Level of doctors’ satisfaction in ophthalmology telemedicine at the Philippine General Hospital

Objectives@#This quantitative, cross-sectional, descriptive research aims to determine the level of satisfaction of doctors using telemedicine in Ophthalmology.@*Methods@#An online questionnaire was sent to ophthalmologists at the Philippine General Hospital, a tertiary referral center, that partially shifted to ophthalmology telemedicine during the COVID-19 pandemic.@*Results@#Respondents perceived telemedicine positively in terms of usefulness (Mean 2.92, Slightly Satisfied), ability to do quick follow-ups and patient updates (Mean 2.90, Slightly Satisfied), simplicity, and ease of use of technology (Mean 2.78, Slightly Satisfied). They were least satisfied with its effectiveness (Mean 2.37, Slightly Dissatisfied).@*Conclusion@#Ophthalmologists expressed only slight satisfaction with telemedicine. The telemedicine platform was simple and useful for end-users, but some aspects may be improved based on questionnaire results.

Epidemiology of eyelid trauma among Filipino patients in a Tertiary Hospital

Objective@#This study aims to identify the epidemiological characteristics and co-morbidities of eyelid injuries among Filipino patients seen at the Emergency and Out-patient Clinics of a single, tertiary, government, urbanbased hospital from June 2014 to June 2015.@*Methods@#This is a retrospective, cross-sectional, descriptive single-center study. Medical records of 85 patients who consulted at the Emergency or Out-Patient Clinics of the Department of Ophthalmology and Visual Sciences of the Philippine General Hospital, Manila due to eyelid injuries that resulted to skin breaks with or without tissue loss or other ocular co-morbidities were reviewed. Information collected included: demographic data of the patient; the offending object; mechanism, place, date and time of injury; date and time of consult; possible risk factors and predisposing conditions such as alcohol intoxication and lack of use of protective gears. Complications associated with eyelid injuries were also noted. Descriptive statistics was used for analysis of patient demographics, epidemiologic characteristics of eyelid injuries and its associated complications.@*Results@#Of the 85 cases, 78% were males. Most of the patients were below 50 years of age with a range of 1-79 and a mean age of 25 years old. There is male preponderance across all age groups except in the pediatric group below 10 years of age. The right eye was involved in 58% of cases. The most common area affected was the right lower lid as seen in 36 cases. Most of the eyelid injuries were severe: 21 (25%) were margin-involving, 17 (20%) had canalicular transection and 34 (40%) had both. Other co-morbidities included some degree of tissue loss or avulsion (16%) and globe involvement (29%). Majority were accidental (36%). Public places (33%) and the home (33%) were the most common places of injury. Most of the injuries that happened at home were accidents (82%) while those that occurred in public places were mostly assault cases (71%). The most common offending objects that caused the eyelid injuries included metal (33%), pavement/cement (18%), and wood (16%). The most common mechanism of injury was blunt trauma (67%). There were 18 cases of vehicular crash, 89% of the patients were not wearing helmets. All work-related injuries reported absence of protective gear. Alcohol intoxication was reported in 30% of assault cases and 72% of vehicular crash. @*Conclusion@#Eyelid injuries continue to pose as a public health concern. Campaigns organized toward educating the public can stress on the importance of increased vigilance regarding safety especially in children and young adults. Use of protective gear and eyewear while driving or working in hazardous environments should also be emphasized. Monitoring of public places for any disturbance can prevent violent acts from escalating. The AntiDrunk and Drugged Driving Act of 2013 should also be strictly enforced.

Botulinum toxin for modulating the muscle strength of patients rehabilitated with zygomatic implants / Toxina botulínica para modulação da força muscular de pacientes reabilitados por implantes zigomáticos

Objective: To measure the intensity of muscle strength and electrical activity of masseter and anterior temporal muscles based on BTX-A therapy in patients rehabilitated with total prostheses on zygomatic implants. Material and Methods: The object of the study was a sample of 20 individuals subjected to zygomatic implant surgery and rehabilitated with implant-supported prostheses, in order to obtain electromyographic data using an eight-channel module (EMG System do Brasil). The data were collected for three consecutive months: prior to the application (single dose) of BTX-A (30 U/ masseter muscle; 10 U/temporal muscle) and after 30 and 90 days of therapeutic treatment. Result: All muscle groups studied showed reduction of muscle electrical activity during voluntary contraction after 30 days of treatment (around 47%) (p < 0.001), which progressively reverted after 90 days of treatment. The anterior temporal muscles presented similar motor behavior, with activity reduction of 39% (p < 0.05). There was a reduction of 17.68% (p < 0.05) in mandibular force and an increase of 14.22% (p < 0.05) in mouth opening after 30 days of BTX-A administration. Conclusions: The results suggest that BTX-A significantly reduces muscle activity, in either the recruitment of motor units or muscle tone, in the first three months of therapeutic treatment. This therapy may also be useful as a preventive method for the failure of zygomatic implant-supported prostheses. (AU)

