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Feasibility study of minimally trained medical students using the Rural Obstetrical Ultrasound Triage Exam(ROUTE)in rural Panama

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World Journal of Emergency Medicine 2018年第3期9卷 216-222页

作者： Annasha Vyas Katherine Moran Joshua Livingston Savannah Gonzales Marlene Torres Ali Duffens Carina Mireles Romo Gnevieve Mazza Briana Livingston Shadi Lahham john christian fox School of Medicine University of California IrvineIrvineCA 92697USA Department of Obstetrics and Gynecology University of California IrvineOrangeCA 92868USA Department of Emergency Medicine University of California IrvineOrangeCA 92868USA

BACKGROUND:Maternal and infant mortality rates reported in rural Panama are greater than those in urban *** del Toro is a region of Panama inhabited by indigenous people at greater risk for pregnancy-related complications and deaths due to geographic isolation and limited access to health *** ultrasound training programs have recently been implemented in low-resource settings to increase access to diagnostic *** goal of this study is to determine the feasibility of teaching firstyear medical students the Rural Obstetrical Ultrasound Triage Exam(ROUTE)to help identify pathology in pregnant women of the Bocas del Toro region of ***:Eight first-year medical students completed ROUTE training *** training,the students were compared to professional sonographers to evaluate their accuracy in performing the *** then performed the ROUTE in mobile clinics within Bocas del *** enrolled women pregnant in their 2nd or 3rd trimesters and measured biparietal diameter,head circumference,amniotic fluid index,fetal lie and placental *** abnormal measurement would be further analyzed by the lead physician for a potential hospital ***:A total of 60 women were enrolled in the *** women were detected as having a possible high-risk pregnancy and thus referred to a hospital for further ***:Based on our data,first-year medical students with additional training can use the ROUTE to identify complications in pregnancy using ultrasound in rural *** studies are required to determine the optimal amount of training required for proficiency.

关键词： Point of care ultrasound Ultrasound education Rural Panama Obstetrics ultrasound

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Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

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World Journal of Emergency Medicine 2019年第1期10卷 46-50页

作者： Genevieve Mazza Carina Mireles Romo Marlene Torres Ali Duffens Annasha Vyas Katherine Moran Joshua Livingston Savannah Gonzales Shadi Lahham Inna Shniter Maxwell Thompson john christian fox School of Medicine University of California Irvine Department of Emergency Medicine University of California Irvine

BACKGROUND: Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava(IVC) to the aorta(Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama. METHODS: This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration. RESULTS: A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half(n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half(n=18) of these subjects also had an IVC/Ao ratio below the American threshold of ***: Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

关键词： Ultrasound Parasitic infection Panama Rural medicine Dehydration Medical education

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A Modified Lagrange Method for Solving Convex Quadratic Optimization Problems

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Open Journal of Optimization 2024年第1期13卷 1-20页

作者： Twum B. Stephen Avoka john christian J. Etwire School of Mathematical Science C. K. Tedam University of Technology and Applied Sciences Navrongo Ghana Department of Mathematics University for Development Studies Tamale Ghana

In this paper, a modified version of the Classical Lagrange Multiplier method is developed for convex quadratic optimization problems. The method, which is evolved from the first order derivative test for optimality of the Lagrangian function with respect to the primary variables of the problem, decomposes the solution process into two independent ones, in which the primary variables are solved for independently, and then the secondary variables, which are the Lagrange multipliers, are solved for, afterward. This is an innovation that leads to solving independently two simpler systems of equations involving the primary variables only, on one hand, and the secondary ones on the other. Solutions obtained for small sized problems (as preliminary test of the method) demonstrate that the new method is generally effective in producing the required solutions.

关键词： Quadratic Programming Lagrangian Function Lagrange Multipliers Optimality Conditions Subsidiary Equations Modified Lagrange Method

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Rethinking neurodegenerative diseases:neurometabolic concept linking lipid oxidation to diseases in the central nervous system

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Neural Regeneration Research 2024年第7期19卷 1437-1445页

作者： Steinunn Sara Helgudóttir Anne Skøttrup Mørkholt Jacek Lichota Preben Bruun-Nyzell Mads christian Andersen Nanna Marie Juhl Kristensen Amanda Krøger Johansen Mikela Reinholdt Zinn Hulda Maria Jensdóttir john Dirk Vestergaard Nieland 2N Pharma ApS NOVI Science ParkAalborgDenmark Molecular Pharmacology Group Department of Health Science and TechnologyAalborg UniversityAalborgDenmark

