Working around a patient, core concept of the patient-centered care with a focus on diabetes mellitus and associated chronic wounds; A review

Management of chronic diseases is a challenging task in current medical practice and treatment of such conditions and their complications is not very straight forward as we deal with multiple clinical problems. This review article provides an overview of the core concept of patient-centered care, effects of diabetes mellitus (DM) on wound healing, and implication of the multidisciplinary team concept for such patients. The literature was searched using “wounds”, “chronic wound healing”, “multidisciplinary team and chronic wound healing” and “patient-centered care and wound healing” as keywords on PubMed as the main source of search. Every chronic disease can involve many health professionals at various stages. The patient-centered approach is a concept that is proving beneficial clinically. This concept considers patient as a center of the circle, and every facility is connected and based upon the patient’s needs. In this article, we have briefly explained implication of such multidisciplinary teams by considering DM management, with a focus on chronic wounds. DM is one of the systemic diseases which puts a significant financial as well as health quality related burden on health systems worldwide. Out of these complications, diabetic foot ulcers (DFUs) and effects of DM on wound healing are extremely important. This clinically important concept of making “teams” to manage various chronic diseases should be investigated in various clinical settings. The data from further research should be analysed to standardize this globally for different categories of wound patients

Joint Planck and WMAP Assessment of Low CMB Multipoles

The remarkable progress in cosmic microwave background (CMB) studies over past decade has led to the era of precision cosmology in striking agreement with the $\Lambda$CDM model. However, the lack of power in the CMB temperature anisotropies at large angular scales (low-$\ell$), as has been confirmed by the recent Planck data also (up to $\ell=40$), although statistically not very strong (less than $3\sigma$), is still an open problem. One can avoid to seek an explanation for this problem by attributing the lack of power to cosmic variance orcan look for explanations i.e., different inflationary potentials or initial conditions for infl ation to begin with, non-trivial topology, ISW effect etc. Features in the primordial power spectrum (PPS) motivated by the early universe physics has been the most common solution to address this problem. In the present work we also follow this approach and consider a set of PPS which have features and constrain the parameters of those using WMAP 9 year and Planck data employing Markov-Chain Monte Carlo (MCMC) analysis. The prominent feature of all the models of PPS that we consider is an infra-red cut off which leads to suppression of power at large angular scales. We consider models of PPS with maximum three extra parameters and use Akaike information criterion ($AIC$) and Bayesian information criterion ($BIC$) of model and Bayesian information criterion ($BIC$) of model selection to compare the models. For most models, we find good constraints for the cut off scale $k_c$, however, for other parameters our constraints are not that good. We find that sharp cut off model gives best likelihood value for the WMAP 9 year data, but is as good as power law model according to $AIC$. For the joint WMAP 9+Planck data set, Starobinsky model is slightly preferred by $AIC$ which is also able to produce CMB power suppression up to $\ell\leq30$ to some extent.Comment: 27 pages, 10 figures, 3 tables, matches with the published version, abstract is shortened to keep it within arXiv's limit (1920 characters

Seasonal influenza vaccination: from hesitancy to social norm

Seasonal influenza is of the most globally burdening vaccine-preventable diseases, infecting 3-5 billion people annually and according to the World Health Organisation (WHO) resulting in 250,000 to 500,000 deaths worldwide. Vaccination against influenza and all respiratory infections carries greater emphasis in the light of the COVID-19 pandemic. With added pressure on healthcare systems due to the coronavirus, Qatar is one country that is keen to emphasise the importance of influenza vaccination to prevent potential co-infection causing severe disease especially in high-risk groups. Currently seasonal influenza vaccines protect against 3 or 4 strains with revised data from the WHO twice yearly due to the changing natures of strains helping to maximise efficacy of the vaccines. It is recommended for specific high-risk groups to be prioritised for vaccination, including pregnant women, the elderly, children above 6 months of age, patients with chronic conditions as well as front line healthcare workers with risk of exposure. However, uptake of the vaccine remains low and contributes significantly to the burden of the disease. Barriers to vaccine uptake can be physical, such as unhealthy lifestyles, psychological, such as perception of disease as low-risk, contextual, such as lack of access to vaccinations, or sociodemographic, such as living alone. Vaccine coverage can be increased by knowledge of these barriers and how to address them. The physical barriers highlight the need to support behavioural change in lifestyle in order to increase vaccine uptake. Psychological barriers, usually due to misconceptions, can be addressed with education through public health campaigns and interactions between health professionals and patients. This education is not just a need for patients but also healthcare workers. It is up to healthcare providers and contractors to find ways of addressing contextual and sociodemographic barriers by increasing access to vaccination whether through transport, or home–care etc. A key barrier of those mentioned to vaccination is a lack of knowledge which needs to be addressed though positive discussions about the health benefits of immunisation as well as the traditional idea of disease-risk prevention. Addressing the above barriers will help to increase vaccine uptake, and produce health-conscientious societies where vaccination becomes a social norm

