A Retrospective Study of Mucopolysaccharidosis Type II in Brazil - Data from Brazilian Health System (DATASUS)

Abstract Data on Mucopolysaccharidosis type II (MPS II) in Latin America are scarce. This retrospective database study, using data from the Informatics Department of the Brazilian Health System (DATASUS), aimed to estimate the prevalence of MPSII in Brazil from 2008 to 2020 and to describe demographic and clinical profiles from patients under treatment. The study population was derived from DATASUS records of MPS II (ICD-10 E76.1) diagnosed in Brazil. Initially 455 patients were found, but only 181 patients who were receiving idursulfase treatment were included in this study. Among these cases, as expected in a X-linked disease, all were males and 40% of the cases were recorded in the Southeast region, and another 34% in the Northeast region. The biggest proportion of patients (39%) were diagnosed when they were 10-19 years old. There are 212 clinical conditions associated with MPS II, although the main comorbidities related to MPSII include: abdominal/inguinal hernia, respiratory complications, and carpal tunnel syndrome. Respiratory disorders were the fifth most frequent comorbidity recorded in these patients. The healthcare professionals in Brazil more involved in the diagnosis of MPS II were radiologists, followed by geneticists and cardiologists. Despite some limitations, DATASUS is a relevant database to provide information on rare diseases such as MPS II. Most cases were reported in southeast and northeast regions, respectively. This information is crucial to help design targeted public policies.

Relative Risk Analysis of Patient Return Within 72 Hours to Emergency Department.

Introduction: Transparency in patient care in an emergency department can be projected by capturing data from the medical records of patients. Policy makers envision that transparency in this data will allow the patient to choose the right hospital of his choice. Relative risk is a ratio of the probability of an event occurring in the exposed group versus the probability of the event occurring in the non-exposed group. It is usually used in the scenario of clinical events. In this study we have used it to analyse one of the key performance indicators used in Emergency Department, as per Emerald standards. The problem statement identified in the study is the returning of patients to the Emergency department of a private, tertiary care hospital within 72 hours after the initial visit. A revisit in this study is assumed as an unplanned visit done by the patient within 72 hours with similar presenting complaints. Methodology: A retrospective cohort study for all emergency visits between January to June 2021. People who returned to EMD within 72 hours were compared to other non-re attending patients based on medical diagnosis, patient demographics, mode of arrival, triage category and qualification of doctors in charge. Multivariate analysis using the generalized linear model was conducted on variables associated with 72-hour ED re-attendance. Result: Among 18,355 patients, 128 (0.69%) were in the 72-hour re-attendees’ group. Multivariate analysis showed female gender as more, above 60 years of age, arrival by ambulance, triaged as yellow. Among the ICD-10 diagnosis for the patients who returned, it was not possible to identify one specific condition. But abdominal pain was one reason for the re-visit of a few patients. There was also a significant difference in the seniority ranking of the doctor-in-charge between both groups. Conclusion: Identification of characteristics of patients lead to improved care by surgeons and gastroenterology.

Integrative Dimensional Personality Inventory for ICD-11: Development and Evaluation in the Peruvian Correctional Setting / Inventario Integrativo de la Personalidad Dimensional para la CIE-11: desarrollo y evaluación en el sistema penitenciario peruano

Abstract Background: Personality disorder (PD) is an important predictor of the commission of crimes; however, there is a lack of clinical instruments adjusted to the characteristics of Peruvian convicts. Objective: To develop a reliable and valid comprehensive personality measurement instrument, the Integrative Dimensional Personality Inventory, ICD-11 version (IDPI-11), according to the standards of the International Classification of Diseases (ICD-11). Method: A stratified simple of prisoners from the Huancayo Penitentiary (HP) was selected (n study 1 = 60; n study 2 = 1095). Results: High reliability indices(McDonald's _ _ .73) and adequate levels of content validity(CVI-S ≥ .87), construct validity, and criterion validity of the scales were found. This could explain the probability (a) of belonging to the group of inmates with instrumental or impulsive crimes (R2 N ≥ .52, OR ≥ 1.02, p ≤ .021), and (b) that recidivism, designated by the prison security level imposed, increases (R2≥ .53, β ≥ 1.16, p ≤ .008). Conclusions: The instrument is a valid and reliable measure that allows a dimensional and integrative assessment of the personality of convicts of the HP, according to ICD-11 standards

