Contraceptive behaviors and awareness in an urban slum community of south India

Objective:To assess the factors associated with knowledge,attitude and behavior of contraception use among urban slum population in Chennai.Methods:A cross-sectional study was conducted in the urban slum of Anakaputhur,Chennai.Married couples between ages of 19-49 years and living in slum areas were taken up for the study by simple random sampling.Pregnant women,postnatal and postmenopausal women were excluded from the study.Data collection was done using a pretested structured questionnaire focusing on details regarding contraception knowledge,attitude,and practices.Data analysis was done using IBM SPSS version 22.Analytical test like Chi square and odds ratio(OR)were used to identify association between knowledge,attitude,and behavior of contraception with the associated variables and enter method of logistic regression analysis was done.Results:Out of the 360 respondents,228 were females,with a mean age of(34±5)years.Approximately 43%demonstrated adequate knowledge of contraception use,and 91%were aware of at least one contraceptive method.Notably,72%exhibited a positive attitude towards contraceptive use.Nevertheless,43%(155 individuals)did not utilize any contraceptive method.Among contraceptive users,intrauterine devices were the most commonly adopted,followed by barrier methods and female sterilization.There was significant association between knowledge of contraception and education(aOR 7.29,95%CI 2.93-18.10,P<0.05),age(aOR 2.04,95%CI 1.19-3.50,P<0.05)and socioeconomic class(aOR 3.66,95%CI 1.71-7.85,P<0.05;aOR 3.97,95%CI 2.12-7.49,P<0.05).Regarding attitude towards contraception use,education(aOR 8.54,95%CI 2.35-31.03,P<0.05),sex(aOR 0.15,95%CI 0.06-0.37,P<0.05),age(aOR 0.53,95%CI 0.28-0.99,P<0.05),socio-economic class(aOR 4.42,95%CI 1.97-9.92,P<0.05;aOR 9.83,95%CI 3.63-26.58,P<0.05)and number of children(aOR 10.04,95%CI 4.26-23.66,P<0.05)were the variables that had a significant association.Conclusions:These findings underscore the imperative for enhanced dissemination of health education pertaining to contraception use within the slum population.The health sectors of the area and other stakeholders need to make sure to extend penetration of family planning related services to the urban slum population.

Feasibility Study of Assist-Linked Brief Intervention for Substance Use Disorders in a Rural Community of Plateau State, Nigeria

Objective: We studied the feasibility of using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) linked with Brief Intervention (ALBI) in treating Substance Use Disorder in Nigeria. There is a clear gap in meeting the needs for treatment and care for people with drug use disorders in Nigeria with many users reporting a self-perceived need for treatment and about 40% of them wanting to receive drug treatment but were unable to access such services. Methods: ASSIST questionnaire was used to gather baseline data, and ALBI along with Motivational Interviewing (MI) was used to intervene for 6 weeks following which ASSIST score was repeated and compared with baseline. Results: Majority of the participants were aged 21 - 30 years, mostly males with (61.3%) lacking steady jobs. Lifetime prevalence of any drug use was (88.2%). Three months prevalence was nicotine (72.0%), alcohol (66.7%), cannabis (47.3%), opioids (11.8%) among others. The ASSIST scores were mostly on the severe ranges. ASSIST result after six weeks showed marked reduction. The Mean Difference (MD) in the ASSIST scores after intervention was significant for tobacco, opioids, alcohol, and cannabis. The Cohen’s D effect size was large for tobacco (1.08), alcohol (0.92) and cannabis (0.73) but low for other substances. Conclusion: ALBI along with MI was helpful in combating the menace of substance use.

Convergence of COVID-19 and recurrent stroke:In-hospital mortality risks explored

This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.

Telemedicine and public health–pearls and pitfalls

We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic.Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs.The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics,and has been beneficial during the coronavirus disease 2019 pandemic.We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability,accessibility and affordability of these programs as methods of healthcare delivery.Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability.However,patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.

Current scenario of traditional medicines in management of diabetic foot ulcers:A review

Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.

Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults

Purpose:This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior,light physical activity(LPA),and moderate-to-vigorous PA(MVPA)with sarcopenia and incident falls over 12 months.Methods:A total of 3334 Swedish 70-year-olds were assessed for sarcopenia,as defined by the revised definition of the European Working Group on Sarcopenia in Older People.Assessments were based on low scores for appendicular lean mass(dual-energy X-ray absorptiometry),hand grip strength,and the Timed Up and Go test.For 7 days after baseline,total time and total number of bouts(≥10 min of continuous activity at a given intensity)of activity performed at sedentary,LPA,and MVPA intensities were assessed by accelerometer.Incident falls were self-reported 6 months and 12 months after baseline.Results:Only 1.8%of participants had probable or confirmed sarcopenia.After multivariable adjustment for other levels of activity,only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass,low hand grip strength,and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria(all p<0.05),and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia(odds ratio=0.80,95%confidence interval:0.71-0.91 h/week).Similar associations were identified for total number of bouts,with no evidence of threshold effects for longer duration of bouts of MVPA.A total of 14%of participants reported-1 fall,but neither total time nor bouts of activity was associated with incident falls(all p>0.05).Conclusion:Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components,regardless of the length of bouts or amounts of sedentary behavior.

Management of polytrauma patients in emergency department:An experience of a tertiary care health institution of northern India

BACKGROUND:In a tertiary care institute of northern India,the emergency department receives an average of 6-7 patients with poly trauma every day.Of these patients,some come directly and many are referred from other hospitals from the region.Various problems are faced in the management of patients with poly trauma.This study aimed to elicit various complaints,suggestions and possible solutions in the management of patients with poly trauma.METHODS:A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months.All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps(step Ⅰ to step Ⅵ).RESULTS:In the younger generation,males were predominantly the primary victims of poly trauma injury,and road traffic accident was the major etiological factor.Injuries involving more than2 specialties induced many problems during the management of patients with poly trauma.Of 210 patients we studied,32 patients had problems at various steps and maximum problems in step Ⅲ,i.e.co-ordination between various specialties in the management of patients with poly trauma.CONCLUSION:A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.

Nutrition interventions and clinical outcomes of pregnant women with gestational diabetes mellitus: More than meets the eye

In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.

A study on the effectiveness of intravenous tramadol in the management of severe traumatic pain in emergency department

Introduction:Patients with pain contribute to 60%-70% of emergency department(ED)attendance and the tramadol is among analgesic of choice in ED.However,the use of intravenous tramadol is limited to moderate pain intensity because of its weak opiod agonist properties.We conducted a study to examine the effectiveness of intravenous tramadol among patients who suffer from severe traumatic pain.Methodology:In this prospective study,eligible patients received a loading dose of intravenous tramadol(2mg/kg).If visual analogue score(VAS)more than 30 mm after the loading dose,intermittent bolus intravenous tramadol 20mg will be administered every 10 minutes.At 30 minutes of study,rescue medication(i.e.morphine or pethidine)will be provided to those patients with VAS more than 30 mm.VAS score,vital signs and side effects were recorded for every 10 minutesResults:Forty-seven patients who suffered from fracture and soft tissue injury were analysed.The median VAS score on presentation and at 30 minutes was 90 mm 20 mm respectively.The median total dose of IV tramadol received by the patients at 30 minutes was 150 mg(IQR=34.0).There was a significant change in medium pain score at 10,20 and 30 minutes treatment(P<0.001).Vital signs were within normal range throughout the study period.About 66.1% of them had side effects of tramadol.The common side effects were sleepiness(75.0%)and dizziness(56.3%).Conclusion:The intravenous tramadol is a safe and effective analgesia in severe traumatic patients if an initial and intermittent dose is given adequately.

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus:A real-world experience

BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.

Anti-Hypertensive Prescription and Cost Patterns in an Outpatient Department of a Teaching Hospital in Lagos State Nigeria

Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are;diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.

