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Main Treatment of HIV / AIDS Using conventional medicine, which is a combination of antiretroviral drugs, the main principle of ARV treatment is only to control the replication of the virus, it cannot kill the HIV viruses. In addition to conventional therapeutic modalities, people with HIV / AIDS (ODHA) often use Complementary and alternative medicine (CAM) or known as alternative and complementary medicine. The purpose of this study is to find out what are the forms and reasons for CAM in ODHA at the Kanti Sehati Sejati Foundation Jambi City. The design of this research is descriptive observational with a sampling technique that is purposive sampling. The subjects in this study were 88 respondents. The results showed that the average age characteristics of ODHA were in the range of late adulthood, the most sexes were male, the most recent education was High School, and the most occupations were private employees. The most commonly used form of CAM is prayer (98.86%), the reason most ODHA use CAM is that of additional therapy in treatment efforts (70.45%), information about CAM comes from friends (48.86%), some ODHA (82, 95%) felt a positive effect after using CAM, most (54.55%) obstacles of ODHA in implementing CAM were busy. This study shows that ODHA at the Kanti Sehati Sejati Foundation Jambi City have used CAM as an additional therapy in the treatment of HIV/AIDSPengobatan Utama Penyakit HIV/AIDS Menggunakan pengobatan konvensional yaitu kombinasi obat Antiretroviral, Prinsip utama pengobatan ARV hanya untuk mengendalikan replikasi virus, tidak dapat membunuh virus HIV. Selain modalitas terapi konvensional, orang dengan HIV/AIDS (ODHA) sering menggunakan Complementary and alternatif medicine (CAM) atau dikenal dengan pengobatan alternatif dan komplementer. Tujuan penelitian ini untuk mengetahui apa saja bentuk serta alasan CAM pada ODHA di Yayasan Kanti Sehati Sejati Kota Jambi. Desain penelitian ini adalah observasional deskriptif dengan teknik pengambilan sampel yaitu purposive sampling. Subjek dalam penelitian ini berjumlah 88 responden. Hasil penelitian menunjukkan bahwa karakteristik usia ODHA rata-rata berada dalam rentang usia dewasa akhir, jenis kelamin terbanyak yaitu laki-laki, pendidikan terakhir yaitu Sekolah Menengah Atas (SMA), dan pekerjaan terbanyak sebagai karyawan swasta. Bentuk CAM yang sering digunakan adalah doa (98,86%), Alasan kebanyakan ODHA menggunakan CAM yaitu sebagai terapi tambahan dalam upaya pengobatan (70,45%), informasi mengenai CAM berasal dari teman (48,86%), sebagian ODHA (82,95%) merasakan efek positif setelah menggunakan CAM, sebagian besar ( 54,55%) hambatan ODHA dalam menerapkan CAM adalah kesibukan. Penelitian ini menunjukkan bahwa ODHA di Yayasan Kanti Sehati Sejati Kota Jambi telah menggunakan CAM sebagai terapi tambahan dalam upaya pengobatan HIV/AIDS

Background: Although psychoactive substance use disorders (PSUDs) are a domain of mental health, addiction psychiatry is only formally recognized as a subspecialty in a few European countries, and there is no standardized training curriculum.Methods: A 76-item questionnaire was developed and disseminated through an online anonymous data-collecting system and hand-to-hand amongst psychiatric trainees from the 47 European countries of the Council of Europe plus Israel and Belarus.Results: 1,049/1,118 psychiatric trainees from 30 European countries completed the questionnaire. Fifty-nine-point nine percent of trainees stated to have training in addictions. Amongst the trainees who described having training in addictions, 43% documented a not well-structured training and 37% an unsatisfactory training, mainly due to poor acquired knowledge. Overall, 97% of trainees stated that addiction represents a core curriculum for their training. Overall, general adult psychiatric trainees reported a better knowledge in addictions, compared to trainees in child and adolescent psychiatry.Conclusion: Despite a growing spread of PSUDs in European countries, addiction psychiatry is a relatively poorly trained field within psychiatry training programs. Further research should investigate reasons for poor training and timings of the educational activities to optimize experiential education training in addiction psychiatry.

