Scripta Medica

Factors Affecting Healthcare Employee Satisfaction and Their Relationship to Patient Satisfaction in Community Health Centres

Alva Cherry Mustamu — 2024-06-28

Background/Aim: In the realm of healthcare services, the satisfaction of medical professionals in their workplace environment has become a central concern closely associated with the perceived satisfaction levels of patients. This research investigated the intricate relationship between employee satisfaction and patient satisfaction within the context of community health centres. The study aimed to identify specific factors of employee satisfaction, such as compensation, supervision and work environment, that potentially influence the level of patient satisfaction.

Methods: Employing a cross-sectional descriptive design, a total of 162 employees and 276 patients from 13 community health centres participated in this study, conducted between June and September 2023. The participants were selected based on specific criteria, including age above 17, fluency in Indonesian and ability to complete the questionnaires. The study utilised two questionnaires: one measuring patient satisfaction with aspects of healthcare service and the other gauging employee satisfaction concerning management practices in community health centres. Both questionnaires employed Likert scale measurements to gather responses.

Results: The findings indicated a significant influence of investigated factors on patient satisfaction. Notably, compensation of employees emerged as a crucial factor significantly affecting patients satisfaction, aligning with previous research emphasising its importance in healthcare settings. Conversely, other factors such as supervision, work relationships, nature of work, opportunities for status change and work interactions with colleagues of employees did not exhibit a significant impact on patient satisfaction.

Conclusions: The study findings conformed the importance of compensation as a pivotal factor in designing strategies to improve patient satisfaction in community health centres. While other factors like supervision and work interactions did not demonstrate statistically significant correlations, this suggests the potential for more complex relationships that warrant further investigation. Identifying specific factors that influence patient satisfaction in community health centres can significantly contribute to enhancing healthcare service quality and overall patient satisfaction in the future.

Clinical and Pharmacological Analysis of the Acute Coronary Syndrome Patients Under 45 Years of Age: A Prospective Cohort Study

Saad Badai Nashtar — 2024-06-28

Background/Aim: Acute coronary syndrome (ACS) in young people is a problem of growing concern. There is an increasing need to evaluate this disease and predict its sequelae for better prevention and management. Aim of this study was to analyse clinical and pharmacological aspects of ACS hospitalised patients for a better evaluation and prediction.

Methods: The study included questionnaire based data taken from 225 patients (207 males, 18 females) admitted to Ibn Al-Nafees tertiary cardiac centre. Socio-economic, clinical and pharmacological data were obtained from all patients with follow up from time of admission to discharge.

Results: Male to female ratio was 11.5:1, anterior infarction was the predominant site (54.6 %), mortality rate was 1.3 %. Ejection fraction (LVEF) was below 45 % in 66.7 % of the patients, majority (70.7 %) with ischaemic hypokinesia. Smoking was the most common risk factor (77.3 %). Heart failure (HF) was the most common complication (57.3 %). There were significant relationship between HF occurrence and number of risk factors, LVEF, anterior site of ACS and number of echo findings. There were non-significant increase in relative risk of HF with each risk factor, positive troponin and pre-admission pain duration. Prediction tests showed an ascending positive slope of HF risk with number of risk factors, duration of admission and age.

Conclusion: There was a high rate of HF occurrence in this study which is mostly attributed to major wall damage due to blockage of the main coronary artery. Analysis demonstrated a good survival rate but high rate of HF occurrence urges for more consideration of guideline-directed management.

Clinical Characteristics and Hospitalisation Outcomes of Hypoglycaemia in Hospitalised Patients With Type 2 Diabetes Mellitus

Swarna Krishnamoorthy — 2024-06-28

Background/Aim: Strict glycaemic control delays the onset as well the progression of diabetes related microvascular complications. The major roadblock in achieving the target glycated haemoglobin (HbA₁c) and blood glucose levels is hypoglycaemia. The aim of this study was to assess the clinical characteristics and outcomes of hypoglycaemia in the type 2 diabetes mellitus (T2DM) hospitalised patients.

Methods: This was an observational study done for nine months in T2DM patients who had documented hypoglycaemia (blood glucose < 70 mg/dL) during the hospital stay. T2DM patients with hypoglycaemia on admission, hypoglycaemia due to anti-diabetic drug overdose, intensive care unit (ICU) patients with hypoglycaemia were excluded from the study. Eligible patients were categorised into two groups as symptomatic and asymptomatic hypoglycaemia. Clinical features, risk factors, hospitalisation outcome were compared between the symptomatic and asymptomatic hypoglycaemia group.

