Usual Protocol Research Articles

Utility of telephone text messages in secondary prevention after acute coronary syndrome

Abstract Introduction The recurrence of events in patients after an acute coronary syndrome (ACS) represents a great challenge for the health systems due to its high prevalence, morbidity and mortality, and cost. For this reason, secondary prevention measures with low cost and easy to implement are necessary. The objective is to evaluate the usefulness of telephone text messages (TTM) in the control of risk factors and reduction of events in the first year after an ACS. Methods Single-blind 1:1 randomized clinical trial in consecutive patients discharged with ACS between May 2019 and October 2021 in our center. The intervention group received a monthly TTM for 12 months with the recommendations of the Spanish Society of Cardiology regarding secondary prevention measures. Both groups followed the usual review protocol of our center in a specific ischemic heart disease consultation at 3 and 12 months after discharge. The center lacks cardiac rehabilitation. The objectives of the study at 12 months were: total and cardiovascular death, myocardial infarction, stroke, weight, blood pressure, LDL, HDL, triglycerides, glycosylated hemoglobin, smoking habit, and hours of exercise per week. The evaluator in charge of collecting data after the end of the year was unaware of the assignment group. Results N= 370. The patient profile was the usual one for ACS, with a mean age of around 65 years and 25% diabetic, with no differences in any of the baseline characteristics between both groups. An invasive approach was performed in almost all of the subjects, with percutaneous intervention in three-quarters of the cases and also without significant differences in the type of treatment, percentage of multivessel disease, and left main disease between both groups. Only a lower number of stents per patient was recorded in the control group. There were also no differences in medical treatment between both groups. The results are shown in the table. Conclusions In our study, monthly TTM had no influence on the control of risk factors or clinical events during the first year of follow-up after an ACS, and therefore it is not cost-effective to allocate resources for this purpose.

Implementation of an early attention strategy to reduce emergency room overcrowding in an academic institution in Colombia, a pilot study

Overcrowding is a worldwide problem, and long waiting times are associated with increased morbidity and even mortality of patients regardless of triage classification. Although there are many tools published in the literature that contribute to the reduction of overcrowding, for the Colombian population there are not many tools evaluated to reduce the length of stay of patients in the emergency department. This is a retrospective analytical study that compared whether there was a difference in patient definition time and ED length of stay between a group attended under an early care protocol (PAT) versus the usual protocol. Of the total of 969 patients included it was found that the group attended under the PAT protocol had a shorter definition time than the usual protocol, also the Emergency department length of stay (EDLOS) was significantly lower in the PAT group compared to the usual protocol. The implementation of the PAT protocol performed by emergency physicians allows a faster contact with the patient by the physician, and leads to a significant reduction of EDLOS, contributing to the reduction of overcrowding in the emergency department.

Effectiveness of Home-Based Cardiac Rehabilitation with Optimized Exercise Prescriptions Using a Mobile Healthcare App in Patients with Acute Myocardial Infarction: A Randomized Controlled Trial.

Despite the effectiveness of cardiac rehabilitation (CR), the actual participation rate in CR is low. While home-based CR offers a viable alternative, it faces challenges in participation due to factors such as a lack of self-motivation and fear of exercising without supervision. Utilizing a mobile healthcare application (app) during counseling may be an effective strategy for patients. Therefore, the aim of this study was to assess whether 6 weeks of home-based CR with exercise readjustment using a mobile app is an effective therapy for patients with acute myocardial infarction (AMI). Post-AMI patients eligible for home-based CR were randomized into the intervention group (CR-Mobile) and the control group, which followed the usual home-based CR protocol (CR-Usual). Both groups participated in a 6-week home-based CR program, with exercise readjustment and encouragement carried out every 2 weeks. The CR-Mobile group was supervised using data recorded in the mobile app, while the CR-Usual group was supervised via phone consultations. The primary outcome measured was maximal oxygen consumption (VO2max). Within-group comparisons showed significant improvements in VO2max (PCR-Mobile = 0.011 vs. PCR-Usual = 0.020) and METs (PCR-Mobile = 0.011 vs. PCR-Usual = 0.011) for both groups. These findings suggest that a 6-week home-based CR program with exercise readjustment using a mobile app can potentially enhance exercise capacity as effectively as verbal supervision.

