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Assessment and predictors of blood glucose levels in hypertensives attending a secondary health centre: relationship with physical activity and diet quality
Get PDFThe aim: this study aims to assess the prevalence of hyperglycaemia, the association between diet quality, physical exercise and blood glucose levels among hypertensives attending a secondary health centre in Nigeria. There is a paucity of data concerning these issues and the study would contribute positively to future management of the patients.
Methods: the study was a cross-sectional study of 354 hypertensives that was conducted at the State Hospital, Oyo, Nigeria. The systematic sampling technique was used to recruit patients, and the data were analysed using SPSS software version 23. Linear regression was done to determine the predictors of hyperglycaemia, and logistic regression was done to determine the predictors of diet quality.
Results: the mean age of the respondents was 52.60(SD±8.26) years. The prevalence of undiagnosed diabetes in this cohort was 19.60 %. The association of glycated haemoglobin (HbAic) with High Density Lipoprotein (HDL) was negative, weak in strength and statistically significant (p-value=0.034). For every 1 unit decrease in High Density Lipoprotein (HDL), there was a statistically significant increase in HbAic by about 0.383 units (95 % C.I equals -0.737 to -0.029, p-value=0.034). For every 1 unit increase in total Cholesterol, there was a significant increase in HbAic by about 0.158 units (95 % CI equals 0.007 to 0.308, p-value=0.04). Age group <45 years were about 2 times less likely to have good diet quality than those of 55 years and above (OR=0.502; 95 % CI=0.270 – 0.932, p-value=0.029).
Conclusions: the study has assisted to characterise this population of hypertensives in terms of serum glucose levels. The prevalence of hyperglycaemia was high among these hypertensives. The predictors of hyperglycaemia were HDL and Cholesterol. Also, the predictor of good diet quality was the age of the respondent
Improvement of the algorithm for diagnostics of postcholecystectomy syndrome taking into account functional and organic changes in the area of the large duodenal nipple
Get PDFThe aim. Improving the algorithm for diagnosing patients with postcholecystectomy syndrome (PCS), taking into account functional and organic changes in the major duodenal papilla (MDP).
Materials and methods. 208 patients with PCS were examined. Laparoscopic cholecystectomy (CE) was performed in 172 patients in history, open CE was performed in 36 patients. 47 patients had obstructive jaundice, 84 had signs of biliary hypertension without an increase in bilirubin, 77 had no signs of biliary hypertension and an increase in bilirubin.
The following instrumental research methods were used: abdominal organs ultrasound examination (AO USE), duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT). In the main group, to study the morphofunctional changes in MDP, duodenoscopy with parietal impedancemetry, ultrasound of the hepatobiliary zone with a choleretic load were used.
Results. In the main group, 34 patients underwent ultrasound of the hepatobiliary zone and Vater's nipple area with a choleretic breakfast according to Boyden according to the method of Grigoriev P.Ya. in our modification, 21 patients had an expansion of the choledochus by 2 mm. At the same time, taking meverin led to a decrease in the diameter of the choledochus, which indicated functional changes in the MDP. In 13 patients, the expansion of the choledochus, observed when taking a choleretic breakfast, persisted with the use of antispasmodics, which indicated the presence of an organic pathology of MDP. Duodenoscopy with impedancemetry was performed in 41 patients: 20 patients had 760–820 Ohm, which indicated the presence of functional changes, 12 patients had inflammatory changes in the MDP and 703–760 Ohm were detected, 9 patients with cicatricial fibrous changes had indicators impedance measurement 640–703 Ohm. The use of ultrasound with a choleretic breakfast and duodenoscopy with parietal impedancemetry in patients of the main group made it possible to identify functional and organic (inflammatory, fibrous) changes in the MDP, which made it possible to develop a therapeutic algorithm using both conservative therapy and the use of various options for transpapillary endoscopic interventions.
Conclusions. Conducting an in-depth diagnosis of morpho-functional changes in MDP using parietal impedancemetry of MDP and ultrasound of the hepatobiliary zone with choleretic load allows us to identify both functional and morphological changes in MDP, which makes it possible to develop a therapeutic algorithm using drug therapy and transpapillary endoscopic techniques.The aim. Improving the algorithm for diagnosing patients with postcholecystectomy syndrome (PCS), taking into account functional and organic changes in the major duodenal papilla (MDP).
