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Open Journal of Endocrine and Metabolic Diseases 2021年第1期11卷 1-11页

作者： Md. Firoj Hossain Tahniyah Haq Md. Fariduddin Shahjada Selim M. A. Hasanat Md. Shahed-Morshed Department of Endocrinology Mugda Medical College Dhaka Bangladesh Department of Endocrinology Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka Bangladesh emergency medical officer Kurmitola General Hospital Dhaka Bangladesh

Background: Very limited data are available regarding the association of vitamin D with glycemic status among adults with newly detected type 2 diabetes mellitus (T2DM) in Bangladesh. Objectives: To determine vitamin D status and its association with glycemic status in Bangladeshi adults with newly detected T2DM. Materials and Methods: This cross-sectional study was carried out in 102 newly detected T2DM diagnosed on the basis of the American Diabetes Association 2017 criteria (age: 42.95 ± 10.68 yrs.;m/f: 44/58) and equal number of age and sex matched controls (age: 40.43 ± 11.04 years) recruited consecutively from the Department of Endocrinology, BSMMU to measure serum vitamin D by high performance liquid chromatography method. Results: Both vitamin D deficiency (p p p 1c (r = -0.249, p = 0.011) in patients with T2DM. HbA1c was linearly associated with vitamin D (β = -0.26, p = 0.009) and severe vitamin D deficiency by binary (OR = 1.37, p = 0.003) and multinomial logistic regression (HbA1c ≥ 10%: OR = 4.25, p = 0.04) in people with T2DM after adjustment for age and BMI. Conclusions:

关键词： Vitamin D Type 2 Diabetes Mellitus Vitamin D Deficiency Glycated Hemoglobin A1c

Pakistan’s experience with risk assessment training and implementation of concepts from the 4th edition of the WHO laboratory biosafety manual

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Journal of Biosafety and Biosecurity 2021年第2期3卷 99-107页

作者： Samreen Sarwar Viji Vijayan Health Security Partners Lahore 54000Pakistan Department of Safety Health and emergency Management Duke-NUS Medical School8 College RoadSingapore 169857Singapore

Introduction:The cyclical process of hazard identification,risk assessment,risk mitigation,and review is a key step in developing a biorisk management(BRM)*** paper describes how this process was initiated in two laboratories in Pakistan using a unique model of blended ***:A training needs analysis showed that the staff had very little knowledge of BRM systems.A workshop using a unique blended model was conducted in which virtual and in-presence learning occurred *** workshop aimed to train the participants by applying two key concepts from the World Health Organization Laboratory Biosafety Manual 4th edition:1)the cyclical process of risk assessment and 2)mapping the core biorisk and establishing heightened control measures in the laboratories of the participants based on the risk *** scenarios and examples used in the training were from the participants’laboratory work ***:Prior to this project,no risk assessment was conducted in these *** the workshop,a risk assessment was performed for six work *** addition,seven core requirements and three heightened control measures were mapped,a biorisk officer was appointed,and a biosafety committee was ***,a biorisk manual,a biological waste management plan,an occupational health center,and a system for audits and inspections are being *** and conclusion:BRM training is not a one-time effort;it has to be strengthened to ensure the development and implementation of a comprehensive and sustainable BRM *** must be applicable to local settings and incremental,in a way that participants are not overloaded with information.

关键词： Training Biosafety Risk assessment Standard operating procedures Biorisk

A rare neurological sequelae of chicken pox in an adult

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Journal of Acute Disease 2018年第6期7卷 268-270页

作者： Kandan Balamurugesan Prem Davis Rajangam Ponprabha Malaimala Sarasveni Associate Professor Department of General MedicineIndira Gandhi Medical College&Research InstitutePuducherry-605009India medical officer Central University of Tamil NaduThiruvarur-610005India Assistant Professor Department of PaediatricsGovernment Villupuram Medical CollegeVillupuram-605601India

Chicken pox is a disease of childhood caused by varicella zoster virus belonging to the α-herpesvirus-3 family. But the clinical presentation in adults is uncommon and is usually associated with complications. The complications are more commonly seen in immunocompromised individuals and in people who get infected at the later age group. Since the varicella zoster virus rarely causes cerebellar disease in adults, hence here we report a non-immunized, immune-competent adult patient presented to the emergency department with unsteadiness in gait, profuse sweating, exanthematous vesicular rash. We made a diagnosis of acute cerebellar ataxia due to varicella zoster virus and treated accordingly.

