Permanent Physical Disability Research Articles

Preclinical antivenom-efficacy testing reveals potentially disturbing deficiencies of snakebite treatment capability in East Africa.

BackgroundAntivenom is the treatment of choice for snakebite, which annually kills an estimated 32,000 people in sub-Saharan Africa and leaves approximately 100,000 survivors with permanent physical disabilities that exert a considerable socioeconomic burden. Over the past two decades, the high costs of the most polyspecifically-effective antivenoms have sequentially reduced demand, commercial manufacturing incentives and production volumes that have combined to create a continent-wide vacuum of effective snakebite therapy. This was quickly filled with new, less expensive antivenoms, many of which are of untested efficacy. Some of these successfully marketed antivenoms for Africa are inappropriately manufactured with venoms from non-African snakes and are dangerously ineffective. The uncertain efficacy of available antivenoms exacerbates the complexity of designing intervention measures to reduce the burden of snakebite in sub-Saharan Africa. The objective of this study was to preclinically determine the ability of antivenoms available in Kenya to neutralise the lethal effects of venoms from the most medically important snakes in East Africa.MethodsWe collected venom samples from the most medically important snakes in East Africa and determined their toxicity in a mouse model. Using a ‘gold standard’ comparison protocol, we preclinically tested the comparative venom-neutralising efficacy of four antivenoms available in Kenya with two antivenoms of clinically-proven efficacy. To explain the variant efficacies of these antivenoms we tested the IgG-venom binding characteristics of each antivenom using in vitro IgG titre, avidity and venom-protein specificity assays. We also measured the IgG concentration of each antivenom.FindingsNone of the six antivenoms are preclinically effective, at the doses tested, against all of the most medically important snakes of the region. The very limited snake polyspecific efficacy of two locally available antivenoms is of concern. In vitro assays of the abilities of ‘test’ antivenom IgGs to bind venom proteins were not substantially different from that of the ‘gold standard’ antivenoms. The least effective antivenoms had the lowest IgG content/vial.ConclusionsManufacture-stated preclinical efficacy statements guide decision making by physicians and antivenom purchasers in sub-Saharan Africa. This is because of the lack of both clinical data on the efficacy of most of the many antivenoms used to treat patients and independent preclinical assessment. Our preclinical efficacy assessment of antivenoms available in Kenya identifies important limitations for two of the most commonly-used antivenoms, and that no antivenom is preclinically effective against all the regionally important snakes. The potential implication to snakebite treatment is of serious concern in Kenya and elsewhere in sub-Saharan Africa, and underscores the dilemma physicians face, the need for clinical data on antivenom efficacy and the medical and societal value of establishing independent preclinical antivenom-efficacy testing facilities throughout the continent.

Patterns of psychiatric emergency department utilization among community-dwelling Medicare beneficiaries under 65.

This study estimated patterns and trends in all-cause (any reason, including psychiatry related) and psychiatric emergency department (ED) utilization among Medicare beneficiaries under 65 who were residing in community settings (i.e., noninstitutionalized or in their own homes). Medicare beneficiaries under the age of 65 enrolled in Medicare for Social Security Disability Insurance (SSDI) due to permanent physical or mental disabilities are a population with poor health conditions and high utilization of health services; however, this vulnerable population has received limited attention from researchers and policymakers compared to the Medicare beneficiaries 65 years and older. Data from the 2002-2009 Medicare Current Beneficiary Survey (MCBS) with linked Medicare administrative claims data were used to select a total of 4,864 Medicare beneficiaries under the age of 65 with a total of 10,384 person-years (weighted n = 30,086,846 person-years). We found that trends in all-cause and psychiatric ED utilization among the young and disabled Medicare beneficiaries remained stable, but trends in the proportion of all-cause ED visits that were psychiatric related increased, and trends in the proportion of psychiatric ED visits resulting in a psychiatric inpatient stay decreased over time. Factors associated with a higher likelihood of psychiatric ED utilization included younger age, residence in the Northeast region, lower education level, Medicare-Medicaid dual eligibility, use of psychotropic medication, and greater number of chronic and psychiatric conditions. These findings highlight the need for policies, programs, and system interventions designed to reduce future psychiatric ED events and improve the access and quality of community mental health services for the community-dwelling, young, and disabled Medicare population. (PsycINFO Database Record

Assessment of Cultivable Oral Bacterial Flora from Important Venomous Snakes of India and Their Antibiotic Susceptibilities.

