| | Clinical Practice Guidelines: Trauma Part 2 | Clinical Practice Guidelines: Trauma Part 2
Clinical Practice Guidelines: Trauma Part 2
Overview “Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004).
The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis.
Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R 410.00 |  |
| | 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 | | R 410.00 | |
| | Clinical Practice Guidelines: Pain and Procedural Sedation | Clinical Practice Guidelines: Pain and Procedural Sedation
Clinical Practice Guidelines: Pain and Procedural Sedation
Overview “The management of acute traumatic pain is a crucial component of pre-hospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based protocols” (Gausche-Hill et al., 2014). Pain management is also frequently based on the assessment of need by a provider, rather than the requirements of patients. Historically only Entonox and morphine have been available for pre-hospital pain management in the local setting with the more recent introduction of ketamine. Availability of appropriate and effective treatment options, especially for non-ALS providers, remains a challenge.
Situations requiring procedural sedation and analgesia in the pre-hospital setting are common and may range from alignment of fracture to extrication and complex disentanglement during medical rescue. Until recently South African pre-hospital providers did not have agents suitable for this purpose, particularly in the setting of severe trauma and hypotension. As ketamine has been introduced into some scopes of practice providing safe and effective dissociative procedural analgesia has become a possibility. However, the use of procedural sedation and analgesia is not without risks and, at this time, no uniform practice has been suggested in the South African pre-hospital setting. Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynaecology Part 4 | Clinical Practice Guidelines: Obstetrics and Gynaecology Part 4
Clinical Practice Guidelines: Obstetrics and Gynaecology Part 4
Overview There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 3 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 3
Clinical Practice Guidelines: Obstetrics and Gynecology Part 3
Overview There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Acknowledgement Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice guidelines—Obstetrics and Gynaecology: Part 2 | Clinical Practice guidelines—Obstetrics and Gynaecology: Part 2
Clinical Practice guidelines—Obstetrics and Gynaecology: Part 2
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice.
Acknowledgement
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 1 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 1
Clinical Practice Guidelines: Obstetrics and Gynecology Part 1
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Neonatal Resuscitation | Clinical Practice Guidelines: Neonatal Resuscitation
Clinical Practice Guidelines: Neonatal Resuscitation
Overview
Monitoring equipment for neonates and infants may not be uniformly available to all EMS providers. All ALS providers should have monitoring equipment appropriate for neonates. It is recommended that oximetry be used when resuscitation can be anticipated, when PPV is administered, when central cyanosis persists beyond the first 5 to 10 minutes of life, or when supplementary oxygen is administered. In summary, from the evidence reviewed in the 2010 CoSTR and subsequent review of delaying cord clamping and cord milking in preterm new-borns in the 2015 ILCOR systematic review, delaying cord clamping for longer than 30 seconds is reasonable for both term and preterm infants who do not require resuscitation at birth. It is recommended that the temperature of newly born non-asphyxiated infants be maintained between 36.5°C and 37.5°C after birth through admission and stabilisation. Targeted temperature management requires specific equipment and well established systems and protocol and system wide clinical governance. In neonates it may also require the establishment of dedicated, specialized and equipped retrieval teams.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Fever and Sepsis | Clinical Practice Guidelines: Fever and Sepsis
Clinical Practice Guidelines: Fever and Sepsis
Overview
Feverish illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. Despite advances in healthcare, infections remain a leading cause of death in children under the age of 5 years. Fever in young children can be a diagnostic challenge for healthcare professionals because it is often difficult to identify the cause. In most cases, the illness is due to a self-limiting viral infection. However, fever may also be the presenting feature of serious bacterial infections such as meningitis and pneumonia. A significant number of children have no obvious cause of fever despite careful assessment. These children with fever without apparent source are of concern to healthcare professionals because it is especially difficult to distinguish between simple viral illnesses and life-threatening bacterial infections in this group.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Overview
There is growing evidence that good early stroke management can reduce damage to the brain and minimise the effects of stroke. Because of this early recognition of stroke, the subsequent response of individuals to having a stroke, and the timing and method by which people are transferred to hospital are important to ensure optimal outcomes. In this hyperacute phase of care, the ambulance service provides a central, coordinating role (Australian Government Health and Medical Research Council, 2007). Appropriate diagnosis of stroke and immediate referral to a stroke team is vital given advances in hyperacute treatments (Australian Government Health and Medical Research Council, 2007).
As in all scene responses, EMS personnel must assess and manage the patient’s airway, breathing, and circulation. Most patients with acute ischemic stroke do not require emergency airway management or acute interventions for respiratory and circulatory support (Jauch et al., 2013).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Airway Part 2 | Clinical Practice Guidelines: Airway Part 2
Clinical Practice Guidelines: Airway Part 2
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008). Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 3 | Clinical Practice Guidelines: Adult Resuscitation Part 3
Clinical Practice Guidelines: Adult Resuscitation Part 3
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 2 | Clinical Practice Guidelines: Adult Resuscitation Part 2
Clinical Practice Guidelines: Adult Resuscitation Part 2
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018)
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 1 | Clinical Practice Guidelines: Adult Resuscitation Part 1
Clinical Practice Guidelines: Adult Resuscitation Part 1
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice Guidelines Airway Part 1 | Clinical Practice Guidelines Airway Part 1
Clinical Practice Guidelines Airway Part 1
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008). Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa | 3 | | R 410.00 | |
| | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2 | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2
Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2
Overview
Chest pain and acute dyspnoea are among the most frequent causes of out-of-hospital emergency medical services (EMS) activation. The challenge of the pre-hospital management of chest pain, beyond rapid diagnosis, is the treatment and transfer of patients with major cardiovascular emergencies to adequate centres (Beygui et al., 2015). The required system infrastructure (i.e. local protocols and pathways of care) needs to be in place for EMS cardiovascular emergency objectives to be met. Not all recommendations below are readily implementable as local infrastructure must still be developed in South Africa. The care of ST-elevation myocardial infarction (STEMI) patients in the pre-hospital setting should be based on regional STEMI networks. Such networks include one or more hospitals and EMS organisations which have a shared protocol for the choice of reperfusion strategy, adjunctive therapy and patient transfer in order to provide consistent treatment to patients. Such protocols should be formally discussed between all components of the network and be available in writing (Beygui et al., 2015). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | Clinical Practice guidelines—Acute Coronary Syndrome & Similar Conditions Part 1 | Clinical Practice guidelines—Acute Coronary Syndrome & Similar Conditions Part 1
