A. Qureshi, Muhammad Zain, S. I. Shah, Rizwan Qureshi, Abdulhameed A. Majeed, Junaid Islam
Purpose: Globally the overuse of systemic antibiotics is now a serious concern for the health professionals. The increase in antimicrobial resistant bacteria because of this practice has made treatment of infections ever more difficult. In providing endodontic treatment it has been found that many dentists are either misusing or overusing systemic antibiotics. The objective of this study was to assess the antibiotic prescribing trends of dentists in a region of Pakistan and if any association could be made of such practices with the experience of the dentist. Methodology: This cross sectional study was based on an on line questionnaire. A total of 150 invitation were sent by emails and social media groups like ’Whattsapp’. This estimation of respondents was made by calculating the total fresh graduates and clinical dental faculty of the three dental institute of the region. The online survey was designed on the checklist based on Checklist for Reporting Results of Internet E-surveys (CHERRIES). SPSS version 20 was used to analyze the data. Chi square test was used with p- value< 0-05. Results: There was an 84% response rate on this online questionnaire. Most of the participants (71.5%) were aware of guidelines for antibiotic use. Only 12.30% participants as a whole had attended a seminar or workshop in the last one year on recent guidelines for antibiotic prescription. Of the total, 42.30% of the respondents were prescribing antibiotics to 2-3 patients on a daily basis. Majority of the respondents (63.84%) would prefer penicillin’s as the first choice of antibiotic if needed. But 62.7% of the fresh graduates would advise systemic antibiotics in a case of endodontic flare up where there is no recommendation or justification. With 44.7% dental practitioners’ prescribing antibiotics in the same scenario it was statistically significant (p=0.0480). Recommendations: Globally, the overuse of antibiotics is a trend which is concerning, here in the region of Abbottabad, Pakistan this same trend is present. Dental health care providers must understand that prescription of systemic antibiotics when not recommended may lead to antimicrobial resistance, whereas non-prescription when necessary may have detrimental health consequences. So the practitioners’ knowledge of guidelines is irrelevant as long as they are not practicing it. Hence the rationale for not practicing on the guidelines is what needs to be further investigated in future studies.
目的:在全球范围内，过度使用全身性抗生素现已成为卫生专业人员严重关切的问题。由于这种做法，抗微生物药物耐药性细菌的增加使得治疗感染变得更加困难。在提供牙髓治疗时，已经发现许多牙医滥用或过度使用全身抗生素。本研究的目的是评估巴基斯坦某地区牙医的抗生素处方趋势，以及是否可以将这种做法与牙医的经验联系起来。方法:本横断面研究基于在线问卷调查。共有150份邀请函通过电子邮件和“whatsapp”等社交媒体群发出。通过计算该地区三所牙科学院的应届毕业生和临床牙科教师总数，对受访者进行了估计。本次在线调查以《互联网电子调查报告结果清单》(樱桃)为基础，采用清单设计。采用SPSS version 20对数据进行分析。采用卡方检验，p值< 0-05。结果:在线问卷的回复率为84%。大多数参与者(71.5%)了解抗生素使用指南。在过去一年中，只有12.30%的参与者参加了关于抗生素处方最新指南的研讨会或讲习班。其中，42.30%的应答者每天给2-3名患者开抗生素。大多数应答者(63.84%)认为必要时首选青霉素类抗生素。但62.7%的应届毕业生在没有建议或理由的情况下会建议系统使用抗生素。在相同情况下，44.7%的牙科医生开抗生素，差异有统计学意义(p=0.0480)。建议:在全球范围内，抗生素的过度使用是一种令人担忧的趋势，在巴基斯坦阿伯塔巴德地区也存在同样的趋势。牙科保健提供者必须明白，在不推荐的情况下开全身性抗生素处方可能导致抗菌素耐药性，而在必要时不开处方可能会对健康造成有害后果。因此，只要从业人员不实践指导方针，他们对指导方针的了解就无关紧要。因此，在未来的研究中需要进一步调查不按照指导方针进行实践的理由。
{"title":"The Antibiotic Prescription Trend of Dentists for Endodontic Treatment from a Region of Pakistan: An Online Survey.","authors":"A. Qureshi, Muhammad Zain, S. I. Shah, Rizwan Qureshi, Abdulhameed A. Majeed, Junaid Islam","doi":"10.47672/ajhmn.1062","DOIUrl":"https://doi.org/10.47672/ajhmn.1062","url":null,"abstract":"Purpose: Globally the overuse of systemic antibiotics is now a serious concern for the health professionals. The increase in antimicrobial resistant bacteria because of this practice has made treatment of infections ever more difficult. In providing endodontic treatment it has been found that many dentists are either misusing or overusing systemic antibiotics. The objective of this study was to assess the antibiotic prescribing trends of dentists in a region of Pakistan and if any association could be made of such practices with the experience of the dentist. \u0000Methodology: This cross sectional study was based on an on line questionnaire. A total of 150 invitation were sent by emails and social media groups like ’Whattsapp’. This estimation of respondents was made by calculating the total fresh graduates and clinical dental faculty of the three dental institute of the region. The online survey was designed on the checklist based on Checklist for Reporting Results of Internet E-surveys (CHERRIES). SPSS version 20 was used to analyze the data. Chi square test was used with p- value< 0-05. \u0000Results: There was an 84% response rate on this online questionnaire. Most of the participants (71.5%) were aware of guidelines for antibiotic use. Only 12.30% participants as a whole had attended a seminar or workshop in the last one year on recent guidelines for antibiotic prescription. Of the total, 42.30% of the respondents were prescribing antibiotics to 2-3 patients on a daily basis. Majority of the respondents (63.84%) would prefer penicillin’s as the first choice