To evaluate rural community-based eye care models from the perspective of community ophthalmology experts and suggest sustainable technological solutions for enhancing rural eye care delivery.
A ...semi-structured descriptive survey, using close-ended and open-ended questions, was administered to the experts in community ophthalmology sourced through purposive sampling. The survey was self-administered and was facilitated through online platforms or in-person meetings. Uniform questions were presented to all participants, irrespective of their roles.
Surveyed participants (n = 22 with 15 from India and 7 from Nepal) in high-volume tertiary eye hospitals faced challenges with resources and rural outreach. Participants had mixed satisfaction with pre-operative screening and theatre resources. Delayed presentations and inexperienced surgeons contributed to the surgery complications. Barriers to rural eye care included resource scarcity, funding disparities, and limited infrastructure. In rural/peri-urban areas 87% of participants agreed with providing primary eye care services, with more than 60% of the experts not in agreement with the makeshift center model of eye care delivery. Key components for an effective eye care model are sustainability, accessibility, affordability, and quality. These can be bolstered through a healthcare management platform and a human-chain supply distribution system.
Tailored interventions are crucial for rural eye care, emphasizing the need for stronger human resources, optimized funding, and community awareness. Addressing challenges pertinent to delayed presentation and surgical training is vital to minimizing complications, especially with advanced cataracts. Enhancements in rural eye care demand a comprehensive approach prioritizing accessibility, affordability, and consistent quality.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The pathogenesis of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still not fully unraveled. Though preventive vaccines and treatment ...methods are out on the market, a specific cure for the disease has not been discovered. Recent investigations and research studies primarily focus on the immunopathology of the disease. A healthy immune system responds immediately after viral entry, causing immediate viral annihilation and recovery. However, an impaired immune system causes extensive systemic damage due to an unregulated immune response characterized by the hypersecretion of chemokines and cytokines. The elevated levels of cytokine or hypercytokinemia leads to acute respiratory distress syndrome (ARDS) along with multiple organ damage. Moreover, the immune response against SARS-CoV-2 has been linked with race, gender, and age; hence, this viral infection’s outcome differs among the patients. Many therapeutic strategies focusing on immunomodulation have been tested out to assuage the cytokine storm in patients with severe COVID-19. A thorough understanding of the diverse signaling pathways triggered by the SARS-CoV-2 virus is essential before contemplating relief measures. This present review explains the interrelationships of hyperinflammatory response or cytokine storm with organ damage and the disease severity. Furthermore, we have thrown light on the diverse mechanisms and risk factors that influence pathogenesis and the molecular pathways that lead to severe SARS-CoV-2 infection and multiple organ damage. Recognition of altered pathways of a dysregulated immune system can be a loophole to identify potential target markers. Identifying biomarkers in the dysregulated pathway can aid in better clinical management for patients with severe COVID-19 disease. A special focus has also been given to potent inhibitors of proinflammatory cytokines, immunomodulatory and immunotherapeutic options to ameliorate cytokine storm and inflammatory responses in patients affected with COVID-19.
Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States' studies reports this finding using primary data from a ...single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking.
Using the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US.
Results are compatible with findings from previous primary studies. While women (relative risk RR = 1.43, 95% confidence interval CI, 1.42-1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33-2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes.
Our findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician's point of view.
An integrated, competency-based curriculum that fosters social accountability including cultural sensitivity among graduates is an educational strategy towards producing practice-ready professionals. ...This study aimed to evaluate pharmacy graduates' perceptions of competency, integration, and social accountability in the undergraduate curriculum of Nigerian schools of pharmacy.
A cross-sectional online survey consisting of a 42-item questionnaire was administered to 467 purposively selected pharmacy graduates who completed their undergraduate training between January 2012 and February 2020 from 20 accredited Nigerian pharmacy schools. Mann-Whitney U test was used to determine the differences in the participants' responses on a Likert scale.