P-007 Surgical sperm retrieval rate in men with Klinefelter syndrome is associated with testicular volume - but not with body constitution or Sertoli cell markers

Abstract Study question Do sperm retrieval and pregnancy rates in men with Klinefelter syndrome (KS) depend upon sperm retrieval method, age, testicular volume, body weight, and hormone concentrations? Summary answer Successful sperm retrieval was significantly associated with total testicular volume but not with sperm retrieval method, age, body weight, BMI, FSH, inhibin-B or AMH. What is known already Testicular sperm can be retrieved from approximately 40% of men with KS, resulting in an average pregnancy rate of 16%. The sperm retrieval rate seems to be unrelated to the age of the man and to preoperative FSH-levels. A decrease in testosterone concentration is usually observed 3 months after surgery. Possible negative effects of testosterone substitution therapy prior to surgery and the predictive value of body constitution, testicular volume and the Sertoli cell markers, AMH and inhibin-B, for sperm retrieval success in KS men are only partly known. Study design, size, duration A total of 14 KS patients underwent subcapsular orchiectomy and 34 KS patients underwent m-TESE at Centre of Andrology & Fertility Clinic, Odense University Hospital. Pre-surgery examination included ultrasonography of the testicles, genetic analyses (standard chromosome analysis and screening for Y microdeletions and CFTR variants) and hormone analyses (including FSH, LH, testosterone, estradiol, prolactin, TSH, AMH, inhibin-B). Testosterone, LH, and FSH were also measured 3 months after surgery. Participants/materials, setting, methods Forty-three men had a 47,XXY karyotype, while 5 (2 from the subcapsular group and 3 from the m-TESE group) had a mosaic karyotype including 47,XXY. Subcapsular orchiectomy was performed unilaterally, while m-TESE was usually performed bilaterally. To avoid freezing the sperm retrieved, oocytes from the female partner was aspirated and vitrified after FSH-stimulation according to our usual IVF protocols. Oocytes were thawed on the day of sperm retrieval and embryos transferred in estrogen-progesterone stimulated cycles. Main results and the role of chance Sperm were obtained in 19 (40%) of the 48 men with KS. In 10 couples (21%) pregnancy was obtained and 7 women (15%) gave birth to at least one child resulting in ten children (6 girls and 4 boys), while one pregnancy is still ongoing. In the group who had a subcapsular orchiectomy, 5 (36%) had sperm retrieved, and pregnancy was obtained in 3 (20%) cases. Two gave birth to a child, while the third woman have had several abortions, most likely due to large fibromyomas of the uterus. In the m-TESE group 14 (41%) had sperm retrieved, and pregnancy was obtained in 7 (21%) cases. Five women (15%) gave birth to 8 children, while 1 pregnancy is still ongoing and the seventh experienced an early pregnancy loss. Furthermore, 3 couples have still not embryos transferred. Sperm were found in 3 men (60%) with mosaic karyotype. Sperm retrieval success was significantly associated with testicular volume (mean total testicular volumes of 3.4 mL vs. 2.3 mL; p < 0.01) but not with age, height, body weight, BMI or preoperative FSH, inhibin-B or AMH levels. Testosterone levels measured 3 months after the surgery, did not differ between men irrespective of surgical method. Limitations, reasons for caution The numbers of patients are limited and randomized studies with sufficient power are difficult to perform. AMH and inhibin-B, were only measured in the m-TESE group. Wider implications of the findings In KS patients, sperm retrieval and pregnancy rates were similar irrespective of the sperm retrieval method. Also serum testosterone 3 months postoperatively and cosmetic results experienced by patients were similar. Multicenter studies and larger studies are needed to provide more detailed information of the potential predictors for successful sperm retrieval. Trial registration number Not applicable

Cutibacterium acnes Infection as a Cause of Nonunion After Ulnar-Shortening Osteotomy.

