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Objective: Social determinants of health (SDH) have been shown to correlate with adverse cancer outcomes. It is unclear if their impact goes beyond behavioral risk or healthcare access. We aimed to evaluate the association of SDH with endometrial cancer outcomes in a public healthcare system. Design and Setting: A retrospective cohort study of endometrial cancer patients in Ontario, Canada. Population: Women diagnosed with endometrial cancer in Ontario between 2009-2017. Methods: Clinical and sociodemographic variables were extracted from administrative databases. Validated marginalization scores for material deprivation, residential instability and ethnic concentration were used. Associations between marginalization and survival were evaluated using log-rank testing and Cox proportional hazards regression. Results: 20228 women with endometrial cancer were identified. Fewer patients in marginalized communities presented with early disease (70% vs. 76%, p

Introduction: Road traffic injuries and deaths caused by motor vehicles is a growing public health problem all over the world. Head injury and blunt abdominal trauma are major health problems and are frequent causes of death among Road Traffic Accident (RTA) victims. Methods: A total of 348 cases were examined in Emergency department and the Department of Forensic Medicine and Toxicology at B.P Koirala Institute of Health Sciences, Dharan during the period of one year. Data were collected using proforma and analyzed using Statistical Package for Social Sciences (SPSS) 11.5. Injury Severity Score (ISS) was used to assess the severity of injuries. Result: There were 318 morbidity and 30 mortality cases. Male to female ratio was 2.2:1. The commonest age group involved was 21-30 years i.e.32.1%. The most common vehicle involved was two wheelers (60.9%) followed by heavy four or more wheelers (20.9%) and the most common nature of accident was through collision of the vehicles. Abrasion was the most common injury occurred during the RTA (61.2%). 34.1% of the victims had laceration, 8.6% had contusion and 20.9% had fractures. Median Injury Severity Score was 31.5 in mortality and 1 in morbidity cases. Conclusion: Road traffic accident is one of the major causes of morbidity and mortality. Injuries in various body regions are frequent findings in victims of RTA. The median Injury Severity Score (ISS) of mortality cases was significantly high compared to that of morbidity cases.

Objective s : There is a need for markers to facilitate the diagnosis of preeclampsia, one of the most chief causes of maternal and infant mortality. Preeclampsia causes damage to the glomeruli and vascular endothelium in pregnant women. Podocalyxin is a sialoglycoprotein found in both glomeruli and vascular endothelium. In this study, we investigated the levels of podocalyxin in preeclampsia, and studied its potential to predict preeclampsia. Material and methods: Women admitted to the Health Sciences University Derince Training and Research Hospital, Department of Obstetrics and Gynecology between February–November 2018 due to high direct blood and diagnosed with preeclampsia according to the 2013 American College of Obstetricians and Gynecologists criteria were included in the study. The control group consisted of healthy volunteers having similar demographic features ‎(gestational week, gravida, parity, and age) with the preeclampsia group. The main outcome variable was serum podocalyxin levels. Results: ‎The mean (± SD) podocalyxin levels of the study and control groups were 124.15 ± ‎39.63 ng/mL and ‎71.47 ± ‎16.86 ng/mL, respectively (‎t = 7.845‎, ‎p < 0.001‎). Using a cut-off of 91.7123, podocalyxin could predict preeclampsia with 90% sensitivity and 98% specificity. Furthermore, podocalyxin levels were significantly higher than the normotensive participants in both early (‎14‎‎3.81‎ ± ‎5‎‎1.96 ng/mL‎ vs. ‎75.‎‎35 ± ‎1‎‎9.36 ng/mL‎) and late-onset (‎11‎‎0.22 ± ‎1‎‎9.11 ng/mL‎ vs ‎68.‎‎26 ± ‎1‎‎4.13 ng/mL‎) preeclampsia (p < 0.001). Conclusions: Serum podocalyxin levels increase in preeclampsia. We conclude that podocalyxin is a candidate for predicting preeclampsia.

Objective At the Maternal Health Clinic (MHC), women with certain pregnancy complications are seen for appointments focusing on lifestyle modification and future pregnancy counselling. This study's objective is to determine whether women who attended the MHC following a pregnancy complicated by gestational diabetes mellitus (GDM) or a hypertensive disorder of pregnancy (HDP) have improved interpregnancy and subsequent pregnancy outcomes, compared with non-attendees. Methods A retrospective cohort study was conducted including all pregnancies ≥20 weeks gestation at Kingston Health Sciences Centre (KHSC) from April 2010 to Dec 2019. Women with ≥2 deliveries were eligible for inclusion, with 2 pregnancies per woman included. These criteria identified 178 patients who attended the MHC and 133 who did not. Continuous variables with normal distribution were assessed with independent sample t tests. Continuous variables without normal distribution and ordinal variables were assessed with Mann–Whitney U tests. Categorical variables were assessed with Pearson's χ2 tests. Preterm delivery, HDP and GDM recurrence, HDP and GDM progression, and change in first-trimester blood pressure and pre-pregnancy weight were examined using multivariate regression modelling. Probability values Results MHC attendance was associated with improvements in interpregnancy weight reduction (P = 0.002), fewer interpregnancy type II diabetes diagnoses (P Conclusion In our examination of MHC outcomes, we found improvements in certain interpregnancy and subsequent pregnancy outcomes. These results support the continued development and funding of these clinics.

Background: Anemia in pregnancy is a globally health-related issue, that affects both mothers and their newborn. Anemia during pregnancy across the world involves approximately 38% of the world population. To evaluate the effect of gestational anemia on perinatal outcome in the population. The aim of present study is to evaluate the effect of gestational anemia on perinatal outcome in the population of Hyderabad, Sindh, Pakistan. Methods: A cross-sectional comparative analysis was conducted among pregnant mothers who were listed to give birth at Liaquat University of medical and health sciences Jamshoro/Hyderabad during the period of September 2018 to September 2019. The study population 400 were selected by convenient random sampling, and grouped into 2 on the basis of their Hb levels, with Hb

On December 18, 2020, the FDA approved osimertinib as adjuvant therapy in patients with non–small cell lung cancer (NSCLC) whose tumors have EGFR exon 19 deletions or exon 21 (L858R) mutations, as detected by an FDA-approved test. The approval was based on the ADAURA study, in which 682 patients with NSCLC were randomized to receive osimertinib (n = 339) or placebo (n = 343). Disease-free survival (DFS) in the overall population (stage IB–IIIA) was improved for patients who received osimertinib, with an HR of 0.20; 95% confidence interval (CI), 0.15–0.27; P < 0.0001. Median DFS was not reached for the osimertinib arm compared with 27.5 months (95% CI, 22.0–35.0) for patients receiving placebo. Overall survival data were not mature at the time of the approval. This application was reviewed under FDA's Project Orbis, in collaboration with Australia Therapeutic Goods Administration, Brazil ANVISA, Health Canada, Singapore Health Sciences Authority, Switzerland Swissmedic, and the United Kingdom Medicines and Healthcare products Regulatory Agency. This is the first targeted therapy adjuvant approval for NSCLC and has practice-changing implications.

