Septic shock diagnosis and its treatment

In critical care, sepsis continues to be a major cause of mortality. The pathogenic, diagnostic, and therapeutic panorama of sepsis is no longer restricted to the critical care unit: many patients who enter treatment through other doors, both inside and outside the hospital, develop severe illness. Next, administer fluids and broad-spectrum antibiotics after taking the proper cultures. Step up the treatment to include monitoring urine output, blood gases for base excess, lactate, haemoglobin, and glucose if the situation does not get better within the following six hours. These will dictate how bicarbonate, insulin, fluids, transfusions, and vasopressors are managed. The patient should be sent to intensive care if the hypotension doesn't improve (septic shock). Sepsis can now be treated with methods that have produced better results with other illnesses. New medicines have been created as a result of a better understanding of the biology of severe sepsis and septic shock, placing a strong emphasis on early detection and aggressive treatment. The major priorities continue to be prevention through screening, preventing cross infection, and prudent antibiotic usage.

Morbidity profiling of patients treated at Ayothidoss Pandithar Hospital of the National Institute of Siddha from 2004 to 2023 in Tamil Nadu, India

Background: Understanding the patient flow for health-seeking patterns and utilization of AYUSH care in India has been considered essential for a greater emphasis on mainstreaming and blending into the existing healthcare systems. This study examines the morbidity profiling of patients reporting to Ayothidoss Pandithar Hospital (APH) of the National Institute of Siddha (NIS), Chennai. Methods: The study included new and old/revisit patients who attended the APH, Outpatient Department (OPD), special OPD, and Inpatient Department (IPD) from October 2004 to December 2023. Results: Through OPD and IPD, APH has treated 98,94,373 cases and 7,61,754 cases, respectively. The average number of cases treated per day at OPD was 1484, and 115 in IPD. Men were higher in OPD and IPD. The more common diseases treated during 2012-2023 at OPD were Madhumegam (diabetes mellitus) 13% and Azhal keelvayu (osteoarthritis) 12% whereas, in IPD, it was Thandagavatham (lumbar spondylosis) 9.5% and Pakkavatham (hemiplegia) 9.4%. At APH, 9 X-ray investigations, 44 Varmam therapies, 37 Thokkanam therapies, 497 pathological, 433 biochemical investigations, and 38 microbiological tests were performed each day. Conclusions: This study reveals the scope of the Siddha system of Medicine in managing Musculoskeletal disorders. The patient data generated at APH would enhance the National Health Policy (NHP) objective of strengthening and prioritizing health services' importance, promoting good health, and creating guidelines for high-quality care.

Prevalence of work-related lower back pain and psychosocial impacts in dentistry

Background: In dentistry, musculoskeletal (MSK) pain creates a significant occupational health hazard jeopardizing the efficient delivery of care to the patients. There are several factors linked to the job that contribute to the higher incidence of MSK pain among dental practitioners. Uncomfortable postures and movements, frequent and prolonged working hours, the amount of time spent with each patient are some of the work-related factors of work related lower back pain which need to be addressed to prevent the disabling effects in the long run. The study aims to evaluate the prevalence of work related lower back pain and significance of associated risk factors in Saudi Arabia. Methods: Self-administered questionnaire were distributed to 384 dental practitioners who were working in various clinics in Saudi Arabia. This survey had four sections with questions related to demographic data, clinical practice, ergonomic principles, and psychosocial impacts. Descriptive statistics including chi-square analyses and associated significance were performed. Results: The relationship between age, years of experience and back pain among dental professionals was found to be significant with back pain lasting between 1 to 7 days in 34.2% among the participants. Older individuals with more experience tend to use back braces, analgesics, and physiotherapy more often. The cumulative prevalence of back pain in the study was 42.2%, with the majority of participants working for 2-8 hours per day. Various types of back strain injuries were observed across age groups and experience levels. Psychosocial impacts like job dissatisfaction and missed workdays were more pronounced in older individuals. The type of dental work and sitting posture also influenced back pain in specific age groups with significant associations observed. Conclusions: Our study sheds light on the significant issue of MSK pain among dental practitioners in Saudi Arabia, emphasizing its complex nature involving physiological, ergonomic and psychosocial factors. Found high prevalence of MSK pain, especially lower back discomfort, linked to factors like sitting postures and long working hours.

