Foot self-care practices among diabetic patients attending a teaching hospital in Tamil Nadu, India.

Introduction: Diabetes is a common non-communicable disease in the world. Diabetic foot ulcer is a common complication of diabetes mellitus. Awareness and practice of foot self-care play a major role in the prevention of complications due to diabetic neuropathy. Methods: Descriptive cross-sectional study was conducted among diabetic patients from Sep 2022 to Feb 2023. A semi-structured questionnaire containing four parts including socio-demographic including clinical details, questions related to knowledge and practice of foot self-care, and clinical examination was used. Ten grams monofilament and 128 Hz tuning fork were used to assess the sensation of the foot. Results: A total of 211 patients were included. The average age was found to be 58.4 ± 10.0 years and the majority were females (64.0%). The mean percentage score of knowledge on diabetes and foot self-care was found to be 59.6 ± 27.5 and 55.1 ± 11.9, respectively. Participants with low knowledge scores and those who do not engage in regular physical activity had significant poor foot care practices. The majority (54.5%) of the participants had at least one of the clinical problems related to diabetic foot. The most common problem was found to be heel fissures (29.4%), followed by deformed nails (15.2%), callus (5.2%), toe web infection (3.3%), and ulcer (2.8%). Monofilament test and vibration was not detectable in 12.3% and 15.2%, respectively. Conclusion: More than half of the participants were found to have good diabetic foot self-care practices. Diabetics having good knowledge on foot care and involving in regular physical activity showed good foot self-care practices.

Fit-testing of respiratory protective equipment in the UK during the initial response to the COVID-19 pandemic.

BACKGROUND: Public Health England guidance stipulates the use of filtering facepiece (FFP3) masks for healthcare workers engaged in aerosol-generating procedures. Mask fit-testing of respiratory protective equipment is essential to protect healthcare workers from aerosolized particles. AIM: To analyse the outcome of mask fit-testing across National Health Service (NHS) hospitals in the UK during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Using the Freedom of Information Act, 137 NHS hospitals were approached on May 26th, 2020 by an independent researcher to provide data on the outcome of fit-testing at each site. FINDINGS: Ninety-six hospitals responded to the request between May 26th, 2020 to October 29th, 2020. There was a total of 86 mask types used across 56 hospitals, 13 of which were used in at least 10% of these hospitals; the most frequently used was the FFP3M1863, used by 92.86% of hospitals. Overall fit-testing pass rates were provided by 32 hospitals with mean pass rate of 80.74%. The most successful masks, in terms of fit-test failure rates, were the Alpha Solway 3030V and the Alpha Solway S-3V (both reporting mean fit-test failures of 2%). Male- and female-specific pass and failure rates were provided by seven hospitals. Across the seven hospitals, 20.1% of men tested failed the fit-test for all masks used, whereas 19.9% of women tested failed the fit-test for all masks used. Failure rates were significantly higher in staff from Black, Asian, and Minority Ethnic (BAME) backgrounds 644/2507 (25.69%) across four hospitals. CONCLUSION: Twenty percent of healthcare workers tested during the first response to the pandemic failed fit-testing for masks. A small sample revealed that this was most prominent in staff from BAME backgrounds.

A new algorithm to find fuzzy Hamilton cycle in a fuzzy network using adjacency matrix and minimum vertex degree.

A Hamiltonian cycle in a graph is a cycle that visits each node/vertex exactly once. A graph containing a Hamiltonian cycle is called a Hamiltonian graph. There have been several researches to find the number of Hamiltonian cycles of a Hamilton graph. As the number of vertices and edges grow, it becomes very difficult to keep track of all the different ways through which the vertices are connected. Hence, analysis of large graphs can be efficiently done with the assistance of a computer system that interprets graphs as matrices. And, of course, a good and well written algorithm will expedite the analysis even faster. The most convenient way to quickly test whether there is an edge between two vertices is to represent graphs using adjacent matrices. In this paper, a new algorithm is proposed to find fuzzy Hamiltonian cycle using adjacency matrix and the degree of the vertices of a fuzzy graph. A fuzzy graph structure is also modeled to illustrate the proposed algorithms with the selected air network of Indigo airlines.

The PARP family: insights into functional aspects of poly (ADP-ribose) polymerase-1 in cell growth and survival.