Materials and methods. 208 patients with PCS were examined. Laparoscopic cholecystectomy (CE) was performed in 172 patients in history, open CE was performed in 36 patients. 47 patients had obstructive jaundice, 84 had signs of biliary hypertension without an increase in bilirubin, 77 had no signs of biliary hypertension and an increase in bilirubin.
The following instrumental research methods were used: abdominal organs ultrasound examination (AO USE), duodenoscopy, endoscopic retrograde cholangiopancreatography (ERCP), computed tomography (CT). In the main group, to study the morphofunctional changes in MDP, duodenoscopy with parietal impedancemetry, ultrasound of the hepatobiliary zone with a choleretic load were used.
Results. In the main group, 34 patients underwent ultrasound of the hepatobiliary zone and Vater's nipple area with a choleretic breakfast according to Boyden according to the method of Grigoriev P.Ya. in our modification, 21 patients had an expansion of the choledochus by 2 mm. At the same time, taking meverin led to a decrease in the diameter of the choledochus, which indicated functional changes in the MDP. In 13 patients, the expansion of the choledochus, observed when taking a choleretic breakfast, persisted with the use of antispasmodics, which indicated the presence of an organic pathology of MDP. Duodenoscopy with impedancemetry was performed in 41 patients: 20 patients had 760–820 Ohm, which indicated the presence of functional changes, 12 patients had inflammatory changes in the MDP and 703–760 Ohm were detected, 9 patients with cicatricial fibrous changes had indicators impedance measurement 640–703 Ohm. The use of ultrasound with a choleretic breakfast and duodenoscopy with parietal impedancemetry in patients of the main group made it possible to identify functional and organic (inflammatory, fibrous) changes in the MDP, which made it possible to develop a therapeutic algorithm using both conservative therapy and the use of various options for transpapillary endoscopic interventions.
Conclusions. Conducting an in-depth diagnosis of morpho-functional changes in MDP using parietal impedancemetry of MDP and ultrasound of the hepatobiliary zone with choleretic load allows us to identify both functional and morphological changes in MDP, which makes it possible to develop a therapeutic algorithm using drug therapy and transpapillary endoscopic techniques
Characteristics and transmission dynamics of COVID-19 in healthcare workers in a tertiary teaching hospital
Get PDFCoronavirus disease-19 (COVID-19) transmission significantly affected Healthcare workers (HCWs) worldwide. As a result, they have paid a heavy toll to the COVID-19 outbreak. However, the literature on its transmission routes and risk factors in HCWs is limited.
The aim. The authors seek to characterize and know the transmission dynamics of COVID-19 infection in the HCWs of our hospital.
Methods: A cross-sectional descriptive study was conducted by the authors. Staff records and virology testing results were used to identify SARS-CoV-2 positive HCWs and study the demographic characteristics and transmission dynamics over one and a half years. Data were analyzed using SPSS software version 23.
Results: A total of 169 healthcare workers were positive for SARS-CoV-2. 6 doctors were positive from non-clinical branches, and 17 were positive from clinical branches. One health worker also died of cardio-pulmonary compromise. 88.2 % of healthcare workers got infected while managing patient’s positive for COVID-19. The most frequent clinical manifestation was myalgias in 90.53 % of health workers, followed by arthralgia in 86.98 %. The least common symptoms were loss of taste/smell followed by radiographic changes, and only 19 (11.24 %) presented with shortness of breath. 79.88 % have taken self-medication to relieve COVID symptoms. Maximum number of health workers got infected from July to September.
Conclusions: Universal masking, reinforcement of hand hygiene, PPE kits with medical masks, appropriate infection control measures and testing of both clinical and non-clinical staff were essential measures for reducing transmission amongst HCW
ST2 and copeptine – modern biomarkers for monitoring the effectiveness of treatment of decompensated heart failure in patients after acute myocardial infarction
Get PDFThe aim of the study was to increase the efficiency of diagnostic methods to find means to improve the treatment of patients with decompensated heart failure in the post-infarction period.
