Abstract:

Background: Sensorineural hearing loss (SNHL) is most common form of hearing loss, (90% of hearing loss cases). It was observed that diabetes and hypertension both can cause SNHL through diabetic microangiography and hypertensive retinopathy in ear respectively. Considering prevalence of diabetes and hypertension in India, particularly in state of Maharashtra and their association with sensorineural hearing loss, it was decided to evaluate relationship and frequency of SNHL in adult population of Mumbai metropolitan region.

Methodology: The aim of study was to investigate relationship and frequency of SNHL due to previously diagnosed diabetes mellitus and/or hypertension in adult population of Mumbai metropolitan region. In present study, protocol was designed for semi-structured qualitative interviews of physicians to determine relationship and prevalence of SNHL. In total 25 respondents were replied to semi-structured interviews.

Results: Semi-structured interviews of physicians and audiologists revealed that there exists close association with duration and control of diabetes and/or hypertension. In semi-structured interviews it was found that out of all SNHL patients, there were 71.43% cases of diabetes; 39.29% cases of hypertension; and 53.57% of both diabetes and hypertension. Severity of hearing loss due to diabetes and/or hypertension was found to be moderate with more prevalence in age group of 50-60 years.

Conclusion: It was found that sensorineural hearing loss occurs due to diabetes and/or hypertension. Better control of these conditions at early stage might prevent causation or progression of sensorineural hearing loss. There is need to create awareness amongst public about hearing loss and utility of hearing aids.

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Abstract:

The present study is a review of literature that covers an aspect of role of BRCA1 gene mutation in breast cancer metastasis, risk of recurrence influenced by stage at initial presentation, the underlying biology of the tumor, time of relapse after diagnosis of the primary tumor, reasons for metastasis, various biological markers discovered up till date, discussion of several mathematical models, with a focus on how they have been used to predict the initiation time of metastatic growth, and standard choice of treatment best suited for triple negative breast cancer metastasis.

Breast cancer starts as a local disease, but it could metastasize to the lymph nodes and distant organs. As by definition, Metastatic breast cancer, also known as Advanced or Stage IV breast cancer, is the stage in breast cancer progression in which malignant cells from the primary tumor successfully create new tumors in distant organs.  According to the Research studies, women who have BRCA1 mutations are at higher risk for triple negative breast cancer. The prognosis of women with triple negative breast cancers (ER-negative, PR-negative and HER2-neu –negative) is poor as compared to women with other subtypes of breast cancer. TNBC relapses more frequently than hormone receptor-positive subtypes and is often associated with poor outcomes.

Patients and oncologists always have a dilemma on how to cope with this aggressive disease. For patients, the diagnosis of breast cancer is fearsome; so when they know additionally that they suffer from TNBC—a subtype with poor outcomes—this situation is often more stressful. TNBC patients have a unique pattern of relapse, which occurs mostly in the first 3 years following diagnosis. Although metastatic breast cancer is not curable, meaningful improvements in survival have been seen, coincident with the introduction of newer systemic therapies.

Keywords: TNBC (Triple Negative Breast Cancer), Metastasis, tumor, ER-negative, PR-negative, HER2-neu negative, BRCA1 mutations, Overall Survival, Lungs, Mathematical Models, Recurrence, Chemokines, Chemotherapy.

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Abstract:

Background: Legg-Calve-Perthes disease (LCPD) is one of the most common causes of paediatric femoral head osteonecrosis. Besides the other known etiological aspects, till now genetic aspect has not been studied extensively. The present study was aimed to find the association of genetic polymorphism of CYR61 and MTHFR gene with the LCPD.

Materials and Methods: Single Nucleotide Polymorphisms (SNPs) analysis of the CYR61 and MTHFR genes in 41LCPDpatients and 110 healthy controls were genotyped in this hospital-based study by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP).

Results: The frequency of CYR61gene homozygous mutant GG polymorphism was not significant in LCPD patients when compared with controls.MTHFRC677T homozygous mutant TT polymorphism was significant in LCPD patients as compared to controls.

Conclusions: The present study showed a significant association of T allele of MTHFR C677T polymorphism with LCPD and may be regarded as a risk factor to develop the LCPD in North Indian patients.

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[27] Yamada R, Tanaka T, Unoki M, Nagai T, Sawada T, Ohnishi Y, Tsunoda T, Yukioka M, Maeda A, Suzuki K, Tateishi H, Ochi T, Nakamura Y, Yamamoto K. Association between a singlenucleotidepolymorphism in the promoter of the human interleukin-3 gene and rheumatoid arthritis in Japanese patients, and maximumlikelihoodestimation of combinatorial effect that two genetic locihave on susceptibility to the disease. Am J Hum Genet.2001;68: 674- 685.

