Report Guidelines Research Articles

Cardiac Complications in Patients with COVID-19: An Integrative Literature Review

Objective: To verify, based on the literature, what the main cardiac complications are in patients with COVID-19, during treatment in a hospital unit. Materials and methods: An integrative review, carried out by searching for studies in eight national and international databases. The final sample consisted of 16 studies published between January and May 2020, which were subjected to structural evaluation by the following instruments: Case Report Guidelines, for case reports; and Strengthening the Reporting of Observational Studies in Epidemiology, for observational studies. Results: The main cardiac complications were predominantly obstructive events, herein understood as acute myocardial infarction, followed by severe arrhythmic conditions and heart failure, all due to the hyperinflammation condition resulting from viral infection. Conclusions: The knowledge about cardiac complications during COVID-19 treatment has become important, since it can collaborate for the adoption of more effective treatment protocols and guide the assistance offered by health professionals, in order to identify such complications and intervene early.

Assessment of the Quality of Case Reports in the Journal of Acupuncture Research Using the CARE and STRICTA Guidelines

The purpose of this study was to assess the quality of the case reports in the Journal of Acupuncture Research (JAR). All case reports were retrieved from November 2017 to June 2020. There were 19 case reports included in this assessment based on the case report (CARE) guidelines and case report and standards for reporting interventions in clinical trials of acupuncture (STRICTA) guidelines. The overall quality of reporting was relatively high (83.08% on Case Report guidelines and 77.78% on Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines), but several crucial items remained substantially underreported, such as identifying as a case report (keywords), patient information and perspective, clinical findings, diagnostic assessment, and intervention information. In 18 out of 19 included case reports of acupuncturerelated interventions, several items remained considerably underreported such as acupuncture regimen variation, depth of needle insertion, response sought, and experience of acupuncturists. In the classification by disease, condition, or syndrome, 13 out of 19 included case reports were for musculoskeletal disorders (68.4%), which is the main clinical medical field of Korean medicine services. The results of this study may help develop more appropriate reporting guidelines for case reports published in JAR.

Assessing perspectives on artificial intelligence applications to gastroenterology

Assessing perspectives on artificial intelligence applications to gastroenterology

RARE GASTROBRONCHIAL FISTULA MISTAKEN FOR ASPIRATION PNEUMONIA IN A PATIENT WITH ESOPHAGEAL CANCER: A CASE REPORT

SESSION TITLE: Medical Student/Resident Disorders of the Mediastinum Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Aspiration pneumonia in the setting of known esophageal cancer typically raises suspicion for dysphagia as the primary cause. Here, however, we present a rare case caused by a gastrobronchial fistula (GBF). This study was written according to the CARE case report guidelines [1]. CASE PRESENTATION: A 64 year old Caucasian female with stage IV esophageal cancer presented with acute nausea, vomiting and dyspnea. She had completed radiation and chemotherapy and underwent esophagogastrectomy with gastric pull through eight months prior. She presented with pulmonary sepsis and was treated with antibiotics. She then became acutely hypoxic and hypercapnic and required emergent intubation. An ETT cuff leak persisted despite radiographic confirmation of placement and appropriate cuff inflation. An urgent bronchoscopy showed bilious, projectile material in the RLL. An upper GI series – challenging given the high volume of gastric reflux – opacified the right mainstem bronchus below the carina. Concurrent bronchoscopy/endoscopy visualized a 1 cm gastric fistula at the surgical anastomosis without evidence of ulceration, infection or recurrent neoplasm, communicating with the posterior bronchus intermedius. Successful fistula closure was achieved with endoscopic OverStitch (TM). DISCUSSION: GBFs are rare, and can occur in the setting of infection, neoplasm, trauma or ulcers [2]. One clue is a persistent ETT cuff leak and a high volume of gastric contents refluxing into the ventilatory circuit. The persistence of hypercapnia despite high minute ventilation (presumably from increased physiologic dead space) should also raise suspicion for GBF [2]. GBFs are rarer than esophagobronchial fistulas. In this case, the proximity of the bronchial tree to the thoracic gastric pull through likely contributed to the GBF. A novel feature of this case was the treatment, achieved via an endoscopic OverStitch. Whereas typical treatment might involve the placement of stents on both sides of an enteropulmonic fistula, the OverStitch technique is able to create a tighter, full thickness closure without the complications of in-dwelling stents [3]. CONCLUSIONS: In patients with refractory aspiration pneumonia and an esophagogastric surgical history, consider GBF as a possible cause. Initial testing is an upper GI series followed by dual bronchoscopy and endoscopy for diagnosis and fistulotomy. Reference #1: Riley DS, Barber MS, Kienle GS, AronsonJK, et al. CARE guidelines for case reports: explanation and elaboration document. JClinEpi 2017 Sep;89:218-235. doi: 10.1016/jclinepi.2017.04.026 Reference #2: Greenberg S, Kanth N, Kanth A. A woman with cough: gastrobronchial fistula as a delayed complication of bariatric surgery. Case report and literature review. Am J Emerg Med. 2015;33(4):597.e1-597.e5972. doi:10.1016/j.ajem.2013.11.022 Reference #3: Chon SH, Toex U, Plum PS, et al. Efficacy and feasibility of OverStitch suturing of leaks in the upper gastrointestinal tract [published online ahead of print, 2019 Oct 7]. Surg Endosc. 2019;10.1007/s00464-019-07152-8. doi:10.1007/s00464-019-07152-8 DISCLOSURES: No relevant relationships by Alan Gandler, source=Web Response No relevant relationships by Eric Gold, source=Web Response No relevant relationships by Prarthna Kulandaisamy, source=Web Response

