OBJECTIVE: to determine the more effective dose of intramuscular (IM) Phenylephrine in preventing hypotension due to spinal anesthesia (SA) administered for cesarean section. METHODS: The study was ...conducted from January1, 2020 to July 31, 2020, at Rehman Medical Institute, Peshawar, Pakistan. Sixty participants of American Society of Anesthesiologists (ASA) physical status 1 and 2, scheduled for elective cesarean section (CS) under SA were enrolled in this prospective double-blind study and randomized into two equal groups, P4-group and P8-group. P4-group received IM Phenylephrine 04 mg and P8-group received IM Phenylephrine 08 mg before SA. The incidence and intensity of hypotension, rescue doses of Phenylephrine and any adverse event, were recorded. Data collected was analyzed using Epi lnfo ™ version 7.2.5. RESULTS: Mean age of patients from P4-Group and P8-Group was 28.10±4.39 years and 28.33±4.95 years respectively. There were no statistically significant differences in the two groups with respect to demographic and clinical characteristics. Hypotension occurred in 33.3% (n=20/60) of participants. The incidence of hypotension in P4-group and P8-group were 46.7% (n=14/30) and 20% (n=6/30) respectively. In P8-group, risk of hypotension was 1.5 times less common compared with P4-group with 95% confidence interval of 1.02–2.19 (p=0.02). There was also no statistically significant difference between the onset of hypotension in the two groups. Those who developed hypotension had consumed a lesser amount of rescue Phenylephrine in P8-group compared with P4-group (p-value <0.01). CONCLUSION: Phenylephrine 08 mg IM preemptively controls SA induced hypotension in a sustained way in the fit participants.
For the most part, heart disease increases with age; on the other hand, although the role of exercise and antioxidants in the health of the elderly has been reported, the simultaneous effect of these ...two interventions is a new research topic. Thus, the aim of this study was to evaluate the effect of eight weeks of high intensity interval training (HIIT) and genistein (G) supplementation on oxidative stress, apoptosis and mitochondrial biogenesis in the heart tissue of elderly rats.
In this experimental study, 40 elderly female Sprague-Dawley rats aged 20 ± 2 months and weighing 250 ± 30 g were randomly divided into five groups of eight animals, including: (1) control (C), (2) sham (Sh), (3) HIIT, (4) HIIT + G and (5) G. Also, to evaluate the effect of time passage on the variables, 8 healthy young rats were included in the healthy young control group. HIIT protocol was performed for eight weeks, three sessions with an intensity of 95–90 % VO2max at high intensity intervals and 45–45 % VO2max at low intensity intervals. Ge was received daily at a dose of 60 mg/kg peritoneally. Data analysis was performed using one-way ANOVA with Tukey's post hoc test (P ≤ 0.05).
In the HIIT and HIIT + G groups, levels of Bax, Bax/Bcl-2 ratio, MDA, PAB, GSSG were lower and levels of PGC-1α, TFAM, GSH, GSH/GSSG ratio and NDUFS7 were higher than the control and sham groups (P ≤ 0.05). In the HIIT + G group, levels of Bcl-2 were significantly higher than the control group (P ≤ 0.05). In the HIIT + G group, levels of Bax, GSSG, Bax/Bcl-2 ratio, and PAB were lower, and levels of GSH/GSSG ratio, Bcl-2, PGC-1α, TFAM and NDUFS7 were higher than the G consumption group (P ≤ 0.05). In the HIIT + G group, levels of PGC-1α and TFAM were significantly higher and levels of MDA and PAB were lower than the HIIT group (P ≤ 0.05).
Both HIIT and G consumption seem to have beneficial effects on reducing oxidative stress; in addition, the interaction of these two variables on the improvement of apoptosis and mitochondrial biogenesis is more favorable than the effect of either one alone. However, more studies are needed on different pathways of apoptosis following G administration.
•Overdose of G can inhibit phenolsulfotransferases and activate apoptotic proteins, but not in the oxidative-antioxidant system•Both HIIT and G consumption can have beneficial effects on reducing oxidative stress.•The interaction of HIIT and G on the improvement of apoptosis and mitochondrial biogenesis is favorable than each one alone.
