Scores Of Study Group Research Articles

Study on the effects of sports induced injuries on Janu sandhi (knee joint) marma - A retrospective observational study

In Ayurvedic samhita, it is explained that marma viddha lakshana are caused due to aghat (trauma). Sports injuries are concerned with traumatic injuries. Comparative study of marma sharira vigyan in shalyatantra of ayurveda with modern aspects of sports medicine can aware a sportsmen about the injuries. Janu sandhi (knee joint) is the mostly used joint in various sports leading to a wide range of injuries. The aim of this study was to evaluate sports injuries especially in Janusandhi Marma and structural damage occurring in it. The viddh lakshannas(traumatic injuries) of Janu Marma are limping (Khanjata) and the objective of this study is to determine the specific injury at the knee joint that might cause limping. Total 30 patients were selected as per the inclusion and exclusion criteria mention in proforma. Observation & Results were noted with the help of Objective criteria mentioned in the proforma which included sports wise distribution, types of injury, mode of trauma, structural deformities clinical examination score and final diagnosis in study group. The result was Maximum patients had Medial Collateral Ligament involvement followed by Anterior Cruciate Ligament & Medial Meniscus injuries. Patellar injuries and Lateral Collateral Ligament injuries were comparatively less. So it was concluded that with the assessment of clinical examination score it is possible to judge the severity of trauma to janu sandhi marma and the structures involved in the traumatic injuries amongst sports athletes. This study can be helpful for deciding the treatment regime of the patient.

A COMPARATIVE STUDY OF EFFICACY BETWEEN MODIFIED KLIGMANS FORMULA AND DERMAROLLER WITH TRANEXAMIC ACID IN TREATMENT OF MELASMA

Background:Melasma is a common hyperpigmentation disorder characterised by symmetrical, marginated, light to dark brown patches that occur mostly in sun exposed areas of skin, mostly on the face, occasionally affecting the neck and forearms. The exact cause of melasma is unknown, however many factors have been implicated in its etiopathogenesis, mainly sunlight, genetic predisposition, pregnancy and certain drugs. Among the factors mentioned above, excessive sun exposure is the most common cause. Objectives: To compare the therapeutic efficacy of topical tranexemic acid (TXA) with Microneedling versus topical modified kligmanÂ’s regimen in the treatment of melasma. Methodology: Patients diagnosed with Melasma of the face attending the Outpatient department Department of Dermatology, explained about the study procedure and benefits of the study before enrolment. Patients fulfilling the inclusion criteria were recruited for the study. Written informed consent was obtained from all patients who are willing to participate in the study in a prescribed format and well explained in the regional language before starting the study. Detailed medical history, clinical examination and essential lab investigations were performed on the participants. This study was conducted on 60 patients with melasma, randomly divided into two groups. In group A, each patient was subjected to a series of 3 sessions of skin microneedling and TXA application, whereas in group B , modified kligmanÂ’s regimen applied daily in the night . Results: At the end of 12 weeks melasma area severity index(MASI ) score was significantly decreased in both groups with statistically significant higher reduction of score in study group compared with control group . No significant adverse effect were observed in both treated sides. Conclusion: The result of the study show that topical tranexemic acid along with Microneedling could be safe and effective in melasma treatment.

A COMPARATIVE STUDY OF EFFECTIVENESS OF INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY WITH AND WITHOUT ITS INSTILLATION IN POST-OPERATIVE PAIN MANAGEMENT

Introduction: Laparoscopic cholecystectomy is a gold standard surgical procedure in post-operative pain recovery time. Though it is associated with lesser post-op pain than open cholecystectomy, few patients still experience pain. Pain relief is an important goal of any surgery. Administration of local anaesthetic either during surgery is a method of reducing post-op pain. To Compare the effect of intraperitoneal Aim: instillation of 0.5% bupivacaine with adrenaline and without intraperitoneal instillation of 0.5% bupivacaine with adrenaline for post-operative analgesia in laparoscopic cholecystectomy. A total of 120 participants we Materials & Methods: re considered for this study with 60 participant receiving bupivacaine and other 60 receiving normal saline. VAS/VRS score is measured at 2, 4, 6, 12 & 24 hours after surgery for each group. Results: From the results, we found signicant differences in the mean scores of study group and placebo group. The patients who were given bupivacaine were found to have reduced pain. Conclusion: In our study, we found that bupivacaine reduces postoperative pain. We conclude that the intraperitoneal instillation of bupivacaine is a safe and effective method for providing postoperative analgesia without signicant side effects.