Unusual presentation of metastatic malignant melanoma: a case report

Introduction: The presentation of metastatic lesion of malignant melanoma (MM) may be unusual, as this case, in which the lesions were multicystic swelling over right arm and necrotized swelling at right chest wall. Identifying the unusual variants of MM is important to allow application of the most appropriate treatment strategies before something wrong happens. Methods: This case report has been prepared following the SCARE guideline 2018, a surgical case report guidelines. Presentation of the case: A 60-year-old man presented with a 14-month history of swelling on right arm and anterior chest wall with the chief complain of blackish discharge from the latter. Six months ago, he amputated his right thumb for melanoma after a histopathology evaluation. It was an unusual presentation of a metastatic lesion of MM. On the basis of the histopathology report, the final diagnosis of our patient was subcuticular metastatic MM which has a very poor prognosis. According to TNM classification, the final diagnosis of the case was T4bN0M1a. Although he has been under regular follow-up, the lesions are still present and his health condition is deteriorating. Discussion: Metastatic melanomas are often rare; their misdiagnosis potentially jeopardizes patients’ health and survival, and have medico-legal implications. Melanoma often has a protracted disease course, in which patients have a disease-free period following surgical excision of the primary tumor, only to discover visceral metastases—months, years, or even decades later. Melanoma metastasis is an ominous sign as it generally predicts a poor prognosis. This case is an unusual presentation of metastatic melanoma where, with the elaboration of history and proper examination of lesion, the diagnosis of metastatic melanoma was made. Conclusion: Metastatic MM has a very poor prognosis and an early diagnosis with clinical presentation is very essential in a country where health facilities are not well developed. Knowing the unusual variants of MM is important to allow application of the most appropriate treatment strategies before something wrong happens.

Instagram’s Pelvic Organ Prolapse Content Discusses Limited Treatment Options Leaving Users Susceptible to Biased Information

Objective The aim of the study was to evaluate the quality, understandability, and actionability of pelvic organ prolapse (POP) posts accessible to users on Instagram. Materials and Methods Instagram posts were analyzed using the hashtag, “#PelvicOrganProlapse.” Posts were limited to the English-language and posts containing POP content. Posts were assessed using the International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report guidelines and two validated questionnaires: DISCERN quality criteria and the Patient Education Materials Assessment Tool (PEMAT). Results Overall, 105 posts were evaluated. Instagram posts published by health and wellness groups (44%) were the most common. Pelvic floor muscle training (PFMT) was the most prevalent treatment option mentioned (59%). Moderate to poor quality information was represented in 76% of posts. Twenty-five posts were found to have commercial bias. Over 2/3 of posts had a low PEMAT score for actionability (score <75%). PFMT was the most frequently discussed treatment option for POP; however, Instagram posts do not address other therapies like surgery and pessaries. Conclusion Instagram posts contain limited content with poor quality information, which increasingly focuses on managing POP with PFMT. The absence of complete information on treatment modalities can limit unknowing users from alternative options, thus hindering their judgment.

