Uneducated Patients Research Articles

Assessment of the Quality of Life in Patients with Epilepsy in the Populous Region of Baku

An article establishes assessment of quality of life, severity of seizures and emotional condition 117 patients with epilepsy, over the age of 18 (35.13±1.19) with different form epilepsy what started from 0 to 69 years (14.22±1.26) in the Machtagа village. How showed analyzes of the survey results, the patients sub clinic 62 (52.9%) and clinic 29 (24.8%) pronounced measure depression and anxiety from scale Ziqmond and high measure severity of seizures from national hospital seizure severity scale (NHS3) (20-27 scores bу 54 (46.1%), (3-9 scores by 40 (34.2%) patients, adversely affecting to their quality of life, assessment by questionnaire «QOLIE-10» (27.1±0.3). Social status research revealed a high patients unemployment rate (82 (70.1%) p=0.911). Between 70 (59.8%) disability patients most had secondary group (р=0.938). The number of lower secondary education and uneducated patient prevailed among native (28 (36.8%)/7 (9.2%)) and nonnative (11 (26.8%)/4 (9.8%)) village population (р=0.547). In population research 65 (55.6%) patients were married, 52 (44.4%) patients were alone (р=0.386). During the study it was revealed influence of ethnocultural characteristics patients to measure quality of life. A form of expression of religious beliefs, which, in the form of a clear implementation of the established religious rules, had a positive effect on the quality of life of patients from the hunhar and kechan mehelle, and mysticism in relation to religion, a form of upbringing in a family without encouraging intellectual development, and even prohibitions on obtaining an education, contributed to the formation passive personality with disabilities among patients from seidler mehelle, which affected their QOL negatively.

OPD Management Of General Surgical Patient In Covid-19 Situation – Ayurvedic And Modern Perspective

Abstract
 
 On 11th March 2020, the World Health Organization declared Severe Acute Respiratory Syndrome COVID-19 as a pandemic and hence lockdown imposed in India resulted in a significant depletion in surgical practices even after unlock down. There were some guidelines for patient care in general surgical practice have been published, overall, publications focusing exclusively on guidelines on starting surgical outpatient departments (OPD) after the COVID-19 lockdown amidst the on-going pandemic are lacking. We hereby propose the evolving knowledge in changes in OPD management practices for general surgeons in the COVID- 19 era. The priority on online registration (e-registration) should be given impetus and become the new norm supplemented by telephonic and spot registration for the uneducated patients. 
 The article also mentions the duties of the help desk, OPD hall supervisor and the new norms of air conditioning, ventilation, safe use of elevators, sanitization of OPD premises and biomedical waste disposal. The optimum and safe utilization of human & material resources DO’s and DON’Ts for patients & health staff have also been proposed. 
 In Ayurveda, a concept similar to the epidemic is narrated by Acharya Charak under a broad heading ‘Janapadodhwamsa’. The word ‘Janapadodhwamsa’ comprises of two words Janapada (large population) & Udhvamsa (destruction) which means the diseases affecting & causing damage of a large number of people. Factors which are familiar to the people under a particular community like air (Vayu), water (Jala), habitat (Desha) and seasons (Kala), Sinful acts (Adharma) in the form of war, affliction by attacks of monsters, demon, alliants (Rakshas) etc. & curses (Abhishap) are responsible for ‘Janapadodhwamsa. . These diseases can be considered as either airborne or waterborne infectious diseases or diseases occurring due to soil contamination or conditions arising due to weather or seasonal hazards. Further, under the heading of Adidaivika Bala Pravritta Vyadhi (diseases arising due to such causes that cannot be controlled by human intelligence), terms such as Sansargaja and Upsragaja are mentioned which indicate that there are certain diseases which can be transmitted directly from infected persons to healthy persons such as contagious diseases or certain diseases can be transmitted by respiration/air borne
 Keywords: COVID 19, Outpatient, general surgery, Corona virus, OPD, Janapadodhwamsa’

The importance of education in patients with metabolic syndrome with regard to their knowledge and attitudes about the disease, and the impact of education on laboratory parameters.

