Knowledge, attitude and practices regarding dengue and its vector among medical practitioners in Malakand region, Pakistan

Abstract Dengue fever (DF) is increasingly recognized as one of the worlds major mosquito borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Dengue fever is endemic in most part of Pakistan and continues to be a public health concern. Knowledge, attitude and practices can play an important role in management of the disease. Current study was aimed to determine the level of knowledge, attitude and practices regarding dengue fever among health practitioners, to study the level of knowledge and attitude with preventive practices for dengue fever. A cross sectional study was carried out in medical practitioners of the four districts of Malakand region during October to November 2019. A pre-structured questionnaire was used to collect data from medical practitioners. Data was analyzed using Graph Pad version 5. Significant value was considered when less than 0.05 (at 95% confidence of interval). The results revealed that most of participants have seen dengue vector (62%), the media being the most quoted source of information. Nearly 81.2% participants were aware from transmission of dengue fever is by mosquito bite. Practices based upon preventive measures were found to be predominantly focused towards prevention of mosquito bites rather than elimination of breeding places. Although the knowledge regarding DF and mosquito control measure was quite high among the medical practitioners but this knowledge was not put into practice. Further studies are required to aware the people about dengue and its vector in order to get prevention and control.

Resumo A dengue (DF) é cada vez mais reconhecida como uma das principais doenças transmitidas por mosquitos do mundo e causa significativa morbidade e mortalidade em países tropicais e subtropicais. A dengue é endêmica na maior parte do Paquistão e continua a ser um problema de saúde pública. Conhecimento, atitude e práticas podem desempenhar papel importante no manejo da doença. O presente estudo teve como objetivo determinar o nível de conhecimento, atitude e práticas em relação à dengue entre os profissionais de saúde, para estudar o nível de conhecimento e atitude com as práticas preventivas da dengue. Um estudo transversal foi realizado com médicos dos quatro distritos da região de Malakand de outubro a novembro de 2019. Um questionário pré-estruturado foi usado para coletar dados de médicos. Os dados foram analisados no Graph Pad versão 5. Valor significativo foi considerado quando menor que 0,05 (com intervalo de confiança de 95%). Os resultados revelaram que a maioria dos participantes já viu o vetor da dengue (62%), sendo a mídia a fonte de informação mais citada. Quase 81,2% dos participantes sabiam que a transmissão da dengue é por picada de mosquito. Constatou-se que as práticas baseadas em medidas preventivas se concentravam predominantemente na prevenção de picadas de mosquitos, e não na eliminação de criadouros. Embora o conhecimento sobre DF e medidas de controle de mosquitos fosse bastante elevado entre os médicos, esse conhecimento não foi colocado em prática. Mais estudos são necessários para conscientizar a população sobre a dengue e seu vetor, a fim de se obter prevenção e controle.

Assessing the performance of ChatGPT in answering questions regarding cirrhosis and hepatocellular carcinoma

Background/Aims@#Patients with cirrhosis and hepatocellular carcinoma (HCC) require extensive and personalized care to improve outcomes. ChatGPT (Generative Pre-trained Transformer), a large language model, holds the potential to provide professional yet patient-friendly support. We aimed to examine the accuracy and reproducibility of ChatGPT in answering questions regarding knowledge, management, and emotional support for cirrhosis and HCC. @*Methods@#ChatGPT’s responses to 164 questions were independently graded by two transplant hepatologists and resolved by a third reviewer. The performance of ChatGPT was also assessed using two published questionnaires and 26 questions formulated from the quality measures of cirrhosis management. Finally, its emotional support capacity was tested. @*Results@#We showed that ChatGPT regurgitated extensive knowledge of cirrhosis (79.1% correct) and HCC (74.0% correct), but only small proportions (47.3% in cirrhosis, 41.1% in HCC) were labeled as comprehensive. The performance was better in basic knowledge, lifestyle, and treatment than in the domains of diagnosis and preventive medicine. For the quality measures, the model answered 76.9% of questions correctly but failed to specify decision-making cut-offs and treatment durations. ChatGPT lacked knowledge of regional guidelines variations, such as HCC screening criteria. However, it provided practical and multifaceted advice to patients and caregivers regarding the next steps and adjusting to a new diagnosis. @*Conclusions@#We analyzed the areas of robustness and limitations of ChatGPT’s responses on the management of cirrhosis and HCC and relevant emotional support. ChatGPT may have a role as an adjunct informational tool for patients and physicians to improve outcomes.

