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Background: Hyperglycemia in pregnancy (HIP) is a common medical complication during pregnancy and is associated with several short and long-term maternal-fetal consequences. We aimed to determine the prevalence and factors associated with HIP among Ugandan women.

Methods: We consecutively enrolled eligible pregnant women attending antenatal care at Kawempe National Referral Hospital, Kampala, Uganda in September 2020. Mothers known to be living with diabetes mellitus or haemoglobinopathies and those with anemia (hemoglobin <11g/dl) were excluded. Random blood sugar (RBS) and glycated hemoglobin A1c (HbA_1c) were measured on peripheral venous blood samples. HIP was defined as an HbA1c ≥5.7% with its subsets of diabetes in pregnancy (DIP) and prediabetes defined as HbA1c_1c of ≥6.5% and 5.7–6.4% respectively. ROC curve analysis was performed to determine the optimum cutoff of RBS to screen for HIP.

Results: A total of 224 mothers with a mean (±SD) age 26±5 years were enrolled, most of whom were in the 2^nd or 3^rd trimester (94.6%, n=212) with a mean gestation age of 26.6±7.3 weeks. Prevalence of HIP was 11.2% (n=25) (95% CI: 7.7–16.0). Among the mothers with HIP, 2.2% (n=5) had DIP and 8.9% (n=20) prediabetes. Patients with HIP were older (28 years vs. 26 years, p=0.027), had previous tuberculosis (TB) contact (24% vs. 6.5%, p=0.003) and had a bigger hip circumference (107.8 (±10.4) vs. 103.3 (±9.7) cm, p=0.032). However only previous TB contact was predictive of HIP (odds ratio: 4.4, 95% CI: 1.2–14.0; p=0.022). Using HbA_1c as a reference variable, we derived an optimum RBS cutoff of 4.75 mmol/L as predictive of HIP with a sensitivity and specificity of 90.7% and 56.4% (area under the curve=0.75 (95% CI: 0.70–0.80, p<0.001)), respectively.

Conclusions: HIP is common among young Ugandan women, the majority of whom are without identifiable risk factors.

The purpose of this paper is to develop a prototype of a wearable medical device in the form of a bandage with a real-time data monitoring platform, which can be used domestically for diabetic patients to identify the possibility of foot ulceration at the early stage.

The prototype can measure blood volumetric change and temperature variation in the forefoot area simultaneously. The waveform extracted using a pulsatile-blood-flow signal was used to assess blood perfusion-related information, and hence, predict ischemic ulcers. The temperature difference between ulcerated and the reference was used to predict neuropathic ulcers. The medical device can be used as a bandage during the application wherein the sensory module is placed inside the hollow pocket of the bandage. A platform was developed through a mobile application where doctors can extract real-time information, and hence, determine the possibility of ulceration.

The height of the peaks in the pulsatile-blood-flow signal measured from the subject with foot ischemic ulcers is significantly less than that of the subject without ischemic ulcers. In the presence of ischemic ulcers, the captured waveform flattens. Therefore, the blood perfusion from arteries to the tissue of the forefoot is considerably low for the subject with ischemic ulcers. According to the temperature difference data measured over 25 consecutive days, the temperature difference of the subject with neuropathic ulcers occasionally exceeded the 4 °F range but mostly had higher values closer to the 4 °F range. However, the temperature difference of the subject who had no complications of neuropathic ulcers did not exceed the 4 °F range, and the majority of the measurements occupy a narrow range from −2°F to 2 °F.

The proposed prototype of wearable medical apparatus can monitor both temperature variation and pulsatile-blood-flow signal on the forefoot simultaneously and thereby predict both ischemic and neuropathic diabetes using a single device. Most importantly, the wearable medical device can be used domestically without clinical assistance with a real-time data monitoring platform to predict the possibility of ulceration and the course of action thereof.

Intense interest has been shown in creating new and effective biocide agents as a result of changes in bacterial isolates, bacterial susceptibility to antibiotics, an increase in patients with burns and wounds and the difficulty of treating infections and antimicrobial resistance. Woven, nonwoven and knitted materials are used to make dressings; however, nonwoven dressings are becoming more popular because of their softness and high absorption capacity. Additionally, textiles have excellent geometrical, physical and mechanical features including three-dimensional structure availability, air, vapor and liquid permeability, strength, extensibility, flexibility and diversity of fiber length, fineness and cross-sectional shapes. It is necessary to treat every burn according to international protocol and along with it has to focus on particular problems of patients and the best possible results.

