Tag: nevin manimala

Cureus. 2023 Apr 19;15(4):e37830. doi: 10.7759/cureus.37830. eCollection 2023 Apr.

ABSTRACT

Introduction Worldwide, thyroid diseases are among the most prevalent endocrine disorders. According to the Saudi Arabian Ministry of Health (MOH), many thyroid disease cases remain undiagnosed and, as a result, are not treated because the patient has no symptoms or is unaware of them. Hence, this study aims to assess the knowledge about hypothyroidism and hyperthyroidism among Saudi Arabia’s population. Methodology A cross-sectional survey was conducted among Saudi adults in five randomly selected regions in Saudi Arabia from December 2022 – January 2023. An Arabic self-administered questionnaire was sent to randomly selected participants via an online link. The questionnaire was composed of four parts: Sociodemographic; knowledge related to hypothyroidism and hyperthyroidism diseases and their differences; knowledge about the thyroid gland in terms of functions and causes of thyroid dysfunction. The Statistical Package for Social Sciences was used for data analysis. Results Out of 996 participants (66.2% women), 70.1% knew the function of the thyroid gland, 66.4% knew that women are more susceptible to thyroid disease, and 49.5% knew the association between thyroid dysfunction and heart disease. Female sex, higher education, and old age were associated with good knowledge, and no differences were evident regarding nationality and residence. The results showed inadequate awareness regarding thyroid diseases in Saudi Arabia, with some parts of this population being very clearly below average. Conclusion Knowledge regarding thyroid disorders was sub-optimal in Saudi Arabia; older women with higher education had the best knowledge. With even larger samples, we recommend that future studies be made to develop clear and decisive public health strategies that can be implemented at once.

PMID:37214007 | PMC:PMC10198238 | DOI:10.7759/cureus.37830

Cureus. 2023 Apr 20;15(4):e37872. doi: 10.7759/cureus.37872. eCollection 2023 Apr.

ABSTRACT

Introduction Fine needle aspiration cytology (FNAC) plays a vital role in the diagnosis of thyroid nodules. However, it is challenging due to the heterogeneity of thyroid nodules, overlapping cytomorphological features, and interobserver variability. Cytomorphometric analysis turns subjective observations into quantitative values. In this study, we performed cytomorphometric image analysis on cytological smears of thyroid nodules, classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Materials and methods A retrospective analysis of Papanicolaou (PAP) and Hematoxylin & Eosin (H&E) stained fine needle aspirate smears from 50 patients with thyroid nodules with available follow-up histopathology was performed for a period of two years (March 2021 – March 2023), after obtaining approval from the institutional human ethical committee (IHEC-LOP/2020/IM0355). The nodules were categorized according to TBSRTC and were then subjected to cytomorphometric image analysis. Each nucleus was analyzed for 14 parameters, including aspect ratio, intensity, diameter, perimeter, roundness, area, fractal dimension, feret diameter, circularity, radii, fournier description, and chromatin texture parameters such as heterogeneity and clumpiness. The data obtained was analyzed through relevant statistical methods using SPSS version 23 (IBM Inc., Armonk, New York) and was compared by using the analysis of variance (ANOVA) test and post hoc test. Results Our results revealed that cytomorphometric image analysis not only distinguishes benign and malignant thyroid nodules but also can aid in categorizing thyroid nodules with predominant follicular patterns, such as follicular variant of papillary carcinoma, follicular adenoma and follicular carcinoma (p<0.001). Conclusions Morphometric analysis of cytological smears combined with cytomorphology has the potential to be an important tool in the diagnosis of thyroid nodules. It can improve diagnostic accuracy for better treatment and improved prognosis.

PMID:37214005 | PMC:PMC10199653 | DOI:10.7759/cureus.37872

Cureus. 2023 Apr 19;15(4):e37832. doi: 10.7759/cureus.37832. eCollection 2023 Apr.

