Family-centered Care for Sick Newborns: A Thumbnail View

Family-centered care (FCC) for sick newborns is emerging as a paradigmatic shift in the practice of facility-based newborn care. It seeks to transforming a provider-centered model into a client-centered one and thus build a new therapeutic alliance. FCC is the cornerstone of continuum of care, imparting caregiving competencies to parents/caregivers both within institutions as well as after the discharge. This has potential gains for the newborn, family members, and facility-level staff. The initial model piloted in tertiary-care settings is now undergoing translation at five sites across the country; the outcomes are keenly awaited.     

A systematic review of capacity assessment tools in pediatric surgery: Global Assessment in Pediatric Surgery (GAPS) Phase I

Background

The Lancet Commission on Global Surgery highlighted global surgical need but offered little insight into the specific surgical challenges of children in low-resource settings. Efforts to strengthen the quality of global pediatric surgical care have resulted in a proliferation of partnerships between low-and middle-income countries (LMICs) and high-income countries (HICs). Standardized tools able to reliably measure gaps in delivery and quality of care are important aids for these partnerships. We undertook a systematic review (SR) of capacity assessment tools (CATs) focused on needs assessment in pediatric surgery.

Therapeutic effects of topical 0.03% Tacrolimus ointment in children with refractory vernal keratoconjunctivitis in Middle East

ObjectiveThe purpose of this paper is to review the efficacy and safety profile in children treated with topical 0.03% Tacrolimus ointment for vernal keratoconjunctivitis in Middle East and to propose a treatment posology. According to recent studies, a complex non-IgE dependent mechanism plays a relevant role in the pathogenesis of vernal keratoconjunctivitis. Numerous cells and mediators have been found in the serum, conjunctiva and tears of patients with Vernal keratoconjunctivitis.DesignThis case series included 10 patients from a single centre, pediatric department of a tertiary hospital with active symptomatic vernal keratoconjunctivitis. All the patients had proliferative lesions and corneal involvement despite conventional medications, including topical steroids. All other medications, systemic and topical: steroids, antihistamines and cyclosporine, were unsuccessful. Patients were treated with topical 0.03% Tacrolimus ointment twice daily for 8 weeks and then once a day for the next two month followed by thrice a week for two months. The changes in symptoms and signs after treatment were evaluated, also the development of possible complications was assessed.ResultsThe results showed a significant reduction in signs and symptoms after 4 weeks of the treatment. Clinical resolution of giant papillae and corneal lesions were seen within eight weeks and no additional drug was required during that period, except tear substitutes. Treatment was continued for period of two months and then slowly reduced.ConclusionThe use of 0.03% Tacrolimus ointment is safe and effective in children refractory to conventional treatment of vernal keratoconjunctivitis even in high temperature climate as Middle East. Due to the effectiveness of the treatment, the dosage used may be proposed for conventional use.     

Assessment of Serum CoQ10 Levels and other Antioxidant Markers in Breast Cancer

Background: The balance of the oxidative state in the body is fundamental for the maintenance of homeostasis. It has been implicated in the onset and progression of several diseases including breast cancer. The way in which the Reactive Oxygen Species (ROS) / antioxidants balance leads to or responds to disease is still controversial. In this study, TAC is used as a reference for the total antioxidant power of the body and Coenzyme Q10 (CoQ10) for its vital importance in cellular antioxidant action and being the only lipid soluble antioxidant synthesized endogenously. Copper and zinc were measured as trace elements reflecting the antioxidant micronutrient profile of the body. Methods: After approval of the ethical committee, 60 recently diagnosed non-intervened breast cancer patients were recruited from the Medical Research Institute hospital, Alexandria University along with 20 apparently healthy volunteers as control group. Full patient history was taken including breastfeeding history, parity, hormone replacement therapy use, body mass index, pathological examination, metastatic work up results, past medical history and drug use. CA 15-3 and laboratory investigations evaluating blood glucose, kidney and liver functions were performed. Q10 levels were measured by HPLC using a kit from Recipe®. TAC was assayed spectrophotometrically (Biodiagnostics®). Copper and Zinc levels were determined by inductively coupled plasma-optical emission spectrometry. Results: There was a statistically significant increase in the CoQ10, TAC and copper levels in the breast cancer group when compared to the control group. Zinc showed no statistically significant difference between the studied groups. Conclusion: Inspite of the fact that a high antioxidant level is usually considered as a favourable state, TAC, CoQ10 and copper levels showed significantly higher levels in the breast cancer group when compared to the control group. It is worth mentioning that the cancer group were all recently diagnosed, non-intervened and showed no signs of metastasis. It is still unclear whether the increased antioxidant levels offer a selective growth advantage to tumor cells over their surrounding normal cells or serve as a protective measure by the body in an attempt to correct the assault triggered by the ROS.     