Clinical Practice guidelines—Acute Coronary Syndrome & Similar Conditions Part 1
Overview
Chest pain and acute dyspnoea are among the most frequent causes of out-of-hospital emergency medical services (EMS) activation. The challenge of the pre-hospital management of chest pain, beyond rapid diagnosis, is the treatment and transfer of patients with major cardiovascular emergencies to adequate centres (Beygui et al., 2015). The required system infrastructure (i.e. local protocols and pathways of care) needs to be in place for EMS cardiovascular emergency objectives to be met. Not all recommendations below are readily implementable as local infrastructure must still be developed in South Africa. The care of ST-elevation myocardial infarction (STEMI) patients in the pre-hospital setting should be based on regional STEMI networks. Such networks include one or more hospitals and EMS organisations which have a shared protocol for the choice of reperfusion strategy, adjunctive therapy and patient transfer in order to provide consistent treatment to patients. Such protocols should be formally discussed between all components of the network and be available in writing (Beygui et al., 2015). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R 410.00 | |
| | 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 | | R 420.00 | |
| | 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 | | R 420.00 | |
| | 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 | | R 420.00 | |
| | 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 | | R 420.00 | |
| | 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
| 3 | | R 420.00 | |
| | 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
| 3 | | R 420.00 | |
| | 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 | | R 420.00 | |
| | 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 | | R 420.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R 440.00 | |
| | 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 | | R 410.00 | |
| | An analysis of adaptations to Multi-level intervention strategies to enhance implementation of clinical practice guidelines for treating tobacco use in dental care settings | An analysis of adaptations to Multi-level intervention strategies to enhance implementation of clinical practice guidelines for treating tobacco use in dental care settings
An analysis of adaptations to Multi-level intervention strategies to enhance implementation of clinical practice guidelines for treating tobacco use in dental care settings
Overview This study conducted a cluster randomized controlled trial (DUET) that compared the effectiveness of three theory-driven, implementation strategies on dental provider adherence to tobacco dependence treatment guidelines (TDT). In this paper it was describe the process of adapting the implementation strategies to the local context of participating dental public health clinics in New York City. Through an iterative process, Stirman's modification framework was used to classify, code and analyse modifications made to the implementation strategies. It was identified examples of six of Stirman's twelve content modification categories and two of the four context modification categories. Content modifications were classified as: tailoring, tweaking or refining (49.8%), adding elements (14.1%), departing from the intervention (9.3%), loosening structure (4.4%), lengthening and extending (4.4%) and substituting elements (4.4%). Context modifications were classified as those related to personnel (7.9%) and to the format/channel (8.8%) of the intervention delivery. Common factors associated with adaptations that arose during the intervention included staff changes, time constraints, changes in leadership preferences and functional limitations of to the Electronic Dental Record. This study offers guidance on how to capture intervention adaptation in the context of a multi-level intervention aimed at implementing sustainable changes to optimize TDT in varying public health dental settings.
Authors D.R. Shelley, C. Kyriakos, A. Campo, Y. Li, D. Khalife, J. Ostrof
Journal Contemporary Clinical Trials Communications | 3 | | R 410.00 | |
| | Protocol for the systematic review of the reporting of transoral robotic surgery | Protocol for the systematic review of the reporting of transoral robotic surgery
Protocol for the systematic review of the reporting of transoral robotic surgery
Overview
This will be a comprehensive review of transoral robotic surgery and will track its innovative evolution since first published description to present day. Inclusion of all study types will allow identification of good and poor examples of the descriptions of innovative invasive procedures. The methods described are applicable to reviews of any innovative surgical or other invasive procedure.
Transoral robotic surgery (TORS) has been adopted in some parts of the world as an innovative approach to the resection of oropharyngeal tumours. The development, details and outcomes of early-to-later phase evaluation of this technique and the quality of evidence to support its adoption into practice have hitherto not been summarised. The aim of this review is to identify and summarise the early and later phase studies of, and evidence for, TORS and to understand how early phase studies report intervention development, governance procedures and selection and reporting of outcomes to optimise methods for using the Idea, Development, Exploration, Assessment, Long-term follow-up (IDEAL) framework for surgical innovation that informs evidence based practice. The protocol has been written in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.
Acknowledgement
Authors Barry G Main, Natalie S Blencowe, Noah Howes, Sian Cousins, Kerry N L Avery, Alexander Gormley, Phil Radford, Daisy Elliott, Benjamin Byrne, Nicholas Wilson, Robert Hinchliffe, Jane M Blazeby,
Journal
BMJ Open
| 3 | | R 420.00 | |
| | A modified anthrax toxin-based enzyme linked immunospot assay reveals robust T cell responses in symptomatic and asymptomatic Ebola virus exposed individuals | A modified anthrax toxin-based enzyme linked immunospot assay reveals robust T cell responses in symptomatic and asymptomatic Ebola virus exposed individuals
A modified anthrax toxin-based enzyme linked immunospot assay reveals robust T cell responses in symptomatic and asymptomatic Ebola virus exposed individuals
Overview
Ebola virus (EBOV) caused more than 11,000 deaths during the 2013 ± 2016 epidemic in West Africa without approved vaccines or immunotherapeutic. Despite its high lethality in some individuals, EBOV infection can produce little to no symptoms in others. A better understanding of the immune responses in individuals who experienced minimally symptomatic and asymptomatic infection could aid the development of more effective vaccines and antivirals against EBOV and related filoviruses.
The West African Ebola virus (EBOV) outbreak is the largest on record with over 28,000 reported symptomatic cases and more than 11,000 deaths. We developed a simple and inexpensive modified anthrax toxin based ELISPOT assay to detect and characterize the T cell responses elicited by prior exposure to EBOV. Our data show robust T cell responses to several EBOV proteins in individuals who experienced both severe and asymptomatic EBOV infections. These results provide further evidence that EBOV transmission events can go undetected. We also show that the seropositive asymptomatic individuals have stronger T cell responses compared to survivors, which has important implications for vaccine development.