PARP family members can be found spread across all domains and continue to be essential molecules from lower to higher eukaryotes. Poly (ADP-ribose) polymerase 1 (PARP-1), newly termed ADP-ribosyltransferase D-type 1 (ARTD1), is a ubiquitously expressed ADP-ribosyltransferase (ART) enzyme involved in key cellular processes such as DNA repair and cell death. This review assesses current developments in PARP-1 biology and activation signals for PARP-1, other than conventional DNA damage activation. Moreover, many essential functions of PARP-1 still remain elusive. PARP-1 is found to be involved in a myriad of cellular events via conservation of genomic integrity, chromatin dynamics and transcriptional regulation. This article briefly focuses on its other equally important overlooked functions during growth, metabolic regulation, spermatogenesis, embryogenesis, epigenetics and differentiation. Understanding the role of PARP-1, its multidimensional regulatory mechanisms in the cell and its dysregulation resulting in diseased states, will help in harnessing its true therapeutic potential.

Antibacterial Effect of Curcuma longa (Turmeric) Against Staphylococcus aureus and Escherichia coli.

This observational study was conducted during the period from July 2010 to June 2011 in the Department of Pharmacology in the collaboration of Department of Microbiology, Mymensingh Medical College, Mymensingh to determine the profile of antibacterial effect of Crude Turmeric paste aqueous turmeric extract, and standard antibiotic Amikacin against Staphylococcus aureus and Escherichia coli. Three separate experiments were done e.g. (Expt- I) Inhibitory effect of Crude Turmeric paste incorporated into nutrient agar (NA) media, (Expt- II) Minimum inhibitory concentration of (a) Aqueous Turmeric extract and (b) Amikacin by broth dilution technique and (Expt-III) their subculture study in nutrient agar (NA) media for confirmation of respective results of previous experiments. Inhibitory effects were observed against the growth of Staph Aureus and Esch coli at 10% and 30% respectively of Crude Turmeric paste incorporated into NA media. The broth dilution technique was followed to determine the MIC of Aqueous Turmeric extract and Amikacin. The MIC of Aqueous Turmeric extract was 800 µg/ml against Staph aureus and that against Esch coli was 2000 µg/ml and the MIC of Amikacin was 10 µg/ml for both the bacteria. The MIC of Amikacin was the lowest in comparison to MIC of Aqueous Turmeric extract for complete inhibition of growth of Staph aureus and Esch coli. The subculture study showed similar results with that of previous experiments in terms of inhibitory effects of Crude Turmeric paste and MIC of Aqueous Turmeric extract and Amikacin against all of the organisms studied.

Cost recovery beds in public hospitals in Indonesia.

A policy of allowing public hospitals to provide some better quality, higher priced hospital beds for those able to pay was introduced as government policy in Indonesia after 1993. A study was conducted in 1998 in three public hospitals in East Java to investigate if the policy objective of cost-recovery was being achieved. Hospital revenue from these commercial beds was less than both the recurrent and total costs of providing them in all three hospitals, but exceeded recurrent costs minus staff salaries in two hospitals. One reason for the low cost-recovery ratios was that between 55% and 66% of the revenue was used as staff incentives, mostly to doctors. This was more than the maximum of 40% stipulated in the policy. The high proportions of total revenue going to staff were a result of hospital management having set bed fees too low. The policy may be contributing to the retention of doctors within public sector employment; however, it is not achieving its stated objective, especially over the longer term where full recovery of salaries and investment costs needs to be considered. Public hospitals that wish to invest in commercial beds need effective management and accounting systems so as to be able to monitor and control costs and set fees at levels that recoup the costs incurred. Further research is required to determine if this form of public-private mix has negative effects on equity and access for poorer patients.

Ankle clonus and thiocyanate, linamarin, and inorganic sulphate excretion in school children in communities with Konzo, Mozambique.

We examined 397 school children for ankle clonus in five communities in three districts affected by konzo, spastic paraparesis associated with cassava consumption. From a subsample of 131 children, we analysed urine specimens for urinary thiocyanate, linamarin, and inorganic sulphate. The proportion of children with clonus varied between sites, ranging from 4 to 22 per cent. Geometric mean thiocyanate, linamarin, and inorganic sulphate concentrations were 163 and 60 mumol/l and 4.4 mmol/l, respectively. Children with ankle clonus had higher urinary thiocyanate concentrations. We recommend prevention to reduce cyanide exposure and further monitoring of cyanide exposure and neurological damage in these communities.

Improving quality in public sector hospitals in Indonesia.

Indonesia has successfully expanded its health system to improve access and quality of care for the population, promote equity, and expand primary health care. More recently, it has sought to undertake policy initiatives to promote involvement of the private sector and to introduce both incentives for efficiency and payment mechanisms which will increase sustainability. Certain public health sector facilities have been given financial autonomy to set prices, introduce and retain user fees, and promote prepayment mechanisms. The autonomous hospitals, Unit Swadana hospitals, have increased revenue sustainability while promoting quality assurance practices. The managers of these hospitals have become adept at introducing business practices into the hospital's operations to promote efficiency. These have attracted private investors to invest in public hospitals.

