Supportive Care Team Challenges on The Border In the Pandemic

Background: Hospice and Palliative Medicine (HPM) is a subspecialty of medicine, recognized in 2008 by the ABMS, with over 200 fellowship programs nationally. This Supportive Care Team (SCT) interprofessional paradigm of MD’s, NP’s, PA’s, MSW’s, Pharm.D.’s, chaplains, RN’s and therapists holistically cares for persons with advanced life-limiting illnesses. UTRGV SOM and DHR Health, in extreme south Texas on the border with Mexico, inaugurated the HPM fellowship in 2019. Its current fellow began in 2021. The intent of the fellowship was for care and services to flow uninterruptedly throughout the RGV. However, in early 2020 the world changed indelibly due to the COVID-19 pandemic. Methods: In early 2020, plans were to inaugurate the DHR Health Inpatient Palliative Care Unit (iPCU). In fact, the building’s façade says, “DHR Hospice.” (see photo) However, nearly on its opening day, DHR Health required its use as their first COVID Care Unit, which it has continued until the present time. This QI Project utilized deidentified chart reviews. Results: Approximately 9 / 107 SCT patients at the DHR main hospital became enrolled into the General Inpatient Care (GIP) category. This data is compared to national rates (https://www.nahc.org/wp-content/uploads/2017/10/GIPAAHPM.pdf). Discussion: The SCT quickly pivoted to develop a “mobile PCU (mPCU)” which continued to reside within the main DHR Health hospital, rendering end-of-life and pain crisis interprofessional care to persons near life’s end. The team became these patients’ “home away from home” at DHR. Conclusion: While it was not the intent of the SCT for this venue (the main hospital) to be its primary site for hospice care, it has continued to do so in the continued face of adversity and challenge as the pandemic has now gone through its second and third waves

ASSESSMENT OF PAP SMEAR QUALITY BY AYRE'S SPATULA VERSUS AYRE'S SPATULA PLUS CYTOBRUSH COMBINATION - ANALYSISINATERTIARY CARE HOSPITAL

Background: Papanicolaou (Pap) smear is a very important screening tool for cervical cancer. The challenge for Pap smear is a high rate of false-negative results. Of the several factors compounding this problem the most important one is the incorrect sampling method and sampling tool limitations. We in the present study tried to evaluate the quality of Pap smear samples obtained by two methods Ayres Spatula and Ayres spatula plus cytobrush combination. Methods: This cross-sectional study was conducted in the Department of Obstetrics and gynecology, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar. The patients were selected from those who were attending the OPD of the Department of gynecology. A total of n=155 women who were sexually active in reproductive age or menopausal were included in the study. Two samples were taken first using Ayres spatula and then the cytobrush. Results: With cytobrush and Ayres spatula n=135(87.09%) of smear were satisfactory compared to the n=98(63.22%) with Ayres spatula alone the p values were found the <0.01 which is considered as significant. Inadequate smear quality due to absent endocervical cells was found in n=12 (7.74%) of the combination and n=80(51.61%) in Ayres spatula alone the p values were also found to be significant. Blood obscuring the slide was found in n=1(0.64%) of spatula and n=3(1.93%) of the combinationA comparison of cytological results by two methods showed n=1(0.6%) of spatula smear versus n=2(1.29%) of combined cytobrush-spatula smears showed atypical squamous cells of undetermined significance. Low-grade Squamous Intraepithelial Lesions were found in n=3(1.93%) of spatula versus n=10(6.45%) of combined smears. High - grade Squamous Intraepithelial Lesions were found in n=1(0.6%) of spatula smear versus n=3(1.93%) of the combined smear Conclusion: that the ability of Ayres spatula and cytobrush combination was more effective in obtaining adequate specimens and it has a better ability to obtain the endocervical cells. The added advantage of the cervical brush is it could be easily used in postmenopausal women who tend to have stenoticos. Therefore this method must be used for screening program

