Local Medical Community Research Articles

Ultrasound-Based Prevalence of Cystic Echinococcosis in the Samarkand Region of Uzbekistan: Results from a Field Survey.

Cystic echinococcosis (CE) is a zoonosis caused by Echinococcus granulosus. Uzbekistan is endemic for CE, but estimates of disease burden are lacking. We present findings from a cross-sectional, ultrasound-based survey evaluating the prevalence of human CE in the Samarkand region, Uzbekistan. The survey was conducted between September and October 2019 in the Payariq district, Samarkand. Study villages were selected based on sheep breeding and reported human CE. Residents aged 5-90 years were invited to receive a free abdominal ultrasound examination. The WHO Informal Working Group on Echinococcosis classification was used for cyst staging. Information regarding CE diagnosis and treatment was collected. Of 2,057 screened subjects, 498 (24.2%) were male. Twelve (0.58%) had detectable abdominal CE cysts. In total, five active/transitional (N = 1 CE1, N = 1 CE2, N = 3 CE3b) and 10 inactive cysts (N = 8 CE4, N = 2 CE5) were identified. Two participants had cystic lesions with no pathognomonic features of CE and were given a 1-month course of albendazole for diagnostic purposes. Twenty-three additional individuals reported previous surgery for CE in the liver (65.2%), lungs (21.6%), spleen (4.4%), liver and lungs (4.4%), and brain (4.4%). Our findings confirm the presence of CE in the Samarkand region, Uzbekistan. Additional studies are needed to assess the burden of human CE in the country. All patients with a history of CE reported surgery, even though most cysts found during the current study were inactive. Therefore, it appears there is a lack of awareness by the local medical community of the currently accepted stage-specific management of CE.

Factors that Impact Patients' Choice of Radiation Oncologist in the Era of Social Media: A Nationwide Analysis in the Largest Country from Latin America

<h3>Purpose/Objective(s)</h3> The choice of a medical facility and professionals to perform any kind of treatment was always based on the indication of doctors or patients, as well as information about clinical staff reputation. In the last five years, with the boom of social media, many health professionals have been using these tools to create a new way of attracting patients, especially in areas related to aesthetic and well-being. We aim to discover the current influence of social media on patients' choice of radiation oncologist and radiation therapy center. <h3>Materials/Methods</h3> We performed a nationwide standardized questionnaire with patients undergoing radiation therapy or with treatment completed in the last 2 years. In addition to demographic and marketing data, an importance score that ranged from not relevant (0) to very important (5) was applied to factors such as the physician's place of training, referral from other physicians, referral from relatives, popularity on social media and availability of state-of-the-art equipment. We also evaluated the importance of data such as online patient testimonials, health insurance coverage, content published on the internet, geographic distance and others in the decision-making process. A Multivariate analysis was performed, completed with multivariate regression and Cox proportional hazard model. <h3>Results</h3> A total of 2012 patients were interviewed, 52% of whom were men, mean age of 53 years, distributed proportionally in the 5 Brazilian geographic regions. The vast majority (65%) sought information before scheduling the first appointment, with 71% using the internet in general for this purpose, of which 19.7% used social media. Factors such as reputation of the place that the physician concluded radiation oncology training and others physicians and patients' recommendations had much more weight in the decision than factors such as popularity on social media, publication of scientific articles and availability of state-of-the-art equipment for treatment in the facility, according to the applied score. Among patients who select their physicians and treatment centers based on information from the internet, the most relevant factor for the decision was the presence of patient testimonials (61%) on the physician's page of any social media or website, followed by the reputation of the physician's main training site (19%) and distance from the treatment facility (5%). <h3>Conclusion</h3> A solid medical education in a center of excellence and a good relationship with the local medical community and patients remains the main ways to attract new patients to radiation oncologists in Brazil, regardless of their popularity on social media. Nonetheless, it is essential to remain present in these digital ecosystems as this is where the vast majority of patients seek to endorse information and references about health professionals in general.

Australia needs to implement a national health strategy for doctors.

Australia needs to implement a national health strategy for doctors.