Depression and the risk factors for isolated infectious disease fever patients in the hospital during the COVID-19.

To compare and analyze the incidence of anxiety and depression of infectious disease fever patients in hospitalized isolation and home isolation during the COVID-19 pandemic, as well as the risk factors for the negative emotions of hospitalized isolation patients. Forty isolated infectious disease fever patients in Baoding No.1 Hospital were randomly selected as the study group, and the other 40 isolated infectious disease fever patients at home were randomly selected as the control group from March 2020 to August 2020. The scores and prevalence of depression and anxiety between the two groups were compared and analyzed. The logistic regression analysis was used to judge and analyze the negative psychological factors of hospitalized isolation patients such as depression and anxiety. The HAMA and HAMD-17 scores of study group are significantly higher than those of control group (HAMA, p=0.00; HAMD-17, p=0.01). The prevalence of anxiety and depression in the study group was significantly higher than that in the control group (p=0.03, p=0.04). The gender (p=0.002), economic status (p=0.004) and isolation attitude (p=0.023) are the related factors of anxiety, among which economic status is the protective factor, while women and resistant attitude are the risk factors. Economic status (p=0.003) and isolation attitude (p=0.001) are the related factors of depression, among which economic status is the protective factor, and resistant attitude is the risk factor. The prevalence and severity of anxiety and depression in hospitalized isolation patients due to infectious disease fever are significantly higher than those of home isolation patients. The focus groups are women, with bad economic status and poor isolation attitude. Necessary psychological counseling and social support should be provided to these groups to reduce negative emotions and increase the experience of isolated patients.

Effects of Home Based Serious Game Training (Brain Talk™) in the Elderly With Mild Cognitive Impairment: Randomized, a Single-Blind, Controlled Trial.

Mild cognitive impairment (MCI) increases with aging society. Serious games may be effective in improving cognitive function in patients with MCI; however, research on their effects remains insufficient. This study aimed to confirm the efficacy and safety of cognitive rehabilitation training using a serious game (Brain Talk™) for the elderly with MCI. Twenty-four elderly individuals with MCI were randomized into study and control groups. The study group received 12 training sessions (30 min/session, 3 times/week), whereas the control group did not receive training. Blinded evaluations were conducted before and after the training and four weeks after the training. The primary outcome measures were the Korean Mini-Mental State Examination (K-MMSE) and K-MoCA (Korean Montreal Cognitive Assessment). Secondary outcome measures were the Semantic Verbal Fluency Task (SVFT), Trail-Making Test-B, and 2-back test. In the study group, the K-MMSE, K-MoCA, and SVFT scores after finishing the training and 4 weeks after training showed a significant increase; however, there was no significant change in the control group. No significant differences were observed between the two groups. Cognitive function significantly improved in the study group after training. Home-based serious games are considered helpful in improving cognitive function.

Value of 3.0T MRI T2 mapping combined with SWI for the assessment of early lesions in hemophilic arthropathy

ABSTRACT Purpose To explore the value of magnetic resonance imaging (MRI) T2 mapping combined with susceptibility-weighted imaging (SWI) in detecting early cartilage damage and joint bleeding in the hemophilic arthropathy (HA). Methods 147 patients and 56 healthy controls were prospectively recruited. The knees were divided into groups A and B according to the criteria of the International Cartilage Repair Society (ICRS). The Regions of Interest (ROIs) of T2 mapping were drawn for the patella, lateral and medial femoral condyle, and lateral and medial tibial condyle. The T2 values were compared between the patients and control group using one-way ANOVA. The joint count data of International Prophylaxis Study Group (IPSG) scores of conventional and SWI sequences were statistically described using the composition ratio, and the rank sum test was used for the difference analysis. Results Finally, there were 99 joints in the control group, 135 knees in group A, and 94 knees in group B. There was a significant difference between the T2 value in each subgroup. Comparison of T2 value groups in each cartilage partition, except for group A and group B of the patella, revealed significant differences (all P<0.05). SWI was likely more sensitive than conventional sequences in detecting hemosiderin deposits in hemophilic joints. In addition, the IPSG scores detected by the SWI were generally higher than those of conventional sequences. Conclusions MR T2 mapping combined with SWI has great potential to be used for detecting early cartilage damage and micro-hemosiderin deposition in hemophiliac arthropathies and developing preventative treatment plans.