Of 467 participants, 54.4% felt that the Nigerian undergraduate pharmacy curriculum was not adequate in content, while 54.2% felt the courses in the curriculum were not well integrated to facilitate easy learning by students. About half (50.6%) strongly agreed or agreed that “the basic pharmacy courses are well synchronized with the clinical components” but 28.9% strongly disagreed or disagreed. The majority (88%), with no significant difference between gender (z = −1.615, P = .11), strongly agreed or agreed that they apply knowledge of clients' culture and disparity to deliver pharmaceutical services.
Marginally above half of the graduates perceived the Nigerian undergraduate pharmacy curriculum to be deficient in course content. There is evidence of limited integration and social accountability in the curriculum. Cultural sensitivity appears to be a component of the curriculum but this needs to be properly structured. The pedagogy strategy for learning cultural sensitivity should be further interrogated.
Abstract
The efficacy of leaf extracts of guava Psidium guajava (L.) were assessed on enteric bacteria isolated from two wells (W1 and W2) prone to faecal contamination in Akure, Nigeria. The load of ...enteric bacteria in the water samples was determined using a standard microbiological method. Leaf extracts of P. guajava (L.) were prepared using ethanol and hot distilled water and the antibacterial effects of the extracts on bacterial isolates were determined using the agar well diffusion method. Phytochemical components of the leaf extracts were carried out using standard methods. Results revealed the following mean concentrations of enteric bacteria in W1 and W2: Salmonella (3.8 and 3.9 log10 CFU/100 ml) and Shigella (3.6 and 3.7 log10 CFU/100 ml). The ethanol leaf extracts of P. guajava (L.) exhibited a zone of inhibition of 22 mm at 200 mg/ml on Shigella and no zone of inhibition was observed on Salmonella. The phytochemical components of ethanol and hot distilled water leaf extracts of P. guajava (L.) revealed the presence of saponin as (13.64 mg/g) and (59.82 mg/g). The findings of this study revealed that ethanol leaf extracts of P. guajava (L.) may be useful as an antibacterial agent against Shigella.
Adherence to medications improves glycaemic control and reduces diabetes-related morbidity and mortality.
The study assessed drug therapy for type 2 diabetes, glycaemic control and association of ...medication adherence with socio-demographic and clinical data, among adult diabetic patients attending a healthcare facility.
Cross-sectional survey and hospital records were used to obtain data. The study included 200 adults with type 2 diabetes mellitus in a Nigerian healthcare facility. Data on patients clinical characteristics, diabetes drug therapy and medication adherence were collected, entered and anlaysed using SPSS version 24 (P <0.05). Primary outcome measure was medication adherence among the patients, while secondary outcome measures was glycaemic control.
A total of 200 (100%) respondents participated in the study and the majority 141(70.5%) were over 60 years old. Oral medications were mostly used 187(93.5%), particularly, metformin 199(99.5%) and pioglitazone 100(50.0%), while dipeptidyl peptidase-4 inhibitors were not used at all. Patients mostly had poor glycaemic control 159 (79.5%) and majority 152(76.0%) did not practice self-blood glucose monitoring. Moderate medication adherence was predominant in the population. Class of medicine and socio-demographics were not significantly associated with medication adherence (P>0.05), unlike results of blood glucose self-tests (p=0.001).
Oral antidiabetics, particularly metformin and pioglitazone were mostly used. Poor glycaemic control and moderate adherence were found in the patients, and medication adherence was associated with self-glucose monitoring. This emphasises the need for regular diabetes education on medication adherence.
There is a general lack of awareness of the risk of aortic dissection in Turner syndrome (TS) from both patients with TS and their physicians. Patients often ignore symptoms for up to 24 h before ...seeking medical advice, significantly increasing their risk of death. A clinical profile of those at risk of dissection is emerging and includes the presence of congenital heart defects, aortic dilatation and hypertension. MRI has revolutionised the visualisation of cardiovascular anatomy in TS but remains underutilised, especially in children and adolescents, and there is currently little guidance on blood pressure (BP) assessment or hypertension management. Children and adolescents with TS at risk of dissection could be easily identified by timely imaging and BP assessment. This would allow medical management or surgical intervention to be put in place to reduce the risk of this major, and often fatal, complication. Since guidance is lacking, we have reviewed the literature on the risk factors for dissection in TS during childhood and adolescence, and make recommendations on the assessment and management of these patients.
