Hospital Practices and Research
Volume:5 Issue: 3, Summer 2020

Most of what we know about the coronavirus disease 2019 (COVID-19) is limited to the severe acute respiratory syndrome, epidemiology, fatality, and acute care. However, infection with COVID-19 may also involve the central nervous system (CNS), which may or may not be due to a multi-organ injury. Our aim in this paper is to briefly summarize the main aspects of the growing literature on neurological manifestations of the COVID-19 infection. As such, after mentioned some general background on the economic and medical pandemic on the populations, the healthcare system, and the society, we summarize some common aspects of the published literature on neurological manifestations of the COVID-19 infection. We also highlight the existing gaps in the literature, which requires additional work. The most common neurological manifestation of COVID-19 infection is the olfactory deficit. However, it is still unknown if it is inflammatory or degenerative in nature. Still, the incidence of neurological involvement, and also mechanisms and their treatments are unknown. This literature is predominantly composed of opinions and reviews rather than original articles, so the patients’ data are not used for a majority of the studies. Multi-center studies that not only conduct chest CT or MRI but also brain CT or MRI are needed. Randomized trials are still required on the management of acute and chronic neurological conditions due to COVID-19 infection. Cohort studies may also determine the natural history of the conditions and factors that are prognostic. Furthermore, while disparities in COVID-19 infections are known, inequalities in neurological manifestations are unknown. Besides, the efficacy of specific treatments on CNS involvement is still unknown. We will discuss the health care needs of patients with chronic neurological conditions. We end the paper with a few recommendations for practice and research.

Nowadays, one of the most important social troubles is the sleep disorder that more than 40% of some population faced. Biofeedback (BFB) as a complementary method could reduce many of its effects. This study aims to show the effects of BFB on the promotion of sleep quality and control sleep disorder impacts. An interventional study was conducted on 48 volunteer patients with sleep disorders. Twelve patients were included in each of four groups consisting of control. Pittsburgh Sleep Quality Index (PSQI) was used as a standard tool for sleep quality measurement in both groups. Abdominal breathing via chest breathing was trained as a BFB training exercise for patients. Heart rate variability (HRV) was measured before and after BFB training. Data were checked for outliers and normal distribution. SPSS version 22 and a diagram prepared by sigma plot version 14 did data analysis. The finding showed the promotion of sleep quality by pulse regulated abdominal breathing (PRAB) by a significant difference before and after BFB for four weeks. Based on the finding of this study, polyvagal BFB training was utilized as a complementary method for HRV thus not only can it treat the patients with a sleep disorder but also promote sleep quality of the normal persons. Hence, the PRAB can be used for the patients with chief complain of sleep disorder.

Abnormal uterine bleeding (AUB) is a major health problem for many women. Homeopathy is one of the treatments for this disease. This study was performed to evaluate the efficacy of homeopathic Ipecacuanha (Ipecac) in the treatment of bleeding, pain, and in the quality of life in patients with AUB compared to the control group. This double blind randomized clinical trial study was performed on women aged 35-55 years with AUB in Tehran, Iran during the years 2017-2018. In this study, patients were assigned to first group: 25 patients with routine treatment (mefenamic acid capsule) + homeopathic “Ipecac” and second group: 25 patients with mefenamic acid + placebo. Pictorial Blood Loss Assessment Chart (PBAC) score, Visual Analogue Scale (VAS) questionnaire, and General Health Questionnaire (GHQ) were utilized to assess bleeding, pain, and quality of life, respectively. This study was performed on 50 women with AUB. In this study, the two groups were similar in demographic characteristics. The results showed that despite the relative improvement in PBAC score, duration of bleeding, and depression score in the homeopathic treatment group, this decrease was not statistically significant. The homeopathic treatment group compared to the control group showed more improvement in pain score, physical symptoms, anxiety and insomnia, social dysfunction, and mental health. Considering the efficacy of homeopathic “Ipecac” in reducing pain and increasing the quality of life of women with AUB in this study, it can be suggested in AUB without the complication of this treatment.

