WHO Definition Research Articles

137 Analysis of Debris Generated During the Process of Cutting and Grinding of Carbon Fibers-Reinforced Plastics

Abstract Carbon fiber reinforced plastics (CFRP) is a leading functional material with superior strength and low mass density compared to metal. Recently, due to its excellent property, it has spread to a wide range of fields from sporting goods, such as golf clubs and fishing rods, to aerospace products. However, there is concern that debris (microparticles) is easily released in the processing process of CFRP. The present study investigated the ambient level, size, and shape of particles generated from CFRP during various machining processes in an occupational setting. The size and shape of particles were observed using scanning electron microscopy (SEM) and their chemical compositions were also analyzed using energy dispersive spectroscopy (EDS). The majority of debris from CFRP was cylindrical with a diameter comparable to the diameter of the original carbon fiber, suggesting transversally split carbon fiber. However, some of the debris was fibrous, length >5 μm, width 3, suggesting longitudinally split carbon fiber. These fibrous fragments were morphologically compatible with the WHO definition of respirable fibers. The particles in the working environment were also monitored with a real-time monitoring device, NanoScan SMPS Model 3910. Measurement by real-time monitoring device showed that not only microparticles but also smaller particles were released in the processing process of CFRP. These particles are probably breakdown elements of the epoxy thermoset polymer (resin) in CFRP. The potential hazard of debris from CFRP in the processing process in an occupational setting and risk assessment is needed for the safe handling of CFRP.

Effects of filgotinib on semen parameters and sex hormones in male patients with inflammatory diseases: results from the phase 2, randomised, double-blind, placebo-controlled MANTA and MANTA-RAy studies

ObjectivesThe phase 2 MANTA and MANTA-RAy studies aimed to determine if the oral Janus kinase 1 preferential inhibitor filgotinib affects semen parameters and sex hormones in men with inflammatory diseases.MethodsMANTA...

Assessment of haemoglobin and serum markers of iron deficiency in people with cardiovascular disease

BackgroundThe prevalence of anaemia and iron deficiency and their prognostic association with cardiovascular disease have rarely been explored at population level.MethodsNational Health Service records of the Greater Glasgow region for...

THE DETERMINANTS OF SHORTER TIME TAKEN TO REACH FULL FEED AMONG EXTREMELY LOW BIRTH WEIGHT NEWBORNS ADMITTED TO LEVEL III NEONATAL INTENSIVE CARE UNIT OF GOVERNMENT HOSPITAL

Background: Although extremely low gestational age newborns (ELGANs) or extremely low birth weight (ELBW)newborns are born they have their third-trimester intrauterine life pertaining to development. During this time, one of the objectives of the NICU staff is to feed the newborn with enough nourishment to reach a growth velocity (GV) comparable to intrauterine GV. Early parenteral & enteral nutrition to ELBW infants during the first twenty-four hrs of life leads to a quick recovery of weight loss, enhanced overall weight growth, and earlier accomplishment of complete enteral feeding. Early & substantial protein administration has also been linked to increased weight gain & brain growth. Aims/Objective: To identify determinants of shorter time taken to reach full feeds among ELBW admitted to level III NICU. Method: It was a retrospective hospital-based study conducted from April 2022 to September 2022 and included 55 ELBW newborns admitted to NICU satisfying the WHO definition of ELBW and categorizedinto group I(<28wks), group II (>28 wks. till 31 wks.). Various determinants like ventilatory support, surfactant therapy, NEC, gestational age (GA), etc. are used for analysis. Results: 55 ELBW analysed their mean gestational age (27±3.1) weeks, Range (25-31 weeks) Mean Birth weight (884±114 gram) Range (500-<1000 gm). There were 2 groups, Group 1 (< 28 weeks) included 28 ELBW who reached full feeding in 16.8±13.8 days whereas 27 ELBW were included in Group 2 who reached full feeding in 13.07±8.5 days. Most of the determinates have P VALUE-0.0 except birth weight(P-0.89) and metabolic factor (P-0.14). Overall, all determinates have an impact the on duration to reach full feed in ELBW. Conclusion: ELBW newborns who require minimal ventilatory support, no surfactant, less association with NEC, IVH, Sepsis, and average gestation age above 28 weeks attained early full feed regain birth weight also decreases hospital stay. Funding source: None. Ethics committee clearance submitted Conflict of interest: None.

