Tertiary Education Commission

Objective: Nasal obstruction has significant impact on life quality, with deviated nasal septum being the third most common cause. This condition involves nasal structural abnormalities that reduce airflow. This study evaluates the comparative effectiveness of septoplasty alone versus septoplasty combined with turbinectomy in patients presenting with a deviated nasal septum. Study Design and Setting: This was a prospective, randomized comparative study conducted in ENT Department at CMH Hospital Malir. Patients underwent septoplasty with and without turbinectomy. Methodology: A total of 88 patients underwent septoplasty for a deviated nasal septum. Participants were randomly assigned into two groups, with 44 patients in each. Group A underwent septoplasty alone, while Group B received septoplasty with turbinectomy. The nasal obstruction severity was evaluated using the NOSE score, with a mean preoperative score of (11.16±1.1) for septoplasty and (8.6±1.19) for septoplasty with turbinectomy. Surgical outcomes were assessed one month postoperatively using NOSE scores to compare the effectiveness of both procedures. Results: Results revealed significant postoperative improvement in nasal obstruction symptoms, with both septoplasty alone and septoplasty with turbinectomy showing relief in symptoms. However, patients who underwent combined procedure experienced greater reductions in nasal blockage, congestion, trouble sleeping, and difficulty breathing during exertion. Statistical analysis confirmed that septoplasty with turbinectomy provided significant symptomatic improvement compared to septoplasty alone (P<0.05), emphasizing added benefit of turbinate reduction in improving nasal airflow. Conclusion: Combining inferior turbinectomy with septoplasty is more effective than performing septoplasty alone in patients with nasal obstruction due to deviated nasal septum

Background: The increasing prevalence of chronic respiratory conditions has led to a greater reliance on home respiratory devices such as Continuous Positive Airway Pressure machines and oxygen concentrators. These devices are essential in managing conditions like obstructive sleep apnea and chronic obstructive pulmonary disease. Understanding patient experiences with these devices is vital for improving adherence and overall satisfaction. Non-invasive ventilation is widely recognized as the gold standard for treating OSA. It functions by delivering a continuous flow of air through a mask, preventing airway collapse during sleep. While NIV can significantly enhance sleep quality and reduce daytime drowsiness, adherence remains a significant challenge. It has been reported that nearly 30% of patients discontinue NIV therapy within the first year, primarily due to discomfort, nasal congestion, and feelings of claustrophobia. Such discontinuation not only affects the individual’s health but can also lead to long-term complications associated with untreated sleep apnea, including cardiovascular disorders and impaired cognitive function. While NIV machines and oxygen concentrators are vital in managing chronic respiratory conditions, patient experiences vary widely based on numerous factors, including device comfort and cultural perceptions. This research will address the factors for patient experience and satisfaction with the use of non-invasive home respiratory therapy devices. Methodology: A quantitative, cross sectional study design using online survey technique distributed among participants as data collection methods in a tertiary hospital. We will utilize two validated questionnaires in one form: the standard method for analyzing System usability scale (SUS) and the S3-NIV questionnaire. Usability will be assessed using the SUS, developed by Brooke in 1986, which has demonstrated reliability and validity in numerous studies. The S3-NIV questionnaire will also be used to assess patient experience. Results: Total of 197 participants, with a mean age of 62.0 years (SD = 10.5) and a balanced gender distribution (55% male, 45% female). Participants reported an average device usage duration of 2.5 years (SD = 1.2). The System Usability Scale revealed a high overall mean score of 78.5 (SD = 12.3), with approximately 75% of participants scoring above 70, indicating strong perceived usability and ease of operation. Patient satisfaction, as measured by the S3-NIV questionnaire, was notably high, with 85% of participants reporting being "satisfied" or "very satisfied." While 70% found device setup easy, and 80% found daily operation easy, maintenance presented a more varied challenge. The devices had a generally positive impact on daily life for 60% of participants, though 25% reported a neutral impact and 15% a negative one. A weak but statistically significant positive correlation ($r = 0.45, p < 0.05$) was found between perceived usability and overall patient satisfaction. Importantly, no statistically significant correlations were identified between demographic factors (age, gender, duration of use) and either usability or satisfaction scores, suggesting a robust user experience across diverse patient profiles. Conclusion: This study investigated patient experiences and satisfaction with non-invasive home respiratory therapy devices. It found high levels of perceived usability and overall satisfaction, with participants generally finding the devices easy to set up and operate. A statistically significant positive correlation between usability and satisfaction highlighted the importance of user-centered design for positive patient outcomes and enhanced quality of life. Despite these positive perceptions, device maintenance was identified as an area needing improvement, suggesting a need for simplified designs and enhanced patient education from manufacturers and healthcare providers. The varied impact of devices on daily life also indicates the importance of a holistic approach to patient care, beyond just device functionality. DOI : https://doi.org/10.52783/pst.2541