Ulnar-shortening osteotomy is a reliable solution to treat ulnar impaction syndrome, but it has a significant rate of nonunion as a known complication. Generally nonunion after the procedure is attributed to noninfectious causes. When infections happen, they follow the microbiological trends of nonunions elsewhere in the body. We present a case of ulnar-shortening osteotomy using an oblique-cut osteotomy system that resulted in septic nonunion. At the time of revision surgery, Cutibacterium acnes and Staphylococcus hominis were isolated from the osteotomy site. The patient was successfully treated using intravenous antibiotics and the two-stage Masquelet technique and eventually went on to bony union. As C acnes is rarely encountered in this context, this report highlights the need to consider all possible pathogens in the workup of a potentially septic nonunion. Surgeons should consider bacteria such as C acnes that require prolonged incubation for isolation from cultures, which may not be part of many institutions' usual protocol. [Orthopedics. 2024;47(4):e211-e213.].

COVID-19 Modified mRNA “Vaccines”: Lessons Learned from Clinical Trials, Mass Vaccination, and the Bio-Pharmaceutical Complex, Part 1

Our understanding of COVID-19 synthetic, modified mRNA (modmRNA) products and their public health impact has evolved substantially since December 2020. Published reports from the original randomized placebo-controlled trials concluded that the modmRNA injections could greatly reduce COVID-19 symptoms. However, the premature termination of both trials obviated any reliable assessment of potential adverse events due to an insufficient timeframe for proper safety evaluation. Following authorization of the modmRNA products for global distribution, problems with the methods and execution of the trials have emerged. The usual safety testing protocols and toxicology requirements were bypassed. Many key trial findings were either misreported or omitted entirely from published trial reports. By implication, the secondary estimates of excess morbidity and mortality in both trials must be deemed underestimates. Rigorous re-analyses of trial data and post-marketing surveillance studies indicate a substantial degree of modmRNA-related harms than was initially reported. Confidential Pfizer documents had revealed 1.6 million adverse events by August 2022. A third were serious injuries to cardiovascular, neurological, thrombotic, immunological, and reproductive systems, along with an alarming increase in cancers. Moreover, well-designed studies have shown that repeated modmRNA injections cause immune dysfunction, thereby potentially contributing to heightened susceptibility to SARS-CoV-2 infections and increased risks of COVID-19. This paper also discusses the insidious influence of the Bio-Pharmaceutical Complex, a closely coordinated collaboration between public health organizations, pharmaceutical companies, and regulatory agencies. We recommend a global moratorium on the modmRNA products until proper safety and toxicological studies are conducted.

Long-term follow-up of pulmonary vein cryoballoon isolation using a double 120s vs single 240s standard freeze protocol

Abstract Background Recently, pulmonary vein isolation (PVI) using a double 120s freeze protocol has demonstrated to be non-inferior to a single 240s protocol despite a potentially increased procedural safety. Main advantages of a double 120s protocol are a reduction of phrenic nerve injury and an increase of the mean minimal esophageal temperature during the procedure. Methods We performed a long-term follow-up comparison between groups of patients with history of symptomatic atrial fibrillation undergoing PVI with second generation cryoballoon (CB) between 2019 and 2020. Our usual energy dosing protocol was modified including 2 times 120 seconds applications instead of a single 240 seconds application. Of A total of 160 consecutive patients, 80 were treated with double 120s (CB120) and 80 with single 240s (CB240) freeze protocol. 107 patients were, successfully, followed-up. The primary end-point was freedom from atrial tachyarrhythmia. Results Before PVI a total of 11/52 patients (21%) had persistent AF and 41/52 (79%) had paroxysmal AF in the CB120 group; a total of 20/55 patients (36%) had persistent AF and 35/55 (64%) had paroxysmal AF in the CB240 group. On a mean follow-up time of 17 months, freedom from atrial tachyarrhythmia was 63% in those patients undergoing CB240 and 74% with CB120 (log-rank P=0.255). Conclusions The double 120s freeze protocol is not-inferior as compared to the standard 240s in terms of freedom from recurrences on a long term follow-up, but with a more favorable procedural safety profile.

