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Background and Objective: Pressure ulcers regarded as preventable but occur in approximately 5% of all hospitalized patients (range of 3% to 12 % in published literature). It is more common in paraplegic patients. Only after the complete debridement of slough in grade 3 and grade 4 pressure sores the healing progresses and the infection can be controlled. A chemical solution of 5%Tankana in Gomutra Arka was reviewed in the management of a case of pressure ulcer. Presentation of Case: A 26 year old male hemiplegic patient presented with a wound in the sacral region which was diagnosed as a Grade 4 pressure ulcer measuring 12x13 cm. Manual Debridement of ulcer was associated with bleeding. Methodology: There after the solution of 5% Tankana in Gomutra Arka was applied upon the wound by soaking a gauge with the above solution. A regular passive movement of the lower part of the body was done to prevent further development of new Ulcer. Result: After 3 days of dressing 90 % or slough was reduced, discharge from the ulcer reduced and progression of infection had stopped. Discussion: Pressure ulcers impose an economic burden on the patient and common problem amongst bed ridden patients. Grade 4 pressure ulcers have a poor prognosis. Manual slough removal is usually associated with bleeding. Chemical debridement not only helps us in avoiding instances of bleeding but also is more effective in its reach and action. Conclusion: In this case 5% Tankana bhasma in Gomutra Arka was found to be very effective in slough removal which in turn reduced the total duration of management. Use of Chemical debriding agents in a grade 4 ulcer had hastened the process of slough removal and improves the overall rate of recovery. Mixture of Tankana and Gomutra Arka seemed to complement each other’s action on Vrana Shodhana. How to cite this article:Kumar BK, Sweta KM. Role of 5% Tankana bhasma in Gomutra Arka as a Chemical Debridement agent in the Management of Pressure Ulcer - A Case Report. J Adv Res Ayur Yoga Unani Sidd Homeo.2021;8(1&2):1-4.

Background: Unplanned hospital readmission is concerning health care providers and is frequently used as a quality indicator for hospital care. Objectives: This study was conducted in order to examine the rate and associated factors for 30-day readmission in internal medicine units at King Abdulaziz University Hospital, Jeddah. Methods: We retrospectively collected data for patients who had readmission within 30 days of hospital discharge from January 2010 to December 2013. We obtained the following information for all patients: patient demographics, admitting medical service, diagnosis at the first admission, presence of hypoxia, sepsis, and hospital length of stay at the first admission. We then compared the data for patients with 30-day readmissions to those who did not have readmission within 30 days Results: Of the 3838 patients who had hospital admission within the study period, 678 (17.7%) had readmission within 30 days. The mean patient age was 52 years (SD, 21.2 years). Patients who had readmission within 30 days were more likely to be female; older than 65 years of age; diabetic; hypertensive; bed ridden; and to have a history of stroke, bed sores and/or sepsis (all P values ≤0.001, except for stroke, P=0.003). Conclusion: Our study showed that about 18% of patients had readmission within 30 days. Those patients were of older age, with comorbidities like, diabetes or stroke or were bedridden.

DOI: https://doi.org/10.3126/jucms.v6i2.22471 Introduction: Height is a significant parameter for growth and development of an individual. Arm span and knee height measurement are useful when accurate measurement for stature is unobtainable. Studies have shown that the relationship between stature and arm span varies with age and population. Thus, the aim of the present study was to analyze the correlation between stature and two measurements; the arms span and knee height of medical students of Kathmandu Medical College Public Limited, Kathmandu, Nepal. Materials and methods: This is a descriptive study. A total two hundred medical students, presently studying at Kathmandu Medical College, aged between eighteen and twenty eight years were randomly selected as the subjects for the present study. Among them, seventy six were females and one hundred twenty four were males. Arm span and knee height was measured by flexible steel tape and height was taken by stadiometer. The collected data were tabulated and SPSS 20 was used to perform analysis. Results: There is statistically strong correlation (r) between height and arm span (r=0.858, =0.736; r=0.849,=0.720, p

Muscle atrophy occurs in human musculature system due to inactivity of muscles in microgravity environment. Herein, a novel designed countermeasure gravitational load modulation bodygear is developed to enhance muscle activity. The bodygear is devised to compress the body through axial loading from shoulder to feet. The time and frequency domain parameters of electromyography (EMG) signals showed that the activity of gastrocnemius and soleus muscle was increased by 87% and 90% respectively in comparison to without bodygear during stepping. The enhanced muscle activity might be due to the increase in the recruitment of extra motor units, increase in contraction and more potential firing in muscles with bodygear. The results of analysis of variance confirmed that the root mean square, peak and mean frequency values were increased significantly (p

Amavata is one of the most challenging diseases caused by Ama combining with vitiated Vata Dosha. The disease Amavata manifests where patient cries out of pain, severe stiffness, loss of appetite, vague body ache and crippling deformity of joints, which make them bed ridden. Having several features similar to Rheumatoid arthritis, Amavata is generally compared with it. Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. Pain and stiffness often worsen following rest. Pain medications, steroids, and NSAIDs are frequently used in contemporary science, to treat the disease. Disease modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine and methotrexate, are also used to slow the progression of disease but these have their own side effects. Jaloukavacharana described in Ayurveda plays a major role in reducing pain and swelling. Hence an effort has been made in this present study to evaluate the efficacy of Jaloukavacharana in the acute management of pain in Amavata. 10 subjects between 20-60yrs with classical symptoms of Amavata were selected from IP section of SJIIM Hospital, Bengaluru. The assessment was done before the day of initiation of treatment, after the treatment and on 8th day. Clinically patients found significant relief in pain, swelling and range of movements after one sitting of Jaloukavacharana, hence it can be concluded that Jaloukavacharana is effective in management of pain in acute phase of Amavata.

