Impacto de la pandemia por COVID-19 en la conducta alimentaria de niñas, niños y adolescentes con trastorno del espectro autista / Impact of the COVID-19 pandemic on the eating behaviors of children and adolescents with autism spectrum disorder

Introducción. Los niños con trastorno del espectro autista (TEA) presentan dificultades de adaptación a situaciones estresantes, como la pandemia por COVID-19. Objetivo. Evaluar el impacto del primer año de pandemia en las dificultades alimentarias de niños con TEA. Población y métodos. Se invitó a participar a cuidadores de niños con TEA no sindromático (edad: 2-18 años) de una unidad de neurodesarrollo. Los participantes respondieron en línea un cuestionario y la escala de evaluación de problemas de conducta alimentaria (BPFAS por su sigla en inglés) antes y durante el primer año de pandemia. Se calculó un puntaje de prioridad (producto entre promedio de frecuencia y problema) para cada ítem del BPFAS. Resultados. El 56,6 % (86/152) de los cuidadores contestó la encuesta (madre 74,4 %), mediana de edad 6,3 años (p25-p75: 4,7-8,2); el 80,2 % de los niños eran de sexo masculino; el 58,1 % mantuvo terapia durante la pandemia y el 61,6 % presentaba problemas de comportamiento previo a esta. Durante el primer año de pandemia, los niños presentaron mayor intensidad en dificultades conductuales (34,9 %) y de alimentación (61,6 %); sin embargo, el 31,4 % refirió mejoría en la alimentación. No existieron diferencias significativas entre puntajes BPFAS antes y durante la pandemia. Los ítems con mayor puntaje de prioridad fueron "se levanta de la mesa durante la hora de comer", "no probar alimentos nuevos", "no come verduras", "no come frutas". Conclusiones. Hubo alta frecuencia de dificultades en las conductas alimentarias durante el primer año de pandemia. No se presentaron diferencias en las características de estas conductas antes y durante la pandemia.

Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2­18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children's median age was 6.3 years (p25­p75: 4.7­8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.

Mutual promotion action between the self-directed learning ability of medical students and the effect of flipped classroom teaching / 中华医学教育探索杂志

Objective:To explore the correlation between the self-directed learning ability of medical students and the effect of flipped classroom teaching.Methods:The questionnaire survey was used. From November to December 2020, 123 students of 5-year program enrolled in 2019 in Peking University Health Science Center were chosen as the study objects and Neurobiology is a required course for them. The Medical Students' Autonomous Learning Ability Assessment Scale (MSALAAS) was used to assess the students' self-directed learning ability. The final examination score and a questionnaire survey were used to assess the teaching effect of the course. Descriptive analysis and Mann-Whitney analysis were used to analyze the change of self-directed learning ability of students after the course. One-dimensional linear regression was used to analyze the influence of self-directed learning ability on the final examination score, course experience and course assessment. Results:The total score of MSALAAS was increased from [(109.84 ± 14.12) points] to [(113.65±15.88) points] ( P<0.05) after the course. If the total score of the MSALAAS was referred to as an independent variant, and the final examination score, the course experience and course assessment was referred to as a dependent variable, respectively. The one-dimensional linear regression analysis showed that the total score of the MSALAAS was correlated with the final examination score ( B=0.248, t=3.59, P<0.001), the course experience ( B=0.049, t=3.15, P=0.002) and course assessment ( B=0.048, t=3.18, P=0.002). Conclusion:Flipped classroom teaching can promote the improvement of the self-directed learning ability of medical students. In converse, the students with higher self-directed learning ability might achieve higher examination score and get the better course experience and assessment.

Establishment of Thoracic Surgical Difficulty Assessment Scale based on Delphi method / 中南大学学报(医学版)

Objective: The difficulty of surgery, which is related to surgical safety, has only been mentioned as a subjective perception for a long time. There are few studies to quantitatively and systematically evaluate the difficulty of thoracic surgery. This study aims to establish a quantitative evaluation index system for thoracic surgical difficulty, and to evaluate its reliability and validity.Methods: During the 2 national thoracic surgery academic conferences, the factors that may affect the difficulty of thoracic surgery were evaluated by the thoracic surgeons via semi open questionnaires, and then the evaluation item pool of thoracic surgery difficulty was established. The importance of each indicator in the evaluation item pool was graded by 2 rounds of Delphi method. The average score, full score rate and coefficient of variation of each index were calculated, and the composite index method was used to decide whether to delete the indicator. Finally, the difficulty evaluation scale of thoracic surgery was constructed. The surgical data of patients with thoracic tumors were collected. The scale was used to evaluate the difficulty of thoracic surgery for lung, esophageal, and mediastinal tumors. The reliability and validity of the scale were evaluated by the commonly used difficulty evaluation indexes: Operation time, intraoperative estimated blood loss, Visual Analog Scale (VAS), side injury rate, and blood transfusion rate as standards. Results:A total of 230 questionnaires were distributed in the 2 rounds of survey, and 149 valid questionnaires were collected after eliminating duplicate questionnaires. Through 2 rounds of Delphi consultation with 20 experts, the difficulty evaluation indexes were scored and screened, and the difficulty evaluation scale of thoracic surgery was established. It included 5 main indexes (surgical decision-making, operation space, separation interface, reconstruction method, and surgical materials) and 16 secondary indexes [American Society of Anesthesiologists (ASA) classification, surgical trauma, operator experience, space size, space depth, space source, space adjacent, interface content, anatomical gap, visual field, interface size, reconstruction complexity, reconstruction scope, autologous materials, artificial biomaterials and instruments]. After weighting, the total score of Thoracic Surgery Difficulty Evaluation Scale was from 1 to 3. A Score at 1 standed for simplicity, and score at 3 standed for difficulty. Further data were collected for 127 cases of thoracic tumor surgery. The difficulty scores of surgery for lung, esophageal, and mediastinal tumor were 1.69±0.26, 1.86±0.18, and 1.56±0.31, respectively, and the Cronbach ' sαcoefficients of the scale in 3 tumor surgeries were 0.993, 0.974, and 0.989, repectively, and the Spearman Brown coefficients were 0.996, 0.984, and 0.996, respectively. The Spearman correlation coefficients of operation difficulty score with operation time, estimated blood loss, and VAS were 0.360 and 0.634, 0.632 and 0.578, 0.696 and 0.875, respectively (all P<0.05). The incidence of postoperative complications in the difficult operation group (difficulty score >1.85) was higher than that in the non-difficult operation group (P=0.02).Conclusion: The quantitative Thoracic Surgical Difficulty Assessment Scale has been successfully established, which shows good reliability and validity in thoracic tumor surgery. The Thoracic Surgical Difficulty Assessment Scale has broad application prospects in reducing the difficulty of the surgery, controlling surgical complications, and training surgeons.