The role of clinical vignettes in rapid ethnographic research: a folk taxonomy of diarrhoea in Thailand.

This paper presents the findings of a rapid ethnographic research methodology used to investigate the beliefs and practices of rural mothers and grandmothers concerning diarrhoeal diseases in children under five years of age in Khon Kaen Province, Northeast Thailand. The multi-phase study used a combination of focus groups and clinical vignettes, semi-formal questionnaires and open-ended interviews. The efficiency of the combination of focus groups and clinical vignettes in obtaining an understanding of the important areas of belief in a short period of time is discussed, as well as the importance of quantifying and validating this information using other methodologies. A folk taxonomy of diarrhoea and its management is presented, and the implications of this for health planners is discussed. Most diarrhoea in children under one year is perceived to be su, a normal developmental stage which requires no treatment. As su is not considered to be diarrhoea, health messages concerning diarrhoea are not considered by care-givers. The labelling of a child with diarrhoea as having su results in a delay in help-seeking, a risk factor for dehydration. Thus su needs to be taken into consideration in health education campaigns. The informants demonstrated little understanding of the role of infection in diarrhoea, nor of the role of personal and domestic hygiene for its prevention, nor of the place and function of ORS, highlighting important areas where education is still necessary.

Clinical evaluation of encephalitis.

A series of 325 or 31.11% children out of 1045 inpatients of neurological cases diagnosed as encephalitis was reviewed in Pediatrics Neurology Subdivision Child Health Department, Medical School, University of North Sumatera/Dr. Pirngadi Hospital Medan since 1985 to 1988. Boys were more than girls with the ratio of 4:3. Most encephalitis cases (249 or 76.80%) of children occurred in the early age namely before 3 years. Associated diseases were respiratory disease in 61 (45.61%) cases, gastrointestinal disease in 48 (34.67%) cases and measles in 13 (9.35%) cases. There were three mayor clinical features of encephalitis i.e. sudden fever, convulsion and consciousness depression. The cerebrospinal fluid investigation might be normal. There was however mild to moderate lymphocitic pleiositosis with cell numbers varying from 20-200 per cubic mm. The protein content was slightly elevated. The mortality rate was 21.53% (70 cases). There was no significant difference (P greater than 0.05) found between mortality rate of boys and girls. There was no significant difference (P greater than 0.05) found between mortality rate below and above 3 years of age.

The costs of public primary health care services in rural Indonesia.

Described are the results of a cost study of national rural health services carried out in Indonesia between November 1986 and March 1987. Detailed costings of government inputs to all public health services below the district hospital level were made for 41 subdistricts in five provinces that were representative of the different regions of the country. The total costs of services as well as the average costs for specific service functions were estimated for the whole country as well as for the different provinces. The results indicate a low overall level of government spending on rural primary health care. Regional differences in this respect were not significant, suggesting that the government policy of encouraging regional balance in allocations has been successful. The average costs for most services were much greater than the charges made to patients, and this provided information on the current level of government subsidies. There was a large variability in the average costs, indicating that the existing system is inefficient, that some districts were able to attain much higher levels of efficiency than others within the existing constraints, and that improvements in this respect are possible.

PIP: Described are the results of a cost study of national rural health services carried out in Indonesia between November 1986-March 1987. Detailed costings of government inputs to all public health services below the district hospital level were made for 41 subdistricts in 5 provinces that were representative of the different regions of the country. The total costs of services as well as the average costs for specific service functions were estimated for the whole country as well as for the different provinces. The results indicate a low overall level of government spending on rural primary healthcare. Regional differences in this respect were not significant, suggesting that the government policy of encouraging regional balance in allocations has been successful. The average costs for most services were much greater than the charges made to patients, and this provided information on the current level of government subsidies. There was a large variability in the average costs, indicating that the existing system is inefficient, that some districts were able to attain much higher levels of efficiency than others within the existing constraints, and that improvements in this respect are possible. (author's)

The cost of public primary health care services in rural Indonesia

Described are the results of a cost study of national rural health services carried out in Indonesia between November 1986 and March 1987. Detailed costings of government inputs to all public health services below the district hospital level were made for 41 subdistricts in five provinces that were representative of the different regions of the country. The total costs of services as well as the average costs for specific service functions were estimated for the whole country as well as for the different provinces

The results indicate a low overal level of government spending on rural primary health care. Regional differences in this respect were not significant, suggesting that the government policy of encouraging regional balance in allocations has been successful. The average costs for most services were much greater that the charges made to patients, and this provided information on the current level of government subsidies. There was a large variability in the average costs, indicating that the existing system is inefficient, that some districts were able to attain much higher levels of efficiency than others within the existing constraints, and that improvements in this respect are possible(AU)