Traumatic avulsion of female urethra: a case report

Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity. We report a case of 26 years old lady with crescentic tear of anterior urethra from pubic symphysis. Management consisted of primary urethral repair

FACTORS INFLUENCING PROLONGED STAY IN THE INTENSIVE CARE UNIT AFTER CARDIAC SURGERY

  Background: There are different risk factors that affect the intensive care unit (ICU) stay after cardiac surgery. The aim of this study was to evaluate possible risk factors influencing prolonged ICU stay. Methodology: We conducted 443 adult patients undergoing different cardiac surgery to determinate causes of prolonged ICU stay. These patients were divided into two groups according to ICU stay ≤ 4 days and >4 days. We evaluated preoperative, intraoperative and postoperative risk factors for prolong ICU stay. Results: Among the 443 patients studied, 277 (62.52%) had stayed ≤ 4 days and 166 (37.42%) had stayed >4 days in ICU. Frequency of prolonged ICU stay was 42.7% in patients undergoing coronary artery bypass graft (CABG), 37.3% in patients with valve surgery, 9% in patients with CABG plus valve surgery and 10.8% others surgery. Patients with > 4 days of ICU stay received more blood transfusion and higher inotropes duration. They also had longer time duration of surgery, cardiopulmonary bypass, and long ventilation hours and other preoperative and postoperative risk factors. (P < 0.05 for all comparisons). Conclusions: The relationships between the pre-, intra- and postoperative risk factors and prolonged ICU stay after coronary artery bypass grafting with cardiopulmonary bypass, suggest that serum creatinine, urea and liver dysfunction were risk factors for prolong ICU stay, Whereas among surgical variables cardio pulmonary bypass time, cross clamp time and time duration of surgery are the main associates of higher ICU duration

Dynamic spillover effects and interconnectedness of DeFi assets, commodities, and Islamic stock markets during crises

Decentralized Finance (DeFi) assets, commodities, and Islamic stock market cointegration are affected by technological innovations, market dynamics, investor behavior, and crises. This study investigates the dynamics of returns and volatility for three DeFi assets, six commodities, and three Islamic stock markets from December 2019, to March, 2023, and identifies higher spillover effects during crises. Links among the Cross-DeFi, commodity, and Islamic markets significantly influence returns and volatility during crises. Notably, the commodities index emerged as a pivotal and substantial transmitter of risk during the Russian-Ukraine war crisis, with Emerging Markets (EM) being a key recipient. However, during the COVID-19 pandemic, livestock indices assume the role of prominent risk-return spillover receivers. The findings indicate robust returns and volatility interconnected between DeFi assets and Islamic markets with a moderate level of connectivity among commodity groups. WDI, ACWI, and EM explained 75 % of the variance observed during crisis episodes. This study formulates strategic portfolio management within and between connectedness among return volatilities by highlighting the stability of DeFi assets, the diversification potential in commodities, and a balanced option in Islamic markets. Our study provides a deep and insightful understanding of the stakeholders across markets during crises

Spillover Dynamics in DeFi, G7 Banks, and Equity Markets During Global Crises: A TVP-VAR Analysis

Decentralized finance (DeFi) has become of significant interest for investors in both the financial and digital sectors. We use a time-varying parameter vector autoregression (TVP-VAR) approach to estimate the static and dynamic connections between and within DeFi, G7 banking, and equity markets. We focus on critical events such as the COVID-19 pandemic, the cryptocurrency bubble, and the Russia-Ukraine conflict. The results highlight interconnectedness and significant spillovers within and between the markets, especially during the COVID-19 pandemic. Notably, there were significant spillover effects from the G7 banking and equity markets to Japan and DeFi assets. The findings demonstrate a robust connection between DeFi platforms, G7 banking, and stock markets throughout these tumultuous periods. Policymakers, investors, and entrepreneurs are recommended to keep a close eye on changes in traditional banking and equity markets to adjust the risk of DeFi assets

Young people's data governance preferences for their mental health data: MindKind Study findings from India, South Africa, and the United Kingdom

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people's preferences for how their data are governed and quantifies potential participants' willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16-24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the "right people" access their data. Throughout the study, we recognized young people's commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research

Evidencing the Impact of Web-Based Coproduction With Youth on Mental Health Research: Qualitative Findings From the MindKind Study