Snakebite is a common, frequently devastating, occupational, socio-economic hazard, and it has a great impact on the rural population of India. Snakebite is a major cause of the human morbidity and mortality since ancient times, as it not only affects the victim by systemic envenomation but also by wound infections originating from deadly pathogenic microorganisms from the oral cavity of the offending snake. The pathogens from the oral cavity of the snake tend to initiate an infection, resulting in gas gangrene, soft tissue necrosis, and permanent physical disabilities. In light of this, the present study is designed to evaluate the oral microbiota of venomous snakes commonly found in India and assessment of their antibiotic susceptibilities. Oral cavity swabs of twenty snakes representing the Indian cobra, Russell's viper, Saw-scaled viper, and Common krait were selected for the study. These materials were enriched using microbiological media to facilitate the growth of bacteria and their subsequent isolation to assess the antibiotic susceptibilities. A total 205 strains were isolated from the oropharyngeal cavity of snakes, which represent the common pathogens, especially Morganella morganii, Escherichia coli, Aeromonas hydrophila, Pseudomonas aeruginosa, coagulase-negative Staphylococcus aureus, Bacillus species, Micrococcus species, and some anaerobes including Clostridium perfringens. The study can conclude that the oral cavity of the snakes has a diversity of Gram-positive and Gram-negative bacteria are susceptible to several antibiotics. The Gram-negative microorganisms showed 100% susceptibility to imipenem and levofloxacin, whereas Gram-positive microorganisms to azithromycin and amoxicillin/clavulanic acid.

Challenges and options for disease vector control

The ongoing Zika virus outbreak, which briefly threatened to put a stop to the 2016 Olympic Games in Brazil, has again focused attention on the threat of vector‐borne diseases. One efficient strategy to battle such diseases, now underway in Brazil to fight the Zika virus, is to kill the insects that carry the pathogen. Vector control has been practised with varying effectiveness for at least half a century, especially for malaria; the Brazil outbreak again highlights the need for integrating existing methods including the use of insecticides, vaccines, drugs and low technology such as sanitation to keep insect vectors at bay. In addition, new approaches are being developed based on sophisticated methods such as genome editing of the insect vector and deliberate infection of mosquitoes with the Wolbachia bacteria. However, attempts to scale up these new methods from field trials to deployment have been slowed down or halted by environmental concerns or public resistance against genetically modified organisms. The Zika outbreak in South America has stimulated cross‐border collaboration of public health authorities and increased pressure to use new integrative approaches that are essential for combatting vector‐borne diseases. The irony is that the Zika virus itself has a minimal global impact compared with other insect‐borne pathogens, but it has attracted enormous publicity because of the risk of causing microcephaly in unborn children, combined with the coincidence of the outbreak during the Olympic year. The exact risk for the foetus is as yet unknown [1], but it is clear that Zika is otherwise a relatively mild disease with no symptoms in the majority of cases (http://www.cdc.gov/zika/symptoms/index.html). By contrast, other mosquito‐borne diseases, including malaria, yellow fever, dengue and chikungunya (CHIKV), are major causes of both mortality and morbidity, responsible for hundreds of millions of cases each year and millions of deaths …

Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

BackgroundLeprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76 % of the reported new cases coming from Oromia and Amhara Regional States. This study was aimed to assess the knowledge, attitude and skill of general health workers in leprosy control activities at public health facilities in Oromia and Amhara Regional States.MethodsA cross-sectional study was conducted from September 2011 to February 2012 at different public health facilities in selected eight zones in Oromia and Amhara Regional States. A multistage sampling method was used to obtain representative samples. High and low endemic zones for leprosy were included in the study in both regional states. Data were collected from general health workers through a structured self-administered questionnaire and at on-site assessment of their performance. Baseline socio-demographic data, health workers’ attitude towards leprosy and their knowledge and skill in the management of leprosy were assessed. Bloom’s cut off point was used to describe the knowledge and practical skills of the respondents while Likert’s scale was used for attitude assessment.ResultA total of 601 general health workers responsible for leprosy control activities at public health facilities were included in knowledge and attitude assessment and 83 of them were subjected to practical evaluation, with on-site observation of how they handle leprosy patients. These included medical doctors (4 %), health officers and nurses with Bachelor degree in Science (27 %), clinical nurses with diploma (66 %) and health assistants (2.8 %). The median age of the respondents was 26.0 years and females made up of 45 %. Generally the knowledge and skills of the respondents were found to be poor while attitude towards leprosy was positive for the majority of the respondents. The result showed that 519 (86.3 %) had poor knowledge. Overall 155 (25.8 %) of the respondents had positive attitude towards leprosy while 205 (34.1 %) had intermediate (mixed) attitude and 241 (40.1 %) had negative attitude to the disease. Among 83 respondents assessed for diagnosis of leprosy only 15(18.0 %) diagnosed leprosy correctly. Variation in knowledge and attitude indicated a significant difference (p < 0.05) among different health institutions, professions, gender, in-service training and years of experience.ConclusionThe current finding underlines that although leprosy control activities are integrated to the general health services in the country, the knowledge and skills of leprosy diagnosis, treatment and management by health workers was unsatisfactory. Hence, attention should be given to develop training strategies that can improve health worker knowledge and promote better leprosy management at public health facilities. This could be achieved through pre-service and in-service training and giving adequate emphasis to leprosy related practical work and continuous follow- up.

Changes in the preferences of US physicians-in-training for medical interventions throughout medical education.

There exists a disparity between the views of physicians and the views of their patients on end-of-life decisions. However, the timing of when the end-of-life preferences of physicians and non-medically-trained individuals diverge is currently unknown. The objective of this paper is to characterise how preferences for medical interventions change throughout medical education and residency or fellowship training when confronted with scenarios of critical or terminal illness. This is a single-centre cross-sectional study that enrolled medical students at Sidney Kimmel Medical College and residents and fellows at Thomas Jefferson University Hospital. Through an online survey we determined the preferences of medical trainees for specific interventions throughout medical training when presented with different clinical scenarios. Interventions were organised into three categories: standard, intermediate and aggressive. We analysed responses to questions regarding different scenarios in separate repeated measures logistic regression models. The probability of declining medical interventions was modelled, and significant predictors of refusal of interventions were identified. Years of training was a significant predictor of declining interventions for several scenarios. When faced with permanent physical disability, increased years of training led to a higher rate of refusal of intermediate (OR = 1.14 [1.02-1.28], p = 0.02) and aggressive interventions (OR = 1.15 [1.03-1.28], p = 0.01). For the scenario of terminal illness with associated physical disability, years of training significantly influenced refusal of intermediate (OR = 1.14 [1.04-1.26], p = 0.006) and aggressive (OR = 1.20 [1.08-1.34], p = 0.001) interventions. For the scenario of permanent cognitive impairment, increased years of training led to a higher rate of refusal of standard (OR = 1.14 [1.01-1.29], p = 0.03), intermediate (OR = 1.30 [1.13-1.50], p < 0.001) and aggressive (OR = 1.38 [1.14-1.66], p = 0.001) interventions. Changes in end-of-life preferences occur throughout medical training. Years of training influenced the likelihood of declining medical interventions when faced with scenarios of terminal illness and physical or cognitive disability.

Spine Injuries from Diving Accidents: Our experience in Los Angeles, Chile

Introduction In our country, amateur diving is a frequent summer activity in young people. Spinal injuries after diving in recreational context can lead to catastrophic consequences, mostly in young and economically active population. Patients and Methods We reviewed 34 patients hospitalized in our center who were admitted to the neurosurgery unit between 2006 and 2014, with spinal injuries because of driving accidents. Data were collected from their initial admission and from follow-up records. Statistical analysis was performed using Microsoft Excel 2010 and STATA v10. Results Of the total number of patients evaluated, 97% (33/34) sustained injuries. Mean age was 30 (SD, 15–54) years. All reported injuries occurred during summer. Alcohol consumption was present in 44% of cases. The most affected segment was cervical (88%), and the most common injuries were C4–C5 dislocation and fracture (18%) and C5–C6 dislocation and fracture (12%). Overall, 32% of patients presented severe neurological compromise (ASIA A, B, and C) at time of admission. Surgical treatment was required in 50% of cases, the majority using an anterior cervical approach. The other 50% underwent orthopedic management. NASCIS 2 methylprednisolone protocol was used in 18% of cases. Overall, 29% of patients received steroid therapy. Thirty-day mortality for the cohort was 8.8%, all ASIA A. Mean hospital stay was 22 (SD, 1–354) days. Conclusion Driving accidents in Los Angeles, Chile, while uncommon can result in spinal injuries with drastic consequences, including permanent physical disability, mortality, and a profound socioeconomic impact. In our experience, early surgical and orthopedic management resulted in best clinical results. The consumption of alcohol worsen the outcomes prevention strategies should be implemented to reduce the incidence and impact of this problem.