58 Introduction of a Basic Trauma Course and an Observational Study of Attitudes to Open Fractures in a Rural Region of Sierra Leone

Abstract Introduction Sierra Leone ranks in the bottom quartile of the ‘Least Developed Countries’ across the world. ‘Injury’ is responsible for an estimated 325,000 deaths per annum. Kambia is a rural district in the northwest of the country with an approximate population of 340,000 people. We were invited to teach the regions community health care officers (CHO) the first ever trauma skills course. Our secondary aim while in Kambia was to investigate the barriers to safe open fracture care in the region. Method A 4day teaching course was created and co-ordinated. Questionnaires examining candidate’s trauma knowledge, were utilised. Feedback sheets were collected to assess the courses local acceptability. Three senior CHOs were invite for a semi-structured interview exploring Open Fractures. This was recorded and a thematic analysis was performed on the results. Results The mean pre course questionnaire score was 9.0 (SD 3.45), and post course score 19.7(SD 3.8). This gave a mean difference of 10.7(CI 9.5 – 11.8, p value 0.01). All feedback collected was positive, with 15/23 candidates reports ‘Primary Survey’ the most useful teaching session. The reported boundaries to open fracture care included local beliefs, Lack or resources and services, Lack of finances. Conclusions Our basic trauma course provided an effective method of teaching trauma skills to the CHO’s of Kambia. It offered a widely accepted teaching structure and was enjoyed by the local medical community. We also identified barriers to optimal open fracture care in the region of Kambia, which can be targeted for further work.

The influence of augmented renal clearance on vancomycin blood concentrations in patients with traumatic brain injury: Case report

Traumatic brain injury is a severe condition frequently complicated with infections, hypermetabolism, and augmented renal clearance (ARC). The ARC is a phenomenon characterized by increased creatinine clearance above 130 mL/min/1.73m2. This phenomenon has been associated with decreased blood concentrations of selected antibiotics, like vancomycin, probably causing treatment failure. Despite ARC's possible fatal consequences in our local medical community, it is rarely assessed. Patient with traumatic brain injury accompanied with secondary infection and augmented renal clearance accompanied with subtherapeutic vancomycin concentrations in the time of treatment is presented. Since concentrations of antibiotics are not routinely measured in Serbian hospitals, clinical practice adjustment and widely accepted method of antibiotics blood concentration measurement which is particularly important in critically ill patients is suggested. The clinical pharmacologist is a significant team member for the treatment of critically ill patients due to his/her expert knowledge of pharmacokinetics and drug interactions, especially important in this category of patients, contributing to positive clinical outcomes.

Influence of ultraviolet blood irradiation on COVID-19 associated community-acquired pneumonia

The pandemic of the 21st century caused by the SARS-CoV-2 virus has posed a challenge for the global medical community. Community-acquired polysegmental pneumonia caused by the novel coronavirus infection (COVID-19) proceeds in a variety of types and may be complicated by a potentially lethal immune response — the cytokine storm. The latter is characterized by rapid proliferation and increased activity of T cells, macrophages and natural killer cells releasing various inflammatory cytokines and chemical mediators by protective cells. This pathological condition can be treated by recombinant humanized monoclonal antibody against monofunctional cytokine human interleukin-6 receptor. The effect of IL-6 blockers is to selectively bind and inhibit both soluble and membrane IL-6 receptors (sIL-6R and mIL-6R). There are studies demonstrating a positive effect and increased survival rate while using drugs that block the production of interleukin-6. The new coronavirus infection causes inflammation of the artery wall with intravascular thrombogenesis, which justifies the high efficiency of anticoagulant and hormone therapy. The standards of drug treatment of the studied infection include antiviral, anti-inflammatory, anticoagulant, mucolytic, symptomatic, intravenous infusion and oxygen therapy. Methodological recommendations for the diagnosis and treatment of a new coronavirus infection, issued by the Ministry of Health of the Russian Federation, are regularly updated in accordance with the accumulation of positive treatment results by global and local medical communities. In addition to drug therapy, there are other methods of body detoxification. One of the additional methods for treatment of community-acquired pneumonia along with viral “vasculitis” and correction of the immune response can be provided by ultraviolet blood irradiation (UBI). It is well known that ultraviolet radiation has a disinfecting effect. The wavelengths used in UBI affect the efficiency of UV absorption by DNA molecules of the pathogen. Bactericidal UV radiation at certain wavelengths causes thymine dimerization in DNA molecules. The accumulation of such changes in the DNA of microorganisms leads to a slowdown in the rate of their reproduction and extinction. The photohemocorrection method is characterized by immunostimulatory, antiinflammatory, anti-hypoxic, membrane stabilizing, antioxidant and detoxifying effects. In the current study we obtained data on a significant decrease in the systemic inflammatory response, marked and fast decrease of the C-reactive protein in blood tests of patients while receiving ultraviolet blood irradiation. The relief of the systemic inflammatory reaction had a positive effect on the reduction of infiltrative changes in the lung tissue, as well as the timing of discharge from hospital.