Results: Two hundred patients were enrolled in this study (n = 89, symptomatic group and n = 111, asymptomatic hypoglycaemia). Hypoglycaemic episode in past was significantly associated with symptomatic hypoglycaemic events during hospitalisation [34 (38.2 %) vs 27(24.3 %)], p = 0.01. Admission blood glucose levels (mg/dL), HbA₁c (%) were significantly higher in symptomatic hypoglycaemia group [(225.93 vs 178.72, p = 0.008), (8.55 ± 2.49 vs 7.72 ± 1.82, p = 0.007)], respectively. The blood glucose level during the hypoglycaemia episode was significantly higher in patients with asymptomatic hypoglycaemia group (56.38 ± 9.51 vs 44.22 ± 11.21 mg/dL, p < 0.001). Patients with HbA₁c ≤ 6 % were significantly higher in asymptomatic hypoglycaemia (n = 12, 10.8 % vs n = 2, 2.24 %, p = 0.02). Majority recovered fully without complications and got discharged (n = 155, 77.5 %).

Conclusion: In presented study, symptomatic hypoglycaemic patients had significantly higher admission blood glucose levels and HbA₁c %. Patients with HbA₁c < 6 % were significantly higher in asymptomatic group. Past history of hypoglycaemia was significantly associated with symptomatic hypoglycaemia during hospitalisation.

Effectiveness of Counterpressure Technique With a Birth Ball on Cervical Dilatation and Reduction of Labour Pain and Uterine Contractions: A Prospective Cohort Study

Adriana Egam — 2024-06-28

Background/Aim: Non-pharmacological interventions play a crucial role in managing labour pain and facilitating labour progression. The counterpressure technique is a commonly utilised method purported to alleviate pain and enhance cervical dilation during childbirth. However, its effectiveness remains a subject of debate, necessitating further investigation. This study aimed to evaluate the efficacy of the counterpressure technique in managing labour pain and influencing labour progression among women in labour.

Method: A randomised controlled trial was conducted involving participants in active labour. The intervention group received the counterpressure technique, while the control group received standard care. Pain levels, uterine contractions and cervical dilation were assessed and compared between the two groups.

Results: Analysis revealed no significant difference in pain levels or uterine contractions between the intervention and control groups. However, there was a significant increase in cervical dilation in the intervention group compared to the control group (p = 0.034, Cohen's d = -0.586).

Conclusion: Despite the counterpressure technique's limited impact on pain relief and uterine contractions, it significantly facilitated cervical dilation during labour. These findings contribute to understanding of non-pharmacological interventions in childbirth and underscore the importance of evidence-based approaches to labour management. Further research is warranted to elucidate the underlying mechanisms of the counterpressure technique and optimise its implementation in clinical practice.

Rare Occurrence of RHD Null Alleles With Del Expression Among Serologically D-Negative Blood Donors

Marko Lilić — 2024-06-28

Background/Aim: An investigation into the diversity of serologically D-negative blood donors in the Republic of Srpska entity of Bosnia and Herzegovina forms the basis of this research. The primary purpose of the study was the examination of RHD variants over a period of five years.

Methods: A comprehensive depiction of the RHD distribution in D-negative blood donors is achieved through a combination of serological observations and DNA testing (PCR-SSP with fluorometric signal detection), involving 74,149 blood donors. The adsorption/elution method was used to confirm the Del phenotype.

Results: A small fraction (0.31 %) of the serologically D-negative blood donors was found to contain eight different RHD alleles. The Del phenotype of the RHD*01N.03 and RHD*01EL.44 alleles was highlighted, challenging the common perception that these alleles are associated exclusively with a D-negative expression.

Conclusion: The importance of molecular methods in analysing and understanding Del variants, which typically elude conventional serological assays, is underscored by the findings. A group of donors seemingly having the RHD*01 allele but who lacked D antigen expression was encountered, hinting at the potential presence of still unidentified, possibly geographically restricted, RHD variants or alterations in other genes responsible for the expression of Rh proteins in the erythrocyte membrane.

