Prevalence, resistant pattern and associated risk factors of asymptomatic bacteriuria among antenatal clients in a municipal hospital in Ghana

Background: The aim of the study was to determine the prevalence and factors associated with asymptomatic bacteriuria among pregnant women. Methods: A cross-sectional study was used to determine the prevalence of uro-pathogens among pregnant women attending Antenatal Clinic at Weija-Gbawe Municipal Hospital. The data was collected between May 2023 and October 2023. The data collection process involved the use of a structured questionnaire, while urine specimens were collected in sterile urine containers and cultured on CLED medium. The bacteria colonies were identified and evaluated for their susceptibility to antibacterial agents. Multiple logistics regression was used to determine the factors associated with bacteriuria among pregnant women. Results: The age range of the participants was 14 years to 45 years with mean age of 30 years (SD±6.5). About 13% of the participants had no formal education. Majority (77.4%) of study participants were obese while only 3.42% had normal weight. Isolates were Escherichia coli (27%), Klebsiella species (23%), Proteus species (18%) and Citrobacter koseri (18%). Gentamicin was sensitive to E. coli and cotrimoxazole was the most resistant antibiotics. Factors such as BMI, educational level, smoking status, recurrent UTI, parity were not found to have statistical influence on prevalence of bacteriuria among pregnant women. Conclusions: The study revealed 15.1% prevalence of ASB among pregnant women with E. coli being the predominate isolates. Gentamicin and cotrimoxazole were the most sensitive and resistant antibiotics respectively. Pregnant women should be advised to adhere to optimal hygiene practices and safe sexual behaviours, with a focus on the role of these practices in preventing uro-pathogen colonization.

Team based learning: an effective teaching-learning method in undergraduate teaching in community medicine

Background: “Team-based learning (TBL)” is a special approach by using small groups that is student centered, teacher guided Teaching and Learning method. Medical Council of India (MCI) emphasizes small group teaching. With increasing student numbers and decreasing/no change in faculty strength, the need for an effective T-L method for incorporating small group teaching in a large group is essential. So, this study attempts to evaluate the effectiveness and student reaction for TBL. Methods: A cross sectional study was conducted among III-year MBBS students attending block posting in the Department of Community Medicine, KIMS and RC. Pre-test and post-test after Team based learning implementation by designated faculties was conducted, and scores were analysed. The feedback of TBL was collected by using a Likert scale from students and also from faculties. Results: The mean scores of pre- and post-test were analyzed by Paired T test which was statistically significant (p value <0.05). The student reaction evaluated by 7 items Likert scale questionnaire showed that most of the students either agreed or strongly agreed that TBL enhanced their learning experience and confidence. The faculty feedback about TBL was also positive. Conclusions: TBL can be effectively implemented in medical colleges for the better results and student reaction.

Level of utilization of eLearning among students at selected KMTC campuses

Background: Technology continues to impact various spheres of life, including learning. Over the years, eLearning has experienced a steady rise in popularity. At Kenya Medical Training College (KMTC), the influence of technology on education became more noticeable due in part to a policy directive. This directive, prompted partly by the COVID-19 pandemic, emphasized adopting online teaching to address the loss of instructional hours. This study addressed a specific gap in KMTC's internal quality assurance efforts by accumulating evidence related to the extent of E-learning and user satisfaction. Methods: The study employed a descriptive cross-sectional design, utilizing qualitative and quantitative techniques. It involved KMTC campuses conveniently selected from the Coast and Nairobi regions, with 1139 students selected through simple random, stratified, and proportionate sampling methods. A mixed questionnaire (both open and closed-ended questions) was used to collect data. Specifically, the study aimed to assess the level of eLearning utilization among students in selected KMTC campuses and identify the determinants of this utilization. Results: Most of the respondents (89.2%) participated in online classes; 11.8% of those who did not participate cited reasons such as lack of gadgets, bundles, and poor internet connectivity, among others. Despite widespread e-learning utilization, 76.8% of learners strongly preferred face-to-face classes. Conclusions: Key factors linked to e-learning utilization included effective instructional strategies, quality technical support, and well-conducted online classes. The choice of communication channels, particularly platforms like WhatsApp, was strongly linked to e-learning utilization. Therefore, this study recommends that KMTC should acknowledge the strong preference for face-to-face classes and offer hybrid learning options. Further, the KMTC should address accessibility challenges and competing responsibilities at home by supporting data connectivity, ensuring user-friendly online platforms, and providing flexible scheduling options for diverse learner needs.

