Development of the EldenCare application: Empowering physicians and clinical pharmacists towards enhancing elderly care.

The growing healthcare burden on the elderly population, combined with an increase in prescription drug use, necessitates the development of novel solutions for improving elderly care. EldenCare connects doctors, clinical pharmacists, and elderly patients. EldenCare was developed by a multidisciplinary team comprising geriatricians, clinical pharmacists, and software engineers. The software offers various features tailored to the needs of each user group, revolutionizing medication management and patient care. For geriatricians, EldenCare provides efficient means of recording patient information, scheduling appointments, and documenting follow-up. Clinical pharmacists can take advantage of the software's advanced features, including identifying medication risks, facilitating dose adjustments, identifying potentially inappropriate medications, and tracking adverse drug reactions. Elderly patients benefit from features such as medication alerts, appointment management, medication lists and an adverse drug reaction diary. The study is divided into five distinct phases: requirements phase, design phase, coding & unit testing phase-frontend, coding & unit testing phase-database/cloud, testing phase. The expected benefits of the EldenCare software include increased medication safety, improved communication between healthcare providers and patients, and improved healthcare outcomes for older adults. EldenCare aims to revolutionise medication management and promote a patient-centered healthcare system by empowering clinical pharmacists and engaging older adults in their care-using technology.

The Orthodontist's Role in Post-Battlefield Craniomaxillofacial Trauma Reconstruction.

INTRODUCTION: In modern conflicts, deployed members are more vulnerable to craniomaxillofacial (CMF) injury than in previous conflicts. Patients presenting with CMF trauma are susceptible to post-trauma dental malocclusion and may require lengthy rehabilitation to achieve pre-injury function. This study surveyed military health care professionals who are potential contributors to CMF trauma rehabilitation teams to evaluate the orthodontist's inclusion in treating to the final outcome. METHODS: Following approval from the Defense Health Agency Information Management Collections Office (Control Number: 9-DHA-1031-E) and the Air Force 59th Medical Wing Institutional Review Board (Reference Number: FWH20210061E), a survey study was conducted from April 2021 to July 2021. Volunteer participants were recruited from orthodontists, oral maxillofacial surgeons, medical specialists, and other dental specialists who have worked in military healthcare. Respondents reported their current practice treating CMF trauma, self-evaluated their knowledge of different aspects of the process, and submitted their perceptions on system and patient-limiting factors which affect outcomes. Descriptive statistics were conducted for ordinal data and chi-square tests for categorical data. Kruskal-Wallis analyses of variance compared cohorts with further Mann-Whitney U tests to distinguish the difference in cohorts. RESULTS: Valid responses were collected from 171 participants. The responses were mostly from active duty military (93%) and well distributed among orthodontists, oral maxillofacial surgeons, other dental specialists, and medical specialists. When reporting current CMF trauma treatment practices, the majority of dental specialists stated they most commonly participate in a multidisciplinary team that addresses any CMF trauma case (68.4%) whereas medical specialists most commonly act as solo independent provider practice (53.6%). Dental specialists reported follow-up with post-trauma patients greater than 1 year and medical specialists reported the shortest post-trauma follow-up time with a median of 0 to 3 months. The majority of participants selected at least one system factor limiting CMF trauma care (78.7%) and at least one patient factor limiting CMF trauma care (86.3%). When asked about orthodontic participation in multidisciplinary teams, the responses showed a great range with orthodontists never included in CMF trauma care 23.1% of the time and always consulted regarding trauma cases 10.7% of the time. Other survey data collected allows the investigators to draw conclusions regarding specific limitations to treatment and recommendations for improvement, along with qualitative responses from survey participants. CONCLUSIONS: Orthodontics, while available in the military, is underutilized in treating post-warfare or other CMF trauma. There are both system- and patient-limiting factors in the treatment of battlefield and non-battlefield CMF trauma. In addition, there are limitations to the inclusion of orthodontists in CMF trauma care which include the physical distance from primary treating specialists and the absence of standard referral protocols. Oral maxillofacial surgeons reported the highest understanding of the military orthodontist's contribution to a CMF trauma treatment team and medical specialists reported the lowest understanding. Advanced technology tools could help improve outcomes and multidisciplinary interactions. Further research is needed to study the complete CMF trauma rehabilitation process in military treatment facilities, evaluate the efficiency of cross-specialty referrals, and highlight best practices and protocols of functioning multidisciplinary teams.

