Imaging skills for transthoracic echocardiography in cardiology fellows: The value of motion metrics.

Background: Proficiency in transthoracic echocardiography (TTE) requires an integration of cognitive knowledge and psychomotor skills. Whereas cognitive knowledge can be quantified, psychomotor skills are implied after repetitive task performance. We applied motion analyses to evaluate psychomotor skill acquisition during simulator-based TTE training. Methods and Results: During the first month of their fellowship training, 16 cardiology fellows underwent a multimodal TTE training program for 4 weeks (8 sessions). The program consisted of online and live didactics as well as simulator training. Kinematic metrics (path length, time, probe accelerations) were obtained at the start and end of the course for 8 standard TTE views using a simulator. At the end of the course TTE image acquisition skills were tested on human models. After completion of the training program the trainees reported improved self-perceived comfort with TTE imaging. There was also an increase of 8.7% in post-test knowledge scores. There was a reduction in the number of probe accelerations [median decrease 49.5, 95% CI = 29-73, adjusted P < 0.01], total time [median decrease 10.6 s, 95% CI = 6.6-15.5, adjusted P < 0.01] and path length [median decrease 8.8 cm, 95% CI = 2.2-17.7, adjusted P < 0.01] from the start to the end of the course. During evaluation on human models, the trainees were able to obtain all the required TTE views without instructor assistance. Conclusion: Simulator-derived motion analyses can be used to objectively quantify acquisition of psychomotor skills during TTE training. Such an approach could be used to assess readiness for clinical practice of TTE.

HPV vaccination impact on a cervical cancer screening program: methods of the FASTER-Tlalpan Study in Mexico / Impacto de la vacunación de VPH en un programa de tamizaje de cáncer cervical: métodos del Estudio FASTER-Tlalpan en México

Abstract Objective: To outline the design of a clinical trial to evaluate the impact of HPV vaccination as part of a hrHPV-based primary screening program to extend screening intervals. Materials and methods: A total of 18,000 women aged 25-45 years, attending the regular cervical cancer-screening program in primary health care services in Tlalpan, Mexico City, will be invited to the study. Eligible participants will be assigned to one of three comparison groups: 1) HPV16/18 vaccine and hrHPV-based screening; 2) HPV6/11/16/18 vaccine and hrHPV-based screening; 3) Control group who will receive only hrHPV-based screening. Strict surveillance of hrHPV persistent infection and occurrence of precancerous lesions will be conducted to estimate safety profiles at different screening intervals; participants will undergo diagnosis confirmation and treatment as necessary. Conclusion: The FASTER-Tlalpan Study will provide insights into new approaches of cervical cancer prevention programs. It will offer valuable information on potential benefits of combining HPV vaccination and hrHPV-based screening to safety extend screening intervals.

Resumen Objetivo: Describir los métodos de un ensayo clínico que permita evaluar el impacto de la incorporación de la vacunación contra VPH en el programa de detección oportuna de cáncer cervical con el fin de ampliar los intervalos de tamizaje. Material y métodos: Un total de 18 000 mujeres entre 25 y 45 años, usuarias del programa de detección oportuna de cáncer cervical de la Ciudad de México en Tlalpan, serán invitadas a participar en el estudio. Las mujeres elegibles serán aleatorizadas a uno de tres grupos de comparación: 1) Vacunación contra VPH16/18 y tamizaje con VPHar; 2) Vacunación contra VPH6/11/16/18 y tamizadas con VPHar; 3) Grupo control que será sólo tamizado con VPHar. Se llevará a cabo una estrecha vigilancia de la infección persistente de VPHar y de la ocurrencia de lesiones precancerosas, con el fin de estimar el perfil de seguridad de intervalos de tamizaje de distinta duración. Todas las participantes contarán con procedimientos de confirmación diagnóstica y tratamiento en caso necesario. Conclusión: El estudio FASTER-Tlalpan introducirá una nueva visión de la implementación de nuevos abordajes en la prevención de cáncer cervical. Ofrecerá información de los potenciales beneficios de la combinación de la vacunación contra VPH y el tamizaje basado en VPHar para extender los intervalos de tamizaje.

Control of skin infection in HIV positive individuals and AIDS patients

HIV prevalence is still increasing in many parts of the world. Poverty and inequity still prevail; and drugs are inaccessible to the majority of people living with HIV. Opportunistc infections constitute the major problem which makes their lives uncomfortable. At a Catholic Community Health Care giving health services to about 500;000 people living in the slums of Nairobi city; it has been observed that the main health problems facing HIV/ADS patients are: recurrent skin infection due to exfoliative staphylococcus aureus which presents as itchy rashes and pseudomycosis; development of cellulities or black pigmentation of skin; recurrent herpes zoster infection; chest infection and diarrhoea. This staph aureus is resistant to affordable topical antibiotics. Applying 2 percent chlorohexidine/cetrimide (savlon) once daily is useful when itching and rashes start; before they become septic. When the rashes are gone; savlon is applied once or twice in a week to keep the load of Staph aureus within normal range. If the patient develops superficial or deep cellulitis he is treated with neomycin/cetrimide ointment (oral erythromycin is added if the patient is having boils). Once the skin is back to normal the patient is also maintained as above. This management has proved quite effective in reducing recurrent skin infection. There is less use of topical antibiotics; antifungal drugs and hydrocortisone due to pseudomycosis compared with the previous period before the above managment was started

Trivandrum Developmental Screening Chart.

The Trivandrum Developmental Screening Chart (TDSC) was designed by selecting 17 test items from BSID (Baroda Norms). It was validated both at the hospital and community level against the standard DDST. TDSC had a sensitivity of 66.7% and specificity of 78.8%, which makes it an acceptable simple screening tool even for the community level worker.

The first attack of acute rheumatic fever in childhood--clinical and laboratory profile.

One hundred consecutive cases of 'first attack' of acute rheumatic fever were studied. There were 52 males and 48 females, constituting 1.12% of total hospital admissions. Nearly 10% of children were below the age of 5 years, stressing the early onset of rheumatic fever in tropics. Only 47% gave a definite history of overcrowding at home. Sore throat was present in 67%, overt arthritis in 66%, carditis in 57%, arthralgia alone in 22% of which 45.45% had carditis. Small joint involvement was noticed in 23% of cases of which 73.91% had carditis. Only 33.33% had congestive cardiac failure. Ten per cent of children had chorea, while subcutaneous nodules were seen in 4% of cases, all of whom had associated carditis. Erythrocyte sedimentation rate (ESR) showed good correlation with clinical profile. Throat cultures were positive for beta hemolytic streptococci only in 12% of cases. Anti-streptolysin 'O' (ASO) titre showed significant titres on 68% of cases, anti-deoxyribonuclease "B" (ADN-B) in 69.32%, antibody to group A carbohydrate (ACHO) in 70.65%. ASO, ADN-B, and ACHO titres together gave 87.5% positivity while estimations in paired sera showed ASO 79.54%, ADN-B 82.27% and ASO, ADN-B together 99.92% significant titres. Study of blood groups showed A group children to be more vulnerable to rheumatic fever (37.5%) and rheumatic carditis (47.37%). Mortality in the present study was nil.

Description of Aedes (Aedimorphus) alboscutellatus occuring in Korea

Aedes alboscutellatus was recorded first in Korea. This mosquito was collected near Demilitarized Zone of Korea Penninsula from 1979-1980. Its morphology and taxonomical position was described(abstracted from English content).