Impact of a World Health Organization (WHO) Surgical Safety Checklist Implementation During Urgent Operations on Compliance with Basic Standards of Care and Occurrence of Complications

Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. Use of the WHO Surgical Safety Checklist has been shown to be associated with significant reductions in complications and deaths. A 19-item surgical safety checklist was implemented  to  reduce complications and deaths associated with surgery as well as increase the compliance with basic standards of care .The aim of this study is to assess the effect of implementation of a 19-item World Health Organization (WHO) Surgical Safety Checklist in urgent operations on compliance with basic standards of care as indicated by adherence to 6 selected safety measures and rates of complications at National Bank Hospital for the integrated care affiliated to the Egyptian Ministry of Health and Population. To fulfill this aim a prospective pre- and post intervention study design was used.  A total of 60 adult male & female patients undergoing urgent operations are recruited to this study divided into two equal and matched groups (study& control). Three tools were utilized for data collections; 1) Socio-demographic and operative data sheet, 2) Complications monitoring sheet and 3) Performance of the 6 specified safety measures check list. More information can be found in the full paper

Influence of depression, anxiety and stress on the quality of life of dialysis patients

Background: Depressive Anxiety and Stress Scale (DASS-21) is considered as a suitable tool to be used in the clinical practice and/or research. The use of DASS-21 as a higher-order measure of psychological distress was supported by the data in the first part of this study. In the present study the three constructs of DASS have been used in predicting the quality of life of patients undergoing dialysis. Method: A Cross-sectional survey. The DASS-21 scale was administered to 1,333 patients undergoing renal dialysis. In assessing the influence of DAS on the Quality of life of the Malaysian population who are experiencing series of renal dialysis, competing models of latent structures of Depression, Anxiety and Stress Scale-21 item (DASS-21) and World Health Organization Quality of Life BREF scale (WHOQOL-BREF were evaluated using Confirmatory Factor Analysis (CFA) and Structural Equation Modeling (SEM). Objectives: Main objective was to validate the WHOQOL-BREF scale and DASS-21 as the first stage of SEM in developing and testing the structural model of Predictors of the Quality of Life (POQOL) of Malaysian patients undergoing series of Renal Dialysis. Secondly to meet high psychometric standards of both measurement models and the SEM model of POQOL. Results: Through CFA and SEM, the current study produced shorter scales i.e. from 26 items of WHOQOL-BREF to QOLS-13; and from DASS-21 to DASS-13. Results proved that the three constructs of the modified QOLS-13 and three constructs of the modified DASS-11 met high psychometric standards hence, gave a go-ahead to use them in developing the model of POQOL which also proved to have met high psychometric standards. Results showed a very significant inter-relationship between depression, anxiety and stress; and a significant influence of DASS-11 on the three significant inter-related constructs of the QOL-13. Conclusion: The model of Predictors of the Quality of life (POQOL) has been able to meet high psychometric standards and therefore recommended to be used in assessing the influence of Psychological Distress on the Quality of Life

A comparative study of climate change and security challenges of water crisis in cities of Urmia lake and central Iran basins

Objective: The effects of climate on the water crisis and the creation of multiple challenges need to be scrutinized to raise the level of society at large. Damage can be avoided if the various dimensions are identified and how they occur. Methodology: Using a questionnaire survey method, this study has conducted a comparative study of the security challenges of a water crisis in two cities of Urmia and Central Lake watersheds in terms of roots and causes, the geographical scale of events, nature of challenges. Results: The mean score of respondents' perceptions in the geographical scale of events is 29.08.08 and 31.47 for the Central Urmia catchment and Lake Urmia respectively, which is local in both catchments. Regarding the nature of the challenges, the average of respondents' views for the Central catchment and Lake Urmia are 22.64 and 23.49, respectively, and the nature of the challenges is managerial, social, environmental and political. Regarding the causes of the challenges, the respondents' viewpoints for the central catchment and Lake Urmia are 40.68 and 44.33, respectively, which are human-managerial factors in the Urmia catchment and the natural causes of the challenges in the central catchment, respectively. Conclusion: Crisis Capacity The security implications of climate crises, and especially water scarcity due to impacts on economic, social and political spheres, are not necessarily limited to the boundaries of a village or city, but beyond their geographical boundaries and on a larger scale it can be effective

DASS21: a useful tool in the psychological profile evaluation of dialysis patients