of antibiotic if needed. But 62.7% of the fresh graduates would advise systemic antibiotics in a case of endodontic flare up where there is no recommendation or justification. With 44.7% dental practitioners’ prescribing antibiotics in the same scenario it was statistically significant (p=0.0480). \u0000Recommendations: Globally, the overuse of antibiotics is a trend which is concerning, here in the region of Abbottabad, Pakistan this same trend is present. Dental health care providers must understand that prescription of systemic antibiotics when not recommended may lead to antimicrobial resistance, whereas non-prescription when necessary may have detrimental health consequences. So the practitioners’ knowledge of guidelines is irrelevant as long as they are not practicing it. Hence the rationale for not practicing on the guidelines is what needs to be further investigated in future studies.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"46 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91469604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To evaluate the impacts of educational program on a group of physicians from PHC regarding knowledge and management decision making for NCDs during the COVID-19 pandemic. Methodology: An instructional curriculum for the management of many common NCDs was designed and made available. Pre- and post-test were provided before and after the program. Findings: Average score for Pretest was 11.2 +/- 3.014 while the average score for posttest was 14.0 +/- 2.891 (P<0.001). Eight questions showed a significant difference between pre and post-test results. Eleven questions showed no significant difference between pre and post-test. A satisfaction questionnaire showed that 39 attendees highly satisfied and 10 were moderately satisfied. Recommendations: Educating physicians on the management of NCDs during the COVID is beneficial in changing general management concepts. Further enhancements to the education program are required in certain areas, notably diabetes management.
{"title":"Management of Non-communicable Diseases (NCD) in the COVID Era: Impact of Medical Education on Physician Concepts.","authors":"B. Zarif, Ahmed Elsabaawy, Gehan Elasaal","doi":"10.47672/ajhmn.1061","DOIUrl":"https://doi.org/10.47672/ajhmn.1061","url":null,"abstract":"Purpose: To evaluate the impacts of educational program on a group of physicians from PHC regarding knowledge and management decision making for NCDs during the COVID-19 pandemic. \u0000Methodology: An instructional curriculum for the management of many common NCDs was designed and made available. Pre- and post-test were provided before and after the program. \u0000Findings: Average score for Pretest was 11.2 +/- 3.014 while the average score for posttest was 14.0 +/- 2.891 (P<0.001). Eight questions showed a significant difference between pre and post-test results. Eleven questions showed no significant difference between pre and post-test. A satisfaction questionnaire showed that 39 attendees highly satisfied and 10 were moderately satisfied. \u0000Recommendations: Educating physicians on the management of NCDs during the COVID is beneficial in changing general management concepts. Further enhancements to the education program are required in certain areas, notably diabetes management.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74614948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ul Haq Ul Haq, M. Khan, A. Jalal, Inyat Shah, Musa Khan
Background: Although glioblastoma (GB) is kept up to date, rate of progress is nearly unavoidable. Earlier researches put forward the endurance advantages with removal of GB; but comparatively a small number of literatures have assessed the role of operative intervention in glioblastoma management. Objective: The aim of this research is to assess the results of surgical resections in patients with glioblastoma. Methods: Study conducted in Bacha Khan Medical College, Mardan Medical Complex Records were retrospectively identified and reviewed for all individuals that went through gliolastoma biopsy or its removal between Oct 2017 and Dec 2020 to identify 50 progressive GB patients. The Kaplan-Meier method produced median survival and 95 percent CI. The Cox Proportional Risks model was used for the multivarian analysis, which conducted for age, Karnofsky score, extent of resection, and tumor site and tumor multifocality of survival after the advancement of disease. Results: Patients with progressing illness received first recorded resection. The median survival after progression was 12.8 and 7.0 months for patients who had not received resections at this time. In multivariable analyses, KPS 0.70 (HR 0.438), and surgical intervention were linked with better survival after advancement of glioblastoma. Recommendations: In the circumstance of present maximum non-operative treatment, operative intervention for advancing glioblastoma is effective in controlling the symptoms but however, the survival of the patients is limited. Further research is required to determine if any, the role of surgical intervention may prolong post-progressive endurance in progressive GB individuals.
