Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

Background

Point of care ultrasound (POCUS) is a useful diagnostic tool in medicine. POCUS provides an easy and reproducible method of diagnosis where conventional radiologic studies are unavailable. Telemedicine is also a great means of communication between educators and students throughout the world.

Hypothesis

Implementing POCUS with didactics and hands-on training, using portable ultrasound devices followed by telecommunication training, will impact the differential diagnosis and patient management in a rural community outside the United States.

Materials and methods

This is an observational prospective study implementing POCUS in Las Salinas, a small village in rural western Nicaragua. Ultrasound was used to confirm a diagnosis based on clinical exam, or uncover a new, previously unknown diagnosis. The primary endpoint was a change in patient management. International sonographic instructors conducted didactic and practical training of local practitioners in POCUS, subsequently followed by remote guidance and telecommunication for 3 months.

Results

A total of 132 patients underwent ultrasound examination. The most common presentation was for a prenatal exam (23.5 %), followed by abdominal pain (17 %). Of the 132 patients, 69 (52 %) were found to have a new diagnosis. Excluding pregnancy, 67 patients of 101 (66 %) were found to have a new diagnosis. A change in management occurred in a total of 64 (48 %) patients, and 62 (61 %) after excluding pregnancy.

Conclusion

Implementing POCUS in rural Nicaragua led to a change in management in about half of the patients examined. With the appropriate training of clinicians, POCUS combined with telemedicine can positively impact patient care.     

穴位敷贴联合情志护理对缓解鼻腔手术患者术后疼痛的影响

目的：探讨穴位敷贴联合情志护理对缓解鼻腔手术患者术后疼痛的影响。方法将116例拟行鼻腔手术的患者随机分成观察组与对照组各58例,对照组实施常规围手术期护理,观察组在对照组的基础上给予穴位敷贴联合情志护理,采用焦虑自评量表(SAS)、视觉模拟镇痛评分法(VAS)、护理工作满意度调查表评估两组患者术前术后焦虑程度、术后疼痛程度及护理满意度。结果观察组术前30 min、术后6 h SAS评分分别为(43.28±6.25)分和(39.45±5.23)分,均明显低于对照组的(47.62±7.31)分和(43.36±5.65)分,差异均有统计学意义(P<0.05);术后2 h、6 h、12 h VAS分别为(3.87±1.72)分、(4.28±1.84)分和(4.76±1.54)分,均明显低于对照组的(5.96±1.78)分、(6.73±1.82)分和(7.38±1.35)分,差异均有统计学意义(P<0.05);观察组护理满意度为96.55%,明显高于对照组的86.21%,差异有统计学意义(P<0.05)。结论穴位敷贴联合情志护理能有效缓解患者术后疼痛与焦虑情绪,提高患者满意度。     

柴芍六君子汤配合耳穴压豆预防微创保胆取石后结石复发

目的:观察中药柴芍六君子汤配合耳穴压豆预防微创保胆内镜取石术后患者胆囊结石复发的疗效。方法:80例行微创保胆取石术后患者随机分成观察组和对照组各40例,两组术后均给予饮食和生活习惯改变的指导,观察组加用中药柴芍六君子汤配合耳穴压豆,对照组加用牛磺熊去氧胆酸(TUDCA,商品名:滔罗特)。结果:观察组患者治疗前后胆囊壁厚度、胆囊收缩功能相比均有显著性差异(P<0.05);对照组患者治疗前后胆囊壁厚度、胆囊收缩功能相比均有显著性差异(P<0.05);两组患者治疗后胆囊壁厚度比较及胆囊收缩功能组间比较,无明显差异(P>0.05)。两组患者均有1例胆囊结石复发,复发率2.5%。结论:中药柴芍六君子汤配合耳穴压豆有利于减轻胆囊壁的炎症,增强胆囊的收缩功能,有助于防止胆囊结石的复发。     

