Prehospital Levetiracetam Use in Adults With Status Epilepticus: Results of a Multicenter Registry

Background@#and Purpose Status epilepticus (SE) is a neurological emergency due to prolonged seizure activity or multiple seizures without full recovery in between them. Prehospital SE management is crucial since its duration is correlated with higher morbidity and mortality rates. We examined the impact of different therapeutic strategies in the prehospital setting with a focus on levetiracetam. @*Methods@#We initiated the Project for SE in Cologne, a scientific association of all neurological departments of Cologne, the fourth-largest city in Germany with around 1,000,000 inhabitants. All patients with an SE diagnosis were evaluated over 2 years (from March 2019 to February 2021) to determine whether prehospital levetiracetam use had a significant effect on SE parameters. @*Results@#We identified 145 patients who received initial drug therapy in the prehospital setting by professional medical staff. Various benzodiazepine (BZD) derivatives were used as first-line treatments, which were mostly used in line with the recommended guidelines. Levetiracetam was regularly used (n=42) and mostly in combination with BZDs, but no significant additional effect was observed for intravenous levetiracetam. However, it appeared that the administered doses tended to be low. @*Conclusions@#Levetiracetam can be applied to adults with SE in prehospital settings with little effort. Nevertheless, the prehospital treatment regimen described here for the first time did not significantly improve the preclinical cessation rate of SE. Future therapy concepts should be based on this, and the effects of higher doses should in particular be reexamined. 

Students and faculty experiences, perceptions and knowledge on distress during the COVID-19 pandemic: A descriptive cross-sectional study

Background and Objective@#The University of the Philippines Manila (UPM) subcommittee on students in distress was convened during the COVID-19 pandemic to develop “plans, programs and mechanisms” to deal with students experiencing distress and mental health concerns. This study was conducted as one of the activities of the Subcommittee to inform policy to address the following research objective: to describe the experiences, perceptions, and knowledge of both students and faculty members of UP Manila regarding distress.@*Methods@#An online survey tool was created using the results from seven online focus group discussions among 20 faculty of UP Manila. The survey was conducted for one month among faculty and students sampled from the seven colleges of UP Manila and the three extension campuses of the Schools of Health Sciences. The different categories which were consistently perceived as important by both faculty and students as well as those with disparity in the perceptions between faculty and students were described and discussed.@*Results@#A total of 136 faculty (F) and 290 students (S) participated in the study, representing 39% vs 98% (F vs S) of the target sample, respectively. Results showed that among the effects of stressors for students, avoidance of schoolwork (F79 vs S70.3%) and sleep disturbance (F79.4 vs S72.4%), were perceived by both faculty and students as the most frequently perceived response of students to stress.Among the causes of stress, unclear boundaries between school and home (F73.5 vs S63.1%), family duties (F76.5 vs S50.7%), lack of socialization (F89 vs S57.6%), limited recreational activity (F76.5 vs S64.8%), adapting to new ways of socialization (F67.6 vs S53.8%), and internet signal (F99.3 vs S88.3%) were perceived by both faculty and students as the most frequently perceived causes of stress. Among the coping mechanisms, connecting with friends online (F86.8 vs S69.7%), listening to music (F72.8 vs S78.3%), browsing social media (F82.4 vs S81%), viewing movies (F84.6 vs S74.5%), and sleeping or resting (F67.6 vs S84.1%) were perceived by both faculty and students as the most employed by students to cope with stress.Results also show that there were marked disparities in the perceptions of faculty and students. Among the effects of stressors, the largest disparities were in non-performance in academics (F86 vs S51.7%) and academic failure (F76.5 vs S53.8%). Of the causative factors, the largest disparities were in the areas of death (F94.1 vs S14.5%) or sickness in the family (F66.9 vs S0%), family issues (F82.4 vs S24.5%), financial concerns (F89 vs S36.9%), absence of physical connectedness and interaction, (F94.9 vs S23.8%) lack of socialization (F89 vs S57.6%), owning a gadget (F73.5 vs S22.1%), and lack of funds for the internet (F79.4 vs S22.4%).Among the support systems available in the university (psychosocial, academic and wellness activities of the colleges), 70% of the faculty perceived that the students were aware of the support process offered by the university. In contrast, 28% of students were aware of the support services offered to them. @*Conclusion@#This study shows that UP Manila faculty and students perceived stress due to the effects of COVID-19 on teaching, learning, and everyday living. Distress among student respondents was commonly perceived to be caused by family concerns, environmental restrictions, connectivity issues, and experiencing a sense of lack. While support services and mental health programs have been in place within the university, only 28% of students perceive that students in distress were aware of the process in receiving support.