Resumen Antecedentes: el trastorno de la personalidad (TP) es un predictor importante en la comisión de delitos; sin embargo, existe una ausencia de instrumentos clínicos para las características del convicto peruano. Objetivo: desarrollar un instrumento de medición integral de la personalidad confiable y válido, el Inventario Integrativo de Personalidad Dimensional versión CIE-11 (IDPI-11), según los estándares de la Clasificación Internacional de Enfermedades (CIE-11). Método: se utilizó una muestra estratificada de reclusos del Establecimiento Penitenciario de Huancayo (EPH) (n estudio 1 = 60; n estudio 2 = 1095). Resultados: se encontraron altos índices de confiabilidad (ω de McDonald ≥ .73) y niveles adecuados de validez de contenido (CVI-S ≥ .87), constructo y criterio de sus escalas, pudiendo explicar la probabilidad de: (a) pertenecer al grupo de internos con delitos instrumentales o impulsivos (R2≥ .52, OR ≥ 1.02, p ≤ .021);y(b) que la tendencia a reincidir, designada por el grado de seguridad penitenciaria impuesto, aumente (R2 ≥ .53, β ≥ 1,16, p ≤ .008). Conclusiones: el instrumento construido es una medida válida y confiable que permite una evaluación dimensional e integrada de la personalidad del convicto de la EP de Huancayo, de acuerdo con los estándares de la CIE-11.

Muerte Súbita Post Infarto: ¿Cuándo Implantar un Desfibrilador Automático? Breve revisión a propósito de un caso / Sudden Death After Infarction: when To Implant An Automatic Defibrillator? Brief review about a case

Sudden death is the most serious complication of acute coronary syndromes. The highest percentage occurs at home with a very low survival rate. The highest risk group are patients with ejection fraction under 40% after an acute myocardial infarction. So far the indication of the clinical practice guides are the implantation of ICD as a secondary prevention, and as a primary prevention when the systolic function is severely diminished, however there is an interval of 40 days in which the implant has not managed to demonstrate benefits. In this critical period patients should be managed with beta-blockers. So far, the absolute benefit of using portable cardioverter-defibrillators as a prophylactic bridge to the ICD implant has not been demonstrated. The following revision is based on the most relevant clinical practice guides in the field carried out in relation to a clinical case

Comparative analysis of work-related musculoskeletal disorders catalogues / 中华劳动卫生职业病杂志

Work-related musculoskeletal disorders (WMSDs) refer to musculoskeletal disorders caused by work or work as the main cause, which are characterized by high prevalence and heavy burden of disease as a global problem. The classification and catalog of occupational diseases is of great significance for guiding the prevention and control of occupational diseases and safeguarding the rights and interests of workers. The types of WMSDs included in the list of occupational diseases vary greatly from country to country, and the regulations on specific pathogenic factors are also inconsistent. By sorting out and analyzing the lists and characteristics of WMSDs at home and abroad, and using the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in occupational health to standardize of WMSDs in various countries, which would lay the foundation for future multi-country WMSDs occupational health registration and disease burden research, and provide a reference for China to revise the WMSDs list.

Symphony of nanomaterials and immunotherapy based on the cancer-immunity cycle

The immune system is involved in the initiation and progression of cancer. Research on cancer and immunity has contributed to the development of several clinically successful immunotherapies. These immunotherapies often act on a single step of the cancer-immunity cycle. In recent years, the discovery of new nanomaterials has dramatically expanded the functions and potential applications of nanomaterials. In addition to acting as drug-delivery platforms, some nanomaterials can induce the immunogenic cell death (ICD) of cancer cells or regulate the profile and strength of the immune response as immunomodulators. Based on their versatility, nanomaterials may serve as an integrated platform for multiple drugs or therapeutic strategies, simultaneously targeting several steps of the cancer-immunity cycle to enhance the outcome of anticancer immune response. To illustrate the critical roles of nanomaterials in cancer immunotherapies based on cancer-immunity cycle, this review will comprehensively describe the crosstalk between the immune system and cancer, and the current applications of nanomaterials, including drug carriers, ICD inducers, and immunomodulators. Moreover, this review will provide a detailed discussion of the knowledge regarding developing combinational cancer immunotherapies based on the cancer-immunity cycle, hoping to maximize the efficacy of these treatments assisted by nanomaterials.

