Sensor for prednisolone detection in sports doping / Sensor para detecção de prednisolona no doping esportivo / Sensor para la detección de prednisolona en el dopaje deportivo

ABSTRACT Introduction: Prednisolone causes pro-inflammatory impulses to be inhibited and anti-inflammatory signals to be promoted. As a result, it alters how the body's immune system reacts to certain diseases. The World Anti-Doping Agency, however, has banned SNP and other glucocorticosteroids. An electrochemical sensor can be developed using a gold nanocomposite, polypyrrole nanoparticles and synthesized carbon nanotubes (Au-PPy NPs@CNTs). Objective: Develop an electrochemical sensor to detect prednisolone. Method: Au-PPy NPs@CNTs nanocomposite was chemically synthesized with a modified glassy carbon electrode (GCE) surface. Results: According to SEM data, the nanocomposite was composed of amorphous Au NPs, and PPy NPs deposited in tubes strongly entangled in a CNTs network. The wide linear range and low detection limit of the Au-PPy NPs@CNTs/GCE as prednisolone sensors were attributed to the combined catalytic performance of the Au and PPy NPs@CNTs nanostructures. Conclusion: The results of prednisolone detection in each specimen using the amperometric method indicated good accuracy. The accuracy and precision of Au-PPy NPs@CNTs/GCE for prednisolone detection were explored in blood samples from 5 young athletes aged 20-24 years who used prednisolone tablets (RSD less than 4.25%). In addition to monitoring prednisolone concentrations in athletes' serum, Au-PPy NPs@CNTs/GCE can be used as a reliable prednisolone sensor. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução: A prednisolona faz com que os impulsos pró-inflamatórios sejam inibidos e os sinais anti-inflamatórios sejam promovidos. Como resultado, ela altera a forma como o sistema imunológico do corpo reage a certas doenças. A Agência Mundial Antidoping, no entanto, proibiu o SNP e outros glucocorticoesteroides. Usando um nanocomposto de ouro, nanopartículas de polipirrol e nanotubos de carbono sintetizados (Au-PPy NPs@CNTs), um sensor eletroquímico pode ser desenvolvido. Objetivo: Desenvolver um sensor eletroquímico para detectar a prednisolona. Método: O nanocompósito Au-PPy NPs@CNTs foi sintetizado quimicamente com uma superfície de eletrodo de carbono vítreo modificado (GCE). Resultados: De acordo com dados da SEM, o nanocomposto foi descoberto como sendo composto de Au NPs e NPs de PPy amorfo, depositados em tubos fortemente emaranhados em uma rede de CNTs. O amplo alcance linear e o baixo limite de detecção do Au-PPy NPs@CNTs/GCE como sensores de prednisolona foram atribuídos ao desempenho catalítico combinado das nanoestruturas de Au e PPy NPs@CNTs. Conclusão: Os resultados da detecção de prednisolona em cada espécime usando o método de amperometria indicaram boa precisão. A precisão e a acurácia de Au-PPy NPs@CNTs/GCE para a detecção de prednisolona foram exploradas em amostras de sangue preparadas de 5 atletas jovens de 20 a 24 anos que usaram comprimidos de prednisolona (RSD inferior a 4,25%). Além de monitorar as concentrações de prednisolona no soro dos atletas, Au-PPy NPs@CNTs/GCE pode ser usado como um sensor confiável de prednisolona. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: La prednisolona hace que se inhiban los impulsos proinflamatorios y se promuevan las señales antiinflamatorias. Como resultado, altera la forma en que el sistema inmunológico del cuerpo reacciona a ciertas enfermedades. Sin embargo, la Agencia Mundial Antidopaje ha prohibido el SNP y otros glucocorticosteroides. Utilizando un nanocompuesto de oro, nanopartículas de polipirrol y nanotubos de carbono sintetizados (Au-PPy NPs@CNTs), se puede desarrollar un sensor electroquímico. Objetivo: Desarrollar un sensor electroquímico para detectar la prednisolona. Método: Se sintetizó químicamente el nanocompuesto Au-PPy NPs@CNTs con una superficie de electrodo de carbono vítreo (GCE) modificada. Resultados: Según los datos del SEM, se comprobó que el nanocompuesto estaba compuesto de Au NPs y NPs de PP amorfo y depositados en tubos fuertemente enredados en una red de CNTs. El amplio rango lineal y el bajo límite de detección de Au-PPy NPs@CNTs/GCE como sensores de prednisolona se atribuyeron al rendimiento catalítico combinado de las nanoestructuras de Au y PPy NPs@CNTs. Conclusión: Los resultados de la detección de prednisolona en cada muestra mediante el método amperométrico indicaron una buena precisión. Se exploró la exactitud y precisión de las Au-PPy NPs@CNTs/GCE para la detección de prednisolona en muestras de sangre preparadas a partir de 5 jóvenes atletas de entre 20 y 24 años de edad que utilizaban tabletas de prednisolona (RSD inferior al 4,25%). Además de controlar las concentraciones de prednisolona en el suero de los deportistas, Au-PPy NPs@CNTs/GCE puede utilizarse como un sensor fiable de prednisolona. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

