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Enantioselective functionality involving 1-aminoindene derivatives via asymmetric Brønsted acid solution catalysis.
Objective The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression. Methods A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies. Results This paper includes two main sections 1) depression - a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists' role in providing high-quality care - the main aspects of pharmaceutical care for patients with depression with specific examples. Conclusion The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug-drug, drug-food and drug-alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression. © 2020 Kamusheva et al.This report describes two cases of Salmonella mesenteric lymphadenitis leading to septic peritonitis in two young dogs. The cases were similar in presentation, diagnosis, treatment, and length of hospitalization. Both cases presented with clinical signs of vomiting, abdominal pain, and fever and were treated successfully via surgical debridement, omentalization, and antibiotic therapy. Both cases grew multi-drug resistant Salmonella spp. with resistance to ampicillin sulbactam, which is a common empiric antibiotic choice for cases of canine septic peritonitis. In both cases, the source of Salmonella is proposed to be the raw diet that preceded the septic peritonitis diagnosis. While Salmonella mesenteric lymphadenitis has been reported in humans and pigs, to the authors' knowledge, this is the first report of Salmonella mesenteric lymphadenitis in dogs. selleck chemicals © 2020 Binagia and Levy.Objective The aim of this study is to evaluate the presence of significant differences regarding the lateral acromial angle, critical shoulder angle, and the acromial index between patients with and without rotator cuff tears. Method The MRIs (Magnetic Resonnance Imaging) of 82 patients were studied. The rotator cuff tear group (RCT group) included 41 patients while the control group also included 41 patients without rotator cuff tears. Acromial parameters and demographical data were extracted for statistical analysis. Results No statistical significant difference was found in terms of the studied acromial parameters between patients with and without rotator cuff tears. No correlation was found between age and any of the studied parameters. LAA (Lateral Acromial Angle) was found to be significantly different between males and females of the studied sample. However, no difference was found between patients with and without rotator cuff tears when both genders were studied separately. Moreover, no statistical significant difference was found in terms of the studied acromial parameters between males and females when the RCT group and the control group were studied separately. When gender was the covariate in the one-way MANCOVA test, gender was not significantly dependent on the type of groups (RCT group vs control group). Conclusion The results obtained from this study suggested that the studied acromial parameters in patients with rotator cuff tears were not different from the parameters found in patients without rotator cuff tears. Moreover, gender was not found to influence the acromial parameters, with no subsequent effect on the development of rotator cuff tears. Further studies may be required for better understanding on the biomechanics, taking into consideration age, gender, and the given population. © 2020 Asia Pacific Knee, Arthroscopy and Sports Medicine Society. Published by Elsevier (Singapore) Pte Ltd.Recalcitrant neonatal hypoglycemia poses a treatment challenge for clinicians. When a patient's hypoglycemia does not respond to dextrose infusion, several medication options are available, including diazoxide(1,2). Several side effects of diazoxide are described in the literature, including fluid retention with the risk of development of congestive heart failure(3,4). We describe a case of necrotizing enterocolitis in a patient with Beckwith-Wiedemann Syndrome with persistent neonatal hypoglycemia who was treated with increasing doses of diazoxide.Introduction Diabetic ketoacidosis (DKA) often becomes the primary focus and in turn masks a similar serious condition like hyperchloremic metabolic acidosis. Case report A 20 years old female with type 1 diabetes mellitus presented to the emergency department (ED) with signs and symptoms corresponding to DKA. Initial pH, HCO3, Na and Cl concentrations were 6.83, 3.6 mmol/l, 143 mmol/l and 122 mmol/l respectively; anion gap 17.4 mmol/l and absent urinary ketones. DKA regime showed no improvement in the measured parameters nor the patient. The diagnosis changed to hyperchloremic high-anion gap acidosis and treatment modifications were made by adding sodium bicarbonate infusion. There was significant improvement in the clinical status of the patient and the calculated parameters. Discussion Hyperchloremic acidosis is associated with a non-anion gap, decrease in plasma bicarbonate and increase in plasma chloride. Rarely, as with this case, it may present with a high-anion gap. The use of bicarbonate therapy has shown improvement in cases of non-anion gap acidosis however there is very little data to support its role in high-anion gap hyperchloremic metabolic acidosis. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Background In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world. Methods We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between travel time and socioeconomic status. Results We estimate the average minimum travel time during uncongested traffic conditions to any level 4 health facility (primary hospitals) or above in Nairobi to be 4.5 min (IQR 2.5-6.1). Traffic added an average of 9.0 min (a 200% increase). In uncongested conditions, we estimate an average travel time of 7.9 min (IQR 5.1-10.4) to level 5 facilities (secondary hospitals) and 11.6 min (IQR 8.5-14.2) to Kenyatta National Hospital, the only level 6 facility (tertiary hospital) in the country. Traffic congestion added an average of 13.1 and 16.0 min (166% and 138% increase) to travel times to level 5 and level 6 facilities, respectively. For individuals living below the poverty line, we estimate that preferential use of public or faith-based facilities could increase travel time by as much as 65%. Conclusion Average travel times to health facilities capable of providing emergency care in Nairobi are quite low, but traffic congestion double or triple estimated travel times. Furthermore, we estimate significant disparities in timely access to care for those individuals living under the poverty line who preferentially seek care in public or faith-based facilities. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Background Clinical simulation has become widespread as a training and assessment tool across a range of health professions, including emergency care. As with any form of assessment, simulations may be associated with stress and anxiety ("distress") which may have a negative effect on student performance if demands required by the simulation outweigh the available resources. This study aimed to assess the effect of participation by students in an emergency care simulation on an objective measure of stress and a subjective measure of anxiety. Methods Heart rate variability (HRV) and scores from a validated state anxiety instrument (the State-Trait Anxiety Inventory) were assessed in 36 emergency medical care students participating in scheduled simulation assessments. Data recorded during a resting control period were used for comparison. Results HRV variables showed changes in the simulation assessment group suggesting decreased variability and parasympathetic withdrawal, however these were not significantly different to control. Heart rate in the simulation assessment group increased significantly (73.5/min vs. 107.3/min, p less then 0.001). State anxiety scores increased significantly both before (33.5 vs. 49.1, p less then 0.001) and after (33.5 vs. 60, p less then 0.001) the simulation assessment, compared to control. No linear relationship was found between any HRV variables and anxiety scores. Conclusion Participating in an emergency care simulation assessment significantly elevated levels of anxiety in a group of 36 students, however an objective measure of stress did not identify changes significantly different to those at rest, with the exception of heart rate. The high levels of anxiety documented before and after simulation assessments may have a negative effect on performance and require further investigation. © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.Introduction The World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, in-person course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BEC-App) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting. Methods We conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course.
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