Strict Protocol Research Articles

Colonization of the Gastrointestinal Tract of Chicks with Different Bacterial Microbiota Profiles.

This study aimed to investigate the consequences of early-life microbiota transplantation using different caecal content sources in broiler chicks. We hypothesized that chicks receiving at-hatch microbiota from organic hens would harbour a distinct microbiota from chicks receiving industry-raised broiler microbiota after six weeks of age. Three hundred Cobb broilers eggs were randomly assigned to one of four groups according to the caecal content received: organic laying hens (Organic); autoclaved caecal content of organic laying hens (Autoclaved); conventionally grown broilers (Conventional); and sterile saline (Control). caecal microbiota transplantation was given by gavage on day 1. Ten birds/group were euthanized on days 2, 7, 14, 28, and 42. The caecal tonsils and contents were collected for cytokines and microbiota analyses. The microbiota from chicks receiving live inocula resembled the donors' microbiota from day seven until day 42. The microbiota composition from the chickens who received the Organic inoculum remained markedly different. Starting on day 7, the Organic group had higher richness. Simpson and Shannon's indices were higher in the Conventional group on days 2 and 7. Chickens in the Conventional group presented higher production of IL-1β and IL-6 in plasma on days 2 and 28, increased IL-6 expression in the caecal tonsils at days 7 and 42, and increased IL-12 expression on day 7. However, the Conventional group was infected with Eimeria spp., which likely caused inflammation. In conclusion, microbiota transplantation using different microbiota profiles persistently colonized newly hatched broiler chicks. Future studies evaluating the importance of microbiota composition during infections with common enteropathogens are necessary. This study also highlights the need for a strict screening protocol for pathogens in the donors' intestinal content.

COVID-19 Infection Among Healthcare Workers at a Tertiary Healthcare Hospital.

SARS-CoV-2 or COVID-19 virus was the culprit of the global pandemic that began in 2019. With alarming mortality rates reaching sky-high worldwide, the virus prompted the masses to switch to online working. However, this was not feasible for healthcare workers (HCWs) exposed to a higher-than-normal risk of acquiring COVID-19 infection. This study aims to observe the prevalence of COVID-19 positivity among the various areas of a healthcare facility in Saudi Arabia. A cross-sectional study of positive employees among all departments at a tertiary care hospital in Riyadh, Saudi Arabia, such as administration, capital projects/facilities, and healthcare. The study included all hospital employees-permanent staff, rotating physicians, and trainees-who tested positive for COVID-19 between March20, 2020 and December 30, 2020. It was found that HCWs had the most significant number of infected individuals with nursing staff being the predominant demographic. This was followed by the capital projects/facilities departments, of which the environmental services staff were the most infected. It is pertinent that strict protocols be taken by hospital management to limit the spread of future infectious diseases within hospital settings. This includes the provision of personal protective equipment (PPE) and adequate education on its proper usage, alongside regular surveillance of staff with regard to adherence and early detection of symptoms.

Safety of Citrate Anticoagulation in CKRT: Monocentric Experience of a Dynamic Protocol of Calcium Monitoring.

Regional Citrate Anticoagulation (RCA) is considered the first-line anticoagulation for Continuous Kidney Replacement Therapy (CKRT). The RCA requires strict protocols and trained staff to avoid unsafe use and ensure its benefit. We have analyzed all our CKRT prescriptions from December 2020 to April 2022 anonymously, collecting data on CKRT, lab tests, clinical conditions, and complications of RCA. In addition, in order to better detect citrate accumulation, we have performed an RCA protocol by reducing the CaTot/Ca2+ ratio cut-off from 2.50 to 2.40 and increasing the number of calcium checks according to its trend. Among the 374 patients in CKRT, 104 received RCA prescriptions, of which 11 (10.6%) were discontinued: 4 for the suspicion of citrate accumulation, 1 for the development of metabolic alkalosis, 1 for the shift to a different CKRT procedure due to the need for a higher bicarbonate dose, 4 for the elevation of hepatocytolysis indexes, and 1 due to a preemptive discontinuation following massive post-surgery bleeding. None of the patients have had citrate toxicity as indicated by a CaTot/Ca2+ greater than 2.50, and our protocol has allowed the early identification of patients who might develop clinical citrate toxicity.

