Medical Problems Research Articles

Ongoing decision-making dilemma for treatment of de novo spinal infections: a comparison of the Spinal Infection Treatment Evaluation Score with the Spinal Instability Spondylodiscitis Score and Spine Instability Neoplastic Score.

De novo spinal infections are an increasing medical problem. The decision-making for surgical or nonsurgical treatment for de novo spinal infections is often a non-evidence-based process and commonly a case-by-case decision by single physicians. A scoring system based on the latest evidence might help improve the decision-making process compared with other purely radiology-based scoring systems or the judgment of a single senior physician. Patients older than 18 years with an infection of the spine who underwent nonsurgical or surgical treatment between 2019 and 2021 were identified. Clinical data for neurological status, pain, and existing comorbidities were gathered and transferred to an anonymous spreadsheet. Patients without an MR image and a CT scan of the affected spine region were excluded from the investigation. A multidisciplinary expert panel used the Spine Instability Neoplastic Score (SINS), Spinal Instability Spondylodiscitis Score (SISS), and Spinal Infection Treatment Evaluation Score (SITE Score), previously developed by the authors' group, on every clinical case. Each physician of the expert panel gave an individual treatment recommendation for surgical or nonsurgical treatment for each patient. Treatment recommendations formed the expert panel opinion, which was used to calculate predictive validities for each score. A total of 263 patients with spinal infections were identified. After the exclusion of doubled patients, patients without de novo infections, or those without CT and MRI scans, 123 patients remained for the investigation. Overall, 70.70% of patients were treated surgically and 29.30% were treated nonoperatively. Intraclass correlation coefficients (ICCs) for the SITE Score, SINS, and SISS were 0.94 (95% CI 0.91-0.95, p < 0.01), 0.65 (95% CI 0.91-0.83, p < 0.01), and 0.80 (95% CI 0.91-0.89, p < 0.01). In comparison with the expert panel decision, the SITE Score reached a sensitivity of 96.97% and a specificity of 81.90% for all included patients. For potentially unstable and unstable lesions, the SISS and the SINS yielded sensitivities of 84.42% and 64.07%, respectively, and specificities of 31.16% and 56.52%, respectively. The SITE Score showed higher overall sensitivity with 97.53% and a higher specificity for patients with epidural abscesses (75.00%) compared with potentially unstable and unstable lesions for the SINS and the SISS. The SITE Score showed a significantly higher agreement for the definitive treatment decision regarding the expert panel decision, compared with the decision by a single physician for patients with spondylodiscitis, discitis, or spinal osteomyelitis. The SITE Score shows high sensitivity and specificity regarding the treatment recommendation by a multidisciplinary expert panel. The SITE Score shows higher predictive validity compared with radiology-based scoring systems or a single physician and demonstrates a high validity for patients with epidural abscesses.

IMPROVE THE EFFECTIVENESS OF PREDICTIVE MODELS FOR LENGTH OF HOSPITAL STAY (LOS) BY ADDING ELECTRONIC HEALTH RECORDS DATA: A RETROSPECTIVE STUDY IN PATIENTS WITH HEART FAILURE

Abstract Background Length of hospital stay (LOS) is considered a key process that has a clinical, economic, and organizational impact representative of the quality of care. In particular, in patients with heart failure (HF), which is a life–threatening multifactorial syndrome and a major public health problem, when a prolonged LOS (PLOS) occurs, frequent readmission and high mortality are common, with worrying consequences for health systems. Although the LOS is often explained by standard medical data (e.g., comorbidities), it may depend on many other patient characteristics. Therefore, considering additional elements collected in electronic health records (EHRs) could be crucial to predict the occurrence of a LOS and correctly estimating this risk. The aim of this study is to demonstrate the predictive power of clinical and organizational data collected through an EHR on LOS in HF patients. Methods A descriptive, retrospective study was conducted in an Italian university hospital. Data related to HF inpatients consecutively admitted across 1 year were collected from the hospital’s HER. PLOS was defined as a stay ≥ 14 days. Sociodemographic data, administrative data, and clinical data (such as the number of active medical problems, the number of medications, frailty, and nursing dependency), were tested in a predictive model as potential determinants of LOS. Results A total of 608 HF patients were included. The mean age of patients was 76 ± 13.06 years (range: 23–102); 61.5% were male. Prolonged LOS was found in 25.2% of patients. The univariable linear regression model explained 10.2% of LOS variance. Being female, living without social support, having an increased number of previous admissions and nursing dependency, being dependent on functional status, having a worse behavior pattern and mobility, and experiencing a sensory deficit were significant determinants (p &amp;lt; .05) of LOS. Conclusion The inclusion of EHRs data in addition to clinical variables, can help clinicians and researchers to improve the predictive ability on LOS, ensuring its early identification and ultimately enhancing the patients’ health outcomes through the implementation of targeted interventions.