Thiotepa, Orelabrutinib, and Methotrexate Combined with or without the Rituximab Regimens in the Treatment of Patients with Central Nervous System Lymphoma

Background: Central nervous system lymphoma (CNSL) is a rare but lethal type of non-Hodgkin lymphoma (NHL), including primary CNSL (PCNSL) and secondary CNSL (SCNSL) (Zorofchian et al. Frontiers in Oncology. 2018). High-dose (HD) methotrexate (MTX, M)-based regimens followed by autologous stem cell transplantation (ASCT) or whole-brain radiotherapy (WBRT) (Young et al. Clin Lymphoma MyelomaLeuk. 2020) constitute the main therapeutic strategies. However, the outcome remains poor; nearly 50% of patients had relapsed disease, and 10%-15% were primary refractory (Dasgupta et al. Leuk Lymphoma. 2018; Sacks et al. Int J Stroke. 2018). Recently, several studies have shown that the B-cell receptor (BCR) signaling pathway is more susceptible to mutations in PCNSL (Zhang et al. EHA. 2022). Bruton tyrosine kinase (BTK) is a fundamental component in the BCR pathway. Orelabrutinib is a novel and potent irreversible BTK inhibitor with high cerebrospinal fluid (CSF) concentration and has shown efficacy in the treatment of CNSL (Wu et al. Invest New Drugs. 2022; Yang et al. Front Oncol. 2022; Zhang et al. HemaSphere. 2022). Thiotepa inhibits tumor growth by disrupting DNA bonds showing promising activity in CNSL. Thus, we conducted a retrospective study to evaluate the efficacy and safety of the thiotepa, orelabrutinib, and methotrexate combined with or without the rituximab (TOM±R) regimens in the treatment of patients with CNSL. Methods: Between March 2021 and March 2022, 13 patients with CNSL who received TOM±R regimens (thiotepa, 30-40 mg/m2, d4; orelabrutinib, 150 mg, daily; methotrexate, 3.5g/m2, d1; rituximab, 375mg/m2, d0; 21 days/cycle) as induction therapy was included in this retrospective study. Dose modification was administered in old patients or patients with renal impairment. After 4 to 6 cycles of the combination treatment, patients could receive consolidation therapy as ASCT or WBRT with or without afterward orelabrutinib maintenance. The primary endpoint was the best overall response rate (ORR) during the induction therapy according to the International PCNSL Collaborative Group (IPCG) standard, and the secondary endpoints included complete response (CR), partial response (PR), progression-free survival (PFS), and adverse events (AEs). Results: Thirteen patients (6 males; median age 58 years, range, 52-64) with histologically confirmed diffuse large B-cell lymphoma were included in this retrospective study, of whom 6 patients with PCNSL were treatment-naïve, 4 patients with PCNSL were first relapsed, and the rest 3 patients received their first treatment for SCNSL. Most patients had a history of Hepatitis virus infection (n=7), International Extranodal Lymphoma Study Group (IELSG) scores ≥ 2 (n=12), high-risk Memorial Sloan Kettering Cancer Center (MSKCC) score (n=11) and deep intracranial lesions (n=12).The median treatment cycle was 3 cycles (range, 2-9), and 7 patients received TOM+R. The ORR/CR and 6-month PFS rate was 92.3%/53.9% and 63.6% in all patients, 83.3%/66.7% and 66.7% in patients with PCNSL receiving first-line therapy, 100.0%/50.0% and 66.7% in patients with PCNSL receiving second-line therapy, and 100.0%/33.3% and 50% in patients with SCNSL receiving first-line therapy (Table 1). Among the 13 patients, 5 patients received orelabrutinib maintenance treatment, of whom 1 patient underwent WBRT and 1 patient underwent ASCT before orelabrutinib maintenance treatment. The ORR/CR and 6-month PFS rate of the 5 patients receiving orelabrutinib as maintenance treatment were 100%/80% and 100%, respectively (Figure 1). The most commonly reported AEs of all patients included leukopenia (53.9%) and pneumonia (15.4%). Grade 3-4 AEs included white blood cell count decreased (23.1%), thrombocytopenia (7.7%), fever (7.7%), and pneumonia (7.7%). No patients experienced severe AEs, and 1 patient died due to progressive disease. Conclusion: TOM±R regimens were effective and well-tolerated for patients with CNSL in this retrospective study. This combo regimens may provide a potential treatment strategy for patients with CNSL. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effect of a combination of general anesthesia and superficial cervical plexus block with ropivacaine on patients undergoing thyroidectomy

