Abstract: Background: Sickle Cell Disease (SCD) is of major public-health concern globally, with majority of patients living in Africa. Despite its relevance, there is a dearth of research to determine the socio-demographic distribution and psychosocial impact of SCD in Africa. The objective of this study therefore was to examine the socio-demographic distribution and psychosocial consequences of SCD among patients in Ghana and to assess their quality of life and coping mechanisms. Methods: A cross-sectional research design was used, involving the completion of questionnaires on socio-demographic characteristics, quality of life of individuals, anxiety and depression. Participants were 387 male and female patients attending a sickle cell clinic in a public hospital. Results: Results showed no gender and marital status differences in anxiety and depression. However, there were age and level of education variances in depression but not in anxiety. In terms of quality of life, patients were more satisfied by the presence of love, friends, relatives as well as home, community and neighbourhood environment. While pains of varied nature and severity were the major reasons for attending hospital in SCD condition, going to the hospital as well as having Faith in God was the frequently reported mechanisms for coping with an unbearable SCD attacks. Multiple regression analysis showed that some socio-demographic and quality of life indicators had strong associations with anxiety and/or depression. Conclusion: It is recommended that a multi-dimensional intervention strategy incorporating psychosocial dimensions should be considered in the treatment and management of SCD.
Abstract: This paper presents a classifier ensemble approach for
predicting the survivability of the breast cancer patients using the
latest database version of the Surveillance, Epidemiology, and End
Results (SEER) Program of the National Cancer Institute. The system
consists of two main components; features selection and classifier
ensemble components. The features selection component divides the
features in SEER database into four groups. After that it tries to find
the most important features among the four groups that maximizes the
weighted average F-score of a certain classification algorithm. The
ensemble component uses three different classifiers, each of which
models different set of features from SEER through the features
selection module. On top of them, another classifier is used to give
the final decision based on the output decisions and confidence
scores from each of the underlying classifiers. Different classification
algorithms have been examined; the best setup found is by using the
decision tree, Bayesian network, and Na¨ıve Bayes algorithms for the
underlying classifiers and Na¨ıve Bayes for the classifier ensemble
step. The system outperforms all published systems to date when
evaluated against the exact same data of SEER (period of 1973-2002).
It gives 87.39% weighted average F-score compared to 85.82% and
81.34% of the other published systems. By increasing the data size to
cover the whole database (period of 1973-2014), the overall weighted
average F-score jumps to 92.4% on the held out unseen test set.
Abstract: Neurological disorders are the most debilitating of manifestations seen in patients infected with HIV. The clinical profile of neurological manifestations in HIV patients has undergone a shift in recent years with opportunistic infections being controlled with combination anti-retroviral therapy and the advent of drugs which have higher central nervous system penetrability. The aim of this paper is to study the clinical, investigation profile and various neurological disorders in HIV patients on anti‐retroviral therapy. Fifty HIV patients with neurological manifestations were studied. A complete neurological examination including neurocognitive functioning using Montreal Cognitive Assessment and HIV Dementia scale were assessed. Apart from relevant investigations, CD4 count, cerebrovascular fluid analysis, computed tomography (CT) and magnetic resonance imaging (MRI) of brain were done whenever required. Neurocognitive disorders formed the largest group with 42% suffering from HIV associated Neurocognitive Disorders. Among them, asymptomatic neurocognitive impairment was seen in 28%; mild neurocognitive disorder in 12%, and 2% had HIV‐associated dementia. Opportunistic infections of the nervous system accounted for 32%, with meningitis being the most common. Four patients had space occupying lesions of central nervous system; four tuberculomas, and one toxoplasmosis. With the advent of highly active retroviral therapy, HIV patients have longer life spans with suppression of viral load leading to decrease in opportunistic infections of the nervous system. Neurocognitive disorders are now the most common neurological dysfunction seen and thus neurocognitive assessment must be done in all patients with HIV.