Objectives: This study was carried out in order to determine the prevalence of obesity among the students of the Faculty of Health Sciences and to evaluate the anthropometric measurements of the students. Materials and methods: The population of the study was in total 984 volunteering undergraduate students from Ankara University Faculty of Health Sciences, Child Development, Midwifery, Nursing, Health Management and Social Work departments. The sociodemographic characteristics of the students were obtained with the help of the questionnaire and the anthropometric measurements by the researchers. SPSS package program was used for descriptive statistics, chi-square test and multiple logistic regression analysis for assessment of data. Results: 16.5% of the students participating in the study were overweight and 4.5% were obese. Approximately half of the students who are overweight and obese reported staying in the dormitory. Average BMI value in males is 23.1 kg/m2 and 22.3 kg/m2 in females. 29.1% of females are at risk in terms of abdominal obesity and 30.6% of males in terms of waist/height ratio. Male gender and presence of an obese person in the family increases the risk of being overweight or obese. Conclusions: Risky health behaviors are observed among university students and in order to avoid such behaviors, it is necessary to provide training especially on subjects such as nutrition and physical activity. Adopting the right nutritional habits and healthy lifestyle is important in individuals who will be the future healthcare professionals, for both their and future generations' health. © 2021 European Society for Clinical Nutrition and Metabolism WOS:000757020900062

Blood flow restriction (BFR) with low-load resistance exercise (RE) is often used as a surrogate to traditional high-load RE to stimulate muscular adaptations, such as hypertrophy and strength. However, it is not clear whether such adaptations are achieved through similar cellular and molecular processes. We compared changes in muscle function, morphology and signaling pathways between these differing training protocols. Twenty-one males and females (mean ± SD: 24.3 ± 3.1 years) experienced with resistance training (4.9 ± 2.6 years) performed nine weeks of resistance training (three times per week) with either high-loads (75-80% 1RM; HL-RT), or low-loads with BFR (30-40% 1RM; LL-BFR). Before and after the training intervention, resting muscle biopsies were collected, and quadricep cross-sectional area (CSA), muscular strength and power were measured. Approximately 5 days following the intervention, the same individuals performed an additional 'acute' exercise session under the same conditions, and serial muscle biopsies were collected to assess hypertrophic- and ribosomal-based signaling stimuli. Quadricep CSA increased with both LL-BFR (7.4±4.3%) and HL-RT (4.6±2.9%), with no significant differences between training groups (p=0.37). Muscular strength also increased in both training groups, but with superior gains in squat 1RM occurring with HL-RT (p 0.05 for between-group comparisons). Together, these findings validate low-load resistance training with continuous BFR as an effective alternative to traditional high-load resistance training for increasing muscle hypertrophy in trained individuals.

To analyze the scientific production regarding maternal folic acid (FA) supplementation and its relationship with autistic spectrum disorder (ASD). We performed unrestricted electronic searches in the BIREME virtual bank, Virtual Health Library (VHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) databases. For sample selection, articles that met the proposed objectives were included, published in English, Spanish and Portuguese, the use of Health Sciences Descriptors (DeCS): Data extraction was performed by the reviewers with a preestablished data collection formulary. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) was used based on a checklist with 27 items and a 4-step flowchart. A total of 384 articles was found by the search strategies, of which 17 were eligible following the pre-established criteria. The main findings of the present review point to maternal FA supplementation in the pre-conception period and beginning of pregnancy as a protective effect in relation to ASD, which should be indicated in this period as prevention to the problem. According to the research analyzed, more studies are necessary to know its effects on pregnancy, since the consumption of excessive FA may not be innocuous. Analisar a produção científica a respeito da suplementação de ácido fólico (AF) materno e sua relação com o transtorno do espectro autista (TEA). Realizamos buscas eletrônicas irrestritas nas bases de dados do banco virtual BIREME, Biblioteca Virtual em Saúde (VHL) e Medical Literature Analysis and Retrieval System Online (MEDLINE / PubMed). SELEçãO DOS ESTUDOS: Incluímos os artigos publicados em inglês, espanhol e português, com o uso dos DeCS: A extração de dados foi realizada pelos revisores com um formulário de coleta de dados pré-estabelecido. SíNTESE DOS DADOS: Foram usados os itens de relatório preferidos para protocolos de revisão sistemática e meta-análise (PRISMA-P) com base em uma lista de verificação com 27 itens e um fluxograma de 4 etapas. Foram encontrados 384 artigos pelas estratégias de busca, dos quais 17 eram elegíveis segundo os critérios pré-estabelecidos. Os principais achados da presente revisão apontam para a suplementação de AF materno no período de preconcepção e início da gravidez como efeito protetor em relação ao TEA, que deve ser indicada neste período como prevenção do problema. CONCLUSãO: De acordo com as pesquisas analisadas, mais estudos são necessários para conhecer seus efeitos sobre a gravidez, uma vez que o consumo excessivo de AF pode não ser inócuo.

Introduction: Asthma in children is one of the most common chronic diseases and little information available on factors associated with this disease in our part of the world. Objective: The present study is an attempt to find out the socio-demographic and clinical profile of children with asthma. Methodology: This was a retrospective analysis of data of asthmatic children below 14 years attending pediatric chest clinic from July 2014 till March 2016. Results: Of the 200 children, there were 142 (71%) males. The median age of presentation was 3 years and 139 (69.5%) from the age group 1-5years One third had poorly controlled asthma. Comorbidity was present in 59(29.5%) and allergic rhinitis (7%) was the most common. 90.5% had onset of wheezing before 5 years of age. Family history of asthma and/or atopy and smoking was present in 24% and 31%, respectively. 22% had exposure to pet animals. Upper respiratory tract infection (URTI) (37%) was the most common trigger for exacerbation. Cough (99%) and fast breathing (98%) were the most common symptoms. Conclusion: The majorities were males of young age with rhinitis as most common co-morbidity and many of them had a history of parental smoking at home. One third of them had poorly controlled asthma which shows the need for proper management of asthma including its comorbidity in younger children and changing certain habits like parental smoking at home.

Objective: To find out the frequency of anemia, agranulocytosis and thrombocytopenia in hyperthyroid patients after the use of propylthiouracil. Study Design: Cross sectional study. Place and Duration of Study: Out Door Patients Department and Pathology Laboratory in Liaquat University Medical & Health Sciences, Hospital Hyderabad/Jamshoro, from May 2016 to Apr 2017. Methodology: Two hundred cases, comprising of adult patients were categorized into five groups, age group 15-30 years 79 (39.5%) patients presenting the highest out of total, age group 31-45 years 68 (34%) patients, age group 46-60 years 36 (18%), age group 61-75 years 14 (7%) patients, age group >75 years 3 (1.5) patients. Complete blood count was analyzed on Sysmex Kx21 and thyroid profiles were analyzed on Elecysis 2010 from the Pathology Department. SPSS version 22 was used for data analysis. Result: Out of total patients, 32 (16%) were males and 168 (84%) were females with mean age of 37.44 ± 14.82 years. Majority of patients 68 (34%) were anemic, while 4 (2%) had agranulocytosis and 11 (5.5%) had thrombocytopenia. Headache was reported in 111 (55.5%), exophthalmos in 106 (53%), sore throat in 172 (86%), fever in 136 (68%) and weight loss in 95 (47.5%) patients. Conclusion: Propylthiouracil causes defective hematopoiesis in hyperthyroid patients because propylthiouracil has adverse suppressive effects on bone marrow.

Objective:To compare the clinical effects of Antibiotic amoxicillin-clavulanate and calcium hydroxide on inter appointmentpain in cases of Symptomatic Apical Periodontitis. Methodology:It was a single blind randomized controlled trial study performed in operative Dentistry Department ofLiaquat University of Medical and Health Sciences Jamshoro. This study was conducted from 02-Jan-2017 to 27-June-2017. Total n=324 patients with symptomatic apical periodontitis were targeted. Patients were randomly allocated into twogroups. Total n=162 patients in group1 treated with Antibiotic amoxicillin-clavulanate and n=162 patients in group 2 ofcalcium hydroxide. Procedure was performed by single operator. Clinical effect was assessed if pain present or absent after24 hours and 7 days on recalled visit and was labeled as positive when there was no pain (0-3 on VAS) and as negativewhen there was pain (4-10 on VAS). Data of the study was analyzed by using the SPSS version 20. Mean and standarddeviation was calculated for quantitative variables like age and pre and postoperative pain. Frequency and percentageswere calculated for type of tooth. Both groups were compared byusing Chi- square test for clinical effect. Results:The average age of the patients was 39.807.36 years. There were 50% male and 50% female. Clinical effectivenesswas significantly high in group 1 than group 2 [79.01% vs. 65.43% p=0.006]. Conclusion:The findings of this study are encouraging that patients in which Amoxicillin-clavulanate was used as intracanalmedicament appeared to show a greater decrease in pain levels over the observation period when compared to the control group