Purpose: To investigate the effect of a combination of general anesthesia and superficial cervical plexus block (SCPB) with ropivacaine on patients undergoing thyroidectomy.&#x0D; Methods: Ninety-six (96) patients undergoing thyroidectomy were randomly divided into control and study group. Both groups were subjected to SCPB in combination with general anesthesia. Ropivacaine was used for SCPB in the study group. Vital signs, visual analogue scale (VAS) scores, and serum interleukin 1β (IL-1β) levels were determined at various time points (T) after tracheal intubation. Occurrence of adverse reactions was recorded.&#x0D; Results: Compared with the control group, mean arterial pressure (MAP), heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) levels from T1 to T5 were declined in study group (p &lt; 0.01). VAS scores of study group were significantly lower at 12, 24, and 48 h after thyroidectomy than in control group (p &lt; 0.05). At 5, 10 and 15 h after surgery, serum IL-1β level in study group was down-regulated (p &lt; 0.05). Moreover, a marked decrease in the incidence of adverse reactions was also found in the study group post-surgery (p &lt; 0.05).&#x0D; Conclusion: Ropivacaine is effective for SCPB in combination with general anesthesia in patients undergoing thyroidectomy. It is safer and more feasible in SCPB when combined with general anesthesia. However, further clinical trials are required to validate this technique.

Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial

Gestational hypertension (GH) is associated with adverse cardiometabolic and pregnancy outcomes. Though yoga is known to be beneficial in pregnancy, the effects of yoga rendered for twenty weeks starting from 16th week of gestation in pregnant women having risk of GH on the incidence of hypertension, cardiometabolic risks and fetomaternal outcomes have not been studied. A randomized control trial was conducted on 234 pregnant women having risk of GH receiving standard antenatal care (Control group, n = 113), and receiving standard care + yoga (Study group, n = 121). Interventions were given for twenty weeks starting at 16th week of gestation. Baroreflex sensitivity (BRS), heart rate variability (HRV), insulin resistance, lipid-risk factors, and markers of inflammation, oxidative stress and vascular endothelial dysfunction (VED) were assessed before and after intervention. Incidence of new-onset hypertension, level of cardiometabolic risks at 36th week, and fetomaternal-neonatal outcomes in the perinatal period, were noted. The link of hypertension, pregnancy outcomes and cardiometabolic risks with nitric oxide (NO), the marker of VED was assessed by analysis of covariance, Pearson’s correlations, and multilinear and logistic regressions. In study group, 6.61% women developed hypertension compared to 38.1% in the control group following 20-week intervention and there was significant decrease in risk of developing GH (RR, 2.65; CI 1.42–4.95). There was less-painful delivery, decreased duration of labor, increased neonatal birthweight and Apgar score in study group. Increase in total power of HRV (β = 0.187, p = 0.024), BRS (β = 0.305, p < 0.001), and decrease in interleukin-6 (β = − 0.194, p = 0.022) had significant association with increased NO. Twenty weeks of practice of yoga during pregnancy decreases the incidence of hypertension, improves fetomaternal outcomes, and reduces cardiometabolic risks in pregnant women having risk of GH. Decreased blood pressure, increased HRV, BRS and birth weight and decreased inflammation were associated with improved endothelial function.Trial registration: Clinical Trials Registry of India (CTRI), registration number: CTRI/2017/11/010608, on 23.11.2017.

Effectiveness Of Local Anaesthetic In Reducing Postoperative Pain At Port Site After Laparoscopic Cholecystectomy.

Laparoscopy has become the highest quality level way to deal with cholecystectomy since its inception 30 years preceding, and is perhaps the most normally performed general surgeries. Pain being a significant issue after laparoscopic cholecystectomy bringing about extended admissions or readmissions. With significant varieties in pain relieving conventions an integrated approach is important to diminish pain. The aim of this study is to assess the effectiveness of Bupivacaine as local anesthetic agent at port sites after laparoscopic cholecystectomy. Study population of 84 patients was divided into control group (receiving no local anesthetic) and study group (receiving Bupivacaine as local anesthetic). Visual analogue scale was used to quantify and compare pain perceived by each group; at fixed intervals of 6, 12 and 24 hours after shifting of the patients back to the ward. Each group comprised 42 patients. At 6 hours post operative pain score in study group, 4.5±0.32 was significantly lower than in control group, 7.6±0.41 (p<0.05). Though pain assessments at 12 and 24 hours didn't reveal any significant differences among the two groups; postoperative requirement of Tramadol was significantly (p<0.05) lower in study group (92±0.064mg) in comparison to control group (158±0.21mg). Use of long-acting local anesthetic injections at port sites after laparoscopic cholecystectomy significantly lowers pain during first 6 hours post operatively and also lowers narcotic analgesics requirements during post operative period.