Comprehensive Rare Disease Care model for screening and diagnosis of rare genetic diseases - an experience of private medical college and hospital, South India.

Rare diseases (RD) of genetic origin are raising public health concern contributing to a massive economic burden in India. Establishing Specialty Centers to bridge the RD community with apex centers is felt as a need in developing countries. Hence a Comprehensive Rare Disease Care (CRDC) model was set up at the department of pediatrics under Center for Human Genomics and Counseling at a medical college hospital in South India. The patients suspected to have genetic disease were evaluated as per the work flow of the designed model. The utilization statistics depict the outcome of this model. In the face of limited resources, it was possible to establish a functional RD unit with meticulous planning, supportive administration and trained interdisciplinary staff. A scalable prototype that could be replicated in other Medical colleges and Hospitals of India is described.

Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives.

BACKGROUND: Turkey hosts the world's largest community of Syrians displaced by the conflict. The Minimum Initial Service Package (MISP) is a coordinated set of priority reproductive health services. There is not any scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. The objectives of this review is to identify the situation of sexual and reproductive health (SRH) among Syrian refugee women in Turkey, and document the health services provided for them in terms of the components of MISP. We hoped to show evidence of gaps and help guide future research to focus on priority areas to improve the range, quality, and access to SRH services and to recommend public health interventions. METHOD: The literature search was conducted in Turkish and English. Multiple electronic databases (Turkish Medline, Google Scholar, PubMed, Web of Science, Medline, Cochrane Database of Systematic Reviews, EBSCOHost, CINAHL, and Embase) were searched from January 2011 to May 2018. References published in the peer-reviewed literature, the grey-literature, and on websites were eligible for inclusion if they had conducted research on one or more of the following SRH topics specifically for Syrian women in Turkey: maternal and neonatal health/antenatal care, HIV and sexually transmitted infections, use of contraceptives, sexual violence, and services delivery and accessibility. References were excluded if any of the following criteria were relevant: not specific to Syrian women refugees in Turkey. Firstly, the titles and abstracts of the articles that were found were examined to determine if they met the eligibility criteria. Secondly, if the abstracts and titles met one or more of the eligibility criteria, the full text of the articles have been examined. Finally, standard forms were prepared and used to summarize the articles narratively. The results of the screening were recorded in Excel spreadsheets for comparison, and any disagreements among the researchers were resolved by consensus. The studies were grouped according to the MISP objectives. RESULTS: A total of 24 publications were eligible for inclusion in the review. Consanguineous marriage rate was 56%. The rate of marriage under age 18 were very high. Mean age at first marriage was found to be between 18 and 20. The rate of antenatal care was inadequate. The rate of using a modern contraceptive method was 24% among married and all age groups of Syrian women. The rates of unmet family planning needs were about 35%. Among patients admitted to gynecology outpatient clinics, about half of the applicants were reported to have abnormal vaginal discharge. The reported rates of sexual violence were about 8%. Only 20% of Syrian women had regular gynecological visits. CONCLUSION: Overall, we conclude that early marriage, low modern contraceptive use, unmet need for contraception, sexual and gender-based violence are the major SRH issues reported. There is a need for further studies to identify the barriers limiting service uptake as well as to document successful practices. Long term strategies to improve the SRH status of Syrian refugee women should be developed with participation of all stakeholders. This review is significant in terms of that it is the first scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. Based on the data of this review, relevant policy makers should consider to improve the SRH status of Syrian women refugees in Turkey.

Habilitation services for children blind from retinopathy of prematurity: Health care professionals' perspective in Maharashtra.

Purpose: To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation. Methods: A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality. Results: Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum. Conclusion: Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.

Smoking Cessation and Attitudes, Belief, Observation, and Education of Medical Students, in Turkey.