Abstract:

Background: In clinical trials, turnaround time, data accuracy and quality are critical for developing safe and new medicine for patients. The cost of a one-day delay in a drug being brought to the market can be in millions.¹ It is essential; therefore, that all stakeholders in clinical trials take steps forward to improve efficiency, accuracy and quality of the clinical research overall. Doing so requires that organizations look beyond symptoms to uncover the true causes of errors in quality and delays. Additionally, new processes must be implemented in such a way as to become part of institutional culture, ensuring the consistent, on-going success of future efforts.

Purpose/Aim: To integrate, study and develop a stable, robust and reproducible Quality Management System (QMS) using combined quality management techniques such as Six Sigma, ISO and Lean together in clinical research.

Methods: Group of Students and working professionals will be asked to assess these three techniques individually and combined using pre-defined, developed and validated paper questionnaires. Different studies will be conducted over the period of 6-18 months and data will be collected. These studies will have an objective of testing each of three techniques on established processes to see if these can be used for process improvements. Result of these studies and quality matrix will be looked at to see how Six Sigma, ISO and Lean work independently and in combination of each other at the same time. Validated questionnaires will be used to obtain the results. Any survey tool developed will be piloted before using in the main phase of the study. Model needs will vary according to level of accessibility and sub-techniques, and this will need to be considered when selecting the sample for detailed study. Standard statistical packages will be used for examination. Standard qualitative and qualitative data analysis software package will be used to interpret the data generated form the review, questionnaire and interviews.

Conclusions: It is expected from proposed studies that combined use of ISO, Lean and Six Sigma techniques can improve quality of processes, data and produce robust Quality Management System.

These three techniques are different but complement each other. It is anticipated that a combination of these techniques will be of a great magnitude and beneficial to clinical research.

References:

[1]. Applied Clinical Trials; Retrieved on 06 October 2014,

http://www.appliedclinicaltrialsonline.com/appliedclinicaltrials/article/articleDetail.jsp?id=791938; Dawn Pope; Lean Six Sigma in the Clinical Trial Industry: Two Perspectives, published on 09 October 2012

[2]. ClinicalTrials.gov; Retrieved on 06 October 2014, https://clinicaltrials.gov/ct2/resources/trends

[3]. International Conference on Harmonization (ICH); Good Clinical Practice (GCP) E6 – Guidelines; retrieved on 06 October 2014, http://www.ich.org/fileadmin/Public_Web_Site/ICH_Products/Guidelines/Efficacy/E6/E6_R1_Guideline.pdf

[4]. Lui EW. Clinical research: the Six Sigma way. J Assn Lab Automat 2006;11(1):42–49.

[5]. Chow-Chua, Clare; Goh, Mark; Wan, Tan Boon (2003). "Does ISO 9000 certification improve business performance?". International Journal of Quality & Reliability Management 20 (8): 936.

[6]. Cynthis F. Kleppinger; Leslie K. Ball. Building Quality in Clinical Trials With Use of Quality Systems Approach; Journal of Clinical Infectious Diseases 2010; 51(S1):S111–S116.

[7]. Zidel, Tom (2006), A Lean Guide to Transforming Healthcare ISBN 0-87389-701-3

Abstract:

This present study was designed to assess the level of some hematological parameters among pretreatment pulmonary tuberculosis infected patients, treatment in 2 months, 4 months, 6 months pulmonary tuberculosis infection and control, non-infected subjects in Anambra State University Teaching Hospital, Awka. Anambra State, Nigeria. A total of 220 pulmonary tuberculosis (PTB) infected subjects aged 18 – 60 were recruited for the study. Hundred (100) subjects were in their pretreatment stage (group B), and 40 each in their 2 months (group C), 4 months (group D) and 6 months (group E) treatment stages. Eighty (80) non PTB subjects served as control. Blood samples collected from the subjects were used for the determination of Haemoglobin concentration (g/dl), packed cell volume (l/l), Mean cell haemoglobin concentration (g/dl), Erythrocyte sedimentation rate (mm/hr), platelet count (x10⁹/l), total white blood count (x10⁹/l), absolute neutrophil count (x10⁹/l), absolute lymphocyte count (x10⁹/l) and absolute monocyte count (x10⁹/l) using standard laboratory methods for analysis as described by Dacie and Lewis^[1]. Tuberculosis diagnosis was carried out using Ziehl Neelsen technique. The result showed that the mean ±SD Haemoglobin concentration and packed cell volume were significantly lower in pretreatment PTB subjects than the Post treatment subjects (P<0.05 in each case). The mean ±SD mean cell haemoglobin concentration showed no significant difference among the groups. The mean ±SD ESR in pretreatment subjects was significantly higher than the control and post treatment subjects. The mean (±SD) platelet count (x10⁹/l), TWBC (x10⁹/l) and ANC (x10⁹/l) were significantly higher while the ALC (x10⁹/l) was significantly lower respectively in pretreatment PTB patients compared with the control subjects and post treatment PTB subjects (P <0 .05 in each case). The mean (±SD) AMC (x10⁹/l) showed no significant difference when compared among the groups (P<0.05).

