RESUMO
Background: Ovarian cancer is the most lethal gynecological malignancy. The present study was therefore designed to determine the accuracy of IL-6 and CA-125 in the early diagnosis of malignant ovarian tumors. The aim of the study was to evaluate the predictive value of pre-operative serum IL-6 and CA-125 levels in identifying malignant ovarian tumors.Methods: This cross-sectional study took place at BSMMU and NICRH in Dhaka, Bangladesh, from February 2022 to January 2023. It involved 94 women undergoing surgery for suspected ovarian tumors. The Mann-Whitney test was used to compare IL-6 and CA-125 levels between groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to correlate serum markers with histopathological diagnoses. Statistical analysis used SPSS version 23.0 with significance set at p<0.05.Results: The study involved 94 patients with ovarian tumors, where the mean age was higher in those with malignant tumors. The most common malignant histopathological finding was serous carcinoma (34%), while benign tumors often included endometriotic cysts (12.8%) and mucinous cystadenomas (10.6%). Elevated levels of IL-6 and CA-125 were significantly associated with malignant tumors (p<0.05). Both IL-6 and CA-125 showed high diagnostic accuracy in identifying malignant ovarian tumors when used alone or in combination, as indicated by receiver-operator characteristic curves.Conclusions: Serum IL-6 shows higher sensitivity and specificity for detecting malignant ovarian tumors, both epithelial and non-epithelial, making it a valuable diagnostic tool alongside CA-125 in assessing suspicious ovarian masses.
RESUMO
Background: Pseudomonas aeruginosa are known for their multiple mutations and rapid acquirement of antimicrobial resistance genes. The presence of metallo-?-lactamase (MBL) is the commonest reason for the treatment failure in carbapenem therapy. Production of extended spectrum ?-lactamase (ESBL) in these isolates makes the treatment more challenging. Due to the importance of the carbapenems in resistant infection management, finding the true frequencies of such enzymes is imperative. Methods: A total of 446 samples were collected from the admitted patients with infected burn, surgical wound, and endotracheal tube in situ. Isolation and identification of organisms and antimicrobial susceptibility testing were done by established methods. Identification of P. aeruginosa was confirmed by polymerase chain reaction (PCR). Production of ESBLs was detected phenotypically by double disc synergy, and MBL by double-disc synergy, combined disc, and modified Hodge test. Genes encoding ESBLs and MBLs were detected by PCR. Results: Among the 446 samples, 84.31% yielded growth, from which 232 (61.70%) were P. aeruginosa. Among the P. aeruginosa, 72 (31.03%) were resistant to imipenem. Phenotypically, 57 (79.17%) of these strains were ESBL and all were MBL producers. blaOXA-10 was the most common ESBL encoding gene (29.83%). blaNDM-1 was the most prevalent MBL encoding gene (34.72%). Moreover, 27 (38%) imipenem resistant P. aeruginosa had concurring ESBL and MBL genes.
RESUMO
Background: Cervical cancer, characterized by malignant growth in the cervix uteri, often manifests with vaginal bleeding and can progress silently until reaching an advanced stage. It ranks as the most common cancer among women in numerous developing nations. The study aimed to evaluate the knowledge of the women about the prevention of carcinoma cervix by vaccination.Methods: This cross-sectional observational study was conducted at the outpatient department of obstetrics and gynecology, Dhaka medical college and hospital, Bangladesh from Jan 2020 to Dec 2021. In this study, 100 women attending the mentioned department, were interviewed with a view in mind to find out their knowledge level regarding the vaccination of cervical cancers. Data were analyzed by using MS office tools.Results: The study revealed a direct correlation between education level and awareness of HPV, underscoring a significant lack of knowledge about cervical cancer vaccination. It emphasizes the urgent need to educate individuals about the vaccine's role in preventing cervical cancer. Education campaigns utilizing local media could effectively disseminate information.Conclusions: The unavailability and cost of the vaccine pose barriers to its accessibility. Integrating the vaccine program into existing expanded program on immunization (EPI) initiatives could be transformative for community health.