Aim A metabolic syndrome (MetS) increases the risk of heart disease and diabetes mellitus type 2, thus the aim of this study is to correlate the clinical and laboratory parameters in patients suffering from MetS who have previously had education compared to patients who have not had any education about a healthy lifestyle, and to check their knowledge and attitudes about healthy lifestyle. Methods The study included patients of both genders aged 18 - 70 years, diagnosed with MetS, who are members of the Association of Diabetics in Canton of Sarajevo. It used anthropometric parameters, laboratory findings, and an original, structured questionnaire about diet and frequency of physical activities. Results Clinical and laboratory parameters did not differ significantly between educated and uneducated patients, as well as habits in diet, physical activity, and knowledge about metabolic syndrome. The questions from the questionnaire have shown a good value of variance, suggesting that the questionnaire can be considered reliable. Conclusion This study showed that people with metabolic syndrome are not educated and motivated enough to change their lifestyle. The need for education of such patients is necessary.

Evaluation of General Health Status in Diabetic Patients Using Short Form Health Survey (SF-36).

The aim of this study is to assess the general health of diabetic type 2 patients by using SF-36 and also to find if there was an association between the scores of eight domains of this tool with disease-specific and demographic variables. A cross-sectional study was conducted to evaluate the general health of patients with diabetes mellitus type 2. The participants of the present study were randomly selected from rural and urban areas. The diabetic patients visiting community pharmacies in these areas were invited to participate in this study after explaining the goal of the study. A self-reported questionnaire in the Arabic version of the medical outcome survey, the Short-Form (36-item), was conducted. However, uneducated patients were interviewed by trained pharmacists in the community pharmacies. Two hundred confirmed DM patients were enrolled in this study with a mean age of (50.65 ± 8.914 years). 142 (71%) were male and the remaining 58 (29%) were female. The scores of all domains of SF-36 were significantly lower (p < 0.05) in female patients in comparison to that recorded in men. In addition, diabetic patients aged more than 50 years showed significantly lower scores of most domains of SF-36 (p < 0.05) except for emotional well-being (p > 0.05). The multivariate linear regression analysis demonstrated that gender, age, and treatment type were independent of health status based on the SF-36 survey, while emotional well-being, social functioning, and pain were exceptional. The outcomes of this study showed a negative correlation between diabetes mellitus and the health status as measured by SF-36. Furthermore, excluding emotional well-being, social functioning, and pain domains, the other parameters of gender, age, and treatment type showed a significant correlation with health status.

Impact of Psychological Burden on Marital Life among Diabetic Patients: A Case Study of District Lodhran

The study was accomplished through correlational research design. The purpose was comprised of investigating the impact of psychological burden on patients’ level of their marital life. The convenient sampling technique was utilized to approach 139 patients with diabetes mellitus as a sample. The data was collected through questionnaires as a source of measurement. The permission was taken to keep information confidential. The collected data was entered into SPPS for analysing. Inferential statistics were used to test hypothesis with the help of the following tests; linear regression and t-test for independent sample designs. The results of the study reflect that the psychological burden of diabetic patients influences their degree of marital satisfaction significantly. In addition, the difference of psychological burden (stress, depression and anxiety) and marital satisfaction was found significant with respect to demographic characteristics of the participants; gender, type of disease, education and working status. Female patients are reported with a greater level of psychological burden but they were observed with a poor degree of marital satisfaction as compared to males. Psychological burden and satisfaction associated with marital life due to diabetes was discussed as significant between working and non-working, type 1 and type 2 diabetes mellitus, and educated and uneducated patients. In the future, there is a need to investigate the coping styles as mediator between psychological disturbance and marital satisfaction.

