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Objective To assess the recent trends, acceptability, and effectiveness of digital maternal patient education through summarizing the literature. Methods Articles published in 2010–2020 on patient education, digital tools, and maternal health were searched on PubMed. Abstract and full texts were reviewed to identify eligible studies and extract key information. Results Digital patient education studies covered various topics throughout pregnancy, with the greatest number of studies targeting the prenatal period. Among the 55 studies, 38 (69%) reported significant patient outcomes, with the main benefits of increased knowledge (83.3%), emotional benefits (73.7%), and behavioral changes (60.6%). The number of studies per year increased steadily over the past decade, with frequently utilized formats of texts with images (40%), SMS (30.9%), and videos (25.5%). Video produced the highest rate of positive patient outcomes; however, no statistical significance was found. Conclusion Our study presented evidence supporting the high effectiveness and prevalence of digital tools in maternal patient education, and analyzed the content, platforms, and formats utilized by digital tools of the past decade. Practice implications Digital tools are effective and feasible in conducting maternal patient education. No specific patient education format is found to be superior in improving patient’s health outcomes.

Read about how one nursing team utilized Magnet tenets in their daily operations to achieve not only positive patient outcomes, but also a resilient workforce.

We presented the clinical course and immune responses of a well-controlled HIV-positive patient with COVID-19. The clinical presentation and antibody production to SARS-CoV-2 were similar to other COVID-19 patients without HIV infection. Neutralizing antibody reached a plateau from 26th to 47th day onset but decreased on 157th day after symptoms.

Background The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD. No study has yet compared S-ICD and transvenous ICD by assessing patient acceptance as a patient-centered outcome. Objective To evaluate patient acceptance of the S-ICD and to investigate its association with clinical and implantation variables. In patients with symptomatic heart failure and reduced ejection fraction (HFrEF), the acceptance of the S-ICD was compared with a control group of patients who received a transvenous ICD. Methods Patient acceptance was calculated with the Florida Patient Acceptance Survey (FPAS) which measures four factors: return to function (RTF), device-related distress (DRD), positive appraisal (PA), and body image concerns (BIC). The survey was administered 12 months after implantation. Results 176 patients underwent S-ICD implantation. The total FPAS and the single factors did not differ according to gender, body habitus, or generator positioning. Patients with HFrEF had lower FPAS and RTF. Younger patients showed better RTF (75 [56-94] versus 56 [50-81], p=0.029). Patients who experienced device complications or device therapies showed higher DRD (40 [35-60] versus 25 [10-50], p=0.019). Patients with HFrEF receiving the S-ICD had comparable FPAS, RTF, DRD, and BIC to HFrEF patients implanted with the transvenous ICD while exhibited significantly better PA (88 [75-100] versus 81 [63-94], p=0.02). Conclusions Our analysis revealed positive patient acceptance of the S-ICD, even in groups at risk of more distress such as women or patients with thinner body habitus, and regardless of the generator positioning. Among patients receiving ICDs for HFrEF, S-ICD was associated with better PA versus transvenous ICD. This article is protected by copyright. All rights reserved.

Various routine disclosure statements relating to the performance of ultrasound (US) during the COVID-19 pandemic are finding their way into radiology reports. These statements usually suggest that US examinations during the pandemic, or on a COVID-19 positive patient, are somehow limited and urge the clinicians to reflect on these considerations when accepting radiology reports. However, such disclosure statements are generally unhelpful to clinicians and are not consistent with the realities of current clinical US practice. This article provides a critique of these disclosure statements and concludes by discouraging sonographers and radiologists from making such statements as a routine part of their clinical ultrasound reports.

Splenic injuries are amongst the most frequent trauma-related injuries which requires emergency surgeries demanding meticulous surgical and anesthetic management. The aim while managing splenic trauma patients, is to restore homeostasis and normal pathophysiology in the body by achieving hemostasis with an emergency splenectomy. To date, there have been few reports describing the anaesthetic management of COVID-19 patients presenting for emergency surgery. In this article, we outline the anaesthetic management for a case with hemoperitoneum, posted for emergency exploratory laparotomy and splenectomy in our operating theatre who was incidentally diagnosed to be COVID positive in the emergency unit by a rapid antigen test. Keywords: COVID 19, Splenectomy.

Deep brain stimulation (DBS) is an effective neuromodulatory therapy for Parkinson’s disease (PD). Early studies using globus pallidus internus (GPi) DBS for PD profiled the nucleus as having two functional zones. This concept disseminated throughout the neuromodulation community as the “GPi triangle”. Although our understanding of the pallidum has greatly evolved over the past 20 years, we continue to reference the triangle in our clinical decision-making process. We propose a new direction, termed the spatial boundary hypothesis, to build upon the 2-dimensional outlook on GPi DBS. We believe an updated 3-D GPi model can produce more consistent, positive patient outcomes.

