Understanding Experiences of Young Adult Males with Below-Knee Amputation

@#PURPOSE: This study was done to explore the experiences of young adult males with below-knee amputation at surgical wards and clinics in Teaching Hospital, Kurunegala, Sri Lanka. DESIGN: The study used the phenomenology design of qualitative research. METHODS: Face-to-face interviews were conducted for data collection using a theme list with a saturation point reached at 16 participants. The duration of an interview was 30-45 minutes and was recorded on audiotape and transcribed later. Phases of familiarization with the data, coding, searching for themes, reviewing themes, defining and naming themes, and writing up were conducted accordingly to thematic analysis. FINDINGS: The young adult male below-knee amputees showed changes in lifestyle with dependence on others, supporting aids, and experiencing discomfort. They showed mental distress with dissatisfaction with life and suffering of life. Additionally, they lacked power with identity changes and encounter economic problems in their lives. CONCLUSIONS AND RECOMMENDATIONS: It is essential to give special education to the staff caring for the below-knee amputees to minimize their unpleasant and challenging experiences. Health staff can motivate family members and friends for individuals' mental adjustment to their new life. Additionally, the social attitude of the community should be changed positively regarding amputated patients.

Effect of Oral and Maxillofacial Injuries on the Development of Post-Traumatic Stress Disorder: A Cross-Sectional Study

ABSTRACT Objective: To assess the influence of oral and maxillofacial trauma on the development of Post-Traumatic Stress Disorder (PTSD) and to determine the efficiency of the Impact of Event Scale-Revised (IES-R) as a diagnostic tool for detecting PTSD in patients with Oral and Maxillofacial injuries. Material and Methods: PTSD was assessed one month postoperatively by the diagnostic instrument, IES-R, to arrive at a provisional diagnosis. A structured clinician-administered PTSD Scale then assessed the patients for the Diagnostic and Statistical Manual of Mental Disorders-5th edition (CAPS-5) to establish a final diagnosis. The assessment of the severity of PTSD was done based on various types of oral and maxillofacial injuries. Results: The IES-R scale provisionally diagnosed 54 subjects with PTSD, out of which 42 were diagnosed to have PTSD by the CAPS-5 scale. Subjects with injuries involving the 'orbital complex,' those presenting with a perceptible scar in the maxillofacial region and with multiple avulsed/ luxated anterior teeth, showed a higher affinity to develop PTSD, and this was statistically significant. Conclusion: Higher levels of PTSD in patients with injuries to the maxillofacial region warrants correct diagnosis and detection, and hence the maxillofacial surgeon plays a vital role in this regard. The IES-R is a useful diagnostic tool to detect PTSD early.

Simultaneous detection and quantification of bronchodilators in pure form and from in-vitro drug release of a novel combinational formulation

The analytical method was developed and validated for the quantification of salbutamol sulfate (SS) and ipratropiumbromide (IPB) in accordance with the International Council for Harmonization guidelines in its pure form. Thechromatographic partition was completed utilizing a blend of acetonitrile:phosphate buffer (30:70 v/v) with the pHscale adjusted to 3.0 using o-phosphoric acid at a flow rate of 1 ml/minute in Luna C-18(2)(150 × 4.6 mm i.d., 5 μm)column. The wavelength for detection was fixed at 212 nm. The SS and IPB showed a standard linearity curve in therange of 2–12 µg/ml, with retention time at 2.4 and 3.8 minutes, respectively. The developed method was reported tobe specific, linear (r2 ≥ 0.999), precise at intraday and interday levels (% relative standard deviation < 2.0%), accurate(% recovery: 96.02%–103.62%), and robust. The limit of detection and limit of quantification for SS was found to be0.42 and 1.26 µg/ml, while that of IPB was 0.44 and 1.34 µg/ml, respectively. Additionally, the developed method waseffectively applied in quantifying SS and IPB from its pure, commercial, and in-house prepared transdermal system tounderstanding the in-vitro drug release pattern from patches.

Functioning adrenocortical carcinoma causing virilisation: a case report

Adrenocortical carticnoma (ACC) is an uncommon tumor with an incidence of 1-2 cases/million/year. It has two peak incidences; the first one in the first decade and the second one in the fourth decade. Most patients present with features of steroid hormone excess or abdominal mass effects, but about 15% of ACC are diagnosed incidentally. It is hormonally functional in 80 - 100% patients and the predisposing lesions include congenital adrenal hyperplasia and adenoma. ACC has significant syndromic and genetic association. Surgery offers the best chance of cure, especially in localized disease. Here, we present the case of virilization in a young female child secondary to a functioning ACC. The child had classical hormonal and imaging features of functioning ACC and underwent resection of the tumor (Adrenalectomy) with good outcome.

