Finding acute coronary syndrome with serial troponin testing for rapid assessment of cardiac ischemic symptoms (FAST-TRAC): a study protocol

Objective@#To determine the utility of a highly sensitive troponin assay when utilized in the emergency department. @*Methods@#The FAST-TRAC study prospectively enrolled >1,500 emergency department patients with suspected acute coronary syndrome within 6 hours of symptom onset and 2 hours of emergency department presentation. It has several unique features that are not found in the majority of studies evaluating troponin. These include a very early presenting population in whom prospective data collection of risk score parameters and the physician’s clinical impression of the probability of acute coronary syndrome before any troponin data were available. Furthermore, two gold standard diagnostic definitions were determined by a pair of cardiologists reviewing two separate data sets; one that included all local troponin testing results and a second that excluded troponin testing so that diagnosis was based solely on clinical grounds. By this method, a statistically valid head-to-head comparison of contemporary and high sensitivity troponin testing is obtainable. Finally, because of a significant delay in sample processing, a unique ability to define the molecular stability of various troponin assays is possible.Trial registration ClinicalTrials.gov Identifier NCT00880802

Treating acutely ill patients at home: Data from Singapore

INTRODUCTION@#Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes.@*METHODS@#We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge.@*RESULTS@#A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again.@*CONCLUSION@#Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.

Genomics and epidemiology of the P 1 SARS-CoV-2 lineage in Manaus, Brazil

Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Manaus, Brazil, resurged in late 2020 despite previously high levels of infection. Genome sequencing of viruses sampled in Manaus between November 2020 and January 2021 revealed the emergence and circulation of a novel SARS-CoV-2 variant of concern. Lineage P.1 acquired 17 mutations, including a trio in the spike protein (K417T, E484K, and N501Y) associated with increased binding to the human ACE2 (angiotensin-converting enzyme 2) receptor. Molecular clock analysis shows that P.1 emergence occurred around mid-November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.7- to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.1 that it provides against non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.

Incidence of Meniscal Tears in Cruciate Deficient Knee with Respect to Early and Delayed Reconstruction of ACL

Introduction: Descriptions of meniscus and articularcartilage lesions associated with anterior cruciate ligamentinjury have been reported by many authors. There are twoschools of thought regarding reconstruction either Earlyreconstruction and structured rehabilitation or Structuredrehabilitation with delayed reconstruction The aim of thisstudy was to identify the impact on the meniscus in earlyand delayed presentation of anterior cruciate ligament tearsand to emphasize the importance of early reconstruction ofanterior cruciate ligament to prevent further meniscal damageand articular cartilage lesions and subsequentially preventingOsteoarthritis.Materials and methods: The retrospective study wasconducted at Lourdes Hospital, Ernakulam, Kerala.Patients who presented with anterior cruciate ligament tearswere grouped into three based on their time of injury toreconstruction and the associated meniscal tears were noted.GROUP I included patients who had ACL Reconstructionwithin 2 months of injury, GROUP II within 2-6 months ofinjury and GROUP III within 6-12 Months of injury. Patientswere further divided within the groups according to their ageand grouped with a difference of ten years starting at less than25 years of age to greater than 45 years of age. Location andincidence of tear was compared between the three groupsResults: Incidence of Meniscal injury increases over timein patients as they passed through the acute, sub-acute andchronic phases of ACL deficiency. Immediately followingACL Injury Lateral meniscal injuries were more commonand was found in the acute phase (Group I). Lateral meniscustears decreased as patients passed through the acute phaseinto the sub-acute phase (Group II), whereas medial meniscaltears began to increase and predominated in the chronic phase(Group III).Conclusion: This study was able to demonstrate that theIncidence of Meniscal injury increased over time in ACLdeficient knees. Lateral meniscal injuries were more commonin acute ACL Tears. Medial meniscal injuries increased dueto instability of the knee. Hence an early Acl reconstructionpreferably within two months of injury is a good option forpatients as it prevents further meniscal damage and decreasesIncidence of Osteoarthritis.

New geographical records and key to the species of Eumerus Meigen, 1823 (Diptera, Syrphidae) introduced into the Americas and Hawaii

Abstract Eumerus Meigen, 1823 is a very speciose genus of flower flies from the Eastern Hemisphere. Several reports of introduced species of this genus in the Americas have been recorded since early in the twentieth century, with a present list of six species recorded to date from the Americas and the US territory of Hawaii. In this paper we give new geographical records for the African-native species Eumerus obliquus (Fabricius, 1805), which reflect the expansion of this fly through Brazil and Paraguay along the last twenty years. At the same time, we report a second species from Paraguay, Eumerus aurifrons (Wiedemann, 1824), being this the first Western Hemisphere record for this Asian-native species. We finally provide an identification key to all of the species of Eumerus presently known from the Americas and Hawaii.