Membrane-based rapid test reagents including immunochromatography are widely used in clinical practice. Recently, high-sensitive reagents based on the immunochromatography method, such as silver amplification method and time resolved fluorescence method for influenza testing, has been developed and early confirmation of infection can be achieved. Furthermore, genetic testing, automated all the steps from extraction till detection, is getting popular. Genetic testing of mycoplasma by Smart Gene Myco system and Coronavirus disease 2019 (COVID-19) test is a good example of membrane-based rapid test reagents. This system uses silica particle-containing membrane filter and enable to shorten the assay time by automates pre-treatment process for removing contamination substances in the sample which affect polymerase-chain-reaction amplification. We hope utilized genetic testing application will help quick confirmation of COVID-19 positive patient and prevent the collapse of medical system under COVID-19 development.

Major risks associated with inadequate discharge preparation and execution include medication errors, adverse drug events, and hospital readmissions. Nurses must develop pertinent skills to assess how the social environment impacts patients' likelihood of a safe and healthy transition back into the community as they prepare patients for discharge. Recognition and consideration of social determinants of health are critical to minimizing health disparities, enhancing health equity and supporting positive patient outcomes. Examples of strategies for enhanced discharge practices include implicit bias assessment and training, screening for food insecurity, and assessment for quality referral sources.

Human Immunodeficiency Virus (HIV) is one of the gravest health challenges worldwide in the present era as it has been for the past 4 decades. HIV has always been a sort of stigma and most clinicians are reluctant to perform liver transplantation for chronic liver disease patients with HIV co-infection. Patients with CD4+ cell count >100/ml along with suppressed mRNA levels on PCR, stable HAART regimen, and absence of any AIDS-specific illness or opportunistic infectionsare the requirements for selecting HIV-positive recipients for liver transplantation. We report the first living donor liver transplant in an HIV-positive recipient in a developing country. Here are the details of the case. Keywords: HIV, living donor, Liver transplantation, developing country

Corona virus causes influenza, vomiting, sneezing, respiratory disease and coughing while diarrhea and upper respiratory diseases are found in animals. The corona virus was transmitted by airborne droplets to humans or primates. Corona virus reaches the human cell through an exo-peptidase receptor with membrane ACE-2. WHO and ECDC also recommended the avoidance of public spaces and close interaction with contagious individuals and pets. Firstly, on 7 January 2020, Corona virus (2019-nCoV) was isolated from the Chinese Wuhan market. © 2021 MEDIC SCIENTIFIC. All right reserved.

Purpose: To investigate how patients value radiologists, using data from the Dutch healthcare assessment website. Method: The Dutch healthcare assessment website was searched for patient reviews about radiologists in The Netherlands. The scores (scale of 1 & ndash;10) assigned to the most recent review of each radiologist were extracted. All written reviews were assessed using standardized coding taxonomy, in the domains "clinical competencies" (including quality and safety of clinical care) and "relationships" (including communication with patients and humaneness/caring). For each category, it was assessed whether the review was positive or negative with regard to the performance of the radiologist.Results: 217 of 941 radiologists (23 %) had been reviewed between 2017 and 2021. The total number of institutions to which these radiologists were affiliated was 75 (6 academic and 69 non-academic institutions). Median score assigned to each review was 9.6 (interquartile range 1.3, range 1 & ndash;10). 74 of 217 radiologists (34 %) were given a maximum review score of 10. 29 of 217 radiologists (13 %) were given a review score of 5 or lower. The far majority of reviews concerned the categories communication (36 % of all positive patient reviews and 30 % of all negative patient reviews) and humaneness/caring (45 % of all positive patient reviews and 49 % of all negative patient reviews).Conclusion: Radiologists are generally highly valued by patients, although there is room for improvement to decrease the number of negative patient experiences. Communication and empathy appear to be the most important skills on which radiologists are judged from a patient & rsquo;s perspective.

COVID-19, Aralık 2019’dan itibaren Çin’in Wuhan bölgesinden tüm dünyaya yayılarak pandemi oluşturan yeni tip koronavirustür. Gebe hastalarda diğer coronavirus enfeksiyonları (Middle East Respiratory Syndrome=MERS-CoV, Severe Acute Respiratory Syndrome=SARS-CoV) olumsuz sonuçlarla seyrettiğinden COVID-19 pozitif gebe hastalar endişeleri arttırmaktadır. Bu olgu sunumunda, kliniğimizin ilk COVID-19 pozitif hastası olan 36 haftalık gebenin sezaryen anestezisi yönetimi ele alınmıştır.