Background: Tuberculosis and human immunodeficiency virus (TB/HIV) co-infection is an important global public health problem. The consequence of co-infection is multidirectional. The mortality rate of co-infected patients’ comes from many aspects or factors. Identification of these factors is important for planning and for the intervention of care and treatment.Objective: To assess tuberculosis and human immunodeficiency virus co-infected patients’ mortality rate and its predictors in Dire Dawa, Eastern Ethiopia. Method: Institution based retrospective cohort study was employed among 471 randomly selected TB/HIV co-infected patients enrolled from January, 2012 to December, 2016. Relevant variables of data were collected from patients ‘medical cards. The collected data were entered into Epi-data 4.2.0.0 and exported to SPSS version 24 for analysis. Univariate analyses were used to describe the baseline characteristics of the patients. Kaplan Meir curve were used for the comparison of time to recovery among the different groups of patients and Cox model was used to identify independent predictors. Result: A total of 79(16.8%) deaths occurred during the median follow-up period of 685 days. being infected with pulmonary tuberculosis(PTB) [AHR=1.99(95%CI:1.16-3.41)], WHO clinical stage III [AHR=2.88(95%CI:1.56-5.30)], IV[AHR=4.20(95%CI:2.21-8.01)], ambulatory functional status[AHR=4.15(95%CI:1.57-10.98)], bedridden functional status [AHR=6.34(95%CI:2.43-16.59)] and delayed Co-trimoxazole preventive therapy [AHR=2.45(95%CI:1.54-3.91)] were important predictors associated with high mortality rate of TB/HIV co-infected patients. Conclusion: About one to six TB/HIV co-infected persons died in their course of treatment follow-up. Important contributing factors were PTB infection, WHO clinical staging III and IV, ambulatory and bed ridden functional status and delayed Co-trimoxazole preventive therapy.Key words: Dire Dawa, Ethiopia, Retrospective cohort, mortality rate, TB/ HIV co-infection. Funding Statement: No financial support was gained to conduct the study. Declaration of Interests: The authors state that they have no competing interests. Ethics Approval Statement: This study has got ethical approval from Haramaya University College of Health and Medical Sciences, Institutional Health Research Ethical Review Committee (IHRERC). Permission for data collection was also secured from each hospitals and Health Centers.

Purpose Over 8 per cent of the Dutch nursing home population is bedfast, and this number is slowly increasing. The quality of life (QoL) of this population is lower than that of residents who are still mobile. Little research has been conducted on how to improve the QoL of this bedfast population, particularly through making technological adjustments to the bed and the direct surroundings. The purpose of this paper is to gain insight into the QoL of bedfast residents and how to improve this through technology. Design/methodology/approach A mixed-method multi-case study with thematic analysis was conducted in two nursing homes with seven participants based on semi-structured interviews and Short Form-12 questionnaire. Findings The major causes of the experienced low QoL were the limited opportunities for engaging in social contacts with others, and coping with the dependency on other people and having limited control. Participants suggested improvements of QoL through the application of modern communication technologies to engage in social contacts and to control the bed itself and environment around the bed. Practical implications The results may help improve the design of the bed and the direct environment in order to improve the QoL of bedfast nursing home residents. Originality/value The QoL of bedfast nursing home residents has not been studied before in relation to the bed itself and technological solutions that may help improve the QoL and level of control.

Intertrochanteric fractures management in elderly pose a serious challenge to the new age orthopaedic surgeons. The implants have evolved from extramedullary implants like dynamic hip screw to the intramedullary types of PFNA2 nail. The main goal of fixing such fractures which hardly complicate with non-union are early mobilization of patient in order to prevent complications of prolonged bed ridden status. 50 patients were included in our study from July 2017 to June 2019. 25 patients were treated with PFNA and PFNA2 Nails. We recorded age, sex, mode of injury, associated injuries and comorbidities of patients. Fracture patterns were classified. We found that PFNA2 had less blood loss intraoperatively and better results with respect to nonunion rates, compared to PFNA implant.

In today’s world more death occurs due to not immediate treatment for bed ridden patients. It also requires more man power. This document presents the model, installation and looks of a hardware and software platform for health monitoring system for patients. The main purpose of this system is to set up a system that can watch over bedridden patient’s health. This project depends on both hardware and software. It is developed using sp02, temperature, heartbeat connected to a raspberry pi micro controller, which get the sensor values and process it in machine learning process to produce a dosage prediction. It also intimates the doctor by triggering an automatic email. In addition, one can know the patients records and prediction of dosage from anywhere using the mobile application linked with it.