Psychometric properties of the Brazilian version of the Sunnybrook Facial Grading System / Propriedades psicométricas da versão brasileira do Sunnybrook Facial Grading System

Abstract Introduction: The Sunnybrook Facial Grading System (SFGS) is a scale to evaluate facial function in three domains, namely resting symmetry, voluntary move-ments, and synkinesis. It is commonly used in scientific research and clinical practice to assess and monitor people with facial paralysis. Objective: To translate and cross-culturally adapt the SFGS, develop a version for the Brazilian population (SFGS - Brazil) and analyze its psychometric properties, including validity, interrater reliability and responsiveness. Methods: A multidisciplinary panel translated and adapted the SFGS into Brazilian Portuguese, creating the SFGS-Brazil version. Next, content validation was carried out by a panel of four physical therapists with clinical experience in caring for people with facial paralysis, in addition to interrater reliability and scale responsiveness after physical therapy intervention. Results: For SFGD validation, committee agreement rate and the content validity index were greater than 90%. Agreement (interrater reliability) was excellent for most items and overall (intraclass correlation coefficient = 0.99; p < 0.000) and the scale proved to be responsive, indicating post-intervention improvement (t = 10.66; p = 0.000). Conclusion: The domains and items of the SFGS-Brazil are conceptually equivalent to those of the original version, and the instrument displays adequate psychometric properties, including validity, agreement and responsiveness. The SFGS-Brazil is suitable for the Brazilian population and can be used in scientific studies and clinical practice.

Resumo Introdução: O Sunnybrook Facial Grading System (SFGS) é uma escala para avaliar a função facial em três domínios, incluindo simetria em repouso, movimentos voluntários e sincinesias. Essa escala é comumente utilizada em pesquisas científicas e na prática clínica para a avaliação e acompanhamento de pessoas com paralisia facial. Objetivo: Traduzir e adaptar transculturalmente o SFGS, elaborar a versão para a população brasileira (SFGS-Brasil) e analisar suas propriedades psicométricas, incluindo validade, confiabilidade interexaminadores e responsividade. Métodos: Um comitê multidisciplinar traduziu e adaptou o SFGS para o português do Brasil, gerando a versão SFGS-Brasil. Após esta fase, realizou-se a validação de conteúdo por um comitê de quatro fisioterapeutas com experiência clínica em atendimento de pessoas com paralisia facial, além da confiabilidade interexaminadores e a responsividade da escala após intervenção fisioterapêutica. Resultados: Para a validação do SFGS, a taxa de concordância do comitê total e o índice de validade do conteúdo mostraram-se maiores que 90%. A concordância (confiabilidade interexaminadores) mostrou-se excelente para maioria dos itens e para o total (coeficiente de correlação intraclasse = 0,99; p < 0,000), e o instrumento mostrou-se responsível, podendo-se identitificar melhora segundo o SFGS-Brasil após a intervenção (t = 10,66; p = 0,000). Conclusão: O SFGS-Brasil possui equivalência conceitual dos domínios e itens à versão original, possui propriedades psicométricas adequadas, incluindo validade, concordância e responsividade. O SFGS-Brasil é adequado para a população brasileira, podendo ser usado em estudos científicos e na prática clínica.

Inventário de autoavaliação do professor: proposta de um instrumento baseado no teacher behaviors checklist / Teacher self-assessment inventory: proposal of an instrument based on the teacher behaviors checklist / Inventario de autoevaluación del profesor: propuesta de un instrumento basado en el teacher behaviors checklist

Esta pesquisa objetiva propor o Inventário de Autoavaliação do Professor, uma versão reduzida e adaptada do Teacher Behavior Checklist, apresentando evidências de validade e precisão do mesmo, além de suas associações com o bem-estar subjetivo. Participaram deste estudo 214 professores universitários, sendo 55,6% do sexo feminino e 44,4% do sexo masculino, com média de idade da amostra total de 39,21 (DP = 9,77). Estes responderam questões sociodemográficas e ocupacionais, o Inventário de Autoavaliação do Professor, a Escala de Satisfação com a Vida e a Escala de Bem-estar Afetivo no Trabalho. Análises Paralelas e Fatoriais Exploratórias sugeriram que o instrumento apresentou evidências adequadas de validade, corroborando as duas dimensões observadas originalmente, cuidado e profissionalismo, com índices de precisão aceitáveis. Cuidado apresentou correlação com os afetos positivos e Profissionalismo com as três dimensões do bem-estar. Tais resultados sugerem a adequação do instrumento para este contexto, assim como levanta possibilidades de pesquisas futuras.