Vandana Ahluwalia,1 Taucha Inrig,2 Tiffany Larsen,3 Rachel Shupak,4 Tripti Papneja,1 Arthur Karasik,5 Carol Kennedy,2 Katie Lundon6 1Division of Rheumatology, Department of Internal Medicine, William Osler Health System, Brampton, ON, Canada; 2Musculoskeletal Health and Outcomes Research, St. Michael’s Hospital, Toronto, ON, Canada; 3Department of Physiotherapy, Headwaters Healthcare Centre, Orangeville, ON, Canada; 4Division of Rheumatology, Department of Internal Medicine, St. Michael’s Hospital, Toronto, ON, Canada; 5Independent Rheumatology Practice, Etobicoke, ON, Canada; 6Continuing Professional Development, Faculty of Medicine, University of Toronto, Toronto, ON, CanadaCorrespondence: Vandana AhluwaliaIndependent Community Rheumatology Practice, 314-40 Finchgate Boulevard, Brampton, ON, Canada, L6T 3J1 Tel +1 905-799-1850 Ext 221Fax +1 905-799-8040Email a7mad.al0rabi@gmail.comPurpose: This study describes patient care experiences of solo-rheumatologist and co-managed care models utilizing an Advanced Clinician Practitioner in Arthritis Care-trained Extended Role Practitioner (ACPAC-ERP) in three community rheumatology practices.Materials and Methods: Patients with inflammatory arthritis (IA) were assigned to care provided by one of three (2 senior, 1 early-career) community-based rheumatologists (usual care), or an ACPAC-ERP (co-managed care) for the 6-months following diagnosis. Patient experiences were surveyed using validated measures of patient satisfaction (Patient Doctor Interaction Scale-PDIS), global ratings of confidence and satisfaction, referral patterns, disease activity (RADAI) and self-perceived disability (HAQ-Disability) as well as demographic information. Practice capacity was evaluated 18-months prior to, and across, the study period.Results: Of 55 participants (mean age 56.6 years, 61.8% female), 33 received co-managed care. Most participants were diagnosed with rheumatoid arthritis (65.5%) with a median symptom duration of 1.1 years. At 6-months, patients from both models of care were equally satisfied in terms of the information provided (usual care 4.6 vs co-managed care 4.7/5=greater satisfaction), rapport with health-care provider (4.6 vs 4.6/5) and having needs met (4.7 vs 4.5/5). Overall satisfaction was high (87.2 vs 85.3/100=completely satisfied) as was confidence in the system by which care was received (85.0 vs 82.1/100=completely confident). Usual care patients reported higher perceived disability than co-managed patients (HAQ-Disability 0.5 vs 0.2/3=unable to do). Significant differences in overall RADAI score (p=0.014) were found between the two models. The senior rheumatologist, with a previously saturated practice, attained a 37% capacity increase for new patients utilizing the co-managed care model.Conclusion: The ACPAC-ERP model was equivalent to the solo-rheumatologist model with regard to patient experience and satisfaction. A co-management model utilizing a highly trained ACPAC-ERP can increase capacity in community rheumatology clinics for patients newly diagnosed with IA while maintaining confidence and satisfaction with their care.Keywords: health service accessibility, interprofessional practice, rheumatology, patient satisfaction, quality improvement, extended role practitioner, integrated delivery systems, model of care

The sequelae and complications of coronavirus disease 2019 infection have continued to emerge during this pandemic era. Although the long-term effects are continually being monitored and studied, we have been seeing more acute and subacute medical complications requiring a thorough discussion and, sometimes, adjustment of our standard of care and intervention. In the present report, we describe a case of an acute, symptomatic inflammatory or mycotic abdominal aortic aneurysm in a patient with coronavirus disease 2019 who had undergone urgent endovascular repair.

Here we share an interesting case of severe trauma with tissue loss to nearly half of the back and a lacerated perineum in a Covid-19 positive patient in septic shock. This article highlights our experiences and hard lessons learnt in successful management of this complicated injury. Managing severe trauma is a challenge especially with respiratory failure resulting from Covid-19 infection. The patient reported to the hospital during a very difficult period, when proper medical care was difficult as hospitals and wards were filled with Covid positive patients. Managing patients was difficult especially wearing personal protective equipment round the clock. It’s a challenge when an entire team of surgeon, anesthesiologist, nursing staff and paramedics, rose above their daily call of duty to save the patient for her children. It was a fight against time and an many unknown enemy over three months for the entire team. The challenge to save a middle-aged patient from the claws of death against all odds was really miraculous. It was highly rewarding to see the patient going back to the family with a smile.

