Background: Critical care practices often rely on tradition rather than evidence, such as Trendelenburg positioning and restricted visiting policies, potentially compromising patient outcomes and care quality. Objective: This study aimed to identify outdated practices in critical care and propose evidence-based improvements to enhance patient safety, satisfaction, and outcomes in an inpatient unit. Method: A prospective observational study was conducted over one year (January–December 2011) in a critical care inpatient unit. Seven traditional practices were analyzed across a sample size of 118 patients and 50 nurses. Data were collected using structured surveys, patient outcomes records, and observational audits, followed by statistical analysis to assess the impact of these practices on care quality. Results: Trendelenburg positioning was utilized in 58% of hypotensive cases, correlating with a 22% higher incidence of respiratory complications (p < 0.05). Restricted visiting policies were applied in 85% of cases, leading to a 40% increase in patient anxiety scores and 30% lower family satisfaction ratings. Physical restraints were employed in 48% of patients, with restrained patients showing a 37% higher delirium rate. After implementing evidence-based alternatives, ventilator duration decreased by 12% (p < 0.01), pressure injury incidence dropped by 22% (p < 0.05), and overall patient satisfaction scores improved by 32%. Nurse adherence to evidence-based practices rose from 42% to 75% post-intervention. Conclusions: Outdated critical care practices negatively impact patient outcomes. Implementing evidence-based interventions significantly enhances care quality, underscoring the importance of continuous education and reform in critical care units.

Background: Thyroid dysfunction is a common comorbidity in individuals living with HIV, with the potential to complicate treatment outcomes, particularly with the use of antiretroviral therapy (ART). This study aims to explore the relationship between HIV progression, ART, and thyroid function in HIV-positive individuals. Materials and Methods: A cross-sectional study was conducted on 100 HIV-positive individuals (49 pre-ART, 51 post-ART). Demographic characteristics were recorded, and thyroid dysfunction was assessed by measuring thyroid hormone levels. The data were stratified according to WHO HIV staging (I-IV) and analyzed to determine the prevalence of thyroid dysfunction across different stages of HIV progression. Results: The study revealed that most participants were aged between 31-50 years, with a higher male prevalence (60%). Unskilled laborers were the majority, highlighting the socio-economic impact of HIV. Thyroid dysfunction was common, with subclinical hypothyroidism being the most prevalent form. Post-ART patients exhibited higher rates of overt hypothyroidism (7%) compared to pre-ART patients (3%). Thyroid dysfunction worsened as HIV progressed, particularly in post-ART individuals, with hypothyroidism increasing in prevalence, while hyperthyroidism was rare. Conclusion: The findings suggest that ART may contribute to thyroid dysfunction, particularly in patients with advanced HIV. Regular monitoring of thyroid function is recommended for HIV-positive individuals, especially those on ART, to manage potential complications.

Primary Hyperparathyroidism is usually diagnosed as an incidental finding of hypercalcemia in blood tests or due to symptoms secondary to the high calcium. Overt bone disease is an extremely rare presentation. Fractures in hyperparathyroidism are unusual and usually affect the vertebrae. Pathological fractures have been described in patients with parathyroid carcinoma. We report on three patients with benign parathyroid adenoma who primarily presented with pathological fractures of long bones. Excision of the parathyroid adenoma and immobilization of the fractures resulted in the return of the serum chemistry to normal, improvement of bone density and fracture union.

“That element of tragedy which lies in the very fact of frequency, has not yet wrought itself into the coarse emotion of mankind; and perhaps our frames could hardly bear much of it. If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel’s heartbeat, and we should die of that roar which lies on the other side of silence”. (George Elliot). I wonder what would be the magnitude of the roar on the other side of silence when Depression, as WHO has it, becomes the second most common disabling condition worldwide by 20201. I don’t know about others but I myself would be relying on my chronic ailment of selective deafness to remain blissfully unaware of the enormity of emotional pain and ceaseless suffering, if these were to penetrate into the much-narrowed range of my sensitivity. I am sure my wise colleagues won’t die of the roar either and would have plenty of effective safeguards to choose from. You might, however, argue that these measures may be gratuitous, as the emotional coldness, which is endemic in our circles, may suffice. You may have a point.

