| | Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study | Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study
Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study
Overview Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.
Journal Int Wound Journal. | 3 | | R485.00 |  |
| | Five-Minute Cognitive Test as A New Quick Screning of Cognitive Impairment in the Elderly | Five-Minute Cognitive Test as A New Quick Screning of Cognitive Impairment in the Elderly
Five-Minute Cognitive Test as A New Quick Screning of Cognitive Impairment in the Elderly
Overview
As old population is dramatically growing, the detection of early cognitive deficit will become increasingly crucial. Effective cognitive screening test with quick and convenient merits will ensure recognition of early cognitive deficit and timely intervention. This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly.
The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated.
Many screening tools are currently available, but no tools meet the four important requirements for widespread use in clinical practice or large-scale epidemiological studies — that is, capture a clinically acceptable range of cognitive domains, take short time to administrate (around 5 minutes), have high accuracy for detecting cognitive impairment, and incorporate visual recall, which is the earliest deficits in Alzheimer’s disease (AD) patients. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.
Journal
JKL International LLC Aging and Disease Volume 10, Number 6 URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844584/pdf/ad-10-6-1258.pdf | 3 | | R425.00 | |
| | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Overview The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. This study aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. A national cohort study was conducted in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Patients were excluded if they did not have a neurological consultation or neurological investigations or both or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR or respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall.
Authors Stephen T J Ray et al
Journal The Lancet Child & Adolescent Health | 3 | | R410.00 | |
| | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Overview To understand the motivations of rural-practicing primary care clinicians who participate in an intensive multiyear pragmatic randomized behavioural obesity intervention trial, Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER).
Structured interviews were conducted with 21 family medicine clinicians who were study leads at participating rural practices. Themes emerged through an analysis of transcripts and interview notes by using the constant comparative method.
The analysis revealed 3 main themes. First, primary care clinicians participated in RE-POWER because it provided a concrete plan to address their recurring clinical care need for effective obesity treatment and management. Second, participation offered help to frustrated physicians who felt a deep professional duty to care for all their patients’ problems but were dissatisfied with current obesity management. Third, participation was also attractive to rural primary care clinicians because it provided a visible and sustainable way to demonstrate their commitment to improving the health of patients and the broader community.
The findings show that clinicians are motivated to try solutions for a clinical problem— in this case obesity—when that clinical problem is also closely connected to a particularly frustrating area of clinical care that challenges their professional identity. Our data suggest that a motivation to close the gap between ideal and real practice can become such a high priority that clinicians are sometimes willing to try potential solutions, such as engagement in research, that they otherwise would not consider.
Authors Joanna Veazey Brooks, PhD, MBE, Kim S. Kimminau, PhD, Stacy McCrea-Robertson, MS, and Christie Befort, PhD Journal Journal of the American Board of Family Medicine | 3 | | R455.00 | |
| | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Overview Women physicians continue to comprise the minority of leadership roles in Academic Family Medicine (AFM) faculty across North American medical schools. This study quantified the current state of gender disparity by analysing academic position, leadership ranking, and research productivity.
A database for 6,746 AFM faculty members was generated. Gender and academic profiles were obtained for 2,892 academic ranks and 1,706 leadership roles by searching faculty listings enlisted in Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS).
The results indicated that women hold 46.11% (3,110/6,746) of faculty positions. The proportional composition decreased with increasing academic ranking (49.84% assistant, 46.78% associate, and 41.5% full professor). The same decreasing trend was demonstrated with leadership rank (57.14% minor leadership, 47.65% second-in-command, and 36.61 first-in command). Compared to their gender counterparts, women in AFM demonstrated lower publication productivity as measured by citation number (p=0.04) and years of study (p=0.008).
In conclusion it was found that the composition of academic family medicine faculty members included in this study demonstrated gender disparity. Inclusivity initiatives and policies to tackle the issue of female retention, promotion, and recruitment need to be further explored.
Authors Szu-Yu Tina Chen, Sabeena Jalal, Maryam Ahmadi, Kiran Khurshid, Nizar Bhulani, Ateeq U. Rehman, Aftab Ahmad, Jeffrey Ding, Terri-Leigh R. Aldred, Faisal Khosa
Journal Cureus
| 3 | | R410.00 | |
| | An integrative medicine case exemplar: The perspectives of a family physician credentialed in acupuncture | An integrative medicine case exemplar: The perspectives of a family physician credentialed in acupuncture
An integrative medicine case exemplar: The perspectives of a family physician credentialed in acupuncture
Overview Although the meaning of Integrative Medicine differs by individual patients, their demand for a more inclusive and integrative approach to care that utilizes both conventional and complementary medicine modalities has been increasing. Integrative medicine is an attempt to fulfil this growing demand for more holistic approaches to healthcare. One advantage of establishing a system that encourages more MCPs is that it allows patients to receive conventional and complementary medical care from one individual, but the time and expense of producing these MCPs poses a significant challenge in creating a pipeline of these individuals. If collaboration among clinicians was facilitated to provide patients with an integrative approach to their health care, this would allow the clinician to specialize in their area of focus; however, differing opinions and perspectives about how to care for the patient may pose significant communication challenges in the delivery of effective integrative care. Both approaches have the potential to create more access to integrative medicine for patients. Generous funding sources that create platforms for integrative medicine healthcare, such as The Bernard Osher Foundation’s support for Integrative Medicine, allow university–based community healthcare systems to generate research data that support evidence-based systemic change.
Authors Iman Majd, Paul S. Amieuxb, Sierra V. Cortes, Masa Sasagawa Journal Advances in Integrative Medicine 7 | 3 | | R410.00 | |
| | HIV and Aids | HIV and Aids
Overview
HIV disease is caused by infection with HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus. Human immunodeficiency virus (HIV) is a blood-borne virus typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding. The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Examples of manifestations include acute seroconversion manifests as a flulike illness, consisting of fever, malaise, generalized rash, generalized lymphadenopathy is common and may be a presenting symptom. This course covers the screening, diagnosis, medication and management of Aids.
Author: Sharespike | 3 | | R425.00 | |
| | Bee Sting and Anaphylaxis | Bee Sting and Anaphylaxis
Bee Sting and Anaphylaxis
Overview Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While most stings cause only minor problems, stings cause a significant number of deaths.
Target organs are the skin, vascular system, and respiratory system. Pathology is like other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis is a common and life-threatening consequence of Hymenoptera stings and is typically a result of sudden systemic release of mast cells and basophil mediators. Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases
This study aims to discuss the different stings, prognosis and emergency reactions and treatment thereto.