关键词： Acute cerebellar ataxia Chicken pox Neurological sequelae Complications

Early infant diagnosis of HIV in India—Early results and sero-positivity determinants

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Open Journal of Preventive Medicine 2012年第3期2卷 318-325页

作者： Urvish Joshi Umesh Oza Anand Solanki Sheetal Vyas Heena Modi Assistant Professor Dept of Community Medicine AMC MET Medical College Ahmedabad Gujarat India Monitoring & Evaluation officer Ahmedabad Municipal Corporation AIDS Control Society Ahmedabad Gujarat India Professor & Head Dept of Community Medicine AMC MET Medical College Ahmedabad Gujarat India Project Director Ahmedabad Municipal Corporation AIDS Control Society Ahmedabad Gujarat India

Introduction: PMTCT under NACP-III cover ex-posed children born to sero-positive mothers. Baby’s sero-status could be confirmed only at 18 months. Under EID, by DBS and/or WB collection, DNA-PCR can be performed earlier, with subsequent ART-linkage and 18-months-con- firmation. In Ahmedabad, with 55,000 annual pre- gnancy-HIV-testing, sero-prevalence is 0.27%. Methodology: Entry-points in EID are at 6 weeks, 6 months or 12 months. Cohort of 213 exposed children since EID roll-out (June 2010-December 2011) at all tertiary care hospitals under Ahme-dabad Municipal Corporation was assessed for sero-positivity-prevalence, DBS validity and assessment of baby’s sero-status-determinants. De-identified, secondary data were captured under routine public-health-program. Necessary permissions taken. Results: 144 HIV sero-positive deliveries took place. 213 exposed children were enrolled in EID. Cumulatively, 18 (8.45%) were tested positive at all entry-points. Out of sero-positives confirmed at 18 months, 60% children’s mothers were detected either in second or third trimester. In 40%, mothers remained undiagnosed intra-partum. Mothers were not on ART intra-partum in 80% (RR 1.8). Peri-partum ARV prophylaxis-single-dose-Nevirapine (sdNVP) was not given in 60%. [RR 18, CI 3.69 to 87.70 at 95% (p emergency. History of exclusive breastfeeding was in 60%. Discussion: Rise in yield of sero-positivity with age, highest proportion of sero-positivity and highest number of entrants at 6 weeks call for efforts targeted towards increasing earliest EID uptake clubbed with immunization visits. Feasibility, validity and early-ART-linkage to reduce mortality are features of DBS. Results justify its use in national program. Earliest pregnancy-HIV detection, HIV-testing for emergency deliveries, intra-partum sdNVP to both mother and baby, ART-linkage of eligible mothers and following infant feeding guidelines remain c

关键词： PMTCT Early-Infant-Diagnosis (EID) Dried-Blood-Spot (DBS) HIV Sero-Positivity Determinants Vertical Transmission

对WHO严重急性呼吸综合征诊断标准用于门诊患者的评价:前瞻性观察研究

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英国医学杂志中文版 2003年第4期6卷 210-214页

作者： Timothy H Rainer Peter A Cameron De Villiers Smit Kim L Ong Alex Ng Wing Huang David Chan Po Nin Anil T Ahuja Lowis Chan Yik Si Joseph J Y Sung 张隽 Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew TerritoriesHong Kong China associate professor Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew TerritoriesHong Kong China professor and director Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew TerritoriesHong Kong China assistant professor Accident and emergency Medicine Academic Unit Cbinese University of Hong KongShatinNew TerritoriesHong Kong China associate professor Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew Territories.Hong Kong China medical officer Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew TerritoriesHong Kong China medical officer Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew Territories.Hong Kong China professor Accident and emergency Medicine Academic Unit Chinese University of Hong KongShatinNew TerritoriesHong Kong China professor