BACKGROUND Deep venous thrombosis (DVT) is a major cause of morbidity and mortality among hospitalized patients worldwide and, simultaneously, the most preventable. Studies revealed several risk factors of deep venous thrombosis in hospitalized patients. OBJECTIVE to identify frequency and factors associated with occurrence of deep venous thrombosis among diabetic patients referred to King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia. METHODS This cross-sectional hospital-based study was conducted from June to December, 2016. All diabetic patients referred to the hospital departments and who were suspected to have deep venous thrombosis (DVT) and subjected to Doppler examination were included in the study. A questionnaire was designed to obtain data about deep venous thrombosis frequency among participants and factors associated with the development of deep venous thrombosis among them. Data was collected through face to face interviews with patients included in the study. We used SPSS version 16 for data analysis through descriptive statistics and Chi-square test. RESULTS DVT was detected in 14.7 % of the examined patients. There were significant and positive associations between age and DVT (X2=10.13, p=0.03) and between ischemic heart disease and DVT (X2=1.628, p=0.043) with the development of deep venous thrombosis among the studied patients. On the other hand, gender, other comorbidities, history of previous DVT, being bed ridden and using orthopedic casting were not significantly associated with the occurrence of deep venous thrombosis among the participants. CONCLUSION DVT development rate among the participants was 14.7 %. Aging was significantly associated with DVT occurrence. Most of the studied factors and comorbidities had no significant role in DVT development among participants and only ischemic heart disease was significantly associated with DVT development.

Fecal impaction is common in elderly, bed ridden, schizoaffective patients on antipsychotics. Intestinal obstruction due to distal colonic fecaliths is rare as it is amenable to digital manual evacuation and enemas. Our patient presented with abdominal distention, with last bowel evacuation reported 3 months ago. Computed tomography (CT) abdomen demonstrated a huge sigmoid fecalith causing bilateral hydronephrosis. He was managed through laparotomy with sigmoid colon resection and end colostomy., We present the case of a fecaloma presenting as a huge abdominal mass.

Modern science and technology has been increasing rapidly for human convenience. But, these convenient methods and techniques have made human an idle being with everything has been got in a single touch. People who are aged and disabled are meant to be idle in their respective places. This has become the major and initial cause of decubitis ulcer, what we call bed sore. So, we have came up with an idea of preventing such sores that are caused because of the immobility of people. We can prevent such sores by providing a even blood circulation throughout the body. This can be achieved only through bodily movements of patients who are elderly and disabled. So, a blood flow equalizing bed will be very much useful to those decubitus ulcer victims and bed ridden patients. This blood flow equalizing bed will provide automatic physiotherapic movements to those patients by changing the positions of bed and thereby the prevention of such sores can be very much achieved. The change in position of bed is done with linear actuators connected to bed which are driven by DC motors providing high torque. The DC motors are controlled by a motor driver board which is programmed through an Adriano open source software that providing the timing and limits of the positions of bed.

Background: Millions of people all over the world are living with degenerative disc disease, some bed ridden, others with crippling pains, while some have intermittent pains that reduce their productivity. Appropriate treatment that will be preventive, curative, and cost-effective is still being sought for. Objective: To find out the treatment outcome of patients who were managed with sit up exercise for degenerative disc disease over a five year period. Methods: It was a prospective study of patients managed in our center for degenerative disc disease using sit up exercise from January 1, 2014 to December 31, 2018. Patients were clerked and physically examined in the clinic noting the site(s) of pain and muscle weaknesses. Sit up exercise and passive muscle movement (for those with muscle weakness) were done. Paracetamol and Diclofenac were given for pains. Results: Thirty five patients qualified for the study. Males were twenty. The average age was 57·14 years. Sixteen patients had pain and muscle weaknesses. In 96·97% of patients with pain and 83·33% of patients with muscle weakness, the symptoms/signs resolved within six months. Age played significant role in region involved P = 0·01, duration of symptoms P =0·00, and time for pain to resolve P = 0·00. There was significant relationship between gender and symptoms P = 0·04, and time for pain to resolve P = 0·01 Conclusion: Thirty four patients recovered with sit up exercise, while the 35th patient is still improving. Age and gender played significant roles in the disease. Funding Statement: There was no sponsorship. Declaration of Interests: There was no conflict of interest. Ethics Approval Statement: The study was component of our prospective data bank that was approved by our hospital research and ethics committee.

Background Repositioning of individuals with reduced mobility and at risk of pressure ulcers is an essential preventive step. Manual or automatic lateral tilting is a way of doing this and the international guidelines propose a 30° to 40° side lying position. The goal of the present study was to determine the internal strains in individuals lying in a supine position and during tilting. Methods Based on magnetic resonance imaging (MRI) of the sacral area of human volunteers, subject specific finite element models were developed. By comparing calculated contours of the skin, fat and muscle with MRI measurements on a flat surface the models were validated. A parameter study was performed to assess the sensitivity of the model for changes in material properties. Simulations were performed at tilting angles of volunteers between 0° and 45°. Findings Subjects in a supine position or tilted have the highest strains in the muscle and fat. Tilting does affect the strain distribution, taking away the highest peak strains. There seems to exist an optimal tilting angle between 20° and 30°, which may vary depending on factors such as BMI of the subject and is in the current paper investigated only for the sacrum. Interpretation The study shows that tilting indeed has a significant, positive influence on internal strains, which is important for the prevention of deep tissue injury. Additional studies are needed to draw conclusions about the greater trochanter area and the tissues around the shoulder.

