Development of a Relative Dosimetric System for Calibration of 32P Eye Applicators Using Radiochromic Films.

Introduction: Beta irradiation after bare scleral surgery of primary pterygium is an effective and safe treatment, which reduces the risk of local recurrence. Purpose: Obtaining the reference dose rate for a radioactive applicator consisting of a plate as a 32P absorber, a steel window and a steel capsule. Methods: Relative dosimetry and dose profile were measured using two types of radiochromic films, HD-810 and EBT1, for the 32P applicator and were compared with Monte Carlo simulation data. Dose uniformity in the 32P applicator was obtained with radiochromic HD-810 film. Results: The measurement depth dose distribution data at distances up to 3.8 mm were compared with calculation data, and the values were not found to differ statistically. Depth dose distribution with a large dose gradient was determined and the dose rate data obtained 0.0053 ± 9.9% in unit of Gy/s.mCi at a 0.1 mm depth distance. Practical results indicated that the dose nonuniformity and the maximum symmetrical for the 32P applicator were 11.5% and 9.2%, respectively. Conclusions: Our experiments show that the use of the radiochromic film to perform the relative dosimetric checks is feasible and the activity value with acceptable error can be determined through this indirect method.

Impact of Continued Social Network-based Learning Based on Midwives Knowledge and Implementation of the Helping Babies Breathe Program.

Background: The Helping Babies Breathe (HBB) program is a simple neonatal resuscitation protocol implemented in low-resource clinical systems. Therefore, it is necessary to train midwives on the implementation of this program and ensure the sustainability of the learned materials. The present study aimed to assess the impact of continued social network-based learning based on midwives knowledge and implementation of the HBB program. Materials and Methods: This randomized controlled field trial was performed on 50 midwives who were selected by the available sampling method. All midwives attended the HBB workshop; thereafter, in the intervention group, the learned materials were reinforced for 3 months using WhatsApp messenger. Data were collected using Objective Structured Clinical Examination (OSCE), which was administered before the HBB program and 3 months later (HBB guide; 2th Ed, 2018). The data were analyzed in SPSS software (version 19) using independent and paired t-tests. Results: Based on the results, the mean knowledge score was not significantly different in both groups (control and intervention) immediately after the workshop. The mean scores of knowledge and skill variations did not decrease significantly in the WhatsApp group during the 3 months; nonetheless, a marked decrease was observed in the control group (t21 = 16.68, p < 0.05). Conclusions: The results of this study pointed out that continued social network-based education promoted the knowledge and skills of health care providers, highlighting the importance of social networks in education.

Cryptogenic Hypervirulent Klebsiella pneumoniae Pyogenic Liver Abscess: A Case Report.

BACKGROUND Klebsiella pneumoniae is a gram-negative organism known to cause pyogenic liver abscesses. It is most often caused by one of the hypervirulent strains, which are capable of causing metastatic infection. This occurs most commonly in Asia in patients without hepatobiliary disease; however, it is becoming increasingly recognized in North America. CASE REPORT We report a previously healthy man in his 50s who presented to hospital with 3 weeks of fever, chills, and mild abdominal pain following a minor motor vehicle collision. Ultrasound and computed tomography of his abdomen revealed a large multi-loculated liver abscess. This was drained percutaneously and grew a hypervirulent strain of Klebsiella pneumoniae known to cause metastatic infection. His blood cultures were negative. In addition to percutaneous drainage, he was treated with 8 weeks of antimicrobial therapy. Fortunately, he did not develop evidence of metastatic infection despite the hypervirulent strain. Etiology of the abscess was not clearly identified; however, it was speculated that the motor vehicle collision could have led to its development through gut translocation. CONCLUSIONS Presentation of Klebsiella pneumoniae liver abscesses is often nonspecific, and clinicians must have a high index of suspicion in order to ensure rapid diagnosis and treatment. Delay in diagnosis is associated with increased morbidity and mortality, and thus it is an important entity for clinicians to be aware of, especially as it becomes more prevalent in North American populations. Additionally, it is important that physicians are aware of the hypervirulent strains and screen patients clinically for evidence of metastatic infection.

Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

INTRODUCTION AND AIM: Occult hepatitis C infection (OHCI) is the presence of HCV-RNA in the liver or peripheral blood mononuclear cells (PBMC) accompanying with negative serologic results. The aim of this study was to evaluate the prevalence of OHCI among Iranian chronic hemodialysis (HD) patients. MATERIAL AND METHODS: In this cross sectional study 200 chronic HD patients with negative HCV antibody enrolled the study. Blood sample of patients were obtained, followed by Polymerase Chain reaction (PCR) testing for detection of HCV RNA. Patients with positive serum HCV RNA were considered as manifest hepatitis C infection (MHCI). However, patients with negative serum HCV RNA underwent further tests on PBMCs for detection of OHCI. RESULTS: Serum HCV RNA was positive in 2 (1%) patients whom considered as MHCI, and 6 (3.03%) patients had positive PBMC HCV RNA. CONCLUSION: In conclusion, chronic HD patients have been considered as a high risk group for hepatitis C infection. The results of this study suggest that these patients are also at risk for OHCI. Furthermore, evaluating PBMCs to detect HCV RNA would be a sensitive diagnostic method to find OHCI patients.

A Hepatitis C Educational Needs Assessment of Canadian Healthcare Providers.

Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes. The survey assessed several domains (e.g., participant and practice demographics, access to resources, knowledge of new treatments, and educational preferences). Results. A total of 163 HCPs responded to the survey. All hepatologists and 8% of primary care providers (PCPs) reported involvement in treatment of CHC. Physicians most frequently screened patients who had abnormal liver enzymes, while nurses tended to screen based on lifestyle factors. More than 70% of PCPs were not aware of new medications and their mechanisms. Conclusion. Overall, the needs assessment demonstrated that there was a need for further education, particularly for primary care physicians, to maximize the role that they can play in screening, testing, and treatment of hepatitis C in Canada.

A Case Report of Homocystinuria With Dystonia and Stroke.

Inherited homocystinuria is a rare autosomal recessive aminoacidopathy which through early diagnosis can prevent its severe neurologic and vascular complications. Here we report a 9-year-old girl with homocystinuria, presenting with sequential symptoms of bilateral lens dislocation, skeletal complication, and eventually dystonia from the age of 4 years. Laboratory evaluation revealed severe high serum homocysteine level. Although pathophysiologically unexplained, evidence of deep white matter watershed infarct along with remarkable ipsilateral carotid stenosis was detected on the contralateral side of the dystonia in the neuroimaging. Treatment with high dose of pyridoxine relieved limb and gait dystonia significantly, while carotid stenosis remained unchanged. Therefore, homocysteine might have both structural and irreversible effect and functional and reversible impact that could be overcome even in late stages.