Micronutrients supplementation and the outcome in preterm neonates in a tertiary health centre

Approximately 15 mil[1]lion babies are born preterm each year.1 Preterm infants commonly experience postnatal growth failure due to insufficient intake of micro[1]nutrients. We aim to determine the outcome of preterm neonates that received micronutrients. Methods: The study subjects com[1]prised of 210 preterm neonates admitted to (SCBU) of Federal Medical Centre, Brinin kebbi, Kebbi State from 1st June 2020 to 30st May, 2022. The subjects were randomized into two groups; 100 preterm neonates (Study group) received micronutrients (Reload; Reload Brands, LLC, Salt Lake City, Utah, USA) while, 110 preterm neonates (Control group) did not receive micronutrients. Biodata and other important information were obtained. All the babies (210) received the usual treatment protocol of preterm admitted to our SCBU. Ethical ap[1]proval was obtained from the Research and Ethics Committee. Results: Birth weights of the 210 neonates ranged from 800grams to the highest 2500grams with mean CC –BY 4.0 birth weight of 1.54kg ±0.95. Av[1]erage daily weight gains in 71% of the study subjects ranged from 25grams to a maximum of 29 grams per day while, in the non- micronutrients group, 54% had daily weight gain range of 10- 14grams per day (p = 0.001). Twelve (12%) of the Micronutrient group (MG) and 30% 0f the Non-Micronutrient group (NMG) had need for blood transfusion respectively (p = 0.002). The average ho sp ital stay wa s 22.95±9.68; hospital stay for the MG was 8 to 21 days while that of the NMG was 22 to 42 days (p = 0.001). C o n c l u s i o n s : M i c r o n u t r i - ents intake were in consistent with optimal weight gain, shorter hospital stay and lower need for blood transfusion in preterm newborns. Recommendations: We recommend early commencement of mi c r o n u t r i e n t s u p p leme n t (Reloads) in preterm babies.

Women with Gaucher Disease.

Gaucher disease is an inherited disorder in which there is a deficiency of the enzyme glucocerebrosidase, which leads to the accumulation of glucosylceramide. Although much scientific evidence is now available, there is still limited data on the impact on the different life stages of women with this disease. Among other alterations, a delay in menarche has been described, although it has not been related to fertility problems. Menorrhagia is relatively frequent, being related to the presence of thrombocytopenia, thrombocytopathies or coagulation disorders. On the other hand, pregnancy planning is an increasingly frequent concern. All patients should undergo genetic counseling, and it is important to monitor the appearance or worsening of organomegaly, bone and hematologic abnormalities to establish clinical and therapeutic recommendations. Management during the puerperium will depend on the evolution of gestation, and, during the lactation period, the potential appearance of bone complications should be assessed. An early onset of menopause, compared to the general population, has also been described, which may accelerate the development of osteopenia. Finally, although the usual screening protocols for neoplasms are currently being performed, it is recommended to watch for early signs of liver or renal neoplasms when examining the results of imaging tests performed during evaluations for this disease.

Prevalence of major embolic findings and incidental findings on early cardiac CT in patients with suspected ischemic stroke