ALS is a degenerative disease which affects the patients muscular activity in feet and hands, leading to a bed ridden status. The loss of independency affects their will to live, for this reason an environmental control system to handle the home appliances and make telephone calls is proposed. The system uses a tablet as a visual human interface so that the patient can select the desired appliance by selecting the corresponding item on the tablet screen. Based on the remaining patient’s abilities an input device that detects slight finger movement is proposed. In this paper three types of input devices are considered and their performance is evaluated by four ALS patients. Their comments about the usage of the devices are discussed in this work. Finally the environmental control was implemented on an ALS patient home and their impressions were satisfactory for the patients, relatives and care-givers.

In this work we propose a non-wearable sensor based approach for longitudinal monitoring of the primary health conditions without using the wearables. The approach adapted is using the varied sensors and the algorithms to arrive at the non-obstructive continuous holistic monitoring of the primary health conditions (Obesity, Stress and Posture). The approach uses the slouch angle, curvature information, and deformity map to determine the type of the posture of the person, pressure sensors for obesity and stress is computed by analyzing the heart rate variability. The application of this approach is envisioned for the office based setting, pregnant women, bed ridden patients and for postoperative care.

Objective: It was to find out the efficacy and benefits of anterior cervical spinal stabilization procedu-res in cases of cervical trauma.Material and Methods: It is a prospective study of 30 cases of Cervical Spinal Trauma in which anterior cervical spinal stabilization and fusion was performed. Study span is three years i.e from July 2005 to June 2008 with follow up period of one year and it was carried out in the Department of Neurosurgery, Quaid-e-Azam Medical College / Bahawal Victoria Hospital Bahawalpur.Results: 30 cases of cervical spinal trauma were included in the this study. Age range was 15 years to 40 years. Twenty three (23) were males and seven (7)) were females with male to female ratio of 3.2:1. Most common cause of cervical spinal injury was road traffic accidents and most common site of traumatic involvement was C5/C6 cervical spinal level. All the patients were belonging to poor and middle socio-economic class. Nine (9) patients sustained complete cervical cord injury and they were quadriplegic and remaining twenty one (21) patients were quadripretic as a result of partial cervical cord injury. All patients were assessed clinically and radiologically. Plain X-rays of cervical spine, AP and LAT. views, C-T scan and MRI of cervical spine were obtained to get information of injuries in detail. In almost all the cases, anterior two columns of spine were disrupted resulting in instability and cord compression. In all the cases cervical traction was applied to get alignment of the cervical column first and then anterior fixation and fusion was performed. All patients were mobilized early after surgery.Outcome: Nine (9) cases with complete cord injury did not improve neurologically after surgery. Eleven (11) patients with partial cord injury and power of G 3/5 before surgery improved to G 4+/5 after surgery and ten (10) patients with power G 2/5 before surgery improve to G 3/5 after surgery. All patients were out of bed early, to prevent the complications of being and ridden for long time.Conclusion: Anterior cervical spinal fixation and fusion is an excellent way of cervical spinal stabilization in cases of cervical trauma. Patients improve Neurologically with these procedures and they are mobilized early from the beds to prevent complications of being bed ridden for longer periods of time.

The present study proposes an assistive device for the bed-ridden persons. The ocular activity of the bed-ridden patients is not lost even during the condition of limited or no motor activities. The proposed device acquires biosignals associated with the eye blinks and activates an alarm or communication protocol. The device is capable of communicating via SMS, e-mail and voice calls to a landline/mobile number once activated. The device can enable the patients to interact with the healthcare-givers whenever they are in need. Hence, the device is supposed to reduce the workload on the healthcare-giver.

Introduction Since the , emotional intelligence is related with components mental and physical healths so the main aim of present research is studying the effects of emotional intelligence training on systolic and diastolic blood pres and pulse rate among patients with cardiovascular disease. Method This study is a quasi-experimental research that designed for 30 womens to heart disease from Coronary artery type that bed ridden in Tehran Modares hospital.The womens were randomly divided into two groups experimental and control group. After the measurement of systolic blood pres, diastolic blood pres and pulse rate Participants, emotional intelligence was taught to experimental group over seven ninety- minute sessions. Then both experimental and control group Measurements were again .data are analyzed using Co-variance test(Ancova). Results The findings of research showed that : emotional intelligence training in significance level(p0.05) reduces the rate systolic and diastolic blood pres among womens to heart disease from Coronary artery type ( p 0.006 , p 0.003) but in this patients in significance level(p0.05) pulse rate didn,t reduce ( p 0.978) . Conclusion This emotional intelligence training has an important role in reducing systolic and diastolic blood pres rate among womens to heart disease from Coronary artery type. so results of this research can be used in programming interventional prevention and remedial ,like deployment of educational programs for patients with cardiovascular disease.

