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Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a 'train the trainer' (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre-and post-survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.
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This article reports an action research study conducted to solve the problem that twenty-two English language students from a school in Cartagena de Indias considered the current teaching inadequate, and that they needed to develop topics of interest, aural-oral skills, and acquire vocabulary. The authors adjusted their practices, combined global and local themes, and brought multimodal texts to respond to the problem. The action stage of the study required the structuring of the course with themes on the identity of Cartagena de Indias under a Task-Based Learning methodology. The use of information and communication technologies was forced by the challenge of Covid-19, which demanded an abrupt transition from face-to-face to remote teaching and thus the inclusion of computer literacy. The new syllabus included topics close to the identity of the participants such as historical landmarks, economy, and tourism to simulate being a Cartagena tour guide so that learning was contextualized, evocative and expressive. The article presents one of the six workshops followed by an analysis of the data collected. The results of the study show that there were gains in language development attributable to the theme of global-local issues in the workshops that took half a school year for development. The pedagogical innovation also gave positive results in verbal fluency in which technological mediations and Task-Based Learning played an important role.
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INTRODUCTION: The coronavirus disease pandemic 2019 (COVID-19) constitutes a Public Health emergency. SARS-CoV-2 binds to angiotensin-converting enzyme 2 and serine transmembrane protease 2 receptors, which are highly expressed in salivary glands, tongue and sulcular epithelium. Intervention aimed at reducing viral load in saliva through rinses may help control and decrease viral transmission. OBJECTIVES: To determine the efficacy of cetylpyridinium chloride (CPC) mouth rinses in reducing the salivary viral load of SARS-CoV-2 in COVID-19 patients with less than 4 days of evolution. MATERIAL AND METHOD: Eighty SARS-CoV-2 positive patients were recruited and randomly assigned to two groups: a CPC intervention group (n=40) and a water control group (n=40). Saliva samples were collected from the patients at the time of diagnosis and within 2 hours after application of CPC/water rinses. Samples were subjected to RT-PCR and ELISA analysis. RESULTS: Patients had a mean age of 48.6 years and 60% were male, with no significant differences between the two groups. With RT-PCR analysis, we found no statistically significant differences in viral load reduction in the CPC mouthwash group. With the ELISA technique, there were no baseline differences between the two groups;however, 2 hours after rinsing, a significantly higher amount of nucleocapsids was observed in the CPC group versus the control group (CPC group;Mean:288.43, SD: 367.73, control group: Mean: 188.76, SD: 366.01;p<0.038) which we interpreted as a destructive action of CPC. CONCLUSIONS: The use of CPC in mouthwashes could be useful in reducing viral load, which may have an impact on the reduction of COVID-19 transmission. This pilot trial should lead to further investigations with larger sample sizes.
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Coronavirus disease 2019 (COVID-19) pneumonia is associated with a high rate of pulmonary embolism (PE). In patients with contraindications for CT pulmonary angiography (CTPA) or non-diagnostic on CTPA, perfusion single photon emission computed tomography/computed tomography (Q-SPECT/CT) is a diagnosis option. The goal of this work is to develop an Intelligent Radiomic system for the detection of PE in COVID-19 patients from the analysis of Q-SPECT/CT scans. Our Intelligent Radiomic System for identification of patients with PE (with/without pneumonia) is based on a local analysis of SPECT-CT volumes that considers both CT and SPECT values for each volume point. We present an hybrid approach that uses radiomic features extracted from each scan as input to a siamese classification network trained to discriminate among 4 different types of tissue: no pneumonia without PE (control group), no pneumonia with PE, pneumonia without PE and pneumonia with PE. The proposed radiomic system has been tested on 133 patients, 63 with COVID-19 (26 with PE, 22 without PE, 15 indeterminate-PE) and 70 without COVID-19 (31 healthy/control, 39 with PE). The per-patient recall for the detection of COVID-19 pneumonia and COVID-19 pneumonia with PE was, respectively, 91% and 81% with an area under the receiver operating characteristic curves equal to 0.99 and 0.87.