O papel do cuidador formal de idosos: facilidades e dificuldades no exercício do cuidado / El papel del cuidador formal del anciano: facilidades y dificultades en el ejercicio del cuidado / The role of the elderly formal caregiver: facilities and difficulties in the exercise of care

Objetivo: conhecer os desafios vivenciados pelos cuidadores formais nas práticas cotidianas do cuidado ao idoso. Método: estudo descritivo-exploratório, cujas entrevistas foram realizadas entre dezembro de 2016 e maio de 2017 com 18 cuidadores formais, captados a partir da associação de cuidadores do estado de Minas Gerais seguido da técnica de bola de neve, e analisadas a luz da análise de conteúdo. Resultados: foram encontradas três categorias temáticas: Papel da enfermagem para a prática cotidiana do cuidador formal de idosos, limites (in)visíveis do cuidado ao idoso entre os cuidadores de idosos e a enfermagem, e cuidador visto como profissionais da enfermagem - autopercepção do cuidador. Conclusões: a crescente demanda por cuidados ao idoso e a busca por recursos torna necessário a delimitação de atuações que garanta sua qualidade e o exercício legal da profissão do cuidador como uma velha-nova ocupação que comprime atividades de vários profissionais, principalmente da enfermagem.(AU)

Objective: to know the challenges experienced by formal caregivers in the daily practices of everyday care. Method: descriptive-exploratory study, whose interviews were conducted between December 2016 and May 2017 with 18 formal caregivers, captured from the association of caregivers of the state of Minas Gerais followed by the snowball technique, and analyzed considering the content analysis. Results: three thematic categories were found: Nursing role in the daily practice of formal elderly caregivers; (In)visible limits of elderly care between elderly caregivers and nursing; and Caregiver seen as nursing professionals - caregiver's self-perception. Conclusions: the growing demand for elderly care and the search for resources make it necessary the delimitation of performances to ensure its quality and the legal exercise of the caregiver's profession as an old-new occupation that compresses activities of various professionals, especially nursing.(AU)

Objetivo: conocer los desafíos vividos por los cuidadores formales en las prácticas cotidianas del cuidado de ancianos. Método: estudio descriptivo-exploratorio, cuyas entrevistas fueron realizadas entre diciembre de 2016 y mayo de 2017 con 18 cuidadores formales, captados de la asociación de cuidadores del estado de Minas Gerais seguidos por la técnica de bola de nieve, y los datos manejados por análisis de contenido. Resultados: se encontraron tres categorías: Papel de la enfermería en la práctica cotidiana de los cuidadores formales de ancianos; Límites (in)visibles del cuidado al anciano entre cuidadores de ancianos y enfermería; y Cuidadores vistos como profesionales de enfermería ­ autopercepción del cuidador. Conclusiones: la creciente demanda de cuidados a los ancianos y la búsqueda de recursos hacen necesario delimitar acciones que garanticen su calidad y el ejercicio legal de la profesión de cuidador como una vieja-nueva ocupación que comprime las actividades de varios profesionales, especialmente de enfermería.(AU)

Epidemiological study of dengue fever in District Swabi, Khyber Pakhtunkhwa, Pakistan / Estudo epidemiológico da dengue no distrito Swabi, Khyber Pakhtunkhwa, Paquistão

Dengue is a viral disease which is serious health concern from last few decades and the infection transmitted through mosquito bite into human. This study was conducted to carry out prevalence of dengue fever in District Swabi. A total of 196 blood sample were collected from patients with age ranges (0-80 years) having dengue fever on the basis of physical symptoms from Bacha Khan Medical Complex Swabi during August to October 2017. Serological test were performed for detection of IgM, IgG and NS1 (Non structural protein antigen of virus) against dengue. Out of total 196 confirmed dengue cases the most prone gender was male 123(62%) while 73(38%) were female. Among the age groups; 21-30 years group 62 (31.6%) was found the most predominated age group. The higly affected areas in district Swabi were Topi (40.8%) followed by Main Swabi (27%), Maneri (8.2%), Marghuz (6%), Shawa Ada (5.1%), Shah Mansoor (5.1%), Gohati (4.1%), and Chota Lahore (3.6%). Therefore, the health department should take actions by educating the public about basic cleanliness of the environment. The community should be encouraged to participate in the control of such vector based diseases/infections.

A dengue é uma doença viral que é um sério problema de saúde das últimas décadas e a infecção transmitida através da picada de mosquito em humanos. Este estudo foi realizado para realizar a prevalência da dengue no distrito de Swabi. Foram coletadas 196 amostras de sangue de pacientes com faixa etária (0 a 80 anos) com dengue com base nos sintomas físicos do Complexo Médico Bacha Khan de Swabi, no período de agosto a outubro de 2017. Foram realizados testes sorológicos para detecção de IgM, IgG e NS1 (antígeno proteico não estrutural do vírus) contra a dengue. Do total de 196 casos confirmados de dengue, o sexo mais propenso foi o masculino 123 (62%), enquanto 73 (38%) eram do sexo feminino. Entre as faixas etárias; A faixa etária de 21 a 30 anos 62 (31,6%) foi a faixa etária mais predominante. As áreas altamente afetadas no distrito de Swabi foram Topi (40,8%), seguidas por Main Swabi (27%), Maneri (8,2%), Marghuz (6%), Shawa Ada (5,1%), Shah Mansoor (5,1%), Gohati (4,1%) e Chota Lahore (3,6%). Portanto, o departamento de saúde deve tomar ações educando o público sobre a limpeza básica do meio ambiente. A comunidade deve ser incentivada a participar do controle de tais doenças / infecções baseadas em vetores.