Proteomic Signature of Endothelial Dysfunction Identified in the Serum of Acute Ischemic Stroke Patients by the iTRAQ-Based LC-MS Approach.

Acute ischemic stroke (AIS) is a devastating cerebrovascular disorder that leads to permanent physical and neurological disabilities in adults worldwide. Proteins associated with stroke pathogenesis may appear in the serum of AIS patients due to blood-brain barrier dysfunction, thus permitting the development of blood-based biomarkers for early diagnosis of stroke. These biomarkers could perhaps be an adjunct to the existing imaging modalities and aid in better management and therapeutic intervention during the course of the disease. For this exploratory study, a combination of multiplexed isobaric tagging using iTRAQ reagents and high resolution tandem mass spectrometry was used to identify differentially expressed proteins in serum samples from AIS patients. The quantitative proteomic analysis of serum from both AIS and control subjects revealed 389 high confidence protein identifications and their relative levels. Among them, 60 proteins showed a ≥1.5-fold change in the AIS subjects. We verified the altered serum levels of candidate proteins such as vWF, ADAMTS13, S100A7, and DLG4 through ELISA, and the results also corroborate with the experimental findings. vWF and ADAMTS13 are key players that regulate blood hemostasis, and their altered concentration may contribute to endothelial dysfunction. S100A7 is a novel candidate protein identified in this study that is also known to mediate inflammation, endothelial proliferation, and angiogenesis. The current study provided a potential and novel biomarker panel that may in turn provide diagnostic aid to the existing imaging modalities for the rapid diagnosis of ischemic stroke.

Reducing intrathecal pressure after traumatic spinal cord injury: a potential clinical target to promote tissue survival.

Spinal cord injury (SCI) is an unexpected event that is both devastating and debilitating, resulting in not just motor and sensory loss, but also autonomic dysfunction of the bladder, bowel and sexual organs. Currently, there are no treatments available to improve outcome following SCI, leaving individuals with permanent and lifelong physical disability. Worldwide it is estimated that more than 500,000 people sustain a SCI each year, with average lifetime cost of paraplegia and quadriplegia estimated at $5 million and $9.5 million respectively. We therefore urgently need effective therapies to improve quality of life following SCI, and this requires a greater understanding of how cell and axonal injury develops after the traumatic event.

A Study of Permanent Physical Disability Pattern in Motor Vehicle Accident Cases Presenting at Sms Hospital, Jaipur During the Year 2012–2013 a Prospective Study

Worldwide motor vehicle collisions lead to death and disability as well as financial costs to both society and the individuals involved. The maximum numbers of disabled people as a consequence of motor vehicle collision in our study were in 21-30 years age group (30.3%) followed by 31-40 years (24.6%) and 41-50 years (15.7%). Majority of the disabled people were literates constituting 85.43% of total cases. Majority of the disabled persons in our study were persons engaged in the private sector (49%) and about 20% of the disabilities were found to have occurred in students. Majority of the disabled persons were on motorized two wheelers (66.6%) followed by 22% pedestrians. Among the 350 disabled people, majority of the people suffered locomotor disabilities (88.57%) followed by visual (4%); hearing disability (3.15%) and speech disability (2.28%). The aim of this study to evaluate the level and patterns of disabilities resulting from traffic injuries among the study population as well as its distribution by age, gender and type of motor-vehicle user. Language: en

The development and implementation of a nurse practitioner sepsis screening team: Impact on transfer mortality