A case study of post traumatic meningitis after a road traffic accident

In road traffic accident cases one of the main reasons for hospitalization is traumatic brain injury (TBI) with subdural hematomas (SDH). The in-hospital course is further complicated by variety of infections including meningitis. A significant concern in the field of bacterial resistance is the multidrug-resistant strain of K. pneumoniae. Due to the dearth of therapeutic options, treating K. pneumoniae infections can be difficult and have an adverse impact on morbidity, mortality, and healthcare-related expenses. Here, we present the case of a 34-year-old polytrauma patient who was in good physical health prior to the road traffic accident. The patient sustained right fronto temporo parietal SDH, frontal contusion, frontal bone fracture, multiple facial bone fracture and CSF rhinorrhoea. He underwent bifrontal craniotomy and ACF repair on the following day. His in-hospital course was complicated by Klebsiella meningitis. He was discharged from the hospital after 25 days of successful treatment of meningitis. In the present study, effective and satisfactory results were achieved through antibiotic therapy which included Colistin IV and intrathecal, Fosfomycin IV, and Tigecycline IV, for a post-operative K. pneumoniae infection. On review day, the CSF analysis had revealed total leucocyte count of 9 and CSF showed no growth.

Comparison of the incidence of post-ERCP pancreatitis between combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is now widely accepted as a therapeutic modality for benign and malignant diseases of the pancreaticobiliary tree. Acute pancreatitis is the most common and feared complication of ERCP, associated with substantial morbidity and mortality. This study aimed to compare the incidence of post-ERCP pancreatitis in combined rectal indomethacin and sublingual nitroglycerin with that of rectal indomethacin alone. Methods: This was a randomized controlled trial conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period from July, 2019 to September, 2020. In this study, 100 hospitalized patients of >18 years age undergoing ERCP based on clinical indication and proper investigation were included. The study population was randomly divided into two groups - group A (patients who were given indomethacin suppository plus sublingual glyceryl trinitrate) and group B (patients who were given indomethacin alone). Results: In this study, we found that PEP developed in 11 out of 100 patients (11%). Post-ERCP pancreatitis developed in 2 (4%) in group A and 9 (18%) in group B (p=0.025), which was statistically significant. Mild PEP developed in none in group A and 4 (8%) in group B whereas moderate in 2 (4%) in group A and 3 (6%) in group B. Severe pancreatitis occurred in none in group A and 2 (4%) in group B (p=0.231) which was not statistically significant. Conclusions: This study showed that the combination of indomethacin suppository and sublingual GTN is superior to indomethacin suppository alone in preventing post-ERCP pancreatitis.

Assessment of lead augmented vector left (aVL on surface electrocardiogram) for confirming atrioventricular nodal reentrant tachycardia

Background: Atrioventricular nodal reentrant tachycardia (AVNRT) stands as one of the most common forms of paroxysmal supraventricular tachycardia (PSVT), encompassing a wide spectrum of clinical presentations and diagnostic challenges. The aim of this study was to evaluate the assessment of lead aVL (surface ECG) for confirming AVNRT. Methods: This was a prospective observational study and was conducted at the Department of Cardiology and Electrophysiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh during the period from February 2019 to January 2020. Results: In our study 41 patients (66.1%) had AVNRT and 21 patients (33.9%) had AVRT on the final evaluation. Total 33.9% of patients had aVL notch on ECG. Among patients who had AVNRT, 46.3% had an aVL notch and among patients who had AVRT, 9.5% had an aVL notch on ECG. The difference was statistically significant (p=0.004). Among 21 patients who had aVL notch on ECG, 6 (31.6%) male patients had AVNRT, 13 (64.8%) female patients had AVNRT, 1 (50%) male patients had AVRT and 1 (50%) female patient had AVRT. Conclusions: In conclusion, the interpretation of electrocardiographic criteria, including the aVL notch, plays a pivotal role in confirming the diagnosis of AVNRT and guiding therapeutic interventions.

