A realist review of effective university-based wellness programs on physical activity, occupational balance, and vocal health

Background@#Wellness programs can be implemented in a university setting and may include varied elements such as physical activity, occupational balance, and vocal health. However, there is limited information that highlights and synthesizes why and how these programs work. Therefore, this study aimed to understand effective programs on physical activity, occupational balance, and vocal health for university constituents in relation to the implementation contexts, mechanisms, and outcomes (CMO).@*Methodology@#Guided by the Health Belief Model in the context of a realist review design, the researchers conducted an iterative search among seven peer-reviewed electronic databases in the health and education fields using a predetermined set of eligibility criteria. @*Results@#The search identified 6564 records, of which programs from 20 records contributed to data synthesis. Nine CMO statements were created, with physical activity programs accounting for most configurations. Key themes identified were tailored and individualized interventions, medium-term incentivization, lifestyle education programs utilizing information and communications technology, interdisciplinary multi-component programs, use of self-monitoring strategies, social support, and shared experiences among employees and students. Analysis of the mechanisms of these effective university programs revealed processes and structures that were consistent with elements of the Health Belief Model.@*Conclusion@#Effective university-based PA programs result from a health-supporting culture among staff and students, utilizing self-based, technological, and social approaches that target and address individual and organizational behaviors in physical activity, occupational balance, and vocal health. This realist review provides practical information that may guide the development of university-based programs and policies targeting these areas of wellness.

UPLC-QTOF mass spectrometry detection of four endocrine disrupting chemicals (Methyl Paraben, 2,4-Dichlorophenoxyacetic acid, Monobutyl Phthalate, and Bisphenol A) in urine of Filipino women

Background and Objective@#Endocrine Disrupting Chemicals (EDCs) are ubiquitously found as low-level contaminants and pose serious threat to women’s health. EDCs may result in various reproductive disorders, fetal birth and developmental abnormalities, and endocrine and metabolic disorders. EDCs can be detected in body fluids of exposed individuals including blood and urine. This study aimed to detect four EDCs — Methyl Paraben (MP), 2,4-Dichlorophenoxyacetic acid (2,4-D), Monobutyl Phthalate (MBP), and Bisphenol A (BPA) in urine samples of women using Ultra-Performance Liquid Chromatography – Quadrupole Time-of-Flight (UPLC-QTOF) mass spectrometry.@*Methods@#Sequential steps of enzymatic deconjugation, liquid-liquid extraction, solid phase extraction, and liquid chromatography separation and mass spectrometry detection were optimized in urine samples. The method was used to analyze 70 urine samples from women of reproductive age.@*Results@#The sample preparation method showed a recovery ranging from 86.6% (MBP) to 100 % (2,4-D). The method demonstrated limits of quantitation ranging from 1.52 ng/m(MP) to 6.46 ng/mL(2,4D). Intra-day precisions expressed as relative standard deviation were all below 15% while accuracy was shown to range from 67.10% (2,4-D) to 102.39% (MBP). MP was detected in nine samples (12.86%) with a geometric mean value of 10.15 ng/ml (range: 3.62-52.39 ng/ml). MBP was detected in 68 samples (97.14%) with a geometric mean value of 97.62 ng/ml (range: 15.32-698.18 ng/ml). BPA was detected only once (9.58 ng/ml) while 2, 4-D was not detected in all samples.@*Conclusion@#A UPLC-QTOF mass spectrometry method to detect four EDCs at parts per billion level (ng/ml) was adapted and applied for analysis of urine samples. This method can find applicability in routine testing of clinical specimens as well as surveillance and other epidemiological studies.

Economic burden of acute myeloid leukemia on patients in a resource-limited tertiary hospital in the Philippines