ABSTRACT

Introduction Mental health problems affect millions worldwide, and the prescription of psychotropic drugs is increasing globally. The World Health Organization (WHO) has emphasized the need for proper monitoring of psychotropic drug prescriptions. This study aims to characterize and find trends in the prescription of psychotropics in a Latin American General Hospital. Methods The study analyzed the dispensation of psychotropic prescriptions to outpatients at three pharmacies in the central headquarters of Hospital Clínica Bíblica in San José, Costa Rica, from 2017 to 2021. Psychotropic drugs were classified by the Anatomical Therapeutic Chemical (ATC) code, and the amount of each medication dispensed was standardized using the defined daily dose per 10,000 population per day metric. Patients’ ages were categorized into four groups: under 18 years, 18 to 39 years, 40 to 64 years, and 65 years and above. The prescriptions were categorized according to medical specialty. Regression analyses were performed to determine the significance of trends observed in the data Results A total of 5793 psychotropic prescriptions were recorded. The average age of the patients was 58 years. The total consumption of psychotropics decreased by 33.94% from 2017 to 2021, with the most significant decline until 2020. However, there was an increase in consumption in 2021. Clonazepam was the most consumed medication, followed by bromazepam and alprazolam, which was the sole drug to exhibit an escalation in usage between 2017 and 2021. Regression analysis showed that only alprazolam and zopiclone had statistically significant trends. The highest number of prescriptions was dispensed to patients aged between 40 and 64 years, followed by those aged over 65 years. Anxiolytics were also the most commonly prescribed group of drugs. General medicine (20.22%), psychiatry (19.95%), and internal medicine (12.73%) were the primary specialties that prescribed psychotropic; 38.6% of prescriptions were associated with the 10th decile of patients, and 44.9% of prescriptions were issued by the 10th decile of physicians. Conclusion The consumption of psychotropic drugs decreased from 2017 to 2020 but increased in 2021, with alprazolam being the only drug that showed an increase in consumption throughout the entire period. General practitioners and psychiatrists were found to be the specialties that most commonly prescribe these medications. The study found significant trends only for the consumption of alprazolam and zopiclone and for prescription patterns among psychiatrists and internal medicine physicians.

PMID:37213996 | PMC:PMC10198243 | DOI:10.7759/cureus.37832

Cureus. 2023 Apr 19;15(4):e37820. doi: 10.7759/cureus.37820. eCollection 2023 Apr.

ABSTRACT

OBJECTIVE: To evaluate surgical outcomes using sets of techniques to achieve single dry dressing for two weeks post total knee replacement (TKR) at Dr. Sulaiman Al-Habib Hospital, Riyadh, Saudi Arabia.

MATERIAL AND METHODS: A prospective study comprised of 110 consecutive unilateral total knee replacements was conducted at the orthopedic department of Dr. Sulaiman Al-Habib Hospital, Suwaidi, Riyadh, KSA. Patients of both genders underwent knee replacement surgery due to primary knee osteoarthritis, Kellgren-Lawrence grades 3 and 4. Routine investigations and fitness evaluations of patients were carried out preoperatively. Preoperative minimal use of a tourniquet and release prior to arthrotomy closure; intravenous tranexamic acid, no drains; capsule infiltration with local anesthetics without adrenaline; tight closure with barbed sutures up to the skin in three layers; skin glue; Aquacel dressing; adductor canal block; and continuation of oral anticoagulant for four weeks.

RESULTS: A total of 110 cases were included, of which 81 (73.6%) were females and 29 (26.4%) were males. The mean age of the study population was 60.5+10.3 years (48 to 88 years). The mean BMI in our patients was 30.57+10.5 kg/m². Most patients were morbidly obese 13 (30.95%). The mean preoperative Hb% was 13.07+1.6 g/dl, while the mean postoperative Hb% was 12.58+1.9 mg/dl with a p-value of 0.28, which was non-significant statistically. Only two patients needed a change of Aquacel wound dressing for ooze. None of our patients developed deep venous thrombosis (DVT) or an infection.

CONCLUSION: A sequential use of sets of techniques is observed to be associated with improved outcomes in terms of blood loss, wound infection, mobility, and patient satisfaction, leading to the ultimate end point of dry Aquacel wound dressing.

PMID:37213992 | PMC:PMC10197911 | DOI:10.7759/cureus.37820

Cureus. 2023 Apr 18;15(4):e37764. doi: 10.7759/cureus.37764. eCollection 2023 Apr.