Age-related and species-specific methylation changes in the protein-coding marmoset sperm epigenome.

The sperm epigenome is thought to affect the developmental programming of the resulting embryo, influencing health and disease in later life. Age-related methylation changes in the sperm of old fathers may mediate the increased risks for reproductive and offspring medical problems. The impact of paternal age on sperm methylation has been extensively studied in humans and, to a lesser extent, in rodents and cattle. Here, we performed a comparative analysis of paternal age effects on protein-coding genes in the human and marmoset sperm methylomes. The marmoset has gained growing importance as a non-human primate model of aging and age-related diseases. Using reduced representation bisulfite sequencing, we identified age-related differentially methylated transcription start site (ageTSS) regions in 204 marmoset and 27 human genes. The direction of methylation changes was the opposite, increasing with age in marmosets and decreasing in humans. None of the identified ageTSS was differentially methylated in both species. Although the average methylation levels of all TSS regions were highly correlated between marmosets and humans, with the majority of TSS being hypomethylated in sperm, more than 300 protein-coding genes were endowed with species-specifically (hypo)methylated TSS. Several genes of the glycosphingolipid (GSL) biosynthesis pathway, which plays a role in embryonic stem cell differentiation and regulation of development, were hypomethylated (<5%) in human and fully methylated (>95%) in marmoset sperm. The expression levels and patterns of defined sets of GSL genes differed considerably between human and marmoset pre-implantation embryo stages and blastocyst tissues, respectively.

Complex Pythagorean Normal Interval-Valued Fuzzy Aggregation Operators for Solving Medical Diagnosis Problem

This paper presents a new methodology for solving multiple-attribute decision-making problems (MADMs) using a complex Pythagorean normal interval-valued fuzzy set (CPNIVFS), which is an extended concept of a complex Pythagorean fuzzy set. Four types of different aggregating operations (AOs), including CPNIVF weighted averaging (CPNIVFWA), CPNIVF weighted geometric (CPNIVFWG), generalized CPNIVFWA (CGPNIVFWA), and generalized CPNIVFWG (CGPNIVFWG), are discussed. The scoring function, accuracy function, and operational laws of the CPNIVFS are defined. Algebraic structures, such as associative, distributive, idempotent, bounded, commutativity, and monotonicity properties, are also shown to be satisfied by complex Pythagorean normal interval-valued fuzzy numbers. Furthermore, an algorithm is proposed to solve the MADM problems based on the defined AOs. The proposed approach is then used for a medical diagnosis problem about brain tumors because computer science and machine tool technology are among the most important components of brain tumor research. The five types of brain tumors diagnosed in these patients are gliomas, meningiomas, metastases, embryonal tumors, and ependymomas. Several types of treatments are available, which are often combined as part of an overall treatment plan. Brain tumors can be treated in various ways, including surgery, radiation therapy, chemotherapy, immunotherapy, and clinical trials. Based on the comparisons and options gathered, the most suitable treatment can be chosen. In this regard, it is evident that the value of the integer ⅁\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\Game $$\\end{document} plays a significant role in determining the model. The candidate models under consideration can be validated by comparing them with the previously proposed ones. The proposed technique is compared with the existing method to demonstrate its superiority and validity, and the results conclude that the former is more reliable and effective than the latter. Finally, the criteria are evaluated by expert assessments to determine the most appropriate options.