Currently,there is a lack of effective medicines capable of halting or reve rsing the progression of neurodegenerative disorde rs,including amyotrophic lateral sclerosis,Parkinson s disease,multiple sclerosis,or Alzheimer s *** the unmet medical need,it is necessary to reevaluate the existing para digms of how to to rget these *** considering neurodegenerative diseases from a systemic neurometabolic perspective,it becomes possible to explain the shared pathological *** innovative approach presented in this paper draws upon exte nsive research conducted by the authors and researchers *** this review,we highlight the importance of metabolic mitochondrial dysfunction in the context of neurodegenerative *** provide an overview of the risk factors associated with developing neurodegenerative disorders,including genetic,epigenetic,and environmental fa ***,we examine pathological mechanisms implicated in these diseases such as oxidative stress,accumulation of misfolded proteins,inflammation,demyelination,death of neurons,insulin resistance,dysbiosis,and neurotransmitter ***,we outline a proposal for the restoration of mitochondrial metabolism,a crucial aspect that may hold the key to facilitating curative therapeutic interventions for neurodegenerative disorders in forthcoming advancements.

关键词： brain disease carnitine palmitoyl transferase 1 epigenetics metabolism gut microbiome mitochondrial dysfunction neurodegeneration oxidative stress

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Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter

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World Journal of Emergency Medicine 2015年第1期6卷 10-15页

作者： Yuanting Zha Michelle Zhou Anjali Hari Bradley Jacobsen Neha Mitragotri Bianca Rivas Olga Gabriela Ventura Janice Boughton john christian fox Irvine School of Medicine University of California Gritman Medical Center Department of Emergency Medicine Irvine Medical Center University of California

BACKGROUND: Over 90% of all cases of malaria worldwide occur in Africa. Current methods of diagnosis are time and labor intensive, and could lead to delayed ***: In this study we investigated the effectiveness of measurements of spleen, liver, and optic nerve sheath diameter(ONSD) in identifying patients with malaria or severe malaria through the use of hand-held ultrasound devices. We recruited 40 adult patients with malaria and 16 adult control subjects at two hospitals in Mwanza, Tanzania. Ultrasonographic diagnosis was compared with rapid antigen diagnostic test and peripheral blood smear as the gold standards. An receiver operating characteristic curve test was performed to determine the most optimal diagnostic threshold for malaria and severe malaria, using each of the measurements for liver size, spleen size, and ONSD. The thresholds were determined to be >12 cm for spleen length and >15.1 cm for liver length, whereas ONSD was not signifi cant in this ***: The sensitivities for malaria diagnosis were 66.7% and 58.3% for liver and spleen length respectively, suggesting that these measurements may not be suitable for identifying patients with severe malaria. However, the high specificity of 90.9% for spleen length and the acceptable specifi city of 75.0% for liver length suggest that these measurements can be used as a method to eliminate false-positive diagnoses(i.e. patients who do not have severe malaria but are classifi ed as having it by a test with a high sensitivity), giving a high positive predictive ***: We report a high specifi city for spleen size and a moderate specifi city for liver size in the ultrasonographic diagnosis of severe malaria. Thus when paired with a highly sensitive method of malaria diagnosis, ultrasonographic measurement of spleen and liver size is promising as part of a diagnostic algorithm for malaria. It could be used to stratify risk in patients diagnosed with malaria and assist in their tri

关键词： Diagnostic ultrasound Malaria International health Sub-Saharan Africa Tanzania

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Epidemiological, Diagnostic, Therapeutic and Progressive Aspects of Arterial Hypertension in Children at the University Hospital Center of Bouaké (Côte d’Ivoire)

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Open Journal of Pediatrics 2024年第2期14卷 379-390页

作者： Richard Azagoh-Kouadio Yao Kossonou Roland Yeboua Kouassi christian Yao john Patrick Yenan Iburaima Alamun Akanji Kouadio Vincent Assé Pediatric Department of Angré University Hospital Abidjan Ivory Coast Pediatric Department of Bouaké University Hospital Bouaké Ivory Coast

Introduction: Arterial hypertension (AH) in children is under-diagnosed and often has a poor prognosis. The aim of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of hypertension in children at the University Hospital of Bouaké, with a view to improving the prognosis. Methods: This was a cross-sectional, analytical study carried out in the paediatrics department of Bouaké University Hospital. It concerned the medical records of children aged 4 to 15 hospitalised from 1 January 2017 to 31 December 2020 for hypertension. Diagnosis was based on the simplified blood pressure guidelines of the Expert Consensus of the French Society of Hypertension. The variables studied were epidemiological, diagnostic, therapeutic and evolutionary. Quantitative variables were compared at the significance level p ≤ 0.05. Results: The hospital incidence of hypertension was 0.32% (69/21,642). The sex ratio was 0.72. 97.1% of the children were over five years of age. Oedema (49.3%) and breathing difficulties (20.2%) were the main reasons for consultation. Hypertension was classified as threatening (56.5%), confirmed (31.9%) and borderline (11.6%). The cause was renal in 66.7%, dominated by impure nephrotic syndrome (24.6%). Treatment for hypertension consisted mainly of a diuretic (79.7%) and a calcium channel blocker (47.8%). Outcome was favourable in 50.7% of cases. Mortality was 20.3%. No factor was significantly associated with death. Conclusion: Hypertension in children at Bouaké University Hospital is serious. The aetiology is mainly renal. Early diagnosis and management are key to improving prognosis.