Male and Female Patient’s Evaluation of Different Types of Restorations on the Anterior Teeth

Background: In this sense, the beauty of smile is a correlation between teeth, gingiva, and lips. In daily clinical practice,esthetics of anterior teeth is a common presenting complaint of patients, which is affected by caries, malformation, anatomicalteration, discoloration/staining, and hypoplastic defects.Aims and Objectives: The aim of the present study is to evaluate the level of patient’s satisfaction with the appearance ofmaxillary anterior teeth restoration with regard to gender.Materials and Methods: The participants were surveyed by means of a questionnaire containing questions about gender, age,and education level. The age of patients was recorded. A total of 150 subjects participated in the study (58 men, mean age32 years; and 92 women, mean age 35 years). All participants had composite filling restorations, acrylic faceted metal crowns,porcelain-fused-to-metal crowns, or all-ceramic crowns on maxillary anterior teeth.Results: Test for independent samples showed that there was a statistically significant gender difference in patients’ assessmentof color and surface texture for composite fillings and overall patients’ average assessment score for color of all assessments(P < 0.05).Conclusion: Women in this study were less satisfied with the color and surface texture of their composite fillings and all colorassessments (P < 0.05). Their general impression of the maxillary anterior teeth restorations was lower as well (P = 0.054).

Incidence of Apical Periodontitis and Frequency of Root Canal Treatments in Geriatric and Medically Compromised Patients in Jammu Population

Background: With the increase in life expectancy, there has been rise in cases of apical periodontitis. The present study was conducted to assess the prevalence of apical periodontitis and root canal treatment among the elderly and medically compromised patients in the Jammu population. Materials and Methods: The present study was conducted on 150 elderly patients with deep carious teeth of both genders. An equal number of healthy subjects was also recruited. Patients were divided into two groups: Group I was medically compromised patients with apical periodontitis and Group II was healthy subjects with apical periodontitis. Periapical status was scored based on the periapical index. Results: Group I had 95 and Group II had 60 patients with more than 1 periapical lesion. Group II had 110 and Group I had 48 patients with 1 periapical lesion with at least one obturated tooth. The difference was significant (P < 0.05). There was a nonsignificant difference between Groups I and II with more than 1 periapical lesions with at least one obturated tooth (P > 0.05). More than 1 periapical lesion was seen more in renal and respiratory patients (45), 1 periapical lesion with at least one obturated tooth was seen more one diabetic patients (22). The difference was non-significant (P > 0.05). Conclusion: The authors found that medically compromised patients have more periapical lesions with radiographic evidence. They have a lower frequency of obturated teeth than healthy subjects.

Configuration of power relations in physicians and nurses' professional practices / Configuración de las relaciones de poder en las prácticas profesionales de médicos y enfermeros / Configuração das relações de poder nas práticas profissionais de médicos e enfermeiros

ABSTRACT Objective: to analyze the configuration of power relations constituted in and by the knowledge and daily practices of physicians and nurses in an Intensive Care Unit (ICU). Method: qualitative study in which data were collected through interviews with physicians and nurses from an ICU of a hospital in Belo Horizonte, Minas Gerais. A semi-structured script was used. Data were analyzed through discourse analysis in a Foucaultian perspective. Results: three categories were developed - Professional Identity: self-recognition in the profession; Discipline: individualizing attitudes or collective need?; and Circularity of knowledge and power in the constitution of daily practices. Final considerations: the identity, discipline and circulation of power are connected in a continuous movement of subjectivation of the subject, which, in turn, uses discourse as a persuasion strategy to modify the position taken over in different situations thereby causing the circulation of power.

RESUMEN Objetivo: analizar la configuración de las relaciones de poder constituidas en y por el conocimiento y las prácticas cotidianas de médicos y enfermeros en una Unidad de Cuidados Intensivos. Método: investigación cualitativa con datos recopilados a través de entrevistas con guiones semiestructurados con médicos y enfermeros de una Unidad de Cuidados Intensivos de un hospital en Belo Horizonte, Minas Gerais. Para analizar los datos, se utilizó el análisis del discurso desde la perspectiva de Foucault. Resultados: se elaboraron tres categorías - Identidad profesional: auto reconocimiento en la profesión; Disciplina: ¿actitudes individualizadoras o necesidad colectiva?; y Circularidad de conocimiento y poder en la constitución de las prácticas cotidianas. Consideraciones finales: la identidad, la disciplina y la circulación del poder se conectan en un movimiento continuo de subjetivación del sujeto, que, a su vez, utiliza el discurso como estrategia de persuasión para modificar la posición asumida en diferentes situaciones, lo que provoca la circulación de poder.