Audit of Vaginal Route and Abdominal Route of Hysterectomy at a Tertiary Care Hospital

Background: Hysterectomy is “Surgical removal of all or part of uterus”. Abdominal and vaginal route of hysterectomies are both predominant operative techniques being employed by the gynecologists all the world for various uterine conditions. Indications to select any particular technique in any of the hospital setting might not be optimally defined. This study was planned to evaluate particular route of hysterectomy (vaginal hysterectomy and abdominal hysterectomy) as there was no such study available which could document the data of our local population so this study was planned to be conducted to determine burden of problem and deficiencies for clinicians to opt better treatment options among targeted population. The results of this study will not only add in national data but will also be comparable with other international studies. Objective: To determine mean duration of surgery, mean duration of hospital stay and post-operative pyrexia in vaginal route and abdominal route of hysterectomy. Material and methods: A total of 240 women meeting inclusion and exclusion criteria of this study were registered in this study. Informed consent was taken from each patient. All the relevant data were recorded on pre-designed proforma. Data were entered and analyzed using SPSS-17. Results: A total of 240 subjects fulfilling the inclusion and exclusion criteria were registered in this study for abdominal hysterectomy and vaginal hysterectomy. Out of these 240 cases, 79 (32.9%) had undergone vaginal hysterectomy and 161 (67.1%) underwent through abdominal hysterectomy. Mean age of the study cases was 42.72±5.18 years (minimum age was 31 years while maximum age was up to 50 years). Mean parity of the study cases was 5.67±2.08 (minimum para 1 and maximum para 10). Pyrexia was seen in 90 (37.5%) of the study cases, of these 27 (30%) had undergone through vaginal hysterectomy and 63 (70%) underwent abdominal hysterectomy. Minimum duration of the surgery was 45 minutes and maximum duration of the surgery was 90 minutes, mean duration of the surgery was 69.75±14.92 minutes. Minimum Hospital stay was 3 days ranging to maximum hospital stay being 10 days, mean hospital stay in these study cases was observed to be 4.42±1.65 days. Conclusion: Vaginal route of hysterectomy is associated with lesser postoperative complications in terms short duration surgery, significantly short hospital stays and lower rates of postoperative pyrexia than that of abdominal route of hysterectomy. Keywords: Abdominal Hysterectomy, Vaginal hysterectomy, Uterovaginal prolapse

Acute Myocardial Infarction as Predictor of Mortality in Patients with Premature Coronay Disease

Background: Recent data from various parts of the world have led to the conclusion that more than 80 % of CVD deaths occur in developing countries like Pakistan. This high burden of heart diseases is largely attributed to the industrial and technological progress which is associated with economic and social transformations which have lead to life style modification and sedentary life style. This study was planned to ascertain mortality rate of premature coronary artery disease in patients with AMI as it directly affects main workforce of our national economy. Objective: To determine rate of mortality in premature coronary artery disease patients with acute myocardial infarction.  Material and methods: A total of 145 patients having premature coronary artery disease presenting with acute myocardial infarction were included in this descriptive study. This study was conducted in the department of medicine, District Headquarters Hospital, Rajan Pur from June 2017 to September 2017. These patients were followed during current hospitalization to see mortality in these patients and all the findings were noted in the proforma. Results:Of these 145 study cases, 96 (66.2%) were male patients and 49 (33.8%) were female patients. Mean age of our study cases was noted to be 47.67 ± 7.59 years. Mean time taken before presentation at hospital was 113.79 ± 54.36 minutes. Diabetes was present in 48 (33.1%) of our study cases, hypertension was present in 58 (40%), smoking in 39 (26.9%), family history of IHD in 67 (46.2%) and obesity in 49 (33.8%) of our study cases. Mortality was noted to be in 19 (13.1%) of our study cases, post MI angina was seen in 36 (24.8%) and cardiogenic shock was noted in 29 (20%). Conclusion: Our study results indicate that patients with premature coronary artery disease having acute myocardial infarction (AMI) have high frequency of adverse clinical outcomes. Positive family history, hypertension, obesity and diabetes were major risk factors noted in our study. Keywords: Premature coronary artery disease, mortality, acute myocardial infarction

Identification Of The Social Development In Early Childhood In Pakistan

This study was conducted to identify the social development in early childhood years. It was delimited to eight private schools of Lahore City from the area of Faisal Town and Shadman. Forty students (male and female) were randomly selected as the sample. Five students from Nursery, Prep and grade one were selected from each school.  A checklist was developed by reviewing the related literature which covered attributes of social developments under the sections of individual, social skills, peer relationships and communication skills. It was revealed that individual, social skills, peer relationships and communication skills were developed in the children but a positive mood was lacking in them at this stage