Author Sharespike | 3 | | R410.00 | |
| | Applying machine learning on health record data from general practitioners to predict suicidality | Applying machine learning on health record data from general practitioners to predict suicidality
Applying machine learning on health record data from general practitioners to predict suicidality
Overview Suicidal behaviour is difficult to detect in the general practice. Machine learning (ML) algorithms using routinely collected data might support General Practitioners (GPs) in the detection of suicidal behaviour. In this paper, we applied machine learning techniques to support GPs recognizing suicidal behaviour in primary care patients using routinely collected general practice data. Machine learning was applied to predict suicidal behaviour using general practice data. Our results showed that these techniques can be used as a complementary step in the identification and stratification of patients at risk of suicidal behaviour. The results are encouraging and provide a first step to use automated screening directly in clinical practice. Additional data from different social domains, such as employment and education, might improve accuracy.
Authors Kasper van Mens, Elke Elzinga, Mark Nielen, Joran Lokkerbol, Rune Poortvliet, Gé Donker, Marianne Heins, Joke Korevaarc, Michel Dückers, Claire Aussems, Marco Helbich, Bea Tiemens, Renske Gilissen, Aartjan Beekman, Derek de Beurs
| 3 | | R425.00 | |
| | Ischemic Stroke Part 2 | Ischemic Stroke Part 2
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Ischemic Stroke Part 1 | Ischemic Stroke Part 1
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Vertigo, DIzziness and Imbalance | Vertigo, DIzziness and Imbalance
Vertigo, DIzziness and Imbalance
Overview
Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches). Falling can be a direct consequence of dizziness in this population, and the risk is compounded in elderly persons with other neurologic deficits and chronic medical problems.
Mild hearing loss is the most common disability worldwide. The incidence of hearing loss is 25% in people younger than 25 years, and it reaches 40% in persons older than 40 years. About 25% of the population report tinnitus.
Primary care physicians evaluate most cases of dizziness and related symptoms. Their role and that of neurologists in this setting has increased over the past decade. This article outlines the clinical approach to dizziness with emphasis on differentiating peripheral from central dizziness and on office management of the most common diseases. It also addresses indications for referral to an otolaryngologist or neuro-otologist and for specialized auditory and vestibular testing.
To diagnose dizziness, physicians must use the essential tools of history, clinical examination, and follow-up. The etiology in most of these patients mainly involves a vestibular disorder, such as BPPV, Ménière disease, or bilateral vestibular hypofunction. Appropriate management and follow-up are necessary to improve the well-being of these patients.
Authors
Sharespike
| 3 | | R425.00 | |
| | Ventricular Tachycardia Part 2 | Ventricular Tachycardia Part 2
Ventricular Tachycardia Part 2
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | Ventricular Tachycardia Part 1 | Ventricular Tachycardia Part 1
Ventricular Tachycardia Part 1
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | The eye: ‘‘An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic’’ | The eye: ‘‘An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic’’
The eye: ‘‘An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic’’
Overview The coronavirus family is a group of zoonotic viruses with some recognized reservoirs particularly some bats. A novel coronavirus emerged in the province of Wuhan (China) in December of 2019.The number of infected patients with serious respiratory infection quickly spread around the world to become a global pandemic. The clinical presentation and viral pathogenesis of the coronavirus disease named COVID-19 indicated that the virus is transmitted from person to person through infected droplets entering the respiratory mucosa. Close contact with infected individuals particularly in crowded environments has characterized the rapid spread of the infection. Clinical manifestations of the viral infection have mentioned the presence of some ocular findings such as conjunctival congestion, conjunctivitis and even corneal injury associated with the classical COVID-19 infection. Some animal models of different coronaviruses eye infection shave described the viral pathogenesis through tear and conjunctival sampling. On the other hand, we are recommended protective measure to prevent contagion and limit the spread of the virus in health care professionals and contact lenses wearers.
ACKNOWLEDGMENTS Authors Sandra C. Durán C, Diana C. Mayorga G Journal Journal of Optometry (2020)
| 3 | | R435.00 | |
| | Wide Complex Tachycardia | Wide Complex Tachycardia
Overview
Correct diagnosis of wide complex tachycardia (WCTs) can be challenging. With EMS providers' ever-expanding scope of practice, it is no longer safe to label any rhythm that is wide and fast as ventricular tachycardia (VT). Though many paramedic curricula do not address advanced cardiac dysrhythmias and treatments, several EMS departments have protocols that require advanced training in 12-lead ECG interpretation and treatment of specific cardiac dysrhythmias. One must possess the proper diagnostic tools and knowledge to decide whether a WCT is VT or SVT with aberrant conduction. EMS providers should be able to differentiate VT and SVT with aberrant conduction with confidence and a high degree of certainty. In order to understand the visual differences between VT and SVT with aberrant conduction, one must first understand the basic pathophysiology behind the two dysrhythmias. The first steps are maintenance of the patient’s airway with assisted breathing if necessary, cardiac monitoring to identify the heart rhythm, monitoring of blood pressure and oximetry, and establishing intravenous access. In the emergency setting, a wide-complex tachycardia always should be considered as ventricular tachycardia unless proven otherwise, as treatment must be initiated immediately to avoid degeneration into ventricular fibrillation.
| 3 | | R425.00 | |
| | Unstable Angina | Unstable Angina
Overview
Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which also includes ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Unstable angina is considered to be an ACS in which there is myocardial ischemia without detectable myocardial necrosis (ie, cardiac biomarkers of myocardial necrosis —such as creatine kinase MB isozyme, troponin, myoglobin—are not released into the circulation).
With unstable angina, symptoms may (1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitro-glycerine. Symptoms of unstable angina are similar to those of myocardial infarction (MI).
The traditional term unstable angina was meant to signify the intermediate state between myocardial infarction (MI) and the more chronic state of stable angina. The old term pre-infarction angina conveys the clinical intent of intervening to attenuate the risk of MI or death. Patients with this condition have also been categorized by presentation, diagnostic test results, or course over time; these categories include new-onset angina, accelerating angina, rest angina, early postinfarct angina, and early post-revascularization angina.
This course deals with the causes and management of unstable angina.
| 3 | | R425.00 | |
| | Severe Distress – COVID 19 | Severe Distress – COVID 19
Severe Distress – COVID 19
Overview Since the emergence of the 2019 novel coronavirus (SARS-CoV-2) infection in December 2019, the coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. The clinical spectrum of patients with COVID-19 ranges from asymptomatic or mild symptoms to critical disease with a high risk of mortality. Coronavirus disease 2019 (COVID-19) is the illness associated with the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was initially noted during an outbreak of respiratory illness in the population of Wuhan, the capital of Hubei province, China. The first cases were seen in November 2019, with COVID-19 quickly spreading throughout the city. The World Health Organization (WHO) was notified of the outbreak on December 31, 2019. The cases continued to spread outside of the area and then across the world. COVID-19 was reported as a global health emergency by the end of January 2020. As the worldwide case numbers increased, the WHO declared on March 11, 2020, that COVID-19 had reached the pandemic stage.