Masho Tigabe Tekel, Abaynesh Fentahun Bekalu, Faisel Dula Sema Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Faisel Dula Sema Email Faiselye1203@gmail.com; faisel.dula@uog.edu.etBackground: The adequate knowledge, attitude, and practice (KAP) of pharmacovigilance and ADRs reporting is crucial for health care students.Objective: This study aimed at assessing the KAP of final-year medical, pharmacy, and nursing (MPN) students towards pharmacovigilance and ADRs reporting at the University of Gondar, College of Medicine and Health Sciences, Northwest Ethiopia.Methods: A cross-sectional study was conducted among 296 final-year MPN students at the University of Gondar College of Medicine and Health Sciences from November 1, 2020 to January 30, 2021. A close-ended, structured, self-administered questionnaire was used for data collection prospectively. SPSS® (IBM Corporation) version 24 was used to analyze the data with descriptive and inferential statistics. The comparison of the KAP of groups was made by using a Kruskal–Wallis test and Mann–Whitney U-test. Statistical significance was declared at a p-value < 0.05.Results: Among 296 participants, the majority of them had a poor level of knowledge (69.9%), practice (95.9%), and moderate attitude (62.5%) towards pharmacovigilance and ADRs reporting. The median (interquartile range) score of the students’ knowledge (maximum score = 15), attitude (maximum score = 50), and practice (maximum score = 5) towards PV and ADR reporting was 6 (5– 8), 32 (28.25– 35), and 1 (0– 1), respectively. The KAP of the students has shown differences with age, sex, hearing of the term PV, and discipline. A lack of training on ADRs (49%) reporting and not knowing where and how to report ADRs (47.3%) were among the main reasons of MPN students for not reporting ADRs.Conclusion: A majority of final-year MPN students had poor knowledge, practice, and a moderate attitude towards PV and ADRs reporting. The school of medicine, pharmacy, and nursing should adequately cover the issue of PV and ADRs reporting in the undergraduate curriculum.Keywords: knowledge, attitude, practice, pharmacovigilance, adverse drug reaction, students

Patients with emerging anosmia may be asymptomatic carriers of coronavirus disease 2019 infection requiring self-isolation; otherwise, there are risks of facilitating the spread of the disease.This study aims to evaluate the loss of smell with visual analogue scale and to determine the relationship between the loss of smell and blood parameters.All patients' coronavirus disease 2019 swab cultures were polymerase chain reaction positive and pneumonia was found in computed tomographies consistent with oronavirus disease 2019. The study was conducted on 114 patients hospitalized between 01.11.2020 and 31.12.2020 in the Otorhinolaryngology coronavirus disease 2019 Service of University of Health Sciences Adana City Training and Research Hospital and followed up by us.A score of 10 indicates that the olfactory function is completely normal in all patients undergoing visual analogue scale, and a score of 0 indicates that they cannot smell anything. Patients who received visual analogue scale scored 10 points were categorized as Group 1 and others as Group 2. Statistical significance level was determined as p < 0.05. A statistically significant difference was found between Group 1 and Group 2 in terms of visual analogue scale smell score, neutrophil, lymphocyte, neutrophil-lymphocyte ratio. Visual analogue scale smell score, neutrophil count, neutrophil-lymphocyte ratio value were found to be lower in Group 2 and lymphocyte count was found to be higher. Neutrophil, lymphocyte, neutrophil/lymphocyte ratio, platelet, platelet/lymphocyte ratio, which are also used in nasal diseases, may be used to detect loss of smell, predict, and even determine the prognosis of loss of smell if supported by further studies.

Background The use of Instrumented Gait Analysis (IGA) for the clinical management of individuals with cerebral palsy (CP) has increased in recent years. Previous systematic reviews have been completed to evaluate and summarize the evidence related to the efficacy of IGA in general. However, a focused summary of research studies on IGA for children with CP related gait disorders is needed. Research Question The purpose of the current work was to perform a scoping review to describe and categorize the range of existing literature about IGA as applied to the clinical management of children with CP related gait disorders. Method A health sciences librarian developed a search strategy to include four key inclusion criteria of original research study, population included children with CP, study employed IGA, available in English. The available literature was organized into six study categories: reliability and validity, documentation of subgroups or model development, IGA for clinical decision making, effectiveness of treatments that depend on IGA, cost effectiveness, IGA used to evaluate the outcome of surgical, medical or rehabilitation treatment. Results 909 studies met the inclusion criteria and were placed into the six study categories. 14 % of studies were in reliability and validity, 33 % in subgroups or modeling, 2% in IGA for clinical decision making, 2% in treatments that depend on IGA, 1% in cost effectiveness, and 49 % of studies had IGA used as an outcome measure for treatment. Significance This scoping review has documented the wide range, diversity and extent of original research studies investigating the use of IGA for the clinical management of children with CP related gait disorders. The large volume of studies provides a basis for future work to develop a CPG about the use of IGA for the clinical management of children with CP related gait disorders.

Introduction: The new corona virus (2019-nCoV OR HCOV-19 or CoV2), has emerged in China as the main cause of viral pneumonia (COVID-19, Coronavirus Disease-19). Objective: To provide evidence-based Physiotherapy and functionality in patients with adult and pediatric COVID-19. Methods: This is an integrative literature review using the MedLine / PubMed databases, library of Latin American and Caribbean Literature in Health Sciences (LILACS) and Physiotherapy Evidence Database (PEDRo). Results: Part of the patients with covid 19 show signs of respiratory deficiency with hypoxemia, with low severity in children. Impaired functionality is also expected. Conclusion: COVID-19 causes low pulmonary compliance and important changes in lung function with hypoxemia and cardiovascular repercussions. These changes lead to the need for Physiotherapy and the management of oxygen therapy and ventilatory support (invasive and non-invasive) for these patients.

OBJECTIVE: We explored the association between hypertension (>140/90) at the latent phase of labor (resistant hypertension) and the subsequent development of major maternal complications or adverse infant outcomes in women with preeclampsia under medical care. STUDY DESIGN: We drew data from 824 women who were under follow-up at the Department of Perinatology of Health Sciences University Zeynep Kamil Women and Children’s Health Training and Research Hospital with a diagnosis of preeclampsia. Women with and without resistant hypertension were compared in terms of major maternal complications and adverse infant outcomes. RESULTS: Mean age and body mass index were similar between the two groups (p>0.05). The rate of preeclamptic complaints was significantly higher in groups with resistant hypertension (90.1% vs. 67.2%, p

Objectives: To determine the serum calcium levels in mild and severe preeclampsia and compare it with normal pregnancy. Methods: It was a comparative cross sectional study. Thirty five normotensive pregnant women, n=30 women with mild preeclampsia and n=70 with severe preeclampsia were recruited at Liaquat University of Medical and Health Sciences, Hospital. The serum calcium was measured and levels were compared among three groups. The data was analysed on SPSS v. 20. Results: The gestational age was more in the normal pregnancy compared to mild and severe preeclampsia (38.7±2.1 vs 36.7±3.6 and 36.2±2.8, p-value=0.0002). The calcium concentration was less in the both groups of preeclampsia i.e., 8.41± 0.96 mg/dl in mild and 8.02± 0.77 mg/dl in severe preeclampsia vs 9.2± 0.32 mg/dl in normal pregnant women, (p-value