References:

[1]. Al- Omar, I. A., Ashban, R. M., Shah, A. H. (2009). Hematological abnormalities in Saudis suffering from pulmonary tuberculosis and their response to the treatment. Research journal of pharmacology. 3(4): pp 78-85

[2]. Bradley, G.W., Nicholas, A.C., Banfield, L. (2003). Serological diagnosis of tuberculosis. Journal of respiratory Disease. 6: 176-713.

[3]. Cheesbrough, M. (2000). District laboratory Practice in Tropical Countries. Part 2. Pp 36-41.

[4]. Dacie, J.V., Lewis, S.M. (2001). Practical Hematology. 9^th edition. Churchill Livingstone. Edinburgh, pp. 19-51.

[5]. Daniel, J.M. Baum, G.L. (2008). Immunological response to TB: Molecular characterization of haemagglutinating antibody to tuberculo-Polysaccharide in Sera from patients with tuberculosis. Amer. Journal of Res. Dis. 98: 677-680.

[6]. Kartalogu, Z.K., Cerrahoglu, O., Okutan, A., Ozturk, B., Aydilek, R. (2001). Parameters of blood Coagulation in patients with pulmonary tuberculosis. The Journal of Internal Medicine.

[7]. Konstantinous, A. (2010). Testing for Tuberculosis. Australian Prescribe 33(1): 12-18.

[8]. Kumar, V., Abbas, A.K., Fausto, N. Mitchell, R. N. (2007). Robbins Basic Pathology. 8^th edition. Saunders Elservier, pp. 516-522.

[9]. Olaniyi, J.A., Aven Ovi, V.A. (2003). Hematological profile of patients with pulmonary tuberculosis in Ibadan, Nigeria. African Journal of Medical Sciences. 32 (3): 239-242.

[10]. Stop T.B. Partnership (2002). London Tuberculosis rates now at third world proportions. PR Newswire Europe Ltd. 4^th December 2002. Retrieved on 3 October, 2006.

[11]. Snider, D., Roper, W. (2002). The New Tuberculosis. New England Journal of Medicine. 104.

[12]. World Health Organization (2009). Epidemiology. Global tuberculosis Control. Epidemiology, Strategy Financing. pp 6-33.

Abstract:

Surgery-related complications and mortality have remained unbearably high, particularly in developing countries. Consequently the WHO, developed a Safe Surgery checklist (SSC) to improve the safety of surgeries and reduce mismanagement in surgery. This study was designed to assess the knowledge, attitude and perception of theatre staff about the SSC.

A cross sectional study involving theatre staff of Jos University Teaching Hospital, Nigeria was employed. Information on socio-demographic characteristics, Knowledge and awareness of the SSC, Perception towards safety culture and team work, Willingness and attitude of participants to use the SSC and Challenges affecting the implementation of the SSC in JUTH operating theatres were collected, using a semi-structured questionnaire.

A total of 68 theatre staff participated in the study. Majority 63 (92.5%) had heard about the safe surgery checklist. About 47.0% mentioned they did not usually have enough time for safety preparation, (72.1%) noted that there was not enough resources put in place to ensure safety. Majority (92.7%), indicated that they wanted the checklist to be used for all surgical procedures. and also improve communication and collaboration between operating room staff. Only 13.3% agreed that the checklist is easy to use. More than half (54.4%) felt that the checklist may not bring any extra value to existing safety procedures already in place. Lack of commitment from the Management (16.2%), Lack of interest of health worker (14.7%), Shortage/lack of manpower (20.6%), Lack of team spirit (23.5%) and Inadequate supply of consumable instruments and other equipment/facilities (22.0) were pointed out by the participants as challenges that can affect the implementation of the safe surgery checklist.

References:

[1]. Abdel-Galil K (2010) The WHO Surgical Safety Checklist: are we measuring up? Br J Oral Maxillofac Surg 48: 397–398.

