Tuberculosis can affect one-third of the musculoskeletal system, but isolated bone tuberculosis in infants is extremely rare, often presenting with non-specific symptoms that can lead to misdiagnosis. Cystic forms of tuberculosis can resemble various other pathological conditions Here, we present a case of tuberculosis osteomyelitis affecting the distal tibia in a nine-month-old infant who visited our outpatient department due to swelling and pain in the left ankle. The lesion was treated with curettage and debridement on two occasions. The patient was fitted with an under-knee splint for three months and received anti-tuberculosis therapy for twelve months. During a one-year follow-up, there were no signs of relapse, and no epiphyseal injury or deformity was observed. This case emphasizes the need to consider tuberculous osteomyelitis in the differential diagnosis of lytic lesions in the distal tibia metaphysis in infants.
Introduction: This study aimed to compare the effectiveness of bevacizumab administered alone versus combined with methylcellulose in reducing intraocular pressure during a six-month period following deep sclerectomy. Methods: This comparative investigation, serving as an extension of a prospective randomized controlled trial, enrolled 30 eyes from 30 individuals diagnosed with open-angle glaucoma (15 eyes assigned to each treatment arm). Among participants, 33.3% presented with secondary open-angle glaucoma (pseudoexfoliation syndrome), while 66.7% had primary open-angle glaucoma requiring deep sclerectomy. Postoperatively, Group A received subconjunctival bevacizumab injections, whereas Group B received subconjunctival injections of a bevacizumab-methylcellulose mixture. Primary outcome measures included surgical success rates and bleb morphology assessment. Results: Among eligible participants, 66.7% were male and 33.3% were female. Visual acuity measurements demonstrated no significant intergroup differences before or after surgery. Although Group B exhibited greater IOP reduction compared to Group A, statistically significant differences between groups emerged only at postoperative day one and at the six-month follow-up assessment. Success rates (complete or relative success) at six months showed no statistically significant variation between groups (*P*>0.05), nor did mean preoperative and postoperative values with standard deviations differ significantly. Vascularity scores decreased markedly in Group B at one-month, three-month, and six-month evaluations relative to Group A. Conclusion: Utilizing a sustained-release delivery system that extends bevacizumab bioavailability appears to enhance surgical outcomes compared to conventional isolated bevacizumab ocular injections. Trial Registration: IRCT2016121831450N1
Introduction: Ventilator-associated pneumonia (VAP), a common nosocomial infection, increases the length of hospitalization and the patient mortality rate. A ventilator care process "bundle", composed of peptic ulcer disease prophylaxis, deep vein thrombosis (DVT) prophylaxis, elevation of the head of the bed, and a sedation vacation, may decrease VAP rates. This cross-sectional descriptive study aimed to assess the knowledge, attitudes, and practical levels of intensive care unit (ICU) nurses toward VAP bundle. Methods: A four-part questionnaire was designed and distributed to the all-general ICU nurses (n=100) at Sina, Shohada and Imam Reza hospitals of Tabriz University of Medical Science in Iran, from November 2021 to November 2022, who intended to take part in this project and completed the questionnaire form completely. Analysis of variance (ANOVA) tests were used to compare ICU nurses’ knowledge, attitude, and practice levels. Results: 54% of nurses presented high knowledge, 64% had moderate practices, and 90% had a positive attitude toward VAP bundles. Nursing experience in ICU wards, level of education, and participation in infection control courses had a significant relation with the knowledge and practice levels (P<0.05), while only the education level showed significant association with positive attitude (P=0.007). Conclusion: ICU nurses demonstrated a high level of knowledge, a positive attitude, and a moderate level of practice regarding the VAP bundle.
Introduction: In the flipped class, students study the educational content before attending the class. They enter the classroom for cooperative learning, therefore, in this project, the effect of holding a critical care workshop in the flipped teaching method on the improvement of knowledge, and practical skills in medical students has been investigated. Methods: In this descriptive interventional study, the sample size was calculated to be 45 people in both groups. The educational content of critical care through the center’s website and virtual channels was provided to the intervention group a month ago, and then the students practiced and asked questions in the practical class under the supervision of the professor. The knowledge, and practical skills in the fields of intubation, ATLS, BLS, and ACLS were checked before and after the training through a questionnaire and OSCE test. Results: The acceptable amount of students’ awareness in doing critical care between two training and control groups after training and two months after training is statistically significant (P<0.001). The difference in the average skill score of students in critical care was statistically significant (P<0.001). Conclusion: Learning through interaction and discussion increases knowledge, improves skills and stability, and deepens learning in critical patient care education.