Effect of reflexology on anxiety level among patients undergoing coronary angiography

Background Angiography is a highly effective invasive method for diagnosing coronary artery diseases but can lead to certain psychological problems such as anxiety. Aim To investigate the effect of foot reflexology therapy on anxiety level among patients undergoing coronary angiography. Research hypothesis H: patients undergoing coronary angiography who will receive the foot reflexology therapy will reveal lesser mean anxiety scores than before the intervention. Design A quasi-experimental research design was used. Setting This study was conducted at two selected critical care units affiliated to Cairo University Hospitals. Sample A purposive sample of 40 adult patients undergoing coronary angiography was recruited throughout 8 months. Tools Two tools were utilized to collect data: first, demographic characteristics and medical data, and second, state-trait anxiety inventory. Results There were significant statistical differences in mean anxiety scores in the reflexology study group before intervention, immediately, and 30 min after intervention (f=13.32/P=0.00). So, there was a significant decrease in anxiety scores immediately after intervention. Moreover, significant differences were detected among the studied patients’ anxiety mean scores according to their age 30 min after intervention (0.00); the age categories between 40 and 49 years showed less anxiety at this point of time. Finally, no significant statistical correlations whatsoever were found between selected demographic variables and mean anxiety scores at all time series of intervention. Conclusion It can be concluded that, foot reflexology was an effective method to decrease anxiety among patients undergoing coronary angiography.

Joint status of patients with nonsevere hemophilia A

BackgroundJoint bleeding in hemophilia may eventually lead to joint damage. In nonsevere hemophilia, joint bleeds occur infrequently. Currently, knowledge on the joint status of patients with nonsevere hemophilia using objective imaging is limited. ObjectiveTo investigate the joint status in patients with nonsevere hemophilia A. MethodsThis cross‐sectional study included patients with nonsevere hemophilia A aged 24–55 years. Joint status was assessed by magnetic resonance imaging (MRI) of the elbows, knees, and ankles and International Prophylaxis Study Group (IPSG) scores were calculated. Lifetime joint bleeding history was collected from medical files. The contribution of factors to joint outcome was explored using multivariable linear regression analysis. ResultsIn total, 51 patients were included, of whom 19 (37%) had moderate and 32 (63%) had mild hemophilia. Patients had a median age of 43 years (interquartile range [IQR] 32–50), a median factor VIII activity of 10 IU/dl (IQR 4–16) and a median annual joint bleeding rate (AJBR) of 0.0 (IQR 0.0–0.2). Soft‐tissue changes (IPSG subscore > 0) in the elbows, knees, and ankles were present in 19%, 71%, and 71% of patients, respectively. Osteochondral changes (IPSG subscore > 0) in the elbows, knees, and ankles were present in 0%, 20%, and 35% of patients, respectively. In 14% of bleed‐free joints, hemosiderin depositions were observed. Age and AJBRs were most strongly associated with the IPSG score. ConclusionThis study demonstrates that a substantial proportion of adults with nonsevere hemophilia has joint changes on MRI despite low joint bleeding rates.

Observation on the Effect of Solution-Focused Approach Combined with Family Involvement in WeChat Platform Management on Inpatients with Intracerebral Hemorrhage.

Objective To explore the effect of the solution-focused approach combined with family involvement in the WeChat platform management on inpatients with intracerebral hemorrhage (ICH). Methods A total of 80 ICH patients hospitalized in our hospital from June 2018 to June 2021 were split into the control group (CG) and the study group (SG) according to the clinical nursing modes, with 40 cases in each group. Both groups received routine intervention, while SG additionally received the solution-focused approach combined with family involvement in the WeChat platform management to compare the self-care ability, psychological status, and hope levels between the two groups after intervention. Results No significant differences in general data were observed between the two groups (P > 0.05). The SAS and SDS scores before intervention showed mild depression and anxiety in both groups, which improved after intervention. In addition, the SAS and SDS scores after intervention were remarkably lower in SG than in CG (P < 0.05). After intervention, the scores of ICH-related knowledge, self-care skills, self-care responsibility, and rehabilitation knowledge in SG were notably higher compared with CG (P < 0.05). After intervention, the Herth scores of both groups increased, with a higher score in SG than in CG (P < 0.05). After intervention, SG had higher quality of life (QOL) scores in general health, physiological function, physiological role, body pain, vitality, social function, emotional role, and physiological health than CG (P < 0.05). Conclusion The implementation of the solution-focused approach combined with family involvement in the WeChat platform management for ICH inpatients can effectively improve their psychological status, enhance their self-care ability and hope levels, promote body recovery, and improve their QOL after intervention.