Safety and efficacy of Yaobitong capsules for lumbar disc herniation: A multicenter, randomized, double-blinded, parallel, positive-controlled clinical trial.

Lumbar disc herniation (LDH) is one of the most common diseases and is a global medical and socioeconomic problem characterized by leg or back pain, weakness in the lower extremities and paresthesia. A multicenter, randomized, double-blinded, parallel, positive-controlled clinical trial was conducted to evaluate the efficacy and safety of Yaobitong capsules (YBT) for LDH. Patients (n = 479) were recruited and randomized into YBT and Jingyaokang capsule (JYK) groups (the positive control), and received YBT or JYK at a dose of 3 capsules 3 times per day after a meal for 30 days. The primary efficacy outcome was the Oswestry Disability Index (ODI), with the visual analogue scale (VAS) used as the secondary efficacy outcome. The adverse events and adverse reactions were also evaluated. There was no significant difference in baseline characteristics between YBT (n = 358) and JYK groups (n = 120), and no difference was observed between groups for mean ODI score at day 0 (p = 0.064) or day 7 (p = 0.196), but there were differences at days 14, 21 and 30 (p < 0.001). The YBT showed more decline from baseline, and the decreased ODI score was substantially different from JYK (p < 0.001). The differences in decreased VAS scores between YBT and JYK were also significant at each time point (days 7, 14, 21, and 30), with better scores in the YBT group than in the JYK group (p < 0.001). In terms of safety, there was no obvious disparity in adverse events or adverse reactions between the 2 groups (p > 0.05). Yaobitong was better than JYK for LDH treatment, with no significant difference in safety. The study suggests that YBT is a promising and effective treatment for LDH.

GERIATRIC ASPECTS OF THE ORGANIZATION OF MEDICAL-SOCIAL, PALLIATIVE AND HOSPICE CARE IN THE CONDITIONS OF THE WAR: COMBINATION OF MEDICAL, PSYCHOLOGICAL AND SOCIAL PROBLEMS

The aim of the study is to characterize, from the point of view of geriatric aspects, the current problems of the organization of medico-social, palliative and hospice care (PHC) and social services for palliative care in the war conditions based on multidisciplinary, interagency and inter-sectoral approaches, as well as a combination of medical, psychological and social problems. Materials and methods. The research materials were scientific literary sources and regulatory documents. A pilot survey of 200 people was conducted to study the psychological state and psychological support needs of the elderly and internally displaced persons (IDPs). The survey results of 3,705 client’s questionnaires of the “Vseturbota” Project were also evaluated, of which 63.6 % are people aged 67-84 years, 26.4 % are 85–101 years old. The following research methods were used in the work: bibliosemantic, sociological, system approach and system analysis. Results and discussion. After February 24, 2022, IDPs will experience significant difficulties, suffer from reduced income, increased dependence on humanitarian aid, do not feel safe and protected. All these are reflected in their psychological state. It was found that among respondents aged ≥75 years had the most people with medium (57.1 %) and low (25.0 %) levels of anxiety, 71.4 % had a low level of mood. 32.17 % of the “Vseturbota” Project clients needed additional consultation with a family doctor, 3.83 % needed consultation with a psychologist, and 3.35 % with other specialists. Most often, they needed help around the house (26.02 %), buying medicines/foodstuff (22.43 %), 34.97 % needed information, and 13.36 % needed psychological counseling. An important condition for providing geriatric patients, including IDPs, with affordable, high-quality and effective PHC is the creation of a system and service of ambulatory/mobile and inpatient PHC facilities and medico-social care. Conclusions. The military aggression of the Russian Federation caused considerable suffering to the population of Ukraine. The state of anxiety and fear has a negative impact not only on the psycho-emotional, but also on the physical sphere of the elderly, which necessitates the implementation of psychological services and effective strategies for overcoming stress and distress, which requires the development and implementation of mechanisms for interagency coordination and cooperation, involving and training of multidisciplinary teams’ specialists and volunteers, effective advocacy activities, etc.