Introduction: Studies show that chest computed tomography (CT) findings in patients with COVID-19 may differ among different populations, which could be attributed to demographic differences. The present study is done to provide evidence regarding the effect of demographic factors on imaging findings. Methods: This retrospective study involved 202 participants with COVID-19. The participants underwent CT imaging before hospitalization or on the first day of admission. Two expert radiologists determined each patient’s radiologic signs and symptoms. Results: by comparing dead participants and survivors, airspace consolidation, air Bronchogram, and posterior segment involvement were commonly seen in passing participants. Lung score and mean number of involved segments were higher in passing participants. Participants over 75 were less likely to have lymphadenopathy, septal thickening, and sub-pleural transparent lines. The area under the curve was 0.706 (95% CI: 0.631-0.782), higher among women older than 75. Conclusion: Although demographic features generally do not affect common imaging findings in COVID-19 participants, the prognostic significance of chest CT imaging may differ based on gender and age.
Introduction: Stroke is the third most common cause of death and most common debilitating neurological disease with balance disorder as one of its major clinical manifestations. The purpose of this study is to investigate the balance and related neurophysiological measurements in ischemic stroke patients. Methods: Stroke patients with 0 or 1 modified Rankin Scale (mRS) level and National Institutes of Health Stroke Scale (NIHSS) below 10 was involved in this study. Balance measuring device (BSS), Pittsburgh Sleep Quality Index (PSQI) Questionnaire, Vienna Test System (VTS), paraclinical measurements including transcranial Doppler and MRI were used to evaluate the condition. Results: In evaluation of 58 patients with acute stroke, the average score of the overall stability index was 3.38 ± 1.75. The left-right average was 8.93 ± 67.90 and front-back average was 7.58 ± 133.50. The mean reaction time was 659.64 ± 197.72 milliseconds, which was 17.31 in terms of percentage rank. Also, average movement time was 337.77 ± 146.44, which was equal to 9.18 in terms of percentage rank. Total score was 2.78 ± 4.27, its average percentile rank is 13.27 and time for correct answers was 6.70 ± 1.83, and average percentile rank is 22.50. Sleep quality score of the patients indicated low. Conclusion: Balance, reaction time, follow-up, and sleep disturbance among the studied stroke patients were significantly worse than the community average and in poor range. In addition, it was shown that several factors are effective in balance of stroke patients, and thus paying attention to those factors can be effective in improving the balance.
Insulin therapy is vital for managing elevated glucose levels among patients with type 1 diabetes and some individuals with type 2 diabetes. A drawback in traditional methods of insulin administration, including syringes and pens, lies in their limited effectiveness, mainly due to improper storage and poor patient adherence. Furthermore, the invasive nature of these traditional modalities contributes to the observed challenges in patient adherence. By using insulin pumps, clinicians and patients can achieve more consistent and improved euglycemic control. This paper summarizes knowledge and research through a comprehensive literature review. Through our research, we want to highlight the various recent advancements in insulin pump therapy. We hope this paper contributes significantly to understanding new technologies and moves us closer to making insulin pump therapy more accessible.
