Miguel A. Fernández-Villacañas, Matilde Moreno-Cascales, Sergio Alemán-Belando, Manuel Matías-Sánchez, Diego Flores-Funes, Carmen Botella and Joaquín García-Estañ
Introduction: The present study analyzes the evaluation of communication skills by standardized patients (SPs) and medical evaluators (Es) in an OSCE setting.
Methods: The OSCE involved 189 sixth-year medical students, as well as 34 SPs and 63 Es. Communications skills were evaluated in 8 stations, simultaneously by SPs and Es. The SPs were actors who had been trained in the clinical case and who acted in accordance with a standardized script in a simulated clinical situation. The evaluators, also standardized, were Resident Doctors or staff Doctors from the Hospital Services involved.
Results: The global scores awarded to students for communication skills were very similar in both groups, although the score awarded by Es was significantly higher, and a direct relationship was also observed between the mean scores awarded by both groups. Evaluators awarded significantly higher scores than SPs in 7 out of the 10 items on the checklist. Female medical students also scored significantly higher than their male counterparts in many items, including external appearance, listening, cordiality, optimism, interest, expression and empathy.
Discussion: Our data indicate that SPs and Es evaluated communication skills in a similar manner in an OSCE setting, a finding which suggests that health-related professionals can be used as an alternative to SPs, thus helping to lower economic costs. Our study also confirms a gender difference (in favor of women) in the evaluation of communications skills by both groups.
Bilgin Emre, Vincenten Cornelis, Kati Yusuf Alper, Kose Ozkan and Kalenderer Onder
Bilateral extensor tendon ruptures of the knee are not uncommon. However, simultaneous ruptures of the patellar tendon (PT) and contralateral quadriceps tendon (QT) are relatively rare injuries. These ruptures are frequently associated with chronic renal failure and minor trauma. However, they can occur spontaneously in healthy individuals. In this case report, a 43-year-old male with chronic renal failure who sustained bilateral extensor tendon ruptures (right knee: QT rupture, left knee: PT rupture) following an alternating current electrical shock was reported. To our knowledge, simultaneous quadriceps and contralateral patellar tendon rupture following an electric shock have not been reported yet. Etiology, mechanism of injury and treatment options of this rare injury are discussed together with a thorough literature review.
Cornelia Nitipir, Cristina Orlov-Slavu and Lucian Alecu
The second most frequent malignant tumor of the bone after osteosarcoma, chondrosarcoma is subdivided in conventional type, mesenchymal, clear cell, and the dedifferentiated subtype. Each of these pathological entities has a particular clinical behavior. For most, surgery remains the sole valid option. However, efficient systemic therapy options for advanced and metastatic cases are scarce. This short review is aimed at describing the latest options presented by current literature in these cases. Most of the data is derived from preclinical trials, but some drugs were also included in clinical research as far as phase two trials. After reviewing this data, it could be concluded that the future in unresectable or metastatic chondrosarcoma is personalized medicine and that more specific biomarkers to aid the choice are necessary.
Tropenol ester is a highly toxic anticholinergic substance and an intermediate used in industrial production of the bronchodilator tiotropium bromide. The aim of this study was to systematically test workers involved in its production for tropenol ester in urine to identify any exposure pathways and define additional preventive measures. Twelve workers performing tasks involving potential exposure to tropenol ester were repeatedly monitored at the end of each production cycle. Medical exams revealed no symptoms of acute poisoning with tropenol ester, but biological monitoring of urine showed 36 positive findings in 79 samples, with tropenol ester concentrations ranging between the detection limit of 54 pg/mL and 2160 pg/mL. We managed to establish the cause of only one positive finding, which was a hole in a protective glove, whereas the rest most likely occurred due to human error. Because of this, the plant decided to modify the production process by replacing tropenol ester with a safer intermediate. While it is the safest course of action, there where it cannot be taken, biological monitoring can be very helpful in raising awareness about exposure to toxic substances, including the new ones that have not been studied for their adverse potential.
Aleksandar Dodovski, Zagorka Popova and Vladimir Savić
Avian avulavirus type 1 (AAvV-1) belongs to the family Paramyxoviridae, genus Avulavirus. Even though belonging to a single serotype, there is great genetic variability between these viruses. On the basis of the available complete fusion (F) gene and whole genome sequences and using the genotype classification system, AAvV-1 viruses are divided in two major groups: class I and class II. Class I viruses are predominantly avirulent viruses and majority of the isolations come from waterfowl and domestic poultry from live bird markets in USA and China although isolations from wild birds are reported globally. In our study we used classical, molecular and phylogenetic tools to characterize an AAvV-1 isolated from a mute swan in Macedonia. Based on the complete F gene sequence, we have concluded that the virus designated as AAvV-1/mute swan/Macedonia/546/2012 (KP123431) belongs to the class I of AAvV-1 with an avirulent cleavage site motif 112ERQER*L117. The virus could not be assigned to any of the four currently existing subgenotypes (1a, 1b, 1c or 1d) of the single genotype 1 of class I viruses. Two distant viruses, isolated from goose in Alaska in 1991 and from goose in Ohio in 1987, shared the highest nucleotide sequence identity of the complete F gene with the isolate in our study: 92.7% and 92.8%, respectively. This is the first report of isolation of class I AAvV-1 in Southeastern Europe. The asymptomatic nature and the underreporting of sequences from the class I viruses impede the understanding of the molecular epidemiology and evolution of this group of viruses.
