METHODS: Focus group discussions with patients attending a family medicine center attached to a tertiary care hospital were carried out using the four gates model of Arabian medical professionalism that is appropriate to Arab culture. Discussions with patients were recorded and transcribed. Data were thematically analyzed using NVivo software.
RESULTS: Three main themes emerged from the data. (1) In dealing with patients, participants expected respect but understood delays in seeing physicians due to their busy schedules. In communication, participants expected to be informed about their health conditions and to have their questions answered. (2) In dealing with tasks, participants expected proper examination and transparency of diagnosis, but some expected the physician to know everything and did not appreciate them seeking outside opinions. They expected to see the same physician at every visit. (3) In physician characteristics preferences, participants preferred friendly smiling physicians. Some cared about the outer appearance of the physician whereas others did not.
DISCUSSION/CONCLUSIONS: The findings of the study explained only two themes of the four gates model namely dealing with patients and dealing with tasks. Cultural competence and how to benefit from patients' perceptions to be an ideal physician should be incorporated into the process of physicians' training.
OBJECTIVES: To assess the healthcare workers' (HCWs) knowledge, attitude and practice (KAP) in relation to AR during the era of COVID-19, and identify the associated factors with good knowledge, positive attitude and good practice.
METHODS: A cross-sectional design was used to assess the KAP of HCWs in Najran, Kingdom of Saudi Arabia (KSA). A validated questionnaire was used to collect participants' data, which consisted of the following information; socio-demographics, knowledge, attitude and items for practice. Data were presented as percentages and median (IQR). Mann-Whitney and Kruskal Wallis tests were used to compare them. Logistic regression was used to identify the associated factors linked to KAP.
RESULTS: The study included 406 HCWs. Their median (IQR) knowledge score was 72.73% (27.27%-81.82%), attitude score was 71.43% (28.57%-71.43%) and practice score was 50% (0%-66.67%). About 58.1% of the HCWs stated that antibiotics could be used to treat COVID-19 infection; 19.2% of the participants strongly agreed and 20.7% agreed that during the COVID-19 pandemic, antibiotics were overused at their healthcare institutions. Only 18.5% strongly agreed and 15.5% agreed when asked whether antibiotics used properly for the right indication and duration can still result in AR. The significantly associated factors with good knowledge were nationality, cadre and qualification. A positive attitude was significantly associated with age, nationality and qualification. Good practice was significantly associated with age, cadre, qualification and working place.
CONCLUSION: Although the HCWs had a positive attitude regarding AR during COVID-19, their knowledge and practice need significant improvement. Implementation of effective educational and training programmes are urgently needed. In addition, further prospective and clinical trial studies are needed to better inform these programmes.
OBJECTIVE: The aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy.
METHODS: Single-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging.
RESULTS: Fifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips (n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage [n = 2/52 (4%)] or an isolated intraventricular hemorrhage [n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation.
CONCLUSION: The method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications.
MATERIAL AND METHODS: This was a retrospective cross-sectional study involving 107 undergraduate students in Universiti Sains Malaysia. Subjects recalled information during the first lockdown implemented in Malaysia from early March 2020 to July 2020. The questionnaire consisted of socio-demography, anthropometry, and physical activity using International Physical Activity Questionnaire and sleep quality using Pittsburgh Sleep Quality Index. Chi-square analysis was used to determine the association between the variables using Statistical Package for Social Sciences software version 26.0.
RESULTS: There was a significant increase of 1.8 kg in weight before and after the lockdown period. The majority of respondents had poor sleep quality (80.4%) and low physical activity (60.2%), respectively. Almost 29% of the subjects had sleep latency of more than 30 min while 69.1% of them had sleep duration of <7 h. There was no significant association between sleep quality and BMI as well as physical activity and BMI.
CONCLUSION: Our study demonstrated that the prevalence of poor sleep quality and low physical activity among university students was high during Covid-19 confinement. Moreover, youths have a significant increase in body weight during the lockdown period. Thus, university students may adopt exciting leisure activities to keep themselves active such as doing meditation or joining online exercise classes.
RECENT FINDINGS: We performed a systematic search of the PubMed, EMBASE, and Web of Science databases to evaluate the impact of inguinal and pelvic LND on the oncological outcomes of PUC and to identify indications for this procedure.
RESULTS: Three studies met the inclusion criteria. The cancer detection rate in clinically nonpalpable inguinal lymph node (cN0) was 9% in men and 25% in women. In clinically palpable lymph node (cN+), the malignancy rate was 84% and 50% in men and women, respectively. Overall cancer detection rate in pelvic lymph nodes in patients with cN0 was 29%. Based on tumor stage, the detection rate was 11% in cT1-2 N0 and 37% in cT3-4 N0. Nodal disease was associated with higher recurrence and worse survival. Pelvic LND seems to improve overall survival for patients with LND regardless of the location or stage of lymph nodes. Inguinal LND improved overall survival only in patients with palpable lymph nodes. Inguinal LND had no survival benefit in patients with nonpalpable lymph nodes.
SUMMARY: The available, albeit scarce, data suggest that inguinal LND derives the highest benefit in women and in patients with palpable inguinal nodes, whereas the benefit of pelvic LND seems to be more pronounced across all stages of invasive PUC. Prospective studies are urgently needed to further address the prognostic benefit of locoregional LND in PUC.
METHODS: A web-based survey was sent to clinicians involved in the management of SE, across all states and at all levels of healthcare services.
RESULTS: A total of 158 responses were received from 104 health facilities, including 23 tertiary government hospitals (95.8% of all government tertiary hospitals in Malaysia), 4 (80.0%) universities, 14 (6.7%) private, 15 (11.5%) district hospitals and 21 clinics. Intravenous (IV) diazepam was available in 14 (93.3%) district and 33 (80.5%) tertiary hospitals for prehospital management. Non-IV benzodiazepine (rectal diazepam and intramuscular midazolam) was not widely available in prehospital services (75.8% and 51.5%). Intramuscular midazolam was underutilised (60.0% in district and 65.9% in tertiary hospitals). IV sodium valproate and levetiracetam were only available in 66.7% and 53.3% of the district hospitals, respectively. Electroencephalogram (EEG) services were available in only 26.7% of the district hospitals. Non-pharmacological therapies such as ketogenic diet, electroconvulsive therapy, and therapeutic hypothermia were not available in most district and tertiary hospitals for refractory and super-refractory SE.
CONCLUSIONS: We identified several gaps in the current practice of SE management, including limited availability and underutilization of non-IV midazolam in prehospital services, underutilization of non-IV midazolam and other second-line ASMs, and lack of EEG monitoring in district hospitals and limited treatment options for refractory and super-refractory SE in tertiary hospitals.
METHODS AND RESULTS: The results showed that the bioprocess of T. harzianum K179 bioagent production in a laboratory bioreactor on the medium with optimal composition (dextrose 10 g l-1, soy flour 6.87 g l-1, K2HPO4 1.51 g l-1, KCl 0.5 g l-1, and MgSO4 × 7H2O 0.5 g l-1), at stirring speed of 1.75 × g and aeration intensity of 1.5 vvm, can be shortened from 96 to 36 h. The results of bioprocess economic analysis showed that with a 25-year project lifetime and an investment payback time of 7.58 years, this project represents an economically viable system.
CONCLUSIONS: Complete analysis of the bioprocess of T. harzianum K179 biocontrol agent production showed that the biologically produced preparation can be competitive on the market with synthetic preparations.