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Immune Thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of <100 × 10⁹/L in the absence of other underlying causes of thrombocytopenia and increased risk of bleeding. Glucocorticoids are the mainstay drugs of treatment for ITP. The response rate to steroids is around 60%–70% in adults, but only 10%–15% of these patients will have a durable response. If patients do not respond to steroids by 4 weeks, they are considered to have steroid-resistant ITP. Some patients though they respond, need frequent courses of steroids to maintain a platelet count above 30 × 10⁹/L or to avoid bleeding and are considered nonresponders to steroids. A number of potential mechanisms for this resistance to steroids have been suggested, including receptor downregulation by glucocorticoid exposure and negative inhibition by the beta-isoform of the glucocorticoid receptor. The available treatment options for these patients include various drugs including rituximab, thrombopoietin receptor agonists, fostamatinib, danazol, immunosuppressive drugs, and biological therapies including intravenous immunoglobulin, Rh immunoglobulins, and immunoadsorption. Splenectomy has been performed surgically, by radiation, or chemoembolization. Supportive treatment includes screening for osteoporosis and management, vaccination, and platelet therapy. Newer therapies such as veltuzumab, belimumab, and toralizumab which deplete B-cells have been tried. Nearly 70% of adult chronic ITP patients failing to respond to splenectomy still achieve stable remission with additional therapies.

Background: Stroke is one of the major causes of loss of quality-adjusted life years and inflicts varying degree of physical deficits, psychological distress, and strained social relationships among stroke survivors. However, knowledge regarding risk factors, warning symptoms, and first aid management of stroke can help to minimize this burden. Aim: This study aims to assess knowledge and awareness of general population regarding risk factors, warning symptoms, and first aid management of stroke. Materials and Methods: The cross-sectional study was conducted to collect information from general population regarding risk factor, warning symptoms, and first aid management of stroke by administering a pretested questionnaire. Five hundred patients attending Outpatient Departments of Selected Hospital were selected using simple random sampling. After explaining purpose of the study and taking written consent from the participants, the participants were requested to fill the questionnaire. Results: The findings revealed that only 22.6% of participants were having good knowledge, 56.6% were having average knowledge, and rest 20.8% of them had poor knowledge regarding risk factors, warning symptoms, and first aid management of stroke. The mean knowledge score was 11.86 ± 3.651. 31.4%, 36.2%, and 33.6% of participants were not aware about even single risk factors, warning symptoms, and first aid management of stroke, respectively. Conclusion: The low level of knowledge regarding risk factor, warning symptoms, and first aid management of stroke indicates immense need of initiatives to implement stroke education.

Background: The resistance of the bacteria toward the antibiotics is growing day by day, and it is a serious threat globally. The reasons are self-medication, unjustified prescription of antibiotics, high use of antibiotics in livestock, and nonadherence to antibiotic treatment guidelines by prescribers. The aim of the present study is to assess the knowledge and attitude of the prescribers toward the prescription of antibiotics and antibiotic resistance. Methodology: A descriptive cross-sectional study was conducted using a questionnaire which contains questions to assess the knowledge and attitude of the prescribers. The questionnaire had three parts: the first part was used to obtain the basic demographic characteristics from participants, the second part had questions regarding the antibiotic indication in common infections, and the third part assessed the knowledge questions about antibiotic resistance. The questionnaire was attempted by eighty prescribers. Results: More than 50% of the medical practitioners agreed that antibiotics had to be used for some common infections such as acute gastroenteritis, asymptomatic bacteriuria in nonpregnant patients, and burn wounds with no evidence of infection. The knowledge of the prescribers regarding antibiotic resistance is variable. Conclusion: A higher percentage of the prescribers responded in favor of the use of antibiotics for common infections. It requires an awareness program to sensitize the prescribers regarding the prescription of antibiotics for appropriate indications and the seriousness of antibiotic resistance.

Background: With the increasing use of magnetic resonance imaging (MRI) in diagnostic radiology, the problem of anxiety is also encountered more often in patients undergoing MRI. Anxious patients may not co-operate well with the procedure resulting in poor image quality. Repetition of sequences to acquire the images of better quality prolongs the total scan time and precludes optimal patient experience. For satisfactory completion and clinical usefulness of the scan, patient compliance is vital. Aim: The aim of this study is to assess the effectiveness of video-based education (VBE) versus music therapy (MT) on anxiety, experience, and co-operation among patients undergoing MRI. Materials and Methods: Randomized controlled trial pre- and posttest-based study was carried out among 90 patients undergoing MRI who were randomly allocated to VBE group (30), MT group (30), and control group (30). The data on anxiety, experience, and cooperation were collected using the appropriate tools. Patients in VBE group were provided with VBE, patients in MT group received MT and control group received routine procedural instructions. Results: No significant differences were found in VBE group, MT group, and control group in terms of posttest anxiety scores. With regard to mean experience scores, the VBE group had better experience (81.70 ± 3.153) as compared to the control group (77.27 ± 6.817). A significant strong positive correlation was found between experience and co-operation of patients in VBE group (r = 0.860, P < 0.001) and MT group (r = 0.640). All of the patients (100%) agreed that VBE was easy to understand and also suggested to use VBE for all patients undergoing MRI procedure. Most of the patients (96.7%) found MT effective during the waiting time of MRI procedure and useful for diverting the mind. Conclusions: Both VBE and MT were effective in improving the experience and co-operation of patients undergoing MRI as compared to routine procedural instructions in the control group.

Background: Conflict is an inevitable and integral part of any work environment including nursing. Unresolved conflicts among nurses may lead to increased errors in patient care, affect their morale, and even increase turnover. Objective: The objective of the study is to determine the conflict-handling styles practiced by newly joined nursing staff working in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted on newly joined 297 nurses. Standardized Thomas-Kilmann Conflict Mode Instrument was used to collect the data. Nurses were asked to give answers that characterized their dominant response in a conflict situation. Results: A total of 34.7% nurses used accommodating style for conflict management whereas 30.3% used collaborating style. It was followed by compromising, competing, and avoiding styles of conflict management. Conclusion: There is a need to enhance nurses' conflict management skills which in long run may lead to improvement in the quality of work as well as job satisfaction among nurses.