Retraction: Medication Non-Adherence among Patients with Heart Failure.

[This retracts the article DOI: 10.7759/cureus.5346.].

Medication Non-Adherence among Patients with Heart Failure.

IntroductionPoor adherence or non-adherence to the prescribed medications among heart failure (HF) patients is a common problem. This leads to hospital admission due to increased HF exacerbations, reduced physical function, and even death. The study was conducted to assess the heart failure medication adherence level, using Morisky Medication Adherence Scale (MMAS-8), among heart failure patients visiting the adult cardiology department of a tertiary care cardiac center in Karachi.MethodsThis cross-sectional study included patients diagnosed with heart failure visiting for the follow-up to both inpatient and outpatient departments of a tertiary care cardiac center of Karachi, Pakistan. Medication adherence level was assessed using a validated Morisky Medication Adherence Scale (MMAS-8). The total MMAS-8 score was calculated by adding all of the 8 individual question scores and patients with a score of eight were classified as adherent, otherwise non-adherent.ResultsA total of 200 patients were included in this study, out of which 61.5% (123) were male and 38.5% (77) were female. More than half, 54% (108), of the patients were rural residents and majority were Urdu (39.5%) speaking followed by Sindhi (19.5%) and Pashto (19.0%) speaking. Almost all, 99.5% (199) were married and 52% (104) patients were uneducated. Overall 76.5% (153) were adherent to the prescribed medication. And reaming 23.5% (47) were moderately adherent with MMAS-8 score of seven and six. Non-adherence to the prescribed medication is more common among rural residents and uneducated patients.ConclusionNon-adherence to the prescribed medication was observed in a significant number of heart failure patients (23.5%) in our population, and it was more common observation for the patients with rural residence and uneducated. It is important to counsel the patients about the importance of medication adherence to marginalize the re-hospitalization and complications these patients.

Studying the relationship of Nosocomial infection to the age, gender and educational level of the patient

A total of 140 samples were collected from patients staying at Tikrit Teaching Hospital for three days or more in order to identify the most common bacterial isolates within the infections acquired from Tikrit Teaching Hospital and its relation to the age, gender and educational level of the patient. The samples included 75 urine samples, 28 stool samples, 28 wound swabs, and 9 sputum samples. The percentage of nosocomial infections was (45.7%), where the highest percentage were among UTIs (50.7%) from the total of (75) samples, followed by wound infections (42.9%) from the total of (28) samples, gastrointestinal infections (39.3%) from the total of (28) samples, and pneumonic infections (33.3%) from the total of (9) samples. It was noticed that hospital infections were more common in females, age group (51-89) years followed by the age group (5 years and less), and the uneducated (illiterate) where the number of hospital infected patients was 47 uneducated (illiterate) patients with 71.2%, while the number of educated patients was 19 patients with 28.8%. Various bacterial species were isolated in this study, including Citrobacter.koseri, E.coli, Staphylococcus schleiferi, Staphylococcus epidermidis, Proteus vulgaris, Staphylococcus saprophyticus, Klebsiella ozaenae, Klebsiella ornithindytica, Enterobacter aerogenes, Providencia stuartii, Staphylococcus warneri, Staphylococcus aureus, Proteus mirabilis, Prov. rettgeri, Staph. flexneri, Prov.alcalifaciens and K.pneumoniae

Prevalence and Associated Factors of Depression among Patients with Diabetes at Jazan Province, Saudi Arabia: A Cross-Sectional Study.