The correlation between circulating growth differentiation factor 11 and the risk of osteopenia/osteoporosis in men.

Male osteopenia/osteoporosis remains a neglected subject or is under- or misdiagnosed. Many studies have confirmed the role of growth differentiation factor 11 (GDF11) in bone metabolism, although its role in bone metabolism remains controversial. In this study, we aimed to investigate the association between serum GDF11 levels and the prevalence of osteopenia/osteoporosis (OP) in a male cohort and explore the possibility of GDF11 to be a useful target for prediction of osteopenia/osteoporosis to enable prompt intervention for this disease. This cross-sectional study included 121 native Chinese men randomly aged 20-87 years, excluded the subjects who had the conditions of bone metabolism-related disease and administration of hormonal drugs, and grouped the subjects to OP and non-OP, based on the WHO definition and latest guidelines of OP. The serum GDF11 concentration was determined using a GDF11-specific immunoassay. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Tartrate-resistant acid phosphatase 5b (TRAP-5b) were measured in serum samples with ELISA method. We observed a negative correlation between serum GDF11 levels and age, a positive correlation between serum GDF11 levels and the femoral neck BMD, and a negative correlation between serum GDF11 levels and TRAP-5b in men. The prevalence and risk of OP were significantly higher in men with low serum GDF11 levels. The serum GDF11 concentration is significantly associated with the risk of bone metabolism dysfunction and may be a useful target for prediction of OP in male cohort.

P151 Prevalence and risk factors of osteoporosis in Indian systemic sclerosis patients

Abstract Background/Aims Systemic sclerosis (SSc) is a systemic autoimmune disease in which osteoporosis has been reported to be more prevalent than in healthy individuals. Bone loss is hypothesised to be related to vasculopathy in SSc, but the causative pathways are not very clear. This study was conducted to investigate the prevalence of osteoporosis in Indian patients with SSc and to assess its association with various disease-related characteristics. Methods This was a cross-sectional, case-control study performed in a 1,250 bedded tertiary care hospital. Between August 2017 and June 2019, all consecutive patients attending the outpatient and in-patient departments of the Department of Rheumatology & Clinical Immunology at our institute, classified as SSc as per the ACR/EULAR 2013 criteria, were included after taking their informed consent. Age and gender-matched healthy controls were included and all enrolled subjects were subjected to a dual energy X-ray absorptiometry (DEXA) scan. Demographic and clinical details of all patients were recorded. Osteoporosis was defined as per the WHO definition of a T score ≤ -2.5. The study was approved by the Institutional Review Board and the Institutional Ethics Committee. Results 90 patients with SSc and 45 age and gender-matched healthy controls were included in the study. Confounding factors for bone health, like smoking or alcohol intake, the proportion of post-menopausal women, and past or family history of fragility fractures, were matched between the two groups. The prevalence of osteoporosis among SSc cases was significantly higher than in the healthy controls (34.4% vs. 6.6%, p < 0.001). In univariate analysis, age, low body mass index (BMI), post-menopausal status, diffuse cutaneous phenotype, gastrointestinal involvement, digital ulcers, and pulmonary arterial hypertension were found to be significantly associated with osteoporosis. Multivariate analysis revealed that the presence of osteoporosis was significantly associated with lower BMI, post-menopausal status, and the presence of digital ulcers in patients. Interestingly, glucocorticoid use did not appear to increase the risk of osteoporosis in our cohort. Conclusion Patients with systemic sclerosis and digital ulcers, low BMI, or post-menopausal status are at high risk of developing osteoporosis and therefore should be screened for osteoporosis by DEXA scan to prevent unforeseen fracture-related morbidity and mortality. Glucocorticoids may not be the major culprit as evidenced by this study, while control of disease activity may lead to better bone health status. Disclosure D. Tanna: None. S. Ghosh: None. K. Telang: None. G. Ekbote: None. V. Singal: None. R. Gupta: None.

Components and Outcomes in Under- and Postgraduate Medical Education to Prepare for the Delivery of Integrated Care for the Elderly: A Scoping Review.