{"title":"Surgical Management of Glioblastoma Multiforme","authors":"Ul Haq Ul Haq, M. Khan, A. Jalal, Inyat Shah, Musa Khan","doi":"10.47672/ajhmn.1052","DOIUrl":"https://doi.org/10.47672/ajhmn.1052","url":null,"abstract":"Background: Although glioblastoma (GB) is kept up to date, rate of progress is nearly unavoidable. Earlier researches put forward the endurance advantages with removal of GB; but comparatively a small number of literatures have assessed the role of operative intervention in glioblastoma management. \u0000Objective: The aim of this research is to assess the results of surgical resections in patients with glioblastoma. \u0000Methods: Study conducted in Bacha Khan Medical College, Mardan Medical Complex Records were retrospectively identified and reviewed for all individuals that went through gliolastoma biopsy or its removal between Oct 2017 and Dec 2020 to identify 50 progressive GB patients. The Kaplan-Meier method produced median survival and 95 percent CI. The Cox Proportional Risks model was used for the multivarian analysis, which conducted for age, Karnofsky score, extent of resection, and tumor site and tumor multifocality of survival after the advancement of disease. \u0000Results: Patients with progressing illness received first recorded resection. The median survival after progression was 12.8 and 7.0 months for patients who had not received resections at this time. In multivariable analyses, KPS 0.70 (HR 0.438), and surgical intervention were linked with better survival after advancement of glioblastoma. \u0000Recommendations: In the circumstance of present maximum non-operative treatment, operative intervention for advancing glioblastoma is effective in controlling the symptoms but however, the survival of the patients is limited. Further research is required to determine if any, the role of surgical intervention may prolong post-progressive endurance in progressive GB individuals.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91005392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Hussain Afridi, Muhamamd Naeem Khan, A. Khan, M. Abbass, Muhammad Khalid Khan, Wali Gul, Shah Zaib
Background: Diabetes mellitus is on the rise at an alarming rate, and it has now become a global issue. Type 2 Diabetic Mellitus is a disease characterized by disturbances in glucose, protein, and fat metabolism. Diabetes has been increasingly common in recent decades, causing significant socioeconomic burden, particularly in poorer countries. Objective: To investigate the prevalence of vitamin B12 deficiency in Type 2 diabetes patients taking metformin. Methodology: This study was conducted on T2 diabetic patients in the Diabetic Department of Diabetes and Endocrinology HMC Hospital, Peshawar, for a year (10 February 2019 to 12 March 2020). The demographic data of the recruited patients was obtained after they gave their informed written consent. Patients inquired about their metformin use history, dosage, and duration of type 2 diabetes mellitus. A 5cc venous blood sample was taken from the arm and kept at 4 degrees Celsius. Vitamin B12 levels were measured using enzyme-linked immunoassay assays after serum was withdrawn. ELISA was used to determine the Vitamin B12 level in serums. Results: A total of 149 people were enrolled in this trial. The patients' average age was 55 years. In this study, there were 67 (38.8%) males and 82 (55.2%) females. The individuals had a 5.12-year history of diabetes mellitus. The average HbA1c level was 8.280.32. The individuals that were included have taken metformin for at least 4.8 years. There were 25 (22.6%) patients using 1000-1500 mg metformin daily, 76 (46.4%) receiving 1500-2000 mg metformin daily, and 48 (40.7%) taking greater than 2000 mg metformin daily. There were 44 patients with a normal BMI, 80 patients who were overweight, and 25 patients who were obese. The average B12 level in the blood was 223pg/ml. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are taking metformin, and patients should be given R.D.A (Recommended Dietary Allowance) multivitamins to avoid sequaela of cobalamin deficiency.
{"title":"Deficiency of Vitamin B12 in Type 2 Diabetic Patients Receiving Metformin Therapy at HMC Hospital Peshawar","authors":"Muhammad Hussain Afridi, Muhamamd Naeem Khan, A. Khan, M. Abbass, Muhammad Khalid Khan, Wali Gul, Shah Zaib","doi":"10.47672/ajhmn.1051","DOIUrl":"https://doi.org/10.47672/ajhmn.1051","url":null,"abstract":"Background: Diabetes mellitus is on the rise at an alarming rate, and it has now become a global issue. Type 2 Diabetic Mellitus is a disease characterized by disturbances in glucose, protein, and fat metabolism. Diabetes has been increasingly common in recent decades, causing significant socioeconomic burden, particularly in poorer countries. \u0000Objective: To investigate the prevalence of vitamin B12 deficiency in Type 2 diabetes patients taking metformin. \u0000Methodology: This study was conducted on T2 diabetic patients in the Diabetic Department of Diabetes and Endocrinology HMC Hospital, Peshawar, for a year (10 February 2019 to 12 March 2020). The demographic data of the recruited patients was obtained after they gave their informed written consent. Patients inquired about their metformin use history, dosage, and duration of type 2 diabetes mellitus. A 5cc venous blood sample was taken from the arm and kept at 4 degrees Celsius. Vitamin B12 levels were measured using enzyme-linked immunoassay assays after serum was withdrawn. ELISA was used to determine the Vitamin B12 level in serums. \u0000Results: A total of 149 people were enrolled in this trial. The patients' average age was 55 years. In this study, there were 67 (38.8%) males and 82 (55.2%) females. The individuals had a 5.12-year history of diabetes mellitus. The average HbA1c level was 8.280.32. The individuals that were included have taken metformin for at least 4.8 years. There were 25 (22.6%) patients using 1000-1500 mg metformin daily, 76 (46.4%) receiving 1500-2000 mg metformin daily, and 48 (40.7%) taking greater than 2000 mg metformin daily. There were 44 patients with a normal BMI, 80 patients who were overweight, and 25 patients who were obese. The average B12 level in the blood was 223pg/ml. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. There was no vitamin B12 deficiency in 53 (45.4%) of the patients. \u0000Recommendations: It is strongly advised based on the findings of this study that Serum cobalamin levels should be measured in Type II diabetes patients who are taking metformin, and patients should be given R.D.A (Recommended Dietary Allowance) multivitamins to avoid sequaela of cobalamin deficiency.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81272724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Zarif, Ehab Cherif, Mohammad Shafiq, Marwa Ahmed Hanafy, H. Mahmoud