ABSTRACT

Background In this study, we aimed to demonstrate the efficacy of cysteinyl leukotriene levels, which play a role in inflammation, in predicting the severity of preeclampsia (PE) and to determine whether this marker can be used as a screening tool. Methods In this cross-sectional analytic study, we classified pregnant women who were normotensive (control) or PE or severe PE (SPE) between March 2019 and July 2019. Singleton pregnant 60 women who met the following criteria for the diagnosis of PE were included in the study group. We identified 30 patients with PE and 30 patients with SPE. Normotensive pregnant women (n=30) who met this criterion were included as a control group by randomly selecting them on odd days of the week. Results All pregnant women who participated in the study had a singleton pregnancy, and maternal age ranged from 18 to 40 years, with a mean age of 28.77±6.37 years. The mean gestational week of the group was 35.54±3.247 weeks. Gestational age was higher in women in the control group (p=0.018), shock index was higher in women in the control group (p < 0.001), and body mass index (BMI) value was lower in this group than in the other groups (p=0.002). The values of mean arterial pressure (MAP) were found to have a strong correlation with shock index value and a weak and negative correlation with gestational week and platelet/lymphocyte ratio (p < 0.05). The mean cysteinyl leukotriene levels of 206.15 pg/mL for the control group, 273.2 pg/mL for PE, and 211.85 pg/mL for SPE were calculated. However, no statistically significant difference was found between the groups (p=0.707). Conclusion We found that cysteinyl leukotrienes were not clinically important in assessing the risk for developing PE and predicting SPE. Alanine aminotransferase, white blood cell, lymphocyte, C-reactive protein, platelet/lymphocyte ratio, and shock index were positively correlated with the value of MAP.

PMID:37213986 | PMC:PMC10194035 | DOI:10.7759/cureus.37764

Cureus. 2023 Apr 19;15(4):e37840. doi: 10.7759/cureus.37840. eCollection 2023 Apr.

ABSTRACT

INTRODUCTION: Nasal cavity blood circulation and ocular blood circulation have common pathways for both arterial blood supply and venous drainage. Therefore, nasal pathologies can affect ocular blood circulation. This study aimed to evaluate the relationship between nasal obstruction and choroidal thickness.

METHODS: A prospective study was planned by forming a group of 144 patients diagnosed with nasal septum deviation at the otorhinolaryngology clinic and 100 healthy voluntary individuals. Of the total, 69 patients with nasal right septum deviation were evaluated as Group 1, 75 patients with nasal left septum deviation as Group 2, and 100 healthy volunteers as the control group. Detailed ophthalmological examinations of all the participants were performed, and choroidal thickness was measured using spectral domain optical coherence tomography. The relationship between choroidal thickness and ocular parameters was evaluated and compared between the patient groups with nasal septum deviation and the control group.

RESULTS: When the choroidal thickness measurements of the patients in Group 1 were examined, the choroidal thickness increased in all the regions in the eye contralateral to the deviation side (left), and intraocular pressure (IOP) was higher compared to the eye on the deviation side (right) and the control group at a statistically significant level. In Group 2, the choroidal thickness measurements increased in all the regions in the eye contralateral to the deviation side (right), and IOP was higher compared to the deviation side (left) and the control group.

CONCLUSIONS: We found that the patients with nasal septum deviation had higher choroidal thickness and IOP values in the eye contralateral to deviation.

PMID:37213969 | PMC:PMC10198657 | DOI:10.7759/cureus.37840

Cureus. 2023 Apr 19;15(4):e37851. doi: 10.7759/cureus.37851. eCollection 2023 Apr.

ABSTRACT

The consequences of lung cancer over the past century have been quite deadly and cost millions of lives. Besides the statistics that show its brutal mortality rate, the comorbidities secondary to lung cancer have had their toll and burden on patients too. Lung cancer is broadly and histologically divided into small and non-small cell lung cancers (NSCLC), with the latter associated with a heavy smoking history. Initial presentation of NSCLC varies, and many patients present with an advanced disease that has spread to different parts of the body. Metastasis to the bone can lead to severe pain requiring extreme analgesia regimens. Here, we present a case of a 68-year-old male with advanced NSCLC who initially presented with bony pain due to metastasis.

PMID:37213967 | PMC:PMC10198757 | DOI:10.7759/cureus.37851

Cureus. 2023 Apr 17;15(4):e37732. doi: 10.7759/cureus.37732. eCollection 2023 Apr.

ABSTRACT

Introduction Non-steroidal anti-inflammatory drugs (NSAIDs) are the most prescribed analgesics for controlling post-exodontia pain, administered by various routes. The transdermal route possesses the advantages of providing sustained release of the drug, being non-invasive, bypassing first-pass metabolism, and eliminating gastrointestinal adverse effects. This study compared the analgesic efficacy of diclofenac 200 mg and ketoprofen 30 mg transdermal patches for post-orthodontic exodontia pain. Materials and methods Thirty patients who underwent orthodontic bilateral maxillary and/or mandibular premolar extractions under local anaesthesia were included in the study. Each patient received single transdermal diclofenac 200 mg patch and single transdermal ketoprofen 30 mg patch on the outer, ipsilateral upper arm immediately post-extraction in the two appointments in random order. The pain score was recorded every second hourly for the first 24 hours postoperatively using a visual analog scale (VAS). The requirement of rescue analgesics at various time points and the total number of rescue analgesics taken in the first 24 hours postoperatively were noted. Any allergic reaction to the transdermal patches was also recorded. Results The analgesic efficacy of the two transdermal patches at any given time point in 24 hours by Mann-Whitney U test showed no statistically significant (p<0.05) difference. An overall intragroup statistically significant difference (p<0.05), by Wilcoxon matched pairs test, was found by comparison of VAS pain scores at different time points to that at 0-2 hours after application of transdermal ketoprofen and diclofenac patches, respectively. The mean maximum pain intensity was slightly lower for ketoprofen (2.33) than diclofenac (2.60) transdermal patch. Patients consumed the rescue analgesic within the first 12 hours postoperatively, with the mean value of the total number of rescue analgesics taken with ketoprofen transdermal patch (0.23) slightly lower than diclofenac transdermal patch (0.27) application. Conclusion Ketoprofen and diclofenac transdermal patches provide similar analgesia post orthodontic extraction. The patients required rescue analgesics only during the initial hours of the postoperative follow-up period.

