Introduction: Currently, the Doctor-Patient relationship of all cultures and societies is in crisis due to the distrust that has arisen in this social contract. This distrust origins from various changes that have occurred worldwide. We, as doctors, can contribute to solving this crisis, reaffirming the values that integrate medical professionalism. In the absence of specific studies and programmes on medical professionalism in Spanish universities, we consider knowing the perception of medical professionalism by medical students at the University of Murcia essential to see if there is a need to introduce educational improvements in our faculty.
Methods: A professionalism questionnaire from the Penn State University School of Medicine (PSCOM) was provided online, voluntarily and anonymously to all students of the Medicine degree of the University of Murcia.
Results: The perception of professionalism in students was high, since all categories have more than 75% positive responses on average. The categories of Respect and Altruism were the best rated. On the other hand, there is a slight increase in negative responses as students progress through the degree. Between sexes, however, there were no differences in the criteria.
Conclusions: Although the perception of professionalism is good, it is still a perception, so it should reach values closer to 100%. Therefore, the faculty is encouraged to carry out specific programmes to promote medical professionalism in the degree courses.
I reported a case of a seventy-five-year-old woman with a backache and pain in left femur. Magnetic resonance imaging (MRI) of back, pelvis and hips showed bone marrow lesion suggesting bone metastasis. The patient was admitted to nuclear medicine department of Krasnoyarsk Regional Clinical Oncology Center. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) of the skeletal system together with several laboratory tests (alkaline phosphatase, calcium, phosphorus), provided grounds for the diagnosis of Paget’s disease. The patient was qualified for treatment to the Rheumatologist.
Background: pulmonary edema results from the shift of excessive fluid into the alveoli space and can be clinically classified into cardiogenic or non-cardiogenic by pathophysiology. This study aimed to elucidate the mechanism, outcomes, and prevention of poisoning induced non-cardiogenic pulmonary edema (PINCPE).
Materials and methods: we conducted a study on etiology, epidemiology, mechanism, risk, and length of hospital stay in PINCPE. A PubMed search using terms: poisoning and non-cardiogenic pulmonary edema. From 1986 to 2017, a total of 15 articles with 16 cases (2 cases in one article) were included. Cut-off value of mean age was used for classification of subjects into younger group and older group, and length of stay (LOS) was compared between the two groups.
Results: the age range of the patients was 7 to 72 years, and the average age (mean ± SD [standard deviation]) was 35.7±19.5 years. Among the reported substances in PINCPE, calcium channel blockers (CCBs) were most frequently used (n=8; 50%). In electrocardiogram (ECG), sinus tachycardia (n=8; 50%) was the most common finding. The overall rate of intubation with mechanical ventilator support was 81.3%. The mortality rate was 12.5%. Among patients with PINCPE, LOS was significantly shorter in the younger group aged <35.7 years than in the older group (5.7 vs. 8.9; p=.022).
Conclusion: CCB was the most common etiologic agent in PINCPE. Up to 81.3% of PINCPE cases required intubation with ventilator support due to respiratory failure. LOS may increase 3.2 days if the case is complicated with extra-pulmonary organ failure.
Introduction: Peer learning is an important component of the postgraduate medical curriculum, and it is considered as an integral part of learning in some countries. The practice of peer learning among postgraduate trainees, especially the resident doctors, is an area that has not been explored in Nigeria and other third world countries. This study aims to examine the practice, perception, and drivers of peer-to-peer training in Nigeria.
Methodology: This study was a national multi-centre and multi-disciplinary cross-sectional survey, conducted among resident doctors in Nigeria. Semi-structured questionnaires were used to obtain respondents’ biodata, perception and practice on peer learning. Data were analysed using SPSS version 23 software. Results were presented as frequency table and proportion, means, and standard deviation. Inferential statistics such as bivariate analysis was performed.
Results: Majority, 287 (73.2%), considered the peer education programme as an appropriate learning practice, 173 (45.9%) considered peer education programme integrated part of the training, while 350/383 (88.2%) engaged in a peer education programme. Statistically, a significant association was found between those who considered peer training as appropriate (p = 0.038) and those who considered peer education as an integral part of postgraduate medical training curriculum (p =0.009).
Conclusion: Peer learning is popular among resident doctors in Nigeria. Concerted efforts are needed to re-structure the residency training curriculum in order to maximize the benefits of this learning approach for an effective training programme.
Permanent pacemaker (PPM) implantation can lead to thromboembolic events at different times after the procedure. According to literature, 1.7% of patients with pulmonary embolism have an implantable cardiac device. This frequency is higher than reported so far, from 0.16 to 0.47% of the total population.
The pathophysiologic mechanism of pulmonary embolism in chronic thromboembolic pulmonary hypertension (CTEPH) is multifactorial. Recently, there is evidence that not only the organisation of thrombotic deposits in the proximal pulmonary arterial vessels is important, but also the development of small vessel disease, which plays an important role in the evolution and progression of the disease. The role of thrombosis in medical devices in contact with blood flow, such as stents, vascular grafts, heart valves, has been well studied and documented in scientific literature on biomaterials. It is clear that implantable cardiac devices such as pacemakers, similarly to other foreign surfaces exposed to blood flow, promote blood clotting and complement activation. Numerous studies to date have addressed the potential risk of distal vascular involvement of pulmonary circulation in the presence of a pacemaker, but none has conclusively proven this hypothesis.