This article provides information on a comparison of elderly care systems in two regions in Indonesia with different ethnicities and cultures, namely the Minangkabau in West Sumatra and the Abui of Alor. This article shows how the saparuik kinship in the Minangkabau community which is matrilineal with different customary constellations and how the patrilineal moknehi kinship in the Abui community takes care of elderly women. This paper explains the influence of caregivers’ life journey on their burdens of life. The burden of life perceived by caregivers arises from various factors. Among the various influencing factors are emotions, economy, knowledge, kinship and the right to manage inheritance. Kinship is a form of reciprocal relationship between various elements in both Minangkabau and Abui societies. In the Minangkabau ethnic group, the smallest kinship system in society is called saparuik kinship (Minang language), while the smallest kinship system in Abui is called moknehi (Abui language) which means “brother”. Paruik can be interpreted as “stomach”. While the word moknehi, which has variants in Abui such as muknehi, mokneng and motneng, likely derives from words moku “child” and neng “male”, whose meaning is equivalent to “brother, sibling”. Literally, saparuik are people who come from the same stomach or mother, while moknehi refers to people who come from the same mother and or father. People who are in saparuik are people who come from the same grandmother, while moknehi are male brothers who come from the same grandfather, who then develop into several extended families. Both extended families in paruik or moknehi consist of several nuclear families. Likewise, saparuik and moknehi consist of several extended families. The extended family in saparuik is formed in one grandmother (not a literal grandmother, the grandmother in this case is the mother of the grandmother or the grandmother of the grandmother), in one “rumah gadang”, and sharing inheritance. Otherwise, moknehi are not only formed in one grandfather, but also male great-grandfather and great-great-grandfather (male great-grandfather and great-great-grandfather in this case are father of grandfather and grandfather of grandfather), in one clan, and sharing inheritance.

Asas legalitas merupakan dasar fundamental dalam penegakan hukum pidana, sehingga diperlukan pemahaman yang mendasar dan mendalam mengenai hal tersebut. Adapun penelitian ini bertujuan untuk memberikan potret asas legalitas dalam dua sistem hukum utama di dunia, yaitu common law dan civil law. Menggunakan pendekatan hukum normatif, data-data yang digunakan dalam penelitian ini bersumber dari bahan hukum primer, sekunder, dan tersier yang diperoleh melalui studi kepustakaan. Penelitian ini menyoroti perbedaan penerapan asas legalitas di dalam common law dan civil law. Hasilnya, dalam common law, Nulla Poena Sine Lege menjadi rumusan asas legalitas yang pada praktiknya bertumpu pada preseden hasil putusan pengadilan. Sementara dalam civil law, rumusan asas legalitasnya adalah Nullum Crimen, Nulla Poena Sine Praevia Lege Poenali, yang menitikberatkan pada peraturan tertulis dalam berbagai regulasi hukum pidana.