Oxytocin administration, which may be of therapeutic value for individuals with social difficulties, is likely to affect endogenous levels of other socially relevant hormones. However, to date, the ...effects of oxytocin administration on endogenous hormones have only been examined in neurotypical individuals. The need to consider multi-hormone interactions is particularly warranted in oxytocin trials for autism due to evidence of irregularities in both oxytocin and sex steroid systems.
In this double-blind cross-over study, saliva samples were collected from 16 autistic and 29 neurotypical women before and after intranasal administration of 24 IU oxytocin or placebo. Oestradiol, testosterone, and oxytocin levels were quantified in saliva samples. Participants also completed the Autism-Spectrum Quotient (AQ) and Empathy Quotient (EQ) questionnaires.
Distinct patterns of change in testosterone and oestradiol levels pre- to-post-administration were observed in autistic relative to neurotypical women (ANCOVA, p < 0.05 main effect of Group), controlling for sample collection time. The mean percent change oestradiol was + 8.8% for the autism group and - 13.0% for the neurotypical group (t = 1.81, p = 0.08), while the mean percent change testosterone was + 1.1% in the autism group and - 12.6% in the neurotypical group (t = 1.26, p = 0.22). In the oxytocin condition, the mean percent change oestradiol was + 12.6% in the autism group and - 6.9% in the neurotypical group (t = 1.78, p = 0.08), while the mean percent change testosterone was + 14.4% in the autism group and - 15.2% in the neurotypical group (t = 3.00, p = 0.006). Robust regression confirmed that group differences in percent change hormone levels were not driven by a small number of influential individuals. Baseline hormone levels did not differ between groups when considered individually. However, baseline testosterone relative to oestradiol (T:E2 ratio) was higher in autistic women (p = 0.023, Cohen's d = 0.63), and this ratio correlated positively and negatively with AQ and EQ scores, respectively, in the combined sample.
Further studies with larger and more diverse autistic sample are warranted to confirm these effects.
This study provides the first evidence that oxytocin influences endogenous testosterone levels in autistic individuals, with autistic women showing increases similar to previous reports of neurotypical men. These findings highlight the need to consider sex steroid hormones as a variable in future oxytocin trials.
Objective. To study the efficacy of alendronate, in the treatment of avascular necrosis (AVN) of the hip. Methods. Sixty patients with AVN of the hip (100 hips with AVN) were studied. The follow-up ...period ranged from 3 months to 5 yr. The most common cause of AVN was steroids. Parameters studied were walking time, standing time, pain and disability on a visual analogue scale (VAS), range of motion of the hip, X-ray and MRI of the hip. All patients were treated with alendronate 10 mg/day (or 70 mg/week) along with 500–1000 mg of daily calcium and vitamin D supplements, and were advised to avoid weight-bearing. NSAIDs and analgesics were permitted as needed and were recorded. Results. Forty-one patients (71 AVN hips) with AVN have been followed up for a minimum of 1 yr, 24 patients (42 AVN hips) for 2 yr and 21 patients (37 AVN hips) for more than 2 yr (average 37 month). Fourteen patients have been followed up for less than 1 yr (3–9 months). Significant reduction in pain and disability scores (P<0.001) and significant increase in standing and walking time (P<0.001) were observed. All hip movements improved at 1 yr (P value 0.000–0.009) with an insignificant decline after that (P>0.001). Radiologically, the hips either stabilized in the same grade or progressed by one grade. MRI showed a decrease in marrow oedema in most cases at the 1-yr follow-up. Six patients (10 hips) required surgery and there were two (three hips) dropouts. The drug was well tolerated and there was a reduction in NSAID requirement. Conclusion. Alendronate reduces pain, improves function and retards AVN progression. Early surgical intervention can be avoided in most patients.
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