PurposeThe purpose of this study was to assess the type and prevalence of stroke and non-stroke-related findings diagnosed on early cardiac computed tomography (CT) in patients with suspected stroke. The secondary objective was to assess the clinical consequences on the management of patients with non-stroke-related conditions identified by early cardiac CT. Materials and methodsThis single-center, retrospective, observational study included 1111 consecutive patients with suspected ischemic stroke between November 2018 and March 2020 who underwent cardiac CT examination in addition to the usual brain CT protocol (i.e., non-enhanced brain CT, perfusion brain CT when needed, aortic arch and supra-aortic CT angiography, and post contrast brain CT). There were 562 women and 549 men with a median age of 74 years (range: 60–85 years). Of these, 415 (415/1111; 37.4%) patients had ischemic stroke and 692 (692/1111; 62.3%) had no stroke. Cardiac CT examinations were retrospectively reviewed for cardiac CT findings at high embolic risk and clinically significant extracardiac incidental findings. ResultsAmong 1111 included patients, 89 (89/1111; 8.0%) had a stroke-related condition identified on early cardiac CT. This was significantly more frequent in patients with ischemic stroke (66/415; 15.9%) by comparison with those without ischemic stroke (23/696; 3.3%) (P < 0.001), with 41 patients (41/415; 9.9%) diagnosed with left atrial thrombus. Cardiac CT revealed a clinically significant non-stroke-related finding in 173 patients (173/1111; 15.6%), including 17 pulmonary embolisms (1.5%), seven suspicious pulmonary lesions (0.6%), and three breast lesions suspected to be malignant (0.3%). Twenty out of 173 patients (20/173; 11.5%) with incidental findings on early cardiac CT had a change in their management. ConclusionThis study shows that adding early cardiac CT to brain CT during the acute phase of an ischemic stroke leads to a higher rate of etiological diagnoses and highlights the major interest of looking at the bigger picture.

Feasibility and preliminary efficacy of metacognitive therapy for health anxiety: A pilot RCT

BackgroundHealth anxiety is a pervasive mental health condition, in which people worry about having or developing a serious illness or disease. Cognitive behavioural therapy (CBT) is currently considered the most researched psychological treatment for health anxiety, although several systematic reviews and meta-analysis have shown mixed findings for its efficacy. More efficacious interventions that can be easily integrated within services are required. An alternative to CBT, that has proven more effective in some other disorders, is metacognitive therapy (MCT). The aim was to evaluate the feasibility of delivering MCT for health anxiety and to collect pilot data on the treatment's preliminary efficacy. MethodTwenty participants with health anxiety were recruited to an open randomized feasibility trial and randomized to MCT or waitlist control. Acceptability and feasibility of MCT was based on recruitment rates, withdrawal, and drop-out, number of MCT sessions attended, completion of questionnaires, and any adverse reactions observed. The study was also used to evaluate initial treatment effects. ResultsMCT was found to be feasible and acceptable for individuals with health anxiety. Recruitment and retention of all participants was high, and no adverse events were observed in either group. Pre to post between group effect sizes on the primary outcome measure The Whiteley Index (Pilowsky, 1967) were large (Hedges’ g = 3.18-Mdiff= 26.2, [95 % CI=18.7–33.6]) in favour of MCT. Clinically significant recovery rates were 80 % at post treatment and follow up. ConclusionThe results suggest that a trial of MCT was acceptable and feasible in individuals with health anxiety and the treatment effects were statistically significant in comparison to the waiting list. Based upon the design used in this study MCT should be compared with active treatments such as medication, treatment as usual or specific cognitive behaviour therapy protocols in a future definitive randomised trial.

Influence of serum ferritin on glycemic control in patients with type 2 diabetes mellitus.

Objective: To determine the influence of serum ferritin levels on glycemic control in patients with type 2 diabetes mellitus (T2DM) patients. Study Design: Cross-sectional study. Setting: Department of Medicine, Liaquat University Hospital, Hyderabad, Pakistan. Period: July 2021 to December 2021. Material &amp; Methods: A total of 180 patients of 30-60 years of age and either gender, and known cases of diabetes mellitus for ≥3 year duration were included. Demographic, clinical and laboratory data was recorded. HbA1c below 7% was labeled as good glycemic control while HbA1c above or equal to 7% was designated as poor glycemic control. The serum ferritin ≥307 μg/L was considered as raised. Association of glycemic control with respect to serum ferritin levels was noted. Results: In a total of 180 patients of T2DM, the mean age, duration of diabetes, and HbA1c were 53.62 ± 5.82 years, 11.91±4.92 years, and 12.41 ± 5.73% respectively. The mean serum ferritin was 512±22.53 ug/L, whereas serum ferritin was raised in 109 (60.5%). The serum ferritin levels were significantly higher in patients with poor glycemic control than those having good glycemic control (56.0% versus 44.0%, p=0.044). Conclusion: In contrast to individuals with good glycemic control, patients with poor glycemic control more frequently had elevated serum ferritin levels, according to the current study. In order to properly manage diabetes patients and prevent the negative effects of elevated serum ferritin levels, serum ferritin should be included in the usual screening protocol of diabetic patients while monitoring their glycemic status.

