Comparison of amoxicillin administered twice and three times daily in children with acute otitis media.

To compare the effectiveness of amoxicillin administered in regimens of two or three daily doses in children with acute otitis media (AOM). As a secondary aim, we measured and compared treatment adherence between the two groups.A prospective observational study was conducted in the emergency department of a children's hospital.We recruited a total of 353 patients having a median age of 1.58 years. Twice-daily dosing was prescribed to 58%, while 42% received three doses per day. The clinical course of AOM was favourable in 92% of the patients who received two doses of amoxicillin and in 95% of those who received three doses (p = 0.25). Four patients (1%) had persistent symptoms beyond day 7. None developed intracranial complications. In the group receiving three doses daily, 31% reported difficulties with the dosing schedule, and 9.6% faced challenges when administering the medication at the specified volume, compared with 5.8% and 25% of those who received the two-dose regimen, respectively.  Conclusion: Twice-daily amoxicillin has similar efficacy to a three-dose daily regimen and can offer advantages for caregivers in terms of administration schedule. What is Known: • Amoxicillin given in two daily doses is as effective as a three doses regimen in the treatment of acute otitis media in children. • The lower the number of daily doses, the higher the adherence to a drug treatment. What is New: • Administration of amoxicillin in twice-daily doses may improve adherence, as it is less frequently associated with family-perceived problems with dosing schedules.

Barriers and facilitators to reproductive health service utilization in Cote d'Ivoire: A community-based qualitative study / Barrières et facilitateurs de l'utilisation des services de santé de la reproduction en Côte d'Ivoire : une étude qualitative auprès de la communauté

Introduction: Improving Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) indicators is a challenge for health systems, especially those in sub-Saharan Africa. The objective of this study was to identify barriers and facilitators to the use of RMNCAH+N services in areas with low indicators in Cote d'Ivoire. Methods: A qualitative case study was conducted in September 2021, with 76 beneficiaries of RMNCAH+N services in the health districts of Boundiali, Toulepleu and Tanda. Individual interviews (09) and focus groups (09) were conducted with community leaders/tradi-practitioners/midwives and pregnant women/ women of childbearing age/men who have or are responsible for a child under the age of 5, respectively. A thematic analysis was performed after coding the data in NVivo 12. Results: Barriers to utilization of RMNCAH+N services were unavailability of certain equipment/amenities, disrespectful care in some RMNCAH+N services, women's lack of financial autonomy, lack of autonomy in decision making, and male healthcare providers. Facilitators identified were geographic accessibility, men's involvement in the mother-child dyad's health, and community awareness. Conclusion: Improving utilization of RMNCAH+N services requires the implementation of interventions that address these barriers and facilitators, such as raising community awareness of RMNCAH+N services and promoting respectful, patient-centered, humanized care among healthcare providers.

Introduction: L'amélioration des indicateurs de santé reproductive, maternelle, néonatale, infantile et adolescente et de la nutrition (SRMNIA+N) représente un challenge pour les systèmes de santé, principalement ceux des pays d'Afrique subsaharienne. Cette étude avait pour objectif d'identifier les barrières et facilitateurs à l'utilisation des services de SRMNIA+N dans les zones à faibles indicateurs en Côte d'Ivoire. Méthodes: Une étude de cas par approche qualitative auprès de 76 bénéficiaires des services de SRMNIA+N a été menée en septembre 2021 dans les districts sanitaires de Boundiali, Toulepleu et Tanda. Des entretiens individuels et des discussions de groupe (focus groups) ont été organisés respectivement auprès des leaders communautaires, tradipraticiens ou matrones et des femmes enceintes ou en âge de procréer et des hommes ayant la charge d'un enfant de moins de 5 ans. Une analyse thématique a été réalisée après codage des données dans NVivo 12. Résultats: Les barrières à l'utilisation des services de SRMNIA+N étaient la non-disponibilité de certains équipements ou commodités, les soins irrespectueux dans certains services de SRMNIA+N, le manque d'autonomie financière et/ou décisionnelle des femmes et la présence de prestataires de sexe masculin. Les facilitateurs identifiés étaient : l'accessibilité géographique, l'implication des hommes dans la santé du couple mère/enfant, la sensibilisation de la population. Conclusion: L'amélioration de l'utilisation des services de SRMNIA+N nécessite la mise en œuvre d'interventions adressant ces barrières et facilitateurs tels que la sensibilisation de la communauté sur les services de SRMNIA+N, la promotion auprès des prestataires de santé des soins humanisés respectueux et centrés sur le patient.