An elderly, bed ridden patient with a history of stroke was admitted for management of aspiration pneumonia. Two days after insertion of a nasopharyngeal airway, sudden respiratory distress prompted further investigations which led to the eventual diagnosis and removal of the nasopharyngeal airway that had been aspirated. The device was removed under conscious sedation with fiber optic bronchoscopy. Keywords: Nasopharyngeal airway, Aspiration, Respiratory distress, X-ray

Introduction: Recently, the diagnosis of occult frac- tures has been facilitated due to increased availability and utilization of MRI. Diagnosing a fracture of the ischiopubic rami from a proximal femoral fracture, in particular, is difficult using physical exam alone and can be facilitated by having access to an MRI. Here we report both physical exam findings and MRI findings that help in differentiating occult fractures of the iliopubic rami. Materials and Methods: From April 2010 to December 2012, we identified 30 pa- tients (5 male and 25 female; aged 43 - 93 years old). We recorded if a traumatic episode occurred, ambu- latory status at the initial visit (bed ridden, standing up with an aid, walking with an aid). We also re- corded if imaging was used in determining the final diagnosis (radiographs, MRI or CT). Results: Twenty- one patients had a fracture as a result of a traumatic episode. In the remaining 9 cases, no trauma oc- curred and therefore the fractures were insufficiency fractures. Ten patients were bed ridden at the initial visit, eight patients were able to stand only with a walking aid, and the remaining twelve patients were able to walk with an aid. Occasional radiographs were used to confirm the presence of a fracture in 4 cases, MRI in 11 cases, and CT scan in 15 cases. Dis- cussion and Conclusions: Occult fractures of the is- chiopubic rami can occur without trauma and it can be difficult to differentiate these fractures from occult proximal femoral fractures. In these cases, MRI is useful to definitively obtain a diagnosis. In cases of pacemaker, bullet implantation or artificial hip joints, CT or occasional radiographs are also useful to diag- nose occult fractures of the ischiopubic rami.

Pressure ulcers are the major problem in the stroke management and rehabilitation. Prevention of pressure ulcer is of keen interest and is achieved by frequently changing the position of patient on the mattress. However, the care needs to be intensive to address this issue; else it would lead to pressure ulcer or bed sores formation. Skin surface over the bony prominences provide comparatively more pressure than the other regions. Therefore they are called as pressure vulnerable regions. Skin over these regions is more susceptible for formation of ulcers. An engineering approach is needed to shift the accumulating pressure from the pressure vulnerable regions. Although pressure sensed in these region would be more than that of which sensed in other regions, shifting protocol has to be designed to channelize or to grade the pressure shift in order to avoid any injuries to the non pressure vulnerable region. This paper aims at devising one such protocol using MATLab and thereby designing the layout of mattress using Pro/Engineer: the number of partitions needed to cover the entire surface of the skin that is in contact with the mattress.

Objective Lisinopril is the drug of choice in hypertension. Bioavailability of the drug is 25% of orally administered dose. An attempt was made to provide safe medicine meeting pharmacokinetics requirement of plasma concentration by formulating a sublingual tablet of Lisinopril. The Objective of present study is to develop the sublingual tablet of Lisinopril and improve its bioavailability, in view to maximize therapeutic effect of the drug. Method The directly compressed tablet of Lisinopril was formulated using Mannitol, Micro Crystalline Cellulose and Kyron T-314 as super disintegrant. Formulation (F1-F7) was evaluated for disintegration time and in vitro release study. Further the optimized sublingual formulation (F6) and marketed formulation was subjected to in-vivo comparative bioavailability study using white New Zealand rabbits. Results It was observed that concentration of Micro Crystalline Cellulose, Kyron T-314 has significant effect on the disintegration time of Lisinopril sublingual tablet formulations. The super disintegrant concentration 5% w/w (Kyron T-314) was found optimum in all tablet formulations. AUC of optimized sublingual tablet and oral tablet are 925.35μg×h/mL and 641.97 μg×h/mL with Cmax of 60.80 μg/mL and 41.21 μg/mL and Tmax of 4 h and 4 h respectively. The bioavailability of optimized sublingual tablet of Lisinopril was improved by 1.44 times as compared to conventional oral marketed tablet of Lisinopril. Conclusions The present approach of formulating sublingual tablet of Lisinopril would definitely improve bioavailability leading to reduced conventional dose of this drug. The administration of sublingual tablet becoming easy and it will improve patient compliance to therapy for hypertension for pediatrics, geriatric and bed ridden patient.