Nurses' knowledge, attitudes, and practices regarding postoperative pain management in Sri Lanka

@#PURPOSE OF THE STUDY: This study aimed to investigate the knowledge, attitudes, and practices regarding post-operative pain management among nurses working in the surgical units in Kandy, Sri Lanka. DESIGN: The study was based on quantitative method, specifically descriptive design. Samples were selected using the probability sampling technique of simple random sampling. The sample size obtained was 200 nurses using 95% confidence level and a 4% margin of error for a population of 300 nurses in the research setting. METHODS: A self-administered questionnaire was chosen as a data collection method, and this questionnaire contained 36 questions under four sub-topics. A box was kept in the matron office in the surgical section to collect the questionnaire. The data were analyzed using descriptive analysis with percentages. FINDINGS: According to the research findings, 66% (132) were knowledgeable about the meaning of post-operative pain management. Post-operative pain management was identified by 74% (148) of the respondents, and 26% (52) correctly indicated that the most accurate judge of post-operative pain is the patients' self-report. When considering the attitudes, 66% (132) of the participants agreed that post-operative patients show discomfort before receiving the next analgesics. Among the participants, 60% (120) of nurses worried that patients would become addicted to analgesics that they give, while 20% (40) disagreed, and 2% strongly disagreed. 54% (108) of the nurses stated that patients were kept under close observation and the pain was monitored regularly, while 46% (92) expressed that patient is kept in a comfortable position. To manage post-operative pain, 80% (160) used non-pharmacological methods while 20% (40) did not. CONSLUSIONS: The findings of this study identified problems such as inadequate knowledge, and inappropriate attitudes and practices regarding postoperative pain management.

Prevalence and determinants of nocturnal enuresis in school going children in Southern Maharashtra, India

Background: Nocturnal enuresis or bedwetting is a common health problem in children in the age group of 5 to 15 years. In India the prevalence of nocturnal enuresis ranges from approximately 7% to 12.6%. The prevalence from other parts of the world ranges from 6% to 42%. This study was planned to find the prevalence and determinants of nocturnal enuresis in school going children.Methods: This cross-sectional study was conducted in four primary and secondary schools in Solapur. A predefined questionnaire, prepared in English and translated to local languages, Marathi and Kannada, was handed over to all the children attending the selected schools. Children were asked to hand over the questionnaire to their parents and return with the filled questionnaire. The questionnaire was prepared to obtain the information related to the socio-demographic factors of the family and child, frequency of enuresis and information related the risk factors. Nocturnal enuresis was defined if the frequency of enuresis was more than twice per week.Results: The overall prevalence of nocturnal enuresis was 11.4 %. The maximum prevalence was found in the age group of 8 -9 years (22.96 %). The prevalence of nocturnal enuresis in boys (14.34 %) was significantly more than the prevalence in girls (8.31 %). The study showed that nocturnal enuresis was significantly associated with stress, poor school performance, sleep pattern (hard to awaken), family history, burning micturition etc. But it was not associated with maternal or paternal education, birth order, type of family.Conclusions: The prevalence of nocturnal enuresis is 11.40 % in school going children and it is associated with age, sex, stress, family history, burning micturition, hyperactive child, poor school performance, sleep pattern (hard to awake) avoidance of going to micturate before sleep etc.