ABSTRACT Introduction: The remission induction treatment for acute myeloid leukemia (AML) has remained unchanged in the resource-limited setting in the Philippines. AML treatment consists of induction chemotherapy followed by high dose consolidation chemotherapy or allogeneic hematopoietic stem cell transplantation. In the Philippines, the Filipino household bears the burden of health care cost of hospitalization expenditure. Insights into the treatment costs becomes an essential requirement as these guides the allocation of resources to scheme health programs. Method: This study involved a retrospective cohort analysis of AML patients who underwent treatment for AML. Review of the statements of account per admission per patient during treatment for remission induction, consolidation, relapsed and refractory disease and best supportive care from 2017 to 2019. Of the 251 eligible patients, 190 patients were included. Result: The mean healthcare expenditure for remission induction chemotherapy (Phase 1) was US $2, 504.78 (Php 125,239.29). While 3 to 4 cycles of consolidation chemotherapy cost an average of US $3,222.72 (Php 162,103.20). For patients who had relapsed and refractory disease, an additional mean cost of US $3,163.32 (Php 159,115.28) and US $2, 914.72 (Php 146,610.55) were incurred, respectively. The average cost of palliative care was US $1,687.00 (Php 84,856.59). Conclusion: The cost of chemotherapy and other therapeutics bear most of the weight of the direct healthcare cost. The cost of AML treatment represents a significant economic burden for patients and the institution. The cost increases as patients proceed through subsequent lines of treatment for induction failure. Existing subsidy for health insurance benefits could still be improved for appropriate source allocation of resources.

Importance of assessing biomarkers and physiological parameters of anemia-induced tissue hypoxia in the perioperative period

Abstract Anemia is associated with increased risk of Acute Kidney Injury (AKI), stroke and mortality in perioperative patients. We sought to understand the mechanism(s) by assessing the integrative physiological responses to anemia (kidney, brain), the degrees of anemia-induced tissue hypoxia, and associated biomarkers and physiological parameters. Experimental measurements demonstrate a linear relationship between blood Oxygen Content (CaO2) and renal microvascular PO2 (y = 0.30x + 6.9, r2= 0.75), demonstrating that renal hypoxia is proportional to the degree of anemia. This defines the kidney as a potential oxygen sensor during anemia. Further evidence of renal oxygen sensing is demonstrated by proportional increase in serum Erythropoietin (EPO) during anemia (y = 93.806*10−0.02, r2= 0.82). This data implicates systemic EPO levels as a biomarker of anemia-induced renal tissue hypoxia. By contrast, cerebral Oxygen Delivery (DO2) is defended by a profound proportional increase in Cerebral Blood Flow (CBF), minimizing tissue hypoxia in the brain, until more severe levels of anemia occur. We hypothesize that the kidney experiences profound early anemia-induced tissue hypoxia which contributes to adaptive mechanisms to preserve cerebral perfusion. At severe levels of anemia, renal hypoxia intensifies, and cerebral hypoxia occurs, possibly contributing to the mechanism(s) of AKI and stroke when adaptive mechanisms to preserve organ perfusion are overwhelmed. Clinical methods to detect renal tissue hypoxia (an early warning signal) and cerebral hypoxia (a later consequence of severe anemia) may inform clinical practice and support the assessment of clinical biomarkers (i.e., EPO) and physiological parameters (i.e., urinary PO2) of anemia-induced tissue hypoxia. This information may direct targeted treatment strategies to prevent adverse outcomes associated with anemia.

Does Baseline Severity of Arm Pain Influence Outcomes Following Single-Level Anterior Cervical Discectomy and Fusion?

Methods@#Individuals undergoing single-level ACDF were identified. Patients were grouped by preoperative Visual Analog Scale (VAS) arm ≤8 vs. >8. PROMs collected preoperatively and postoperatively included VAS-arm/VAS-neck/Neck Disability Index (NDI)/12-item Short Form (SF-12) Physical Composite Score (PCS)/SF-12 mental composite score (MCS)/Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF). Demographics, PROMs, and MCID rates were compared between cohorts. @*Results@#A total of 128 patients were included. The VAS arm ≤8 cohort significantly improved for all PROMs excepting VAS arm at 1-year/2-years, SF-12 MCS at 12-weeks/1-year/2-years, and SF-12 PCS/PROMIS-PF at 6-weeks, only (p ≤0.021, all). The VAS arm >8 cohort significantly improved for VAS neck at all timepoints, VAS arm from 6-weeks to 1-year, NDI from 6-weeks to 6-months, and SF-12 MCS/PROMIS-PF at 6-months (p ≤0.038, all). Postoperatively, the VAS arm >8 cohort had higher VAS-neck (6 weeks/6 months), VAS-arm (12 weeks/6 months), NDI (6 weeks/6 months), lower SF-12 MCS (6 weeks/6 months), SF-12 PCS (6 months), and PROMISPF (12 weeks/6 months) (p ≤0.038, all). MCID achievement rates were higher among the VAS arm >8 cohort for the VAS-arm at 6-weeks/12-weeks/1-year/overall and NDI at 2 years (p ≤0.038, all). @*Conclusions@#Significance in PROM score differences between VAS arm ≤8 vs. >8 generally dissipated at the 1-year and 2-year timepoint, although higher preoperative arm pain patients suffered from worse pain, disability, and mental/physical function scores. Furthermore, clinically meaningful rates of improvement were similar throughout the vast majority of timepoints for all PROMs studied.