This research aims to propose the Teacher Self-Assessment Inventory, a short-version adaptation of the Teacher Behavior Checklist, presenting evidence of its validity and accuracy, as well as its associations with subjective well-being. Participating in this study were 214 university professors, 55.6% female and 44.4% male, with a mean age of the complete sample of 39.21 (SD = 9.77). They answered sociodemographic and occupational questions, the Teacher Self-Assessment Inventory, the Life Satisfaction Scale, and the Job-related affective well-being scale. Parallel and Exploratory Factor Analyzes suggested that the instrument presented evidence of validity, corroborating the two originally observed dimensions, Care and Professionalism, with acceptable precision indices. Care presented correlation with positive affect and Professionalism with the three dimensions of well-being. These results suggest the adequacy of the instrument to this context, as well as possible future research studies.

Esta investigación objetiva proponer el Inventario de Autoevaluación de Profesores, una versión reducida y adaptada del Teacher Behavior Checklist, presentando evidencias de validez y precisión del mismo, además de sus asociaciones con el bienestar subjetivo. Participaron de esta investigación 214 profesores universitarios, siendo el 55,6% del sexo femenino y 44,4% del sexo masculino, con una media de edad de la muestra total de 39,21 (DP = 9,77). Estos respondieron cuestiones sociodemográficas y ocupacionales, el Inventario de Autoevaluación del Profesor, la Escala de Satisfacción con la Vida y la Escala de Bienestar Afectivo en el Trabajo. Análisis paralelos y factorial exploratorio sugirió que el instrumento presentó evidencias de validez, corroborando las dos dimensiones observadas originalmente, Cuidado y Profesionalismo, con índices de precisión aceptables. El cuidado presentó correlación con los afectos positivos y el profesionalismo con las tres dimensiones del bienestar. Estos resultados sugieren la adecuación del instrumento para este contexto, así como plantea posibilidades de investigaciones futuras.

The application of the Griffiths development scales (Chinese edition) among 2-4 year-old children with autism spectrum disorder / 中华物理医学与康复杂志

Objective:To evaluate the development of children 2-4 years old with autism spectrum disorders (ASDs) using the Chinese version of the Griffiths Development Scales (GDS-C).Methods:Eighty-eight children with ASD, 80 children with developmental language disorder (DLD) and 82 healthy children aged 2-4 were evaluated using the GDS-C. They were compared and their development in sports, personal and social relationships, language, hand-eye coordination and other performance were analyzed. The personal-social and language results of the ASD and DLD children were compared.Results:No significant differences were found between the ASD and DLD children in their language development. The development quotient of the ASD children was significantly lower, on average, than those of the DLD and healthy children in all fields except language. However, the ASD children′s development was not balanced. Their average developmental quotients in the language and the personal-social fields were significantly lower than in the sports, performance and hand-eye coordination fields. In the field of language, the entry loss rates of the two structural modes of receptive language and non-verbal expression of the ASD children were significantly higher than the DLD children′s averages. In the personal-social field the entry loss rates of communication and housework skills and of self-care skill were significantly higher than the DLD children′s averages. The command structure model of the ASD children was also superior, on average.Conclusions:The GDS-C can effectively assess the development of ASD children aged 2-4, especially in terms of language and personal and social skills. It can provide clinical evidence useful for early diagnosis and intervention for children with ASD.

Adaptação de uma Escala de Avaliação de Anomalias Perceptuais para o Brasil / Adaptation a Scale of Evaluation of Perceptual Anomalies for Brazil / Adaptación de una Escala de Evaluación de Anomalías Perceptuales para Brasil

Resumo O objetivo desta pesquisa foi adaptar a Structured Interview for Assessing Perceptual Anomalies (SIAPA) para o Brasil para ser utilizada como instrumento de autorrelato. Utilizou-se uma amostra não probabilística de 854 universitários, a maioria do sexo masculino (51,4 %) e com idades entre 16 e 65 anos (M = 23,7; DP = 6,8). Após a tradução e validação semântica da SIAPA, testaram-se os parâmetros de validade e precisão por meio de análises fatoriais, coeficientes alfa de Cronbach e análises via Teoria de Resposta ao Item (TRI). Os resultados confirmaram a adequação psicométrica da medida, apontando uma solução unidimensional com altas cargas no fator geral e alta consistência interna (α = 0,88; Ω = 0,88). Acredita-se que o objetivo proposto tenha sido satisfeito, de modo que, ao final da pesquisa, contou-se com uma medida válida e fidedigna que pode ser utilizada, tanto para rastreio quanto para pesquisa, para compreender e diagnosticar anomalias perceptuais. (AU)

Abstract The purpose of this research was to adapt the Structured Interview for Assessing Perceptual Anomalies (SIAPA) for use in Brazil as a self-report tool. A non-probabilistic sample of 854 undergraduate students was used, mostly men (51.4%) and aged between 16 and 65 years (M = 23.7, SD = 6.8). After the translation and semantic validation of SIAPA, the validity and precision parameters were tested by means of factor analysis, Cronbach's alpha coefficients, and Item Response Theory (IRT) analysis. The results confirmed the psychometric adequacy of the measure, pointing to a one-dimensional solution with high loads on the general factor and high accuracy (α = 0.88; Ω = 0.88). It is believed that the proposed objective was satisfied, so that at the end of the investigation there was a valid and reliable measure that can be used, both for screening and research, to understand and diagnose perceptual anomalies. (AU)