Assessing patient satisfaction with care is crucial for healthcare quality improvement. However, little is known about patient satisfaction with care in adolescent-friendly health facilities in Ghana.

This study aimed to assess patient satisfaction with quality of healthcare in adolescent-friendly health facilities.

A cross-sectional survey was conducted of four adolescent-friendly health facilities in Tema, Ghana. In all, 386 adolescent clients/patients were recruited using the convenience sampling technique. A structured questionnaire was administered to respondents, and data was analyzed using Statistical Package for Social Sciences (SPSS) software, version 22.0.

It was found that the majority (62%) of respondents were satisfied with the quality of care in adolescent-friendly health facilities. It was also found that overall satisfaction with quality of care was significantly influenced by the availability of health information materials (AOR = 4.99; 95% CI: 1.90-3.96) and positive provider attitudes (AOR = 25.76; 95% CI: 8.01-109.78).

This study demonstrated that most adolescents were satisfied with the quality of care in adolescent-friendly health facilities. This is one of the few studies that have assessed adolescent satisfaction with the quality of care in Ghana. Stakeholders can leverage these findings to improve the quality of adolescent health services.

Knowledge and attitude are the main indicators of awareness about the use of artificial sweeteners.

This study aimed to evaluate the knowledge, attitude, and practices (KAPs) of patients with type 2 diabetes mellitus (T2DM) in relation to the consumption of low-calorie artificial sweeteners.

In this descriptive-analytical study, 400 diabetic patients admitted to the diabetes clinic of Bu-Ali hospital in Zahedan were selected by the census method. After recording the demographic characteristics, we assessed participants’ knowledge and attitude through a researcher-made questionnaire. Also, the subjects’ practices were evaluated based on their nutritional behaviors. The answers were marked as good, moderate, and poor.

The knowledge and attitude of the study population were 39% and 34.8%, respectively at the ‘poor’ level, 58% and 58.3% at the ‘moderate’ level, and 3% and 7% at the ‘good’ level. There was a significant relationship between patients’ knowledge, attitude and their demographic indicators (p <0.001). Moreover, 8% of patients reported side effects after taking artificial sweeteners, and 20.2% of patients used artificial sweeteners in their pure form beside food.

The findings showed that half of the diabetic patients had moderate knowledge and attitude concerning the consumption of artificial sweeteners. They had limited information about low-calorie sweeteners, which affected their nutritional behaviors so that almost half of the subjects did not consume any sweeteners. It has been suggested that appropriate educational programs be designed and implemented to overcome this information gap.

Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions.

The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries.

This randomized control clinical trial study was carried out from December 2018 to October 2020, on ASA I and II patients aged between 30-80 years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (18 cases), and group II received fentanyl and morphine bolus injection (18 cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded.

The mean age was 52.21±16.13 years (41.6% male, 58.4 female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P < 0.05). There were no differences between the two groups regarding PLT, ESR, CRP, and PCT preoperative postoperative (P > 0.05). The mean of pain was less in the epidural group than in the morphine group postoperative (P = 0.02).

The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.

Parquet poisoning has been elaborated to be very common among developing countries, particularly in regions with agriculture economy. One of the most common presentations of paraquat poisoning is oropharyngeal burns. Herein, we report a patient from a dry and warm district in the geographic center of Iran where agriculture and, as a result, paraquat poisoning are not commonly reported.

A 25-year-old man presented to hospital subsequent to a suicide attempt by ingesting oral paraquat poison. He gradually developed odynophagia and trismus-like appearance that, after a psychiatric consultation, was misdiagnosed as a drug side effect in the form of dystonia. Upon further physical examination, oral ulcers on his tongue were revealed to be responsible for the symptom.

Paraquat poisoning is very rare in regions with lower rates of agriculture activities. In any patient with poisoning, however, it is necessary to consider intraoral examination to rule out any other suspected diagnosis.