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.

Citrate does not Change Viscoelastic Haemostatic Assays after Cardiopulmonary Bypass

Context:Viscoelastic hemostatic assays (VHA) are commonly used to identify specific cellular and humoral causes for bleeding in cardiac surgery patients. Cardiopulmonary bypass (CPB) alterations to coagulation are observable on VHA. Citrated VHA can approximate fresh whole blood VHA when kaolin is used as the activator in healthy volunteers. Some have suggested that noncitrated blood is more optimal than citrated blood for point?of?care analysis in some populations. Aims: To determine if storage of blood samples in citrate after CPB alters kaolin activated VHA results. Settings and Design: This was a prospective observational cohort study at a single tertiary care teaching hospital. Methods and Material: Blood samples were subjected to VHA immediately after collection and compared to samples drawn at the same time and stored in citrate for 30, 90, and 150 min prior to kaolin activated VHA both before and after CPB. Statistical Analysis Used: VHA results were compared using paired T?tests and Bland–Altman analysis. Results: Maximum clot strength and time to clot initiation were not considerably different before or after CPB using paired T?tests or Bland– Altman Analysis. Conclusions: Citrated samples appear to be a clinically reliable substitute for fresh samples for maximum clot strength and time to VHA clot initiation after CPB. Concerns about the role of citrate in altering the validity of the VHA samples in the cardiac surgery population seem unfounded.

Spinal Anesthesia for Open Gastrostomy in an Infant after Stage I Norwood for Hypoplastic Left Heart

Infants with hypoplastic left heart are at increased risk of adverse events including mortality when they undergo procedures with general anesthesia in the inter?stage period after stage I Norwood. This is primarily caused by an imbalance between pulmonary and systemic blood flows augmented by decreased function of the single ventricle. These factors can be aggravated by general anesthesia, hence the increased risk. Many of these infants experience feeding dysfunction and require a gastrostomy to optimize nutrition. We report a case of open gastrostomy in an infant with Norwood physiology under spinal anesthesia with an excellent outcome.

The influence of haematogenous bone marrow on the early osseointegration of a titanium implant which penetrates the endosteum / La influencia de la médula ósea hematógena en la osteointegración temprana de un implante de titanio que penetra en el endostio

SUMMARY: The utility of metallic bio-medical implants in osseous or dental affections is irrefutable. The paper aims to test the tolerance of the bone marrow to titanium implants. Titanium implants were inserted in the femur of 11-months old rabbits. The implants penetrated the endosteum, half of their length getting into the haematogenous bone marrow. Seven days after the insertion we collected bone fragments containing the implant. The CT exam revealed a significant decrease in the density of the bone at the interface with the implant and a more discrete one aloof from the insertion area. The histologic exam after 7 days revealed osseous reparatory processes only in the endosteal area from where it expanded on the surface of the implant which was inside the marrow. The presence and intensity of the osseous reparatory processes after only seven days post-implant demonstrates that the marrow actively participates in bone regeneration and implants osseointegration.

RESUMEN: La utilidad de los implantes biomédicos metálicos en afecciones óseas o dentales es irrefutable. El documento tiene como objetivo probar la tolerancia de la médula ósea a los implantes de titanio. Se insertaron implantes de titanio en el fémur de conejos de 11 meses. Los implantes penetraron en el endostio y la mitad de su longitud penetró en la médula ósea hematógena. Siete días después de la inserción, recolectamos fragmentos de hueso que contenían el implante. El examen de TC reveló una disminución significativa en la densidad del hueso en la interfaz con el implante y una más discreta alejada del área de inserción. El examen histológico a los 7 días reveló procesos de reparación ósea solo en el área endóstica desde donde se expandió en la superficie del implante que estaba dentro de la médula. La presencia e intensidad de los procesos de reparación ósea después de solo siete días del implante demuestra que la médula ósea participa activamente en la regeneración ósea y en la osteointegración de los implantes.