Purpose: The SYNTAX Score is a crucial tool to grade angiographic complexity and risk stratification of patients for revascularization. Excessive coronary calcification can lead to adverse outcomes after percutaneous coronary intervention (PCI), and it represents an essential part of SYNTAX score calculation. The sensitivity in detecting any CAC by CT is much higher than in ICA. Our purpose is to evaluate the impact of CT-enhanced calcium detection on SYNTAX score in the evaluation of complex coronary anatomy. Methodology: This study was conducted at Beni-suef University Hospital and National Heart Institute from December 2019 to January 2021. Fifty consecutive male patients were enrolled, Their Coronary CT Angiography showed significant MVD; then, conventional coronary angiography was done. The additive value, rather than the comparative value, of adding Calcification from CT to CA syntax score (CT enhanced SYNTAX (CTeSx)), was assessed regarding its impact on the classification of complexity. Findings: Using a CTeSX Vs CA Sx results in Lower Possibilities of Low Syntax group (39% vs 24%) (P-value <0.001) and a higher Possibilities of High Syntax score (23% vs 52% P-value 0.004 Recommendation: CTeSX results in a significant change in the percentage of all complexity categories with a higher possibility to categorize complex anatomy.
{"title":"Impact of CT Enhanced Syntax Score (Ctesx) on Grading Complexity of Coronary Artery Disease","authors":"B. Zarif, Ehab Cherif, Mohammad Shafiq, Marwa Ahmed Hanafy, H. Mahmoud","doi":"10.47672/ajhmn.1035","DOIUrl":"https://doi.org/10.47672/ajhmn.1035","url":null,"abstract":"Purpose: The SYNTAX Score is a crucial tool to grade angiographic complexity and risk stratification of patients for revascularization. Excessive coronary calcification can lead to adverse outcomes after percutaneous coronary intervention (PCI), and it represents an essential part of SYNTAX score calculation. The sensitivity in detecting any CAC by CT is much higher than in ICA. Our purpose is to evaluate the impact of CT-enhanced calcium detection on SYNTAX score in the evaluation of complex coronary anatomy. \u0000Methodology: This study was conducted at Beni-suef University Hospital and National Heart Institute from December 2019 to January 2021. Fifty consecutive male patients were enrolled, Their Coronary CT Angiography showed significant MVD; then, conventional coronary angiography was done. The additive value, rather than the comparative value, of adding Calcification from CT to CA syntax score (CT enhanced SYNTAX (CTeSx)), was assessed regarding its impact on the classification of complexity. \u0000Findings: Using a CTeSX Vs CA Sx results in Lower Possibilities of Low Syntax group (39% vs 24%) (P-value <0.001) and a higher Possibilities of High Syntax score (23% vs 52% P-value 0.004 \u0000Recommendation: CTeSX results in a significant change in the percentage of all complexity categories with a higher possibility to categorize complex anatomy.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87524505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To examine factors associated with adherence of patients on Anti-tuberculosis treatment in Health facilities at Masaka City. Specifically the study was guided by four objectives; to establish the current level of adherence, to explore the patient knowledge, to find out socio-economic factors, and to identify Health facility factors contributing to adherence of patient on tuberculosis treatment. Methodology: A cross-sectional research design with both quantitative and qualitative approaches of data collection and analysis was used. At least 110 patients on tuberculosis drug were selected and 15 health workers working in tuberculosis clinics to give expert views on the problem under investigation. Interview guide and questionnaires were used and data were analyzed using Stata version 13. Descriptive statistics, percentages were presented in the findings on frequency distribution tables. Qualitative data obtained using interviews was analyzed using thematic content analysis and narrative reasoning. Results: Prevalence of adherence to TB treatment was at 86% from the patients the study was conducted. In the study most patients had adequate knowledge on Tuberculosis treatment and it had attributed a majority 86% with good adherence on Tuberculosis Drug. On health facility factors there was limited medical supplies of drug to improve care, most patients were youth. Statistically, there was significant relationship between frequent counseling and patient adherence at multivariate levels. (OR=15.5073; [95% Cl: 3.73553 to 27.27917]; p=0.010). There was no relationship between patients’ adherence and employment status and good conduct of health workers was significally associated with patient adherence. (OR=7.0566; [95%Cl: 2.77620 to 11.3371]; P=0.001). In this study factors affecting adherence included stigma, discrimination and suspension of transport as COVID-19 prevention guideline by Ministry of health Uganda negatively contributed to poor adherence of patients. This was attributed to by isolation and neglect by family members, relatives, health workers and the community for fear of COVID-19 suspicion at each respective health facility. Involvement of TB survivor in TB treatment would increase adherence and retention in care. Recommendations: In the study there was suboptimal adherence of 86% as opposed to MOH Uganda of 95%, due to stigma and discrimination. The study recommended each TB patient be assigned a family member and a village health team as treatment supporters. Intensified health education and pre TB treatment counselling on adherence increases patients ability to take medication consistently leading to good TB treatment outcomes. Not involving and supporting private clinics to provide TB services is a very big missed opportunity by the health sector. Most patients first visit private clinics before coming to public health centers. Involvement of TB survivor in TB treatment would increase adherence and retention in care.