Resumen El objetivo de esta investigación fue adaptar la Structured Interview for Assessing Perceptual Anomalies (SIAPA) para Brasil para utilizarla como instrumento de autoinforme. Se utilizó una muestra no probabilística con 854 universitarios, la mayoría del sexo masculino (51,4%) y con edades entre 16 a 65 años (M = 23,7, DP = 6,8). Después de la traducción y validación semántica de la SIAPA, se probaron los parámetros de validez y precisión por medio de análisis factoriales, coeficientes alfa de Cronbach y análisis vía Teoría de Respuesta al Ítem (TRI). Los resultados confirmaron la adecuación psicométrica de la medida, apuntando una solución unidimensional con altas cargas en el factor general y alta precisión (α = 0,88; Ω = 0,88). Se cree que el objetivo propuesto ha sido satisfecho, de modo que al final de la investigación se contó con una medida valida y fidedigna que se puede utilizar, tanto para detección como investigación, para comprender y diagnosticar anomalías perceptuales. (AU)

Polydioxanone as Buried Suture in Facial Trauma - A Prospective Study.

Irrespective of cause of injury, facial scars are always considered as a stigma causing both mental and social disgrace to the victim. The principle aim of any suturing is to produce aesthetically pleasing scar. Besides surgical skills, the choice of suture material also plays a very important role in getting a good scar. Though suture material used for suturing is mostly Nylon everywhere, it’s the buried sutures which obliterate the dead space and reduce wound tension which make the real difference in the appearance of scar. Sutures of different types are today available & the operating surgeon uses the best suture material for the patient in a given circumstance based on his personal experience, scientific observations, & manufacturer’s advice.1 METHODSThis is a prospective study conducted in the department of plastic surgery at Christian Medical College, Ludhiana from May 2012 to April 2013. The study included all the patients of facial trauma registered during that period of one year. Demographic profile was noted along with the cause of trauma. A well-informed consent was taken. In our study skin approximation was done by either 5-0 or 6-0 Nylon suture. Buried suture used in all was Polydioxanone (PDS) 5-0. Skin sutures were removed on 5th POD. Beusang Clinical Scar assessment scale2 was used in the study to assess scar appearance. Patients were followed every month for 5 months after removal of skin sutures. The parameters noted included, colour, contour, matte/shine, and texture of scar. Photographic record of the patients was maintained. Statistical analysis was done using McNemar test. RESULTSOut of the 40 patients in our study, road traffic accidents constituted 85 percent of facial trauma, rest included fall on floor. M:F ratio was 3:1. With Polydioxanone as buried suture, 35 patients (87.5%) had normal texture, 30 patients (75%) had Matte appearance of the scar, 20 patients (50%) had no distortion of scar, 25 patients (62.5%) had perfect match of colour with hypertrophic scar noticed in 4 patients (0.1%). CONCLUSIONSPolydioxanone as buried suture gave aesthetically pleasing scar which improved in appearance during the follow up periods. There was significant statistical improvement in scar appearance starting from 5th day of suture removal to assessment at 5 months. No discharge from the wound site was noted in any of the patients. Hypertrophic scars noticed were later treated with steroid injection

A pharmacovigilance study of anti-depressant agents in psychiatric patients at a tertiary care teaching hospital

Background: Anti-depressant drugs have great benefit in treating a many psychiatric disorders, including schizophrenia and bipolar disorder, although all these drugs are associated with many potential adverse effects. In this study, the occurrence of adverse effects like weight gain, sleep disturbances, dry mouth were assessed and reported in drug naïve patients Anti-depressant drugs.Methods: It is a prospective observational study of patients attending Psychiatry department in NRI General Hospital of age 10 to 80 years who were prescribed with anti-depressant drugs. The study was conducted for a period of 8 months from June 2018 to February 2018.Results: Among 86 patients prescribed with antidepressants, the occurrence of adverse drug reactions due to antidepressants was 60.78% with Selective serotonin reuptake inhibitors being the most common class of drugs implicated for adverse drug reactions followed by 24.49% with Tricyclic antidepressants. A total of 51 adverse drug reactions were noted of which weight gain was most common, closely followed by sleep disturbances and drowsiness. Out of 52 adverse drug reactions assessed for causality, 88.2% of the adverse drug reactions cases were probable, while 11.7% were possible. According to Hartwig and Siegel’s Scale 84.3% of the cases are found to be mild, 15.68% moderate.Conclusions: The study allows knowing information about the occurrence and pattern of adverse drug reactions associated with Anti-depressant drugs in the population thus reducing its incidence and protecting the user population from available harm.

Validation of track and act online developmental screening tool: a pilot study

Background: The global prevalence of developmental delay in children is reported as 1-3% according to WHO. Early diagnosis and intervention improve the quality of life in disabled children. There is need for screening tool. So, study was started to evaluate the ability of the online screening tool in detecting the developmental delay in the Indian children.Methods: After IRB approval, around 30 children after parental consent of either gender aged 4 months to 5 years attending the immunization outpatient department were involved in the study After a detailed history, children were screened with online screening tool 'Track and Act'. Due to the logistic reasons among them 30 were assessed in detail using Developmental Assessment Scale for Indian Infants (DASII) which is used as gold standard in this study.Results: Study showed high sensitivity and specificity for all the four domains of the tool. It showed sensitivity and specificity in physical of 83.3% and 91.6%, in language 66.6% and 87.5%, in cognitive 66.6% and 91.6% and in socio-emotional domain 83.3% and 91.6 % respectively.Conclusions: Track and Act screening tool has good test characteristics for detecting developmental delay among Indian children and it can be used for office practice for screening children.