Acknowledgement
Authors Bobby Brooke Herrera, Donald J. Hamel, Philip Oshun, Rolake Akinsola, Alani S. Akanmu, Charlotte A. Chang, Philomena Eromon, Onikepe Folarin, Kayode T. Adeyemi, Christian T. Happi, Yichen Lu, Folasade Ogunsola, Phyllis J. Kank
Journal PLoS Neglected Tropical Disease | 3 | | R 420.00 | |
| | A prospective study of frequency of eating restaurant prepared meals (cardiometabolic mortality) | A prospective study of frequency of eating restaurant prepared meals (cardiometabolic mortality)
A prospective study of frequency of eating restaurant prepared meals (cardiometabolic mortality)
Overview
Restaurant prepared foods are known to be energy-dense and high in fat and sodium, but lower in protective nutrients. There is evidence of higher risk of adiposity, type II diabetes, and heart disease in frequent consumers of restaurant meals. However, the risk of mortality as a long-term health consequence of frequent consumption of restaurant meals has not been examined. We examined the prospective risk of all-cause and coronary heart disease, cerebrovascular disease and diabetes (cardiometabolic) mortality in relation to frequency of eating restaurant prepared meals in a national cohort.
The results were robust to effect modification by baseline BMI, years of education, and baseline morbidity. Expectedly, the 24-h dietary intakes of whole grains, fruits, dietary fiber, folate, vitamin C, potassium and magnesium at baseline were lower, but energy, energy density, and energy from fat were higher in more frequent restaurant meal reporters. Although both self-reported food group and nutrient intakes, and serum concentrations of several nutritional biomarkers in more frequent reporters of restaurant meals were suggestive of poor quality of diets reported at baseline, we found no prospective associations with mortality from all-causes or cardiometabolic diseases in this national cohort.
Acknowledgement
Author Ashima K. Kant and Barry I. Graubard
Journal PLoS One Volume 13 Issue 1
Publisher Cross Mark | 3 | | R 378.00 | |
| | EcoHealth and the Determinants of Health: Perspectives of a Small Subset of Canadian Academics in the EcoHealth Community | EcoHealth and the Determinants of Health: Perspectives of a Small Subset of Canadian Academics in the EcoHealth Community
EcoHealth and the Determinants of Health: Perspectives of a Small Subset of Canadian Academics in the EcoHealth Community
Overview
EcoHealth is an emerging field that examines the complex relationships among humans, animals, and the environment, and how these relationships affect the health of each of these domains. Our previous research demonstrates that the academic EcoHealth literature had a low, uneven engagement with the determinants of health. Accordingly, to make sense of this gap, our research aim is to better understand the views of a small subset of the Canadian EcoHealth community about EcoHealth and the determinants of health relative to EcoHealth. We used a qualitative research design involving seven semi-structured interviews, which were analysed using thematic analysis.
Our findings suggest a tension across themes and a lack of conceptual engagement with the determinants of health. As we consider a future with rapid, unsustainable changes, we expect the identification and integration of the different types of determinants of health within EcoHealth to be imperative for EcoHealth to attain its goal of improving the health and well-being of humans, animals, and in the environment.
Acknowledgement
Author Aryn Lisitza and Gregor Wolbring
Journal International Journal of Environmental Research & Public Health Volume 15 Issue 8 | 3 | | R 380.00 | |
| | Evidence for increasing densities and geographic ranges of tick species of public health significance other than Ixodes scapularis in QueÂbec, Canada | Evidence for increasing densities and geographic ranges of tick species of public health significance other than Ixodes scapularis in QueÂbec, Canada
Evidence for increasing densities and geographic ranges of tick species of public health significance other than Ixodes scapularis in QueÂbec, Canada
Overview
Climate change is driving emergence and establishment of Ixodes scapularis, the main vector of Lyme disease in QueÂbec, Canada. As for the black-legged tick, I. scapularis Say, global warming may also favor northward expansion of other species of medically important ticks. The aims of this study were to determine (1) current diversity and abundance of ticks of public health significance other than I. scapularis, (2) sex and age of the human population bitten by these ticks (3), and the seasonal and geographic pattern of their occurrence.
Of the 862 people bitten by these ticks, 43.3% were I. cookei ticks removed from children aged < 10 years. These findings demonstrate the need for surveillance of all the tick species of medical importance in QueÂbec, particularly because climate may increase their abundance and geographic ranges, increasing the risk to the public of the diseases they transmit.
Acknowledgement
Author Salima Gasmi, Catherine Bouchard, Nicholas H. Ogden, Ariane Adam-Poupart, Yann Pelcat, Erin E. Rees, FrancËois Milord, Patrick A. Leighton, Robbin L. Lindsay, Jules K. Koffi and Karine Thivierge Journal PLoS One Volume 13 Issue 8
| 3 | | R 420.00 | |
| | Human Milk Oligosaccharides: 20-Fucosyllactose (20-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula | Human Milk Oligosaccharides: 20-Fucosyllactose (20-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula
Human Milk Oligosaccharides: 20-Fucosyllactose (20-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula
Overview
The authors reviewed the published evidence on the presence of oligosaccharides in human milk (HMO) and their benefits in in vitro and in vivo studies. The amount of HMOs in mother’s milk is a dynamic process as it changes over time. Many factors, such as duration of lactation, environmental, and genetic factors, influence the number of HMOs.
The limited clinical data suggest that the addition of HMOs to infant formula seems to be safe and well tolerated, inducing a normal growth and suggesting a trend towards health benefits. HMOs are one of the major differences between cow’s milk and human milk, and available evidence indicates that these components do have a health promoting benefit. The addition of one or two of these components to infant formula is safe and brings infant formula closer to human milk. More prospective, randomized trials in infants are needed to evaluate the clinical benefit of supplementing infant formula with HMOs.
Acknowledgement
Author Yvan Vandenplas, Bernard Berger, Virgilio Paolo Carnielli, Janusz Ksiazyk , Hanna Lagström, Manuel Sanchez Luna, Natalia Migacheva, Jean-Marc Mosselman, Jean-Charles Picaud, Mike Possner, Atul Singhal and Martin Wabitsch
Journal Nutrients 2018, Volume 10 Issue 9 Publisher MDPI
| 3 | | R 380.00 | |
| | Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series | Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series
Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series
Overview
Accidental and iatrogenic foreign body injuries to heart require immediate attention and its timely management is cornerstone to the life of an individual. We describe in detail five cases of Accidental and iatrogenic foreign body injuries to heart encountered between January 2013 and July 2016. Our series included the following: needle stick injury to the right atrium retained catheter fragments in the distal main pulmonary artery, right ventricle injury during catheterisation study, right ventricle injury during permanent pacemaker lead placement, device migration in atrial septal defect closure. Foreign bodies were removed from the cardiac cavities when the patient presented with features of infection, cardiac tamponade, anxiety, and haemodynamic instability. Foreign bodies in the heart should be removed irrespective of their location and symptomatology. Asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; asymptomatic foreign bodies without associated risks factors or diagnosed accidentally after the injury also need surgical intervention to allay fears of anxiety in patient and their relatives, to prevent any late complications as well as for medico-legal purpose.
