Validity and reliability of image intensifier articular step-off and gap measurements for distal radius fractures using a cadaveric model

OBJECTIVES@#The purpose of this study was to determine the accuracy and reproducibility of image intensifier (fluoroscopic) measurements of gap and step-off displacements on the articular surface of the distal radius using a standard cadaver osteotomy fracture model.@*METHODS@#Fourteen orthopedic residents were randomly assigned using the fish bowl method to measure the gap and step-off displacements in cadaveric fluoroscopic images using a digital caliper. Each physician was randomly assigned the images where they examined the images twice and the average taken using a standard technique. The interobserver and intra-observer reliability were calculated using the intraclass correlation coefficient (ICC). Rank Sum test was used to evaluate the validity of measurements.@*RESULTS@#The results of the study showed that there was no significant difference between the cadaveric and measured step-off and gap displacements. Intraclass correlation coefficient scores showed moderate (0.41) to perfect (1.0) agreement.@*CONCLUSION@#The study showed that fluoroscopy can aid in the interpretation of gap and step-off displacements in acute distal radius fractures.

Building capacities for universal health care in the Philippines: Development and implementation of a leadership training program for public health nurses

@#Achievement of Universal Health Care (UHC) in the Philippines requires capable health workers who can navigate changes and lead in the local implementation of health system reforms. Public health nurses are in a strategic position to lead in UHC implementation as they constitute the largest cadre of health workers in the public health setting, and core concepts of UHC intersect with principles of public health nursing practice. This paper aims to describe the development and implementation of a leadership training program for public health nurses in the Philippines, in response to UHC. Document reviews of training reports and evaluations, including course site data analytics, and evaluation of the training program were done for the four cohorts of the course. The University of the Philippines Manila College of Nursing, with support from the Department of Health, responded to the increased demand of the Philippine health system for public health nurses with strong foundations and advanced skills by designing and offering a leadership development course specific to PHNs. From November 2019 to March 2022, a total of 183 participants from 17 regions completed the training. With the COVID-19 pandemic and dynamic changes in governance, the experiences of the project highlighted the need for flexibility in delivering the training program, updating module contents according to the latest developments, and improving course duration and evaluation. Barriers to course engagement and completion must be addressed for PHNs, their workplaces, clients, and the health system to benefit the most from the training.

Classification of Childhood Glaucoma in Patients of a Government Tertiary Hospital in Manila, Philippines using the Childhood Glaucoma Research Network System

@#Background. Childhood glaucoma is a rare multifactorial disease with limited information regarding the demographics and characteristics in the Filipino setting. It can be categorized via the Childhood Glaucoma Research Network Classification scheme. Objective. Determine the clinical classification of patients diagnosed with childhood glaucoma in the ophthalmology service of a government tertiary hospital in Manila, Philippines. Methods. Medical records of all patients ≤16 years-old referred to Glaucoma Section of Philippine General Hospital from January 2015 to December 2017 were reviewed retrospectively and classified. Results. One-hundred four (104) eyes in 77 children were classified. Glaucoma associated with acquired conditions was the most prevalent in 44.2% of the patients with trauma consisting of 19.5% of all patients. Primary childhood glaucoma consisted of 15.6% and juvenile open-angle glaucoma was diagnosed in 5.2%. Glaucoma following cataract surgery was noted in 7.8% of patients. Trabeculectomy was the primary surgical intervention in 22.2% of eyes, with 78.9% of eyes reaching an IOP control of <21mmHg on final follow-up. Conclusion. Glaucoma associated with acquired conditions was the most common childhood glaucoma in the patient population. Trabeculectomy was the most common surgery done. Trauma was the most prevalent cause of glaucoma from acquired conditions.