The quality of care delivered and clinical outcomes of care are of paramount importance. Wide variations in the outcome of emergency care have been suggested, but the scale of variation, and the way ...in which outcomes are inter-related are poorly defined and are critical to understand how best to improve services. This study quantifies the scale of variation in three outcomes for a contemporary cohort of patients undergoing emergency medical and surgical admissions. The way in which the outcomes of different diagnoses relate to each other is investigated.
A retrospective study using the English Hospital Episode Statistics 2005-2010 with one-year follow-up for all patients with one of 20 of the commonest and highest-risk emergency medical or surgical conditions. The primary outcome was in-hospital all-cause risk-standardised mortality rate (in-RSMR). Secondary outcomes were 1-year all-cause risk-standardised mortality rate (1 yr-RSMR) and 28-day all-cause emergency readmission rate (RSRR).
2,406,709 adult patients underwent emergency medical or surgical admissions in the groups of interest. Clinically and statistically significant variations in outcome were observed between providers for all three outcomes (p < 0.001). For some diagnoses including heart failure, acute myocardial infarction, stroke and fractured neck of femur, more than 20% of hospitals lay above the upper 95% control limit and were statistical outliers. The risk-standardised outcomes within a given hospital for an individual diagnostic group were significantly associated with the aggregated outcome of the other clinical groups.
Hospital-level risk-standardised outcomes for emergency admissions across a range of specialties vary considerably and cross traditional speciality boundaries. This suggests that global institutional infra-structure and processes of care influence outcomes. The implications are far reaching, both in terms of investigating performance at individual hospitals and in understanding how hospitals can learn from the best performers to improve outcomes.
This systematic review appraises, synthesises, and presents the published evidence on the effect of patient education videos in modifying medication-related health behaviours.
A systematic literature ...review was conducted across 12 databases. Title, abstract and full-text screening was done independently using PICOS. Data extraction results were mapped directly to the Behaviour Change Intervention Functions. Results are reported in accordance with PRISMA 2020.
Out of 583 studies 12 articles from 4 countries were included. Interventions focus on improving patient’s knowledge. Modelling, Enablement, Persuasion, and Training are used in video education development. PASS analysis showed very few well designed studies that allow the reliable determination of behaviour changes.
A reliable or sustained effect of patient education videos in modifying medication-related health behaviours could not be reported due to a lack of robust study design. Modelling, Enablement, Persuasion, and Training are all intervention designs used to target behaviour change often resulting either in a narrative (real people acting) or practice (demonstrating) presentation format.
With the increased use of health education technology, robust, theoretically underpinned studies are urgently needed to evaluate the effectiveness of these interventions in the context of their impact on patient medication-related behaviour change.
OBJECTIVE: To assess the influence of feeding practices, maternal dietary habits and maternal body mass index (BMI) on growth pattern of breast-fed and formula-fed infants. METHODS: This ...cross-sectional study was performed on 50 healthy infants. Twenty-five each breast-fed (BF) and formula-fed (FF) infants along with their mothers were enrolled. The infants’ weight, height, BMI, head circumference and skinfolds (biceps and triceps) were recorded. Infant’s mother weight, height, BMI, mid-arm circumference and skinfolds were also recorded. The mothers filled 24-hours dietary-recall proforma. The 24-hours dietary-recall was then analyzed by windiet® software. RESULTS: Age of infants was 78.40±35.88 days at time of assessment. Height and weight standard deviation score (SDS) was found to be -2.759±3.10 and -0.538±2.05 with SDS of BMI was 1.59±2.30. Mean anthropometric measurements between the two groups were not significantly different except for head circumference (BF=38.12±4.46, FF=40.32±2.34; p-value=0.036). BMI and age of mothers were 26.49±4.93 kg/m2 and 29.54±2.86 years at assessment. Anthropometric analysis of mothers showed an increasing trend of different parameters especially waist circumference (cm) in breast-feeding mothers (lactating=75±15.6, non-lactating=61±18.2, p-value=0.007). Dietary intake of lactating mothers (energy=3032±12 Kcal; % energy intake=125.9±53.3) was more as compared to non-lactating mothers (1878±99 Kcal; % energy intake=78±41.2). Similarly intake of carbohydrates (lactating=414±186, non-lactating=274±175), fats (lactating=109±60.4, non-lactating=66.6±33.7), proteins (lactating=98.2±52.5, non-lactating=60.2±54.2), zinc (lactating=14.64±7.28, non-lactating=8.08±8.53), selenium (lactating=30.4±22.3, non-lactating=4.12±7.64) and dietary fiber (lactating=41.3±19.5, non-lactating=20.4±15.5) were significantly different. CONCLUSION: Growth pattern of both breast-fed and formula-fed infants were not significantly different. Energy intake, percentage energy intake and intake of macronutrients & micronutrients are more in lactating mothers.