Oral glutamine dipeptide or oral glutamine free amino acid reduces burned injury progression in rats / O dipeptídeo de glutamina oral ou aminoácido livre de glutamina oral reduz a progressão da lesão por queimadura em ratos

Abstract This study was carried out to evaluate the effect of Glutamine, as a dipeptide or a free amino acid form, on the progression of burn injuries in rats. Thirty male Wistar rats were burned with a comb metal plate heated in boiling water (98 °C) for three minutes, creating four rectangular full-thickness burn areas separated by three unburned interspaces (zone of stasis) in both dorsum sides. The animals were randomized into three groups (n=10): saline solution (G1-Control) and treated groups that orally received Glutamine as dipeptide (G2-Dip) or free amino acid (G3-FreeAA). Two and seven days after burn injury, lesions were photographed for unburned interspaces necrosis evolution assessment. Seven days after injury, glutathione seric was measured and histopathological analysis was performed. By photographs, there was a significant reduction in necrosis progression in G3-Free-AA between days two and seven. Histopathological analysis at day 7 showed a significantly higher stasis zone without necrosis and a higher number of fibroblasts in G2-Dip and G3-FreeAA compared with G1-Control. Also, glutathione serum dosage was higher in G2-Dip. The plasmatic glutathione levels were higher in the G2-Dip than the G1-Control, and there was a trend to higher levels in G3-FreeAA. The reduction in histological lesions, greater production of fibroblasts, and greater amounts of glutathione may have benefited the evolution of burn necrosis, which showed greater preservation of interspaces.

Resumo Este estudo foi realizado para avaliar o efeito da Glutamina, como um dipeptídeo ou forma de aminoácido livre, na progressão de queimaduras em ratos. Trinta ratos Wistar machos foram queimados com um pente de metal aquecido em água fervente (98 °C) por três minutos, criando quatro áreas retangulares queimadas separadas por três interesespaços não queimados (zona de estase) em ambos os lados do dorso. Os animais foram randomizados em três grupos (n = 10): solução salina (G1-Controle) e grupos tratados que receberam glutamina via oral como dipeptídeo (G2-Dip) ou aminoácido livre (G3-FreeAA). Dois e sete dias após a queimadura, as lesões foram fotografadas para avaliação da evolução da necrose entre os espaços não queimados. Sete dias após a lesão, foi dosada a glutationa sérica e realizada análise histopatológica. Pelas fotografias, houve uma redução significativa na progressão da necrose no G3-Free-AA entre os dias dois e sete. A análise histopatológica no dia 7 mostrou uma zona de estase significativamente maior sem necrose e número mais elevado de fibroblastos em G2-Dip e G3-FreeAA em comparação com G1-Controle. Os níveis plasmáticos de glutationa foram maiores no G2-Dip em relação ao G1-Controle, e houve tendência a níveis mais elevados no G3-FreeAA. A redução das lesões histológicas, maior produção de fibroblastos, maior quantidade de glutationa podem ter beneficiado a evolução da necrose da queimadura, que mostrou maior preservação dos interespaços.

Oral glutamine dipeptide or oral glutamine free amino acid reduces burned injury progression in rats

Abstract This study was carried out to evaluate the effect of Glutamine, as a dipeptide or a free amino acid form, on the progression of burn injuries in rats. Thirty male Wistar rats were burned with a comb metal plate heated in boiling water (98 °C) for three minutes, creating four rectangular full-thickness burn areas separated by three unburned interspaces (zone of stasis) in both dorsum sides. The animals were randomized into three groups (n=10): saline solution (G1-Control) and treated groups that orally received Glutamine as dipeptide (G2-Dip) or free amino acid (G3-FreeAA). Two and seven days after burn injury, lesions were photographed for unburned interspaces necrosis evolution assessment. Seven days after injury, glutathione seric was measured and histopathological analysis was performed. By photographs, there was a significant reduction in necrosis progression in G3-Free-AA between days two and seven. Histopathological analysis at day 7 showed a significantly higher stasis zone without necrosis and a higher number of fibroblasts in G2-Dip and G3-FreeAA compared with G1-Control. Also, glutathione serum dosage was higher in G2-Dip. The plasmatic glutathione levels were higher in the G2-Dip than the G1-Control, and there was a trend to higher levels in G3-FreeAA. The reduction in histological lesions, greater production of fibroblasts, and greater amounts of glutathione may have benefited the evolution of burn necrosis, which showed greater preservation of interspaces.