COVID-19, a viral infection spread across the world affecting many people around the world. In ABO blood type, certain types are more prone to infections and causes severe symptoms. Relationship between ABO blood type and COVID-19 still needs to be found out. A prospective cohort study was conducted to evaluate a relationship between ABO blood type and COVID-19. Data was collected from 148 patients who presented for COVID testing through PCR or nasal swab tests. COVID positive patient’s blood test was performed to find out ABO blood group/type and their symptoms with which they presented. The blood group distributions, age and gender of these patients were recorded. It was seen that there is a statistically significant association between COVID and blood group A+, A-, B+ with p-value of 0.01, 0.03 and 0.01 respectively and no statistical significance was found between B-, O+, O-, AB+ and AB-with P-value of 0.06, 0.1, 0.9, 0.7 and 0.8 respectively. Multi variate analysis performed showed age, blood group and ICU stay to be significantly associated with COVID with p-value of

Introduction Nosodes, the homeopathic preparations sourced from biological materials including clinical samples, cultures of organisms, and diseased tissues have been in use against the source-specific infections as well as other diseases. The nosodes have demonstrated some efficacy in managing epidemics, such as influenza, dengue, and leptospirosis. This article presents the need and process of development of nosodes from the SARS-CoV-2 to explore its prophylactic and therapeutic potentials against certain related viral diseases. MATERIALS AND METHODS A clinical sample of SARS-Cov-2 positive patient, based on the cycle threshold (CT) value of the qRT-PCR, heat-inactivated SARS-CoV-2, and spike glycoprotein all were processed for making nosodes as per the method described in Homoeopathy Pharmacopoeia of India. Molecular tests, such as qRT- PCR and sterility tests were performed to establish the live organisms, RNA material, and the absence of contamination. RESULT Three variants of Coronavirus Nosode were developed using a clinical sample, heat-inactivated SARS-CoV-2, and spike glycoprotein. In potencies 3c and above, no detectable SARS-CoV-2 RNA material was found by PCR. The analytical results for nosodes were reported as compliant for sterility testing as per the IP. CONCLUSION Three variants of Coronavirus nosodes were prepared which need to be evaluated further through pre-clinical and clinical studies.

Several disorders including inflammatory, ischemic, and metabolic can cause longitudinally extensive transverse myelopathy. HIV-associated spinal cord involvement is rare. It can be due to AIDS-associated myelopathy, or opportunistic infections such as cytomegalovirus and herpes simplex virus (HSV). Herein, we describe a 49-year-old man who presented with acute paraparesis and urinary retention. His spinal magnetic resonance imaging revealed extensive hyperintense signal in the long TR sequence throughout C2 to T12, especially in the posterior and lateral columns. Both HIV ELISA test and HSV-2 DNA polymerase chain reaction were positive. Despite treatment, his clinical condition deteriorated. Acute transverse myelopathy can be the initial manifestation of an asymptomatic undiagnosed HIV positive patient. Viral serology reveals the opportunistic infections underlying the disease thereby guiding therapeutic regimens.

Psychological trauma impacts two-thirds of Americans, suggesting that many intensive care unit (ICU) patients have a history of trauma. Our manuscript calls for translating the well-established system of trauma-informed care to the ICU setting – an approach we term “trauma-informed intensive care.” While trauma-informed approaches are being increasingly applied in medical settings such as emergency departments and burn units, the ICU is often overlooked, despite the fact that the ICU environment may be perceived as particularly threatening to those who have experienced trauma. Now is an ideal time to advance efforts for trauma-informed intensive care, given heightened public attention to the ICU experience as a result of the COVID-19 pandemic. Trauma-informed intensive care may promote more positive patient experiences and support patient recovery from critical illness.

Primary lung signet‐ring cell carcinomas are a rare entity and only a few cases of pure signet‐ring cell carcinomas of the lung are reported in the English literature. They usually have an aggressive behavior and a poor prognosis because in most cases they are identified at an advanced stage. We present a unique case of primary signet‐ring cell carcinoma of the lung because the patient was HIV positive, a heavy smoker, and also the tumor, discovered incidentally during chest x‐ray, was a pure type of signet‐ring cell carcinoma. Surgical therapy associated with chemoradiotherapy represents the gold standard in the care of these patients., Primary lung signet‐ring cell carcinomas are a rare entity characterized by poor outcome due to the infiltrating nature of this tumor. We present a unique case of primary signet‐ring cell carcinoma of the lung in an HIV‐positive patient discovered incidentally. An early diagnosis can be of extreme importance for patient survival, as in our case.

Echinococcosis is an endemic disease in countries from the Mediterranean area, Eastern Europe, the Middle and the Far East, Australia, South America and Eastern Africa. However, it has a worldwide distribution because the dog, a definitive host, is a ubiquitous animal. Another important factor that led to a worldwide spread of the disease is population migration, as the number of cases in non-endemic regions has been increasing. We present the case of a 28-year-old HIV positive patient suffering from a liver hydatid cyst that had ruptured inside the biliary pathways. US and CT were the imaging tools used to establish a preoperatory diagnosis and the main therapeutic approach was neutralizing the parasite using 90 degrees alcohol, Lagot deroofing, contents’ evacuation through open surgery and appropriate drainage afterward. ERCP was very useful in unblocking the main biliary pathways after the surgery as well as installing a stent to ensure its further permeability.