Introduction: Recent concerns have surfaced regarding the insufficient development of critical thinking skills among nursing students, resulting in a gap between theoretical knowledge and practical application. This study aimed to address this gap and explore the significance and methods of developing critical thinking among Iranian nursing students. Methods: This study followed the PRISMA guidelines to conduct a systematic literature review, using a rigorous method that included document organization, data extraction, quality assessment, and report writing. The search included all observational or interventional studies, with full-text availability in Persian or English languages. Non-original publications were excluded. PubMed, SID, Magiran, and Scopus databases were searched, and the study selection process involved evaluating titles, abstracts, and full texts. Data extraction included analyzing the characteristics of the included studies, while methodological quality assessment employed suitable tools. Results: Out of 1314 initially identified articles, a total of 22 high-quality studies were reviewed in this systematic review. These studies, conducted between 2016 to 2022, examined critical thinking in Iranian nursing students. The interventions evaluated various approaches including problem-based learning, conceptual mapping, flipped classroom, clinical reasoning, and team-based learning, while the observational studies explored the association between critical thinking and emotional intelligence, learning styles, and academic performance factors. Conclusion: This study underscores the significance of developing critical thinking skills among Iranian nursing students and suggests the effectiveness of utilizing problem-based learning and conceptual mapping strategies in enhancing critical thinking abilities.
Introduction: Despite advancements in cancer treatment, existing therapies like chemotherapy and radiotherapy often face challenges such as treatment resistance and adverse effects, necessitating the exploration of novel approaches. Dendritic cell-derived extracellular vesicles (DEVs) have emerged as a promising immunotherapeutic tool in cancer therapy. The purpose of this review is to summarize recent research on the immunotherapeutic potential of DEV, emphasizing their mechanism of action in the context of cancer treatment. Methods: Eligible studies were identified through comprehensive searches in PubMed, Scopus, and Google Scholar. Inclusion criteria encompassed original research on DEV’s immunotherapeutic efficacy, while reviews and non-original studies were excluded. Results: Nine studies were included, spanning from 2003 to 2022. The studies demonstrated that DEVs can activate CD8+cytotoxic T-cells, CD4+helper T-cells, and NK cells, thereby inducing potent antitumor immune responses. DEVs from interferon-treated dendritic cells exhibited enhanced antigen-presenting capabilities compared to other sources. DEVs also showed potential in regulating inflammation, with studies indicating suppression of the NF-κB signaling pathway in endothelial cells. Conclusion: DEVs represent a promising immunotherapeutic approach for cancer, capable of stimulating both innate and adaptive immune responses. However, challenges such as DEVs’ production variability and the need for standardized purification methods remain. Future research should focus on optimizing DEVs’ production and combining it with other immunotherapies to enhance therapeutic outcomes.
Introduction: Fluoroquinolone (FQ) and co-trimoxazole (STX) are the most effective antibiotics for Escherichia coli; however, antibiotic resistance has become an ever-increasing challenge. The current study investigates the prevalence rate and risk factors for developing FQ and STX resistance in Northwest Iran. Methods: This is a retrospective cohort study of 314 patients admitted to Sina Hospital, the academic hospital affiliated with Tabriz University of Medical Sciences, Iran, between 21st March 2017 to 20th March 2018. Based on specimen culture, patients were divided into two groups, i.e., FQ or SXT-resistant E. coli and the antibiotics sensitive. The potential risk factors for developing FQ or SXT-resistant E. coli were studied in the included patients. Results: FQ and SXT-resistant E. coli prevalence was 66.3% and 70%, respectively. Univariate analyses showed that type II diabetes mellitus, prior antibiotic use, prior FQ administration, prior admission, prior urinary tract infection, urinary catheterization, and anemia were the significant risk factors for developing FQ-resistant E. coli infection. The univariate analyses indicated that prior antibiotic use, hospitalization in an intensive care unit (ICU), and urinary catheterization were the significant risk factors for developing SXT-resistant E. coli infection. FQ and SXT-resistant E. coli infections are prevalent in our region. Prior antibiotic use and urinary catheterization are the common risk factors for developing FQ and SXT-resistant E. coli in our region. Conclusion: Type II diabetes mellitus, prior urinary tract infection, gentamicin resistance, prior FQ administration, and extended-spectrum β-lactamases (ESBL) production are risk factors for developing FQ-resistant E. coli and ESBL production is the risk factor for developing STX-resistant E. coli in our region.