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Purpose: Cervical cancer is one of the leading causes of cancer deaths among women in some countries in the Region of the Americas.1 Cervical cancer is preventable through HPV vaccination, screening and treatment of precancerous lesions, and can be effectively treated if diagnosed early.2 Methods: Under the framework of the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem, the US National Cancer Institute (NCI), the University of Texas MD Anderson Cancer Center (MD Anderson) and the Pan American Health Organization/World Health Organization (PAHO/WHO) partnered to develop ECHO Latin America (ECHO ELA). ECHO ELA is modeled on Project ECHO® (Extension of Community Healthcare Outcomes) a hub-and-spoke knowledge-sharing approach where expert teams lead virtual didactic lectures and case discussions, amplifying the capacity for participants to deliver best practice programs to their regions. ECHO ELA consists of monthly, Spanish-language telementoring conferences about cervical cancer prevention and control. The program targets Ministries of Health, Immunization Program Managers and key cervical Sample output to test PDF Combine only cancer stakeholders in Latin American (LA) countries. Its primary goal is to assist countries in reaching their WHO cervical cancer elimination goals “90-70-90:” vaccinating 90 percent of girls against HPV by the age of 15, screening 70 percent of women for cervical cancer at ages 35 and 45, and treating 90 percent of women diagnosed with preinvasive cervical lesions or cervical cancer. Results: To date, 222 participants from 21 countries have registered. Seven sessions have been held averaging 93 participants per session. 85 participants completed the baseline survey addressing priorities, capacity, and desired outcomes. Baseline, mid-year evaluation results, within the COVID-19 context, and learned lessons will be presented. Conclusion: ECHO ELA is potentially an effective tool to convene participants from multiple countries to enhance collaboration and support countries' progress towards the elimination of cervical cancer in the Americas.
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Objective: To determine the levels of depression, anxiety, and stress in dentists working in the northern region of Peru in times of COVID-19. Material and Methods: 310 dentists working in the northern region of Peru in times of COVID-19 were evaluated by means of an observational and cross-sectional study. Subjects were asked to give their informed consent and answer a virtual questionnaire containing 21 items based on the DASS-21 Scale that assesses depression, anxiety, and stress. A descriptive analysis was carried out with frequencies;for the variables of gender and years of work experience the Chi square test (p<0.05) was used. Results: It was found that 291 (93.87%) of the dentists suffered from some type of psychological disorder: stress (35.74%), anxiety (35.05%), depression (29.21%). Mild stress was the most prevalent accounting for 49.04% (51);mild depression with 45.88% (39), and moderate anxiety with 40.20% (41). A higher prevalence was found in females and in those dentists who had less than 5 years of work experience. Conclusion: 93.87% of dentists working in the northern region of Peru in times of COVID-19 presented some type of psychological disorder, a higher frequency of mild stress was found, followed by mild depression, and moderate anxiety. © 2021, Universidad de Concepcion. All rights reserved.
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Introduction Cervical cancer is the primary cause of cancer among women in Mozambique. There is a shortage of providers trained to deliver cervical cancer screening and manage pre-invasive lesions. We describe a training program to build local capacity to deliver quality cervical cancer prevention services in Mozambique. Methods The program includes training courses led by faculty from the United States (US) and Brazil, and consists of lectures followed by hands-on training stations to practice colposcopy, cervical biopsy, ablation and loop electrosurgical excision procedure (LEEP) using innovative training models. Participants then perform the procedures in clinic with supportive supervision from the international faculty. The courses are complemented by monthly videoconference telementoring sessions, held in Portuguese using the Project ECHO® (Extension for Community Healthcare Outcomes) model. Results From 2016 to 2020, 10 courses were held in the cities of Maputo (n=8), Beira (n=1) and Nampula (n=1). There were 347 participants with an average of 34 participants per course. The courses have recently transitioned from only international faculty to include Mozambican gynecologists, including two fellows from the IGCS Global Curriculum program. A total of 15 ECHO sessions were held with ∼25 participants/ session, 30 patient cases discussed and 14 lectures delivered. Conclusion This collaboration between Mozambique, Brazil and the US is building local capacity to prevent cervical cancer through training, mentoring and support of local providers. Due to the COVID-19 pandemic, the courses are being transitioned to a virtual format led by the Mozambican doctors with the international faculty joining remotely.