{"title":"Factors Associated with Treatment Adherence of Patients on Anti-Tuberculosis Drugs Following Covid-19 Pandemic at Health Facilities of Masaka City, Uganda","authors":"P. Ogwok, Mathias Tumwebaze, Bright Laban Waswa","doi":"10.47672/ajhmn.1030","DOIUrl":"https://doi.org/10.47672/ajhmn.1030","url":null,"abstract":"Purpose: To examine factors associated with adherence of patients on Anti-tuberculosis treatment in Health facilities at Masaka City. Specifically the study was guided by four objectives; to establish the current level of adherence, to explore the patient knowledge, to find out socio-economic factors, and to identify Health facility factors contributing to adherence of patient on tuberculosis treatment. \u0000Methodology: A cross-sectional research design with both quantitative and qualitative approaches of data collection and analysis was used. At least 110 patients on tuberculosis drug were selected and 15 health workers working in tuberculosis clinics to give expert views on the problem under investigation. Interview guide and questionnaires were used and data were analyzed using Stata version 13. Descriptive statistics, percentages were presented in the findings on frequency distribution tables. Qualitative data obtained using interviews was analyzed using thematic content analysis and narrative reasoning. \u0000Results: Prevalence of adherence to TB treatment was at 86% from the patients the study was conducted. In the study most patients had adequate knowledge on Tuberculosis treatment and it had attributed a majority 86% with good adherence on Tuberculosis Drug. On health facility factors there was limited medical supplies of drug to improve care, most patients were youth. Statistically, there was significant relationship between frequent counseling and patient adherence at multivariate levels. (OR=15.5073; [95% Cl: 3.73553 to 27.27917]; p=0.010). There was no relationship between patients’ adherence and employment status and good conduct of health workers was significally associated with patient adherence. (OR=7.0566; [95%Cl: 2.77620 to 11.3371]; P=0.001). In this study factors affecting adherence included stigma, discrimination and suspension of transport as COVID-19 prevention guideline by Ministry of health Uganda negatively contributed to poor adherence of patients. This was attributed to by isolation and neglect by family members, relatives, health workers and the community for fear of COVID-19 suspicion at each respective health facility. Involvement of TB survivor in TB treatment would increase adherence and retention in care. \u0000Recommendations: In the study there was suboptimal adherence of 86% as opposed to MOH Uganda of 95%, due to stigma and discrimination. The study recommended each TB patient be assigned a family member and a village health team as treatment supporters. Intensified health education and pre TB treatment counselling on adherence increases patients ability to take medication consistently leading to good TB treatment outcomes. Not involving and supporting private clinics to provide TB services is a very big missed opportunity by the health sector. Most patients first visit private clinics before coming to public health centers. Involvement of TB survivor in TB treatment would increase adherence and retention in care.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87117398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Hameed, M. Paracha, F. Sagheer, Abdul Qayum Khan, S. M. Noor
Background: Pityriasis Versicolor (PV) is an infection of the superficial layers of skin caused by Malassezia yeasts. It is a non-contagious disease characterized by hypo and hyperpigmented macules on the body. Up to 40% of people face itching, decreased quality of life, social stigmatization, and embarrassment due to the lesions. Adapalene with Ketoconazole provides an efficient option for PV patients due to better toxicity profile and rapid action on the lesions. Objective: Comparison of efficacy of combined therapy with Ketoconazole 2% cream and adapalene 1% gel against Ketoconazole 2% cream monotherapy in Pityriasis Versicolor. Methods: Total 90 patients (45 in each group) were included in the study. Group-A was treated with combination of Ketoconazole 2% cream & adapalene 1% gel while group-B was given Ketoconazole 2% cream monotherapy. Study design was randomized controlled trial and SPSS version 26 was used for data analysis. Results: Mean age of the patients was 24.3±4.3 and 23.3±3.9 years in group-A and B, respectively. There were 30 males (66.7%) & 15 females (33.3%) in group-A while 35 males (77.8%) and 10 females (22.2%) in group-B. Mean duration of disease was 2.0±0.9 months in group-A & 2.3±1.2 months in group-B.The efficacy of combined therapy with Ketoconazole 2% cream & adapalene 1% gel was found to be better when compared with Ketoconazole 2% cream monotherapy in Pityriasis Versicolor. Difference between two groups (p=0.011) was statistically significant. Conclusion: It was concluded that adapalene 0.1% gel & ketoconazole 2% cream in combination is more effective than ketoconazole 2% cream monotherapy in the treatment of PV. Recommendation: It is recommended to use a combination of adapalene 0.1% gel & ketoconazole 2% cream than ketoconazole 2% cream monotherapy in the treatment of PV.
