Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Associative Tasks Computing Offloading Scheme in Internet of Medical Things with Deep Reinforcement Learning

The Internet of Medical Things(Io MT) is regarded as a critical technology for intelligent healthcare in the foreseeable 6G era. Nevertheless, due to the limited computing power capability of edge devices and task-related coupling relationships, Io MT faces unprecedented challenges. Considering the associative connections among tasks, this paper proposes a computing offloading policy for multiple-user devices(UDs) considering device-to-device(D2D) communication and a multi-access edge computing(MEC)technique under the scenario of Io MT. Specifically,to minimize the total delay and energy consumption concerning the requirement of Io MT, we first analyze and model the detailed local execution, MEC execution, D2D execution, and associated tasks offloading exchange model. Consequently, the associated tasks’ offloading scheme of multi-UDs is formulated as a mixed-integer nonconvex optimization problem. Considering the advantages of deep reinforcement learning(DRL) in processing tasks related to coupling relationships, a Double DQN based associative tasks computing offloading(DDATO) algorithm is then proposed to obtain the optimal solution, which can make the best offloading decision under the condition that tasks of UDs are associative. Furthermore, to reduce the complexity of the DDATO algorithm, the cacheaided procedure is intentionally introduced before the data training process. This avoids redundant offloading and computing procedures concerning tasks that previously have already been cached by other UDs. In addition, we use a dynamic ε-greedy strategy in the action selection section of the algorithm, thus preventing the algorithm from falling into a locally optimal solution. Simulation results demonstrate that compared with other existing methods for associative task models concerning different structures in the Io MT network, the proposed algorithm can lower the total cost more effectively and efficiently while also providing a tradeoff between delay and energy consumption tolerance.

Exploration and Research on the Integrated Development of“Internet Plus Medical Treatment”

Objective To analyze the development of“internet plus medical treatment”and to explore advantages.Methods The literature of“internet plus medical treatment”was systematically combed and analyzed.Results and Conclusion After exploring the status quo of“internet plus hospitals”,smart pharmacy and web-assisted health management in China,we find that there are some problems in the medical service at present,such as the imperfect laws and regulations,the hidden dangers of information security and the obstacles of medical insurance payment.Therefore,we propose that the development of web-assisted medical service should be led by the government and relevant policies must be improved.Then,self-regulation should be strengthened,and industry standards should be enhanced.Three suggestions are made to improve medical insurance payment and benefit both hospitals and patients,which can provide reference for promoting the development of“internet plus medical treatment”in China.

Relationships of loneliness and mobile phone dependence with Internet addiction in Japanese medical students

We investigated factors contributing to Internet addiction in 105 Japanese medical students. The subjects were administered by a self-reporting questionnaire designed to evaluate demographic factors, Internet addiction, loneliness, health-related lifestyle factors, depressive state, patterns of behavior, and mobile phone dependence. Results of multivariate logistic regression analysis indicated that loneliness and mobile phone dependence were positively related to degree of addiction. Our findings suggest that Internet addiction is associated with loneliness and mobile phone dependence in Japanese students.

Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts

AIM:To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration(PAIR) in the management of hepatic hydatidosis.METHODS:Twenty-six patients with 32 hepatic hydatid cysts had PAIR.Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure.The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle,the cyst was punctured,cystic content(approximately 30 mL) was aspirated by a 12-14 F pigtail catheter and aspirated fluids were sent for analysis.Once the cyst was almost empty,two-thirds of the net amount of material aspirated was replaced by hypertonic saline and left in the cavity for about 30 min,with the catheter left in place for reaspiration of most of the fluid.When the amount of fluid drained was less than 10 mL per 24 h,the drainage catheter was removed.RESULTS:All 32 cysts showed evidence of immediate collapse after completion of the procedure,and before discharge from hospital,ultrasound examination showed fluid reaccumulation in all cysts.Serial follow-up showed a progressive decrease in the size and change in the appearance of cysts.To confirm the sterility of these cystic cavities,seven cysts were reaspirated on average 3 mo after the procedure.Investigations revealed no viable scolices.CONCLUSION:PAIR using hypertonic saline is very effective and safe with proper precautions.