The objective of this paper is to conduct a thorough examination of research pertaining to the utilization of textiles, as well as alternative materials and innovative techniques, in the context of burn wound dressings. Through a critical analysis of the findings, this study intends to provide valuable insights that can inform and guide future research endeavors in this field.

In the past years, there have been several dressings such as xeroform petrolatum gauze, silver-impregnated dressings, biological dressings, hydrocolloid dressings, polyurethane film dressings, silicon-coated nylon dressings, dressings for biosynthetic skin substitutes, hydrogel dressings, newly developed dressings, scaffold bandages, Sorbalgon wound dressing, negative pressure therapy, enzymatic debridement and high-pressure water irrigation developed for the fast healing of burn wounds.

This research conducts a thorough analysis of the role of textiles in modern burn wound dressings.

In early 2014, recent Stanford University graduate Tyler Shultz was in a quandary. He had been working at Theranos, a blood-diagnostic company founded by Elizabeth Holmes, a Stanford-dropout wunderkind, for almost a year. Shultz had learned enough about the company to realize that its practices and the efficacy of its much-touted finger-prick blood-testing technology were questionable and that the company was going to great lengths to hide this fact from the public and from regulators.

Theranos and Holmes were Silicon Valley darlings, enjoying positive press and lavish attention from potential investors and technology titans alike. Just as companies like PayPal had revolutionized the stagnant payments industry and Uber had upended the for-hire transportation sector, Theranos had been positioned as the latest technology firm to substantially disrupt yet another mature sector: the medical laboratory business. By the start of 2014, the company had raised more than $400 million in funding, and had an estimated market valuation of $9 billion.

Shultz's situation was exacerbated by the fact that his grandfather, the highly respected former US Secretary of State George Shultz, was on the Theranos board and was one of Elizabeth Holmes's biggest supporters.

But Tyler Shultz worried about the customers he was convinced were receiving highly unreliable and often inaccurate blood-test results. With so much at stake, Shultz wondered how he should proceed. Should he raise his concerns with the firm's investors? Blow the whistle externally? Report to industry regulators? Go away quietly?

This case and its subsequent four brief follow-up cases are based largely on interviews with Tyler Shultz, and outline the dilemma he faced and the various steps he would take both to extricate himself from his unsavory position and let the public know the full extent of the deception at Theranos.

Five optional handouts are available to instructors to further discussion after the case has been debriefed. The handouts serve as additional decision points for the students if your class time permits.

This study aims to provide an overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among sentenced female prisoners.

A mixed-methods systematic literature review.

A total of 4 reviews and 39 single studies met the inclusion criteria for the review. Mental disorders were the main area of investigation in the majority of single studies, with substance abuse, particularly drug abuse, as the most consistently gender biased disorder, with higher prevalence among women than men in prison. The review identified a lack of updated systematic evidence on the presence of multi-morbidity.

This study provides an up-to-date overview and quality appraisal of the current scientific evidence concerning the prevalence and characteristics of mental and physical disorders among female prisoners.

Adverse events in health care became more evident at the beginning of the 21st century, being an emerging problem worldwide and impacting the lives of people receiving health care, contributing to preventable injuries and deaths. This evidence has motivated the development of specific training in the area of patient safety with a strong focus on the education and training of health professionals, and, more recently, it also aimed at patient, informal caregiver and all citizens. In this sense, the use of digital technology for patient safety training has been an important challenge and proves to be a good solution for training and continuous learning, both for professionals and people in general. The use of multimedia, videos, games, simulators, among others, are effectively essential resources to improve people’s health literacy and safety of care.