Validation of the Filipino Voice Handicap Index-10 (FVHI-10)

Rationale/Objective@#The Voice Handicap Index (VHI) is a selfassessment tool that evaluates the patient’s reaction and perception to a vocal disorder. This study aimed to establish, validate and assess the reliability of the Filipino translation of the Voice Handicap Index 10 (FVHI-10).@*Methods@#The VHI-10 was translated and adapted to the Filipino language and culture with the help of the Sentro ng Wikang Filipino- University of the Philippines Manila. A self-assessment of voice quality and FVHI-10 were performed by the patients and their GRBAS scale scoring was rated by a speech language pathologist. The Spearman’s correlation between the FVHI-10 and the self-assessment and GRBAS scale scores was obtained to test for validity. To evaluate the reliability of the FVHI-10, testing through determining internal consistency was conducted through the use of Chronbach α coefficient, inter-item correlation, item-total correlation and Cronbach α coefficient if tool item was deleted.@*Results@#Fifty five individuals participated in the study (29 males, 26 females, age range: 30-55 years) with the diagnosis of voice disorder based on complaints of hoarseness or dysphonia and laryngoscopic findings. Convergent validity was confirmed with moderate to strong correlation between the FVHI-10 and self-assessment (r=-.893, p<.05) and GRBAS scale scores (r=.427, p<.05). Reliability as measured through internal consistency was confirmed (Cronbach α=.874) (average ρ<.5) (corrected item-total correlation>0.3) (average interitem correlation=.15-.85). @*Conclusion@#The FVHI-10 was determined to be a valid and reliable instrument that can be utilized in the assessment of Filipino patients with voice disorders.

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Methods@#WC recipients undergoing single-level MIS TLIF were identified. PROMs of Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-item Short Form Physical and Mental Composite Scale (SF-12 PCS/MCS), and Patient-Reported Outcomes Measurement Information System Physical Function evaluated subjects preoperatively/postoperatively. Subjects were grouped according to preoperative SF-12 MCS: <41 vs. ≥41. Demographic/perioperative variables, PROMs, and MCID were compared using inferential statistics. Multiple regression was used to account for differences in spinal pathology. @*Results@#The SF-12 MCS <41 and SF-12 MCS ≥41 groups included 48 and 45 patients, respectively. Significant differences in ΔPROMs were observed at SF-12 MCS at all timepoints, except at 6 months (p≤0.041, all). The SF-12 MCS <41 group had worse preoperative to 6-months SF-12 MCS, 12-weeks/6-months VAS back, 12-week VAS leg, and preoperative to 6-months ODI (p≤0.029, all). The SF-12 MCS <41 group had greater MCID achievement for overall ODI and 6-weeks/1-year/overall SF-12 MCS (p≤0.043, all); the SF-12 MCS ≥41 group had greater attainment for 6-month VAS back (p=0.004). @*Conclusions@#Poorer mental functioning adversely affected the baseline and intermediate postoperative quality-of-life outcomes pertaining to mental health, back pain, and disability among WC recipients undergoing lumbar fusion. However, outcomes did not differ 1–2 years after surgery. While MCID achievement for pain and physical function was largely unaffected by preoperative mental health score, WC recipients with poorer baseline mental health demonstrated higher rates of overall clinically meaningful improvements for disability and mental health

Validation of Neck Disability Index Severity among Patients Receiving One or Two-Level Anterior Cervical Surgery