Similarities and differences in the diagnostic criteria of ICD-11 and DSM-5 for sexual dysfunction / 四川精神卫生

The purpose of this paper is to compare the similarities and differences between the diagnostic criteria of sexual dysfunction in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and the International Classification of Diseases， eleventh edition （ICD-11）. Sexual dysfunction is the inability of adults to experience various forms of satisfactory sexual performance. In this paper， the main diagnostic points of sexual dysfunction in both manuals are summarized and compared with a view to assisting psychiatric and psychological workers to acquire a better understanding of the corresponding sections.

Health expenditures and causa mortis: an investigation on municipalities of the State of Paraná, Brazil / Gastos com saúde e causa mortis: uma investigação dos municípios do Estado do Paraná, Brasil / Gastos en salud y causa mortis: una investigación para los municipios del Estado de Paraná, Brasil

The Brazilian government shares the responsibility of financing public health among federal, state, and municipal levels. Health expenditures are thus uneven across the country and cannot contribute equally to health outcomes across disease categories. This study aims to identify how the health expenditures of municipalities affect the mortality rate in the state of Paraná by causa mortis. We considered years of life lost for each municipality, the chapters of the International Classification of Diseases (10th revision), and the elasticity of this measure in relation to public health expenditure. Considering the possibility of endogeneity, this study follows the instrumental variable approach in a panel of generalized method of moments - instrumental variable (GMM-IV) with fixed effects. Our results show that a 1% increase in health expenditure could decrease the average number of years lost specifically for some causes from 0.176% to 1.56% at the municipal level. These findings could elucidate policy perspective within state finance.

O financiamento da saúde pública é uma responsabilidade compartilhada entre as três esferas governamentais brasileiras, i.e., a federal, estadual e municipal. Logo, gastos divergem pelo território e não se poderia esperar que contribuíssem de forma homogênea para os desfechos de saúde em todos os tipos de doença. Este artigo busca identificar como gastos municipais afetam a taxa de mortalidade no Estado do Paraná dado sua causa mortis. Consideramos anos de vida perdidos para cada município, os capítulos da Classificação Internacional de Doenças (10ª revisão) e estimamos a elasticidade dessa medida em relação aos gastos públicos em saúde. Considerando uma possível endogeneidade, este artigo segue a abordagem variável instrumental em um painel de método generalizado de momentos (GMM-IV) com efeitos fixos. Nossos resultados mostram que um aumento de 1% nos gastos municipais com saúde pode diminuir o número médio de anos perdidos entre 0,176% e 1,56% para algumas causas especificas de mortalidade. Nosso estudo pode lançar alguma luz sobre a perspectiva política das finanças dos estados.

La financiación de la salud pública es una responsabilidad compartida entre las tres esferas del gobierno brasileño, a nivel federal, estatal y municipal. En este sentido, los gastos son desiguales en el territorio, y no se puede esperar que contribuyan de forma homogénea a los resultados de salud en las distintas categorías de enfermedades. La función de este trabajo es identificar cómo los gastos de los municipios afectan a la tasa de mortalidad en el Estado de Paraná, por causa mortis. Se consideraron los años de vida perdidos para cada municipio, los capítulos de la Clasificación Internacional de Enfermedades (10ª revisión), y se estimó la elasticidad de esta medida en relación con el gasto sanitario público. Teniendo en cuenta la posibilidad de endogeneidad, este trabajo sigue el enfoque de variables instrumentales en un panel de los método generalizado de momentos (GMM-IV) con efectos fijos. Nuestros resultados muestran que un aumento del 1% en el gasto sanitario puede disminuir el número medio de años perdidos específicamente por algunas causas del 0,176% al 1,56%, a nivel municipal. Esto puede arrojar algo de luz sobre la perspectiva política dentro de las finanzas de los estados.