This chapter presents a narrative review on patient safety training and the contributions of digital technology. The experience report will also be used, presenting some examples of quality improvement projects developed by Portuguese and Brazilian entities, in training contexts, highlighting the importance of investing in the health literacy of professionals, patients/informal caregivers and civil society, through applying specific techniques and using digital technology.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

The development of new advanced materials, such as photopolymerizable resins for use in stereolithography (SLA) and Ti6Al4V manufacture via selective laser melting (SLM) processes, have gained significant attention in recent years. Their accuracy, multi-material capability and application in novel fields, such as implantology, biomedical, aviation and energy industries, underscore the growing importance of these materials. The purpose of this study is oriented toward the application of new advanced materials in stent manufacturing realized by 3D printing technologies.

The methodology for designing personalized medical devices, implies computed tomography (CT) or magnetic resonance (MR) techniques. By realizing segmentation, reverse engineering and deriving a 3D model of a blood vessel, a subsequent stent design is achieved. The tessellation process and 3D printing methods can then be used to produce these parts. In this context, the SLA technology, in close correlation with the new types of developed resins, has brought significant evolution, as demonstrated through the analyses that are realized in the research presented in this study. This study undertakes a comprehensive approach, establishing experimentally the characteristics of two new types of photopolymerizable resins (both undoped and doped with micro-ceramic powders), remarking their great accuracy for 3D modeling in die-casting techniques, especially in the production process of customized stents.

A series of analyses were conducted, including scanning electron microscopy, energy-dispersive X-ray spectroscopy, mapping and roughness tests. Additionally, the structural integrity and molecular bonding of these resins were assessed by Fourier-transform infrared spectroscopy–attenuated total reflectance analysis. The research also explored the possibilities of using metallic alloys for producing the stents, comparing the direct manufacturing methods of stents’ struts by SLM technology using Ti6Al4V with stent models made from photopolymerizable resins using SLA. Furthermore, computer-aided engineering (CAE) simulations for two different stent struts were carried out, providing insights into the potential of using these materials and methods for realizing the production of stents.

This study covers advancements in materials and additive manufacturing methods but also approaches the use of CAE analysis, introducing in this way novel elements to the domain of customized stent manufacturing. The emerging applications of these resins, along with metallic alloys and 3D printing technologies, have brought significant contributions to the biomedical domain, as emphasized in this study. This study concludes by highlighting the current challenges and future research directions in the use of photopolymerizable resins and biocompatible metallic alloys, while also emphasizing the integration of artificial intelligence in the design process of customized stents by taking into consideration the 3D printing technologies that are used for producing these stents.

The purpose of this study is to determine the impact of two-phase power law nanofluid on a curved arterial blood flow under the presence of ovelapped stenosis. Over the past couple of decades, the percentage of deaths associated with blood vessel diseases has risen sharply to nearly one third of all fatalities. For vascular disease to be stopped in its tracks, it is essential to understand the vascular geometry and blood flow within the artery. In recent scenarios, because of higher thermal properties and the ability to move across stenosis and tumor cells, nanoparticles are becoming a more common and effective approach in treating cardiovascular diseases and cancer cells.

The present mathematical study investigates the blood flow behavior in the overlapped stenosed curved artery with cylinder shape catheter. The induced magnetic field and entropy generation for blood flow in the presence of a heat source, magnetic field and nanoparticle (Fe₃O₄) have been analyzed numerically. Blood is considered in artery as two-phases: core and plasma region. Power-law fluid has been considered for core region fluid, whereas Newtonian fluid is considered in the plasma region. Strongly implicit Stone’s method has been considered to solve the system of nonlinear partial differential equations (PDE’s) with 10–6 tolerance error.

The influence of various parameters has been discussed graphically. This study concludes that arterial curvature increases the probability of atherosclerosis deposition, while using an external heating source flow temperature and entropy production. In addition, if the thermal treatment procedure is carried out inside a magnetic field, it will aid in controlling blood flow velocity.

The findings of this computational analysis hold great significance for clinical researchers and biologists, as they offer the ability to anticipate the occurrence of endothelial cell injury and plaque accumulation in curved arteries with specific wall shear stress patterns. Consequently, these insights may contribute to the potential alleviation of the severity of these illnesses. Furthermore, the application of nanoparticles and external heat sources in the discipline of blood circulation has potential in the medically healing of illness conditions such as stenosis, cancer cells and muscular discomfort through the usage of beneficial effects.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.