Exploring Views on Caregiving for Older Persons among Formal Social Care Workers in Malaysia: A Qualitative Study

The rapid ageing process experienced by many developing countries, lead issues and challenges to deal with the highly demanding social care sector. This qualitative study aimed to explore the understanding and views of the formal caregivers in Malaysia towards social care for older persons. Series of focus group discussions were conducted among 57 institutional social care workers at four public residential care in Peninsular Malaysia based on the identified zones. Two groups of participants involved, those aged less than 40 years old and 40 years old and above, divided based on the mean age. The interview was transcribed verbatim and inductive thematic analysis was conducted to identify the related coding and themes. Three themes were identified to explain the views and understanding of the participants related to social care for older persons namely, religious values, health impact and knowledge. Although many participants emphasized on the negative impact of caregiving for older persons on physical and mental health of the caregivers, they also viewed the job as noble and a useful platform to gain knowledge and enrich their personal experiences related to the later life. Acknowledgement of the negative impacts on health of the carers by the relevant authorities are very important to ensure productivity and quality of work, healthy and safe workplace environment and maintaining the rights of workers.     

Prevalence of EBV infection in 1157 diseased cohorts in Nigeria: A systematic review and meta-analysis

BackgroundEpstein-Barr virus (EBV) is a member of the herpesvirus family that is known to ubiquitously infect people worldwide. However, the actual prevalence of EBV infection in diseased patients in Nigeria, remains unknown. This study was thus conducted to ascertain the true prevalence.MethodsA systematic review and meta-analysis of published data was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Electronic databases including PubMed, Scopus, ScienceDirect, and Google Scholar were searched for studies reporting the occurrence of EBV infection among patients with established diseases. Studies were included if they assessed EBV infection in diseased patients in Nigeria. Data were extracted and subsequently analysed using R software. Funnel plot and Egger's regression test was used to assess publication bias, while JBI prevalence tool was used to assess study quality.ResultsA total of 13 studies covering 228 cases of EBV infection among 1157 diseased patients were included. Summary estimates were computed using random-effects model. The pooled prevalence of EBV infection was 20.3% (95% CI: 10.8–34.9, I² ?= ?92.26, p ?< ?0.001). When stratified according to the type of disease, higher estimates were obtained for patients suffering from Kaposi's sarcoma (98.7%, 95% CI: 82.2–99.9) and Nasopharyngeal malignancy (85.7%, 95% CI: 70.0–93.9). A prevalence of 13.4% (95% CI: 6.0–27.4) and 12.2% (95% CI: 4.8–27.8) was derived for the most reported patient populations, lymphoma and HIV, respectively.ConclusionThis first meta-analysis on the prevalence of EBV among Nigerian patients suffering from various diseases reveals a prevalence that emphasises the need to routinely monitor EBV infection in all EBV-associated diseases in Nigeria.     

The Italian multicenter experience with edaravone in amyotrophic lateral sclerosis

Journal of Neurology - The aim of the study is to analyze the ALS disease progression and respiratory function of Italian patients treated with edaravone (EVN), as well as the adherence to, and the...     

Mechanochemical Endovenous Ablation of Varicose Veins in Pediatric Patients with Klippel-Trénaunay Syndrome: Feasibility,Safety, and Initial Results