9-years-old girl, previously healthy, presented with progressive dystonia. Clinically, she have dysarthria and spastic gait. Her parents are first-degree cousins. She have a paternal cousins who have a similar symptoms started 3 years ago, currently he is bed ridden. ![Graphic][1] Questions

Scabies is a contagious parasitic dermatitis that is a significant cause of morbidity, especially outside of the United States. Scabies is diagnosed most often by correlating clinical suspicion with the identification of a burrow. Although scabies should be on the differential for any patient who presents with a pruritic dermatosis, clinicians must consider a wide range of diagnostic possibilities. This approach will help make scabies simultaneously less over- and underdiagnosed by clinicians in the community. Atypical or otherwise complex presentations may necessitate the use of more definitive diagnostic modalities, such as microscopic examination of KOH prepared skin scrapings, high-resolution digital photography, dermoscopy, or biopsy. Scabies therapy involves making the correct diagnosis, recognizing the correct clinical context to guide treatment of contacts and fomites, choosing the most effective medication, understanding how to use the agent properly, and following a rational basis for when to use and reuse that agent. Although the development of new therapeutic agents is always welcome, tried and true treatments are still effective today. Permethrin is the gold standard therapy, with malathion being an excellent topical alternative. Ivermectin is an effective oral alternative that is especially useful in crusted scabies, patients who are bed ridden, and in institutional outbreaks. Despite the availability of effective therapeutics, treatment failures still occur, mostly secondary to application error (ie, failure to treat the face and scalp or close contacts, failure to reapply medication) or failure to decontaminate fomites. Because increasing resistance to scabies treatments may be on the horizon, we propose that standard of care for scabies treatment should involve routine treatment of the scalp and face and re-treating patients at day 4 on the basis of the scabies life cycle to ensure more efficient mite eradication. Practitioners should attempt to treat all close contacts simultaneously with the source patient. To eradicate mites, all fomites should be placed in a dryer for 10 minutes on a high setting, furniture and carpets vacuumed, and nonlaunderables isolated for a minimum of 2 days, or, for those who wish to be rigorous, 3 weeks.

The ability to live without the help of a caretaker enhances the quality of life of those who are bed-ridden or confined to a wheel-chair. A lot of systems have been proposed to support the daily life of bed-ridden. A smart home, especially a bed-type robot system, can help the movement and action of patients. This paper discusses the development of an intelligent bed robot system (IBRS), which can help the elderly and the disabled have independent life in bed. The IBRS is a special bed equipped with two robot arms and an array of pressure sensors attached to the mattress. The pressure distribution on the mattress is used to estimate the pose of the patient, and an appropriate assistance is provided by the robot arms. The proposed system has been tested experimentally for its effectiveness while maximizing the therapeutic outcome.

Background and objective: Unrecognized BPPV leads to activity limitations. This case report aims to report on use of optokinetic chart stimulation and one off Epley’s manouvre to treat unrecognised BPPV in chronic Meniere’s disease. Methods: This is a single case study in a care of the elderly rehabilitation ward. An 85 year old patient was admitted with abdominal pain, vomiting, clamminess and sweating. She was treated with one off right ear Epley’s manoeuvre and daily optokinetic chart stimulation. Results: The Barthel index improved from 5/100 pre-intervention to 50/100 postintervention and the Elderly Mobility Scale improved from 2/20 to 11/20.

Methods to improve patient’s compliance have always attracted scientists towards the development of fancy oral drug delivery systems. Among them, mouth dissolving drug delivery systems (MDDDS) have acquired an important position in the market by overcoming previously encountered administration problems and contributing to extension of patent life. MDDDS have the unique property of rapidly disintegrating and/or dissolving and releasing the drug as soon as they come in contact with saliva, thus obviating the requirement of water during administration. Therefore, these dosage forms have lured the market for a certain section of the patient population which include dysphagic, bed ridden, psychic, geriatric and paediatric patients. Several techniques have been developed in the recent past, to improve the disintegration quality of these delicate dosage forms without affecting their integrity. This article focuses on the technologies available and the advances made so far in the field of fabrication of mouth dissolving tablets. Apart from the conventional methods of fabrication, this review also provides the detailed concept of some unique patented technologies like Zydis, Lyoc, Quicksolv, Orasolv, Durasolv, Flashtab, Oraquick, Wowtab and Ziplet alongwith their advantages and limitations.

This study aims to develop the functional pants for the hospitalized bed-ridden patient. The procedure of this study consisted of three parts. First, the interview survey of nursing care givers was conducted to inquire into the conditions of bed-ridden patients` clothing. Second, the bed-ridden patients` pants design and sample making were accompanied. Then, the wearing tests and design development were completed. The results are as follows; The conditions of bed-ridden patients` clothing were the convenience of clothing change, the partial opening for diaper change and medical treatment and the ventilation for bedsore prevention. The design development of the bed ridden patients` pants was accomplished which had the side seams with two way opening zippers, the wraparound pattern of abdomen and the opening under crotch applied the advantage of korean traditional underwear sokkot. The samples` wearing tests were performed three times and those subjects were the hospitalized bed-ridden patients. Consequently, we suggested the appropriate hospitalized patients` pants for bed-ridden patient.

Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation.