Objetivo: Medir a intensidade da força muscular e atividade elétrica dos músculos temporal anterior e masseteres em função da terapia com BTX-A em pacientes reabilitados por próteses totais sobre implantes zigomáticos. Material e Métodos: Uma amostra composta por 20 indivíduos submetidos à cirurgia de implantes zigomáticos e reabilitados com próteses implantossuportadas foi objeto de estudo para obtenção de dados eletromiográficos utilizando um módulo de oito canais (EMG System do Brasil). Os dados foram coletados por três meses consecutivos: antes da aplicação (dose única) de BTX-A (30U / masseter muscular; 10U / temporal), após 30 e 90 dias do tratamento terapêutico. Resultados: Todos os grupos musculares estudados apresentaram redução da atividade elétrica muscular durante a contração voluntária, após 30 dias de tratamento (em torno de 47%) (p < 0,001), e revertidos progressivamente após 90 dias de tratamento. Os temporais anteriores apresentaram comportamento motor semelhante, apresentando redução de atividade de 39% (p < 0,05). Foi observada uma redução de 17,68% (p < 0,05) na força mandibular, assim como um aumento na abertura bucal de 14,22% (p < 0,05) após 30 dias da administração da BTX-A. Conclusões: Os resultados sugerem que a BTX-A reduz significativamente a atividade muscular, seja no recrutamento de unidades motoras ou no tônus muscular, nos primeiros três meses de tratamento terapêutico e pode ser útil como método preventivo de falha de prótese suportada por implantes zigomáticos.(AU)

Three Concurrent Periprosthetic Joint Infections: A Case Report and Literature Review / 대한고관절학회지

Periprosthetic joint infections are a major cause of morbidity and mortality following total joint arthroplasty. Two-stage arthroplasty, with the use of an antibiotic cement spacer, is an effective means of managing periperiprosthetic joint infections. There is a lack of data relating to the management, prognosis, and clinical outcomes associated with multiple peri-prosthetic joint infections. Here, we present a case report of a patient successfully treated for three synchronic peri-prosthetic joint infections of both knees and a single hip.

Long-term results of mini-monoka® monocanalicular intubation in the repair of canalicular lacerations

Objective@#To report the epidemiology of canalicular lacerations and surgical outcomes of canalicular laceration repair with Mini-Monoka® (FCI Ophthalmics, Issy-les-Moulineaux, Cedex, France) intubation.@*Methods@#This is a retrospective interventional case series of patients who underwent Mini-Monoka® intubation in the repair of canalicular laceration from 2010 to 2015 at a tertiary state-owned hospital in Manila, Philippines. Patient demographics, surgical outcomes, and complications were analyzed.@*Results@#Fourteen patients (12 males and 2 females) underwent Mini-Monoka® intubation for monocanalicular laceration. The mean age at presentation was 27 years (range, 16-47 years). The mean duration of follow-up was 2.92 years (range, 1.28-6.15 years). Canalicular patency was achieved in 12 out of the 14 patients (86%). None of the 12 patients experienced epiphora following stent removal resulting in a functional success rate of 100%. Two patients had punctal slitting (14%). Premature stent loss occurred in 2 out of the 14 patients (14%).@*Conclusion@#Mini-Monoka® intubation is effective in maintaining the long-term anatomical patency of the lacerated canaliculus. It is a simple and minimally invasive procedure making it a safe and reasonable alternative to the traditional methods of canalicular repair.