Abstract: HIV and Tuberculosis (TB) infections each speed the other's progress. HIV-infection increases the risk of TB disease. At the same time, TB infection is associated with clinical progression of HIV-infection. HIV+TB co-infected patients are also at higher risk of acquiring new opportunistic infections. An important feature of disease progression and clinical outcome is the innate and acquired immune responses. HIV and TB, however, have a spectrum of dysfunctions of the immune response. As cytokines play a crucial role in the immunopathology of both infections, it is important to study immune interactions in patients with dual infection HIV+TB. Plasma levels of proinflammatory cytokines IL-2, IFN-γ and immunoregulating cytokines IL-4, IL-10 were evaluated in 75 patients with dual infection HIV+TB, 58 patients with HIV monoinfection and 50 patients with TB monoinfection who were previously naïve for HAART. The decreased levels of IL-2, IFN-γ, IL-4 and IL-10 were observed in patients with dual infection HIV+TB in comparison with patients who had only HIV or TB which means the profound suppression of Th1 and Th2 cytokine secretion. Thus, those cytokines could possibly serve as immunological markers of progression of HIV-infection in patients with TB.
Abstract: Substandard and counterfeit antimalarials is a major problem in malaria endemic areas. The availability of counterfeit/ substandard medicines is not only decreasing the efficacy in patients, but it is also one of the contributing factors for developing antimalarial drug resistance. Owing to this, a pilot study was conducted to survey quality of drugs collected from different malaria endemic areas of India. Artesunate+Sulphadoxine-Pyrimethamine (AS+SP), Artemether-Lumefantrine (AL), Chloroquine (CQ) tablets were randomly picked from public health facilities in selected states of India. The quality of antimalarial drugs from these areas was assessed by using Global Pharma Health Fund Minilab test kit. This includes physical/visual inspection and disintegration test. Thin-layer chromatography (TLC) was carried out for semi-quantitative assessment of active pharmaceutical ingredients. A total of 45 brands, out of which 21 were for CQ, 14 for AL and 10 for AS+SP were tested from Uttar Pradesh (U.P.), Mizoram, Meghalaya and Gujrat states. One out of 45 samples showed variable disintegration and retension factor. The variable disintegration and retention factor which would have been due to substandard quality or other factors including storage. However, HPLC analysis confirms standard active pharmaceutical ingredient, but may be due to humid temperature and moisture in storage may account for the observed result.
Abstract: Neuromuscular control of posture as understood
through studies of responses to mechanical sudden acceleration
automatically has been previously demonstrated in individuals with
chronic ankle instability (CAI), but the presence of acute condition
has not been previously explored specially in a sudden acceleration.
The aim of this study was to determine neuromuscular control pattern
in those with and without unilateral acute ankle sprains. Design: Case
- control. Setting: University research laboratory. The sinker–card
protocol with surface translation was be used as a sudden acceleration
protocol with study of EMG upon 4 posture stabilizer muscles in two
sides of the body in response to sudden acceleration in forward and
backward directions. 20 young adult women in two groups (10 LAS;
23.9 ± 2.03 yrs and 10 normal; 26.4 ± 3.2 yrs). The data of EMG
were assessed by using multivariate test and one-way repeated
measures 2×2×4 ANOVA (P< 0.05). The results showed a significant
muscle by direction interaction. Higher TA activity of left and right
side in LAS group than normal group in forward direction
significantly be showed. Higher MGR activity in normal group than
LAS group in backward direction significantly showed. These
findings suggest that compared two sides of the body in two
directions for 4 muscles EMG activities between and within group for
neuromuscular control of posture in avoiding fall. EMG activations
of two sides of the body in lateral ankle sprain (LAS) patients were
symmetric significantly. Acute ankle instability following once ankle
sprains caused to coordinated temporal spatial patterns and strategy
selection.
Abstract: This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.
Abstract: Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Lung-protective ventilation is still the key of better outcome in ARDS. Prone position reduces the trans-pulmonary pressure gradient, recruiting collapsed regions of the lung without increasing airway pressure or hyperinflation. Prone ventilation showed improved oxygenation and improved outcomes in severe hypoxemic patients with ARDS. This study evaluates the effect of prone positioning on mechanically ventilated patients with ARDS. A quasi-experimental design was carried out at Critical Care Units, on 60 patients. Two tools were utilized to collect data; Socio demographic, medical and clinical outcomes data sheet. Results of the present study indicated that prone position improves oxygenation in patients with severe respiratory distress syndrome. The study recommended that use prone position in patients with severe ARDS, as early as possible and for long sessions. Also, replication of this study on larger probability sample at the different geographical location is highly recommended.