Resumo Este estudo foi realizado para avaliar o efeito da Glutamina, como um dipeptídeo ou forma de aminoácido livre, na progressão de queimaduras em ratos. Trinta ratos Wistar machos foram queimados com um pente de metal aquecido em água fervente (98 °C) por três minutos, criando quatro áreas retangulares queimadas separadas por três interesespaços não queimados (zona de estase) em ambos os lados do dorso. Os animais foram randomizados em três grupos (n = 10): solução salina (G1-Controle) e grupos tratados que receberam glutamina via oral como dipeptídeo (G2-Dip) ou aminoácido livre (G3-FreeAA). Dois e sete dias após a queimadura, as lesões foram fotografadas para avaliação da evolução da necrose entre os espaços não queimados. Sete dias após a lesão, foi dosada a glutationa sérica e realizada análise histopatológica. Pelas fotografias, houve uma redução significativa na progressão da necrose no G3-Free-AA entre os dias dois e sete. A análise histopatológica no dia 7 mostrou uma zona de estase significativamente maior sem necrose e número mais elevado de fibroblastos em G2-Dip e G3-FreeAA em comparação com G1-Controle. Os níveis plasmáticos de glutationa foram maiores no G2-Dip em relação ao G1-Controle, e houve tendência a níveis mais elevados no G3-FreeAA. A redução das lesões histológicas, maior produção de fibroblastos, maior quantidade de glutationa podem ter beneficiado a evolução da necrose da queimadura, que mostrou maior preservação dos interespaços.

A Comparative Study of the Anti-Candidal Activity of Four Medicinal Plants Used in C魌e d'Ivoire

Some plants groups are used by traditional practitioners to treat infectious diseases. The ongoing development of antibiotic resistance continues to have a lasting impact on public health. This study aimed to assess the potential activity of the medicinal plants found in Ivorian soil. Spectrometric measurements was employed in addition to the moss test, revealed the presence of sterols and polyterpenes, polyphenolic compounds, saponins, quinones, alkaloids, and tannins in the extracts of the four plants studied. The use of the double dilution method in tilted tubes revealed the Anti-candida potential of the plant extracts. Results revealed showed that the hydroethanolic extract of T. mantaly produced the lowest MFC (3.125 mg/mL) and IC50 (0.3 mg/mL) values. It was followed by Z. gilletii (MFC = 3.125 mg/mL; IC50 = 0.62 mg/mL) and T. catappa (MFC = 3.125 mg/mL; IC50 = 0.68 mg/mL). No significant inhibition was observed with the extracts of A. occidentale. This study contributes to the valorization of medicinal plants and the floral heritage of C魌e d'Ivoire.

Knowledge on sexually transmitted infections among HIV-pre-exposure prophylaxis users in Nairobi city county, Kenya

Background: Sexually transmitted infections remain a significant public health problem mainly in low-income countries. Despite the high efficacy of HIV-PrEP, an upsurge of STIs is recorded globally after HIV-PrEP introduction due to sexual behaviour change among the users. Nairobi has the highest rate of HIV-PrEP uptake and large number of HIV-PrEP users visit health facilities to get treatment for STIs. This study aimed to assess knowledge on STIs among HIV-PrEP users in Nairobi, Kenya. Methods: Analytical cross-sectional research design was employed. Simple random sampling technique was adopted to obtain a sample size of 357 respondents seeking HIV-PrEP service in five health facilities in Nairobi, from July to November 2022. The study used primary data which was collected using structured questionnaire and secondary data (laboratory results). Results: Most of the respondent were knowledgeable about STIs occurrence. 56.7% of the respondents knew that STIs could be transmitted through sex without using condom, 43.3% knew that sex with sex workers could make one get STIs, 58.7% of the respondents were aware that STIs could be transmitted through sexual contact with multiple partners. A statistically significant association was found between STI related level of knowledge and STIs prevalence among HIV-PrEP users in Nairobi. Conclusions: The knowledge about STIs among HIV-PrEP users in Nairobi does not translate into safe sexual behaviour against STIs. The study recommends that the facility management and service providers should encourage HIV-PrEP users to undertake routine STIs screening tests and treatment as well as frequent safe sexual behaviour awareness creation education.