Julian André Bradley

Julian Andre Bradley gave so much to the local medical community, and so many of us are deeply indebted to him for the support and guidance he gave to us...

Bimanual motor performance in everyday life activities of children with hemiplegic cerebral palsy.

Motor impairments in children with cerebral palsy significantly reduce their ability to learn and adapt bimanual actions into their life roles. The current evidence on bimanual coordination performance in children with hemiplegic cerebral palsy were mostly drawn from kinematic studies. Whether these kinematic findings on bimanual motor performance can be observed when performing daily life activities in a natural environment is not clear. Further, there is no evidence what and how the verbal prompting influences bilateral motor performance. We intend to explore its role on bimanual motor performance as well. This study aimed to investigate the bimanual motor performance in everyday life activities of children with hemiplegic cerebral palsy and the role of verbal prompts in facilitating affected hand use. This is an observational study. Local medical center and community. Twenty-five children with hemiplegic cerebral palsy and 25 age-matched typically developing children. The Observation-based Test of Capacity, Performance, and Developmental Disregard and Melbourne Assessment 2 were used to assess the quantitative and qualitative use of hands in everyday activities. Children with hemiplegic cerebral palsy, demonstrated different motor coordination patterns in daily bimanual activities compared with their counterparts. With verbal prompts, children with hemiplegic cerebral palsy significantly increased the use of their affected hands in bimanual activities. However, the increases were observed only in basic motor components, such as reaching and grasping, and not in complex motor components such as manipulation. These findings will assist researchers and clinicians to develop and refine intervention programs that maximize rehabilitation benefits in improving bimanual hand coordination performance for children with hemiplegic cerebral palsy. This study increased our understanding of bimanual motor performance of children with hemiplegic cerebral palsy in everyday life activities. The results demonstrated children with cerebral palsy rely more on their less-affected hand to perform bimanual activities with or without verbal prompts. Incorporating bimanual activities and verbal prompts during intervention may only be effective on facilitating basic hand movements but not on improving complex movements of affected hands. Further research is needed to explore other intervention strategies to facilitate complex bilateral hand movements.

The Discussion of Questions on the Development of Russian Charity and Public Assistance on the Verge of the 20th Century

The article is dedicated to the topic of construction of the dialogue between the society and the government about the questions of the development of public assistance and charity. The first attempt of public discussion of the legislative base of Russian charity was undertaken by the Commission, which took place from 1892 to 1897, under the leadership of K. K. Grot. In the beginning of the 20th century representatives of local self government and medical community repeatedly addressed state organisations with proposals to call a congress in order to discuss the state of affairs in the charity and social assistance sphere, but received a refusal. The most active stage of the process were all-Russian congresses of benefactors, which took place in 1910 and 1914. This dialog between the government and the society provides interesting material for the analysis of the development of the system of public assistance in the Russian Empire.

Szkoła na krańcu Galicji. Gimnazjum prywatne w Borszczowie 1909–1914

[A school on the outskirts of Galicia. The private gimnazjum in Borshchiv 1909–1914] The secondary school (gimnazjum) in the town of Borshchiv (Borszczów) was established in 1909. An important figure who took part in its creation was Count Tadeusz Czarkowski-Golejewski. Though the school had existed for a short period before the First World War, it utilized interesting educational solutions based on student autonomy, relationship with the parents and combining intellectual and physical effort. In the local community the school gave the incentive to develop regionalism. Due to a large number of auditors taking part in the lessons, and evening courses for girls, elements of co-education were introduced in the provinces. Co-operation with branches of the “Falcon” Polish Gymnastic Society as well as involvement of local medical community made it possible to popularize physical education and provide medical and hygienic supervision to a large group of young people. The pedagogical offer of the school was above all directed to Polish people from the town and its vicinity, which was evident in the changing ethnic and religious structures.