Abstract: The aim of this audit was to examine the efficiency of alcohol history documentation and screening for hazardous drinkers at the Medical Admission Unit (MAU) of Northern General Hospital (NGH), Sheffield, to identify any potential for enhancing clinical practice. Data were collected from medical clerking sheets, ICE system and directly from 82 patients by three junior medical doctors using both CAGE questionnaire and AUDIT-C tool for newly admitted patients to MAU in NGH, in the period between January and March 2015. Alcohol consumption was documented in around two-third of the patient sample and this was documented fairly accurately by health care professionals. Some used subjective words such as 'social drinking' in the alcohol units’ section of the history. CAGE questionnaire was applied to only four patients and none of the patients had documented advice, education or referral to an alcohol liaison team. AUDIT-C tool had identified 30.4%, while CAGE 10.9%, of patients admitted to the NGH MAU as hazardous drinkers. The amount of alcohol the patient consumes positively correlated with the score of AUDIT-C (Pearson correlation 0.83). Re-audit is planned to be carried out after integrating AUDIT-C tool as labels in the notes and presenting a brief teaching session to junior doctors. Alcohol misuse screening is not adequately undertaken and no appropriate action is being offered to hazardous drinkers. CAGE questionnaire is poorly applied to patients and when satisfactory and adequately used has low sensitivity to detect hazardous drinkers in comparison with AUDIT-C tool. Re-audit of alcohol screening practice after introducing AUDIT-C tool in clerking sheets (as labels) is required to compare the findings and conclude the audit cycle.
Abstract: In Rwanda, many healthcare organizations are still using a paper based patients’ data record system although it still present weaknesses to share health patients’ information across different services when necessary. In developed countries, the EHR has been put in place to revolutionize the paper based record system but still the EHR has some challenges related to privacy, security, or interoperability. The purpose of this research was to assess the existing patients’ data record system in healthcare sector in Rwanda, see what an EHR can improve to the system in place and assess the acceptance of EHR as system which is interoperable, very secure and interoperable and see whether stakeholders are ready to adopt the system. The case based methodology was used and TAM theoretical framework to design the questionnaire for the survey. A judgmental sample across two cases, CHUB and Hopital de Nemba, has been selected and SPSS has been used for descriptive statistics. After a qualitative analysis, the findings showed that the paper based record is useful, gives complete information about the patient, protects the privacy of patients but it is still less secure and less interoperable. The respondents shown that they are ready to use the proposed EHR System and want it secure, capable of enforcing the privacy but still they are not all ready for the interoperability. A conclusion has been formulated; recommendations and further research have been proposed.
Abstract: The security of the medical images and its related data is the major research area which is to be concentrated in today’s era. Security in the medical image indicates that the physician may hide patients’ related data in the medical image and transfer it safely to a defined location using reversible watermarking. Many reversible watermarking methods had proposed over the decade. This paper enhances the security level in brain tumor images to hide the patient’s detail, which has to be conferred with other physician’s suggestions. The details or the information will be hidden in Non-ROI area of the image by using the block cipher algorithm. The block cipher uses different keys to extract the details that are difficult for the intruder to detect all the keys and to spot the details, which are the key advantage of this method. The ROI is the tumor area and Non-ROI is the area rest of ROI. The Non-ROI should not be spoiled in any cause and the details in the Non-ROI should be extracted correctly. The reversible watermarking method proposed in this paper performs well when compared to existing methods in the process of extraction of an original image and providing information security.
Abstract: Access to advanced medical services has been one of the medical challenges faced by our present society especially in distant geographical locations which may be inaccessible. Then the need for telemedicine arises through which live videos of a doctor can be streamed to a patient located anywhere in the world at any time. Patients’ medical records contain very sensitive information which should not be made accessible to unauthorized people in order to protect privacy, integrity and confidentiality. This research work focuses on a more robust security measure which is biometric (fingerprint) as a form of access control to data of patients by the medical specialist/practitioner.