RESUMO Objetivo: analisar a configuração das relações de poder constituídas nos e pelos saberes e práticas cotidianas de médicos e enfermeiros em um Centro de Terapia Intensiva. Método: pesquisa qualitativa, com dados coletados por meio de entrevistas com roteiro semiestruturado com médicos e enfermeiros de um Centro Terapia Intensiva de um hospital de Belo Horizonte, Minas Gerais. Para a análise dos dados, foi utilizada a análise de discurso na perspectiva Foucaultiana. Resultados: foram elaboradas três categorias - Identidade profissional: o reconhecimento de si na profissão; Disciplina: atitudes individualizantes ou necessidade coletiva?; e Circularidade do conhecimento e do poder na constituição das práticas cotidianas. Considerações finais: a identidade, a disciplina e circulação do poder se conectam em um movimento contínuo de subjetivação do sujeito que, por sua vez, utiliza-se do discurso como estratégia de persuasão para modificar a posição assumida em diferentes situações, fazendo com que o poder circule.

Awareness among Patients of Jammu Regarding Dental Implants as Treatment Option for Replacement of Missing Teeth

Background: Dental implant has gained importance over the last few years. The higher success rate of dental implants with>95% survival in 5 years is considered a successful dental implant therapy. The present study was conducted to assessawareness among the population of Jammu regarding dental implants as a treatment option for missing teeth.Materials and Methods: The present study was conducted on 580 patients visiting the department for replacement of missingteeth. Patients were provided with a questionnaire and asked to respond to it.Results: Of 580 patients, males were 350 and females were 230. We found that 30% were aware of RPD as options for missingteeth, 25% of FPD, and 30% of dental implants and 15% all of the above options. The source of information regarding dentalimplants was friends in 0%, dentists in 70%, and social media in 20%; 80% were well informed regarding dental implants bythe dentist and 10% moderately well. Reason for opting for dental implants was high success rate in 65%, esthetics in 20%,and function in 15%, the reason for not opting for dental implants was cost in 55%, long treatment time in 30% and need forsurgery in 15%, 40% replied that everyone should opt for dental implants, 35% replied rich patients, and 25% replied, theyI do not know. About 60% replied that it demands special treatment and care, 20% replied no, and 20% replied that I do notknow. About 60% think that the main complication of dental implants was a failure, infection by 30%, and I do not know by10%. About 68% replied that they would recommend friends/family about dental implants, 12% replied no, and 20% I do notknow. Suggestion to make people aware of dental implants was dental education by camps by 18%, newspapers by 24%, anddental awareness by dentists by 58%.Conclusion: The authors found that patients had sufficient awareness regarding dental implants as a treatment option formissing teeth

Nutritional assessment of school going children in district Abbottabad, K.P. Pakistan

Background:To assess the nutritional assessment of the primary school children in Abbottabad. Methods:A descriptive cross-sectional study, conducted among children of private and public sectors primary schools of Abbottabad from January -September 2018 by simple random sampling. 200 students from each school (7 and 13 years), present on the day of data collection were included in this study and those who were absent, sick or not willing, were excluded. The data was collected on apre-tested questionnaire.Results:Total 200 students, males 49.5% (n=99) and females 50.5% (n=101) were interviewed and assessed for their nutritional assessment. Their mean age was 11.67±1.66years, height was 144.93±12.34 cms and weight was 37.69±12.96 kgs. Male students (n=67) 67.7% and from private schools (n=67) 65.7% were healthier then female (n=55) 55.4% and government schools (57.1%), P valve 0.085 and 0.026. Most of the students with grade C in last year school performance were underweight (100%). Raven Test for both types of school gave 0.012 P value which indicated more intelligent students resides in private schools. Furthermore, children of well-serviced fathers and qualified mothers were healthy, more intelligent and practiced good hygiene.Also, children of a private school who has better nutritional status scored more than Public school children.Conclusions:Nutritional status of children have a direct effect on their cognitive abilities. Private school children who have scored better in the intelligence test, have better nutritional status. Socioeconomic status and mother qualification have a direct effect on children’s nutrition, health status, school performance and hygiene.

Adesão ao tratamento: percepção de adolescentes dependentes químicos* / Adherence to treatment: perception of adolescents in chemical dependency / Adhesión al tratamiento: percepción de adolescentes dependientes químicos

OBJETIVO: descrever a percepção de adolescentes sobre a adesão ao tratamento da dependência química. MÉTODO: estudo descritivo, exploratório, com abordagem qualitativa. Participaram onze adolescentes atendidos no Centro de Atenção Psicossocial Álcool e Drogas (CAPS ad), no interior de Minas Gerais. Os dados foram coletados por meio de entrevistas, utilizando um instrumento semiestruturado, e após analisados através da técnica de análise de conteúdo. RESULTADOS: constatou-se que os vínculos estabelecidos, as atividades desenvolvidas e o apoio familiar facilitam a adesão ao tratamento, e a ordem judicial auxilia a frequência no serviço. CONCLUSÃO: conclui-se que a identificação e a compreensão dos fatores que interferem no processo de adesão ao tratamento possibilitam a elaboração de programas e abordagens terapêuticas adequadas e eficazes, pautadas nas necessidades dos adolescentes.