ACKNOWLEDGEMENTS:
Authors: Rupesh Kumar; Sandeep Singh Rana; Sanjay Kumar; Deepanwita Das; Monalisa Datta
Journal: J Clin Diagn Res (Journal of Clinical Diagnostic Research) Volume 11 Issue 3
Publisher: JCDR Research and Publications Private Limited | 3 | | R 410.00 | |
| | Phytochemicals in Helicobacter pylori Infections: What Are We Doing Now? | Phytochemicals in Helicobacter pylori Infections: What Are We Doing Now?
Phytochemicals in Helicobacter pylori Infections: What Are We Doing Now?
Overview
In this critical review, plant sources used as effective antibacterial agents against Helicobacter pylori infections are carefully described. The main intrinsic bioactive molecules, responsible for the observed effects are also underlined and their corresponding modes of action specifically highlighted. In addition to traditional uses as herbal remedies, in vitro and in vivo studies focusing on plant extracts and isolated bioactive compounds with anti-H. pylori activity are also critically discussed. Lastly, special attention was also given to plant extracts with urease inhibitory effects, with emphasis on involved modes of action.
Among the various opportunistic infections, those caused by Helicobacter pylori, a human opportunistic pathogen, is attracting much attention [29]. In fact, it is widely recognized that this bacterium plays an important role in the etiology of peptic and gastric ulcers and even gastric cancers and gastric lymphomas [29]. About half of the worldwide population is colonized by this bacterium, but there are only about 20% who manifest clinical symptoms, which has been linked to the ability of some H. pylori strains to both adapt to host’s immunological responses and to support an ever-changing gastric environment [29]. Relatedly, increasing rates of antibiotic-resistant H. pylori strains have been found, and therefore, the search for new eradication strategies and effective antibiotic therapies has become an issue of crucial importance [30]. Hence, research effort is focused on exploring plants as sources of anti-H. pylori agents.
Acknowledgement
Author Bahare Salehi 1,2, Farukh Sharopov 3, Miquel Martorell 4, Jovana Rajkovic 5, Adedayo Oluwaseun Ademiluyi 6, Mehdi Sharifi-Rad 7, Patrick Valere Tsouh Fokou 8 Natália Martins 9,10, Marcello Iriti 11, and Javad Sharifi-Rad 12,13
Journal
International Journal of Molecular Sciences Volume 19 Issue 8 | 3 | | R 460.00 | |
| | 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 | | R 395.00 | |
| | Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study | Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Overview
South Africa faces a complex burden of disease consisting of infectious and non–communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. Objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north–east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality.
The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting.
Acknowledgement
Authors Nitya Hullur, Lucia D’Ambruoso, Kerstin Edin, Ryan G Wagner, Sizzy Ngobeni Kathleen Kahn, Stephen Tollman, Peter Byass
Journal Global Health Action Volume 6 Issue 1
| 3 | | R 460.00 | |
| | Commensal bacteria produce GPCR ligands that mimic human signalling molecules | Commensal bacteria produce GPCR ligands that mimic human signalling molecules
Commensal bacteria produce GPCR ligands that mimic human signalling molecules
Overview
Commensal bacteria are believed to play important roles in human health. The mechanisms by which they affect mammalian physiology are poorly understood; however, bacterial metabolites are likely to be key components of host interactions. Here, we use bioinformatics and synthetic biology to mine the human microbiota for N-acyl amides that interact with G-protein-coupled receptors. GPR119 is most highly expressed in the pancreas and duodenum, S1PR4 in the spleen and lymph node, G2A in the lymph node and appendix, PTGIR in the lung and appendix and PTGER4 in the bone marrow and small intestine.
Commensal GPR119 agonists regulate metabolic hormones and glucose homeostasis as efficiently as human ligands although future studies are needed to define their potential physiologic role in humans. This work suggests that chemical mimicry of eukaryotic signaling molecules may be common among commensal bacteria and that manipulation of microbiota genes encoding metabolites that elicit host cellular responses represents a new small molecule therapeutic modality.
Acknowledgement
Author Louis J. Cohen, Daria Esterhazy, Seong-Hwan Kim, Christophe Lemetre, Rhiannon R. Aguilar, Emma A. Gordon, Amanda J. Pickard, Justin R. Cross, Ana B. Emiliano, Sun M. Han1, John Chu, Xavier Vila-Farres, Jeremy Kaplitt, Aneta Rogoz, Paula Y. Calle, Craig Hunter, J. Kipchirchir Bitok, and Sean F. Brady
Journal Nature
Publisher Department of Health & Human Services – USA
| 3 | | R 395.00 | |
| | 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 | | R 460.00 | |
| | 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 | | R 390.00 | |
| | 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 | | R 390.00 | |
| | Ebolaviruses: New roles for old proteins | Ebolaviruses: New roles for old proteins
Ebolaviruses: New roles for old proteins
Overview
In 2014, the world witnessed the largest Ebolavirus outbreak in recorded history. The subsequent humanitarian effort spurred extensive research, significantly enhancing our understanding of ebolavirus replication and pathogenicity. The main functions of each ebolavirus protein have been studied extensively since the discovery of the virus in 1976; however, the recent expansion of ebolavirus research has led to the discovery of new protein functions. The international containment effort spurred extensive research that is enhancing.
These newly discovered roles are revealing new mechanisms of virus replication and pathogenicity, whilst enhancing our understanding of the broad functions of each ebolavirus viral protein (VP). Many of these new functions appear to be unrelated to the protein's primary function during virus replication. Such new functions range from bystander T-lymphocyte death caused by VP40-secreted exosomes to new roles for VP24 in viral particle formation. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity.
Acknowledgement Authors Diego Cantoni and Jeremy S. Rossman Journal PLoS Neglected Tropical Diseases Publisher Cross Mark | 3 | | R 420.00 | |
| | Non-referral of potential organ donors in South Africa: insights, challenges and ethical dilemmas | Non-referral of potential organ donors in South Africa: insights, challenges and ethical dilemmas
Non-referral of potential organ donors in South Africa: insights, challenges and ethical dilemmas
Non-referral of potential organ donors in South Africa: insights, challenges and ethical dilemmas
Overview
Traditionally, minimal potential organ donor referrals emanate from general medicine departments. We use a clinical vignette to draw attention to challenges related to referral of potential organ donors from general internal medicine departments. In addition, we provide potential solutions to overcome challenges and reflect on the ethical issues of non-referral of potential organ donors. It is hoped that this paper will increase the awareness of organ donation in the medical fraternity in Africa and thus mitigate critical shortages of organs for transplantation.