关键词： Hypertension Children Renal Pathologies Prognosis Côte d’Ivoire

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Post Episiotomy Morbidity among Parturient in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State

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Open Journal of Obstetrics and Gynecology 2024年第8期14卷 1144-1160页

作者： john Chinedu Obasi Ayodele Adegbite Olaleye Boniface N. Ejikeme john O. Egede Charles Nwambeke Edene Enemma christian Enemma Victor Onuchukwu Emmanuel Onyekelu Nathan C. Ekpe Wendy Oliobi Emmanuel C. Uwakwe Department of Obstetrics and Gynaecology Alex Ekwueme Federal University Teaching Hospital AbakalikiNigeria

Background: Episiotomy is a very common obstetric surgery, and it could be associated with serious complications. However, these complications largely are not noticed due to the shift of attention from mother to baby, after a successful delivery. Objective: To identify the morbidities associated with episiotomies and factors associated with such morbidities. Method: This was a questionnaire based cross sectional descriptive study among women who attended the Obstetric Department of Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State, between 1st July and 31st Nov, 2023. The study population consisted of parturients who had episiotomies in their previous confinements, attending either the antenatal clinic or the postnatal clinic at Alex Ekwueme Federal University Teaching Hospital Abakaliki Ebonyi State. Results: Macrosomia was the most common indication of episiotomy at a rate of 31.6%. The majority of episiotomies were performed on the parturients in their first confinement at a rate of 64.5% and the majority of repairs were performed by the Registrar at a rate of 65.0%. Informed consent was obtained from 45.79% of parturients while 54.21% were not informed before the episiotomy was administered. Only 55.3% of the parturient received analgesia before episiotomy was administered. The majority of the parturients had their episiotomy repaired between 10 - 15 minutes at a rate of 40.3%. Postoperative pain at the rate of 44.5% was the most common complication and dyspareunia as a form of sexual complication was the commonest at a rate of 31.3%. Conclusion: The parturient needs to be properly counselled before administration of episiotomy and adequate analgesia should be given, as episiotomy is a surgical procedure. Proper training of health workers on both the technique of administering and repairing episiotomy is important. Restrictive use of routine episiotomy in primigravidae is advised to reduce the rate of episiotomy.

关键词： Episiotomy Vulva Pains Primigravidae Morbidities Analgesia

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Endoscopic ultrasound-guided portal pressure gradient identifies patients with previously undiagnosed clinically significant portal hypertension

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Portal Hypertension & Cirrhosis 2024年第2期3卷 67-74页

作者： Jerome C.Edelson Scott F.D.Edelson john G.Quiles Cyrus V.Edelson Eric M.Montminy christian L.Horn john P.Magulick Don C.Rockey Department of Gastroenterology and Hepatology Brooke Army Medical CenterFort Sam HoustonTexasUSA Department of Medicine Uniformed Services University of the Health SciencesBethesdaMarylandUSA Department of Medicine Brooke Army Medical CenterFort Sam HoustonTexasUSA john H.Stroger Jr.Hospital of Cook County ChicagoIllinoisUSA Digestive Disease Research Center Medical University of South CarolinaCharlestonSouth CarolinaUSA

Aims:Portal hypertension(PH)is a complication of cirrhosis that leads to hepatic *** the portal pressure gradient(PPG)provides valuable information for disease assessment,staging,and *** this study,we aimed to report the utilization of endoscopic ultrasound(EUS)-guided PPG(EUS-PPG)measurements in a real-world ***:This retrospective analysis included patients at a tertiary care center who underwent EUS-PPG between February 2021 and May *** most common indication was to establish or exclude the diagnosis of cirrhosis,followed by an assessment of surgical risk in the setting of suspected *** demographic and clinical data were collected,and statistical analysis was performed using the Student's t ***:Eighteen patients underwent *** success was achieved in 17 of the 18 *** complications were *** mean scores of Child-Pugh,Model for End-Stage Liver Disease-Sodium,and Fibrosis-4 scores were 5.1±0.5,9.0±3.0,and 3.7±4.5,*** the 18 patients,two presented with esophageal varices and six with portal hypertensive *** mean PPG was 5.8±4.5 mmHg,and five patients exhibited clinically significant PH(CSPH).Of the 18 patients,15 underwent concurrent EUS-liver biopsy,which was 100%successful and provided diagnostic histology for all *** PPG data led to changes in the clinical management of 17 ***:EUS-PPG is safe and technically *** Child-Pugh score did not correlate well with the presence of CSPH;however,PPG measurements resulted in changes in the management of almost all *** studies correlating EUS-PPG with other assessments of liver diseases are required.