COVID-19 PREVENTION SIGNS IN THE INDONESIA'S SUPER PRIORITY TOURIST DESTINATION

After a long struggle against Covid-19 for more than a year, the spread of COVID-19 in Indonesia gradually decreased and was considerably under control. Several public places, including some tourist destinations, were allowed to re-open. The Ministry of Tourism and Creative Economy made 20 tourist attractions for trial, including the Borobudur temple, the world’s largest Buddhist temple. It is carried out cautiously and under strict health protocols procedure. Implementing health protocol regulations was encouraged by making and placing many protocol signs in strategic places. The aim of this study was to identify and investigate the compositions meaning of the COVID-19 prevention sign at Borobudur Temple. The data were collected through the documentation method with photographic technique. The result showed that all signs have real and ideal information value. Salience signs appear as a result of a variety of fascinating text and images. The framing of the sign is presented in centered/circular with a linear and nonlinear composition. Overall, the signs proved the management of Borobudur temple’s strong commitment to opening the site with strict protocols to prevent the spread of COVID-19 in the Borobudur area.

Insights on liver transplantation and multimodal treatment for intrahepatic cholangiocarcinoma

The treatment of intrahepatic cholangiocarcinoma (iCCA) has traditionally been limited to surgical resection or systemic therapy. The role of liver transplantation in the management of iCCA is a topic currently being explored. This paper serves as a review to highlight past, present, and future work being done in regard to liver transplantation for iCCA. Strict protocols with specific selection criteria have shown promising results. Neoadjuvant therapy, locoregional therapy, and immunotherapy are some of the tools that may aid in bridging selected patients with iCCA to liver transplantation. There are currently three ongoing trials designed to further evaluate the efficacy of liver transplantation for iCCA. As criteria continue to be refined and evidence accumulates, liver transplantation may become a suitable option as a curative treatment strategy for highly selected patients with unresectable intraoperative cholangiocarcinoma.

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy.

Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols. We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway. Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches. Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.

Service Excellent lembaga pendidikan di era pandemi Covid-19

Service excellent training for educational institutions of Yayasan Pendidikan dan Sosial Cendekia Bantul aims to improve the ability of teachers and foundation managers in providing excellent service to student stakeholders, parents, the community and the government.The method used in this service activity is in the form of lectures and practices. The implementation of community service activities lasted for 2 days online due to the Covid-19 pandemic conditions while still following strict health protocols to maintain health during the Covid-19 pandemic. The material provided is in the form of theory and practice on strategies to develop superior schools, excellent service, and standard operational procedures (SOPs). The results of this PPM activity show that participants can understand the training material well. During the activity, participants also gave positive responses to the material provided, especially in discussing case studies of excellent service to parents and making simple SOPs. The achievement of activity targets is measured using evaluation instruments on the clarity of PPM objectives, training benefits, implementation time, training materials and future program sustainability.

Validation of computational models to characterize cumulative intake curves from video-coded meals.