Methods@#A surgical database was reviewed to identify patients undergoing cervical spine procedures. Demographics, operative characteristics, comorbidities, NDI, Visual Analog Scale (VAS), and 12-item Short Form (SF-12) physical and mental composite scores (PCS and MCS) were recorded. NDI severity was categorized using previously established threshold values. Improvement from preoperative scores at each postoperative timepoint and convergent validity of NDI was evaluated. Discriminant validity of NDI was evaluated against VAS neck and arm and SF-12 PCS and MCS. @*Results@#All 290 patients included in the study demonstrated significant improvements from baseline values for all patient-reported outcome measures (PROMs) at all postoperative timepoints (p<0.001) except SF-12 MCS at 2 years (p =0.393). NDI showed a moderate- to-strong correlation (r≥0.419) at most timepoints for VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS (p<0.001, all). NDI severity categories demonstrated significant differences in mean VAS neck, VAS arm, SF-12 PCS, and SF-12 MCS at all timepoints (p<0.001, all). Differences between NDI severity groups were not uniform for all PROMs. VAS neck values demonstrated significant intergroup differences at most timepoints, whereas SF-12 MCS showed significantly different values between most severity groups. @*Conclusions@#Neck disability is strongly correlated with neck and arm pain, physical function, and mental health and demonstrates worse outcomes with increasing severity. Previously established severity categories may be more applicable to pain than physical function or mental health and may be more uniformly applied preoperatively for cervical spine patients.

Anatomic total shoulder arthroplasty with a nonspherical humeral head and inlay glenoid: 90-day complication profile in the inpatient versus outpatient setting

Background@#Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a successful bone-preserving treatment for glenohumeral arthritis. This study aimed to describe the 90-day complication profile of TSA with this prosthesis and compare major and minor complication and readmission rates between inpatient- and outpatient-procedure patients. @*Methods@#A retrospective review was performed of a consecutive cohort of patients undergoing TSA with a nonspherical humeral head and inlay glenoid in the inpatient and outpatient settings by a single surgeon between 2017 and 2022. Age, sex, body mass index, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and 90-day complication and readmission rates were compared between inpatient and outpatient groups. @*Results@#One hundred eighteen TSAs in 111 patients were identified. Mean age was 64.9 years (range, 39–90) and 65% of patients were male. Ninety-four (80%) and 24 (20%) patients underwent outpatient and inpatient procedures, respectively. Four complications (3.4%) were recorded: axillary nerve stretch injury, isolated ipsilateral arm deep venous thrombosis (DVT), ipsilateral arm DVT with pulmonary embolism requiring readmission, and gastrointestinal bleed requiring readmission. There were no reoperations or other complications. Outpatients were younger with lower ASA and CCI scores than inpatients; however, there was no difference in complications (1/24 vs. 3/94, P=1.00) or readmissions (1/24 vs. 1/94, P=0.37) between these two groups. @*Conclusions@#TSA with a nonspherical humeral head and inlay glenoid can be performed safely in both inpatient and outpatient settings. Rates of early complications and readmissions were low with no difference according to surgical setting.Level of evidence: IV.

Application of the International Classification of Functioning, Disability, and Health in Clinical Speech-Language Pathology practice: A scoping review

Background@#The use of the International Classification of Functioning, Disability, and Health (ICF) framework is advocated in Speech-Language Pathology (SLP) clinical practice. As using the ICF leads to improved quality of life in relation to communication and swallowing compared to the medical model, SLP practitioners are encouraged to adopt the ICF framework in their practice. However, there is a lack of ICF-related literature in the Philippines that can serve as a guide for SLP practitioners. @*Objectives@#The study aimed to identify and describe available international literature and extract key ideas that can serve as a guide for SLP practitioners as they adopt ICF into their practice. @*Methodology@#The York Framework for scoping reviews was utilized. The review consisted of five stages: (1) identifying research questions, (2) identifying relevant literature, (3) identifying eligible literature, (4) data charting, and (5) summarizing and extracting themes. @*Results@#The majority of the articles collated were research studies from developed countries. The ICF was applied equally across all age groups and focused on activities and participation rather than health conditions. Thematic analysis showed that ICF was applied in assessment, intervention, and health care service delivery. @*Conclusion@#Gaps exist in using ICF-based tools in the SLP clinical practice and in the social understanding of the ICF. SLP practitioners are encouraged to learn and adapt the identified ICF-related themes in their practice as it facilitates a holistic understanding of their patient's functioning, disability, and evidence-based clinical decisions, thus, contributing to effective diagnostic and therapeutic processes.