Abstract: Liver cancer is one of the common diseases that cause the death. Early detection is important to diagnose and reduce the incidence of death. Improvements in medical imaging and image processing techniques have significantly enhanced interpretation of medical images. Computer-Aided Diagnosis (CAD) systems based on these techniques play a vital role in the early detection of liver disease and hence reduce liver cancer death rate. This paper presents an automated CAD system consists of three stages; firstly, automatic liver segmentation and lesion’s detection. Secondly, extracting features. Finally, classifying liver lesions into benign and malignant by using the novel contrasting feature-difference approach. Several types of intensity, texture features are extracted from both; the lesion area and its surrounding normal liver tissue. The difference between the features of both areas is then used as the new lesion descriptors. Machine learning classifiers are then trained on the new descriptors to automatically classify liver lesions into benign or malignant. The experimental results show promising improvements. Moreover, the proposed approach can overcome the problems of varying ranges of intensity and textures between patients, demographics, and imaging devices and settings.
Abstract: Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.
Abstract: Cloud computing can reduce the start-up expenses of implementing EHR (Electronic Health Records). However, many of the healthcare institutions are yet to implement cloud computing due to the associated privacy and security issues. In this paper, we analyze the challenges and opportunities of implementing cloud computing in healthcare. We also analyze data of over 5000 US hospitals that use Telemedicine applications. This analysis helps to understand the importance of smart phones over the desktop systems in different departments of the healthcare institutions. The wide usage of smartphones and cloud computing allows ubiquitous and affordable access to the health data by authorized persons, including patients and doctors. Cloud computing will prove to be beneficial to a majority of the departments in healthcare. Through this analysis, we attempt to understand the different healthcare departments that may benefit significantly from the implementation of cloud computing.
Abstract: Pain management is a question of quality of life and
an indicator for nursing quality. Chronic pain which is predominant
in oncology and palliative nursing situations is perceived today as a
multifactorial, individual emotional experience with specific
characteristics including the sociocultural dimension when dealing
with migrant patients. This dimension of chronic pain is of major
importance in professional nursing of migrant patients in hospices or
palliative care units. Objectives of the study are: 1. To find out more
about the sociocultural views on pain and nursing care, on customs
and nursing practices connected with pain of both Turkish Muslim
and German Christian women, 2. To improve individual and family
oriented nursing practice with view to sociocultural needs of patients
in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women,
Turkish Muslims immigrants (4 from the first generation, 5 from the
second generation) and German Christian women of two generations
(5 of each age group) of the same age groups as the Turkish women
and with similar educational backgrounds were interviewed (semistructured
ethnographic interviews using Spradley, 1979) on their
perceptions and experiences of pain and nursing care within their
families. For both target groups the presentation will demonstrate the
following results in detail: Utterance of pain as well as “private” and
“public” pain vary within different societies and cultures. Permitted
forms of pain utterance are learned in childhood and determine
attitudes and expectations in adulthood. Language, especially when
metaphors and symbols are used, plays a major role for
misunderstandings. The sociocultural context of illness may include
specific beliefs that are important to the patients and yet seem more
than far-fetched from a biomedical perspective. Pain can be an
influential factor in family relationships where respect or hierarchies
do not allow the direct utterance of individual needs. Specific
resources are often, although not exclusively, linked to religious
convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to
the relevant literature and present nursing interventions and
instruments beyond medication that are helpful when dealing with
patients from various socio-cultural backgrounds in painful end-oflife
situations.
Abstract: Thoracotomy is a great surgery that has serious pulmonary complications, so purpose of this study was to determine the response of diaphragmatic excursion to inspiratory muscle trainer post thoracotomy. Thirty patients of both sexes (16 men and 14 women) with age ranged from 20 to 40 years old had done thoracotomy participated in this study. The practical work was done in cardiothoracic department, Kasr-El-Aini hospital at faculty of medicine for individuals 3 days Post operatively. Patients were assigned into two groups: group A (study group) included 15 patients (8 men and 7 women) who received inspiratory muscle training by using inspiratory muscle trainer for 20 minutes and routine chest physiotherapy (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Group B (control group) included 15 patients (8 men and 7 women) who received the routine chest physiotherapy only (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Ultrasonography was used to evaluate the changes in diaphragmatic excursion before and after training program. Statistical analysis revealed a significant increase in diaphragmatic excursion in the study group (59.52%) more than control group (18.66%) after using inspiratory muscle trainer post operatively in patients post thoracotomy. It was concluded that the inspiratory muscle training device increases diaphragmatic excursion in patients post thoracotomy through improving inspiratory muscle strength and improving mechanics of breathing and using of inspiratory muscle trainer as a method of physical therapy rehabilitation to reduce post-operative pulmonary complications post thoracotomy.