Long-term medical treatment of patients with severe burns at exposed sites

BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental health.However,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental burden.AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds.Active and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological status.RESULTS Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control group.In addition,the color,thickness,vascular distribution and softness score of the scars improved(P<0.01),and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair,limb functional exercise,anti-scar and psychological rehabilitation.

Advances in medical treatment for pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms(PanNENs)are rare neoplasms with strong heterogeneity that have experienced an increasing incidence rate in recent years.For patients with locally advanced or distant metastatic PanNENs,systemic treatment options vary due to the different differentiations,grades and stages.The available options for systemic therapy include somatostatin analogs,molecularly targeted agents,cytotoxic chemotherapeutic agents,immune checkpoint inhibitors,and peptide receptor radionuclide therapy.In addition,the development of novel molecularly targeted agents is currently in progress.The sequence of selection between different chemotherapy regimens has been of great interest,and resistance to chemotherapeutic agents is the major limitation in their clinical application.Novel agents and high-level clinical evidence continue to emerge in the field of antiangiogenic agents.Peptide receptor radionuclide therapy is increasingly employed for the treatment of advanced neuroendocrine tumors,and greater therapeutic efficacy may be achieved by emerging radiolabeled peptides.Since immune checkpoint inhibitor monotherapies for PanNENs appear to have limited antitumor activity,dual immune checkpoint inhibitor therapies or combinations of antiangiogenic therapies and immune checkpoint inhibitors have been applied in the clinic to improve clinical efficacy.Combining the use of a variety of agents with different mechanisms of action provides new possibilities for clinical treatments.In the future,the study of systemic therapies will continue to focus on the screening of the optimal benefit population and the selection of the best treatment sequence strategy with the aim of truly achieving individualized precise treatment of PanNENs.

Review of Medical Treatment of Stable Ischemic Heart Disease

Medical treatment is the initial treatment strategy and is the cornerstone of management in patients with stable ischemic heart disease (IHD). Many patients are not suitable for percutaneous or surgical revascularization because of unfavourable anatomy, or the presence of co-morbidities. In addition, many patients have recurrence of angina following revascularization due to restenosis or incomplete revascularization. Furthermore, randomized clinical trials comparing optimal medical treatment to revascularization have not clearly shown that myocardial revascularization is superior to optimal medical treatment. Traditional drugs for angina treatment include b-blockers, calcium channel blockers and nitrates. Newer drugs are available with different mechanisms of action and with equal efficacy that do not cause significant hemodynamic deterioration. The availability of these newer drugs expands the therapeutic potential of medical treatment to even a wider population with stable IHD. Revascularization in patients with stable ischemic heart disease has never been shown to reduce hard endpoints (death or myocardial infarction) in randomized clinical trials.

Antireflux surgery vs medical treatment for gastroesophageal reflux disease: A meta-analysis

AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease(GERD) patients using meta- analysis.METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only included randomized controlled trials(RCTs) comparing the effect of surgical intervention with medical therapy for GERD. Statistical analyses were performed using Rev Man 5.2 and STATA 12.0 software. Rev Man 5.2 was used to assess the risk of bias and calculate the pooled effect size, while Stata 12.0 was used to evaluate publication bias and for sensitivity analysis. We evaluated the primary outcomes with GERD-/health-related quality of life in short(one to three years) and long(three to twelve years) periods of follow-up. Secondary outcomes evaluated were De Meester scores and the percentage of time that p H < 4 to evaluate the degree of acid exposure.RESULTS: This meta-analysis included 7 studies with 1972 patients. It showed a positive effect of antireflux surgery compared with medical treatment in terms of health-related quality of life [standardized mean difference(SMD) = 0.18; 95%CI: 0.01 to 0.34] and GERD-related quality of life(SMD = 0.35; 95%CI: 0.11 to 0.59). We also conducted the subgroup analyses based on follow-up periods and found that surgery remained more effective than medicine over the short to medium follow-up time, but the advantage of antireflux surgery probably not maintained for long time. GERD-related quality of life in the surgical group was significantly higher than medical group for the < 3 years follow-up(SMD = 0.45; 95%CI: 0.23 to 0.66); the difference was not statistically significant when the follow-up time was ≥ 3 years(SMD = 0.30; 95%CI:-0.10 to 0.69). Meta-analysis showed a statistically significant difference between thesurgical group and medical group in the percentage of time that p H < 4(SMD = 0.38; 95%CI: 0.14 to 0.61). Meta-analysis indicated a positive effect of antireflux surgery compared with medical treatment concerning De Meester scores(SMD = 0.32; 95%CI: 0.00 to 0.65).CONCLUSION: Although both were effective, in some respects surgical intervention was more effective than medical therapy to treat GERD when follow-up time was up to three years.

Medical treatment for a fish bone-induced ileal micro-perforation:A case report

Ingested fish bone induced intestinal perforations are seldom diagnosed preoperatively due to incomplete patient history taking and difficulties in image evidence identification.Most literature suggests early surgical intervention to prevent sepsis and complications resulting from fish bone migrations.We report the case of a 44-year-old man suffered from acute abdomen induced by a fish bone micro-perforation.The diagnosis was supported by computed tomography(CT) imaging of fish bone lodged in distal ileum and a history of fish ingestion recalled by the patient.Medical treatment was elected to manage the patient's condition instead of surgical intervention.The treatment resulted in a complete resolution of abdominal pain on hospital day number 4 without complication.Factors affecting clinical treatment decisions include the nature of microperforation,the patient's good overall health condition,and the early diagnosis before sepsis signs develop.Micro-perforation means the puncture of intestine wall without CT evidence of free air,purulent peritoneum or abscess.We subsequently reviewed the literature to support our decision to pursue medical instead of surgical intervention.

Incidence and Management of Occupational Blood Exposure (OBE) among Medical Students at the University of Bangui

Introduction: Like healthcare workers, medical students are also exposed to a risk of accidental contamination during their hospital internships. However, they do not benefit from prevention services in the same way as workers in this sector, although they actively participate in the routine care provided to patients in the various hospital departments. The objective of our study is to determine the incidence of these accidents and their medical and administrative management among these victims (medical students) not classified in the category of workers. Materials and Method: This was a cross-sectional study carried out over three months from January 15 to March 14, 2023. The study population consisted of all medical students at the Faculty of Health Sciences at the University of Bangui. Regularly enrolled students from 2nd to 7th year, on placement in hospitals in the Central African Republic and who gave their informed consent were included. Data were collected through a self-administered questionnaire. Results: A cross-sectional study was carried out among medical students concerning the incidence and management of accidents involving exposure to blood in the Central African Republic. Of the 254 students included, three (9%) had already been correctly vaccinated against the viral hepatitis B virus, 198 (77.9%) reported still having access to personal protective equipment, 133 students (52.4%) reported being victims of OBE in the past 12 months. The main types of OBE were stings (62%), followed by liquid splashes (32%) and cuts (6%). Among the 133 victims, 92.9% carried out immediate hand disinfection or abundant eye washing, 41.9% obtained the serology of the source patient and 37% reported the accident to their supervisor. Conclusion: It is important that students benefit from better prevention and management of these accidents.