{"title":"COMPARATIVE STUDY OF EFFICACY OF COMBINED TREATMENT WITH KETOCONAZOLE 2% CREAM AND ADAPALENE 0.1% GEL VS. KETOCONAZOLE 2% CREAM MONOTHERAPY IN PITYRIASIS VERSICOLOR","authors":"S. Hameed, M. Paracha, F. Sagheer, Abdul Qayum Khan, S. M. Noor","doi":"10.47672/ajhmn.1029","DOIUrl":"https://doi.org/10.47672/ajhmn.1029","url":null,"abstract":"Background: Pityriasis Versicolor (PV) is an infection of the superficial layers of skin caused by Malassezia yeasts. It is a non-contagious disease characterized by hypo and hyperpigmented macules on the body. Up to 40% of people face itching, decreased quality of life, social stigmatization, and embarrassment due to the lesions. Adapalene with Ketoconazole provides an efficient option for PV patients due to better toxicity profile and rapid action on the lesions. \u0000Objective: Comparison of efficacy of combined therapy with Ketoconazole 2% cream and adapalene 1% gel against Ketoconazole 2% cream monotherapy in Pityriasis Versicolor. \u0000Methods: Total 90 patients (45 in each group) were included in the study. Group-A was treated with combination of Ketoconazole 2% cream & adapalene 1% gel while group-B was given Ketoconazole 2% cream monotherapy. Study design was randomized controlled trial and SPSS version 26 was used for data analysis. \u0000Results: Mean age of the patients was 24.3±4.3 and 23.3±3.9 years in group-A and B, respectively. There were 30 males (66.7%) & 15 females (33.3%) in group-A while 35 males (77.8%) and 10 females (22.2%) in group-B. Mean duration of disease was 2.0±0.9 months in group-A & 2.3±1.2 months in group-B.The efficacy of combined therapy with Ketoconazole 2% cream & adapalene 1% gel was found to be better when compared with Ketoconazole 2% cream monotherapy in Pityriasis Versicolor. Difference between two groups (p=0.011) was statistically significant. \u0000Conclusion: It was concluded that adapalene 0.1% gel & ketoconazole 2% cream in combination is more effective than ketoconazole 2% cream monotherapy in the treatment of PV. \u0000Recommendation: It is recommended to use a combination of adapalene 0.1% gel & ketoconazole 2% cream than ketoconazole 2% cream monotherapy in the treatment of PV. \u0000 \u0000 ","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87778264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shandana Bawar, Tanveer Shafqat, S. Hussain, Qudsia Qazi, R. Rahim
Purpose: To review the placenta weight birth weight ratio (PWBW ratio) and determine an association between PWBW ratio and gestational age in patients with placenta previa. Methodology: This descriptive cross sectional study took place in Gynae A unit, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan, from March 2018 to February 2020.Ethical approval from IRB (institutional review board) was taken before start of study. Patients with genital tract bleeding were admitted throughout patient department and Emergency with 28 weeks gestation and onwards. Diagnosis of placenta previa was confirmed and were included in study after taking consent. Results: Total of 173 patients with placenta previa were admitted in gynae A. Patients with major placenta previa were 151 (87.2%) while 22 (12.7%) patients had minor placenta previa. Birth weight placental weight ratio was calculated by measuring weight of placenta and baby after the delivery. Most of the patients, 92 (53.2%) had PWBW ratio less than 1:6 (relatively large placenta), patients with BWPW ratio of 1:6 (normal ratio) were 14 (8.1%) and 67 (38.7%) patients had PWBW ratio of 1:6 (relatively smaller placenta). Patients with placenta previa have relatively larger placenta (PWBW ratio less than 1:6) to compensate for lesser vasculature of lower uterine segment. Patients with larger placenta are prone to necrosis and abruption. Recommendation: igilant antenatal care and surveillance in these patients due to higher incidence of antepartum and postpartum hemorrhage, as well as invasive propensity of lager placenta.