Background: COVID-19 is newly emerging infectious disease that spread globally at unpredictable and unique pattern to the extent that the World Health Organization announced COVID-19 as a pandemic in the first couple months of 2020. This study aims to describe clinical and demographic features of COVID-19 patients and the influence of various risk factors on the severity of disease. Methods: This research is a retrospective study based on Saudi Arabia's ministry of health's Covid-19 data. The analysis relies on data of all COVID-19 patients recorded in Riyadh between 1st, March 2020 and 30th, July 2020. Statistical analyses were performed to investigate the effect of demographic characteristic, clinical presentation, and comorbidities on infection severity. Results: A total number of 1026 COVID-19 patients were identified based on the demographic data as follows: 709 cases (69% of cases) were males and 559 cases (54% of cases) were Saudi. Most of patients were diagnosed with mild signs and symptoms 697 (68% of cases), while 164 patient (16% of cases) demonstrated moderate signs and symptoms, and 103 cases (10%) were severe and 62 (6%) had critical febrile illness. Fever, cough, sore throat, and shortness of breath were the most common symptoms among patients with COVID-19. Among studied comorbidities in COVID-19 patients, diabetes mellitus and hypertension were the most prevalent. The results from the bivariate logistic regression analysis revealed that older age, diabetes mellitus, asthma, smoking, and fever are associated with severe or critically ill cases. Conclusion: The findings of this study show that old age, fever, and comorbidities involving diabetes mellitus, asthma, and smoking were significantly associated with infection severity. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Whole-body magnetic resonance imaging (WB-MRI) is a noninvasive imaging method that can be used to diagnose and stage tumors, as well as to assess therapeutic responses in oncology. The objective of this meta-analysis was to evaluate the accuracy of WB-MRI for the diagnosis of metastases in pediatric patients. The following electronic databases were searched: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. All of the selected studies included children and adolescents with histopathological confirmation of a primary tumor. Collectively, the studies included 118 patients ranging in age from 7 months to 19 years. The pooled sensitivity and specificity of WB-MRI were, respectively, 0.964 (95% CI: 0.944-0.978; I2 = 0%) and 0.902 (95% CI: 0.882-0.919; I2 = 98.4%), with an area under the curve (AUC) of 0.991. We found that WB-MRI had good accuracy for the diagnosis of metastases in pediatric patients and could therefore provide an alternative to complete the staging of tumors in such patients, being a safer option because it does not involve the use of ionizing radiation. Resumo A ressonância magnética de corpo inteiro (WB-MRI) é um método de imagem não invasivo que pode ser usado para diagnosticar, estadiar e avaliar a resposta terapêutica em oncologia. O objetivo desta meta-análise foi avaliar a precisão do diagnóstico de WB- MRI no diagnóstico de metástases em crianças. Foram pesquisadas as seguintes bastes de dados: Medline, Embase, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, Latin-American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and ClinicalTrials.gov. Todos os estudos incluíram crianças e adolescentes com prova histopatológica de um tumor original. Os estudos selecionados incluíram 118 pacientes com idade variando de 7 meses a 19 anos. A sensibilidade e especificidade combinadas de WB-MRI foram, respectivamente, 0,964 (IC 95%: 0,944-0,978; I2 = 0%) e 0,902 (IC 95%: 0,882-0,919; I2 = 98,4%), com AUC de 0,991. A WB-MRI tem uma boa precisão para o diagnóstico de metástases em pediatria e pode potencialmente fornecer um método alternativo não ionizante mais seguro para completar o estadiamento da doença maligna em crianças.

We aim to delineate the relationship between breast and axillary pathologic complete response (pCR) in patients receiving neoadjuvant chemotherapy for breast cancer. We performed a retrospective cohort study of patients with clinical T1–4N0–3M0 breast cancer receiving neoadjuvant chemotherapy followed by surgical therapy at Sunnybrook Health Sciences Centre in Toronto, Canada between 2014 and 2019. Clinicopathologic data were abstracted from the electronic medical record. Women were stratified into receptor subtypes as follows: hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2–), HR+/HER2+, HR–/HER2+ and HR–/HER2– (triple negative) and compared with Fisher’s exact test. Our primary outcome was to assess the positive predictive value of breast pCR for determining axillary pCR, and vice versa. There were 374 breast cancers, with 109 (29.1%) achieving breast pCR (ypT0/Tis). Amongst node-positive tumours achieving breast pCR, rates of associated axillary pCR (ypN0/0i+) were as follows: HR+/HER2– (2/6, 33.3%), HR+/HER2+ (12/13, 92.3%), HR–/HER2+ (15/17, 88.2%) and triple negative (15/17, 88.2%) (P = 0.02). Conversely, amongst node-positive tumours achieving axillary pCR, rates of associated breast pCR were: HR+/HER2– (2/10, 20.0%), HR+/HER2+ (12/23, 52.2%), HR–/HER2+ (15/24, 62.5%) and triple negative (15/26, 57.7%) (P = 0.1). Breast pCR is a strong predictor of axillary pCR in women with HER2-positive and triple-negative breast cancers. Conversely, axillary pCR is a modest predictor of breast pCR for these subtypes. There is a poor relationship between breast and axillary pCR in women with hormone receptor-positive disease. These data may inform future de-escalation of surgery in women with HER2-positive and triple-negative disease.

The role of certain viruses in the etiology of some tumors is today indisputable, but there is a lack, however, of annoverview of the relationship between viruses and cancer with amultidisciplinary approach. For this reason, the Health Sciences Foundation has convened a group of professionals from different areas of knowledge to discuss the relationship between viruses and cancer, and the present document is the result of these deliberations. Although viruses cause only 10-15% of cancers, advances in oncology research are largely due to the work done during the last century on tumor viruses. The clearest cancer-inducing viruses are: HPV, HBV, HCV, EBV and, depending on the geographical area, HHV-8, HTLV-1 and HIV. HPVs, for example, are considered to be the causative agents of cervical carcinomas and, more recently, of a proportion of other cancers. Among the Herpes viruses, the association with the development of neoplasms is well established for EBV and HHV-8. Viruses can also be therapeutic agents in certain neoplasms and, thus, some oncolytic viruses with selective tropism for tumor cells have been approved for clinical use in humans. It is estimated that the prophylaxis or treatment of viral infections could prevent at least 1.5 million cancer deaths per year.

OBJECTIVE: The objective was to evaluate the level of evidence about the associated factors and the risk factors of osteonecrosis of femoral head (ONFH) in sickle cell individuals. METHODS: The review was based on the search and selection of studies available in the electronic databases PubMed, SCIELO, LILACS, BVS. As descriptors, the terms of Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) corresponding to “Osteonecrosis”, “Necrosis avascular” and “Aseptic necrosis” and “Femoral head” and “sickle cell disease” and “risk factor” and “predictor”. RESULTS: Among clinical and laboratorial factors the most promising risk factors were the severity of sickle cell disease and acute chest syndrome. As a result, from studies of a moderate level of quality, blood pressure, body weight, previous trauma, haemoglobin to haematocrit ratio (Hb/HCT), and number of hospitalizations can be highlighted. Others, such as genetic markers and male gender, have also been positively associated in lower quality studies. CONCLUSION: For a better clarification of what the risk factors are for the ONFH, it is necessary to study with populations of different origins, different ages, different profiles of Hb, which present greater methodological rigor and perform a multivariate analysis to control confounding factors. Further study is also needed to understand the genetic determinants of ONFH.

A úlcera diabética é considerada uma complicação grave do Diabetes Mellitus pelo alto í­ndice de amputações ocasionando elevadas taxas de morbimortalidade. Objetivo: Conhecer os impactos na sexualidade e autoestima dos pacientes portadores de úlceras diabéticas. Método: Revisão integrativa da literatura, realizada nas bases de dados: Scientific Eletronic Library Online e Literatura Latino-Americana e do Caribe em Ciências da Saúde, Google acadêmico, Medical Literature Analysisand Retrieval System Online no Banco de Dados de Enfermagem, publicados entre 2010 a 2020, com descritores: Úlcera diabética; Imagem corporal; Qualidade de vida; Diabetes mellitus; Sexualidade, úlcera. Realizado o cruzamento utilizando o operador booleano "AND". Resultados: Após a análise dos artigos selecionados, 10 artigos compuseram a amostra. Conclusão: O papel da enfermagem no contexto da trajetória do paciente com úlcera diabética é imprescindí­vel na realização de curativos para tratamento da ferida e no processo de educação para promoção do auto cuidado.