High efficacy treatment of murine Pseudomonas aeruginosa catheter-associated urinary tract infections using the c-di-GMP modulating anti-biofilm compound Disperazol in combination with ciprofloxacin.

Persistent urinary tract infections (UTIs) in hospitalized patients constitute an important medical problem. It is estimated that 75% of nosocomial UTIs are associated with urinary tract catheters with P. aeruginosa being a species that forms biofilms on these catheters. These infections are highly resistant to standard-of-care antibiotics, and the effects of the host immune defenses, which allows for development of persistent infections. With antibiotics losing their efficacy, new treatment options against resilient infections, such as catheter-associated urinary tract infections (CAUTIs), are critically needed. Central to our anti-biofilm approach is the manipulation of the c-di-GMP signaling pathway in P. aeruginosa to switch bacteria from the protective biofilm to the unprotected planktonic mode of life. We recently identified a compound (H6-335-P1), that stimulates the c-di-GMP degrading activity of the P. aeruginosa BifA protein which plummets the intracellular c-di-GMP content and induces dispersal of P. aeruginosa biofilm bacteria into the planktonic state. In the present study, we formulated H6-335-P1 as a hydrochloride salt (Disperazol), which is water-soluble and facilitates delivery via injection or oral administration. Disperazol can work as a monotherapy, but we observed a 100-fold improvement in efficacy when treating murine P. aeruginosa CAUTIs with a Disperazol/ciprofloxacin combination. Biologically active Disperazol reached the bladder 30 min after oral administration. Our study provides proof of concept that Disperazol can be used in combination with a relevant antibiotic for effective treatment of CAUTIs.

Prevalence of Chronic Rhinosinusitis in the Jazan Region of Saudi Arabia

Background: Chronic rhinosinusitis (CRS) is one of the most common medical problems worldwide. It has a significant impact on the quality of life and productivity of many people. The prevalence of CRS varies throughout the world. In this study, we evaluated the prevalence of CRS in the Jazan region of Saudi Arabia. Methods: We conducted a cross-sectional study, using an online questionnaire to collect data on demographic, Sinonasal outcome test-22 (SNOT-22), chronic diseases, and smoking status. The prevalence was estimated based on the established diagnosis and a high SNOT-22 score with the presence of three of the cardinal symptoms of CRS. Variables associated with the presence of CRS were evaluated. Results: The 1081 contributors that met our inclusion criteria included 594 males and 487 females with a median (interquartile range) age of 31 (17) years. More than half of all participants (n = 653, 60.4%) had high SNOT-22 (&gt;18/110), but many did not fulfill the criteria for CRS in this study. Of the 1081, 215 had an established diagnosis and had three or more of the cardinal symptoms of CRS. In addition, 134 cases had not been clinically evaluated before but were suffering from three or more of the cardinal symptoms of CRS. Based on this, the estimated prevalence of CRS among our sample was 349 CRS patients (32.3%). CRS was less in people from mountainous areas (24.8%, P = 0.020). Conclusions: CRS was more prevalent in the hotter plains and coasts than in the mountains. Further studies are warranted to estimate the annual incidence and the impact on the health-care services as well as on the occupational and personal lives of the individuals.

Assessment of weaning practices among mothers for their infants attending the Pediatric Outpatient Department of Sindh Government Hospital Paretabad Hyderabad.