A Better World in the Future

A Better World in the Future

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

The opioid-impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety.

Trauma and orthopaedics in the COVID-19 pandemic: breaking every wave.

The coronavirus disease 2019 (COVID-19) pandemic has placed the whole world and the medical profession in an unprecedented situation. Each medical specialty has had to develop protocols within the local context to cope with this crisis. We aimed to provide a commentary on the evolving situation in orthopaedic departments in Singapore and share insights and recommendations for the consideration of orthopaedic surgeons worldwide. The COVID-19 threat in Singapore can be classified into ‘waves’, which started with the confirmation of the first COVID-19-positive patient in Singapore on 23 January 2020. The first wave of cases was traced to travel or contact with travellers to and from the Chinese city of Wuhan, Hubei.(1) This progressed to more cases from North Asian cities in February 2020, with few cases from Europe or North America. As Singapore braced itself for community spread, the national disease threat level was stepped up from Disease Outbreak Response System Condition (DORSCON) Yellow to Orange on 7 February 2020.(2-4) By early March, the number of COVID-19-positive cases in Europe and North America had increased exponentially with a high number of fatalities, signalling a global pandemic. The second wave of cases in Singapore, many of whom were returning students and Singaporeans working abroad, was traced to previous travel to Europe, North America and other cities in Asia. Unlike many countries that imposed a lockdown to limit local community spread, Singapore maintained a strategy of testing and isolation of infected individuals, and quarantine of all close contacts of infected individuals. This aggressive public health strategy allowed most Singaporeans to continue work and school with limited restrictions in February and March 2020. The policy of ‘social distancing’ was additionally promoted to mitigate local transmission. The end of March 2020 saw multiple new local clusters and increased numbers of local unlinked COVID-19-positive cases. This heralded the start of the third wave of patients from significant local case transmission.(5) Over this period, the resources of the local medical community – community practice, government restructured hospitals and the National Centre for Infectious Diseases (NCID) – were strained and further put to the test. The significant rise of new local unlinked cases necessitated a national ‘circuit breaker’ period that commenced on 7 April 2020 for one month (i.e. two COVID-19 incubation cycles). During this time, only essential services were permitted to continue. A nationwide school and non-essential workplace closure took effect in order to create a period of enhanced social distancing and reduced human traffic in Singapore. Trauma and orthopaedics encompass both non-elective and elective work. Trauma involves the management of fractures that are categorised as urgent and semi-urgent. Elective orthopaedic surgery covers soft tissue repair and reconstruction, joint replacement in the shoulder, knee, ankle and hip joints, and spine surgery. Musculoskeletal oncology surgery and certain aspects of spine surgery such as spinal cord decompressions are generally considered urgent and semi-urgent. During this pandemic, orthopaedic departments in Singapore have to frequently calibrate and recalibrate their organisational structure and clinical operations as the crisis evolves.

Cross-cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids\u2019 Life Assessment Tool (CHO-KLAT) in C\xf4te d\u2019Ivoire (the Ivory Coast)