RESUMO
Background: Breastfeeding is essential for health of both infants and mothers, but it often encounters challenges such as postpartum breast complications. These issues can adversely affect maternal health and significantly hinder success of breastfeeding practices. Aim of study was to assess postpartum breast complications and breast-feeding practices.Methods: This cross-sectional study was conducted in department of obstetrics and gynaecology, Dhaka medical college hospital, Dhaka, Bangladesh from February 2006 to July 2006. Two hundred patients in the postnatal ward who delivered their babies at DMCH were randomly selected.Result: Among 200 postnatal women, 33.5% experienced breast problems. Women with breast problems were designated as group A and women without breast problems were designated as group B. Most women in groups A and B were aged between 21-30 years with average 24.8 years for both groups. Antenatal check-ups were similar across groups, with breastfeeding advice given to 55.2% in group A and 64.7% in group B pre-lacteal feeds were given to 19.4% of group A and 21.8% of group B neonates, while colostrum was fed to the majority. Most neonates were breastfed within 2 hours. Good breastfeeding position and attachment were observed in most cases. Exclusive breastfeeding was more common in group B (73.7%) than in group A (58.2%). Breast problems in group A included engorgement, lactation insufficiency, and nipple issues.Conclusions: The study reveals that postpartum breast complications, notably breast engorgement and lactation insufficiency, significantly affects the breastfeeding effectiveness of new mothers.
RESUMO
Background: Twin births are often associated with increased risks and complications compared to singleton births. This study aims to analyze the clinical profile, morbidity pattern, and risk factors associated with twin births, focusing on maternal characteristics, neonatal outcomes, and the prevalence of conditions such as low birth weight (LBW) and preterm births.Methods: This hospital-based observational study was conducted at a tertiary care center, involving 25 mothers who had given birth to twins and their 50 neonates. The study assessed maternal age, antenatal care, parity, medical history, and neonatal outcomes including birth weight, gestational age, respiratory and cardiac parameters, and overall health status. Data were collected through medical records and direct observations in the neonatal intensive care unit.Results: The majority of mothers (64%) were aged between 21-30 years, with a mean age of 24.8 years. A significant proportion (92%) had regular antenatal visits, and 96% were multiparous. The majority of neonates (68%) were aged ?12 hours at assessment, with a near-equal distribution between very low birth weight (VLBW) and LBW. Preterm births were common, affecting 84% of the neonates. Respiratory challenges were evident, with 62% of neonates having SpO2 levels below 94%. The mortality rate among the neonates was 32%.Conclusions: The study highlights the high-risk nature of twin pregnancies, characterized by a significant prevalence of LBW, VLBW, and preterm births. The findings emphasize the need for enhanced prenatal care and specialized neonatal interventions. The high mortality rate among neonates indicates the critical need for targeted strategies to improve neonatal outcomes in twin pregnancies. These insights are crucial for informing clinical practices and developing comprehensive care protocols for managing twin pregnancies and their associated risks.
RESUMO
Background: Cesarean section (CS) stands as the foremost major surgical procedure in contemporary obstetrics. Initially developed primarily to safeguard maternal life during challenging childbirth scenarios, its prevalence has shown a concerning upward trajectory in recent times. The aim of this study was to investigate the prevalence and determinants of Cesarean section deliveries in a rural tertiary care hospital.Methods: This was a retrospective observational study and was conducted in the Department of Obstetrics and Gynaecology of Khwaja Yunus Ali Medical College & Hospital, Sirajganj, Bangladesh during the period from January 2018 to December 2019.Results: Out of a total of 1600 deliveries, 390 (24.4%) were vaginal deliveries, while 1210 (75.6%) were cesarean sections respectively. Majority 94.8% patients were 20-34 years old, 1.8% were less than or equal to 19 years and 3.4% were great than or equal to 35 years old respectively. The majority of cesarean sections, 814 (67.3%), were performed as elective procedures and 396 (32.7%) were performed as emergency procedures respectively. Majority 512 (42.3%) were performed on women who had a history of previous cesarean deliveries, 34 (2.8%) were performed due to non-progression or prolonged labor, 99 (8.2%) were performed due to malpresentation of the baby and 308 (25.5%) were performed at the request of the mother respectively.Conclusions: In conclusion, this retrospective observational study provides valuable insights into the prevalence and determinants of caesarean sections in a rural tertiary care hospital.