Association between serum non-high-density lipoprotein cholesterol and cognitive dysfunction after acute ischemic stroke: a cross-sectional study

This study aimed to explore the association between serum non-high-density lipoprotein cholesterol (non-HDL-C) and cognitive dysfunction risk in patients with acute ischemic stroke (AIS). This cross-sectional study enrolled 583 AIS patients. Biochemical markers and lipid profile were collected after admission. AIS patients were classified into high group (non-HDL-C ≥3.4 mM) and normal group (non-HDL-C <3.4 mM). Mini-Mental State Examination scale (MMSE), Montreal Cognitive Assessment scale (MoCA), Activities of Daily Living (ADL) scale, Neuropsychiatric Inventory (NPI), and Hamilton Depression scale 21 version (HAMD-21) were applied on the third day after admission. Compared with the control group, patients of the high group had higher body mass index and higher frequency of intracranial artery stenosis, and exhibited higher levels of non-HDL-C, total cholesterol, triglycerides, low-density lipoprotein cholesterol, homocysteine, fasting blood glucose, and glycosylated hemoglobin (HbA1c), and lower levels of high-density lipoprotein cholesterol (all P<0.05). Compared with the control group, patients of the high group had significantly lower MMSE and MoCA scores (MMSE: 26.01±4.17 vs 23.12±4.73, P<0.001; MoCA: 22.28±5.28 vs 20.25±5.87, P<0.001) and higher scores on the NPI and HAMD-21 (both P<0.001). MMSE (r=-0.306, P<0.001) and MoCA scores (r=-0.251, P<0.001) were negatively associated with non-HDL-C level. Multivariate regression analysis revealed that non-HDL-C level (OR=1.361, 95%CI: 1.059-1.729, P=0.016) was independently associated with the presence of cognitive dysfunction after adjusting for confounding factors. High serum non-HDL-C level might significantly increase the risk of cognitive dysfunction after AIS.

Botulinum toxin a injection in the prevention of facial trauma or postoperative hypertrophic scar: A systemic review of effectiveness and safety / 中国组织工程研究

BACKGROUND: Facial scars are mainly caused by trauma or surgery, which greatly affect the appearance. Dermatologists and plastic surgeons have tried many ways to change the appearance of scars. Botulinum toxin A injection is widely used in clinical practice for prevention of scars, but the efficacy and safety are not proved. OBJECTIVE: To evaluate the effectiveness and safety of botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar. METHODS: PubMed, EMbase, the Cochrane library, CNKI, CBM, WanFang, and VIP were searched for randomized controlled trials regarding botulinum toxin A injection in the prevention of facial scars. Manual retrieval was done for supplement of incomplete data. Two doctors were responsible for literature screen and evaluation. Finally, 11 randomized controlled clinical trials were included. The experimental group was injected with botulinum toxin A, and the control group was given saline or nothing. Part of the data was analyzed using Revman 5.3 software for meta-analysis, and the data that could not be analyzed using software were subjected to a descriptive analysis. RESULTS AND CONCLUSION: Eleven randomized controlled trials were included, involving 436 patients with 518 wounds. Meta-analyses showed that Vancouver scar scale score, visual analogue scale score and width of scars in the botulinum toxin A group were significantly better than those in the control group (weighted mean difference (WMD)=-1.61, 95% confidence interval (CI)=-2.06 to -0.26, P = 0.02; WMD=1.7, 95%CI=0.38 to 3.02, P = 0.01; WMD=-0.17, 95%CI=-0.22 to -0.12, P < 0.000 1). Incidence of adverse reactions of botulinum toxin A group was higher than that in the control group (χ2 =8.335, P=0.004), but they were all slight and easy to release. There were no serious adverse events in both groups. It seems that botulinum toxin A injection can reduce the width of scars, improve Vancouver scale and visual analogue scale scores. However, it is suggested to make clear communication before and after the operation and take measures to deal with various adverse reactions in advance.

Criterios para la construcción de un instrumento de evaluación funcional en pacientes con enfermedad cerebrovascular / Criteria for Functional Evaluation Instrument Building in Stroke Patients / Critérios para a construção de um instrumento de avaliação funcional em pacientes com enfermedad cerebrovascular

Resumen Introducción: Ninguna escala simple, por diseño, es lo suficientemente abarcadora para evaluar de forma integral la función motora de pacientes con enfermedad cerebrovascular (ECV); sin embargo, es posible la selección de una batería de ellas para controlar las distintas etapas del proceso de rehabilitación. El objetivo de este estudio fue identificar los criterios que sirven de referencia para la construcción de un instrumento de evaluación funcional en pacientes con ECV. Materiales y métodos: Se realizó una búsqueda bibliográfica en las bases de datos PubMed, Rehabilitation Measures Database, EBSCO y Medline, donde se incluyeron escalas de evaluación funcional dirigidas al control de la postura, marcha, equilibrio, tono muscular, miembros superiores e inferiores y actividades de la vida diaria. Resultados: Para la construcción de un instrumento de evaluación funcional se identificaron un total de trece criterios de referencia agrupados en: 1) criterios psicométricos y 2) criterios de diseño y aplicación. Utilizando estos criterios, se seleccionaron las escalas: Barthel Index, Action Research Arm Test, Ashworth Scale y 10 Meter Walk Test. Conclusión: Las escalas seleccionadas brindan información sobre cuatro aspectos relevantes para la evaluación funcional y la práctica terapéutica: autocuidado, función motora, tono muscular y rendimiento físico, estrechamente relacionados con las principales áreas de trabajo durante el proceso de rehabilitación en pacientes con ECV. Los recursos materiales necesarios para su aplicación son mínimos y el tiempo estimado, a partir de la integración de sus tiempos parciales, no sobrepasa los 30 minutos.

