Articles

Background: Around 75% of seniors seeking treatment for injuries in Emergency Departments (ED) are discharged home with minor injuries that put them at risk of functional decline in the following months. Objectives: To 1) describe seniors’ characteristics using or not physiotherapy services following ED visits for minor injuries and 2) examine their functional status according to physiotherapy use. Methods: Secondary data analyses of the Canadian Emergency Team Initiative cohort study. Participants were 65 years and older, discharged home after consulting EDs for minor injuries and assessed three times: ED, 3- and 6-months. Physiotherapy use was recorded as yes/no. Functional status was measured using the Older American Resources Scale (OARS). Multivariate linear regressions were used to examine change in OARS scores over time, accounting for confounders. Results: Among the 2169 participants, 565 (26%) received physiotherapy, and 1604 (74%) did not. Physiotherapy users were more likely females (71% vs. 64%), more educated, and less cognitively impaired. The overall change in OARS at 6 months was -0.31/28 points (95% CI: -0.55; -0.28) with no difference across groups after adjustment. Subgroup analyses among frail seniors showed that physiotherapy users maintained their function while non-users lost clinically significant function (-0.02 vs. -1.26/28 points, p = 0.03). Among the severely injured (Injury Severity Scale ≥ 5), physiotherapy users’ results were higher by almost 1/28 points (p = 0.03) compared to non-users. Conclusion: These results suggest that among seniors discharged home after consulting the ED for minor injuries, the frail and severely injured may benefit from being systematically referred to physiotherapy services. 

Chronic infectious, granulomatous and suppurative dermatosis, classified among the subcutaneous mycoses, prevalent in tropical and subtropical regions and caused by the traumatic implantation of dematiaceous fungal species, where the presence of muriform bodies is an expression of the causal agent in the grafted tissue, are characteristic of chromoblastomycosis. Considered the second implantation mycosis in the world, it manifests itself with slow and progressive growth lesions of exophytic and verrucous plaques and black dots on the surface.The disease is considered a neglected and occupational disease, which occurs mainly among agricultural workers, coconut and babassu harvesters, lumberjacks, and traders of agricultural products. It is important to highlight that people at risk of contracting chromoblastomycosis work in tropical countries, where the temperature can be above 40 °C in summer, and generally refuse to wear protective equipment during the day (shoes, gloves, clothes, etc.), although they know that this type of prophylactic measure can prevent different types of diseases. These vulnerable people often live in low-income countries and sometimes live far from medical services and, once infected, do not seek medical attention. We report below an exuberant and unusual case due to multiple simultaneous inoculations on the back after the patient suffered an accidental fall while working on his farm. The diagnosis was established by direct mycological examination, histopathological examination, culture, microculture, and MALDI-TOF MS analysis that identified the agent of the Fonsecaea pedrosoi.

Sunflower (Helianthus annuus L.) is one of the most important vegetable oil sources in the world and in our country. The preference for sunflower oil in the consumption of vegetable oil increases the importance of sunflowers in our country. Rust, downy mildew, Verticillium wilt, Sclerotinia stalk and head rot, charcoal rot, blight, and leaf spot are some of the important diseases most commonly seen in sunflowers. In some years, depending on the climatic conditions, Downy mildew (Plasmopara halstedii) is widely observed and it causes an epidemic in sunflower-planted areas in the Adana province. Genetically resistant hybrids have started to be grown in Turkey in recent years due to the resistance of downy mildew disease to fungicides. The aim of the study was to determine the status of sunflower diseases and Downy Mildew disease in Adana.

Background: Stroke occurs in 11% of patients with SCA before 20 years of age. In Northwestern Tanzania, the prevalence of stroke among children living with SCA under the age 15 years is 16.9%, of which might be attributed to the absence of routine screening for the risk of stroke by using Transcranial Doppler Ultrasound (TCD). Screening with TCD allows preventive measures such as chronic blood transfusion to be done which has led to the reduction of stroke by 92%.Methods: This was a prospective analytical cross sectional study which enrolled 267 SCA children aged 2 to 16 years attending Bugando Medical Centre Pediatric Sickle Cell Clinic from July 2019 to June 2020. Assessment of factors associated with elevated TCD included a clinical history of stroke in sibling, death in sibling, temperature, oxygen saturation in room air, blood pressure, hemoglobin level and total white blood cell count. TCD was done by accessing transtemporal window and recording the highest time average mean of maximum velocity (TAMMV) of major vessels mainly, middle cerebral artery (MCA) and distal internal carotid artery (dICA).Results: The median age of enrolled was 6.6 (IQR: 4-9) years. The prevalence of elevated TCD (> 170 cm/s)was found to be 21% (56/267). By multivariate logistic regression, low oxygen saturation in room air, p - value = 0.037, OR 1.08 [95% CI 1.00-1.17] and low hemoglobin level, p - value = 0.001, OR 1.76 [95% CI 1.26-2.45] were statistically significantly associated with elevated TCD among children living with SCA.Conclusion: The high prevalence of elevated TCD velocity, with low hemoglobin and low oxygen saturation in room air as associated factors under multivariate logistic regression, warrants routine TCD screening for children with SCA aged 2 to 16 years.