Experimenting with Pig-based Skin Model for Burns. Testing of Mean Literature Findings.

Introduction: Animal models that closely mimic human burn wound healing processes are essential for developing effective burn wound treatments. Pigs are useful animal models for studying burn wound healing. From their extensive literature review, Andrews and Cuttle (2017) reported mean temperature and exposure time values. This study was done to provide initial burn depth for another experiment comparing two burn wound treatments. The secondary goal was to validate a systematic review on porcine burn model standardization. Material and Methods: Six four-week-old Large White x Landrace gilts were housed in a closed structure for 10 days to acclimatize. The procedures were performed under general anesthesia. A round 2.5 cm copper plate welded to an aluminum rod with a wooden handle caused the injuries. The burning device was used to reach a contact temperature of 110 C on the pig's skin. The objective was to create a superficial partial thickness (SPT) burn for 10 seconds (Group 10s) and a deep partial thickness (DPT) burn for 20 seconds (Group 20s) using a plate heated at 110ºC. No stabilizer or pressure controller was used. Wounds were conclusively dressed and harvested 24 hours later. The usual hematoxylin-eosin protocol was used to cut and stain 4-micron sections. Results: A significant difference (p 0.01) was observed in dermis involvement, with a mean of 85.61 % (95% CI= 80.62 to 90.61) for group 10s and 123.71% (95% CI= 114.91 to 132.50) for group 20s. An exposure time of 20 seconds increased dermis depth-related total collagen denaturation by almost 50% compared to 10 seconds. Conclusions: In conclusion, our experiment produced DPT burns in 10 seconds and FT burns in 20 seconds without a pressure application device.

Modulation of radiant oncological therapy through the intervention with substances of vegetable origin

Introduction: the search for substances that modulate the adverse effects of radiotherapy is key to optimizing the efficacy of these treatments and improving the patient's quality of life. We consider the evaluation of green tea (Camellia Sinensis) opportune for its antioxidant and anti-inflammatory properties, while its composition in polyphenols would make it possible to reduce radiosensitivity and improve cell recovery. Thus, our objective was to assess the efficacy of this infusion in the management of mucositis developed during radiant treatment of patients with head and neck cancer. Materials and Methods: a prospective and controlled clinical trial was carried out on a population of 20 patients, under treatment with intensity modulated radiation (IMRT). The result of the intervention with green tea rinses (4 times/day) or compliance with the usual protocol, was assessed by detailed recording of radiotoxicity, using the RTOG scale. Statistical analysis was performed using the T-Test: Student's t-Mann-Whitney U. Results: all the patients who adhered to and exhaustively complied with the protocol with the infusion, although they did not significantly recover the state of the oral cavity, demonstrated better control of the radio-induced acute effects (xerostomia and mucositis). Conclusion: although our results are preliminary, they allow us to suggest that from the intervention with green tea, the acute radiation-induced effects could be modulated. We believe intervention with this substance is opportune, given its easy administration, availability, cost, and lack of toxicity in a wide range of doses.

Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the aim to reduce the incidence of caries in children at the age of 18 months, an interdisciplinary primary prevention intervention is designed for families with children following the pediatric health program “Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica” (PAPPS). Methodology: non-randomized clinical trial, carried out in two primary care centers in Catalonia from January 2019 to June 2022. In one of the centers, an educational intervention for primary prevention of caries was designed and implemented with advice and skills to the families. In the other center, the usual protocol of recommendations was maintained. The incidence of caries was evaluated and compared in both groups at the age of 18 months with a logistic regression model estimated with the R program. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI 1.8-20.2), despite the fact that the caries risk assessment based on the called “Caries Management by Risk Assessment” (CAMBRA) indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention incorporated into child health programs reduces the incidence of caries in the first years of life.