Implementation of Sharia Compliance to Optimize Zakat Governance in the Frontier and Outermost Regions in Indonesia

This research is a juridical and empirical study about the implementation of sharia compliance based on Law no. 23 the year 2011 on the Management of Zakat. BAZNAS, as the zakat management authority under the government, must implement good governance based on Islamic Sharia principles, trustworthiness, benefit, justice, legal certainty, integrated and accountability as a mandate from the zakat regulation. Sharia compliance is the main aspect in the management of zakat which consists the rules and the principles of sharia are essentially listed in the Qur’an, Hadith and developed in zakat fiqh related to principles of collecting and management of zakat, such as subject dan object of zakat, nisab and haul and the utilization and empowerment of zakat property. This study discusses the regulatory aspects of sharia compliance in the management of zakat, sharia principle in the operation of zakat, the stakeholders, indicators, reporting and auditing systems, and the benefits of implementing sharia compliance in zakat management. The research field was conducted in six ProvinceS in Indonesia (Aceh, West Nusa Tenggara, East Kalimantan Province, East Nusa Tenggara, North Sulawesi, Gorontalo). The implementation of sharia compliance in zakat institutions began to be effective in 2018 after the Decree of the Ministry of Religious Affairs Number 733 in 2018 concerning sharia audit guidelines for zakat management reports. The implementation of sharia compliance has a positive correlation with the implementation of good governance in the management of zakat institutions because it is associated with increased accountability and responsibility of zakat institutions. Sharia compliance is a strategic issue in achieving best practices in the management of zakat institutions, especially in ensuring legal certainty and trust in the community to optimize the empowerment of zakat in Indonesia.

Guidelines for minimal report in gynaecologic sonography: Are they useful for emergency department resident physicians?

ObjectivesThis study aimed to evaluate the impact of Collège National des Gynécologues et Obstétriciens Français (CNGOF) guidelines on the minimal sonographic reports generated by emergency department resident physicians. Material and methodsThis prospective observational study was conducted in the gynaecologic emergency unit of a teaching hospital from November 2016 to May 2017. We analysed sonographic reports generated by residents during gynaecological emergencies before and after training on the minimal report standards. An analysis of the evaluated items was carried out. We also compared residents according to their specialities and seniority. ResultsA total of 240 reports were analysed, 120 before and 120 after the training. Half of the reports concerned women with an early pregnancy while the others concerned women with negative hCG. All residents significantly improved their practice after the training, as shown by the increase in ratings of the evaluated items (38 % before training vs 44.8 % after, p < 0.01). General practitioners had greater improvement (48.1 % of evaluated items), whereas older residents reported fewer items before or after the training (43.5 %) than younger residents. Finally, all residents improved their practice with a conclusion that followed the guidelines in 92.5 % of cases (versus 68.3 % before the training; p < 0.01). ConclusionTraining on the CNGOF minimal sonographic report guidelines significantly improved the emergency sonographic reports generated by residents. Wider dissemination of this training, particularly to young residents, would probably improve the quality of sonographic reports performed at gynaecological emergencies.