The moral dilemma of the polio eradication programme

During the last five years, globally, cases of polio caused by vaccine viruses have outnumbered those of polio caused by natural (wild) polioviruses, posing a moral dilemma. Public health ethics should ensure the best interests of the community, with equity in sharing benefits and risks irrespective of socioeconomic disparities. Vaccine viruses in oral polio vaccine (OPV) cause vaccine-associated paralytic polio (VAPP), while paralytic polio is also caused by vaccine-derived polioviruses (VDPVs). By its policy of the use of OPV in low and middle-income countries, while rich countries use the safe inactivated polio vaccine (IPV), the Global Polio Eradication Programme has been responsible for social injustice. In 2017 and 2018, there were outbreaks of polio in Syria and Papua New Guinea due to circulating VDPVs, after many years of these countries remaining free of polio due to wild polioviruses. The only ethical way forward for global polio eradication is to replace OPV with IPV in all countries.

An ethical appraisal of the choice of vaccines against Poliomyelitis

Medical ethics is invoked for immunisation of children as it involves an interaction between a healthcare professional and the child. Immunisation under the national immunisation programme is a public health intervention and the common belief is that ethics is not relevant. Two vaccines with contrasting safety and efficacy profiles were available against polio before the national immunisation programme was launched: the inactivated poliovirus vaccine (IPV) and the live attenuated oral poliovirus vaccine (OPV). India chose OPV and excluded IPV. We carried out an ethical appraisal of that choice. Principles of medical ethics comprising four elements—non-maleficence, beneficence, autonomy and justice—was already in vogue at the time. Applying each of them, a head-to-head comparison between IPV and OPV is made. The results clearly show that the choice of vaccine was made without using ethical principles, resulting in serious adverse effects in hundreds of thousands of children. We recommend that medical ethics must be applied to all choices of public health interventions

A cross-sectional study on the knowledge, attitude and practices (KAP) of mothers and caregivers on immunization in Quezon City / The Health Sciences Journal

INTRODUCTION@#Despite establishing immunization as an effective approach, the number of deaths from immunizable diseases among 0 to 14 years old remained high in 2012. This prompted the researchers to determine the knowledge, attitude and practices of mothers/caregivers regarding the immunization of their children. @*METHODS@#The research utilized a descriptive cross-sectional design. An interviewer-guided validated questionnaire was administered to mothers and caregivers with at least one child 12 months or younger who was eligible for immunization. @*RESULTS@#Around half of the 211 respondents were aged 20-35 years old, married and living in their own home. A large percentage were unemployed, and the highest educational attainment was high school. Most respondents had one child in care undergoing immunization, mostly in a health center. Results showed that all respondents scored below the MPL for knowledge. For attitude, all scored above the MPL. Only 45.02% of mothers/caregivers scored above the MPL for practices.@*CONCLUSION@#Despite poor knowledge, mothers and caregivers displayed good attitude towards immunization, however this did not translate into bringing their children for vaccination.

Differences Regarding the Molecular Features and Gut Microbiota Between Right and Left Colon Cancer

For many years, developmental and physiological differences have been known to exist between anatomic segments of the colorectum. Because of different outcomes, prognoses, and clinical responses to chemotherapy, the distinction between right colon cancer (RCC) and left colon cancer (LCC) has gained attention. Furthermore, variations in the molecular features and gut microbiota between right and LCCs have recently been a hot research topic. CpG island methylator phenotype-high, microsatellite instability-high colorectal cancers are more likely to occur on the right side whereas tumors with chromosomal instability have been detected in approximately 75% of LCC patients and 30% of RCC patients. The mutation rates of oncogenes and tumor suppressor genes also differ between RCC and LCC patients. Biofilm is more abundant in RCC patients than LLC patients, as are Prevotella, Selenomonas, and Peptostreptococcus. Conversely, Fusobacterium, Escherichia/Shigella, and Leptotrichia are more abundant in LCC patients compared to RCC patients. Distinctive characteristics are apparent in terms of molecular features and gut microbiota between right and LCC. However, how or to what extent these differences influence diverging oncologic outcomes remains unclear. Further clinical and translational studies are needed to elucidate the causative relationship between primary tumor location and prognosis.

Urethral Pressure Measurement as a Tool for the Urodynamic Diagnosis of Detrusor Sphincter Dyssynergia / 대한배뇨장애요실금학회지

PURPOSE: To describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD. METHODS: Multiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups. RESULTS: Seventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm H₂O urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm H₂O during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10–500 seconds) and mean urethral pressure amplitude was 73 cm H₂O (range, 1–256 cm H₂O). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology. CONCLUSIONS: Urethral pressure amplitude of >20 cm H2O during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.

