Development and validation of a stressor-coping style scale for students in a public medical school

Background@#The medical curriculum is one of the most stressful academic curricula worldwide. Studies indicate that great levels of stress, that encompass academics to personal life, may be connected to a number of worrying statistics for the mental health of Philippine medical students.@*Objectives@#To develop a validated stressor-coping style scale for students in a public medical school.@*Methods@#The study employed a sequential mixed-methods design. An open-ended questionnaire was used to determine the common stressors and coping styles through convenience sampling. A scale was constructed from this data and was statistically tested for concurrent validity and reliability from a random sample.@*Results@#Following thematic analysis, an initial six stressor domains and eleven coping mechanisms were identified. However, after item analysis and principal component analysis of responses, the scale was transformed to seven stressor domains and five coping mechanism domains. All of which are deemed internally consistent (α>0.6). Scores from the scale were also convergent with the scores of Brief COPE (r=0.5 to 0.9). @*Conclusions@#The developed stressor-coping style scale for medical students is a reliable and valid tool for Filipino medical students in a public medical school.

Identificación oportuna del sangrado anormal postparto: método gravimétrico para cuantificar sangrado. Proyecto de mejora / Timely detection of abnormal postpartum bleeding: use of the gravimetric method to quantify bleeding. Improvement project

Resumen: Introducción: La hemorragia postparto es una entidad que no se detecta oportunamente con la estimación visual del sangrado. Material y métodos: Se implementó un protocolo estandarizado de cuantificación gravimétrica del sangrado postparto en pacientes sometidas a cesárea. Un estudio prospectivo, comparativo, no aleatorizado determinó el cumplimiento del protocolo, frecuencia proporcional del sangrado postparto anormal, basal y postintervención de mejora; y asociación entre metodologías de evaluación del sangrado y clasificación del sangrado. Pruebas z, Fisher, p < 0.05 significativa. Resultados: El cumplimiento del protocolo estandarizado fue 53% (± 0.18). En el grupo postintervención de mejora, la frecuencia del sangrado anormal postparto se incrementó en 30% con respecto al grupo basal (p < 0.05). Se demostró asociación significativa entre la cuantificación gravimétrica del sangrado postparto, y el sangrado postparto anormal. Conclusión: La implementación del protocolo de cuantificación gravimétrica del sangrado postparto fue posible, permitió mejorar la capacidad de identificación del sangrado postparto anormal en pacientes sometidas a cesárea.

Abstract: Introduction: Postpartum hemorrhage is a complication, that is not timely detected with the visual estimation of bleeding. Material and methods: A standardized protocol for the gravimetric quantification of postpartum bleeding was implemented to improve the ability to identify abnormal bleeding in patients undergoing caesarean section. A prospective, comparative, non-randomized study evaluated the improvement intervention. Compliance with the protocol, classification of postpartum bleeding before and after intervention; and the association between methodologies for assessing bleeding and postpartum bleeding classification were determined. Fisher z tests, p < 0.05 significant. Results: Compliance with the standardized protocol was 53% (± 0.18). In the post-intervention group, the frequency of abnormal postpartum bleeding increased by 30% with respect to the baseline group (p < 0.05). A significant association was demonstrated between gravimetric quantification of postpartum bleeding and abnormal postpartum bleeding. Conclusion: The implementation of the protocol for the gravimetric quantification of postpartum bleeding was possible. It improved the ability to identify abnormal postpartum bleeding in patients undergoing cesarean section.

A case of intramural coronary amyloidosis associated with hemodialysis

Dialysis-related amyloidosis predominantly occurs in osteo-articular structures and dialysis-related amyloid (DRA) substances also deposit in extra-articular tissues. Clinical manifestations of DRA include odynophagia, gastrointestinal hemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction, and subcutaneous tumors. The pathological characteristics of DRA in the heart of hemodialysis patients have rarely been reported. We report the case of a 73-year-old female with a history of cerebral palsy and end-stage renal disease status post two failed renal transplants who had been on hemodialysis for 30 years. The patient was admitted with the working diagnosis of pneumonia. An echocardiography showed markedly reduced biventricular function manifested by low blood pressure with systolic in the 70s and elevated pulmonary artery pressure of 45 mmHg, which did not respond to therapy. Following her demise, the autopsy revealed bilateral pulmonary edema and pleural effusions. There was cardiac amyloid deposition exclusively in the coronary arteries but not in the perimyocytic interstitium. Amyloids were also found in pulmonary and intrarenal arteries and the colon wall. Previous case reports showed that beta 2-microglobulin amyloid deposits in various visceral organs but less frequently in the atrial and/or the ventricular myocardium. In the present case, amyloids in the heart were present in the intramural coronary arteries causing myocardial ischemia and infarction, which was the immediate cause of death.

Comparative in vitro dissolution studies between different types of acetaminophen suppository dosage forms using a novel modified basket method

Objective: Diverse studies have demonstrated that no single method of dissolution testing is suitable for different types of suppository dosage forms by either current USP and Ph.Eur methodologies. The objective of the research work was to overcome the methodological problem and limitations by a novel modified basket method

Materials and Methods: USP dissolution apparatus-I was modified by placing a dialysis membrane of specific molecular weight cut off to prevent any kind of clogging which may give irreproducible, inconsistent results. Physical properties like melting range, liquefaction and solidification time, disintegration time and mechanical strength were studied as per Ph.Eur III