Comparison Of The Prevalence Of Hypertension Using Fourth Report And The Aap Guidelines Among Nigerian Children And Adolescent

BACKGROUND: This study compared the prevalence of hypertension based on the Fourth Report guidelines issued in 2004 (old) and the recent (new) 2017 American Academy of Pediatrics (AAP) clinical practice recommendation for describing hypertension among Nigerian children and adolescents. METHODS: Descriptive cross-sectional study of 1758 (boys= 631; 35.9% and girls=1127; 64.1%) aged between 9 and 19 years in Ado-Ekiti, Southwest Nigeria participated in the study. Stature, body mass, abdominal obesity, systolic and diastolic blood pressure (BP) were determined using the standard protocols of ISAK, and BPs for all school-going children at each screen were classified by both fourth report guidelines (FRGs) and AAP guidelines. RESULTS: Mean body mass, waist-to-hip ratio (WHR) (p≤0.05), body mass index (BMI) (p<0.01), body fat percentage and both systolic and diastolic blood pressure were significantly higher among boys compared to girls (p < 0.001). Based on the new guideline (AAP), the prevalence of hypertension by gender systolically, stands at 9.5% and 5.9% compared to the 4th report guidelines of 1.5% and 1.7% for boys and girls, respectively, and diastolically stands at 6.3% and 3.9% compared to the 1.6% and 0.9% for boys and girls, respectively. Based on AAP and by age, 12.1% and 12.8% of children aged 15 and 16 years were systolically and diastolically hypertensive, respectively. The result of the hypertension prevalence based on the 4th report criteria by age revealed that 5.8% and 2.8% of those aged 15 and 14 years were systolically and diastolically hypertensive, respectively. CONCLUSIONS: A strikingly high prevalence of hypertension was found in children and adolescents following the recent AAP guidelines compared to the Fourth Report guidelines highlighting the need to scale up the intervention and prevention in children especially from low-income countries.

A guide to writing a case report of an osteopathic patient

Case reports provide a valuable insight into osteopathic practice. They allow for the description of diagnoses, interventions and management strategies for complaints that present to practice. Although case reports are traditionally associated with descriptions of rare or unique cases, reports of more common presentations to osteopaths are exceptionally useful. The purpose of this Masterclass is to describe how to construct a case report for the journal, and many other medical journals. The Masterclass outlines how to use the Case Report (CARE) guidelines and provides examples from published case reports related to osteopathic practice. We hope that this Masterclass will encourage practitioners to consider publishing case reports to expand the professions’ evidence base and inform future research.

PRICE 2020 guidelines for reporting case reports in Endodontics: explanation and elaboration.

Case reports play a key role in showcasing new, unusual or rare disease(s), and the impact of newer therapeutic approaches or interventions. The Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines are being introduced exclusively for Endodontics by adapting and integrating the CAse REport (CARE) guidelines and Clinical and Laboratory Images in Publications principles. The PRICE 2020 guidelines have been developed to help authors improve the completeness, accuracy and transparency of case reports in Endodontics and thus enhance the standard of manuscripts submitted for publication. The aim of this document is to provide a comprehensive explanation for each item in the PRICE 2020 checklist along with examples from the literature that demonstrate compliance with these guidelines. This information will highlight the importance of each item and provide practical examples to help authors understand the necessity of providing comprehensive information when preparing case reports. A link to this PRICE 2020 explanation and elaboration document is available on the Preferred Reporting Items for study Designs in Endodontology website at http://www.pride-endodonticguidelines.org.

Cardiac autonomic modulation in juvenile idiopathic arthritis with use of biological medication: case report

Introduction: The introduction of biological medication in Juvenile Idiopathic Arthritis (JIA) proposes better therapeutic results with decreased pain and inflammation and consequent reduction in joint damage. The autonomic state can be a predictor for verifying the response to immunomodulation therapy. Thus, measuring heart rate variability can express autonomous behavior and possibly accompany the response to therapy through the expression of the inflammatory condition.&#x0D; Objective: Analysis of heart rate variability in a child with Juvenile Idiopathic Arthritis using the anti-Tumor Necrosis Factor.&#x0D; Methods: This is a clinical case report of an 8-year-old male with a diagnosis of JIA - oligoarticular form, using etanercept, admitted to Clínica Escola de Fisioterapia UNINORTE, Acre, Brazil in 2017. We analyzed laboratory and imaging tests, kinetic-functional evaluation, examination of cardiac autonomic modulation and physiotherapeutic treatment for analgesic, anti-inflammatory purposes, gaining flexibility, strength and postural re-education, according to CARE guidelines, case report guidelines.&#x0D; Results: After medication administration, there was a decrease in pain and normalization of serum creatinine (0.50 mg / dL) and CRP (less than 6 mg / dL) and an increase in erythrocyte sedimentation rate (17 mm3). In the examination of heart rate variability, the linear indices in the time domain showed a predominance of parasympathetic activity (RMSSD: 35ms), with decreased sympathetic control measured through the frequency domain (LF: 27.1 un). However, non-linear methods showed low variability with little dispersion of RR intervals.&#x0D; Conclusion: In the present report, the linear indices showed parasympathetic predominance and in the non-linear analysis a low heart rate variability with abnormal and insufficient adaptation of the autonomic nervous system in a child with juvenile idiopathic arthritis using biological medication.