Current status of simulation training in plastic surgery residency programs: A review

Increased emphasis on competency-based learning modules and widespread departure from traditional models of Halstedian apprenticeship have made surgical simulation an increasingly appealing component of medical education. Surgical simulators are available in numerous modalities, including virtual, synthetic, animal, and non-living models. The ideal surgical simulator would facilitate the acquisition and refinement of surgical skills prior to clinical application, by mimicking the size, color, texture, recoil, and environment of the operating room. Simulation training has proven helpful for advancing specific surgical skills and techniques, aiding in early and late resident learning curves. In this review, the current applications and potential benefits of incorporating simulation-based surgical training into residency curriculum are explored in depth, specifically in the context of plastic surgery. Despite the prevalence of simulation-based training models, there is a paucity of research on integration into resident programs. Current curriculums emphasize the ability to identify anatomical landmarks and procedural steps through virtual simulation. Although transfer of these skills to the operating room is promising, careful attention must be paid to mastery versus memorization. In the authors' opinions, curriculums should involve step-wise employment of diverse models in different stages of training to assess milestones. To date, the simulation of tactile experience that is reminiscent of real-time clinical scenarios remains challenging, and a sophisticated model has yet to be established.

Body mass index and waist circumference of Latin American adult athletes with intellectual disability / Índice de masa corporal y circunferencia de cintura en atletas adultos latinoamericanos con discapacidad intelectual

Abstract: Objectives: To examine both body mass index (BMI) status and waist circunference (WC) in a large international sample of adult Special Olympics participants from Latin America. It also explored the association of age and sex with obesity in this population. Materials and methods: BMI and WC records from a total of 4174 (2683 male and 1491 female) participant records from the Special Olympics International Health Promotion database were examined. Results: The prevalence of overweight and obesity was quite high (i.e. > 40%), but generally lower than studies involving adults with intellectual disabilities from Europe and the USA. Chi-square analyses revealed that both increasing age and being female significantly predicted levels of overweight, obesity, and WC. Conclusions: These results suggest that efforts need to be made to prevent and reduce rates of overweight and obesity among Latin American Special Olympics participants, particularly women.

Resumen: Objetivos: Examinar tanto el estado de índice de masa corporal (IMC) como la circunferencia de cintura (WC) en una muestra significantemente grande de participantes internacionales de Olimpiadas Especiales de América Latina. También este estudio exploró la asociación de la edad y el género con la obesidad en esta población. Material y métodos: Se examinaron los registros de IMC y WC de un total de 4174 (2683 hombres y 1491 mujeres) del banco de datos de la Promoción Internacional de la Salud de Special Olympics (Special Olympics International Health Promotion). Resultados: El predominio de sobrepeso y obesidad fue bastante alta (es decir, > 40%), pero generalmente menor en comparación con los estudios con adultos con discapacidad intelectual de Europa y los Estados Unidos. El análisis Ji cuadrada reveló que tanto el aumento de la edad y ser mujer predijo significativamente los niveles de sobrepeso, obesidad y WC. Conclusiones: Estos resultados sugieren que hay que hacer esfuerzos para prevenir y reducir las tasas de sobrepeso y obesidad entre los participantes de las Olimpiadas Especiales de América Latina, particularmente las mujeres.

Effect of antiplatelet therapy on mortality and acute lung injury in critically ill patients: A systematic review and meta‑analysis.

Aim: Platelet function is intricately linked to the pathophysiology of critical Illness, and some studies have shown that antiplatelet therapy (APT) may decrease mortality and incidence of acute respiratory distress syndrome (ARDS) in these patients. Our objective was to understand the efficacy of APT by conducting a meta‑analysis. Materials and Methods: We conducted a meta‑analysis using PubMed, Central, Embase, The Cochrane Central Register, the ClinicalTrials.gov Website, and Google Scholar. Studies were included if they investigated critically ill patients receiving antiplatelet therapy and mentioned the outcomes being studied (mortality, duration of hospitalization, ARDS, and need for mechanical ventilation). Results: We found that there was a significant reduction in all‑cause mortality in patients on APT compared to control (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.70–0.97). Both the incidence of acute lung injury/ ARDS (OR: 0.67; 95% CI: 0.57–0.78) and need for mechanical ventilation (OR: 0.74; 95% CI: 0.60–0.91) were lower in the antiplatelet group. No significant difference in duration of hospitalization was observed between the two groups (standardized mean difference: −0.02; 95% CI: −0.11–0.07). Conclusion: Our meta‑analysis suggests that critically ill patients who are on APT have an improved survival, decreased incidence of ARDS, and decreased need for mechanical ventilation.