Clinical and Humanistic Outcomes of Tuberculosis Treatment in a Nigerian Directly Observed Treatment Short Course Centre

Background:Tuberculosis remainsa major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. The objective of the study was to evaluate the clinical and humanistic outcomes of tuberculosis treatment at the directly observed treatment short-course (DOTS)centre in Jos University Teaching Hospital.Methods:Data for clinical outcomes was collected retrospectively at the directly observed treatment shortcousecentre of Jos University Teaching Hospital from a cross-section of patients’ folders who had been treated for tuberculosis at the study site for at least 12months as at 1stApril to 30thSeptember 2018 while a validated questionnaire was administered prospectively to a census population of tuberculosis patients still undergoing treatment between 1stOctober 2018 and 31stMarch 2019 to determine the humanistic outcomes. A descriptive data analysis was done using SPSS version 23 and proportions were tested using chi squared statistics with significance level set at P<0.05.Results:The study revealed that tuberculosis treatment success in the centre was 76.33% which falls short of WHO standard of minimum of 85%. Patients taking tuberculosis treatment in the centre are satisfied with the services rendered to them and the improvement in their health conditions. Unfriendly attitude of some health care providers in the facility is an area for intervention. Conclusion: Clinical and humanistic outcomes of tuberculosis treatment was found to be satisfactory in the facility owing to the level of treatment success and patient reported satisfaction with facility services and improvement in their health conditions

Assessment of Heat and Mass Transfers by the Evaporation of a Large Impoundment under Dry and Hot Climate: Case of Burkina Faso

This paper aims to report a numerical study of the assessment of heat and mass transfers by evaporation of a large impoundment under Burkina Faso climate conditions. This impoundment is considered as a parallelepiped which upper face, in contact with the ambient environment and subject to solar radiation, is the seat of a natural convection-based evaporation. The intensity of this evaporation is modeled by a correlation in the literature. Transfers into water are made by natural convection. They are caused by temperature differences due to solar radiation and ambient conditions (wind, hygrometry of the air,) on water. These transfers are described by the Navier-Stokes equations and energy and the initial and boundary conditions associated with them. The finite volume method and the SIMPLE algorithm were used for speed-pressure coupling. The systems of algebraic equations deduced from the discretization of transfer equations and boundary conditions associated with them are solved with Thomas’ algorithm, the SIMPLE algorithm and an iterative procedure because evaporated water quantity depends on the temperature and concentration of water vapor at the surface of the impoundment which are the unknowns of the problem. The numerical model developed is validated in relation to previous work and experimental data from Burkina Faso meteorology. The results obtained concern the evolution of the evaporated water flux under dense solar flows, a relative humidity of the air proportional to the wind speed and also the evolution of the evaporated water flux against the solar flux density for high relative moisture content. Also the evolution of the evaporated water flow against the depth of the impoundment for a solar flux density, relative humidity and the temperature of the surface of the body of water is given. The determination of evaporated water flux for typical years was calculated on a 10-year period. The results obtained show that the flux of evaporated water increases with a high solar flux rate and decreases for a high relative humidity level.

Domestic violence against women workers in selected tea estates of South India

Background: Violence against women is an important public health problem, due to its consequences on women health. There is a considerable variation in the prevalence of domestic violence across the states and different settings in India. Objectives: The objectives of the study were to estimate the prevalence of different forms of domestic violence and determine the associated factors among women working in tea estates. Materials and Methods: A cross-sectional study was conducted in two tea estates in Tamil Nadu. All (266) ever-married women workers aged 15–49 years were included in the study. Data were collected using a pre-designed interview schedule including sociodemography and physical, psychological, and sexual domains of domestic violence. It was developed using the National Family Health Survey 3 interview schedule and the World Health Organization multi-country study on women’s health and life experiences questionnaire version 10. Results: The prevalence of domestic violence was 65%, while specifically psychological, physical, and sexual violence were 63.5%, 44.1%, and 4.1%, respectively. Domestic violence was significantly associated with socioeconomic status, spousal literacy status, age at marriage, and alcohol use (P < 0.05). Any form of violence and psychological violence were twice as common with illiterate (unadjusted odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.4–4.9) (unadjusted OR: 2.4; 95% CI: 1.1–4.9) and a spouse who consumed alcohol (unadjusted OR: 2.7; 95% CI: 1.6–4.6) (unadjusted OR: 2.5; 95% CI: 1.5–4.2), respectively. Conclusion: The prevalence of all forms of domestic violence was high among women in the selected two tea estates in South India. Significant association was found with spousal characteristics. This calls for stringent enforcement of laws and educating men toward changing the social attitude toward violence against women.