Background: The effect of dialysis treatment is complex, with both clinical and socio-psychological effects. In this study, we aimed to assess the psychological status of this growing population of end-stage renal disease. Methods: Using the Short Form of Depression, Anxiety and Stress Scale (DASS21) questionnaire, we aimed (1) to measure the psychological states of hemodialysis (HD) or peritoneal dialysis (PD) subjects from 15 sites, (2) to compare DASS21 scores between HD and PD, and (3) to identify the associated demographic and medical factors of better psychological states. Results: A total of 1,332 were eligible for analysis. Stress (48%) recorded the highest negative emotional states, followed by depression (37%) and anxiety (20%). By multivariate analysis, normal body mass index weight status, religion and absence of coronary artery disease were associated with lower score for depression, anxiety and stress, respectively. Tertiary education was associated with the lowest score in depression and anxiety, whereas HD had a lower score in stress than PD. A younger age was associated with worse DASS21 score of anxiety and stress. Conclusions: Obesity, religion and coronary artery disease were significantly associated with all 3 symptoms of depression, anxiety and stress. Older age has a protective effect on anxiety and stress. Further study is needed to evaluate the relationship between these significant factors and each psychological state

Depression, anxiety and stress among patients with dialysis and the association with quality of life

Studies addressing the nature of relationship between psychological symptoms and quality of life among dialysis patients in Malaysia are scarce. Hence, this study is intended to investigate the association between psychological symptoms such as depression, anxiety and stress on the quality of life in dialysis patients. A cross sectional multicentre study was conducted from May to October 2012 at 15 centres that provide haemodialysis and/or peritoneal dialysis. Apart from socio-demographic profile data collection, WHOQOL-BREF and DASS21 questionnaires were administered to study subjects. All three psychological symptoms had significant impact on quality of life domains of physical health, psychological health, social impact, perceived environment and overall quality of life. These findings suggest that subjects with symptoms of depression, anxiety and stress had poorer quality of life than those without, highlighting the negative impact of psychological symptoms

A multicentre, multi-national, double-blind, randomised, active-controlled, parallel-group clinical study to assess the safety and efficacy of PDA10 (Epoetin-alpha) vs. Eprex® in patients with anaemia of chronic renal failure

Background Erythropoietin stimulating agent (ESA) has been standard of care in treating renal anaemia for the past 20 years. Many patients have limited access to ESA in view of long-term costs leading to suboptimal ESA dosage. Biosimilar epoetin is a potential cost-effective alternative to originator for optimal renal anaemia management. Objective To determine efficacy and safety of PDA10 in treating renal anaemia in haemodialysis patients, in comparison to the originator epoetin-α, Eprex®. Methods A phase 3, multicentre, multi-national, double-blind, randomised, active-controlled and parallel group study conducted over 40 weeks in Malaysia and Korea. End stage kidney disease patients undergoing regular haemodialysis who were on erythropoietin treatment were recruited. The study has 3 phases, which included a 12-week titration phase, followed by 28-week double-blind treatment phase and 24-week open-label extension phase. Results The PDA10 and Eprex® were shown to be therapeutically equivalent (p < 0.0001) with mean absolute change in haemoglobin from baseline of − 0.176 (± 0.91) g/dl and − 0.118 (± 1.114) g/dl, respectively. Weekly dose change was 10.01 IU/kg/week in PDA10 group and 10.30 IU/kg/week in Eprex® group, which has no significant difference. There were no significant differences in the safety profile between PDA10 and Eprex® groups. Conclusion This study has confirmed the therapeutic equivalence between PDA10 and Eprex® in terms of efficacy, dosage requirement and safety profile in haemodialysis patients with renal anaemia. Trial registration The study was registered with the National Medical Research Register ( NMRR-13-400-16313 ). This study has been registered retrospectively with Clinical Research Information Service ( CRiS ), Republic of Korea on 25 March 2021.This study was supported by a grant from Duopharma Biotech Bhd. (Malaysia) and Pangen Biotech Inc. (Korea)

Anemia in pregnancy in Malaysia: a cross-sectional survey

Anemia is the most prevalent nutritional deficiency during pregnancy. Except for a study conducted 10 years ago in Kelantan, Malaysia's available statistics are based on isolated small urban maternity hospital studies from the 1980s. There was therefore, a need for a large study at national level to estimate the magnitude of the problem in the country as well as to understand its epidemiology. This multi-center, cross-sectional study was conducted from February to March 2005, to assess the prevalence of anemia. Multistage stratified random sampling technique was used and 59 Ministry of Health (MOH) primary health care clinics were selected. Our final dataset consisted of 1,072 antenatal mothers from 56 clinics. The overall prevalence of anemia in this population was 35 % (SE 0.02) if the cut off level is 11 g/dL and 11 % (SE 0.03) if the cut-off level is 10 g/dL. The majority was of the mild type. The prevalence was higher in the teenage group, Indians followed by Malays and Chinese being the least, grandmultiparas, the third trimester and from urban residence. After multiple linear regression analysis, only gestational age remained significant. These findings are useful for our Maternal Health program planners and implementers to target and evaluate interventions. Work is in progress for outcomes and cost-effectiveness studies to best tackle this problem. In conclusion, the prevalence of anemia is 35% and mostly of the mild type and more prevalent in the Indian and Malays

