Toilet Paper, Minced Meat and Diabetes Medicines: Australian Panic Buying Induced by COVID-19

The COVID-19 pandemic has impacted the management of non-communicable diseases in health systems around the world. This study aimed to understand the impact of COVID-19 on diabetes medicines dispensed in Australia. Publicly available data from Australia’s government subsidised medicines program (Pharmaceutical Benefits Scheme), detailing prescriptions by month dispensed to patients, drug item code and patient category, was obtained from January 2016 to November 2020. This study focused on medicines used in diabetes care (Anatomical Therapeutical Chemical code level 2 = A10). Number of prescriptions dispensed were plotted by month at a total level, by insulins and non-insulins, and by patient category (general, concessional). Total number of prescriptions dispensed between January and November of each year were compared. A peak in prescriptions dispensed in March 2020 was identified, an increase of 35% on March 2019, compared to average growth of 7.2% in previous years. Prescriptions dispensed subsequently fell in April and May 2020 to levels below the corresponding months in 2019. These trends were observed across insulins, non-insulins, general and concessional patient categories. The peak and subsequent dip in demand have resulted in a small unexpected overall increase for the period January to November 2020, compared to declining growth for the same months in prior years. The observed change in consumer behaviour prompted by COVID-19 and the resulting public health measures is important to understand in order to improve management of medicines supply during potential future waves of COVID-19 and other pandemics.

Effects of stretching exercises on human gait: a systematic review and meta-analysis

Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.

Regional anesthesia and COVID-19

In the light of the spread of COVID-19, the anesthesiology services has been challenged with an urgent need to ensure safety of the practicing professionals. Suggesting no manipulations on face-to-face contacts, regional anesthesia has proved to be the most appropriate method of anesthesia in the situation of the COVID-19 pandemic. The review outlines indications for recommending regional anesthesia to patients diagnosed with COVID-19 and offers safety rules of its conduction. Any detailed and substantiated treatment plan for the patient category under discussion shall enable not only the recovery of the patient, but also the safety of the medical workers.

Effects of stretching exercises on human gait: a systematic review and meta-analysis

Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.

Acute and Chronic Depressive Disorders in Head and Neck Cancer Patients

The review focuses on depressive disorders in cancer patients. The article summarizes the findings of domestic and foreign studies on depression prevalence, clinical symptoms and treatment in head and neck cancer patients. Early detection of affective disorder and timely administration of antipsychotic drug treatment is shown to be important for this patient category.

Skin Shrinkage with Vibration Amplification of Sound Energy at Resonance (VASER) Liposelection of Abdomen: Avoiding Abdominoplasty

Objective / Purpose of the Study: For abdominal reshaping / contouring, patient with excess abdominal skin and redundant fat quite often require abdominoplasty / tummy tuck. Inconsistent results achieved with traditional liposuction especially in the supraumbilical area. This study is to assess the role of abdominal VASER liposelection and if the abdominoplasty can be avoided. Material and Methods: This is retrospective cross sectional observational study conducted at Dundrum Medical Cosmetic Clinic, Dublin 16, Ireland. The study period includes two years from March 2009 to February 2011. In this study total number of consecutive 85 patients, operated by single surgeon were included with type I-IV patient category according to Matarasso classification system (1). There were 10 (11.8%) male and 75 (88.2%) female patient with mean age 42.4 years ± 10.95 years. Results: All of the 85 patients were treated with abdominal VASER liposelection. There were 75 female (88.2%) patients and 10 male (11.8%) patients in this study. Seven (8.2%) female patient require second session of VASER liposelection procedure 3 months after the first procedure and 3 (3.5%) female patient underwent third session to complete the abdominal contouring. None of the total 10 male patient required 2nd or 3rd session of abdominal VASER liposelection. The satisfaction level achieved 90 to 100 % by using visual analogue scoring system for all types I - IV abdomen. No early or late complication was noted in this study. Conclusion: This is a low risk, minimally invasive, scarless ambulatory technique performed under local anaesthetic, highly satisfactory to the patient as well as surgeon and is effective in all the categories of protuberant abdomen avoiding the local and systemic risk of abdominoplasty.

Myocardial Infarction in the Group of Patients With Atrial Fibrillation

Prevalence of patients with myocardial infarction (MI) and atrial fibrillation (AF) has been growing every year. These patients represent a highest risk group and, thus, require special attention of clinicians. The article foсused on mechanisms of the AF and MI interaction, special aspects of prediction depending on the type of AF and MI, and the issue of antithrombotic therapy in this patient category. A group of AF-associated, embologenic MIs was isolated, and diagnostic criteria and therapeutic regimens were provided.