Association of clinicodemographic factors and tissue biopsy results among patients with thyroid nodules at the Southern Philippines Medical Center

Objective@#To compare selected clinicodemographic factors of patients with thyroid nodules who underwent thyroid surgeries with their tissue biopsy results and determine any association between clinicodemographic factors and tissue biopsy results.@*Methods@#Design: Retrospective review of records. Setting: Tertiary Government Training Hospital. Participants: 251 patients with thyroid nodules.@*Results@#Of 251 patients with thyroid nodules, the majority (218; 86.9%) were females while 33 (13.1%) were males. The average age in years was 41.5±13.3 The same population also had malignant outcomes at 79.3%. Most of the patients did not have family history of thyroid malignancy (54%) and had no palpable cervical lymph nodes at presentation (75.9%). Furthermore, there was no distant metastasis at presentation for both lungs (97.7%) and bones (98.9%). There were no significant differences in tissue biopsy results when correlated with age (df=249; t=-.144; p = .886), duration of goiter (df=249; t=-.829; p = .408), and distant metastasis at presentation for lungs (Z=-5.977; p = .052) and bones (Z=-.457; p = .648). Significant differences were only evident for clinicodemographic factors such as sex (Z=-2.570; p = .010), family history (Z=-2.239; p = .020), palpable cervical lymph nodes at presentation (Z=-5.977; p = .000), and the following comorbidities: pulmonary tuberculosis (Z=-2.388; p = .017) and bronchial asthma (Z=-2.148; p = .032) and smoking history (Z=-3.455; p=.001). Furthermore, having no palpable cervical lymph nodes at presentation were associated with malignant tissue biopsy results (B=3.616; p=.001). Patients without palpable cervical lymph nodes at presentation were 37.204 times [OR=37.204] more likely to have benign biopsy results [95% CI: 4.705 – 294.168].@*Conclusion@#There are greater odds of having benign biopsy results for patients without palpable cervical lymph nodes at presentation.

Small Intestinal Bacterial Overgrowth Complicating Gastrointestinal Manifestations of Systemic Sclerosis: A Systematic Review and Meta-analysis

Background/Aims@#Systemic sclerosis (SSc) often is complicated by small intestinal bacterial overgrowth (SIBO). A systematic review and meta-analysis thus examined the prevalence of SIBO in SSc (SSc-subtypes), identify risk factors for SIBO in SSc and the effects of concomitant SIBO on gastrointestinal symptoms in SSc. @*Methods@#We searched electronic databases until January-2022 for studies providing prevalence rates of SIBO in SSc. The prevalence rates, odds ratio (OR) and 95% confidence intervals (CI) of SIBO in SSc and controls were calculated. @*Results@#The final dataset comprised 28 studies with 1112 SSc-patients and 335 controls. SIBO prevalence in SSc-patients was 39.9% (95% CI, 33.1-47.1; P= 0.006), with considerable heterogeneity, (I 2 = 76.00%, P < 0.001). As compared to controls, there was a 10-fold increased SIBO prevalence in SSc-patients (OR, 9.6; 95% CI, 5.6-16.5; P< 0.001). The prevalence of SIBO was not different in limited cutaneous SSc as compared to diffuse cutaneous SSc (OR, 1.01; 95% CI, 0.46-2.20; P = 0.978). Diarrhea (OR, 5.9; 95% CI, 2.9-16.0; P = 0.001) and the association between SIBO in SSc and proton pump inhibitor use (OR, 2.3; 95% CI, 0.8-6.4; P = 0.105) failed statistical significance. Rifaximin was significantly more effective as compared to rotating antibiotic in eradicating SIBO in SSc-patients (77.8% [95% CI, 64.4-87.9]) vs 44.8% [95% CI, 31.7-58.4]; P < 0.05). @*Conclusions@#There is a 10-fold increased prevalence of SIBO in SSc, with similar SIBO prevalence rates in SSc-subtypes. Antimicrobial therapy of SIBO-positive SSc-patients with diarrhea should be considered. However, the results must be interpreted with caution due to substantial unexplained heterogeneity in the prevalence studies, and the low sensitivity and specificity of the diagnostic tests suggesting that the reliability of the evidence may be low.

