A TRADITIONAL MEDICINE PRACTICE IN SNAKEBITE

2021 ◽  
Vol 8 (17) ◽  
pp. 121-126
Author(s):  
Hüseyin GÜRBÜZ ◽  
Hülya ÇİÇEK
Keyword(s):  
Rural Areas ◽  
Blood Parameters ◽  
Wound Area ◽  
Wound Site ◽  
Medical Practices ◽  
Left Hand ◽  
Antiseptic Solution ◽  
Neurotoxic Effects ◽  
Vacuum Method

Snakebite is one of the main causes of morbidity and mortality in Turkey, especially in rural areas. There are 41 snake species living in Turkey, 28 of which are non-poisonous and 13 are venomous. Of these 13 venomous snakes, 10 species are from the Viperidae family, 2 species from the Colubridae and 1 species from the Elapidae (Cobras) family and can be lethal with the venom they inject when they bite. The venom has mostly hematotoxic rarely neurotoxic effects. In addition to these effects, it also has cardiotoxic, myotoxic and nephrotoxic properties. A 50-year-old female patient was admitted to the emergency department 30-40 minutes after her left hand was bitten by a snake bite from the second finger. The patient, who was conscious, agitated and restless, had ecchymosis, widespread edema, pain and tenderness at the wound site. The wound area was cleaned with an antiseptic solution, 80 mg Prednisolone, 20 snake antiserum, 100 mg ulcer and tetanus prophylaxis were administered in the emergency room. The patient was absorbed 80-90 cc of fluid and blood absorption from three different areas on the left hand using the cupping vacuum method, then a splint was taken and elevation was performed. In the examination of the patient 20 hours after the application, edema in the hand decreased, swelling decreased, limitation of movement disappeared and the patient had minimal pain. The blood parameters of the patient were checked and evaluated as normal. The patient was discharged in a healthy way after 40 hours of admission to the hospital, following control and follow-up. As in our case, it should not be forgotten that besides all modern medical practices, cupping absorption therapy, which is a traditional medical treatment, is also very important in terms of supportive treatment and local tissue.

scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

Assessment of incident frailty hazard associated with depressive symptoms in a Taiwanese longitudinal study

2021 ◽  
pp. 1-10
Author(s):  
Che-Chia Chang ◽  
Chi-Shin Wu ◽  
Han-Yun Tseng ◽  
Chun-Yi Lee ◽  
I-Chien Wu ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Longitudinal Study ◽  
Rural Areas ◽  
Healthy Aging ◽  
Asian Population ◽  
Epidemiological Studies ◽  
Frailty Status ◽  
Health Need ◽  
The Impact

ABSTRACT Objectives: To estimate the risks of depressive symptoms for developing frailty, accounting for baseline robust or pre-frailty status. Design: An incident cohort study design. Setting: Community dwellers aged 55 years and above from urban and rural areas in seven regions in Taiwan. Participants: A total of 2,717 participants from the Healthy Aging Longitudinal Study in Taiwan (HALST) were included. Subjects with frailty at baseline were excluded. The average follow-up period was 5.9 years. Measurements: Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) Scale. Frailty was assessed using the Fried frailty measurement. Participants were stratified by baseline robust or pre-frailty status to reduce the confounding effects of the shared criteria between depressive symptoms and frailty. Overall and stratified survival analyses were conducted to assess risks of developing frailty as a result of baseline depressive symptoms. Results: One hundred individuals (3.7%) had depressive symptoms at baseline. Twenty-seven individuals (27.0%) with depressive symptoms developed frailty, whereas only 305 out of the 2,617 participants (11.7%) without depressive symptoms developed frailty during the follow-up period. After adjusting for covariates, depressive symptoms were associated with a 2.6-fold (95% CI 1.6, 4.2) increased hazard of incident frailty. The patterns of increased hazard were also observed when further stratified by baseline robust or pre-frailty status. Conclusions: Depressive symptoms increased the risk of developing frailty among the older Asian population. The impact of late-life depressive symptoms on physical health was notable. These findings also replicated results from Western populations. Future policies on geriatric public health need to focus more on treatment and intervention against geriatric depressive symptoms to prevent incident frailty among older population.