Factores predictores de aparición de fibrilación auricular en pacientes con miocardiopatía dilatada / Predicting factors of atrial fibrillation in patients with dilated cardiomyopathy

Resumen Introducción El uso de terapia anticoagulante en pacientes con miocardiopatía dilatada es controvertido. El riesgo hemorrágico hace que habitualmente no se use en pacientes en ritmo sinusal. Objetivo Analizar los factores predictores de fibrilación auricular (FA) en pacientes con miocardiopatía dilatada y fracción de eyección del ventrículo izquierdo (FEVI) < 40. Método: Se estudiaron los pacientes incluidos en el registro multicéntrico UMBRELLA a quienes se había implantado un desfibrilador (DAI) bicameral o tricameral y que presentaban miocardiopatía dilatada isquémica o no isquémica y FEVI < 40%. Se definió FA como cualquier episodio > 30 segundos de duración y una frecuencia auricular > 175 latidos por minuto. Resultados Se incluyeron 684 enfermos. La mediana de edad fue de 70 años (rango intercuartílico [RIQ]: 62-77). El 79.1% eran varones. La FEVI fue < 30% en el 76.3%. El 87.3% presentaban insuficiencia cardiaca (ICC) clínica. Se implantó un DAI resincronizador en el 59.5%. El 51.2% tenían bloqueo de rama izquierda del haz de His y el 7.1% de rama derecha (BRDHH). Se documentó FA en el 49% de los enfermos con una mediana de seguimiento de 29.93 meses (RIQ: 14.78-45.63). Las variables que se relacionaron con la aparición de FA fueron la presencia de ICC (hazard ratio [HR]: 2; intervalo de confianza del 95% [IC 95%]: 1.31-3.04; p = 0.001), el BRDHH (HR: 1.48; IC 95%: 1-2-18; p = 0.045), el ictus previo (HR: 2.11; IC 95%: 1.4-3.19; p < 0.001) y la edad > 75 años (HR: 1.21; IC 95%: 1.05-1.40; p = 0.008). Conclusiones La edad > 75 años, el BRDHH, la ICC y el ictus previo predicen la aparición de FA en la población con miocardiopatía dilatada y FEVI < 40%.

Abstract Introduction Anticoagulant treatment in patients with dilated cardiomyopathy and sinus rhythm is controversial due to haemorrhage risk. Objective To analyze the factors predicting atrial fibrillation (AF) in patients with dilated cardiomyopathy and ejection fraction (LVEF) < 40%. Method All patients included in UMBRELLA multicentre registry without AF, who had a dual or three-chamber implantable cardiac defibrillator (ICD), dilated cardiomyopathy and LVEF < 40% were included. AF was defined as any episode > 30 seconds of duration and atrial frequency > 175 bpm. Results 684 patients were included. Median age was 70 years (IQR 62-77); 79.1% were male. LVEF was < 30% in 76.3% of cases; 87.3% presented clinical heart failure (CHF). A CRT-D was implanted in 59.5%; 51.2% of patients presented Left Bundle Branch Block (LBBB) and 7.1% presented Right Bundle Branch Block (RBBB). AF was documented in 49% of patients, with a median follow-up of 29.93 months (IQR: 14.78-45.63). The presence of CHF (HR: 2; 95% CI: 1.31-3.04; p = 0.001), RBBB (HR: 1.48; 95% CI: 1-2-18; p = 0.045), previous stroke (HR: 2.11; 95% CI: 1.4-3.19; p < 0.001) and age > 75 years (HR: 1.21; 95% CI: 1.05-1.40; p = 0.008) were associated with diagnosis of AF. Conclusions Age > 75 years, RBBB, CHF and previous stroke are predictors of AF development in the population with dilated cardiomyopathy and LVEF < 40%.

