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Minor Gynecologic Surgery: A Review of the Training Experience and Skill Building Opportunities for Providers in Low and Middle Income Countries

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Open Journal of Obstetrics and Gynecology 2014年第7期4卷 432-444页

作者： Rachel marie Clark Leslie Siriya Bradford Jessica Opoku-Anane joseph Ngonzi Ferdous Islam Mithila Faruque Annekathryn Goodman Department of Obstetrics and Gynecology Birdem Hospital Dhaka Bangladesh Department of Obstetrics and Gynecology Dhaka Medical College Hospital Dhaka Bangladesh Department of Obstetrics and Gynecology Division of Gynecology Oncology Massachusetts General Hospital Boston USA Department of Obstetrics and Gynecology Division of Gynecology Oncology University of Massachusetts Worcester USA Department of Obstetrics and Gynecology George Washington University Hospital Washington D.C. USA Department of Obstetrics and Gynecology Mbarara University Teaching Hospital Mbarara Uganda

Purpose: Minor gynecologic surgery is the cornerstone of gynecologic evaluation and intervention in countries with a well-established medical infrastructure. Surgical training and exposure to minor procedures are not available in low and middle-income countries due to the complex challenges of patient delay and lack of access to healthcare, physician shortages, and the lack of ancillary services such as pathology and radiology. This paper reviews current training statistics, the international literature on minor gynecologic surgery and training strategies. Methods: PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop electrosurgical excision procedure were performed. Statistics of minor surgical procedures among US Obstetrics and Gynecology Residency programs were tabulated. We then searched for data of training programs and surgical statistics in low resource countries. Results:Dilation and curettage is the most common minor gynecologic procedure in the United States but is performed with significantly lower frequency in low and middle-income countries. The most common procedure for the treatment of preinvasive disease was cryotherapy followed by loop electrosurgical excision procedure. There was no information about minor surgical procedures performed in hospitals in low and middle-income countries. Statistics from four-year American training programs showed an average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor gynecologic procedures is vital and requires the development of both adequate training programs and local medical infrastructure. Strategies for training in minor surgery for providers in low and middle-income countries include online curriculums, mentored relationships with senior physicians, and simulation models.

关键词： Minor Surgery Gynecology Dilation and Curettage Hysteroscopy Cone Biopsy Residency Training LMICs

Displacements, Strains, and Stresses Investigations in an Inhomogeneous Rotating Hollow Cylinder Made of Functionally Graded Materials under an Axisymmetric Radial Loading

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World Journal of Mechanics 2018年第3期8卷 59-72页

作者： Elise Rose Atangana Nkene Luc Leroy Mambou Ngueyep joseph Ndop Emma Sandring Djiokeng Jean-marie Bienvenu Ndjaka Department of Physics Faculty of Sciences University of Douala Douala Cameroon Douala Institute of Technology Douala Cameroon Laboratory of Material Sciences Department of Physics Faculty of Sciences University of Yaoundé 1 Yaoundé Cameroon Department of Mine Mineral Processing and Environment School of Geology and Mining Engineering University of Ngaoundéré Meiganga Cameroon

In this paper, an analytical and numerical study of strain fields, stress fields and displacements in a rotating hollow cylinder, whose walls were completely made in Functionally Graded Materials (FGM), was conducted. We have considered the rotating hollow cylinder submitted to an asymmetric radial loading. It is assumed that, because of the functional graduation of the material, the mechanical properties such as Young elastic modulus and the density varies in the radial direction, in accordance with a the power law function. The inhomogeneity parameter was selected between -1 and 1. On the basis of the second law of Newton, Hooke’s law and the strain-stress relationship, we established the differential equation which governs the equilibrium for a rotating hollow cylinder. We found the analytical solution and compared to the numerical solution obtained by using the shooting method and the fourth order Runge-Kutta algorithm. The analytical and numerical results lead to the conclusion that the magnitude of the tangential stresses is greater than that of the radial stresses. The changes due to the graduation of FGM does not produce consistent variations in the distribution of radial stresses, but strongly affects the distribution of tangential stresses. The tangential stresses, tangential strains and displacements are much higher at the inner surface of the cylinder wall. The internal radial pressure intensely affects the radial stresses and the radial strain.

