Effect of the Coronavirus Disease 2019 Pandemic on the Quality of Stroke Care in Stroke Units and Alternative Wards: A National Comparative Analysis / 대한뇌졸중학회지

Background@#and Purpose Changes to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients’ treatment setting (stroke unit or alternate ward). @*Methods@#We conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients’ treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses. @*Results@#In total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks). @*Conclusions@#During the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.

Knowledge, attitudes, and practices related to COVID-19 among patients at Hospital Universitario de Caracas triage tent: A cross-sectional study / Conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes atendidos en la carpa de triaje del Hospital Universitario de Caracas: un estudio transversal

Abstract | Introduction: The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures. Objective: To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent. Materials and methods: We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey. Results: Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients. Conclusions: This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.

Resumen | Introducción. Los estudios de conocimientos, actitudes y prácticas (CAP) relacionados con la Covid-19 permiten establecer los conceptos erróneos y las prácticas inadecuadas en torno a esta enfermedad, información fundamental para diseñar estrategias eficaces y mejorar el cumplimiento de las medidas de prevención. Objetivo. Establecer los conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes venezolanos cribados en la carpa de triaje del Hospital Universitario de Caracas. Materiales y métodos. Se hizo un estudio transversal en 215 pacientes entre el 25 de abril y el 25 de mayo de 2020, mediante entrevistas personales y utilizando una encuesta sobre conocimientos, actitudes y prácticas. Resultados. La mayoría (53,5 %) de los pacientes encuestados se encontraba asintomática; los encuestados tenían un conocimiento adecuado sobre los síntomas y la transmisión de la enfermedad, sin distinción entre sintomáticos y asintomáticos. La mayoría de ellos indicó estar respetando las prácticas de cuarentena, lavado de manos frecuente y uso de tapabocas en público; sin embargo, el reemplazo diario de los tapabocas de tela fue más frecuente en el grupo de los asintomáticos, en tanto que el reemplazo cada tres días fue más común entre los sintomáticos. Por último, más de la mitad de los participantes admitió haber estado en lugares concurridos, siendo esta práctica más frecuente entre los sintomáticos que entre los asintomáticos. Conclusiones. Este es el primer estudio de conocimientos, actitudes y prácticas sobre la Covid-19 en Venezuela. El conocimiento y las prácticas de los venezolanos podrían mejorar mediante el fortalecimiento de los programas de educación y capacitación. Esta información, obtenida durante la fase inicial de la pandemia en Venezuela, podría contribuir al diseño de estrategias de promoción y prevención de la Covid-19.

Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation

Objective@#To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect. @*Methods@#This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect. @*Results@#The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16). @*Conclusion@#Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.

Correlations among vitamin K intake, body fat, lipid profile and glucose homeostasis in adults and the elderly

ABSTRACT Objective Recent research has investigated the possible inverse relationship between vitamin K intake and body fat. In addition, an increasing number of studies are supporting a key role for this vitamin in improving lipid profile and insulin sensitivity and reducing the risk of type 2 diabetes mellitus, but little is known about what mechanisms would be involved. Thus, the objective of this study was to investigate the relationship between vitamin K intake (in the form of phylloquinone - PK), body fat, lipid profile and markers of glucose homeostasis in adults and the elderly. Subjects and methods A cross-sectional study with 298 participants (46% men) in the São Paulo Health Survey 2014-2015. Spearman correlations were performed to evaluate the associations between vitamin K intake and the biochemical and body composition measures. Results Among normal-weight male adults (n = 15), PK intake presented a positive correlation with the quantitative insulin sensitivity check index (QUICKI) (r = 0.525; p = 0.045). Among men with high fat mass index (FMI) (n = 101), PK intake had a negative correlation with homeostasis model assessment estimate for β-cell function (HOMA-β) (r = −0.227; p = 0.022). In women with high FMI (n = 122), PK intake had a negative correlation with HOMA-β (r = −0.199, p = 0.032) and insulin (r = −0.207, p = 0.026). No correlations were found between PK intake and lipid profile. Conclusions Our findings support a potential relationship among PK intake, body fat and markers of glucose homeostasis in adults and the elderly.