The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
| 3 | | R425.00 | |
| | Septic Shock Part 2 | Septic Shock Part 2
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R425.00 | |
| | Septic Shock Part 1 | Septic Shock Part 1
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R425.00 | |
| | Respiratory Distress Syndrome | Respiratory Distress Syndrome
Respiratory Distress Syndrome
Overview
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the new-born infant.
Shortness of breath is a common complaint encountered by the EMS provider. We often hear it as part of a litany of other S/S or as a primary chief complaint. In either case SOB is never to be taken lightly and its causes should always be thoroughly investigated. My desire with this article is to give you some tips on how to streamline your treatment and formulate your thoughts as to how to proceed. In all cases the EMS team is responsible to respond to the needs of the patient. Hypoxia, regardless of the source needs to be vigorously addressed. The lungs need to be opened or cleared as determined by the physical exam. The cause of the SOB needs to be determined and addressed. Education and counselling of parents, caregivers, and families of premature infants must be undertaken as part of discharge planning. These individuals should be advised of the potential problems infants with respiratory distress syndrome may encounter during and after their nursery stay.
Author
Sharespike
| 3 | | R425.00 | |
| | Preeclampsia for MD's | Preeclampsia for MD's
Overview
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema.
Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.).
In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia.
Eclampsia is defined as seizures that cannot be attributable to other causes in a woman with preeclampsia. HELLP syndrome (haemolysis, elevated liver enzyme, low platelets) may complicate severe preeclampsia.
Because the clinical manifestations of preeclampsia can be heterogeneous, diagnosing preeclampsia may not be straightforward. Preeclampsia without severe features may be asymptomatic. Many cases are detected through routine prenatal screening.
Authors
Sharespike
| 3 | | R380.00 | |
| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions.
The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities.
Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike | 3 | | R420.00 | |
| | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
| 3 | | R435.00 | |
| | Hypertension Part 1 | Hypertension Part 1
Overview
Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
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| | Sleep and the athlete: narrative review and 2021 expert consensus recommendations | Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Overview An ever-growing volume of peer-reviewed Publications speaks to the recent and rapid growth in scope and understanding of sleep for optimal athlete health and performance.
Herein, a panel of international experts review the current knowledge on sleep and the athlete, briefly covering the background, exploring continued controversies, highlighting fruitful avenues for future research and providing practical recommendations. The introduction section covers the need for sleep, including sleep architecture and the restorative benefits of sleep for the brain and body.
Pitfalls and challenges measuring athlete sleep are reviewed, and practical recommendations provided. The following section, entitled sleep and the athlete, covers the influence of sleep inadequacy and sleep extension on athletic performance. This article reviews the evidence that elite athletes are particularly susceptible to sleep inadequacy, for example, during intensified training and in those reporting symptoms of over-reaching and overtraining. The final section, entitled strategies to improve sleep, provides practical recommendations to alleviate the symptoms of jet lag, nutritional strategies to enhance sleep and a toolbox for practitioners to manage and optimise athlete sleep.
Authors Neil P Walsh et al.
Journal British Journal Sports Med 2020
| 3 | | R420.00 | |
| | Burn Resuscitation and Early Management | Burn Resuscitation and Early Management
Burn Resuscitation and Early Management
Overview Burn resuscitation refers to the replacement of fluids in burn patients to combat the hypovolemia and hypoperfusion that can result from the body’s systemic response to burn injury. The history of modern burn resuscitation can be traced back to observations made after large urban fires at the Rialto Theatre (New Haven, Conn) in 1921 and the Coconut Grove nightclub (Boston, Mass) in 1942. At the time, physicians noted that some patients with large burns survived the event but died from shock in the observation periods. Underhill and Moore identified the concept of thermal injury–induced intravascular fluid deficits in the 1930s and 1940s, and Evans soon followed with the earliest fluid resuscitation formulas in 1952. Up to that point, burns covering as little as 10-20% of total body surface area (TBSA) were associated with high rates of mortality.
Burns are a serious cause of human suffering and mortality globally. As many as 5% of burn victims will die as a result of their injuries, and many others will suffer disability, disfigurement, or scarring. This course addresses vital information regarding burn resuscitation and the early management thereof.
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| | Convulsions and Seizures | Convulsions and Seizures
Overview
Emergency services attend patients who are having a seizure on almost a daily basis. Consequently, they should understand the disease processes related to seizures and be confident in their prehospital management. In general, with the exception of a patient in Status Epilepticus, seizure management should be relatively straight forward.
So, what is a seizure and what causes it? Basically, a seizure is any unusually excessive neuronal firing from the brain which manifests as changes in a patient’s motor/sensory control, sensory perception, behaviour and autonomic function.
At a chemical level a seizure occurs when there is a sudden biochemical imbalance between the excitatory neurotransmitters and inhibitory neurotransmitters. The primary excitatory neurotransmitter found in the human central nervous system is called N-Methyl D Aspartate (NMDA); whereas the primary inhibitory neurotransmitter is called gamma-amino butyric acid (GABA). When there is an imbalance between these chemical mediators repeated firing and excitations of the neuronal cells occur.
Depending on the area of the brain in which this occurs, the seizure will manifest as a focal seizure, sensory change, behaviour disturbance, or complete tonic and clonic muscular activity. This course addresses important aspects relating to convulsions and seizures
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| | Bradycardia | Bradycardia
Overview Anaphylaxis is a life-threatening emergency that requires immediate prehospital care, but to date all treatment guidelines have been based on an in-hospital treatment. At EMS World Expo Peter Taillac, MD, detailed the process of an expert panel to research and publish an evidence-based guideline (EBG) for the recognition and treatment of anaphylaxis. The expert panel attempted to answer a series of questions about anaphylaxis assessment and treatment through literature research and review. The guideline is intended to serve as the scientific basis for future EMS anaphylaxis protocols.
Good evidence suggests that physicians under-prescribe epinephrine and that patients (or their parents) fail to use epinephrine as quickly as possible. Accordingly, at discharge, all patients should be provided an epinephrine autoinjector and should receive proper instruction on how to self-administer it in case of a subsequent episode.
| 3 | | R420.00 | |
| | The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective | The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
Overview Despite evidence demonstrating that medications for opioid use disorder (OUD) reduce morbidity and mortality, most patients do not receive treatment. The National Academies of Science call for more research exploring the patient’s perspective of treatment modalities to increase access to individualized, patient-centred care. The aim of this article is to build on existing literature by describing patient experiences treated for OUD in a rural family medicine setting. Participants’ experiences with OBOT were generally positive and shaped by societal structures and institutions, their life before treatment, their treatment history, and the kind of care they received in OBOT. Patients identified accessibility and privacy as advantages to receiving OBOT in primary care. This research identifies ways providers can provide individualized and effective OUD treatment within the family medicine setting.