1. Eduardo Fox, MD*,† 2. Linda Y. Fu, MD, MS*,† 1. *Department of Pediatrics, Children’s National Hospital, Washington, DC 2. †The George Washington University School of Medicine and Health Sciences, Washington, DC * Abbreviations: CDC: : Centers for Disease Control and Prevention FERPA: : Family Educational Rights and Privacy Act HIPAA: : Health Insurance Portability and Accountability Act LABA: : long-acting beta2-agonist NACP: : National Asthma Control Program NAEPP: : National Asthma Education and Prevention Program Pediatric health-care providers may be unaware of how best to partner with their patients’ schools to create asthma-friendly environments in which patients’ asthma health needs are communicated clearly, school heath staff are empowered and equipped to react to asthma exacerbations appropriately, and school personnel reinforce asthma health maintenance messages with families. After completing this article, readers should be able to: 1. Understand how best to collaborate with school staff to promote asthma-friendly environments. 2. Describe the barriers and facilitators of students’ access to quick-relief asthma medication in school. 3. List the key elements to include in an asthma action plan so that it may serve as both a medication administration authorization form and an effective tool for communication with school health staff. 4. Recognize how to collaborate with school nurses to implement preventive interventions for students with poorly controlled asthma or chronic absenteeism. More than 5.5 million school-age children in the United States are diagnosed as having asthma. (1) This equates to almost 1 in 10 school-age children, making asthma the most common chronic childhood condition in the country. More than half of all children with a diagnosis of asthma have at least 1 asthma exacerbation each year. Particularly concerning, rates of pediatric asthma deaths have been increasing. In 2018, 156 children aged 5 to 17 years died of asthma. Non-Hispanic black children have a 6 times greater mortality rate from asthma complications than Hispanic white children and a 7 times greater rate than non-Hispanic white children. (1) Deaths that occur outside the clinical setting account for 13% of all asthma deaths in children. Asthma can affect a child’s academic attendance and education. Children with asthma miss more school than those without asthma and are at greater risk for missing more than 10 school days per year, a degree of absenteeism that may put …

Mobile health, or mHealth, solutions offer great potential in the area of self-monitoring of chronic conditions, where most of the day-to-day management of the condition is done at home by the patient or their caregivers. Narcolepsy is a chronic sleep condition caused by an orexin deficiency in the brain resulting in its inability to regulate sleep cycles, causing poor quality sleep during the day and problems with wakefulness during the day. This paper set out to investigate whether Habitual, an app for tracking symptoms, daily habits and medication adherence for people with narcolepsy could increase their sense of empowerment. Ten participants were asked to test the app during a period of 30 days, after which they were asked to answer a survey to investigate whether their perception of their empowerment towards the management of narcolepsy had changed. Although using the app for only 30 days provides a very limited understanding of the impact of Habitual, this study shows positive indication for future mHealth solutions for the management of narcolepsy. Future studies should test the openness to using an app for the management of narcolepsy with a wider cohort.

Objective: This study aims to assess the knowledge and attitude about oral cancer among undergraduate medical and dental students at Kuwait University Health Sciences Center. Subjects and Methods: Using a structured questionnaire, a cross-sectional survey was conducted among 140 undergraduate Health Sciences Center students at Kuwait University, 70 were medical students and 70 were dental students. Students’ knowledge and attitude about oral cancer and its risk factors, in addition, their diagnostic concepts and opinions were assessed. Moreover, the students’ confidence in their ability to detect and refer clinically suspicious cases was evaluated and the responses were analyzed. Results: Of the 140 undergraduate dental and medical students surveyed, 131 returned the completed questionnaire (93.5% response rate). There was a statistically significant difference detected in the students’ knowledge about betel quid and smokeless tobacco as risk factors for oral cancer development. Also, there was a statistically significant difference in the students’ knowledge about the high-risk age group associated with oral cancer, the viral association with oral cancer, oral premalignant lesions, high-risk areas associated with oral cancer, and the warning features that can raise the suspicion of oral cancer. In addition, there was a statistically significant difference in the students’ confidence and ability to detect pre-malignant lesions and their opinion in their faculty curriculum development.Conclusion: This study highlighted the importance of increasing awareness and attitude towards oral cancer detection by both undergraduate dental and medical students who are considered to be the future primary care providers.

Background: Both hepatitis B and coronavirus vaccines are important requirement for all health science student because of their potential exposure to hepatitis B and coronavirus diseases during their clinical experience. Vaccine uptake has recently been affected by lack of confidence to their efficacy and safety. This attitude is vaccine dependent and understanding of the determinants will help to prevent vaccine hesitancy. This study was designed to compare the attitude of health science student toward hepatitis B vaccine and coronavirus vaccine. Method: A descriptive cross-sectional study carried out among students of one of the colleges of health sciences in Enugu Nigeria. The students comprised of medical students, medical laboratory students and nursing students who visit the hospital for their clinical postings and experiences. Three, two and two classes in the departments of medicine, medical laboratory science and nursing science respectively met the inclusion criteria for the study. They are six hundred and two students in the three departments of the college. Two classes were selected from the department of medicine and one class each from the department of medical laboratory science and nursing science respectively using simple random sampling method. A total of 303 (135; medicine students, 85; medical laboratory and 83; nursing students) students were in the selected classes and all of them participated in the study. The questionaries were distributed to all the students in the selected classes during their lectures. A pre-tested self-administered questionnaire was used to assess the knowledge, attitude and vaccine status, and beliefs concerning Hepatitis B vaccines and coronavirus vaccine. The questions on knowledge were adopted from related literatures while questions on attitude were adopted from Parental Attitude on Childhood Vaccine (PACV) questions and Global Vaccine Confidence (GVC) survey. The findings and scores were analysed using IBM SPSS Statistic software for windows (SPSS statistical software V.21 (IBM Corp. 2019). Total of 11 responses were incomplete in either one or more questions and they were all removed bringing the total number of valid participants to 292. The age of the respondents was grouped, and the simple mean obtained. Scores on knowledge were calculated by scoring correct response as 1 and scoring incorrect as 0. All ‘I don’t know’ responses were regarded as negative answer. A score of less than 50% correct responses was regarded as ‘less than average’, and 50% or more correct responses was regarded as ‘above average’. The attitude of the students towards hepatitis B vaccine and coronavirus vaccine were compared using chi-square and the p-value less than 0.05 was regarded as statistically significant. Results: Out of 303 students, 292 responded to all the questions while 11 were incomplete. Two hundred and four participants (69.9) were females while 88(30.1) were males with the mean age of 22.6 SD 2.6. The medical students, nursing students and medical laboratory students contributed to 134(45.9), 81(27.7) and 77(26.4) respectively. On the general knowledge, 282(96.6%) had knowledge above average. Although the responses to the question ‘Upon discovery of vaccine for a particular disease, the “efficacy” of the vaccine will be considered before approval by the appropriate organizations’ were little above average, 161(55.1). The students had better attitude towards hepatitis B vaccine than coronavirus vaccine. For instance, 114(39%) students had decided not to have coronavirus vaccine against 43(14.7%) for hepatitis B vaccine. Again, 204(69.9) and 125(42.8) expressed concern on the ‘safe’ of coronavirus vaccine and hepatitis B vaccine, respectively. Similar responses were observed on the question concerning the side effect of the two vaccines. The questions on the ‘Trust”: the respondent expressed significant distrust to their doctors, government, media, and their spiritual leader concerning the coronavirus than the hepatitis B vaccine. The difference in the responses on the ‘efficacy’ of the two vaccine was not significant. In the practice domain, the majority of the students have not had both hepatitis B and coronavirus vaccine. There was significant difference between those who indicated wiliness to take hepatitis B vaccine and coronavirus vaccine as soon as they are available. In conclusion: The knowledge about vaccine as expressed by the students in this study was above average. They expressed negative attitude to coronavirus vaccine than hepatitis B vaccine. The student expressed concern on the efficacy of the two vaccines and the vaccine generally. It was also observed that many of the students have not had hepatitis B vaccine despite their willingness. It therefore important to introduce the concept of vaccine confidence in the health science curriculum and emphasis should be made on the efficacy of vaccines. There is also a need to scale up hepatitis B vaccine coverage among students of health sciences.