Tuberculosis infectious pool and associated factors in East Gojjam Zone, Northwest Ethiopia

Background Globally, tuberculosis (TB) lasts a major public health concern. Using feasible strategies to estimate TB infectious periods is crucial. The aim of this study was to determine the magnitude of TB infectious period and associated factors in East Gojjam zone. Methods An institution-based prospective study was conducted among 348 pulmonary TB (PTB) cases between December 2017 and December 2018. TB cases were recruited from all health facilities located in Hulet Eju Enesie, Enebse Sarmider, Debay Tilatgen, Dejen, Debre-Markos town administration, and Machakel districts. Data were collected through an exit interview using a structured questionnaire and analyzed by IBM SPSS version25. The TB infectious period of each patient category was determined using the TB management time and sputum smear conversion time. The sum of the infectious period of each patient category gave the infectious pool of the study area. A multivariable logistic regression analysis was used to identify factors associated with the magnitude of TB infectious period. Results Of the total participated PTB cases, 209(60%) were male, 226(65%) aged < 30 years, 205(59%) were from the rural settings, and 77 (22%) had comorbidities. The magnitude of the TB infectious pool in the study area was 78,031 infectious person-days. The undiagnosed TB cases (44,895 days), smear-positive (14,625 days) and smear-negative (12,995 days) were major contributors to the infectious pool. The overall average median TB management time was 142.4 days (IQR, 98–238 days). Similarly, the average sputum smear conversion time of PTB cases (new and repeat) was 46 days. Residence, knowledge, form of TB, smoking, alcohol history, distance from the facility, comorbidity history and stigma were statistically significant factors TB infectious period (p-value< 0.05). Conclusions The magnitude of the TB infectious pool is high even if it is lower than the findings of previous studies. This might be an indicator of poor access to TB services, service delays, low community awareness, impaired facility readiness, and poor transportation. Improving personal awareness and behavior, timely management of commodities, and using the TB management time in TB control are crucial to improving TB control activities.

The Spatial Mixed effect Ordinal Logistic Regression Modeling of Cancer disease: West Amhara, Ethiopia

Background: There are numerous patients that are suffering with cancer disease in Ethiopia. However, as far as our knowledge concerned there was no any study that have been conducted to determine the factors on cancer disease. The main objective of this study was to assess the distribution risk of cancer disease by taking into account the spatial effect. It was also aimed to determine the effects of some common clinical patients characteristics, complications of cancer disease and prognostic factor on current patient status, and finally predict the patient status. Methods: The data was obtained from 415 cancer patients. Statistical models were used to investigate the spatial difference of incidence of cancer across different districts and different disk factors identified using spatial mixed OLR model. Results: The findings of this study shows that only 1.45% cured of patients who have taken treatment were cured and 46.02% improved while the rest have shown no change and even worse status after they getting treatment. Prognostic factor (stage and grade of cancer tumor), complication of cancer disease such as anemia during diagnosis and treatment of patients given in the hospital had significant effect on the patient status. Conclusion: Patients without anemia complication at diagnosis were more likely to fall in the lower patient category than patients with anemia complication during diagnosis. Most of the patients had advanced stage (IV) and grade of cancer tumor that dismantle the capability of the treatment to be less effective. There was negative spatial effect on the incidence of cancer indicate that districts with higher cancer incidence usually surrounded by districts with lower incidence. Keywords: Incidence of cancer, Patient Status, Spatial (Mixed) OLR

Analytical Performance and Clinicopathologic Correlation of Four Fecal Calprotectin Methods

Objectives Calprotectin is a noninvasive biomarker that can distinguish inflammatory bowel disease from irritable bowel syndrome. We investigated four automated fecal calprotectin methods on five different platforms for their preanalytical process, analytical performance, and clinicopathologic correlation. Methods Four calprotectin methods (Bühlmann, EliA CN, EliA CN2, and DiaSorin) were performed on five platforms (Cobas 8000 E502, Phadia Immunocap 100 and 250, and Liaison and Liaison XL) in two hospital laboratories. Results Overall variation for the different extraction devices was less than 19% when feces were of normal consistency. Freeze-thawing of samples resulted in comparable results compared with fresh samples. The different methods had a good analytic correlation (R = 0.83-0.95). Their clinicopathologic correlation was comparable, but the Bühlmann method showed significantly higher calprotectin values in every patient category. Conclusions The automated calprotectin methods showed a good performance and comparable clinicopathologic correlation. Due to lack of standardization, the numerical values differ for the various methods.