[2]. Agency for Healthcare Research and Quality (AHRQ). Surveys on patient safety culture. Available at http://www.ahrq.gov/qual/patientsafetyculture/.

[3]. Arriaga, A. F., Bader, A. M., Wong J .M., Lipsitz, S. R., Berry W.R., John E., Ziewacz., David L., Hepner, M. D., Boorman, D. J., Pozner, C. N., Smink D. S and Gawande, A. A. Simulation-Based Trial of Surgical-Crisis Checklists. N Engl J Med 2013; 368:246-253.

[4]. Birkmeyer, J. D. Strategies for improving surgical quality — checklists and beyond. N Engl J Med 2010;363:1963-5.

[5]. Carpenter, K. B., Duevel, M. A., Lee, P.W., Wu, A.W., Bates, D.W., Runciman, W. B., Baker, G.R., Larizgoitia I., & Weeks, W. B. 2010. Measures of patient safety in developing and emerging countries: a review of the literature. Quality and Safety in Health Care 19, 48-54.

[6]. Chukuezi, A. B and Nwosu, J.N. 2010. Mortality pattern in the surgical wards: A five year review at Federal Medical Centre, Owerri, Nigeria. International Journal of Surgery 8:5, 381–383

[7]. Cullati S, Licker M-J, Francis P, Degiorgi A, Bezzola P, et al. (2014) Implementation of the Surgical Safety Checklist in Switzerland and Perceptions of Its Benefits: Cross-Sectional Survey. PLoS ONE 9(7): e101915.

[8]. Edmondson AC. “Speaking up in the operating room: how team leaders promote learning in interdisciplinary action teams”, Journal of Management Studies, 40, 2003, 1419–52.

[9]. Ente, C., Oyewumi, A., and Mpora, O. B. 2010. Healthcare professionals’ understanding and awareness of patient safety and quality of care in Africa: A survey study. International Journal of Risk & Safety in Medicine, 22, 103–110.

[10]. Fourcade A, Blache JL, Grenier C, Bourgain JL, Minvielle E (2012) Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf 21: 191–197.

[11]. Patterson P (2009) In survey, about half of ORs are using the WHO checklist. OR Manager 25: 1, 6–8.

[12]. Gueguen T, Coevoet V, Mougeot M, Pierron A, Blanquart D, et al. (2011) [Deployment of the checklist “Patient safety in the operating room” in two Lorraine hospitals. Performances and difficulties]. Ann Fr Anesth Reanim 30: 489–494.

[13]. Haynes, A. B., Weiser, T. G., Berry, W. R., et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360:491-9.

[14]. Hurtado et al., 2012. Acceptance of the WHO Surgical Safety Checklist among surgical personnel in hospitals in Guatemala city. BMC Health Services Research 12:169

[15]. Institute for Healthcare Improvement (IHI) 2015: adapted from: http://www.ihi.org/resources/Pages/Tools/WHOSurgicalSafetyChecklistGettingStartedKit.aspx

[16]. Neily J, Mills, P. D., Young-Xu Y., et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010;304:1693-700.

[17]. Pickering SP, Robertson ER, Griffin D, Hadi M, Morgan LJ, et al. (2013) Compliance and use of the World Health Organization checklist in UK operating theatres. British Journal of Surgery 100: 1664–1670.

[18]. Pierre C Kariyoi, Joyce Hightoweri, Jean Bosco Ndihokubwayoii, Prosper Tumusiimei and Chris Mwikisai. 2013. Challenges facing the introduction of the WHO surgical safety checklist: A short experience in African countries. African Health Monitor, 2013 pp 36-40

[19]. Standard Written Checklists Can Improve Patient Safety During Surgical Crises. January 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsroom/press-releases/2013/checklistpr.html

[20]. Thomassen O, Espeland A, Softeland E, Lossius HM, Heltne JK, et al. (2011). Implementation of checklists in health care; learning from high-reliability organisations. Scand J Trauma Resusc Emerg Med 19: 53.

[21]. van Klei, W. A, Hoff, R. G., van Aarnhem, E. E., et al. Effects of the introduction of the WHO “Surgical Safety Checklist” on in hospital mortality: a cohort study. Ann Surg 2012;255:44-9.

[22]. Vats A et al. “Practical challenges of introducing WHO surgical checklist: UK pilot experience”, British MedicalJournal, 340, 2010, b5433.

[23]. de Vries E. N., Prins, H. A., Crolla, R. M., et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010;363:1928-37.