Study of Aerosol Impact on the Solar Potential Available in Burkina Faso, West Africa

This paper is an assessment of aerosols impact on solar potential available in Burkina Faso in 2017. Three measurement stations were selected from the North to the South according to the climatic zones, with sites at Dori (14.035°N, 0.034°W) in the North, Ouagadougou (12.20°N, 1.40°W) in the Center and Gaoua (10.29°N, 3.25°W) in the Southwest, respectively. This study is based on in-situ measurements, satellite observations and a tropospheric standard model of the Streamer radiative transfer code of atmospheric particles. The results show a high availability of solar irradiation with average monthly values ranging between 4.46 kWh/m²/d and 6.82 kWh/m²/d. The most favorable periods with maximum radiation are observed in Spring in March and in Fall in October. Yet, the qualitative comparison between the evolution of aerosols and that of solar potential clearly shows aerosols capacity to influence the radiation at the crossing of the atmosphere. Thus, the aerosols maxima correspond to the solar potential minima. Moreover, a comparison between the day cycles of solar radiation and those of the simulation model shows a good accuracy of the Streamer code to estimate the solar flows at the surface in a standard atmosphere without clouds in Burkina Faso.However, a quantification of the aerosol impact by the Streamer code reveals a reduction in the normal direct flow compared to clear days defined by aerosol optical depth (AOD) less than 0.2 (AOD<0.2) of nearly 75.04% at the Dori site in the North, 57.33% at the Ouagadougou site in the Center and 40.89 % at the Gaoua site in the Southwest during polluted days corresponding to AOD higher than 0.8.This corresponds to an increase in the diffuse flow of 279.69 W/m², 246.05 W/m² and 226.09 W/m², respectively calculated on the same sites. In case of a mixed day (0.2 <AOD <0.8), this decrease in direct solar flow is estimated at 41.25%, 22.11% and 37.13% with an increasein the diffuse solar flux of 115.04 W/m², 150.43 W/m² and 79.58 W/m² at the sites of Dori, Ouagadougou and Gaoua, respectively.

Pulmonary Mycobacterium kyorinense disease: A case report and review of literature

We report here the first case of pulmonary infection due to Mycobacterium kyorinense in a 55-year-old hypertensive woman treated for pulmonary tuberculosis earlier on two occasions. She presented with productive cough, intermittent episode of left-sided chest pain, loss of appetite, low-grade fever, and breathlessness. Sputum cultures revealed non-tuberculous mycobacteria (NTM). She remained persistently symptomatic with sputum cultures positive for acid-fast bacilli even after 6 months of treatment. Hence, a 16SrRNA gene amplification and sequencing were done that revealed M. kyorinense. Based on the guidelines of the American Thoracic Society, she was started on weight-based dosing of clarithromycin, levofloxacin, ethambutol, isoniazid and injection amikacin daily. The patient improved symptomatically and became culture-negative after 3 months of therapy with the above regimen and continued to be culture negative for 12 months of treatment. She continues to remain symptom-free without evidence of any clinical or bacteriological relapse.

Mandatory HIV testing as a prerequisite for surgical procedures: Perspectives on rights and ethics

Background. Undergoing mandatory HIV testing as a criterion for a surgical or invasive procedure is illegal in Nigeria, and unethical. This includes requesting an HIV test without the consent of the client, and the disclosure of the test results.Objectives. To assess the practice of mandatory HIV testing among health practitioners, andtoexamine HIV testing without consent, and the disclosure of test results to the patient.Methods. This was a cross-sectional survey of both medical doctors and nurses with surgical skills. We used convenience sampling to selectrespondents from Jos University Teaching Hospital, Nigeria and Federal Teaching Hospital, Gombe, Nigeria. A total of 99 respondents filled and returned a questionnaire. Statistical Package for the Social Sciences version 20 was used to manage the data, and the results were presented using descriptive statistics.Results. Over one-third (34.3%) of the respondents reported that they would insist on seeing an HIV test result before performing a surgical or invasive procedure; meanwhile, 4 (4%) of the respondents had refused to render surgical or invasive intervention to HIV clients, while (3%) admitted having refused surgical procedures to patients who refused to take an HIV test. The majority of the respondents (79; 79.8%)reported that the basic equipment and consumables needed for universal precautions were either not available or grossly inadequate.Conclusion. Requests for patients to take an HIV test before surgical procedures are frequent; however, only a few respondents had ever refused to provide a surgical intervention on the basis of a patient's HIV-positive status. Equipment and consumables necessary for universal precautions were either not available or grossly inadequate in the surveyed hospitals