Impact of the adherence to medical treatment on the main urinary metabolic disorders in patients with kidney stones

Objective:To assess the effect of the adherence to medical treatment on urinary parameters in the 24-h metabolic study of patients with kidney stones.Methods:A retrospective,longitudinal,descriptive,and observational study was carried out by reviewing the hospital electronic medical record from 2014 to 2018.The adherence to drug treatment was measured 6 months after its initiation,and the numerical values of the metabolic studies were compared.Wilcoxon tests were performed to compare the difference before and after treatment.Results:Ninety patients were evaluated,with 73.3% of adherence.The 180-day overall adherence rate was 61.2% in patients treated with a single drug and 85.4% in patients treated with multiple drugs.There is a statistically significant increase in citrate levels in patients with good adherence in comparison with non-adherent patients(p=0.031 vs.p=0.528).Conclusions:Medical treatment and dietary measures in patients with kidney stones have an initial impact at 6 months on the values of the main urinary metabolic alterations that predispose to calculi formation;the most significant is seen in those patients with adherence to medical treatment for hypocitraturia.

Deep Forest-Based Fall Detection in Internet of Medical Things Environment

This article introduces a new medical internet of things(IoT)framework for intelligent fall detection system of senior people based on our proposed deep forest model.The cascade multi-layer structure of deep forest classifier allows to generate new features at each level with minimal hyperparameters compared to deep neural networks.Moreover,the optimal number of the deep forest layers is automatically estimated based on the early stopping criteria of validation accuracy value at each generated layer.The suggested forest classifier was successfully tested and evaluated using a public SmartFall dataset,which is acquired from three-axis accelerometer in a smartwatch.It includes 92781 training samples and 91025 testing samples with two labeled classes,namely non-fall and fall.Classification results of our deep forest classifier demonstrated a superior performance with the best accuracy score of 98.0%compared to three machine learning models,i.e.,K-nearest neighbors,decision trees and traditional random forest,and two deep learning models,which are dense neural networks and convolutional neural networks.By considering security and privacy aspects in the future work,our proposed medical IoT framework for fall detection of old people is valid for real-time healthcare application deployment.

Access to Child Health Care, Medical Treatment of Sick Children and Childhood Mortality Relationships in Kenya

Child health care factors such as medical treatment of sick children have direct and indirect effect on childhood mortality. Through international cooperation, a number of countries including Kenya have gathered information on provision of child health services at facility level from periodic Service Provision Assessment (SPA) surveys. Kenya has also gathered information on medical treatment of sick children at household level from periodic Demographic and Health Surveys (DHS). However, establishing how health care information in the SPA surveys relates to childhood mortality and also how these factors relate to medical treatment of sick children in the DHS has been constrained by differences in sample designs of the surveys. This study deployed a fstrategy of constructing community level variables derived from the SPA survey data and incorporated them into DHS data which served as the main data source. The SPA and DHS sampling designs for Kenya allow computation of stable estimates of regional demographic and health service indicators at provincial level. This study analyzed information gathered from 690 health facilities in 2010 SPA and 6079 births born less than 60 months from 2008/09 DHS. The study found that access to child health services, waiting time before service in facility and time to the nearest referral facility were significant facilitating factors for medical treatment of sick children. The study also established that waiting time before service in facility was the only access to health care factor which had a significant effect on childhood mortality when HIV prevalence was excluded in the analysis. However, the significance of waiting time before service diminished with inclusion of HIV prevalence. Further research is required to refine definition and measurement for child health care variable on female autonomy.

Image Color Rendering Based on Hinge-Cross-Entropy GAN in Internet of Medical Things

Computer-aided diagnosis based on image color rendering promotes medical image analysis and doctor-patient communication by highlighting important information of medical diagnosis.To overcome the limitations of the color rendering method based on deep learning,such as poor model stability,poor rendering quality,fuzzy boundaries and crossed color boundaries,we propose a novel hinge-cross-entropy generative adversarial network(HCEGAN).The self-attention mechanism was added and improved to focus on the important information of the image.And the hinge-cross-entropy loss function was used to stabilize the training process of GAN models.In this study,we implement the HCEGAN model for image color rendering based on DIV2K and COCO datasets,and evaluate the results using SSIM and PSNR.The experimental results show that the proposed HCEGAN automatically re-renders images,significantly improves the quality of color rendering and greatly improves the stability of prior GAN models.