Abstract Introduction: No simple scale, by design, is comprehensive enough to comprehensively evaluate the motor function of with stroke patients; however, it is possible to select a battery of them to control the different stages of the rehabilitation process. The objective of this study was to identify the criteria that serve as a reference for the construction of a functional evaluation instrument in stroke patients. Materials and methods: A bibliographic search was conducted in the PubMed, Rehabilitation Measures Database, ebsco and Medline databases, which included functional assessment scales aimed at controlling posture, gait, balance, muscle tone, upper and lower limbs and activities daily life. Results: For construction of a functional evaluation instrument, a total of thirteen reference criteria were identified grouped into: 1) psychometric criteria and 2) design and application criteria. Using these criteria the scales were selected: Barthel Index, Action Research Arm Test, Ashworth Scale, and 10 Meter Walk Test. Conclusion: The selected scales provide information on four relevant aspects for functional evaluation and therapeutic practice: self-care, motor function, muscle tone and physical performance, closely related to main work area during the rehabilitation process in stroke patients. The material resources necessary for its application are minimal and the estimated time, from the integration of its partial times, does not exceed 30 minutes.

Resumo Introdução: Nenhuma escala simples, por concepção, é abrangente o suficiente para avaliar de forma abrangente a função motora de pacientes com doença cerebrovascular (DCV), no entanto, é possível selecionar uma bateria deles para controlar as diferentes etapas do processo de reabilitação. O objetivo deste estudo foi identificar os critérios que servem de referência para a construção de um instrumento de avaliação funcional em pacientes com DCV. Materiais e métodos: Foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, Rehabilitation Measures Database, EBSCO e Medline, que incluíram escalas de avaliação funcional para controle de postura, marcha, equilíbrio, tônus muscular, membros superiores e inferiores e atividades de vida diario. Resultados: Para a construção de um instrumento de avaliação funcional, foram identificados 13 critérios de referência, agrupados em: 1) critérios psicométricos e 2) critérios de projeto e aplicação. Utilizando esses critérios, as escalas foram selecionadas: Barthel Index, Action Research Arm Test, Ashworth Scale, and 10 Meter Walk Test. Conclusão: As escalas selecionadas fornecem informações sobre quatro aspectos relevantes para avaliação funcional e prática terapêutica: autocuidado, função motora, tônus muscular e desempenho físico, intimamente relacionados à principal área de trabalho durante o processo de reabilitação em pacientes com DCV. Os recursos materiais necessários para sua aplicação são mínimos e o tempo estimado, a partir da integração de seus tempos parciais, não excede 30 minutos.

Development and psychometric properties of the Subtle Gender-Based Violence Among Medical Residents Assessment Scale (SGEVRA) / Desarrollo y propiedades psicométricas de la Escala de Violencia Sutil de Género en Médicos Residentes (SGEVRA)

Abstract Introduction Medical residents (MR) are an important pillar for a future effective health system. As such, it is important to study all the factors throughout their training that may influence their professional development, like gender-based violence (GV). Objetive To design and evaluate the psychometric proprieties of subtle GV among medical residents' assessment scale (SGEVRA). Method The design was carried out in two phases: (1) in the qualitative phase, three focus groups were interviewed to obtain information about GV during medical training; and (2) in the quantitative phase, the information was incorporated into the instrument and the psychometric properties were tested. Results A total of 1,645 medical residents (MRs) completed the instrument. Exploratory factor analysis led to a final two factor model comprised of 31 items that explained 74.9% of the variance. The factors were labelled as gender discrimination (factor 1) and sexual violence (factor 2); both demonstrated high internal consistency using Cronbach's alpha (factor 1: .987; factor 2: .935). Discussion and conclusion The SGEVRA is a brief, valid, and reliable instrument for assessing subtle GV among MR.

Resumen Introducción Los residentes médicos (MR) son un pilar importante para un futuro sistema de salud efectivo. Por ello, es importante estudiar todos los factores a lo largo de su capacitación que puedan influir en su desarrollo profesional, como la violencia de género (GV). Objetivo Diseñar y evaluar las propiedades psicométricas de la Escala de Violencia Sutil de Género en médicos residentes (SGEVRA, por sus siglas en inglés). Método El diseño se realizó en dos fases: (1) cualitativa: se entrevistó a tres grupos focales para obtener información sobre la VG durante la capacitación médica; y (2) cuantitativa, donde la información se incorporó al instrumento y se evaluaron las propiedades psicométricas. Resultados 1,645 residentes médicos (MR) completaron el instrumento. El análisis factorial exploratorio condujo a un modelo final de dos factores compuesto por 31 reactivos que explicaron el 74.9% de la varianza. Los factores fueron etiquetados como discriminación de género (factor 1) y violencia sexual (factor 2); ambos demostraron una alta consistencia interna con el alfa de Cronbach (factor 1: .987; factor 2: .935). Discusión y conclusión SGEVRA es un instrumento breve, válido y confiable para evaluar GV en MR.