General Objective: To assess the weaning practices among mothers for their infants those attending the pediatric outpatient department of Sind Government Hospital, Paretabad, Hyderabad.Specific objectives:1. To determine the age of onset of weaning2. To determine the type of weaning food3. To determine the level of education and its relation to weaningMethods: It was a cross-sectional study conducted at Sind Government Hospital, Paretabad, Hyderabad, duringthe period of 15th May 2008 to 15th June 2008. We had included all the patients according to the inclusion criteriaand did not do sampling. Data was collected by principal investigator herself on a pre-formed, pre – tested questionnaire about weaning practices among mothers for their infants. Respondents were mothers/care givers accompanying their infants who were interviewed in their own language to avoid inconvenience. The operationaldefinitions of variables were already set before the starting of data collection process. The study population included all new patients visiting in out patient department of Sindh Government Hospital Paretabad, Hyderabadduring the study period. The variables included the basic demographic variables i.e. age, residence, occupation,education and socio-economic status of mothers, age of onset of weaning, type of first food given as weaning,hygienic practices of mothers etc.The exclusion criteria included prematurely borne infants, those revisiting OPD, and those who visited the facilityfor acute medical problems that required hospitalization.Result: Among 307 infants aged 3-12 months registered, males were 54.1% in comparison to females (45.9%).The majority of the mothers visiting the facility belonged to slum areas (79.2%). Regarding maternal attitudesand practices of weaning, 67 (21.8%) mothers considered cow’s milk as a weaning diet while majority of them i.e.240 (78.2%) were of the opinion that semisolids were the weaning foods. About 24.8% mothers started weaningearlier and only 47.6% of them started to give weaning food to their infants between ages 3 – 6 months. A strongassociation is evident between socio- economic status of mothers and the use of commercial weaning foods(p=0.01). The study concludes that there is a dire need of promoting among mothers the norms of giving properweaning foods to their infants.

Fibroblast growth factor 21 (FGF21): diagnostic, prognostic and therapeutic aspects in heart failure. A review

Chronic heart failure (CHF) is a global medical, social and economic problem. Currently, the search and study of new biomarkers that can provide early diagnosis of CHF, serve as a laboratory tool for assessing the effectiveness of treatment, or be used as prognostic markers and risk stratification criteria are ongoing. Scientists' interest is focused, in particular, on studying the role of fibroblast growth factor 21 (FGF21) in CHF. There is increasing evidence highlighting the value of FGF21 as a new marker for the diagnosis and assessment of prognosis in patients with CHF. The role of FGF21 in CHF is very interesting due to its cardioprotective aspects. Final confirmation of the diagnostic, prognostic and therapeutic roles of FGF21 will come from future studies.

The Role of Oxidative Stress and Inflammatory Parameters in Heart Failure

Heart failure (HF) remains a major medical and social problem. The NT-pro-brain natriuretic peptide (NT-proBNP) and its active form, brain-type natriuretic peptide (BNP), in a simple blood test are the gold-standard biomarkers for HF diagnosis. However, even good biomarkers such as natriuretic peptides fail to predict all the risks associated with HF due to the diversity of the mechanisms involved. The pathophysiology of HF is determined by numerous factors, including oxidative stress, inflammation, neuroendocrine activation, pathological angiogenesis, changes in apoptotic pathways, fibrosis and vascular remodeling. High readmission and mortality rates prompt a search for new markers for the diagnosis, prognosis and treatment of HF. Oxidative-stress-mediated inflammation plays a crucial role in the development of subsequent changes in the failing heart and provides a new insight into this complex mechanism. Oxidative stress and inflammatory biomarkers appear to be a promising diagnostic and prognostic tool in patients with HF. This systematic review provides an overview of the current knowledge about oxidative stress and inflammation parameters as markers of HF.

Effect of weight loss and exercise on joint pain in patients with osteoarthritis and obesity