Readiness of clients in returning to face-to-face therapy in an outpatient rehabilitation clinic: a preliminary study

BACKGROUND@#The Clinic for the Therapy Services (CTS) has considered reverting to face-to-face service delivery due to the downward trend in COVID-19 cases in the Philippines. However, the clinic has yet to investigate the willingness of the clients to this mode as a basis for its effective implementation.@*OBJECTIVES@#The study described the readiness of CTS clients in returning to face-to-face therapy amidst the pandemic. It also discussed the factors affecting readiness based on a survey.@*METHODOLOGY@#Fifty-five screened survey responses on the readiness of clients in returning to face-to-face therapy were gathered from January 30 to February 28, 2021. These underwent retrospective data analysis. Eight prospective online key informant interviews were conducted for clarifications in May 2022. This study utilized a descriptive analysis of quantitative categorical variables and a thematic content analysis of qualitative data.@*RESULTS@#The majority of the respondents (35) stated readiness to attend face-to-face therapy followed by those who answered “No” (11), “Maybe” (5), and others (4). Factors that may have affected readiness included travel, characteristics of face-to-face therapy, health conditions, vaccine, and COVID-19 concerns. Frequently preferred health and safety strategies were the provision of hygiene products, disinfection, limited people inside the clinic, separate therapy areas, and ventilation.@*CONCLUSION@#Most of the respondents expressed willingness to receive face-to-face therapy in April or May of 2021. Feasibility of travel and decreased number of COVID-19 cases may have encouraged willingness to attend. Those who were hesitant reported concerns with traveling, characteristics of face-to-face therapy, health conditions, the COVID-19 situation, and the vaccine.

Reflections of university students' experience under the online learning approach: A phenomenological study

Background@#The pandemic has reshaped the lives of everyone, including the way learning is delivered. Online learning in Physical Education (OLPE) is a form of distance learning where fundamental concepts of physical fitness are conducted remotely through the aid of technology. @*Objectives@#The study aimed to explore students' lived experiences in OLPE through the reflective narratives and photos generated from digital diary entries they made every other day for three weeks. The specific objective includes describing the students' feelings, processes, and realizations. @*Methodology@#Eight health professions students participated in this hermeneutic phenomenological study. The reflective accounts were analyzed following the interpretive phenomenological analysis (IPA) approach and revealed super-ordinate themes clustered into three categories: feelings, processes, and realizations. @*Results@#The first category is feelings evoked with super-ordinate themes, namely optimism with the course, appreciation of the teachers' attitude, empathy towards others, and desperation for a better set-up. The second category is processes experienced with super-ordinate themes, namely self-directed learning, awareness of the body, and dealing with heavy academic requirements. The third category is realizations with super-ordinate themes, namely experience of OLPE was a rollercoaster ride of successes and challenges, an experience that led to desires for improving self and the course, and finally, an opportunity for reflective learning. @*Conclusion@#Reflective accounts of feelings, processes, and realizations as students experience the sudden shift to OLPE are crucial in improving curricular policies and instructional designs for achieving quality outcomes.

Nuevos factores de riesgo de hemorragia pulmonar que complican la biopsia pulmonar guiada por TC en técnica coaxial / Novel risk factors of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial technique

Objetivos: Evaluar la frecuencia y gravedad de la hemorragia parenquimatosa pulmonar tras la biopsia pulmonar con aguja transtorácica coaxial, según factores de procedimiento, aún no descritos en la literatura. El objetivo de este estudio fue determinar si la elección de la tecnología de biopsia coaxial, el posicionamiento del paciente y la dignidad de la lesión son tres nuevas variables que influyen en el riesgo de hemorragia parenquimatosa tras biopsias coaxiales de pulmón. Métodos: Se revisaron retrospectivamente los registros de 117 pacientes que se sometieron a biopsias con aguja transtorácica del pulmón entre enero de 2018 y abril de 2020. El resultado primario fue la hemorragia pulmonar. Se ha utilizado un sistema de clasificación para clasificar la hemorragia parenquimatosa pulmonar: Grado 0 - Grado 3. Se evaluaron tres variables novedosas relacionadas con el paciente, la técnica y la lesión como predictores de hemorragia pulmonar: tecnología de biopsia coaxial, posición del paciente y dignidad de la lesión. Resultados: De los 117 pacientes, 18 (15,4%) pacientes con tecnología de biopsia coaxial de corte, versus 29 (24,8%) pacientes con tecnología coaxial de núcleo completo mostraron hemorragia significativa en las exploraciones de control posteriores a la biopsia. (IC del 95% 0,06-0,33, p <0,0001). No hubo diferencias significativas en la hemorragia pulmonar entre el diagnóstico histológico benigno y maligno (IC 95% 0,84-4,44, p = 0,1199) y la posición del paciente en decúbito prono o supino (IC 95%: 0,57-2,57, p = 0,6232). Conclusiones: La incidencia y gravedad de la hemorragia pulmonar depende de la tecnología de biopsia coaxial utilizada; siendo mayor en pacientes sometidos a una biopsia con tecnología full-core y menor después del uso de tecnología de corte. En este estudio de pronóstico no se estableció una correlación significativa entre la hemorragia pulmonar parenquimatosa y la posición del paciente o la dignidad de la lesión