关键词： Functionally Graded Materials Radial Stresses Tangential Stresses Cylinder Wall

Presymptomatic Diagnosis and Gene Therapy for Alzheimer’s Disease: Genomic, Therapeutic, and Ethical Aspects—A Systematic Review

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Advances in Alzheimer's Disease 2023年第4期12卷 55-74页

作者： Théodora M. Zohoncon joseph Sawadogo Abdoul Karim Ouattara Abdou Azaque Zoure marie N. L. Ouedraogo Paul Ouedraogo Florencia W. Djigma Christelle W. M. Nadembèga Raphael Kabore Djénéba Ouermi Dorcas Obiri-Yeboah Jacques Simpore Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA) Ouagadougou Burkina Faso Faculty of Medicine University Saint Thomas d’Aquin (USTA) Ouagadougou Burkina Faso Laboratoire de Biologie Moléculaire H&#244pital Saint Camille de Ouagadougou (HOSCO) Ouagadougou Burkina Faso Laboratoire de Biologie Moléculaire et de Génétique (LABIOGENE) Université Joseph KI-ZERBO Ouaga Burkina Département de Biochimie microbiologie Université Norbert Zongo/Centre Universitaire de Manga Koudougou Burkina Faso Department of Microbiology and Immunology School of Medical Sciences University of Cape Coast Cape Coast Ghana

Over the past three decades, genomic and epigenetic sciences have identified more than 70 genes involved in the molecular pathophysiology of Alzheimer’s disease (AD). DNA methylation, abnormal histone and chromatin regulation and the action of various miRNAs induce AD. The identification of mutated genes has paved the way for the development of diagnostic kits and the initiation of gene therapy trials. However, despite major advances in neuroscience research, there is yet no suitable treatment for AD. Therefore, the early diagnosis of this neurodegenerative disease raises several ethical questions, including the balance between the principle of non-maleficence and the principle of beneficence. The aims of this research were to present the genomic and ethical aspects of AD, and to highlight the ethical principles involved in its presymptomatic diagnosis and therapy. A systematic review of the literature in PubMed, Google Scholar and Science Direct was carried out to outline the genomic aspects and ethical principles relating not only to the presymptomatic diagnosis of AD, but also to its gene therapy. A total of 16 publications were selected. AD is a multifactorial disease that can be genetically classified into Sporadic Alzheimer’s Disease and Familial Alzheimer’s Disease based on family history. Gene therapy targeting specific disease-causing genes is a promising therapeutic strategy. Advancements in artificial intelligence applications may enable the prediction of AD onset several years in advance. While early diagnosis of AD may empower patients with full decision competence for early decision-making, it also carries implications for the patient’s family members, who are at risk of developing the disease, potentially becoming a source of confusion or anxiety. AD has a significant impact on the life of individuals at risk and their families. Given the absence of disease modifying therapy, genetic screening and early diagnosis for this condition raise ethical issue

关键词： Neurodegenerative Diseases Alzheimer’s Disease Molecular Mechanism Gene Therapy Presymptomatic Diagnosis Ethics Gene Therapy Ethics

Gene therapy for Parkinson’s Disease and Ethical Challenges: A Systematic Review

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Advances in Parkinson's Disease 2023年第2期12卷 9-28页