Results: The amount of drug released from water soluble bases were fast with 94.5 1.8 %, 96.8 2.2% during 1h and slow with lipophilic bases with 91.6+/-2.3% and 92.7%+/-3.7% respectively during 6h. There was no significant difference between the dissolution profiles by flow through cell and modified basket method [P>0.005]. Average lag time was 8.2, 9.8 min for water soluble suppositories and 14.4 and 11.8 min for lipophilic suppositories respectively. Release kinetics showed first order release rate for water miscible suppositories and zero order release profiles for lipophilic suppositories till 3 h and first order release after this time interval. Disintegration time of water soluble suppositories was 12-15 min but lipophilic suppositories demonstrated an extended disintegration time of 20-22 min Determination of plastic viscosity versus temperature indicated higher yield value for fatty bases compared to water soluble bases

Conclusion: Based on the data, it was concluded that proposed method could be used as a substitute for flow through cell of Ph.Eur. We further hypothesized that change in viscoelastic behavior due to the variation in temperature and aging may be responsible for the differences in the dissolution behavior between different suppositories bases

Formulation and evaluation of stable ascorbic acid multiple emulsion

Objective: The Primary objective of the present investigation was to stabilize ascorbic acid by blocking its irreversible conversion to biologically inactive form. Further aim of the project was to disperse stabilized ascorbic acid in internal aqueous phase of multiple emulsions and deliver it in a suitable base for topical application and enhanced transdermal permeation

Materials and Methods: The o/w/o emulsions were formulated by a two-step emulsification procedure, with different types and ratios of surfactant and oil using sodium oxalate as a stabilizer. Physical and chemical stability of the optimized formulation was evaluated at 8[degree sign]C, 25[degree sign]C, 40[degree sign]C and 40[degree sign]C /75% relative humidity. Physical stability of the formulation was determined by organoleptic characteristics, globule size, viscosity, pH and conductivity. Ascorbic acid release profile was measured with Franz diffusion cell using sigma membrane

Results: There was no change in color or liquefaction was observed in primary or multiple emulsion stored at 8[degree sign]C, 25[degree sign]C, 40[degree sign]C and 40[degree sign]C/75% relative humidity for a period of 6 months. Physical stability studies revealed change in globule size, phase separation and increase in pH for all primary and multiple emulsions kept at 40[degree sign]C and 40[degree sign]C/75% relative humidity. But there was only marginal change in pH and conductivity, globule size, and rheological parameters for multiple emulsions stored at 25[degree sign]C. In vitro release study showed that multiple emulsions followed a zero order release rate with an average flux value of 0.125 micro g/cm[2] /min

Conclusion: Based on the data, it was proved that multiple emulsion using sodium oxalate as a stabilizer remarkably improved the stability of ascorbic acid in aqueous solutions. The data given in this research led us to conclude that stabilized multiple w/o/w emulsion could be employed as a potential prolonged release vehicle for topical application of ascorbic acid

First degree heart block with multi-focal atrial ectopics in an adolescent girl due to hypomagnesemia

Nutritional deficiencies are common in adolescent children and include deficiencies of both micro- and macronutrients. Magnesium is an important mineral that is essential for maintenance of numerous electrophysiological and biochemical processes in the body. We report an adolescent girl who developed an episode of syncope with first degree heart block on electrocardiography and run of multifocal atrial ectopics on 24 h holter monitoring. Serum magnesium was found to be low with decreased urinary magnesium excretion. There were no other electrolyte abnormalities. Structural heart disease was ruled out by a normal echocardiogram. The rhythm changes were attributable to nutritional hypomagnesemia and were promptly reversed on correcting the hypomagnesemia

Green synthesis of titanium dioxide nanoparticles using Psidium guajava extract and its antibacterial and antioxidant properties

Objective: To determine the efficacies of antibacterial and antioxidant activities of aqueous leaf extract of Psidium guajava mediated biosynthesis of titanium dioxide nanoparticles (TiO

Green synthesis of titanium dioxide nanoparticles using Psidium guajava extract and its antibacterial and antioxidant properties

OBJECTIVE@#To determine the efficacies of antibacterial and antioxidant activities of aqueous leaf extract of Psidium guajava mediated biosynthesis of titanium dioxide nanoparticles (TiO2 NPs).@*METHODS@#Synthesized TiO2 NPs were tested by disc diffusion method against against human pathogenic bacteria. The total antioxidant activity and phenolic content (Folin-Ciocalteau method) of synthesized TiO2 NPs and aqueous plant extract were determined. The scavenging radicals were estimated by DPPH method. The synthesized TiO2 NPs were characterized by XRD, FTIR, FESEM and EDX.@*RESULTS@#FTIR spectra of synthesized TiO2 NPs exhibited prominent peaks at 3 410 cm(-1) (alkynes), 1 578 cm(-1), 1 451 cm(-1) (alkanes), and 1 123 cm(-1)(C-O absorption). The morphological characterization of synthesized TiO2 NPs was analysed by FESEM which showed spherical shape and clusters with an average size of 32.58 nm. The maximum zone of inhibition was observed in the synthesized TiO2 NPs (20 μg/mL) against Staphylococcus aureus (25 mm) and Escherichia coli (23 mm). The synthesized TiO2 NPs showed more antibacterial activity than the standard antibiotic disk, tetracycline which drastically reduces the chances for the development of antibiotics resistance of bacterial species. The plant aqueous extract and synthesized TiO2 NPs were found to possess maximum antioxidant activity when compared with ascorbic acid. The content of phenolic compounds (mg/g) in leaf aqueous extract and synthesized TiO2 NPs were found to be 85.4 and 18.3 mgTA/g, respectively.@*CONCLUSIONS@#Green synthesized TiO2 NPs provides a promising approach can satisfy the requirement of large-scale industrial production bearing the advantage of low-cost, eco-friendly and reproducible.