PRICE 2020 guidelines for reporting case reports in Endodontics: a consensus-based development.

Case reports can provide early information about new, unusual or rare disease(s), newer treatment strategies, improved therapeutic benefits and adverse effects of interventions or medications. This paper describes the process that led to the development of the Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines through a consensus-based methodology. A steering committee was formed with eight members (PD, VN, BC, PM, PS, EP, JJ and SP), including the project leaders (PD, VN). The steering committee developed an initial checklist by combining and modifying the items from the Case Report (CARE) guidelines and Clinical and Laboratory Images in Publications (CLIP) principles. A PRICE Delphi Group (PDG) and PRICE Face-to-Face Meeting Group (PFMG) were then formed. The members of the PDG were invited to participate in an online Delphi process to achieve consensus on the wording and utility of the checklist items and the accompanying flow chart that was created to complement the PRICE 2020 guidelines. The revised PRICE checklist and flow chart developed by the online Delphi process was discussed by the PFMG at a meeting held during the 19th European Society of Endodontology (ESE) Biennial Congress in Vienna, Austria, in September 2019. Following the meeting, the steering committee created a final version of the guidelines, which were piloted by several authors during the writing of a case report. In order to help improve the clarity, completeness and quality of case reports in Endodontics, we encourage authors to use the PRICE 2020 guidelines.

A Phase I Cultural Resource Survey for the Proposed Six Mile Boat Ramp Expansion Project (Texas Antiquities Permit #9155)

Cultural Resource Analysts, Inc., personnel completed a records review and cultural resource survey for the proposed expansion of the existing Six Mile Boat Ramp in Sabine County, Texas. This work was performed to assist the Sabine River Authority of Texas in complying with Section 106 of the National Historic Preservation Act of 1966 (Public Law 89-665, 16 U.S.C. 470h-2) as an applicant for a Section 404 Clean Water Act Permit from the US Army Corps of Engineers, and the provisions of the Texas Administrative Code regarding archaeological resources on public lands. The Texas Administrative Code requires review of projects on state-owned lands by the Texas Antiquities Commission. The Sabine River Authority of Texas is considered a political subdivision of the State of Texas, and therefore it has a responsibility to provide the Texas Antiquities Commission an opportunity to review projects that may affect potential or designated archaeological sites. This project was performed under Texas Antiquities Permit (No. 9155). All work was performed pursuant to the guidelines published by the Council of Texas Archeologists and adopted by the Texas Historical Commission, and this report was prepared following the short report format in the Guidelines for Cultural Resource Management Reports published by the Council of Texas Archeologists. The current proposed project includes the expansion of the Six Mile Boat Ramp on the Toledo Bend Reservoir in Sabine County, Texas. The proposed development includes the addition of a handicap-accessible floating boat ramp, the clearing of approximately 0.4 ha (1.0 acre) of trees, the construction of a parking area, the addition of a vault toilet, the addition of two tables on concrete platforms, and the clearing of trees along the shoreline to provide an enhanced scenic view. In order to provide some flexibility in siting these facilities, the direct and visual areas of potential effect for this project were within a polygon adhering on its southern and western boundaries to the property line, and roughly buffered to the north and east by the existing shoreline of the Toledo Bend Reservoir. It is estimated that the area of potential effect for this project measures 1.2 ha (3.0 acres), of which approximately 0.9 ha (2.2 acres) could be surveyed, excluding paved surfaces. The records review for this project was conducted on October 18, 2019, prior to the commencement of the field survey, to identify cultural resources or cultural resource investigations previously documented within the area. This file search utilized online files maintained by the Texas Archaeological Research Laboratory at the University of Texas. Additionally, historic maps were examined to identify the locations of any potential historic archaeological sites. The records review indicated that one previously documented site, 41SB58, was located within approximately 50 m (164 ft) to the north of the proposed project area. Additionally, one historic structure was depicted within the project area on historic mapping. Fieldwork was conducted on November 19, 2019, and was completed in 11.5 person hours. The project area was systematically investigated by pedestrian survey and screened shovel tests spaced at a 30 m (98 ft) interval on pedestrian transects spaced at 30 m. The fieldwork for this project resulted in one newly recorded isolated find that is not eligible for designation as a Texas State Archeological Landmark or for listing in the National Register of Historic Places. Based on the findings of this work, it is recommended that the project area be considered cleared from a cultural resource perspective.