Ethical considerations are many. Organ donation and transplant in SA is imbued with ethical issues. These are shaped by the context in which health care is provided and then borne out in the clinical system where transplant referrals and the process of consenting to organ donation take place. In terms of context, there appears to be a distrust of transplant amongst the SA population.
The non-referral of potential organ donors has societal and ethical ramifications. General internal medicine teams can increase the number of referrals to organ transplant coordinators. Consultant physicians have the knowledge and expertise to lead the referral of potential organ donors to transplant coordinators.
Acknowledgement
Author Poobalan Naidoo, Harriet Rosanne Etheredge, Virendra Rambiritch, Akira Singh, Scott Mahoney and Vanesha Naidu
Journal Pan American Medical Journal June 2018, Vol. 29 Issue 223 Publisher CrossMark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6080966/pdf/PAMJ-29-223.pdf
| 3 | | R 470.00 | |
| | Advances in Pharmacotherapy of Tuberculosis | Advances in Pharmacotherapy of Tuberculosis
Advances in Pharmacotherapy of Tuberculosis
Advances in Pharmacotherapy of TuberculosisOverview
Tuberculosis remains a growing threat of infectious diseases of twenty-first century. An attempt to find new anti-tuberculosis agents was made especially to treat multidrug resistant and extensively drug-resistant tuberculosis. One of the most promising drugs is bedaquiline - a new drug approved by Food and Drug Administration (FDA) and by the European Union countries. This compound is intended to treat multi drug-resistant pulmonary tuberculosis in adult patients in combination regimens in case of impossibility of using other drugs. Alarming epidemiological indicators suggesting increased amount of incidents of tuberculosis tended to search for new compounds with potential anti-tuberculosis activity.
This paper is also focused on some interesting molecules in treating multidrug-resistant tuberculosis which are currently tested in clinical studies: delamanid, AZD5847, pretomanid , sutezolid and SQ109 - and some prospective molecules at the level of preclinical studies. Disturbing statistics of frequency of newly recognized tuberculosis or multi-drug resistant tuberculosis was a step to counteract this disease and give some perspectives in clinical trials. The hope in new anti-tuberculosis agents, still tested in clinical studies and the creation of new regimens.
Acknowledgement
Authors Michal Pstragowski, Malgorzata Zbrzezna and Magdalena Bujalska-ZadroØny
Journal Acta Poloniae Pharmaceutica
Publisher Pharmacodynamics, Medical University of Warsaw URL: http://ptfarm.pl/pub/File/Acta_Poloniae/2017/1/003.pdf
| 3 | | R 460.00 | |
| | Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s). | Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
Characteristics and predictors for Gastro-intestinal haemorrhage among adult patients with dengue virus infection: Emphasizing the impact of existing comorbid disease(s).
Overview
Gastrointestinal (GI) bleeding is a leading cause of death in dengue. This study aims to identify predictors for GI bleeding in adult dengue patients, emphasizing the impact of existing co-morbid disease(s). Of 1300 adults with dengue virus infection, 175 (mean age, 56.5±13.7 years) patients with GI bleeding and 1,125 (mean age, 49.2±15.6 years) without GI bleeding (controls) were retrospectively analyzed.
Our study is the first to disclose that end stage renal disease and previous stroke, with additional co-morbidities, were strongly significant associated with the risk of GI bleeding in patients with dengue virus infection. Identification of these risk factors can be incorporated into the patient assessment and management protocol of dengue virus infection to reduce its mortality. Our study emphasizes that, in addition to older age and thrombocytopenia , end stage renal disease and previous stroke, with additional co-morbidities, are important clinical predictor of GI bleeding in adult patients with DENV infection. More studies, particularly prospective studies are required to validate these findings for better generalization of their clinical utility.
Acknowledgement
Author Wen-Chi Huang, Ing-Kit Lee, Yi-Chun Chen, Ching-Yen Tsai and Jien-Wei Liu.
Journal PLoS ONE Volume 13 Issue 2
Publisher Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819790/pdf/pone.0192919.pdf
| 3 | | R 470.00 | |
| | The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery | The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
Overview
Postsurgical infections represent an important cause of morbidity after abdominal surgery. The microbiological diagnosis is not achieved in at least 30% of culture with consequent worsening of patient outcome. In this study, procalcitonin measurement, during the first 3 days after abdominal surgery, has been evaluated for the early diagnosis of postsurgical infection. Receiver operating characteristic (ROC) analysis was performed to define the diagnostic ability of PCT in case of post-surgical infections.
PCT values resulted significantly different between patients developing or not developing postsurgical infections. PCT >1.0ng/mL at first or second day after surgery and >0.5ng/mL at third day resulted diagnostic for infectious complication, whereas a value <0.5 ng/mL at the fifth day after surgery was useful for early and safety discharge of patients. In conclusion, PCT daily measurement could represent a useful diagnostic tool improving health care in the postsurgical period following major abdominal surgery and should be recommended.
Acknowledgement
Author Silvia Spoto, Emanuele Valeriani, Damiano Caputo, Eleonora Cella, Marta Fogolari, MDe, Elena Pesce, Maria Tea Mulè, Mariacristina Cartillone, Sebastiano Costantino, MDa, Giordano Dicuonzo, Roberto Coppola, Massimo Ciccozzi and Silvia Angeletti,
Journal Medicine (2018) Volume 97 Issue 3
Publisher Wolters Kluwer Health, Inc.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779742/pdf/medi-97-e9496.pdf
| 3 | | R 455.00 | |
| | Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro | Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro
Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro
Attempts to grow human noroviruses, a sapovirus, and a bovine norovirus in vitro
Overview
Noroviruses (NoVs) and Sapoviruses (SaVs) are enteric caliciviruses that have been detected in multiple mammalian species, including humans. Currently, efficient cell culture systems have been established only for murine NoVs and porcine SaV Cowden strain. Establishment of an efficient in vitro cell culture system for other NoVs and SaVs remains challenging; however, human NoV (HuNoV) replication in 3D cultured Caco-2 cells and a clone of Caco-2 cells, C2BBe1, human enteroids and in human B cells has been reported.