论我国医患冲突成因及和谐关系构建

目前我国医患之间的矛盾与冲突，实质上是新时期我国社会矛盾在卫生工作中的具体表现，反映了社会群体在经济状况、价值取向、角色意识、道德水平、法律法规等多方面的矛盾与冲突。和谐医患关系应是构建我国和谐社会的内容之一。和谐医患关系的构建需要完善的社会医疗保障体系建立、国家卫生行政管理加大、财政补偿合理投入、医疗服务质量提高、医学知识教育普及与提高、媒体理性传播、社会大众道德控制水平提升，法律法规完善等全方位的努力，有赖于医事主体双方及全社会的关注与通力改善。     

低胆红素血症对机体抗氧化能力和脂质过氧化的影响及VitE的干预效果

目的 :探讨低胆红素血症对机体抗氧化能力和脂质过氧化的不良影响并观察VitE的干预效果。方法 :从体检健康人群中有意选择 4 5例胆红素水平偏高者 (≥ 15 μmol/L)和 4 0例胆红素水平偏低者 (≤ 9μmol/L)作为研究对象 ,抽空腹静脉血检测血清总抗氧化能力 (T -AOC) ,丙二醛 (MDA)及血浆氧化修饰低密度脂蛋白(Ox -LDL) ,并给低胆红素组每人每天口服VitE 10 0mg ,连续 2周 ,复测上述指标。结果 :与高胆红素组比 ,低胆红素组T -AOC明显降低 (P <0 .0 1) ,而MDA和Ox -LDL明显升高 (P <0 .0 5和P <0 .0 1) ,但低胆红素组补充VitE干预后 ,T -AOC显著升高 ,而MDA和Ox -LDL显著降低 (均P <0 .0 1) ,分别达到甚至超过了高胆红素组的相应水平。结论 :低胆红素血症可显著降低机体抗氧化能力 ,促进脂质过氧化 ,但这一不良影响可以通过补充VitE得到有效纠正。     

Determination of needed radiographic room capacity to serve an emergency department

This study describes a method for determining the number of radiographic rooms devoted to emergency radiology that would be required to keep mean patient waiting time at a desired level. A desired mean waiting time for patients must be determined. In our setting, a mean waiting time of 8 minutes resulted in few complaints. The waiting time then sets the required utilization rate of available capacity. Daily and hourly volume and variability in volume of examinations were measured over a 3-month period. This represents the demand. The needed number of rooms is determined by comparing demand with effective available capacity for different numbers of rooms. To maintain an 8-minute mean waiting time, 50% utilization of capacity is required. Mean demand on Sundays is 176 examinations. Five rooms are required, since this gives a 180-examination effective capacity. Using waiting time as the primary decision criterion for making capacity decisions in emergency radiology has several advantages: the method is easy to use, volume variability is taken into account, and the focus is on service to patients.     

Transient aphasia with lithium toxicity

A case of transient aphasia in a 48-year-old woman is described. The aphasia occurred when progressive renal insufficiency led to accumulation of lithium to toxic levels, and was associated with well-known clinical findings of lithium toxicity.