RESUMO
Background: Pregnant individuals with polycystic ovarian syndrome (PCOS) seem to face a heightened susceptibility to unfavorable outcomes. This investigation aimed to evaluate the consequences of pregnancies in patients diagnosed with PCOS.Methods: This cross-sectional study involving 115 pregnant patients with PCOS was carried out at the department of obstetrics and gynecology, Dhaka medical college and hospital, Dhaka, Bangladesh, tertiary care facility, from January 2023 to December 2023. Data on the ongoing pregnancy, PCOS, and outcomes were analyzed by SPSS version 20.Results: Average age of participants was 25.07 years. Incidence of premature rupture of membranes (PROM) was 33.91%, low APGAR score at 5 minutes was 12.17%, gestational diabetes (GDM) occurred in 23.47% of cases, miscarriage was reported in 2.1%, preterm delivery in 13.91%, cesarean delivery in 37.39%, low birth weight babies accounted for 2.6%, macrosomia occurred in 0.7%, preterm PROM (PPROM) in 19.52%, perinatal mortality 1.73%.Conclusions: In pregnancy with PCOS, the percentage of GDM, preterm delivery, meconium-stained liquor, small for gestational age (SGA)/intrauterine growth restriction (IUGR), macrosomia, PPROM, perinatal mortality, neonatal intensive care unit (NICU) admission, and congenital anomalies were either comparable or lower. However, a higher percentage of hypertension in pregnancy, PROM, low birth weight babies, and low APGAR score at five minutes was observed in this population.
RESUMO
@#Introduction: Understand the progression of colorectal cancer from the beginning until the advance stages is difficult and challenging. However, this could be overcome with a good animal model. Methods: In this study, a modified approach had been used to develop colorectal cancer model. The model was developed and monitored from colitis formation until the late stage of colorectal cancer. The changes of neutrophil lymphocyte ratio (NLR), serum microRNAs and infiltrate neutrophil in different stages of colorectal cancer were assessed in this study. Results: Results showed that the progression of the disease is correlated with NLR as early as the formation of colitis (r=0.121, p<0.026). Meanwhile, the size of the tumor at each stage is also associated with the NLR value (r=0.185, p<0.0012). In the serum microRNAs study, it was found microRNAs expression in blood serum change in different stages of colorectal cancer. In the early stage of colitis formation, miR223 (> 3 fold expression, p < 0.0025) were abundantly found in the blood serum. Meanwhile in others stage mild (miRNA345 > 2.5 fold, p<0.0011), moderate (miRNA347 & miR512 > 3 fold, p<0.002) and severe (miR31 & miR145 > 2 fold, p<0.0001) microRNAs were also found expressed differently. The quantities of infiltrate neutrophil were varied in different stages of the disease. Conclusion: This study provides an insight into the immunity and molecular level of colorectal cancer and it allows a progressive monitoring on the changes in the molecular, cellular and histological level.
RESUMO
Background: In march 2020, with the declaration of COVID-19 as a global pandemic, the schools, colleges, and universities of the highly contagious areas of the world were instantaneously closed to mitigate the deleterious effects of COVID-19. Moreover, as a result of social distancing, the most effective preventative strategy since the emergence of COVID-19, medical education has been profoundly disturbed. In light of the prevailing pandemic, an abrupt shifting of the educational system was made from face-to-face learning to online methodologies to provide uninterrupted education to the students of the affected countries. By and large, traditional education was replaced by various forms of e-learning. The aim of this study was to evaluate the perception of e-learning in undergraduate medical students at Medical Colleges during covid pandemic. Material & Methods: This was a cross-sectional questionnaire-based study and was conducted from December, 2020 to February, 2021 in the CARe Medical College, Dhaka, Bangladesh. In the present study we included 270 undergraduate medical students as our participants and students who were not willing to participate were excluded from our study. Results: In our study we found the mean age of the respondents was 23.05 ± 1.28 years and majority of our students were female (68%) compared to male (32%). Most of the students (67%) had moderate grade of IT skills. We found major advantage of e-learning was the ability to record classes 67% and the disadvantage was poor internet speed (68.9%). Among all students, 51.1% & 6.7% students were able to increase knowledge, 62.6% & 3% were able to increase clinical skill and 37.8% & 7.4% were able to increase social skill via conventional & e-learning methods respectively. Majority (88.1%) students preferred face-to face learning method and 11.9% preferred e-learning method. Conclusion: In our study, we evaluated the student’s perception of e-learning and its associated advantages and disadvantages in terms of learning outcomes. While comparing e-learning and face-to-face learning among undergraduate medical students,we found face-to-face learning was considered the most effective way of learning to increase knowledge, practical skills and social skills. Therefore, most of our students preferred the face-to-face learning method compared to e-learning.