The ageing society requires physicians who can deliver integrated care, but it is unclear how they should be prepared for doing so. This scoping review aims to create an overview of educational programmes that prepare (future) physicians to deliver integrated care while addressing components and outcomes of the interventions. We included papers from five databases that contained: (1) integrated care (2) education programme (3) medical students (4) elderly, or synonyms. We divided the WHO definition of integrated care into ten components for the concept of 'integrated care'. Data were collected with a charting template, and template analysis was used to formulate themes. We found 17 educational programmes in different learning settings. All programmes addressed several components of the WHO definition. The programmes primarily focused on care for individual patients (micro-level), and the outcomes suggested that experiencing the complexity of care is key. This review revealed the limited evidence on educational programmes about integrated care for the elderly. Our findings suggest that educational programmes on integrated care should not be limited to the micro-level, and that students should obtain adaptive expertise by experiencing complexity. Future research should contain an explicit description and definition of integrated care.

Evaluating Preoperative Intravenous Iron and Erythropoietin Treatment and Outcomes in Cardiac Surgery Patients.

Anemia is more common in cardiac surgery patients than in other people. Severe anemia before cardiac surgery strongly predicts blood transfusion. This study aimed to evaluate the outcomes of Intravenous (IV) iron and erythropoietin (EPO) injection preoperatively in anemic patients waiting for coronary artery bypass graft (CABG) surgery. This cross-sectional study was performed between May to December 2020 at Masih Daneshvari hospital in Tehran, Iran. Anemia was described according to the WHO definition (Hb < 130 g/L in men). The study was designed in two groups of men CABG patients. Hematocrit level, platelet count, partial thromboplastin time, international normalized ratio, prothrombin time before surgery, red blood cells (RBCs) transfusion, as well as plasma and platelet units' transfusion during surgery and at the time of hospitalization were obtained from patient's files. The length of stay in the hospital and the consequences, including infection, stroke and heart attack, and mortality, were also obtained from the patient's files and recorded in the checklists. Pearson's chi-squared test, Fisher's exact test, independent samples t-test, univariate logistic regression, and odds ratio (OR) were used. All statistical analyses were performed by the SPSS software version 21. The significance level in this study was considered 0.05. In this study, the data of 64 patients were gathered, among whom 16 (25%) were injected with IV iron and EPO, and the remaining 48 (75%) did not receive any medications for stimulating erythropoiesis. The mean age of patients was 64.05 ± 8.21 years, with an age range of 51 - 91 years. Infection (P = 0.258) and mortality rate (P = 0.440) in the two groups of injection and non-injection did not show a statistically significant difference. The duration of the clamp at the time of surgery (r = 0.699, P = 0.001) and the duration of hospitalization (r = 0.399, P = 0.023) had statistically significant positive relationships with the pump duration. Red blood cell consumption in the injection and non-injection groups was 2.50 ± 2.07 and 2.90 ± 1.80 (P = 0.469), respectively. Infection (P = 0.258), mortality rate (P = 0.440), and RBC utilization (P = 0.469) in the two groups of injection and non-injection were not significantly different.

Safety and effectiveness of vaccines against COVID-19 in children aged 5–11 years: a systematic review and meta-analysis