Materials and methods. This study is based on an examination of 120 patients with decompensated HF (60 patients with STEMI and 60 with non-STEMI). Patients with previous STEMI complicated by decompensated heart failure were divided into groups, depending on their treatment. The studied groups were homogeneous in terms of age, sex, the severity of the course of the disease, duration of the post-infarction period, and the presence of clinical manifestations of decompensation. The patients were observed on the first day after hospitalization, after 1 and 2 months after treatment. Copeptin serum levels were assayed using the EK 065-32, EIA Copeptine kit (RayBiotech, Inc., USA). ST-2 in blood serum was determined with the help of the Presage ST-2 kit (Critical Diagnostics, USA). The level of ST2 was determined in ng/ml.
Results. We analysed the effect of therapy on the level of ST2 in the blood serum of examined patients with STEMI and non-STEMI complicated by decompensated heart failure. All the treatment regimens we proposed led to a significant decrease in the level of this peptide in blood serum after the end of the treatment. In patients of group I who received basic therapy drugs, the average ST2 concentration was (49.47±1.77) ng/ml before treatment. After 1 and 2 months of therapy, it was (44.92±1.22) ng/ml and (41.67±1.18) ng/ml, respectively (p˂0.05). The patients with decompensated heart failure after non-STEMI from group I had a copeptin level of (18.13±0.10) pg/ml before treatment and probably decreased to levels of (16.29±0.15) pg/ml and (15.09±0.14) pg/ml after 1 and 2 months under the influence standard therapy.
Conclusions. We found the dependence of copeptin and ST2 levels on decompensated HF in the early and late post-infarction periods. It was established that the use of the therapy with a combination of the studied drugs led to a more intense decrease in serum copeptin, compared to therapy with succinic acid, arginine drugs, and standard therapy (p˂0.05). Using a differentiated treatment algorithm for patients with decompensated heart failure in the post-infarction period, copeptin and ST2 in blood serum increases the effectiveness of treatment and prevents complications
Surgical treatment of acute complicated duodenal ulcer
Get PDFThe aim. To analyze treatment approaches and tactics and improve acutely complicated duodenal ulcers (DU) treatment results.
Materials and methods. The results of the analysis of the surgical treatment of acutely complicated duodenal ulcers (a combination of 3 and/or 4 combined complications) are presented for 2 periods: the 1st (2000–2014) years (group A) – 47 patients, the 2nd (2015–2021) years (group B) – 34 patients.
Results. 81 (100 %) patients were operated on for acutely complicated duodenal ulcers, of which 68 (84.3 %) patients had a combination of three complications, and 13 (15.7 %) had four complications. Out of 81 patients, 72 had bleeding complications, which is 89.3 %. Complications of ulcer perforation – in 36 patients, 44.7 % of all other complications.
Based on the obtained analysis data, there is a steady trend towards an increase in the share of organ-sparing operations (OSO) by 1.6 times (from 50.9 % to 81.4 %), a decrease in the number of gastric resections (GR) by 2.9 times (from 14.9 % to 4.9 %) and palliative operations (PO) by 3.2 times (from 15.8 % to 4.9 %) with a relatively stable number of performed organ-preserving operations (OPO): in group A – 17 (24 .6 %) interventions, in group B – 4 (21.1 %).
Conclusions. The use of modern measures of endoscopic hemostasis made it possible to adequately prepare and operate on patients in the delayed period, and their share from the first period to the second increased by 2.9 times.
The number of patients who underwent emergency surgery with ulcer perforation and bleeding as combined complications decreased in the second period compared to the first by 2.5 times, which is associated with the widespread use of modern proton pump inhibitors (PPIs) in the conservative treatment of DU.
The number of complications and mortality of this cohort of patients also significantly decreased due to the use of endoscopic hemostasis methods, making it possible to stabilize and prepare patients on the operating table.
According to the analysis results, it became known that the chosen active-individualized tactics and the use of developed algorithms for choosing the type of surgical intervention made it possible to achieve a stable level of postoperative mortality at 8.1 %
Knowledge of nurses on neonatal sepsis: a tertiary teaching hospital based study
Get PDFNeonatal sepsis is a significant cause of morbidity and mortality in hospitalized newborns and premature infants. Therefore, knowledge of essential newborn Care (ENC) is important for a newborn's survival, growth and development.