Inpatient and home-based rehabilitation regimen after COVID-19 illness

The severe acute respiratory coronavirus-2 syndrome infection has spread worldwide and has an abrupt effect on human, economic, and health system. The data are collected from various relevant sources such as PubMed, Infection Prevention Control, World Health Organization novel coronavirus disease (COVID-19) situation update report, Australian and New Zealand Intensive Care Society guidelines, Society of Critical Care Medicine, World Confederation for Physical therapy guidelines, and from other Internet sources. It is observed that about 30% of COVID-19 patients with sepsis needed hospital rehabilitation, while 20% requires a home-based rehabilitation program. Based on the evidence, it is anticipated that severe and critical COVID-19 patients develop postintensive care syndrome, resulting in pulmonary disabilities, dyspnea on exertion, physical deconditioning, cognitive impairment, and mental health disturbances. Most of these symptoms may also occur in patients recovered from symptoms, or who were not admitted to intensive care unit, or in older adults with chronic health conditions, or who have been deconditioned due to mobility disability, social isolation, etc. Such patients need access to effective pulmonary therapy, functional rehabilitation, and stress management in the hospital- and home-based settings to regain their previous independence level. The evidence suggests that viruses could even survive in the oropharyngeal cavity and stool for up to 15 days after COVID-19 infection has been declared cured. The physiotherapist must take proper safety measures before managing patients at home; a virtual care therapy is therefore highly recommended. Due to the increasing demands of hospital beds, the patients may need to be discharged earlier than expected. Rehabilitation act as adjuvant therapy in preparing patients for discharges, reducing the experience of disability, and ensuring the quality of treatment among recovered/discharged COVID-19 patients in hospital- or home-based settings.

Walk-Through Energy Audit of An Institutional Building

Improving energy efficiency requires detailed information on energy utilization. Many a times, institutional buildings across developing countries are not energy efficient. Thus, they require quantitative energy consumption audit information. This study outlines daily, weekly and annually projected energy consumption in an academic building within Nigeria. Measurements of the energy utilizations of the building were in accordance to ASHRAE Standard 22, ASHRAE/IES Standard 100-2015 and BCA Health Check report guidelines. Results showed that HVAC appliances and electrical motors driven gadgets consumed 36% and 61.9% of the total energy supplied. In conclusion, improving energy efficiency of similar facilities requires energy conservation practice in terms operating motors and other HVAC devices off idle-time and non-occupancy period respectively.

Lower Limb Amyoplasia in a Filipino Female: A Case Report and a Review of the Literature

Amyoplasia is the most common form of arthrogryposis (multiple congenital contracture). &nbsp;It&nbsp;has an estimated incidence of one in 10,000 live births. Lower limb- Amyoplasia is a specific subtype with an estimated incidence of 1 in 75,000 - 100,000 live births. There are only 85 cases of lower limb Amyoplasia identified in literature, and there are no published cases from the Philippines. &nbsp;We discuss a rare case of lower limb Amyoplasia in an 11-year-old Filipino female presenting with additional unique features of severe scoliosis (managed with spine correction surgery) and multiple skin dimples in the gluteal area.&nbsp;The study was performed according to the CARE guidelines for case reports.

