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Investigation of antiviral substances in Covid 19 by Molecular Docking: In Silico Study
No full textAims: This paper aimed to investigate the antiviral drugs against Sars-Cov-2 main protease (MPro) using in silico methods.
Material and Method: A search was made for antiviral drugs in the PubChem database and antiviral drugs such as Bictegravir, Emtricitabine, Entecavir, Lamivudine, Tenofovir, Favipiravir, Hydroxychloroquine, Lopinavir, Oseltamavir, Remdevisir, Ribavirin, Ritonavir were included in our study. The protein structure of Sars-Cov-2 Mpro (PDB ID: 6LU7) was taken from the Protein Data Bank (www.rcsb. Org) system and included in our study. Molecular docking was performed using AutoDock/Vina, a computational docking program. Protein-ligand interactions were performed with the AutoDock Vina program. 3D visualizations were made with the Discovery Studio 2020 program. N3 inhibitor method was used for our validation.
Results: In the present study, bictegravir, remdevisir and lopinavir compounds in the Sars-Cov-2 Mpro structure showed higher binding affinity compared to the antiviral compounds N3 inhibitor, according to our molecular insertion results. However, the favipiravir, emtricitabine and lamuvidune compounds were detected very low binding affinity. Other antiviral compounds were found close binding affinity with the N3 inhibitor.
Conclusion: Bictegravir, remdevisir and lopinavir drugs showed very good results compared to the N3 inhibitor. Therefore, they could be inhibitory in the Sars Cov-2 Mpro target.
Keywords: Sars-CoV-2 Main Protease; Antiviral Drugs; Molecular Dockin
Human immunodeficiency virus positive status disclosure among children in northwest Ethiopia: a cross-sectional study
No full textBackground: Human Immunodeficiency Virus positive status disclosure is an essential component of pediatric care and longterm disease management. However, one of the greatest challenges that caregiver/mothers and health care workers face is the disclosure of HIV positive status to children living with the virus. Therefore, the objective of this study was to assess HIV positive status disclosure and associated factors among HIV positive children in northwest Ethiopia.
Methods: Institutional based cross-sectional study was conducted among 417 sampled HIV positive children attending pediatric ART clinics of public health facilities from February 01 to March 30 2020 in northwest Ethiopia. Simple random sampling technique was used to select study participants. A structured interviewer administered questionnaire was used for data collection and the collected data entered into Epi data software. Binary logistic regression analysis was done and variables with P-value <0.05 was considered as a significant predictors of HIV positive status disclosure of HIV positive children.
Result: From 417 sampled population, 390 were involved in this study making 93.5% response rate. The study revealed that 53.6% with 95% CI (0.486-0.586) of HIV positive children knew their HIV positive sero status. Caregiver/mothers who had greater than three family sizes (AOR=1.984, 95% CI=1.046-3.762), children whose ages greater than 10 years (AOR=6.679, 95% CI=3.372-13.227) and children on ART for more than 5 years (AOR=8.96, 95% CI=6.402-12.257) were predictors of HIV positive status disclosure.
Conclusion: The HIV positive status disclosure was high in the study area relative to other studies. Family size, children age, and length of children on ART were predictors of HIV positive status disclosure for HIV positive children. Health care providers, especially those working at pediatrics ART clinics should keep these factors in mid while working with caregivers to encourage disclosure of HIV positive status.
Keywords: ART; Bahir Dar; Caregiver/mother; Children; HIV; HIV positive status disclosure
Lifestyle, vulnerability to stress and prevailing health conditions of ambulatory older patients in a care facility
No full textBackground: Lifestyle and vulnerability to stress are major determinants of age-related health outcomes.
Objectives: To assess the lifestyle and health states of older adults, and evaluate their personality-related vulnerability to stress, to enable improved and targeted health promotional activities.
Methods: A hospital record review and a purposive cross-sectional study was conducted among 200 respondents who were ≥ 50 years old, and visited the General Hospital Oyo, South-western Nigeria. Descriptive statistics was performed using SPSS version 21. Analysis of vulnerability to stress was performed by the addition of scores from Marshal’s personality stress prone test. Lifestyle were measured by frequencies and Chi-Square tests, while presence of chronic diseases was measured by respondents’ past prescriptions, from the hospital case notes. P < 0.05 was considered statistically significant.
Results: A total of 200 respondents participated in the study. Majority, 156 (78.0%) were 50-59 years old and self-employed 96 (46.0%). Ninety-three (46.5%) smoked, 65 (32.3%) consumed alcohol, 128 (64.0%) had periodic exercise and 67 (33.3%) experienced insomnia. Majority (60.5%) were vulnerable to stress, and this was significantly associated with age (P=0.001), marital status (P=0.021), body weight (P=0.05), occupation (P=0.002) and income (P=0.002). From the retrospective study, most frequently prescribed drugs were anti-hypertensives 225 (69.7%), vitamins/minerals (49.5%), sedatives 158 (48.9%) and analgesics158 (48.9%) respectively.