Observational coding of eating behaviors (e.g., bites, eating rate) captures behavioral characteristics but is limited in its ability to capture dynamic patterns (e.g., temporal changes) across a meal. While the Universal Eating Monitor captures dynamic patterns of eating through cumulative intake curves, it is not commonly used in children due to strict behavioral protocols. Therefore, the objective of this study was to test the ability of computational models to characterize cumulative intake curves from video-coded meals without the use of continuous meal weight measurement. Cumulative intake curves were estimated using Kisslieff's Quadratic model and Thomas's logistic ordinary differential equation (LODE) model. To test if cumulative intake curves could be characterized from video-coded meals, three different types of data were simulated: (1) Constant Bite: simplified cumulative intake data; (2) Variable Bite: continuously measured meal weight data; and (3) Bite Measurement Error: video-coded meals that require the use of average bite size rather than measured bite size. Performance did not differ by condition, which was assessed by examining model parameter recovery, goodness of fit, and prediction error. Therefore, the additional error incurred by using average bite size as one would with video-coded meals did not impact the ability to accurately estimate cumulative intake curves. While the Quadratic and LODE models were comparable in their ability to characterize cumulative intake curves, the LODE model parameters were more distinct than the Quadradic model. Greater distinctness suggests the LODE model may be more sensitive to individual differences in cumulative intake curves. Characterizing cumulative intake curves from video-coded meals expands our ability to capture dynamic patterns of eating behaviors in populations that are less amenable to strict protocols such as children and individuals with disordered eating. This will improve our ability to identify patterns of eating behavior associated with overconsumption and provide new opportunities for treatment.

Faktor yang Memengaruhi Penerapan Protokol Kesehatan di Masa Pandemi Covid-19 pada Pengunjung RSUD Tanjung Pura

Health development in Indonesia generally aims to increase awareness, ability and willingness to live healthily for every resident in order to achieve the highest level of health, especially during the Covid-19 pandemic. The aim of this research is to determine the influence of knowledge, attitudes and support from health workers on the implementation of health protocols during the Covid-19 pandemic among visitors at Tanjung Pura Hospital, Langkat Regency. The method in this research uses an analytical survey with a cross-sectional approach. The research population was all visitors to Tanjung Pura Regional Hospital in October 2022 with a total sample of 96 people using the Accidental Sampling technique. The data collected was obtained by interviews using a questionnaire. Data analysis used univariate and bivariate analysis. The results of the study showed that knowledge was poor as much as 57.3%, positive attitude was 56.3%, support from health workers was poor as much as 53.1%. The results of bivariate analysis show that the knowledge variable is 0.000, attitude is 0.001, support from health workers is 0.001. So it can be concluded that there is an influence of the variables of knowledge, attitudes and support of health workers on the implementation of health protocols during the Covid-19 pandemic. It is recommended that hospitals implement strict health protocol checks, such as carrying out checks at hospital entrances, making regulations regarding health protocol raids, and imposing sanctions for those who do not comply with health protocols.

A transformer model blended with CNN and denoising autoencoder for inter-patient ECG arrhythmia classification

Researchers have proposed numerous novel features and models under the intra-patient paradigm. However, their performance suffers when considering the inter-patient paradigm. While some state-of-the-art results have been reported in recent years under the inter-patient paradigm, many of them deviate from the standard test protocol. The performance of minority classes remains unsatisfactory for practical applications under strict test protocols. This paper presents a novel framework based on a lightweight Transformer combined with CNN and a denoising autoencoder, which enhances the performance of minority classes under the standard test protocol. The proposed model includes a new seq2seq network that extracts local features from a single heartbeat using CNN or a denoising encoder, and attends to global features from neighboring heartbeats based on a lightweight Transformer encoder. In particular, we pretrained the autoencoder on the MIT-BIH dataset and an additional dataset, considering several transfer modes for feature representation. We organized multiple continuous heartbeats into a vector sequence, where each heartbeat incorporates information from its neighbors to improve feature representation. The model evaluation was conducted using the MIT-BIH inter-patient dataset, following the AAMI standard. The Transformer with CNN embedding achieved a total accuracy of 97.66% on the test set, while the Transformer with pretrained denoising autoencoder achieved a total accuracy of 97.93%. These results demonstrate the promising performance of our models for imbalanced inter-patient ECG classification under the standard test protocol.

Feasibility of Cerebellar Measurements with Phased Array Sonography through the Anterior Fontanelle in Comparison to MRI.