IntroductionHealth-related quality of life evaluation is recognized as an important outcome in the assessment of boys with haemophilia. In fact, reliable health-related quality of life data are even more critical in developing countries to advocate for government agencies to develop national haemophilia care programmes. However, validated tools are not yet available in sub-Saharan African countries.AimsThe purpose of this study was to complete the cultural adaptation and validation of the Canadian Haemophilia Outcomes-Kids’ Life Assessment Tool version2.0 (CHO-KLAT2.0) in Côte d’Ivoire.MethodsThe process included four steps: a linguistic adaptation, cognitive debriefing interviews with children and their parents, a validity assessment with the Pediatric Quality of Life Inventory (PedsQL) as a comparator, and a test-retest reliability assessment.ResultsThe initial Ivoirian version of the CHO-KLAT2.0 was developed through a linguistic adaptation performed in close collaboration with members of the local medical team and haemophilia community. Cognitive debriefings were completed with five boys and their parents, with the final Ivoirian version of the CHO-KLAT2.0 developed in September 2017. The validation process included 37 boys with haemophilia (mean age: 11.4 years; 34 with severe and three with moderate forms of haemophilia, all treated on demand) and their parents. Among the child-reported population (n = 20), we observed a mean CHO-KLAT2.0 score of 51.3 ± 9.2; there was a moderate correlation between the CHO-KLAT2.0 and PedsQL scores (r = 0.581; p = 0.007) and an inverse correlation of the CHO-KLAT2.0 and PedsQL scores with the global rating of the degree to which the boys were bothered by their haemophilia. The mean parent proxy CHO-KLAT2.0 score (n = 17) was 53.5 ± 9.8. Among the parents, we found no significant correlation between the Ivoirian CHO-KLAT2.0 and PedsQL scores or between the parent-reported scores and the parent global ratings of bother. The test-retest intraclass correlation coefficient was 0.879 (95% CI: 0.673; 0.954) for the child-reported questionnaires and 0.880 (95% CI: 0.694; 0.955) for the proxy-reported questionnaires.ConclusionsA cross-culturally adapted and validated version of the CHO-KLAT2.0 for Côte d’Ivoire is now available that enables baseline values to be obtained and intervention outcomes (namely, prophylaxis) to be measured in Ivoirian boys with haemophilia.

Consolidation of the rural medical community in the Tobolsk Governorate in the early 20th century

The present article is aimed at studying district congresses of rural doctors from the Tobolsk Governorate, a unique phenomenon in the history of the Siberian medical community. Congresses are considered to be an inte-gral part and development indicator of the corporate social initiative, as well as the professional interaction of medical specialists. On the basis of documents being introduced into scientific circulation for the first time, the author analysed the activity of rural doctors within the paradigm of the general theory of modernisation, as well as characterised the materials of meetings, the range of issues under discussion, main recommendations and re-sults. It is shown that the activity of the medical community was not limited to the work of scientific and practical societies of governorate centres — it was much wider and richer. The fact of holding two provincial and a number of district congresses in the Tobolsk Governorate (from 1903 to 1912) was established. District congresses be-came a place for establishing personal contacts between doctors, sharing opinions and experiences, formulating proposals, which were then discussed at the governorate forum and laid the foundation for administrative deci-sions. They demonstrated a strong motivation of rural specialists in medicine, which in fact began to develop in Siberia only starting from the late 1880s, for professional consolidation and for the development of common ap-proaches to solving regional problems. The materials of district congresses also prove the formation of a new health model among the rural population, characteristic of modern society. A doctor became a familiar and neces-sary element of the social environment for a peasant. It should be noted that district congresses were not large-scale, they were not public mouthpieces, did not become the driving force of reforms and the generator of signifi-cant public projects. Their history was too short; the level of rural medicine and, in general, the entire medicine of the governorate was too low. Nevertheless, the need for professional consolidation and communication turned out to be so strong that it allowed doctors, albeit with the support of the administration, to carry out serious prepara-tory work in districts and hold two governorate congresses. Clearly, this constitutes definite evidence of qualitative changes in the state of the local medical community.

The Use of Biological Disease-modifying Antirheumatic Drugs for Inflammatory Arthritis in Korea: Results of a Korean Expert Consensus

Biological disease-modifying antirheumatic drugs (bDMARDs) are highly effective agents for the treatment of inflammatory arthritis; however, they also possess a potential risk for serious infection. Recently, with the rapid expansion of the bDMARDs market in Korea, reports of serious adverse events related to the agents have also increased, necessitating guidance for the use of bDMARDs. Current work entitled, “Expert Consensus for the Use of bDMARDs Drugs for Inflammatory Arthritis in Korea,” is the first to describe the appropriate use of bDMARDs in the management of inflammatory arthritis in Korea, with an aim to provide guidance for the local medical community to improve the quality of clinical care. Twelve consensus statements regarding the use of bDMARDs for the management of rheumatoid arthritis and ankylosing spondylitis were generated. In this review, we provide detailed guidance on bDMARDs use based on expert consensus, including who should prescribe, the role of education, indications for use, and monitoring strategies for safety. (J Rheum Dis 2020;27:4-21)

Fourth Annual Clinician Scientist Trainee Symposium at the Schulich School of Medicine and Dentistry