Positive patient outcomes depend on successful communication. Increased use of personal protective equipment such as face masks during the COVID-19 pandemic can exacerbate communication difficulties. This article describes situations in which miscommunications may occur, identifies sources of communication breakdowns, and offers strategies to prevent them in real-life scenarios.

Chronic pain is a debilitating condition that afflicts a significant number of people throughout the world. The mechanisms of chronic pain remain to be fully understood, and treatment for chronic pain has remained a challenge for pain practitioners. Cannabis and cannabis-based medicine (CBM) have emerged over the last two decades as potential treatment options for an array of medical issues, of which chronic pain is one of them. Clinical trials thus far seem to suggest that medical cannabis may have some clinical effect in reducing pain severity in chronic noncancer pain as an adjunct to standard treatment, but inherent weaknesses in the available evidence mean that the verdict for medical cannabis has yet to be set in stone. The issue of medical cannabis is further complicated by the connection of cannabis with neuropsychiatric side effects and substance misuse. Much work needs to be done by both clinicians and government bodies to translate the benefits of medical cannabis in the laboratory into positive patient outcomes at the bedside in a safe manner.

Background Although the novel 2019 coronavirus (COVID-19) pandemic delayed elective microsurgical reconstruction cases, traumatic injuries requiring microsurgical reconstruction for limb salvage still presented to our hospital. Recent data suggests a link between COVID-19 and increased venous and arterial thromboembolic events, theoretically increasing the risk of microvascular anastomotic thrombosis and flap failure. Methods We provide a single case report of microsurgical limb salvage in a COVID-19-positive patient with a Gustilo IIIb open tibial-fibular fracture. Results A free latissimus dorsi muscle flap was used to successfully cover a Gustilo IIIb open tibial-fibular fracture with exposed orthopedic hardware and large soft tissue defect, with 5-month follow-up demonstrating a well-healed flap allowing for preserved ambulation. Conclusion Although there is a theoretical increased incidence of venous and arterial thrombotic microvascular failure in COVID-19-positive patients, microsurgical reconstruction is occasionally the lone option for salvage. Microsurgical reconstruction in this population must be carefully considered, meticulously executed, and closely monitored.

Purpose: The aim of this study was to improve patient oral hygiene outcomes in a rehabilitation unit by implementing a nursing education package and oral hygiene assessment tool. Design: A case–control design with 50 rehabilitation patients was performed. Methods: Nursing staff received education and training in applying the Modified Oral Health Assessment Tool. Clinician assessment of patient oral hygiene occurred on admission and at days 5–7. Each patient reported their perceptions of oral hygiene and comfort prior to hospitalization, while in the hospital, and after transfer to the rehabilitation unit. Findings: Oral hygiene rating scores improved significantly from admission to the rehabilitation unit to days 5–7 (p = .00). The mean score of patient perceived cleanliness improved from hospital admission to admission to the rehabilitation unit. Conclusion: Oral hygiene was improved following admission to a rehabilitation unit with a consistent and individualized approach to oral hygiene. Clinical Relevance: The introduction of a consistent and individualized approach to oral hygiene demonstrates positive patient outcomes and high patient acceptance.

Presence and therapeutic listening are complementary therapies that are incorporated into daily nursing practice. This article presents the nurse's role in facilitating complementary therapies of presence and therapeutic listening, barriers encountered, and the behaviors and techniques to be used. Also discussed is the impact that using presence and therapeutic listening has on patient outcomes. These interventions have the potential to significantly alter patients' perceptions of care and improve patient outcomes. Presence and therapeutic listening are vital to developing a therapeutic nurse-patient relationship. This relationship is what drives positive patient outcomes and increases overall satisfaction and quality of care.

Aim: To detect the frequency of confirmed corona infection (covid-19) in children in affected families in Gujrat. Study design; cross sectional study. Place and duration of study: This study was conducted from January 2020 to 10 June 2020 at Gujrat Pakistan. Methods: Total 214 children were included in the study from 141 families in which at least one family member was confirmed positive for corona virus infection (COVID-19). This study was started in the beginning of year 2020 but in Gujrat first positive case was reported in March 2020. First of all a family was decided where a confirmed positive case was there. This particular family was included and decided for testing if there was abroad travelling history within 14 days or there was a contact with a confirmed positive patient for corona infection (COVID-19). Results: Total 214 children were included from January 2020 to June 2020. Out of total 214 children, 78 children were positive for (COVID-19) corona infection. Out of 78 (COVID-19) corona infection positive children, 46(58.97%) were female children whereas 32(41.02%) were male children. 37 children (47.44%) were from 1 to 6 years of age whereas 41 (52.56%) were 7-15 years of age. Conclusions: Children can acquire corona virus infection (COVID-19) from adults. Though the severity of corona virus infection (COVID-19) is mild in children, in spite of all this the children should not come in contact with positive person for corona virus infection (COVID-19). Keywords: COVID-19, affected family, contact with positive patients