Cerebral sonography (CS) through the anterior fontanelle is a neonatal brain imaging method that has become an integral part of modern neonatal bedside care for both screening and diagnostic purposes. Premature infants with cognitive delay have a reduction in cerebellar size at term corrected age on magnetic resonance imaging (MRI). We aimed to determine the level of agreement between postnatal MRI and CS for cerebellar biometry and to determine the level of agreement within one and between different examiners. Cerebellar sonography and MRI measurements of the cerebellum from 30 term infants was assessed by Bland-Altman plots. Measurements between both modalities were compared using Wilcoxon's signed rank test. A p-value < 0.01 was considered statistically significant. Intraclass correlation coefficients (ICC) for intra- and interrater reliabilities of CS measurements were calculated. There was no statistically significant difference between CS and MRI for linear measurements, but the measurements of perimeter and surface area differed significantly between the two techniques. There was a systematic bias between both modalities for most measurements except for anterior-posterior (AP) width and vermis height (VH). For measurements that were not statistically different from MRI, we found excellent intrarater ICC for the AP width, VH, and cerebellar width. The interrater ICC was excellent for the AP width and VH, but poor for the transverse cerebellar width. With a strict imaging protocol, cerebellar measurements of the AP width and the VH can be used as an alternative to MRI for diagnostic-screening purposes in a neonatal department where multiple clinicians perform bedside CS. · Abnormal cerebellar growth and injuries affect neurodevelopmental outcome.. · Cerebral sonography through the anterior fontanelle is used for bedside imaging.. · Postnatal sonographic cerebellar measurements are not validated against MRI.. · Measuring vermis height and anterior-posterior width are reliable.. · Measuring transverse cerebellar width through anterior fontanelle is unreliable..

Pharmacokinetics and tolerability of multiple-day oral dosing of mycophenolate mofetil in healthy horses.

Additional efficacious immunomodulatory treatment is needed for the management of immune-mediated disease in horses. Mycophenolate mofetil (MMF) is an immunosuppressive drug that warrants assessment as a viable therapeutic agent for horses. To evaluate the pharmacokinetics (PK) of multiple-day oral dosing of MMF in healthy horses and to determine the tolerability of this dosing regimen. Six healthy Standardbred mares. Horses received MMF 10 mg/kg PO q12h for 7 days in the fed state. Serial sampling was performed over 12 hours on Days 1 and 7 with trough samples collected every 24 hours, immediately before morning drug administration. Noncompartmental PK analyses were performed to determine primary PK parameters, followed by calculation of geometric means and coefficients of variation. A CBC, serum biochemical profile, physical examination, and fecal scoring were used to assess dose tolerability. Seven days of treatment resulted in a mycophenolic acid (MPA) area under the curve (AUC0-12 ) of 12 594 h × ng/mL (8567-19 488 h × ng/mL) and terminal half-life (T1/2 ) of 11.3 hours (7.5-15.9 hours), yielding minor metabolite accumulation in all horses treated. Salmonellosis was detected in the feces of 2 horses by Day 7, and all horses developed myelosuppression, hyperbilirubinemia, hyporexia, decreased gastrointestinal motility, and decreased fecal output by the seventh day of treatment. Administration of MMF at 10 mg/kg PO q12h resulted in hematologic and clinical toxicity within 1 week of treatment. A decreased MMF dose, frequency, or both is needed to avoid colic. Drug monitoring should include frequent hemograms, serum biochemical profiles, and strict biosecurity protocols.