An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States

2021 ◽  
pp. 089719002110002
Author(s):  
David Rhys Axon ◽  
Melissa Johnson ◽  
Brittany Abeln ◽  
Stephanie Forbes ◽  
Elizabeth J. Anderson ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Program Effectiveness ◽  
Small Town ◽  
The United States ◽  
Small Towns ◽  
Academic Community ◽  
Service Needs ◽  
Medication Therapy

Background: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. Objective: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. Methods: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). Results: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. Conclusion: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

scholarly journals Prediction of Reproductive Success in Multiparous First Service Dairy Cows by Parameters from In-Line Sensors

Agriculture ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 334
Author(s):  
Ramūnas Antanaitis ◽  
Vida Juozaitienė ◽  
Dovilė Malašauskienė ◽  
Mindaugas Televičius ◽  
Mingaudas Urbutis ◽  
...  
Keyword(s):  
Electrical Conductivity ◽  
Blood Parameters ◽  
Negative Energy ◽  
Hydroxybutyric Acid ◽  
Pregnancy Status ◽  
Group A ◽  
Biochemical Indices ◽  
Relationship Of ◽  
The Relationship

The aim of the current study was to evaluate the relationship of different parameters from an automatic milking system (AMS) with the pregnancy status of multiparous cows at first service and to assess the accuracy of such a follow-up with regard to blood parameters. Before the insemination of cows, blood samples for measuring biochemical indices were taken from the coccygeal vessels and the concentrations of blood serum albumin (ALB), cortisol, non-esterified fatty acids (NEFA) and the activities of aspartate aminotransferase (AST) and gamma glutamyltransferase (GGT) were determined. From oestrus day to seven days after oestrus, the following parameters were registered: milk yield (MY), electric milk conductivity, lactate dehydrogenase (LDH) and β-hydroxybutyric acid (BHB). The pregnancy status was evaluated using ultrasound “Easy scan” 30–35 days after insemination. Cows were grouped by reproductive status: PG− (non-pregnant; n = 48) and PG+ (pregnant; n = 44). The BHB level in PG− cows was 1.2 times higher (p < 0.005). The electrical conductivity of milk was statistically significantly higher in all quarters of PG− cows (1.07 times) than of PG+ cows (p < 0.05). The arithmetic mean of blood GGT was 1.61 times higher in PG− cows and the NEFA value 1.23 times higher (p < 0.05) compared with the PG+ group. The liver function was affected, the average ALB of PG− cows was 1.19 times lower (p < 0.05) and the AST activity was 1.16 times lower (p < 0.05) compared with PG+ cows. The non-pregnant group had a negative energy balance demonstrated by high in-line milk BHB and high blood NEFA concentrations. We found a greater number of cows with cortisol >0.0.75 mg/dL in the non-pregnant group. A higher milk electrical conductivity in the non-pregnant cows pointed towards a greater risk of mastitis while higher GGT activities together with lower albumin concentrations indicated that the cows were more affected by oxidative stress.

“Craniotomy Within Craniotomy” Technique for Safe Resection of an Intracranial Arteriovenous Malformation With Frontal Bony Erosion: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
MirHojjat Khorasanizadeh ◽  
Kristine Ravina ◽  
Aristotelis Filippidis ◽  
Christopher S Ogilvy
Keyword(s):  
Surgical Resection ◽  
Endovascular Embolization ◽  
Acute Onset ◽  
Bone Flap ◽  
Intracranial Arteriovenous Malformation ◽  
Excessive Bleeding ◽  
Left Hand ◽  
The Right ◽  
Venous Varix

Abstract Surgical resection is one option in the treatment of large high-grade brain arteriovenous malformations (AVMs). Resection of AVMs with skull-eroding components can be challenging due to the risk of excessive bleeding from these components during craniotomy and bone flap removal. We present a case of a 25-yr-old woman who presented with an acute onset right-sided frontal headache. She was found to have a large, frontal Spetzler-Martin grade IV AVM with an associated dural AVM. The AVM had caused focal erosions of the right frontal bone by a venous varix traversing the region of the calvarial defect. An elective staged endovascular embolization followed by surgical resection was recommended considering the patient's young age and the large size of the AVM located in a noneloquent area. Given the high risk of intraoperative hemorrhage during the craniotomy portion of the procedure, a “craniotomy within craniotomy” approach was planned. During this approach, a small rectangle of bone, including the portion eroded by the venous varix, was left in place, while the larger bone flap surrounding it was removed for an initial approach to the AVM. The small bony piece was safely removed at later stages of resection once the arterial feeders had been reasonably obliterated. Immediate postoperative catheter angiogram demonstrated good filling of the intracranial vascular territories with no residual AVM. The patient developed mild left facial and left hand weakness postoperatively, which resolved after 2 wk of follow-up. The patient remained neurologically intact on further follow-up.