Efficacy and tolerability of 20% aluminum sesquichlorohydrate vs 20% aluminum chloride for the treatment of axillary hyperhidrosis: A randomized controlled trial.

This study evaluated the efficacy and tolerability of topical aluminum sesquichlorohydrate (AS) when compared to aluminum chloride (AC) as a treatment for primary axillary hyperhidrosis (PAH). Twenty subjects were included in this randomized, controlled, split-side 8-week study. All participants applied 20% AS and 20% AC lotions in their axillae (one treatment per axilla) every night for 2 weeks; next, the application was reduced to three times a week for 4 weeks. The assessment was performed using the sweating intensity visual scale (SIVS), hyperhidrosis disease severity score (HDSS), patient satisfaction score, and the appearance of adverse effects on weeks 0, 1, 2, 4, 6, and 8. Both AS as well as AC application showed positive results, significantly differing from the baseline, as assessed using SIVS, HDSS, and patient satisfaction score at every follow-up visit; however, no significant difference was observed between the AS and AC groups at any follow-up visit. The mean time of response was 1.14 weeks for both treatments. A side effect was observed in one subject (5%), who reported itching on the AC axilla. The therapeutic effects persisted even after reducing the frequency of application and lasted for at least 2 weeks after cessation of use. In conclusion, topical 20% AS demonstrated similar efficacy to topical 20% AC in the treatment of PAH, with a high safety profile.

Guidelines for the prevention of ventilator-associated pneumonia and their implementation. The Spanish "Zero-VAP" bundle.

BACKGROUND: "Zero-VAP" is a proposal for the implementation of a simultaneous multimodal intervention in Spanish intensive care units (ICU) consisting of a bundle of ventilator-associated pneumonia (VAP) prevention measures. METHODS/DESIGN: An initiative of the Spanish Societies of Intensive Care Medicine and of Intensive Care Nurses, the project is supported by the Spanish Ministry of Health, and participation is voluntary. In addition to guidelines for VAP prevention, the "Zero-VAP" Project incorporates an integral patient safety program and continuous online validation of the application of the bundle. For the latter, VAP episodes and participation indices are entered into the web-based Spanish ICU Infection Surveillance Program "ENVIN-HELICS" database, which provides continuous information about local, regional and national VAP incidence rates. Implementation of the guidelines aims at the reduction of VAP to less than 9 episodes per 1000 days of mechanical ventilation. A total of 35 preventive measures were initially selected. A task force of experts used the Grading of Recommendations, Assessment, Development and Evaluation Working Group methodology to generate a list of 7 basic "mandatory" recommendations (education and training in airway management, strict hand hygiene for airway management, cuff pressure control, oral hygiene with chlorhexidine, semi-recumbent positioning, promoting measures that safely avoid or reduce time on ventilator, and discouraging scheduled changes of ventilator circuits, humidifiers and endotracheal tubes) and 3 additional "highly recommended" measures (selective decontamination of the digestive tract, aspiration of subglottic secretions, and a short course of iv antibiotic). DISCUSSION: We present the Spanish VAP prevention guidelines and describe the methodology used for the selection and implementation of the recommendations and the organizational structure of the project. Compared to conventional guideline documents, the associated safety assurance program, the online data recording and compliance control systems, as well as the existence of a pre-defined objective are the distinct features of "Zero VAP".

Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. DATA SOURCES: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. REVIEW METHODS: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. CONCLUSIONS: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. IMPLICATIONS FOR PRACTICE: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance.

Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.

The surgical outcome of inferior oblique recession on bilateral superior oblique palsy in children.

OBJECTIVE: To study the surgical effects of bilateral graded inferior oblique muscle (IO) recession on the reduction of the V pattern deviation and severity of inferior oblique muscle overaction (IOOA) in children who had bilateral superior oblique muscle palsies (SOP) with secondary inferior oblique muscle overaction. MATERIAL AND METHOD: Seven patients who presented with bilateral SOP with secondary IOOA were included. All patients had V pattern deviation and bilateral graded IO recession was done. The data of age, sex, deviation in primary position, V pattern and severity of IOOA was recorded both pre- and post -operatively. The comparison of pre-operative and post-operative amount of V pattern and IOOA was analyzed with nonparametric statistical analysis. RESULTS: Four females and three males had the average age of 5.7 +/- 1.8 years old. The mean pre-operative severity of IOOA was + 3 and the mean pre-operative deviation of the V pattern was 36 +/- 11.4 prism diopters (PD). The mean post-operative severity of IOOA was + 0.4 and of V pattern deviation was 10.7 +/- 4.4 PD. Comparing the pre-operative and post-operative severity of lOOA and V pattern deviation by non-parametric statistical analysis and the result was statistically significant. CONCLUSION: Bilateral graded IO recession is an effective surgical procedure to reduce the V pattern and the severity of IOOA in the children who are suffering from bilateral SOP with secondary IOOA.