Nutritional anaemia: clinical and haematological presentation in children

Background: There are three main causes of anemia, decreased production of RBCs, and excessive destruction of RBCs or Excessive blood loss. In India, the main reason of anaemia is the decreased production due to nutritional deficiency. The main nutrients required in the process of haemoglobin production are iron, folic acid and cyanocobalamine. The objective of the present study was to find the clinical presentations and hematological changes in children with nutritional anaemia.Methods: This Cross-sectional study was conducted from January 2018 to October 2018 in the department of Paediatrics of Ashwini Rural Medical College Hospital and Research Centre, Solapur. Children visiting the paediatric OPD due to any illness and having clinical suspicion of anemia were initially screened for inclusion in the study. Detailed laboratory investigation such as CBC, peripheral blood for Leishman's stain and reticulocyte count were performed. Serum Ferritin, vitamin B12, folic acid levels were also done to ascertain the cause of anemia. World Health Organization recommended criteria were used to diagnose and grade the anemia.Results: A total of 405 anemic children were included in the study. Out of that 213 were boys and 192 were girls. A total of 226 children presented with mild anemia. The most common clinical presentation was respiratory tract infection, found in 62.22 % of children followed by fever in 53.09 % of children. Maximum numbers of patients were suffering from iron deficiency anemia, followed by folic acid deficiency. Deficiency of both of these nutrients was also common. Vit B12 deficiency was found in only 5 children.Conclusions: The study concluded that iron deficiency anemia was the commonest nutritional anemia in children in the age group of 5 to 15 years. Second most common deficiency was of folic acid. Majority of the anemic patients presented with respiratory tract infection and fever.

Unrecognized double aortic arch in a preterm infant: Diagnostic challenges and perioperative management

Vascular rings are relatively rare, and are frequently overlooked as a potential cause of neonatal respiratory distress in non specialized centres. This might lead to delay in diagnosis during which the child is subjected to repeated respiratory insults. Procrastination in prompt diagnosis and management can lead to significant comorbidities or even death. We highlight the case report of a preterm infant with an unrecognized double aortic arch who presented with severe respiratory morbidity and the subsequent management.

An institutional survey for knowledge‑based and self‑awareness assessment in temporomandibular joint disorders among dental students.

Context: Temporomandibular joint disorders (TMDs) have been recognized as one of the most common causes of nondental orofacial pain. Various studies have been reported in literature regarding the relationship between prevalence of signs and symptoms of TMDs and gender, suggestive of female predilection; however, none of the studies have yet been reported to suggest the relationship between knowledge about temporomandibular joint (TMJ) and TMDs and self‑awareness of its signs and symptoms. Aim: To find a relationship between the level of knowledge about TMJ and TMDs and self‑awareness of its signs and symptoms. Settings and Design: This study was designed as an institutional survey. The study sample comprised 491 undergraduate and postgraduate (PG) students, consisting of 90 males and 401 females with age ranging between 18 and 32 years. Subjects and Methods: Two sets of questionnaire were distributed among the students. Statistical Analysis Used: Statistical analysis was performed with the help of Epi Info (TM) 3.5.3, descriptive statistical analysis, test of proportion, Chi‑square test, one‑way analysis of variance, Tukey’s test, and knowledge index. Results: It was observed that there was a gradual increase in the level of knowledge about TMJ and TMDs and self‑awareness of its signs and symptoms from the 1st year to PG students. Conclusions: A direct relationship exists between the level of knowledge about TMJ and TMDs and self‑awareness of its signs and symptoms.

Surviving a recurrent Scedosporium prolificans endocarditis : A case report.

Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. We report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.

Epidermoid Cysts of Head and Neck Region: Case Series and Review of Literature / Quistes Epidermoides de Región Cabeza y Cuello: Serie de Casos y Revisión de la Literatura

Epidermoid and dermoid cysts are hamartomas localized on the neck, head, or trunk, usually visible at birth. In some instances, careful medical examination may help to find most epidermoid and dermoid cysts. Ambiguity about their exact pathogenesis exists and dysontogenetic, traumatic, and thyroglossal anomaly theories have been postulated. Histopathologically epidermoid cysts have a cystic capsule lined with thin stratified epithelium. Surgical excision though completes the treatment, complications have been reported. We report three cases of epidermoid cyst on the maxillofacial region.

Los quistes epidermoides y dermoides son hamartomas localizados en el cuello, la cabeza o el tronco, por lo general visibles al nacer. En algunos casos, el examen médico cuidadoso puede ayudar a encontrar quistes epidermoides y dermoides. Existe cierta ambigüedad acerca de su patogenia exacta, postulando teorías disontogenéticas, traumáticas y anomalías del conducto tirogloso. Los quistes epidermoides histopatológicamente tienen una cápsula quística revestida con epitelio estratificado delgado. Aunque la escisión quirúrgica completa es su tratamiento, se han reportado complicaciones. Presentamos tres casos de quiste epidermoides en la región maxilofacial.