Authors Claire Kane, BA, Catherine Leiner, Chase Harless, Kathleen A. Foley, E. Blake Fagan, and Courtenay Gilmore Wilson
Journal J Am Board Fam Med: first published as 10.3122/jabfm.2020.04.190389 on 16 July 2020
| 3 | | R385.00 | |
| | COVID-2019 -A comprehensive pathology insight | COVID-2019 -A comprehensive pathology insight
COVID-2019 -A comprehensive pathology insight
Overview Corona virus disease-2019 (COVID-19) caused by severe acute respiratory syndrome corona virus-2 (SARS CoV- 2), a highly contagious single stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Occasionally patient may present with gastro-intestinal, cardiac and neurologic symptoms with or without lung involvement. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. Other organs like liver and kidneys may be involved secondarily.
Currently the treatment is principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. During the pandemic there is paucity of literature on pathological features including pathogenesis, hence in this review we provide the current pathology centred understanding of COVID-19. Furthermore, the pathogenetic pathway is pivotal in the development of therapeutic targets.
Authors Chandrakumar Shanmugam, Abdul Rafi Mohammed, Swarupa Ravuri, Vishwas Luthra, Narasimhamurthy Rajagopal, Saritha Karre
Journal Pathology - Research and Practice 216 (2020) 153222
| 3 | | R440.00 | |
| | Adolescent knee pain: fracture or normal? A case report. | Adolescent knee pain: fracture or normal? A case report.
Adolescent knee pain: fracture or normal? A case report.
Overview Knee injuries are the second to fourth most common injuries in youth soccer. In this population, sprains/strains, fractures and contusions are most common. Due to variations in the developing skeleton, it can be difficult to rule out fractures. We present a case of a 13-year-old presenting to the emergency department (ED) with patellar pain after pivoting during a soccer game. After radiographic clearance, he was allowed to return to sport. Following another fall and ED visit, his full leg was casted. He presented to a chiropractor after cast removal, who made recommendations for progressive rehabilitation owing to the lack of evidence for fracture on radiographs. We suggest a thorough history, physical and Ottawa knee rules to determine whether We suggest a thorough history, physical and Ottawa knee rules to determine whether radiographs are indicated in the management of a pediatric knee injury. Due to normal skeletal variance, we recommend bilateral radiographs and if findings are ambiguous, consultation with a radiologist to confirm clinical suspicions.
Authors: Melissa Corso and Scott Howitt
Journal: The Journal of the Canadian Chiropractic Association Volume 62 Issue 2 | 3 | | R465.00 | |
| | Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors | Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors
Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors
Overview To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centres and nursing homes in the Healthcare Area of León (Spain). The work centre, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.
Authors: V. Martín, T. Fernández-Villa, M. Lamuedra Gil de Gomez, O. Mencía-Ares, A. Rivero Rodríguez, S. Reguero Celada, M. Montoro Gómez, M.T. Nuevo Guisado, C. Villa Aller, C. Díez Flecha, A. Carvajal, J.P. Fernández Vázquez
Journal: Semergen. 2020;46(S1):42---46 | 3 | | R400.00 | |
| | Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project | Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project
Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project
Overview Prevention of infectious diseases through immunisation of the growing ageing adult population is essential to improve healthy ageing. However, many licenced and recommended vaccines for this age group show signs of waning of the protective effect due to declining immune responses (immunosenescence) and decreasing vaccine uptake. Today’s major challenge is to improve vaccine effectiveness and uptake and to deploy efficient vaccination strategies for this age group. The Vaccines and Infectious diseases in the Ageing population (VITAL) project, with partners from 17 academic & research groups and public institutes as well as seven industry collaborators, aims to address this challenge. The ambition is to provide evidence-based knowledge to local decision makers. Using a holistic and multidisciplinary approach and novel analytical methods, VITAL will provide tools that allow the development of targeted immunisation programs for ageing adults in European countries. The project is based on four pillars focussing on the assessment of the burden of vaccine-preventable diseases in ageing adults, the dissection of the mechanisms underlying immuno-senescence, the analysis of the clinical and economic public health impact of vaccination strategies and the development of educational resources for healthcare professionals.
Authors Debbie Van Baarle, Kaatje Bollaerts, Giuseppe Del Giudice, Stephen Lockhart, Christine Luxemburger, Maarten J. Postma, Aura Timen, Baudouin Standaert
Journal Vaccine 38 (2020) 5896–5904 https://doi.org/10.1016/j.vaccine.2020.07.005
URL https://www.sciencedirect.com/science/article/pii/S0264410X20309051?via%3Dihub | 3 | | R425.00 | |
| | Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours | Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours
Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours
Overview
Global pandemic outbreaks are a cause of fear. Healthcare workers (HCWs), especially those fighting the pathogens at the front line, are at higher risk of being infected while they treat patients. In addition, various environmental fomites in hospitals, which may carry infectious agents, can increase the risk of acquiring an infectious disease.
To deliver the best healthcare practice, it is critical that HCWs feel safe and protected against infectious diseases. The aim of this study was to improve understanding of HCWs’ hand hygiene (HH) behaviours and perceptions of infectious diseases from a psychological perspective.
This study found that an increase in the number of HH stations at convenient locations would increase HH compliance and perceived safety against infectious diseases among HCWs. In response to the current research gap in psychological aspects associated with HH, this study found that HCWs’ coping behaviours can be predicted by their perceived likelihood of contamination and perceived vulnerability.
Author S. Bae
Journal Journal of Hospital Infection 106 (2020) 107e114 https://doi.org/10.1016/j.jhin.2020.06.022
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308774/pdf/main.pdf | 3 | | R420.00 | |
| | Clinical Practice Guidelines: Pediatric Gastroenteritis | Clinical Practice Guidelines: Pediatric Gastroenteritis
Clinical Practice Guidelines: Pediatric Gastroenteritis
Overview
Infective gastroenteritis in young children is characterised by the sudden onset of diarrhoea, with or without vomiting. Most cases are due to an enteric virus, but some are caused by bacterial or protozoal infections. The illness usually resolves without treatment within days; however, symptoms are unpleasant and affect both the child and family or carers. Severe diarrhoea can quickly cause dehydration, which may be life threatening (National Institute for Health and Care Excellence, 2009).
Oral rehydration therapy is replacement of fluids and electrolytes, such as sodium, potassium, and chloride necessary for normal physiological functions and is effective in 95% of cases of mild to moderate dehydration. Oral rehydration therapy is less invasive, less expensive, is associated with less morbidity and can be dispensed outside of the hospital setting, while being as effective as IV treatment (Medical Services Commission, 2010).
Acknowledgement
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R410.00 | |
| | Tuberculosis Part 2 | Tuberculosis Part 2
Overview
Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors:
Thomas E Herchline,Thomas E Herchline, Judith K Amorosa, Judith K Amorosa. | 3 | | R420.00 | |
| | Tuberculosis Part 1 | Tuberculosis Part 1
Overview Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors: Thomas E Herchline and Judith K Amorosa | 3 | | R420.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease.