Report on the 9th MHLW ICF Symposium"Looking to a New Stage of ICD-11 and ICF Utilization - Toward a Common Language in Various Fields" / 全日本鍼灸学会雑誌

The International Classification of Functioning, Disability and Health (ICF), adopted by WHO in 2001, is an evolution of the International Classification of Impairments, Disabilities and Handicaps (ICIDH). It is a model that integrates the levels of 1) body function and structures, 2) activity, and 3) participation, and uses a holistic approach by focusing on the health of the entire body with an emphasis on the positive aspects of being able to do things. In May 2019, the WHO General Assembly adopted ICD-11, revised after 30 years, and for the first time introduced the classification of diseases used in traditional medicine. A symposium organized by the Ministry of Health, Labour and Welfare of Japan (MHLW) was held online on February 20, 2021, and is reported here.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for somatic symptoms and related disorders / 四川精神卫生

The purpose of this paper is to compare the similarities and differences between the diagnostic criteria for somatic symptoms and related disorders in the International Classification of Diseases， eleventh edition （ICD-11） and the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. The clinical features of somatic symptoms and related disorders are prominent somatic symptoms that cause significant functional impairment and suffering. This paper discusses the similarities and differences between the two diagnostic systems in order to facilitate mastery of the corresponding content.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for feeding and eating disorders / 四川精神卫生

The purpose of this paper is to discuss the similarities and differences between the diagnostic criteria of feeding and eating disorders in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and International Classification of Diseases， eleventh edition （ICD-11）. Feeding and eating disorders are clinically characterized by persistent disturbances in feeding or food-related behaviors that result in altered food consumption or absorption and significant impairment in physical health or social function. This paper discusses the similarities and differences of feeding and eating disorders in the two diagnostic manuals， in order to improve psychiatric and psychological workers’ understanding of the corresponding sections.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for elimination disorders / 四川精神卫生

The purpose of this paper is to discuss the similarities and differences between the diagnostic criteria of elimination disorders in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and International Classification of Diseases， eleventh edition （ICD-11）. Elimination disorders are clinically characterized by inappropriate urination or defecation， resulting in pain or functional impairment. This paper discussed the main points of elimination disorders in the two diagnostic manuals， in order to improve psychiatric and psychological workers’ understanding of the corresponding sections.

Similarities and differences between the diagnostic criteria of ICD-11 and DSM-5 for sleep-wake disorders / 四川精神卫生

This paper aims to discuss the similarities and differences between the diagnostic criteria for sleep-wake disorders in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） and International Classification of Diseases， eleventh edition （ICD-11）. Sleep-wake disorders are characterized by the unsatisfactory quality， quantity and circadian rhythm of sleep， leading to daytime distress and impaired social functioning. Therefore， the main diagnostic points of sleep-wake disorders in both manuals are summarized and compared in this study， in order to assist psychiatric and psychological workers to acquire a better understanding of the corresponding sections.

Diagnosis associated with COVID-19 (U07.1), pneumonia- unspecified (J18. 9) and other types of admissions: A restricted medical scheme case study-South Africa

The primary objective of this study was to assess the characteristics of patients admitted for COVID-19, 'J18.9 Pneumonia, unspecified organism' and other types of diagnoses. The aim was to assess as to what extent do COVID-19 related admissions changed to pneumonia, and as to what extent do 'J18.9 Pneumonia, unspecified organism' related admissions that changed to COVID-19 diagnosis at discharge stage. The secondary objective of the study was to assess' predictors of readmissions in private hospitals. The review period was private hospital claims received by the scheme between January and August 2020. The inclusion criteria for COVID-19 admissions were patients that had a laboratory-confirmed (RT ? PCR assay) COVID-19. Predictors of readmissions were modelled using logistic regression. The study found that restricted scheme patients admitted for a COVID-19 diagnosis changed to a 'J18.9 Pneumonia, unspecified organism' diagnosis. The converse was found to be true in that some patients that were admitted as J18.9 Pneumonia, unspecified organism' diagnosis changed to a COVID-19 diagnosis. This study showed underlying factors associated with hospital admissions and predictors of readmissions in private hospitals.

Caracterización del trastorno por videojuegos: ¿Una problemática emergente? / Characterization of Gaming Disorder: An Emerging Problem? / Caracterização do transtorno pelos videojogos: um problema emergente?