Troponinas de alta sensibilidad T vs I en Sindrome Coronario Agudo: Predicción de lesiones coronarias significativas y pronóstico a largo plazo / High-Sensitivity Troponin T vs I in Acute Coronary Syndrome: Prediction of Significant Coronary Lesions and Long-term Prognosis

Antecedentes: Los ensayos de troponinas cardíacas de alta sensibilidad (hs-cTn) tanto T e I son una herramienta crucial y bien establecida para el diagnóstico de infarto agudo de miocardio (IAM), ya que se ha demostrado ampliamente su superioridad respecto a las antiguas determinaciones de troponina. Sin embargo, eventuales diferencias entre ambos ensayos en la predicción de lesiones coronarias significativas y el pronóstico a largo plazo en pacientes con síndrome coronario agudo (SCA) no han sido aclarados completamente. Métodos: Se evaluaron las concentraciones séricas de hs-cTnT (Roche), hs-cTnI (Abbott) y porción amino-terminal del pro-péptido natriurético tipo B (NT-proBNP) (Roche) en 390 pacientes con SCA sin elevación del segmento ST, y se relacionaron con lesiones coronarias significativas detectadas por angiografía coronaria (definidas como estenosis >50% del diámetro luminal, con necesidad de revascularización) y con la precisión pronóstica de mortalidad cardiovascular, mortalidad por cualquier causa, así como también con el punto final compuesto por mortalidad cardiovascular y hospitalizaciones por IAM o insuficiencia cardiaca. Resultados: La media (+DE) del seguimiento fue de 2921+168 días. Las concentraciones absolutas de hs-cTnI fueron significativamente mayores que las concentraciones de hs-cTnT. La relación entre los biomarcadores analizados y lesiones coronarias significativas en angiografía coronaria, cuantificada por el área bajo la curva ROC (AUC), no reveló diferencias entre hs-cTnT [AUC, 0,81; IC del 95%, 0,77- 0,86] y hs-cTnI (AUC, 0,81; IC del 95%, 0,76-0,86; P=NS). Sin embargo, NT-proBNP fue superior a ambos ensayos de hs-cTn en relación con la precisión pronóstica tanto para mortalidad cardiovascular y por cualquier causa, como para el punto final compuesto durante el seguimiento, aún también en análisis multivariados. Conclusiones: Los determinaciones de hs-cTnT y hs-cTnI mostraron una capacidad similar para predecir lesiones coronarias significativas en pacientes con SCA sin elevación del segmento ST. NT-proBNP fue superior a ambos ensayos de uscTn, como marcador de pronóstico a largo plazo en este grupo de pacientes.

Background: High-sensitivity cardiac troponin (hs-cTn) T and I assays are established as crucial tools for the diagnosis of acute myocardial infarction (AMI), as they have been found superior to old troponin assays. However, eventual differences between the assays in prediction of significant coronary lesions and long-term prognosis in patients with acute coronary syndrome (ACS) have not been fully unraveled. Methods: Serum concentrations of hs-cTnT (Roche), hs-cTnI (Abbott), and amino-terminal pro-B-type natriuretic peptide (NT-proBNP; Roche) in 390 non-ST-elevation (NSTE) ACS patients were evaluated in relation to significant coronary lesions on coronary angiography (defined as a stenosis >50% of the luminal diameter, with need for revascularization) and prognostic accuracy for cardiovascular mortality, all-cause mortality, as well as the composite end point of cardiovascular mortality and hospitalizations for AMI or heart failure. Results: The mean+SD follow-up was 2921+168 days. Absolute hs-cTnI concentrations were significantly higher than the hs-cTnT concentrations. The relationship between analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by the area under the ROC curve (AUC), revealed no difference between hs-cTnT [AUC, 0.81; 95% CI, 0.77-0.86] and hs-cTnI (AUC, 0.81; 95% CI, 0.76-0.86; P=NS). NT-proBNP was superior to both hs-cTn assays regarding prognostic accuracy for both cardiovascular and all-cause mortality and for the composite end point during follow-up, also in multivariate analyses. Conclusions: The hs-cTnT and hs-cTnI assays displayed a similar ability to predict significant coronary lesions in NSTE-ACS patients. NT-proBNP was superior to both hs-cTn assays as a marker of long-term prognosis in this patient group.