The aim of this study was to assess the knowledge of nurses regarding essential newborn care in our Special Care Neonatal Unit (SCNU).
Methods: A descriptive cross-sectional study was conducted between 1st September 2021 and 30th November 2021 among the nurses working in SNCU of Government Medical College and Hospital (GMC), Doda, Jammu and Kashmir, India. Data was collected using a pre-tested questionnaire by purposive sample. Collected data were checked, and coding was done and analyzed using SPSS 20 software.
Results: 72.0 % of nurses were of the age group of 21–30 years. The majority (74 %) were females, 78 % had completed B Sc Nursing, and 66 % had experience of 2 to 4 years. Most of the nurses had good knowledge about ENC, about basic equipment’s used in SNCU, and about advanced equipment’s or procedures had less knowledge. All nurses answered bacteria correctly as a causative organism of neonatal sepsis.
Conclusions: Most of the nurses working in the SCNU of GMC Doda had good knowledge regarding ENC. The knowledge appeared irrespective of their age, gender, religion, educational status, working place and special courses/training in neonatology
Subunit-dependent interaction of propoxazepam and its metabolite with the -aminobuturic acid type A receptor
Get PDFBenzodiazepines (BDZ) are widely used in clinics in the treatment of psychiatric disorders, and their main action is considered to be determined by more selective binding with α1, α2, α3 or α5 subunits of GABA receptor.
The aim of this work was studying of the molecular mechanism of action of new analgesic – propoxazepam and its metabolite (3-hydroxypropoxazepam) on α1, α2, α3, α4 or α5 subunits containing GABAA channels.
Materials and methods GABA ha1b3g2, ha2b3g2, ha3b3g2, ha4b3g2 and ha5b3g2 ionotropic GABAARs expressed in HEK293 were used on the automated SP384PE Patch Clamp system. In addition, Propoxazepam, 3-hydroxypropoxazepam, diazepam (positive allosteric modulator) and GABA (positive control) were administered at concentrations 0.001–300 nM to determine the EC50 and Emax for corresponding substances.
Results The α subunit plays a significantl role in determining the receptor’s affinity for propoxazepam and 3-hydroxypropoxazepam. The rank order of decreasing EC50 are α1 = α5> α2 > α3 > α4 (propoxazepam) and α1> α2> α5 > α3 > α4 (3-hydroxypropoxazepam), and for Emax α3 > α2 >α5 > α1 > α4 (propoxazepam), α3 > α1 > α2> α5 > α4 (3-hydroxypropoxazepam).
The data, transformed to Emax/EC50, show that propoxazepam exhibits tenfold (compared to diazepam) activity (taking into account the magnitude of the maximum effect) to the α3 subunit, which distinguishes it from 3-hydroxypropoxazepam.
Conclusion Due to the determined selectivity of propoxazepam for binding with different α subunit-containing GABAA-receptors (mostly α3 and α2 types), it has the potential to provide analgesia with less sedation than non-selective BDZ
Retrospective study of Ct brain imaging findings indicated for infants at a tertiary care hospital
Get PDFComputed tomography in the diagnosis of pathologies in children is becoming increasingly popular.
The aim: to study findings of referrals for CT scans (Computerised Tomography) of the brain in children in the department of Radiology in a developing environment.
Materials and methods: retrospective imaging observational study was done in a 1000 bedded tertiary care hospital in South India in the year 2022 from April to August for 5 months under 16 slice CT scan. Cases are referred from the department of Pediatrics to the department of Radiology as part of the routine clinical evaluation and treatment protocol.
Results: Our sample includes 100 infants; after exclusion criteria total of 60 infants' brain CTs were taken into account, and analysed their imaging from radiology department records. Of 60 cases, 18 (30 %) showed HIE Pattern, and 42 (70 %) had normal plain CT Brain findings. However, due to clinical signs and symptoms, they are evaluated under сontrast CT imaging (after checking creatinine levels), showing 20 cases (33.3 %) are standard, 10 cases (16.6 %) show meningitis, and 2 cases (3.3 %) show SOL. Out of 18 cases of HIE, 10 cases (16.6 %) are under less than 6 months and they undergone neuro sonogram showing 4 cases (6.6 %) normal NSG, 2 cases (3.3 %) showing grade IV HIE, another 2 cases (3.3 %) showing grade II, III HIE Findings.