Anesthesia for fetoscopic intervention

This is the first case report on anesthesia for fetoscopy performed in Saudi Arabia. Epidural anesthesia was given to the mother in her late second trimester for the fetoscopic intervention. The anesthesia related issues such as physiological and anatomical changes in pregnancy, tocolytic medications and their interactions with anesthesia, anesthetizing/sedating the primary patient are discussed

Phytochemical and Pharmacological Profile of Withania somnifera Dunal: A Review.

Withania somnifera (L) Dunal is a well known Indian medicinal plant widely used in the treatment of many clinical conditions in India. It is an important drug commonly known as Asgand which has been used either single or in combination with other drugs in Unani as well as Ayurvedic system of medicine for centuries. It has been described by Dioscorides (78 AD) in his book “Kitab-ul-Hashaish”. Asgand consists of the roots of Withania somnifera which has various therapeutic actions such as anti-inflammatory (Muhallil-e-Warm), sedative (Musakkin), alterative (Muaddil) and aphrodisiac (Muqawwi-e-Bah). Keeping in view the medicinal properties of Withania somnifera Dunal (Asgand), an attempt has been made in this review paper to explore various dimensions of the drug including phytochemical and pharmacological studies carried out on this drug.

Posterior reversible encephalopathy syndrome [PRES]

We report a 40-year-old pregnant woman who presented to the emergency room with recurrent seizures; altered mental status and vomiting patient developed profuse vaginal bleeding and delivered a dead fetus. She has been diagnosed clinically and radiologically as a case of Posterior reversible encephalopathy syndrome

Placebo controlled comparison of the opioid sparing effect of meloxicam and diclofenac after abdominal hysterectomy

To compare the opioid sparing effect of meloxicam, diclofenac, and placebo after abdominal hysterectomy. This study was conducted at the Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from February 2004 to November 2006. Women of American Society of Anesthesiologist's classification I or II of ages 25-60 years scheduled for abdominal hysterectomy were included. Those with significant systemic disease or contraindication to opioid or non-steroidal anti-inflammatory drugs were excluded from the study. All patients received general anaesthesia and intravenous IV morphine, and were intubated and ventilated for the operation. The patients were randomized and rectally received meloxicam 15 mg, diclofenac 100 mg, or placebo suppository. Patients, anesthetists, and nurses managing the patients postoperatively were blinded to these drugs. In the recovery room, IV patient controlled morphine was commenced. The information sought included patient characteristics age, weight, duration of operation, and doses of morphine consumed in 24 hours. Seventy-five patients 25 in each group participated in this study and only 5 patients dropped out. There was no difference in age and body weight of the patients, and duration of the operation. All underwent either total or sub-total hysterectomy. The mean SD morphine consumption in the 24-hour postoperative period was 37.7 11.1 mg for the diclofenac group, 40.1 7.8 mg for the meloxicam group, and 45.2 9.8 mg for the placebo group. As compared to placebo, the mean morphine consumption in diclofenac but not in meloxicam group was significantly p<0.05 reduced. Our study demonstrates a significant opioid sparing effect after abdominal hysterectomy with diclofenac, but not with meloxicam

