Patient Profiles and Cost of Otolaryngologic Surgeries in an LMIC Country.

Objectives: This study aims to analyze the cost of patient care among ORL-HNS patients admitted in a tertiary, teaching government hospital in a low- to middle-income country. Methods: This is a prevalence-based, prospective, bottom-up, cost-of-illness analysis among patients of the Department of Otorhinolaryngology-Head and Neck Surgery in a tertiary training government hospital admitted from July 2021 to March 2022. The value assessment method used is the human capital approach. The societal perspective is used for analysis to estimate and reflect payer (insurance providers) and patient perspectives. Results: A total of one hundred fifty seven (157) patients were admitted for elective surgery under the service of ORL-HNS consisting of 75 females and 82 males. The average total overall cost was $3,851.10 (Php 199, 870.50 ± 164, 725.60). The total direct health care cost for all patients within the study period amounted to $3,712.18 (Php 192, 662.22 ± 159, 548.60) while the direct non-health care cost was $58.60. The workforce cost (58.5%) and medication cost (18.8%) comprised the majority of in-patient expenses with a mean cost of $2,221.36 (Php 37,083.66) and $714.51 (Php 44,363.14), respectively. In this study, an average of $80.29 was lost due to illness and hospitalization (± $81.74). The total PHIC coverage pays a range from zero to 67.5% with an average coverage of only 17%. Conclusion: Our analysis has shown that workforce and medication expenses are the main cost drivers for the direct healthcare costs among Otolaryngology patients admitted for elective procedures. Stakeholders, such as the otolaryngologists and hospitals should coordinate closely to create a more encompassing coverage of Philhealth to prevent patients from suffering from financial crises due to their illness.

Supporting clinical competency in managing peripherally inserted central catheters during the COVID-19 pandemic: an education evaluation.

INTRODUCTION: Hospitals had to create new practices and training due to the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pandemic. An increase in patient acuity and the need for peripherally inserted central catheters (PICC) across the hospital required an urban community hospital to educate and support in-patient nurses to manage PICCs in acute and complex care units. Traditionally, these skills were performed by specialized registered nurses (RNs) from the Vascular Access Team (VAT). This paper highlights the education plan, implementation, and evaluation of a hospital-wide training for RNs and registered practical nurses (RPNs) in in-patient units during the SARS-CoV-2 pandemic. METHODS: Clinical Resource Leaders (CRLs) created a modular approach to upskill existing nurses and train new hires. Various education strategies, such as the use of competency assessments, creating practice supports, and incorporating specialists as a resource, were utilized to ensure knowledge transfer, application, and guidance of evidence-informed clinical practices. Vascular Access Team documentation was utilized to obtain Kirkpatrick's (2021) level 4 evaluation. RESULTS: This training program was implemented after the second wave of the pandemic and was also embedded into nursing orientation. This structured approach ensured that nurses were competent to support the increased acuity and needs of patients. Eighty percent of full-time and part-time nurses were trained to manage PICC lines. CONCLUSION: Education evaluation results show a decrease in PICC-related VAT assistance requests with a baseline of 570 calls down to 149 six months after education was implemented. Leaders are encouraged to ensure teams have role clarity, policies, and practice supports to be successful.

Microorganisms Associated with the Ambrosial Beetle Xyleborus affinis with Plant Growth-Promotion Activity in Arabidopsis Seedlings and Antifungal Activity Against Phytopathogenic Fungus Fusarium sp. INECOL_BM-06.

Plants interact with a great diversity of microorganisms or insects throughout their life cycle in the environment. Plant and insect interactions are common; besides, a great variety of microorganisms associated with insects can induce pathogenic damage in the host, as mutualist phytopathogenic fungus. However, there are other microorganisms present in the insect-fungal association, whose biological/ecological activities and functions during plant interaction are unknown. In the present work evaluated, the role of microorganisms associated with Xyleborus affinis, an important beetle species within the Xyleborini tribe, is characterized by attacking many plant species, some of which are of agricultural and forestry importance. We isolated six strains of microorganisms associated with X. affinis shown as plant growth-promoting activity and altered the root system architecture independent of auxin-signaling pathway in Arabidopsis seedlings and antifungal activity against the phytopathogenic fungus Fusarium sp. INECOL_BM-06. In addition, evaluating the tripartite interaction plant-microorganism-fungus, interestingly, we found that microorganisms can induce protection against the phytopathogenic fungus Fusarium sp. INECOL_BM-06 involving the jasmonic acid-signaling pathway and independent of salicylic acid-signaling pathway. Our results showed the important role of this microorganisms during the plant- and insect-microorganism interactions, and the biological potential use of these microorganisms as novel agents of biological control in the crops of agricultural and forestry is important.