Objectives: To evaluate the frequency and severity of pulmonary parenchymal hemorrhage after coaxial transthoracic needle biopsy of the lung, according to procedural factors, not yet described in literature. The aim of this study was to determine whether the choice of the coaxial biopsy technology, patient positioning and the lesion dignity are three new variables influencing the risk of parenchymal hemorrhage after coaxial biopsies of the lung. Methods: Records from 117 patients who underwent transthoracic needle biopsies of the lung between January 2018 and April 2020 have been retrospectively reviewed. The primary outcome was pulmonary hemorrhage. A grading system has been used to classify pulmonary parenchymal hemorrhage: Grade 0 ­ Grade 3. Three novel patient, technique and lesion-related variables were evaluated as predictors of pulmonary hemorrhage: coaxial biopsy technology, patient positioning and lesion dignity. Results: Out of the 117 patients, 18 (15,4%) patients with cutting coaxial biopsy technology, versus 29 (24,8%) patients with full core coaxial technology showed significant hemorrhage on the post-biopsy control scans. (95% CI 0,06-0,33, p<0,0001). No significant difference in pulmonary hemorrhage between benign and malignant histological diagnosis (95% CI 0,84-4,44, p=0,1199) and prone or supine patient positioning (95% CI: 0,57-2,57, p= 0,6232) was found. Conclusions: The incidence and severity of pulmonary hemorrhage depends on the coaxial biopsy technology used; being higher in patients undergoing a biopsy with full-core technology and lower after the use of cutting technology. No significant correlation between parenchymal pulmonary hemorrhage and patient positioning or lesion dignity was established in this prognostic study.

Concretizing occupational justice principles in Philippine community-based drug rehabilitation practice settings

Background@#The substance addiction and rehabilitation situation in the Philippines is a complex health and social crisis that has plagued individuals, groups, and communities in the past decades. While pluralistic and critical approaches to address the drug demand reduction issue are available, hegemonic practices continue to eclipse evidenceinformed approaches underpinned by resiliency and occupational justice perspectives. @*Methodology@#This case study utilized a qualitative and interpretive approach to describe the practice processes of localized community-based drug rehabilitation programs in selected Filipino communities and to propose concrete practice processes to improve the development and implementation of the local community-based drug rehabilitation. Two independent focus group discussions were conducted. Participants were health care professionals, community workers, and citizens who have an affinity to the substance addiction rehabilitation setting. Framed by the Participatory Occupational Justice Framework, specifically the practice process “engage collaboratively with partners,” qualitative data extracted from the focus group discussions were thematically analyzed. @*Results@#Three themes emerged: (1) Changing perspective: starting from the community; (2) Better together: collaboration and coordination in substance addiction and rehabilitation; and (3) “Juan for All, All for Juan”: contextualized strategies in substance addiction and rehabilitation. The findings in the case study reaffirm the value of shifting from an individualistic (symptom-eradication) to populational (social and systemic interventions) perspectives in developing community-based drug rehabilitation programs. @*Conclusion@#To reify occupational justice and resiliency approaches, proposed strategies include understanding drug use from critical and occupational perspectives, enacting social modeling and mentorship, promoting inter-agency and inter-professional collaborative practices, and infusing culturally appropriate strategies in the development and implementation of local community-based drug rehabilitation programs.