Assessment of Key HIV Misconceptions among Inhabitants of a Rural Community in Enugu State, Nigeria

In 2015, about 35 million people died of HIV infection globally, with about 36.7 million infected. Most of the infection occurred in Sub-Saharan Africa. Misconceptions about HIV/AIDS exist mostly in developing countries. The research was a cross-sectional study, conducted in Enugu state, Nigeria. Objective was to assess key HIV misconceptions among rural community dwellers. Interviewer administered questionnaire was used, and information was collected from 296 respondents, most of whom were above 50 years of age, married, had no formal education, and were farmers. Correct responses to the misconceptions investigated were: HIV infection found only among sinners (29.7%);HIV can be transmitted by eating from the same plate with an infected person (24.7%);HIV can be transmitted through handshake (29.7%);HIV can be transmitted by touching the urine or faeces of an infected person (24.0%);HIV can be transmitted by hugging or touching an infected person (28.0%);HIV can be cured (19.9%);Praying daily can prevent HIV infection (20.3%);and Worshipping our ancestors can prevent HIV infection (27.0%). Inhabitants of rural communities are more likely to hold misconceptions about HIV. It is recommended that relevant governments in developing countries design interventions aimed at addressing misconceptions about HIV/AIDS.

Sexual Identity, Preference and Prevalence of Forced Sexual Intercourse among Young People in an Urban Community in Ovia North East Local Government Area, Edo State, Nigeria

Background: Young people are at risk of being victims or perpetrators ofcoerced or forced sexual sex. In predominantly low- and middle-income countries, this contributes significantly to their risk for HIV infection, unwanted pregnancy, and sexually transmitted diseases. Current trends show that young people sexual identity and preferences affect their sexual and reproductive health. Objective: This study aims to determine prevalence of coerced or forced sexual intercourse, sexual identity and sexual preferences of young people in Oluku Community, Ovia North East, Local Government, Edo State, South Nigeria. Methods: A descriptive cross-sectional study conducted in June, 2013 using multi-stage sampling method. Results: A total of 400 young people participated in this study. The mean age was 17.8 ± 3.9 years. A higher proportion of respondents were of the Bini ethnic group 145 (36.3%). Most respondents were Christians 346 (86.5%) while 33 (8.2%) were Moslems. Majority of the respondents had secondary education 271 (67.8%), most were single 363 (90.8%) and were from families with a monogamous setting 289 (72.3%). The prevalence of forced sex was 12.9%, similarly, condom use during forced sex was 27.8%. More females (15.3%) than males (9.6%) had experienced forced sex;forced sex was common among young people from older age group, monogamous homes, and those living in a flat or self contained. Majority (95.3%) of adolescent’s sexual preference was vaginal, only a few preferred oral (3.3%) and anal sex (1.5%). Religion was associated with sexual preference and identity. The sexual identity of most (98.0%) young person’s was heterosexual (or different sex), while 0.5% were homosexual (or same sex) and 1.5% bisexual (or both). Conclusion and Recommendations: Legislation against forced and coerced sex, rape and other forms of sexual violence should be formulated and implemented.

Role of community health nurse in the prevention of elderly dehydration:A mini-review

As dehydration is related to negative health outcomes in the elderly,including an increased risk of disability and death,prevention may help improve health,functional status,and quality of life.Dehydration diagnosis can be challenging in the elderly as the traditional physical indications of dehydration may be absent or ambiguous.Numerous etiologies place the elderly at an increased risk.The role of the community health nurse(CHN)derives from the responsibilities attached to her,and the Betty Neuman’s Systems Model of health care with three levels of protection is usually applied to the CHN.In this mini-review,we try to integrate the Betty Neuman’s Systems Model with the results of identified articles.This study includes a literature search of reputable international databases such as SpringerLink,PubMed,Embase,and Wanfang,particularly for the period 2005 to the present.Ten articles that met the qualifying criteria were included in this study.The findings of this study draw a picture of the role of CHN in preventing dehydration across the three levels of prevention as mentioned by Betty Neuman.

Effect of Distance of Sanitary Pits on the Physicochemical Properties of Hand Dug Well Water Samples Consumed by People Living in Akwuke Community, Enugu South Local Government Area of Enugu State

