Scielo RSS http://scielo.isciii.es/rss.php?pid=2695-507520200002&lang=en vol. 2 num. 2 lang. en http://scielo.isciii.es/img/en/fbpelogp.gif http://scielo.isciii.es http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200001&lng=en&nrm=iso&tlng=en http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200002&lng=en&nrm=iso&tlng=en Abstract Background: In recent years, due to the inappropriate use of antibiotics, drug resistance has increased in gram negative bacilli, including Klebsiella pneumoniae. Drug resistance is associated with an increase in mortality and therapeutic costs. Therefore, determination of an antibiotic resistance pattern for choosing the appropriate treatment for infections caused by this bacterium seems necessary. This study was conducted to determine the antibiotic resistance pattern of Klebsiella pneumoniae species isolated from patients referring to Ziaee Hospital in Ardakan in 2016-2017. Materials and Methods: For this descriptive-analytic study, all positive cultures of Klebsiella pneumoniae in patients referred to Ziaee Hospital in Ardakan during 2016 to 2017, were evaluated. Antibiotic resistance patterns of the samples were determined by the standard method of propagation of the disk from 12 different antibiotics and data analyzed by SPSS 21 software. Results and discussions: The results of this study, which were performed on 75 samples, showed that 22 (29.3%) were male and 53 (70.7%) were female. Klebsiella's resistance to clarithromycin was 100%, but was 100% susceptible to amikacin. The percentage of Klebsiella's resistance to ampicillin was 78.3%, cefalotin 75%, cotrimoxazole 43.9%, ceftriaxone 32%, ciprofloxacin 30.9%, cefotaxime 24%, and ampicillin 20%. The highest sensitivity of Klebsiella pneumoniae for antibiotics was 100% for amikacin, 82.8% for meropenem and 82% for cefepime. Due to the high prevalence of resistance in Klebsiella samples, there is a need for strict measures in the administration of antibiotics. Antibiotic resistance can also be reduced by choosing the appropriate antibiotic for treatment and by taking antibiotic susceptibility tests. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200003&lng=en&nrm=iso&tlng=en Abstract Introduction: We held a class for supporters in dementia prevention to nurture people who can carry out activities that prevent dementia and restrict its advancement. The objective was for enrollees who have completed the class to be able to visit the homes of older adults who have difficulty leaving their homes and help them carry out activities that prevent dementia. The trained supporters then evaluated the cognitive and psychological effects of interaction. Method: The participants were local residents of Nara and Aichi Prefectures. In the supporter training to prevent dementia, we held 12 training sessions a year at Nara Medical University in Nara Prefecture and Shubun University in Aichi Prefecture. Supporters gather older people in the community to practice dementia prevention activities, and visit the homes of older adults who have difficulty leaving their homes to help the latter carry out activities that prevent dementia. Results: A total of 128 people were enrolled in the training for supporters in dementia prevention. Pre- and post-training supporter evaluations showed significant improvements in both dementia-related skills and availability (p=0.000). In terms of the comparisons before and after visiting 31 older adults people with difficulty leaving their homes, the results of the immediate recall test for cognitive function among the older adults who participated in the activities designed to prevent dementia improved from 4.5 to 7.2, whereas the results of the belated recall test improved from 3.9 to 6.6 (p=0.000). Conclusion: Training for supporters in dementia prevention significantly improved skills. A characteristic of the older adults who had difficulty leaving their homes was that their levels of activity and conversation were low, but the change to their daily lives, increased conversation, and improved activity through the visits of the supporters affected their minds and bodies and significantly improved their cognitive function. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200004&lng=en&nrm=iso&tlng=en Abstract Introduction: Over the past 10 years, much attention has been paid to the development of new antiviral drugs based on the suppression of the proteolytic activity of enzymes by trypsin inhibitors of plant and animal origin. Material and methods: We used a trypsin inhibitor from barley, trielin- (isolated by employees of the Agro-Industrial Institute of Selection and Genetics of the Ukrainian Academy of Sciences from the salivary glands of a dog); ovomukoid (isolated from duck eggs by employees of N, I, Bach Research Institute of Biology, Russian Academy of Sciences); Influenza virus APR 8/34 (fourth passage), adapted to the lungs of mice at a dose