{"title":"Placental weight Birth weight Ratio, in patients with Placenta Previa: A 2 year study in MTI Lady Reading Hospital Peshawar","authors":"Shandana Bawar, Tanveer Shafqat, S. Hussain, Qudsia Qazi, R. Rahim","doi":"10.47672/ajhmn.1016","DOIUrl":"https://doi.org/10.47672/ajhmn.1016","url":null,"abstract":"Purpose: To review the placenta weight birth weight ratio (PWBW ratio) and determine an association between PWBW ratio and gestational age in patients with placenta previa. \u0000Methodology: This descriptive cross sectional study took place in Gynae A unit, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan, from March 2018 to February 2020.Ethical approval from IRB (institutional review board) was taken before start of study. Patients with genital tract bleeding were admitted throughout patient department and Emergency with 28 weeks gestation and onwards. Diagnosis of placenta previa was confirmed and were included in study after taking consent. \u0000Results: Total of 173 patients with placenta previa were admitted in gynae A. Patients with major placenta previa were 151 (87.2%) while 22 (12.7%) patients had minor placenta previa. Birth weight placental weight ratio was calculated by measuring weight of placenta and baby after the delivery. Most of the patients, 92 (53.2%) had PWBW ratio less than 1:6 (relatively large placenta), patients with BWPW ratio of 1:6 (normal ratio) were 14 (8.1%) and 67 (38.7%) patients had PWBW ratio of 1:6 (relatively smaller placenta). Patients with placenta previa have relatively larger placenta (PWBW ratio less than 1:6) to compensate for lesser vasculature of lower uterine segment. Patients with larger placenta are prone to necrosis and abruption. \u0000Recommendation: igilant antenatal care and surveillance in these patients due to higher incidence of antepartum and postpartum hemorrhage, as well as invasive propensity of lager placenta.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91126072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: In secondary peritonitis patients, optimal management after index laparotomy is poorly defined. Although an open abdomen or temporary abdominal closure with planned relaparotomy is used to reassess bowel viability or contamination severity, recent studies show that primary abdominal closure has comparable morbidity and mortality. The differences between Open Abdomen (OP) and Primary Closure (PC) after emergent laparotomy are examined in this study. Material and Methods: A systemic review on open abdomen versus primary closure after emergency laparotomy for peritonitis from January 2017 to December 2021 were analyzed. This systemic review was conducted in the department of surgical Qazi Hussain Ahmad Medical complex, Nowshera, Pakistan with approval from the hospital ethical and research committee. The study enrolled 200 patients who met the eligibility requirements. A lottery method was used to divide the patients into two groups at random. Patients with secondary peritonitis requiring emergent laparotomy were identified (N = 200) using the Premier database at a quaternary level. Mannheim Peritonitis Index, lactate, and vasopressor requirement were used to perform propensity matching for PC (n = 100; 65%) or OA (n = 100; 35%). A total of 200 closely matched pairs (PC: OA) were examined. Results: About 65 percent of the 200 women patients enrolled in the study had an emergency laparotomy (mean age of 52.2 years). Only one relaparotomy was performed on 100 (65.0%) of the (O.A) patients, while 35 (35.0%) had multiple reoperations. Overnight (4 pm–4 am) laparotomies had more temporary closures with O.A (35.0 percent OA vs. 65.0 percent PC, p = 0.05) than daytime laparotomies. Surgical subspecialties performed PC in 82.1 percent of laparotomies, compared to 35.0 percent (p 0.0002) of acute care surgeons. Postoperative complications and n-100 (65.0 percent vs. 35.0 percent, p = 0.0002), mortality (18.0 percent vs. 09.2 percent, p = 0.005), and a longer median length of stay (12 vs. 12 days p = 0.0001) were all higher in OA patients. Conclusion: The study's systemic review revealed that compared to PC, the complications, mortality rates, and costs associated with OA were significantly higher. Given these findings, more research is needed to determine appropriate OA indications.
目的:在继发性腹膜炎患者中，剖腹手术后的最佳处理方法尚不明确。虽然开放腹部或临时腹部关闭与计划开腹术被用于重新评估肠道活力或污染严重程度，最近的研究表明，原发性腹部关闭具有相当的发病率和死亡率。本研究探讨急诊剖腹手术后开腹手术(OP)与一期闭锁手术(PC)的差异。材料和方法:系统回顾分析2017年1月至2021年12月腹膜炎紧急剖腹手术后开放腹部与初步封闭腹部的对比。该系统评价是在巴基斯坦Nowshera的Qazi Hussain Ahmad医疗综合体外科部门进行的，并得到了医院伦理和研究委员会的批准。该研究招募了200名符合资格要求的患者。采用摇号法将患者随机分为两组。需要紧急剖腹手术的继发性腹膜炎患者(N = 200)在四级水平使用Premier数据库进行鉴定。使用Mannheim腹膜炎指数、乳酸和血管加压素需求对PC进行倾向匹配(n = 100;65%)或OA (n = 100;35%)。共检测了200个紧密匹配对(PC: OA)。结果:参与研究的200名女性患者中，约65%接受了紧急剖腹手术(平均年龄52.2岁)。100例(65.0%)患者仅行一次再开腹手术，35例(35.0%)患者多次再开腹手术。夜间(下午4点至凌晨4点)剖腹手术比日间剖腹手术有更多的OA暂时性闭合(35.0% OA vs 65.0% PC, p = 0.05)。手术亚专科在82.1%的剖腹手术中执行PC，而急症护理外科医生的这一比例为35.0% (p 0.0002)。OA患者的术后并发症和n-100(65.0%对35.0%，p = 0.0002)、死亡率(18.0%对0.02%，p = 0.005)以及较长的中位住院时间(12天对12天，p = 0.0001)均较高。结论:该研究的系统评价显示，与PC相比，OA相关的并发症、死亡率和费用明显更高。鉴于这些发现，需要更多的研究来确定合适的OA适应症。