PurposeTo evaluate feasibility, safety, and results of endovenous mechanochemical ablation (MOCA) for treatment of persistent embryonic and dysplastic veins in pediatric patients with Klippel-Trénaunay syndrome (KTS).Materials and MethodsThirteen MOCA procedures were performed in 11 patients (age range, 4–16 years) with KTS and symptomatic persistent embryonic or dysplastic veins during a 24-month period. All patients were evaluated with color Doppler (CD) ultrasound (US), contrast-enhanced MR imaging, and venography to assess the anatomy of the target vessels and patency of the deep venous system. All procedures were performed under general anesthesia with a ClariVein catheter and liquid sodium tetradecyl sulfate as the sclerosing agent. US and fluoroscopic guidance were used in all cases. Technical success rate, primary occlusion rate, adverse effects, and recanalization rates were evaluated. Clinical and radiological (CD US) controls were performed 1 day, 7 days, 1 month, and 6 months after the procedure and once a year thereafter, with a mean follow-up of 16 months (range, 6–25 months).ResultsTechnical success and primary occlusion were achieved in all patients with no adverse events. During the follow-up period, CD US demonstrated partial recanalization and symptom recurrence in 2 patients (18%), 14 and 18 months after the initial procedure. These 2 patients had a second ablation procedure with no recanalization or symptom recurrence during the subsequent follow-up period.ConclusionsMOCA is feasible and appears to be a safe and effective technique for treatment of varicose veins in pediatric patients with KTS.     

Autotransplantation of maxillary canine following removal of compound odontome: a case report

Obstruction remains as an important cause of failure in the eruption of a tooth. In this article, a 15-year-old girl was presented with retained upper left primary canine (63) and first primary molar (64), while the contralateral permanent canine (13) and premolars (14 and 15) have erupted. Upon radiographic examination, a mass which was diagnosed later to be compound odontome was detected. The treatment consisted of surgical removal of the odontome, extraction of the primary canine (63) and left permanent canine (23), and transplantation of the permanent canine (23). The management of this case and the literature related to autotransplantation are discussed.     

Critical adjustments and trauma surgery trends in adaptation to COVID-19 pandemic in Malaysia

Malaysia has one of the highest total numbers of COVID-19 infections amongst the Southeast Asian nations, which led to the enforcements of the Malaysian “Movement Control Order” to prohibit disease transmission. The overwhelming increasing amount of infections has led to a major strain on major healthcare services. This leads to shortages in hospital beds, ventilators and critical personnel protective equipment. This article focuses on the critical adaptations from a general surgery department in Malaysia which is part of a Malaysian tertiary hospital that treats COVID-19 cases. The core highlights of these strategies enforced during this pandemic are: (1) surgery ward and clinic decongestions; (2) deferment of elective surgeries; (3) restructuring of medical personnel work force; (4) utilization of online applications for tele-communication; (5) operating room (OR) adjustments and patient screening; and (6)continuing medical education and updating practices in context to COVID-19. These adaptations were important for the continuation of emergency surgery services, preventing transmission of COVID-19 amongst healthcare workers and optimization of medical personnel work force in times of a global pandemic. In addition, an early analysis on the impact of COVID-19 pandemic and lockdown measures in Malaysia towards the reduction in total number of elective/emergent/trauma surgeries performed is described in this article.     

Relación entre la autopercepción y autoeficacia para el desarrollo de competencias en soporte vital en entornos de simulación clínica de alta fidelidad

Objective

To determine if there is a correlation between self-perception and self- efficacy in the development of learning abilities associated with the care of the critically ill patient in a Clinical Environment of High Fidelity Simulation, as part of the training for nursing students in the field of Life Support.

Utilization of extracellular information before ligand-receptor binding reaches equilibrium expands and shifts the input dynamic range