Monitoring real time polymorphic transformation of sulfanilamide by diffuse reflectance visible spectroscopy$ / 药物分析学报

This study investigated the development of a novel approach to surface characterization of drug poly-morphism and the extension of the capabilities of this method to perform ‘real time’ in situ measure-ments. This was achieved using diffuse reflectance visible (DRV) spectroscopy and dye deposition, using the pH sensitive dye, thymol blue (TB). Two polymorphs, SFN-β and SFN-γ, of the drug substance sul-fanilamide (SFN) were examined. The interaction of adsorbed dye with polymorphs showed different behavior, and thus reported different DRV spectra. Consideration of the acid/base properties of the morphological forms of the drug molecule provided a rationalization of the mechanism of differential coloration by indicator dyes. The kinetics of the polymorphic transformation of SFN polymorphs was monitored using treatment with TB dye and DRV spectroscopy. The thermally-induced transformation fitted a first-order solid-state kinetic model (R2 ? 0.992), giving a rate constant of 2.43 ? 10 ? 2 s ? 1.

Cervical HPV Infection in Indian Women: Screening and Immunization as Preventive Strategies.

Invasive cervical cancer (ICC) is the second leading cause of cancer related mortality among women in India. Human papillomavirus (HPV), the etiological agent of cervical cancer is widely prevalent worldwide. Persistent HPV infection, particularly with HPV 16, is essential for progression to cervical cancer. Human papillomavirus 16 and 18 are the most common genotypes detected among Indian HIV-infected and uninfected women, although their relative contributions vary. HIV-infected Indian women experience a higher risk for HPV infection compared to the general population. Although cervical screening and vaccination to protect against HPV infection are the two main strategies for prevention, there are significant challenges to their implementation in India. Scaling up of cervical screening using simple, rapid tests followed by colposcopy and treatment within a minimal number of visits is essential to prevent loss to followup. Increasing the uptake of the HPV vaccine combined with cervical screening can greatly reduce the burden of ICC in India.

Extracellular forms of Mycobacterium bovis BCG in the mucosal lymphatic tissues following oral vaccination

Oral vaccination with BCG provides protective systemic immunity against pathogenic mycobacterial challenge. In this study, the anatomical distribution of Mycobacterium bovis BCG following oral vaccination was investigated. Replicating bacteria in the Peyer's patches and mesenteric lymph nodes were present as solitary rods or clusters of two to three bacteria, the majority of which were isolated ex vivo as extracellular forms. Only a minority were shown to be associated with typical antigen-presenting cells. Acid-fast staining of mast cell granules in lymphoid tissues revealed a potential pitfall for these analyses and may explain previous reports of acid-fast 'coccoid' forms of mycobacteria in tissues

Utilização do monobloco ósseo removido de sínfise mentoniana para reconstrução de pré-maxila atrófica / Use of bone monoblock removed from symphisis for reconstruction of atrophic pre-maxilla

A ausência de tecido ósseo é considerada por muitos o principal fator limitante da instalação de implantes visando a reabilitação de pacientes desdentados totais ou parciais. No presente trabalho, relatamos um caso clinico em que o paciente edentado na região anterior superior (pré-maxila), foi submetido a procedimento de enxertia óssea com osso autógeno proveniente do mento. O tecido ósseo foi removido em forma de um bloco é o mesmo foi acomodado sobre o leito receptor de forma a reconstruir o formato da região que se apresentava atrofiada devido a reabsorção fisiológica ocorrida após a perda dos elementos dentais. Após a cicatrização observou-se a reconstrução do contorno da pré-maxila o que propiciou a instalação de implantes

The absence of bone tissue is considered by many to be the main factor limiting the installation of implants for the rehabilitation of edentulous patients or partial. In this paper, we report a clinical case where the patient edentate in the anterior superior (pre-maxilla), underwent a surgical procedure of bone grafting with autogenous bone from the chin. The bone tissue was removed in the form of a block is the same was accommodated on the recipient bed in order to reconstruct the shape of the region that had atrophied due to physiological resorption occurredafter the loss of dental elements. After healing observed the reconstruction of the contour of the premaxilla which allowed the installation of implants

Osso homógeno fresco congelado utilizado na reconstrução de maxila atrófica / The use of fresh-frozen homogenous bone graft for reconstruction of the atrophic maxilla: a case report

O objetivo deste artigo foi relatar um caso clínico onde houve a utilização de osso homógeno fresco congelado, proveniente de um banco de ossos, na reconstrução de uma maxila comprometida, por meio do preenchimento da cavidade antral e aumento da espessura do rebordo alveolar, possibilitando, dessa forma, a instalação de implantes osseointegráveis e suas respectivas próteses. Foi concluído que esse enxerto é uma alternativa viável, segura e pouco traumática para o aumento ósseo com finalidade reabilitadora, embora haja a necessidade de mais pesquisas em longo prazo.