Objectives: To assess the effects of home massage rehabilitation therapy on the bed-ridden elderly. Design: Alternatively allocated trial. Setting: Subjects' homes, three home nursing stations, 13 visit care stations and one day service centre in Aichi prefecture, Japan. Subjects: Bed-ridden patients who were 65 years and above, no dementia, stable general condition, and receiving no rehabilitation therapy. Intervention: Thirty-minute sessions of home massage rehabilitation therapy by a massage practitioner 2 or 3 days a week for three consecutive months or usual care. Main measurements: Barthel Index (BI), Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score. Results: Fifty-three subjects were recruited, 26 in the home massage rehabilitation group (HMG) and 27 in the routine care group without massage (RCG). The protocol was completed for 40 subjects, 22 in the HMG and 18 in the RCG. There were no significant differences between the baseline characteristics of both groups; age, presence of spouse, diseases associated with disabilities and use of day care rehabilitation (p / 0.76, 0.36, 0.94 and 0.71, respectively). The total BI score of the HMG (15.279=4.51) at baseline was nonsignificantly lower (p=0.03) than those of the RCG (11.449=5.90). Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score of both groups at baseline were matched (p / 0.12, 0.32 and 0.89, respectively). There were no statistical differences between the intergroup changes over time in BI, Subjective Satisfaction and Refreshment Scale, Apathy Scale and Self-rating Depression Score (p / 0.35, 0.08, 0.70 and 0.55, respectively). Conclusion: Home massage rehabilitation therapy did not show a positive effect on the bed-ridden elderly, either mentally or physically. We would require large-size trials to determine whether it is effective.

臥位では視野や動作が拘束されるために現状の什器は使い辛く, 臥床生活者は, ティッシュ, 体温計, 携帯ラジオなどの身の回り品の置き場に困っていた. この状況を改善するために, 男女各10名の被験者について臥位での作業域と視野を計測した. その結果, 身の回り品の配置に適した領域は, 臥床面からの高さ150～200mmの範囲で, 上肢を30～70°外転させた時に指尖点と手首によって描かれる円弧に挟まれた領域になることがわかった. この位置で利用でき, また邪魔なときは動かせるように, レールによる移動機構と支柱回りの回転機構を有する小型の収納什器 (300W×200D×250H) を開発した. これらの特性により, 本器は, 看護作業や既設什器との干渉なしに臥床者自身が自由に使用することができ, 臨床評価でも, 患者の自立が高まるなど, 患者, 看護・医療関係者から高い評価を受けた.

Disability may be broadly defined as a physical or mental condition that limits a person's movements, senses, or activities. Functional clothing is essentially designed to fulfil special requirements of the wearer including body disproportions or impairment. It also may affect a person's emotional wellbeing. This is an exciting field of study where opportunities of research, design and development of clothing for differently persons are being explored all over the world. Research and development of functional clothing in India is a relatively new field. This paper traces outstanding global advances in the field of functional clothing for the differently abled. Disabilities are of many types and functional clothing for each type of disability has entirely different requirements. Persons who are wheelchair bound, those who are bed ridden, persons who are spastic, autistic etc. all require different kinds of functional clothing. Clothing should be aesthetically appealing and should follow current fashion trends wherever possible; they should be easy to wear by themselves; they should be easy to care for and also provide the wearers with a sense of physical and mental comfort. Special requirements which arise from disabilities require the application of design and development to address the physical, physiological and mental issues for the differently abled. Global standards in quality, aesthetics and convenience should be followed so that such persons do not feel uncomfortable in any way. The paper introduces readers to new and exciting developments in the field of functional clothing for the disabled.

We are interested in healthcare for a bed ridden patient. Although a bed ridden patient in the hospital can be led to a circulatory disorder or a serious secondary disease, it is still difficult to give an adequate healthcare service for the patient due to side effects. Thus, we focus on the method of measuring the continuous and non-invasive bio signal in order to provide important insight into the patient's overall physical condition. In this paper, we estimate the blood pressure during the change of body posture based on the pulse transit time. Accordingly, we newly propose the measurement system and the equation for estimating the blood pressure, and then prove the effectiveness through the experiment of changing the body posture. Through all of results, we found that it is possible to estimate the blood pressure during the change (45 and 75 deg) of body posture with the continuous (5 min) and non-invasive method by monitoring the condition of patient.

Home-bound patients, mostly elders face many problems regarding their critical health parameter variations and timely assistance in case of emergencies. It is really a malady when they suffer from other severe diseases, heart problems etc. A constant and reliable assistive technology is essential while taking care of home-bound patients. The system, HOPE we have proposed has sensors to monitor the heart rate, body temperature, tilt and fall. The sensors are attached to the body of the elderly patient in a contented manner. The data can be sent to any Smartphone with Bluetooth support. In case of any emergency the caretaker will be given a notification about the critical situation. The provision to monitor the posture of the patient in the bed helps to reduce the cases of bedsore in bedridden elders. Day by day the menace of weakening health and chances of skin related problems, bed sores etc. are becoming critical in case of bed ridden patients. The experimental results presented in this paper give some insight into the behavior of the proposed system.

Drug delivery systems are becoming increasingly sophisticated as pharmaceutical scientists acquire a better understanding of the physicochemical and biochemical parameters pertinent to their performance. Over the past three decades, Fast Dissolving Tablets (FDTs) have gained much attention as a preferred alternative to conventional oral dosage form such as tablet and capsules. FDTs are solid unit dosage forms containing medicinal substances which disintegrate or dissolve rapidly usually in a matter of seconds, when they come in contact with saliva, thus obviating the requirement of water during administration. Therefore, these dosage forms have lured the market for a certain section of the patient population which includes dysphagic, bed ridden, psychic, geriatric and paediatric patients. This has encouraged both academia and industry to generate new orally disintegrating formulations and technological approaches in this field. This article focuses on the various formulation aspects, disintegrates employed and technologies developed for FDTs, along with various excipients, evaluation tests, marketed formulations, future prospects and drugs explored in this field.