Cell signaling systems sense and respond to ligands that bind cell surface receptors. These systems often respond to changes in the concentration of extracellular ligand more rapidly than the ligand equilibrates with its receptor. We demonstrate, by modeling and experiment, a general “systems level” mechanism cells use to take advantage of the information present in the early signal, before receptor binding reaches a new steady state. This mechanism, pre-equilibrium sensing and signaling (PRESS), operates in signaling systems in which the kinetics of ligand-receptor binding are slower than the downstream signaling steps, and it typically involves transient activation of a downstream step. In the systems where it operates, PRESS expands and shifts the input dynamic range, allowing cells to make different responses to ligand concentrations so high as to be otherwise indistinguishable. Specifically, we show that PRESS applies to the yeast directional polarization in response to pheromone gradients. Consideration of preexisting kinetic data for ligand-receptor interactions suggests that PRESS operates in many cell signaling systems throughout biology. The same mechanism may also operate at other levels in signaling systems in which a slow activation step couples to a faster downstream step.Detecting and responding to a chemical gradient is a central feature of a multitude of biological processes (1). For this behavior, organisms use signaling systems that sense information about the extracellular world, transmit this information into the cell, and orchestrate a response. Measurements of the direction and proximity of the extracellular stimuli usually rely on the binding of diffusing chemical particles (ligands) to specific cell surface receptors. Different organisms have evolved different strategies to make use of this information. Small motile organisms, including certain bacteria, use a temporal sensing strategy, measuring and comparing concentration signals over time along their swimming tracks (2). In contrast, some eukaryotic cells, including Saccharomyces cerevisiae, are sufficiently large to implement a spatial sensing mechanism, measuring concentration differences across their cell bodies (3).The observation that some eukaryotes that use spatial sensing exhibit remarkable precision in response to shallow gradients (1–2% differences in ligand concentration between front and rear) (4, 5) has led to several proposed models in which large amplification is achieved by positive feedback loops in the signaling pathways triggered by the ligand-receptor binding (6, 7). Here, we describe a different mechanism, dependent on ligand-receptor binding dynamics, which improves gradient sensing when the concentration of external ligand is close to saturation. We use the budding yeast S. cerevisiae to study the efficiency of this mechanism.Haploid yeast cells exist in two mating types, MATa and MATα (also referred to as a and α cells). Mating occurs when a and α cells sense each other’s secreted mating pheromones: a-factor and α-factor (αF) (8). The pheromone secreted by the nearby mating partner diffuses, forming a gradient surrounding the sensing cell. Pheromone binds a membrane receptor, Ste2, in MATa yeast (9) that activates a pheromone response system (PRS), which cells use to decide whether to fuse with a mating partner or not. At high enough αF concentrations, cells develop a polarized chemotropic growth toward the pheromone source (4). To do that, the nonmotile yeast determines the direction of the potential mating partner measuring on which side there are more bound pheromone receptors, which are initially distributed homogeneously on the cell surface (10). However, this sensing modality can only work when external pheromone is nonsaturating: If all receptors are bound, cells should not be able to determine the direction of the gradient. Surprisingly, even at high pheromone concentrations, yeast tend to polarize in the correct direction (4, 11). Different amplification mechanisms have been proposed to account for the conversion of small differences in ligand concentration across the yeast cell, as is the case for dense mating mixtures, into chemotropic growth (6).We previously studied induction of reporter gene output by the PRS after step increases in the concentration of αF. We found large cell-to-cell variability, the bulk of which was due to large differences in the ability of individual cells to send signal through the system and in their general capacity to express proteins (12). The level of induced gene expression matches well the equilibrium binding curve of αF to receptor (13, 14), a phenomenon known as dose–response alignment (DoRA), common to many other signaling systems (14). In the PRS, DoRA persists for several hours of stimulation.During these studies, we realized that the binding dynamics of αF to its receptor is remarkably slow: At concentrations near the dissociation constant (K_d), binding takes about 20 min to reach 90% of the equilibrium level (15, 16). This dynamics is slow relative not only to the 90-min cell division cycle but also to the pheromone-dependent activation of the mitogen-activated protein kinase (MAPK) Fus3, which takes 2 to 5 min to reach steady-state levels (14). An unavoidable conclusion is that the machinery downstream of the αF receptor must be using pre-equilibrium binding information for its operation.This observation led us to study the consequences of fast and slow ligand-receptor dynamics on the ability of cells to sense extracellular cues. In biology, the rates of ligand binding and unbinding to membrane receptors span a large range, including many cases with dynamics similar to, or even slower than, that of mating pheromone (e.g., rates for EGF, insulin, glucagon, IFN-α1a, and IL-2 in