Experiences and Reflections of Clinical Supervisors on Online Occupational Therapy Internship during the COVID-19 pandemic

@#Due to restrictions brought by the COVID-19 pandemic, occupational therapy (OT) programs in the Philippines postponed face-to-face internship indefinitely. While guidelines encourage the use of the different alternative strategies in emergency remote learning, many Filipino clinical supervisors are apprehensive about online internship to prepare interns for clinical practice. In response to the growing concerns regarding online internship, an online forum was organized and attended by 23 clinical supervisors who shared their experiences and reflections. The online forum included sharing of speakers from major practice settings, breakout sessions, and sharing of insights from the breakout sessions. Qualitative data were collected and analyzed. Four themes emerged: issues and challenges in using telehealth as part of OT internship; maximizing technology in OT internship; re-envisioning competencies of students and internship supervisors towards the quality of client care, and; potentialities for the future of OT internship. Components of online internship will stay and must be further developed even after the pandemic. Through the forum, clinical supervisors can achieve collective goals in order to effectively educate OT interns amid unprecedented times.

Combined use of C-MAC Video laryngoscope and bonfils intubating fiberscope in a pediatric patient with a huge laryngeal mass: A case report

@#<p style="text-align: justify;">An anticipated difficult airway requires careful planning and teamwork among the anesthesiologists and the surgical team. This paper reports the airway management of a 7-year-old female scheduled for LASER excision of a huge, obstructing laryngeal neoplasm. Initial attempts to secure the airway with the patient minimally sedated using a C-MAC Video Laryngoscope (C-MAC) and a traditional intubating stylet failed. Successful tracheal intubation was achieved when C-MAC was combined with a pediatric Bonfils Intubating Fiberscope (BIF) with the patient under general anesthesia.</p>

Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study / Prevalência de anormalidades de condução no eletrocardiograma de pacientes em diálise: um estudo comparativo

ABSTRACT Background: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Methods: Retrospective review of adult inpatients' charts, comparing those with billing codes for "Hemodialysis" vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

RESUMO Introdução: O eletrocardiograma (ECG) pode auxiliar na identificação de pacientes com doença renal crônica (DRC) e alto risco para doenças cardiovasculares. Estudos de coorte descrevem anormalidades no ECG de pacientes em hemodiálise (HD), mas não encontramos dados comparando anormalidades no ECG entre pacientes com função renal normal ou aqueles em diálise peritoneal (DP), com aqueles em hemodiálise. Nossa hipótese foi de que as anormalidades de condução no ECG seriam mais comuns, e o intervalo de condução cardíaca seria mais longo entre os pacientes em hemodiálise comparados àqueles em diálise peritoneal e DRC 1 ou 2. Métodos: revisão retrospectiva dos prontuários de pacientes adultos internados, comparando aqueles com códigos de cobrança para "Hemodiálise" versus pacientes internados sem esses encargos, e uma coorte de pacientes em diálise peritoneal ambulatorial. Pacientes com DRC 3 ou 4 foram excluídos. Resultados: Cento e sessenta e sete prontuários foram revisados. Os intervalos de condução no ECG foram consistente- e estatisticamente mais longos entre os pacientes em hemodiálise (n = 88) vs. em diálise peritoneal (n = 22) e DRC estágios 1 e 2 (n = 57): PR (175 ± 35 vs 160 ± 44 vs 157 ± 22 msec) (p = 0,009); QRS (115 ± 32 vs. 111 ± 31 vs 91 ± 18 ms) (p = 0,001); QT (411 ± 71 vs. 403 ± 46 vs 374 ± 55 ms) (p = 0,006 ), QTc (487 ± 49 vs. 464 ± 38 vs 452 ± 52 ms) (p = 0,0001). A única anormalidade de condução significativamente diferente foi a prevalência de bloqueio do ramo esquerdo: 13,6% nos pacientes em HD, 5% em DP e 2% na DRC 1 e 2 (p = 0,03). Conclusão: Pelo que sabemos, este é o primeiro estudo a relatar que os intervalos de condução no ECG são significativamente maiores à medida que se progride das DRC Estágios 1 e 2, para DP, e para HD. Esses e outros dados corroboram a necessidade de estudos futuros para utilizar os tempos de condução no ECG para identificar pacientes em diálise que poderiam se beneficiar de avaliações cardíacas proativas e assim redução de risco.