This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements
Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Malaria | Malaria
Overview Malaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Most patients with malaria have no specific physical findings, but splenomegaly may be present. In patients with suspected malaria, obtaining a history of recent or remote travel to an endemic area is critical. Asking explicitly if they travelled to a tropical area at any time in their life may enhance recall. Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas.
It is also important to determine the patient's immune status, age, and pregnancy status; allergies or other medical conditions that he or she may have; and medications that he or she may be using.
Acknowledgements Authors:
Thomas E Herchline, Thomas E Herchline, Ryan Q Simon
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| | Diabetes Mellitus Part 3 | Diabetes Mellitus Part 3
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori
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| | Diabetes Mellitus Part 2 | Diabetes Mellitus Part 2
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Diabetes Mellitus Part 1 | Diabetes Mellitus Part 1
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Hyperglycemia | Hyperglycemia
Overview:
Hyperglycemia (also spelled hyperglycaemia or hyperglycæmia), is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 13.9–16.7 mmol/l (~250–300 mg/dl). For diabetics, glucose levels that are too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. Hypoglycemia, also known as low blood sugar, is a fall in blood sugar to levels below normal. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures or death. A feeling of hunger, sweating, shakiness and weakness may also be present. Symptoms typically come on quickly. The most common cause of hypoglycemia is medications used to treat diabetes mellitus such as insulin and sulfonylureas. Risk is greater in diabetics who have eaten less than usual, exercised more than usual or drunk alcohol. Other causes of hypoglycemia include kidney failure, certain tumours (such as insulinoma), liver disease, hypothyroidism, starvation, inborn error of metabolism, severe infections, reactive hypoglycemia and several drugs including alcohol. Low blood sugar may occur in otherwise healthy babies who have not eaten for a few hours.
Acknowledgements:
Author:
Jasvinder Chawla
| 3 | | R410.00 | |
| | Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues | Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues
Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues
Overview The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia.
The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.
Authors: Suzanne Delwel, Tarik T. Binnekade, Roberto S. G. M. Perez, Cees M. P. M. Hertogh, Erik J. A. Scherder, Frank Lobbezoo Journal: Clinical Oral Investigations
| 3 | | R390.00 | |
| | Pharmacological and Dietary Factors in preventing Colorectal Cancer | Pharmacological and Dietary Factors in preventing Colorectal Cancer
Pharmacological and Dietary Factors in preventing Colorectal Cancer
Overview
Colorectal cancer (CRC) is the third most prevalent neoplasm worldwide and fourth most frequent reason of cancer-related death throughout the world. About 70% of malignant tumours are related to lifestyle and environmental factors, and better knowledge of their significance might reduce the prevalence of CRC. The cyclo-oxygenase-2 (COX-2) inhibitory and other direct and indirect pathways of aspirin are translated to inhibition proliferation and enhanced apoptosis of cancer cells.
A high energy diet consisting of red meat, animal fat, highly processed foods and unsaturated fats increases the risk of CRC. Carcinogenic role of fat and cholesterol depends on increased production of primary bile acids. Fruits, vegetables and grain are considered to have protective effects against adenoma and CRC. Excessive alcohol consumption, smoking and physical inactivity are considered as important CRC risk factors.
This article briefly summarizes current state of knowledge about the role of pharmacological and dietary prevention of colorectal cancer. Moreover, it indicates that despite many studies some aspects of this issue are not clear and require future studies.
Acknowledgement
Author M. Waluga, M. Zorniak, J. Fichna, M. Kukla and M. Hartleb
Journal Journal of Physiology and Pharmacology 2018
| 3 | | R435.00 | |
| | Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer | Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer
Overview
Endometrial cancer is the most common gynaecologic cancer in developed countries and has been increasing at a rate of over 2.5% per year in North America for the last decade [1]. Most women are diagnosed at an early stage and surgery is the primary treatment, including total hysterectomy, bilateral salpingo-oophorectomy and surgical staging, which can include pelvic and para-aortic lymph node assessment [2].
This online course aims at evaluating patient-reported outcomes (PROs) between women treated by laparoscopic, robotic and open approaches for endometrial cancer. Historically, the preferred surgical approach for treatment of endometrial cancer has been laparotomy. However, multiple randomized controlled trials (RCTs) comparing laparoscopy to laparotomy have reported decreases in postoperative complication rates and length of hospital stay in women undergoing laparoscopy [3–6]. Importantly, there appears to be no difference in disease-free and overall survival in those women treated by a minimally invasive approach [6,7]. Based on these findings, laparoscopy, and more recently robotic surgeries, have become standard surgical approaches for endometrial cancer.
It was concluded that minimally invasive approaches result in improved QOL beyond the short-term postoperative
Acknowledgement
Author Sarah E. Ferguson, Tony Panzarella, Susie Lau, Lilian T. Given, Vanessa Samouëlian, Christopher Giede, Helen Steedi, Tien Le, Ben Renkosinski, Marcus Q, Bernardini,
Journal
Gynecologic Oncology
| 3 | | R410.00 | |
| | Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials | Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials
Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials
Overview
We recently published two independent randomized controlled trials of vitamin D supplementation during pregnancy, both indicating a >20% reduced risk of asthma/recurrent wheeze in the offspring by 3 years of age. However, neither reached statistical significance. VDAART (N = 806) and COPSAC2010. (N = 581) randomized pregnant women to daily high-dose vitamin D3 (4,000 IU/d and 2,400 IU/d, respectively) or placebo. All women also received a prenatal vitamin containing 400 IU/d vitamin D3. The primary outcome was asthma/recurrent wheeze from 0-3yrs.
We conducted random effects combined analyses of the treatment effect, individual patient data (IPD) meta-analyses, and analyses stratified by 25(OH)D level at study entry. This combined analysis shows that vitamin D supplementation during pregnancy results in a significant reduced risk of asthma/recurrent wheeze in the offspring, especially among women with 25(OH)D level 30 ng/ml at randomization, where the risk was almost halved. Future studies should examine the possibility of raising 25(OH)D levels to at least 30 ng/ml early in pregnancy or using higher doses than used in our studies
Acknowledgements
Authors Helene M. Wolsk, Bo L. Chawes, Augusto A. Litonjua, Bruce W. Hollis, Johannes Waage, Jakob Stokholm, Klaus Bønnelykke, Hans Bisgaard and Scott T. Weiss.
Journal PLoS One
| 3 | | R465.00 | |
| | Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis | Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis
Pregnancy following robot-assisted laparoscopic partial cystectomy and gonadotropin-releasing hormone agonist treatment within three months in an infertile woman with bladder endometriosis
Overview
Endometriosis is a benign disease defined as endometrial tissue implanting outside the uterine cavity and often causes dysmenorrhea, pelvic pain, dyspareunia and infertility. The prevalence of endometriosis has been reported in up to 50% of infertile women. This article serves to report an infertility case of deep-infiltrating bladder endometriosis conceiving following robot-assisted surgery and modified gonadotropin-releasing hormone agonist (GnRHa) treatment.