Context Patients with diabetes mellitus (DM) have a poorer quality of life when compared with patients without DM. In fact, one in every five diabetic patients suffers from comorbid depression, which can lead to poor management, poor compliance with treatment, and low quality of life. Therefore, we assessed the prevalence of depression and identified its associated factors among diabetic patients at Jazan Province, KSA. Methods and Materials A cross-sectional study was conducted among 500 diabetic patients attending a diabetic center in addition to four primary healthcare centers. We used a simple Arabic translation of the Beck Depression Inventory (BDI II) tool to evaluate the depression level among the subjects. We also evaluated the frequencies of certain sociodemographic characteristics and clinical information. Moreover, we performed univariate and multivariate analyses to identify the potential risk factors using adjusted odds ratios (AORs). Results The prevalence of depression among DM patients was 20.6%. The majority of patients showed no depression (N = 285, 59.4%), one-fifth had mild depression (N = 96, 20.0%), some (N = 55, 11.4%) had moderate depression, and some had severe depression (N = 44, 9.2%). Depression was significantly more prevalent among uneducated patients (N = 27, 31.8%) (X2 = 17.627, P = 0.001) and patients with low monthly income (< 2500 SR/month) (N = 33, 22.8%) (X2 = 9.920, P = 0.019). Hypertension (AOR = 2.531, 95% CI [1.454, 4.406]) and ischemic heart diseases (AOR = 3.892, 95% CI [1.995, 7.593]) were considered as risk factors for depression among diabetic patients. Conclusions Almost one in every five patients with DM is affected by depression coexisting with cardiovascular diseases. Therefore, screening for psychological problems, proper treatment, and educating patients with diabetes about DM self-management should be routine components of DM care.

Prevalence of dental anxiety in relation to sociodemographic factors using two psychometric scales in Baghdad

Background: In spite of advances in dentistry, anxiety about dental treatment and thefear of pain remains public health problem and is a significant impediment todental treatment. The purpose of this study was to assess the levels of dentalanxiety in patients who referred to Al-Mustansiriyah dental clinics and Al-ShiekhOmar specialized dental center in Baghdad and their relation to their gender, age,educational level.Materials and methods: The study was done on (800) patients, aged (20-59) years inBaghdad. The survey form was prepared and translated from English to Arabiclanguages by certified translator and were filled by patients themselves withoutany help from dentists. Patients with mental retarded, those who not havingcompleted the survey form and those below 20 years and above 59 years wereexcluded. The survey was divided into 3 parts (socio-demographic information,Modified dental anxiety scale (MDAS) and Dental fear survey (DFS).Results: The present study showed that females had higher anxiety (13.57, 47.38)than males (8.98, 37.75) for Modified dental anxiety scale and Dental fear surveyrespectively. The anxiety decreased with advance of age (12.31, 11.41, 10.89,10.45 for Modified dental anxiety scale and 43.10, 41.22, 38.69, 37.93 for Dentalfear survey) in groups (1,2,3,4) respectively. The anxiety decreased with advanceof teaching, so the uneducated patients had higher mean of anxiety (14.45, 48.59)while the postgraduate patients had lower anxiety (9.10, 36.30) for Modifieddental anxiety scale and Dental fear survey respectively than others. There washigh significant difference between males and females at P-value (≤ 0.01) for bothModified dental anxiety scale and Dental fear survey scales.Analysis of variance (ANOVA) test showed high significant difference among agegroups and among education level groups at P-value (≤ 0.01) for both Modifieddental anxiety scale and Dental fear survey scales. The higher percentage ofanxiety scales was appeared in minimal anxiety score in males (56%, 48%) inModified dental anxiety scale and Dental fear survey respectively, while lessorpercentage was appeared in very high anxiety score in males (5.1%, 5.5%) inModified dental anxiety scale and Dental fear survey respectively. Pearson'scorrelation coefficient (R) showed that there was a positive relationship betweengender and anxiety scales, with statistically high significant at P-value (≤ 0.01).While, there was inverse relationship between age and anxiety scales, and between education and anxiety scales with statistically high significant at P-value (≤ 0.01)for both relations.Conclusion: The females had higher rate of anxiety than males. The anxietydecreased with advance of age and education level of patients. There was a strong(positive) relationship between gender and anxiety. While, there was inverse(negative) relationship between anxiety with age and education.