A cross sectional study on prevalence of hypertension and associated risk factors among bus drivers of Metropolitan Transport Corporation Limited, Chennai

Background: The job of bus driving is not only risky due to probable accidents and incidents but also risky due to probable health risk factors associated with the nature of bus driving. Sedentary work was done by many professional drivers and they were found to be physically inactive during their leisure time which lead to an increase in risk for obesity and hypertension. Therefore, this study was done with the aim to detect the prevalence of hypertension and its associated risk factors among metropolitan transport corporation bus drivers. Methods: A cross sectional descriptive study was conducted among bus drivers of metropolitan transport corporation Limited, Chennai. The sample size obtained was 422. A multistage sampling method was used. A Validated semi-structured questionnaire containing questions on basic socio demographic particulars, lifestyle factors, past and family history and anthropometric and blood pressure measurement was done and was analyzed using SPSS 21. Results: The prevalence of hypertension was found to be 49.5%. Smoking was found in 23.2% of the respondents, tobacco and betel nut chewing in 14.7% of the respondents and 45.5% were found to consume alcohol. It was found that as age increases the prevalence of hypertension also increases which was statistically significant (p=0.001). Conclusions: This rampant disease can be prevented and managed through lifestyle modifications and medication therapy. The risk factors may be avoided by maintaining a regular physical activity, focussing on dynamic exercise, having medical checkups.

Prevalence of internet addiction in south Indian chat rooms

Background: There are various reasons for internet addiction. In the recent covid and post covid era people have taken up chatting as a pastime. Many spend time chatting with strangers for various reasons. This study was conducted to see the prevalence of internet addiction in south Indian chat rooms and the reasons leading to it Methods: After doing a pilot study, many chat room users were administered an online questionnaire. Of the 1763 people approached only 700 of them agreed to participate in this study Results: Of the seven hundred participants, two hundred and sixteen suffered from internet addiction. Of those with Internet addiction, 85% of the chat room users agreed that they drink alcohol when they chat,63.9% cited individual factors as a reason,62% of the chat room users said they visit chat rooms to game with their friends,31% stated cyber relation addiction as a cause,7.4% said lack of a steady job made them get online and chat and 2.3% of the chat users said they frequented chat sites for want of cyber sex Conclusions: People should understand that it’s a virtual world and not real. They should start stepping out and decrease spending time online. Chat rooms should be on a strict vigilance and steps should be taken to screen the chat room users.

Tumeurs bénignes des glandes salivaires accessoires au CHU de Bouaké: aspects épidémiologique, diagnostique et thérapeutique de 18 cas / Benign tumor of the accessory salivary glands at the chu de Bouaké: epidemiological, diagnostic and therapeutic aspects of 18 cases

Introduction : l'adénome pléomorphe est le type histologique le plus fréquemment observé des tumeurs bénignes des glandes salivaires accessoires (GSA). L'objectif de cette étude était de décrire les particularités épidémiologiques, diagnostiques et thérapeutiques des tumeurs bénignes des GSA. Matériel et méthodes : Il s'est agi d'une étude transversale à collecte rétrospective descriptive réalisée dans le service de Stomatologie et Chirurgie MaxilloFaciale du CHU de Bouaké, sur une période de 8 ans (1er Janvier 2015 au 31 Décembre 2022). Résultats : 18 dossiers de patients dont 12 femmes et 6 hommes, opérés pour une tumeur bénigne des GSA, ont été colligés. L'âge médian des patients était de 37 ans avec des extrêmes de 35 et 62 ans. Le siège de prédilection était le palais dans 12 cas, les lèvres dans 3 cas, la joue dans 2 cas et la langue dans 1 cas. La tomodensitométrie maxillo-faciale a été l'examen de choix pour l'orientation diagnostique. Le traitement a consisté en une exérèse en mono bloc sous anesthésie générale par voie endo buccale. L'examen anatomopathologique a confirmé le diagnostic d'un adénome pléomorphe dans tous les cas. Après un recul de 2 ans, aucune récidive n'a été observée. Discussion : L'adénome pléomorphe représente le type histologique le plus fréquent des tumeurs bénignes des GSA. Il atteint avec prédilection l'adulte jeune de sexe féminin et siège au palais. L'exérèse chirurgicale reste le traitement de choix.