OBJECTIVE: the objective of this study was to describe the adolescents' perception about adherence to the chemical dependency treatment. METHOD: descriptive, exploratory study with a qualitative approach. Eleven adolescents attended the Psychosocial Care Center for Alcohol and Drugs (CAPS ad) in the interior of Minas Gerais. Data were collected through interviews, using a semi-structured instrument and then analyzed through the content analysis technique. RESULTS: it was found that the established links, the activities developed, the family support facilitates the adherence to the treatment and the court order assists in the frequency of service. CONCLUSION: it is concluded that the identification and understanding of the factors that interfere in the process of adherence to treatment allow the elaboration of adequate and effective therapeutic programs and approaches, based on the needs of adolescents.

OBJETIVO: el trabajo tuvo se objetivó describir la percepción de adolescentes sobre la adhesión al tratamiento de la dependencia química. MÉTODO: se trata de un estudio descriptivo, exploratorio, con abordaje cualitativo. Participaron del estudio once adolescentes atendidos en el grupo psicoterapéutico en el Centro de Atención Psicosocial Alcohol y Drogas (CAPS ad) en el interior de Minas Gerais. RESULTADOS: los datos fueron recolectados por medio de entrevistas, utilizando un instrumento semiestructurado y después de analizadas a través de la técnica de análisis de contenido. Se constató que los vínculos establecidos, las actividades desarrolladas, el apoyo familiar facilitan la adhesión al tratamiento y el orden judicial auxilia en la frecuencia al servicio. CONCLUSIÓN: se concluye que la identificación y la comprensión de los factores posibilitan la elaboración de programas y enfoques terapéuticos adecuados y eficaces.

Presentation and management outcome of tibial infected non-union with Ilizarov technique

Objective: To document the presentation of tibial infected non-union and analyze the management outcome with Ilizarov technique in terms of bone results, functional outcome, bone transport time, external fixation time, external fixation index and any complications

Methods: This case series was conducted at the Departments of Orthopedic Surgery, National Institute of Rehabilitation Medicine [NIRM], Islamabad and Civil hospital, Quetta over a period of 3-years

Results: There were 56 patients with 53[94.64%] males and 3[5.35%] females. The age range was 16-50 years with a mean of 32.58+/-9.98 years. According to ASAMI criteria, bone results were excellent in 37[66%], good in 10[17.85%], fair in 6[10.71%] and poor in 3[5.35%]. The functional results were excellent in 37[66%], good in 9[16%], fair in 7[12.5%] and poor in 3[5.35%]. The bone union rate was 98.21%

Conclusion: Ilizarov method beautifully addresses the formidable issue of infected non union of tibia with good outcome in terms of bone healing and infection eradication. The treatment period is relatively lengthy and hence patience on part of patient as well as the surgical team is imperative for achieving favourable outcomes

Phase Changing Material for Therapeutic Hypothermia in Neonates with Hypoxic Ischemic Encephalopathy – A Multi-centric Study

Objective: To assess the feasibility and safety of coolingasphyxiated neonates using phase changing material baseddevice across different neonatal intensive care units in India.Design: Multi-centric uncontrolled clinical trial.Setting: 11 level 3 neonatal units in India from November 2014 toDecember 2015.Participants: 103 newborn infants with perinatal asphyxia,satisfying pre-defined criteria for therapeutic hypothermia.Intervention: Therapeutic hypothermia was provided usingphase changing material based device to a target temperature of33.5±0.5oC, with a standard protocol. Core body temperature wasmonitored continuously using a rectal probe during the coolingand rewarming phase and for 12 hours after the rewarming wascomplete.Outcome measures: Feasibility measure - Time taken to reachtarget temperature, fluctuation of the core body temperatureduring the cooling phase and proportion of temperaturerecordings outside the target range. Safety measure - adverseevents during coolingResults: The median (IQR) of time taken to reach targettemperature was 90 (45, 120) minutes. The mean (SD) deviationof temperature during cooling phase was 33.5 (0.39) ºC.Temperature readings were outside the target range in 10.8%(5.1% of the readings were <33oC and 5.7% were >34oC). Mean(SD) of rate of rewarming was 0.28 (0.13)oC per hour. Thecommon adverse events were shock/ hypotension (18%),coagulopathy (21.4%), sepsis/probable sepsis (20.4%) andthrombocytopenia (10.7%). Cooling was discontinued before 72hours in 18 (17.5%) babies due to reasons such as hemodynamicinstability/refractory shock, persistent pulmonary hypertension orbleeding. 7 (6.8%) babies died during hospitalization.Conclusion: Using phase changing material based coolingdevice and a standard protocol, it was feasible and safe to providetherapeutic hypothermia to asphyxiated neonates across differentneonatal units in India. Maintenance of target temperature wascomparable to standard servo-controlled equipment.

Extracorporeal Shock Wave Lithotripsy (ESWL) Versus Uretero–Renoscopic Lithotripsy (URSL) For Management Of Upper Ureteric Calculi, Our Experience At Tertiary Care Hospital.