Resumen Objetivo. Sistematizar la literatura actual disponible en torno a la caracterización del trastorno por videojuegos (VDJ), aportando a la comprensión de este fenómeno en el contexto latinoamericano y su incidencia en la población infanto-juvenil. Método. Se utilizó una revisión sistemática de literatura, de corte analítico. Como eje de búsqueda se consideraron las categorías: (a) uso de las TIC, (b) videojuegos, (c) adicción y (d) trastorno por videojuegos, de acuerdo con estudios publicados en las bases de datos PubMed, ScienceDirect y Google Scholar, teniendo como referencia el DSM-V y CIE-11. Resultados. Las manifestaciones clínicas descritas para su uso adictivo son aún heterogéneas. También, se pudo observar que, cuanto más temprano se empieza, mayor será la frecuencia de su uso en edades posteriores, lo que aumenta las conductas de riesgo en el futuro y su incidencia en el tiempo de ocio y la recreación cotidiana. Conclusión. Los efectos que puede generar el uso problemático de dispositivos tecnológicos en el desarrollo de las personas, se contrapone al uso de los VDJ en el tratamiento de diversos trastornos como en el plano educativo. Adicionalmente, se reafirma el desafío de construir saberes e investigaciones multidisciplinares en torno al uso problemático de estos dispositivos.

Abstract Objective. Systematize the current literature available on the characterization of video game disorder, in order to contribute to the understanding of this phenomenon in the Latin American context and its incidence in the child/youth population. Method. A systematic review and analysis of the literature was used. The following categories were considered lines of inquiry: (a) use of ICT, (b) video games, (c) addiction and (d) video game disorder, according to studies published in the PubMed, ScienceDirect and Google Scholar databases, having the DSM-V and ICD-11as references. Results. The clinical manifestations of its addictive use are still heterogeneous. Also, it was observed that the earlier it starts, the greater the frequency of its use in later ages, which increases risk behaviors in the future and its incidence in leisure time and daily recreation. Conclusion. The effects that the problematic use of technological devices can generate in the development of individuals are contrasted to the use of video games in the treatment of various disorders, such as in the educational field. Additionally, the challenge of building knowledge and multidisciplinary research around the problematic use of these devices is reaffirmed.

Resumo Escopo. Sistematizar a literatura atual disponível sobre a caracterização do transtorno pelos videojogos (VDJ), aportando à compreensão de este fenômeno no contexto latino-americano e sua incidência na população infanto-juvenil. Metodologia. Foi empregada uma revisão sistemática de literatura, de corte analítico. Como eixo de procura foram consideradas as categorias: a) uso das TIC, b) Videojogos, c) Vício e d) transtorno pelos videojogos, de acordo com estudos publicados nas bases de dados PubMed, ScienceDirect e Google Scholar, tendo como referencia o DSM-V e C1E-11. Resultados. As manifestações clínicas descritas para o seu uso aditivo ainda são heterogéneas. Também, foi observado que, quanto mais cedo começar, maior será a frequência do seu uso em idades posteriores, o que aumenta as condutas de risco no futuro e sua incidência no tempo de ócio e a recreação cotidiana. Conclusão. Os efeitos que pode gerar o uso problemático de dispositivos tecnológicos no desenvolvimento das pessoas, está contraposto ao uso dos VDJ no tratamento dos diversos transtornos como no plano educativo. Além do mais, é reafirmado o desafio de construir saberes e pesquisas multidisciplinares sobre o uso problemático de estes dispositivos.

Penetrating Chest Trauma with Iron Rod In-situ: A Surgical Challenge

Introduction: Chest trauma both blunt and penetratingconstitutes 10-15% of all traumas and 25% of all deaths fromtraumatic injuries.Case report: We present a case of penetrating right chesttrauma following road traffic accident (RTA) with big metallicrod in-situ, entering from right axillary region and coming outfrom posterior chest wall. The force of impact was so severethat the heavy iron rod got bent upon itself making its removala surgical challenge.Conclusion: In cases of penetrating chest trauma earlyassessment, accurate diagnosis, and rapid transport with noattempt to remove the penetrating foreign body and meticulousplanning play key role in its successful management.