Introduction: Every woman should receive quality antenatal care during pregnancy wherever she lives. We carried out this research with the objective of evaluating the quality of antenatal consultations (ANC) in terms of periodicity, screening, and prophylaxis interventions during antenatal consultations in Kamina and to identify the determinants associated with inadequate ANC. Material and methods: This was a descriptive and analytical cross-sectional study carried out in 6 health facilities in Kamina over a period of 17 months with 476 women who had given birth having attended antenatal consultations at least once. A scoring grid of periodicity standards, screening, and prophylactic interventions with a score of 40 was used to qualify the ANC as adequate. Logistic regression was performed to identify the determinants of inadequate ANC. Results: 40.3% of mothers had reached at least 4 antenatal visits (3.4±1.36); 21.2% had started the ANC no later than 16 weeks for an average age of 22.8 weeks ± 6.19. Overall, 72.5% of pregnant women had benefited from ANC qualified as inadequate. After adjustment, the determinants of inadequate ANC were multigestity (aOR=1.86[1.08-3.19]), low level of education of the mother (aOR=3.93; 95% CI=[2, 08-7.42]), and attendance at a first-level health facility (aOR=3.22; 95% CI=[2.06-5.05]. Conclusion: In the majority of cases, the ANC received by pregnant women in Kamina is inadequate. The determinants thus identified should serve the actors to direct the means to improve the quality of antenatal care in Kamina.

To evaluate the safety and efficacy of weight-based mycophenolate mofetil (MMF) dosing in adult kidney transplant recipients (KTR), this single-center retrospective study of adult KTR compared biopsy-proven acute rejection (BPAR), infections, hospitalizations, granulocyte colony-stimulating factor (G-CSF) use, and MMF dose changes within one year of transplant pre-and post-implementation of a weight-based MMF dosing protocol. Adult patients who received a kidney transplant at University Health Transplant Institute were reviewed for inclusion. Patients in the weight-based MMF group received 1000 mg twice daily by the first clinic visit if ≥ 80 kg, 750 mg twice daily if 50-79 kg, and 500 mg twice daily if < 50 kg. Patients in the fixed-dose MMF group received MMF 1000 mg twice daily. A total of 170 KTR (50.0% ≥ 80 kg, 44.1% 50-79 kg, 5.9% < 50 kg) were included. Baseline characteristics were similar between groups. The majority of patients were middle-aged Hispanic males and received lymphocyte-depleting induction therapy. Incidences of BPAR, infection, and hospitalization were similar between both groups at one-year post-transplant. Weight-based MMF dosing is safe and effective in adult KTR.

Introduction: Aluminum Phosphide (AlP) poisoning is a life-threatening condition that commonly occurs in developing countries, often resulting in cardiac, respiratory, and metabolic complications, leading to multi-organ failure and mortality. Extracorporeal Membrane Oxygenation (ECMO) has been proposed as a potential therapy for severe AlP poisoning cases refractory to conventional management, though its use remains controversial. Methodology: for this literature review, we conducted a comprehensive analysis of existing literature concerning the utilization of ECMO in patients with severe AlP poisoning. We meticulously examined available publications to explore the relationship between ECMO initiation and patient outcomes. Discussion: The review reveals that early ECMO initiation within 6 hours of presentation is associated with better outcomes and higher survival rates in severe AlP poisoning cases. However, uncertainties persist regarding the optimal timing and duration of ECMO support, and potential complications, including bleeding, acute renal injury, and ventilator-associated pneumonia, need careful consideration. Conclusion: Despite promising results in certain cases, the risks and benefits of ECMO in AlP poisoning require meticulous evaluation. Ethical considerations, encompassing resource allocation and implications for other patients, necessitate appropriate patient selection criteria.