Lesión por medusa: una entidad poco conocida en país mediterráneo. Reporte de caso

Las diferentes especies de medusas, marinas o de agua dulce, pueden inyectar toxinas a los humanos si estos entran en contacto con ellas, ocasionando eritema, prurito, dolor neurogénico agudo y enrojecimiento localizado, derivados de la acción de las toxinas en el sistema nervioso periférico. En casos más severos, pueden manifestarse reacciones alérgicas sistémicas como anafilaxia, dificultades respiratorias y taquicardia, e incluso la muerte. El tratamiento involucra la inmediata remoción de los tentáculos adheridos, preferiblemente con agua salada, seguida de la aplicación local de frio moderado para inactivar las toxinas. El uso de analgésicos, antihistamínicos y, en casos graves, la administración de epinefrina, son medidas terapéuticas comunes. Es necesario y urgente derivar casos complicados o de reacciones alérgicas graves a unidades de atención médica para evaluación y manejo adecuado. Presentamos el caso de un adulto que sufrió envenenamiento por medusa de zona marítima.

Different species of jellyfish, marine or freshwater, can inject toxins into humans if they come into contact with them, causing erythema, pruritus, acute neurogenic pain and localized redness, derived from the action of the toxins in the peripheral nervous system. In more severe cases, systemic allergic reactions such as anaphylaxis, breathing difficulties and tachycardia, and even death may occur. Treatment involves immediate removal of attached tentacles, preferably with salt water, followed by local application of moderate cold to inactivate toxins. The use of analgesics, antihistamines and, in severe cases, the administration of epinephrine, are common therapeutic measures. It is necessary and urgent to refer complicated cases or severe allergic reactions to medical care units for evaluation and appropriate management. We present the case of an adult who suffered poisoning by jellyfish from the maritime area.

Etoposide Model-Induced Changes in Antioxidant Studies Histological and Ultrastructural Evaluations of Hepatic, Renal, and Cardiac Tissues of Male Rats / Cambios Inducidos por el Modelo de Etopósido en Estudios de Antioxidantes, Evaluaciones Histológicas y Ultraestructurales de Tejidos Hepáticos, Renales y Cardíacos de Ratas Macho

SUMMARY: Etoposide is an effective antimitotic and antineoplastic agent used to treat various human malignancies. In the present study, Etoposide was injected intraperitoneally into the rats at 1 mg/kg/day for 52 days (52 doses). The control animals received physiological saline (0.5 ml) intraperitoneally daily for 52 doses. The body weight of etoposide-treated rats was significantly reduced compared to control rats. Lipid peroxidation demonstrated an insignificant rise in hepatic tissue, a non-significant decline in renal tissue, and a significant reduction in cardiac tissue. The levels of GSH in hepatic and renal tissue were found to be non-significantly increased but significantly increased in cardiac tissue compared to controls. GR activity was found to be considerably decreased in the treated group. G-S-T levels increased significantly in all treated group. Etoposide injections caused a non-significant change in the GPX level of hepatic tissue, whereas renal and cardiac tissues showed a significant increase. The activity of CAT in hepatic tissue was significantly increased, while CAT activity in renal tissue showed a non-significant decrease, whereas in cardiac tissue, significantly lower levels were observed than in control group. The level of CYTp450 in hepatic and cardiac tissues showed a significant increase; however, renal tissue showed non-significant depletion, whereas CYTb5 in hepatic, renal, and cardiac tissues was significantly lower than controls. The protein content in the hepatic tissue was not significantly increased, whereas the total protein in the renal and cardiac tissues was increased significantly. The research finding is indicative of detoxification activity in the etoposide model.