Studies were carried out to evaluate the effect of distance of sanitary pits on the physicochemical properties of hand-dug well water samples consumed by people living in Akwuke community, Enugu South Local Government Area of Enugu State, using standard analytical procedures and instrumentation. The mean range of pH, turbidity, electrical conductivity, total dissolved solids, nitrate and sulphate in the well water samples at the determined sampling distances of 3, 6 and 10 m from the sanitary pits were 5.9 - 7.24, 1.92 - 6.63 NTU, 122.03 - 303.91 μs/cm, 100.00 - 261.90 mg/L, 1.21 - 4.68 mg/L and 28.89 - 49/61 mg/L respectively. The investigated mean physicochemical parameters of the well water samples were generally observed to increase with decrease in the distance of the well water samples from the sanitary pits. The levels of the determined physicochemical parameter of the well water samples at sampling distances of 3, 6, and 10 m respectively from the sanitary pits were statistically significant. The mean pH values of the well water samples at sampling distances of 3 and 6 m respectively from the sanitary pits were below the WHO recommended threshold limits for safe drinking water. Additionally, the mean values of turbidity and total dissolved solids of the well water samples at a sampling distance of 3 m from the sanitary pits were above the WHO permissible limits. The pH, turbidity and total dissolved solids are some of the most important parameters used in assessing the quality of any water source, therefore, the poor physicochemical properties of well water samples at a sampling distance of 3 m from the sanitary pits could put at severe health risk consumption of this water over a prolonged time. Siting well water at a reasonable far distance (above 10 m) for sanitary pits especially in communities with severe water scarcity would definitely help guarantee access to safe drinking water by rural as well as urban dwellers in Nigeria.

Assessment of Contributions of Community Tuberculosis Intervention to Tuberculosis Case Detection and Treatment Outcome in Two States in Nigeria

Background: Nigeria, one of the high burden Tuberculosis countries, has developed various intervention strategies to ensuring universal access to quality-assured tuberculosis diagnosis and treatment. However, low case detection and unsuccessful treatment outcome still remains a serious challenge in most states. Community Tuberculosis care was born against this background in 2010 as a complementing front to combat the challenges, bringing directly observed treatment short-course strategy beyond the clinic settings to the door steps of patients. This study evaluates the contributions of the intervention to Tuberculosis case detection and treatment outcomes in two states in Nigeria. Materials and Method: A retrospective study with multistage sampling technique was employed to review 23,241 presumptive Tuberculosis cases enrolled for management between 2014-2017. Chi-square (χ2) test was used for test of association between the independent variables and the main outcomes of the study, with statistical significance set at p-value of 5%. Results: The annual percentage increase for both states was 24.7%, 189.8% and 114.5% in the study group as against 5.2%, 44.6% and 65.6% in control group. Overall, 23.8% were bacteriologically positive (either AFB or Gene-Xpert MTB/Rif) and 1.4% were clinically evaluated to be positive, while 74.8% were bacteriologically negative. Of the total 5861 cases treated, successful treatment rate of the patients in the study group was 88.6% as compared to 76.1% in the control group. The relationship between the referral system from communities where the intervention program was implemented and the case detection/treatment outcome was statistically significant (OR 95% CI = 3.15, 2.95 - 3.35). Conclusion: The community level Tuberculosis intervention led to significantly better case detection and treatment outcome when compared to the conventional approach (p ≤ 0.05). Therefore, full community engagement should be advocated as a major strategy for End Tuberculosis planed by WHO since the patients are found in the community and not in the health facilities.

Addressing constraints to informal providers’involvement in tuberculosis control:a qualitative study of patent medicine dealers and tuberculosis programme managers

Background:A major constraint to tuberculosis control is low case finding with under-reporting to national authorities.Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis,yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation.This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control.Methods:This was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Control Programme Managers in Ebonyi State Nigeria.Sixty-four Patent Medicine Dealers and five Tuberculosis Control Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively.Data was collected with electronic audio-recording device and analyzed using thematic approach.Results:There are some knowledge gaps about tuberculosis signs,symptoms,free-treatment policy and mode of operation of care service among Patent Medicine Dealers.Patent Medicine Dealers and Tuberculosis Control Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to keep up with such demands are obvious constraints.Conclusions:Knowledge gaps in tuberculosis,its control,constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control.More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

Ophthalmic complications of injectable facial fillers

The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery.One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit,causing unexpected effects at a site distant from that of the initial injection,including ophthalmoplegia,ptosis and even visual compromise.Acute vision loss following filler injection is a devastating complication,occurring in up to 0.0008%of cases.The greatest risk of this complication occurs with nasal augmentation,followed by glabellar wrinkle treatment.While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery,hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally.Treatment interventions include thrombolysis,hyperbaric oxygen therapy,oral aspirin,cobamamide and acetazolamide and administration of corticosteroids.However,most studies show a poor prognosis in the form of partial or no recovery of vision.Hence,prevention is of paramount importance.A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.