In this study, we tested various cells and culture conditions to grow HuNoVs and a human SaV (HuSaV) to test the possibility of the propagation in different cells and culture conditions. We also attempted to grow a bovine NoV (BoNoV) in ex vivo organ cultures. Our results demonstrated that HuNoVs, BoNoV and HuSaV largely failed to grow in vitro under our test conditions. Our purpose is to share our findings with other researchers with the goal to develop efficient, reproducible simplified and cost-effective culture systems for human and animal NoVs and SaVs in the future.
Acknowledgement
Author Tomoichiro Oka, Garrett T. Stoltzfus, Chelsea Zhu, Kwonil Jung, Qiuhong Wang and Linda J. Saif.
Journal PLoS ONE
Publisher Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810978/pdf/pone.0178157.pdf
| 3 | | R 445.00 | |
| | 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 | | R 455.00 | |
| | 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
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| | Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein | Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein
Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein
Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein
Overview
We have produced a new Ebola virus pseudotype, E-S-FLU, that can be handled in biosafety level 1/2 containment for laboratory analysis. The E-SFLU virus is a single-cycle influenza virus coated with Ebolavirus glycoprotein, and it encodes enhanced green fluorescence protein as a reporter that replaces the influenza virus hemagglutinin. Infection of cells with the E-S-FLU virus was dependent on the Niemann-Pick C1 protein, which is the well-characterized receptor for Ebola virus entry at the late endosome/lysosome membrane. The E-S-FLU virus was neutralized specifically by an anti-Ebolavirus glycoprotein antibody and a variety of small drug molecules that are known to inhibit the entry of wild-type Ebola virus.
To demonstrate the application of this new Ebola virus pseudotype, we show that a single laboratory batch was sufficient to screen a library of 1,280 pharmacologically active compounds for inhibition of virus entry. The E-S-FLU virus is a new tool for Ebola virus cell entry studies and is easily applied to high throughput screening assays for small-molecule inhibitors or antibodies. Acknowledgement
Author Julie Huiyuan Xiao, Pramila Rijal, Lisa Schimanski, Arun Kumar Tharkeshwar, Edward Wright, Wim Annaert and Alain Townsend.
Journal Journal of Virology
Publisher Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790926/pdf/e00941-17.pdf
| 3 | | R 445.00 | |
| | 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 | | R 465.00 | |
| | Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy | Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy
Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy
Atezolizumab: feasible second-line therapy for patients with non-small cell lung cancer? A review of efficacy, safety and place in therapy Overview
Advanced non-small cell lung cancer (NSCLC) prognosis is still poor and has recently been reformed by the development of immune checkpoint inhibitors and the approval of anti PD-1 (programmed cell-death 1) treatments such as nivolumab and pembrolizumab in second line. More recently, Atezolizumab (MDPL 3280A), a programmed cell-death-ligand 1 (PD-L1) inhibitor, was also studied in this setting.
Here, we report a review of the literature assessing the efficacy, safety, and place of Atezolizumab in the second-line treatment of advanced NSCLC. We are still far from fully understanding cancer immunity and the mechanisms leading to the success or not of immunotherapy agents. For this reason, we should investigate to a greater level the factors of failure, such as EGFR-mutant tumours.
We performed a literature search of PubMed, American Society of Clinical Oncology, European Society of Medical Oncology and World Conference on Lung Cancer meetings. Atezolizumab showed a good tolerance profile and efficacy in comparison with docetaxel for second-line treatment of advanced NSCLC. Potential predictive biomarkers also have to be assessed.
Acknowledgement
Author Fanny Jean, Pascale Tomasini and Fabrice Berlesi
Journal Therapeutic Advances in Medical Oncology 2017, Vol. 9(12) 769-779 Special Collection/review Immunotherapy for Lung Cancer: Progress, Opportunities and Challenges journals. sagepub.com/home/tam
| 3 | | R 445.00 | |
| | Diagnostic Approaches for Invasive Aspergillosis – Specific Considerations in the Pediatric Population | Diagnostic Approaches for Invasive Aspergillosis – Specific Considerations in the Pediatric Population
Diagnostic Approaches for Invasive Aspergillosis – Specific Considerations in the Pediatric Population
Diagnostic Approaches for Invasive Aspergillosis—Specific Considerations in the Pediatric Population
Overview
The Invasive aspergillosis (IA) is a major cause of morbidity and mortality in children with hematological malignancies and those undergoing hematopoietic stem cell transplantation. Similar to immune-compromised adults, clinical signs, and symptoms of IA are unspecific in the pediatric patient population. As early diagnosis and prompt treatment of IA is associated with better outcome, imaging and non-invasive antigen-based such as galactomannan or ß-D-glucan and molecular biomarkers in peripheral blood may facilitate institution and choice of antifungal compounds and guide duration of therapy.
The early and reliable diagnosis of IA is difficult in immune-compromised patients, in particular in the pediatric population. In patients in whom imaging studies suggest IA or another mold infection, invasive diagnostics such as broncho-alveolar lavage and/or bioptic procedures should be considered. Here we review the current data of diagnostic approaches for IA in the pediatric setting and highlight the major differences of performance and clinical utility of the tests between children and adults.
Acknowledgement
Author Thomas Lehrnbecher , Angela Hassler , Andreas H. Groll and Konrad Bochennek
Journal Frontiers in Microbiology
Publisher Cross Mark
| 3 | | R 480.00 | |
| | Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims. | Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims.
Sensitivity and specificity of CT scan in revealing skull fracture in medico-legal head injury victims.
Overview:
Aims: The study was conducted with the objective of knowing the sensitivity and specificity of ante-mortem CT scan findings indicating the presence or absence of skull fractures.
Methods: Findings were confirmed during post-mortem examination of the subjects who had died during management but who had not had any surgical intervention. A comparative study of ante-mortem CT scan and autopsy findings with respect to fracture in traumatic head injuries was undertaken on 60 deceased individuals brought in for medico-legal post-mortem examination over a period of two years.
Results: Considering the autopsy findings as the gold standard, we have concluded that 14.6 per cent of the fractures were missed on CT scan findings compared to fractures found during autopsy. The sensitivity of CT scan for skull fractures was found to be 85.4 per cent and specificity was 100 per cent. Kappa was 0.787, which shows good agreement with p<0.001, which was highly significant.
Conclusion: In developing countries, images are interpreted in the axial plane only on a CT scan of the head, which may be due to a lack of financial and human resources. For better delineation of fractures, the use of techniques like multi-detector CT with sagittal and coronal reformations should be considered in the routine interpretation of a CT scan of the head.