[24]. Watts BV, Percarpio K, West P, Mills PD: Use of the Safety Attitudes Questionnaire as a measure in patient safety improvement. J Patient Saf. 2010, 6(4):206–9

[25]. Weiser, T. G., et al. An estimation of the global volume of surgery Lancet, 2008, 372:139-144

[26]. WHO 2008. World Alliance For Patient Safety: Implementation Manual WHO Surgical Safety Checklist (First Edition) _ Safe Surgery Saves Lives pp 1-20.

[27]. WHO 2009. Surgical Public Health: WHO and the Safe Surgery Saves Lives Campaign, from http://www.cugh.org/sites/default/files/MODULE_%20WHO%20Surgical%20Public%20Health_0.pdf

[28]. World Health Organization (WHO) Patient Safety Campaigns. Accessed March, 6, 2011 at http://www.who.int/patientsafety/campaigns/en/.

Abstract:

This is a cross-sectional descriptive study which sought to identify the factors that affects the use of contraception among postnatal mothers in Komfo Anokye Teaching Hospita(KATH), Kumasi, Ghana. Purposive and convenience sampling methods were used to select the directorates and health workers respectively. Self-structured and validated questionnaires were administered to 200 postnatal mothers at KATH. Data collected was processed and analysed with Statistical Package for Social Sciences and Microsoft Excel. Results obtained showed that mothers’ education and marital status are the main factors affecting the use of family planning. Education exposes the mothers to information on methods of birth control and increases understanding on various aspects of contraceptives such as mechanism of action, method specific instructions and side effects. The years spent in school also delay start of childbearing and enable the women to make informed decisions in matters affecting their reproductive health at a mature age. Marriage exposes mothers to sexual intercourse in the postpartum period and increases the risk of conception. Consequently, the married mothers have a higher intention to use postpartum family planning than their unmarried counterparts. This means that their needs for post-partum family planning (PPFP) should be addressed to ensure their intentions translate into actual use, which will reduce the unmet need for PPFP in KATH.

References:

[1]. Anna, T., and Nassoro, R. (2006) Utilization of Modern Family Planning Methods Among Women of
Reproductive Age in Rural Setting: The Case of Shinyanga Rural District, Tanzania. East African Journal of Public
Health, Vol.3 No.2, pp.26-30.
[2]. Adinma B.(2002) An overview of the global policy consensus on women's sexual and reproductive rights: The
Nigerian perspective. Tropical Journal of Obstetrics Gynaecology Vol.1No.1, pp.9-12.
[3]. Barber, L.S. (2007). Family planning advice and postpartum contraceptive use among low-income women in
Mexico. International Family Planning Perspectives, 33(1): 6-12
[4]. DaVanzo, J. (2007) Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy
outcome in Matlab, Bangladesh. BJOG, 114(9): 1079-1087
[5]. Day, T., Raker, C.A., and Boardman, L.A. (2008).Factors associated with the provision of antenatal
contraceptive counseling. Contraception, 78(4): 294-299.
[6]. Depineres, T., Blumenthal, P.D and Diener-West, M. (2005). Postpartum contraception: the New Mexico
pregnancy risk assessment monitoring system. Contraception, 72(6): 422- 425.
[7]. Ghana National Bureau of Statistics(2010) Ghana Demographic and Health Survey 2008-13
[8]. Glasier, A.F., Logan, J., and McGlew, T.J. (1996).Who gives advice about postpartum contraception?
Contraception, 53(4): 217-220.
[9]. Hani,A., Moss, M., Cooper, D., Morroni, C & Hoffman, M. (2007).Informed choice-the timing of postpartum
contraceptive initiation. South Africa Medical Journal, 93(11): 862-864.
[10]. Kariuki, W.D. (2011) Factors determining the intension to use postpartum family planning among the first time mothers aged 15-29
years in Kenya. Retrieved from: www.docs.mak.ac.ug/sites/default/files/DAINAH%20DISSERTATION.doc
[11]. King, J. (2007). Contraception and lactation. Journal of Midwifery and Women’s Health, 52(6):614-620.
[12]. Kumssa, E., Kahaliw, W., and Ergetie, Z. (2013) Assessment of Knowledge, Attitude and Practice Among
Women of Child Bearing Age Towards Contraceptive Drug Utilization in Adama (Kebele 12). International Journal
of Medical and Pharmaceutical Sciences, 3 (10), 01-08.
[13]. Mao J. Knowledge, Attitude and Practice of Family Planning: A Study of Tezu Village, Manipur (India). The
Internet Journal of Biological Anthropology 2007; 1(1); 45-52
[14]. Manandhar N, Singh SK, Patowary S, Krishna G.(2012) Study of knowledge, attitude and practice of family
planning in an urban area of Bharatpur. Journal of Institute of Medicine Vol. 28(2); 35-44
[15]. McKaig, C and Deller, B. (2006).After the fact: family planning for the postnatal period. ACCESS-
FP/JHPIEGO.http://www.maqweb.org/miniu/present/2006/After%20the%20Fact- PPFP.ppt
[16]. Onwuzurike B.K, and Uzochukwu B.C. Knowledge, Attitude and Practice of Family Planning amongst
Women in a High Density Low Income Urban of Enugu, Nigeria. African Journal of Reproductive Health 2001;
5(2); 83-89.
[17]. Ross, A.J., and Winfrey, W.L. (2001).Contraceptive use, intention to use and unmet need during the extended
postpartum period. International Family Planning Perspective, 27(1):20-27.
[18]. Salway, S., and Nurani, S. (1998).Uptake of contraception during postpartum amenorrhea: understandings
and preferences of poor, urban women in Bangladesh. Social Science and Medicine, 47(7): 899-909.
[19]. World Health Organization, Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide to Essential
Practice, 2006.
(http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9241590 84X/en/. Accessed on 27
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[20]. World Health Organisation. Selected Practice Recommendations for Contraceptive Use. 2nd edition and 2008
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(http://www.who.int/reproductivehealth/publivcations/family_planning/9241562846index en/index.html. Accessed
on 27 January 2014).