Prevalence and Risk Factors of Psychological Distress Among Indonesian Incarcerated Male Juveniles

Prasetyo Aji Nugroho — 2024-06-28

Background/Aim: Adolescence is a developmental period that is rife with emotional problems as adolescents lack psychological maturity. Juvenile offenders who are incarcerated may be more vulnerable to psychological distress. Aim of this study was to analyse the prevalence and risks of psychological distress among male juveniles (MJs) incarcerated in Indonesia.

Method: The participants of this study were 206 male juvenile offenders (MJOs) aged 12-17 from 28 Special Child Development Institutions (Lembaga Pemasyarakatan Khusus Anak; LPKA) in Indonesia. The participants' socio-demographic data was gathered while the strength and difficulties questionnaire (SDQ) was used to assess the extent of their psychological distress.

Results: Of the 47.6 % of participants that reported psychological distress, peer relationship problems (64.6 %) was the most severe, followed by conduct problems (51.5 %). The binary logistic regression results revealed that education level (p = 0.005) and psychological trauma (p < 0.001) correlated with psychological distress and that they were responsible for 37.5 % of psychological distress. Therefore, education level and psycho-trauma significantly affect the extent of the psychological distress that MJOs in Indonesia experience.

Conclusion: Juveniles require support to further their formal or informal education. Furthermore, healthcare providers could develop appropriate interventions to manage specific traumatic events as well as prevent or improve the mental health of MJOs.

Inhibitory Effect of Selenium Nanoparticles on the Biofilm Formation of Multidrug-Resistant Acinetobacter Baumannii

Aleksandra Šmitran — 2024-06-28

Background/Aim: Treatment of infections caused by biofilm-producing multidrug-resistant (MDR) pathogens represents a huge global problem due to primary antimicrobial multi-resistance enhanced by reduced penetration of antibiotics in the biofilm-embedded bacteria. The aim of this study was to determine the capacity of biofilm production among MDR Acinetobacter baumannii (A baumannii) isolates obtained from different clinical specimens and to evaluate the inhibitory effect of selenium nanoparticles (SeNPs) coated with cationic polymer cetyltrimethylammonium bromide (CTAB) on the biofilm formation.

Methods: Antimicrobial effect of antibiotics (meropenem, imipenem, gentamicin, amikacin, ciprofloxacin, levofloxacin and trimethoprim-sulfamethoxazole) was determined by disk-diffusion assay, while sensitivity to colistin was determined with E test. All 60 isolates were tested on biofilm production in microtiter plates with crystal violet dye. Minimal biofilm inhibitory concentration (MBIC) of SeNPs was tested in order to prevent biofilm formation in microtiter plates.

Results: All tested clinical isolates were classified as MDR (n = 60) and extensively drug-resistant (XDR, n = 60). Out of the total 60 isolates, 55 isolates (92 %) showed the ability for biofilm formation, with the majority of them classified as strong (42 %) and moderate (42 %) biofilm producers. MBIC values of SeNPs for 55 biofilm-producing isolates ranged from 0.07 to 1.25 mg/mL. Strong biofilm producers had statistically higher MBIC (0.15 mg/mL) in correlation to other biofilm-producing isolates (0.07 mg/mL). There was no correlation between invasiveness of isolates with biofilm production and MBIC values.

Conclusion: Presented results are very promising and interesting especially in nanotechnology and medical fields, while SeNPs with the addition of cationic surfactant inhibit biofilm formation of MDR A baumannii clinical isolates.

Comparison of Dexmedetomidine and Fentanyl as Adjuvants to Intrathecal Isobaric Levobupivacaine in Lower Segment Caesarean Section

Talha Rehman Zahid — 2024-06-28

Background/Aim: Caesarean section is one the most common surgeries encountered in the operating room worldwide in the younger demographic ages from 18-39 years of age. The objective of this study was to compare the efficacy of dexmedetomidine versus fentanyl as adjuvants to intrathecal levobupivacaine in the lower segment caesarean section.

Methods: This quasi-experimental study was carried out at the Anaesthesia Department, Combined Military Hospital, Rawalpindi, Punjab, Pakistan from July 2021 to July 2023. A total of 240 patients were studied. They were divided into the dexmedetomidine group (n = 120) and fentanyl group (n = 120) group. Patients in both groups received 2.5 mL of 0.5 % of isobaric levobupivacaine with the dexmedetomidine group receiving 5 mcg of the drug and the fentanyl group 25 mcg of fentanyl to a total volume of 3 mL. Primary variables measured were: time to complete sensory and motor block, total duration of the block, time to first rescue analgesia after block regression in the post anaesthesia care unit (PACU) and mean PACU stay. Secondary variables observed were hypotension, nausea, vomiting and shivering.