In vitro and in vivo antioxidant potentials of the methanolic crude extract from Inula glomerata Oliv. & Hiern (Asteraceae) and Salacia kraussii (Harv) Harv (Celastraceae) / Potenciales antioxidantes in vitro e in vivo del extracto crudo metanólico de Inula glomerata Oliv. & Hiern. (Asteraceae) y Salacia kraussii (Harv) Harv (Celastraceae)

Reactive oxygen species are implicated in multiple pathological conditions including erectile dysfunction. This study evaluated the in vitro and in vivo antioxidant potential of the methanolic extracts of Inula glomerata and Salacia kraussii. The plant materials were pulverized and extracted with methanol. The phytochemical analysis, ability of the crude extracts to scavenge free radicals (ABTS, DPPH, NO.) in vitroas well as the total phenolic and flavonoid contents was investigated. In vivo, antioxidant potentials of the crude extracts (50/250 mg/kg body weight) were determined in an erectile dysfunction rat model. The phytochemical analysis revealed that both plants contain flavonoids, tannins, terpenoids, and alkaloids. The crude extracts at varying degree of efficiency, scavenged ABTS and DPPH radicals. The crude extracts at low concentrations (50 mg/kg b.w) significantly (p<0.05) diminished the level of malondialdehyde, augmented catalase activities and elevated glutathione levels. However, SOD activities were significantly boosted in a dose-dependent manner by the crude extracts. Therefore, I. glomerataand S. kraussiipossess antioxidant properties, hence, can serve as a therapeutic modality in the treatment of oxidative stress-induced erectile dysfunction.

Las especies reactivas de oxígeno están implicadas en múltiples condiciones patológicas, incluyendo la disfunción eréctil. Este estudio evaluó el potencial antioxidante in vitro e in vivo de extractos metanólicos de Inula glomeratay Salacia kraussii. Los materiales vegetales fueron pulverizados y extraídos con metanol. A estos extractos crudos se les llevó a cabo el análisis fitoquímico junto con el contenido total de fenólicos y flavonoides, así como se les investigó la capacidad in vitro para atrapar radicales (ABTS, DPPH, NO.). Los potenciales antioxidantes in vivo de los extractos crudos (50/250 mg/kg de peso corporal) se determinaron en un modelo en ratas con disfunción eréctil. El análisis fitoquímico reveló que ambas plantas contuvieron flavonoides, taninos, terpenoides y alcaloides. Los extractos crudos con un grado variable de eficiencia, atraparon a los radicales ABTS y DPPH. Los extractos crudos a bajas concentraciones (50 mg/kg p.c) significativamente (p<0.05) disminuyeron el nivel de malondialdehído, aumentaron las actividades de catalasa y elevaron los niveles de glutatión. Sin embargo, las actividades de SOD por los extractos crudos fueron significativamente dosis-dependientes. Así, los extractos de I. glomeratay S. kraussii mostraron propiedades antioxidantes, y por lo tanto, podrían servir como una alternativa terapéutica en el tratamiento de disfunción eréctil inducida por estrés oxidativo.

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for victims of sexual abuse with severe post-traumatic stress disorder: an open label pilot study in Brazil

Objective: To conduct Brazil's first clinical trial employing 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD), given its high prevalence resulting from epidemic violence. Methods: Of 60 volunteers, four matched the inclusion & exclusion criteria. Three patients with PTSD secondary to sexual abuse (diagnosed by the Structured Clinical Interview for DSM-IV and the Clinician Administered PTSD Scale for DSMV-4 [CAPS 4]) completed enrollment and treatment, following a standardized Multidisciplinary Association for Psychedelic Studies protocol consisting of 15 weekly therapy sessions: three with orally administered MDMA with concurrent psychotherapy and music, spaced approximately 1 month apart. CAPS-4 scores two months after the final MDMA session were the primary outcome. Results: No serious adverse events occurred. The most frequent adverse events were somatic pains and anguish. CAPS-4 reductions were always greater than 25 points. The final scores were 61, 27, and 8, down from baseline scores of 90, 78, and 72, respectively. All reductions were greater than 30%, which is indicative of clinically significant improvement. Secondary outcomes included lower Beck Depressive Inventory scores and higher Post-Traumatic Growth Inventory and Global Assessment of Functioning scores. Conclusions: Considering the current limitations in safe and efficacious treatments for PTSD and recent studies abroad with larger patient samples, MDMA-assisted psychotherapy could become a viable treatment in Brazil. Clinical trial registration: RBR-6sq4c9