Background: Urinary stones are the third most common affliction of urinary tract, exceeded only by urinary tract infections and pathological conditions of prostate (BPH and Prostate cancer). Extracorporeal Shock Wave Lithotripsy (ESWL) and Uretero-renoscopic Lithotripsy (URSL) are among various treatment options available. Aims and Objectives:To compare ESWLand URSLprocedural and post procedural characteristics including outcome. Methods: A Prospective study was conducted in the department of Urology, SKIMS, on 100 patients with proximal Ureteric stone, from September 2015 to July 2017.By random selection, fifty patients were subjected to ESWL and another fifty to URSL. Various parameters were recorded on preformed proforma designed for the comparative study. Results: In our study, Parameters like Age and Gender distribution, symptoms at presentation and duration of symptoms, number of stones, laterality of stones (right/left) and grade of Hydronephrosis or Hydroureteronephrosis were uniformly distributed in the two groups (URSL VS ESWL). Spinal anaesthesia (SA) or General Anaesthesia(GA) was required in URSL group only, while as local anaesthesia and sedation was required in some patients in ESWLgroup. 72% and 88% patients achieved stone clearance in ESWLand URSLgroup respectively, (p=0.046). DJ stent was used in 20% of URSL patients and none in ESWL group. Procedure time was relatively less for URSL (p=0.001). Although statistically insignificant, Post procedure hematuria and urosepsis were higher in URSL group, where as pain/colic and fever was slightly higher in ESWL group. Steinstrasse was significantly higher in ESWL group (p=0.008). Hospital stay was significantly higher in URSL group (p<0.001). Cost involvement was higher in ESWLgroup (p=0.016). Conclusion: Although ESWL is regarded as the preferred choice of treatment for upper Ureteric stone, URSL is a safe alternative, with an advantage of obtaining an earlier or immediate stone free status in patients with stone size >10mm. In patients with smaller stones (<10mm), ESWL may be considered a reasonable alternative to URSL.

Circulação do poder-saber na constituição das práticas profissionais de médicos e enfermeiros / Circulación del poder-saber en la constitución de las prácticas profesionales de médicos y enfermeros / Circulation of power-knowledge in the constitution of professional practices of physicians and nurses

Objetivo analisar a circulação do poder nas práticas profissionais de médicos e enfermeiros de um Centro de Terapia Intensiva. Método pesquisa qualitativa, com dados coletados por meio de entrevista semiestruturada, com médicos e enfermeiros de Centro de Terapia Intensiva situado em Minas Gerais, Brasil, e submetidos à análise de discurso. Resultado em geral, a equipe médica não se mostrou muito atenta às normas institucionais, sendo os enfermeiros mais envolvidos nos processos normalizadores e disciplinares. A visibilidade do médico está relacionada à legitimação do domínio do saber científico expresso em seu discurso, o que lhe confere posição de detenção do poder, à medida que o enfermeiro tem um discurso que mostra certa resistência em assumir visibilidade e protagonismo na equipe. Conclusão o Centro de Terapia Intensiva é um cenário onde há interseção de diversos saberes especializados, que se expressam nos discursos de médicos e enfermeiros, favorecendo a circulação do poder nas práticas desses profissionais.

Objetivo analizar la circulación del poder en prácticas profesionales de médicos y enfermeros de Centro de Terapia Intensiva. Método investigación cualitativa, con datos recogidos por medio de entrevista semiestructurada, con médicos y enfermeros de Centro de Terapia Intensiva, en Minas Gerais, Brasil, y sometidos al análisis de discurso. Resultado en general, el equipo médico no se mostró muy atenta a las normas institucionales, siendo los enfermeros más involucrados en procesos normalizadores y disciplinarios. La visibilidad del médico está relacionada a la legitimación del dominio del saber científico expresado en discurso, lo que le confiere posición de detención del poder, a medida que el enfermero tiene discurso que muestra cierta resistencia en asumir visibilidad y protagonismo en el equipo. Conclusión el Centro de Terapia Intensiva es escenario donde hay intersección de diversos saberes especializados, que se expresan en discursos de médicos y enfermeros, favoreciendo la circulación del poder en las prácticas de esos profesionales.

Objective analyze the circulation of power in the professional practices of physicians and nurses of an Intensive Care Center. Method This is a qualitative research that uses data collected through semi-structured interview with physicians and nurses of an Intensive Care Center located in Minas Gerais, Brazil, and submitted to discourse analysis. Result in general, the medical team was not very attentive to institutional norms; therefore, nurses were the most involved in normalizing and disciplinary processes. The visibility of physicians is related to the legitimacy of the domain of scientific knowledge expressed in their discourse, which gives them a position of power, as the nurses have a discourse that shows some resistance in assuming visibility and protagonism in the team. Conclusion Intensive Care Center is a scenario where there is an intersection of several specialized knowledge, expressed in the discourses of doctors and nurses, favoring the circulation of power in the practices of these professionals.

