Kirschner Wire as a Reference Marker for the Positioning of a Syndesmotic Screw: A Radiological Study

2020 ◽  
Author(s):  
congming zhang ◽  
Qian Wang ◽  
Ning Duan ◽  
Teng Ma ◽  
Hangzhong Xuan ◽  
...  
Keyword(s):  
Kirschner Wire ◽  
Ideal Space ◽  
Cross Sectional ◽  
Medial Border ◽  
Syndesmotic Screw ◽  
Tibial Plafond ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
Poor Outcomes ◽  
Foot Fractures

Abstract Background: Without a reliable and static reference, the rate of eccentrically positioned distal syndesmotic screw trajectories is very high. Meanwhile, a malpositioned screw may result in poor outcomes and early osteoarthritis. As such, this article describes an additional method to improve surgeons’ ability to ideally place a screw trajectory. The purposes of our study were (1) to determine if an ideal space at 2.5 cm proximal to the plafond existed between the tibia and fibula for the placement of a Kirschner (K) wire and (2) to detect if it could act as a reliable and static fibular incisura plane reference.Methods: Computed tomography scans of 42 uninjured adult ankles with foot fractures were analysed to measure the tibiofibular vertical distance (TFVD) at 2.5 cm proximal to the tibial plafond on cross-sectional images. The TFVD was defined as the distance between two lines: Line 1 was tangent to the fibular incisura, and Line 2 was parallel to Line 1 along the medial border of the fibula. Patients were divided into 4 groups according to our TFVD data: 0–1, 1–2, 2–3, and 3–4 mm, and the number of patients in each group was counted.Results: The TFVD measured 2.23±1.01 mm (mean ± standard deviation) at 2.5 cm proximal to the plafond. According to our grouping, TFVD occurred at 25% of the distance from 2 to 3 mm in 47.6% of patients. Conclusions: Placing a 1.6-mm K-wire in the syndesmosis at 2.5 cm proximal to the tibial plafond is easy because of emerging TFVDs. The K-wire’s path is restricted to the anterior and posterior borders of the fibular incisura pass because of the limitation of the medial border of the fibula and syndesmosis tendon. Therefore, K-wire could be used as a reliable and static intraoperative reference of the fibular incisura plane through which surgeons can accurately place a screw trajectory.

scholarly journals Kirschner Wire as a Reference Marker for the Positioning of a Syndesmotic Screw: a Radiological Study and Clinical Application

2021 ◽  
Author(s):  
Congming Zhang ◽  
Qian Wang ◽  
Ning Duan ◽  
Teng Ma ◽  
Kun Zhang ◽  
...  
Keyword(s):  
Conventional Method ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
New Technique ◽  
Ideal Space ◽  
Syndesmotic Screw ◽  
Number Of Patients ◽  
Anatomic Axis ◽  
Foot Fractures ◽  
Very High

Abstract Background: Without a reliable and static reference, the rate of eccentrically positioned distal syndesmotic screw is very high. This article describes an additional method to improve surgeons’ ability to ideally place this screw. The purposes of our study were (1) to determine if an ideal space at 2.5 cm proximal to the plafond existed between the tibia and fibula for the placement of a Kirschner (K) wire and (2) to detect if it could act as a reliable and static fibular incisura plane reference. Methods: Computed tomography (CT) scans of 42 uninjured adult ankles with foot fractures were analysed to measure the tibiofibular vertical distance (TFVD) at 2.5 cm proximal to the plafond on transverse images. TFVD was defined as the distance between two lines: Line 1 was tangent to the fibular incisura, and Line 2 was parallel to Line 1 along the medial fibula. Patients were divided into four groups according to our TFVD data: 0–1, 1–2, 2–3, and 3–4 mm, and the number of patients in each group was counted. We assessed 23 patients who underwent syndesmotic screw fixation for ankle fractures. Comparison of the angle between the anatomic axis of the syndesmosis and screw axis (AAS) was performed between patients using conventional method (11 patients) and with K-wire marker (12 patients). Results: TFVD measured 2.23 ± 1.01 mm at 2.5 cm proximal to the plafond. TFVD occurred at 25% of the distance from 2 to 3 mm in 47.6% of patients. This new technique decreased the deformation of AAS by 75%, from 13.06 ± 2.55° to 4.28 ± 1.72°, in the conventional group.Conclusions: Placing a 1.6-mm K-wire in the syndesmosis at 2.5 cm proximal to the tibial plafond is easy because of emerging TFVDs. Compared to the conventional method, this new technique increased the accuracy of syndesmotic screw placement by up to 75 percent. Therefore, K-wire could be used as a reliable and static intraoperative reference of the fibular incisura plane through which surgeons can accurately place a screw trajectory.