The aim of this paper was to report a clinical case where a frozen homogenous, bone bank graft was used in the reconstruction of a compromised maxilla, filling the maxillary sinus cavity and increasing the thickness of the alveolar bone, to provide an adequate site for dental implants and their respective prostheses. Within the limits of this study, it was concluded that this graft is a possible, secure, and a non-traumatic alternative when used to increase the bone volume for further patient rehabilitation, although more clinical long-term research is necessary.

Indicaciones de estudio genético invasivo en una población seleccionada: Agosto de 2005 a diciembre de 2007 / Indications for invasive genetic studies in a population-based sample: August 2005 to december 2007

Antecedentes: la mayor utilización de ecografía prenatal y procedimientos diagnósticos invasivos ha permitido mejorar la identificación de malformaciones fetales al nacimiento. El dilema conlleva un riesgo relacionado con el procedimiento, por lo que los médicos siguen lidiando con la manera de identificar las pacientes con riesgo elevado para no someter a las de bajo riesgo a procedimientos diagnósticos innecesarios. En el presente estudio nos hemos planteado describir las diferentes indicaciones para el diagnóstico genético invasivo de alteraciones cromosómicas en una población seleccionada de Bogotá D.C. Pacientes y métodos: se realizó un estudio descriptivo de corte transversal entre el 1 de agosto de 2005 y el 31 de diciembre de 2007. Se revisaron las historias clínicas de embarazadas remitidas con indicación de estudio genético invasivo por anomalías cromosómicas. Resultados: se analizaron 374 embarazos, de los cuales el 98,9% (n=370) eran simples y el 1,1% (n=4) correspondían a gemelares, para un total de 378 análisis del cariotipo fetal. La edad materna promedio fue de 35 años y la gestacional promedio de 17,4 semanas. Se realizaron 366 amniocentesis (96,8%) y 12 biopsias de vellosidades coriónicas (3,2%). El estudio citogenético más solicitado fue el cariotipo 64,8% (n=245) y en 33,6% (n=127) de los casos se hizo análisis por FISH y cariotipo. Entre las indicaciones para solicitar estudio genético invasivo se destacan la edad materna con 35,7% (n=135), seguida de malformaciones menores ecográficas 14,8% (n=56), tamizaje segundo trimestre 9,3% (n=35), sonolucencia nucal aumentada 6,9% (n=26) y malformaciones mayores ecográficas 6,3% (n=24). Se reportaron 54 estudios citogenéticos alterados (14,3%); de ellos, 36 correspondieron a aneuploidías (66,67%) y dieciocho a variaciones estructurales (33,33%). Cuando la edad materna fue la única indicación de un procedimiento invasivo, sólo se detectó el 6,66% de cariotipos alterados, mientras que en el grupo...

Antecedents: increased use of prenatal ultrasound and invasive diagnostic procedures has improved the detection of congenital fetal defects. The dilemma entails a procedure-related risk for which physicians continue to put up with a way to identify highrisk patients to avoid unnecessary diagnostic procedures in low-risk patients. This population-based study, conducted in Bogotá D.C., describes the various indications for an invasive genetic study to identify chromosomal abnormalities. Patients and methods: this is a descriptive cross-sectional study performed between August 1st 2005 and December 31st 2007. The clinicalrecords of pregnant women referred with an indication for invasive prenatal testing due to chromosomal abnormalities were reviewed. Results: 374 pregnancies were assessed, where 98.9% (n=370) were single pregnancies and 1.1% (n=4) twin pregnancies, thus, 378 fetal karyotype analyses were conducted. The mean age was 35 years and the mean gestational age was 17.4 weeks. We performed 366 amniocentesis (96.8%) and 12 choryonic villus sampling (3.2%). Karyotype analysis was the most frequently requested cytogenetic study accounting for 64.8% (n=245) of cases and FISH and karyotype analyses wereperformed in 33.6% (n=127). Advanced maternal age in 35.7% (n=135) was the main indication for invasive genetic studies request, followed by minor malformations detected by ultrasound 14.8% (n=56), second-trimester screening 9.3% (n=35), enhanced nuchal translucency 6.9% (n=26) and major defects detected by ultrasound 6.3% (n=24). Fifty-four (54) cytogenetic studies were reported as abnormal (14.3%); 36 corresponding to aneuploidy (66.67%) and 18 to structural variations (33.33%). Only 6.66% abnormal karyotypes were determined when maternal age was the only indication for an invasive procedure, while aneuploidy was diagnosed in the minor or major defect or nuchal translucency groups in 25%, 29% and 26% respectively...