Results: The time on onset for a sensory block in the dexmedetomidine group was delayed compared to the fentanyl group (4.35 ± 0.14 min and 3.39 ± 0.11 min, respectively), (p < 0.0001). The duration of the block was longer for the dexmedetomidine group with a mean time of 327.26 ± 12.60 min versus 243.3 ± 22.75 min (p < 0.0001). When comparing the motor blockade, the time of onset to successfully reach Bromage score 3 was similarly delayed in the dexmedetomidine group with a mean time of onset of 3.33 ± 0.12 min versus 2.36 ± 0.09 min (p < 0.0001). A similar trend was seen in the duration of the block with a mean time of 262.17 ± 13.31 min versus 203.34 ± 1.47 min (p < 0.0001).

Conclusion: Dexmedetomidine offered advantages over fentanyl as an adjunct to levobupivacaine spinal anaesthesia with a longer block duration and less adverse effects profile. It is recommended to use dexmedetomidine due to its better safety profile, longer duration and better hemodynamic stability. Fentanyl should be reserved when the early onset of the block is required in emergency cases.

Innovative Approaches for Onychomycosis Treatment: An Insight Into Natural Remedies and Novel Pharmaceutical Formulations

Hitesh Chopra — 2024-06-28

Onychomycosis, commonly referred to as nail fungus, is a persistent and difficult-to-treat condition that affects both toes and fingernails. Even though traditional treatments such as antifungal medications and topical ointments are effective in some cases, they are often associated with significant side effects and a high recurrence rate. There has been a growing interest in alternative and complementary treatments in recent years, including natural remedies and new pharmaceutical formulations, which are becoming increasingly popular. This review aims to explore the current state of knowledge surrounding onychomycosis treatment and its challenges, with a particular focus on the benefits and limitations of the current therapeutic options. Also, light is shed on the prospects available as treatment options.

Blockchain Technology in Pharmaceutical Industry: A Review of Recent Research Articles on PubMed

Varun Pareek — 2024-06-28

Blockchain technology has emerged as a formidable force ready to transform the pharmaceutical business. This study investigated the integration of smart contracts and decentralised apps as potential future possibilities, emphasising their ability to automate crucial operations and strengthen pharmaceutical product integrity, based on the recently published articles in PubMed between 2015 to 2023 with “pharmacology” and “blockchain” as search keywords. Recent study backed up the idea that blockchain can improve openness, security and efficiency in the industry. According to research, it has the ability to speed up regulatory approvals while also considerably reducing the risk of counterfeit medications penetrating the supply chain. Furthermore, the ability of blockchain to disrupt existing intermediaries and enable disintermediation may result in a more streamlined and efficient industry. While there are implementation obstacles, the benefits of this technology in medicines are significant. Embracing blockchain promises a future of increased security, transparency and patient-centricity, ultimately changing healthcare. This article explored blockchain application in the pharmaceutical sector with innovations like Medledger and chaincodes, addressing drug tracing and supply chain security. It presents a structure for a private network using Hyperledger Fabric, showcasing blockchain's potential to enhance transparency, security and efficiency beyond traditional areas.

Bibliometric Analysis of Triggers on Environmental Stress Among Medical and Health Sciences Students at the University

Wawan Kurniawan — 2024-06-28

Continuing to improve services to students while studying on campus, lecturers and all elements at the university need information about triggers of environmental stress among medical and health sciences students. Thus, the purpose of this study was to explore triggers of environmental stress among medical and health sciences students in the university through bibliometric analysis by analysing the network visualisation, overlay visualisation and density visualisation on the topic. Bibliometrics analysis was used in assessing related topics. The data sources are based on online searches via https://app.dimensions.ai/. Data was collected on 3 December 2023. The literature followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. Data were analysed using VOSviewer and further analysed and reviewed by co-occurrence and co-authors. Four major themes of environmental stress were found in this study: 1) The internal situation in the university; 2) External situations outside of the university; 3) Comfort situation during the study; 4) Academic process. Environmental stress factors related to internal situation in the academic situation were academic stress, air pollution, anxiety in the academic process, COVID-19, depression, fear, medical student, nursing student, physical activity, school regulation, smoking and uncertainty of study. From the visualisation and density visualisation, it can be seen that the academic process related to the duration of study was a trending theme discussed in several papers related to triggers of environmental stress among students in the university. All elements of the university especially policy makers should pay attention to this problem to reduce the risk of stress while students are studying.