Objective To evaluate changes in empathy for pharmacy, nursing, and health sciences students after the use of a Chronic Pain Simulation Empathy Training Kit (CPSETKit). Methods The apparatuses contained in the CPSETKit simulated chronic pain from several disease states. With kit devices applied, participants completed ten Activities of Daily Living (ADLs). The Jefferson Scale of Empathy-Health Professions Scale (JSE-HPS) and the Kiersma-Chen Empathy Scale (KCES) were used to measure empathy pre-/post-kit use. Results Scores from the empathy scales indicate the use of this kit significantly increased the empathy (p values Conclusion Conclusion: The use of the CPSETKit increased empathy for chronic pain patients in health care students. Further research may determine whether the use of the kit improves patient outcomes.

Objective: To determine the incidence and management of post cholecystectomy biliary fistula at tertiary care Hospital. Methodology: This was a prospective study which was conducted at general surgery department of Liaquat University of Medical and health Sciences, during one year from March 2017 to February 2018. All the patients those underwent laparoscopic cholecystectomy or open cholecystectomy, age more than15 years and either of gender were included. All the patients were evaluated for developed biliary fistula after cholecystectomies. All the patients of biliary fistula were managed conservatively and surgically and their management outcome was recorded. After operation most of patients were followed up to 6 months. The data was collected via study designed proforma. Data was analyzed by using SPSS version 20. Results: Out of 318 patients, 280 patients underwent laparoscopic cholecystectomies, 38 patients underwent open cholecystectomies. Mean age of the patients was 41.34+8.23 years. Females were in majority 233(73.3%) and males were 95(29.7%). Out of all post-cholecystectomy biliary fistula was seen in 10(3.14%) patients. Incidence of post-cholecystectomy biliary fistula was insignificantly associated with types of cholecystectomies (p=0.425), while it was highly prevalent in females (p=0.001). Conclusion: In the conclusion of this study the post cholecystectomy biliary fistula was observed to be 3.14% and mostly patients were manged via conservative treatment.

Background: Postoperative atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) surgery. Patients with POAF are at higher risk of stroke and mortality. The use of oral anticoagulation (OAC) in POAF remains inconsistent, and the care gap is unknown. Objective: We sought to evaluate rate of adherence and factors associated with OAC use in POAF patients after isolated CABG. Methods: In this study, all patients who had an isolated CABG between April 1, 2019 and March 30, 2020, at Health Sciences North, Sudbury retrospectively were evaluated. We identified all patients who developed POAF and captured the use of OAC. Multivariable logistic regression models were used to identify predictors of OAC prescription. Results: In total, 339 CABG patients between April 1, 2019 and March 30, 2020, were identified; 86 patients developed POAF. No patients had major perioperative bleeding. All POAF patients had an indication for OAC therapies based on CHADS 65 score. However, only 17 (19.8%) patients with POAF had OAC prescription at the time of hospital discharge. Baseline characteristics were similar between those with or without OAC. In multivariable analysis, the use of dual antiplatelet therapy was associated with a decreased use of OAC therapy in POAF (OR 0.037 (95% CI 0.005, 0.29), P = .002). Moreover, in comparison to surgeon A, surgeon B was associated with a decreased use of OAC therapy, whereas surgeon C was associated with an increased use of OAC therapy in POAF (OR 0.15 (95% CI 0.03, 0.83), P = .03 and OR 6.49 (95% CI 1.21, 34.82), P = .03, respectively). None of the CHADS 65 elements, including age, hypertension, stroke, diabetes mellitus or congestive heart failure, correlated with the use of OAC. Key findings: Eighty percent of patients who developed POAF after isolated CABG failed to receive stroke prevention therapies. The use of dual antiplatelet therapy and individual surgeons’ preference were associated with the use of OAC therapy among POAF. Conclusions: This data set suggests that approximately only 1 in 5 patients with POAF after isolated CABG got prescribed OAC.

Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology Ciaran M Fairman1 and Jesper F Christensen()2,3 1Department of Exercise Science, University of South Carolina, USA 2Center for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark 3Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Denmark © The Authors Abstract The field of exercise oncology has rapidly evolved over the past 30 years. Initial investigations of safety and feasibility have progressed towards efficacy and effectiveness trials with a variety of health-related outcomes in mind. More recently, it has been recognized that interventions aimed at modifying physical activity behavior (i.e. behavioral interventions to increase participation in un/structured physical activity) are distinctly different from those aiming to target a clinically relevant outcome (using a specific exercise prescription). There is a strong rationale for the latter, where cancer/treatment toxicities can result in musculoskeletal, cardiopulmonary, and/or hematological declines with important prognostic implications. Treatment intolerance, unfavorable tumor response and heightened risk of mortality are all consequences of leaving these impairments unaddressed. Importantly, the control/reversal of the decline in these systems is more likely to occur through a targeted exercise prescription, specifically designed to target the impairment, rather than interventions trying to change behavior. This requires careful consideration in the study design in exercise oncology in relation to the selection of clinically relevant outcomes, decisions on methods of assessments and ensuring the exercise is targeted to the outcome. The objective of this review is to 1) conceptualize and provide a clinical rationale for targeted exercise interventions in exercise oncology, and 2) provide a framework for consideration in the design and execution in targeted exercise interventions in oncology. We hope that this framework can encourage research into targeted exercise interventions in oncology and that our framework can be used to inform the design of future trials.

Exercise, Pharmaceutical Therapies and Type 2 Diabetes: Looking beyond Glycemic Control to Whole Body Health and Function Thomas Yates()1,2, Joseph Henson1,2, Jack Sargeant1,2, James A King2,4, Ehtasham Ahmad1, Francesco Zaccardi1,3 and Melanie J Davies1,2 1Diabetes Research Center, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK 2NIHR Leicester Biomedical Research Center, University Hospitals of Leicester NHS Trust and University of Leicester, UK 3Leicester Real World Evidence Unit, Diabetes Research Center, University of Leicester, Leicester, UK 4National Center for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK © The Authors Abstract Exercise is a powerful therapy for improving glycemic control and increasing cardiorespiratory fitness in adults with type 2 diabetes mellitus (T2DM). However, there is a dearth of evidence investigating interactions or synergies between exercise and most pharmaceutical therapies. This is important as exercise is rarely prescribed in isolation of other background medications used to manage T2DM. Therefore understanding which exercise and drug combinations optimize or blunt responses is crucial. This narrative review discusses advances in weight loss management in diabetes and highlights research opportunities and challenges for combining exercise therapies with newer generations of glucose-lowering therapies with weight loss effects, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is). We discuss the role of exercise in preserving lean mass and increasing physical function along with other potential areas of synergy. We conclude that until the evidence base investigating areas of interaction or synergy between exercise and other glucose-lowering or weight loss therapies is developed, exercise will remain a generic rather than a tailored therapy in the management of T2DM.

Aim. To determine the opinions of II and III stage breast cancer patients on the non-pharmacological pain-relief methods. Methods. The research was performed from November 2019 to January 2020 in the Oncology and Hematology department of Lithuanian University of Health Sciences Kaunas Clinics. Patients completed a survey of 25 questions. 33 surveys were analysed. Statistical data analysis was performed using IBM SPSS Statistics 25.0 and Microsoft Excel 2016 software packages. Results. Almost half of the survey participants were unaware of the pain-relief methods, had not tried any of physical pain-relief methods and did not know or have an opinion about their effectiveness. Half of the survey participants thought that music, spiritual and cognitive behavioral therapies can relieve the pain. Also, more than half of the participants had not tried any psychological pain-relief methods and did not know or have an opinion about their effectiveness. More than half of the participants did not know if it is possible to reduce pain using medical marijuana, virtual reality glasses and hypnosis.