Osteoarthritis (OA), the most common joint disease, coexists with obesity in most of the world’s population. According to the forecast of the World Health Organization, the number of patients with these diseases is expected to increase, which represents a serious medical and social problem due to increased disability, the need for surgical treatment, an increase in comorbid diseases, treatment complications and mortality in this group of patients. OA and obesity have common pathogenetic mechanisms, and the development of one disease increases the risk of developing the other, which can become the beginning of a vicious circle. In recent years, obesity is considered not only as a biomechanical factor (excessive load on the joint, destruction of articular cartilage), but also as a cause of metabolic syndrome and systemic inflammatory effects. Inflammatory cytokines, especially IL-1β and TNF-α, drive catabolic pathways and promote the progression of OA. There is compelling evidence that weight loss reduces pain and joint inflammation and improves prognosis in patients with OA. The review presents data on the prevalence of OA and obesity, the role of immune disorders in these diseases, and indicates methods of pharmacological and non-pharmacological treatment of OA. General principles and specific updated recommendations of the European League Against Rheumatism for non-drug treatment of OA of the hip and knee joints are outlined, and recommendations for weight loss through dietary interventions and exercise are formulated.

Lessons Learned in Building Expertly Annotated Multi-Institution Datasets and Hosting the RSNA AI Challenges.

The Radiological Society of North America (RSNA) has held artificial intelligence competitions to tackle real-world medical imaging problems at least annually since 2017. This article examines the challenges and processes involved in organizing these competitions, with a specific emphasis on the creation and curation of high-quality datasets. The collection of diverse and representative medical imaging data involves dealing with issues of patient privacy and data security. Furthermore, ensuring quality and consistency in data, which includes expert labeling and accounting for various patient and imaging characteristics, necessitates substantial planning and resources. Overcoming these obstacles requires meticulous project management and adherence to strict timelines. The article also highlights the potential of crowdsourced annotation to progress medical imaging research. Through the RSNA competitions, an effective global engagement has been realized, resulting in innovative solutions to complex medical imaging problems, thus potentially transforming health care by enhancing diagnostic accuracy and patient outcomes. Keywords: Use of AI in Education, Artificial Intelligence © RSNA, 2024.

Adult Cancer Patients' Perceptions of Factors That Influence Hospital Admissions.

To explore cancer patients' perceptions of factors that influence hospital readmissions. A cross-sectional, prospective design was employed utilizing a 1-time survey and brief interviews to measure patients' perceptions and unplanned hospital admissions. The principal investigator collected data from medical record review, the Hospital Admission Survey, and interviews to measure patient characteristics and perceptions of influencing factors that contributed to an unplanned hospital admission upon admission. Data were analyzed using descriptive statistics to categorize patient perceptions of influencing factors of unplanned hospital admissions. The top reasons for admission were symptoms of uncontrolled gastrointestinal, pain, fever, and respiratory problems. The majority perceived the admission was unavoidable and wanted to avoid an admission. Perceived influencing factors were related to survey categories of 1) communication (ie, cannot reach physician anytime, cannot get a next-day appointment, medical problems are out of control, advised to go to the emergency department) and 2) home environment (ie, unable to adequately manage symptoms at home and hospital admission is the best place for care). Other survey categories of patient education and palliative care were not perceived as influencing or contributing factors. These findings highlight opportunities for clinical nurse specialists to target these vulnerable patients and provide expert consultation to address potential barriers and gaps in utilization of appropriate supportive services that may reduce unplanned hospital admissions.

Организационные аспекты домашней телереабилитации пациентов, перенесших инсульт.

Restoring neurological functions after a stroke is one of the main medical and social problems of the 21st century. Telemedicine technologies increase the accessibility and coverage of medical care for patients living remotely from medical organizations, with limited mobility, and also during periods of pandemics. However, to date there are no methodological recommendations for making management decisions on organizing home telerehabilitation for patients who have suffered a stroke. This is due to the comparative novelty of technologies and insufficient knowledge of clinical studies, absence or lack of managerial experience. Therefore, the purpose of this article – develop a methodological framework for drawing up methodological recommendations when making management decisions on organizing home telerehabilitation after a stroke, which is a relevant area in the context of the digital transformation of healthcare. Materials and methods. The study was conducted using analytical methods and information retrieval. Results. Matrices have been developed to assess the readiness of the patient and the medical organization to conduct personalized telerehabilitation. A management decision-making scheme is proposed to assess the possibility of organizing telemedicine rehabilitation of a post-stroke patient at home. Findings. The results of the study may be useful to healthcare organizers and become the basis for the development of methodological recommendations when making management decisions on organizing home telerehabilitation for patients of the relevant profile.