作者： Théodora M. Zohoncon joseph Sawadogo Abdou Azaque Zoure Abdoul Karim Ouattara marie N. L. Ouedraogo Luc Zongo Paul Ouedraogo Florencia W. Djigma Christelle W. M. Nadembèga Raphael Kabore Djénéba Ouermi Dorcas Obiri-Yeboah Jacques Simpore Pietro Annigoni Biomolecular Research Centre (CERBA) Ouagadougou Burkina Faso Faculty of Medicine University Saint Thomas d’Aquin (USTA) Ouagadougou Burkina Faso Saint Camille Hospital Ouagadougou (HOSCO) Ouagadougou Burkina Faso Molecular Biology and Genetics Laboratory (LABIOGENE) Joseph KI-ZERBO University Ouagadougou Burkina Faso National Center for Scientific and Technological Research (CNRST/IRSS) Ouagadougou Burkina Faso Norbert Zongo University/Manga University Centre Koudougou Burkina Faso Department of Microbiology and Immunology School of Medical Sciences University of Cape Coast Cape Coast Ghana

Background: Parkinson’s disease (PD) is a complex, multifactorial neurodegenerative disorder with a pathophysiology deriving from the synergy of abnormal aggregation of neuroinflammation, synuclein and dysfunction of lysosomes, mitochondria and synaptic transport difficulties influenced by genetic and idiopathic factors. Worldwide, PD has a prevalence of 2-3% in people over the age of 65. To date, there is no certified, effective treatment for PD. Aim: The aims of this research were: (i) to present, on the basis of recent advances in molecular genetics and epigenetics, the genomic aspects and challenges of gene therapy trials for PD;(ii) to outline the ethical principles applicable to therapeutic trials for PD. Method: A systematic literature review was carried out to identify relevant articles reporting on genomic aspects and gene therapy in PD from 2001 to October 2023. The search was conducted in French and/or English in three databases: PubMed, Google Scholar and Science Direct. PRISMA guidelines were used in this systematic review. Results: A total of thirty-three publications were selected. An inductive thematic analysis revealed that numerous genetic mutations (SNCA, Parkin, PINK1, DJ-1, LRRK2, ATP13A2, VPS35, Parkin/PRKN, PINK1, DJ1/PARK7) and epigenetic events such as the action of certain miRNAs (miR-7, miR-153, miR-133b, miR-124, miR-137) are responsible for the onset of PD, and that genetic therapy for this pathology raises ethical questions that need to be elucidated in the light of the bioethical principles of autonomy, beneficence, non-maleficence and justice. Conclusion: There is no zero risk in biotechnology. Then, it will be necessary to assess all the potential risks of Parkinson disease’s gene therapy to make the right decision. It is therefore essential to pursue research and, with the guidance of ethics, to advance treatment options and meet the challenges of brain manipulation and its impact on human identity. The golden rule of medicine remai

关键词： Neurodegenerative Diseases Parkinson Disease Molecular Mechanism Gene Therapy Gene Therapy Ethics

Road map for pain management in pancreatic cancer: A review

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World Journal of Gastrointestinal Oncology 2016年第8期8卷 599-606页

作者： marie José Lahoud Hampig Raphael Kourie Joelle Antoun Lana El Osta Marwan Ghosn Department of Anesthesiology and Critical Care Faculty of Medicine Saint Joseph University Department of Oncology Faculty of Medicine Saint Joseph University

Beside its poor prognosis and its late diagnosis, pancreatic cancer remains one of the most painful malignancies. Optimal management of pain in this cancer represents a real challenge for the oncologist whose objective is to ensure a better quality of life to his patients. We aimed in this paper to review all the treatment modalities incriminated in the management of pain in pancreatic cancer going from painkillers, chemotherapy, radiation therapy and interventional techniques to agents under investigation and alternative medicine. Although specific guidelines and recommendations for pain management in pancreatic cancer are still absent, we present all the possible pain treatments, with a progression from medical multimodal treatment to radiotherapy and chemotherapy then interventional techniques in case of resistance. In addition, alternative methods such as acupuncture and hypnosis can be added at any stage and seems to contribute to pain relief.