Evidence for Differentiation of Colon Tissue Microbiota in Patients with and without Postoperative Hirschsprung's Associated Enterocolitis: A Pilot Study / 대한소아소화기영양학회지

Purpose@#To investigate the differences in the colon microbiota composition of Hirschsprung's disease (HSCR) patients with and without a history of postoperative Hirschsprung's associated enterocolitis (HAEC). @*Methods@#Colon tissue microbiota was characterized by bacterial deoxyribonucleic acid (DNA) extraction and 16S rDNA sequencing for taxonomic classification and comparison. @*Results@#The sequence diversity richness within samples was significantly higher in samples from patients with a history of postoperative HAEC. We observed an increased relative abundance of the phyla Bacteroidetes, Firmicutes and Cyanobacteria in HAEC patients and Fusobacteria, Actinobacteria and Proteobacteria in HSCR patients and, an increased relative abundance of the genera Dolosigranulum, Roseouria and Streptococcus in HAEC patients and Propionibacterium and Delftia in HSCR patients. @*Conclusion@#Our findings provide evidence that the colon tissue microbiota composition is different in HSCR patients with and without postoperative HAEC.

Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis

Objective@#Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD. @*Methods@#A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000. @*Results@#The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations. @*Conclusions@#Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.

The Knowledge, Attitudes and Practices of Primary Pediatric Caregivers towards COVID-19 in a Tertiary Hospital

Background@#Coronavirus disease 2019 (COVID-19) is a respiratory disease that causes remarkable morbidities and mortalities worldwide. Public health measures have been implemented to control the spread of the disease. Knowledge, attitudes, and practices (KAP) of the community have to be optimum for the successful implementation of the prevention and control measures. @*Objective@#Cognizant that children may possibly contribute to community transmission and that primary caregivers are the main educators of their children and implementers of preventive measures at the household level, the study aimed to determine the KAP of primary caregivers towards COVID-19 in a private tertiary hospital in Metro Manila, Philippines. @*Methodology@#The study utilized a descriptive, cross-sectional design employing a web-based self-administered survey to determine the KAP of primary caregivers towards COVID-19 in a tertiary hospital. @*Results@#There were a total of 149 respondents. Participants had a generally high knowledge of COVID-19, its symptomatology, and its prevention. Most of the respondents agreed that vaccination, quarantine, and community quarantine are necessary to prevent transmission. Primary caregivers responded that they protected their children by avoiding exposure and observing good hygiene measures. Despite the ongoing pandemic, most respondents would still bring their children to the doctor for routine vaccinations and consultations at the hospital when sick. @*Conclusion@#The findings of the study revealed a generally good KAP among the primary caregivers of pediatric patients which can help ensure the prevention and control of COVID-19. A strong health education campaign is needed to provide accurate information that will help sustain and/or increase compliance with COVID-19 prevention and control measures.

Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis

Objective@#Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD. @*Methods@#A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000. @*Results@#The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations. @*Conclusions@#Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.

Evidence for Differentiation of Colon Tissue Microbiota in Patients with and without Postoperative Hirschsprung's Associated Enterocolitis: A Pilot Study / 대한소아소화기영양학회지

Purpose@#To investigate the differences in the colon microbiota composition of Hirschsprung's disease (HSCR) patients with and without a history of postoperative Hirschsprung's associated enterocolitis (HAEC). @*Methods@#Colon tissue microbiota was characterized by bacterial deoxyribonucleic acid (DNA) extraction and 16S rDNA sequencing for taxonomic classification and comparison. @*Results@#The sequence diversity richness within samples was significantly higher in samples from patients with a history of postoperative HAEC. We observed an increased relative abundance of the phyla Bacteroidetes, Firmicutes and Cyanobacteria in HAEC patients and Fusobacteria, Actinobacteria and Proteobacteria in HSCR patients and, an increased relative abundance of the genera Dolosigranulum, Roseouria and Streptococcus in HAEC patients and Propionibacterium and Delftia in HSCR patients. @*Conclusion@#Our findings provide evidence that the colon tissue microbiota composition is different in HSCR patients with and without postoperative HAEC.

Antiplatelet therapy within 24 hoursof tPA: lessons learned from patientsrequiring combined thrombectomyand stenting for acute ischemic stroke