Acute heat trauma model in rats, gender-dependent thermoresistance, and screening of potential thermoprotectors

Heat trauma (HT) is an urgent medical and social problem. Heat damage is a widespread effect of the environment on humans, driven by global warming, military conflicts, technological disasters, work in hot environments, and engagement in extreme sports and tourism. The aim of the study: to propose a model of acute HT in rats that does not cause the death of animals, to determine the dependence of thermoresistance on gender, and to compare the effectiveness of the thermoprotective effects of a range of non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, and glucosamine hydrochloride in this model. Materials and Methods: The experiment was conducted on adult white rats of both genders. Acute HT was modelled by using a specially developed method involving heat exposure to animals at +55 °C for 30 minutes, followed by a recovery period of 60 minutes. Rectal temperature was measured every 15 minutes. The degree of hyperthermia in males and females was determined. The presence and intensity of the thermoprotective effect of glucosamine hydrochloride (G h/ch), diclofenac sodium, acetylsalicylic acid (ASA), nimesulide, etoricoxib, celecoxib, and paracetamol were evaluated through intragastric administration 60 minutes before heat exposure. The results were analyzed using the STATISTICA 12.0 program. Results: It was established that heat exposure at +55 °C for 30 minutes effectively replicates acute HT in rats without causing animal fatalities, adhering to bioethical requirements. Body temperature increases by 10-13 %, characterized as a heat stroke. Occasionally, thermoresistant animals are encountered, where the temperature increase during the first 15 minutes of exposure is less than 1 °C. These animals should not be used for further modelling of heat trauma. Male rats are more sensitive to the effect of high environmental temperatures than females, exhibiting greater hyperthermia (temperature increase of 5.03±0.39°C compared to 3.72±0.22 °C in females, p&lt;0.01). The thermoprotective effect of glucosamine hydrochloride depends on gender, being more pronounced in males. Among the 6 tested COX inhibitors, the most significant thermoprotective effect was observed in the highly selective COX-2 inhibitor celecoxib and the weakly selective central inhibitor paracetamol, warranting in-depth research into their impact on organ and system states following heat trauma, as well as the mechanisms of their thermoprotective action. The thermoprotective effect is not associated with selectivity towards COX (cyclooxygenase): it is not observed in the highly selective COX-2 inhibitor etoricoxib and moderately selective COX-2 inhibitor nimesulide, as well as in non-selective COX inhibitors such as diclofenac sodium and aspirin, which also slows down the recovery of body temperature after heat exposure. Conclusions: A convenient and simple model of acute HT in rats is proposed, demonstrating higher thermosensitivity and a more pronounced thermoprotective effect of glucosamine hydrochloride in males. A significant thermoprotective effect was identified in celecoxib and paracetamol, surpassing other investigated NSAIDs. The mechanism and specific features of this effect require further clarification

Criminal Liability Arising from Medical Malpractice on Patients: A Review from the Perspective of Positive Law And Islamic Law

The suspicion in cases of medical malpractice in is only slightly raised, meanwhile, there are actions by the health profession by doctors as medical personnel which have the potential to be a malpractice that can be reported by the public, but are not resolved legally because the community only has limited knowledge of science medical and because there is no form of specific legal regulations governing malpractice in Indonesia so that the occurrence of these malpractices can cause legal problems. This study aims to determine criminal liability for medical malpractice acts committed by doctors to patients in anticipating and dealing with medical malpractice problems in criminal cases. The research method used in this study is doctrinal, where the author collects material from the literature, both hardcopy and softcopy, which is related to the title of this research by using an analysis of the research object. Criminal malpractice occurs when a patient dies or is disabled and/or seriously injured as a result of actions taken by health workers who are careless or less careful in making efforts to treat patients who die or are disabled and are criminally liable as a result of medical malpractice acts committed. doctors on patients can be accounted for under Article 359 and Article 360 of the Criminal Code. In this case the health law is considered insufficient and does not clearly regulate the crime of medical malpractice. So it is necessary to regulate the crime of medical malpractice by giving birth to a new health law, namely by explicitly regulating criminal liability for medical malpractice acts by doctors against patients in Indonesia.