scholarly journals Visceral leishmaniasis (Kala-azar) in Qom Province, Iran: Report of two cases

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1371
Author(s):  
Leyli Zanjirani Farahani ◽  
Abedin Saghafipour ◽  
Mehdi Mohebali ◽  
Behnaz Akhoundi ◽  
Hedayatollah Raufi
Keyword(s):  
Visceral Leishmaniasis ◽  
Rural Areas ◽  
Control Strategies ◽  
Sand Fly ◽  
Recurrent Fever ◽  
Kala Azar ◽  
Periodic Monitoring ◽  
History Of ◽  
The Common

Visceral leishmaniasis (VL) is a fatal parasitic zoonotic worldwide disease, which transmits to humans by the infected Phlebotomine sand fly bite. The common form of VL in Iran is the Mediterranean type with the causative agent of Leishmania infantum, whose main reservoirs are stray and domesticated dogs. The disease has several endemic foci in Iran, mostly seen among children under the age of 10, living in rural areas and nomadic tribes. The first cases of Kala-Azar in Qom province, central Iran, were reported in the year 2001, from the villages of Ghahan district. After conducting VL control strategies in the area, no new cases of the disease had been reported until recently. The cases described here are two 2-year-old girls, living in the urban parts of Qom province, one of whom did not have a history of traveling to known endemic areas of the disease. The patients were admitted to hospital in 2016-2017, complaining from recurrent fever with unrecognized reason, associated with decreased appetite and weight loss. Disease follow-up demonstrated anemia and splenomegaly, which led to diagnosis of VL, and both patients are now fully recovered. VL was presumed to be controlled in Qom province but the present cases indicate that possible VL existence remains in the region. Therefore, urgent studies and periodic monitoring are needed to identify potential reservoirs of VL in the area.

scholarly journals Reliability of the MMSE Administered In-Person and by Telehealth

2008 ◽  
Vol 35 (5) ◽  
pp. 643-646 ◽  
Author(s):  
Wendaline McEachern ◽  
Andrew Kirk ◽  
Debra G. Morgan ◽  
Margaret Crossley ◽  
Carol Henry
Keyword(s):  
Rural Areas ◽  
Access To Health Care ◽  
Mini Mental State Examination ◽  
Remote Memory ◽  
Rural And Remote ◽  
Remote Areas ◽  
Access To Health ◽  
State Examination ◽  
Community Patients

Background:Recent advances in telehealth have improved access to health care for those in rural areas. It is important that examinations conducted via telehealth are comparable to in-person testing. A rural and remote memory clinic in Saskatoon provided an opportunity to compare scores on the Mini-Mental State Examination (MMSE) administered in-person and via telehealth.Methods:After an initial one day assessment in Saskatoon, patients were seen in follow-up at 6 and 12 weeks. Individual patients were randomly assigned to either in-person follow-up assessment in Saskatoon or telehealth assessment in their home community. Patients who initially received in-person assessments were seen by telehealth for their next follow-up visit and vice-versa. The same neurologist administered MMSEs at all visits. The first 71 patients with both 6 and 12 week follow-up assessments were included in this study. The scores of in-person and telehealth MMSE administrations were compared using the methods of Bland and Altman as well as a paired t-test.Results:MMSE scores did not differ significantly between telehealth (22.34 +/- 6.35) and in-person (22.70 +/- 6.51) assessments.Conclusion:Telehealth provides an acceptable means of assessing mental status of patients in remote areas.