No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South / Não foi observada correlação entre os níveis séricos de vitamina D e a incapacidade em pacientes com esclerose múltipla entre as latitudes Sul 18° e 30°

ABSTRACT Objective: Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area. Methods: Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn. Results: The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration. Conclusion: At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

RESUMO Objetivo: Vitamina D assumiu um papel central na pesquisa e tratamento da esclerose múltipla (EM). O objetivo deste estudo foi avaliar os níveis séricos de vitamina D de pacientes com EM e controles que residem em uma área tropical. Métodos: Foram analisados dados de 535 pacientes com EM e 350 indivíduos controle em 14 cidades próximas ao Trópico de Capricórnio. Resultados: O valor médio da determinação de 25-OH vitamina D foi 26,07 ± 10,27 ng/mL para controles e 28,03 ± 12,19 ng/mL para pacientes com EM. Não houve correlação entre os níveis de vitamina D e o grau de incapacidade ao longo da duração da doença. Conclusão: Pelo menos na região que cerca o Trópico de Capricórnio, os níveis séricos de vitamina D estão entre valores de 20 a 30 ng/mL tanto para controles quanto para pacientes com EM.

Profile of delivering mothers in Lubumbashi, Democratic Republic of the Congo

The aim of our study was to establish an inventory of deliveries in Lubumbashi, Democratic Republic of Congo. We carried out a descriptive study in 10 General Reference Hospitals in the city from 1 December 2013 to 31 May 2014. The study reports that pregnant mothers in Lubumbashi deliver at a mean age of 28.2 years. The women have a mean parity of 3.8, they are married (97.7%), overweight (mean BMI 25.68 kg/m2) and had 2.6 antenatal care on mean. The primary mode of delivery was spontaneous vaginal delivery (91.7%). About 10% of mothers had a complication dominated by perineal or vaginal tears and haemorrhagic complications. Newborns weighed on average 3121.2 grams and 0.56% had a congenital malformation dominated by polydactyly and cleft-palate. Maternal and perinatal mortality rates were 310 per 100,000 live births and 42.4 per 1,000 live births, respectively

Gestational Trophoblastic diseases: alternatives to biological monitoring in under-resourced settings (Two clinical observations)

Gestational trophoblastic disease (GTD) is a condition requiring regular monitoring of hormone human chorionic gonadotropin (HCG). The semi-quantitative method presented here is an alternative for monitoring in under-equipped environments. The illustration made from two clinical cases of GTD that we have followed shows that this method can be used in under-equipped settings and where the quantitative dosage is unavailable

Designing interprofessional simulation based faculty development in a new women and children's hospital in the Middle East: a pilot study

Objectives: This study sheds light on information for clinical educators interested in designing interprofessional simulation based faculty development initiatives

Methods: A one group pre- and post-test design with a convenience sample was used to examine the relationship between participant knowledge of simulation based learning and effective feedback and the impact of precourse eLearning on participant cognitive entry behaviours and achievement

Results: There were significant improvements in aggregate MCQ scores, [[t [39] 1/4 4.08, p < 0.000]] from pre- to post-test. Participant ability to apply the theory of feedback, with a focus on debriefing, did not improve significantly over the course. Achievement scores related to items on pre-course topics were higher on the pre-test than course-related items. Incoming clinicians recruited from around the world need faculty education fuelled with deliberate practice and mentorship to develop competence in the application of simulation based learning [SBL] theory. Participant achievement scores will benefit from early exposure to concepts in pre-course eLearning