Efficient Certificateless Authenticated Key Agreement for Blockchain-Enabled Internet of Medical Things

Internet of Medical Things(IoMT)plays an essential role in collecting and managing personal medical data.In recent years,blockchain technology has put power in traditional IoMT systems for data sharing between different medical institutions and improved the utilization of medical data.However,some problems in the information transfer process between wireless medical devices and mobile medical apps,such as information leakage and privacy disclosure.This paper first designs a cross-device key agreement model for blockchain-enabled IoMT.This model can establish a key agreement mechanism for secure medical data sharing.Meanwhile,a certificateless authenticated key agreement(KA)protocol has been proposed to strengthen the information transfer security in the cross-device key agreement model.The proposed KA protocol only requires one exchange of messages between the two parties,which can improve the protocol execution efficiency.Then,any unauthorized tampering of the transmitted signed message sent by the sender can be detected by the receiver,so this can guarantee the success of the establishment of a session key between the strange entities.The blockchain ledger can ensure that the medical data cannot be tampered with,and the certificateless mechanism can weaken the key escrow problem.Moreover,the security proof and performance analysis are given,which show that the proposed model and KA protocol are more secure and efficient than other schemes in similar literature.

Medical Treatment Process Modeling Based on Process Mining and Treatment Patterns

activities.Ex-periments on a synthetic log of the non-secondary hy-pertension MTP and empirical findings demonstrate the effectiveness of our approach.The results show that the process mining in our approach framework can automatically generate more accurate MTP mod-els,and the subprocess models based on treatment pat-terns make the models easy to understand.

Clinical diagnosis,treatment,and medical identification of specific pulmonary infection in naval pilots:Four case reports

BACKGROUND Specific pulmonary infection could seriously threaten the health of pilots and their companions.The consequences are serious.We investigated the clinical diagnosis,treatment,and medical identification of specific pulmonary infections in naval pilots.CASE SUMMARY We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections,who had accepted treatment at the Naval Medical Center of Chinese People’s Liberation Army between January 2020 and November 2021,including three cases of tuberculosis and one of cryptococcal pneumonia.All cases underwent a series of comprehensive treatment courses.Three cases successfully obtained medical waiver for flight after being cured,while one was grounded after reaching the maximum flight life after being cured.CONCLUSION Chest computed tomography scanning should be used instead of chest radiography in pilots’physical examination.Most pilots with specific pulmonary infection can be cured and return to flight.

Blockchain-Enabled EHR Framework for Internet of Medical Things

The Internet of Medical Things(IoMT)offers an infrastructure made of smart medical equipment and software applications for healthcare services.Through the internet,the IoMT is capable of providing remote medical diagnosis and timely health services.The patients can use their smart devices to create,store and share their electronic health records(EHR)with a variety of medical personnel including medical doctors and nurses.However,unless the underlying commination within IoMT is secured,malicious users can intercept,modify and even delete the sensitive EHR data of patients.Patients also lose full control of their EHR since most healthcare services within IoMT are constructed under a centralized platform outsourced in the cloud.Therefore,it is appealing to design a decentralized,auditable and secure EHR system that guarantees absolute access control for the patients while ensuring privacy and security.Using the features of blockchain including decentralization,auditability and immutability,we propose a secure EHR framework which is mainly maintained by the medical centers.In this framework,the patients’EHR data are encrypted and stored in the servers of medical institutions while the corresponding hash values are kept on the blockchain.We make use of security primitives to offer authentication,integrity and confidentiality of EHR data while access control and immutability is guaranteed by the blockchain technology.The security analysis and performance evaluation of the proposed framework confirms its efficiency.