Assessment of medication adherence among patients with chronic diseases: a descriptive cross-sectional study

Background: Adherence is a key factor associated with effectiveness of all pharmacological therapies. Medication non-adherence is a significant barrier to achieve positive health outcomes especially for patients suffering from chronic diseases. Improving medication adherence is a public health priority and could reduce economic and health burdens. The aim of the present study was to assess medication adherence to some common chronic ailments.Methods: Pre-validated questionnaires were distributed among 300 patients suffering from chronic illnesses, by simple randomization out of which 240 patients returned completely filled questionnaires. The analysis was done by manual calculators, VassarStats, and SPSS V20. Results were calculated using univariate linear regression, with each patient’s adherence score as the dependent variable and each predictor as the independent variable. Results are expressed in frequencies and percentages.Results: In this study, 46.66% patients were males and 53.33% females. The mean age was 56.69 years ranging from 24 to 90 years.65.00% patients were uneducated.40.00% were taking one drug, 53.33% two to four drugs and 6.66% more than four drugs. 63.33% had low medication adherence, 35.00% medium and only 1.66% had high adherence. Compared to 14.28% men, 43.75% women were moderately adherent to medications. 41.02% uneducated patients had medium adherence as compared to 14.28% educated patients. 92.30% young patients had low adherence as compared to 53.25% in adults. 44.79% of patients receiving a single drug had medium adherence as compared to 25.00% in those receiving multiple drugs. Linear regression analysis demonstrated that the level of medication adherence was associated with patient gender, age, educational level, and number of prescribed drugs.Conclusions: There are many challenges in understanding the reasons for non-adherence. In this study medication adherence in chronic diseases was found suboptimal and associated with patient`s socio-demographic characteristics. Patient-tailored interventions are required to achieve sufficient adherence to therapeutic drug regimens.

Health seeking behaviour and delayed management of tuberculosis patients in rural Bangladesh

BackgroundEarly diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers.MethodsA cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care.ResultsTwo hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39–3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38–3.96) to be independent predictors of health system delay.ConclusionsCompared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended.

Assessment of health-related quality of life (HRQoL) in patients with spasmodic dysphonia

Background: There is paucity of literature regarding health related quality of life in Spasmodic Dysphonia (SD) especially from India. This study assessed HRQoL in it’s global and disease specific aspect by previously validated instruments in patients with SD.Methods: The study was performed in AIIMS, New Delhi. Subjects with SD as well as age and gender matched healthy controls were enrolled from Movement Disorder and botulinum toxin clinic, Department of Neurology, AIIMS, New Delhi. Uneducated patient, those could not read questionnaires &amp; cases who had received botulinum toxin within 6 months were excluded from the study. Each patient filled SF-36, BDI, VoiSS-30 and VPQ questionnaire.Results: 14 pts of Spasmodic Dysphonia (SD) were enrolled. Compared with controls SD patients suffered from statistically significant impaired global health related quality of life (SF36) in areas of role physical (p = 0.007), general health (p = 0.004), social functioning (p = 0.024), role emotion (p = 0.008) and mental health (p=0.039). Patients with SD scored much worse in BDI scale than their control group (12.57±8.0 vs. 4.71±5.0, p=0.005). 65% pt of SD had depression out of whom 14% had moderate depression. SD patient group showed statistically significant impaired scores in disease-specific QOL (VoISS) in 2 out of 3 subscales, impairment (p= &lt;0.001) and emotional (p=&lt;.001) but not in physical (p=0.44). Voice quality of patients with SD was severely affected compared to controls (mean 37± 8.0 vs. 12.9± 1.5).Conclusions: This study clearly demonstrated that patients with SD suffered from significant impairment in HRQoL as compared to controls. Higher proportion of patients with SD suffered from mild to moderate depression compared to their control.

Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period?

Long-term antipsychotic treatment of schizophrenia: does it help or hurt over a 20-year period?