INTRODUCTION: Tobacco use is an important public health problem around the world.Aim of this study is to assess attitudes,belief and observation of the students on smoking cessation and medical education. METHODS: This study is part of a multi-country study called "Global Health Profession Student Survey". The study population consisted of third year medical students in Turkey. The sample consisted of a total of 1834 medical students from randomly selected 12 medical schools. RESULTS: Of the students, 1209 (92.1%)thought that health professionals should get specific training on cessation techniques, and that health professionals should serve as "role models" for their patients and the public. The percentage of the students who answered "Health professionals should routinely advise their patients who smoke to quit smoking" was 1211 (93.3%). Of the students, 1204 (60.8%) responded that health professionals who use other tobacco products were less likely to advise patients to stop smoking. The percentage of the students who had received a formal training on smoking cessation approaches was 48.2% (1196). Of the students, 91.5% (1203) had heard of nicotine replacement therapies in tobacco cessation programs. More than half of smokers tried to quit smoking last year, and majority of them did not take professional help or advice. CONCLUSIONS: Majority of students are aware of health professionals' role on smoking cessation. Most of the students are willingness to take specific formal training on tobacco. Student's behaviours and attitudes were different by gender and smoking status.Improvement of tobacco cessation issues in medical curricula will be beneficial.

Chemical solution approaches to YBa2Cu3O7_delta-Au nanocomposite superconducting thin films.

We explore the feasibility of preparing YBa2CU3O7-Au (YBCO-Au) nanocomposite thin films by chemical solution deposition (CSD). Two approaches were used: (i) A standard in-situ methodology where Au metallorganic salts are added into the precursor solution of YBCO trifluoroacetate (TFA) salts and (ii) a novel approach where stable colloidal solutions of preformed gold nanoparticles (5-15 nm) were homogeneously mixed with TFA-YBCO solutions. A detailed analysis of the microstructure of the films showed that in both cases, there is a strong tendency of gold nanoparticles to migrate to the film surface. However the kinetics of this migration evidences important differences and in the case of preformed nanoparticles their size remains unchanged (a few nanometers) whereas for the in-situ nanocomposites gold ripening leads to large particles (hundreds of nanometers). The grown YBCO-Au films showed good superconducting characteristics (J(c) 2 MA/cm2 at 77 K) but the absence of Au inclusions inside the YBCO matrix explains the fact that no enhancement of vortex pinning was observed.

Application of magnetic separation to steelmaking slags for reclamation.

Integrated iron and steel plants generate large amounts of metallurgical slag, which usually contains some quantity of metals or mixtures of oxides that could be treated to be recycled in various applications. The conventional method for disposal of slags is dumping. However, it is possible to process the slags to be used in the production of metallic iron, or as an additive in cement making. In this study, a basic oxygen furnace (BOF) steelwork slag obtained from the Kardemir integrated iron and steel works, Karabuk, Turkey is used. A drum magnetic separator system with pre-engineered crucial processing parameters of drum revolution speed, drum radius, drum flesh thickness, and magnitude of the magnetic field applied is utilized, as these parameters have a competing influence on the results. Subsequently, the effects of slag grain size and the drum-blade gap are investigated in the separation efficiency of magnetic grains. It is found that collection of magnetic grains is improved by decreasing the grain size of slags and moreover, the collection of magnetic grains fraction is increased with an increase in the gap between the blades and drum.

Neuroethology application for the study of human temporal lobe epilepsy: from basic to applied sciences.