scholarly journals DECOMPENSATED CIRRHOSIS

2015 ◽  
Vol 22 (11) ◽  
pp. 1397-1402
Author(s):  
Sarwat Iqbal ◽  
Muhammad Haroon Yousaf ◽  
Muhammad Ifitikhar Yousuf ◽  
Wasim Uddin
Keyword(s):  
Portal Hypertension ◽  
Gastric Varices ◽  
Cross Sectional Study ◽  
Decompensated Cirrhosis ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Upper Gi Endoscopy ◽  
Diagnostic Modalities ◽  
Poor Outcomes

Cirrhosis with subsequent portal hypertension is a major health problemworldwide. Among various etiologies, HCV is the leading cause of chronic hepatocellularinjury. Cirrhosis being the commonest cause of portal hypertension results in a spectrum ofcomplications. Approximately 5-15% of cirrhotic develop varices. Gastric varices althoughpresent less frequently as compared to esophageal varices but are associated with greatermortality and morbidity. Objectives: To determine prevalence of Gastric varices in patients withdecompensated cirrhosis. Study Design: Cross sectional study. Place & Duration: Carriedout at two centers, Pakistan Ordinance Factories Hospital Wah Cantt and Shalimar HospitalLahore from Jan 2014 to Jan 2015. Subjects: A total of 421subjects of decompensate cirrhosiswere included in the study. Methods: Patients with decompensate cirrhosis of any etiology whowere visiting the two hospitals as inpatient or outpatient were included in the study. Upper GIendoscopy was done in all these subjects for determination of gastric varices. Results: Among421 patients of decompensate cirrhosis, frequency of gastric varices was 10.9%, GOV1 as themost common variant. Gastric varices contributed to 5.4% of all variceal bleeds. Conclusion:Gastric varices are found in significant number of patients of decompensate cirrhosis. Sincegastric varices are associated with increased mortality and poor outcomes, these shouldbe carefully looked during upper GI endoscopy. Successful management of gastric varicealhemorrhage necessitates availability of expertise and newer diagnostic modalities.

What are Hidden Facts behind Intestinal Parasitic Infections in Ilam City?

2019 ◽  
Vol 19 (3) ◽  
pp. 284-287
Author(s):  
S. Viesy ◽  
J. Abdi ◽  
Z. Rezaei
Keyword(s):  
Public Health ◽  
Intestinal Parasites ◽  
Parasitic Infection ◽  
Public Health Education ◽  
Health Problems ◽  
Parasitic Infections ◽  
Blastocystis Hominis ◽  
Cross Sectional ◽  
Intestinal Parasitic Infections ◽  
Number Of Patients

Background: Intestinal parasitic infections are the one of the most common health problems in developing countries. Objective: A number of patients die annually due to complications caused by these parasites.Therefore, the aim of this study was to investigate the rate and type of parasitic infections, determine the factors affecting them in Ilam city and also provide strategies to prevent them.In this descriptive cross-sectional study conducted in one of the Ilam labs in 2016, 417 stool specimens were randomly collected. All specimens were examined using direct and ethanol formaldehyde.Suspect specimens were examined using Trichrom staining. Demographic information was also recorded in a questionnaire, and finally the results were analyzed using statistical software SPSS 20.The data were then compared with Chi-square test. Results: Out of the 417 patients examined, 59 (14.1%) were infected with intestinal parasites. The type of parasitic infection in 9.4% was Blastocystis hominis, 3.6% Entamoeba coli, 0.5% Entamoeba histolytica, 0.5% Giardia and 0.2% Trichomonas hominis. Conclusion: Despite the improvement of public health, parasitic infections are still considered as one of the health problems in the city of Ilam. Therefore, proper planning, public health education, raising the level of health in the area and the provision of safe drinking water are some of the ways to reduce parasitic infections in the region.