BACKGROUND: Public involvement in research is a growing phenomenon as well as a condition of research funding, and it is often referred to as coproduction. Coproduction involves stakeholder contributions at every stage of research, but different processes exist. However, the impact of coproduction on research is not well understood. Web-based young people's advisory groups (YPAGs) were established as part of the MindKind study at 3 sites (India, South Africa, and the United Kingdom) to coproduce the wider research study. Each group site, led by a professional youth advisor, conducted all youth coproduction activities collaboratively with other research staff. OBJECTIVE: This study aimed to evaluate the impact of youth coproduction in the MindKind study. METHODS: To measure the impact of web-based youth coproduction on all stakeholders, the following methods were used: analysis of project documents, capturing the views of stakeholders using the Most Significant Change technique, and impact frameworks to assess the impact of youth coproduction on specific stakeholder outcomes. Data were analyzed in collaboration with researchers, advisors, and YPAG members to explore the impact of youth coproduction on research. RESULTS: The impact was recorded on 5 levels. First, at the paradigmatic level, a novel method of conducting research allowed for a widely diverse group of YPAG representations, influencing study priorities, conceptualization, and design. Second, at the infrastructural level, the YPAG and youth advisors meaningfully contributed to the dissemination of materials; infrastructural constraints of undertaking coproduction were also identified. Third, at the organizational level, coproduction necessitated implementing new communication practices, such as a web-based shared platform. This meant that materials were easily accessible to the whole team and communication streams remained consistent. Fourth, at the group level, authentic relationships developed between the YPAG members, advisors, and the rest of the team, facilitated by regular web-based contact. Finally, at the individual level, participants reported enhanced insights into mental well-being and appreciation for the opportunity to engage in research. CONCLUSIONS: This study revealed several factors that shape the creation of web-based coproduction, with clear positive outcomes for advisors, YPAG members, researchers, and other project staff. However, several challenges of coproduced research were also encountered in multiple contexts and amid pressing timelines. For systematic reporting of the impact of youth coproduction, we propose that monitoring, evaluation, and learning systems be designed and implemented early

Adenomatoid Odontogenic Tumor with Tooth-like Structure Arising from a Dentigerous Cyst: Report of a Unique Case

Adenomatoidni odontogeni tumor (AOT) rijedak je benigni tumor odontogenog podrijetla sastavljen od odontogenog epitela. Histopatološka slika je različita. U nedavnim klasifikacijama SZOa uvedeno je nekoliko je promjena u vezi s tom novotvorinom. Prema posljednjoj je klasificirana kao odontogeni tumor epitelnog podrijetla. U britanskoj literaturi nabrojeno je vrlo malo slučajeva toga tumora povezanog s odontogenom cistom. Opisali smo adenomatoidni odontogeni tumor nastao kod dvanaestogodišnjeg dječaka iz odontogene ciste smještene perikoronarno oko donjeg očnjaka koji još nije izniknuo. Klinički je bila postavljena dijagnoza odontogene ciste. Histolološka pretraga pokazala je područja nalik na odontom. Takav isti zabilježen je u samo još dva slučaja. Pretpostavljamo da opisani slučaj predstavlja odontogenu cistu s neoplastičnim promjenama epitelnog i mezenhimalnog podrijetla. Potrebna su daljnja istraživanja kako bi se adenomatoidni odontogeni tumor nastao iz odontogene ciste mogao potvrditi kao zasebna hibridna novotvorina.Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. Recently, the WHO classification of odontogenic tumors has been revised and few changes have been made. According to WHO, the AOT is reclassified as an epithelial odontogenic tumor. Very few cases of AOT associated with a dentigerous cyst have been reported in the available literature. We present an additional case of an AOT arising from a dentigerous cyst around the crown of an unerupted lower canine in a 12-year-old boy, which was clinically diagnosed as a dentigerous cyst. Histologically, our case showed ‘odontoma-like’ areas which have been described in only two other previous case reports. We believe that this case represents an odontogenic cyst with neoplastic change containing both epithelial and mesenchymal components. Further studies to determine whether the AOTs derived from an odontogenic cyst could represent a distinct ‘hybrid’ variant (different from the three variants described so far) are to be done

Adenomatoid Odontogenic Tumor with Tooth-like Structure Arising from a Dentigerous Cyst: Report of a Unique Case