Clinical applications, accuracy and limitations of guided endodontics: a systematic review.

The novel concept of guided endodontics has been reported as an effective method to obtain safe and reliable results in root canal treatment. To evaluate by means of a systematic review the clinical applications, accuracy and limitations of guided endodontic treatment. A search of the literature was performed on PubMed, Embase, Web of Science and Cochrane Library databases, until 25 April 2019. No language or year restrictions were applied. Articles that answered the research question, including case reports, in vitro and ex vivo studies were included. Data extraction was performed independently by two reviewers. Quality assessment was done using STROBE, CARE and Modified CONSORT guidelines for observational, case reports and pre-clinical studies, respectively. A total of 22 articles, including fifteen case reports, six pre-clinical studies (in vitro and ex vivo studies) and one observational study, were included. Even though the level of evidence is low, and the methodology described among studies heterogeneous, all articles describe guided access cavity preparation and guided surgery as being highly accurate and successful techniques when comparing the drilled path to the planned treatment. More studies with a larger number of patients are necessary to obtain significant conclusions.

Correlation of registered drug packs with Maastricht V/Florence Consensus Report and national treatment guidelines for management of Helicobacter pylori infection.

High prevalence of Helicobacter pylori infection, the complexity for its treatment, poor correlation of registered drug packs or poor patient adherence to the treatment may contribute to antibiotic resistance and healthcare costs. The aim of the present study was to investigate whether registered drug packs are in accordance with European and national guidelines for Hpylori eradication with reference to the number of drug units. In this study, we considered treatment options for the management of Hpylori infection recommended by the Maastricht V/Florence Consensus Report and by national guidelines in the United Kingdom (UK), Croatia, Italy and Slovenia for adults. Drugs proposed by the guidelines were identified in national drug databases in July of 2019. When considering correlation for 10-day treatment regimens, drug packs registered in Croatia could not be matched with recommendations for sequential therapies. A number of proposed treatments could not be matched due to small variety of drug packs in Croatia. Drug packs registered in the UK more often matched recommended 14-day treatment regimens and national guidelines. With reference to European guidelines, 10-day treatments could more frequently be matched in Italy and in Slovenia. Furthermore, results of this study indicate that there is smaller variety in drug pack sizes registered in Croatia and Slovenia when compared to UK and Italy. Considering poor correlation of drug packs with treatment guidelines for Hpylori, adherence to antimicrobial treatment and proper disposal of antimicrobials is warrant. Discussing adherence to antimicrobial treatment with patients should be introduced as a standard of patient care and education.

Vulnerability Index Elaboration for Climate Change Adaptation in Peru

This paper evidences one of the most relevant information gaps of climate change adaptation in Peru: its vulnerabilities. First, it contextualizes main national level impacts and progress made in adaptation measures definition from prioritized thematic areas. Then, it addresses the difficulty of finding tools to measure climatic risk level. For instance, this arises the need to focus on the vulnerability associated with climate change adaptation efforts. Therefore, a vulnerability index based on a multi criteria analysis is proposed, with three parts. In the first one, three-work axes were chosen following the fifth IPCC report guidelines: climatic phenomena dangers, territorial exposure, and subjects’ vulnerability. The territorial area analysis was carried on at district level. With regard to subjects, five indicator groups were identified, and measurable variables were chosen: population; species and ecosystems; functions, services, and environmental municipalities’ assets; economic, social and cultural assets; and infrastructure. Next, data was searched for each variable and it was systematized in a multi-criteria database. Finally, an index (0-15) was developed to calculate socio-climatic vulnerability of all the Peruvian District Municipalities. They were classified according to social, climatic, and socio-climatic vulnerability range. This facilitates a targeting instrument for public policies that can generate better climate change risk management and contributes to commitments fulfillment of the Sustainable Development Goals.Keywords: Climate change, Vulnerability, Climate change adaptation, Socio-climatic vulnerabilities, Climate risk, Sustainable Development Goals