Background: Sepsis is a potentially deadly but treatable condition that occurs as a result of the systemic manifestations of infection. Despite large healthcare expenditures, patient outcomes can be poor, and survivors may still suffer from permanent organ damage, cognitive impairment, and physical disability. Failure to recognize and implement early goal-directed therapy leads to increased mortality. A review of hospital mortality identified that sepsis among inbound transfer patients to acute care units significantly contributed to the overall hospital mortality. As part of a multipronged, multidisciplinary approach, a nurse practitioner sepsis screening team was implemented to improve early diagnosis and treatment of sepsis and decrease mortality in this high-risk population. Methods: A large academic medical facility located in the Texas Medical Center in Houston accepts a significant number of transfer patients requiring a higher level of care from other institutions. A nurse practitioner sepsis screening team was created to focus on this highly vulnerable group. A validated, electronic screening tool was utilized to screen patients and facilitate early identification and treatment of sepsis. The nurse practitioner team screened and evaluated 3,268 inbound transfer patients from 10/01/2009 to 06/30/2012. When a high suspicion for sepsis was appreciated, or another acute condition was identified, the nurse practitioner collaborated with the attending physician and initiated appropriate treatment. The data analyzed were part of an Institutional Review Board (IRB) approved prospectively collected data set. The data were collected over a 57 month period spanning from 09/30/2007 through 06/30/2012 on all inbound transfer patients to the facility, which include pre-screening baseline statistics. Basic demographics including the patient’s age, gender, and race were collected. The outcome variable was status at discharge from the facility (alive or dead). After verifying assumptions of the chi-square test were met, a Pearson’s chi-square was run against the data set. All data were analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. Results: There was a significant association between inbound transfer patients who were evaluated upon arrival at this institution by the nurse practitioner sepsis screening team and mortality in this population regardless of their diagnoses (χ 2 (1) 115.04, p &lt; .001). A patient not screened by the team was more likely to die during the hospitalization than a transfer patient that was screened. Conclusion: In this institution, the development and implementation of a nurse practitioner sepsis screening team has contributed to reducing mortality among the inbound acute care patient transfer population regardless of diagnoses. Further investigation is needed to understand the exact mechanisms that have contributed to this outcome.

Prevalence of neural tube defect in southern Thailand: a population-based survey during 2009-2012.

Neural tube defects (NTDs) are a group of congenital malformation of the central nervous system that leads to permanent physical disability and requires lifelong treatment. In Thailand, there have been three published articles on NTDs, all hospital-based studies, which found prevalence of NTDs of 4.8-6.7 per 10,000 live births. It was our purpose with this study to determine the prevalence and type of NTDs in southern Thailand through a population-based survey. Data were obtained through the population-based surveillance during 2009-2012 in three provinces (Songkhla, Phatthalung, Trang) in southern Thailand. Entries in the birth defects registry included all live births, all stillbirths after 24-week gestational age, and termination of pregnancy following the prenatal diagnosis at any gestational age of all congenital anomalies. During 2009-2012, 148,759 births were registered in the three provinces. Twenty-eight NTD cases were identified, giving an average of 1.88 per 10,000 births (95% CI 1.20-2.51): 12 cases with anencephaly (42.8%), 5 with occipital encephalocele (17.9%), and 11 with myelomeningocele (39.3%). The birth prevalence per 10,000 births of anencephaly, encephalocele, and myelomeningocele were 0.81, 0.33, and 0.74, respectively. Sixteen (57%) were detected in live births, and 12 (43%) were detected by prenatal diagnosis which later resulted in termination of pregnancy. The prevalence of NTDs based on the population-based study in southern Thailand was low. About 40% of NTD cases were detected prenatally and later terminated. Hence, examining only registry live births will result in an inaccurately low NTD prevalence rate.

Narratives of athletic identity after acquiring a permanent physical disability.

Individuals with acquired physical disabilities report lower levels of athletic identity. The objective of this study was to further explore why athletic identity may be lost or (re)developed after acquiring a physical disability. Seven women and four men (range = 28-60 years) participated in approximately 1-hour-long semistructured interviews; data were subjected to a narrative analysis. The structural analysis revealed three narrative types. The nonathlete narrative described physical changes in the body as reasons for diminished athletic identity. The athlete as a future self primarily focused on present sport behavior and performance goals such that behavior changes diminished athletic identity. The present self as athlete narrative type focused on the aspects of their present sport involvement, such as feedback from other athletes and skill development, which supported their athletic identity. Implications of these narrative types with respect to sport promotion among people with acquired physical disabilities are discussed.