Satisfaction among the patients attending the health centres attached to a tertiary care hospital in Gandhinagar, Gujarat

Background: There is a need of quality health services in developing countries like India. Uneducated patients are transformed in to educated clients and demands for better services. It is important to measure satisfaction of the patients towards catered health services for betterment of the institute as well as community. The objective of the study was to know the satisfaction of patients attending the OPD of Rural health training centre and urban health training centre of a medical college.Methods: A cross-sectional survey was conducted among people attending the OPD of RHTC and UHTC of a Medical college and they were interviewed by using patient satisfaction survey from.Results: Overall satisfaction was 98% participants in RHTC and 99% in UHTC were satisfied. Almost all patients were satisfied with the behaviour of the doctor, paramedical staff and class 3 workers at RHTC and UHTC (100% in RHTC and 98.5% in UHTC.Conclusions: Overall patient satisfaction was good but based on the statistics; areas which had a void can be corrected by implementing the suggestions given by respondents.

Quality of life in hemodialysis diabetic patients: a multicenter cross-sectional study from Palestine

BackgroundBoth diabetes and hemodialysis can seriously impair patients’ health related quality of life (HRQOL). This study seeks to obtain data which will help to address the factors associated with impaired HRQOL in hemodialysis patients with diabetes in Palestine.MethodsA cross-sectional study was performed in multiple centers in the period from November 2016 to June 2017. We utilized the Arabic version of EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L) scale and EuroQol-visual analogue scale (EQ-VAS) to measure patients’ HRQOL. The study was conducted in six dialysis centers in the North of West Bank, Palestine. Descriptive and comparative statistics were used to describe clinical and socio-demographic features of patients. Multiple linear regression analysis was used to determine the association between clinical and socio-demographic factors and HRQOL score.ResultsOne hundred and forty one diabetic patients undergoing hemodialysis were enrolled in our study. Overall, 52.5% of them (74 patients) were males; the patients had a mean age of 60.32 with 52.5% of them aged below 60. The mean ± standard deviation of EQ-5D-5L index and EQ-VAS score was 0.314 ± 0.4 and 50.85±22.43, respectively. The findings of this study suggest that female patients, uneducated patients, unemployed patients, unmarried patients, and patients with more chronic diseases and comorbidities had a significant poor HRQOL scores (p values <0.05). Variables such as marital status and occupational status were significantly (p < 0.05) associated with the QOL score. More specifically, married status and employed patients positively associated with QOL score (β = 0.22; p = 0.016 and β = 0.27; p = 0.013, respectively).ConclusionsAmong diabetic patients undergoing hemodialysis, married status and being employed were associated with modestly higher scores of QOL. We recommend that healthcare providers give more attention to diabetic dialysis patients who are unemployed and unmarried, as they are at a higher risk of having impaired HRQOL.

Are the Beck depression inventory score, SF 36 score and progression of the disease changing with education in chronic kidney disease patients?

Aim: Patient education is important for patients with predialysis chronic renal disease (CKD)because it can delay the progression of the disease to end-stage renal failure.Anxiety and depression may also contribute to the progression of the disease in patients with CKD. We evaluated the influences of education on progression ofCKD, the Short Form 36 Health Survey (SF36), and the Beck Depression Inventory (BDI) in predialysis CKD patients. Material and Methods: 121 patients with nondialysis stage 2-5 CKD were involved in this study. At the start of the study, the SF36 and BDI scoring were performed in all patients and their creatinine clearances were calculated. 31 patients were given education on CKD by the dialysis specialist nurse once a month. At the end of the sixth month, SF36 and BDI were rescored, and their creatinine clearances were recalculated. Results: There were no significant differences between the two groups regarding age, gender, creatinine clearance, and duration of chronic kidney disease. At the end of the sixth month, when the educated and uneducated patients were compared, while the increase of the creatinine level was significant in the two groups, the SF36 and BDI scores were found to be improved significantly in the study group. Conclusion: The results of this study suggested that patient education may improve the SF36 and BDI scores, but it does not affect the progression of the disease for at least six months in duration.