Applying the Model of the European Foundation for Quality Management to evaluate quality of care alongside the merger of mental health care institutes in Amsterdam: a five year pre–post study

Abstract Background Health care reforms over the past decades in the Netherlands enforced institutions to enhance quality and to contain costs. To cope with the policy context, a majority of mental health care institutes applied a merger strategy and hence large mental health care organizations were created. This study assesses the impact of a merger and the related quality management approach on the quality of care of three large Dutch mental health care institutes in Amsterdam. The nine criteria of the Model of the European Foundation for Quality Management (EFQM Model) with 32 criteria parts for total quality management were used. Method A case study with a pre–post design was applied, with the EFQM baseline (pre) and follow-up (post) assessments using the standardized EFQM protocol with a 0%–100% scoring system. The baseline status of 2007–2008 was scored and validated by seven independent certified assessors. During a period of 5 years, the merge was conducted, enhancing the quality management and effectuating the findings of the advice of the feedback report. An EFQM post-assessment of the status of 2012–2013 was carried out by five independent certified assessors applying the strict EFQM assessment protocol. The statistics of pre–post differences were evaluated. The study can be seen as a before–after assessment of a naturalistic experiment. Results The comparison of the nine EFQM criteria before and after the merger on the bases of the scores of the assessors shows an overall improvement from 358 to 425 points on the EFQM scale 0–1000. There is one slight deterioration concerning criterion 8: Society Results, five criteria show positive changes. The top three criteria with the highest improvement are 1: Leadership (15% improvement), 5: Processes, Products, and Services (12%), 6: Customer Results (15%). The overall statement of the audit team of 2013 is ‘The merged organisation strives for effectiveness, which leads to better results in most of the areas.’ Learning from the results is one recommendation of the assessors for the future. Conclusion The conduced merge of three Dutch mental health care institutions in Amsterdam showed an improvement of quality based on the criteria of the EFQM Model over a period of 5 years. This naturalistic experiment can stimulate further studies about mergers. The systematic and transparent approach and documentation can facilitate mutual learning.

Benefits, key protocol components, and considerations for successful implementation of extracorporeal cardiopulmonary resuscitation: a review of the recent literature.

The application of venoarterial extracorporeal membrane oxygenation (ECMO) in patients unresponsive to conventional cardiopulmonary resuscitation (CPR) has significantly increased in recent years. To date, three published randomized trials have investigated the use of extracorporeal CPR (ECPR) in adults with refractory out-of-hospital cardiac arrest. Although these trials reported inconsistent results, they suggest that ECPR may have a significant survival benefit over conventional CPR in selected patients only when performed with strict protocol adherence in experienced emergency medical services-hospital systems. Several studies suggest that identifying suitable ECPR candidates and reducing the time from cardiac arrest to ECMO initiation are key to successful outcomes. Prehospital ECPR or the rendezvous approach may allow more patients to receive ECPR within acceptable timeframes than ECPR initiation on arrival at a capable hospital. ECPR is only one part of the system of care for resuscitation of cardiac arrest victims. Optimizing the chain of survival is critical to improving outcomes of patients receiving ECPR. Further studies are needed to find the optimal strategy for the use of ECPR.

Prevalence of Hepatitis B Virus, Hepatitis C Virus, and HIV Infections in Hemodialysis Patients at Kano Kidney Center.