The Annual Clinician Scientist Trainee Symposium (CSTS) gathers the local medical research community at the Schulich School of Medicine and Dentistry, including research trainees at the medical student, resident and fellow levels. Trainees showcase their current and upcoming work, and leaders in the community impart their perspectives on the importance and future of research in medicine. At the 4th Annual CSTS, perseverance and cautious optimism emerged as the characteristics that trainees should foster through their future careers as clinician scientists. This was echoed by the challenges and encouraging findings presented by trainees, who conducted their work as part of research projects within the MD, MD/PhD and clinical investigator programs. The four oral presentations and 10 three-minute thesis presentations covered the full breadth of medical disciplines across the spectrum of translational medicine, from fundamental sciences through knowledge translation. The CSTS concluded with the keynote presentation by Michael Strong, current president of the Canadian Institutes of Health Research, who gave a glimpse into his decades-long path of overcoming and overturning dogmatic views in the world of amyotrophic lateral sclerosis research, demonstrating how roadblocks in research can become an impulse for stronger science.

Managing Immuno-Oncology Toxicity: Top 10 Innovative Institutional Solutions.

Expanded use of immuno-oncology (IO) therapy to treat cancer has led to an increased frequency of novel toxicities known as immune-related adverse events (irAEs). Delayed recognition of IO toxicity can be life-threatening or even fatal. To address this issue, intervention is possible at three levels: patients, medical providers, and institutions. Patients and the medical community need institutional safeguards in place to promote swift recognition, assessment, and treatment of IO toxicity. Patients receiving IO therapy must be educated to identify the drugs they have received and to recognize potential IO toxicity, and they must know how to report symptoms. Medical providers must be able to reliably identify that patients have received IO therapy as well as recognize rare or subtle symptoms of IO toxicity. Institutions can establish guidelines and order sets to standardize the treatment of patients receiving IO therapy with irAEs, including the complex management of steroid-refractory irAEs. Additional interventions at an institutional level include identification of IO toxicity champions (subspecialists with expertise in IO toxicity), creating immunotherapy-specific tumor boards and lecture series to educate clinicians and staff, and establishing research programs to evaluate IO toxicity. IO therapy and toxicity experiences must be published and shared with both oncology and nononcology providers in the local, national, and international medical community. These efforts aim to improve patient-related outcomes, increase provider education and awareness, and build institutional safety standards for our oncology patients.

On center field or at the sidelines? - A plea for a multimodal approach between medical schools and medical student communities while integrating international medical students.

An increasing number of medical schools offer support services for international students. Their frequent focus on linguistic and academic support often reflects a rather deficit-oriented perception of international medical students. Therefore, this comment advocates a stronger focus on the integration into the local medical student communities. This happens both against the background of the expected academic benefits and the added value of intercultural learning at medical schools.

Patients with mental problems - the most defenseless travellers.

Severe mental illness occurring abroad is a difficult situation for patients, their families, and for the local medical community. Patients with mental problem are doublely stigmatized due to their mental illness and because they are foreigners in an unfamiliar country. The appropriate treatment is often delayed, while patients are often dealt with in a manner that violates their human rights. Moreover, repatriation - which is vital in this case - is often delayed due to the lack of international protocols for the transportation and treatment of mentally ill travelers. Authors analyzed several factors related to acute mental health problems during travel: the etiology of symptoms, the appropriate treatment possibilities abroad, and medical evacuation and repatriation of the psychotic patient. The article presents a brief review of travel-related mental disorders, the epidemiology of mental health issues faced by travelers, and the significance of pre-travel advice for these patients. The first problem is to recognize (and redress) the particular challenges faced by a psychotic patient in a strange country. The second challenge is to prepare the patients, often in a poor psychiatric state, for medical evacuation by commercial aircraft. Another important question is the best way to take the patient through customs and security control. All of these, as yet unresolved, issues can make the mental patient virtually defenseless. Although timely repatriation of a mentally ill patient is vital and urgent, most travel insurance policies exclude treatment and repatriation costs incurred due to acute mental illness. The high cost of treatment and repatriation must be paid by the patient or their family, which could lead to severe financial strain or insolvency. Changing the approaches taken by the local mental health care community, police, airport security, and insurance companies remain a challenge for psychiatrists.