Introduction: Although the prevalence of thyroid tumor is about 7% in the general population, the malignancy rate is approximately 5% among thyroid tumors. This emphasizes the need for effective preoperative diagnostic methods for proper patient management. Methods: A descriptive cross-sectional study was conducted at Colombo South Teaching Hospital and the Department of Pathology, University of Sri Jayewardenepura, Sri Lanka. Patients with radiologically suspected malignant thyroid nodules (n=107) were enrolled. fine needle aspiration cytology (FNAC) was performed under ultrasound scan (USS) guidance by an experienced consultant radiologist. Direct smears and cell block preparations were prepared from FNAC specimens. Smears were reviewed by two independent pathologists. USS and FNAC findings were reported according to Thyroid Imaging Reporting and Data System (TIRADS) system and Bethesda system, respectively. Descriptive statistics were expressed as frequencies and percentages. Diagnostic performance of USS and FNAC was assessed using receiver operating characteristic (ROC) curve. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. Results: The Majority (79.4%) were females. Age ranged from 15 to 76 years (47.3±12.89). Malignant risk prediction of 77% was observed in TIRADS system. Malignant risk of 17.9%, 37.5%, and 87.5% were reported respectively for TIRADS 4a, 4b, 4c categories while TIRADS 5 reports a risk of 60.0%. Sensitivity, specificity, NPV, and PPV of FNAC were 88.9%, 87.5%, 96%, and 70% respectively compared with the histology results. Conclusion: Bethesda system cytology reporting and radiologic TIRADS classification are important preoperative diagnostic tools for identifying suspicious thyroid nodules in resource-limited setting. FNAC was a better diagnostic test compared to USS for evaluating thyroid nodules.
Introduction: Malabsorption is a complex medical condition with a diverse range of underlying etiologies posing a diagnostic challenge. The aim of the study was to investigate the correlation between endoscopic findings and histopathological diagnoses in patients with suspected malabsorption syndrome. Methods: This cross-sectional study was conducted over 12 months on 160 patients aged 2 to 60 years with chronic diarrhea and nutritional deficiencies. Endoscopic biopsies of the small intestine were performed and reported based on the following parameters including number and site of the biopsy specimens, villous height, and architecture, villous to crypt (V:C) ratio, presence of crypt hyperplasia and intra-epithelial lymphocyte (IEL) count. Results: Clinical presentations included chronic diarrhea (41.9%), weakness (12.9%), weight loss (9%), and constipation (2.5%). Endoscopic findings were normal in 49.69% of population. Histopathological examination revealed villous atrophy (18.6%), increased IEL count (16.9%) and crypt hyperplasia (6.2%). Chronic duodenitis was the most common diagnosis (64.4%). Celiac disease (3.1%) and tropical sprue (1.2%) were diagnosed based on specific criteria, emphasizing the need for histopathological confirmation. Conclusion: This study highlights the spectrum of histopathological changes in malabsorption and underscores the importance of its correlation with clinical and endoscopic findings. In clinical scenario of malabsorption, endoscopy findings vary from normal to abnormal mucosal morphology. Normal mucosal study may also reveal pathological changes on histopathological evaluation. Hence histopathology remains a crucial step for understanding etiopathogenesis thus helping to streamline the management.
Introduction: Some changes in the peripheral blood and arterial blood gas (ABG) parameters will occur in patients with severe COVID-19 infections. These changes have the potential to provide clues or guidance for the diagnosis, treatment, and prognosis of COVID-19 patients. The aim of this study was to evaluate the association of hemodynamic, peripheral blood markers and arterial blood gas parameters with respiratory insufficiency and mortality rate in severe COVID-19 patients. Methods: This single-center, prospective observational study was conducted on severe COVID-19 patients admitted to the general ICU of a university affiliated hospital in the northwest of Iran. Hemodynamic, hematological, coagulation, biochemical and ABG parameters were compared between survivors and non-survivors and also between patients with mild to moderate and severe respiratory insufficiently. Unadjusted and adjusted binary logistic regression analyses were employed to identify risk factors related to the respiratory insufficiency and mortality. Results: In adjusted binary logistic regression, low oxygen saturation (odds ratio [OR]: 0.763, 95% CI: 0.037-0.990, P=0.008), elevated polymorphonuclear leukocyte (PMN)/lymphocyte ratio (OR: 1.999, 95% CI: 1.224-3.008, P=0.008), elevated lactate dehydrogenase [LDH] (OR: 1.711, 95% CI: 1.222-2.051, P=0.045), elevated creatine phosphokinase [CPK] (OR: 1.712, 95% CI: 1.323-2.004, P=0.038), high level of [FiO2] (OR: 1.736, 95% CI: 1.419-2.052, P<0.001) and low level of partial pressure of oxygen (PaO2)/FiO2 ratio (OR: 0.894, 95% CI: 0.387-1, P=0.047) had increased risk of ICU mortality. Conclusion: The potential risk factors of high LDH, CPK, PMN/lymphocyte ratio, FiO2, low SpO2 and PaO2/FiO2 ratio could help clinicians identify patients at high risk of death early in the ICU admission.
