Improving the Patient Colonoscopy Prep Experience

AIM: To improve patient prep compliance, prep quality, and an overall better experience by designing a prep specific website that will address the most common prep questions and concerns Once launched, the website address will be placed on printed colonoscopy prep instructions and stated on the after hours GI clinic voicemail as an additional patient resourcehttps://jdc.jefferson.edu/patientsafetyposters/1049/thumbnail.jp

Protein ligation : selenocysteine

Selenium is present in human and animal body in the form of selenocysteine an

A rare case of heterotopic pregnancy: case report

Heterotopic pregnancy is defined as the coexistence of intrauterine and extrauterine gestation. The incidence is low and estimated to be 1 in 30,000 of spontaneous pregnancies though it is becoming commoner with assisted reproductive technique. It can be a life-threatening condition and can be easily missed with the diagnosis being overlooked. We present a rare case of spontaneous heterotopic pregnancy with intrauterine gestation without cardiac activity and unruptured tubal ectopic

Patient satisfaction with the behavioral competencies of their treating doctors: a hospital based study

Introductions:Patient satisfaction surveys are essential in identifying gaps in providing health care to patients and developing an effective plan for its quality improvement. This study aimed to assess the level of patient’s satisfaction with doctors’ behavioral competencies in communication skills, interpersonal manner, confidentiality maintenance and general satisfaction. Methods:A cross-sectional study was conducted in admitted patients of Department of Surgery, Orthopaedics, Internal Medicine and Obstetrics Gynaecology between August 4, 2015 and August 28, 2015. Samples were selected by stratified random sampling technique. They were interviewed using a validated tool in 7-point Likert scale and collected data were analysed using SPSS. Results:Out of 101 respondents, percentage of patients who had very high, high, medium, low overall satisfaction (communication skills, interpersonal manner, confidentiality maintenance and general satisfaction) were 27.7% (28), 24.8% (25), 20.8% (21) and 26.7% (27) respectively. Pearson Chi-square test and Mann-Whitney U test showed level of satisfaction did not differ with age, gender and educational level of respondents. There was positive Spearman’s rank correlation of general satisfaction with communication skill, confidentiality maintained and interpersonal manners. Communication skill had the highest correlation coefficient (57.8%). Conclusions: The overall satisfaction (very high and high satisfaction) of the patient with the behavioral competencies of doctors at Patan Hospital is 52.5%. Communication skill had the highest degree of influence on the level of patient satisfaction. The level of satisfaction was not affected by age, gender and educational level of patients.  Keywords:behavioral competencies of doctors, communication skill, patient satisfaction, quality of health car

Cardiovascular disease in pregnancy

Background: Maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality. The care of pregnant women with cardiac disease requires a multidisciplinary approach, involving obstetricians, cardiologists and anesthesiologist.Methods: A prospective analytical study of maternal heart disease and its fetomaternal outcome is carried out in the department of obstetrics and gynecology at tertiary hospital and teaching institute. The study was carried out on 50 cases belonging to age group 18-50 years with various cardiac diseases during their pregnancy and peripartum period.Results: In this study, 78% of the cases were registered with our hospital. The present study shows about 32% of the women having cardiac disease were in the age group of 20-25 years. 34% belonged to NYHA class II and had a relatively uneventful peripartum period. Among all forms of heart disease, RHD was common constituting 26% of cases. Most common condition associated with cardiac disease in pregnancy was preeclampsia (36%) in our study, with anemia being other one (10%). The common complications were congestive cardiac failure (12%) and pulmonary edema (8%). Combination of diuretics and beta blockers was used most commonly (22%). 56% of women delivered with caesarean section. 42 patients delivered after age of viability with 29 (69%) term deliveries and 13 (30%) preterm deliveries with 8 requiring NICU care.Conclusions: Valvular heart disease of rheumatic origin is the most common cardiac disease associated with pregnancy.The availability of adequate systems of early diagnosis of cardiac lesion, reference to tertiary care center & close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise that can minimize the serious consequences and helps to improve fetomaternal outcome. Pre-conceptional counseling and surgical correction of certain conditions improves maternal as well as fetal outcome. Awareness needs to be created about heart diseases during pregnancy and the importance of regular antenatal check-ups