El etopósido es un agente antimitótico y antineoplásico eficaz que se utiliza para tratar diversas neoplasias malignas humanas. En el presente estudio, se inyectó etopósido por vía intraperitoneal a las ratas a razón de 1 mg/kg/día durante 52 días (52 dosis). Los animales control recibieron solución salina fisiológica (0,5 ml) por vía intraperitoneal diariamente por 52 dosis. El peso corporal de las ratas tratadas con etopósido se redujo significativamente en comparación con las ratas del grupo control. La peroxidación lipídica demostró un aumento insignificante del tejido hepático, una disminución no significativa del tejido renal y una reducción significativa del tejido cardíaco. Se encontró que los niveles de GSH en el tejido hepático y renal no aumentaron significativamente, pero sí aumentaron significativamente en el tejido cardíaco en comparación con los controles. Se encontró que la actividad de GR disminuyó considerablemente en el grupo tratado. Los niveles de G-S-T aumentaron significativamente en todos los grupos tratados. Las inyecciones de etopósido provocaron un cambio no significativo en el nivel de GPX del tejido hepático, mientras que los tejidos renal y cardíaco mostraron un aumento significativo. La actividad de CAT en el tejido hepático aumentó significativamente, mientras que la actividad de CAT en el tejido renal mostró una disminución no significativa, mientras que en el tejido cardíaco se observaron niveles significativamente más bajos que en el grupo de control. El nivel de CYTp450 en los tejidos hepático y cardíaco mostró un aumento significativo; sin embargo, el tejido renal mostró un agotamiento no significativo, mientras que CYTb5 en los tejidos hepático, renal y cardíaco fue significativamente menor que los controles. El contenido de proteínas en el tejido hepático no aumentó significativamente, mientras que la proteína total en los tejidos renal y cardíaco aumentó significativamente. El hallazgo de la investigación es indicativo de la actividad de desintoxicación en el modelo de etopósido.

Understanding the factors influencing pharmacokinetics of tacrolimus

Tacrolimus, a potent calcineurin inhibitor integral to immunosuppressive regimens, exhibits complex pharmacokinetics influenced by diverse factors and understanding these factors is crucial for safety, efficacy and dose optimisation. Genetic variations, particularly in CYP3A enzyme systems and P- Glycoprotein, contribute significantly to inter-individual variability in tacrolimus metabolism. Polymorphisms in these systems alter drug bioavailability, impacting clinical outcomes. Ethnicity further compounds this variability, with distinct genetic profiles leading to differential drug responses. Notably, black patients, often characterized by CYP3A5 expressor status, may have higher drug clearance. Age-related changes in tacrolimus clearance highlights the discrepancies in elderly and paediatric populations. On the other hand, prediction of gender-specific differences is difficult due to lack of evidence. Body composition, specifically variations in fat and muscle mass, significantly impacts drug distribution and clearance. Obesity, associated with altered CYP3A activity, results in decreased drug clearance, emphasizing the importance of accounting for body composition in dosing calculations. Pregnancy -induced physiological changes affect tacrolimus absorption, distribution, metabolism, and excretion, necessitating careful monitoring and dose adjustments in pregnant individuals. Dietary factors and drug interactions, particularly with CYP3A4 and P-glycoprotein, further contribute to the intricate web of variables influencing tacrolimus pharmacokinetics. In conclusion, this review sheds light on the multifaceted factors influencing tacrolimus pharmacokinetics, providing essential insights for clinicians to tailor individualized dosing regimens and enhance therapeutic efficacy while minimizing the risk of adverse events.