A Review of the Role Micronutrient Status in the Elderly Plays in Their Immune Response to Viral Respiratory Infections and the Potential Compromising Effects Medications Might Cause

The elderly are a growing proportion of the global population. They are more susceptible to non-communicable diseases and respiratory viral diseases like influenza and covid19, which may lead to increased levels of morbidity and mortality than those of a younger generation.It is also reported that co-morbidities, especially diabetes, hypertension and coronary heart disease contribute significantly to the prognosis with these types of infections. That the immune system operates in a less efficient way as an individual ages, is now well understood and likely contributes significantly to this situation. The role of certain micronutrients in maintaining a healthy immune system is well recognised and demonstrated to play an important role both in preventing and controlling infection. However, for a number of reasons many elderly individuals have a less than optimal intake of many of the micronutrients that support the immune system. This review examines the contributory roles an aging immune system, suboptimal intake of micronutrients, comorbidities and the impact of the intake of medications typically used to treat them can play in the outcome of viral respiratory infections. It identifies the need for supplementation, especially in the elderly to support the immune system

Interaction of genetic background and exercise training intensity on endothelial function in mouse aorta

The purpose of this study was to characterize the genetic contribution to endothelial adaptation to exercise training. Vasoreactivity was assessed in aortas from four inbred mouse strains (129S1, B6, NON, and SJL) after 4 weeks of moderate intensity continuous exercise training (MOD), high intensity interval training (HIT) or in sedentary controls (SED). Intrinsic variations in endothelium-dependent vasorelaxation (EDR) to acetylcholine (ACh) as well as vasocontractile responses were observed across SED groups. For responses to exercise training, there was a significant interaction between mouse strain and training intensity on EDR. Exercise training had no effect on EDR in aortas from 129S1 and B6 mice. In NON, EDR was improved in aortas from MOD and HIT compared with respective SED, accompanied by diminished responses to PE in those groups. Interestingly, EDR was impaired in aorta from SJL HIT compared with SED. The transcriptional activation of endothelial genes was also influenced by the interaction between mouse strain and training intensity. The number of genes altered by HIT was greater than MOD, and there was little overlap between genes altered by HIT and MOD. HIT was associated with gene pathways for inflammatory responses. NON MOD genes showed enrichment for vessel growth pathways. These findings indicate that exercise training has non-uniform effects on endothelial function and transcriptional activation of endothelial genes depending on the interaction between genetic background and training intensity.

Using participatory curriculum development for Barangay Health Workers in a local community: A pilot study

Background and Objectives@#Reforms in health professions education in the past decade entails the development of effective curricula that impact and improve health outcomes. Along with health professionals, barangay health workers (BHW) are not spared from experiencing curricular mishaps when they undergo trainings for community health work. This article described the process of a participatory approach in curriculum development for BHWs in a local community in the Ilocos Region. @*Methodology@#An exploratory sequential mixed method design was used for this pilot study. The method was framed from six (out of ten) steps in the Research and Development Cycle; these steps were categorized in three phases: 1) needs assessment, 2) participatory curriculum development, and 3) implementation of the curriculum and evaluation. @*Results@#Our findings yielded both qualitative (Phases 1 and 2) and quantitative (Phase 3) data which were analyzed separately and sequentially. Phase 1 revealed findings based on the strengths, weaknesses, opportunities, and threats found in the community's health care context which were used to determine the four potential training topics to develop a curriculum. Phase 2 generated a curriculum on hilot wellness through the participation of the local government and curriculum experts. Phase 3 produced evaluative data on the reaction, learning, and behavior of BHWs towards the implemented curriculum on hilot wellness. @*Conclusion@#The participatory curriculum development process entailed the generation and analysis of data from the community that produces a curriculum for the community. This curriculum does not only offer sustainable and longitudinal health care services but is sensitive to the values and culture of the community while considering the notion that learning it not linear. This article demonstrated that a participatory approach in curriculum development within health professions education can be pursued to address the everchanging healthcare needs of local communities.

Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Background@#Preoperative radiographic templating for total knee arthroplasty (TKA) has been shown to be inaccurate. Patient demographic data, such as gender, height, weight, age, and race, may be more predictive of implanted component size in TKA. @*Materials and methods@#A multivariate linear regression model was designed to predict implanted femoral and tibial component size using demographic data along a consecutive series of 201 patients undergoing index TKA.Traditional, two-dimensional, radiographic templating was compared to demographic-based regression predictions on a prospective 181 consecutive patients undergoing index TKA in their ability to accurately predict intraoperative implanted sizes. Surgeons were blinded of any predictions. @*Results@#Patient gender, height, weight, age, and ethnicity/race were predictive of implanted TKA component size.The regression model more accurately predicted implanted component size compared to radiographically templated sizes for both the femoral (P = 0.04) and tibial (P < 0.01) components. The regression model exactly predicted femoral and tibial component sizes in 43.7 and 43.7% of cases, was within one size 90.1 and 95.6% of the time, and was within two sizes in every case. Radiographic templating exactly predicted 35.4 and 36.5% of cases, was within one size 86.2 and 85.1% of the time, and varied up to four sizes for both the femoral and tibial components. The regression model averaged within 0.66 and 0.61 sizes, versus 0.81 and 0.81 sizes for radiographic templating for femoral and tibial components. @*Conclusions@#A demographic-based regression model was created based on patient-specific demographic data to predict femoral and tibial TKA component sizes. In a prospective patient series, the regression model more accurately and precisely predicted implanted component sizes compared to radiographic templating.Level of evidence: Prospective cohort, level II.

Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Background@#Preoperative radiographic templating for total knee arthroplasty (TKA) has been shown to be inaccurate. Patient demographic data, such as gender, height, weight, age, and race, may be more predictive of implanted component size in TKA. @*Materials and methods@#A multivariate linear regression model was designed to predict implanted femoral and tibial component size using demographic data along a consecutive series of 201 patients undergoing index TKA.Traditional, two-dimensional, radiographic templating was compared to demographic-based regression predictions on a prospective 181 consecutive patients undergoing index TKA in their ability to accurately predict intraoperative implanted sizes. Surgeons were blinded of any predictions. @*Results@#Patient gender, height, weight, age, and ethnicity/race were predictive of implanted TKA component size.The regression model more accurately predicted implanted component size compared to radiographically templated sizes for both the femoral (P = 0.04) and tibial (P < 0.01) components. The regression model exactly predicted femoral and tibial component sizes in 43.7 and 43.7% of cases, was within one size 90.1 and 95.6% of the time, and was within two sizes in every case. Radiographic templating exactly predicted 35.4 and 36.5% of cases, was within one size 86.2 and 85.1% of the time, and varied up to four sizes for both the femoral and tibial components. The regression model averaged within 0.66 and 0.61 sizes, versus 0.81 and 0.81 sizes for radiographic templating for femoral and tibial components. @*Conclusions@#A demographic-based regression model was created based on patient-specific demographic data to predict femoral and tibial TKA component sizes. In a prospective patient series, the regression model more accurately and precisely predicted implanted component sizes compared to radiographic templating.Level of evidence: Prospective cohort, level II.

A Review of the Effects of Oral Contraceptives on Nutrient Status, with Especial Consideration to Folate in UK

Oral contraceptives (OCs) are widely used by a significant number of women, often commencing at early adolescence. Whilst most research has investigated the physiological effects of OCs, some studies have identified impacts upon nutritional status of certain vitamins and minerals. In this context, a report published by the World Health Organization (WHO) is relevant, since women who take OCs-especially in less well-developed countries might not always have adequate diet. Furthermore, women whose life style is unhealthy, those with malabsorption pathologies, or have genetic polymorphisms that affect vitamin metabolism might also be at risk of the negative impacts on an individual’s nutrient status. This literature review investigates the effects that oral contraceptives might have upon nutrient status. It identifies potential interactions with Vitamins A, B1, B2, B6, B12, C, and E and folic acid as well as magnesium, zinc, selenium, copper, co-enzyme Q10, and beta-carotene status. It then examines the possible consequences that induced depletion of folic acid might cause with especial focus on neural tubes defects in UK, where food supplementation with this vitamin is not yet mandatory. It suggests that in those using this form of contraception or hormone replacement therapy, it is valid to consider appropriate nutritional supplements as a complementary first line strategy in order to prevent possible vitamin and mineral deficiencies

TpTe and TpTe/QT: novel markers to predict sudden cardiac death in ESRD? / TpTe e TpTe/QT: novos marcadores para prever morte súbita cardíaca na DRT?