Concomitant production of detergent compatible enzymes by Bacillus flexus XJU-1

A soil screened Bacillus flexus XJU-1 was induced to simultaneously produce alkaline amylase, alkaline lipase and alkaline protease at their optimum levels on a common medium under submerged fermentation. The basal cultivation medium consisted of 0.5% casein, 0.5% starch and 0.5% cottonseedoil as an inducer forprotease, amylase, and lipase, respectively. The casein also served as nitrogen source for all 3 enzymes. The starch was also found to act as carbon source additive for both lipase and protease. Maximum enzyme production occurred on fermentation medium with 1.5% casein, 1.5% soluble starch, 2% cottonseed oil, 2% inoculum size, initial pH of 11.0, incubation temperature of 37 °C and 1% soybean meal as a nitrogen source supplement. The analysis of time course study showed that 24 h was optimum incubation time for amylase whereas 48 h was the best time for both lipase and protease. After optimization, a 3.36-, 18.64-, and 27.33-fold increase in protease, amylase and lipase, respectively was recorded. The lipase was produced in higher amounts (37.72 U/mL) than amylase and protease about 1.27 and 5.85 times, respectively. As the 3 enzymes are used in detergent formulations, the bacterium can be commercially exploited to secrete the alkaline enzymes for use in detergent industry. This is the first report for concomitant production of 3 alkaline enzymes by a bacterium.

Assessment of Essential Newborn Care Services in Secondary-level Facilities from Two Districts of India.

India faces a formidable burden of neonatal deaths, and quality newborn care is essential for reducing the high neonatal mortality rate. We examined newborn care services, with a focus on essential newborn care (ENC) in two districts, one each from two states in India. Nagaur district in Rajasthan and Chhatarpur district in Madhya Pradesh were included. Six secondary-level facilities from the districts─two district hospitals (DHs) and four community health centres (CHCs) were evaluated, where maximum institutional births within districts were taking place. The assessment included record review, facility observation, and competency assessment of service providers, using structured checklists and sets of questionnaire. The domains assessed for competency were: resuscitation, provision of warmth, breastfeeding, kangaroo mother care, and infection prevention. Our assessments showed that no inpatient care was being rendered at the CHCs while, at DHs, neonates with sepsis, asphyxia, and prematurity/low birthweight were managed. Newborn care corners existed within or adjacent to the labour room in all the facilities and were largely unutilized spaces in most of the facilities. Resuscitation bags and masks were available in four out of six facilities, with a predominant lack of masks of both sizes. Two CHCs in Chhatarpur did not have suction device. The average knowledge score amongst service providers in resuscitation was 76% and, in the remaining ENC domains, was 78%. The corresponding average skill scores were 24% and 34%, highlighting a huge contrast in knowledge and skill scores. This disparity was observed for all levels of providers assessed. While knowledge domain scores were largely satisfactory (>75%) for the majority of providers in domains of kangaroo mother care and breastfeeding, the scores were only moderately satisfactory (50-75%) for all other knowledge domains. The skill scores for all domains were predominantly non-satisfactory (<50%). The findings underpin the need for improving the existing ENC services by making newborn care corners functional and enhancing skills of service providers to reduce neonatal mortality rate in India.

In vitro screening and evaluation of antivenom phytochemicals from Azima tetracantha Lam. leaves against Bungarus caeruleus and Vipera russelli

Snakebites are considered a neglected tropical disease that affects thousands of people worldwide. Although antivenom is the only treatment available, it is associated with several side effects. As an alternative, plants have been extensively studied in order to obtain an alternative treatment. In folk medicine, Azima tetracantha Lam. is usually used to treat snakebites. The present study aims to provide a scientific explanation for the use of this plant against snakebite. The extracts of shade dried leaves of A. tetracantha were tested for in vitro inhibitory activity on toxic venom enzymes like phosphomonoesterase, phosphodiesterase, acetylcholinesterase, hyaluronidase etc. from Bungarus caeruleus and Vipera russelli venoms.

In vitro screening and evaluation of antivenom phytochemicals from Azima tetracantha Lam. leaves against Bungarus caeruleus and Vipera russelli

Snakebites are considered a neglected tropical disease that affects thousands of people worldwide. Although antivenom is the only treatment available, it is associated with several side effects. As an alternative, plants have been extensively studied in order to obtain an alternative treatment. In folk medicine, Azima tetracantha Lam. is usually used to treat snakebites. The present study aims to provide a scientific explanation for the use of this plant against snakebite. The extracts of shade dried leaves of A. tetracantha were tested for in vitro inhibitory activity on toxic venom enzymes like phosphomonoesterase, phosphodiesterase, acetylcholinesterase, hyaluronidase etc. from Bungarus caeruleus and Vipera russelli venoms.