audit of Acute Pain Service in Central, Saudi Arbia

A retrospective analysis of acute pain service [APS] was performed to look at the epidural and patient-controlled analgesia [PCA] with respect to their indications, duration and quality of pain control, dosage regimen and common side effects. This study was conducted in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. All APS monitoring forms, from the year 1994 to 2003 were collected. Every tenth PCA and epidural form was then randomly taken out and reviewed. From each sample form information concerning operation, analgesic modality [epidural or PCA], its duration, side effects and non-steroidal anti-inflammatory drug [NSAID] use was collected. Postoperative pain and sedation were monitored as 0=none, 1=mild, 2=moderate and 3=severe. For the first 24 hour of APS period, information was also gathered concerning duration of each pain score, highest pain score, sedation score and lowest respiratory rate. Informations of PCA [incremental dose, lock-out interval, back ground infusion, number of hours PCA not activated and total morphine consumed] and epidural infusion [concentration of mixture of local anesthetic with opioid and its volume consumed during first 24 hours] were also collected. A total of 10002 patients aged 16-74 years received APS; one third of them receiving epidural and two thirds receiving PCA. Eighty-five% of patients received APS after cesarean section and 7.8% received APS after abdominal hysterectomy. Acute pain service served 77% of total APS patients for 24-48 hours. The average duration of APS was 44.2 hours. For the first 24 hours, PCA and epidural was compared for severity and duration of pain. A pain score of zero was found for a longer period [average 19.6 hours] with epidural whilst; a pain score of 1 and 2 was observed for a longer period [average 11.4 and 4.0] with PCA. The mean highest pain score was 0.7 for epidural and 1.7 for PCA. Patients having no postoperative pain included 35.7% of the epidural analgesia group and 0.5% of the PCA group. The highest sedation score of one was found more often in the epidural group and a score of 2 was found more often in the PCA group. No case was documented where the respiratory rate was <12/minute. Most [51%] PCA patients were prescribed an incremental dose of 1.5mg of morphine with a lock-out interval of 10 minutes. Basal morphine infusion was used in 96% of PCA patients. Patient-controlled analgesia was not activated for the mean period of 13.2 hours in the first 24 hours postoperative period. Average total amount of morphine consumed by patients was 76.8 mg during the average total duration of 42.9 hours of PCA. Amongst patients who received epidural analgesia, 93.6% received the mixture of fentanyl [4 microgram/ml] and Bupivacaine [0.03%]. On average, 194 mls of epidural infusion was used in the first 24 postoperative hours. Overall, 35% of patients received NSAIDs along with APS and 12.6% of patients developed complications during APS. Complications were recorded in 25.6% of epidural patients and 4.4% of PCA patients. The most common complication was pruritis. In the past decade, APS has provided a safe and efficient service to over 10 thousand postoperative obstetric and gynecology patients. Epidural analgesia as compared to PCA provided superior analgesia but caused more frequent minor side effects. More resources are required to provide good quality APS to all eligible postoperative patients for the desirable period

Obstetric admissions to the intensive care unit

To describe clinical characteristics, interventions required, and outcome of critically ill obstetric patients admitted to a general intensive care unit [ICU]. All obstetric patients admitted to ICU at Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia from 1997 to 2002 were included in the study. The data related to demographics, obstetric history, pre-existing medical problems, indications for ICU admission, intervention required, length of stay, and outcome of ICU admission were collected by retrospective review of medical records. The 99 obstetric admissions to ICU were represented by 0.2% of all deliveries and 1.6% of all ICU admissions. Most patients were young [median age of 30 years] with parity [median] of 3 and stayed in ICU for an average of 2 days. All except one patient were admitted during the postpartum period. The majority [76%] were admitted after cesarean section. Obstetric hemorrhage [32%] and hypertension [29%] were the 2 most common indications for admission. The majority [59/99] of patients also had pre-existing medical problem and most common [16/59] was rheumatic heart disease. Preeclampsia [23/99] and eclampsia 10/99 were the most frequent obstetric complication. Thirty-six% of our patients required ventilatory support. In the majority of patients, direct arterial [81%] and central venous [73%] pressure monitoring was carried out. Pulmonary arterial and left atrial pressure was monitored in 4%. Almost one third of patients received antihypertensive therapy. Inotropic support was given to 9% and blood [and its products] was given to 46% of patients. Antibiotics [28%] and magnesium sulphate [25%] were the most frequently used medicines. Out of the total 99 admissions, one patient died and 16 patients developed complications. In our survey, the 2 most common indications for admitting obstetric patients to ICU were hemorrhage and hypertension. Invasive hemodynamic monitoring and ventilatory support are the 2 main interventions. Improving quality of care before and after admission to ICU may reduce maternal morbidity

sensibilite pulpaire: Ciments oxyphosphates v / s ciments verres ionomeres

Glass ionomer cements are recent compared to oxyphosphate cements. They were accused of dental sensitivity at short and mid terms without real causes. the goal of this presentation is to define, after excluding pulp irritation, traumatic dental preparation, bacterial contamination, clinical results concerning post-operative sensitivity