Risk stratification of newly diagnosed multiple myeloma patients

Background: Multiple Myeloma is a neoplastic proliferation of plasma cells, associated with an M (monoclonal) protein in serum and/or urine and evidence of organ damage. Despite advances in treatment, the disease remains heterogeneous, necessitating a comprehensive understanding of its risk stratification. Risk-adapted initial therapy, maintenance therapy, refractory disease management and prognosis varies according to risk group. The aim of our study is to categorize the newly diagnosed MM patients according to their risk groups. Methods: This cross-sectional observational study was conducted at the Department of Haematology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from August 2019 to July 2020. A total of 31 newly diagnosed MM patients were enrolled based on specific inclusion and exclusion criteria. Risk stratification was performed using ISS, R-ISS, mSMART criteria and Avets risk group categorization. Result: The majority of the patients were male (64.52%) and aged between 55-64 years (45.16%). Clinical features predominantly included low back pain (74.19%) and general weakness (38.71%). Cytogenetic abnormalities were noted in 38.7% of the patients, with del (13q) being the most common (32.30%). Most patients were in ISS Stage III (70.97%) and R-ISS Stage II (48.39%). According to mSMART criteria, 80.65% were at standard risk while Avet's risk stratification identifies 58.06% were at intermediate risk. Conclusion: The study reveals a high prevalence of patients in advanced ISS stages and intermediate to high-risk categories, emphasizing the need for early and personalized intervention strategies.

Relation of radial artery occlusion after trans-radial percutaneous coronary intervention with the duration of hemostatic compression

Background: Trans-radial percutaneous coronary intervention (PCI) in cardiac procedures accesses coronary arteries through the wrist's radial artery. Post-PCI, hemostatic compression on the radial artery prevents bleeding and aids healing. Radial artery occlusion (RAO), a possible complication, involves blockage of the radial artery. This study aimed to assess the relationship between radial artery occlusion after trans-radial percutaneous coronary intervention with the duration of hemostatic compression. Methods: This prospective observational study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, spanning from September 2018 to August 2019. The study enrolled 140 patients who underwent percutaneous coronary intervention (PCI) through the trans-radial approach (TRA), randomly assigned to two groups: Group I (2-hour hemostatic compression after PCI) and Group II (6-hour hemostatic compression post-procedure). Data analysis was performed using SPSS version 23.0. Results: In this study, early radial artery occlusion was observed in 4.3% of patients in group I and 12.8% in group II (P=0.04), while late radial artery occlusion occurred in 2.8% of patients in group I and 11.4% in group II, with a statistically significant difference (P=0.04). Multivariate logistic regression analysis identified a 6-hour hemostatic compression duration (P=0.01), post-procedural nitroglycerine use (P=0.03), and procedure time (P=0.03) as predictors of radial artery occlusion. Conclusions: Reduced hemostatic compression duration is linked to a decreased occurrence of both early and late radial artery occlusion following trans-radial intervention.

Efficiency of ganciclovir ophthalmic gel of 0.15% in treatment of acute adenoviral keratconojunctivities

Background: Adenoviral eye infection is contagious, self-limiting, causing symptoms like burning, pain, photophobia, and tearing. Diagnosis is clinical; existing treatments lack consistency. Ganciclovir, a selective and less toxic antiviral, shows promise for inhibiting viral DNA synthesis. The primary objective of this study was to assess the efficacy of topical 0.15% Ganciclovir gel in treating adenoviral keratoconjunctivitis, focusing on symptom and sign improvement during the follow-up period. Methods: A study at the National Institute of Ophthalmology and Hospital included 40 adenoviral keratoconjunctivitis patients diagnosed by cornea specialists. Symptoms were scored on a 0-3 scale during a 6-week follow-up. Patients were randomly assigned to group 1 (0.15% ganciclovir) or group 2 (artificial tear control). Data included history and ophthalmic exams. Statistical analyses used SPSS version 13.0 with p<0.05 significance, employing unpaired t-tests and chi-square tests. Results: A study with 40 adenoviral keratoconjunctivitis patients assessed Ganciclovir 0.15% ophthalmic gel efficacy. No age difference between groups was observed. Most patients were male (82.5%), spanning different economic classes. Symptom variations included more foreign body sensation in group 1 and increased watering in group 2. Group 1 exhibited faster symptom improvement over 6 weeks, while group 2 had a slower decline. Both groups experienced complications, but group 1 showed faster recovery, suggesting Ganciclovir's potential efficacy in treating adenoviral keratoconjunctivitis. Conclusions: In summary, the study confirms the effectiveness of 0.15% Ganciclovir gel in treating acute adenoviral keratoconjunctivitis, showing statistically significant and rapid improvement in signs and symptoms.