Knowledge of Hospital Acquired Infections (HAIs) among Medical Students in a Tertiary Hospital in Jos North Local Government Area, Plateau State, Nigeria

Background: Hospital Acquired Infections (HAIs) remain a common cause of death, functional disability, emotional suffering and economic burden among hospitalized patients. Knowledge of HAIs is important in its prevention and control. This study seeks to assess the knowledge of Hospital Acquired Infections (HAIs) among medical students in a Tertiary Hospital in Jos North Local Government Area, Plateau State, Nigeria. Methods: This was a descriptive cross-sectional study done in October 2019 among clinical medical students using a Multistage sampling technique. Data was collected using a self-administered structured questionnaire and analyzed using the IBM SPSS 20 (Statistical Package for the Social Sciences). Ethical approval was granted by Bingham University Teaching Hospital, Ethics Committee, Jos, Plateau State. Results: A total of 219 students in the clinical arm of the College of Medicine and Health Sciences were selected. A higher proportion (97.7%) of respondents knew about Hospital Acquired Infections and 85.4% knew that Hospital Acquired infections occur in the hospital, and (86.3%) considered patients contagious with half (58.9%) considered patients as the most important source of HAIs, followed by care givers (13.2%), then doctors including medical students and interns (10.0%) and lastly nurses (8.7%). The majority of respondents (70.8%) considered Surgical Wound Infections to be the most commonly occurring HAI, followed by UTIs (69.9%), RTIs (61.2%), BSIs (37.0%) and others (0.9%). The clinical thermometer was the instrument that most commonly transmits HAIs (82.6%), then followed by stethoscope (62.1%), white coats (53.9%), and blood pressure cuff (51.1%). Most respondents knew the infectious substances, like blood (96.3%), nasal discharge (82.6%), saliva (85.3%), and faeces (79.4%) transmitted HAIs, 72.6% of the respondents said that they were aware of the recommended hand washing techniques by WHO. Conclusion: The majority of students 91.3% had good knowledge while 8.7% had poor knowledge of HAIs. Lower classes had more respondents with poor knowledge. This finding was statistically significant (p = 0.002, Chi-square 12.819). Students are encouraged to keep up the level of knowledge they have about HAIs. These students can help improve the knowledge of those whose knowledge level is low. Government and NGOs should support sponsorship for capacity-building events targeted at HAIs for healthcare workers and medical students.

Research trends of clinical studies on acupuncture protocols over the past 20 years:a bibliometric analysis

Background:Acupuncture protocols are essential as they guide study design and improve the quality of clinical trial,thus preventing avoid research waste.Given the increasing number of publications on acupuncture protocols,this study aimed to assess the publications trends of acupuncture protocols over the past two decades and provided an overview for future research directions.Methods:Publications focusing on acupuncture protocols in clinical settings were retrieved and compiled from the Web of Science Core Collection spanning the period from 2004 to 2023.CiteSpace and Microsoft Excel software were used to analyze the relationship of publication with countries,institutions,authors,co-cited author,journals,references,keywords and other literature aspects.Results:This study analyzed 721 articles encompassing acupuncture protocols.A continuous yet fluctuating growth in publications volume were observed from 2004 to 2023.Notably,China stands at the forefront in contributing to acupuncture protocols,publishing 513 papers and demonstrating a high centrality score of 1.07 in cooperative network.Furthermore,China has fostered close collaborations with the USA and South Korea.Beijing University of Chinese Medicine(89),Zhishun Liu(36)and Trials(306)emerged as the top contributors in terms of institution,author,and journal,respectively.However,inter-institutional and author collaboration was relatively weak.Macpherson H was the most frequently cited author.High-frequency keywords included“randomized controlled trials”,“acupuncture”,“management”,“study protocol”,“quality of life”.Analysis of timeline diagram of keywords indicated that“functional dyspepsia”,“stroke”,“electroacupuncture”,and“colorectal cancer”were the research development trends and focus.Conclusion:Clinical acupuncture protocols have experienced robust development over the past two decades,with current research hotspots focusing on disease management and quality of life,which remain key research concerns.Moreover,we advocate for researchers to publish acupuncture protocols,which remain key research concerns.This approach allows for thorough pre-study planning of methodologies and objectives,enhancing scientific rigor through peer review,thereby laying the foundation for conducting high-quality research.