ABSTRACT Pseudomonas aeruginosa is an opportunistic pathogen which causes chronic, drug-resistant lung infections in cystic fibrosis (CF) patients. In this study, we explore the role of genomic diversification and evolutionary trade-offs in antimicrobial resistance (AMR) diversity within P. aeruginosa populations sourced from CF lung infections. We analyzed 300 clinical isolates from four CF patients (75 per patient) and found that genomic diversity is not a consistent indicator of phenotypic AMR diversity. Remarkably, some genetically less diverse populations showed AMR diversity comparable to those with significantly more genetic variation. We also observed that hypermutator strains frequently exhibited increased sensitivity to antimicrobials, contradicting expectations from their treatment histories. Investigating potential evolutionary trade-offs, we found no substantial evidence of collateral sensitivity among aminoglycoside, beta-lactam, or fluoroquinolone antibiotics, nor did we observe trade-offs between AMR and growth in conditions mimicking CF sputum. Our findings suggest that (i) genomic diversity is not a prerequisite for phenotypic AMR diversity, (ii) hypermutator populations may develop increased antimicrobial sensitivity under selection pressure, (iii) collateral sensitivity is not a prominent feature in CF strains, and (iv) resistance to a single antibiotic does not necessarily lead to significant fitness costs. These insights challenge prevailing assumptions about AMR evolution in chronic infections, emphasizing the complexity of bacterial adaptation during infection.IMPORTANCEUpon infection in the cystic fibrosis (CF) lung, Pseudomonas aeruginosa rapidly acquires genetic mutations, especially in genes involved in antimicrobial resistance (AMR), often resulting in diverse, treatment-resistant populations. However, the role of bacterial population diversity within the context of chronic infection is still poorly understood. In this study, we found that hypermutator strains of P. aeruginosa in the CF lung undergoing treatment with tobramycin evolved increased sensitivity to tobramycin relative to non-hypermutators within the same population. This finding suggests that antimicrobial treatment may only exert weak selection pressure on P. aeruginosa populations in the CF lung. We further found no evidence for collateral sensitivity in these clinical populations, suggesting that collateral sensitivity may not be a robust, naturally occurring phenomenon for this microbe.

Background: Coronavirus disease 2019 (COVID-19) pandemic raised an immediate demand for skilled workforce in hospitals. There is limited literature related to perspectives of trainers in this unprecedented situation. This study aimed to examine lived experience of trainers while delivering training to a large number of participants in a challenging situation with the fear of contracting the infection themselves. Methods: A qualitative, phenomenological research was conducted in a tertiary care training centre among 21 trainers who trained 8417 healthcare personnel. Data was collected through Google Forms, which consisted of open-ended questions. Thematic analysis was done using MAXQDA software. Three themes and nine subthemes related to the teaching–learning method, administrative support, and challenges faced by the trainers were extracted. Results: Participants included nurses, nursing tutors, resident doctors, and faculty from nursing and medical specialities. Classroom teaching strategies with demonstration, simulation & hands-on training, and even virtual demonstrations were favoured as the effective teaching methods and modes. Well-planned modules, availability of infrastructure and advanced supporting software facilitated training sessions. Hands-on skill assessment was favoured as the best evaluation method. Trainers also expressed various challenges faced in planning and executing the training. Conclusion: A meticulous planning of preparedness training based on the understanding level of participants and their scope of work led to feasible and fast large-scale capacity building of healthcare professionals during COVID-19 pandemic. Diverse educational methods, as per demand of situations, online training, and in-person hands-on techniques via simulation lead to more responsive delivery of training and learning than a single method.

Background: Pregnant women's understanding of maternal health information is critical in the application of information for pregnancy care, birth preparedness, and newborn care. However, the influence of socio-demographic characteristics on pregnant women's understanding of maternal health information is least understood. Purpose: The study examined the influence of social and demographic characteristics on pregnant women's comprehension of maternal health information. Methodology: A mixed research approach and descriptive cross-sectional design were applied. Questionnaires and focus group discussions were used to collect data from 132 pregnant women and 8 nurses/midwives. Data were analyzed using IBM SPSS version 21 and thematic analysis. Findings: Most of the pregnant women had a good ability to comprehend maternal health information. Level of education was found to influence the reading ability and language understanding ability of the pregnant women unlike age, marital status, income, and occupation. Age, level of education, monthly income, occupation, and marital status were found to influence the ability of pregnant women to understand maternal health information. Conclusion: The socio-demographic characteristics of pregnant women have an influence on their ability to comprehend maternal health information.