Introduction: Non-smoking chronic obstructive pulmonary disease (COPD) is one of the major contributors among total COPD cases in low- and middle-income countries. This study aimed to investigate pulmonary functions and estimate systemic and airway inflammatory and oxidative stress markers in serum and exhaled breath condensate (EBC) of cigarette-smoking COPD and biomass smoke-exposed COPD patients, comparing them with healthy smokers and healthy non-smokers. Methods: A total of 45 participants were enrolled: smoker COPD (n=10), biomass smoke-exposed COPD (n=10), smoker control (n=10), and non-smoker control (n=15). Pulmonary function tests, including spirometry and impulse oscillometry, were performed. Inflammatory and oxidative stress marker levels in both serum and EBC were estimated. Results: Spirometric parameters, including slow vital capacity (SVC), forced expiratory volume at 1st second (FEV1), forced vital capacity (FVC), and FEV1/FVC were significantly less in COPD groups (smoker/biomass) as compared to controls. Smoker COPD had less FEV1/FVC than biomass-exposed COPD. COPD groups (smoker/biomass) exhibited significant impairment in lung mechanics, characterized by increased peripheral airway resistance (R5-R20), reactance at 5 Hz (X5), and resonant frequency (Fres), indicating involvement of peripheral airways. However, no significant change in lung mechanics exists between smokers’ COPD and biomass-exposed COPD. Among the oxidative stress markers, 8-isoprostane and nitrotyrosine-3 (NT3) levels in EBC were significantly higher in smoker-COPD compared to biomass-exposed COPD and non-smoker controls, respectively. Conclusion: Significant pulmonary function impairment was observed in both smoker COPD and biomass smoke-exposed COPD. Inflammatory and oxidative stress markers are more deranged in smoker COPD than in biomass smoke-exposed COPD and healthy controls.
Introduction: India is committed to achieving the United Nations Sustainable Development Goals, aiming to eradicate human immunodeficiency virus (HIV) by 2030. India has 2.4 million people living with HIV. This study aims to identify gender gaps in internet access and their impact on comprehensive HIV knowledge. Methods: India’s National Family Health Survey-5 (NFHS-5) data, which is public and anonymised, is used for the study. The sample is divided into urban and rural men and women. Correlation coefficient analysis, linear regression analysis, and descriptive statistical analysis were performed. Results: National-level data on internet access show a greater number of men with internet access (total 57.1%, urban 72.5%, and rural 48.7%) than women (total 33.3%, urban 51.8%, and rural 24.6%). The descriptive analysis shows that in every region of India; men are more numerous compared to women with access to the internet and comprehensive knowledge of HIV. Linear regression analysis at a significance level of 0.05, when compared with the total women population (0.347), urban women (0.3529), and rural women (0.3963), with values for total men population (0.6051), urban men (0.4159), and rural men (0.5538) for the study variables, shows a significant gender difference. Correlation coefficient analysis at a significance level of 0.05 shows a linear association between the study variables. Conclusion: This study identified an urban-rural and gender disparity. As a result, differences were discovered in internet access and HIV awareness. Men have more access to the internet than women. Our findings revealed a clear link between internet access and HIV knowledge. Gender inequalities affect social variables such as access to technology, with men having greater access to the internet than women. Men, irrespective of cities or rural areas, have greater access to the internet than women, which may explain why they are more knowledgeable about HIV. Compared to rural women, urban women have better internet access, which could explain why urban women have a higher level of HIV knowledge. Gender inequality in information access has an impact on health outcomes.