To date, more than 761 million confirmed SARS-CoV-2 infections have been recorded globally, and more than half of all children are estimated to be seropositive. Despite high SARS-CoV-2 infection incidences, the rate of severe COVID-19 in children is low. We aimed to assess the safety and efficacy or effectiveness of COVID-19 vaccines approved in the EU for children aged 5-11 years. In this systematic review and meta-analysis, we included studies of any design identified through searching the COVID-19 L·OVE (living overview of evidence) platform up to Jan 23, 2023. We included studies with participants aged 5-11 years, with any COVID-19 vaccine approved by the European Medicines Agency-ie, mRNA vaccines BNT162b2 (Pfizer-BioNTech), BNT162b2 Bivalent (against original strain and omicron [BA.4 or BA.5]), mRNA-1273 (Moderna), or mRNA-1273.214 (against original strain and omicron BA.1). Efficacy and effectiveness outcomes were SARS-CoV-2 infection (PCR-confirmed or antigen-test confirmed), symptomatic COVID-19, hospital admission due to COVID-19, COVID-19-related mortality, multisystem inflammatory syndrome in children (MIS-C), and long-term effects of COVID-19 (long COVID or post-COVID-19 condition as defined by study investigators or per WHO definition). Safety outcomes of interest were serious adverse events, adverse events of special interest (eg, myocarditis), solicited local and systemic events, and unsolicited adverse events. We assessed risk of bias and rated the certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development and Evaluation approach. This study was prospectively registered with PROSPERO, CRD42022306822. Of 5272 screened records, we included 51 (1·0%) studies (n=17 [33%] in quantitative synthesis). Vaccine effectiveness after two doses against omicron infections was 41·6% (95% CI 28·1-52·6; eight non-randomised studies of interventions [NRSIs]; CoE low), 36·2% (21·5-48·2; six NRSIs; CoE low) against symptomatic COVID-19, 75·3% (68·0-81·0; six NRSIs; CoE moderate) against COVID-19-related hospitalisations, and 78% (48-90, one NRSI; CoE very low) against MIS-C. Vaccine effectiveness against COVID-19-related mortality was not estimable. Crude event rates for deaths in unvaccinated children were less than one case per 100 000 children, and no events were reported for vaccinated children (four NRSIs; CoE low). No study on vaccine effectiveness against long-term effects was identified. Vaccine effectiveness after three doses was 55% (50-60; one NRSI; CoE moderate) against omicron infections, and 61% (55-67; one NRSI; CoE moderate) against symptomatic COVID-19. No study reported vaccine efficacy or effectiveness against hospitalisation following a third dose. Safety data suggested no increased risk of serious adverse events (risk ratio [RR] 0·83 [95% CI 0·21-3·33]; two randomised controlled trials; CoE low), with approximately 0·23-1·2 events per 100 000 administered vaccines reported in real-life observations. Evidence on the risk of myocarditis was uncertain (RR 4·6 [0·1-156·1]; one NRSI; CoE low), with 0·13-1·04 observed events per 100 000 administered vaccines. The risk of solicited local reactions was 2·07 (1·80-2·39; two RCTs; CoE moderate) after one dose and 2·06 (1·70-2·49; two RCTs; CoE moderate) after two doses. The risk of solicited systemic reactions was 1·09 (1·04-1·16; two RCTs; CoE moderate) after one dose and 1·49 (1·34-1·65; two RCTs; CoE moderate) after two doses. The risk of unsolicited adverse events after two doses (RR 1·21 [1·07-1·38]; CoE moderate) was higher among mRNA-vaccinated compared with unvaccinated children. In children aged 5-11 years, mRNA vaccines are moderately effective against infections with the omicron variant, but probably protect well against COVID-19 hospitalisations. Vaccines were reactogenic but probably safe. Findings of this systematic review can serve as a basis for public health policy and individual decision making on COVID-19 vaccination in children aged 5-11 years. German Federal Joint Committee.

The definition of long COVID used in interventional studies.

There has been little consensus for a specific definition of long COVID, though several organizations have created varying ones. We sought to examine the definition of long COVID used in ongoing clinical trials. We searched 'long COVID' and related terms on both PubMed and clinicaltrials.gov for randomized studies that either included patients with long COVID or had a persistent or long-term COVID-related outcome and abstracted long COVID definition components. Of the 92 studies, a laboratory-only confirmed diagnosis of COVID-19 was stipulated in 54.3% (n = 50) studies. We found eight different time durations specified for how long symptoms needed to have occurred, ranging from 4 to 52 weeks, with 12 weeks being the most common (34.8%; n = 32). 35.9% (n = 33) did not specify a time duration. There were 57 different symptoms specified in total, with a median of one symptom identified per study (range 0-32). 8.7% of trials adhered to NICE or WHO definitions. Standardized definitions of long COVID should be applied in studies assessing this condition to unify and harmonize research on this topic.

Physio-metabolic and clinical consequences of wearing face masks-Systematic review with meta-analysis and comprehensive evaluation.

As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation. A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes. We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, p < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31-0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01). Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health. Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.

Australian COVID-19 pandemic: A Bradford Hill Analysis of Iatrogenic Excess Mortality

Australian official mortality data show no clear evidence of significant excess deaths in 2020, implying from an older WHO definition that there was no COVID-19 pandemic. A seasonality analysis suggests that COVID-19 deaths in 2020 were likely misclassifications of influenza and pneumonia deaths. Australian excess mortality became significant only since 2021 when the level was high enough to justify calling a pandemic. Significant excess mortality was strongly correlated (+74%) with COVID-19 mass injections five months earlier. Strength of correlation, consistency, specificity, temporality, and dose-response relationship are foremost Bradford Hill criteria which are satisfied by the data to suggest the iatrogenesis of the Australian pandemic, where excess deaths were largely caused by COVID-19 injections. Therefore, a strong case has been presented for the iatrogenic origins of the Australian COVID-19 pandemic and therefore, the associated mortality risk/benefit ratio for COVID injections is very high.