Summary: The aim of this article is to review the diagnosis and management of Dementia with Lewy Bodies. Dementia with Lewy bodies (DLB) is considered the second most common cause of dementia in the elderly after Alzheimer's disease. Diagnostic criteria for DLB is categorized into central feature ( progressive dementia), core features( fluctuating cognition, recurrent visual hallucinations and parkinsonism), suggestive features( rapid eye movement sleep behaviour disorder, increased sensitivity to neuroleptics and low dopamine transporter uptake in the brain's basal ganglia) and supportive features(repeated falls , transient loss of consciousness, hallucinations in other modalities, visuospatial abnormalities and autonomic dysfunction). DLB patients have the diffuse presence of Lewy Bodies in both sub cortical and cortical areas of the brain. Patients with DLB also have more severe dopamine and acetylcholine loss as compared to Alzheimer’s disease. Cholinesterase inhibitors can be used for the treatment of neuropsychiatric symptoms. Treatment with levodopa- carbidopa combinations should be considered when parkinsonian symptoms cause functional impairment. Antipsychotics should be used with great caution due to increased extra pyramidal adverse reactions. Clonazepam can be helpful to manage REM sleep behaviour disorder. Clinicians need to be aware of the diagnosis of DLB in order to provide appropriate pharmacological and nonpharmacological treatment for its cognitive, neuropsychiatric, motor and sleep disturbances without causing distressing side effects due to inappropriate drug prescription. Abbreviations: DLB=Dementia with Lewy Bodies, AD=Alzheimer’s disease, PD=Parkinson’s disease, REM=Rapid eye movement, SPECT=Single- photon emission computed tomography, PET=positron emission tomography.

Objectives: Optimizing drug therapy for elderly is often challenging. Sometimes treatment causes more harm than the disease. The aim of this article is to review the body of literature addressing polypharmacy to determine its definition, explore how polypharmacy was assessed in primary care, and seek evidence-based interventions that address polypharmacy. Data Sources: An electronic search of the PUBMED database utilizing the search terms ‘‘polypharmacy,’’ ‘‘polypharmacy and elderly,’’ ‘‘adverse drug reactions,’’ ‘‘multiple medications’’, “inappropriate prescribing”, and “Beer’s criteria” was performed and the search was supplemented with online site searches of relevant journals and review of reference lists of each article. Results and discussion: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe. Polypharmacy continues to be a significant issue. There is a gap in the literature regarding the interventions implemented by physicians to address polypharmacy. There are no robust prospective studies that test the clinical benefit to patients of using drug utilization review tools. Conclusion: There is no specific definition for polypharmacy. It has been defined in many different ways depending upon patient population and study settings. Prospective randomized controlled trials are needed to identify useful interventions. Drug utilization review tools should be designed on the basis of a country’s national drug formulary and should be evidence based as most existing drug utilization review tools have been designed on the basis of North American system.

Introduction: It is not a revelation, that practicing psychiatry or psychotherapy and pursuing psychological research, rely heavily on phenomenology, which may be descriptive (Jasper, Husserl), or dynamic (Freudian), and influences that which may have on several diagnostic categories. The question of how our use of terms correlates with whatever it is trying to describe, requires serious consideration. The aim of this editorial is to sketch some significant developments in psychological, biological, physical and philosophical studies, with specific reference to the role of language in these evolving scientific endeavours. Conclusion: Francis Crick’s (1979) remark that “we are deceived at every level by our introspection” may well be more appropriately applied to our capacity to use language. This is especially relevant when language is employed in describing human behavior, psychiatric diagnostic categories and neurophysiological studies. By virtue of its logical incompleteness, self referentiality and the context in which it is employed, language may lead to erroneous interpretations, would that be a therapeutic session, a psychiatric diagnosis, or even describing the microscopical functions of a nerve cell.