Case report: A 33-year-old infertile female presenting with dysmenorrhea was found to have a bladder mass by pelvic ultrasound. Cystoscopy revealed a protruding tumour from the posterior bladder wall, and endometriosis was highly suspected. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating bladder endometriosis. With postoperative half-dose GnRHa treatment and timed intercourse, she got pregnant within 3 months.
It was concluded that robot-assisted complete resection of deep-infiltrating endometriosis and bladder repair immediately followed by GnRHa therapy and medical assistance improves reproductive outcomes efficiently in women with endometriosis-associated infertility
Acknowledgement
Author Shun-Jen Tan, Chi-Huang Chen, Shauh-Der Yeh, Yun-Ho Lin, Chii-Ruey Tzeng
Journal Taiwanese Journal of Obstetrics & Gynaecology
| 3 | | R435.00 | |
| | Mortality effects of timing alternatives for hip fracture surgery | Mortality effects of timing alternatives for hip fracture surgery
Mortality effects of timing alternatives for hip fracture surgery
Overview:
The appropriate timing of hip fracture surgery remains a matter of debate. It was sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.
We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram.
Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
Acknowledgement
Authors:
Boris Sobolev PhD, Pierre Guy MD, Katie Jane Sheehan PhD, Lisa Kuramoto MSc, Jason M. Sutherland PhD, Adrian R. Levy PhD, James A. Blair MD, Eric Bohm MD, Jason D. Kim MPH, Edward J. Harvey MD, Suzanne N. Morin MD, Lauren Beaupre PhD, Michael Dunbar MD, Susan Jaglal PhD, James Waddell MD; for the Canadian Collaborative Study of Hip Fractures
Journal:
CMAJ Group Volume 190 Issue 31
Publisher:
National Centre for Biotechnology Information | 3 | | R460.00 | |
| | Offspring sex impacts DNA methylation and gene expression in placentae from women with diabetes during pregnancy | Offspring sex impacts DNA methylation and gene expression in placentae from women with diabetes during pregnancy
Offspring sex impacts DNA methylation and gene expression in placentae from women with diabetes during pregnancy
Overview
We hypothesized that diabetes during pregnancy (DDP) alters genome-wide DNA methylation in placenta resulting in differentially methylated loci of metabolically relevant genes and downstream changes in RNA and protein expression.
We mapped genome-wide DNA methylation with the Infinium 450K Human Methylation Bead Chip in term fetal placentae from Native American and Hispanic women with DDP using a nested case-control design. Placentae from female offspring were 40% more likely to have significant gains in DNA methylation compared with placentae from male offspring exposed to DDP (p<0.001). Changes in DNA methylation corresponded to changes in RNA and protein levels for 6 genes: PIWIL3, CYBA, GSTM1, GSTM5, KCNE1 and NXN. Differential DNA methylation was detected at loci related to mitochondrial function, DNA repair, inflammation, oxidative stress.
In conclusion, we explain mechanisms responsible for the increased risk for obesity and type 2 diabetes in offspring of mothers with DDP
Acknowledgement
Author Jacqueline Alexander, April M. Teague, Jing Chen, Christopher E. Aston, Yuet-Kin Leung, Steven Chernausek, Rebecca A. Simmons and Sara E. Pinney
Journal
PLoS One Volume 13 Issue 2
Publisher
Crossmark
| 3 | | R425.00 | |
| | Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors | Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors
Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors
Overview
Understanding determinants of community mobility disability is critical for developing interventions aimed at preventing or delaying disability in older adults. To understand these determinants, capturing and measuring community mobility has become a key factor. The objectives of this paper are to present and illustrate the signal processing workflow and outcomes that can be extracted from an activity and community mobility measurement approach based on GPS and accelerometer sensor data and 2) to explore the construct validity of the proposed measurement approach using data collected from healthy older adults in free-living conditions.
Wearability and usability of the devices used to capture free-living community mobility impact participant compliance and the quality of the data. The construct validity of the proposed approach appears promising but requires further studies directed at populations with mobility impairments.
Acknowledgement
Author Patrick Boissy, Margaux Blamoutier, Simon Brière and Christian Duval Journal Frontiers in Public Health Volume 6 Article 216 | 3 | | R395.00 | |
| | Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry | Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry
Simultaneous Detection of Key Bacterial Pathogens Related to Pneumonia and Meningitis Using Multiplex PCR Coupled With Mass Spectrometry
Overview
Pneumonia and meningitis continue to present an enormous public health burden and pose a major threat to young children. Among the causative organisms of pneumonia and meningitis, bacteria are the most common causes of serious disease and deaths. It is challenging to accurately and rapidly identify these agents.
Using the BP-MS method, we could accurately identify the expected bacteria without cross-reactivity with other pathogens. For the 11 target bacterial pathogens, the analytical sensitivity of the BP-MS method was as low as 10 copies/reaction. To further evaluate the clinical effectiveness of this method, 204 nasopharyngeal swabs from hospitalized children with suspected pneumonia were tested using this method.
We used real-time PCR and nested PCR to confirm positive results, with identical results obtained for 81.4% (136/167) of the samples. The BP-MS method is a sensitive and specific molecular detection technique in a multiplex format and with high sample throughput. Therefore, it will be a powerful tool for pathogen screening and antibiotic selection at an early stage of disease.
Acknowledgements
Authors Chi Zhang, Leshan Xiu, Yan Xiao, Zhengde Xie, Lili Ren and Junping Peng
Journal Frontiers in Cellular and Infection Microbiology Volume 8
Publisher Cross Mark
| 3 | | R460.00 | |
| | A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma | A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma
A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma
Overview
Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumours. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass.
Primary cardiac angiosarcomas in all age groups mostly occur in the right atrium. The most common complaints presented are dyspnea and chest pain, usually related to a malignant cardiac effusion. The pericardium is frequently involved with a right sided angiosarcoma; cardiac tamponade and pericardial effusion are common complications. Our patient had a massive pericardial effusion and malignant cells were seen in cytologic examination.
The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl. Acknowledgement
Authors Elvan Caglar Citak, MD, PhD; Murat Ozeren, MD; M. Kerem Karaca, MD; Derya Karpuz, MD; Feryal Karahan, MD; Eda , Bengi Yilmaz, MD; Yuksel Balci, MD; Pelin Ozcan Kara, MD; Rabia Bozdogan Arpaci, MD Journal Brazilian Journal of Cardiovascular Surgery
| 3 | | R460.00 | |
| | Efficacy of Internet-delivered cognitive-behavioural therapy for the management of chronic pain in children and adolescents A systematic review and meta-analysis | Efficacy of Internet-delivered cognitive-behavioural therapy for the management of chronic pain in children and adolescents A systematic review and meta-analysis
Efficacy of Internet-delivered cognitive-behavioural therapy for the management of chronic pain in children and adolescents A systematic review and meta-analysis
Overview
Paediatric chronic pain is relatively common in the world. Although cognitive behaviour therapy (CBT) has been shown to be efficacious in children and adolescents, it is generally recognized that availability and accessibility of CBT are limited. However, Internet-delivered cognitive-behavioural therapy (ICBT) performs better in these areas. This systematic review aims to evaluate the clinical effects of ICBT for chronic pain in youth when compared with the control treatments.