目的研究严重急性呼吸综合征(SARS)患者的临床和影像学特征并评价世界卫生组织(WHO)关于SARS诊断指南的准确性。试验设计前瞻性观察研究。研究地点香港新界一所教学医院急诊科新建立的SARS鉴别门诊。研究对象有SARS患者接触史的... 详细信息

目的研究严重急性呼吸综合征(SARS)患者的临床和影像学特征并评价世界卫生组织(WHO)关于SARS诊断指南的准确性。试验设计前瞻性观察研究。研究地点香港新界一所教学医院急诊科新建立的SARS鉴别门诊。研究对象有SARS患者接触史的556名医院工作人员、患者及曾访问过该门诊的工作人员和患者的亲属。主要观察指标 SARS患者的确诊人数。结果 556名研究对象中,收入院141人,其中97人被确诊为SARS。97例确诊患者中,发热、寒战、乏力、肌痛、畏寒、纳差、呕吐、腹泻、颈痛等非呼吸道症状的发生率均显著高于其他患者。WHO关于诊断可疑SARS患者指南的准确性为83％,其阴性预计值为86％(95％可信区间为83％～89％),敏感性为26％(17％～36％),特异性为96％(93％～97％)。结论现行WHO关于诊断可疑SARS患者的指南,用于诊断入院前的患者尚不够敏感,而每天随诊、评价非呼吸道和全身的症状以及胸部X线检查可能是更好的鉴别工具。

关键词： WHO 严重急性呼吸综合征诊断世界卫生组织 SARS 病毒

The Importance of Both the Technical and Social Domains in Creating a Culture That Accelerates Improvement in Healthcare

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Health 2020年第12期12卷 1575-1582页

作者： Lane F. Donnelly Karen Frush John Shook Peter A. Schein Edgar H. Schein Stanford Medicine Center for Improvement School of Medicine Stanford University Palo Alto USA Department of Radiology School of Medicine Stanford University Palo Alto USA Center for Pediatric and Maternal Value Lucile Packard Children’s Hospital—Stanford Stanford Children’s Health Palo Alto USA Department of emergency Medicine School of Medicine Stanford University Palo Alto USA Office of the Chief Quality officer Stanford Health Care Palo Alto USA Lean Enterprise Institute Boston USA Organizational Culture and Leadership Institute Menlo Park USA

Driving improvement in healthcare can be challenging related in part related to the degree of complexity. We break down the aspects of culture needed to accelerate improvement into a technical domain and a social domain. Task processes can be considered an organization’s technical domain. The social processes, how those doing the work interact, can be thought of as the organization’s social domain. The technical domain focuses on the work related to tasks and the social domain on the relationships that make efficient and effective work possible. We argue that work requirements and social relations are inexorably intertwined—each profoundly impacting, reflecting, and even determining the other. In this review, we argue that in order to accelerate healthcare system improvement, focus must be given to processes that take into consideration both on the social and technical domains.

关键词： Improvement Culture Sociotechnical

Disaster response approach in Hong Kong

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实用休克杂志（中英文） 2020年第3期4卷 186-192页

作者： Lau Tingleung Auxiliary medical Service HomantinHong Kong

The article will have a brief look at the overall disaster response approach in Hong *** roles and responsibilities of individual frontline emergency response forces will be *** of individual parties in a multiple casualty incident(MCI)will be ***,common on-site problems will be identified and suggestions for improving the effectiveness of field operation in a frontline practical perspective will be discussed and summarised.

关键词： Ambulance incident officer Disaster management emergency medical assistant Multiple casualty incident Triage