QT interval prolongation in people treated with bedaquiline for drug-resistant tuberculosis

Background: Bedaquiline (BDQ) is indeed recommended for treating multidrug-resistant tuberculosis (MDR-TB). However, it's essential to monitor patients receiving bedaquiline therapy closely because it has been associated with prolongation of the QTc interval. This study aimed to assess the association of bedaquiline to QT interval prolongation in DR-TB patients. Methods: This was an observational longitudinal study conducted in the Department of Respiratory Medicine in Chest Disease Hospital, Rajshahi, from August 2020 to February 2023. A total of 44 MDR-TB patients were included in the study. Data analyses were done by using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of 44 patients the majority 30(68.2%) patients belonged to age >40 years with a mean age of 49.3±15.6 years, and all patients were male. All MDR patients were detected by sputum Gene-Xpert, 44 (100%), and sputum for AFB culture was done in all patients, 44 (100%). QT level and QT changes were statistically significant for baseline and 24 weeks. Only one patient died in 2 weeks of follow-up (Table 3). Changes of QT >60 ms was found in 6 (13.6%) and ?60 ms was 38 (86.4%). Age, sex, marital status, residence, educational status, occupational status, monthly income, chief complaints, co-morbidities, and using drug-causing QT prolongation were not statistically significant (p>0.05). Conclusions: Prolonged QT interval is in DR-TB patients who receive treatment using the bedaquiline regimen. We observed that with a moderate prolongation of QTc, there were no arrhythmias recorded and 1 death occurred due to acute MI.

Examining folic acid intake: a cross-sectional study of pregnancy-related practices

Background: Folic acid supplementation during the periconceptional period is critical in preventing neural tube defects (NTDs) in the developing fetus. In Pakistan, a profound lack of awareness is seen regarding preventable pregnancy-related illnesses and the consequential high maternal and fetal mortality and morbidity rates. However, data from the surveys in the region of Sindh lacks inquiries regarding the baseline characteristics of the surveyed participants. Therefore, this study endeavoured to address this gap. Methods: Between October 2022 and April 2023, a cross-sectional study was conducted at two major tertiary care hospitals in Hyderabad and Jamshoro, Pakistan. A total of 374 participants, chosen by non-probability consecutive sampling, comprised the sample size. The association of demographic variables and knowledge, attitude, and practice of consumption of folic acid during pregnancy was determined using the ?2 test. A p value of less than 0.5 was considered statistically significant. Results: The mean age of the participants was 26.4�7 years. A total of 199 (53.20%) participants were literate, compared to 175 (46.79%) participants who were illiterate. Literate women fared better than illiterate women in all the metrics with a p-value of <0.001 and a Pearson correlation coefficient (r) of >0.7. Moreover, folic acid was consumed by only 38% of pregnant women during the periconceptional period. Conclusions: A substantial lack of knowledge regarding folic acid was found in the surveyed sample, significantly more marked in the illiterate faction. Additionally, the practice was rather unsatisfactory. However, the attitude remained encouraging.