COVID-19 en Latinoamérica: una revisión sistemática de la literatura y análisis bibliométrico / COVID-19 in Latin America: a systematic review and bibliometric analysis

RESUMEN Objetivo Describir y analizar la actividad científica sobre la COVID-19 en Latinoamérica. Materiales y Métodos Mediante una revisión sistemática de la literatura en PubMed, LILACS y los repositorios preimpresos BioRxiv y medRxiv, se recuperaron todos los documentos disponibles sobre la COVID-19 en Latinoamérica desde el primero de enero hasta el 24 de abril de 2020, para su análisis bibliométrico. Resultados Un total de 29 publicaciones fueron incluidas en el análisis. El país con más producción científica fue Brasil (10/29; 34,4%), seguido de Colombia (6/29; 20,6%) y México (6/29; 20,6%). La universidad con más artículos fue la Universidad Tecnológica de Pereira, Colombia (5/29; 17,24%). El 41,3% de las publicaciones fueron documentos preimpresos. La mayoría de los estudios excluidos fueron comentarios editoriales u opiniones de expertos. Tres de cada cuatro investigaciones tenían un enfoque epidemiológico (21/29; 72,4%); limitados estudios sobre el diagnóstico (5/29; 17,2%), la fisiopatogenia (2/29; 2,8%) y los aspectos terapéuticos (1/29; 3,4%) fueron encontrados. Conclusión Pese al crecimiento exponencial de publicaciones en el mundo, existe una limitada cantidad de información sobre el comportamiento de esta infección en Latinoamérica. Se requiere la publicación de estudios con alta calidad metodológica, que aporten conocimiento sobre el impacto de la pandemia en la región.(AU)

ABSTRACT Objective Describe and analyze scientific activity on COVID-19 in Latin America. Materials and Methods Through a systematic review of the literature in PubMed, LILACS, and the preprinted repositories BioRxiv and medRxiv, all available documents on COVID-19 in Latin America from January 1 to April 24, 2020, were retrieved for review and bibliometric analysis. Results A total of 29 publications were included in the analysis. The country with the most scientific production was Brazil (10/29; 34,4%) followed by Colombia (6/29; 20,6%) and Mexico (6/29; 20,6%). The university with the most articles was the Technological University of Pereira, Colombia (5/29; 17,2%). 41,3% of the publications were preprinted documents. Most of the excluded studies were editorial comments or expert opinions. Three out of four investigations had an epidemiological focus (21/29; 72,4%); Limited studies on diagnosis (5/29; 17,24%), pathophysiology (2/29, 2,8%) and therapeutic Conclusion Despite the exponential growth of publications in the world, there is a limited amount of information on the behavior of this infection in Latin America. The publication of studies with high methodological quality is required, which provide knowledge of the impact of the pandemic in the region.(AU)

High C-reactive protein instead of metabolic syndrome is associated with lower bioimpedance phase angle in individuals clinically screened for a lifestyle modification program

BACKGROUND: Phase angle (PhA) value is a useful tool for identifying cell membrane integrity dysfunction. It is known that metabolic syndrome (MetS) increases oxidative stress and inflammation; and consequently can promote cellular damage. We hypothesized that MetS and inflammatory blood markers could be associated with lower PhA values. Therefore, the aim of this study was to identify the association of PhA values with MetS and blood markers in individuals clinically screened for a lifestyle modification program. METHODS: In a cross-sectional study, 417 selected subjects (76 men and 341 women, 53.9 ± 9.4 years old) were evaluated. Assessments included clinics, anthropometric measures, body composition by bioimpedance, and laboratory blood markers, including plasma lipids, glucose, and C-reactive protein concentrations. According to the PhA median values, subjects were classified in low (≤6.3°) and high (>6.3°) PhA groups. RESULTS: Subjects with lower PhA values were older and showed lower body mass index, waist circumference, muscle mass index, creatinine, and uric acid; and higher gamma-GT and HDL cholesterol. Neither the presence of MetS nor the presence of the increasing number of MetS components was associated with PhA values. The logistic regression analysis adjusted for age, gender, body mass index, and muscle mass index showed that higherC-reactive protein concentrations (>3.0 mg/L) increased the odds of low PhA values (OR = 1.62; CI = 1.01­2.60).CONCLUSION: Higher C-reactive protein concentrations increased the odds of low PhA independently of the presence of MetS. Additionally, contrary to our hypothesis, MetS was not associated with PhA values.