RationaleThere are limited data on the impact of the coronavirus disease (COVID-19) pandemic on intensive care unit (ICU) recovery clinic care delivery practices.ObjectivesWe sought to better understand the patient-level factors affecting ICU recovery clinic care and changing clinical thinking during the COVID-19 pandemic. We also sought to understand how the COVID-19 pandemic sparked innovation within ICU recovery clinics.MethodsA multicenter qualitative study was conducted with ICU recovery clinic interprofessional clinicians involved with the Critical and Acute Illness Recovery Organization (CAIRO) between February and March 2021. Data were collected using semistructured interviews and were analyzed using thematic analysis. Key themes were organized in a working analytical framework.ResultsTwenty-nine participants from 15 international sites participated in the study. Participants identified three patient-level key themes that influenced care delivery in ICU recovery programs: 1) social isolation, 2) decreased emotional reserve in patients and families, and 3) substantial social care needs. Changes in ICU recovery clinic care delivery occurred at both the clinician level (e.g., growing awareness of healthcare disparities and inequities, recognition of financial effects of illness, refinement of communication skills, increased focus on reconstructing the illness narrative) and the practice level (e.g., expansion of care delivery modes, efforts to integrate social care) in response to each of the patient-level themes. Identified gaps in ICU recovery clinic care delivery during the COVID-19 pandemic included a need for multidisciplinary team members, access to care issues (e.g., digital poverty, health insurance coverage, language barriers), and altered family engagement.ConclusionsThis study demonstrates that addressing patient-level factors such as efforts to integrate social care, address financial needs, refine provider communication skills (e.g., empathic listening), and enhance focus on reconstructing the illness narrative became important priorities during the ICU recovery clinic visit during the COVID-19 pandemic. We also identified several ongoing gaps in ICU recovery clinic care delivery that highlight the need for interventions focused on the integration of social and clinic services for critical care survivors.

Objectives:To identify the clinical profile, etiology, and outcome of culture-positive mycotic keratitis in a tertiary referral centre in the northeastern part of Malaysia.Materials and Methods:A retrospective review of all patients with culture-positive mycotic keratitis in Hospital Universiti Sains Malaysia over a 3-year period, from January 2015 to December 2017.Results:This study included 27 eyes of 27 patients treated for mycotic keratitis based on a positive fungal culture. The most common predisposing factor was ocular trauma, in 22 patients (81.5%). Eleven patients (40.7%) had a presenting visual acuity worse than 6/60, due to central ulcer involvement. Approximately half of these (6 patients) experienced visual improvement post-treatment. Fusarium spp. was the most common fungus isolated (37%), followed by non-sporulating fungi and Curvularia spp. Three patients (7.4%) had corneal microperforations, which healed after gluing and bandage contact lens application. One patient (3.7%) required tectonic penetrating keratoplasty and 1 patient (3.7%) underwent evisceration. The final visual acuity was 6/18 or better in approximately half (14 patients) of our cohort and worse than 3/60 in approximately 20% (5 patients).Conclusion:Mycotic keratitis occurred mainly in males and secondary to ocular trauma. The most common organism isolated was Fusarium spp. Although treatment may improve vision, the visual outcome is guarded.

ABSTRACT This article explores the academic trajectories of transnational postgraduates. We draw upon interrelated theories of globalization and transnational social fields to frame the globalizing social and educational contexts in which international students navigate their lives and careers after earning doctoral degrees. We draw on in-depth interviews where transnational postgraduates’ voices are placed at the center of the findings, and we explore how their background, journey, and environment simultaneously shaped them as well as transformed the spaces they inhabited. We highlight how the movement of transnational postgraduates is not simply a transfer from one physical location to another, but rather that the movement itself constitutes and structures a new space of identification and of belonging and global imagination.

Individuals acting as surrogate decision makers for critically ill patients frequently struggle in this role and experience high levels of long-term psychological distress. Prior interventions designed to improve the sharing of information by the clinical team with surrogate decision makers have demonstrated little effect on surrogates' outcomes or clinical decisions. In this report, we describe the study protocol and corresponding intervention fidelity monitoring plan for a multicenter randomized clinical trial testing the impact of a multifaceted surrogate support intervention (Four Supports) on surrogates' psychological distress, the quality of decisions about goals of care, and healthcare use. We will randomize the surrogates of 300 incapacitated critically ill patients at high risk of death and/or severe long-term functional impairment to receive the Four Supports intervention or an education control. The Four Supports intervention adds to the intensive care unit (ICU) team a trained interventionist (family support specialist) who delivers four types of protocolized support-emotional support; communication support; decisional support; and, if indicated, anticipatory grief support-to surrogates through daily interactions during the ICU stay. The primary outcome is surrogates' symptoms of anxiety and depression at 6-month follow-up, measured with the Hospital Anxiety and Depression Scale. Prespecified secondary outcome measures are the Patient Perception of Patient Centeredness Scale (modified for use with surrogates) and Impact of Event Scale scores at 3- and 6-month follow-up, respectively, together with ICU and hospital lengths of stay and total hospital cost among decedents. The fidelity monitoring plan entails establishing and measuring adherence to the intervention using multiple measurement methods, including daily checklists and coding of audiorecorded encounters. This approach to intervention fidelity may benefit others designing and testing behavioral interventions in the ICU setting. Clinical trial registered with www.clinicaltrials.gov (NCT01982877).