Development and Performance Assessment of a Digital Serious Game to Assess Multi-Patient Care Skills in a Simulated Pediatric Emergency Department

2020 ◽  
Vol 51 (4) ◽  
pp. 550-570
Author(s):  
Cindy Luu ◽  
Thomas B. Talbot ◽  
Cha Chi Fung ◽  
Eyal Ben-Isaac ◽  
Juan Espinoza ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Patient Care ◽  
Skill Acquisition ◽  
Video Game ◽  
Rank Correlation ◽  
Fixed Time ◽  
Serious Game ◽  
Cross Sectional ◽  
Number Of Patients

Objective. Multi-patient care is important among medical trainees in an emergency department (ED). While resident efficiency is a typically measured metric, multi-patient care involves both efficiency and diagnostic / treatment accuracy. Multi-patient care ability is difficult to assess, though simulation is a potential alternative. Our objective was to generate validity evidence for a serious game in assessing multi-patient care skills among a variety of learners. Methods. This was a cross-sectional validation study using a digital serious game VitalSignsTM simulating multi-patient care within a pediatric ED. Subjects completed 5 virtual “shifts,” triaging, stabilizing, and discharging or admitting patients within a fixed time period; patients arrived at cascading intervals with pre-programmed deterioration if neglected. Predictor variables included generic multi-tasking ability, video game experience, medical knowledge, and clinical efficiency with real patients. Outcome metrics in 3 domains measured diagnostic accuracy (i.e. critical orders, diagnoses), efficiency (i.e. number of patients, time-to-order) and critical thinking (number of differential diagnoses); MANOVA determined differences between novice learners and expected expert physicians. Spearman Rank correlation determined associations between levels of expertise. Results. Ninety-five subjects’ gameplays were analyzed. Diagnostic accuracy and efficiency distinguished skill level between residency trained (residents, fellows and attendings) and pre-residency trained (medical students and undergraduate) subjects, particularly for critical orders, patients seen, and correct diagnoses (p < 0.003). There were moderate to strong correlations between the game’s diagnostic accuracy and efficiency metrics compared to level of training, including patients seen (rho = 0.47, p < 0.001); critical orders (rho = 0.80, p < 0.001); time-to-order (rho = −0.24, p = 0.025); and correct diagnoses (rho = 0.69, p < 0.001). Video game experience also correlated with patients seen (rho = 0.24, p = 0.003). Conclusion. A digital serious game depicting a busy virtual ED can distinguish between expected experts in multi-patient care at the pre- vs. post-residency level. Further study can focus on whether the game appropriately assesses skill acquisition during residency.

scholarly journals Adverse Events in Home-Care Nursing Agencies and Related Factors: A Nationwide Survey in Japan

2021 ◽  
Vol 18 (5) ◽  
pp. 2546
Author(s):  
Noriko Morioka ◽  
Masayo Kashiwagi
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
Adverse Events ◽  
Home Care ◽  
Process Of Care ◽  
Related Factors ◽  
Cross Sectional ◽  
Home Care Nursing ◽  
Number Of Patients ◽  
Care Nursing

Despite the importance of patient safety in home-care nursing provided by licensed nurses in patients’ homes, little is known about the nationwide incidence of adverse events in Japan. This article describes the incidence of adverse events among home-care nursing agencies in Japan and investigates the characteristics of agencies that were associated with adverse events. A cross-sectional nationwide self-administrative questionnaire survey was conducted in March 2020. The questionnaire included the number of adverse event occurrences in three months, the process of care for patient safety, and other agency characteristics. Of 9979 agencies, 580 questionnaires were returned and 400 were included in the analysis. The number of adverse events in each agency ranged from 0 to 47, and 26.5% of the agencies did not report any adverse event cases. The median occurrence of adverse events was three. In total, 1937 adverse events occurred over three months, of which pressure ulcers were the most frequent (80.5%). Adjusting for the number of patients in a month, the percentage of patients with care-need level 3 or higher was statistically significant. Adverse events occurring in home-care nursing agencies were rare and varied widely across agencies. The patients’ higher care-need levels affected the higher number of adverse events in home-care nursing agencies.