Acknowledgement
Author:
Chawla H, Yadav RK, Griwan MS, Malhotra R, Paliwal PK
Journal:
The Australasian medical journal.
Publisher:
The Australasian medical journal
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531150/pdf/AMJ-08-235.pdf
| 3 | | R 385.00 | |
| | Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications. | Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.
Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.
Overview
Concerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation.
Acknowledgement
Author:
Vassalini M, Verzeletti A, De Ferrari F
Journal:
Monaldi archives for chest disease
Publisher:
PIME Editrice
http://www.monaldi-archives.org/index.php/macd/article/view/25/728
| 3 | | R 430.00 | |
| | 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
https://www.racgp.org.au/download/Documents/AFP/2015/January/February/focus-leggat.pdf
| 3 | | R 360.00 | |
| | 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 | | R 410.00 | |
| | Sensitivity of plain radiography for pediatric cervical spine injury. | Sensitivity of plain radiography for pediatric cervical spine injury.
Sensitivity of plain radiography for pediatric cervical spine injury.
Overview
Pediatric patients with suspected cervical spine injuries (CSI) often receive a computed tomography (CT) scan as an initial diagnostic imaging test. While sensitive, CT of the cervical spine carries significant radiation and risk of lethal malignant transformation later in life. Plain radiographs carry significantly less radiation and could serve as the preferred screening tool, provided they have a high functional sensitivity in detecting pediatric patients with CSI.
We hypothesize that plain cervical spine radiographs can reliably detect pediatric patients with CSI and seek to quantify the functional sensitivity of plain radiography as compared to CT. We analyzed data from the NEXUS cervical spine study to assess the sensitivity of plain radiographs in the evaluation of CSI. We identified all pediatric patients who underwent plain radiographic imaging, and all pediatric patients found to have CSI. We then determined the sensitivity of plain radiographs in detecting pediatric patients with CSI. We identified 44 pediatric patients with CSI in the dataset with age ranging from 2 to 18 years old.
Plain radiography was highly sensitive for the identification of CSI in our cohort of pediatric patients and is useful as a screening tool in the evaluation of pediatric CSI.
Acknowledgement
Author:
Cui LW, Probst MA, Hoffman JR, Mower WR
Journal:
Emergency Radiology
Publisher:
Springer
https://cloudfront.escholarship.org/dist/prd/content/qt95p3x9hg/qt95p3x9hg.pdf?t=odi6kh&v=lg
| 3 | | R 380.00 | |
| | Application of cervical collars – An analysis of practical skills of professional emergency medical care providers. | Application of cervical collars – An analysis of practical skills of professional emergency medical care providers.
Application of cervical collars – An analysis of practical skills of professional emergency medical care providers.
Overview:
The application of a cervical collar is a standard procedure in trauma patients in emergency medicine. It is often observed that cervical collars are applied incorrectly, resulting in reduced immobilization of the cervical spine. The objective of this study was to analyze the practical skills of trained professional rescue personnel concerning the application of cervical collars.
Within emergency medical conferences, n = 104 voluntary test subjects were asked to apply a cervical collar to a training doll, wherein each step that was performed received an evaluation. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. The most common
error consisted of incorrect adjustment of the size of the cervical collar (66%). No association was found between the correct application of the cervical collar and the occupational group of the test subjects (trained rescue personnel vs. emergency physicians) or the participation in certified trauma courses.
In conclusion despite pronounced subjective confidence regarding the application of cervical collars, this study allows the conclusion that there are general deficits in practical skills when cervical collars are applied. A critical assessment of the current training contents about trauma care must, therefore, be demanded.
ACKNOWLEDGEMENT
AUTHORS: Michael Kreinest1,2, Sarah Goller1,2, Geraldine Rauch3, Christian Frank4,2, Bernhard Gliwitzky2, Christoph G. Wölfl1,2, Stefan Matschke1, Matthias Münzberg 1,2*
JOURNAL: PLOS One
PUBLISHER: Public Library of Science
https://www.plos.org | 3 | | R 355.00 | |
| | A critical Appraisal of Clinical Trials Conducted and Subsequent Drug Approvals in India and South Africa. | A critical Appraisal of Clinical Trials Conducted and Subsequent Drug Approvals in India and South Africa.
A critical Appraisal of Clinical Trials Conducted and Subsequent Drug Approvals in India and South Africa.
Overview
The drugs that are used in treating any condition, be it an innocuous cough or a life-threatening cancer are the hard work of human clinical trials. Of course, these trials are the only credible way to determine the safety and efficiency of drugs. As a matter of fact, without clinical trials, pharmaceutical research will not advance to improve disease management as well and the quality of life in human beings.
This study was therefore designed to assess the relation between the number of clinical trials conducted as well as respective new drug approvals in India and South Africa. The research was nonetheless conducted in four different settings, namely, USA, Europe, India and South Africa. The research was done though the construction and analysis of a comprehensive database of completed randomized controlled clinical trials based on clinical trials.
The results from distribution of the market application approvals between the EU/USA as well as India and South Africa revealed that out of clinical trials with the participation of test centers in India and/or South Africa, 39.6% (India) clinical trials and 60.1% (South Africa) clinical trials led to market authorization in the EU/USA without a New Drug Application (NDA) approval in India or South Africa.
ACKNOWLEDGEMENT
AUTHORS: Dnyanesh Limaye, Janka Marisa Langer, Tjorben Rühling, Gerhard Fortwengel JOURNAL: BMJ Journals
PUBLISHERS: group.bmj.com URL: http://bmjopen.bmj.com/
| 3 | | R 345.00 | |
| | Effectiveness of multidisciplinary team case management: difference-indifferences analysis. | Effectiveness of multidisciplinary team case management: difference-indifferences analysis.
Effectiveness of multidisciplinary team case management: difference-indifferences analysis.
OVERVIEW
Recently, there are increasing focus on increasing on the benefits of integrated care, to enable a more efficient and effective response to LTCs. This study was carried out in Single clinical commissioning group (CCG) in the UK’s National Health Service (NHS). The objective of this study was to evaluate a multidisciplinary team (MDT) case management intervention, at both the individual and practice levels.
The design that was used for this study was the difference-in-differences design with multiple intervention start dates, that hospital admissions data. The participants for this study were 2049 intervention patients using propensity scoring one-to-one with control patients. During the research, 30 practices were compared using a natural experiment through staged implementation.