深圳市耐多药结核分枝杆菌耐药基因突变特征分析

目的 利用全基因组序列分析方法研究深圳市耐多药结核分枝杆菌(MDR-MTB)的耐药基因突变类型特点,为耐药结核病的快速分子检测提供依据。方法 对2013—2017年深圳市慢性病防治中心及各区慢性病防治院门诊收集的所有449株MDR-MTB临床分离株进行全基因组测序,经与结核分枝杆菌标准菌株(H37Rv)基因组模板序列比对后获得447株满足分析要求的全基因组测序菌株。每株菌株经单核苷酸多态性(SNP)鉴定后与H37Rv各基因型和亚型的特异性突变和对11种抗结核药品已知的耐药基因突变进行比对,获得各菌株独属的基因型或亚型和耐药基因突变,并分析不同药品耐药基因中的主要耐药突变类型不同基因型或亚型间的相关性。结果 447株MDR-MTB中全基因组测序结果显示,432株(96.6%)发生基因突变,MTB对11种药品主要的耐药突变类型分别为katG-315-S/T[INH, 81.7%(353/432)]、rpoB-450-S/L[RFP, 59.7%(258/432)]、rpsL-43-K/R[Sm, 66.0% (198/300)]、embB-306-M/V[EMB, 35.5% (94/265)]、pncA启动子-11-T/C[PZA, 8.9% (11/123)]、gyrA-90-A/V [Ofx, 31.5% (39/124)]、rrs-1401-A/G[Am,48.1% (25/52)]、rrs-1401-A/G [Cm, 100.0% (27/27)]、rrs-1401-A/G [Km, 84.4% (27/32)]、inhA-15-C/T[Eto, 84.2% (48/57)]、thyA-75-H/N[PAS, 31.3% (10/32)],且发现存在2种及2种以上联合突变者有对INH、RFP、EMB和Sm耐药的菌株。深圳市MDR-MTB菌株的3个基因型为L1[0.4%(2/447)]、L2[84.6% (378/447)]和L4[15.0%(67/447)]型,其中L2型又分为3个亚型[L2.1型:1.9%(7/378)、L2.2型: 37.0%(140/378)、L2.3型: 61.1%(231/378)]。突变类型为katG-315-S/T、rpsL-43-K/R和embB-306-M/V在L2型菌株中的突变率[分别为79.6%(301/378)、50.5%(191/378)、23.0%(87/378)]明显高于L4型菌株[分别为61.2%(41/67)、10.4% (7/67)、10.4% (7/67)](χ ²值分别为10.874、37.021、5.396,P值分别为0.001、0.000、0.020),且PAS耐药突变类型folC-43-I/T和thyA-75-H/N仅出现在L2型菌株中;其中katG-315-S/T在L2.2型菌株中突变频率[88.6%(124/140)]高于L2.3型[74.5%(172/231)](χ ²=10.764,P=0.000),而inhA-15-C/T(INH)、rpoB-450-S/L、rpsL-43-K/R和inhA-15-C/T(Eto) 在L2.3型菌株中的突变频率[分别为8.2% (19/231)、61.9%(143/231)、 59.3% (137/231)、15.6% (36/231)]明显高于L2.2型[分别为2.9% (4/140)、49.3% (69/140)、37.9% (53/140)、3.6% (5/140);χ ²值分别为4.319、5.668、16.053、12.797,P值分别为0.038、0.017、0.000、0.000)]。结论 深圳市MDR-MTB菌株中11种药品耐药基因主要突变类型分别为katG-315-S/T、rpoB-450-S/L、rpsL-43-K/R、embB-306-M/V、pncA启动子-11-T/C、gyrA-90-A/V、rrs-1401-A/G、inhA-15-C/T、thyA-75-H/N;基因型为L1、L2和L4型,以L2.2型、L2.3型和L4型为主。     

高分辨率熔解曲线分析技术检测苯丙酮尿症患者的苯丙氨酸羟化酶基因突变

目的 应用高分辨率熔解曲线（HRM）分析技术检测苯丙酮尿症患者苯丙氨酸羟化酶基因突变.方法 利用PCR扩增13例苯丙酮尿症（PKU）患者的苯丙氨酸羟化酶（PAH）基因第6、7、11及12外显子,然后对PCR产物进行HRM分析,通过DNA测序对HRM结果进行验证.结果 在13例PKU患者的26个PAH等位基因中共检测出5种不同突变基因,总检出率为38.5％.常见的突变类型是R243Q和A434D.检测出两种多态性位点为Q232Q和V245V.HRM分析结果与测序结果完全一致.结论 HRM技术具有简单、快速、易操作、准确等优点,可用于PKU患者PAH基因突变筛查.     