We searched electronic databases to identify randomized controlled trials that compared ICBT with the control therapy for paediatric chronic pain. The primary outcomes were 95% confidence intervals and mean difference or standardized mean difference in change of pain intensity and activity limitations. Four trials met the inclusion criteria with a total of 404 participants of whom 208 received ICBT. Compared with pre-treatment, children reported significant, medium to large benefits on pain intensity, activity limitations, and parental protective behaviours after receiving ICBT immediately. ICBT for physical and psychological conditions in youth with chronic pain is a full potential therapy; it can be successful on clinically effects and socioeconomic benefits.
Acknowledgement
Author Wen-Xin Tang, Lu-Feng Zhang, Yan-Qiu Ai and Zhi-Song Li
Journal Medicine (Baltimore).
Publisher Wolters Kluwer Health, Inc. | 3 | | R390.00 | |
| | Role of viral and bacterial pathogens in causing pneumonia among Western Australian children | Role of viral and bacterial pathogens in causing pneumonia among Western Australian children
Role of viral and bacterial pathogens in causing pneumonia among Western Australian children
Overview
Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugate Haemophilus influenzae B and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia.
Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies.
Nasopharyngeal swabs are collected from both cases and controls to detect the presence of viruses and bacteria by PCR; pathogen load will be assessed by quantitative PCR. The prevalence of pathogens detected in cases and controls will be compared, the OR of detection and population attributable fraction to CAP for each pathogen will be determined; relationships between pathogen load and disease status and severity will be explored.
Acknowledgement
Authors Natalie Mejbah Uddin Bhuiyan, Thomas L Snelling, Rachel West, Jurissa Lang, Tasmina Rahman, Meredith L Borland, Ruth Thornton, Lea-Ann Kirkham, Chisha Sikazwe, Andrew C Martin, Peter C Richmond, David W Smith, Adam Jaffe, Christopher C Blyth.
Journal BMJ Open Publisher Cross Mark | 3 | | R430.00 | |
| | Early Intervention for Children with Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research. | Early Intervention for Children with Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research.
Early Intervention for Children with Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research.
Overview
This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged <3 years, based on peer-reviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioural teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized and facilitating the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8- to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research.
Acknowledgement:
Authors: Zwaigenbaum L, Bauman ML, Choueiri R, Kasari C, Carter A, Granpeesheh D, Mailloux Z, Smith Roley S, Wagner S, Fein D, Pierce K, Buie T, Davis PA, Newschaffer C, Robins D, Wetherby A, Stone WL, Yirmiya N, Estes A, Hansen RL, McPartland JC, Natowicz MR
Journal: Pediatrics. Publisher: American Academy of Pediatrics
| 3 | | R465.00 | |
| | QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient | QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient
QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient
Overview
Life-threatening arrhythmia may be induced by corrected QT (QTc) interval prolongation. Several antimicrobial drugs have been associated with QTc interval prolongation. Favipiravir is an inhibitor of the RNA-dependent RNA polymerase of many RNA viruses, including influenza viruses, arenaviruses, phleboviruses, hantaviruses, flaviviruses, enteroviruses, and noroviruses. Favipiravir has also been used in the recent epidemic of Ebolavirus (EBOV) in West Africa. To date, no significant effects of favipiravir on the QT/QTc interval have been detected. We report a case of QTc interval prolongation during favipiravir therapy in an EBOV-infected patient treated at our institution.
In conclusion, we suggest that favipiravir administered at high doses, together with the cofactors discussed above, may have contributed to inducing a QTc interval prolongation in our EBOV patient. If feasible, ECG monitoring could be advisable during high-dose favipiravir therapy, especially when patients experience electrolyte disturbances and concomitant use of drugs with QTc-prolonging potential. Encephalitis or central nervous system (CNS) pathology may have a role in prolonging QT interval. Acknowledgement
Authors Pierangelo Chinello, Nicola Petrosillo, Silvia Pittalis, Gianluigi Biava, Giuseppe Ippolito, Emanuele Nicastri, on behalf of the INMI Ebola Team
Journal PLoS Neglected Tropical Diseases
Publisher Cross Mark
| 3 | | R390.00 | |
| | Structure and assembly of the Ebola virus nucleocapsid | Structure and assembly of the Ebola virus nucleocapsid
Structure and assembly of the Ebola virus nucleocapsid
Structure and assembly of the Ebola virus nucleocapsid
Overview
Ebola and Marburg viruses are filoviruses: filamentous, enveloped viruses that cause haemorrhagic fever1. Filoviruses are within the order Mononegavirales2 which also includes rabies virus, measles virus, and respiratory syncytial virus. Mononegaviruses have non-segmented, single-stranded negative-sense RNA genomes that are encapsidated by nucleoprotein (NP) and other viral proteins to form a helical nucleocapsid (NC). NC acts as a scaffold for virus assembly and as a template for genome transcription and replication. Insights into NP-NP interactions have been derived from structural studies of oligomerized, RNA-encapsidating NP3–6 and cryo-electron microscopy (cryo-EM) of NC7–12 or NC-like structures11–13. There have been no high-resolution reconstructions of complete mononegavirus NCs.
Here, we have applied cryo-electron tomography and sub-tomogram averaging to determine the structure of Ebola virus NC within intact viruses and recombinant NC-like assemblies. These structures reveal the identity and arrangement of the NC components, and suggest that the formation of an extended alpha-helix from the disordered C-terminal region of NP-core links NP oligomerization, NC condensation, RNA encapsidation, and accessory protein recruitment. Acknowledgement
Author William Wan, Larissa Kolesnikova, Mairi Clarke, Alexander Koehler, Takeshi Noda, Stephan Becker and John A. G. Briggs.
Journal Nature. 2017 November 16; 551(7680-397)
Publisher URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714281/pdf/emss-74396.pdf
| 3 | | R455.00 | |
| | Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening | Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening Overview
The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening.
During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.
Acknowledgement
Authors Philomena Raftery, Orla Condell, Christine Wasunna, Jonathan Kpaka, Ruth Zwizwai, Mahmood Nuha, Mosoka Fallah, Maxwell Freeman, Victoria Harris, Mark Miller, April Baller, Moses Massaquoi, Victoria Katawera, John Saindon, Philip Bemah, Esther Hamblion, Evelyn Castle, Desmond Williams, Alex Gasasira, Tolbert Nyenswah.