Use of transoral carbon dioxide laser for supraglottic web from caustic ingestion in a 13 year old.

A 13 year old male was referred to the Department of Otorhinolaryngology due to unsuccessful decannulation. At 2 years of age, patient accidentally ingested a caustic liquid alkali and underwent emergency tracheostomy, exploratory laparotomy, and tube gastrectomy. 11 years after, patient was seen at the outpatient department for decannulation. On nasopharyngolaryngoscopy, a supraglottic stenosis with a central 1-mm opening was visualized. Patient underwent transoral carbon dioxide laser excision of supraglottic stenosis. Fused aryepiglottic folds were released from the epiglottis. Patient was discharged well with no immediate complications and was successfully decannulated 1 month post operation with good voice outcome. No recurrence of stenosis at one year post operation. Accidental caustic ingestion commonly occurs in the pediatric age group. A frequent complication of accidental caustic ingestion is strictures. The use of transoral carbon dioxide laser in the surgical treatment of supraglottic stenosis is a suitable option for pediatric patients as this offer several advantages such as less post operative edema, good intraoperative control of hemorrhage, few post-operative complications and is less invasive compared to open laryngeal procedures. This case exhibits the importance of close monitoring for pediatric patients after caustic ingestion in order to diagnose complications earlier.

Microbiota Associated With Cholesteatoma Tissue in Chronic Suppurative Otitis Media.

Otitis media (OM), defined as infection or inflammation of the middle ear (ME), remains a major public health problem worldwide. Cholesteatoma is a non-cancerous, cyst-like lesion in the ME that may be acquired due to chronic OM and cause disabling complications. Surgery is required for treatment, with high rates of recurrence. Current antibiotic treatments have been largely targeted to previous culturable bacteria, which may lead to antibiotic resistance or treatment failures. For this study, our goal was to determine the microbiota of cholesteatoma tissue in comparison with other ME tissues in patients with long-standing chronic OM. ME samples including cholesteatoma, granulation tissue, ME mucosa and discharge were collected from patients undergoing tympanomastoidectomy surgery for chronic OM. Bacteria were profiled by 16S rRNA gene sequencing in 103 ME samples from 53 patients. Respiratory viruses were also screened in 115 specimens from 45 patients. Differences in bacterial profiles (beta-diversity) and the relative abundances of individual taxa were observed between cholesteatoma and ME sample-types. Additionally, patient age was associated with differences in overall microbiota composition while numerous individual taxa were differentially abundant across age quartiles. No viruses were identified in screened ME samples. Biodiversity was moderately lower in cholesteatoma and ME discharge compared to ME mucosal tissues. We also present overall bacterial profiles of ME tissues by sample-type, age, cholesteatoma diagnosis and quinolone use, including prevalent bacterial taxa. Our findings will be useful for fine-tuning treatment protocols for cholesteatoma and chronic OM in settings with limited health care resources.

Promoción del lavado de manos en la población con manos en la población con discapacidad auditiva / Promoting handwashing among people with hearing impairment

Introducción: las campañas de promoción y prevención del lavado de manos son estrategias económicas y de alto impacto según la OMS/OPS. Las personas con discapacidad auditiva presentan dificultades para acceder a estas. Objetivo: realizar una reflexión sobre la promoción del lavado de manos en población con discapacidad auditiva mediante la virtualidad. Desarrollo: la experiencia con la aplicación de un OVA en estudiantes con discapacidad auditiva permite comprender que diseñar y aplicar herramientas a partir de las TICs para transmitir educación en salud a la población con discapacidad auditiva, requiere recursos tecnológicos, humanos y financieros que pueden ser financiados por entes gubernamentales y asociaciones que apoyen esta población. Conclusiones: los profesionales del área de la salud deben diseñar programas de promoción y prevención virtual para comunidades con discapacidades o diferentes vulnerabilidades para generar un aporte desde la salud.

ntroduction: According to the WHO/PHO handwashing promotion campaigns are high-impact economic strategies. People with hearing disability have difficulties for accessing these campaigns. Objective: to conduct a discussion exercise on promoting handwashing among people with hearing disability by means of a virtual campaign. Development: the experience applying VLA (virtual learning objects) in students with hearing disability allows understanding that designing and applying information and communication technology (ICT) tools to transmit heath education to people with hearing challenges, requires technological, human and financial resources which may be provided by the state and organizations supporting this population. Conclusions: healthcare professionals must design virtual promotion and prevention programs targeted at communities with disabilities and various vulnerabilities, as a contribution from the health sector.