Quality of nutritional care assessment among critically-ill patients in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> Malnutrition is prevalent both at baseline admission and because of hospitalization. It is aggravated by adverse hospital practices and results in poor outcomes, reduced quality of life, and higher treatment costs. Improving quality of care involves nutritional intervention as a low-risk, cost-effective strategy which guides providers in improving practices systems-wise. This study aims to assess the quality of nutritional care and the nutritional status of critically- ill patients admitted in a low-resource setting.</p><p style="text-align: justify;"><strong>Materials and Methods:</strong> This is a mixed methods study among adults admitted in intensive care units (ICUs) of a tertiary government hospital. Anthropometric and biochemical indicators were obtained through chart review. The degree of malnutrition was assessed using the Subjective Global Assessment. Quality indicators under Donabedian domains were assessed and compared to current standards. The length of ICU stay and mortality rate were recorded. Dietary prescription and provision practices of healthcare providers were supplemented by a focus group discussion (FGD). Factors causing provision interruptions were also identified.</p><p style="text-align: justify;"><strong>Results and Discussion:</strong> Sixty-four ICU admissions were included. Staff-to-patient ratio was not ideal. Under process-related factors, out of 49% with actual anthropometric documentations (rest were estimates), 24% had normal body mass indices (BMI), 17% were underweight, and the rest were either overweight or obese. The baseline ICU malnutrition rate was 69%. Malnutrition screening, and assessment of risk and biochemical indicators were not done routinely. Majority (92%) had baseline dietary prescription but only 69% had specific energy and macronutrient breakdown, all done through predictive weight-based equations. Nutritional supplies arrived within 8 hours in 65% of patients. Feeding was initiated within 24-28 hours in 94% of patients. Commercial formula was the preferred type of enteral nutrition (EN). Total duration on nothing-by-mouth (NPO) (hours) throughout ICU stay was significant. Supportive measures to improve gastro-intestinal (GI) tolerance were not standardized. Common factors in delaying feeding initiation were hemodynamic instability, fasting for procedures and GI bleeding. Throughout the ICU stay, fasting for procedures, hemodynamic instability and mechanical ventilation (MV)-related factors were common. ICU mortality rate was 19% and average length of ICU stay was 5 days.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Malnutrition is still prevalent in our ICUs and is affected by suboptimal healthcare practices. Staff - to-patient ratios, malnutrition risk screening and assessment, dietary referrals, documentation and minimizing interruptions in nutritional care provision needs improvement. A system review and establishment of a nutrition team is imperative.</p>

Incidence and Significance of Biliary Stricture in Chronic Pancreatitis Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Stones

Background/Aims@#This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi. @*Methods@#A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis. SBS was initially managed by either a plastic stent or fully covered self-expandable metallic stent (fcSEMS). If the stricture did not resolve, the stent was replaced with either multiple plastic stents or another fcSEMS. Data were collected by retrospectively reviewing the medical records. @*Results@#Biliary strictures were noted in approximately one-third of patients (34/97, 35%) undergoing ESWL for pancreatic calculi. Approximately one-third of the biliary strictures (11/34, 32%) were SBS. Pseudocysts were more frequently found in those with SBS (36% vs 8%, p=0.02), and all pseudocysts in the SBS group were located in the pancreatic head. The initial stricture resolution rates with fcSEMSs and plastic prostheses were 75% and 29%, respectively. The overall success rate for stricture resolution was 73% (8/11), and the recurrence rate after initial stricture resolution was 25% (2/8). @*Conclusions@#Although periductal fibrosis is the main mechanism underlying biliary stricture development in chronic pancreatitis, inflammation induced by obstructing pancreatic calculi, including pseudocysts, is an important contributing factor to SBS formation during the acute phase.