Abstract 11832: Carotid Sinus Massage Can Obviate the Need for Tilt Table Testing in Patients With Undiagnosed Vasodepressor Syncope

Introduction: Head-up tilt table (HUTT) testing is typically utilized for patients with syncope where the diagnosis is unclear but suspicion of a vasovagal etiology. Carotid sinus massage (CSM) can be used to elicit a vasopressor response though typically used to diagnose carotid sinus hypersensitivity. The usual protocol of HUTT consists of baseline CSM, 30-mins of HUTT, a repeat of CSM, and drug infusion. This is time-consuming and tedious. Hypothesis: CSM has a high predictive value for a vasodepressor response and may prevent the need for the completion of the HUTT protocol. Methods: Consecutive patients with clinical suspicion of vasovagal syncope underwent HUTT. Protocol consisted of baseline CSM in the supine posture, 30-mins of HUTT at 60 degrees, repeat CSM, and infusion of isoproterenol infusion from 1 to 3 mcg/min. Beat-to-beat blood pressure (BP) monitoring was performed non-invasively and standard cuff BP monitoring every minute. Positive tilt was defined as a drop in BP by more than 20 mmHg with reproducible symptoms (correlation to clinical symptoms). Results: 55 consecutive patients with a history of syncopal episode(s) underwent HUTT. 46 were females and 9 were male with a mean age of 54.4 ± 17.4 years old. They presented symptoms suggestive of a vasovagal etiology but were not diagnostic. 12 out of 55 (21.8%) patients had a positive reproducible response with supine CSM. 11 out of 12 of these patients subsequently had a positive result with protocol completion. This provided a positive predictive value (PPV) of 92%. 36 out of 55 (65.5%) patients had a negative response to CSM. All 36 had a negative result on completion of the HUTT protocol. This provided a negative predictive value (NPV) of 100%. 7 out of 55 (12.7%) patients had a “borderline” positive supine CSM. All 7 had a positive result with the completion of the HUTT protocol. Of note, these patients became positive only with isoproterenol infusion. Conclusions: CSM in the supine posture has a high PPV and NPV in eliciting a possible vasodepressor etiology. A full HUTT protocol may be only required in a patient who presents with a “borderline” CSM response in the supine posture. Therefore, CSM may easily be performed at the bedside with a monitor and a BP apparatus obviating the need for the full HUTT protocol.

The Functional Dexterity Test in Adult Populations: An Exploration of a Simplified Test Protocol and Parameters Guided by Statistical Outcomes

The Functional Dexterity Test (FDT) is a standardized assessment used to quantify dexterity, in-hand manipulation, related to function. Recommendations to modify the scoring have been proposed to eliminate penalties, adapt the test protocol, and change the outcome parameter. A new psychometrically sound scoring system has been used in the pediatric population; however, research in the adult population requires exploration. The purpose of this study was to test if alterations in test administration, outcome recording, and outcome parameters show predictive validity for measured outcomes for age, ethnicity, and self-identified gender. The new method of administering the FDT eliminates penalties for improper performance and uses a score of speed derived from the timed score. It was theorized that eliminating assessment of reported errors in quality of movement in the quantitative scoring may improve the test validity. Clinical Measurement. The FDT was administered to 148 healthy adults aged between 18 and 78years. No penalties were included in the quantitative scoring. Age, self-identified gender, ethnicity, and self-reported hand dominance were recorded. Time to complete the test was measured in seconds per usual protocol. The result was recorded as time and calculated as speed. Linear regression was performed to predict FDT speed from age, hand dominance, and self-identified gender. The three predictors (age, hand dominance, and gender) associated with a linear decline in dexterity were significant (p ≤0.02). Dexterity showed a linear decline with age, and participants showed faster speeds with the dominant hand. Gender was a significant predictor of speed, with males having faster speeds by an average of 0.047 pegs per second (p=0.01). Scores using a simplified administration and speed as an outcome showed moderate predictive validity with age, gender, and the dominant hand used in this adult population. Future research exploring relationships with activities of daily living is needed.