Conclusion: Periodic exercise, alcohol use, and smoking were reported at varying degrees. High prevalence of vulnerability to stress and use of anti-hypertensives were also observed, and vulnerability to stress was associated with selected socio-demographics. These findings reinforce the need for routine education of this category of populace on healthy lifestyle for improved health.
Keywords: Lifestyle; older adults; vulnerability to stress; health conditions; health care facility; Nigeria
Clopidogrel-induced thrombotic thrombocytopenic purpura: a case report
No full textThrombotic thrombocytopenic purpura (TTP) is a rare variant of thrombotic microangiopathy. We report a case of TTP in a Nigerian chronic kidney disease (CKD) patient who was previously on clopidogrel. The features of TTP resolved soon after clopidogrel was withdrawn. Clopidogrel is a cardio-protective anti-platelet drug used in CKD patients at risk of dyspepsia. However, its potential to cause TTP should be recognized and considered in acute kidney injury (AKI) patients previously on clopidogrel.
Keywords: Clopidogrel; Thrombotic Thrombocytopenic Purpura; CKD; AKI; uremic encephalopathy
Prevalence of gastrointestinal bleeding and frequency of selected predictors of mortality on the medical emergency ward at Mulago hospital
No full textBackground: There was no data on the prevalence of Gastrointestinal bleeding (GI) among patients admitted on the emergency ward at Mulago hospital. This was partly because the medical records were not adequately completed as designed.
Objective: To estimate the prevalence of gastrointestinal bleeding and the frequency of selected predictors of mortality on the emergency ward.
Methods: This was a chart review incorporating quality improvement methods in the process of data collection. The health care team was educated on documentation of gastrointestinal bleeding while being assessed weekly for knowledge and practice of completion of the Casualty Assessment form (CAF) from which a documented diagnosis of GI bleeding and selected predictors of mortality were looked for.
Results: Of the 1881 CAF assessed, 278 had a documented diagnosis of GI bleeding, resulting in a prevalence of 6.8%. Of the patients with GI bleeding, 14.1% had age greater than 60 years, 24.0% had a systolic blood pressure less than 100mmHg and 44.5% had a heart rate greater than 100 beats per minute.
Conclusion: The prevalence of GI bleeding on the medical emergency ward of Mulago hospital is high. This calls for strategies for resuscitative management of this life-threatening medical emergency. Among the selected predictors of mortality, tachycardia was most frequent followed by hypotension. These should always be assessed in a patient with GI bleeding and resuscitative measures with blood transfusion and intravenous fluids undertaken to correct them.
Keywords: Gastrointestinal bleeding; predictors of mortality; Emergency ward
Is preoperative pulmonary rehabilitation effective in the postoperative period after lung resection?
No full textObjective: Investigating the effects of the preoperative short term intensive pulmonary rehabilitation program applied for patients who have undergone lung resection by thoracotomy, on lung functions, complication rates and length of hospital stay during the postoperative period.
Methods: A prospective randomized trial of sixty patients were enrolled who would undergo pulmonary resection by thoracotomy and were randomly divided in two groups. Intensive pulmonary rehabilitation was performed on these patients in the study group 3 hours a day throughout 7 days during the preoperative period. Groups were compared with respect to their spirometric pulmonary functions, respiratory parameters, blood gas parameters, complication rates and length of hospital stay.
Results: Total incidence rate of complications in the patients from the control group significantly increased(p=0,028). When patients who underwent lobectomy and wedge resection were observed, length of hospital stay of those in the control group was seen to be statistically higher in comparison with the study group(p<0,05).
Conclusion: We consider that it will be very beneficial to perform a short term and intensive pulmonary rehabilitation program on every patient possible who is planned to undergo thoracotomy and lobectomy or wedge resection treatment.
Keywords: Thoracic; pulmonary rehabilitation; breathing exercise
Physician perspectives on the DNR order in Turkey: A survey of physicians in Internal Medicine
No full textBackground: Do not resuscitate (DNR) is a controversial ethico-legal issue and there is no legal regulation in Turkey. Evaluating the physicians' views on DNR is critical to the current problems and contributes to legal regulation.
Objectives: To examine the views of intensive care unit residents on DNR and the sociocultural and occupational factors affecting them.
Methods: The research is a descriptive cross-sectional study. The sample of the study consists of 203 residents of internal medicine working in the intensive care unit in a university hospital. A questionnaire form was used as a data collection tool.