Introduction: Magnetic resonance imaging (MRI) scans of the brain are used to identify signs of disease, enabling more precise diagnosis of brain-related conditions. Neurological disorders pose significant risks and can lead to the deterioration of normal bodily functions. Various strategies are employed to monitor anomalies. However, significant improvements are still required in diagnostic processes and in the detection of cerebral diseases. Methods: This method first involved preprocessing the image, followed by threshold-based segmentation. We used elastic net regression (ENR) due to its superior performance metrics compared to the approaches we evaluated for image classification. Results: This strategy yielded improved outcomes, with an accuracy of 98.7% and precision of 98.88%. The recall score was 98.75%, while the F1 score was 98.23%. Conclusion: In this study, the TSENR method was used to detect brain disease. Although many techniques are used to diagnose neurological disorders, not all of them are suitable for reliable evaluation. However, the implemented TSENR model provided a more accurate, sensitive, and predictive response. This technique can be applied to medical image analysis.
Introduction: Vertigo is a common clinical complaint with various underlying causes, making a clear understanding of patient characteristics essential for accurate diagnosis and management. This study aimed to investigate the age distribution, sex, medical history, and neurological symptoms in patients with vertigo. Methods: We collected data from 100 patients with complaints of vertigo who were referred to Ali Ibn Abi Taleb Hospital. Inclusion criteria included: 1) Age between 18 and 80 years, 2) A definitive diagnosis of true vertigo, and 3) Completion of the informed consent form. The collected information encompassed demographic characteristics, paraclinical evidence, and specifics of the vertigo. Statistical analysis was performed using descriptive statistics (frequency) and inferential statistics (chi-square test) within a 95% confidence interval. Results: Of the patients, 84% were diagnosed with peripheral vertigo, 63% were women, and 39% were aged between 45 and 65 years. A significant relationship was found between the type of vertigo and paraclinical evidence (P<0.000), and history of stroke (P=0.001). However, there was no significant relationship between the type of vertigo and history of head trauma and transient ischemic attack (TIA) (P>0.05). Additionally, no correlation was observed between vertigo and symptoms such as nausea, vomiting, auditory issues, or other neurological symptoms. Conclusion: The findings of this study show that the occurrence of central vertigo increases as people age. Most patients with abnormal paraclinical evidence were diagnosed with central vertigo, and many patients with a history of stroke experienced central vertigo. Therefore, it is important for physicians treating vertigo to provide appropriate management, carefully review patients’ medical histories and symptoms, and use paraclinical findings when needed.
Introduction: The clinical significance of coagulase-negative staphylococci (CoNS) is becoming increasingly concerning in healthcare settings, with dire consequences such as mortality. We investigated an unusual increase in blood-borne CoNS among patients in a private tertiary health facility in Southwest Nigeria and described mitigation strategies. Methods: CoNS bacteraemia descriptive analysis was conducted among inpatients between April 2022 and June 2022. Blood cultures were processed with an automated system. Phenotypic and molecular analyses (using 16S rDNA) of CoNS were performed according to established guidelines. We implemented the multimodal infection prevention and control (IPC) approach recommended by the World Health Organisation. Results: Eighty-two blood cultures (non-duplicate samples) were requested during the period. Of these, 30 (36.5%) were culture-positive, and 10 were CoNS (10/30, 33.3%).The cumulative incidence of CoNS bacteraemia was 12 cases per 100 patients over 90 days, compared to 1-2% in previous months. Staphylococcus haemolyticus (4/10, 40%), Staphylococcus hominis (3/10, 30%), Staphylococcus epidermidis (2/10, 20%), and Staphylococcus saccharolyticus (1/10, 10%) were identified. All isolates were resistant to ciprofloxacin, trimethoprim-sulfamethoxazole, and cefoxitin (methicillin-resistant surrogate marker), while they were susceptible to vancomycin and linezolid. All the isolates fell into the S. epidermidis and S. haemolyticus clusters in phylogenetic studies. The rates returned to baseline following the implementation of the IPC strategies. Conclusion: The unusual surge in CoNS incidence at the hospital resulted from multidrug-resistant clusters of S. haemolyticus and S. epidermidis, which were addressed by the implementation of multimodal IPC strategies.