LPG Gas Leakage Detection and Prevention System

Gas leakage has been a major concern in recent times. Though its usage has been extended in various industries, a small unattended leakage can lead to catastrophic damage. The objective of this project is to present the design of a cost effective automatic alarming system, which can detect and prevent liquefied petroleum gas leakage in various premises. This system alerts the user by sending him an SMS and alerting the neighbors by buzzer alarm after the gas leaks above setpoint1.The stepper motor is used to close the gas pipe valves. To reduce risks to human life, main power supply is cut off, if the gas leakage goes above setpoint2. This device ensures safety and prevents suffocation and explosion due to gas leakage. This project is implemented using ARM 7 processor and simulated using keil software

Management of Recurrent Pilonidal Sinus through Ayurveda Care and Surgery - A Case Report

Introduction: Pilonidal disease refers to subcutaneous infection occurring in the upper half of the gluteal cleft having no communication in the anal canal. In Ayurveda it can be correlated to Shalyajanya Nadivrana which is described in detail by Acharya Sushrutha. It presents as an acute abscess or chronic wound associated with pus discharge and severe discomfort. In this case report we present 20 years old female patient who reported to the OPD of Shalya SDMCAH with the complains of pain associated with pus discharge at the natal cleft region since two weeks with a history of Z plasty surgery. Methods: The case was managed by surgical excision followed by Kshara Karma, Triphala Prakshalana and dressing with Jatyadi Taila. Internally the patient was administered with Triphala Guggulu and Gandhaka Rasayana. Discussion: Apamarga Kshara helps in removal of unhealthy granulation tissue and cellular debris by sclerosing properties thereby lowering the recurrence rate. Triphala Prakshalana and wound dressing by Jathyadhi Taila fastens the healing process by microcidal effect. Results: The initial complains of pain associated with pus discharge subsided within seven days, while complete healing of the tract was observed within two months. Conclusion:&nbsp; The surgical approach in contemporary science includes excision with reconstructive flaps (z-plasty). However, the recurrence rate is more and there are increased chances of developing wound infection. Hence in this case excision of sinus followed by apamarga kshara pratisarana was incorporated which showed promising results along with complete healing of the tract

Theory and description in African Linguistics: Selected papers from the 47th Annual Conference on African Linguistics

The papers in this volume were presented at the 47th Annual Conference on African Linguistics at UC Berkeley in 2016. The papers offer new descriptions of African languages and propose novel theoretical analyses of them. The contributions span topics in phonetics, phonology, syntax, semantics, and pragmatics and reflect the typological and genetic diversity of languages in Africa. Four papers in the volume examine Areal Features and Linguistic Reconstruction in Africa, and were presented at a special workshop on this topic held alongside the general session of ACAL

Theory and description in African Linguistics: Selected papers from the 47th Annual Conference on African Linguistics

The papers in this volume were presented at the 47th Annual Conference on African Linguistics at UC Berkeley in 2016. The papers offer new descriptions of African languages and propose novel theoretical analyses of them. The contributions span topics in phonetics, phonology, syntax, semantics, and pragmatics and reflect the typological and genetic diversity of languages in Africa. Four papers in the volume examine Areal Features and Linguistic Reconstruction in Africa, and were presented at a special workshop on this topic held alongside the general session of ACAL

Theory and description in African Linguistics: Selected papers from the 47th Annual Conference on African Linguistics

The papers in this volume were presented at the 47th Annual Conference on African Linguistics at UC Berkeley in 2016. The papers offer new descriptions of African languages and propose novel theoretical analyses of them. The contributions span topics in phonetics, phonology, syntax, semantics, and pragmatics and reflect the typological and genetic diversity of languages in Africa. Four papers in the volume examine Areal Features and Linguistic Reconstruction in Africa, and were presented at a special workshop on this topic held alongside the general session of ACAL

Theory and description in African Linguistics: Selected papers from the 47th Annual Conference on African Linguistics

The papers in this volume were presented at the 47th Annual Conference on African Linguistics at UC Berkeley in 2016. The papers offer new descriptions of African languages and propose novel theoretical analyses of them. The contributions span topics in phonetics, phonology, syntax, semantics, and pragmatics and reflect the typological and genetic diversity of languages in Africa. Four papers in the volume examine Areal Features and Linguistic Reconstruction in Africa, and were presented at a special workshop on this topic held alongside the general session of ACAL