PP159 Telemedicine In Paraguay: Contributions Of The Institute Of Health Sciences Research, National University Of Asunción

2020 ◽  
Vol 36 (S1) ◽  
pp. 18-18
Author(s):  
Ronald Rivas ◽  
Pedro Galván
Keyword(s):  
Public Health ◽  
Biomedical Engineering ◽  
List Type ◽  
Telemedicine System ◽  
Cellular Telephony ◽  
Imaging Department ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
National University ◽  
Development And Validation

IntroductionThe modalities of telemedicine that have been developed and applied so far by the Department of Biomedical Engineering and Imaging at the National University of Asunción (IICS-UNA) are as follows: (i) telediagnosis: the remote sending of data, signals, and images for diagnostic purposes; (ii) general telediagnostic imaging; (iii) telemonitoring (including telemetry): remote monitoring of vital parameters to provide automatic or semi-automatic surveillance or alarm services in emergencies, epidemiology, or tele-public health; and (iv) tele-education: the use of telematic networks to provide virtual platforms for educating and training health professionals.MethodsWe conducted a comprehensive review of the scientific works developed by the IICS-UNA in order to evaluate the systematic implementation of Telemedicine in Paraguay. Documents, pilot projects (satellite telegraphy), telediagnostic research, telematics, tele-education, published articles, and statistical data (number of patients attending or studies performed, etcetera) relating to the implementation of the National Telemedicine System by the Ministry of Public Health and Social Welfare since 1999 were reviewed.ResultsImplementation of the telemedicine system has meant that 472,038 patients have attended referral centers nationwide, with 297,999 electrocardiographs, 165,323 computed tomography scans, and 8,697 electroencephalograms being conducted. Projects developed within the framework of the Telemedicine Research Line have included the following: (i)Development and validation of a clinical telemicroscopy system based on cellular telephony;(ii)Implementation of a telemetry system for temperature monitoring of the collection of biological samples from a biomedical research center; and(iii)Production and development of a virtual campus at the National University of Asunción.ConclusionsGiven the current healthcare environment, developing a line of research based on telemedicine is a proactive step, since telemedicine provides an alternative solution to the problem of access to the health system. That is why the IICS-UNA Biomedical Engineering and Imaging Department has developed telemedicine as one of its main lines of research.

scholarly journals POS1274 THERAPEUTIC MANAGEMENT OF RHEUMATOLOGISTS VERSUS OTORHINOLARYNGOLOGISTS OF CERVICOGENIC DIZZINESS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 921.2-922
Author(s):  
M. Yasmine ◽  
K. Maatallah ◽  
H. Ferjani ◽  
W. Triki ◽  
D. Ben Nsib ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Treatment Approach ◽  
Cross Sectional Study ◽  
Treatment Modalities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Standard Assessment ◽  
Number Of Patients ◽  
Cervicogenic Dizziness ◽  
No Gold Standard

Background:The treatment of patients presenting with cervicogenic dizziness (CGD) may be challenging. Indeed, there is no consensual treatment approach for CGD, nor is there no gold-standard assessment for diagnosis.Objectives:Our study aimed to assess the management of CGD by rheumatologists versus otorhinolaryngologists.Methods:We conducted a cross-sectional study including Tunisian doctors dealing with CGD. Rheumatologists (RTO) and otorhinolaryngologists (ORL) were invited to answer a questionnaire via google form about CGD daily management. Outcomes of interest were treatment modalities.Results:The study included 30 RTO and 32 ORL. Most of the doctors (RTO, vs ORL) were females (88.3%, vs 56.3%), aged between 35 and 45 (43.3%, vs 62.5%), and worked at a private practice (33.3%, vs 59.4%). The number of patients diagnosed with CGD by RTO was as follows: 1-2 per year (33.3%), 1-2 per month (18.8%), 1-2 per week (20%), less than one patient a year (10%) and none in 3.3% of cases. The number of patients diagnosed with CGD by ORL was as follows: 1-2 per year (50%), 1-2 per month (33.3%), 1-2 per week (6.2%), less than one patient a year (15.7%) and none (9.4%). Most patients presenting with CGD were females in both groups (93.1%, vs 82.8% respectively) with a mean age between 36 and 65 (79.3%, vs 82.1%). Most of the respondents declared treating patients with CGD (93.1%, vs 79.1%). Regarding treatment modalities, physical therapy was the most prescribed in both specialties (81.5% and 48.3%, respectively). Only RTO (18.5%) prescribed manual therapy. Concerning medical treatment, anti-inflammatory were the most prescribed drugs in both groups (92.6, and 34.5%, respectively). Sixty-seven percent of RTO prescribed anti-vertigo medication. Interestingly, it was the least prescribed drug by ORL (6.9%). Only RTO (59.3%) prescribed Muscle relaxants.Conclusion:Despite the disparities in the management of CGD, physical therapy remains the first prescribed treatment by Tunisian doctors. Further studies are needed to establish a consensus to treat CGD.Disclosure of Interests:None declared