Objective: To determine the frequency of incidental findings on diagnostic laparoscopy in patients undergoing elective laparoscopic cholecystectomy at tertiary care hospital Jamshoro. Study design: This is a descriptive cross sectional study. Setting: Study carried out at department of general surgery, Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro from 1st February 2019 to 30th July 2019. Materials and methods: A total of 164 patients of both gender undergoing diagnostic laparoscopy in patients of laparoscopic cholecystectomy were included in the study. Laparoscopy was done under general anesthesia in all patients. The whole of peritoneal cavity was sequentially visualized using trendelenberg and reverse trendelenberg positions, and right or left tilt as required. Results: Age range in this study was from 20 to 79 years with mean age of 43.622±9.31 years. 40.2% patients were of male gender and 59.8% patients were females. Peritoneal band & adhesions was seen in 9.8% patients, Ovarian Cyst 5.5%, Abdominal Tuberculosis 19.5% and Gall Bladder Carcinoma was 3%. Conclusion: We conclude that laparoscopy is very safe, can obviate the need for a full exploratory laparotomy & minimize the surgical trauma in chronically ill patients.

Objective: This study aims to determine the in-hospital outcome of patients with acute ST-segment elevation myocardial infarction who did not receive reperfusion therapy at our institute. Methodology: Cohort of patients recruited from Emergency Department of Liaquat University Hospital, Hyderabad affiliated with Liaquat University of Medical & Health sciences, Jamshoro, Sindh, Pakistan from August 2nd, 2019 to 1st July 2020. All the patients who were diagnosed as a case of acute STEMI belongs to any age group of either gender and who did not receive reperfusion therapy either percutaneous or pharmacological therapy due to any cause were included in our study to assess their in-hospital outcome. Results: Total of 106 patients were enrolled having mean age and SD of 51.09 ± 13.50 years in which 67.92% were males. Significantly higher proportion of patients who did not receive reperfusion therapy died during hospitalization (27.35%, N = 29). The most common risk factors associated with higher mortality rates were increasing age, increased mean duration of hospitalization from the onset of chest pain, raised RBS, diabetes mellitus, and smoking, p

Background: Alopecia induced by androgens in genetically predisposed individuals is termed as Androgenetic alopecia (AGA). There is proof appearance the relationship between Androgenetic alopecia and metabolic condition. Objective: To determine frequency of metabolic syndrome in Androgenetic alopecia as a biomarker of disease in adult male patients. Materials and methods: It was a Cross Sectional Study conducted at the Department of Dermatology, Liaquat University of Medical and Health Sciences Hospital, Jamshoro/Hyderabad. Total 178 diagnosed male patients of Androgenetic alopecia were included. The grading of male pattern Androgenetic alopecia was done according to modified Norwood-Hamilton classification. Norwood-Hamilton Stage I-III were regarded to be mild to moderate and Stage IV and higher were regarded as severe. Vein was engorged by a tourniquet applied above the cubital fossa. Blood glucose levels were estimated. The level of triglycerides was determined. HDL-Cholesterol was estimated by a pre­cipitant method. Descriptive statistics were calculated using SPSS. Chi square tests were applied to determine the relationship of independent variables with metabolic syndrome. Results: The overall mean age of the patients was 39.08±10.14 years. The mean waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and fasting blood glucose were 94.71±12.30 cm, 133.83±13.27 mg/dl, 48.10±7.89 mg/dl,102.94±17.67 mmHg, 76.88±8.56 mmHg, and 93.06±9.78 mg/dl respectively. A total of 10.1% of the patients were found to have metabolic syndrome. There was a significant association between metabolic syndrome and age and family income. Conclusion: Metabolic syndrome was observed in 10.1% of the patients and this was more commonly found in: the age group >40 years, married individuals, low socioeconomic status individuals, and illiterate individuals.

Objective: Novel Corona Virus Disease (COVID-19) has not only brought the risk of morbidity and mortality but also psychological burden on individuals. The objective of the study was to assess psychological effect of COVID- 19 among nursing students of Patan Academy of Health Sciences School of Nursing and midwifery, Lalitpur, Nepal. Method: A cross sectional analytical study was conducted in July 2020 among 382 nursing students. Stress was assessed by Perceived Stress Scale (PSS) 10 item scale, Anxiety level was assessed using Generalized Anxiety Disorder 7-Item Scale and depression with Patient Health Questionnaire (PHQ) 9 item scale. The total enumerative sampling technique was used for sample selection and data was collected by an online survey. Descriptive and inferential statistics were used to analyze data. Result: The findings of the study revealed that that 278 (72.8%) nursing students had moderate level and 11 (2.9%) had high perceived stress, 202 (52.9%) had mild anxiety and only 8 (2.1%) had severe anxiety. Regarding depression, 220 (57.6%) did not have depressive symptoms and only 4 (1%) had severe depression. Significant mean difference in stress, anxiety and depression between PCL, BSc and BNS were found with p value

Introduction: Coronary Artery Disease (CAD) contributes to the increase in the prevalence of cardiovascular disease, being the main cause of death worldwide. Objectives: This study compares the sensitivity of different methods of execution of Stress Echocardiography (SE) as to the accuracy in determining the presence of CAD, through a Systematic Literature Review (RSL). Methods: The databases of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (Lilacs) and the Spanish Bibliographic Index of Health Sciences (IBECS) were searched through the Virtual Health Library (VHL) for articles published until December 2018 and including scientific articles published in journals, in any language, which met the following criteria: (A) Descriptive or analytical studies of primary or secondary basis and (B) Studies whose theme was the SE in adult coronary heart disease. Studies related to: (a) Elderly; (b) Animals; (c) Children and Adolescents; (d) Pregnant women; (e) Articles that alluded to left ventricular function, valvulopathies, aneurysms, endocarditis, arrhythmias, implanted electronic devices and other titles that were outside the scope of this work and (f) Articles published in languages other than English or Neolatin languages. Results: The study has selected 14 articles, which demonstrated that SE was accurate to diagnose CAD with sensitivities ranging from 41 to 100% with studies included within the normality curve, demonstrating that it is an excellent tool for the diagnosis of CAD compared to other methods.

Periodontitis is a chronic inflammation of the soft tissue surrounding and supporting the teeth, which causes periodontal structural damage, alveolar bone resorption, and even tooth loss. Its prevalence is very high, with nearly 60% of the global population affected. Hence, periodontitis is an important public health concern, and the development of effective healing treatments for oral diseases is a major target of the health sciences. Currently, the application of local drug delivery systems (LDDS) as an adjunctive therapy to scaling and root planning (SRP) in periodontitis is a promising strategy, giving higher efficacy and fewer side effects by controlling drug release. The cornerstone of successful periodontitis therapy is to select an appropriate bioactive agent and route of administration. In this context, this review highlights applications of LDDS with different properties in the treatment of periodontitis with or without systemic diseases, in order to reveal existing challenges and future research directions.

Objective: The aim of study is the determination of prevalence of asymptomatic bacteriuria during antenatal period in PUMHSW, with prevalence of antenatal asymptomatic bacteriuria in neighboring countries. Methodology: This study is Cross Sectional-Prospective, and conducted at the Department of Pathology Peoples University of Medical & Health Sciences (PUMHS) for Women Nawabshah (Shaheed Benazir Abad). All the samples (417) were obtained from the pregnant women attending the Outpatient Department of Gynecology and Obstetrics PUMHS Hospital Nawabshah.All mid-stream clean catch collected urine sample in sterile container processed for urine detailed report (physical, chemical and microscopic examination).All the demographic details were entered and analyzed by SPSS 20.More than 8 international as well as national databases were searched to the year 2020, consisting of google, Pub-med, Science direct, Web of Science, Medline. The data obtained were analyzed and their results reported with a random-effects model with confidence level 95%. Result: Out of 417 patients the mean age of the pregnant female was 29.32± 5.74 years.There were females with mean parity of 2.66 ±2.42 and mean gestational age was25.84± 11.80.Age when compared with asymptomatic bacteriuria revealed statistically significant value p value 0.000 with an increased incidence seen among age group of 26-30yrs n=33(44%). The total prevalence of asymptomatic bacteriuria (ASB) was 83(19.9%).Age when compared with asymptomatic bacteriuria revealed statistically significant value p value 0.000 with an increased incidence seen among age group of 26-30yrs. Conclusion: Asymptomatic bacteriuria during pregnancy is increasingly found in younger age women, with increasing gestational age. Therefore urine cultures during antenatal period should be done to diagnose asymptomatic bacteriuria in order to make preventative planning and control of asymptomatic bacteriuria among pregnant women.