Coronavirus 2019 disease (COVID-19) is a highly deadly disease that causes 77 million cases and 1.6 million deaths worldwide. Many cutaneous manifestations are seen in COVID-19 disease.Cutaneous pathologies such as vascular endothelial damage, prothrombotic conditions, hemorrhagic cutaneous lesions, vasculitis, disseminated intravascular coagulopathy (DIC), ecchymotic skin lesions, purpura, dry gangrene are seen in patients with COVID-19.While our 84-year-old male patient was being treated with COVID-19 pneumonia in the infection ward, DIC developed on the 9th day of his treatment and widespread petechia, purpura, ecchymosis, necrosis, gangrene, bullous skin lesions were observed in his left arm related to this.In our case, we aimed to present a case of DIC that developed as a complication as a result of COVID-19 infection and having a mortal course with cutaneous involvement due to it, to the literature.

Objectives: To describe a case of rapidly relapsing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in the setting of positive serum IgG tubulin autoantibodies. Methods: We wrote a case report and performed a literature review of IgG tubulin autoantibodies and the use of rituximab in treatment resistant CIDP. Results: Our case report describes a 29-year-old woman with CIDP that was resistant to treatment with steroids, intravenous immunoglobulin, and plasma exchange. An extensive workup of her rapidly relapsing CIDP was negative, with the exception of positive serum IgG tubulin autoantibodies. She ultimately stabilized on oral steroids, plasma exchange and rituximab, with a regular recurrence of weakness occurring approximately every month that led to rehospitalization. Conclusion: Anti-tubulin antibodies could be a marker of a subtype of CIDP that is treatment resistant. We detail her clinical course to serve as an example for other cases of IgG tubulin autoantibody positive CIDP patients that could be described in the future.

Objectives Development and implementation of SARS-CoV-2 serologic assays gained momentum. Laboratories keep on investigating the performance of these assays. In this study, we compared three fully automated SARS-CoV-2 antibody assays. Methods A total of 186 samples from 84 PCR-positive COVID-19 patients and 120 control samples taken before the SARS-CoV-2 pandemic were analyzed using commercial serologic assays from Roche, Siemens and DiaSorin. Time after the positive COVID-19 PCR result and onset of symptoms was retrieved from the medical record. An extended golden standard, using the result of all three assays was defined, judging if antibodies are present or absent in a sample. Diagnostic and screening sensitivity/specificity and positive/negative predictive value were calculated. Results Diagnostic sensitivity (ability to detect a COVID-19 positive patient) ≥14 days after positive PCR testing was 96.7% (95% CI 88.5–99.6%) for DiaSorin, 93.3% (95% CI 83.8–98.2%) for Roche and 100% (95% CI 94.0–100%) for Siemens. Lower diagnostic sensitivities were observed Conclusions This study revealed acceptable performance for all three assays. An orthogonal testing algorithm using the Siemens and Roche assay achieved the highest positive predictive values for antibody detection in low seroprevalence settings.

The demands of curtailing the impact of the coronavirus disease 2019 (COVID-19) global pandemic have disrupted the world’s ability to care for patients with thoracic pathologies. Those who undergo thoracic surgical therapeutic procedures are a high-risk category, likely to have impaired lung function but also high risk for exposing clinical teams to aerosolised viral loads. In light of this global pandemic, thorough pre-procedural planning, adequate personal protective equipment (PPE), experienced personnel and judicious anaesthetic and intra-operative measures will serve to be instrumental in ensuring positive patient outcomes whilst still protecting the safety of healthcare workers.

A single undiagnosed COVID-19 positive patient admitted in the green zone has the potential to infect many Health Care Workers (HCWs) and other patients at any given time with resultant spread of infection and reduction in the available workforce. Despite the existing triaging strategy at the Obstetric unit of a tertiary hospital in New Delhi, where all COVID-19 suspects obstetric patients were tested and admitted in orange zone and non-suspects in green zone, asymptomatic COVID-19 positive patients were found admitted in the green zone. This was the trigger to undertake a quality improvement (QI) initiative to prevent the admission of asymptomatic COVID-19 positive patients in green zones. The QI project aimed at reducing the admission of COVID-19 positive patients in the green zone of the unit from 20% to 10% in 4 weeks’ time starting 13/6/2020 by means of dynamic triaging. A COVID-19 action team was made and after an initial analysis of the problem multiple Plan-Do-Study-Act (PDSA) cycles were run to test the change ideas. The main change ideas were revised testing strategies and creating gray Zones for patients awaiting COVID-19 test results. The admission of unsuspected COVID-19 positive cases in the green zone of the unit reduced from 20% to 0% during the stipulated period. There was a significant reduction in the number of HCWs, posted in the green zone, being quarantined or test positive for COVID-19 infection as well. The authors conclude that Quality Improvement methods have the potential to develop effective strategies to prevent spread of the deadly Corona virus.

