Overview of substance use disorder and available treatments

Substance use disorders are a major health problem worldwide. Substance use is a chronic disorder associated with significant mortality and morbidity. These diseases also cause significant healthcare utilization and medical costs. Substance use disorders occur when the use of alcohol, prescription drugs, or illegal drugs causes problems in his life and daily activities. Substance use disorders encompass a variety of behaviors, including but not limited to addiction, overuse, and behaviors caused by dangerous substances. Diagnosis is based on behavioral criteria, which include the inability to control substance use, dysfunction at school, home, or work, interpersonal problems caused or worsened by substance use, and risky or hazardous use of the substances. The first step in treating substance use disorders is to stop using the substance. In extreme cases of physical dependence, detoxification is necessary to help with withdrawal symptoms. Creating a supportive environment and eliminating triggers for substance abuse are essential to overcoming a substance abuse disorder. Treatment in management can be outpatient or inpatient, depending on the severity of the problem. Depending on the person's condition, a doctor may suggest individual counseling from a psychologist, psychiatrist, or addiction counselor. Family counseling is often important. A doctor may also recommend specific rehabilitation and/or treatment programs; Self-help groups for children and families with addiction problems are often very helpful. In this article, we would like to briefly review substance use disorders and treatment modalities that are available to treat them. Keywords: Substance use disorder, Alcohol, Cannabis

Menstruation hygiene and related issues in adolescent girls: A brief commentary

Between childhood and adulthood, adolescence is a phase of physiological, psychological, and social transformation. Menstrual difficulties are a common symptom and one of the primary causes of adolescent doctor visits. Therefore, adolescent girls' knowledge of reproductive health, including menstruation, may be incomplete and impacted by sociocultural obstacles. The majority of teenage females in India know nothing about menstruation, reproduction, and sexuality. As menstruation remains a taboo, the culture adheres to numerous myths and prohibitions. During menstruation, poor personal cleanliness and dangerous sanitary circumstances heighten the risk of reproductive tract infections and gynecological issues. In resource-poor environments, where women lack access to basic facilities such as water, bathrooms, and privacy, it is extremely difficult to maintain a high level of hygiene. There is a need to enhance housing conditions in terms of fundamental amenities. Every girl may only be encouraged to use sanitary pads if they are offered at cheap costs. It is urgent that separate teenage gynecological clinics be established. Sensitization and counseling in schools, together with a complete school education program on menarche and menstruation difficulties, may assist girls in coping better and seeking appropriate medical support. Keywords: Menstrual disorders, Adolescence, Sanitary Pads, Reproductive Health

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Hukah smoking and lung cancer in Kashmir

Background The literature about the causal relationship between lung cancer and tobacco smoking mostly concerns cigarettes. Hookah smoking is popular in the Kashmir valley, and is generally believed to be innocuous because of the passage of the smoke through water before inhalation. Hookah smoking is widely practiced in Kashmir and was found to be the commonest form of smoking amongst the patients with lung cancer. An earlier study from Kashmir also reported hookah smoking as the dominant form of smoking in a small cohort of 25 lung cancer patients. Methods The study was conducted in the Sheri Kashmir Institute of Medical Sciences, Kashmir (India), a 650 bedded tertiary care university hospital that serves as the main referral center for the Pulmonary and Oncology cases of the Kashmir valley of the Indian subcontinent. Predesigned questionnaire in locally understandable language was tested and validated in a cohort of 10 cases of lung cancer and 20 controls and subsequently administered to the study cases and controls. Results Study provides evidence that hookah smoking is associated with an increased risk of lung cancer in ethnic Kashmiri population with the risk being 6 times more as compared to non smokers. The study reaffirms the previous report by Nafae et al in the sixties who found hookah smoking as the commonest form of smoking in a cohort of 25 patients of lung cancer, seen in 20 of the 25, being exclusive in 17. Hookah smoking has since the olden times been the major form of smoking in Kashmir and is nearly the exclusive form of smoking in women (all of our female smokers had a history of hookah smoking). Conclusions Hookah smoking in Kashmir is associated with increased risk of lung cancer and the commonly held belief that passage through water renders the smoke harmless seems ill founded and potentially dangerous. Further studies in this regard are warranted so as to fully analyze the various variables associated with the habit of hookah smoking and associated development of lung cancer

Stem Cells in Cervical Cancer: An Overview

Cervical cancer has emerged as the leading cause of women's cancer-related deaths despite screening and vaccination programs. Surgery and chemotherapy help patients with cervical cancer live longer, but they do not provide a permanent cure. Radical surgery is the only option in the advanced stage of cervical cancer, which also affects patients' ability to conceive. Sometimes it also causes the disease to return. As a result, new therapeutics must be developed immediately. According to the CSC hypothesis, a tumor has a hierarchical cellular structure with a small subset of cells called cancer stem cells that induce tumorigenesis. The CSCs' tumor-initiating capacity has been the subject of numerous studies. These CSCs are crucial in tumor metastasis, relapse, and radiotherapy resistance. Because they play a role at the beginning of the spread of the tumor, they are thought to improve outcomes. The most well-known gynecological danger is cervical carcinoma, which shows a high malignant growth death rate in females. As a result, research into cervical cancer has increasingly turned to stem cells from the disease. In this review, we have summarized CSCs and CCSCs as emerging key players in cervical cancer early diagnosis and as a therapeutic target in this cancer. Keywords: Cancer, Cervical Cancer, Cancer Stem Cell, Cervical Cancer Stem Cell, Human Papilloma Viru

Cancer Treatment with Nanoparticles: An overview

One of the greatest global causes of death is cancer. Chemotherapy, radiation therapy, and immunotherapy are all forms of cancer treatment, but they all have a number of drawbacks, including cytotoxicity, drug resistance, and other restrictions. The surface properties, ideal size, and shape of nanoparticles have revolutionised cancer treatment by enhancing biodistribution, pharmacokinetics, and biocompatibility. Additionally, the delivery of bioactive plant-based anticancer medicines such as vinca alkaloids, taxanes, podophyllotoxin, and others has been improved using phytonanotechnology. Novel silver nanoparticles are also used as a delivery mechanism for anticancer medications. In this overview, we'll look at silver nanoparticles for drug delivery in cancer disorders, phytonanotechnology, and important uses of nanotechnology. Keywords: Cancer, Conventional chemotherapy, Mechanism, Nanotechnology, Silver nanoparticle

Species of curcuma: a source of anticancer agents

Cancer alludes to any one of a huge number of maladies characterized by the advancement of irregular cells that isolate wildly and have the capacity to invade and devastate ordinary body tissue. Cancer regularly has the capacity to spread all through your body. Cancer is the second-leading cause of passing in the world. But survival rates are moving forward for numerous sorts of cancer, much obliged to enhancements in cancer screening, treatment and avoidance. Cancer is one of the foremost feared infections which influences individuals all through the globe. Treatment of this malady has been a major challenge for clinicians. With the understanding of the instrument of cancer advancement, it was found that the way of life and nourishment propensity is one of the causes of cancer. Herbs and flavours are minor constituents of our eating less; they have appeared to have a few therapeutic properties with numerous anticancer characteristics. This audit centres on the potential anticancer impacts of species of the sort Curcuma commonly utilize as herbs and flavours customarily. Keywords: Chemotherapeutic medicines, Cancer, Curcuma, Curcumin.