IMPACT OF PULMONARY DENERVATION ON QUALITY OF LIFE AFTER COMPLEX MITRAL VALVE SURGERY

Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3rd group was 100%, in the 2nd and 1st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

PM2.5 and Dementia in a Low Exposure Setting: The Influence of Odor Identification Ability and APOE.

Growing evidence show that long term exposure to air pollution increases the risk of dementia. The aim of this study was to investigate associations between PM2.5 exposure and dementia in a low exposure area, and to investigate the role of olfaction and the APOE ɛ4 allele in these associations. Data were drawn from the Betula project, a longitudinal study on aging, memory, and dementia in Sweden. Odor identification ability was assessed using the Scandinavian Odor Identification Test (SOIT). Annual mean PM2.5 concentrations were obtained from a dispersion-model and matched at the participants' residential address. Proportional hazard regression was used to calculate hazard ratios. Of 1,846 participants, 348 developed dementia during the 21-year follow-up period. The average annual mean PM2.5 exposure at baseline was 6.77μg/m3, which is 1.77μg/m3 above the WHO definition of clean air. In a fully adjusted model (adjusted for age, sex, APOE, SOIT, cardiovascular diseases and risk factors, and education) each 1μg/m3 difference in annual mean PM2.5-concentration was associated with a hazard ratio of 1.23 for dementia (95% CI: 1.01-1.50). Analyses stratified by APOE status (ɛ4 carriers versus non-carriers), and odor identification ability (high versus low), showed associations only for ɛ4 carriers, and for low performance on odor identification ability. PM2.5 was associated with an increased risk of dementia in this low pollution setting. The associations between PM2.5 and dementia seemed stronger in APOE carriers and those with below average odor identification ability.

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Palliative care and COVID-19: a bibliometric analysis

ObjectiveTo assess the impact of COVID-19 on the palliative care (PC) publication trend in the last 10 years and the collaboration between countries and main topics that were discussed in...

INTEGRATION OF PALLIATIVE CARE INTO MEDICAL SCHOOL CURRICULUM IN NEPAL – An analytical study among medical students in Nepal

Introduction The holistic approach of palliative care aims at improving the life of patients with life-threatening diseases and their families through early identification, assessment, and treatment of physical, psychological, or spiritual pain. Despite the recognition of palliative care as a human right and essential for the improvement of the quality of life of patients – and their families, many low-income countries either lack palliative care services or have limited access to it. The WHO suggests that one of the steps that countries can take to eliminate these barriers is to include palliative care into the core curricula of all new health professionals. A study in 2019 showed that 58,000 adults required palliative care in Nepal in 2012, and most of them lived in rural areas. Palliative care in Nepal is still new and training programs for doctors and nurses are not fully developed and in place in undergraduate medical schools. This study evaluates the working knowledge of palliative care among undergraduate medical students, and the presence of it in their academic curriculum. Methods This analytical study was designed during an internship at the Binaytara Foundation Cancer Center in Nepal. The study was conducted among undergraduate medical students between March 6th, 2020 to July 6th, 2020. The questionnaire results were entered on Microsoft Excel and then analyzed. Results Results showed that 63.2% of the respondents had heard of “Palliative Medicine”, but 68.4% did not know the WHO definition of Palliative Care (Table 2 (135189)). Among all the students from the different universities, 33.3% said that palliative care is part of their curriculum, while 66.6% said it is not (Table 5 (135192)). Conclusions The results from the study demonstrated inadequate knowledge and perception of palliative care among undergraduate medical students in Nepali institutions. The EAPC indications on a palliative care curriculum could be taken as a blueprint for developing a tailored one for medical schools in Nepal to set a strong base for the next generation of doctors to be able to appropriately meet the needs of patients and their families.