Delay in diagnosis of pulmonary tuberculosis in low-and middle-income settings: systematic review and meta-analysis

BackgroundAssessment of delays in seeking care and diagnosis of tuberculosis is essential to evaluate effectiveness of tuberculosis control programs, and identify programmatic impediments. Thus, this review of studies aimed to examine the extent of patient, health system, and total delays in diagnosis of pulmonary tuberculosis in low- and middle- income countries.MethodsIt was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases were searched to retrieve studies published from 2007 to 2015 including Pubmed central, Springer link, Hinari and Google scholar. Searching terms were pulmonary tuberculosis, health care seeking, health care seeking behavior, patient delay, diagnostic delay, health system delay, provider delay, and doctor delay. Retrieved studies were systematically reviewed and summarized using Comprehensive Meta-analysis software.ResultsForty studies involving 18,975 patients qualified for systematic review, and 14 of them qualified for meta-analysis. The median diagnostic delay ranged from 30 to 366.5 days [IQR = 44–77.8], with a 4–199 days [IQR = 15–50] and 2–128.5 days [IQR = 12–34] due to patient and health system delays, respectively. The meta-analysis showed 42% of pulmonary tuberculosis patients delayed seeking care by a month or more; uneducated patients [pooled OR = 1.5, 95%CI = 1.1–1.9] and those who sought initial care from informal providers [pooled OR = 3, 95%CI = 2.3–3.9] had higher odds of patient delay.ConclusionDelay in diagnosis is still a major challenge of tuberculosis control and prevention programs in low- and middle- income settings. Efforts to develop new strategies for better case-finding using the existing systems and improving patients’ care seeking behavior need to be intensified.

Imaging of forgotten indwelling D.J. stent with encrustment

Abstract A poor, uneducated male patient from a remote rural place had undergone Right open pyelolithotomy with Double J (D.J. stent) stenting for obstructive uropathy 15 years ago. He presented with the following prevailing conditions: right flank pain, interrupted urinary stream and burning micturition. Ultrasound showed Gross Hydronephrosis with multiple calculi and D.J. stent in the right kidney. Urinary bladder also showed presence of D.J. stent with encrustment around the tip of the stent. The mid part of D.J. stent was not visualized. Later, on X-ray, broken parts of the stent with encrustment were seen in the right renal pelvis and bladder, which were removed, and cystolithotomy was done. Imaging plays a pivotal role in detection of such broken or forgotten stents and can direct early and prompt management to prevent complications.

Self-Medication of Corticosteroids: A Life Threatening Case Report from Pakistan

A 70 years-old male patient with poor socioeconomic status seeks medical treatment from a quack for a minor injury. The Quack assured him to improve his health while offering him a miracle medicine that went wrong. A registered medical practitioner made a working diagnosis of the mismanaged early stage cellulitis and patient was shifted to a specialized hospital with subsequent deterioration of his health due to septicemia leading to unconsciousness. Pertinent medical history determined patient’s self-medication habits for the last 10 years including Prednisolone and Tetracycline for upper respiratory tract disorders–identified as per medicine color and shape. A number of potent antibiotics were tried but in vain. Finally the patient was diagnosed with corticosteroid induced adrenal suppression which shifted a minor injury into life threatening condition. In ICU, physician added injection Dexamethasone which regains patient’s consciousness within 3–4 hrs. It is concluded that in a country like Pakistan where provision of prescription medicines are similar to over the counter medicines, self-medication driven disease mismanagement coupled with treatment and procedural qualms for uneducated patients, mightsteer a minor health event to a life-threatening incident. Key words: Self-medication, Corticosteroid, Cellulitis, Septicemia, Quackery.