Hepatic epithelioid hemangioendothelioma: a report from three university centers / Hemangioendotelioma epitelioide hepático: pesquisa em três centros universitários

Abstract Objective: To determine common imaging findings of hepatic epithelioid hemangioendothelioma on magnetic resonance images. Materials and Methods: A search was made of three institutional databases between January 2000 and August 2012. Seven patients (mean age, 47 years; range, 21-66 years; 6 women) with pathology-confirmed diagnosis of hepatic epithelioid hemangioendothelioma who had undergone magnetic resonance imaging were identified. None of the patients had received any treatment for hepatic epithelioid hemangioendothelioma at the time of the initial magnetic resonance imaging examination. Results: Hepatic epithelioid hemangioendothelioma tumors appeared as focal masses in 7/7 patients, greater than 5 in number, with a coalescing lesion in 1/5, and peripheral localization in 6/7. Capsular retraction was present in 4/7, and was associated with peripherally located lesions. Early ring enhancement was appreciated in the majority of lesions in 7/7 patients. Centripetal progressive enhancement was shown in 5/7 patients on venous phase that exhibited a distinctive thick inner border of low signal on venous phase images, and a central core of delayed enhancement. Small lesions did not show this. Conclusion: The combination of multifocal round-configuration lesions that are predominantly peripheral and exhibit early peripheral ring enhancement and late appearance of an inner thick border of low signal and central core of high signal may represent an important feature for hepatic epithelioid hemangioendothelioma.

Resumo Objetivo: Determinar os achados comuns de hemangioendotelioma epitelioide hepático em imagens de ressonância magnética. Materiais e Métodos: Uma pesquisa foi feita em três bases de dados institucionais entre janeiro de 2000 e agosto de 2012. Sete pacientes (média de idade, 47 anos; variação, 21-66 anos; 6 mulheres) com diagnóstico confirmado por exame patológico de hemangioendotelioma epitelioide hepático submetidos a ressonância magnética foram identificados. Nenhum dos pacientes havia recebido tratamento para hemangioendotelioma epitelioide hepático antes do exame inicial por ressonância magnética. Resultados: Tumores de hemangioendothelioma epitelioide hepático apareceram como massas focais, maiores que 5 em número, em 7/7 pacientes, com uma lesão coalescente em 1/5 e localização periférica em 6/7 pacientes. Retração capsular esteve presente em 4/7 pacientes e foi associada com lesões perifericamente localizadas. Realce precoce em anel foi visto na maioria das lesões, em 7/7 pacientes. Realce progressivo centrípeto foi demonstrado em 5/7 pacientes na fase venosa, que exibia uma borda interna espessa distinta de baixo sinal nas imagens de fase venosa e um núcleo central de realce tardio. As lesões pequenas não mostraram isso. Conclusão: A combinação de lesões de configuração arredondada multifocais que são predominantemente periféricas e exibem realce precoce em anel periférico e aparecimento tardio de uma borda espessa interna de baixo sinal e um núcleo central de alto sinal pode representar uma característica importante para hemangioendotelioma epitelioide hepático.

Improving research and scientific publications in Africa: analysis of a centennial issue of The FASEB Journal towards effective mentoring

In Nigeria, the flourishing of universities and turn-out of graduates do not adequately reflect in national development. The aim of this study was to determine some factors that can guarantee career success in the field of biomedical science in Nigeria. The objectives were to examine thirty three articles of a centennial issue (April 2012) of the FASEB Journal for: a) Number of printed pages of the journal, b) Number of major studies described in the article, c) Number of figures and presentation of data within the figures, d) Number of days the journal took to review the article before acceptance for publication, e) Number of scientific references listed at the end of the article. The data showed that articles took up 10.5±1.5 printed pages, reported 8.03±0.36 major studies, utilized 49.76±7.4 references, and took 87.76± 8.4 days to be accepted. Data were presented as tables in 16/33 articles; diagrams in 18/33 articles; graphs in 21/33 articles; histograms (and other charts) in 31/33 articles; photos/pictures in 24/33 articles, blots (mainly western) in 20/33 articles; machine print-outs in 10/33 articles; and sequences, arrays, or mappings in 7/33 articles. The author concludes that young biomedical scientists need to be directed to take care of the following factors along their research career: a) quantity of work, b) quality of work, c) richness of evidence, d) planning and pacing of work, e) relationship of work with universal knowledge and development