Journal PLoS Neglected Tropical Diseases Volume 12 Issue 1
Publisher
Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755746/pdf/pntd.0006135.pdf
| 3 | | R465.00 | |
| | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review
Overview
Cardiovascular evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published since 2016. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates. Despite the empirical debate regarding the cognitive benefit of de-worming for STH, the current ethical, clinical and health policy environments remain strongly skewed in favor of de-worming for child growth, prevention of anaemia and potentially avoidance of preventable cognitive deficits
Acknowledgement
Author
Noel Pabalan, Eloisa Singian, Lani Tabangay, Hamdi Jarjanazi, Michael J. Boivin, Amara E. Ezeamama
Journal PLoS Neglected Tropical Diseases
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766095/pdf/pntd.0005523.pdf
Publisher Cross Mark
| 3 | | R465.00 | |
| | Medical Tourism. | Medical Tourism.
Overview
BACKGROUND: Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment.
OBJECTIVE:
This article provides an outline of the current research around medical tourism, especially its impact on Australians.
DISCUSSION:
Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad
Acknowledgement
Author:
Leggat P
Journal:
Australian family physician.
Publisher:
Focus Environmental
| 3 | | R360.00 | |
| | Suicide in Pretoria: A retrospective review, 2007 - 2010. | Suicide in Pretoria: A retrospective review, 2007 - 2010.
Suicide in Pretoria: A retrospective review, 2007 - 2010.
Overview
Background: The World Health Organization has declared suicide a global ealth crisis, predicting that ~1.53 million people will commit suicide annually by 2020.
Obejective:
A study from South Africa reviewed 1 018 suicide cases in Pretoria over 4 years (1997 - 2000). Our study was undertaken to establish whether there have been substantial changes in the profile of suicide victims who died in Pretoria a decade later.
Methods:
Case records at the Pretoria Medico-Legal Laboratory were reviewed retrospectively from 2007 to 2010.
Results:
A total of 957 suicide cases were identified. Hanging was the most common method of suicide, followed by self-inflicted firearm injury. The true incidence of suicidal intake of prescription drugs/medication was difficult to determine, because of a backlog at the state toxicology laboratories. White males and females appeared to be over-represented among suicide victims, but there has been an increase in suicide among blacks. There seems to have been a substantial decrease in the use of firearms to commit suicide - possibly reflecting a positive outcome of gun control legislation that has been introduced in the interim.
Conclusion: Suicide continues to constitute almost 10% of all fatalities admitted to the Pretoria Medico-Legal Laboratory, confirming suicide as a major cause of mortality in our society. Further research is needed to clarify the profile of suicidal deaths, with a view to informing resource allocation and to improve preventive strategies
Acknowledgement
Author:
Engelbrecht C, Blumenthal R, Morris NK, Saayman G
Journal:
South African medical journal.
Publisher:
SAMJ Research
http://www.samj.org.za/index.php/samj/article/view/12015/8182
| 3 | | R410.00 | |
| | Denial of abortion in legal settings. | Denial of abortion in legal settings.
Denial of abortion in legal settings.
Overview
Background: Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce.
Methods: In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care.
Results: The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions.
Conclusions: The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services.
Acknowledgement
Author:
Gerdts C, DePiñeres T, Hajri S, Harries J, Hossain A, Puri M, Vohra D, Foster DG
Journal:
The journal of family planning and reproductive health care.
Publisher:
BMJ Publishing Group Limited | 3 | | R420.00 | |
| | Peptic Ulcers | Peptic Ulcers
OVERVIEW
Peptic Ulcers are a common disease characterised by injuries of the gastrointestinal mucosa of the stomach or duodenum. The enzyme pepsin and gastric acid are factors involved in the pathogenesis of ulcers.
The most important risk factors for the development of peptic ulcers are infection with Helicobacter Pylori and the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). If neither of these factors is present, an alternative aetiology must be sought, such as hypersecretory states (e.g. Zollinger-Ellison syndrome) or one of the other less common causes of ulcer disease, including Crohn's disease, vascular insufficiency, viral infection, radiation therapy, and cancer chemotherapy.
This study looks at the common causes and what medicine to treat with. | 3 | | R325.00 | |
| | Prognostic Factors for Disability and Sick Leave Patients with Subacute Non-Malignant Pain. | Prognostic Factors for Disability and Sick Leave Patients with Subacute Non-Malignant Pain.
Prognostic Factors for Disability and Sick Leave Patients with Subacute Non-Malignant Pain.
OVERVIEW
Pain is one of the most common reasons patients consult general practice. It has been observed that long-term disability and sick leave due to a pain conditions are associated with huge negative consequences for the individual and for society.
The objective of this systematic review was therefore to identify generic prognostic factors for disability and sick leave in sub-acute pain patients. The setting of this study was nevertheless general practice and other primary care facilities. Participants in this study were adults (>18 years) with a sub-acute non-malignant pain condition. 19 studies were included, referring to a total of 6266 patients suffering from pain in the head, neck, back and shoulders. The primary outcome of this study was long-term disability (>3 months) due to a pain condition whereas the secondary outcome was sick leave, defined as ‘absence from work’ or ‘return-to-work. Data was obtained through a search via PubMed, EMBASE, CINAHL and PEDro databases from 16 from January 2003 to 16 January 2014.
The study was concluded that multiple site pain, high pain severity, older age, baseline disability and longer pain duration were potential prognostic factors for disability across pain sites.
ACKNOWLEDGEMENT
AUTHOR: Gitte H Valentin, Marc S Pilegaard, Henrik B Vaegter, Marianne Rosendal, Lisbeth Ørtenblad, Ulla Væggemose, Robin Christensen
JOURNAL: BMJ General Practice
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com
| 3 | | R365.00 | |
| | Understanding quit decisions in primary care: a qualitative study of older GPs | Understanding quit decisions in primary care: a qualitative study of older GPs
Understanding quit decisions in primary care: a qualitative study of older GPs
OVERVIEW
The UK, notably England faces a major and imminent problem in respect of general practitioner (GP) workforce capacity. According to a recent work survey, 54.1% of GPs aged 50 years and older reported a ‘considerable’ or ‘high’ likelihood of quitting direct patient care within 5 years.
The objective of this study was to investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50–60 years. This research was a qualitative study based on semi structured interviews with GPs in the South West region of England. The participants for this study were 23 GPs aged 50–60 years. 3 of these GPs had retired from direct patient care before the age of 60, meanwhile 20 intended to quit direct patient care within the next 5 years.
Conclusively, this research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions.
ACKNOWLEDGEMENT
AUTHORS: Anna Sansom, Raff Calitri, Mary Carter, John Campbell
JOURNAL: Journal of General Practice
PUBLISHER: BMJ Group
URL: http://bmjopen.bmj.com | 3 | | R360.00 | |