Jackson and Tull (United States)

Background: Consumers contribute largely in getting healthcare services in Bangladesh. This formal and informal consumer cost leads a large section of population into poverty. Objective of this study was to capture the self-reported consumer cost of illness as well as satisfaction regarding availed healthcare services among patients admitted in Sir Salimullah Medical College Mitford Hospital (SSMCMH). Methods: This cross-sectional survey was conducted from November 2022 to May 2023 among conveniently selected 636 indoor patients of medicine, surgery, orthopedics, pediatrics, and Gynecology & Obstetrics departments of SSMCMH. Mixed method approach was applied to collect data using a semi-structured questionnaire during the discharge of indoor patients whom were selected by stratified sampling method. Results: Respondents had to pay for any of the services, only one fifth (18.10%) said the payment was at the high end. We found that outside facility outweighed inside facility cost, medicine (69.34%) and investigation contributed the largest share. Non-medical costs were a significant component of health expenditure. Though stake of informal tips (2%) were a smaller portion compared to other cost, apparently it was a norm. Patients paid highest for surgical care (Tk 12789.50) and lowest for orthopedic care (Tk 2936.66). There was significant difference between consumer cost of delivery by NVD and CS (p=0.0008). There was significant difference with variation of age (p<0.05), sex (p<0.05), monthly income (p<0.05), but marital status, and year of education was not significant. Consumer satisfaction on payment was seen to be largely dependent on amount they had to spend out of pocket (p<0.05) along with providers behavior and cleanliness of the premises. Conclusion: The study suggested that although direct medical costs are of special importance and it is necessary to protect patients against such costs, patients usually encounter a variety of costs when receiving inpatient services. Findings of this study could help local authority and policy makers to develop strategies within the health system to reduce the burden and ensure patient compliance. Bangladesh Armed Forces Med J Vol 58 No (1) June 2025, pp 1-6

This article examines the significance of phraseological units in literature and the challenges of translating them. Idioms, proverbs, and set phrases enhance literary texts but often carry culture-specific meanings that are difficult to translate. The article reviews key translation strategies, such as functional equivalence and cultural adaptation, highlighting the need to preserve both meaning and style in translation.

The visual system adapts dynamically to stabilize perception over widely varying illuminations. Such adaptation allows the colors of objects to appear constant despite changes in spectral illumination. Similarly, the wearing of colored filters also alters spectral content, but this alteration can be more extreme than typically encountered in nature, presenting a unique challenge to color constancy mechanisms. While it is known that chromatic adaptation is affected by surrounding spatial context, a recent study reported a gradual temporal adaptation effect to colored filters such that colors initially appear strongly shifted but over hours of wear are perceived as closer to an unfiltered appearance. Presently, it is not clear whether the luminance system adapts spatially and temporally like the chromatic system. To address this, spatial and temporal adaptation effects to a colored filter were measured using tasks that assess chromatic and luminance adaptation separately. Prior to and for 1 hour after putting on a pair of colored filters, participants made achromatic and heterochromatic flicker photometry (HFP) settings to measure chromatic and luminance adaptation, respectively. Results showed significant chromatic adaptation with achromatic settings moving closer to baseline settings over 1 hour of wearing the filters and greater adaptation with spatial context. Conversely, there was no significant luminance adaptation and HFP matches fell close to what was predicted photometrically. The results are discussed in the context of prior studies of chromatic and luminance adaptation.

Obstructive uropathy is an important cause of acute and chronic kidney disease. Decompression of the urinary tract is an essential aspect of treatment. The cause and aetiology of obstruction typically determine the surgical approach. Acute relief of obstruction is frequently complicated by fluid and electrolyte imbalance. Standard therapeutic interventions for acute or chronic renal failure also apply for cases of obstructive uropathy. This narrative review summarises the early and long-term medical management of obstructive uropathy.

The recent increase in the adoption of total ankle arthroplasty (TAA) reflects the improvements in implant designs and surgical techniques, including the use of preoperative navigation system and patient-specific instrumentation (PSI), such as custom-made cutting guides. Cutting guides are customized with respect to each patient's anatomy based on preoperative ankle computed tomography scans, and they drive the saw intra-operatively to improve the accuracy of bone resection and implant positioning. Despite some promising results, the main queries in the literature are whether PSI improves the reliability of achieving neutral ankle alignment and more accurate implant sizing, whether it is actually superior over standard techniques, and whether it is cost effective. Moreover, the advantages of PSI in clinical outcomes are still theoretical because the current literature does not allow to confirm its superiority. The purpose of this review article is therefore to assess the current literature on PSI in TAA with regard to current implants with PSI, templating and preoperative planning strategies, alignment and sizing, clinical outcomes, cost analysis, and comparison with standard techniques.