Late Presentation of Mayer-Rokitansky-Kuster-Hauser Syndrome in the Tropics-Northern Nigeria.

Mayer-Rokitansky-Kuster-Hauser syndrome is a congenital malformation characterized by failure of the mullerian duct to develop, resulting in missing of the uterus and upper part of the vagina in women showing normal development of secondary sexual characteristics and a 46, XX karyotype. It is the second most common cause of primary amenorrhea after Turner’s syndrome. A 30 year old nulliparous lady who has been married for 13years presented with history of primary amenorrhoea. Examination revealed a young lady, with normal female pubic and axillary hair distribution, and breast was at tanner stage 4. Pelvic examination showed a normal sized clitoris, labia majora and minora, normal urethra, and blind ended vagina extending to about 7cm. Abdomino-pelvic USS revealed both kidneys normal in position and size, hypoplastic uterus measuring 1.05cm in anteroposterior diameter, left adnexium and pouch of Douglas were normal. Buccal and peripheral blood smear show Barr bodies and drumstick appendages suggested karyotype is XX. She subsequently had diagnostic laparoscopy which revealed a streak of thickened ligament at the position of the uterus. Both ovaries and their ligaments were visualised with a follicular cyst on the right ovary. We made a diagnosis of mullerian agenesis. The couple were counselled and the poor prognosis for fertility explained since they did not seem to have significant problem with intercourse. Gestational surrogacy is a viable treatment option for patients with Rokitansky syndrome and was offered to this patient, but couldn’t afford it due to the prohibitive cost of the procedure.

Comparación de los niveles de contaminación por humo de tabaco ambiental en lugares de trabajo en 4 ciudades de Venezuela / Comparison of environmental tobacco smoke, indoor pollution levels in workplaces in 4 cities in Venezuela

Es bien sabido que el Humo de Tabaco Ambiental (HTA) es un contaminante del aire sumamente peligroso. Este humo contiene alrededor de 4.800 componentes químicos, de los cuales 69 son carcinógenos y muchos otros son irritantes, tóxicos y mutagénicos. Por esta razón Venezuela se ha unido a la lucha mundial contra este enemigo de la salud y para sustentarla se realizó en nuestro país en el año 2006 un estudio de los niveles de contaminación causada por HTA. Con esto se logró comparar la calidad de aire en ambientes cerrados sin prohibición para fumar, o con prohibición parcial (división de área para fumadores y no fumadores), como por ejemplo bares, restaurantes, casinos y transporte; con ambientes con prohibi-ción total para fumar, como universidades y hospitales. Este estudio se realizó midiendo en tiempo real la concentración (µg/m3) de partículas respirables con un diámetro menos a 2,5 µm (PM2.5), estas partículas son liberadas en grandes cantidades por cigarrillos encendidos y están relacionadas con los efectos adversos a la salud que produce el cigarrillo. Se determinó que en los ambientes con prohibición total los niveles de contaminación son 92% más bajos que los ambientes sin prohibición o con una prohibición parcial. Este resultado da a nuestro país el soporte científico para la implementación de políticas Ambientes Libres de Humo de Tabaco, que garanticen a la población un ambiente inocuo.