Active and uncontrolled asthma among children exposed to air stack emissions of sulphur dioxide from petroleum refineries in Montreal,Quebec: A cross-sectional study

BACKGROUND:

Little attention has been devoted to the effects on children’s respiratory health of exposure to sulphur dioxide (SO₂) in ambient air from local industrial emissions. Most studies on the effects of SO₂ have assessed its impact as part of the regional ambient air pollutant mix.

OBJECTIVE:

To examine the association between exposure to stack emissions of SO₂ from petroleum refineries located in Montreal’s (Quebec) east-end industrial complex and the prevalence of active asthma and poor asthma control among children living nearby.

METHODS:

The present cross-sectional study used data from a respiratory health survey of Montreal children six months to 12 years of age conducted in 2006. Of 7964 eligible households that completed the survey, 842 children between six months and 12 years of age lived in an area impacted by refinery emissions. Ambient SO₂ exposure levels were estimated using dispersion modelling. Log-binomial regression models were used to estimate crude and adjusted prevalence ratios (PRs) and 95% CIs for the association between yearly school and residential SO₂ exposure estimates and asthma outcomes. Adjustments were made for child’s age, sex, parental history of atopy and tobacco smoke exposure at home.

RESULTS:

The adjusted PR for the association between active asthma and SO₂ levels was 1.14 (95% CI 0.94 to 1.39) per interquartile range increase in modelled annual SO₂. The effect on poor asthma control was greater (PR=1.39 per interquartile range increase in modelled SO₂ [95% CI 1.00 to 1.94]).

CONCLUSIONS:

Results of the present study suggest a relationship between exposure to refinery stack emissions of SO₂ and the prevalence of active and poor asthma control in children who live and attend school in proximity to refineries.     

Detecting viruses by using salivary diagnostics

BackgroundDiagnostics that involve the use of oral fluids have become increasingly available commercially in recent years and are of particular interest because of their relative ease of use, low cost and noninvasive collection of oral fluid for testing.Types of Studies ReviewedThe authors discuss the use of salivary diagnostics for virus detection with an emphasis on rapid detection of infection by using point-of-care devices. In particular, they review salivary diagnostics for human immunodeficiency virus, hepatitis C virus and human papillomavirus. Oral mucosal transudate contains secretory immunoglobulin (Ig) A, as well as IgM and IgG, which makes it a good source for immunodiagnostic-based devices.Clinical ImplicationsBecause patients often visit a dentist more regularly than they do a physician, there is increased discussion in the dental community regarding the need for practitioners to be aware of salivary diagnostics and to be willing and able to administer these tests to their patients.     

小麦纤维素颗粒联合穴位贴敷治疗痔疮术后便秘临床研究

目的:观察口服小麦纤维素颗粒联合穴位贴敷治疗痔疮术后便秘的临床疗效。方法:将手术治疗的痔疮患者84例按入院顺序编号后采用奇偶数字法分为研究组42例和对照组42例。对照组采用小麦纤维素颗粒治疗,研究组在对照组基础上加用穴位贴敷治疗,2周为1个疗程,1个疗程后比较2组中医证候疗效及排便困难程度评分、7 d内排便次数、7 d内排便间隔时间、排便持续时间。结果:中医证候疗效总有效率研究组为95.24%,对照组为80.95%,2组比较,差异有统计学意义(P<0.05)。治疗后,研究组排便困难程度评分、7 d内排便间隔时间、排便持续时间均低于对照组,7 d内排便次数多于对照组,差异均有统计学意义(P<0.05)。结论:小麦纤维素颗粒口服联合穴位贴敷治疗痔疮术后便秘效果显著。