{"title":"Systemic Review of Open Abdomen versus Primary Closure after Emergency Laparotomy for Peritonitis: Experience in Qazi Hussain Ahmed Medical Complex, Nowshera, Pakistan.","authors":"M. Shahzad, K. Ahmad, F. Ghani, K. Khan","doi":"10.47672/ajhmn.1012","DOIUrl":"https://doi.org/10.47672/ajhmn.1012","url":null,"abstract":"Objective: In secondary peritonitis patients, optimal management after index laparotomy is poorly defined. Although an open abdomen or temporary abdominal closure with planned relaparotomy is used to reassess bowel viability or contamination severity, recent studies show that primary abdominal closure has comparable morbidity and mortality. The differences between Open Abdomen (OP) and Primary Closure (PC) after emergent laparotomy are examined in this study. \u0000Material and Methods: A systemic review on open abdomen versus primary closure after emergency laparotomy for peritonitis from January 2017 to December 2021 were analyzed. This systemic review was conducted in the department of surgical Qazi Hussain Ahmad Medical complex, Nowshera, Pakistan with approval from the hospital ethical and research committee. The study enrolled 200 patients who met the eligibility requirements. A lottery method was used to divide the patients into two groups at random. Patients with secondary peritonitis requiring emergent laparotomy were identified (N = 200) using the Premier database at a quaternary level. Mannheim Peritonitis Index, lactate, and vasopressor requirement were used to perform propensity matching for PC (n = 100; 65%) or OA (n = 100; 35%). A total of 200 closely matched pairs (PC: OA) were examined. \u0000Results: About 65 percent of the 200 women patients enrolled in the study had an emergency laparotomy (mean age of 52.2 years). Only one relaparotomy was performed on 100 (65.0%) of the (O.A) patients, while 35 (35.0%) had multiple reoperations. Overnight (4 pm–4 am) laparotomies had more temporary closures with O.A (35.0 percent OA vs. 65.0 percent PC, p = 0.05) than daytime laparotomies. Surgical subspecialties performed PC in 82.1 percent of laparotomies, compared to 35.0 percent (p 0.0002) of acute care surgeons. Postoperative complications and n-100 (65.0 percent vs. 35.0 percent, p = 0.0002), mortality (18.0 percent vs. 09.2 percent, p = 0.005), and a longer median length of stay (12 vs. 12 days p = 0.0001) were all higher in OA patients. \u0000Conclusion: The study's systemic review revealed that compared to PC, the complications, mortality rates, and costs associated with OA were significantly higher. Given these findings, more research is needed to determine appropriate OA indications.","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77558772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Fatima, Laila Zeb, Tanveer Shafqat, Qudsia Qazi
Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates. Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate. Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III. Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III. Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified
{"title":"ANALYSIS OF CAESAREAN SECTION RATE ACCORDING TO ROBSON CLASSIFICATION CRITERIA: A CROSS SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL.","authors":"S. Fatima, Laila Zeb, Tanveer Shafqat, Qudsia Qazi","doi":"10.47672/ajhmn.1009","DOIUrl":"https://doi.org/10.47672/ajhmn.1009","url":null,"abstract":"Purpose: The World Health Organization, recommends the Robson Ten Group Classification System (RTGCS) as a global standard for assessing, monitoring and comparing CS rates at both national and international levels. This study was aimed to analyze CS rate in Department of Obstetrics and Gynaecology MTI, LRH, Peshawar; according to RTGCS. This will help understand the major contributory groups to the overall CS rate and to formulate strategies to optimize the escalating rates. \u0000Methodology: A cross-sectional study for a period of 1 year from 1st January 2021 to 31st December 2021 was conducted at a tertiary care hospital located in the capital city of KPK Province, Pakistan. Women (n=7376) who delivered during the study period, fulfilling the inclusion/exclusion criteria were included. All relevant obstetric information was entered into a structured proforma. The study population was classified into Robson 10 groups and percentages were calculated for the overall CS rate, the representation of groups and contributions of the each group to the total CS rate. \u0000Findings: A total of 7376 deliveries were analyzed as per RTGCS. Of these 1679 (22.76%) were caesarean sections. According to the criteria used, Group I & III represented more than half (53.75%) of the obstetric population. The major contributor to the overall CS rate was group V (Previous caesarean delivery, single, cephalic > or equal to 37weeks), followed by group I (Nulliparous, single, cephalic > or equal to 37 weeks, in spontaneous labour), group X (All singleton, cephalic, < 37 weeks gestation pregnancies-including previous CS) and group III. \u0000Conclusion: The implementation of RTGCS at MTI, LRH, Peshawar helped to identify the contribution of each group to the overall CS rate. Group V was the leading contributor to the overall CS rate. This study also revealed a high rate of CS among low risk groups i.e. group I and III. \u0000Recommendations: Current study can be used to compare results among the institutions at provincial and national levels to design uniform policies throughout the Pakistan to optimize CS rate. Furthermore, education for both pregnant women and obstetricians is required to encourage and promote ECV and VBAC to avoid repeat Caesarean sections. Moreover, the instrumental vaginal delivery should be encouraged where clinically indicated and justified","PeriodicalId":7672,"journal":{"name":"American Journal of Health, Medicine and Nursing Practice","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75155473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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