An Evaluation Of Short-Term Prognostic Significance Of Various Clinical Parameters In Patients Of Stroke

Sonali Saxena', Shadab A. Khan", Jalaj Saxena’" * Consultant Cardiologist, ** Professor (Medicine), *** Assistant Professor (Physiology) Ishwardevi Medical and Cardiology Centre, Kanpur J.N. Medical College, A.M.U., Aligarh and G.S.V.M. Medical College, Kanpur ABSTRACT: Objectives :To predict the short-term prognostic significance of various clinical parameters at the time of admission in patients of stroke. Setting: Department of General Medicine, J.N. Medical College, A.M.U., Aligarh Participants : 100 patients of stroke (Cerebro-vascular accident) comprising 54 males and 46 females. Clinical Parameters : Admission Blood Pressure, Side of paralysis, Extent of Paralysis, Gastro-intestinal Haemorrhage, Level of consciousness at the time of admission. Statistical Analysis: ‘Z’ test (Z>_ 1.96). Results : The admission B.P. was raised in 75% of patients. The mortality was significantly high (57.1%) in the severe grade B.P. while recovery was significantly high (64.3%) in mild or moderate grade B.P patients. The left sided paralysis was having significantly high mortality of patients (49%) while recovery was significantly high (56.2%) in the patients with right sided paralysis. The paralysis with Grade O power was in 58% of stroke patients and was associated with signifi­cantly high (53.4%) mortality while 100% recovery was found in patients with power grade 4 and 5 at the time of admission. The G.l. haemorrhage was associated with 5% of patients but mortality was significantly high (100%) in these patients. The level of consciousness of grade / was highest (34%) while mortality was significantly high (100%) in the patients admitted with grade 3 level of consciousness. The recovery was significantly high (92.9%) in the patients admitted with grade 'O’ level of consciousnes

Lessons Learned: Case Studies in Sustainable Use, Conclusion

The conclusion of Lessons Learned: Case Studies in Sustainable Use summarizes the overarching lessons learned from the case studies provided in the volume. 1. Sustainability of uses of renewable natural resources is dependent on the existence of a 'sustainable society'at the local, national and global levels. 2. Successful biological conservation is a function of equity and democracy. 3. To achieve greater sustainability of uses of natural resources will likely require modification of the roles of organizations and government agencies in authority. 4. The current conservation paradigm of Protected Areas (including as applied to the 'biodiversity hotspots'concept) may not be economically viable in many developing countries, simply because the opportunitycosts often exceed the value local people receive from their existence. National and international agencies and organizations realize most of the value from designation of protected areas and 'hotspots'. 5. It is not possible to transpose directly the combination of factors that influence one case to another site, and expect the same impact or result.6. Donor agencies and/or central government policies need to consider management requirements beyond project cycles in order to promote long-term sustainability of resource uses.7. External factors such as war and natural disasters can have an over-riding influence on the sustainability of resource use. 8. Interventions on key resources by external institutions often pressure transformation of local governance systems. The impact of these changes is often overlooked. More specific observations of common features. Furthermore, the conclusion provides lessons related to policy, social processes, institutions, and information

Hypersensitivity reactions to intravenous ferric carboxymaltose in a patient with iron deficiency anemia: a rare case report

Ferric carboxymaltose (FCM) is a non-dextran iron preparation recently approved in the United States for intravenous treatment of iron deficiency anemia (IDA) in adult patients with intolerance or poor response to oral iron therapy. Acute hypersensitivity reactions (HSRs) during iron infusions are very rare but can be life-threatening. Adverse events, including immune system disorders (0% in FCM) and skin disorders (7.3% in FCM), are less frequently observed with FCM. On treatment with FCM, the change in hemoglobin from baseline to the highest observed level is about 2.8g/dL. Treatment of IDA with FCM resulted in fewer hypersensitivity reactions. Here, authors report a case of a 23 years old female diagnosed for IDA presented with the picture of adverse drug reaction due to injection FCM given by the physician. The patient was managed with Antibiotics, Corticosteroids and Intravenous fluids and recovered well within 12 hours of admission from this adverse drug reaction. Since such cases have been rarely reported, authors are intended to notify about this potentially dangerous drug reaction due to FCM which is used extensively in the treatment of IDA. Hence management of iron infusions requires very careful and precise observation, and, in the event of an adverse reaction, prompt recognition and severity-related interventions by well-trained medical and nursing staff

Experiences of online occupational therapy education during the COVID-19 pandemic at a South African university