Prevalence of leprosy Cases in Eastern Visayas, Philippines

Leprosy is an important global health problem. Moreover, important for its potential to cause progressive and permanent physical disability. However, there is limited study conducted pertaining to the prevalence of leprosy in Eastern Visayas region, as well as to the association of its treatment, population, poverty rate, and gender. This study aimed to explore the prevalence of leprosy in terms of population growth, poverty rate, its treatment, and to determine association between provinces and the type of leprosy treatment for both completed and continuing treatment, between newly diagnosed (2010) and population in its provinces, between average per capita (2001-2009) and continuing treatment of leprosy (2001-2009) between the completed treatment (2001-2009) and population (2001-2009), leprosy cases (2010) between sexes among provinces. It employed descriptive inferential design, and utilizing chi-square test with the used of SPSS version 19. Findings revealed that there were no significant association between provinces and the type of leprosy treatment for both completed and continuing treatment, between newly diagnosed (2010) and provinces, between average per capita (2001-2009) and continuing treatment of leprosy(2001-2009) between the completed treatment (2001-2009) and population (2001-2009), leprosy cases (2010) between sexes among provinces. Finding of this investigation suggests everyone is prone to leprosy, whether or not it’s male or female, and rich or poor. Furthermore, studies identifying other factors like literacy rate, present health status could also be investigated.

Associations of depression diagnosis and antidepressant treatment with mortality among young and disabled Medicare beneficiaries with COPD

ObjectiveDepression is prevalent in chronic obstructive pulmonary disease (COPD) patients and a risk factor for COPD exacerbation and death. The objective of this study was to determine the associations of depression diagnosis and antidepressant treatment with mortality among Social Security Disability Insurance (SSDI)-eligible (age <65 years who had permanent physical or mental disabilities) Medicare beneficiaries with COPD. MethodThis retrospective cohort study used a 5% random sample of SSDI-eligible Medicare beneficiaries with COPD in stand-alone Part D plans during 2006–2008 (n=17,320). COPD and depression diagnoses were assessed during 2006. Evidence of antidepressant treatment was measured in 2006–2008. All-cause mortality was measured in 2007–2008. Cox proportional hazards models were used to examine the associations of depression diagnosis with mortality and, among depressed beneficiaries, antidepressant treatment (time dependent) with mortality after controlling for covariates. ResultsMore than one third (37.3%) of SSDI-eligible beneficiaries with COPD had a baseline depression diagnosis; of those, 86.8% had evidence of antidepressant treatment. Baseline depression diagnosis was an independent risk factor for 2-year mortality [hazard ratio (HR)=1.21; 99% confidence interval (CI)=1.07–1.37]. Among depressed beneficiaries, receiving antidepressant treatment was associated with significantly lower mortality (HR=0.55; 99% CI=0.44–0.68). ConclusionProactive antidepressant treatment should be considered as an intervention to reduce mortality for this young and disabled Medicare population.

Quality of life after lung resection is not associated with functional objective measures

To the Editor: Patient and physician perspectives about surgical risk may differ. Physicians are mostly focused on objective end-points ( i.e. mortality and survival), whereas most patients are worried about permanent physical and emotional disability resulting from the operation [1]. Can objective clinical information be used to predict patient-reported health status? In the attempt to respond to this question, we studied 221 consecutive patients submitted to major anatomic pulmonary resections (204 lobectomy and 17 pneumonectomy) during a 36-month period. All patients had a pre-operative measurement of maximum oxygen uptake ( V ′O2max), as a part of their routine pre-operative functional work-up, and a complete assessment of their pre-operative and post-operative (3 months after surgery) quality of life. All patients gave their consent for inclusion of their clinical data in our institutional database for clinical and scientific purposes and the Institutional Review Board of our hospital approved the study. No formal pre-admission or post-discharge physiotherapy or psychological support programmes were administered in this series. Neurological or psychotropic personal medications, if present, were generally resumed the day after surgery. Quality of life was assessed before and 3 months after the operation by the administration of Short Form 36v2 (SF36v2) survey [2], which …

The need for full integration of snakebite envenoming within a global strategy to combat the neglected tropical diseases: the way forward.