of 20 LD /0.1 ml, titre HA( hemagglutenin) 1:32) ,white BALB/c mice weighing 12-14 g. Infection with influenza virus and treatment with inhibitors was carried out intranasally under light ether anesthesia. Doses studied were: 0.5mg/ml; 2.5 mg/ml; 5.0 mg/ml; The treatment regimen of 10 mg/ml differed only in the initial stages (1 hour before infection, during infection and 1 hour after infection, and then 6 hours after infection, 24 hours after infection, 48 hours after infection, 72 hours after infection and 96 hours after infection). Results and discussion: We found that an in vivo inhibitor from barley at a dose of 10 g/l delayed the development of influenza for 8 days. The ovomukoid possessed only prophylactic properties at a dose of 100 gamma / ml. With an increase in dose, it was toxic to animals. Trielin at a dose of 10 g/l had a pronounced therapeutic effect in influenza and was not toxic. The presence of hemagglutinin influenza virus in the lungs of treated mice was observed only on the 10th day after infection; 40% of the animals remained alive for 14 days (observation period). http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200005&lng=en&nrm=iso&tlng=en Abstract Objective: The study aimed to highlight the pattern and treatment outcome of childhood burn injuries in northwestern Cameroon. Such reports are expected to provide preventive and improvement guidelines in our settings in the long run. Methods: Forty-two consecutive patients under fifteen with burns injuries managed at our facility were prospectively enrolled in the study. Results: The study population was 42 patients, which consisted of 23 (54%) male and 19 (46%) female, with the median 2.40±3.05 years, interquartile range of 1-14 years. The most frequent timing of burns was about mid-day (median 11:50 am). The majority of injuries were right at the patient's homes (70% cases). Interestingly, 4%, 15%, and 20% applied raw-egg, ice, and nothing as the first intervention for their children burns, respectively. Scald burns were the leading category of wounds (p<0.012). The majority of the cases were minor burns injuries with TBSA of 1-12% (p=0.002), with a mortality rate of 4%. Conclusion: Burns is still a significant health problem among children in northwestern Cameroon. Considering the application of raw egg and others like local herbs, therefore pre-hospital interventions may be harmful in our settings. Early and prompt response may be desirable, with strong advocacy for aggressive and urgent public health enlightenment campaigns on the prevention of childhood. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200006&lng=en&nrm=iso&tlng=en Abstract Background: Cancer is one of the most devastating diseases that influence humanity in the modern era. The effect is not confined to morbidity and mortality, but it is also extended to social and economic consequences despite the advancements made in the medical and healthcare fields. The present case overview will focus on the overall long-term assessment of death rates from malignancy from 1960 to 2017 as part of a global study of the mortality trend of this disease. Methods: Statistical analysis and process control methodologies were used to study the death rate trend over this recorded period using statistical programs platform. A combination of techniques that could be used sequentially after database processing and stratification were used including distribution fitting, descriptive statistics, data fitting mathematical pattern, Gaussian Mixture Model (GMM) box plot and Individual-Moving Range (I-MR) trending chart. Results: Two-parameter Weibull distribution (or Weibull 2) was the most appropriate that has fitted the distribution pattern of data and used for the construction of the process-behavior chart. The last two decades of the dataset showed a progressive decline in the mortality rates, which were almost linear with a higher magnitude of a negative slope than that of the initial rising pattern from 1960 until the 1990s. The hump-shaped trend showed underlying two distribution clusters: An initial distribution (I) of 81% of data of higher average mortality rates and minor one (II) that covers the last decade of monitoring record. Discussion: A significant improvement in cancer healthcare was witnessed with a noticeable breakthrough in the last decade in the USA. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200007&lng=en&nrm=iso&tlng=en Abstract Background: In cases of respiratory failure, Lung-Protective Ventilation Strategy (LPVS) which limits ventilator-induced lung injury is recommended. However, CO2 retention is a major impediment for LPVS and Extracorporeal membrane oxygenation (ECMO) supplies enough time to the lungs for rest and recovery. We aimed to find out the connection between ECMO usage and the reduction of mechanical ventilatory values in patients who required ECMO therapy after cardiac surgery due to pulmonary failure. Methods: In this retrospective cohort study, we analyzed 21 consecutive patients receiving a venovenous ECMO for pulmonary failure after cardiac surgery and 19 patients non-ECMO group. Demographic variables including age, gender, predicted body weight, and heart rate and the arterial blood gas analysis data, mechanical ventilator parameters and clinical outcomes were derived from institutional database. Results: The mean age of the patients was 55.57 years and ECMO patients were younger than non-ECMO group patients (p=0.005). The other descriptive variables and clinical parameters did not differ between groups statistically. The mechanical ventilator parameters and arterial blood gas analysis were worse in the ECMO group before the procedure (p <0.001) whereas improvement in data was more significant in the ECMO group after the procedure (p<0.001 in Pplateau and PaO2) . The patients in the non-ECMO group stayed longer in hospital (35.68 days vs 16.9 days) and in ICU (31.11 days vs 13.33 days) than the patients in the ECMO group. The duration of the mechanical ventilatory support did not differ between groups. Conclusion: The intensivists had a big dilemma involving the balance between maintaining a sensible blood-gas exchange and protecting the lung from adverse effects of mechanical ventilatory support. The extracorporeal life support –ECMO- was advised until the pulmonary failure was resolved. We found that ECMO support was decreasing the high Plateau Pressure and respiratory rate more than the non-ECMO group. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200008&lng=en&nrm=iso&tlng=en Abstract Introduction: Coronavirus disease 2019 is the recent most devastating global outbreak that influenced humanity in the new millennium since decades from the last devastating pandemic. Despite being of low mortality rates - if compared with the previous epidemics in human history - the progressively spreading epidemic does not impact health and life but also has changed man's lifestyle, economy, politics and many other undisputed admitted daily routines. Methods: The present case provides statistical analysis with a unique perspective using statistical process control (SPC) methodologies in a fast, simple and efficient way to study disease dissemination in terms of morbidities and mortalities globally. Results: Countries and territories with low population count were subjected relatively to a higher count of morbidities and mortalities than those of higher census count. Accordingly, the associate cases and death rates would be greater with a lower population number, suggesting that other factors should be involved in the outbreak hazard rather than the population number. Countries were arranged dissentingly by the residential census for illustration. The main contributing countries that showed collectively about 60% of the total CoVID-19 cases and deaths were arranged in descending order like the following: for cases, USA, Italy, Spain, China and Germany and for deaths, Italy, Spain, USA and France. A cubic relationship exists between the emerging number of cases and daily death records. CUSUM charts showed that the daily variations of the epidemic disease records have been rising and became out-of-control statistically on 17 and 19 March 2020. Conclusion: SARS-CoV-2 is still showing progressive dissemination patterns globally with variable impact between different countries or territories. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200009&lng=en&nrm=iso&tlng=en Abstract Introduction: Stroke is defined as sudden onset of focal neurological deficit lasting more than 24 hours duration. There are several complications derived from these illness, including neurological disorders like gait dysfunction. Attending to this problem, some treatments have been developed, including ankle foot orthosis (AFO), knee gaiter and bobath intervention. The aim of this study is to compare the efficacy of functional task in patients affected by stroke. Material and Methods: Timed up and go (TUG) was the measurement evaluated. A total of 10 stroke patient were recruited for the study. 5 (Group A) received treatment with Functional Task Intervention with AFO knee gaiter). Group B (n=5) were treated with Bobath Intervention. The inclusion criteria were unilateral stroke with 3-6 months duration after onset, age limit 45-65 years and ability to comprehend the instructions for testing procedures. The exclusion criteria were bilateral stroke, mental dysfunction, non cooperative patients, cognitive and perceptual dysfunction, visual and auditory impairment and orthopedic disorders that impair ambulation. Results: The pretest mean score of Group A was 30.18 and the post-test mean score was 13.08. On the other hand, group B patients obtained a pre-test mean score of 31.48 and the post-test mean score was 18.04. Conclusion: The result of the present comparative study concluded that the functional task intervention with unilateral AFO and knee gaiter was more effective than Bobath intervention on stroke population. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200010&lng=en&nrm=iso&tlng=en Abstract Simulation-Based Learning is considered the best alternative teaching and assessment tool that able to make the change in education, training, improving the quality and assessing the performance of the medical students. It helps students for acquiring many skills such as professionalism, communication, self-evaluation, time management, and teamwork. In addition, the use of simulation in medical education is based on many noble goals and ethical rules; it provides the best standards for patient care and safety, patient autonomy, and social justice. However, assessment of the application of simulation appropriateness depends on validity, reliability, and utility. Simulation has many types and classifications; it may be classified into human simulation such as role-play and standardized patient or non-human simulation such as manikin and the based computer simulation. It may be also classified according to the type or the fidelity. According to the type, it is classified into compiler-driven and event-driven, or according to the fidelity as a low, medium, and high-fidelity. There are specific criteria and steps that should be applied when designing a simulation course or operation a simulation training session as well as designing a skill checklist for ensuring a successful simulation application in medical education. However, many challenges and obstacles are still facing simulation implementation in medical education in different medical schools. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200011&lng=en&nrm=iso&tlng=en Abstract World Health Organization (WHO) is gathering the latest scientific findings and knowledge on coronavirus disease (SARS-CoV-2) and compiling it in a database. WHO update the database daily from searches of bibliographic databases, hand searches of the table of contents of relevant journals, and the addition of other relevant scientific articles that come to our attention. The entries in the database may not be exhaustive and new research will be added regularly. Nobel coronavirus investigators, the recognition of a nobel coronavirus as the cause of severe acute respiratory syndrome (SARS) was certainly remarkable, yet perhaps not surprising. Advances in the biology of coronaviruses have resulted in greater understanding of their capacity for adaptation to new environments, transspecies infection, and emergence of new diseases. New tools of cell and molecular biology have led to increased understanding of intracellular replication and viral cell biology, and the advent in the past five years of reverse genetic approaches to study coronaviruses has made it possible to begin to define the determinants of viral replication, transpecies adaptation, and human disease. This summary will discuss the basic life cycle and replication of the well-studied coronavirus, mouse hepatitis virus (MHV), identifying the unique characteristics of coronavirus biology and highlighting critical points where research has made significant advances, and which might represent targets for antivirals or vaccines. Areas where rapid progress has been made in SCoV research will be described. Finally, areas of need for research in coronavirus replication, genetics, and pathogenesis will be summarized. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200012&lng=en&nrm=iso&tlng=en Abstract Introduction: Public health security is concerned with infection prevention and control worldwide. These measures are the concern of all and sundry to ensure prevention of any outbreaks of diseases that has epidemic potential. Africa may be uniquely positioned to have the most severe and under-detected outcomes related to COVID-19 infection. This article seeks to highlight such challenges of healthcare delivery systems in the context of the COVID-19 pandemic in sub-Saharan Africa. The communique also suggests possible strategies for improvement in such settings. Method: We identified relevant articles to date using a manual library search, journal publications on the subject, and critically reviewed them. Results: We identified and exhaustively discussed the main limitations to public health security in sub-Saharan Africa as follows i) Continuing deterioration of the public health infrastructure for disease control, ii) The changing outlooks of contagious diseases, iii) Private sector reforms like the managed care, iv) Relatively weak health care systems, and v) Poor organizational structures. Conclusion: Most Africans are eager to see the desired transformation in our public health systems. Unfortunately, the political will to invest in public health infrastructure is lacking. Also, the system is characterized by human resources shortage and diverted resources, which significantly impacted the provision for emerging COVID-19 pandemic –related care. Interestingly the monumental breakthroughs in research development for bio-therapeutics and vaccines in African countries appear a mirage even with extensive past study experience with such products from China and the Western world. Finally, notwithstanding these challenges in our public health systems as elaborated, the facts are that enormous capacities exist that can be harnessed in African countries for the COVID-19 preparedness and response. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200013&lng=en&nrm=iso&tlng=en Abstract Since the outbreak of the novel Coronavirus in December 2019 in Wuhan China, this novel Coronavirus disease(COVID-19) has spread worldwide taking not only epidemic proportions but with its rapid spread world health organization(WHO) was forced to declare it as a pandemic. The Severe Acute respiratory syndrome (SARS)-Coronavirus (CoV2) virus is responsible for clusters of severe respiratory illness that simulates acute respiratory syndrome that was what was initially. It is thought although that it is equivalent to the high altitude pulmonary oedema (HAPE), showing glass ground opacities in lungs. More experience is getting acquired with changes in treatment approaches from PEEP to avoid intubation and just ensure oxygen levels maintained. Human to human transmission through droplets, contaminated hands as well as surfaces, has been revealed with an incubation period varying from 2-14 days. Early diagnosis using reverse transcription polymerase chain reaction (RT-PCR) or computed tomography (CT) scan chest, quarantine, as well as supportive treatment are necessary for getting a cure. In this review we have tried to analyze the epidemiology, diagnosis, isolation, and treatment, including antiviral drugs like remdesivir, favipiravir, chloroquine and hydroxychloroquine, corticosteroids, antibiotics, and ivermectin. With 3 successful cases of convalescent plasma achieved in USA, trials going on in India along with vaccines are also detailed in this article. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200014&lng=en&nrm=iso&tlng=en Abstract Melkersson-Rosenthal syndrome (MRS) is a rare neuromucocutaneous granulomatous disorder classically defined by the triad: fissured tongue (lingua plicata), recurrent orofacial edema, and relapsing facial paralysis. Association with other dysimmune disorders was reported suggesting an immunological origin to this syndrome. The association with autoimmune thyroiditis remains exceptional and unusual. We report the original case of an MRS associated with Hashimoto autoimmune thyroiditis in a 39-year-old Tunisian man with favorable outcome under thyroxine and systemic glucosteroids. A dosage of thyroid hormones and a screening for anti-thyroid antibodies would be useful in patients with an MRS. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200015&lng=en&nrm=iso&tlng=en Abstract This case report presents a lipofibromatous hamartoma of the median nerve in a 31-year-old man who presents local deformity and a sensory deficit in the nerve territory. The tumor was evaluated with magnetic resonance, computed tomography, and plain film radiography, studying the pathognomonic findings of this tumor. The patient did not want surgical treatment because of prior surgical sequelae. A prior surgical biopsy was reported as a peripheral nerve with normal axonal fascicles surrounded by abundant fibroadipose tissue. This tumor has a low incidence with less than 180 cases reported in the literature. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S2695-50752020000200016&lng=en&nrm=iso&tlng=en Abstract Acute mesenteric lymphadenitis (AML) remains unusual during systemic lupus erythematosus (SLE), and only a few sporadic observations have been found in the medical literature. It may exceptionally be the first manifestation revealing SLE representing a real diagnostic and therapeutic challenge for clinicians (specific lupus manifestation or infectious complication?). We report an original observation of isolated AML revealing SLE in a 29-year-old Tunisian woman without pathological medical history. She was explored for acute and febrile abdominal pain evolving for a week and not improved by symptomatic treatment. The somatic examination noted a fever at 38.5°C and a discrete diffuse abdominal tenderness. Biology showed a marked biological inflammatory syndrome, leukopenia at 3400/mm3, neutropenia at 1900/mm3, and lymphopenia at 1140/mm3 with no other abnormalities. The abdominal ultrasound and computed tomography objectified multiple large, hypoechoic, and richly vascularized on Doppler mesenteric lymph node compatible with the diagnosis of AML. Subsequent investigations concluded to SLE. The patient was treated with systemic glucocorticoids and hydroxychloroquine with favorable outcome. No recurrence has been noted for two years.