Effat Hatefnia, Kobra Alizadeh and Mostafa Ghorbani
Hypertension is the leading preventable cause of premature deaths worldwide. Physical activity reduces the levels of blood lipids and blood pressure in people suffering from hypertension.
To apply the theory of planned behavior (TPB) to determine factors associated with physical activity by women with hypertension who were referred to health care centers in Kiashahr in 2016.
The present observational study was conducted in a cross-section of 215 women diagnosed with hypertension who had records in health care centers in Kiashahr and who were recruited through census from August to September 2016. The data collection tool was a custom-designed questionnaire based on the TPB, and the collected data were analyzed using descriptive and analytical statistical methods.
The mean scores of knowledge, attitudes, subjective norms, perceived behavioral control, and intention to undertake physical activity were significantly (P < 0.01) higher among women who performed regular physical activity than in those without regular physical activity. Constructs including behavioral intention (P < 0.001, odds ratio (OR) 1.36, 95% confidence interval (CI) 1.15, 1.61) and attitude (P = 0.004, OR 1.27, 95% CI 1.08, 1.50) were significant predictors for undertaking physical activities.
Attitude and behavioral intention were predictors for undertaking physical activities. We recommended the design of interventional programs based on these 2 factors for women with hypertension living in rural areas of Iran.
Jarmmaree Sornboot, Wichai Aekplakorn, Pongrama Ramasoota, Surat Bualert, Somying Tumwasorn and Wiroj Jiamjarasrangsi
Long-term surveillance of airborne bioaerosols in health care facilities is required to protect the health of patients and health care workers. Feasible methods to measure airborne bioaerosol concentrations and determine associated environmental factors may help to avoid nosocomial tuberculosis (TB).
To describe the concentrations and size of airborne bioaerosols and to identify the potential contributors to indoor airborne bioaerosols in TB high-risk areas in health care facilities.
We conducted a cross-sectional study in 7 large health care facilities located in Bangkok and nearby in central Thailand using a 6-stage Andersen cascade impactor to collect viable airborne bioaerosols that were quantified using culture techniques. Environmental parameters were determined using a tracer gas technique with an indoor air quality meter. Other potential factors were assessed using a questionnaire.
The mean indoor airborne bacterial and fungal concentrations were 596.1 and 521.2 colony-forming units (cfu)/m3, respectively, and the mean outdoor airborne bacterial and fungal concentrations were 496.5 and 650.1 cfu/m3, respectively. The majority of airborne bioaerosols were in respirable sizes. The indoor-to-outdoor ratios were 1.2 for bacteria and 0.8 for fungi. Air change rate was inversely correlated with indoor airborne bioaerosol concentrations, whereas emergency department central-type air conditioners and relative humidity were positively correlated with the indoor airborne bioaerosol concentrations (P < 0.05).
High indoor bioaerosol concentrations found in the health care facilities suggest that it is imperative to improve the indoor air quality. Improved air change rate and avoiding use of central-type air-conditioning systems may reduce bioaerosol concentrations.
Cirrhotic patients are susceptible to drug toxicity, which presents frequently with antituberculosis drug (ATD) treatment. Previous studies of ATD-induced liver injury (ATDILI) in cirrhotics have been limited to patients with early-stage cirrhosis.
To describe characteristics and determine risk factors for ATDILI in cirrhotic patients.
We included 64 cirrhotic patients treated with ATDs between 2006 and 2016 in a tertiary referral university teaching hospital in Bangkok, Thailand. Cirrhosis was diagnosed by radiological features, including small-sized nodular liver and/or caudate lobe hypertrophy or evidence of portal hypertension (collateral vessels, varices, and/or splenomegaly). Clinical information was retrospectively abstracted. Characteristics of patients with ATDILI vs. those without ATDILI were compared.
Six (9.4%) patients developed ATDILI with the median duration from ATD initiation of 14 days (range: 6–66). All the 6 patients who developed ATDILI received 3 hepatotoxic ATDs (isoniazid, rifampin, and pyrazinamide) and had Child–Turcotte–Pugh class B cirrhosis. The patients with ATDILI were found to have a higher percentage of human immunodeficiency virus (HIV) infection than patients without ATDILI (50% vs. 8.6%; P = 0.02).
Cirrhotic patients, particularly those with underlying HIV infection, are at risk of developing ATDILI. Pyrazinamide should be used cautiously in cirrhotic patients due to the significantly increased risk of ATIDLI. This study supports the current recommendation for the use of ATD in patients with cirrhosis; however, the ATD regimen should be carefully selected, particularly for cirrhotic patients with HIV infection.