Objective@#Although stroke guidelines recommend antiplatelets be started 24 hoursafter tissue plasminogen activator (tPA), select mechanical thrombectomy (MT)patients with luminal irregularities or underlying intracranial atherosclerotic diseasemay benefit from earlier antiplatelet administration. @*Methods@#We explore the safety of early (< 24 hours) post-tPA antiplatelet use byretrospectively reviewing patients who underwent MT and stent placement for acuteischemic stroke from June 2015 to April 2018 at our institution. @*Results@#Six patients met inclusion criteria. Median presenting and pre-operativeNational Institutes of Health Stroke Scale scores were 14 (Interquartile Range [IQR]5.5-17.3) and 16 (IQR 13.7-18.7), respectively. Five patients received standard intravenous(IV) tPA and one patient received intra-arterial tPA. Median time from symptomonset to IV tPA was 120 min (IQR 78-204 min). Median time between tPA and antiplateletadministration was 4.9 hours (IQR 3.0-6.7 hours). Clots were successfullyremoved from the internal carotid artery (ICA) or middle cerebral artery (MCA) in 5patients, the anterior cerebral artery (ACA) in one patient, and the vertebrobasilarjunction in one patient. All patients underwent MT before stenting and achievedthrombolysis in cerebral infarction 2B recanalization. Stents were placed in the ICA(n=4), common carotid artery (n=1), and basilar artery (n=1). The median time fromstroke onset to endovascular access was 185 min (IQR 136-417 min). No patientsexperienced symptomatic post-procedure intracranial hemorrhage (ICH). Medianmodified Rankin Scale score on discharge was 3.5. @*Conclusions@#Antiplatelets within 24 hours of tPA did not result in symptomatic ICHin this series. The safety and efficacy of early antiplatelet administration after tPA inselect patients following mechanical thrombectomy warrants further study.

CLEVER maternity care: a before-and-after study of women's experience of childbirth in Tshwane, South Africa

Background: Birthing care matters to women and some women experience mistreatment during childbirth. Aim: To determine the effect the 'CLEVER Maternity Care' package, a multi-faceted intervention to improve respectful, quality obstetric care. Setting: Ten midwife-led obstetric units in Tshwane health district, South Africa; five intervention and five control units. Methods: We conducted an anonymous baseline and end-line survey to measure the change in women's perceptions and experiences of childbirth care after the implementation of the CLEVER package. A convenience sample of women returning for a postnatal follow-up visit was obtained at baseline (n = 653) and after implementation of CLEVER (n = 679). Results: Six survey items were selected as proxies for respectful clinical care. There was no significant change in proportions of responses regarding one question, and with regard to patients receiving attention within 15 min of arrival, both the intervention and control group units showed a significant increase in positive responses (odds ratios of 8.4 and 6.1, respectively, and p values of 0.0001 and 0.0007). For the remaining four items (asking permission before doing an examination, positive communication, respectful treatment and overall satisfaction), only the intervention group showed a significant positive change (odds ratios ranging from 2.4 to 4.3; p ≤ 0.0018), with no significant change for the control group (odds ratios between 1.0 and 1.8; p ≥ 0.0736). Conclusion: After the implementation of CLEVER Maternity Care, women reported a more positive experience of childbirth. The CLEVER intervention is a potential strategy for addressing respectful, quality obstetric care that warrants further investigation

Acute renal failure due to bilateral renal vein thromboses: A rare complication of heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia type II is a rare but devastating complication of heparin exposure. We review a case of a 66-year-old female who underwent aortic valve surgery requiring venoarterial extracorporeal membranous oxygenation (ECMO) support postoperatively. She subsequently developed acute renal failure due to bilateral renal vein thromboses and thrombocytopenia and was found to have platelet factor 4/heparin antibodies and was diagnosed with heparin-induced thrombocytopenia (HIT). She was transitioned to nonheparin anticoagulation and her thrombocytopenia improved. Although a rare complication of anticoagulation, diagnosing HIT in a patient on ECMO requires a high index of suspicion and should be considered.

Knowledge retention after focused cardiac ultrasound training: a prospective cohort pilot study / Retenção do conhecimento após treinamento de ultrassonografia cardíaca focada: estudo-piloto prospectivo de coorte