RESUMO
Background: Pregnancy with jaundice is considered a high-risk pregnancy. It is the most usual health complaint in pregnant women found more often in developing countries than in developed ones. Jaundice can be concurrent with 1st trimester due to pathological infection for instance viral hepatitis or gall stones or due to the drug administered during pregnancy. These patients may feel better if initial diagnosis and suitable management are provided. This present study intended to evaluate the clinical profile & complications of jaundice during pregnancy. Material & Methods: This descriptive cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2012 to June 2012. A total (N=50) of pregnant women with symptoms of jaundice were enrolled in the study. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 16.0. Descriptive inferential statistics were performed to determine the results of this study. Results: Among the study population (N=50), the majority of patients (34, 68.0%) age were between 20 to 24 years. The mean gestational age of patients was 35.3±3.2 weeks and twelve patients (12, 24.0%) underwent caesarean delivery. Based on clinical features, twenty-seven respondents (27, 54.0%) had mild jaundice, fourteen respondents (14, 28.0%) had moderate jaundice & about one-fifth of the patients (9, 18.0%) had severe jaundice. Fifteen pregnant (15, 30.0%) women had a fever, around two-fifth of the patients (19, 38.0%) had vomiting, pruritus in one patient (1, 2.0%), vaginal bleeding in twelve patients (12, 24.05), & more than half of the patients (27, 54.0%) had ruptured membrane. The causes of jaundice during pregnancy were viral hepatitis in forty-three patients (43, 86.0%). The majority of the patients (27,54.0%) had serum bilirubin less than 10mg, fourteen patients (14,28.0%) had 10 to 15mg of serum bilirubin & only one patient (1,2.0%) had serum bilirubin more than 20mg. SGOT & SGPT was found 100-500 IU/ml in twenty-three patients (23,46.0%) & 500-1000 IU/ml in ten patients (10,20.0%). Alkaline was raised in eighteen cases (18, 36.0%) Based on maternal complications, the majority of patients (31, 62.0%) had a postpartum haemorrhage, and ten patients (10, 20.0%) experienced encephalopathy. Thirty-eight babies (38, 76.0%) were born alive, intrauterine death was in seven cases (7, 14.0%), and stillborn in five cases (5, 10.0%). Conclusion: Hepatitis E was the most common cause of viral hepatitis in our study. Major complications were postpartum haemorrhage and encephalopathy. This study also prevailed, jaundice in pregnancy is related to an increase in maternal mortality and morbidity, obstetric complications, and perinatal complications.
RESUMO
Background: Injuries are a significant public health issue and a leading cause of morbidity and mortality among adolescents. This study aimed to observe the incidence and risk factors of injury among urban adolescent students. Methods: The study was conducted at Dhanmondi high school in Dhaka, Bangladesh, from January to June 2018. A total of 325 students were purposefully selected for the study. The prevalence of injury, the pattern of injury, the socioeconomic and demographic characteristics, and the proportion of social determinants of injury were estimated. Results: 60% of the participants reported an injury in the last 6 months, with moderate injuries being the most common (63.59%). Seeking care was through visiting a doctor (28.72%) or hospital (33.33%). Most injuries occurred at home (33.33%) or in an institution of education (31.28%). The most common site of injury was the hand (39.49%) and the most common mode was sudden attack or fighting (28.21%). A significant association was found between injury occurrence and sex, grade of students, and age of students, but not with monthly income, education level of the father, occupation of the mother, or number of family members. Conclusions: The most prevalent risk factors for injury were fighting, violating traffic laws, and taking risks while getting into a vehicle. These factors were also statistically significant predictors of injury occurrence. The findings suggest a need for targeted injury prevention programs to address these risk factors among urban adolescent students in Bangladesh.