The need for full integration of snakebite envenoming within a global strategy to combat the neglected tropical diseases: the way forward.

Impact of nutritional status and dietary quality on stroke: do we need specific recommendations?

Stroke, one of the most prevalent geriatric diseases, is a leading cause of death worldwide that often results in permanent physical disability and decreased quality of life, and can have a negative impact on families both financially and emotionally. Although many previous studies have shown relationships between the risk of stroke and nutritional factors, clear dietary recommendations for the prevention and reduction of stroke recurrence have not been established. Several factors should be considered to control and manage stroke. For example, a considerable number of patients with stroke are poorly nourished, have several comorbidities and undesirable health-related behaviors may be present. Stroke patients are less likely to consume beneficial foods, have poorer eating habits and have impoverished dietary quality. In addition, psychological factors such as depression must also be considered in stroke management. Given these factors, dietary recommendations for stroke patients should be established. In this article, we summarized the nutritional status and dietary quality of stroke patients. We also suggested some nutritional guidelines for stroke patients and for those who are at risk for stroke.

Illness experience of adults with cervical spinal cord injury in Japan: a qualitative investigation

BackgroundThere is growing recognition that healthcare policy should be guided by the illness experience from a layperson’s or insider’s perspective. One such area for exploration would include patient-centered research on traumatic Spinal Cord Injury (SCI), a condition associated with permanent physical disability requiring long-term and often complex health care. The chronicity of SCI can, in turn, affect individuals’ sense of self. Although previous research in Western countries suggests that people with SCI find a way to cope with their disability through social participation and family bonds, the process of adjustment among people with cervical SCI (CSCI) living in Japan may be different because of the restrained conditions of their social participation and the excessive burden on family caregivers. The purpose of this study was to examine the impact of injury and the process of accommodation in people with CSCI in Japan.MethodsSemi-structured home interviews were conducted with 29 participants who were recruited from a home-visit nursing care provider and three self-help groups. Interviews were recorded, transcribed and analyzed based on the grounded theory approach.ResultsFive core categories emerged from the interview data: being at a loss, discrediting self by self and others, taking time in performance, restoring competency, and transcending limitations of disability. Overall, the process by which participants adjusted to and found positive meaning in their lives involved a continuous search for comfortable relationships between self, disability and society.ConclusionsThe results of this study suggest that persons with CSCI do not merely have disrupted lives, but find positive meaning through meaningful interactions. Family members added to the discredit of self by making the injured person entirely dependent on them. Gaining independence from family members was the key to restoring competency in people with CSCI. At the same time, social participation was pursued for transcending the limitations of disability. The results also imply that social issues affect how people interpret their disability. These findings suggest that public health policy makers should recognize the need to enhance independence in people with disability as well as change the social assumptions about their care.

Temporal Adverse Effects in Leprosy Saudi Patients Receiving Multi Drug Therapy

Background/Purpose: Leprosy or Hansen’s disease is an infectious disease that yet represents major socioeconomic burden to humanity. It results in permanent physical disabilities besides disgraceful social perception to patients. Multi Drug Therapy (MDT) treatment protocol is a combinatorial anti microbial treatments which has been approved by the WHO as the best treatment option for Hansen’s disease. Side effects to MDT protocol are the main limiting obstacle for the treatment course completion that might differ from population to another. Methods: Herein, we are assessing the temporal hematological and biochemical markers of side effects in Saudi leprosy patients treated with MDT protocol for one year. Results: Hematological assessment revealed progressive temporal but mild decline in all the examined parameters (RBC, PCV, Hb, MCH and MCHC) in males and females patients treated with MDT compared to control group. Biochemical assessment for MDT treated leprosy Saudi patients presented mild progressive temporal hepato-renal complications. Patients were fully recovered from all hemato-biochemical adverse effects after 6 months of the MDT treatment completion. Conclusion: MDT was well tolerated in Saudi leprosy patients with mild to moderate temporal hematological and biochemical adverse reactions.