Abstract Background and objectives: Focused Cardiac Ultrasound (FoCUS) has proven instrumental in guiding anesthesiologists' clinical decision-making process. Training residents to perform and interpret FoCUS is both feasible and effective. However, the degree of knowledge retention after FoCUS training remains a subject of debate. We sought to provide a description of our 4-week FoCUS curriculum, and to assess the knowledge retention among anesthesia residents at 6 months after FoCUS rotation. Methods: A prospective analysis involving eleven senior anesthesia residents was carried out. At end of FoCUS Rotation (EOR) participants completed a questionnaire (evaluating the number of scans completed and residents' self-rated knowledge and comfort level with FoCUS), and a multiple-choice FoCUS exam comprised of written- and video-based questions. Six months later, participants completed a follow-up questionnaire and a similar exam. Self-rated knowledge and exam scores were compared at EOR and after 6 months. Spearman correlations were conducted to test the relationship between number of scans completed and exam scores, perceived knowledge and exam scores, and number of scans and perceived knowledge. Results: Mean exam scores (out of 50) were 44.1 at EOR and 43 at the 6-month follow-up. Residents had significantly higher perceived knowledge (out of 10) at EOR (8.0) than at the 6-month follow-up (5.5), p = 0.003. At the EOR, all trainees felt comfortable using FoCUS, and at 6 months 10/11 still felt comfortable. All the trainees had used FoCUS in their clinical practice after EOR, and the most cited reason for not using FoCUS more frequently was the lack of perceived clinical need. A strong and statistically significant (rho = 0.804, p = 0.005) correlation between number of scans completed during the FoCUS rotation and 6-month follow-up perceived knowledge was observed. Conclusion: Four weeks of intensive FoCUS training results in adequate knowledge acquisition and 6-month knowledge retention.

Resumo Justificativa e objetivos: A ultrassonografia cardíaca no local de atendimento (USCLA) provou ser importante para orientar o processo de tomada de decisão clínica dos anestesiologistas. Treinar os residentes para fazer e interpretar uma USCLA é viável e eficaz. No entanto, o grau de retenção do conhecimento após o treinamento permanece um assunto de debate. Procuramos fornecer uma descrição do currículo de quatro semanas do treinamento de USCLA e avaliar a retenção do conhecimento entre os residentes de anestesia seis meses após a rotação em USCLA. Métodos: Uma análise prospectiva foi realizada com 11 residentes seniores de anestesia. Ao final da rotação em USCLA, os participantes preencheram um questionário (avaliando o número de exames ultrassonográficos concluídos, o conhecimento adquirido e o nível de conforto dos residentes com a USCLA) e fizeram um exame de múltipla escolha para USCLA, composto por perguntas escritas e baseadas em vídeo. Seis meses depois, os participantes preencheram um questionário de acompanhamento e um exame similar. A autoavaliação do conhecimento e os escores do exame foram comparados no final da rotação e após seis meses. Correlações de Spearman foram usadas para testar a relação entre o número de exames concluídos e os escores dos exames, o conhecimento percebido, os escores dos exames, o número de exames e o conhecimento percebido. Resultados: Os escores médios dos exames (50) foram: 44,1 no final da rotação e 43 após seis meses. Os residentes tiveram conhecimento percebido significativamente maior (10) no final da rotação (8,0) que após seis meses (5,5), p = 0,003. No final da rotação, todos os residentes se sentiram confortáveis usando o aparelho de USCLA e, aos seis meses, 10/11 ainda se sentiam confortáveis. Todos os residentes haviam usado o USCLA em sua prática clínica após o final da rotação e a razão mais citada para não usar o USCLA com mais frequência foi a falta de necessidade clínica percebida. Uma correlação forte e estatisticamente significativa (rho = 0,804, p = 0,005) foi observada entre o número de exames realizados durante a rotação em USCLA e o conhecimento percebido em seis meses de seguimento. Conclusão: Quatro semanas de treinamento intensivo de USCLA resultaram em aquisição e retenção adequadas do conhecimento por seis meses.

Why Don't Cancer Survivors Quit Smoking? An Evaluation of Readiness for Smoking Cessation in Cancer Survivors

BACKGROUND: Cancer survivors have a high rate of participation in cigarette-smoking cessation programs but their smoking-abstinence rates remain low. In the current study, we evaluated the readiness to quit smoking in a cancer-survivor population. METHODS: Cross-sectional data survey conducted among 112 adult cancer survivors who smoked cigarettes in Tennessee. Analyses were conducted using a two-sample t-test, χ2 test, Fishers Exact test, and multivariable logistic regression with smoker's readiness to quit as the dependent variable. We operationally defined a smoker not ready to quit as anyone interested in quitting smoking beyond the next 6 months or longer (or not at all), as compared to those that are ready to quit within the next 6 months. RESULTS: Thirty-three percent of participants displayed a readiness to quit smoking in the next 30 days. Smokers ready to quit were more likely to display high confidence in their ability to quit (OR = 4.6; 95% CI, 2.1–9.7; P < 0.0001) than those not ready to quit. Those ready to quit were nearly five times more likely to believe smoking contributed to their cancer diagnosis (OR = 4.9; 95% CI, 1.1–22.6; P = 0.0432). Those ready to quit were also much more likely to attempt smoking cessation when diagnosed with cancer (OR = 8.9; 95% CI, 1.8–44.3; P = 0.0076) than smokers not ready to quit. Finally, those ready to quit were more likely to endorse smoking more in the morning than other times of the day, compared to those not ready to quit (OR = 7.9; 95% CI, 1.5–42,3; P = 0.0148), which increased odds of readiness to quit within the next 6 months. CONCLUSIONS: Despite high participation in smoking-cessation programs for cancer survivors, only one-third of participants were ready to quit. Future research is needed to develop programs targeting effective strategies promoting smoking cessation among cancer survivors who are both ready and not ready to quit smoking.