Driver Behavior and Performance with Augmented Reality Pedestrian Collision Warning: An Outdoor User Study.

This article investigates the effects of visual warning presentation methods on human performance in augmented reality (AR) driving. An experimental user study was conducted in a parking lot where participants drove a test vehicle while braking for any cross traffic with assistance from AR visual warnings presented on a monoscopic and volumetric head-up display (HUD). Results showed that monoscopic displays can be as effective as volumetric displays for human performance in AR braking tasks. The experiment also demonstrated the benefits of conformal graphics, which are tightly integrated into the real world, such as their ability to guide drivers' attention and their positive consequences on driver behavior and performance. These findings suggest that conformal graphics presented via monoscopic HUDs can enhance driver performance by leveraging the effectiveness of monocular depth cues. The proposed approaches and methods can be used and further developed by future researchers and practitioners to better understand driver performance in AR as well as inform usability evaluation of future automotive AR applications.

[Health Campaigns Against Malaria in Spain through the Specialized Journalism in Spain (1929-1954)]. / Campañas sanitarias frente al paludismo en España a partir de los trabajos publicados en dos revistas científicas: Medicina de los Países Cálidos y La Medicina Colonial(1929-1954).

BACKGROUND: Malaria was one of the most important public health problems of the Colonial Medicine and, for this reason, the subject was reflected in the Spanish medical journalism. The aim of the paper was to reconstruct the Spanish contributions to international health during the first half of the twentieth century. METHODS: The primary sources of information on malaria were the medical journals Medicina de los Países Cálidos and Medicina Colonial, between 1929 and 1954. The documents were classified according to the sections of the magazine and its contents were studied, framing them in the history of international public health. RESULTS: In primary sources were found 466 documents. Malaria was one of the major diseases of the Spanish Protectorate in Morocco and Spanish Guinea, favoured by the occupation of the Spanish army. Antimalaria campaigns included strategies such as the use of Dichloro-diphenyl-trichloroethane, preventive education and massive quininización. Malariology in the specialized journalism, experienced a growing boom. The most outstanding authors in magazines analyzed were Gustavo Pittaluga, Sadí de Buen, Eliseo de Buen and Juan Gil-Collado. CONCLUSIONS: The Spanish specialized journalism provides the importance e interaction in antimalaria campaigns in Spain and Spanish African colonies of scientific, professional, political and military factors. The colonial situation was negative and marked differences between metropolis and colonies in terms of the effort, efficiency and the different temporal sequence of the measures undertaken.

OBJETIVO: El paludismo fue uno de los más importantes problemas sanitarios de la Medicina Colonial y objeto de estudio de gran interés en las revistas médicas españolas. El objetivo del trabajo fue reconstruir las aportaciones españolas a la salud internacional durante la primera mitad del siglo XX. METODOS: Las fuentes primarias de información sobre paludismo fueron las revistas Medicina de los Países Cálidos y La Medicina colonial, publicadas entre 1929 y 1954. Los documentos se clasificaron según las diferentes secciones de las revistas y se estudiaron sus contenidos, enmarcándolos en la historia de la salud pública internacional. RESULTADOS: Se encontraron en las fuentes primarias 466 documentos. El paludismo fue una de las principales enfermedades del Protectorado Español de Marruecos y Guinea Española, favorecido por la ocupación del ejército español. Las Campañas antipalúdicas incluyeron estrategias como: uso de Dicloro-difenil-tricloroetano, educación preventiva y quininización masiva. La malariología experimentó un auge creciente en el periodismo especializado. Los autores de mayor presencia en las revistas analizadas fueron Gustavo Pittaluga, Sadí de Buen, Eliseo de Buen y Juan Gil-Collado. CONCLUSIONES: El periodismo español especializado en medicina colonial muestra la importancia e interacción de factores científicos, profesionales, políticos y militares en las campañas antipalúdicas realizadas en España y las colonias africanas. La situación colonial fue negativa y marcó las diferencias entre metrópoli y colonias en cuanto al esfuerzo, eficacia y la diferente secuencia temporal de las medidas emprendidas.