Exodontia múltipla preventiva e instalação de implantes cônicos, utilizando a técnica de múltiplas incisões circulares na preservação do rebordo alveolar e obtenção de perfil gengival estético / Preventive multiple extraction and installation of conical implants, using the technique of multiple circular incisions for the preservation of the alveolar rim and attachment of aesthetic profile gingival

Atualmente os implantes bucais são parte importante na reabilitação bucal, sendo que cada vez mais pacientes e profi ssionais optam por esta modalidade de tratamento. O presente trabalho relata um caso clínico, no qual através de um planejamento detalhado, foram feitas preventivamente as extrações dos elementos dentais remanescentes da maxila, por estarem comprometidos devido a perda óssea generalizada e doença periodontal crônica com mobilidade graus II e III. Após a instalação de nove implantes cônicos foi fi xada uma prótese provisória de arco total aparafusada, sendo a mesma ferulizada parcialmente em estrutura de titânio, soldada a laser e revestida em resina acrílica termopolimerizável. As incisões conservadoras, realizadas com punch durante a cirurgia para instalação dos implantes, permitiram um melhor contorno mucosal, tempo cirúrgico menor devido à ausência de suturas, maior estabilidade dimensional dos tecidos duros e moles devido à ausência de retalho mucoperiostal. A instalação de implantes cônicos favoreceu a estabilização primária dos mesmos em osso de baixa densidade, o que possibilitou a aplicação de carga imediata, reduzindo o tempo de tratamento e a perda óssea, devolvendo, assim, a auto-estima da paciente e melhorando a sua interação social.

Conexão protética mais utilizada em implantes unitários por cirurgiões-dentistas que praticam implantodontia / Which is the highest preference related to abutments for unitary implants in private implantoloty clinics?

Objetivos: Estudar a conexão protética mais utilizada em implantes unitários por cirurgiões-dentistas que praticam implantodontia. Métodos: Cinco conexões foram escolhidas tais como Pilar Cônico ou Esteticoneri, Uclari, Cera-oneri ou Pilar Sextavado, Munhão estéticori (Cera-adaptri ou pilar de óxido de alumínio ou zircônia) e Munhão personalizadori, e fizeram parte de um questionário entre os profissionais da Odontologia durante o evento em São Paulo û Brasil 40 anos de Osseointegraçãoõ em 2005. Resultados: Após coleta dos dados e análise estatística, evidenciou que a maior preferência na escolha da conexão recaiu sobre a conexão UCLAri. Esta conexão foi mais usada por 35,5% dos especialistas em implantodontia ali presentes quando se considerou a região anterior da boca e 37,5% na região posterior. Para os mestrados, a preferência foi de 29,1% para a região anterior e de 33,7% para a região posterior da boca. Para os doutores a percentagem de 22,2% ocorreu na região anterior da boca e de 38,9% na sua região posterior. Conclusão: Diante dos resultados obtidos pode-se concluir que a conexão UCLAri tem sido a mais utilizada pelos cirurgiões-dentistas da amostra.

The challenge of preparation for a chemical, biological, radiological or nuclear terrorist attack.

Terrorism is not a new phenomenon, but, in the contemporary scene, it has established itself in a manner which commands the most serious attention of the authorities. Until relatively recently, the major threat has been through the medium of conventional weaponry and explosives. Their obvious convenience of use and accessibility guarantees that such methods will continue to represent a serious threat. However, over the last few years, terrorists have displayed an enthusiasm for higher levels of carnage, destruction and publicity. This trend leads inexorably to the conclusion that chemical, biological, radiological and nuclear (CBRN) methods will be pursued by terrorist organisations, particularly those which are well organised, are based on immutable ideological principles, and have significant financial backing. Whilst it is important that the authorities and the general public do not risk over-reacting to such a threat (otherwise, they will do the work of the terrorists for them), it would be equally ill-advised to seek comfort in denial. The reality of a CBRN event has to be accepted and, as a consequence, the authorities need to consider (and take seriously) how individuals and the community are likely to react thereto and to identify (and rehearse in a realistic climate) what steps would need to be taken to ameliorate the effects of such an event.