Ayurvedic management of supraspinatus tendon tear: a case report

The two main causes of rotator-cuff injuries are trauma and degeneration. Modern medical sciences recommend operative reconstruction surgery for ruptured injuries of the rotator cuff. But the outcome of surgery often leads to restrictions on movement. In this case, supraspinatus tendon tears with degenerative causes were satisfactorily managed with ayurvedic conservative management alone. A 68-year-old patient was admitted to the Kayachikitsa inpatient department of Vaidyaratnam ayurveda college, Ollur, on September 21, 2023, with right shoulder pain and restricted shoulder movements. In an MRI, the case was diagnosed as a partial tear of the anterior fibres of the supraspinatus tendon of the rotator cuff with sub-coracoid bursitis of the right shoulder joint. On examination of the right shoulder joint, all shoulder movements were restricted due to pain. Hawkins抯 impingement test, Neer抯 test, and the painful arc test were found to be positive. She underwent a treatment protocol of Vatavyadhi Chikitsa incorporated with Bhagna Chikitsa. Internal and external medications, along with Upanaham, Abhyanga, Thaila pichu, bandage, and active shoulder exercises, were the treatments followed in this case. After the treatment, patient got relief from pain (VAS scale: 7 to 4) and considerable improvement in range of motion (ROM) for the right shoulder joint. This case study highlighted that within one month, the chronic rotator cuff injury got partial functional restoration (SPADI-56 to 30) by conservative ayurvedic management.

Fear and depression among health care professionals: a cross-sectional study during COVID-19 pandemic in Bangladesh

Background: COVID-19 pandemic is a public health emergency of international concern that can result in severe mental health conditions like depression and fear in health-care professionals (HCPs). Methods: A cross-sectional study was conducted, where 834 HCPs were self-recruited via social media. Multiple linear regression analyses were performed to identify predicting factors. Results: Approximately one-third of the total participants were depressed (27.3%) and those with depressive symptoms had significant fear of COVID-19. Significant risk factors for depressive symptoms were being female, being married, having no children, having high risk elderly persons at home, being afraid of death due to COVID-19 and having comorbid diseases. Fear of death due to COVID-19 was the most common significant contributing factor the scales for depression model, ?=0.397, for fear of COVID-19 model and ?=0.478 respectively. Quality of PPE played a vital role for depression as majority of HCPs. About 65.3% of HCPs who were restless while examining a patient with flu symptoms and majority of HCPs who felt insecure about their family members. Conclusions: Most of the HCPs faced several challenges during COVID-19 and psychological impacts of frontline HCPs were associated with interventions and rehabilitations to improve the mental health.

A study on drug utilization pattern of anticoagulants in post-cardiac surgeries at a tertiary care hospital

Background: The study is being carried out mainly to understand the prevention of coagulation of blood after a patient undergoing various types of cardiac surgeries, using different anticoagulation therapies suitable to particular types of cardiac surgery. This study was conducted to know the types of anticoagulants prescribed to patients who have undergone different types of cardiac surgeries along with the prescribed anticoagulants. Methods: The study method used was a retrospective and prospective observational study carried out on 50 patients who underwent cardiac surgeries in the department of cardiology and medicine. Results: A total of 50 patients were enrolled for this study who satisfied the inclusion criteria, out of which 64% of patients were males, and 36% were females. The highest number of patients were found to be in between the age group of 61-70 yrs (34%), whereas age group between 51-60 yrs (28%), age group 71 and above (18%), 41-50 (14%), 21-30 yrs (4%) and 18-20 yrs (2%) respectively. Most of the patients had undergone Coronary Artery bypass grafting. It was seen that the highest Anticoagulant being prescribed was Heparin in most of the post-cardiac surgeries. Whereas drugs like dalteparin, acenocoumarol, and warfarin were prescribed the majority in valvular heart surgeries. Conclusions: Various cardiac surgeries were taken into consideration for the study. The most common anticoagulants prescribed were heparin, dalteparin, acenocoumarol, and warfarin in coronary artery bypass surgery and valvular heart surgeries respectively.