Background: The nursing process is an important tool that has transformed the standards of nursing practices. Application of the nursing process required proper training, guidelines and resources to be used by the nurses. Aim: The objective of this study was to assess the knowledge and practice of nursing process among nurses and explore factors influencing its applications by nurses. Methods: An exploratory, descriptive study was conducted among 210 nurses using a simple random sampling technique. A pre-designed, self-structured questionnaire on knowledge and practice of nurses regarding nursing process and factors influencing its application were used to collect data. The data were analysed using descriptive and inferential statistics. Results: Most of the nurses were female (60.5%), had General Nursing and Midwifery (76.2%) as professional education, working in general medicine units (52.5%) and had more than 5 years of professional experience. The mean knowledge and practice score regarding nursing process were 13.93 ± 5.204 and 6.51 ± 0.96, respectively. Major hindering factors were the absence of a format for recording nursing process, poor nurse–patient ratio and excessive workload and never attended in-service education on the nursing process. Many nurses reported working in a stressful environment and were dissatisfied due to excessive clerical paperwork. Conclusion: The majority of nurses had average knowledge of nursing process, but they were not practicing. Certain factors such as no format, in-service education and equipment supplies affected the nursing process application in clinical areas. Hence, it is recommended to modify the above factors for proper application of nursing process.

Penelitian ditujukan untuk menganalisis lebih mendalam tentang umur konstruksi secara normatif dengan menjadikan objek analisisnya berupa Surat Perjanjian Kerja (Kontrak) No. 012/SP-Kontrak/PPK/BM-I/DPU-PR/LS/2017, tertanggal 09 Agustus 2017 antara Dinas Pekerjaan Umum dan Penataan Ruang Kabupaten Labuhanbatu Selatan TA. 2017 dengan CV. Karya Jasa Utama. Surat Perjanjian Kerja (Kontrak) tersebut tidak mencantumkan klausula “rencana umur konstruksi” sebagaimana diwajibkan Pasal 65 UU Jasa Konstruksi jo. Pasal 86 Peraturan Pemerintah RI No. 22 Tahun 2020 tentang Peraturan Pelaksanaan UU Jasa Konstruksi. Berbagai masalah hukum yang menjadi perhatian penelitian ini meliputi kewajiban pencantuman rencana umur konstruksi dalam kontrak konstruksi dan konsekwensi hukumnya serta pertanggungjawabannya. Penelitian dilaksanakan dengan menggunakan metode penelitian hukum normatif dan didukung data empiris. Tehnik pengumpulan data menggunakan studi pustaka dan studi lapangan di Dinas PPR Kabupaten Labuhanbatu Selatan. Analisis data dilakukan dengan kualitatif, dengan hasil penelitian menyimpulkan bahwa kontrak kerja konstruksi sebagai perjanjian privat berdimensi publik mewajibkan Penyedia Jasa (Kontraktor) dan Pengguna Jasa untuk mencantumkan klausula rencana umur konstruksi dalam kontrak.

Setiap Negara bebas untuk melakukan kerjasama dalam bidang perdagangan dengan Negara mana pun guna meningkatkan perekonomiannya yang didasarkan pada kesepakatan World Trade Organization (WTO). Indonesia sebagai Negara anggota WTO juga telah mengikuti berbagai perjanjian perdagangan internasional baik yang bersifat bilateral maupun multilateral, salah satunya adalah Asean-China Free Trade Agreement (ACFTA). Banyaknya produk China yang masuk ke pasar Indonesia membuat Pemerintah Indonesia harus menjaga kepentingan nasional dengan memberlakukan standardisasi melalui Standar Nasional Indonesia (SNI). Penelitian ini membahas tentang bagaimana standar internasional atas produk barang dalam kerangka kesepakatan WTO, bagaimana kebijakan pemerintah tentang standardisasi barang dalam menghadapi ACFTA, dan bagaimana harmonisasi SNI dengan standar internasional berdasarkan kesepakatan WTO dalam rangka ACFTA. Penelitian ini merupakan penelitian yuridis normatif dengan menggunakan data sekunder dengan pendekatan peraturan perundang-undangan (statute approach) yang dianalisis melalui analisis kualitatif. Standar internasional atas barang melalui kesepakatan WTO kaitannya dengan ACFTA mengacu kepada perjanjian internasional yang telah disepakati melalui kesepakatan WTO yakni Agreement on the Application of Sanitary and Phyto-sanitary Measures (SPS) dan Agreement on Technical Barriers To Trade (TBT). Kebijakan Pemerintah Republik Indonesia tentang standardisasi barang dalam menyikapi ACFTA yakni membuat Undang-Undang mengenai Standardisasi dan Penilaian Kesesuaian Nomor 20 Tahun 2014 serta melakukan kerjasama dengan lembaga eksternal. Harmonisasi SNI dengan standar internasional dilakukan dengan menerapkan prinsip-prinsip Technical Barriers to Trade baik melalui adopsi maupun modifikasi.