Análise da expressão de integrinas em células OsA-CL cultivadas sobre implantes de titânio tratado à laser / Análise da expressão de integrinas em células OsA-CL cultivadas sobre superfície de implante de titânio tratado à laser

Diversos estudos têm demonstrado que os implantes de titânio são altamente biocompatíveis e passíveis de osseointegrar, contudo os mecanismos moleculares que atuam por trás da osseointegração permanecem largamente inexplorados. Uma das possibilidades é que o implante exposto ao sangue do paciente durante a cirurgia absorve proteínas relacionadas com a adesão celular, como a fibronectina e vitronectina presentes no plasma. Células como osteoblastos podem então aderir a estas proteínas através dos mecanismos mediadas pelas integrinas. No presente estudo, utilizamos a imunofluorescência para marcação dos anticorpos contra integrinas α2, α3, α5, α6, αv e β1 em células OsA-CL cultivadas sobre lamínulas de vidro e superfície de titânio modificada por radiação à laser no período de 1h à 24 horas. As células aderidas na superfície lisa das lamínulas de vidro tiveram um maior espalhamento durante as primeiras 3 horas, porém nos outros períodos estudados o espalhamento ocorreu de maneira similar em ambas as superfícies. A expressão de integrinas na superfície rugosa dos implantes manteve-se uniforme em todos os períodos estudados, contudo no grupo controle a expressão de integrinas diminuiu na avaliação de 24 horas. Concluiu-se que as características de superfície dos diferentes biomateriais podem afetar o comportamento celular durante a interação inicial das células com a superfície de material utilizado como substrato

Paediatric open heart surgery in Trinidad and Tobago: an example of collaborative care / Cirugía Pediátrica a Corazón Abierto en Trinidad y Tobago

Between September 1998 and February 2003, 204 children underwent cardiac surgery in Trinidad and Tobago to correct or palliate congenital heart disease. The defects included isolated ventricular or atrial septal defects as well as tetralogy of fallot and coarctation of the aorta. A few patients also had complex cyanotic congenital heart disease. The patients ranged in age from 2 days to 17 years. In some cases, palliative surgery was undertaken as a first step towards complete correction but the majority of patients underwent complete repair. The commonest postoperative complications were haemorrhage and small transient pericardial effusions. The overall mortality rate was < 1. This paper describes the cardiac lesions, post-operative morbidity and mortality of these patients

Entre septiembre de 1998 y febrero de 2003, 204 niños fueron sometidos a cirugía cardíaca en Trinidad y Tobago, a fin de corregir o paliar la enfermedad cardíaca congénita. Las cardiopatías incluían defectos septales atriales o venticulares aislados, así como tetralogía de Fallot y coartación de la aorta. Algunos pacientes también presentaban cardiopatía congénita cianótica compleja. Los pacientes tenían edades que fluctuaban de dos días a 17 años. En algunos casos, la cirugía paliativa se emprendió como un primer paso hacia la corrección completa pero a la mayoría de los pacientes se les practicó la reparación completa. Las complicaciones más comunes del post-operatorio fueron hemorragias y pequeñas efusiones pericadiales transitorias. La tasa general de mortalidad fue <1%. Este trabajo describe las lesiones cardíacas, la morbilidad y mortalidad post-operatoria de estos pacientes.

Did exclusive breast-feeding and early discharge lead to excessive bilirubin levels in newborns in Antigua and Barbuda?