Over the last decade, there has been significant progress in the therapeutic potential of CTEPH. Pulmonary endarterectomy remains the only therapeutic method that can lead to lasting clinical improvement in these patients while achieving a good quality of life. This method is operational, with high financial value and is associated with the presence of a highly specialised team of specialists. This justifies the search for ways to prevent the onset of the disease rather than treat the consequences.
The connection between venous thrombotic events in patients with implanted pacemakers and changes in coagulation factors has been the basis of numerous scientific studies for years. Results show that the effect on the coagulation system is a long-term and dynamic process, as well as presence of a significant dependence with many concomitant cardiovascular diseases.
Advances in medicine in recent decades and increase in life expectancy of patients with implanted cardiac devices (ICD) increase the risk of a variety of complications. These adverse events may be associated with development of thrombosis, change in the stimulation threshold, need for ablation due to concomitant rhythm pathology and others. Analysis of data from literature shows unequivocally that placement of endocardial electrodes leads to activation of the coagulation system in the body. On the one hand, this is a result of the direct traumatic moment and endothelial damage in the early post-procedure period, and subsequently, the presence of electrodes of the foreign body type in some individuals can provoke a procoagulation state.
More in-depth research is needed in this area to clarify the answers to these questions, namely: in which phase of the coagulation cascade are the changes most significant; is there a way to anticipate these changes and prevent them accordingly; is disturbed homeostasis of coagulation temporary or persistent.
These questions will be answered after sufficient data have been accumulated on these changes and how to modulate them.
The novel coronavirus SARS-CoV-2 has caused a global health threat. This review summarizes comprehensive research findings about the SARS-CoV-2 persistence in inanimate surfaces and opportunities for applying biocides to limit spread of COVID-19. SARS-CoV2 is highly stable at 4°C but sensitive to heat and extremely stable in a wide range of pH values at room temperature. Coronaviruses also well survive in suspension. Desiccation has a more severe effect. SARS-CoV-2 can survive in the air for hours and on surfaces for days. Hospitals are significant epicenters for the human-to-human transmission of the SARS-CoV-2 for healthcare workers. The most contaminated SARS-CoV-2 zones and objects in isolation wards, in intensive care unit specialized for novel coronavirus pneumonia, are under discussion. SARS-CoV2 is sensitive to standard disinfection methods. Studies revealed that 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite inactivated SARS-CoV2 in 1 minute exposition; while 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate were less effective. Both ethanol and isopropanol were able to reduce viral titers after 30-seconds exposure. It was found for reusing personal protective equipment vaporized hydrogen peroxide treatment exhibits the best combination of rapid inactivation of SARS-CoV-2 and preservation of N95 respirator integrity under the experimental conditions. Overall, SARS-CoV-2 can be highly stable in a favourable environment, but it is also susceptible to standard disinfection methods. Environmental infection control of the air and especially for surfaces is considered as a mandatory step in addition to limiting person-to-person contact.
Background. Conflicts across professional workgroup and hierarchies inundate the clinical workplace. Early Career Doctors (ECDs) are also affected either as victims or as a provocateur/perpetrator. The effects of conflict at their workplaces have both significant positive and negative dimensions and impacts on ECDs. Little has been reported about conflict among ECDs in Nigeria.
Thus, this study explored the issue of conflict and conflict resolution among ECDs in Nigeria, in a bid to elicit information on the causes, consequences, perpetrators and victims.
Method. This was a qualitative study, using Focus Group Discussions (FGD) to explore information on conflict and conflict management among purposively selected key respondents (n = 14) from seven tertiary hospitals in Nigeria. The respondents are ECDs who were leaders and representatives of other ECDs in their various hospitals. Two FGDs were conducted.
Results. The result showed that conflict is inescapable in clinical settings and occurred at different levels. The perpetrators are varieties of health workers, and most are task-related conflicts, although there are relational ones. The conflicts with the government on labour-related issues are also frequent. The lack of job description and specification and power struggle among others were highlighted as the drivers of conflicts between ECDs and other health-workers. Conclusion. The findings of the study were discussed, and suggestions were made to reduce its effect, which would require structural solutions to mitigate at different levels and the diverse players in the health sectors.
Pathological aggregation and accumulation of α-synuclein in neurons play a core role in Parkinson’s disease (PD) while its overexpression is a common PD model. Autophagy-lysosomal pathways are general intraneural mechanisms of protein clearance. Earlier a suppressed autophagy in the brain of young transgenic mice overexpressing the А53Т-mutant human α-synuclein (mut(PD)) was revealed. Previous studies have recognized that Cystatin C displays protective activity against neurodegeneration. This cysteine protease inhibitor attracts particular attention as a potential target for PD treatment related to autophagy modulation. Here we evaluated the mRNA levels of Cst3 encoding Cystatin C in different brain structures of 5 m.o. mut(PD) mice at standard conditions and after the chronic treatment with a neuroprotective agent, ceftriaxone (100 mg/kg, 36 days). The inflammatory markers, namely, microglial activation by IBA1 expression and mRNA levels of two chitinases genes (Chit1, Chia1), were also assessed but no significant difference was found between control and transgenic mice. Cst3 mRNA levels were significantly reduced in the striatum and amygdala in the transgenic PD model. Furthermore, this was associated with autophagy decline and might be added to early signs of synucleinopathy development. We first demonstrated the modulation of mRNA levels of Cst3 and autophagy marker Becn1 in the brain by ceftriaxone treatment. Taken together, the results support the potential of autophagy modulation through Cystatin C at early stages of PD-like pathology.