Type 2 diabetes is the chronic metabolic disease associated with cardiovascular, renal and neurological complications, responsible for morbidity and mortality. In addition, the incidence of cardiovascular disease was 10.3 out of 1000 type 2 diabetics per year in low-income countries like Gabon. Thus, this work was setup to determine the cardiometabolic profile of type 2 diabetic subjects in Libreville. Materials and Methods: This was a cross-sectional analytical study, which took place at the Endocrinology Department of the University Hospital Center of Libreville (CHUL) and at the Biochemistry Laboratory of Health Sciences University (USS). 210 subjects were enrolled, including 95 diabetics and 115 controls. Their anthropometric values were recorded and biochemical parameters obtained by spectrophotometric methods. Metabolic syndrome was defined according to NCEP ATP III criteria, and 10-years cardiovascular risk was assessed using Framingham and American Heart Association (AHA) / ACC risk scores. Results: The metabolic syndrome was found among 75.8% of diabetics against 24.2% among controls (p = 0.000). In all, 42.1% of diabetics had a high cardiovascular risk by the Framingham equation versus 6.1% for the controls and 41.1% with the AHA / ACC score versus 4.3% for the controls. Diabetic women were more affected than men (54.6% against 13.8% p = 0.000). Conclusion: Type 2 diabetics should undergo intensive management of cardiovascular risk factors in order to reduce the level of cardiovascular risk. Thus their life shall be improved by reducing morbidity and mortality. Keywords: Type 2 diabetes, Cardiovascular risk factors, Metabolic syndrome, Cardiometabolic, Framingham.

Objective: Objective of this study was to assess the effect of nursing educational session on nurse’s knowledge level related to breast cancer. Methods: Single pretest and posttest quasi experimental study was conducted among 131 enrolled participants in two tertiary care hospitals of Karachi after signed consent. Study was held between the period of January 2018 to July 2018 and after approval of Institutional reviews Board of Dow University of Health Sciences Karachi. Questionnaire of Comprehensive Breast Cancer Knowledge Test (CBCKT) was used to collect data. Results: Majority of the participants were General Nursing Diploma holder i.e. 53 (40.5%). 92 (70.2%) were married, 108 (82.4%) had no history of BC and 47 (35.9%) had 1-4 years of working experience. Statistically significant difference was observed between pre-test score and post-test score in all the three components of knowledge of facts, risk factors and causation and myths of BC( p-value

Background: It has been reported that a new type of headache may develop as a result of face mask use during the COVID-19 pandemic. The aim of this study is to investigate the clinical features of face mask-related headache during the COVID-19 pandemic. Methods: This is a cross-sectional study carried out on healthcare workers at the Afyonkarahisar Health Sciences University. The number of workers at our university was established. Sample size was calculated using the G*Power program. A questionnaire consisting of questions relating to pre-existing headache, an aggravation in headache, and de-novo headache was filled out by 3 neurologists with all participants. Results: Data was collected from a total of 375 participants, after the exclusion of 5 individuals who refused to participate. Out of all participants, 26 (6.9%) used a filtering mask, 274 (73.1%) used a surgical mask, 75 (20.0%) participants used a combination of both masks. The number of participants with preexisting headache was 114 (30.4%) had pre-existing headache. Of those with pre-existing headache, 77 (67.5%) healthcare workers had reported an aggravation in their headache after mask use. De-novo headache was observed in 116 (30.9%) of participants. De-novo headache characteristics included throbbing in 17 (14.7%) participants and pressing in 99 (85.3%) participants. In addition, symptoms such as tachypnea, sleep disturbance, and fatigue were found to be significantly higher. Conclusions: This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak.

OBJECTIVE To determine the success rate of minimally invasive parathyroidectomies (MIPs) with preoperative scintigraphy and ultrasonography, and to assess whether these imaging modalities are sufficient. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY Department of General Surgery, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey between March 2017 and December 2019. METHODOLOGY Medical records of 61 patients, who underwent MIP to treat primary hyperparathyroidism, were examined. Age, gender, and pre- and postoperative calcium, parathormone, and phosphorus levels were obtained from patient records. For all patients, the parathyroid (PT) glands were localised, using ultrasonography and Tc-99m methoxyisobutylisonitrile (MIBI) scintigraphy. RESULTS The average patient age was 56.89 ± 13.47 years. Of the patients, 83.6% (n = 51) were females. Localisation of the PT glands with preoperative scintigraphy had an accuracy rate of 100%. However, ultrasonographic localisation was unsuccessful in five patients. Adenomas were noted in 44 patients (72.1%), hyperplasia in 15 patients (24.6%), and neoplasia in two patients (3.3%). Serum parathormone and calcium levels were measured 24 hours after surgery, and were found to be significantly reduced compared to the corresponding preoperative levels (p

Background: Cardiovascular disease (CVD) is the leading cause of death worldwide. Aware­ness of risk factors of CVD is the first step towards effective preventive strategies to combat the CVD burden in diabetes patients. This study aimed to assess the awareness of risk factors of CVD among patients with diabetes mellitus attending diabetic clinic of B.P Koirala Institute of Health Sciences (BPKIHS). Methods: A cross- sectional study was conducted among 112 patients with diabetes in diabetic clinic of BPKIHS. Convenient sampling was used for data collection over duration of six weeks using interview schedule by HDFQ II tool. The data were analyzed in the statistical package for social sci­ence software (SPSS) 16 versions and analyzed using descriptive and inferential statistics. Results: Majority of respondent were aware about common risk factors such as (83.9%) smoking, (78.6%) physical activity, (75%) increasing age, (75.9%) high blood pressure, (71.4%) overweight respectively. Whereas most of the respondents were not aware about high cholesterol, fatty diet, preventive strategies and association of diabetes with CVD. Awareness was statistically significant with educational status, monthly income, residence, CVD information received and co-morbid condition as a heart disease. Conclusions: Based on finding most of the respondents were aware about common risk factor even though they have inadequate level of awareness on overall risk factors of CVD among the risk factor they were poorly aware about cholesterol, gender and preventive aspect. So Effective education on diet and appropriate preventive strategies of CVD are indeed important to reduce CVD burden in diabetes patients.

Background: Adolescent pregnancy is a multifactorial social and global health problem, es­pecially in remote, rural setting in low-middle-income countries. This study was conducted to determine the perinatal outcome of adolescent pregnancy of this region. Methods: A retrospective study was conducted in Karnali Academy of Health Sciences (KAHS), Jumla among nulliparous pregnant adolescent women aged 15 to 19 years (n=363) and those aged 20 to 24 years (n=445) who delivered in this hospital from April 2017 to April 2020 AD. Maternal and perinatal characteristics were compared between these groups. The categorical data between adolescent and adult women were compared. Chi-square test, Odds ratio and 95% confidence interval were examined using SPSS version 16. Results: During the study period, the incidence of adolescent pregnancy was 22%. The adolescent mothers had significantly higher incidence of anemia (p=0.005, OR:2.7; 95% CI:1.34-5.78), abnor­mal fetal presentation (p=0.006, OR:3.1; 95%CI:1.38-7.31) and preterm deliveries (p value