Pleomorphic Adenoma: A Case Report and Review of Literature / Adenoma Pleomórfico: Reporte de Caso y Revisión de la Literature

Pleomorphic adenoma, the most common salivary gland tumor, consists of epithelial and mesenchymal components. Its morphologic complexity results from differentiation of tumor cells into fibrous, hyalinized, myxoid, chondroid and osseous areas. The diagnosis is made by the clinical and histo pathological examination. The treatment of pleomorphic adenoma is surgical excision. Malignant transformation, though rare, has been reported. In this article, we report a case of pleomorphic adenoma with literature review.

El adenoma pleomórfico es el tumor más frecuente de las glándulas salivales, con componentes epiteliales y mesenquimales. Su complejidad morfológica es resultado de la diferenciación de las células tumorales en las zonas fibrosas, hialinizadas, mixoides, condroides y óseas. El diagnóstico se realiza mediante el examen clínico e histopatológico. El tratamiento de adenoma pleomórfico es la escisión quirúrgica. La transformación maligna, aunque rara, ha sido reportada. En este artículo se presenta un caso de adenoma pleomórfico con revisión de la literatura.

Tracking Survival of Institutional Births for Neonatal Period- Feasibility at District Hospitals.

We assessed the feasibility of involving routine district health system personnel in tracking survival of institutional births for neonatal period in two district hospitals (Nagaur in Rajasthan and Chhatarpur in Madhya Pradesh) for the month of March 2010. A centralized district level tracking system was used in Nagaur, whereas in Chattarpur, block-wise tracking of births was performed. A total of 607 live births were tracked with 17 identified neonatal deaths. Prematurity and infections were commonest causes of deaths with majority occurring within first week of life. The block-wise approach resulted in identifying extra neonatal deaths.

Design and in vitro evaluation of effervescent gastric floating drug delivery systems of propanolol HCl / Diseño y evaluación in vitro de sistemas de administración de tabletas flotantes gástricas everfescentes de HCl propanolol

The purpose of this research was to develop and evaluate effervescent gastric floating tablets of propranolol HCl. The oral delivery of antihypertensive propranolol HCl was facilitated by preparing an effervescent floating dosage form which could increase its absorption in the stomach by increasing the drug’s gastric residence time. In the present work, effervescent floating tablets were prepared with a hydrophilic carrier such as polyethylene oxide (PEO WSR N 60K and PEO WSR 303) as a release retarding agent and sodium bicarbonate as a gas generating agent. The prepared tablets were evaluated for all their physicochemical properties, in vitro buoyancy, drug release and rate order kinetics. From the results, P9 was selected as an optimized formulation based on their 12 h drug release, minimal floating lag time and maximum total floating time. The optimized formulation followed first order rate kinetics with erosion mechanism. The optimized formulation was characterized with FTIR studies and no interaction between the drug and the polymers were observed.

El propósito de la presente investigación fue desarrollar y evaluar tabletas flotantes, efervescentes de HCL propranolol. La administración oral del antihipertensivo HCL propranolol se facilitó mediante la preparación de una forma de dosificación flotante y efervescente que permitiría su absorción en el estómago, mediante el aumento del tiempo de residencia gástrico de la droga. En el presente trabajo, las tabletas flotantes efervescentes fueron preparadas con un portador hidrofílico, tal como el óxido de polietileno (PEO WSR N 60K and PEO WSR 303), como agente retardador y bicarbonato de sodio como un agente generador de gas. Se evaluaron todas las propiedades fisicoquímicas de las tabletas preparadas, su flotación in vitro y su tasa de orden cinético. Se seleccionó el P9 a partir de los resultados obtenidos, como una fórmula óptima, basados en la liberación de la droga a las 12 h, tiempo mínimo de retraso para flotación y máximo tiempo total de flotación. La formulación optimizada siguió una tasa cinética de primer orden con mecanismo de erosión. Esta fórmula óptima se caracterizó mediante estudios FITR y no se observó ninguna interacción entre la droga y los polímeros utilizados.