RESUMO
Background: Neonatal candidemia is among the leading causes of mortality in neonatal intensive care units of the developing countries like India. This work aimed at determining the prevalence of candidemia, spectrum of disease, risk factors and the antifungal susceptibility in low birth weight neonates in neonatal intensive care unit (NICU)’s at a tertiary care level. Methods: This was a prospective cross-sectional study of blood culture positive candidemia cases in neonates admitted to the neonatal intensive care unit of tertiary care hospital, SMHS, Jammu and Kashmir, India, between July 2021 to December 2022. All neonates with a clinical suspicion of candidemia with a positive blood culture (BacT alert) were identified. Patient demographics, clinical details, neonatal risk factors, and laboratory data and antifungal susceptibilities (using VITEK 2 compact system) were recorded and analyzed. Results: A total of 680 neonatal blood culture samples were collected from NICU’s, out of which 88 (12.94%) developed candidemia. Low birth weight (33.33%), indwelling catheters (31.52%), prematurity (31.31%) and prolonged use of antibiotics were important risk factors. The commonest clinical manifestation was feed intolerance 66.1% and respiratory distress 62.2%. Non-albicans candida was seen in majority cases 86.36% with Candida krusei 77.27%. All the Candida spp. showed 100% sensitivity to voriconazole and caspofugin followed by amphotericin B, fluconazole and micafugin. Conclusions: In this study, we focussed on determining the prevalence of candidemia in low birth weight neonates. The persistently emerging non-albicans Candida particularly Candida krusei has emerged as a big concern and needs attention for its prevention and treatment to minimize the morbidity and mortality rate.
RESUMO
Background: Neonatal candidemia is among the leading causes of mortality in neonatal intensive care units of the developing countries like India. This work aimed at determining the prevalence of candidemia, spectrum of disease, risk factors and the antifungal susceptibility in low birth weight neonates in neonatal intensive care unit (NICU)’s at a tertiary care level. Methods: This was a prospective cross-sectional study of blood culture positive candidemia cases in neonates admitted to the neonatal intensive care unit of tertiary care hospital, SMHS, Jammu and Kashmir, India, between July 2021 to December 2022. All neonates with a clinical suspicion of candidemia with a positive blood culture (BacT alert) were identified. Patient demographics, clinical details, neonatal risk factors, and laboratory data and antifungal susceptibilities (using VITEK 2 compact system) were recorded and analyzed. Results: A total of 680 neonatal blood culture samples were collected from NICU’s, out of which 88 (12.94%) developed candidemia. Low birth weight (33.33%), indwelling catheters (31.52%), prematurity (31.31%) and prolonged use of antibiotics were important risk factors. The commonest clinical manifestation was feed intolerance 66.1% and respiratory distress 62.2%. Non-albicans candida was seen in majority cases 86.36% with Candida krusei 77.27%. All the Candida spp. showed 100% sensitivity to voriconazole and caspofugin followed by amphotericin B, fluconazole and micafugin. Conclusions: In this study, we focussed on determining the prevalence of candidemia in low birth weight neonates. The persistently emerging non-albicans Candida particularly Candida krusei has emerged as a big concern and needs attention for its prevention and treatment to minimize the morbidity and mortality rate.