Conclusion: Two days of SBL faculty development is not adequate for achieving participant competence with the theory and application of feedback. Future research should examine this with a more rigorous research design

Objective and subjective image quality with prospectively gated versus ECG-controlled tube current modulation using 256-slice computed tomographic angiography

Introduction: Radiation exposure is one of the major limitations of computed tomographic coronary angiography [CTA]. The purpose of this study was to compare the objective and subjective image quality and radiation dose using prospective ECG gating [PGA] versus ECG-controlled tube current modulation [ECTCM] scanning techniques. A prospective, single-center study was performed at Prince Sultan Cardiac Centre, Qassim, Saudi Arabia. A total of 104 patients with low-to- intermediate probability of coronary artery disease [CAD] underwent CTA with either PGA or ECTCM acquisition. PGA was performed during the study period and compared with the last 50 CTAs previously done using ECTCM. A 4-point scale was used to assess the image quality subjectively. Objective image quality was assessed using image signal, noise, and signal-to-noise ratio [SNR].Patient's Baseline characteristics were not different between the two scanning protocols. The 4-point score of subjective image quality showed no significant differences between the PGA and ECTCM scans [2.9 +/- 0.7, 2.96 +/- 0.7, respectively; p = 0.87]. The objective image quality showed significantly higher noise and lower SNR with PGA compared with ECTCM [31 +/- 9, 27 +/- 9, respectively; p < 0.001 for noise] and [15 +/- 5, 17 +/- 7, respectively; p < 0.001 for SNR], with no statistical difference in the image signal [434 +/- 123, 425 +/- 103 HU, respectively, p = 0.7]. Radiation exposure was significantly lower with PGA than with ECTCM. The dose-length product [DLP] for PGA was 334 +/- 130 mGy, compared with 822 +/- 286 mGy for the ECTCM. This corresponds to a 59% reduction in radiation exposure [p < 0.0001]. Conclusions: Although prospective ECG-triggered axial scanning increased image noise, it maintained subjective image quality and was associated with a 59% reduction in radiation exposure when compared with ECTCM

Tendencias en el uso de la ablación con catéter para el tratamiento de la fibrilación auricular versus el uso de la intervención coronaria para el tratamiento de la cardiopatía isquémica en Australia en los últimos diez años

Propósitos: los procedimientos de intervención coronaria percutánea (ICP) y la ablación con catéter son intervenciones terapéuticas bien aceptadas para el tratamiento de las coronariopatías y de la fibrilación auricular (FA), respectivamente. La intención de los autores fue examinar las tendencias temporales en la prestación de estos servicios en la última década en Australia. Métodos y resultados: la revisión retrospectiva de las cifras de las ICPs y las ablaciones en casos de FA desde 2000/01 a 2009/10 se hizo con base en información proveniente de tres fuentes: el Instituto Australiano de Salud, Bienestar y Tercera Edad (AIHW), la base de datos de Medicare Australia (MA), y los registros locales de un centro de referencia terciario de alto volumen (RMH) para ablación de la FA. Se ajustaron modelos de regresión lineal comparando las tendencias en número de procedimientos ajustados para la población en el curso de un período de diez años. Hubo un incremento de 5%/año ajustado para la población en los ICPs en el curso de diez años, tanto de la fuente de AIHW como de MA respectivamente (p<0,001). Esto fue similar a la tasa de crecimiento de todos los procedimientos cardiovasculares (AIHW: 5,1 versus 3,8%/año, p=0,27). Las ablaciones por FA mostraron un incremento de 30,9%, 23,2% y 39,8% por año ajustado para la población en el curso de diez años de las fuentes AIHW, MA, y RMH respectivamente (p<0,001 para todos). El crecimiento de las ablaciones por FA fue significativamente mayor que el de las ICPs (p<0,001 para las fuentes de AIHW y MA) y todos los procedimientos cardiovasculares (AIHW: 30,9%/año versus 3,8%/año, p<0,001). Conclusión: la realización de servicios de ablación con catéter en caso de FA en Australia ha aumentado de forma exponencial en el curso de la última década. Su tasa de crecimiento anual supera la de las ICPs y todos los procedimientos cardiovasculares. Dada la epidemia creciente de FA, estos datos tienen implicancias cruciales para las políticas de salud pública que evalúan la idoneidad de la infraestructura, la capacitación y la financiación de los servicios de ablación de la FA.