Management protocols for status epilepticus in the pediatric emergency room: systematic review article / Protocolos de manejo de estado de mal epiléptico no pronto socorro pediátrico: análise sistemática

Abstract Objective: This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. Sources: Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline. Summary of findings: 356 articles were retrieved and 13 were selected according to the inclusion criteria. In all six pre-hospital guidelines, the preferred route of medication administration was to use alternatives to the intravenous route: all recommended buccal and intranasal midazolam; three also recommended intramuscular midazolam, and five recommended using rectal diazepam. All 11 emergency department guidelines described three phases in therapy. Intravenous medication, by phase, was indicated as such: initial phase - ten/11 guidelines recommended lorazepam, and eight/11 recommended diazepam; second phase - most (ten/11) guidelines recommended phenytoin, but other options were phenobarbital (nine/11), valproic acid (six/11), and either fosphenytoin or levetiracetam (each four/11); third phase - four/11 guidelines included the choice of repeating second phase therapy, whereas the other guidelines recommended using a variety of intravenous anesthetic agents (thiopental, midazolam, propofol, and pentobarbital). Conclusions: All of the guidelines share a similar framework for management of status epilepticus. The choice in route of administration and drug type varied across guidelines. Hence, the adoption of a particular guideline should take account of local practice options in health service delivery.

Resumo Objetivo: Esta análise sistemática de diretrizes nacionais ou regionais publicadas em inglês tem como objetivo entender melhor a diferença no tratamento do estado de mal epiléptico pré-hospitalar e no departamento de emergência. Fontes: Pesquisa sistemática de diretrizes nacionais ou regionais (janeiro de 2000 a fevereiro de 2017) contidas nas bases de dados do Pubmed e do Google Acadêmico e listas de referência de artigos. As palavras-chave da busca foram estado de mal epiléptico, convulsão prolongada, tratamento e diretriz. Resumo dos achados: Foram identificados 356 artigos e 13 foram selecionados de acordo com os critérios de inclusão. Em todas as seis diretrizes pré-hospitalares, o caminho preferencial de administração da medicação foi usar opções à via intravenosa: todas recomendaram midazolam bucal e intranasal; três também recomendaram midazolam intramuscular; e cinco recomendaram usar o diazepam via retal. Todas as 11 diretrizes de departamento de emergência descreveram três fases na terapia. No que diz respeito à medicação intravenosa, por fase, temos: fase inicial - 10/11 diretrizes recomendaram lorazepam e 8/11 recomendaram diazepam; segunda fase - a maioria (10/11) das diretrizes recomendou fenitoína, porém outras opções foram fenobarbital (9/11), ácido valproico (6/11) e fosfenitoína ou levetiracetam (individualmente, 4/11); terceira fase - 4/11 diretrizes incluíram a opção de repetir a terapia da segunda fase, ao passo que as outras diretrizes recomendaram usar diversos agentes anestésicos intravenosos (tiopental, midazolam, propofol e pentobarbital). Conclusões: Todas as diretrizes compartilham uma estrutura semelhante para manejo do estado de mal epiléptico. A escolha da via de administração e do tipo de medicamento variou em todas as diretrizes. Assim, a adoção de uma diretriz específica deve levar em consideração as opções da prática local na prestação de serviços de saúde.