English

BACKGROUND The motivation to learn begins with a problem. The ideology of problem-based learning (PBL) is to encourage the students to think beyond the books and apply the basic knowledge to various clinical scenarios. Problem based learning has been a concept in existence for decades, yet its implementation in medical education is limited. So the study on PBL was taken up to know analytical skills, comprehensive understanding of disease process and inculcate the practice of self-directed learning in physiology. METHODS This was an educational interventional study carried out on 60 first MBBS students chosen by simple random sampling. Students were further randomly divided into two groups containing 30 students in the control group and 30 students in the study group. Control group was taught by didactic lectures. 10 clinical scenarios were given to study group and discussions were conducted under the moderation of faculties. Objective evaluation was performed using pre-test and post-test examination for both groups. Subjective evaluation of attitude in study group towards PBL was recorded using self-developed questionnaire using Likert’s scale. Data was analysed by using paired students t test. RESULTS The mean pre-PBL (9.83±4.88) and post-PBL scores (15.61 ± 2.99) in study group were significant (p &lt; 0.00001). The comparison of mean scores of postdidactic lectures (12.88 ± 3.13) in control group and post-PBL (15.61 ± 2.99) in study group were significant (p &lt; 0.001). Subjective evaluation using Likert’s scale revealed increased interest in active learning, better confidence, communication, comprehension, and motivation amongst the PBL group. CONCLUSIONS From the results of this study, it can be concluded that problem-based learning is a good supplementary tool in teaching physiology, and it can be included in the regular medical teaching programmes so that the students have a better understanding of the various challenges in the field of medical education and research so that newer strategies for better health care provision can be planned. KEYWORDS Active Learning, Medical Education, Problem Solving, Self-Directed Learning

Echocardiography calcium score as predictive tools of severity of coronary artery disease

Abstract Background Coronary artery disease (CAD) represents a leading cause of death worldwide. Coronary angiography represents the gold standard for diagnosis and selection of the best treatment for the patients with coronary artery disease; however some efforts have been made to predict CAD severity and complexity using non-invasive methods in order to identify the patients at high risk for cardiovascular events with less risk to the patients and before doing coronary angiography. Characterization of coronaryartery calcification by computed tomography known as Coronary artery calcium score (CACS) is equivalent to the total coronary atherosclerosis load and is proven to be related to angiographically significant lesions. Echocardiographic calcium score is now validated against non-coronary calcium by computed tomography with lower cost and no irradiation safety issues for reclassification of cardiac risk. Aim and Objectives to determine the correlation of echocardiography calcium score to severity of coronary artery disease. Patients and Methods Patients coming to Ain Shams University Hospitals for elective coronary angiography were subjected to histoty taking, examination, blood samples and echocardiographic examination. The echocardiographic calcium score was correlated with syntax score of their coronary angiography films. Also syntax score was divided into three groups; low risk ≤ 18, intermediate risk 18-27 and high risk groups &amp;gt;27. Results The study included 45 patients; 21 of which were males representing 46.6% of the participants. The mean age of the whole group was 52.7 ± 8.18. The mean final calcium score of the whole study group was 4.95±1.29. The mean syntax score of the whole study group was 22.88±12.3. There was significant difference between the three subgroups of the syntax score regarding total calcium score (p value 0.013) and highly significant difference between the numerical values of syntax score and final calcium score. Conclusion Echocardiographic calcium score is correlated to syntax score and the severity of coronary artery disease. The low cost, availability and the radiation free nature of echocardiography make it an attractive candidate for the on-going research regarding the non-invasive tools for prediction of CAD.