Ceruminous adenoma

@#A 58-year-old Filipino man with a two-year history of a left external auditory canal mass associated with ipsilateral hearing loss underwent polypectomy for a clinical impression of aural polyp. We received several cream tan, irregular tissue fragments with an aggregate diameter of 1.4 cm. Histopathologic examination shows clusters of tumor cells forming variably sized ducts and glands, some of which are cystically dilated; many of these structures have irregular lumina. (Figure 1) Higher magnification shows a dual cell population: an outer layer of round to ovoid cells with clear cytoplasm, corresponding to basal myoepithelial cells; and an inner layer of cuboidal to columnar cells, that have eosinophilic and granular cytoplasm with decapitating apical ends, corresponding to luminal epithelial cells with apocrine morphology. (Figure 2) Nuclear pleomorphism is mild to moderate, nucleoli are not prominent, and mitoses, perineural invasion and necrosis are not seen. In some glands a yellow to golden brown, coarse pigment is seen at the cytoplasm of the luminal cells. (Figure 3) The tumor does not involve the epidermis, and there is a variable amount of chronic inflammation. (Figure 4) Based on these features we diagnosed it as ceruminous adenoma.

Survival after pneumonectomy for stage III non-small cell lung cancer

To evaluate the plasma lipid profile of cancer patients pre-and-post therapy. Plasma lipid profile was evaluated in 100 specimens comprising 50 patients with cancers of various types such as breast, esophageal, colorectal, pancreatic, cervical, as well as multiple myeloma, leukemia's, Hodgkins and non-Hodgkins lymphoma at the University of Benin Teaching Hospital. Specimen were obtained from 25 [9 males and 16 females] of the 50 cancer patients before therapy while the other 25 specimens [9 males and 16 females] were obtained post therapy. Fifty apparently healthy, age- and sex-matched subjects served as controls. The results obtained showed a statistically significant difference in the plasma lipid levels of cancer patients compared with controls [p<0.05]. A statistically significant difference was also observed in plasma lipid levels of cancer patients before treatment compared to cancer patients after treatment [p<0.05]. There was no statistically significant difference in plasma lipid levels of male cancer patients compared to female cancer patients before and after treatment [p>0.05]. This work suggests that hypolipidemia is expressed in cancer and this may be consequent upon an increased utilization of plasma lipids by neoplastic cells. Therefore, low plasma lipid levels could be an indication of the initial changes occurring in neoplastic cells which could be an index for assessing patients response to treatment

Dynamic Bowel Obstruction: Aetiology; Clinical Presentation; Management and Outcome at Bugando Medical Centre; Mwanza; Tanzania

Dynamic bowel obstruction is a common and potentially dangerous surgical emergency with high morbidity and mortality worldwide. No prospective study has been done on this subject in our setting. This study was conducted to describe in our region; the aetiology; clinical presentation; management and outcome of dynamic bowel obstruction. Data were analyzed using SPSS software system. A total of 342 patients were studied. Males outnumbered females by a ratio of 2.1: 1. The median age of patients at presentation was 34 years (range 11 to 78 years). Obstructed hernias (32.7) were the commonest cause of dynamic bowel obstruction. Abdominal pain (100) and vomiting (86.5) were the most frequent presenting symptoms. Thirty-one (9.1) patients were HIV positive. Small bowel was the commonest site of obstruction accounting for 89.2 of cases. Herniorrhaphy was the most frequent surgical procedure performed in 112 (32.7) patients. Surgical site infection (38.8) was the most common post-operative complication and it was significantly associated with HIV positivity and low CD 4+ count (p0.001). The overall median of length of hospital stay was 26 days (range 1 to 72 days). Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p