Applying the international classification of diseases to perinatal mortality data, South Africa

Objective:To examine the feasibility of applying the International Classification of Diseases-perinatal mortality (ICD-PM) coding to an existing data set in the classification of perinatal deaths.Methods One author, a researcher with a non-clinical public health background, applied the ICD-PM coding system to South Africa's national perinatal mortality audit system, the Perinatal Problem Identification Program. The database for this study included all perinatal deaths (n=26 810), defined as either stillbirths (of birth weight >1000 g and after 28 weeks of gestation) or early neonatal deaths (age 0­7 days), that occurred between 1 October 2013 and 31 December 2016. A clinical obstetrician verified the coding. Findings The South African classification system does not include the timing of death; however, under the ICD-PM system, deaths could be classified as antepartum (n=15 619; 58.2%), intrapartum (n=3725; 14.0%) or neonatal (n=7466; 27.8%). Further, the South African classification system linked a maternal condition to only 40.3% (10 802/26 810) of all perinatal deaths; this proportion increased to 68.9% (18 467/26 810) under the ICD-PM system. Conclusion The main benefit of using the clinically relevant and user-friendly ICD-PM system was an enhanced understanding of the data, in terms of both timing of death and maternal conditions. We have also demonstrated that it is feasible to convert an existing perinatal mortality classification system to one which is globally comparable and can inform policy-makers internationally

environmental deposition of influenza virus from patients infected with influenza A [H1N1] pdm09: Implications for infection prevention and control

In a multi-center, prospective, observational study over two influenza seasons, we sought to quantify and correlate the amount of virus recovered from the nares of infected subjects with that recovered from their immediate environment in community and hospital settings. We recorded the symptoms of adults and children with A [H1N1] pdm09 infection, took nasal swabs, and sampled touched surfaces and room air. Forty-two infected subjects were followed up. The mean duration of virus shedding was 6.2 days by PCR [Polymerase Chain Reaction] and 4.2 days by culture. Surface swabs were collected from 39 settings; 16 [41%] subject locations were contaminated with virus. Overall, 33 of the 671 [4.9%] surface swabs were PCR positive for influenza, of which two [0.3%] yielded viable virus. On illness Day 3, subjects yielding positive surface samples had significantly higher nasal viral loads [geometric mean ratio 25.7; 95% Cl 1.75, 376.0, p = 0.021] and a positive correlation [r = 0.47, ' p = 0.006] was observed between subject nasal viral loads and viral loads recovered from the surfaces around them. Room air was sampled in the vicinity of 12 subjects, and PCR positive samples were obtained for five [42%] samples. Influenza virus shed by infected subjects did not detectably contaminate the vast majority of surfaces sampled. We question the relative importance of the indirect contact transmission of influenza via surfaces, though our data support the existence of super-spreaders via this route. The air sampling results add to the accumulating evidence that supports the potential for droplet nuclei [aerosol] transmission of influenza

Prevalence of coronary heart disease risk factors in physical education students / Prevalência de fatores de risco de doença coronariana em estudantes de educação física / Prevalencia de factores de riesgo de enfermedad coronaria en los estudiantes de educación física

To establish the prevalence of coronary risk in physical education students, and compare risk between the genders and the years of course. We evaluated 246 physical education students using RISKO questionnaire to determine eight risk factors: age, heredity, body weight, smoking, physical inactivity, hypercholesterolemia, hypertension and sex. Students had mean coronary risk score of 16.03 ± 3.52 points, rated "below-average risk." Men had significantly greater risk compared to women. No difference was found between the years of course. The prevalence of risk factors were heritability (58.37%), physical inactivity (32.65%), hypercholesterolemia (32.24%), overweight (27.35%), smoking (3.67%) and hypertension (2.45%). The coronary risk of physical education students was rated as below average, being higher among men than women, and no difference in risk between years of course. The most prevalent risk factors were heredity, physical inactivity, overweight and hypercholesterolemia.

Estabelecer a prevalência de risco coronariano em estudantes de educação física, e comparar o risco entre os gêneros e os anos de curso. 246 estudantes de educação física foram avaliados por questionário Risko, que avalia oito fatores de risco: idade, hereditariedade, peso corporal, tabagismo, inatividade física, hipercolesterolemia, hipertensão e sexo. Os alunos tiveram média do escore de risco coronariano de 16,03 ± 3,52 pontos, classificados como "de risco abaixo da média." Os homens tiveram risco significativamente maior em comparação com as mulheres. Não foram encontradas diferenças entre os anos de curso. A prevalência de fatores de risco foram herdabilidade (58,37%), inatividade física (32,65%), hipercolesterolemia (32,24%), sobrepeso (27,35%), fumo (3,67%) e hipertensão arterial (2,45%). O risco coronariano de estudantes de educação física foi classificada como abaixo da média, sendo maior entre os homens do que as mulheres, e não houve diferença no risco entre os anos de curso. Os fatores de risco mais prevalentes foram hereditariedade, sedentarismo, excesso de peso e hipercolesterolemia.