Adenomatoidni odontogeni tumor (AOT) rijedak je benigni tumor odontogenog podrijetla sastavljen od odontogenog epitela. Histopatološka slika je različita. U nedavnim klasifikacijama SZOa uvedeno je nekoliko je promjena u vezi s tom novotvorinom. Prema posljednjoj je klasificirana kao odontogeni tumor epitelnog podrijetla. U britanskoj literaturi nabrojeno je vrlo malo slučajeva toga tumora povezanog s odontogenom cistom. Opisali smo adenomatoidni odontogeni tumor nastao kod dvanaestogodišnjeg dječaka iz odontogene ciste smještene perikoronarno oko donjeg očnjaka koji još nije izniknuo. Klinički je bila postavljena dijagnoza odontogene ciste. Histolološka pretraga pokazala je područja nalik na odontom. Takav isti zabilježen je u samo još dva slučaja. Pretpostavljamo da opisani slučaj predstavlja odontogenu cistu s neoplastičnim promjenama epitelnog i mezenhimalnog podrijetla. Potrebna su daljnja istraživanja kako bi se adenomatoidni odontogeni tumor nastao iz odontogene ciste mogao potvrditi kao zasebna hibridna novotvorina.Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. Recently, the WHO classification of odontogenic tumors has been revised and few changes have been made. According to WHO, the AOT is reclassified as an epithelial odontogenic tumor. Very few cases of AOT associated with a dentigerous cyst have been reported in the available literature. We present an additional case of an AOT arising from a dentigerous cyst around the crown of an unerupted lower canine in a 12-year-old boy, which was clinically diagnosed as a dentigerous cyst. Histologically, our case showed ‘odontoma-like’ areas which have been described in only two other previous case reports. We believe that this case represents an odontogenic cyst with neoplastic change containing both epithelial and mesenchymal components. Further studies to determine whether the AOTs derived from an odontogenic cyst could represent a distinct ‘hybrid’ variant (different from the three variants described so far) are to be done

Effect of prophylactic single dose parenteral amiodarone in mitral valve replacement surgery

Background & Aims: Amiodarone is a purposive medicine useful in restoring sinus rhythm (SR) after cardiac surgery. The aim of the study was to evaluate the effect of prophylactic intraoperative single-dose intravenous amiodarone and to convert atrial fibrillation (AF) into normal sinus rhythm (NSR) in the patients undergoing valve replacement surgery. Materials & Methods: In this prospective and interventional study, 180 patients of ASA III (American Society of Anesthesiologist) classification between the ages of 18-60 years, posted for Rheumatic Mitral Valve Replacement were allocated randomly to two equal groups (Group-1 and Group-2). Their hemodynamics parameters, Pre and post pulse rate, ECG findings and incidence of AF and VT/VF and ICU, Hospital stay were noted. Data was analysed with SPSS v26 using chi-square test. A two-tailed P value of 0.05 or less was regarded as statistically significant. Results: In our study, we found that there was suggestive significance between both groups as regard to mean pulse rate changes after 5 and 10 minutes of induction (P value >0.05). At the end of surgery, there was developing atrial fibrillation in few patients and sinus rhythm in more (P value >0.05). Postoperative arrhythmias in the first 24 hrs, AF was seen in 9(10%) patients in the Group 1 compare to Group 2 49 (54.4%) (P <0.001). In both groups as regard to Mechanical ventilation & ICU stay was of suggestive significance in amiodarone group (P value <0.0001). Conclusion: The incidence of post-operative AF among high-risk patients was significantly reduced by a prophylactic amiodarone treatment resulting in a shorter time of intensive care unit and hospital stay

Effectiveness of Induction Training on Newly Joined Employee Knowledge and Hospital Performance

Introduction Every organization needs well-trained employees to perform job activities effectively and efficiently. Training and development is a continuous process that helps to develop skills, knowledge, and abilities in its workers, which leads to better performance of employees. This study aims to assess the effectiveness of an induction training program for hospital employees as well as the impact on employee knowledge and performance in the clinical field according quality indicator benchmarks. Methods A sample of individuals (N = 775) who were newly hired, promoted, or re-categorized at our institution in 2021 were included in the program. The effectiveness of the induction training program was assessed with a pre- and post-test and feedback form. Topics covered in the training program will help employees know about the institute and increase knowledge and skills. Results The average pre-test score was 60%, which increased to 84% after the training (p = 0.0001). There was a significantly positive relationship between the quality indicators and the clinical audit results (p = 0.006). Conclusion The induction training program effectively improved the employees' knowledge regarding their rights and responsibilities as well as clinical knowledge (i.e., Infection control and prevention, quality, disaster management, biomedical waste management, and facility safety)