Aerobic capacity of young men (19 years - 24 years) is high, but can be influenced by many factors like physical activity, smoking, and air pollution with environmental PM 2.5. Objectives: (a) - to estimate the aerobic capacity in young men (smokers and non-smokers) living in areas with higher PM 2.5 using Queen’s College Step Test (QCT). (b) - to find whether aerobic capacity is associated with the International Physical Activity Questionnaire (IPAQ)’ three classes, for smokers and non-smokers. Methods: In a cross-sectional study using criteria-based sampling a total of N = 60 smokers & non-smokers were included from the Delhi NCR region. IPAQ, Peak Expiratory Flow Rate (PEFR), Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure, and PM 2.5 and PM 10 levels were recorded. A comparison of smokers and non-smokers was performed using z test. Smokers and non-smokers were divided into three classes using physical activity levels and compared for aerobic capacity. The correlation of aerobic capacity with variables was seen using Pearson’s correlation coefficient. Multiple R was checked to study the model of cause and effect for aerobic capacity. Results: Significant difference is seen between smokers and non-smokers in the aerobic capacity (Mean ± SD smokers - 65.22 ± 8.73 ml/kg/min; Mean ± SD non-smokers 60.04 ± 7.7 ml/kg/min p value = 0.00). For non-smokers, a low level of physical activity shows a strong correlation with aerobic capacity (r = 0.78; p = < 0.05). No correlation of aerobic capacity is seen with physical activity levels among smokers. Aerobic capacity shows a significant negative and moderate correlation with PM 2.5 (r = -3.1; p = 0.016). The multiple R coefficient value for the model of cause and effect is 6.99 with a p - value of 0.0449 for this. Conclusion: Smoking affects aerobic capacity significantly for young men. High and moderate levels of outdoor physical activity do not increase aerobic capacity in areas with high PM 2.5, whereas low levels show a positive correlation among non-smokers only. 

Introduction: In the present study we evaluated and compared RBC parameters, iron status, and ferritin for discriminating between patients with iron deficiency anemia and anemia of chronic disease. Anemia that accompanies infection, inflammation, and cancer, is commonly termed anemia of chronic disease (ACD). Methods: We compared the ability of serum ferritin concentration, using the microplate immunoenzymometric assay method with other, more traditional indicators of iron status like total iron binding capacity [TIBC], mean corpuscular volume [MCV], percent transferrin saturation [%TS], RBC distribution width [RDW], and serum iron concentration [SIC]. The ferritin concentration was determined in 80 serum samples selected from men and women above the age of 18 years. The patients were assigned to IDA and ACD groups based on serum ferritin concentration.Observation: By studying the ROC Curve for various red cell parameters for the diagnosis of IDA and ACD, we found that diagnostic accuracy of various indicators was as follows TIBC>TS%>MCV>MCH>SI>MCHC for anemia of chronic diseases, and TIBC>MCH>MCV>MCHC>TS%>SI for iron deficiency anemia. When both the value of AUCs (Area under Curve) of ROC were compared it is apparent that TIBC, TS%, MCV, and MCH are important discriminating factors between IDA and ACD. Conclusion: Conventional laboratory parameters play an important role in distinguishing overt causes of IDA and ACD. MCV, MCH, and TIBC were found to be (p -value < .05) significantly discriminated against IDA and ACD. Serum ferritin is an important diagnostic tool with reasonable accuracy for the detection and differentiation of iron deficiency anemia and anemia of chronic disease.

Introduction: Pneumothorax is defined as air in the pleural cavity, the iatrogenic cause happens after invasive procedures as thoracic needle aspiration, central line placement, pacemaker placement, etc. Nevertheless, it is possible to be found in non-medical procedures, such as alternative medicine, more specifically acupuncture. There are medications used against aging that FDA has warned to be used only in its first objective, an example is procaine hydrochloride.Case: A 63 y/o female, Mexico City resident, with anxiety, came to a follow-up appointment for an aging cohort, where CT, PFT, and laboratories are made for pulmonary healthy subjects to investigate normal lung aging and how other environmental factors can affect the lungs; at physical examination, we did not find any pleuropulmonary syndrome, but in the CT a left Iatrogenic pneumothorax was found; we re-asked for antecedents and she described that 15 days before the date she had 2 punctures in the middle clavicular line to apply procaine hydrochloride as an anti-aging treatment.Discussion: There is diverse evidence of adverse effects associated with acupuncture, and even if pneumothorax has a small percentage of incidence, in some cases it can be severe and can even cause fatalities.Conclusion: The pneumothorax in this case was iatrogenic due to the thoracic puncture for an anti-aging treatment, with a total resolution with conservative treatment, however we as health professionals have the responsibility to inform our patients that initiatives of administration ways can cause important complications.