Hyperbilirubinaemia is a common neonatal problem worldwide and is the leading cause of admission to the Special Care Nursery in Antigua and Barbuda. In 1990, the Innocenti Declaration in support of breast-feeding led to the adoption of the Baby-Friendly Hospital Initiative in many countries of the Caribbean, including Antigua and Barbuda. Comparing 1989 to the years 1992 to 1994, the Special Care Nursery at Holberton Hospital experienced a 40 increase in newborns admitted with hyperbilirubinaemia (peak total bilirubin > 12 mg/dl or 205 mumol/l). A retrospective review of Special Care Nursery and Maternity Ward records was undertaken to determine the incidence and aetiology of hyperbilirubinaemia from 1992 to 1994. There were 3721 infants born in Antigua and Barbuda in those years, 98 of Afro-Caribbean or mixed ancestry. The overall incidence of peak total bilirubin over 12 mg/dl (205 mumol/l) was 12.5 (466/3721), not inconsistent with the reported incidence of 8 to 20 in other countries. However, the incidence of higher levels of hyperbilirubinaemia in Antigua and Barbuda exceeded those reported for other countries. In Antigua and Barbuda, total bilirubin of 15 mg/dl (255 mumol/l) or higher was found in 263 of 3721 infants (7.1) compared to 5.9 in India and 2 of breast-fed infants in the United States of America (USA). Total bilirubin of 20 mg/dl (340 mumol/l) or higher was seen in 91 of 3721 infants (2.5) exceeding reported prevalence in the USA for both African-American and Caucasian infants (1) and equal to the reported prevalence in Asian infants (2). The possible aetiologies of hyperbilirubinaemia in neonates with total bilirubin 18 mg/dl (306 mumol/l) or higher in our patients were investigated. Medical records of 134 of 156 (86) infants having this level of hyperbilirubinaemia were available for review. The possible reason for hyperbilirubinaemia was ABO incompatibility in 4/134 (3), Rh incompatibility in 1/134 (1), prematurity in 12/134 (9) and sepsis neonatorum in 21/134 (16). The hyperbilirubinaemia was idiopathic in 96/134 (71) infants. Newborns in Antigua and Barbuda were discharged 3.7 days after their mothers' admission, with 50 discharged prior to 48 hours of age. Early discharge in developed countries has led to increased readmissions for hyperbilirubinaemia. Following the appointment of a dietitian to supervise breast-feeding, admissions for hyperbilirubinaemia fell by 50 by 1998. These data suggest that exclusive br

Resistencia natural, in vitro, a los virus de estomatitis vesicular y de rinotraqueitis infecciosa en ganado Blanco Orejinegro / In vitro natural resistance to Vesicular Stomatitis Virus and Infectious Bovine Rinotracheitis Virus in Blanco Orejinegro cattle

Este informe da cuenta de los resultados de un proyecto encaminado a determinar la posible diversidad fenotípica de la resistencia/susceptibilidad, in vitro, de la raza de ganado criollo colombiano, Blanco Orejinegro (BON), a la infección por virus de estomatitis vesicular (EV) y de Rinotraqueitis Infecciosa Bovina (RIB). Se probaron 47 muestras de fibroblastos primarios de igual número de animales, mediante titulación viral, y se determinó la Dosis Infecciosa Mínima 50 por ciento por ml (DIM50 por ciento/ml) por el método de Spearman karber. Luego se obtuvieron los Índices de Resistencia/ Susceptibilidad (IRS) y se agruparon los cultivos primarios de fibroblastos en resistentes y susceptibles con los siguientes resultados: Para RIB los 47 cultivos primarios de fibroblastos de ganado BON resultaron susceptibles; para EV serotipo Indiana, 37 fueron susceptibles y 10 resistentes, y para EV serotipo New Jersey, se encontraron 41 susceptibles y 5 resistentes. Un polimorfismo fenotípico en resistencia/susceptibilidad, in vitro, del ganado BON, se había demostrado previamente para el virus de la fiebre aftosa.

Nosocomial Infection Rate Comparison of Military and Civilian Intensive Care Units / 병원감염관리

BACKGROUND: This study was undertaken to compare nosocomial infection rates between intensive care units of military and civilian hospitals. METHODS: From July to December 2000, we surveyed the intensive care unit of Armed Forces Capital Hospital (AFCH). We compared device use ratios and device-day infection rates with those of Korean Society for Nosocomial Infection Control (KOSNIC) and National Nosocomial Infections Surveillance (NNIS) system. RESULTS: During the period of study, 185 cases were admitted and 24 nosocomial infections were detected: 7 cases of pneumonia, 6 urinary tract, 3 blood stream, 3 cardiovascular system, 3 surgical site infections, 1 skin and soft tissue, and 1 central nervous system infection. Ventilator, urinary catheter and central venous catheter use ratios were 0.14 (95% confidence interval, 0.12-0.16), 0.58 (0.56-0.60) and 0.33 (0.31-0.35). The ratios of NNIS were 0.41, 0.67 and 0.50. Ventilator-, urinary catheter- and central venous catheter-day infection rates were 18.69(11.36-53.32), 6.65 (3.36-14.20) and 1.95 (1.44-9.92). However, the rates of KOSNIC were 9.93, 5.29 and 3.62. The rates of NNIS were 11.24, 6.14 and 5.55. CONCLUSIONS: In AFCH ventilators were used less frequently than NNIS, but more ventilator-associated pneumonia were developed than KOSNIC and NNIS.