Introduction: Immunization is one of the most substantial contributions from the medical field to human beings as a low-cost intervention to prevent major illnesses that contribute to the mortality of children in developing countries like India. Parent’s knowledge plays a vital role in determining the health status of children. Purpose of the study: To assess knowledge, attitude, and compliance of immunization, and explore barriers of immunization among parents of under-five children. Methodology: A cross-sectional study was conducted among 200 parents of under-five children at selected government hospitals in Dehradun district. Study participants were selected by consecutive sampling technique, and data were collected using pre-tested, structured questionnaires. The data was analyzed using descriptive and inferential statistics. Results: Of 200, 39 (19.5%) parents reported that their child was not vaccinated as per schedule. A vast proportion (84.5%) of parents had an average to good level of knowledge regarding under-five immunization. Out of ten components of attitude, most of the parents had agreed in favor of vaccination. The most common barriers of compliance reported by parents were: unaware of the next scheduled doses, illness in family, and absence of vaccine at health centre. Conclusion: Most of the parents of the under-five child had basic knowledge and positive attitude regarding immunization, but the compliance rate for immunization was not 100%. We recommend that health agencies must develop multiple education interventions regarding immunization and periodic reminders for scheduled vaccination for their child. Also, concerned authorities should consider feedback and resolve the issues of parents appropriately.

Background: Many women face disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment violates women's rights to respectful care and jeopardizes their rights to life, health, bodily integrity, and equality. This study aims at identifying the status of respectful maternity care (RMC) in selected hospitals in Rishikesh. Material and Methods: A mixed-method approach was adopted to explore RMC during normal vaginal delivery in a selected hospital in Rishikesh, Uttarakhand. In the quantitative part, 145 women were purposively selected, and data were collected by a pre-structured, validated RMC checklist, developed based on WHO RMC standards. Qualitative data were collected from 18 women, and a face-to-face semi-structured interview was conducted. Results: Forty-two elements of RMC categorized under eight domains show the type of mistreatment and its prevalence faced by women at a health care facility. Data showed that domain-7 (availability of competent and motivated human resources) had higher scoring (95%), and on the other hand, domain-4 (informed consent and effective communication) got lowest-scoring (68.45%). The overall mean percentage score of RMC was 85.68%. There was no statistically significant association between the total score of RMC and the selected socio-demographic variables. Conclusion: The overall RMC score was high, and there was no significant association with mothers' socio-demographic variables. The majority of mothers expressed that competent and motivated professionals were available during their delivery, but their communication skills were found to be lacking.

The use of simulation is a unique teaching–learning approach in medical and nursing education to empower undergraduates with desired clinical skills. Simulation duplicates the events from the real world and influences the learner in a naturalistic setup and evokes a real experience to the learner. This method of learning facilitates students to practice multiple times to attain proficiency in a particular technique without compromising on patient safety. They can rely on simulation exercises in clinical skill laboratories (CSL), which boost their confidence level, reduce anxiety, and promote satisfaction before performing or dealing in real clinical settings. Simulation has been widely used for formative evaluation and is a reliable assessment tool as it ensures a high level of objectivity. The simulation-based approach in undergraduate medical and nursing education is an effective way of learning that can be incorporated into the educational strategy. This article presents the evolutionary growth, modalities, prerequisites, usefulness, and challenges for simulation-based learning.