Comparative observational study between Atorvastatin and Rosuvastatin based on HbA1c levels of patients diagnosed with acute coronary syndrome and heart failure

Background: Our study aims to compare HbA1c levels in hospitalized acute coronary syndrome and heart failure patients treated with atorvastatin versus rosuvastatin Methods: This is a retrospective, prospective observational study in which the study population includes ACS and HF Hospitalized patients, the study subjects are divided based on patients prescribed with Atorvastatin and Rosuvastatin based on the medication chart, and those patients' previous history of statin use is collected from history chart, patient case notes, doctors notes, laboratory data is collected and documented in data collection form, lab data includes HbA1c, finally compared Atorvastatin and Rosuvastatin using excel and JASP descriptive analysis. Results: Overall, we collected data for 132 cases, of which 55% are males and 45% females, 59.10% are above 61 years of age, 39.39% are diagnosed with ACS and 23.48% are diagnosed with HF, among 67 patients who are using Atorvastatin, there was a significant mean decrease in HbA1c% from 8.359% to 7.901%, and among 65 Rosuvastatin users there was an increase in mean HbA1c% from 8.386% to 8.389%. Additionally for non-diabetic individuals, there was an increase in Hba1c% from 6.339% to 6.387%. Conclusions: We concluded that Atorvastatin is a more effective statin than Rosuvastatin which will reduce the risk of new-onset Diabetes Mellitus in non- diabetic individuals and reduce the risk of increasing complications of diabetes mellitus in patients who are Diabetic.

Could nanotechnology improve exercise performance? Evidence from animal studies

Abstract This review provides the current state of knowledge regarding the use of nutritional nanocompounds on exercise performance. The reviewed studies used the following nanocompounds: resveratrol-loaded lipid nanoparticles, folic acid into layered hydroxide nanoparticle, redox-active nanoparticles with nitroxide radicals, and iron into liposomes. Most of these nutritional nanocompounds seem to improve performance in endurance exercise compared to the active compound in the non-nanoencapsulated form and/or placebo. Nutritional nanocompounds also induced the following physiological and metabolic alterations: 1) improved antioxidant activity and reduced oxidative stress; 2) reduction in inflammation status; 3) maintenance of muscle integrity; 4) improvement in mitochondrial function and quality; 5) enhanced glucose levels during exercise; 6) higher muscle and hepatic glycogen levels; and 7) increased serum and liver iron content. However, all the reviewed studies were conducted in animals (mice and rats). In conclusion, nutritional nanocompounds are a promising approach to improving exercise performance. As the studies using nutritional nanocompounds were all conducted in animals, further studies in humans are necessary to better understand the application of nutritional nanocompounds in sport and exercise science.

Retinopathy of prematurity: prevalence, screening and treatment

Retinopathy of prematurity (ROP) is a serious ocular condition arising from improper blood vessel development in the retina, predominantly affecting infants born prematurely or with a birth weight under 1500 g. A global estimate from 2010 indicated that approximately 184,700 infants developed ROP, with around 50,000 progressing to severe stages, yet only 42% received treatment. This article undertakes a thorough review, commencing on 07th November 2023, leveraging databases like Pubmed and Cochrane to synthesize current knowledge and emerging trends in ROP prevalence, screening methodologies, and treatment options. Screening involves repeated eye exams and innovative tools to identify high-risk infants early on. Treatment approaches, encompassing cryotherapy, laser therapy, and anti-VEGF (vascular endothelial growth factor) medications, are tailored to the severity of ROP. Rigorous follow-up assessments are pivotal for tracking progress and ensuring the welfare of infants undergoing ROP interventions. This comprehensive exploration seeks to enhance awareness and understanding of ROP's global prevalence, screening protocols, and evolving treatments, ultimately contributing to informed decision-making and the advancement of best practices in the early identification and management of ROP among premature infants.