Abstract:

Objective: The study examined the pattern of Substance Use among the Nigerian Air Force Personnel.

Method: All the participants were airforce personnel. Officers and Men were randomly selected (N=250) and each subject was assessed using; 1) a Health Questionnaire {that assessed socio-demographic variables as well as the pattern of use and consumption of liquor), 2) Alcohol and drug sections of the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), and the 28 – item General Health Questionnaire (GHQ -28). The personnel were informed that completion and returning the questionnaires would indicate consent to participate in the research.

Results: One hundred and ninety males and sixty females comprising officers and men participated. The mean age of the group was 30.9 years, with a range of 21 – 44 years; SD 4.35. One hundred and eight (42.6 percent) were 20 – 29 years, while one hundred and thirty (52 percent) were 30 – 39 years, and Twelve (5.4 percent) were 40 and above years. The difference in mean age between officers and men was not statistically significant following analysis of variance (ANOVA), F=2.59, P=0.148. The most commonly used substances were mild stimulants (coffee and kolanuts), alcohol, cigarette, cannabis, and hypnosadatives in that order. About the same trend was observed for the lifetime use. As many as 158 (63.3 %) of the respondents were current users of alcohol and almost everyone in the sample 92% have used alcohol in their lifetime. Fifteen 6% of the respondents were currently using cannabis, while 18.7% were lifetime users. Disorders were recorded for past year (ie criteria met within the previous 12 months) and lifetime (ever met criteria) using SCAN. Overall, 21 (8.3%) and 6 (2.3%) of the respondents DSM 1V diagnostic criteria for alcohol abuse and dependence respectively in the past year; Eleven (4.7%) and 13 (5.3%)met the criteria for nicotine abuse and dependence respectively in the past year; 10 (4.0%) and 3 (1.0%)met the criteria for cannabis abuse and dependence respectively in the past year. A total of 42 respondents (16.8%) scored eight and above on the GHQ-28 scale. Thus the probable psychiatric morbidity rate for the cohort was about 17%.

References:

[1]. Bray RM, and Hourani LL. Substance use trends among active duty military personnel: Findings from the United States department of Defence. Health related Behaviour Survey, 1980 – 2005. Addiction. 102, 1092 – 1101. (2007).

[2]. Bryant, C. D. (1979). Khaki-Collar Crime. New York: Free Press.

[3]. Department Of Defense. Directive No. 1010.4:Alcohol and Drug Abuse by DoD Personnel. (Supersedes and cancels 1980 version of Directive No.1010.4 and 1985 version of Directive No. 1010.3). Washington, DC: Department of Defense

[4]. Ebie JC, Obiora M. Use and abuse of psychoactive pharmaceuticals in Nigeria. Nigerian J Psychiatry 1988;1:181-5.

[5]. Hingston R, Mangioney T, barret J Job characteristics and drinking practices in Boston Metropolitant area. QJ stud Alcohol: (1981). 42:725-735.

[6]. Ingraham, L. H. (1984). The Boys in the Barracks. Philadelphia, PA: Institute for the Study of Human Issues.