The aim of this investigation was to apply neuroethology to the study of human temporal lobe epilepsy (TLE). For this purpose, 42 seizures in 7 patients recorded during video/EEG monitoring (1997-1998) were analyzed by means of a behavioral glossary containing all behaviors. Video recordings were reobserved, and all patients' behaviors were annotated second-by-second. Data were analyzed using Ethomatic software and displayed as flowcharts including frequency, mean duration, and sequential statistic interaction of behavioral items (chi2 > or = 10.827, P<0.001). Flowcharts of (1) a group of seizures from a single patient, (2) the sum of four seizures per patient of two patients with right and five patients with left TLE, and (3) the comparison of left versus right TLE are shown. Well-established data in the literature were confirmed, such as aura (especially epigastric), contralateral lateralization value of dystonia and version, consciousness and language alterations in ictal and postictal periods, mostly with respect to dominant hemisphere involvement, among others. Less well established data such as awakening seizures in TLE patients, lateralization value of facial wiping (ipsilateral to the focus), statistically significant associations between behavioral pairs (dyads), and new behavioral sequences in TLE were also observed. We suggest that neuroethology also has great potential in the study of human epilepsy semiology. This work had an important role in method standardization for human epilepsy, setting the basis for the development of future clinical studies including correlation with other diagnostic methods (EEG, magnetic resonance, and SPECT). The next step will be the comparative study of seizures of patients with left and right TLE, with a greater number of patients, and the development of a digital video library.

Unusual localizations of hydatid disease.

Hydatid disease is endemic in several Mediterranean countries, posing an important health problem for these countries. The hydatid cyst is characterized by cystic lesions with clear boundaries, which can be observed in all parts of the body. Approximately 70 % of hydatid cysts are situated in the liver, followed by the lung (25 %). The kidneys, spleen, bile ducts, mesentery, soft tissue and brain are less frequent sites. We investigated patients who were treated for hydatid disease in our departments in the last 5 years with respect to localization of the disease, symptoms, surgical intervention, length of hospitalization, diameters of the cyst, and classification by Gharbi. In this retrospective and descriptive study, 176 patients are evaluated who were treated for hydatid disease between 1995 and 1999 in our departments. Of these patients, 14 were included with localization other than in the liver and lungs. Fourteen of the patients diagnosed with unusually located hydatid disease were men, six were women. Their mean age was 41.6 +/- 20.8 years; the length of hospital stay was 7.07 +/- 0.4 days. Overall, 28.6 % of patients with unusually located hydatid cyst had recurrent disease. The time period since last cyst operation was 5.25 +/- 3.5 years. The mean cyst diameter was 96.5 +/- 54.5 mm. According to Gharbi's classification, three cases (21.4 %) of the unusually located hydatid cysts were type I, two (14.3 %) type II, and eight (57.1 %) type III. There was only one case of type IV and no cases of type V. Spleen and kidneys are the organs where hydatid disease is most frequently observed after the liver and lung. It can be observed in all parts of the body including the brain, peritoneum, mesenterium, choledochus, pancreas, bone and muscles. The type of treatment is determined by the localization and type of hydatid disease. Surgical treatment for splenic hydatid cysts is splenectomy. The functional kidney should be saved in non-communicable hydatid disease. Total excision is almost never possible; endocystectomy and drainage procedure should be preferred for hydatid disease of the brain, pancreas and choledochus. Chemotherapy is usually given because of the risk of recurrence; this medical treatment consists in albendazole and mebendazole administration for 3-6 months in the postoperative period.

Lack of midazolam-induced anxiolysis in the plus-maze Trial 2 is dependent on the length of Trial 1.

The influence of the first exposure length upon the effect of midazolam (MDZ) administration prior to the second exposure in the elevated plus-maze (EPM) was investigated. Drug-free rats were assigned to freely explore the EPM for 1, 2 or 5 min (Trial 1). Twenty-four hours later, each group was subdivided in two further groups, which were retested in the EPM for 5 min, 30 min after either saline or MDZ (1.5 mg kg(-1)) administration (Trial 2). The data showed that during Trial 2, the percentage of entries (%Open arm entries) and time spent in the open arms (%Open arm time) were decreased if rats were pre-exposed to the EPM for 2- or 5-min Trial 1, while the group submitted to 1-min Trial 1 length displayed decreased %Open arm time only. The anxiolytic effect of MDZ prior to Trial 2 was present in the group submitted to 1-min, impaired in the group submitted to 2-min and absent in the group submitted to 5-min Trial 1 length. Data are analyzed taking into account the emotional learning which underlies the exploratory behavior during the EPM Trial 2.