A Rare Case of Idiopathic Pyometra in a Premenopausal Patient

Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy.Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding.Ultimately, the leuprolide acetate effectively resolved the patient’s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable.

A Rare Case of Idiopathic Pyometra in a Premenopausal Patient

Pyometra is a very uncommon disease principally occurring in postmenopausal women. It is characterized by the accumulation of purulent material within the uterine cavity. This paper presents the clinical history of a 35-year-old premenopausal woman with otherwise normal menstruation who developed heavy menstruation and was diagnosed with a benign pyometra of indeterminate etiology in March 2017. The patient underwent repeated ultrasound-guided drainage, dilation and curettage, and antibiotic therapy.Biopsies of the pelvic sidewall revealed endometriosis in June 2017. The heavy menstruation and suppurative fluid in the uterus of the patient persisted in which intramuscular leuprolide acetate was prescribed to address the endometriosis and heavy menstrual bleeding.Ultimately, the leuprolide acetate effectively resolved the patient’s bleeding and pyometra. The medication was concluded after 12 months of supervision and the patient is currently symptom free. Pyometra is an unusual condition rarely identified in premenopausal women. Drainage and antibiotic therapy are routinely employed; however, one may consider gonadotropin-releasing hormone agonist medication to potentially confer a beneficial patient outcome in rare cases where endometriosis and bleeding are intractable.

The growth of ear of paediatric subjects in Hong Kong—A timely reconstruction for unilateral microtia / 中华整形外科杂志

Objective@#To establish the local data on the growth of ear in Hong Kong children and provide a reference for the timing of reconstruction in unilateral microtia.@*Methods@#We reviewed case notes of paediatric patients up to 18 years of age who had attended our Ear, Nose and Throat Out-patient Clinic from March to November 2017. We recorded the pinna length of these patients and that of their parents, compared the patients’ ear length against that of their parents, and investigated any discrepancy of pinna.@*Results@#We recruited 226 local individuals (139 males and 87 females). The patients were divided into different age groups. The means of ear length of patients were compared with the mean length of pinna of their parents. Data of boys and girls are analyzed separately. Boys at 7-8 years old achieved 87.33% and 93.54% of their fathers’ and mothers’ ear length respectively. Girls at 7-8 years old achieved 83.00% and 90.80% of their fathers’ and mothers’ ear length respectively. Moreover, the average ratio of the length of left and right ear ratio is 97.3% in all groups of children.@*Conclusions@#In Hong Kong children, at the age of 7-8 the ear approaches the size of normal adult ear and is the feasible age with less asymmetry after reconstruction of the microtia.

A twenty year experience with the use of intrauterine contraceptive device (IUCD) in a university teaching hospital in South- south Nigeria

Context: Contraceptive prevalence in Nigeria is low at 17%. Amongst Nigerian women and couples who accept to use contraception, the IUCD is the most commonly used contraceptive method with variation in rates of use between geographical areas and among Health Institutions. Factors that determine decision making on IUCD use are not well understood. Aims: To study the use, effectiveness, complications and discontinuation rates for intrauterine contraceptive device received at the University of Benin Teaching Hospital from 1997 to 2016 and analyzed in January, 2019. Study Design: This was a retrospective cross sectional study. Methodology: The case notes of all 3326 new clients who accepted Copper T intrauterine contraceptive device at the UBTH Family Planning Clinic during the review period were retrieved and analyzed. Data regarding acceptors socio-demographic characteristics, side effects, effectiveness, complications, duration of use and reasons for discontinuation were extracted and entered into SPSS for windows version 22.0 and analyzed. Results: Out of the 8203 clients that accepted to commence a family planning method, 3326 (40.55%) accepted to use IUCD. The mean age of IUCD acceptors at commencement was 33.4±5.60 and the mean age of their husbands was 39.85±6.91. The mean parity was 3.73±1.87 (range 0-12), while the mean number of living children was 3.56±1.66 (range 0-10). The mean duration of use (in months) was 40.43±40.13. Women with 5 or more children (P Value 0.000) and at least a minimum of secondary education (P Value 0.000), were significantly associated with IUCD use duration of > or more than 2 years. Also, women who reported satisfaction with IUCD (P Value 0.000) and no complications (P Value 0.000) were also associated with longer duration of use. Conclusion: IUCD is a common family planning method used by women at UBTH. Its duration of use is higher among clients with more children, at least a minimum of secondary school education and no complications from its use. This information is relevant for family planning service providers to increase contraceptive uptake by women in Nigeria