The Effect of Capacity Assessment Combined with Staged Target Nursing Intervention on Swallowing Functional Disturbance and Pulmonary Infection in Elderly Stroke Patients

To investigate the effect of capacity assessment combined with staged target nursing intervention on swallowing functional disturbance (SFD) and pulmonary infection in elderly stroke patients. 82 elderly stroke patients treated in the neurological department of our hospital (June 2019-February 2021) were chosen as the study subjects and randomly split into study group (n=41) and control group (n=41). Both groups received basic treatment for cerebrovascular diseases. After that, control group received routine clinical nursing, while study group underwent capacity assessment combined with staged target nursing intervention. The scores of the Burke Lateropulsion scale in both groups after 3-month nursing intervention were obviously lower (P &lt; 0.001), and after 3-month nursing intervention the scores of the Burke Lateropulsion scale in study group were obviously lower compared with control group (P &lt; 0.001). The NIHSS scores in both groups after 3-month nursing intervention were obviously lower (P &lt; 0.001), and the NIHSS scores in study group after 3-month nursing intervention were obviously lower compared with control group (P &lt; 0.001). The total clinical efficacy rate in study group was obviously higher compared with control group (P &lt; 0.05). The SWAL-QOL scores in both groups after 3-month nursing intervention were obviously higher (P &lt; 0.001), and the SWAL-QOL scores in study group after 3-month nursing intervention were obviously higher compared with control group (P &lt; 0.001). The levels of FVC, FEV1 and PEF in both groups after 3-month nursing intervention were obviously higher (P &lt; 0.001), and those after 3-month nursing intervention in study group were obviously higher compared with control group (P &lt; 0.001). Plus, the total incidence of complications in study group was obviously lower compared with control group (P &lt; 0.05). The capacity assessment combined with staged target nursing intervention can effectively improve patients’ swallowing function, neurological function, pulmonary function and life quality, with obvious therapeutic effect, deserving promotion and popularization.

Application of CBL Teaching Method Combined with Situational Simulation Teaching in Clinical Teaching of Anesthesiology and Its Influence on Improving Theoretical Knowledge and Clinical Practice Ability of Anesthesiology Medical Students

Objective. To analyze the application of case based learning (CBL) teaching method combined with situational simulation teaching in clinical teaching of anesthesiology and its influence on improving theoretical knowledge and clinical practice ability of anesthesiology medical students. Methods. 42 anesthesiology medical students who came to our hospital for internship from March 2019 to March 2020 were selected as the research objects, and were randomly divided into the study group and the reference group, with 21 students in each group. The CBL teaching method combined with situational simulation teaching was adopted for the study group, while the traditional teaching mode was adopted for the reference group. After the teaching, both groups of students were assessed in theory and skill operation, and the scores were compared. Results. There was no significant difference in gender ratio, average age, only-child or not, home address and aspiration to choose this major between the two groups (P&gt;0.05). After training, the scores of theory test and skill operation in both groups were significantly higher than those before training (P&lt;0.001), and the scores in the study group were significantly higher than those in the reference group (P&lt;0.001). The scores of fill-in-the-blankquestions, noun explanations and essay questions of the study group were significantly higher than those of the reference group (P&lt;0.001). The study group was better than the reference group in deepening learning and memory,improving autonomous learning ability, stimulating learning interest, and cultivating clinical thinking (P&lt;0.05). The scores of professional practical ability, professionalattitude,management ability, interpersonal communication ability, professional development ability, and critical thinkingability in the study group were significantly higher than those in the reference group (P&lt;0.05). After training, the humanistic care abilityscores of both groups were significantly higher than those before training (P&lt;0.001), and the score in the study group was significantly higher than that in the reference group (P&lt;0.001).The total recognition of the study group was significantly higher than that of the reference group (P&lt;0.05). Conclusion. CBL teaching method combined with situational simulation teaching can significantly improve students’ mastery of theoretical knowledge and practical operation of clinical anesthesiology, and stimulate their humanistic care consciousness, which can lay the foundation for cultivating professional talents of anesthesiology in our hospital.

Safety Analysis of Apatinib Combined with Chemotherapy in the Treatment of Advanced Gastric Carcinoma: A Randomised Controlled Trial.