Conclusions: Our study concluded that plain CT brain showed normal in the majority of the cases which came to the department of Radiology after admission to the hospital. Those cases with strong clinical history are evaluated with contrast CT and evaluated the findings. After contrast imaging, most cases showing their infective, obstructive, and other causes of illness are interpreted. However, its role is minimal for seizures in which CT/CECT shows normal study. Under 6 months, NSG is a suitable method for evaluating and screening the infant's brain
Ultrasonography (USG) as an adjuvant diagnostic aid in fascial space infections
Get PDFThe aim: to evaluate the efficiency of USG as an adjuvant diagnostic aid in fascial space infections and help draw a treatment plan as per the diagnosis made by USG examination
Materials and methods: 60 patients having odontogenic superficial fascial space infection of the maxillofacial region were included. All of the patients included in our study were properly examined clinically with proper work up done, ordering different radiographs necessary to ascertain odontogenic cause most patients diagnosed with cellulitis were given medical line of treatment, and those with abscess were subjected to incision and drainage. Informed consent was obtained from all the participants involved in the study.
Results: in this study, total of 60 patients were studied. Out of 60 patients of odontogenic facial space infections, 24 were male and 36 were female. Buccal space was the most common space involved (24;40 %) followed by submandibular space (9;15.0 %) than Canine space (6;10 %). In a total of 60 cases, clinical diagnosis of cellulitis was made in 18 cases (30 %) and that of abscess in 42 patients (70.0 %).
All patients were subjected to the USG examination in which cellulitis was diagnosed in 24 cases (40 %) and abscess in 36 cases (60 %).
Conclusion: USG could be considered to be a valuable adjuvant to clinical examination in patients with fascial space infection and help in delivering better treatment, after intervention 34 cases were found to be abscess while USG found 36 cases hence clearly proving the superiority of USG in diagnosis of abscess than clinical examination.
It has its own advantages like minimal cost, repeated examinations, and readily available in especially in developing countries where people could not easily afford better imaging modalitie
Life satisfaction in the caregivers of schizophrenia and factors associated with it: a cross sectional study from South India
Get PDFSchizophrenia is a mental disorder characterized by distortions of thinking and perception, in the process of care giving the caregivers are faced with many challenges. These challenges have a significant impact on the life satisfaction of caregivers. The study investigates various factors associate with life satisfaction in caregivers of schizophrenia
The aim: 1. To evaluate the socio-demographic correlates associated with life satisfaction in the care givers of schizophrenia.
To evaluate the association between life satisfaction with resilience, anxiety, stress, depression perceived social support, self-esteem, self-efficacy, and perceived stigma in the care takers of schizophrenia patients.
Material and methods. In cross sectional study, 513 care takers of schizophrenia were evaluated using semi-structured socio demographic perfoma, DASS-21, Connor-Davidson Resilience 25 item scale, Self Esteem Scale (Rosenberg), The Satisfaction with Life Questionnaire and family stigma stress scale.
Result. The study showed that background of the caregiver, socioeconomic status, family type, education and marital status are significantly positive correlated with life satisfaction. The study also showed significant positive correlation between resilience, perceived social support, self-esteem and self-efficacy with life satisfaction. There is also significant negative correlation between perceived stigma, anxiety stress and depression with life satisfaction.
Conclusion. The study showed that life satisfaction in the care givers of schizophrenia depends on different biopsychosocial variables. There is strong positive correlation between self-esteem, other person support and resilience with life satisfaction, whereas there is moderate positive correlation between self-efficacy, family support and friend support with life satisfaction. There is significant negative correlation between stress, anxiety, depression, and stigma with life satisfaction. We recommended psycho educational interventional programmes in the community level which help to increase resilience self-esteem and self-efficacy. Such programmes also decrease the stigma which in turn increases the social support to the caregiver