[7]. Obot, I. S. Ethical and legal issues in the control of drug abuse and drug trafficking: The Nigerian case. Social Science and Medicine, (1992). 35, 481– 493.

[8]. Odejide A.O. Ohaeri JU; Adelekan, ML and Ikuesan B.A. drinking behaviour and social change among youths in Nigeria- study of two cities. Drug and Alcohol Dependence(1987): 20, 227 – 233.

[9]. Robins, L. N., HELZER, J. E., & DAVIS, D. H. Narcotic Use in Southeast Asia and Afterward: An Interview Study of 898 Vietnam Returnees. Archives of General Psychiatry(1975). 32:955-61.

[10]. RTI International (2009). Department of Defense Survey of Health-Related Behaviors Among Active Duty Military Personnel. Research Triangle Park, NC: RTI International.

[11]. Seal, K.H.; Metzler, T.J.; Gima, K.S.; et al. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health 99(9):1651–1658, 2009.

[12]. Wertsch, M. E. (1991). Military Brats: Legacies of Childhood Inside the Fortress. New York: Harmony Books.

Abstract:

Hypoxic injury of brain can occur at any age from an infant to an adult, also called as global hypoxic ischaemic injury. The patients usually presents with a history of asphyxiation, drowning, cardiac arrest or respiratory arrest. Basalganglia, thalami, cerebral cortex (the sensorimotor and visual cortices are predominantly involved, though involvement is often diffuse), cerebellum, hippocampi are the areas usually affected in the brain. Usually the involvement is bilateral in deep nuclei we here present a rare case of unilateral involvement of basal ganglia in a case of hypoxic brain injury.

References:

1. Arbelaez, a, Castillo, M., & Mukherji, S. K. (1999). Diffusion-weighted MR imaging of global cerebral anoxia. AJNR. American Journal of Neuroradiology, 20(6), 999–1007. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10445435

2. Huang, B. Y. (2008). Brain Injury: Imaging OBJECTIVES. RadioGraphics, 28(2), 417–439. http://doi.org/10.1148/rg.282075066

3. Renard, D., Castelnovo, G., Campello, C., Bouly, S., Floch, A. Le, Thouvenot, E., …Taieb, G. (2014). Thalamic Lesions: A Radiological Review, 2014.

4. The vascular territories in the cerebellum and brainstem: CT and MR study. by Savoiardo M, Bracchi M, Passerini A, Visciani A. AJNR Am J Neuroradiol. 1 987 Mar-Apr;8(2):1 99-209.

Abstract:

The presented article on ‘Reducing bias in open-label trials where blinded outcome assessment is not feasible: strategies from two randomized trials’ provides strategic approach towards creating unbiased approach were blinding in the study is not possible. The study has been supported by two randomized trials which have been well accepted before.

References:

[1]. Boutron I, Tubach F, Giraudeau B, Ravaud P, (2004): Blinding was judged more difficult to achieve and maintain in nonpharmacologic than pharmacologic trials, Journal of Clinical Epidemiology, vol 57(6), pg 543-550.

[2]. Chan AW , Tetzlaff JM , Gotzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hrobjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D, (2013): SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials, Biomedical Journals, vol 346, pg 7586.

[3]. Dechartres A, Boutron I, Roy C, Ravaud P, (2009): Inadequate planning and reporting of adjudication committees in clinical trials: recommendation proposal, J Clin Epidemiol, vol 62(7), pg 695-702.

[4]. Dresler CM, Olak J, Herndon JE 2nd, Richards WG, Scalzetti E, Fleishman SB, Kernstine KH , Demmy T , Jablons DM, Kohman L, Daniel TM, Haasler GB, Sugarbaker DJ, (2005): Phase III intergroup study of talc poudrage vs talc slurry sclerosis for malignant pleural effusion, Chest, vol 127(3), pg 909-915.

[5]. Feagan BG, Sandborn WJ, D’Haens G, Pola S, McDonald JW , Rutgeerts P, Munkholm P, Mittmann U , King D, Wong CJ, Zou G, Donner A, Shackelton LM , Gilgen D, Nelson S, Vandervoort MK, Fahmy M, Loftus EV Jr, Panaccione R , Travis SP, Van Assche GA, Vermeire S, Levesque BG, (2013): The role of centralized reading of endoscopy in a randomized controlled trial of mesalamine for ulcerative colitis, Gastroenterology, vol 145(1), pg 149-157.e2.