INTRODUCTION: The COVID-19 pandemic resulted in a worldwide shift of academic programmes towards a predominantly online forum. There was therefore a need to explore how students experienced these shifts to ensure optimal learning. This study describes students' experiences of online teaching, learning and assessment and perception of their mental health during the COVID-19 pandemic METHODS: A descriptive cross-sectional quantitative study was employed using a four-part self-administered online survey. Following a pilot study with 11 community service occupational therapists, the survey was sent to all eligible participants (N=118) with a response rate of 85% (n=91). Data were collected from second to fourth year registered occupational therapy students at the University of KwaZulu-Natal in 2021. Data were analysed descriptively using R Studio Suite RESULTS: Over 50% of the students reported a positive online experience. Adequate access to infrastructure enabled optimal online learning. However, students experienced difficulty with structuring self-study time, theoretical application and time allocated for online tests. Additional challenges included stress and time management and managing the increased requirements for self-directed learning. Coping was enhanced by the availability and access to student support services CONCLUSION: The key issues identified in the study need to be addressed to enhance online delivery of the curriculum IMPLICATIONS FOR PRACTICE Online teaching, learning, and assessment in occupational therapy curriculum requires review and adaptation to facilitate optimal student learning On an online platform, or with digital learning, students require support with aspects such as structuring of their self-directed learning time, personal time and stress management An understanding of the online experiences of students may assist in the development and revision of curricula that are responsive to students' needs and which may aid in optimal learning outcomes

Lessons Learned: Case Studies in Sustainable Use, Preface Page

This preface page of the volume Lessons Learned: Case Studies in Sustainable Use, provides a summary of the book's purpose and structure. Enhancing sustainability requires a multidisciplinary approach. Because there is such diversity in resources, uses, and users, there is no universal formula, yet to promote, or assess, practices in context is essential. Without this capacity approaches to sustainable use will remain superficial and ineffective.The present volume presents six detailed cases of uses of different facets of biological diversity in Africa (East, West and Southern), Central Asia and South America-Latin America;. The objective of the project was to identify 'Lessons Learned' from examples of sustainable use. To address this objective, six cases were selected because they had been implemented for several years and they were being implemented in different regions, thus enhancing the potential for identifying key lessons. Each of the case studies was examined using an 'Analytic Framework for Assessing the Factors that Influence Sustainability of Uses of Wild Living Natural Resources' The Analytic Framework (Annex 1) provided a consistent, systematic approach to the analysis of the cases according to 'domains of issues' considered important in assessing sustainability, including inter alia, ecological processes and functions, economic factors, societal and institutional factors

Bringing ethical thinking to social change initiatives: Why it matters.

Norms-shifting interventions (NSI) seek to improve people's well-being by facilitating the transformation of harmful social norms, the shared rules of acceptable actions in a group that prop up harmful health behaviours. Community-based NSI aim for incremental normative change and complement other social and behaviour change strategies, addressing gender, other inequalities, and the power structures that hold inequalities in place. Consequently, they demand that designers and implementers-many who are outsiders-grapple with power, history, and community agency operating in complicated social contexts. Ethical questions include whose voices and values, at which levels, should inform intervention design; who should be accountable for managing resistance that arises during implementation? As interest and funding for NSI increases in lower and middle-income countries, their potential to yield sustained change is balanced by unintentionally reinforcing inequities that violate human rights and social justice pillars guiding health promotion efforts. A review of 125 articles on ethical considerations in public health, social justice, and human rights-where NSI actions intersect-indicated little guidance on practice. To begin to address this gap, we propose ten ethical values and practical ways to engage ethically with the social complexities of NSI and the social change they seek, and a way forward

Correlation between Maternal Mid Upper Arm Circumference and Neonatal Birth Weight: A Case-control Study

Introduction: Birth weight is the best marker of optimal foetal growth and development. Apart from being an important determinant of newborn survival, Low Birth Weight (LBW) also indicates nutritional deprivation and poor health of the mother during and before pregnancy. On the other hand, Maternal nutrition and anthropometry also affect infant’s birth weight. Aim: To find out the correlation of maternal Mid Upper Arm Circumference (MUAC) and neonatal birth weight. Materials and Methods: This case-control study was conducted at Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre (tertiary care hospital), Nagpur, Maharashtra, India, from September 2021 to February 2022. Convenient sampling method was used to select cases and control. All the mothers who had delivered full term live singleton new born with birth weight <2.5 kg were selected as a case and mothers who had delivered singleton new born babies ≥2.5 kg were selected as a control. There was a total of 100 mother-infant dyads with 50 pairs having infant with LBW (cases) and the rest 50 with infants having normal birth weight (controls). Data was collected on the socio-demographic status of the mothers using a predesigned questionnaire along with their weight (from record), maternal MUAC measurement, and birth weight of their babies. Analysis was done using Statistical Package for Social Sciences (SPSS) version 16.0. Results: Mean age of cases was 24.48±2.757 years and that of controls was 24.52±2.255 years. Mean birth weight was 2206±200.9 gm for cases and 2934±305.79 gm for the control group. Maternal MUAC was ≤23 cm in 52% of cases and only 16% in controls (OR- 5.69, CI: 2.23-13.74, p-value=0.001). A linear correlation was found between maternal MUAC and birth weight (r-value=0.3376, p-value=0.001). Conclusion: As there was a positive correlation between maternal MUAC ≤23 cm and LBW babies, maternal MUAC can be used as a predictor of LBW, and hence, measurement of maternal MUAC should be included during antenatal check-ups

Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study.

BACKGROUND: Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. OBJECTIVES: To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). DESIGN: A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. SETTING: Twelve general practices and three community settings in London. MAIN OUTCOME MEASURE: HIV SSK return rate. RESULTS: Stage 1 - the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 - of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. LIMITATIONS: Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. CONCLUSIONS: Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. FUTURE WORK: Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. FUNDING: The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care