Background Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections are more prevalent in hemodialysis patients compared to the general population. The objective of this study was to evaluate the prevalence of HBV, HCV, and HIV infections in hemodialysis patients dialyzing regularly at Kano Kidney Center (KKC) in the Eastern Health Cluster of Saudi Arabia in 2022. Methods This retrospective study included all hemodialysis patients who were dialyzed regularly at KKC during 2022. Their electronic medical records were reviewed for the results of HBV, HCV, and HIV along with the patient's demographics, comorbid conditions, and dialysis history. The study was approved and monitored by the Institutional Review Board of Dammam Medical Complex. Results A total of 239 regular hemodialysis patients were included, consisting of 142 males and 97 females (59.41% and 40.59%, respectively), with a mean age of 52.71±15.83 years. Most of the patients were Saudis (156 patients, 65.27%) with the non-Saudi patients being composed mostly of Arabian patients.Nine patients (3.77%) tested positive forhepatitis B surface antigen (HBsAg), the serologic hallmark of HBV infection. Two patients (0.84%) had resolved HBV infections as evidenced by positive hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs). However, the majority (226 patients, 94.56%) were never tested for anti-HBc. Anti-HBs, which can imply long-term immunity against HBV from prior immunizations or infections, were positive in 165 patients (69.04%). A protective anti-HBs level of ≥ 10 IU/L was detected in 158 patients (66.11%) including 104 patients (43.51%) having ≥ 100 IU/L. Eighteen patients (7.53%) had reactive HCV antibodies. Four patients (1.67%) had chronic HCV infection as they had detectable HCV RNA. The remaining 14 patients (5.86%) cleared HCV either spontaneously (seven patients, 2.93%) or by medications (seven patients, 2.93%). HIV screening tests were negative in all 239 patients (100%). HBsAg-positive patients did not have any statistically significant differences from HBsAg-negative patients. On the other hand, the patients who were positive for HCV antibodies were older than the patients who were negative for HCV antibodies (60.66 vs 52.05 years on average, p-value <0.05). They also contained a statistically larger proportion of non-Saudi patients than the patients with no evidence of prior infections (61.11% vs 32.13%, p-value <0.05). Conclusions The study found that the prevalence of HBV and HCV infections among hemodialysis patients in KKC at 3.77% and 1.67%, respectively, is higher than that reported in the general populationin Saudi Arabia, with non-Saudis having a higher prevalence rate of HCV infection than Saudis.However, the current prevalence rate is lower compared to the previous studies that were conducted in Saudi Arabia in the first decade of the 21st century, and there were no cases of HIV infections. Nevertheless, a significant proportion of patients had unprotective or negative anti-HBs antibody titers, indicating the need for strict vaccination protocols and monitoring of antibody titers to ensure optimal protection.

Risk factors associated with Salmonella in dairy cattle farms in Henan and Hubei provinces, China

A cross-sectional study was conducted to evaluate the risk factors associated with the Salmonella infection status of dairy herds in Henan and Hubei provinces, China. Herds were assigned a Salmonella status based on the isolation of Salmonella from fecal samples obtained from adult lactating dairy cows. Information on potential biosecurity risk factors was collected using a questionnaire template via a 15-min face-to-face interview with dairy cattle producers from May 2020 to March 2021. The questionnaire consisted of 23 questions across two broad categories of potential biosecurity risk factors: farm and biosecurity managemental factors. A total of 48 farms were surveyed. In all (100%, 48/48) of the surveyed farms, although sick animals were separated from healthy animals using fencing, there were no strict quarantine protocols for newly introduced animals. Mixed species rearing was practiced in 35.4% (17/48) of the farms. Feces were removed more than once a day in 45.8% (22/48) of the farms, whereas the remainder (54.2%, 26/48) only removed animal feces once a day. A total of 29.2% (14/48) of the farms were located < 2 km from other livestock farms. The use of personal protective equipment was consistently performed on all farms, with a majority of the workers on most farms (81.3%, 39/48) always disinfecting footwear before entering production areas. A significant association between Salmonella-positive status and the high frequency of the presence of wildlife (birds and rodents in sheds and feed storage places) was recorded (OR: 11.9, 95% CI: 1.7, 84.1, p = 0.013). Fortunately, no farms shared farm equipment with other farms. The study highlights the occurrence of wildlife as a risk factor for the presence of Salmonella in investigated dairy herds. There is a need to institute appropriate on-farm control measures for wild birds and rodents to control the potential spread of Salmonella in dairy production systems.

Use of Tranexamic Acid With Resuscitative Endovascular Balloon Occlusion of the Aorta is Associated With Higher Distal Embolism Rates: Results From the American Association of Surgery for Trauma Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery Trial.