[6]. Hrobjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Hilden J, Boutron I, Ravaud P, Brorson S, (2012): Observer bias in randomised clinical trials with binary outcomes: systematic review of trials with both blinded and non-blinded outcome assessors, Biomedical Journals, vol 244, pg 1119

[7]. Hrobjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Hilden J, Boutron I, Ravaud P, Brorson S, (2013): Observer bias in randomized clinical trials with measurement scale outcomes: a systematic review of trials with both blinded and nonblinded assessors, CMAJ, vol 185(4) pg E201 -E211.

[8]. Hrobjartsson A, Thomsen AS, Emanuelsson F, Tendal B, Rasmussen JV , Hilden J, Boutron I, Ravaud P, Brorson S (2014): Observer bias in randomized clinical trials with time-to-event outcomes: systematic review of trials with both blinded and nonblinded outcome assessors, Int J Epidemiol, vol 43(3), pg 937-948.

[9]. Jairath V , Kahan BC, Gray A, Dore CJ, Mora A, Dyer C, Stokes EA, Llewelyn C, Bailey AA, Dallal H, Everett SM, James MW, Stanley AJ, Church N, Darwent M, Greenaway J, Le Jeune I, Reckless I, Campbell HE, Meredith S, Palmer KR , Logan RF, Travis SP, Walsh TS, Murphy MF, (2013): Restrictive vs liberal blood transfusion for acute upper gastrointestinal bleeding: rationale and protocol for a cluster randomized feasibility trial, Transfus Med Rev, vol 27(3), pg 146-153.

[10]. Kahan BC, Jairath V, Murphy MF, Dore CJ, (2013): Update on the transfusion in gastrointestinal bleeding (TRIGGER) trial: statistical analysis plan for a clusterrandomised feasibility trial, Trials, vol 14, pg 06.

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Abstract:

The oxford dictionary defines pain as a “highly unpleasant physical sensation caused by illness or injury”. It is also defined by the International association of pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Fisher, 2000). Now internationally it has been accepted that, pain should be expected, carefully and efficiently restricted in children irrespective of how old or mature they are and how severe their source of pain is considered to be (Fisher & Morton 1998).

A number of researches have been done in the area of pediatric pain and this has led to an improvement in the understanding of pain in children by both their parents or guardians and their clinical health care team. This not withstanding there is still some amount of challenge with the evaluation of pain in children.

Even though internationally so many studies have been conducted in the area of pediatric pain assessment and management, in Ghana there has been little or no study conducted in this area. Even obtaining local information about the assessment of post operative pain in children was not fruitful. As a result one cannot prove that post operative pain in children in Ghana who undergo one surgery or another receives the best control therapy.

This study is to assess the management of post operative pain in children in the biggest tertiary hospital in Ghana and information gathered could inform further studies in this area that can help improve the care given to children when it comes to the management of their post operative pain.

References:

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Abstract:

Clinical data management helps to produce a drastic reduction in time from drug development to marketing. Team members of CDM are actively involved in all stages of clinical trial right from inception to completion. They should have adequate process knowledge that helps maintain the quality standards of CDM including case report form (CRF) designing, CRF annotation, data designing, data-entry, data validation, discrepancy management, medical coding, data extraction and data locking are assessed for quality at regular intervals during the trial. Presently there is an increased demand to improve the CDM standards to meet the regulatory requirements and stay ahead of the competition by means of faster commercialization of product. With the implementation of regulatory complaint data management tools. CDM team can meet these demands. Additionally, it is becoming mandatory for companies to submit data electronically. It is advocated that CDM professionals should meet appropriate expectations and set standards for data quality and also have a drive to adapt to the rapidly changing technology. Pls refer Binny Krishnankutty, Shantala Bellary, Naveen B. R. Kumar et al 2011 Data management in clinical research an overview Indian Journal of pharmacology 44(2):168-172. doi 10. 4103/0253-7613.93842 

References:

[1]. Binny Krishnankutty, Shantata Bellary, Naveen B R Kumar et al 2011 Data management in clinical research : An overview Indian Journal of Pharmacol. 44(2) 168-172

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Abstract:

Drugs : Drug is the chemical substance may be synthesized or derived naturally and is use for its therapeutic effect It plays a vital role in life it is meant to diagnose, mitigate, cure, prevent, or treat or modify the physiological condition. Drug is meant for the safeguard of public health.

Importance of the medicines: medicines are considered to be one of the vital need of the human being. One has to rely upon this once or oftenly in their life time in order to maintain their physical and mental health. In ancient times the illness was considered to be gods wish but after certain period the revolution came and now that is era and till date continuous introduction of drugs to the patient need is available. After continuous Discovery and introduction of the drug the public health is being improved. And the mortality rate compare to ancient time has been reduced.

References:

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