Follow-up of Children With Trait in a Rural Setting

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 876-877
Author(s):  
Herman Harris
Keyword(s):  
Sickle Cell ◽  
Rural Areas ◽  
Urban Areas ◽  
Cost Effective ◽  
Rural Setting ◽  
Urban Centers ◽  
Hb S ◽  
The Individual ◽  
Limited Testing

The Comprehensive Sickle Cell Centers were established in 1972 to test, educate, counsel, and research sickle cell anemia and related hemoglobinopathies. Standards and protocols for testing, education, and research were readily established because similar procedures and methods were already in operation at the institutions where the centers were located. The most difficult and still the most controversial program to provide is counseling. It became evident, early, that there is no universally accepted method for informing carriers of abnormal Hb S about their results. Centers located in large urban areas with a limited testing radius do not face the same problems as centers located in rural areas where the testing radius may cover an entire state or several states. Individual, or one-on-one, counseling of persons with trait results appears to be successful for urban centers where the individual may be called to the center and given information. But, in a rural setting, it is not feasible for the center to ask a person to travel 350 miles to be told he or she has nothing to worry about. And it is not cost-effective to send a caseworker 350 miles to say the same thing. It must, therefore, be concluded that each agency or center must adopt counseling methods that meet its specific needs. Each program must be flexible, imaginative, and creative and must successfully and accurately deliver information about being a carrier for the sickle gene or other hemoglobinopathy and its implication and significance for patients and their future offspring. To do this, we must first look at the problems facing us.

Assessment of patient satisfaction, financial, and environmental impacts of teleoncology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 278-278
Author(s):  
Cindy Jiang ◽  
Garth William Strohbehn ◽  
Rachel Dedinsky ◽  
Shelby Raupp ◽  
Brittany Pannecouk ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
Financial Burden ◽  
Veterans Health ◽  
Health Administration ◽  
Secondary Effects ◽  
Medical Needs ◽  
Care Access ◽  
Strongly Agree

278 Background: There was rapid adoption of teleoncology at Veterans Health Administration (VHA) during the COVID-19 pandemic. One-third of 9 million VHA-enrolled Veterans live in rural areas. While digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology post-pandemic. Methods: Patients with ≥1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 identified retrospectively. Validated, Likert-type survey assessing patient satisfaction developed. Follow-up survey conducted on patients with ≥1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide (CO2) emissions calculated based on zip codes. Results: 100 surveys completed (response rate, 62%). Table with demographics. Patients overall satisfied with teleoncology (83% ‘Agree’ or ‘Strongly Agree’) but felt less satisfied than in-person visits (47% ‘Agree’ or ‘Strongly Agree’). Audiovisual component improved patient perception of involvement in care (two-sided, p = 0.0254), ability to self-manage health/medical needs (p = 0.0167), and comparability to in person visits (p = 0.0223). Follow-up survey demonstrated similar satisfaction. Total travel-related savings: 86,470 miles, 84,374 minutes, $49,720, and 35.5 metric tons of CO2. Conclusions: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization needed to enhance patient experience and address secondary effects.[Table: see text]

The Impacts and Outcomes of Presurgical Nasoalveolar Molding (PNAM) in Newborn Sequential Therapeutic Implementation

2021 ◽  
Author(s):  
Vonda Trivosa
Keyword(s):  
Incidence Rate ◽  
Rural Areas ◽  
Orthodontic Treatment ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Mixed Dentition ◽  
Deciduous Dentition ◽  
Parents And Children ◽  
Nasoalveolar Molding

Cleft lip and palate is a common congenital malformation in the oral and maxillofacial regions. According to epidemiological investigation, the incidence rate is about 1.625%, and the incidence rate is high in poor areas and rural areas. Cleft lip and palate mainly involve the upper lip, hard palate, soft palate and nose, which can damage the appearance of children, affect pronunciation, swallowing and chewing, and also bring different degrees of psychological damage to children in the growth stage. Therefore, we should actively carry out sequential treatment and participate in the treatment work through multi-disciplines. Based on restoring the oral and maxillofacial function and health of children, we should also pay attention to their aesthetic needs, enhance the treatment confidence of parents and children, and lay the foundation for the follow-up repair treatment. Most patients with cleft lip and palate are complicated with malocclusion. Orthodontic treatment is an important part of the treatment of cleft lip and palate. The orthodontic treatment of cleft lip and palate can be divided into five periods: newborn period, deciduous dentition period, mixed dentition period, permanent dentition period and combined orthodontic and orthognathic treatment period. Presurgicalnasoalveolar molding (PNAM) was used to reduce the severity of facial deformity in children with cleft lip and palate. This article discusses the therapeutic effect of newborn PNAM according to clinical cases. Objective to study the opportunity and current situation of PNAM in the treatment of children with cleft lip and palate, and to provide a favorable reference for clinical orthodontists, emphasizing the close communication between various disciplines.

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