The primary measures of direct intervention included accident and emergency (A&E) visits; inpatient non-elective stays, 30-day re-admissions; inpatient elective stays, outpatient visits and admissions for ambulatory care sensitive conditions. The secondary measures on the other hand included inpatient length of stay; total cost of secondary care Services and patient satisfaction. This study was nonetheless concluded that the intervention does not meet its primary aim, and the clinical significance and cost effectiveness of these small practice-level effects is debatable.
ACKNOWLEDGEMENT
AUTHORS: Jonathan Stokes, Søren Rud Kristensen, Kath Checkland, Peter Bower
JOURNAL: Bmj Open
PUBLISHER: group.bmj.com
URL: http://bmjopen.bmj.com/ | 3 | | R 350.00 | |
| | How often are interventions in cluster randomised controlled trials of complex interventions in general practices effective and reasons for potential shortcomings? Protocol and results of a feasibility project for a systematic review. | How often are interventions in cluster randomised controlled trials of complex interventions in general practices effective and reasons for potential shortcomings? Protocol and results of a feasibility project for a systematic review.
How often are interventions in cluster randomised controlled trials of complex interventions in general practices effective and reasons for potential shortcomings? Protocol and results of a feasibility project for a systematic review.
ABSTRACT
Introduction: Most studies conducted at general practices investigate complex interventions and increasingly use cluster-randomised controlled trail (c-RCT) designs to do so. Our primary objective is to evaluate how frequently complex interventions are shown to be more, equally or less effective than routine care in c RCTs with a superior design. The secondary aim is to discover whether the quality of a c-RCT determines the likelihood of the complex intervention being effective. | 3 | | R 330.00 | |
| | Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month. | Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month.
Is herpes zoster an additional complication in old age alongside comorbidity and multiple medications? Results of the post hoc analysis of the 12-month.
OVERVIEW
Shingles, or herpes zoster (HZ), is caused by reactivation, of varicella-zoster virus (VZV) from a latent infection in the dorsal root ganglion.
The purpose of this study was thus to examine the burden of comorbidity, polypharmacy and herpes zoster (HZ), an infectious disease, and its main complication post-herpetic neuralgia (PHN) in young (50–70 years of age: 70-) and old (=70 years of age: 70+) patients. This study took place in primary care in France from November 20, 2006 to September 12, 2008. For this study, 644 general practitioners (GPs) collected data from 1358 patients aged 50 years or more with acute eruptive HZ. Validated questionnaires were used to investigate HZ and PHN burden, pain, quality of life (QoL).
The results of this study indicated that older patients more frequently presented with comorbidities, frequently took analgesics and had poorer response on all questionnaires, indicating greater burden, at inclusion as compared with younger patients.
ACKNOWLEDGEMENT
AUTHORS: Gisèle Pickering et al.
JOURNAL: BMJ Open
PUBLISHER: BMJ Group
URL: http://www.bmjopen.bmj.com
| 3 | | R 330.00 | |
| | Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care. | Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care.
Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care.
OVERVIEW
Most often, majority of patients presenting to primary care with a suspected lower respiratory tract infection (LRTI) are prescribed antibiotics. That doesn’t however change the fact that most respiratory tract infections are viral and only marginal benefit is achieved from the prescription of antibiotics that in some cases does not outweigh the risk of harm.
The aim of this research was thus to determine the barriers and facilitators to adoption of POC CRP testing in National Health Service (NHS) primary care for the diagnosis of lower respiratory tract infection. This study was however done following a qualitative methodology based on grounded theory. This study was however undertaken in two stages. The first consisted of semi structured interviews with 8 clinicians from Europe and the UK who use the test in routine practice, and focused on their subjective experience in the challenges of implementing POC CRP testing. The second stage on the other hand was a multidisciplinary-facilitated workshop with NHS stakeholders to discuss barriers to adoption, impact of adoption and potential adoption scenarios.
The study concluded that Successful adoption models from the UK and abroad demonstrate a distinctive pattern and involve collaboration with central laboratory services.
ACKNOWLEDGEMENT
AUTHOR: Jeremy R Huddy, Melody Z Ni, James Barlow, Azeem Majeed, George B Hanna
JOURNAL: Journal of Clinical Pathology
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com/ | 3 | | R 355.00 | |
| | Practice Issues. | Practice Issues.
OVERVIEW
It is important to note that the responses to the various questions are the views independently expressed and are not necessarily opinions shared by cpdexpress.co.za. As matters involving Ethics and the law are subject to interpretation, the responses cannot, in any way, be regarded as binding or necessarily endorsed by the regulatory authorities.
There are ethical dilemmas regarding patients, colleagues and associates that one doesn’t even consider until they become issues in their practice. There are many questions to be asked regarding ethics, touting, canvassing, advertising, competition and many other issues that need to be addressed and this article addresses most of them. | 3 | | R 450.00 | |
| | Private Practice: The Do's And Don'ts. | Private Practice: The Do's And Don'ts.
Private Practice: The Do's And Don'ts.
OVERVIEW
You have studied extensively to become a healthcare professional in your field of study. You have learned and become adept at identifying a vast range of conditions. You can diagnose and effectively treat those conditions within the scope of the discipline.
Now you are faced with a plethora of dilemmas. What is fair value for your services? What appliances are appropriate and reasonable? What commercial and legal structures are appropriate for you? What influence may these commercial and legal structures have on your clinical recommendations? Who may have access to your record cards? What responsibility can you delegate to your staff? Who carries final responsibility for payment of your claims – member or medical aid? What constitutes anti-competitive behavior?
This is a very informative article that will help you to run your practice within the various guidelines. | 3 | | R 400.00 | |
| | 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 | | R 365.00 | |
| | Understanding Tensions in Early Stage Chronic Kidney Disease. | Understanding Tensions in Early Stage Chronic Kidney Disease.
Understanding Tensions in Early Stage Chronic Kidney Disease.
ABSTRACT
Objectives: Since 2006, general practitioners (GPs) in England, UK, have been incentivised to keep a register and monitor patients with chronic kidney disease (CKD) stages 3–5. Despite tensions and debate around the merit of this activity, there has been little qualitative research exploring clinician perspectives on monitoring early-stage CKD in primary care. This study aimed to examine and understand a range of different healthcare professional views and experiences of identification and monitoring in primary care of early-stage CKD, in particular stage 3.
Design: Qualitative design using semi-structured interviews | 3 | | R 380.00 | |