[Diversidad, utilidad y comunidades de hierbas en trigo de Nowshera, Pakistan

Weeds are disregarded for their competitive nature and difficulties during harvesting and threshing. Categorizing them by economic use classes enables effective management. Weed ecological studies in wheat crop fields were conducted to evaluate the floristic diversity, ecological characteristics, community structures and economic uses of weeds in District Nowshera, Pakistan. Different wheat crop fields were surveyed for the collection and identification of plant species growing as weed. Total 50 plant species from 47 genera and 20 families were recorded in the study area. Asteraceae had the highest number of species (10), followed by Poaceae (9). Therophytes were more with 42 species, followed by geophytes and Hemicryptophytes each with 3 species. Most species had mesophyllous leaf size (15), while nanophyllous (12) and microphyllous (11). Simple leaves were more common (28) than dissected leaves (22). Nonspiny species were (44) while only 6 had spines. Maximum plant species were fodder (35) and medicinal (10). In the study, four distinct weed communities were identified using quadrate method i.e. Cynodon-Anagallis-Melilotus, Arenaria-Anagallis-Cannabis, Cynodon-PartheniumCoronopus and Rumex-Arenaria-Oxalis. These findings provide a valuable starting point for future indepth investigations on the entire flora and vegetation of Nowshera, Pakistan.: Las hierbas se descartan por su naturaleza competitiva y las dificultades para su cosecha y trilla. Categorizarlas por su uso económico usa clases y permite una gestión efectiva. Los estudios ecológicos de las hierbas en los campos de trigo se han conducido para evaluar la diversidad de flora, las características ecológicas, las estructuras de comunidades, y los usos económicos de las hierbas en el distrito de Nowshera, Pakistan. Distintos campos de trigo fueron muestreados para recolección e identificación de especies vegetales que crecen como hierbas. Un total de 50 especies de plantas de 50 géneros y 20 familias se registraron en esta área de estudio. El mayor número de especies pertenecía al género Asteraceae had the highest (10), seguido por Poaceae (9). Therophitos fueron la mayoría, con 42 especies, seguidos por las geófitas y Hemicriptofitas cada una con 3 especies. La mayoría de las especies tenía un tamaño de hoja mesófilo (15), mientras que los nanófilos registraron 12 y micrófilos 11. Las especies de hojas simples fueron más comunes (28) que las hojas diseccionadas (22). Las especies sin espinas predominaron (44) mientras que solo 6 tenían espinas. La mayoría de las especies fueron eran forraje (35) y medicinales 10. En el estudio, cuatro familias distintas fueron identificadas usando el método cuadrado, esto es, Cynodon-Anagallis-Melilotus, Arenaria-Anagallis-Cannabis, CynodonParthenium-Coronopus y Rumex-Arenaria-Oxalis. Estos hallazgos permiten un valioso punto de inicio para futuras investigaciones en profunidad sobre la flora y vegetación de Nowshera, Pakistan

Pattern of mortality in sickle cell disease: an autopsy study

Background: Sickle haemoglobin is highly prevalent in western India. Sickle cell disease (SCD) is the generic term for the group of haemoglobinopathies caused by the occurrence of haemoglobin S (Hbs) in the homozygous form –sickle cell anaemia (Hbss) or as the heterozygous combination of Hbs with another abnormal haemoglobin such as Hbsc or beta –thalassaemias (Hbs b-thal). While doing autopsy in case of death with no apparent cause, the possibility of death may be due to vaso-occlusive crisis in sickle cell disease should be kept in mind. The findings at autopsy are variation of features which may or may not be directly connected to death. The goal is to draw awareness among physicians and relatives on need of autopsy as to minimize future unexpected death from complication or crisis and to enhance knowledge on both parties.Methods: This was a study of autopsy specimens received between January 2015 to December 2015 at tertiary care hospital.Results: Total of 679 autopsy cases were received, out of which sickled erythrocytes were detected in 25 cases. The mean age at death was 30 years, a male/female ratio of 1.5:1 and peak mortality was in the 2nd to 4th decades of life. The commonest presentation was sudden death. The cause of death in middle aged patients were vaso occlusive crisis, in paediatric patients were infection and in older patients were chronic organ damage.Conclusions: Early diagnosis, prompt treatment and extended screening programme are necessary in prevalent tribal belt of western India to reduce morbidity and mortality. we should also introduce awareness programmes in tribal belt of western India

Pattern of histopathological lesions in lung autopsy

Background: A large number of pathologic conditions involve the lung parenchyma like inflammatory, neoplastic and others. The lungs are also involved in almost all terminal events of cardiovascular disease. Autopsy is an important and most useful way to find out the condition of internal organs and to evaluate any localized lesions or systemic disease and hence determine cause of death. Aims and objectives of study are to identify the histopathological spectrum of lung disease. To find out frequency of various lung pathologies in respect to age and sex.Methods: This study was retrospective and done on 649 cases of medico legal autopsies. The tissue specimens were fixed and processed. Routine paraffin sectioning was done followed by Hematoxylene and eosin (H and E) staining. Special stains were done whenever required. Relevant clinical and postmortem findings, gross and microscopic examination findings were recorded.Results: After thorough histopathological examinations, of total 649 cases, various pulmonary lesions were identified in 348(53.6%) cases while in 301(46.4%) cases no significant pathology was seen. Most commonly affected age group was 30-49 years 43.1% followed by age group of >60years 17.8%. Majority of diseased were male 285 (81.9%). Most common lung pathology found was Edema and congestion in 93 cases (26.72%), chronic venous congestion in 92 cases (26.44%) pneumonia in 65 cases (18.68%) followed by Tuberculosis/Tuberculous pneumonia in 29 cases (8.3%).Conclusions: In our population, the present study reveals that infectious disease are still the most common cause of mortality, despite recent advances in diagnostic technology, the autopsy has remained an important complementary tool for identifying and understanding pathology of disease.

Evaluation of complication during third stage of labour at tertiary care center

Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication

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