Arsenic-related Bowen's disease, palmar keratosis, and skin cancer.

Chronic arsenical intoxication can still be found in environmental and industrial settings. Symptoms of chronic arsenic intoxication include general pigmentation or focal "raindrop" pigmentation of the skin and the appearance of hyperkeratosis of the palms of the hands and soles of the feet. In addition to arsenic-related skin diseases including keratosis, Bowen's disease, basal-cell-carcinoma, and squamous-cell carcinoma, there is also an increased risk of some internal malignancies. Arsenic-related diseases are common in areas of the world where the drinking water has a high arsenic content. In this paper, we describe a 35-year-old male patient who had arsenic-related keratosis, squamous-cell carcinoma in the palmar area of his left hand, and Bowen's disease on his left thigh. The patient worked in a borax mine for 15 years, so he was exposed to arsenic in drinking water, airborne arsenic in his workplace, and had direct contact. The patient was treated for 11 months for arsenic-related keratosis until an axillary lymph node metastasis occurred; the lesion was excised and diagnosed to be malignant. Bowen's disease was detected when the patient was being treated for cancer. No other malignancy was found. The patient is still receiving regular follow-up care.

Electrospray mass spectrometry in the structural characterization of cephalosporins.

Six cephalosporins of pharmacological interest, cephalexin, cephuroxime, cephazolin, cephoperazone sodium salt, cephatrizin free acid and cephonicid disodium salt, were analysed by electrospray mass spectrometry. [M - Na]- anions were produced in high yield in the case of cephalexin, cephuroxime, cephazolin and cephoperazone, leading to signals at least two orders of magnitude more intense than those related to [M + Na]+ cations observed in the positive ion mode. In cephatrizin, [M - H]- represented the most abundant species, whereas in cephonicid the [M - 2Na + H]- anions were easily produced. No fragment ions were detectable in the electrospray spectra of any of the compounds, and MSn turned out to be essential to draw the fragmentation patterns. Most of these patterns were related to the substituent of the 7-aminocephalosporin nucleus, suggesting that the nucleus itself is highly stable.

Negative ion electrospray ionization tandem mass spectrometry in the structural characterization of penicillins.

The mass spectrometry (MS) behaviour of ten commercially available penicillins has been studied by means of electrospray and multiple-stage MS/MS experiments performed using an ion trap instrument. For all the examined compounds negative ions are produced under ESI conditions, with a yield two or three orders of magnitude higher than that observed for positive ions. MSn experiments indicate the occurrence of a fragmentation pathway related to the beta-lactam ring, different from that usually described for positive ions of these compounds, and provide structural information on both the beta-lactam ring and the side chains.

Can postoperative abdominal wound dehiscence be predicted?

The purpose of this study was to identify risk factors in wound dehiscence and to determine which factors might be predictable. Forty patients with abdominal wound dehiscence were compared with 40 control patients standardized by sex and age. Hypoproteinemia, nausea/vomiting, fever, wound infection, abdominal distension, type of suture material, 2 or more abdominal drains, and the surgeon's experience were factors significantly associated with wound dehiscence. Emergency surgery, jaundice, ostomy, total parenteral nutrition, ascites, pulmonary morbidity, co-existence of disease, anemia, leucocytosis, and type of incision were nonsignificant variables. The number of patients with wound dehiscence increased with an increase in the number of risk factors, reaching 100% for patients with 8 risk factors. The risk factors of wound dehiscence can be predicted early and their number can be decreased before and after surgery by an experienced surgeon, leading to a lowered incidence of wound failure.

Dichotic performance in elderly Italians with Italian stop consonant-vowel stimuli.

Dichotic listening tests were carried out at various interaural onset asynchronies (from 0 to 500 ms) on normal-hearing young and elderly subjects using a free recall method. The stimuli were Italian stop consonant and vowel syllables computer-edited to reduce prevoicing of the consonant and vowel syllables from the original 100-120 ms to 30 ms. Results suggest that right-ear advantage is uninfluenced by age, despite a significantly lower total dichotic performance and abnormal lag effect in the older group.