This special article is a continuation of an annual series for the Journal of Cardiothoracic and Vascular Anesthesia , highlighting the latest developments in the field of electrophysiology, particularly concerning cardiac anesthesiologists. The selected topics in the specialty for 2023 include consensus statements on left atrial appendage closure, outcomes in patients with atrial fibrillation and heart failure after ablation, further developments in the field of pulse field ablation, alternate defibrillation strategies for refractory ventricular fibrillation, updates on conduction system pacing, new devices such as the Aurora EV system and AVEIR leadless pacemaker system, artificial intelligence and its use in electrocardiogram-based diagnosis and latest evidence regarding the impact of anesthetic techniques on patient outcomes undergoing electrophysiology procedures. [ABSTRACT FROM AUTHOR]

In a rapidly changing context, US institutions of higher education are struggling amidst myriad pressures related, for example, to funding, accountability, standardisation and technology. In particular, pressures on 'progressive' or non-traditional colleges are immense. These schools, which have historically emphasised individualised, student-centred pedagogy, access and diversity, experimentation and a commitment to social justice, are in danger of losing their distinctive vision as the challenges they face have undermined their practices and thrown into question their identity, if not their survival. This essay argues, first, that if progressive institutions are to sustain their distinctive approach, they must not succumb to demands that drive them towards the conventional, but rather must use these challenges to renew their practice; second, that they must examine creative tensions, the perennial questions that reflect a generative interplay between competing values; and, third, that they must remain mindful of the principles undergirding their progressive vision. Mining these tensions as opportunities for grappling with the pressures at hand, the essay provides examples of possibilities for progressive change. Instead of slipping into the conventional or succumbing to despair, the essay shows that we can respond creatively to the challenges all higher education and especially progressive institutions face today.

Intensive farming in highland sloping land can lead to more frequent soil erosion, thus exacerbating soil deterioration. Good agricultural practices on sloping land can prevent soil degradation. This study aimed to identify soil properties within transects consisting of the shoulder slope (forest) and upper and lower slopes (agricultural field) in steep slope ranges between 25 – 40%. The study area was located in Sumberejo village, Banjarnegara Regency, Indonesia, with young coffee tree intercropping carrot land use previously planted with horticulture crops. The result showed that the concentration of potential P and K, pH, N, exchangeable cation (Ca, Mg, K), and CEC within the transect in sloping land resulted in higher concentration in the upper and lower slope than shoulder slope because agriculture area got influence from fertilizer application. Higher soil organic carbon content and dehydrogenase enzyme also lower bulk density value in shoulder slope because the forest had undisturbed condition. This study informs that agricultural activities influence soil characteristics. Implementing proper land management on sloping lands can reduce soil degradation and mitigate the effects of climate change.

Porcine parvovirus 1 (PPV1) is recognized as a major cause of reproductive failure in pigs, leading to several clinical outcomes globally known as SMEDI. Despite being known since the late 1960s its circulation is still of relevance to swine producers. Additionally, the emergence of variants such as the virulent 27a strain, for which lower protection induced by vaccines has been demonstrated, is of increasing concern. Even though constant monitoring of PPV1 using molecular epidemiological approaches is of pivotal importance, viral sequence data are scarce especially in low-income countries. To fill this gap, a collection of 71 partial VP2 sequences originating from eight African countries (Burkina Faso, Côte d’Ivoire, Kenya, Mozambique, Namibia, Nigeria, Senegal, and Tanzania) during the period 2011–2021 were analyzed within the context of global PPV1 variability. The observed pattern largely reflected what has been observed in high-income regions, i.e., 27a-like strains were more frequently detected than less virulent NADL-8-like strains. A phylogeographic analysis supported this observation, highlighting that the African scenario has been largely shaped by multiple PPV1 importation events from other continents, especially Europe and Asia. The existence of such an international movement coupled with the circulation of potential vaccine-escape variants requires the careful evaluation of the control strategies to prevent new strain introduction and persistence.