ABSTRACT Introduction: Reliable markers to predict sudden cardiac death (SCD) in patients with end stage renal disease (ESRD) remain elusive, but echocardiogram (ECG) parameters may help stratify patients. Given their roles as markers for myocardial dispersion especially in high risk populations such as those with Brugada syndrome, we hypothesized that the Tpeak to Tend (TpTe) interval and TpTe/QT are independent risk factors for SCD in ESRD. Methods: Retrospective chart review was conducted on a cohort of patients with ESRD starting hemodialysis. Patients were US veterans who utilized the Veterans Affairs medical centers for health care. Average age of all participants was 66 years and the majority were males, consistent with a US veteran population. ECGs that were performed within 18 months of dialysis initiation were manually evaluated for TpTe and TpTe/QT. The primary outcomes were SCD and all-cause mortality, and these were assessed up to 5 years following dialysis initiation. Results: After exclusion criteria, 205 patients were identified, of whom 94 had a prolonged TpTe, and 61 had a prolonged TpTe/QT interval (not mutually exclusive). Overall mortality was 70.2% at 5 years and SCD was 15.2%. No significant difference was observed in the primary outcomes when examining TpTe (SCD: prolonged 16.0% vs. normal 14.4%, p=0.73; all-cause mortality: prolonged 55.3% vs. normal 47.7%, p=0.43). Likewise, no significant difference was found for TpTe/QT (SCD: prolonged 15.4% vs. normal 15.0%, p=0.51; all-cause mortality: prolonged 80.7% vs. normal 66.7%, p=0.39). Conclusions: In ESRD patients on hemodialysis, prolonged TpTe or TpTe/QT was not associated with a significant increase in SCD or all-cause mortality.

RESUMO Introdução: Marcadores confiáveis para predizer morte súbita cardíaca (MSC) em pacientes com doença renal terminal (DRT) permanecem elusivos, mas os parâmetros do ecocardiograma (ECG) podem ajudar a estratificar os pacientes. Devido a seus papéis como marcadores para a dispersão miocárdica, especialmente em populações de alto risco, como aquelas com síndrome de Brugada, nós hipotetizamos que o intervalo pico da onda T ao final da onda T (TpTe) e TpTe/QT são fatores de risco independentes para MSC na DRT. Métodos: Revisão retrospectiva do prontuário foi realizada em uma coorte de pacientes com DRT iniciando a hemodiálise. Os pacientes eram veteranos de guerra americanos que utilizavam os centros médicos do Veterans Affairs para atendimento médico. A idade média de todos os participantes foi de 66 anos e a maioria era do sexo masculino, consistente com uma população veterana dos EUA. ECGs que foram realizados dentro de 18 meses após o início da diálise, e foram avaliados manualmente para TpTe e TpTe/QT. Os desfechos primários foram MSC e mortalidade por todas as causas, e estes foram avaliados até 5 anos após o início da diálise. Resultados: Após o critério de exclusão, foram identificados 205 pacientes, dos quais 94 com TpTe prolongado e 61 com intervalo TpTe/QT prolongado (não mutuamente exclusivo). A mortalidade geral foi de 70,2% em 5 anos e a MSC foi de 15,2%. Nenhuma diferença significativa foi observada nos desfechos primários ao se avaliar o TpTe (MSC: prolongado 16,0% versus normal 14,4%, p = 0,73; mortalidade por todas as causas: prolongado 55,3% vs. normal 47,7%, p = 0,43). Da mesma forma, nenhuma diferença significativa foi encontrada para TpTe/QT (MSC: prolongado 15,4% vs. normal 15,0%, p = 0,51; mortalidade por todas as causas: prolongado 80,7% vs. normal 66,7%, p = 0,39). Conclusões: Em pacientes com insuficiência renal terminal em hemodiálise, TpTe ou TpTe/QT prolongados não foram associados a um aumento significativo da morte súbita ou mortalidade por todas as causas.

Recovery in schizophrenia: Perspectives from psychiatrists in the Philippines

BACKGROUND@#A reliable and socially validated definition of recovery in schizophrenia is essential to decrease stigma associated with the illness. This study aimed to define recovery in schizophrenia in the Philippine context, determine its specific elements, and describe methods of assessment in clinical practice.@*METHODS@#We invited a group of purposively selected Filipino psychiatrists to participate in six simultaneous roundtable discussions to gather their opinions and perspectives on recovery in schizophrenia. Transcripts of the discussions were then subjected to framework analysis.@*RESULTS AND CONCLUSION@#Most Filipino psychiatrists were of the considered opinion that recovery in schizophrenia is possible, and their vision of a recovered patient resembles a combination of psychological and medical models. The mini-FROGS tool was deemed generally applicable in the Philippine setting except for self-esteem and sense of independence primarily because it is difficult to evaluate. The SWN was received with mixed reactions among the psychiatrists. Spirituality as an element of recovery and the family-oriented culture of the Filipinos were emphasized as important considerations in assessing patients. Other suggestions were given to tailor-fit these tools to the Philippine context.