Metformin and Vitamin B12 Deficiency – What is the Evidence?

Bruno Daniel Oliveira Peixoto — 2024-06-28

The widespread adoption of metformin as a primary therapeutic agent for type 2 diabetes has prompted inquiries into its potential impact on vitamin B₁₂ (cobalamin) levels and subsequent deficiency. This study aimed to elucidate this complex relationship and enhance the care provided to patients undergoing metformin treatment. A comprehensive search of meta-analyses, systematic reviews, randomised controlled trials and guidelines published between January 2010 and September 2021 was conducted. MeSH terms 'metformin' and 'vitamin B₁₂,' along with corresponding DeCS terms, guided the search. Varied recommendations from different scientific associations underscore the need for regular monitoring of vitamin B₁₂ levels in patients undergoing long-term metformin therapy. Different durations of metformin exposure, spanning from 6 weeks to 48 months, were associated with decreased vitamin B₁₂ concentrations. Observed decreases in B₁₂ concentrations ranged from 7.7 to 65.8 pmol/L, with percentage reductions ranging from 6.3 % to over 35 %. The evidence highlights a dosage-dependent correlation between higher metformin doses and an increased prevalence of B₁₂ deficiency. The results obtained highlight the association between metformin and B₁₂ deficiency. The prevalence of B₁₂ deficiency under metformin is of a greater magnitude than the one declared on the Summary of Product Characteristics approved by the medicine regulatory agencies. Thus, clinicians should be aware of this possible side effect when prescribing metformin, in order to prevent, monitor and treat if present.

Radiological Changes in Leprosy Patients With Disabilities and Deformities of Hands and Feet

Sunakshi Sharma — 2024-06-28

Background/Aim: Leprosy (Hansen's disease) affects the skin and nerves. Hands and feet are commonly involved in all types of leprosy often leading to deformities. This study explored radiological changes in leprosy patients with hand and foot disabilities/deformities.

Methods: Observational retrospective study was the chosen design. Study was conducted on 50 leprosy patients presenting at a tertiary care hospital with hand and foot disabilities during 2020-2022. Leprosy types were clinically diagnosed, confirmed by acid-fast bacilli staining. Bacteriological index (BI) and morphological index (MI) were calculated via Ridley's scale. Histopathological examination of the skin lesions was also conducted. Radiological exams, anteroposterior and lateral X-rays, identified specific/non-specific bone changes.

Results: Mean age was 38.8 years, bone changes identified at 40.3 years. Radiological changes were seen in 42.0 % patients (34 % patients had non-specific and 16 % had specific changes). These changes were seen more common and earlier in females as compared to males, the difference however was not significant (p = 0.6). Mean BI (2.8) and MI (32 %) of the patients with bone changes were slightly higher than those without bone changes but the differences were not statistically significant (2.2 and 27 %) (p = 0.2). Common specific changes were periostitis and subarticular erosion while osteopenia and phalangeal resorption were the most common non-specific changes.

Conclusion: Non-specific bone changes were more common than specific ones and in females as compared to males. Lepromatous leprosy (LL) was associated with maximum bone changes with varied involvement in other types of leprosy.

Is Surgery of Atypical Carcinoid Possible During Active Pulmonary Tuberculosis?

Lora Novaković Lacković — 2024-06-28

Atypical lung carcinoids are rare compared to other lung cancers and are classified as tumours of medium malignancy. Pulmonary tuberculosis is the second leading cause of death from infectious diseases. The paper presents the case of a 46-year-old female patient who was surgically treated during acute tuberculosis. The patient recovered and is under the supervision of a pulmonologist oncologist.

Data on Smoking Across Three Generations Increase Both Smoking Prevention and Cessation

Rajko Igić — 2024-06-28

There is an association between grandparent (G1), parent (G2) and child (G3) on smoking behavior. The transmission of smoking behavior from one generation to the next takes place not only through genetics, but also by environmental influences. When smokers and non-smokers realize what factors contributed to smoking, this knowledge increases motivation for both prevention and quitting.