Comparison of the urinary flow rate improvement after transurethral incision and transurethral resection of prostate for small sized symptomatic benign enlargement

Objective: To compare the mean improvement in urinary flow rate after transurethral resection of prostate [TURP] and transurethral incision of prostate [TUIP] for small sized symptomatic benign prostatic enlargement [SBE]

Study design: Randomized controlled trial

Duration of study: January 2016 to December 2017

Setting: Department of Urology Institute of Kidney Diseases Hayatabad Peshawar

Methodology: A total of 216 patients presenting to our OPD having lower urinary tract symptoms due to benign prostatic enlargement were included in the study. Their medical history, physical and digital rectal examination were performed. Urine analysis, urine C/S, Blood Complete, Serum Creatinine Prostate Specific Antigen, Uroflowmetry and Ultrasound were performed. All patients were randomized into two groups; Group A [TURP] and Grouped B [TUIP]

Results: Our study shows that in Group A [TURP] mean age was 57 years with standard deviation +/- 3.78 while in Group B [TUIP] mean age was 60 years with standard deviation +/- 3.13. The status of uroflowmetry[post-operative] among two groups was analyzed as in Group A [TURP] 5[5 percent] patients had uroflowmetry<15 ml while 103[95 percent] patients had uroflowmetry>15 ml. Mean uroflowmetry was 17 ml with standard deviation +/- 3.64. Where as in Group B [TUIP] 9[8 percent] patients had uroflowmetry<15 ml while 99[92 percent] patients had uroflowmetry>15 ml. Mean uroflowmetry was 16 ml with standard deviation +/- 3.55. Mean urinary flow rate was compared between TURP and TUIP in which showed that there is no significant difference between the two surgical procedures in term of urinary flow rate

Conclusion: Our study concludes that there was no significant difference between TURP and TUIP in term of mean urinary flow rate for small sized symptomatic benign prostatic enlargement

Efficacy and safety of thalidomide in treatment of prurigo nodularis

Objective: To determine the efficacy and safety of thalidomide in treatment of idiopathic prurigo nodularis

Methods: A total of 12 patients were enrolled in the study. Patients of child bearing potential and those with active systemic disease were excluded. All the patients had the histopathological confirmation of diagnosis. Patients were given 100mg/day of thalidomide for a period of three months. Follow up visit was every one month and therapy was stopped at three months. Patients were again evaluated for relapse two months after stopping the treatment

Results: 7 [58.3 percent] patients had successful response to the treatment. 3 [25 percent] patients had a partial response and 2 [16.7 percent] had unsuccessful treatment

Conclusion: Thalidomide is safe and effective treatment option for idiopathic recalcitrant prurigo nodulari

Configuração das práticas de saúde entre médicos e enfermeiros no ambiente hospitalar na perspectiva das relações de poder / Configuration of health practices among physicians and nurses in the hospital environment in the perspective of power relations

O ambiente hospitalar é símbolo do poder social da profissão médica, favorecendo a visibilidade desse profissional como ator central do cuidado. A crescente profissionalização administrativa dos hospitais requer que seus funcionários, inclusive médicos, se comprometam com atividades burocráticas, que, muitas vezes, são mediadas pelo enfermeiro. Dessa maneira, apesar da forte valorização do modelo médico-centrado na assistência, observa-se que os enfermeiros têm alcançado visibilidade pelas práticas gerenciais, o que pode gerar tensões nas relações profissionais. Essa nova conformação hospitalar reconfigura as relações de poder. O poder circula constantemente, de acordo com a composição de forças formadas a partir de conhecimentos e práticas pelo referencial Foucauldiano. Nas relações profissionais quem detém maior conhecimento assume uma posição privilegiada nas relações de poder. Com o objetivo de analisar como se configuram as relações de poder constituídas nos e pelos saberes e práticas cotidianas de médicos e enfermeiros no ambiente hospitalar, foi desenvolvida uma pesquisa qualitativa na perspectiva pós-estruturalista, com base no referencial teórico-metodológico do filósofo francês Michael Foucault. O cenário do estudo foi o Centro de Terapia Intensiva de um hospital filantrópico geral, de grande porte, localizado na cidade de Belo Horizonte, capital de Minas Gerais, Brasil. No Centro de Terapia Intensiva procedeu-se à observação do campo e a realização de entrevistas com roteiro semiestruturado a 08 médicos e 12 enfermeiros. A partir da análise dos discursos constituídos, foram identificadas três categorias empíricas principais: Identidade profissional: o reconhecimento de si na profissão; Disciplina: atitudes individualizantes ou necessidade coletiva? e Circularidade do poder: saber na constituição das práticas cotidianas. A avaliação dos dados permitiu refletir que a configuração das práticas de saúde entre médicos e enfermeiros no ambiente hospitalar perpassa questões socioeconômicas, históricas, culturais e de gênero. Tais questões influenciam a formação identitária do sujeito, o desejo pela visibilidade, sua aceitabilidade à disciplina e a busca da movimentação do poder pelo saber. Percebeu-se que as relações entre médicos e enfermeiros são eminentemente problemáticas, assim também como, tensão, disputa de poder, entre os próprios médicos, e ausência de unidade entre os enfermeiros, que estão alienados ao cuidado direto do paciente. Os discursos mostram que a equipe médica em geral, não possui intimidade com as normas institucionais, sendo, portanto, os enfermeiros os principais norteadores desse processo. Contudo, poucos enfermeiros deixaram evidente sua segurança quanto ao conhecimento técnico exigido pela profissão, principalmente no momento de comunicar alterações hemodinâmicas aos médicos, executar procedimentos invasivos ou até mesmo ao auxiliá-los. Este estudo possibilita incentivo a outras pesquisas que associadas a ele poderão contribuir para melhores práticas de saúde entre médicos e enfermeiros que atuam em unidades de terapia intensiva.(AU)