Association between socio-demographic profile and severity of cognitive impairment in elder patients presenting with new onset of psychiatric symptoms: a cross sectional study

Background: Cognitive impairment in the elderly is a common condition and, in most instances, primary care providers are the first point of contact for a patient and family. This study was aimed to find out the association between socio-demographic profile and severity of cognitive impairment in elder patients presenting with new onset of psychiatric symptoms.Methods: A cross sectional study was done among elder subjects (≥60 years of age) presented with new onset of psychiatric symptoms during one year period. A structured questionnaire was used to assess the socio-demographic details such as age, sex, education, occupation, socio-economic status and marital status. Mini International Neuropsychiatric interview and Montreal Cognitive Assessment scale were used for psychiatric diagnosis and severity of cognitive impairment grading, respectively. Association between socio-demographic data and cognitive impairment was statistically analyzed.Results: Among the 67 subjects included in the study, 76.2% had cognitive impairment. Majority of the subjects were females (56.7%) in the age group of 66-70 years. The association between cognitive impairment and sex (p=0.006), education (p=0.002) and occupation (p=0.015) were significant. But no significant association between cognitive impairment and marital status (p=0.0137) or socioeconomic status (p=0.400) was evidenced.Conclusions: Females in the age group of 66-70 years were more prevalent to cognitive impairment. The association between sex, education, occupation and severity of cognitive impairment was significant. No significant association between severity of cognitive impairment score and marital status or socioeconomic status was found.

A cross sectional study on the association between new onset of psychiatric symptoms with severity of cognitive impairment in elderly patients

Background: Neuropsychiatric impairments play significant roles throughout the course of cognitive decline mainly in older adults with dementia or mild cognitive impairment (MCI). This study was aimed to find the association between psychiatric comorbidities and severity of cognitive impairment in elder patients presented with new onset of Psychiatric Symptoms.Methods: A cross sectional study was done among elder subjects (≥60 years of age) presented with new onset of psychiatric symptoms during one year period. Mini International neuropsychiatric interview and Montreal Cognitive Assessment scale were used for psychiatric diagnosis and severity of cognitive impairment grading, respectively. Association between psychiatric comorbidities and MCI was statistically analyzed.Results: Total 67 subjects were included in the study. Analysis of the psychiatric diagnosis revealed that major depressive episode (52.2%) was the most prevalent psychiatric disorder among the study population followed by Psychotic disorders (23.9%). Generalized anxiety disorder contributed to 19.4% of the total study population. Significant association (p<0.002) was identified between the severity of cognitive impairment and the psychiatric comorbidities.Conclusions: A significant association was identified between the severity of MCI and the psychiatric comorbidities. Major depressive episode was the most prevalent psychiatric disorder followed by psychotic disorders and generalized anxiety disorder.

Phenytoin induced toxic epidermal necrolysis: a case report

Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), are severe idiosyncratic reactions characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. The usage of anticonvulsants like carbamazepine, phenytoin, lamotrigine, phenobarbital are associated with high risk for occurrence of TEN. We present a case of toxic epidermal necrolysis in a 30 year old female probably induced by phenytoin. A 30 year old female was admitted to the emergency medicine department of KIMS hospital, Bengaluru. Lesions over the lips and oral cavity, multiple fluid filled blisters were present diffusely all over the body. Patient had a past history of oral cavity lesions with injection phenytoin. Patient is a known epileptic of over 12 years and was on treatment. Patient had a seizure attack 3 days back and visited nearby hospital and did not inform the doctor of her allergy to phenytoin. Patient was given inj phenytoin after which she developed oral lesions and also presented with fluid filled bullae all over the body. A diagnosis of toxic epidermal necrolysis was made based on clinical history and Scoreten score and was treated with betadine wash, fluconazole and antibiotics .The lesions improved significantly with the above management and patient recovered enough to be discharged from the hospital after 5 days. Severe and serious reactions such as toxic epidermal necrolysis can be caused by commonly used drugs like phenytoin.

Medication Therapy Management Services and Pharmacovigilance Studies in Tuberculosis Patients: A Patient Care Aspect in the Pulmonology Department in a Tertiary Care Hospital

Background: Tuberculosis is fundamentally a disease of the lungs, however, it can influence any organ in the body. Objectives: Primary objective was to improve the patient compliance or medication adherence and to identify, detect, monitor ADRs induced by anti-tubercular drugs and report them. A secondary objective was to prevent the emergence of drug resistance and treatment of prolongation/failure in TB patients. Methods: A prospective, observational, cohort study was carried out for 6-months in tertiary care hospital. There were 60 patients included in the study. The data were evaluated for patients’ demographic profile, type of TB, medication adherence and occurrence of ADRs. Adverse drug reactions were observed and recorded. The causality of ADRs was assessed using WHO-causality assessment scale and Naranjo causality assessment scale. The severity of ADRs was determined using Hartwig’s severity assessment scale. Results and Discussion: Total of 60 patients were included in the study. Results showed that among 60 patients included in the study, 44 patients experienced ADRs. Among all age groups, the highest numbers of ADRs were seen in the age group 19-30 (43.1%) years. The occurrence of ADRs was noticed more in females (77.7%). The majority of ADRs occurred in patients was general (28.4%), and gastrointestinal effects (23.8%). Conclusion and Scope of the Study: Adherence to treatment is crucial for the cure of individual patients, controlling the spread of infection, minimizing the development of drug resistance and to reduce the chances of re-infection. Proper therapeutic monitoring of regimen, dose management, and pharmacovigilance activities are necessary. Such approaches will not only improve the treatment outcomes but also minimizes the chances of treatment prolongation/failure. All the health care professionals should interpret their responsibility in this domain of the health care profession.