scholarly journals A Comparison of Orally Administered Misoprostol With Vaginally Administered Misoprostol For Cervical Ripening And Labour Induction

KYAMC Journal ◽  
2017 ◽  
Vol 7 (1) ◽  
pp. 668-672 ◽  
Author(s):  
Sohana Siddique ◽  
Muhammad Jahangir Howlader ◽  
Joysree Saha ◽  
Kazi Shahnaz Begum
Keyword(s):  
Mode Of Delivery ◽  
Cervical Ripening ◽  
Labour Induction ◽  
Efficacy And Safety ◽  
Cross Sectional ◽  
Oral Misoprostol ◽  
Number Of Patients ◽  
Oral Group ◽  
Vaginal Misoprostol ◽  
Duration Of Pregnancy

Objective: To compare efficacy and safety of oral misoprostol over vaginal misoprostol for labour induction.Materials and Methods: This is a cross sectional interventional hospital based comparative study which was carried in the department of Obstetrics and Gynecology in DMCH from 01.07.2008 to 31.12.2008.Results: Almost equal number of patients delivered vaginally spontaneously in both group, there is no association between route of administration and mode of delivery. Nausea,vomiting occurred more in oral group and uterine hypertonicity more in vaginal group.Conclusion: In this study, 50 patients were randomly selected for oral group and 50 patients for vaginal group. There were no significant differences regarding age, duration of pregnancy, Bishop's score and indication of induction of labour.KYAMC Journal Vol. 7, No.-1, Jul 2016, Page 668-672

scholarly journals SAT0476 COMPLIANCE AND PERSISTENCE OF ANTI-OSTEOPOROTIC TREATMENTS IN PATIENTS WITH HIP FRACTURE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1194.2-1195
Author(s):  
S. Paredes ◽  
M. Guinovart ◽  
A. Basco ◽  
C. Llop
Keyword(s):  
Hip Fracture ◽  
Health Service ◽  
Hospital Discharge ◽  
Treatment Time ◽  
Osteoporotic Fractures ◽  
Main Diagnosis ◽  
Pharmacological Treatments ◽  
Cross Sectional ◽  
Good Compliance ◽  
Number Of Patients