Efecto oxitócico del decocto de la flor sagrada de los incas (Cantua buxifolia) sobre útero aislado de rata estrogenizada / Oxytocic effect of the deck of the sacred flower of the incas (Cantua buxifolia) on the isolated uterus of a strogenized rat

Objetivo. El objetivo de este estudio fue investigar el efecto del decocto de la flor sagrada de los incas (Cantua buxifolia) sobre útero aislado de rata estrogenizada. Materiales y métodos. La planta entera fue utilizada para preparar el decocto, obteniendo concentraciones finales 4 mg/mL. Se utilizaron seis ratas hembras procedentes del Instituto Nacional de Salud; posteriormente, se les estrogenizó con valerato de estradiol (solución 0,3%) durante tres días previos al experimento. Luego se sacrificaron mediante dislocamiento cervical y se aislaron los segmentos uterinos de las ratas; finalmente, se fijó en los baños de órgano aislado, determinándose la amplitud, frecuencia de contracción y actividad uterina en los grupos problema (Cantua buxifolia) y oxitocina. Resultados. El decocto de Cantua buxifolia 4 mg/mL evidenció incremento de la amplitud, frecuencia de la contracción y actividad uterina similar a oxitocina en concentración de 2X10-5 UI, (p=0,829; p=1,00 y p=0,762, respectivamente). Conclusión. El decocto de Cantua buxifolia tiene efecto oxitócico en útero aislado de rata estrogenizada.

Objective. The objective of this study was to investigate the effect of the decoct of the sacred flower of the Incas (Cantua buxifolia) on the isolated uterus of estrogenized rats. Materials and methods. The whole plant was used to prepare the decoct, obtaining final concentrations of 4 mg/mL. Six female rats from the National Institute of Health were used, subsequently they were estrogenized with estradiol valerate (0.3% solution) for three days prior to the experiment. Then, they were sacrificed by cervical dislocation and the uterine segments of the rats were isolated, finally it was fixed in the isolated organ baths, determining the amplitude, frequency of contraction and uterine activity in the problem groups (Cantua buxifolia) and oxytocin. Results. The decoct of Cantua buxifolia 4 mg/mL showed an increase in amplitude, frequency of contraction and uterine activity similar to oxytocin at a concentration of 2X10-5 IU, (p = 0.829; p = 1.00 and p = 0.762, respectively). Conclusion. Cantua buxifolia decoct has an oxytocic effect in the isolated uterus of estrogenized rats.

Outcomes of Infected versus Symptomatic Sterile Walled-Off Pancreatic Necrosis Treated with a Minimally Invasive Therapy

BACKGROUND/AIMS: Acute pancreatitis complicated by walled-off necrosis (WON) is associated with high morbidity and mortality, and if infected, typically necessitates intervention. Clinical outcomes of infected WON have been described as poorer than those of symptomatic sterile WON. With the evolution of minimally invasive therapy, we sought to compare outcomes of infected to symptomatic sterile WON. METHODS: We performed a retrospective cohort study examining patients who were undergoing dual-modality drainage as minimally invasive therapy for WON at a high-volume tertiary pancreatic center. The main outcome measures included mortality with a drain in place, length of hospital stay, admission to intensive care unit, and development of pancreatic fistulae. RESULTS: Of the 211 patients in our analysis, 98 had infected WON. The overall mortality rate was 2.4%. Patients with infected WON trended toward higher mortality although not statistically significant (4.1% vs 0.9%, p=0.19). Patients with infected WON had longer length of hospitalization (29.8 days vs 17.3 days, p<0.01), and developed more spontaneous pancreatic fistulae (23.5% vs 7.8%, p<0.01). Multivariate analysis showed that infected WON was associated with higher odds of spontaneous pancreatic fistula formation (odds ratio, 2.65; 95% confidence interval, 1.20 to 5.85). CONCLUSIONS: This study confirms that infected WON has worse outcomes than sterile WON but also demonstrates that WON, once considered a significant cause of death, can be treated with good outcomes using minimally invasive therapy.