RESUMO
Background: Introduction: Intrahepatic cholestasis of pregnancy (ICP), is the most common liver disease specific to pregnancy. Previous studies of fetal effects have suggested that ICP is associated with a higher rate of adverse neonatal outcomes including preterm birth, neonatal respiratory distress syndrome (RDS), meconium-stained amniotic fluid, neonatal intensive care unit admission, and stillbirth. Material & Methods: This was a 4 year retrospective observational study including 43,344 female who delivered in our hospital out of which 1126 cases of ICP were identified, who were compared with 1136 age and parity matched controls. Results: : Previous history and family history of ICP was significant in the ICP group. Gestational diabetes and preterm labour were more frequent in the ICP group. Mean birth weight was lower in the ICP group, rate of small for gestational age foetuses was not significantly different. Cesearean section and post-partum haemorrhage was more frequent in the ICP group. Adverse neonatal outcomes i.e. respiratory distress syndrome (RDS) and need for NICU admission were more in the ICP group. Conclusion: ICP is associated with increased rate of preterm delivery, post-partum hemorrhage and increased neonatal morbidity. Management of patients with ICP should be individualized based on the severity of symptoms and associated medical complications.
RESUMO
Background: To study the menstrual abnormalities among adolescent females attending a gynaecolocial outpatient department (OPD) in a tertiary care hospital. Material & Methods: It was a cross sectional study which was carried at outpatient department (OPD) of obstetrics and gynaecology, Government medical college Srinagar over a period of 6 months. A total of 90 adolescent females in the age group 10-19 years were included in the study. Along with the demographic profile, menstrual abnormalities were evaluated with the help of self-structured questionnaire. Results: The mean age of the study population was 15.6 ± 2.8 years. Majority of the adolescent females were in the age group of 16-19 years (44.4%), literate with formal education above 10th class (37.8%) and from rural background (56.7%).Dysmenorrhea was the most common menstrual morbidity in 64.4% of adolescent females followed by menorrhagia (26.7%). Pain abdomen was the most common premenstrual symptom encountered by 62.2% of females. Conclusion: Menstrual abnormalities are common in the adolescent females with dysmenorrhea being the commonest.
RESUMO
Background: Neurological disorders are a common and significant public health problem globally, and innovative strategies are needed to address the epidemic in resource-poor settings in Bangladesh. The aim of this study was to evaluate the burden and features of neurological diseases requiring hospitalization in a tertiary care hospital in Chittagong, Bangladesh. Methods: This study was a prospective observational study conducted from January to June 2021 on patients admitted to the adult neurology unit of a hospital in Chittagong, Bangladesh. Data was collected through face-to-face interviews, laboratory data, and previous medical records, and in-hospital complications and outcomes were recorded. The data was cleaned and analysed using SPSS and presented in tables. Results: In this study, stroke was the most common neurological condition requiring hospitalization, accounting for 74% of cases and leading to death in 73% of cases. The most frequent in-hospital complication was urinary tract infection (26%), mostly in stroke patients. Of stroke patients, 88% had incomplete recoveries at discharge, while 7% died. Hypertension was the most common risk factor present in both acute confusional state and stroke cases. The median duration of hospital stay was longest among patients with central nervous system infections. Conclusions: Stroke dominates the burden of neurological diseases requiring hospitalization in tertiary care hospitals in Bangladesh. The most frequent in-hospital complication was urinary tract infections, mostly in stroke cases. The overall in-hospital mortality was 7%, most patients recovered incompletely at discharge (82%).
RESUMO
Type 2 diabetes mellitus (T2DM) is a multifactorial, polygenic, and metabolically complicated disease. A large number of genes are responsible for the biogenesis of T2DM and calpain10 (CAPN10) is one of them. The association of numerous CAPN10 genetic polymorphisms in the development of T2DM has been widely studied in different populations and noticed inconclusive results. The present study is an attempt to evaluate the plausible association of CAPN10 polymorphism SNP-19 (rs3842570) with T2DM and T2DM-related anthropometric and metabolic traits in the Noakhali region of Bangladesh. This case-control study included 202 T2DM patients and 75 healthy individuals from different places in Noakhali. A significant association (p 0.05). Additionally, SNP-19 genetic variants showed potential associations with the anthropometric and metabolic traits of T2DM patients in terms of body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol, and triglycerides. Our approach identifies the 2R/3R genotype of SNP-19 as a significant risk factor for biogenesis of T2DM in the Noakhali population. Furthermore, a large-scale study could be instrumental to correlate this finding in overall Bangladeshi population.