It is well known that secondhand smoke (SHS) is the main source of pollution in enclosed places to the people, such as: workplaces, public places, public transportation facilities, communities and home. This pollutant contains 4800 chemicals, 69 of which are carcinogens. In addition, many of these substances are toxic, poisonous and mutagenic to the human body. For this reason Venezuela has united to the worldwide fighting against this health hazard. In 2006 our country carried out a study evaluating the pollution levels caused by SHS. In this study was possible to compare air quality in partial or smoking places such as bars, restaurants and in public transport against nonsmoking places such as hospitals and universities. The study was done measuring concentrations (µg/m³) of breathable particles with a diameter less than 2.5 µm (PM2.5) in realtime, which are release by a lighted cigarette. Based on the measures taken, it was possible to determine that in free smoke places the pollution levels are 92% lower compare to smoking places. This result gives to our country the scientific support to establish policies for environments smokefree that warranty the public from the adverse health effects of passive smoking in public places.

Comportamento da criança durante videonasofaringolaringoscopia: análise de 105 pacientes / Children behaviour during videonasopharyngoscopy: evaluation of 105 patients

Introduçäo e objetivos: Este trabalho tem como objetivos estudar o comportamento da criança ao ser submetida a videonasofaringolaringoscopia - e a eficiência da rotina adotada pelos autores para sua realizaçäo - e descrever a rotina do exame, contribuindo para sua melhor execuçäo por outros profissionais da área médica. Forma do estudo: Prospectivo clínico randomizado. Material e Método: O presente estudo foi realizado com 105 crianças e adolescentes, cuja faixa etária variou de 1 a 15 anos, sendo a média de 7,3 anos, submetidos a endoscopia nasal e/ou faringolaríngea com endoscópio flexível. Resultados: O índice de sucesso do procedimento foi de 99,04 por cento - em apenas uma das crianças foi impossível a execuçäo da endoscopia. A ocorrência de náusea näo impediu a boa avaliaçäo da laringe, estando presente em apenas 6,7 por cento dos casos. O choro ocorreu em alguma das fases da rotina de exame em 24,76 por cento do total de pacientes: em 42,10 por cento das crianças de 0 a 5 anos (Grupo I); em 20,93 por cento das de 6 a 10 anos (Grupo II); e em 0,00 por cento dos adolescentes de 11 a 15 anos (Grupo III). A cavidade nasal foi a regiäo mais relacionada com tal ocorrência, correspondendo a 80 por cento dos casos que choraram durante o exame. Conclusäo: Ao findarmos a pesquisa, concluímos que a videonasofaringolaringoscopia flexível é muito eficiente segundo a rotina adotada e que a tolerância do paciente mostrou-se proporcional a sua idade

Complicação nasal dos implantes dentários. Apresentação de um caso clínico / Nasal Complication Implants of Dental Implants: case report

Os implantes dentários constituem um método terapêutico auxiliar na reabilitação oral, permitindo a fixação permanente de próteses substitutivas de um ou mais dentes. Quando realizados na arcada dentária superior, apresentam-se em intima relação com as cavidades naso-sinusais. Objetivo: O objetivo deste trabalho é apresentar caso em que foi realizado um implante agulhado e de parafuso na arcada dentária superior, com transfixação do assoalho da fossa nasal e exteriorização no interior da mesma em três pontos distintos. A paciente foi submetida à secção das porções exteriorizadas dos implantes por via endonasal com micromotor e broca diamantada. Resultados: O resultado final mostrou reintegração da mucosa nasal recobrindo os implantes, sem prejuízo da fixação da prótese. Conclusão: Os autores alertam para a possibilidade da tentativa de um tratamento que preserve o implante, nos casos de complicações menores.

Dental implants are an auxiliary method in oral rehabilitation, which allows permanent fixation of prosthesis of one or more teeth. When applied in the superior dental arcade, there is an intimate relation-with the pose and paranasal sinus. Aim: The goal of this work is to present a case submitted to neddled implants and screwed dental implants in the superior dental arcade, with transfixation of the nasal floor in thee differents points. The exteriorized portions of the implants were sectioned by endonasal approach with diamond burs. Results: The final result showed reintegration of the nasal mucosa covering the implants, without damage of the prosthesis fixation. Conclusion: In cases of lesser complications, the authors warn out the possibility of conservative treatment preserving-the implants.