Establecer la prevalencia del riesgo cardiovascular en estudiantes de educación física y comparar el riesgo entre los géneros y los años del curso. 246 estudiantes de educación física fueron evaluados por el cuestionario RISKO, que valora ocho factores de riesgo: edad, hereditadiedad, peso corporal, tabaquismo, inactividad física, hipercolesterolemia, hipertensión arterial y sexo. El promedio de riesgo cardiovascular de los estudioantes fue 16.03 ± 3.52 puntos, clasificado como "riesgo bajo el promedio." Los hombres presentaron riesgo significantemente más grande que las mujeres. No fueron encontradas diferencias en el riesgo para los años del curso. Los factores de riesgo más prevalentes fueron hereditariedad (58,37%), inactividad física (32,65%), hipercolesterolemia (32,24%), sobrepeso (27,35%), tabaquismo (3,67%) y hipertensión arterial (2,45%). El riesgo cardiovacular de los estudiantes de educación física fue clasificado como bajo el promedio, presentandose más elevado en los hombres y sin diferencias entre los años del curso. Los factores más prevalentes fueron hereditariedad, inactividad física, sobrepeso y hipercolesterolemia.

Surgeon point‑of‑view recording: Using a high‑definition head‑mounted video camera in the operating room.

Objective: To study the utility of a commercially available small, portable ultra‑high definition (HD) camera (GoPro Hero 4) for intraoperative recording. Methods: A head mount was used to fix the camera on the operating surgeon’s head. Due care was taken to protect the patient’s identity. The recorded video was subsequently edited and used as a teaching tool. This retrospective, noncomparative study was conducted at three tertiary eye care centers. The surgeries recorded were ptosis correction, ectropion correction, dacryocystorhinostomy, angular dermoid excision, enucleation, blepharoplasty and lid tear repair surgery (one each). The recorded videos were reviewed, edited, and checked for clarity, resolution, and reproducibility. Results: The recorded videos were found to be high quality, which allowed for zooming and visualization of the surgical anatomy clearly. Minimal distortion is a drawback that can be effectively addressed during postproduction. The camera, owing to its lightweight and small size, can be mounted on the surgeon’s head, thus offering a unique surgeon point‑of‑view. In our experience, the results were of good quality and reproducible. Conclusions: A head‑mounted ultra‑HD video recording system is a cheap, high quality, and unobtrusive technique to record surgery and can be a useful teaching tool in external facial and ophthalmic plastic surgery.

Selected sociodemographic and psychosocial variables related to mothers' preference for childbirth setting in a barangay in Rosario, Cavite

OBJECTIVES: This study aimed to describe selected sociodemographic and psychosocial factors that are related to mothers' preference for childbirth setting in a barangay in Rosario, Cavite. METHODS: This study utilized a descriptive cross-sectional design. An interview guide was developed, pretested, and used in interviewing mothers who had given birth from September 1, 2007 to August 31, 2010. Data collected was encoded and analyzed using Epi-info 3.5.1 to compute for the means and proportions of relevant variables. RESULTS: A total of 271 mothers were interviewed, of whom 53.5% gave birth at health facilities. Mothers who were young adults, had at least graduated from high school, and/or had a family income of greater than Php 10,000 tended to prefer facility-based delivery. Those who had adequate knowledge of child delivery and postpartum complications, as well as those with a positive attitude towards facility-based delivery, gave birth in health facilities. Among the family members, the spouses had greater influence on the decisions of mothers regarding their preference. Whereas doctors appeared to have influenced the decisions of mothers who had facility-based deliveries, midwives influenced those who had home-based deliveries. CONCLUSION: The maternal mortality ratio in Rosario, Cavite and the facility-based delivery rate in the sampled barangay remain higher than the targeted rates. This necessitates more efforts to achieve Millennium Development Goal (MDG) No 5. The findings of this study can serve as a guide in developing health promotion and education intervention focusing on specific age group, significant others, and health providers in order to achieve the desired outcomes.