关键词： Pain management Interventional Medical Treatment Pancreatic cancer

CT Aspects of Psychomotor Delays in Children Aged 0 to 5 Years at Bogodogo University Hospital (Ouagadougou)

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Open Journal of Radiology 2022年第3期12卷 92-101页

作者： Ouedraogo Nina-Astrid Tall Mohamed Sawadogo Adama Kambou Tiemtore Benilde marie Ange Yougbare Solange Cisse Rabiou Laboratory of Radiodiagnosis and Medical Imaging Joseph Ki Zerbo University Ouagadougou Burkina Faso Radiology Department Bogodogo University Hospital Ouagadougou Burkina Faso Pediatric Department of the University Hospital of Bogodogo Ouagadougou Burkina Faso Radiology Department Yalgado Ouédraogo University Hospital Ouagadougou Burkina Faso

Background: Psychomotor delays in children are mainly investigated by CT imaging, due to the low availability and accessibility of magnetic resonance imaging in our context. Our aim was to study the CT aspects of psychomotor retardation (PMR) in children under 5 years of age at the University Hospital of Ouagadougou. Materials and Methods: Descriptive study with retrospective collection carried out over a period of twelve months (from September 2020 to August 2021). Our study focused on the reports of cranioencephalic CT scans performed on children aged 0 to 5 years, in whom a clinical diagnosis of psychomotor retardation had been made. Variables studied included socio-demographic data, clinical data, technique of CT examination, description of lesions and normality or not of the conclusion. Results: Cranioencephalic CT in children aged 0 - 5 years represented 9.78% of all CT scans performed in this age group. The sex ratio was 1.39. The mean age of the subjects in these reports was 18.31 ± 13.97 months and the modal class was [13 - 24] months. The CT scan was considered pathological in 85.10% of cases (n = 57). The most frequently noted encephalic anomalies were cerebral atrophy isolated in 54.4% of the cases (n = 31) or associated with other lesions in 30.1% of the cases (n = 17). Hydrocephalus was noted in 19.5% of the cases (n = 11). Conclusion: The lesions were mostly sequelae of cerebral ischaemia or cerebromeningeal infections. There were few cerebral malformations. There was no tumour etiology noted.

关键词： CT Scan Brain Child Ouagadougou Psychomotor Delay

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医患共同决策:NICE指南摘要

英国医学杂志中文版 2022年第10期25卷 109-111页

作者： Chris Carmona joseph Crutwell marie Burnham Louisa Polak 王秋梅(译) 刘晓红(校) on behalf of the Guideline Committee National Institute for Health and Care Excellence LondonUK Guildhall and Barrow Surgery Bury St Edmunds IP331ETand Primary Care UnitDepartment of Public Health and Primary CareCambridge UniversityUK 中国医学科学院北京协和医院老年医学科不详

医患共同决策(shared decision-making,SDM)作为优质医疗的核心特征,已经得到普遍认同。英国国家健康体系(National Health Services,NHS)章程第四条规定:"只要情况适当,患者、家属和照护者应参与所有相关医疗和照护决策的讨论及制订过... 详细信息

医患共同决策(shared decision-making,SDM)作为优质医疗的核心特征,已经得到普遍认同。英国国家健康体系(National Health Services,NHS)章程第四条规定:"只要情况适当,患者、家属和照护者应参与所有相关医疗和照护决策的讨论及制订过程"。因为大多数NHS医务人员和专员们承认,并非所有患方都能获得这种机会,所以授权英国国家健康与临床优选研究所(National Institute for Health and Care Excellence,NICE)制订本指南,以促进SDM能更好地用于临床实践。为此,本指南将共同决策定义为"患者和医务人员共同参与,制订医护照料决策的过程"。

关键词：照护者医患共同决策制订过程临床实践 SDM 健康体系核心特征

Outcome of delivery in nulliparous teenagers aged less than 17 years: the cameroon university centre hospital experience

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Open Journal of Obstetrics and Gynecology 2011年第2期1卷 47-52页