# Background The public is hesitant about getting vaccinated for COVID-19, and a few people are still avoiding it. The aim of this study was to evaluate the attitude towards COVID-19 vaccination among rural and urban populations of the Dehradun district in Uttarakhand, India. # Materials and methods A cross-sectional survey was conducted from April to June 2021 in selected urban and rural areas of the Dehradun district, yielding 770 responses (385 from both rural and urban areas). The attitudes towards COVID-19 vaccination were collected via questionnaire and analysed using descriptive and inferential statistics. # Results There were no rural-urban differences in the mean score of attitude towards COVID-19 vaccination (49.22±12.89 vs 50.01 ±11.88; P=0.379). The majority of participants had a neutral to positive attitude, and very few had a negative attitude towards COVID-19 vaccination, equally in the rural and urban population. A significant positive association was found between attitude scores with COVID-19 vaccination and mortality among participant's relatives and friends in rural areas, while participant occupation and number of family members in the urban area were associated with a more positive attitude. # Conclusion These results suggest mainly neutral attitude among the rural and urban populations towards COVID-19 vaccination. Therefore, it is important to design and implement innovative and efficient communication strategies to influence the neutral and offset the negative attitudes regarding vaccination drive to facilitate immunisation outreach and coverage.

BACKGROUND: Urinary tract infections (UTIs) are more common in females than males and predominantly based on their unhealthy practices in their day to day lives. This study is trying to assess the occurrence of UTI and strategies used by female student to prevent UTI. MATERIALS AND METHODS: A cross-sectional descriptive study carried out in a tertiary care teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students were surveyed. The data were collected by using a pretested, a self-structured questionnaire related to occurrence and practices to prevent UTI along with necessary demographic details. Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi-square test) statistics was used to compute the data. RESULTS: The result of this study shows that 10.05% female students reported of having UTI. The proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with Tea Tree Oil, soap, drinking 3–4 l water/day, increased frequency of peri-wash during menstruation period, and use of Citrus Fruits. The use of western toilet was also significantly associated with status of UTI (P = 0.04). CONCLUSION: The occurrence of UTI was more among nursing students. Most of the perineal hygienic practices by the female students were associated with occurrence of UTI; hence, it is necessary to emphasize on preventive practices to minimize re-occurrence.

This special article is the fifth in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors would like to thank the Editor-in-Chief, Dr Kaplan, the Associate Editor-in-Chief, Dr Augoustides, and the editorial board for the opportunity to author this series, which summarizes the key research papers in the electrophysiology (EP) field relevant to cardiothoracic and vascular anesthesiologists. These articles are shaping perioperative EP procedures and practices, such as pulsed-field ablation, cryoablation for first-line treatment for atrial fibrillation, advancements in conduction system pacing, safety issues related to smartphones and cardiac implantable electronic devices, and alterations in EP workflow as the world emerges from the COVID-19 pandemic. Special emphasis is placed on the implications of these advancements for the anesthetic care of patients undergoing EP procedures. [ABSTRACT FROM AUTHOR]

Like in many other African countries, pig production is increasing in Tanzania. To support farmers and stakeholders, it is important to increase our understanding of porcine pathogens present in the country. Currently, little is known about the circulation of porcine circovirus-2 (PCV-2) and porcine circovirus-3 (PCV-3). For this reason, samples from 124 pigs collected throughout the country between 2018 to 2022 were screened by PCR for the presence of PCV-2 and PCV-3. Sequencing and phylogenetic analysis of positive amplicons identified two PCV-2 genotypes (a and d). Limited genetic heterogenicity was observed among the PCV-3. This study provides important data on pathogens present in pigs in Tanzania and should be of use veterinary authorities involved in porcine disease management. [ABSTRACT FROM AUTHOR]