A positive Patient Safety Culture (PSC) is considered as the main barrier to adverse events (AEs) that affect healthcare quality and safety. Thus, the assessment of PSC became a priority for health...

Background and study aims Adenomas per colonoscopy (APC) and adenomas per positive patient (APP) have been proposed as additional quality indicators but their association with adenoma detection rate (ADR) is not well studied. The aim of our study was to evaluate the variability in APC and APP, their association with ADR, and associated risk factors in screening colonoscopies from a community practice. Patients and methods We calculated the APC, APP, and ADR from all screening colonoscopies performed over 5 years. We used adjusted hierarchical logistic regression to assess the association of factors with APC, APP, and ADR. Results There were 80,915 screening colonoscopies by 60 gastroenterologists. The median (Q1-Q3) APC, APP, and ADR were 0.41 (0.36 – 0.53), 1.33 (1.23 – 1.40), and 0.32 (0.28 – 0.38), respectively. Despite the high correlation between APC and ADR, 47.6 % of endoscopists with the lowest APC had a higher ADR, and no endoscopists with the highest APC had a lower ADR. Of endoscopists with the lowest APP, 74.3 % had a higher ADR and 5.6 % of endoscopists with the highest APP had a lower ADR. Factors associated with higher APC after multivariable adjustment included: older patients age (OR 1.003; 95 % CI 1.002 – 1.005), male patients (OR 1.123; 95 % CI 1.090 – 1.156), younger endoscopist age (OR 0.943; 95 % CI 0.941 – 0.945), and longer withdrawal time (OR 3.434; 95 % CI 2.941 – 4.010). Factors associated with higher APP were male sex, younger endoscopist age, and longer withdrawal time. Conclusion APC and APP provides additional information about endoscopist performance. Younger endoscopist age and longer withdrawal time are associated with colonoscopy quality.

Resumen Introduccion El nuevo coronavirus causante de un brote de enfermedad respiratoria aguda en China en diciembre de 2019 se identifico como SARS-CoV-2 La enfermedad, denominada COVID-19, fue declarada pandemia por la Organizacion Mundial de la Salud (OMS) El primer caso de COVID-19 en Colombia se reporto el 6 de marzo de 2020;en este estudio se caracterizo un aislamiento temprano del virus SARS-CoV-2 de una muestra recolectada en abril de 2020 Objetivos Describir y caracterizar una cepa temprana a partir de un aislamiento de SARS-CoV-2 durante la pandemia en Colombia Materiales y metodos Se obtuvo una muestra de un paciente con COVID-19 confirmada por qRT-PCR;la muestra fue inoculada en diferentes lineas celulares hasta la aparicion del efecto citopatico Para confirmar la presencia de SARS-CoV-2 en el cultivo, se utilizo la qRT-PCR a partir de los sobrenadantes, la inmunofluorescencia indirecta (IFI) en celulas Vero-E6, asi como microscopia electronica y secuenciacion de nueva generacion (next-generation sequencing) Resultados Se confirmo el aislamiento de SARS-CoV-2 en celulas Vero-E6 por la aparicion del efecto citopatico tres dias despues de la infeccion, asi como mediante la qRT-PCR y la IFI positiva con suero de paciente convaleciente positivo para SARS-CoV-2 Ademas, en las imagenes de microscopia electronica de trasmision y de barrido de celulas infectadas se observaron estructuras compatibles con viriones de SARS-CoV-2 Por ultimo, se obtuvo la secuencia completa del genoma, lo que permitio clasificar el aislamiento como linaje B 1 5 Conclusiones La evidencia presentada en este articulo permite confirmar el primer aislamiento de SARS-CoV-2 en Colombia Ademas, muestra que esta cepa se comporta en cultivo celular de manera similar a lo reportado en la literatura para otros aislamientos y que su composicion genetica esta acorde con la variante predominante en el mundo Finalmente, se resalta la importancia que tiene el aislamiento viral para la deteccion de anticuerpos, para la caracterizacion genotipica y fenotipica de la cepa y para probar compuestos con potencial antiviral Introduction: SARS-CoV-2 has been identified as the new coronavirus causing an outbreak of acute respiratory disease in China in December, 2019 This disease, currently named COVID-19, has been declared as a pandemic by the World Health Organization (WHO) The first case of COVID-19 in Colombia was reported on March 6, 2020 Here we characterize an early SARS-CoV-2 isolate from the pandemic recovered in April, 2020 Objective: To describe the isolation and characterization of an early SARS-CoV-2 isolate from the epidemic in Colombia Materials and methods: A nasopharyngeal specimen from a COVID-19 positive patient was inoculated on different cell lines To confirm the presence of SARS-CoV-2 on cultures we used qRT-PCR, indirect immunofluorescence assay, transmission and scanning electron microscopy, and next-generation sequencing Results: We determined the isolation of SARS-CoV-2 in Vero-E6 cells by the appearance of the cytopathic effect three days post-infection and confirmed it by the positive results in the qRT-PCR and the immunofluorescence with convalescent serum Transmission and scanning electron microscopy images obtained from infected cells showed the presence of structures compatible with SARS-CoV-2 Finally, a complete genome sequence obtained by next-generation sequencing allowed classifying the isolate as B 1 5 lineage Conclusion: The evidence presented in this article confirms the first isolation of SARS-CoV-2 in Colombia In addition, it shows that this strain behaves in cell culture in a similar way to that reported in the literature for other isolates and that its genetic composition is consistent with the predominant variant in the world Finally, points out the importance of viral isolation for the detection of neutralizing antibodies, for the genotypic and phenotypic characterization of the strain and for testing compounds with antiviral potential