PMID:37213950 | PMC:PMC10191808 | DOI:10.7759/cureus.37732

Cureus. 2023 Apr 20;15(4):e37858. doi: 10.7759/cureus.37858. eCollection 2023 Apr.

ABSTRACT

INTRODUCTION: The troubling issues of conventional antidepressants are inadequate disease remission and potential adverse effects. There is a dearth of research findings comparing vilazodone, escitalopram, and vortioxetine. The objective of this analysis is to determinechanges in the Hamilton Depression Rating Scale (HDRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) scoresand the incidence of adverse events at 12 weeks.

METHODS: This is an exploratory interim analysis of a randomized, three-arm, open-label ongoing study. The participants were randomly assigned in a 1:1:1 ratio to receive either vilazodone (20-40 mg/d), escitalopram (10-20 mg/d), or vortioxetine (5-20 mg/d). Efficacy and safety assessments were done at baseline, four weeks, eight weeks, and 12 weeks.

RESULTS: Forty-nine(69%) of the 71 enrolled participants (mean age 43.9±12.2 years; 37 men (52%)) completed the 12-week follow-up. At baseline, the three groups’ median HDRS scores were 30.0, 29.5, and 29.0 (p=0.76), respectively, and at 12 weeks, they amounted to 19.5, 19.5, and 18.0 (p=0.18), respectively. At baseline, group-wise median MADRS scores were 36, 36, and 36, respectively (p=0.79); at 12 weeks, they were 24, 24, and 23, respectively (p=0.03). In the post-hoc analysis, the inter-group comparison of the change in HDRS (p = 0.02) and MADRS (p = 0.06) scores from baseline did not reach statistical significance. No participants experienced serious adverse events.

CONCLUSION: In this initial assessment of a continuing study, vortioxetine exhibited a clinically (not statistically) significant drop in HDRS and MADRS scores, compared to vilazodone and escitalopram. The antidepressant effects need to be investigated further.

PMID:37213947 | PMC:PMC10199330 | DOI:10.7759/cureus.37858

J Educ Eval Health Prof. 2023;20:15. doi: 10.3352/jeehp.2023.20.15. Epub 2023 May 22.

ABSTRACT

PURPOSE: The number of Korean midwifery licensing examination applicants has steadily decreased due to the low birth rate and lack of training institutions for midwives. This study aimed to evaluate the adequacy of the examination-based licensing system and the possibility of a training-based licensing system.

METHODS: A survey questionnaire was developed and dispatched to 230 professionals from December 28, 2022 to January 13, 2023, through an online form using Google Surveys. Descriptive statistics were used to analyze the results.

RESULTS: Responses from 217 persons (94.3%) were analyzed after excluding incomplete responses. Out of the 217 participants, 198 (91.2%) agreed with maintaining the current examination-based licensing system; 94 (43.3%) agreed with implementing a training-based licensing system to cover the examination costs due to the decreasing number of applicants; 132 (60.8%) agreed with establishing a midwifery education evaluation center for a training-based licensing system; 163 (75.1%) said that the quality of midwifery might be lowered if midwives were produced only by a training-based licensing system, and 197 (90.8%) said that the training of midwives as birth support personnel should be promoted in Korea.

CONCLUSION: Favorable results were reported for the examination-based licensing system; however, if a training-based licensing system is implemented, it will be necessary to establish a midwifery education evaluation center to manage the quality of midwives. As the annual number of candidates for the Korean midwifery licensing examination has been approximately 10 in recent years, it is necessary to consider more actively granting midwifery licenses through a training-based licensing system.

PMID:37211982 | DOI:10.3352/jeehp.2023.20.15