Forensic, medical and legal problems and solutions on passenger and cargo ships

Marine vehicles have an important place in international trade and tourism. There are various directives and studies on the prevention of health problems in marine vessels and injuries and deaths due to occupational accidents. In the literature, not enough studies have been found in which the issues to be considered in cases of injuries, sexual assaults, accidents, suicides and murders that are common in forensic medicine practice, and there are no guidelines or recommendations of internationally accepted organizations. It is important to determine the seafarer who is responsible for intervening in health emergencies on cargo ships, and to detect faulty ones, if any, in work accidents that result in serious injury and death. In addition, injuries, suicides and murders are encountered among the crew, and crime scene findings are lost until they are evaluated by the judicial authorities. Although rare, sexual assaults on cargo ships are also reported, but there are not enough scientific studies that indicate what should be done in terms of evidence evaluation. Our study emphasizes the issues to be considered, that one of the crew should be held responsible and necessary training should be given in order to make a forensic medical evaluation in forensic events that will be encountered on cargo ships, and that physicians and health workers should be competent in the first forensic medical evaluation in case of emergency on passenger ships. It is thought that the launch of the telemedicine application, which provides uninterrupted service for forensic medical emergencies in maritime vessels, under the leadership of organizations such as the “International Maritime Organization” (IMO), will make a significant contribution. In addition, suggestions are made for legal impasses in such cases that take place in high seas.

Pharmacist intervention to improve adherence to medication among heart failure patients at North East Ethiopia hospital.

Heart failure (HF) is a major and growing medical problem and its management is still challenging due to the coexistence of complications, co-morbidity, and medication non-adherence. HF patients who are adherent to their medication have fewer HF exacerbations, improved survival, and lower healthcare expenditure. Adherence to HF medication plays a pivotal role in attaining maximal therapeutic outcomes. The aim was to assess the medication adherence of heart failure patients at Debre Berhan Comprehensive Specialized Hospital (DBCSH). A pre-post interventional study was undertaken from July 1, 2022, to December 31, 2022, at the medical referral clinic of DBCSH. The educational interventions were provided for 6 months. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics and binary logistic regression analysis were performed. The strength of the association between predictor variables and outcome variables was determined using a 95% confidence interval and adjusted odd ratio. In the pre-intervention phase, 54.6% of patients had medium medication adherence, while in the post-intervention phase, 36.4% of patients had high medication adherence and 61.9% of patients had medium medication adherence. Following the intervention, medication cost (120, 50%), inadequate availability of drugs (75, 31%), and forgetfulness (30, 13%) were the main reasons for medication non-adherence. The presence of co-morbidity and the number of co-morbidity (p < .05) were significantly associated with the occurrence of decreased medication adherence in the pre-intervention phase. Interventions by pharmacists to educate HF patients about the nature of their disease and providing brochures to increase awareness of their medications have been shown to improve medication adherence.

Selective Arterial Embolization for the Management of Large Multinodular Cervicomediastinal Goiter

In the surgical treatment of thyroid disease, surgery of cervicomediastinal goiters has always been a challenge, due to the high risk of intraoperative and postoperative complications, especially excessive bleeding. Case report Fifty-one-year-old female patient with multiple underlying diseases, presenting a large cervical mass resulting to be a large multinodular cervicomediastinal goiter. Underwent selective arterial embolization of vascular branches supplying irrigation to the mass and later a total thyroidectomy with minimum blood loss during the intraoperative time. Conclusion Even if preoperative selective artery embolization is far from being a routine technique in cervicomediastinal goiter surgery, in selected patients who have many underlying medical problems, very voluminous goiter, high bleeding risk or high intraoperative risk, it can be considered a useful and safe procedure.