Instrumentos de evaluación psicológica en el ámbito jurídico: Una aproximación a las prácticas profesionales en Uruguay / Psychological evaluation instruments in the juridical sphere: an approximation to the professional practices in Uruguay / Instrumentos de avaliação psicológica no âmbito jurídico: uma aproximação às práticas professionais no Uruguai

Resumen Objetivo: Este trabajo presenta los resultados preliminares de una encuesta realizada a psicólogos(as), para conocer las herramientas de evaluación que utilizan en el ámbito jurídico en el contexto local. Se realiza un primer sondeo de la utilización de instrumentos de evaluación en Uruguay, articulando con la experiencia de los sistemas de evaluación utilizados a nivel internacional basados en la evidencia y su eventual incorporación al sistema uruguayo. Metodología: se realizó a través de una encuesta difundida a nivel nacional, por medio de correo electrónico y redes sociales, dirigida a los profesionales egresados de la carrera de Psicología en universidades uruguayas, con la colaboración de instituciones públicas y privadas vinculadas al ejercicio. Resultados: Se evidencia una mayoritaria utilización de técnicas de tipo proyectivas y escasa administración de instrumentos específicos de valoración de riesgo de conducta violenta y reincidencia por los participantes. Conclusiones: se cuestiona la necesidad de revisión de los estándares de calidad científica en relación con los métodos de evaluación de las personas en conflicto con la ley en tanto se observa la ausencia de protocolos formales, accesibles y específicos que guíen los procedimientos de evaluación en el campo de la Psicología Jurídica respaldándose en la evidencia empírica.

Abstract Objective: this work presents the preliminary results of a survey conducted to psychologists to know the evaluation tools that they use in the juridical sphere in the local context. A first poll of the using of evaluation instruments in Uruguay was performed, articulating with the experience of the evaluation systems used at international level based on the evidence and its eventual incorporation to the Uruguayan system. Methodology: it was carried out through a survey released at national level, by means of email and social networks, addressed to the professionals graduated from the Psychology career in Uruguayan universities, with the collaboration of public and private institutions linked to the exercise. Results: there is evidence of a majority use of projective techniques and scarce management of specific instruments of risk assessment of the violent conduct and recidivism by the participants. Conclusions: it is questioned the need of revision of the standards of scientific quality regarding to the evaluation methods of the people in conflict with the law while it is observed the absence of formal, accessible and specific protocols that guide the procedures of evaluation in the field of the Juridical Psychology relying on empirical evidence.

Resumo Objetivo: este trabalho apresenta os resultados preliminares duma enquete realizada a psicólogos(as), para conhecer as ferramentas de avaliação que utilizam no âmbito jurídico no contexto local. Realiza-se uma primeira sondagem da utilização de instrumentos de avaliação no Uruguai, articulando com a experiência dos sistemas de avaliação utilizados a nível internacional baseados na evidência e a sua eventual incorporação ao sistema uruguaio. Metodologia: realizou-se através de uma enquete difundida a nível nacional, por meio de correio electrónico e redes sociais, dirigida aos profissionais egressos do curso de Psicologia em universidades uruguaias, com a colaboração de instituições públicas e privadas vinculadas ao exercício. Resultados: evidencia-se uma majoritária utilização de técnicas de tipo projetivas e escassa administração de instrumentos específicos de valoração de risco de conduta violenta e reincidência pelos participantes. Conclusões: questionase a necessidade de revisão dos padrões de qualidade científica em relação aos métodos de avaliação das pessoas em conflito com a lei enquanto se observa a ausência de protocolos formais, accessíveis e específicos que guiem os procedimentos de avaliação no campo da Psicologia Jurídica se respaldando na evidência empírica.

Effectiveness Of Neuro-Muscular Electrical Stimulations (NMES) In Reducing Subluxation Of The Shoulder After Stroke: Randomized Controlled Experimental Study

Background: Shoulder subluxation in stroke is one of the most common and challenging squeals. Shoulder subluxation limits the patient’s daily activities, and it may lead to permanent disability. NMES (NeuroMuscular Electrical Stimulation) had been studied widely on shoulder subluxation with controversial results, but no evidence is reported of its effectiveness in shoulder subluxation. As NMES helps in producing strong contraction and thereby helps in improving the strength of the muscles and as it also helps in learning to contract appropriate muscles, this study was made to examine the Effectiveness of Electrical Stimulations in reducing Subluxation of the Shoulder after Stroke. Method: Study design, A Randomized control experimental design of 30 subjects. Subjects were randomly assigned into two groups, experimental (NMES group) and control (Non-NMES group) with 15 subjects in each group. Outcome measures were taken before and after the intervention on both the groups by using ‘Pain Estimation Scale’ (PES), 'Subluxation Grading’ by X-rays (AP view) and upper arm section of ‘Motor Assessment Scale’(MAS). Experimental group electrodes were placed over posterior deltoid and supraspinatus. Treatment time was 30 mints two times a day for five days in a week and six weeks. Results: Comparison of electrical stimulation with non-electrical stimulation was done by considering the differences of pre and post treatments in both groups and significance is observed by using independent sample t-test. Statistical analysis proved that there was significant (p<0.05) improvement using NMES compared to NON-NMES in all the three parameters. Conclusion: Electrical stimulation has shown significant improvement in reducing shoulder subluxation, pain and increased motor recovery of the arm in stroke patients compared to the patient's given non-electrical stimulation training.