The hospital environment is a symbol of the social power of the medical profession, favoring the visibility of this professional as a central actor of care. The growing administrative professionalization of hospitals requires that their employees, including doctors, commit themselves to bureaucratic activities, which are often mediated by nurses. Thus, in spite of the strong valorization of the physician-centered model in care, it is observed that the nurses have achieved visibility by the managerial practices, which can generate tensions in the professional relations. This new hospital conformation reconfigures power relations. The power circulates constantly, according to the composition of forces formed from knowledge and practices by the Foucauldian referential. In professional relations, those who hold the greatest knowledge assume a privileged position in the relations of power. With the objective of analyzing how power relations are constituted in the knowledge and daily practices of physicians and nurses in the hospital environment, a qualitative research was developed in the poststructuralist perspective, based on the theoretical and methodological framework of the French philosopher Michael Foucault. The study scenario was the Intensive Care Center of a large general philanthropic hospital, located in the city of Belo Horizonte, capital of Minas Gerais, Brazil. In the Intensive Care Center, the field was observed and interviews were conducted with a semistructured script to 08 doctors and 12 nurses. From the analysis of the constituted discourses, three main empirical categories were identified: Professional identity: recognition of self in the profession, Discipline: individualizing attitudes or collective need? and Power: constitution knowledge of everyday practices. The evaluation of the data allowed us to reflect that the configuration of health practices among physicians and nurses in the hospital environment pervades socioeconomic, historical, cultural and gender issues. Such questions influence the subject's identity formation, the desire for visibility, its acceptability to discipline and the search for the movement of power through knowledge. It was noticed that the relationships between doctors and nurses are eminently problematic, as well as tension, power struggle among the doctors themselves, and lack of unity among the nurses, who are alienated to the direct care of the patient. The speeches show that the medical team in general, does not have intimacy with the institutional norms, being, therefore, the nurses the main guides of this process. However, few nurses have made their safety clear about the technical knowledge required by the profession, especially when communicating hemodynamic changes to physicians, performing invasive procedures or even assisting them. This study allows the encouragement of other research that associated with it may contribute to better health practices among physicians and nurses working in intensive care units.

Comparison of short-term efficacy of leflunomide and methotrexate in active rheumatoid arthritis

Objective: To compare short-term efficacy of Leflunomide and Methotrexate in active rheumatoids arthritis

Methodology: This study, a randomizeds controlled trial, was conducted at Medical B Unit, Postgraduate Medical Institute Lady Readings Hospital, Pe-shawars over a one year period, from 1[st] June 2014 to 31[st] May 2015. 294 patients with active RA [DAS28>5.1] were randomized via lottery methods to Leflunomide 20mg daily [n=147] and Methotrexate [n=147]. Efficacy of either drug at 6 months of treatment was assessed in terms of DAS 28 scoring as per European League Against Rheumatisms [EULAR] criteria

Results: After 66 months of treatment with Methotrexate, 110 out of 147 [74.82] patients had a moderate response as per EULAR criteria [DAS 28 improvement of >1.2] 37 patients had no response. In Leflunomide group, 100 [68.02%] patients had moderate response and 47 patients had no response. The difference in those achieving moderate response for both groups was statistically not significant [p=0.24]. The mean change in DAS 28 score for Methotrexate group was 1.89 +/- 0.77 while that for Leflunomide group was 1.79 +/- 0.75. The difference in change of DAS 28 score for both groups was statistically not significant [p=0.23]

Conclusion: There is no statistically significant difference between short-term efficacy of Leflunomide and Methotrexate in patients with RA

Knowledge about osteoporosis in women of child bearing age (15-49 years) attending fauji foundation hospital rawalpindi

Objective: The objective of this study was to assess the knowledge on symptoms, risk factors, preventive measures and treatment options for regarding osteoporosis in healthy women of child bearing age [15-49 years] accompanying patients, in Fauji Foundation Hospital [FFH] Rawalpindi

Study Design: Cross sectional survey

Place and Duration of Study: The study was conducted in FFH Rawalpindi from February 2015 to October 2015

Material and Methods: A cross sectional survey was conducted using a validated questionnaire i.e. OKAT [Osteoporosis Knowledge Assessment Tool] from 385 women attending OPDs of Fauji Foundation Hospital Rawalpindi, for a period of Feb-August 2015. The data was analyzed using SPSS [version 21]

Mean knowledge scores were calculated and compared with socio demographic variables

Results: Total knowledge score mean was 8 [total max score achieved 14]. Mean scores were found for knowledge regarding symptoms 0.85 [total score 2], and treatment options were 0.82 [total score 2] for the disease. Comparison of knowledge scores between respondents of different age, residential status [p<0.009], and educational status [p<0.056] was found statistically significant

Conclusion: Women lacked knowledge regarding osteoporosis, especially older uneducated ones, belonging to lower socioeconomic class residing in villages. Community based educational interventional programs targeting this population can help reduce the knowledge gap and contribute towards disease prevention

Oral assessment in medical education: time for change

There has been a phenomenal change in medical education in Pakistan also over the last 30 years. Through medical education, training of future doctors is done in such a way that they are capable of managing the health problems of those who seek their services in a competent and humane manner. The traditional oral examination/viva-voce is a favorite assessment tool in basic medical sciences as well as in clinical examinations for various reasons in our country