The aim of this study was to examine the outcomes of over a decade's experience utilizing preperitoneal ventral hernia repair (PP-VHR).
PP-VHR was first described by our group in 2006, and there have ...been no subsequent reports of outcomes with this technique.
A prospective study of all PP-VHR from January, 2004 to April, 2016 was performed. Multivariate stepwise logistic regression and Cox proportional-hazard models were used to identify predictors of wound complications and hernia recurrence, respectively.
There were 1023 PP-VHRs. Mean age was 57.2 ± 12.6 years, BMI 33.7 ± 11.4 kg/m, defect size 210.0 ± 221.4 cm; 23.7% had diabetes, 13.9% were smokers, 68.7% were recurrent, and 23.6% incarcerated. Component separation was required in 43.6%, and a panniculectomy was performed in 30.0%. Wound complication was present in 27.3% of patients, with 1.7% having a mesh infection. In all, there were 53 (5.2%) hernia recurrences and 36 (3.9%) in the synthetic repairs, with a mean follow-up of 27.0 ± 26.4 months. On multivariate regression (odds ratio or hazard ratio, 95% confidence interval), diabetes (1.9, 1.4-3.0), panniculectomy (2.6, 1.8-3.9), and operations requiring biologic mesh were predictors of wound complications, whereas recurrent hernia repair (2.69, 1.14-6.35), biologic mesh (3.1, 1.67-5.75), and wound complications (3.01, 1.69-5.39) were predictors of hernia recurrence.
An open PP-VHR is a very effective means to repair large, complex, and recurrent hernias resulting in a low recurrence rate. Mesh choice in VHR is important and was associated with hernia recurrence and wound complications in this population.
Indigenous elders play an important role in transmitting knowledge, values and practices, hence fostering identity-building through intergenerational solidarity. We aimed to verify the association ...between intergenerational solidarity involving Indigenous elders and mental health of Indigenous people living off reserve.
We carried secondary analyses of data for a subsample from the cross-sectional 2012 Aboriginal Peoples Survey (total sample: n = 28,410 Indigenous persons aged ≥6 years old living off reserve; subsample: n = 13,020 aged 18-44 years old). Controlling for age as well as material and social deprivation, we used logistic regressions to verify the association between intergenerational solidarity (proxied as time spent with an elder and potential of turning to an elder or grandparent for support in times of need) and mental health (perceived mental health, mood disorders, anxiety, suicidal thoughts and attempts).
About 39 and 9% of the respondents respectively reported having spent time with an elder and would have turned to an elder or grandparent for support in times of need. Women who would not turn to an elder or grandparent for support in times of need were more likely to report fair or poor perceived mental health (OR = 1.69, p = 0.03). Men not spending time with an elder were more likely to experience mood disorders (OR = 1.66, p = 0.004). Women who would not turn to an elder or grandparent for support in times of need were more likely to experience anxiety disorders (OR = 1.57, p = 0.04). Women not spending time with an elder or who would not turn to an elder or grandparent for support in times of need were respectively more likely to have suicidal thoughts (OR = 1.62, p = 0.04) or to have attempted suicide (OR = 3.38, p = 0.04).
Intergenerational solidarity is associated with better mental health outcomes of Indigenous people living off reserve. These results could guide policies and practices that aim to enhance mental health and wellness in Indigenous populations.
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