Results: 62.6% of the physicians know that there is no legal regulation regarding DNR in Turkey, and 14.3% think that DNR is performed. Female physicians approve of DNR at a higher rate than men (p<0.01). Physicians with more experience in the profession stated that not all patients should be performed cardiopulmonary resuscitation (p<0.01), and DNR should be a right (p<0.05). The vast majority of physicians stated that DNR should be legal (88.1%) and should be included in residency training (85.6%).
Conclusions: It is necessary to establish legal regulations on DNR and implement residency training programs that will ensure the continuous professional development of physicians.
Keywords: Do not resuscitate (DNR); physicians' views; legal regulation
Neonatal pain perception, management and review of practices among medical workers in Nigeria newborn units
No full textBackground: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The perception of pain is variable and knowledge may not match practise.
Aims: To ascertain the knowledge, attitude and practice of neonatal pain management (NPM) among HCW in newborn units across Nigeria.
Methods: The validated questionnaire administered to consenting doctors and nurses working in various newborn units in Nigeria was utilised.
Results: There were 256 respondents from tertiary institutions 228 (89.1%) located in 31 states of Nigeria. There were 91% doctors and 8.6% nurses’. The perception of newborn pain was high (≥95%) among doctors and nurses . Up to 67.1% of the doctors and 57.1% of nurses were aware of NPM. One third (37.3%) of doctor respondents knew of NPM from friends and colleagues while half of the nurses knew from course textbooks. Pain definition was in most by sensation (94%), 50% by emotion. Most nurses were aware of the subjective report of potential tissue damage and knew the facial expressions of pain compared to doctors. Crying was equally recognised as an expression of pain. Perception of non-pharmacologic methods of NPM was highest for massaging and KMC; the knowledge of Sucrose analgesia was low. Procedural pain perception was poor and analgesia was for few procedures.
Conclusions: Perception of pain was high but did not match knowledge and practice of NPM. Formal education on NPM was lacking in the training of HCW.
Keywords: Neonatal pain management; Nigerian newborns; health care workers
A critical review of literature on health financing reforms in Uganda – progress, challenges and opportunities for achieving UHC
No full textBackground: Universal health coverage (UHC) is one of the sustainable development goals (SDG) targets. Progress towards UHC necessitates health financing reforms in many countries. Uganda has had reforms in its health financing, however, there has been no examination of how the reforms align with the principles of financing for UHC.
Objective: This review examines how health financing reforms in Uganda align with UHC principles and contribute to ongoing discussions on financing UHC.
Methods: We conducted a critical review of literature and utilized thematic framework for analysis. Results are presented narratively. The analysis focused on health financing during four health sector strategic plan (HSSP) periods.
Results: In HSSP I, the focus of health financing was on equity, while in HSSP II the focus was on mobilizing more funding. In HSSP III & IV the focus was on financial risk protection and UHC. The changes in focus in health financing objectives have been informed by low per capita expenditures, global level discussions on SDGs and UHC, and the ongoing health financing reform discussions. User fees was abolished in 2001, sector-wide approach was implemented during HSSP I&II, and pilots with results-based financing have occurred. These financing initiatives have not led to significant improvements in financial risk protectionas indicated by the high out-of-pocket payments.
Conclusion: Health financing policy intentions were aligned with WHO guidance on reforms towards UHC, however actual outputs and outcomes in terms of improvement in health financing functions and financial risk protections remain far from the intentions.
Keywords: Uganda; Universal health coverage; health financing
Vitamin D deficiency in rheumatoid arthritis patients of India – a single-arm meta-analysis
No full textBackground: Vitamin D deficiency is commonly seen in patients with rheumatoid arthritis (RA).
Objectives: This meta-analysis is aimed to determine the prevalence of Vitamin D deficiency in RA patients in India and also to evaluate the association between vitamin D level and disease activity.
Methods: The relevant works of literature were identified through multiple databases and data was extracted from eligible studies independently. A single-arm meta-analysis was performed to estimate the prevalence of Vitamin D deficiency in RA patients in an Indian setup and its association with disease activity. A total of 15 studies was included in the analyses.
Results: The mean serum vitamin D level was 19.99 ng/ml [95% CI 16.49-24.23]. The proportion of patients with low vitamin D level was 0.80 [95% CI 0.65- 0.90], Vitamin D deficiency was 0.56 [95% CI 0.31-0.77] and vitamin D insufficiency was 0.20 [95% CI 0.12- 0.32]. A negative relationship was seen with serum vitamin D and disease activity score.
Conclusions: The results demonstrate significant low levels of serum vitamin D levels in patients with RA and established a negative correlation of Vitamin D with RA disease activity. The current evidence suggests a rationale for Vitamin D supplementation in the management of RA.
Keywords: Vitamin D level; disease activity score; Vitamin D supplementation; Vitamin D insufficiency