BACKGROUNDThe National Institute for Health and Care Excellence (NICE) guidelines have advised further research is required into investigating the added prognostic value of bone mineral density (BMD) in the assessment of fracture risk with the Fracture Risk Assessment Tool (FRAX) score.AIMTo investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODSInclusion criteria for this study were all patients who underwent dual-energy X-ray absorptiometry (DXA) scan following fracture neck of femur between 2015 and 2017. Analysis of BMD, FRAX scores and patient demographic data was undertaken.RESULTSA total of 69 patients were included in the study, mean age 74.1 years. There was no significant difference between mean BMD of the femoral neck in males (0.65) as compared to females (0.61) (P = 0.364). Analyses showed no significant correlation between BMD and menopause age (rs = -0.28, P = 0.090). A significant difference was seen of the femoral neck BMD between the different fracture pattern types (P = 0.026). A stronger correlation was observed between BMD of femoral neck and FRAX major score (rs = -0.64, P < 0.001) than with BMD of lumbar spine and FRAX major score (rs = -0.37, P = 0.003).CONCLUSIONThis study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.

BACKGROUNDOf 25% of randomised controlled trials (RCTs) on interventions for inflammatory bowel disease (IBD) have no power calculation. AIMTo systematically review RCTs reporting interventions for the management of IBD and to produce data for minimum sample sizes that would achieve appropriate power using the actual clinical data.METHODSWe included RCTs retrieved from Cochrane IBD specialised Trial register and CENTRAL investigating any form of therapy for either induction or maintenance of remission against control, placebo, or no intervention of IBD in patients of any age. The relevant data was extracted, and the studies were grouped according to the intervention used. We recalculated sample size and the achieved difference, as well as minimum sample sizes needed in the future.RESULTSA total of 105 trials were included. There was a large discrepancy between the estimated figure for the minimal clinically important difference used for the calculations (15% group differences observed vs 30% used for calculation) explaining substantial actual sample size deficits. The minimum sample sizes indicated for future trials based on the 25 years of trial data were calculated and grouped by the intervention. CONCLUSIONA third of intervention studies in IBD within the last 25 years are underpowered, with large variations in the calculation of sample sizes. The authors present a sample size estimate resource constructed on the published evidence base for future researchers and key stakeholders within the IBD trial field.

The human gut microbiome has gained increasing attention over the past two decades. Several findings have shown that this complex and dynamic microbial ecosystem can contribute to the maintenance of host health or, when subject to imbalances, to the pathogenesis of various enteric and non-enteric diseases. This scoping review summarizes the current knowledge on how the gut microbiota and microbially-derived compounds affect host metabolism, especially in the context of obesity and related disorders. Examples of microbiome-based targeted intervention strategies that aim to restore and maintain an eubiotic layout are then discussed. Adjuvant therapeutic interventions to alleviate obesity and associated comorbidities are traditionally based on diet modulation and the supplementation of prebiotics, probiotics and synbiotics. However, these approaches have shown only moderate ability to induce sustained changes in the gut microbial ecosystem, making the development of innovative and tailored microbiome-based intervention strategies of utmost importance in clinical practice. In this regard, the administration of next-generation probiotics and engineered microbiomes has shown promising results, together with more radical intervention strategies based on the replacement of the dysbiotic ecosystem by means of fecal microbiota transplantation from healthy donors or with the introduction of synthetic communities specifically designed to achieve the desired therapeutic outcome. Finally, we provide a perspective for future translational investigations through the implementation of bioinformatics approaches, including machine and deep learning, to predict health risks and therapeutic outcomes.

In this editorial, we discuss the remarkable role of physical energies in the control of cell signaling networks and in the specification of the architectural plan of both somatic and stem cells. In particular, we focus on the biological relevance of bioelectricity in the pattern control that orchestrates both developmental and regenerative pathways. To this end, the narrative starts from the dawn of the first studies on animal electricity, reconsidering the pioneer work of Harold Saxton Burr in the light of the current achievements. We finally discuss the most recent evidence showing that bioelectric signaling is an essential component of the informational processes that control pattern specification during embryogenesis, regeneration, or even malignant transformation. We conclude that there is now mounting evidence for the existence of a Morphogenetic Code, and that deciphering this code may lead to unprecedented opportunities for the development of novel paradigms of cure in regenerative and precision medicine.

Modern liver ultrasonography (US) has become a “one-stop shop” able to provide not only anatomic and morphologic but also functional information about vascularity, stiffness and other various liver tissue properties. Modern US techniques allow a quantitative assessment of various liver diseases. US scanning is no more limited to the visualized plane, but three-dimensional, volumetric acquisition and consequent post-processing are also possible. Further, US scan can be consistently merged and visualized in real time with Computed Tomography and Magnetic Resonance Imaging examinations. Effective and safe microbubble-based contrast agents allow a real time, dynamic study of contrast kinetic for the detection and characterization of focal liver lesions. Ultrasound can be used to guide loco-regional treatment of liver malignancies and to assess tumoral response either to interventional procedures or medical therapies. Microbubbles may also carry and deliver drugs under ultrasound exposure. US plays a crucial role in diagnosing, treating and monitoring focal and diffuse liver disease. On the basis of personal experience and literature data, this paper is aimed to review the main topics involving recent advances in the field of liver ultrasound.