India is trying to achieve the target of sustainable development goals of reducing maternal mortality ratio to 70/1,00,000 live births by the year 2030. The maternal mortality in Uttarakhand is 89/100,000 live birth (2015–2017), against the national average of 122. Daley in the care during the labour process, poor transport system, and inadequate health care facilities for maternal care leading to maternal and infant mortality are not well understood, including other contributing factors. In Uttarakhand, maternal haemorrhage (22.9%), eclampsia (14.6%), sepsis (10.6%), rupture of the uterus (6.2%), ectopic pregnancy (2.1%), and pulmonary embolism (2.1%) were the direct causes for maternal mortality; the indirect causes were anaemia (16.6%), jaundice (12.5%), heart diseases during pregnancy (6.2%), and other communicable diseases (6.3%). Age at pregnancy, not having health schemes, health care accessibility, presence of complications, and residing in a rural area were additional risk factors. Being multigravida adds to a higher risk for women to die (66.7%). Common causes of neonatal mortality were birth asphyxia (20.4%) and preterm birth (15.4%), whereas pneumonia (26.1%), septicaemia (12.5%), diarrhoeal and acute gastroenteritis (19%) were common causes for post-neonatal deaths. It was also reported that prematurity with respiratory distress syndrome (37.7%), septicaemia (16.8%), and perinatal asphyxia (13.9%) were the leading causes in Uttarakhand, while neonatal seizures (3.54%), congenital anomalies (3.23%), intrauterine growth restriction (IUGR) (2.6%), and neonatal jaundice (2.3%) were fewer common causes reported. Multidirectional contributing factors had been reported for maternal and infant mortality, so it needs a multidimensional approach to address the issue. [ABSTRACT FROM AUTHOR]

Delirium is a common postoperative complication associated with death and long-term cognitive impairment. The authors studied the association between opioid-sparing anesthetics, incorporating Enhanced Recovery After Cardiac Surgery (ERACS)-guided analgesics and postoperative delirium. The authors performed a retrospective review of nonemergent coronary, valve, or ascending aorta surgery patients. A tertiary academic medical institution. The study authors analyzed a dataset of elective adult cardiac surgical patients. All patients ≥18 years undergoing elective cardiac surgery from November 2, 2017 until February 2, 2021 were eligible for inclusion. The ERACS-guided multimodal pain regimen included preoperative oral acetaminophen and gabapentin, and intraoperative intravenous lidocaine, ketamine, and dexmedetomidine. Delirium was measured by bedside nurses using the Confusion Assessment Method for the intensive care unit (ICU). Delirium occurred in 220 of the 1,675 patients (13.7%). The use of any component of the multimodal pain regimen was not associated with delirium (odds ratio [OR]: 0.85 [95% CI: 0.63-1.16]). Individually, acetaminophen was associated with reduced odds of delirium (OR: 0.60 [95% CI: 0.37-0.95]). Gabapentin (OR: 1.36 [95% CI: 0.97-2.21]), lidocaine (OR: 0.86 [95% CI: 0.53-1.37]), ketamine (OR: 1.15 [95% CI: 0.72-1.83]), and dexmedetomidine (OR: 0.79 [95% CI: 0.46-1.31]) were not individually associated with postoperative delirium. Individual ERACS elements were associated with secondary outcomes of hospital length of stay, ICU duration, postoperative opioid administration, and postoperative intubation duration. The use of an opioid-sparing perioperative ERACS pain regimen was not associated with reduced postoperative delirium, opioid consumption, or additional poor outcomes. Individually, acetaminophen was associated with reduced delirium. [ABSTRACT FROM AUTHOR]

Background and purpose: The objective of this article is to create guidelines for education interventions in the management of patients ([greater than] 18 years old) with rheumatoid arthritis (RA). Methods: The Ottawa Methods Group identified and synthesized evidence from comparative controlled trials using Cochrane Collaboration methods. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with validated and reliable scales. Results: Sixty-four positive recommendations of clinical benefit (35 of A level and 29 of C+ level) were developed for patient education in RA. Discussion and conclusion: For the management of rheumatoid arthritis, the use of patient education is recommended by the Ottawa Panel. (Contains 2 figures and 3 tables.)