作者： Pierre marie Tebeu Inoussa Nsangou Philippe Nana Njotang Paul Théodore Tjek Biyaga Anderson Sama Doh joseph Nelson Fomulu 不详

In a previous study at the Yaoundé-Cameroon University Centre Hospital, we found that delivery at extreme ages of reproductive health was associated with several fetal and maternal risks. We conducted this study aimed at testing the hypothesis that deliveries by teenagers were associated with increased risk. Data collection was retrospective from delivery room registers at between 01/01/1996 and 31/12/2000. Data were collected in singleton pregnancies. The identification of each nulliparous woman aged less than 17 years was followed by that of 4 nulliparous women aged 20 - 29 years following her in the order of delivery. Since it was possible to have consecutive nulliparous teenage pregnancies before four deliveries in women in their twenties, we finally compared 65 cases of teenagers delivery with 218 cases of delivery in women aged 20 - 29 years. The difference was considered significant if p value was less than 0.05. Odd ratio with 95% confidence interval was used to measure the effect of age on the major outcomes. At univariate analysis, the risk of delivery by caesarean section for teenagers (21.5%) was significantly high compared to women in their twenties (11.5%), (OR: 2.1;95%CI: 1.0 - 4.1;p = 0.041). Similar observation was found for stillbirth delivery with 12.3% by teenagers compared to 5.0% by women in their twenties (OR: 2.7;95%CI: 1.0 - 7.1;p = 0.044). The risk of premature delivery by teenagers (30.8%) was also significantly increased compared to women in their twenties (12.4%) (OR: 3.6;95%CI: 1.8 - 7.1;p = 0.0002). After adjustment for different factors associated with the occurrence of several risks, only pre term delivery remained significantly increased at teenage (OR: 3.7;95%CI: 1.8 - 7.6;p = 0.003). These findings underscore the importance of public health programs in preventing the pregnancy in teenagers, and in developing age-appropriate intervention.

关键词： Adolescent Delivery Risk

The Effect on Physician Interpretation after Ultrasound Video Transmission

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Open Journal of Emergency Medicine 2017年第2期5卷 25-36页

作者： Eric Zevallos joseph Coppiano Ann marie Kuchinski Taylor Mueller Bradley White Patrick Loeffler Zachary Farmer Patricia Hall Matt Lyon Emergency Medicine and Hospitalist Services Department Medical College of Georgia Augusta Georgia USA

Title: The Effect on Physician Interpretation After Ultrasound Video Transmis-sion. Objective: There is a limited amount of qualified sonographers, which is problematic to rural, and prehospital settings that require clinical ultrasound. One solution is the use of telemedicine to transmit ultrasound videos to a distant expert. Our objective was to determine the effect of video image transfer using Skype on physician image interpretation. Methods: Three emergency medicine physicians of varied ultrasound proficiency were given 72 pairs of transmitted and non-transmitted ultrasound video clips in random order. Raters were instructed to determine whether ultrasound clips were positive or negative for pathology. Same interpretations between video pairs were categorized as homodiagnostic while different interpretations were categorized as heterodiagnostic. Raters were also asked to rate the image resolution, image detail, and total image quality using a 10-point Likert scale. For the diagnostic results, rater agreement, accuracy, sensitivity, and specificity were calculated. Results: The raters collectively demonstrated high agreement (92.1%), sensitivity (96.3%), specificity (92.8%), and accuracy (94.1%). Raters 1 (95.8%, κ = 0.912) and 3 (97.2%, κ = 0.942) had near perfect agreement, while rater 2 (83.3%, κ = 0.666) had substantial agreement. Only raters 1 and 3 detected a decrease in image resolution, image detail, and total image quality (p Conclusions: This study demonstrates that transmission via Skype has minimal effect on a physician’s interpretation of an ultrasound video. The implications of these results are that ultrasound video transmission can be used to improve access to specialists without compromising accuracy which will ultimately increase patients’ quality of care.

关键词： Ultrasound Telemedicine Emergency Medicine Transmission Skype