Introduction: Pleomorphic adenoma is the most frequently observed histological type of benign tumour of the accessory salivary glands (ASG). The aim of this study was to describe the epidemiological, diagnostic and therapeutic features of ASGs. Material and methods: This was a retrospective descriptive study conducted in the Stomatology and Maxillofacial Surgery Department of the Bouaké University Hospital, over an 8-year period (January 1, 2015 to December 31, 2022). Results: A total of 18 patients (12 women and 6 men) underwent surgery for benign tumours of the GSA. The median age of the patients was 37 years, with extremes of 35 and 62 years. The preferred site was the palate in 12 cases, the lips in 3 cases, the cheek in 2 cases and the tongue in 1 case. Maxillofacial computed tomography has been the examination of choice for diagnostic orientation. Treatment consisted of single-block excision under general anaesthetic via the endo-buccal route. Pathological examination confirmed the diagnosis of a pleomorphic adenoma in all cases. After a 2-year follow-up, no recurrence was observed. Discussion: Pleomorphic adenoma is the most common histological type of benign tumour of the GSA. It prefers to affect young adult women and is located on the palate. Surgical excision remains the treatment of choice

Impact of Habitat on the Development of Coprophagous and Xylophagous Coleopteran Insects in the Park of Bamimgui-Bangoran (Central African Republic)

Coprophagous and Xylophagous Coleopterans are equally impacted by the fragmentation of ecosystems and are recognized for their character as indicators of certain ecosystem functions, such as the recycling of organic matter and pollination. Thus, as part of the program to restore degraded ecosystems in protected areas and others sectors of the Bamingui-Bangoran Prefecture in the Central African Republic (CAR), an inventory of insect species according to their ecological profile is needed. Insects were collected over 8 hectares corresponding to 6 different habitats in the Bamingui-Bangoran park. Sixty different traps were installed in each habitat with 100 meters of distance between the traps. The measured parameters are the number of individuals collected per week. As results, 8 coleopteran families (4 Coprophagous families and 4 Xylophagous families) were identified. The Coprophagous and Xylophagous Coleopterans were much abounded in grassy savannahs with much mixing trees with Imperata cylindrica and in grassy and shrubby savannas with many flowering plants (Melliferous) and less abounded in grassy and shrubby savannahs domined by Imperata cylindrica. However, repartitions of individuals fit uniform distribution in all coleopteran families belonging to Xylophagous group whereas in Coprophagous, uniform distribution fit was established only for one family.

Relevance of Food Labels among Selected Students at the University of Cape Coast, Ghana

Food labels

pre-packed foods

nutritional information

students.

Review of the Literature on Oral Cancer: Epidemiology, Management and Evidence-based Traditional Medicine Treatment

Oral cavity cancers are part of the upper aerodigestive tract cancers and represent a significant burden worldwide. Its epidemiology varies from country to country with high frequencies in South East Asian countries. Tobacco and alcohol are the main risk factors. Survival of oral cancer is low i.e., less than 40% in the advanced stage (stage III and IV), diagnosis of oral cavity cancer is based on a complete clinical examination of the oral cavity complete with biopsy, bio-markers are an adjunct to screening and diagnosis of oral cavity cancers, surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic armamentarium of oral cancer but also have limitations. Traditional medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. Prevention of oral cavity cancers includes not only early detection of precancerous and cancerous lesions but also control of risk factors and education of the population. Surgery, radiotherapy, chemotherapy and immunotherapy are part of the therapeutic strategy of oral cancer treatment but also have limitations. Traditional Medicine is an important and proven alternative in the treatment and support of patients with oral cavity cancer. It is thus desirable to scientifically validate phytochemicals in order to integrate alternative medicine as part of national cancer management strategy. In silico advanced studies on secondary metabolites of medicinal plants traditionally used to treat oral cancer are in progress.

Performance & clinical utility of oropharyngeal versus nasopharyngeal swabs in COVID-19

Background & objectives: The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods: This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results: The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P<0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions: The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.

Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

Evaluation des bonnes pratiques de sondage vésical à demeure chez l'adulte par les soignants: utilisation de « vignettes cliniques »

Introduction. Le sondage urinaire ou vésical est une technique utilisée depuis l'antiquité qui repose sur l'utilisation de dispositifs médicaux invasifs pour le patient. Cet acte de soin doit se faire de façon sécurisée et s'appuyer sur des référentiels. Les objectifs ont été l'évaluation durespect des recommandations du protocole institutionnel sur la pose d'une sonde urinaire à demeure chez l'adulte, le respect del'hygiène et de l'asepsie et l'évaluation des conduites à tenir lors d'une fuite urinaire sur sonde.Matériel et méthodes. Dans le cadre d'une démarche d'évaluation des pratiques professionnelles, une enquête prospective basée sur le concept des « vignettes cliniques » a été menée, avec des mises en situations des soignants du CHU Charles Nicolle, Bois-Guillaume et Oissel en 2011.Résultats. L'enquête révèle un suivi des recommandations sur certains points comme le respect de l'asepsie et du système clos. Des divergences ont été mises en évidence concernant notamment l'usage de la bandelette urinaire chez le patient sondé, le choix du type de sonde et les couples de produits à utiliser pour la détersion et l'antisepsie.Conclusion. Des axes d'améliorations sont proposés comme la sensibilisation des équipes soignantes mais également médicales par le biais notamment d'une plaquette simple et illustrée de support d'information sur les bonnes pratiques de sondage vésical à demeure chez l'adulte et des kits «prêts à l'emploi » de produits pour la détersion et l'antisepsie

Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach

Objective: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. Methods: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. Conclusion: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation. Systematic review registry number: CRD42017054440.

Immunomodulatory activities of Acacia catechu, a traditional thirst quencher of South India

Background: Acacia catechu has been widely used in Ayurveda for treating many diseases. Its heartwoodextract is used in asthma, cough, bronchitis, colic, diarrhea, dysentery, boils, skin afflictions, sores and forstomatitis. The decoction of heartwood is used for drinking purpose in southern part of India especiallyin Kerala.Objective: The current study was carried out to evaluate immunomodulatory effects of heartwood extracts of A. catechu in Swiss albino mice.Material and methods: In vivo immunomodulatory activity was analyzed by hemagglutinating antibody(HA) titer, plaque forming cell assay and delayed type hypersensitivity (DTH). In vitro immunomodulatory potential of the extracts was studied using peritoneal macrophages and splenocytes from mice.Effect of extracts on phagocytic activity of macrophages was analyzed by nitroblue tetrazolium (NBT)reduction assay and cellular lysosomal enzyme assay. Anti-inflammatory activity was studied by nitricoxide (NO) assay and production of TNF-a and IL-10.Results: A dose dependent increase in antibody titer was observed with extracts treatment. Treatmentwith extracts produced an enhancement in the number of antibody producing cells in the spleen. DTHreaction was significantly decreased with extracts treatment. An increased phagocytic response wasshown by peritoneal macrophages on treatment with the extracts as evidenced by its effect on NBTreduction and cellular lysosomal enzyme activity. The extracts inhibited the release of pro-inflammatorycytokine TNF-a and the production of NO. IL-10 production was significantly increased after extracttreatment.Conclusion: The results of the present study indicate the immunomodulatory effects of A. catechu extracts on humoral, cell mediated and non-specific immune functions.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Impact and risk factors for clinically relevant surgery-related muscle loss in patients after major abdominal cancer surgery: study protocol for a prospective observational cohort study (MUSCLE POWER)

Background:Surgery-related muscle loss (SRML) occurs in at least one out of three cancer patients within one week after major surgery. Though, this important phenomenon has hardly been investigated.Methods:The MUSCLE POWERis a prospective, observational cohort study that investigates the presence, impact, and predictors for clinically relevant SRML in 178 cancer patients after major abdominal surgery using ultrasound measurements, squeeze and force measurements, and QoL questionnaires. Primary endpoint is the proportion of patients with clinically relevant SRML defined as ≥5% muscle loss within one week after surgery, measured by the cross-sectional area (CSA) of three different muscles:m. biceps brachii, m. rectus femoris, and m. vastus intermedius. Possible correlation with QoLand fatigue up to six months after surgery will be investigated. Daily physical activity during hospital stay will be monitored by a motility tracker, and protein intake will be monitored by a dietician. Possible predictors for clinically relevant SRML—consisting of age ≥65 years, preoperative diabetes, preoperative sarcopenia, major postoperative complications (Clavien-Dindo ≥III), insufficient physical activity, and insufficient postoperative protein intake—will be investigated with a multivariable logistic regression analyses with a backward stepwise approach. Variables with a p<0.05 will be retrained in the final multivariable model.Discussion: The MUSCLE POWERinvestigates the presence and impact of clinically relevant SRML in cancer patients after major abdominal surgery. Crucial information regarding possible predictors for clinically relevant SRML can be used in future intervention studies to prevent postoperative muscle loss and subsequently improve postoperative outcome and QoL.Trial Registration: Medical Ethics Committee of the University Medical Center Groningen, the Netherlands (METc2018/361, version 3.0, January 21, 2019), and Netherlands Trial Register ([NTR], NTR NL7505, version 1.0, February 7, 2019)