A 45-year-old trader presented to us with 4 weeks history of difficulty in opening his mouth, inability to walk and tonic–clonic seizures with bilateral femoral neck fractures. Three weeks before the onset of problems, the patient had been knocked down by a tricycle and had sustained an open wound over the right medial malleolus; the wound was sutured at a general hospital and the patient discharged home. One week later, the wound started discharging a foul-smelling pus and was dressed at a primary health centre; however, by the second week, the patient started having difficulty in opening his mouth. By the third week, he was bed ridden, developed tonic–clonic seizures and felt a crunching sound associated with severe pain in both hips. He was taken to a traditional bone setter who gave him some herbs, but his symptoms got worse. He was then brought to the Accident and Emergency Department of the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria where a diagnosis of tetanus was made. Further evaluation revealed Gardener-type IV bilateral femoral neck fractures. He was managed for the tetanus, underwent bilateral bipolar hemiarthroplasty and was discharged home. He spent 10 weeks in the hospital.

An 82-year-old female presented to the office with her daughter and daughter-in-law complaining of painful blisters on the legs and arms that had occurred cyclically for the past 6 months (Fig. 1.1). She became hospitalized and bed ridden.

Pressure ulcers (PUs) are an important aspect of geriatrics and palliative care that amplifies morbidity of the chronically bed-ridden patients posing a threat to health-care economy and resources. PUs can interfere with functional recovery, may be complicated by pain and infection and can prolong hospital length of stay. Their presence may be a marker of poor overall prognosis and premature mortality. The pathogenesis and progress in the management of PUs is discussed.

1) 本研究は, 寝たきり老人の基礎代謝量を明らかにするとともに, 一般老人との比較を行うことにより寝たきり老人のエネルギー所要量を検討することを目的として行った。対象者は東京都内の特別養護老人ホームおよび養護老人ホームに入所している寝たきり老人10名と一般老人14名の女性であった。2) 寝たきり老人の身長と体重は, 一般老人と比べて統計的な差がなかったが, 除脂肪体重は有意に低かった。血中のHDL-コレステロール, カルシウム, および鉄濃度は寝たきり老人では有意に低く, とくにカルシウム濃度は正常範囲よりもかなり低い値を示していた。3) 寝たきり老人の基礎代謝量は, 一般老人よりも有意に低く, その値は22.5±5.Okca1/m2/時, 16.9±3.9kca1/kg/日, 23.9±5.0 kca1/LBM/日, および636.3±166.4kca1/日であった。これらの値は一般老人よりも20～30%低下していた。さらに, 基礎代謝量は基礎代謝基準値を用いて求あた推定値との間に相関関係を示さなかった。4) エネルギー消費量とエネルギー摂取量は, 寝たきり老人のほうが有意に低く, その値は一般老人よりも30%低下していた。寝たきり老人ではエネルギー消費量と摂取量の間に相関関係が認められなかった。5) 現在の基礎代謝量推定量を用いて算出するエネルギー所要量とエネルギー消費量との出納バランスがとれているエネルギー量は, 寝たきり老人で1,053kcalとなった。また, 算出されるエネルギー所要量が1,053kca1を基準に10%多く見積もられるごとに, 真のエネルギー必要量は57kcal少なくなることが認められた。

We are reporting a case of ischaemic fasciitis which occurred in a 55-year-old female with no debilitating or long bed ridden history. She presented with a large swelling over left gluteal region. On evaluation, swelling was found to be of size, 5x5 cm, slightly tender and with induration. The operative findings led to a probable diagnosis of a calcified lesion, due to its hard consistency. However, the microscopic picture was typical of ischaemic fasciitis, because of its characteristic central necrosis, vascular and atypical fibroblastic proliferations. Also seen was presence of foreign body giant cell reactions, inflammatory cells and extravasated RBCs. Ischaemic fasciitis is a very rare pseudo sarcomatous proliferation of atypical fibroblasts, which has been described to be located over bony protuberances and said to develop most often in immobile elderly or debilitated patients. Recognition of this distinct entity as a reactive process, mostly associated with debilitation is rare in occurrence.

An adaptable bedding surface for the prophylaxis and treatment of decubitus ulcers was developed and evaluated in a number of preclinical studies. The new bed reduced the average contact pressure peaks in prolonged supine bed rest while significantly decelerating the onset and progression of pressure sores. A special advantage of the surface is its discrete, independently-mobile pin elements that allow localized implementation of sensors and diagnostic tools in the bed structure. The bed is currently being evaluated in clinical trials with at series of different patient populations with different pressure ulcer pathologies. The system's overall ability to prevent the conditions that contribute to the onset of ulcers as indicated by improvements on the ulcer incidence rate is presented here.