Abstract: Introduction: To update ourselves and understand the
concept of latest electronic formats available for Health care
providers and how it could be used and developed as per standards.
The idea is to correlate between the patients Manual Medical Records
keeping and maintaining patients Electronic Information in a Health
care setup in this world. Furthermore, this stands with adapting to the
right technology depending upon the organization and improve our
quality and quantity of Healthcare providing skills. Objective: The
concept and theory is to explain the terms of Electronic Medical
Record (EMR), Electronic Health Record (EHR) and Personal Health
Record (PHR) and selecting the best technical among the available
Electronic sources and software before implementing. It is to guide
and make sure the technology used by the end users without any
doubts and difficulties. The idea is to evaluate is to admire the uses
and barriers of EMR-EHR-PHR. Aim and Scope: The target is to
achieve the health care providers like Physicians, Nurses, Therapists,
Medical Bill reimbursements, Insurances and Government to assess
the patient’s information on easy and systematic manner without
diluting the confidentiality of patient’s information. Method: Health
Information Technology can be implemented with the help of
Organisations providing with legal guidelines and help to stand by
the health care provider. The main objective is to select the correct
embedded and affordable database management software and
generating large-scale data. The parallel need is to know how the
latest software available in the market. Conclusion: The question lies
here is implementing the Electronic information system with
healthcare providers and organization. The clinicians are the main
users of the technology and manage us to “go paperless”. The fact is
that day today changing technologically is very sound and up to date.
Basically, the idea is to tell how to store the data electronically safe
and secure. All three exemplifies the fact that an electronic format
has its own benefit as well as barriers.
Abstract: Multiple Sclerosis (MS) is a disease which affects the
central nervous system and causes balance problem. In clinical, this
disorder is usually evaluated using static posturography. Some linear
or nonlinear measures, extracted from the posturographic data (i.e.
center of pressure, COP) recorded during a balance test, has been
used to analyze postural control of MS patients. In this study, the
trend (TREND) and the sample entropy (SampEn), two nonlinear
parameters were chosen to investigate their relationships with the
expanded disability status scale (EDSS) score. 40 volunteers with
different EDSS scores participated in our experiments with eyes open
(EO) and closed (EC). TREND and 2 types of SampEn (SampEn1
and SampEn2) were calculated for each combined COP’s position
signal. The results have shown that TREND had a weak negative
correlation to EDSS while SampEn2 had a strong positive correlation
to EDSS. Compared to TREND and SampEn1, SampEn2 showed a
better significant correlation to EDSS and an ability to discriminate
the MS patients in the EC case. In addition, the outcome of the study
suggests that the multi-dimensional nonlinear analysis could provide
some information about the impact of disability progression in MS on
dynamics of the COP data.
Abstract: Objective: Acute coronary syndrome is a clinical
condition encompassing ST segments elevation myocardial
infraction, Non ST segment is elevation myocardial infraction and un
stable angina is characterized by ruptured coronary plaque, stress and
myocardial injury. Angina pectoris is a pressure like pain in the chest
that is induced by exertion or stress and relived with in the minute
after cessation of effort or using sublingual nitroglycerin. The present
research was undertaken to study the drug utilization pattern of
antiplatelet drugs for the ischemic heart disease in a tertiary care
hospital. Method: The present study is retrospective drug utilization
study and study period is 6months. The data is collected from the
discharge case sheet of general medicine department from medical
department Rajiv Gandhi institute of medical sciences, Kadapa. The
tentative sample size fixed was 250 patients. Out of 250 cases 19
cases was excluded because of unrelated data. Results: A total of 250
prescriptions were collected for the study according to the inclusion
criteria 233 prescriptions were diagnosed with ischemic heart disease
17 prescriptions were excluded due to unrelated information. out of
233 prescriptions 128 are male (54.9%) and 105 patients are were
female (45%). According to the gender distribution, the prevalence of
ischemic heart disease in males are 90 (70.31%) and females are 39
(37.1%). In the same way the prevalence of ischemic heart disease
along with cerebrovascular disease in males are 39 (29.6%) and
females are 66 (62.6%). Conclusion: We found that 94.8% of drug
utilization of antiplatelet drugs was achieved in the Rajiv Gandhi
institute of medical sciences, Kadapa from 2011-2012.