Background:Osteoporotic fractures have a high health and economic impact. The best strategy to minimize the incidence of fractures is, certainly, the prevention of these that includes pharmacological treatments. However, long-term discontinuation treatment and sub-optimal compliance of the treatment are common.Objectives:The aim of the study is to quantify the therapeutic compliance and permanence of the osteoporosis pharmacological treatments for patients who were discharged from hospitals in Catalonia with hip fracture during 2017.Methods:From the Hospital Discharge Database of the Catalan Health Service, all patients who had been discharged during 2017 were selected with the main diagnosis of femur fracture, according to the coding CIM-9. The consumption of drugs to assess compliance and permanence was obtained from the Catalan Health Service pharmacy Database. The study period was 18 months from the date of hospital discharge. Patients who died, moved to other areas or switched their treatment were excluded from the study. Good compliance was considered when sufficient drug was obtained to cover 80% of the time since treatment was prescribed until the end of the study period. In the case of denosumab, good post-fracture compliance was considered when the treatment time was remained at least 12 months. Permanence was considered positive if a drug had been obtained during the last three months of the study period. To compare the differences in compliance and permanence between the patients treated with different drugs, the chi-square statistic was used, considering statistically significant differences if p<0.05.Results:8,354 patients were discharged with the main diagnosis of hip fracture. Of these, 1,712 patients (20.49%) were treated after been discharged. After applying the exclusion criteria, the final sample was made up of 1,327 patients. 81,54% were women, and the median age was 84,79 years.The most commonly used treatments were bisphosphonates (69%), denosumab (23%) and teriparatide (7%)The results of good compliance and permanence of treatment were those described in the table.nCompliancePermanenceAlendronate86363,27%64,77%Alendronate+colecalciferol2774,07%81,48%Ibandronate366,67%100%Risedronate2339,13%60,87%Raloxifene1100%100%Bazedoxifene10%0%Teriparatide9976,77% (*)73,74%Denosumab31076,77% (*)74,52% (*)(*) p<0.05 for total bisphosphonates and for alendronateConclusion:The results obtained suggest that a small number of patients were treated after a hip fracture (20.49%) in addition the instituted treatments are followed in a suboptimal way. It is necessary to investigate which factors may lead to the detection of potential non-compliant patients. It seems appropriate to consider drugs that facilitate compliance and permanence of treatment.Our results suggest that denosumab and teriparatide improve compliance compared with oral bisphosphonates.The introduction of specific plans and cross-sectional health structures between levels of care should lead to improve detection, treatment and compliance in patients with osteoporosis.Disclosure of Interests:SILVIA PAREDES Consultant of: Amgen, Lilly, Ferrer, Roche, Novartis; BMS, Maria Guinovart: None declared, Aida Basco: None declared, Carles Llop: None declared

scholarly journals The status of integrated care on the chronic abuse of alcohol response - A cross-sectional study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Moreira de Sousa ◽  
L Lopes ◽  
P Costa ◽  
G Martins-Coelho ◽  
R Capucho
Keyword(s):  
Alcohol Consumption ◽  
Alcohol Abuse ◽  
Negative Impact ◽  
Cross Sectional Study ◽  
Treatment Team ◽  
Health Administration ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Index Value

Abstract Background In 2017, the risk-weighted prevalence of alcohol consumption was the health indicator with a more negative impact on the Institute for Health Metrics and Evaluation Sustainable Development Goals Health Index Value in Portugal. According to data from 2012-14, the Alto Tâmega and Barroso (ATB) had the highest value of Years of potential life lost (YPLL) in North Portugal - 4570,1/10.000 people. Liver chronic disease was the specific cause of death that contributed to the value of YPLL - 465,4/10.000 people. Methods A cross-sectional study was conducted with data from the Northern Health Administration and the General Directorate for Intervention on Addictive Behaviours and Dependencies. We compared the number of patients with chronic alcohol consumption (CAC) in 2018, the leading causes of death between 2012-14, the main morbidity causes according to data from primary healthcare (PHC) physicians in 2018 and the number of patients in specialized treatment team (STT) for alcohol abuse treatment in 2018 in ATB. Results In 2018, 2643 patients of ATB had a diagnosis of CAC; only 178 were followed by an STT. Although CAC had a massive influence on YPLL, this was only the 11º cause of morbidity in ATB according to the data from PHC. The number of women with CAC was stable between 2012 (n = 284) and 2018 (n = 291). In the same period, there was an increase of 52,86% of CAC on men (n = 1523 to n = 2348). Even though 18,4% of YPLL due to chronic liver disease happen in women, only 11,2%of the patients with CAC in the PHC are women. Conclusions There is a need for the improvement of CAC diagnosis in PHC, and the improvement of referral of patients to STT and hospital care. Besides, to reach the SDG3, there is the need to work intensely on SDG 17 (partnership for the goals). The Public Health Unit of ATB is organizing Operation PROMETEU to improve communication, institutional collaboration, and monitoring of the existing health activities that are tackling CAC. Key messages The need to integrate data from different healthcare sources for a better analysis on health problems. The urgent need to tackle the alcohol abuse problem in ATB.

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