The first instrument for complex PTSD assessment: psychometric properties of the ICD-11 Trauma Questionnaire

Objective: The ICD-11 Trauma Questionnaire (ITQ) was developed as a joint effort by researchers from several countries to evaluate post-traumatic stress (PTSD) and complex-PTSD (C-PTSD) symptoms. This study is part of a multi-center international collaborative research project that aims to provide psychometric support for this initial instrument in different languages, considering the specific contexts related to complex traumatization. This study verified the psychometric characteristics of the Portuguese version of the ITQ, evaluating symptoms beyond those described the existing literature. Methods: We examined the results of a convenience sample totaling 268 Portuguese and Angolan participants. Two instruments were applied: the ITQ, which evaluates symptoms resulting from a traumatic life event, and the Life Events Checklist (LEC), which evaluates stressful life events. The general characteristics of the scales are described, and reliability analysis and validity studies were performed. Results: Cronbach's alpha varied between 0.84 and 0.88, and the exploratory factorial analysis results were consistent with the concept of C-PTSD, with five components explaining 61.58% of scale variance. Conclusion: The results suggest good psychometric characteristics for the Portuguese version of the ITQ, and thus it can be included in protocols intended evaluating complex traumatic symptoms.

Methemoglobinemia due to local anesthesia: a rare cause of cyanosis and chest pain after placement of implantable cardioverter defibrillator / Journal of Rural Medicine

Although methemoglobinemia is rare in adulthood, it may have fatal consequences if unnoticed. We planned to implant an implantable cardioverter defibrillator ICD in a 50-year-old male patient for primary prevention. Following sterile draping, prilocaine 5 mg/kg (400 mg) was injected subcutaneously for local anesthesia. We injected an additional dose of 200 mg due to pain during subclavian vein puncture. A DDD-R ICD was placed successfully within approximately 40 minutes. The patient complained of sudden chest pain and dyspnea 15 minutes after bed rest and was transferred to the coronary care unit due to cyanosis and deterioration of general status. Physical examination revealed blood pressure of 110/80 mmHg, pulse rate of 110 bpm, and otherwise unremarkable signs. Peripheral oxygen saturation was determined as 83% by pulse oximeter. Possible pneumothorax and cardiac perforation were excluded by emergency chest radiograph and echocardiography. Blood gas analyses was performed to assess for methemoglobinemia, which revealed pH 7.41, pCO2 40 mmHg, oxygen saturation 98.2%, and methemoglobin 7.9% that peaked to 12.3%. Methylene blue (1%) was slowly injected over 10 minutes at a dose of 1 mg/kg. Cyanosis waned and methemoglobin values decreased to 4.1%, 2.1%, and 1.1% at 2, 8, and 16 hours following the administration, respectively. The patient was safely discharged 2 days after implantation of pacemaker. Methemoglobinemia should be considered in cases presenting with cyanosis, non-diagnostic ECG, and a discrepancy in oxygen saturation between pulse oximetry and blood gas analyses.

A digital application for implementing the ICD-11 traditional medicine chapter / 中西医结合学报

On May 25, 2019, the World Health Assembly approved the eleventh revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), containing a chapter on traditional medicine. This means that the traditional East Asian medicine (TEAM) is now officially recognized as a part of mainstream medical practice. However, the patterns presented in the ICD-11 traditional medicine chapter are only the tip of the iceberg of TEAM clinical practice, and it will be necessary to supplement and upgrade the contents. In order to implement this, objectification and standardization of TEAM must be premised, and grafting with proper modern science and technology is imperative. Pattern Identification and Prescription Expert-11 (PIPE-11), which is a TEAM clinical decision support system, adopts vastly from clinical literature on pattern identification and the prescription. By adopting the rule-based reasoning method, the way of diagnosis and prescription by a TEAM practitioner in actual clinical practice is implemented as it is. PIPE-11 could support to improve both the accuracy of medical diagnosis and the reliability of the medical treatment of TEAM in clinical practices. In the field of research, it might facilitate the usage for reliable reference for symptoms and signs retrieval and patient simulation. In the field of education, it can provide a high level of training for learning pattern identification and prescription, and further be used to reinforce skills of diagnosis and prescription by providing self-simulation methods. Therefore, PIPE-11 as a digital application is expected to support the traditional medicine chapter of ICD-11 to successfully contribute to the improvement of human health.