ABSTRACT Objective To examine the clinical utility of 11-13+6 weeks scan for screening for chromosomal abnormalities and to assess the potential value of the same ultrasound examination in the early diagnosis of fetal structural anomalies. Design A prospective interventional study at Fetal Medicine Unit, Fernandez Hospital Pvt Ltd, a tertiary care perinatal center, Hyderabad, India, between September 2005 and March 2010. Methods All pregnant women < 13+6 weeks at booking are offered a routine obstetric scan between 11 and 13+6 weeks. All scans are done by obstetricians who are accredited by Fetal Medicine Foundation. All expectant mothers undergoing 11-13+6 weeks scan were included; all expectant mothers with antenatal booking after 14 weeks were excluded from the study. Results Between September 2005 and March 2010, a total of 11,012 scans were done between 11 and 13+6 weeks. Complete follow-up was available for 7,916 cases; 1,460 are ongoing pregnancies and 1,636 expectant mothers were lost to follow-up. The median maternal age in our population is 27 years and 340 (4.30%) mothers had advanced (> 35 years) maternal age. The median NT in our population is 1.58 mm. Increased nuchal translucency (NT > 95th percentile) was found in 362 (4.59%) scans. Miscarriages/abortions and termination of pregnancy were significantly higher in women whose fetus had an increased nuchal translucency thickness. Nuchal translucency thickness was significantly higher in women with advanced maternal age (ANOVA F = 0.002, Fishers exact test p-value for equality of medians = 0.04). Absent fetal nasal bones were present in 20 (5.57%) of women with increased NT compared to five (0.07%) women with normal NT. Among 7,916 women, 367 (4.64%) women were screen positive for chromosomal abnormalities. After counseling, only 40 screen-positive women accepted prenatal diagnostic procedures. Skull/brain abnormalities were found in 25 fetal images, abdominal abnormalities in 17, spinal abnormalities in eight, bladder abnormalities in five and cardiac abnormalities in five fetal images. Conclusion The 11-13+6 weeks ultrasound scan is an important diagnostic tool that should be offered to all pregnant women as a routine standard of antenatal care in the first trimester of pregnancy in India. However, as a screening tool, it mandates addition of cost-effective biochemical tests. To make the combined screening cost-effective, this study calls for making a national policy for Down's syndrome screening for India.

Healthcare professionals prescribe foot orthoses (FOs) for treatment and prevention of lower limb injuries, but previous reviews of the effectiveness of FOs have been inconclusive. We have therefore performed a review emphasizing the magnitude of treatment effects to evaluate the clinical effectiveness of FOs in the treatment and prevention of lower limb injuries.Qualifying studies were mainly controlled trials, but some uncontrolled clinical trials of patients with chronic injuries were analysed separately. Injuries included plantar fasciitis, tibial stress fractures and patellofemoral pain syndrome; these were included because of the large treatment costs for these frequent injuries in New Zealand. Outcomes were pain, comfort, function and injury status. Continuous measures were expressed as standardized differences using baseline between-subject standard deviations, and magnitudes were inferred from the intersection of 90% confidence intervals with thresholds of a modified Cohen scale. Effects based on frequencies were expressed as hazard ratios and their magnitudes were inferred from intersection of confidence intervals with a novel scale of thresholds.The effects of FOs for treatment of pain or injury prevention were mostly trivial. FOs were not effective in treating or preventing patellofemoral pain syndrome. Some studies showed moderate effects for treatment of plantar fasciitis. Only a few studies showed moderate or large beneficial effects of FOs in preventing injuries.Customized semi-rigid FOs have moderate to large beneficial effects in treating and preventing plantar fasciitis and posterior tibial stress fractures, and small to moderate effects in treating patellofemoral pain syndrome. Given the limited randomized controlled trials or clinical controlled trials available for the injuries of interest, it may be that more or less benefit can be derived from the use of FOs, but many studies did not provide enough information for the standardized effect sizes to be calculated. Further research with randomized controlled trials is needed to establish the clinical utility of a variety of FOs for the treatment and prevention of various lower limb injuries.