It is not uncommon for veterinary practices to be daunting places for many pets. This article highlights the important role that reception staff have in creating a positive patient experience, and identifies a number of practical strategies that can easily be adopted and implemented to achieve this.

Introduction: This survey aims to assess knowledge, attitude and stigma towards HIV patients, among medical students in Tuzla, Bosnia and Herzegovina. We also aimed to assess potential risk factors for HIV infection among fourth year medical students. Methodology: Data were collected from specific questionnaire that was completed by 171 students of the Faculty of Medicine, University of Tuzla. A multivariable logistic regression was performed. Results: Majority of students (79%) had a good knowledge of HIV, (median value of correct answers was 9 (95%) with at least 6 correct responses). Also, majority of students (73.6%) had a positive attitude towards HIV patients and the median positive value was 6 (95% CI: 6-7). More than a third of students considered that all hospitalized patients should be tested for HIV. Total of 81% of students considered that they should inform the sexual partner of HIV positive patient, although she/he disagrees. 61.4% of students had a discriminatory attitude towards HIV, with the median values of 3 (95% CI: 3-3). Multivariate regression analysis identified positive attitude towards HIV patients as an independent predictor for a non-discriminatory attitude. Moreover, an overall attitude towards HIV patients defines student`s determination to work with AIDS population. Male gender, and older age, were identified as predictors of risky behavior. Conclusions: Preventive measures, including better HIV education, are crucial. Knowledge can increase awareness of HIV infection, decrease the incidence and reduce stigma towards HIV patients.

We present a case of a necrotising disease of the orofacial tissues, the so-called noma, in a female patient with AIDS in a stage of severe immune deficiency. To our knowledge, this is the first time a case like that has been reported in Bulgaria. The patient received an antibiotic course of treatment with a triple combination to good effect on the inflammatory process, and began also HAART. Within 3 weeks, the patient’s general condition improved. However, despite the treatment, a demarcation line was formed, and a defect on the lower lip occurred. Noma is a manifestation of severe immune deficiency with lasting adverse consequences for the patient: severe deformation of the maxilo-facial region and functional impairment (i.e. difficulties eating and speaking, and salivary leak).

The altered knee joint function and symptomatic state in younger patients after meniscectomy and progressive tibiofemoral arthritis remain an important unsolved treatment dilemma. Meniscal allograft transplantation has evolved as an acceptable treatment because there are few (if any) other options. The procedure is effective in most patients, who experience a decrease in tibiofemoral pain and improved knee function, even allowing a return to light recreational activities. However, biological remodeling of the implant occurs over time, with replacement of the complex circumferential and radial fibers with disorganized collagen tissues and altered cellular and proteoglycan components that affects load bearing and negates chondroprotective function. Positive patient outcomes may still be reported even with the loss of meniscal transplant function on magnetic resonance imaging giving a false-positive survivorship analysis. Repeated surgical procedures are frequent by 10 years. Patients are advised that meniscal allograft transplant surgery, although beneficial in the short term to buy time, is not curative.

Purpose of review Enhanced recovery after surgery (ERAS) is well documented in a number of surgical specialities. However, it remains an emerging concept in surgical head and neck cancer care. The purpose of this review is to appraise the current evidence investigating enhanced recovery in head and neck cancer, and explore areas for future clinical research. Recent findings There were three key themes in enhanced recovery from the current head and neck cancer literature: early oral feeding, fistula closure and service delivery. This evidence is emerging and the quality of papers remains variable which makes it difficult to draw robust clinical recommendations. However, there are some encouraging clinical findings with regards to early oral feeding protocols and suturing of the trachea-stoma. Summary There is limited literature in enhanced recovery in head and neck cancer, with questionable quality of the papers reviewed. As such, there is no consensus for a standardized enhanced recovery pathway which demonstrates effective service delivery and positive patient outcomes. It is clear that implementation of enhanced recovery pathways is complex and requires patient and clinician buy in. Future research should focus on co-design of a methodologically sound enhanced recovery pathway with evaluation of its implementation.