Study of severe anemia in hospitalized children in Ahmedabad (Gujarat), India

Background: Anemia is a major nutritional problem worldwide especially in developing countries. This research was conducted to find the incidence of severe anemia, to identify the common clinical features and etiology of it and to assess the requirement of packed red cell transfusion. Methods: All patients having severe anemia (hemoglobin &lt;7 gm/dl in 6-59 months and &lt;8 gm/dl in 5-14 years as per WHO definition) between 6-14 years were included in this study. Detailed medical history, anthropometric measurements and clinical examination were done. Complete blood count, peripheral smear, reticulocyte count and stool microscopy were done in all patients. Then anemia classified morphologically into microcytic, normocytic, macrocytic and dimorphic. Further investigations were done according to the peripheral smear to identify the etiology of severe anemia. Results: During the study period, 84 patients of severe anemia were hospitalized with incidence of 2.57%. It was more common in male in 6 months to 5 years and in female in 10-14 years age. 67% patients had microcytic, 28% had dimorphic and 2.5% each had normocytic and macrocytic anemia. The most common anemia was iron deficiency (82%) followed by anemia of chronic disease (17%), hemolytic anemia (12%), megaloblastic anemia (7%) and blood loss anemia (1%). Packed red cell transfusion was required in 16 (19%) patients with severe anemia. Conclusions: Good clinical examination with peripheral smear is helpful in classifying the anemia morphologically. Following this, the use of investigations as per the standard flow charts, helps in identification of etiology.

Initial symptoms and three months follow-up after acute COVID-19 in outpatients: An international prospective cohort study

Background Most studies on long-term follow-up of patients with COVID-19 focused on hospitalised patients. No prospective study with structured follow-up has been performed in non-hospitalised patients with COVID-19. Objectives To assess long-COVID and post-COVID (WHO definition: symptomatic at least 12 weeks), describe lingering symptoms, their impact on daily activities, and general practice visits and explore risk factors for symptom duration in outpatients. Methods A prospective study of adult outpatients with confirmed SARS-CoV-2 infection and symptoms consistent with COVID-19 in 11 European countries, recruited during 2020 and 2021 from primary care and the community. Structured follow-up by phone interviews (symptom rating, symptom impact on daily activities and general practice visits) was performed at weeks 2, 4, 8, and 12 by study personnel. Data was analysed descriptively by using correlation matrixes and Cox regression. Results Of 270 enrolled patients, 52% developed long-COVID and 32% post-COVID-syndrome. When only considering the presence of moderate or (very) severe symptoms at weeks 8 and 12, these percentages were 28% and 18%, respectively. Fatigue was the most often reported symptom during follow-up. The impact of lingering symptoms was most evident in sports and household activities. About half (53%) had at least one general practice contact during follow-up. Obese patients took twice as long to return to usual health (HR: 0.5, 95%CI: 0.3–0.8); no other risk profile could predict lingering symptoms. Conclusion Long-COVID and post-COVID are also common in outpatients. In 32%, it takes more than 12 weeks to return to usual health.

The Relationship between Health Literacy and Hypertension Control: A Cross-Sectional Study.

Uncontrolled hypertension is a major public health problem among patients in developed and developing countries. The present study was conducted to investigate the prevalence and causes of uncontrolled hypertension to facilitate the design of more effective methods of hypertension control. This cross-sectional study was conducted on 303 adults with hypertension. The Standard Health Literacy Questionnaire was used to collect data. Uncontrolled hypertension was ascertained based on the WHO definition. A multiple logistic regression model was used at a 95% confidence level. Variables considered were confounders including age, sex, marital status, family size, income (monthly mean), smoking (past or current), education level, and physical activity (times in a week). The mean (SD) age of the participants (n=303) was 59.3(12.7) years, and 57.4% were men. The prevalence of uncontrolled hypertension was 50.5%. The mean score of health literacy among patients with controlled hypertension was higher than that among patients with uncontrolled hypertension (64.83±23.72 vs 46.28±22.19; P<0.001). The odds of uncontrolled hypertension decreased by 3% in the patients (OR: 0.97; P=0.06). Adherence to treatment (OR: 0.13; P<0.001), salt consumption per package purchased per month (OR: 4.40; P=0.001), increased physical activity per hour per week (OR: 0.56; P<0.001), current or passive cigarette smoking (OR: 4.59; P=0.010), a positive history of chronic diseases (OR: 2.62; P=0.027), and increased family size (per 1 child) (OR: 0.57; P<0.001) were associated with uncontrolled hypertension. The results showed a borderline association between increased health literacy and hypertension control. Additionally, increased salt consumption, reduced physical activity, small family size, and underlying diseases (eg, diabetes, chronic heart disease, and renal disease) could increase the odds of uncontrolled hypertension in Iranian society.