RESUMO
Introduction: @#Influenza is an upper respiratory infection is caused by the influenza virus. It occurs throughout the whole year in Malaysia with occasional outbreaks. Influenza-like illnesses (ILI) are generally treated as outpatient care while the more severe (SARI) is managed in patient care. The Casemix system, used in healthcare professionals' practices, may help in estimating the cost of influenza management. @*Methods: @#This cross-sectional study extracts the cost of influenza management from different public hospitals in years 2016, 2017 and 2018. Data used selected ICD-10 codes, and the cost was abstracted from Malaysian Diagnostic Related Groups (MyDRG) software. The secondary data are from 2 sources, an urban teaching hospital Hospital Cancellor Tuanku Muhriz (HCTM) and Ministry of Health (MoH) inpatient hospitals database. The sample size of the study was 586, while a structured datasheet collating patients' sociodemographic data and cost of admission, per case, was obtained from the MyDRG software. Microsoft Excel and SPSS software were used in the analysis. @*Results: @#Most influenza cases (61.8%) are between the ages of 0 and 10, Malays, and have similar gender proportions. Overall, the influenza treatment cost for inpatient care, totalled to RM 294,017,112. In 2018, the GDP for health consumed 3.76% of Malaysia's GDP income of RM 1.4 trillion, with an estimated RM 60,339 million used for health. Thus, the three-year public cost consumed 0.5% of 2018 GDP.@*Conclusion: @#Influenza screening at the primary healthcare setting, health education and treatment compliance should be scale-up to minimize the cost of influenza management of the public providers.
RESUMO
Introduction@#Milk and dairy products are good sources of high-quality protein. Protein is important during weight loss and subsequent weight maintenance due to the high satiating effect which helps to prevent over-consumption of energy and thereby reduces body fat stores. Furthermore, dairy protein is a good source of essential amino acids for muscle protein synthesis and thus helps to maintain metabolically active muscle mass during weight loss. Regarding milk consumption, it is important to find the association between personal, environmental, and behaviour factors with consuming milk. @*Objective@#The aim of the study is to identify factors influencing milk consumption behaviour among adults. @*Methods @#This study is based on the literature review and on different case studies from different parts of the world to try to fulfill the main scope of factors influencing milk consumption. @*Results@#Based on this review, environmental factors were found to be the main influences on milk consumption behaviour, followed by personal factors and behaviour factors.@*Conclusion@#This review is also expected to enrich the documentation on the influencing of milk consumption behaviour among adults
RESUMO
@#This study aimed to investigate the irrigation dynamics of the positive pressure side-vented (SV) needle, EndoVac (micropores) needle and modified apical negative pressure (mANP) open-ended needle using computational fluid dynamics (CFD). A simulation of a prepared root canal (conical frustum) of 15 mm length with an apical diameter of 0.40 mm following Protaper F4 apical preparation was created using three-dimensional (3D) CAD software. The 3D simulated needle of SV 30G needle, EndoVac with micropores needle and mANP, 30G flat open-ended needle were also created. The irrigation dynamics were evaluated through transient CFD simulations. In addition, the irrigation dynamics of mANP at 0.2 mm, 0.5 mm, and 1.0 mm short from the working length were also assessed. The EndoVac and mANP showed negative apical static pressure and streamline patterns able to reach the apical region, thus indicating negligible extrusion. Meanwhile, SV showed positive apical static pressure and almost nonexistent streamlines beyond the needle tip. The SV showed the highest wall shear stress (WSS) magnitude of 1030Pa whereas Endovac (161 Pa) and mANP1 (258 Pa). However, SV revealed lower average WSS (10 Pa) compared to mANP1 (13 Pa) and mANP2 (11 Pa). This is due to SV developed a localised maximum WSS opposite the open vent area only therefore, uneven distribution of WSS. The EndoVac system developed a localised maximum WSS in the pair of micropores furthest away from the apical. CFD analysis of the EndoVac, mANP and SV showed different technique approach, needle design and needle depths insertion affect the irrigation dynamics pattern and magnitude.