Management of Congenital Cervical Teratoma with Application of EXIT Protocol - Case Report

Background: Congenital teratomas are relatively rare neoplasms, which occurs in about 1:20,000 to 1:80,000 births, and only 1.5% to 5% of which are neoplasm of the cervical. They can be diagnosed through ultrasound during pregnancy and, if not properly handled, have a high mortality rate. Airway compression is a secondary complication following mortality. Case report: A solid-cystic mass was identified in the anterior cervical region of a 30-week-old fetus during an ultrasound scan. EXIT (Ex-Utero Intrapartum Treatment)-to-airway procedure was performed by a multidisciplinary team composed of obstetricians, anesthesiologists, neonatologists and pediatric surgeons to remove the neoplasm. The procedure occurred upon delivery of the fetus, resulting in a positive outcome with neonatal survival. In this case, the fetus was in breech position, and, differently from the usual EXIT protocol, it had to be completely extracted before guaranteeing airway flow. Conclusion: Although congenital teratomas are a rare condition with complex treatment, it is possible to achieve a satisfactory outcome when adequate planning and protocol are established.

Feasibility and impact of online HIV/STI screening addressed to men who have sex with men and transgender women users of pre-exposure prophylaxis (PrEP) in Spain (TESTATE PrEP): a study protocol for a non-blinded randomised controlled trial

IntroductionThe objectives of the study are: to design and implement a pilot intervention to offer self-sampling kits to detect HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum (TP)...

Primary prevention with vaginal chlorhexidine before 16 weeks reduces the incidence of preterm birth: results of the Preterm Labor Prevention Using Vaginal Antiseptics study

Preterm labor is one of the leading causes of perinatal death and is currently considered a syndrome with many causes. One of the most important causes of preterm birth is ascending infection from bacterial vaginosis. Chlorhexidine has proven to be effective against bacterial vaginosis and against bacterial biofilms without affecting gestation. We aimed to evaluate the effectiveness of a universal primary prevention strategy for preterm birth using intravaginal chlorhexidine applied before 16 weeks (Preterm Labor Prevention Using Vaginal Antiseptics study). We performed a prospective observational study with 2 cohorts of pregnant women that were assigned either to prevention of preterm birth by means of intravaginal chlorhexidine (Cum Laude Chlorhexidine, chlorhexidine digluconate 0.2%) before 16 weeks (n=413), or to no treatment following the usual hospital protocol (n=704). Primary outcomes were the incidence of spontaneous preterm birth before 34 and 37 weeks; the incidence of preterm birth before 34 and 37 weeks, including inductions for premature rupture of membranes; and the incidence of preterm birth before 34 and 37 weeks, including any indication for termination of pregnancy. Both cohorts were compared using Mann-Whitney and Fisher tests. Finally, a multivariable analysis, including the odds ratio was performed, adjusting for clinical parameters, to evaluate the importance of the different determinants in the prediction of preterm birth. In pregnancies treated with chlorhexidine, the incidences of spontaneous preterm birth; preterm birth, including induction for premature rupture of membranas; and preterm birth, including any indication for termination of pregnancy were at 34 and 37 weeks: 0% and 0%, 0.24% and 1.69, and 2.90% and 3.15%, respectively; whereas in nontreated pregnancies, these incidences were 9% and 11%, 12% and 23%, and 35% and 43%, respectively. According to the multivariable analysis, the incidence of preterm birth among women treated with chlorhexidine before 16 weeks was halved (Odds ratio, 0.52; P<.05). Universal treatment with vaginal chlorhexidine before 16 weeks reduces the incidence of preterm birth, especially before 34 weeks.