Factores asociados al uso adecuado de la citología cérvico-uterina por mujeres de cartagena (Colombia) / Factors associated to the adequate use of pap smears by women in cartagena (Colombia) / Fatores associados ao uso adequado da citologia cérvico-uterina por mulheres de cartagena (Colombia)

Objetivo: Determinar los factores asociados al uso de la citología en mujeres de la ciudad de Cartagena. Metodología: Se realizó un estudio analítico de corte transversal, en una población de referencia de 237.751 mujeres. Se solicitó consentimiento informado a cada participante de acuerdo a las normas éticas nacionales e internacionales Fueron incluidas mujeres del área urbana de la ciudad de Cartagena, seleccionadas mediante un muestreo polietápico. Se aplicó una encuesta socio-demográfica y el apartado relacionado con cáncer de cuello uterino de la Encuesta Nacional de Demografía y Salud (ENDS - 2010). A los datos se aplicó estadística descriptiva e inferencial. Resultados: Participaron 915 mujeres con una edad promedio de 40 años (DE = 12,9 años). La prevalencia de uso de la citología fue del 85,9%; solo el 39,8% (313) cumple el esquema propuesto por la norma técnica nacional. Las variables que explican el uso adecuado de la citología por parte de las mujeres de Cartagena son: ser mayor de 29 años (OR: 2,1 - IC: 1,3-3,4), reclamar el resultado (OR: 2,5 - IC: 1,1-5,7), tener un resultado anormal (OR: 0,5 - IC: 0,2-0,9) y pertenecer al régimen subsidiado o no tener afiliación en salud (OR: 0,5 - IC: 0,4-0,8). Conclusiones: Los factores asociados al uso de la citología en mujeres de la ciudad de Cartagena, de acuerdo al esquema propuesto por la norma técnica nacional, se explica por factores demográficos, económicos y sociosanitarios.

Objective: To determine factors associated with the use of cytology in women in the city of Cartagena. Methods: A cross-sectional analytical study, with a population of 237,751 women was carried out. Informed consent was requested from each participant as national and international ethic norms request. Women from the urban area of the city of Cartagena were included, selected through multistage sampling. A social-demographic survey and the section related to cervical cancer in the National Demographic and Health Survey (ENDS - 2010) was used. Descriptive and inferential statistics analysis were applied to the data. Results: A total of 915 women with an average age of 40 years (SD = 12.9 years) participated. The prevalence of cytology was 85.9%, only 39.8% (313) which meets the scheme proposed by the national standard. The variables explaining the proper use of cytology by women from Cartagena are: be over 29 years old (OR: 2.1 - CI: 1.3-3.4), pick up the result of the test (OR: 2.5 - CI: 1.1-5.7), have an abnormal result (OR: 0.5 CI 0.2 to 0.9) and belong to the subsidized health care coverage or not having health care coverage (OR: 0.5 - CI: 0.4-0.8). Conclusions: Factors associated with the use of cytology in women in the city of Cartagena according to the scheme proposed by the national standard is explained by, demographic, economical and social health factors.

Objetivo: Determinar os fatores associados ao uso da citologia em mulheres da cidade de Cartagena. Metodologia: Realizou se um estudo analítico de corte transversal, em uma povoação de referencia de 237.751 mulheres. Solicitou se consentimento informado a cada participante de acordo às normas éticas nacionais e internacionais Foram incluídas mulheres da área urbana da cidade de Cartagena, selecionadas mediante uma amostragem polietápico (Nesta as unidades que finalmente compõem a amostragem se determinam em etapas sucessivas). Aplicou-se uma enquete sócia - demográfica e o apartado relacionado com câncer de colo uterino da Enquete Nacional de Demografia e Saúde (ENDS - 2010). Aos dados se aplicou estadística descritiva e inferencial. Resultados: Participaram 915 mulheres com uma idade média de 40 anos (DE = 12,9 anos). A prevalência de uso da citologia foi do 85,9%; só 39,8% (313) faz o esquema proposto pela norma técnica nacional. As variáveis que explicam o uso adequado da citologia por parte das mulheres de Cartagena são: ser maior de 29 anos (OR: 2,1 - IC: 1,3-3,4), reclamar o resultado (OR: 2,5 - IC: 1,1-5,7), ter um resultado anormal (OR: 0,5 - IC: 0,2-0,9) e pertencer ao regime subsidiado ou não ter afiliação e saúde (OR: 0,5 - IC: 0,4-0,8). Conclusões: Os fatores associados ao uso da citología em mulheres da cidade de Cartagena, de acordo ao esquema proposto pela norma técnica nacional, se explicam por fatores demográficos, econômicos e sócio -sanitários.