investigations, and the inaccessibility of cardiac centers were the main challenges during their treatment. This study explored that lived experience of adult HF patients were addressed in in terms of Physical, Psychological and Spiritual, financial, hospital service and challenges to get treatment. Therefore, we recommended providing psychological and economical support for HF patients and in addition to accessing medication and medical care centers.

Use of stool color card as screening tool for biliary atresia in resource-constraint country.

The study was aimed to find out the efficacy of a stool color card (SCC) in differentiating biliary atresia (BA) from non-BA in resource-limited countries. stool color screening system was introduced in 2004 which lead to marked improvement in sensitivity of detecting BA. This cross-sectional observational study was conducted from January, 2019 through July, 2022 on purposively sampled infants who developed jaundice before three months of age, had direct bilirubin of > 20 % of total with pale stool and dark urine. 144 cases (male, 96) were included in the study and their mean age at admission was 87.3±37.2 days and mean age at onset of jaundice was 6.1±7.7 days. BA was confirmed in 106 (73.6%) cases and 38 (26.4%) children were in non-BA group. Frequency of persistent pale stool between BA and non- BA were 88 vs 8 (83.0 % Vs 21.0 %) which was highly significant (p=0.000). Mean difference of total and direct serum bilirubin, median alanine transferase and alkaline phosphatase were not statistically significant between two groups. Median of serum gamma glutamyl transpeptidase (GGT) in BA was 570 U/L and in non-BA it was 138.0 U/L which was statistically significant (p=0.000). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SCC were 83%, 78.9%, 91.7%, 62.5% and 81.9% respectively. SCC has good sensitivity to diagnose BA but failed to prove better specificity to rely simply on it. SCC may be used as early screening tool for prompt referral to appropriate medical care centers for final evaluation of BA.