关键词： EUS portal hypertension portal pressure gradient

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Conservative management of spinal pathology with autologous conditioned serum: A systematic review of the literature

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World Journal of Orthopedics 2024年第9期15卷 870-881页

作者： christian J Rajkovic Matthew L Merckling Alyssa W Lee Galadu Subah Aryan Malhotra Zachary D Thomas Sabrina L Zeller john V Wainwright Merritt D Kinon Department of Neurosurgery Westchester Medical CenterValhallaNY 10595United States

BACKGROUND Chronic inflammatory pain is associated with increased expression of interleukin(IL)-1,an inflammatory cytokine,and activity on its receptor(IL-1R).In response,the body produces IL-1R antagonist(IL-1Ra)to reduce this *** conditioned serum(ACS)is the only biologic therapy for spinal pathologies that enhances the action of endogenous IL-1Ra reserves to improve *** systematic review investigates the effectiveness of ACS in treating pain and dis-ability caused by spinal *** To evaluate the use of ACS as a conservative management option for spinal *** A systematic review of PubMed/Medline was performed to identify studies inve-stigating administration of ACS for treatment of any spinal *** Six articles were included,comprising 684 patients treated with epidural(n=133)or transforaminal(n=551)ACS *** had an average age of 54.0 years with slight female predominance(53.2%).The lumbar spine was most com-monly treated,with 567 patients(82.9%)receiving injections for lumbar radicu-lopathy(n=67),degenerative disc disease(DDD)(n=372),or spinal stenosis(n=128);cervical injections were performed in 109 patients(15.9%).Mean(SD)follow-up was 21.7(4.8)weeks from first ACS *** studies investigating mecha-nical lumbar and lumbar or cervical radicular pain reported significant pain re-duction at final follow-up compared to *** achieved comparable or su-perior results to lumbar epidural steroid *** events were reported in 21 patients(3.1%),with no serious adverse *** ACS injection is a safe and effective intervention for pain reduction in many spinal pathologies,including cervical and lumbar radiculopathies.

关键词： Spine Autologous conditioned serum Orthokine Regenokine Epidural steroid injection Interleukin-1 Inter-leukin-1 receptor antagonist

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Assessment of the Vaccination Status of Children Aged 6 to 30 Months in a Tertiary Level Health Care Center in Côte d’Ivoire

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Open Journal of Pediatrics 2024年第3期14卷 536-546页

作者： Yenan john Patrick Kpangni Jean Bertrand Yao Kouassi christian Yeboua Yao Kossonou Roland Aka-Tanoh Koko Aude Hélène Avi-Siallou Christelle Honorine Asse Kouadio Vincent Department of Pediatrics University Teaching Hospital of Bouake Bouake Ivory Coast Unit Pediatric Surgery University Teaching Hospital of Bouake Bouake Ivory Coast

Introduction: Vaccination coverage in Côte d’Ivoire over the period 2011 to 2015 was below the target of 95% for all antigens. The objective of this study was to analyze the vaccination status of children aged 6 to 30 months with a view to improving vaccination coverage. Patients and Methods: This was a descriptive cross-sectional study which took place from June to September 2018 in a tertiary health center, focusing on children aged 6 to 30 months with a correctly completed health record. The parameters studied were sex, age, educational level of mothers, dates of vaccine administration and reason for missed vaccination opportunities. Results: We retained 212 children. The sex ratio was 1.21 and 93% had received the BCG vaccine before the age of 1 month. The average ages of combined and co-administered vaccines for the 1st and 2nd doses were 7.66 ± 3.81 and 12.88 ± 3.95 weeks, respectively. The median was 16.57 weeks for the 3rd dose. The proportion of vaccinated subjects was greater than 90% for the BCG vaccine and the 3 doses of combined vaccines, and 77% for the yellow fever and measles vaccines. The reasons for non-vaccination were attributable to the children’s parents and health facilities. Conclusion: Improving vaccination coverage requires regular supply of vaccines to centers, and the involvement of all health professionals, community and religious leaders in the vaccination awareness process.

关键词： Children Vaccination Coverage Missed Opportunities

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