Objective To study the safety of apatinib combined with chemotherapy in the treatment of advanced gastric carcinoma (GCA). Methods 74 patients with advanced GCA treated in the oncology department of Weifang People's Hospital (January 2019–January 2020) were enrolled in this study and equally split into study group (SG) and reference group (RG) according to the odd and even admission numbers. RG underwent chemotherapy alone, while SG received apatinib combined with chemotherapy. The clinical indicators of serum matrix metalloproteinase 9 (MMP-9), serum interleukin-2 receptor (SIL-2R), and immune cell level were detected in the two groups before and after treatment to analyze the therapeutic effect of different treatment methods on patients with advanced gastric carcinoma. Results No obvious differences in gender ratio, average age, average BMI, pathological staging, pathological types, organ metastasis types, and residence were observed between the two groups (P > 0.05). The short-term follow-up results showed that the disease control rate (DCR) in SG was markedly higher compared with RG (P < 0.05). The MMP-9 and SIL-2R levels in both groups after treatment decreased (P < 0.05), and the levels in SG after treatment were notably lower compared with RG (P < 0.001). Compared with RG, CD3+, CD4+, and CD4+/CD8+ levels in SG after treatment were notably higher (P < 0.001), while the CD8+ level was notably lower (P < 0.001). The median progression-free survival (MPFS) and overall survival (OS) in SG were markedly higher compared with RG (P < 0.001). The GQOLI-74 scores in both groups after treatment increased (P < 0.001), and the GQOLI-74 score in SG after treatment was markedly higher compared with RG (P < 0.001). The total incidence of adverse reactions was lower in SG than in RG (P < 0.05). Conclusion Apatinib combined with chemotherapy is superior to chemotherapy alone in effectively improving treatment outcomes in patients with advanced GCA.

Maternal verbal scaffolding: association with higher language skills for 20-month-old children with prenatal polysubstance exposure

BackgroundThe number of children with prenatal polysubstance exposure is increasing. Supportive mother-child interaction is a protective factor, which can ameliorate adverse effects of prenatal polysubstance exposure on developmental outcomes. AimTo examine the role of maternal verbal scaffolding on cognitive and language development in children with prenatal polysubstance exposure. Study designPregnant women were recruited, and we prospectively followed mother-child dyads to 20 months of age. This analysis included 66 dyads (33 healthy controls and 33 with prenatal polysubstance exposure). Multivariable linear regression modelling was used to examine the cross-sectional association between maternal scaffolding and Bayley Scales of Infant and Toddler Development (BSID-III) score, as well as an interaction between the study group and scaffolding score. Outcome measuresThe BSID-III cognitive and language score was used. Videotaped mother-child play was coded to obtain a maternal verbal scaffolding score. Effect sizes were measured using average differences in scores between groups. ResultsThere was no evidence of an association between study group and maternal scaffolding scores. Children in the polysubstance exposure group had lower cognitive and language scores compared to controls, but this association was not statistically significant after controlling for maternal education. Maternal scaffolding was predictive of language scores, with scores increasing by 1.24 points on average (95% CI: 0.42, 2.06) for every 1-point increase in scaffolding score after adjustment for covariates. There was no evidence of a study group-by-scaffolding interaction with respect to the language or cognitive scores. ConclusionsMaternal scaffolding during play was associated with language development in children with and without prenatal polysubstance exposure.

Palliative Care Education: Its Effect on Nurses’ Competency during Care of Dying Patients

Background: Palliative care can play a major role in relieving both physical and mental symptoms of the dying patient. Nurses are the key valuable palliative care team members who are responsible for the dimension of physical, functional, social, and spiritual patients' care. Essential factors affecting a successful implementation of palliative care are nurses' knowledge, attitude and self efficacy for providing care to these patients. Aim of the study: To examine impact of palliative care education on nurses’ competency during care for dying patients. Methods: A quasi-experimental design was utilized. Setting: The study was conducted at oncology institute, general medical and general surgical unit of Menoufia University hospital. Subjects: A convenience sample of 120 nurses (52 from oncology institute, 34 from general medical and 34 general surgical unit) of Menoufia University who agreed to participate in this study were divided alternatively and randomly into two equal groups, 60 for group 1 and 60 for group 2.Tools: four tools were utilized by the researchers. Tool I: Structural interviewing questionnaire, Tool II: Palliative Care Quiz for Nursing, Tool III: The Frommelt Attitudes Toward Care of the Dying scale and Tool IV: The Palliative Care Self-Efficacy Scale. Results: the mean total score of Palliative Care nurses’ knowledge in study group (16.48±1.88)was better than control group (7.23± 2.68), nurses' attitude toward palliative care of study group was 113.50±10.75 as compared to 91.21±12.40of control group and palliative care self-efficacy score of study group was 28.06±7.38 as compared to16.08±4.49 of control group at post-intervention. Conclusion: palliative care educational intervention to nurses can be effective in strengthening their knowledge base, improving attitude and level of self efficacy toward care of dying patient. Recommendations: Education and training programs about palliative care with simple illustrated booklet required for all nursing staff in health care setting