Tranexamic acid (TXA) use has been associated with thrombotic complications. We aim to investigate outcomes associated with TXA use in the setting of high- (HP) and low-profile (LP) introducer sheaths for resuscitative endovascular balloon occlusion of the aorta (REBOA). The Aortic Occlusion and Resuscitation for Trauma and Acute Care Surgery (AORTA) database was queried for patients who underwent REBOA using a low-profile 7 French (LP) or high-profile, 11-14 French (HP) introducer sheaths between 2013 and 2022. Demographics, physiology, and outcomes were examined for patients who survived beyond the index operation. 574 patients underwent REBOA (503 LP, 71 HP); 77% were male, mean age was 44 ± 19 and mean injury severity score (ISS) was 35 ± 16. 212 patients received TXA (181 [36%] LP, 31 [43.7%] HP). There were no significant differences in admission vital signs, GCS, age, ISS, SBP at AO, CPR at AO, and duration of AO among LP and HP patients. Overall, mortality was significantly higher in the HP (67.6%) vs the LP group (54.9%; P = .043). Distal embolism was significantly higher in the HP group (20.4%) vs the LP group (3.9%; P < .001). Logistic regression demonstrated that TXA use was associated with a higher rate of distal embolism in both groups (OR = 2.92; P = .021). 2 LP patients (one who received TXA) required an amputation. Patients who undergo REBOA are profoundly injured and physiologically devastated. Tranexamic acid was associated with a higher rate of distal embolism in those who received REBOA, regardless of access sheath size. For patients receiving TXA, REBOA placement should be accompanied by strict protocols for immediate diagnosis and treatment of thrombotic complications.

Dichoptic Vision Therapy in Adults with Anisometropic Amblyopia: A Systematic Review

Introduction: Amblyopia is a condition with reduced best corrected visual acuity in absence of any ocular pathology. Different treatment approaches of amblyopia have been researched for decades. Recent studies on binocular dichoptic therapy using different software and video game based training showed drastic improvement in visual functions in amblyopic adults. Aim of this review is to assess the effect of vision therapy with dichoptic training in adults with anisometropic amblyopes. Method: Review was conducted in articles published within last 25 years from databases like PubMed, research gate, google scholar. Results: Dichoptic therapy has promising results in treatment of adults with anisometropic amblyopia. However, several limitations of these said researches were observed. Conclusion: Further studies particularly RCTs with strict methodology and treatment protocol, larger sample size and longer follow ups are recommended before clinicians could impart dichoptic therapy as a management option of adults with amblyopia into their evidence based practice.

Pemberdayaan Santri PPTQ Abi Ummi Boyolali dalam Mencegah dan Menanggulangi Penyebaran Covid-19

The pandemic has caused a change in the form of activities from direct activities to online activities. On the other hand, educational institutions are allowed to hold learning and teaching activities but with strict health conditions and protocols. One of the educational institutions that carry out the learning and teaching process is the Tahfidzul Qur'an Islamic Boarding School (PPTQ) Abi Ummi Boyolali. Even though they are required to implement strict health protocols, there are still some students who do not implement them. The purpose of this service is to increase the awareness of the students in implementing health protocols. Data collected by interview and observation. The result of this dedication is an increase in the understanding and awareness of the students in implementing health protocols, such as wearing masks, washing hands, and maintaining distance.

Anatomy Practice during COVID-19 Pandemic

Background: Anatomy learning required practice to understanding and comprehend. Anatomical practice used aids such as cadaver. Cadaver was a corpse preserved for anatomy learning. Practice using cadavers was a way of studying the human body with very real details and experiences and must be done offline. The Coronavirus Disease 2019 (COVID-19) pandemic had limited lives, learning, and practice due to the risk of transmission. The interest in understanding some material offline must be facilitated with a supportive environment by medical institutions.Objective: This study will provide recommendation in implementing safe anatomy practice during COVID-19 pandemic.Methods: This article used literature review of anatomical practice and health protocols from books, journals, and guides from home and abroadResults: offline anatomy practice using cadaver should be implemented to help student understand human body more specific and more detail.Conclusion: Health protocol should and can be implemented in offline anatomy practice during COVID-19 pandemic. Anatomy practice can be performed during pandemic using strict health protocols.