State-of-the-art monitoring in treatment of dengue shock syndrome: a case series.

BACKGROUND: Early recognition and treatment of circulatory volume loss is essential in the clinical management of dengue viral infection. We hypothesized that a novel computational algorithm, originally developed for noninvasive monitoring of blood loss in combat casualties, could: (1) indicate the central volume status of children with dengue during the early stages of "shock"; and (2) track fluid resuscitation status. METHODS: Continuous noninvasive photoplethysmographic waveforms were collected over a 5-month period from three children of Thai ethnicity with clinical suspicion of dengue. Waveform data were processed by the algorithm to calculate each child's Compensatory Reserve Index, where 1 represents supine normovolemia and 0 represents the circulatory volume at which hemodynamic decompensation occurs. Values between 1 and 0 indicate the proportion of reserve remaining before hemodynamic decompensation. RESULTS: This case report describes a 7-year-old Thai boy, another 7-year-old Thai boy, and a 9-year-old Thai boy who exhibited signs and symptoms of dengue shock syndrome; all the children had secondary dengue virus infections, documented by serology and reverse transcriptase polymerase chain reaction. The three boys experienced substantial plasma leakage demonstrated by pleural effusion index >25, ascites, and >20 % hemoconcentration. They received fluid administered intravenously; one received a blood transfusion. All three boys showed a significantly low initial Compensatory Reserve Index (≥0.20), indicating a clinical diagnosis of "near shock". Following 5 days with fluid resuscitation treatment, their Compensatory Reserve Index increased towards "normovolemia" (that is, Compensatory Reserve Index >0.75). CONCLUSIONS: The results from these cases demonstrate a new variation in the diagnostic capability to manage patients with dengue shock syndrome. The findings shed new light on a method that can avoid possible adverse effects of shock by noninvasive measurement of a patient's compensatory reserve rather than standard vital signs or invasive diagnostic methods.

Recomendaciones del Grupo interdisciplinario intersociedades científicas e intercátedras de Uruguay. Versión de 24 de marzo de 2020 / Recommendations of the Interdisciplinary Group of Scientific Inter-Societies and Inter-Cathedra of Uruguay / Recomendações do Grupo Interdisciplinar de Inter-Sociedades Científicas e Inter-Cathedra do Uruguai

Resumen: Las recomendaciones incluidas en este documento están en continua revisión y serán modificadas de acuerdo a la situación epidemiológica. Por ello, dado el probable escenario de transmisión comunitaria sostenida de SARS-CoV-2, y para dar cumplimiento a la demanda asistencial en todos sus niveles, es fundamental asegurar la capacidad de respuesta del sistema sanitario. Enfrentamos una sobredemanda en el nivel prehospitalario, y, previendo una eventual saturación de los otros niveles de atención, se realizan las siguientes recomendaciones referidas a recursos materiales, personal de la salud, estudios diagnósticos y tratamiento específico antiviral.

Use of pharmacodynamic end points in the evaluation of gatifloxacin for the treatment of acute maxillary sinusitis.

The relationship between drug exposure and the time course of antimicrobial effect at the primary infection site for acute maxillary sinusitis has not previously been explored. This single-center, open-label study quantified the time course of sinus sterilization, described gatifloxacin exposure at the infection site, and posed the hypothesis that the use of continuous and quantitative time-related end points may allow for better characterization of drug effect with fewer patients than traditional clinical trial approaches. Of the 12 enrolled patients, 10 were clinically evaluable, from whom 7 pathogens were isolated: 4 Streptococcus pneumoniae, 2 staphylococci, and 1 Enterobacter aerogenes. The median predicted 24-h area under the curve (AUC) in sinus aspirates and plasma samples was 54.7 mg x h/L and 30.1 mg x h/L, respectively. The median 24-h AUC ratio for sinus aspirates and plasma samples was 1.51 (range, 0.88-2.23). For patients infected with pneumococci, the median time to sinus sterilization was 50 h. The use of quantitative time-related end points may be useful in evaluating the efficacy of antimicrobial agents with fewer patients.