Association of dietary patterns with serum phosphorus in maintenance haemodialysis patients: a cross-sectional study

Sources of dietary phosphate differentially contribute to hyperphosphatemia in maintenance haemodialysis (MHD) patients. This cross-sectional study in Malaysia investigated association between dietary patterns and serum phosphorus in MHD patients. Dietary patterns were derived by principal component analysis, based on 27 food groups shortlisted from 3-day dietary recalls of 435 MHD patients. Associations of serum phosphorus were examined with identified dietary patterns. Three dietary patterns emerged: Home foods (HFdp), Sugar-sweetened beverages (SSBdp), and Eating out noodles (EO-Ndp). The highest tertile of patients in HF (T3-HFdp) pattern significantly associated with higher intakes of total protein (p = 0.002), animal protein (p = 0.001), and animal-based organic phosphate (p  2.00 mmol/l was significantly 2.35 times higher (p = 0.005) with the T3-SSBdp. The SSBdp was associated with greater consumption of inorganic phosphate and higher serum phosphorus levels

Novel loss-of-function variants expand ABCC9-related intellectual disability and myopathy syndrome

Loss-of-function mutation of ABCC9, the gene encoding the SUR2 subunit of ATP sensitive-potassium (KATP) channels, was recently associated with autosomal recessive ABCC9-related intellectual disability and myopathy syndrome (AIMS). Here we identify nine additional subjects, from seven unrelated families, harbouring different homozygous loss-of-function variants in ABCC9 and presenting with a conserved range of clinical features. All variants are predicted to result in severe truncations or in-frame deletions within SUR2, leading to the generation of non-functional SUR2-dependent KATP channels. Affected individuals show psychomotor delay and intellectual disability of variable severity, microcephaly, corpus callosum and white matter abnormalities, seizures, spasticity, short stature, muscle fatigability and weakness. Heterozygous parents do not show any conserved clinical pathology but report multiple incidences of intra-uterine fetal death, which were also observed in an eighth family included in this study. In vivo studies of abcc9 loss-of-function in zebrafish revealed an exacerbated motor response to pentylenetetrazole, a pro-convulsive drug, consistent with impaired neurodevelopment associated with an increased seizure susceptibility. Our findings define an ABCC9 loss-of-function-related phenotype, expanding the genotypic and phenotypic spectrum of AIMS and reveal novel human pathologies arising from KATP channel dysfunction.publishedVersio

Dietary fatty acid intake in hemodialysis patients and associations with circulating fatty acid profiles: a cross-sectional study

Objectives: The aims of this study were threefold: first, to assess the dietary fatty acid (FA) intake and blood FA status in Malaysian patients on hemodialysis (HD); second, to examine the association between dietary FA intakes and blood FA profiles in patients on HD; and third, to determine whether blood FAs could serve as a biomarker of dietary fat intake quality in these patients. Methods: Using 3 d of dietary records, FA intakes of 333 recruited patients were calculated using a food database built from laboratory analyses of commonly consumed Malaysian foods. Plasma triacylglycerol (TG) and erythrocyte FAs were determined by gas chromatography. Results: High dietary saturated fatty acid (SFA) and monounsaturated fatty acid (MUFA) consumption trends were observed. Patients on HD also reported low dietary ω-3 and ω-6 polyunsaturated fatty acid (PUFA) consumptions and low levels of TG and erythrocyte FAs. TG and dietary FAs were significantly associated respective to total PUFA, total ω-6 PUFA, 18:2 ω-6, total ω-3 PUFA, 18:3 ω-3, 22:6 ω-3, and trans 18:2 isomers (P < 0.05). Contrarily, only dietary total ω-3 PUFA and 22:6 ω-3 were significantly associated with erythrocyte FAs (P < 0.01). The highest tertile of fish and shellfish consumption reflected a significantly higher proportion of TG 22:6 ω-3. Dietary SFAs were directly associated with TG and erythrocyte MUFA, whereas dietary PUFAs were not. Conclusion: TG and erythrocyte FAs serve as biomarkers of dietary PUFA intake in patients on HD. Elevation of circulating MUFA may be attributed to inadequate intake of PUFAs