How to Deal with Skin Biopsy in an Infant with Blisters?

The onset of blisters in a neonate or an infant is often a source of great concern for both parents and physicians. A blistering rash can reveal a wide range of diseases with various backgrounds (infectious, genetic, autoimmune, drug-related, traumatic, etc.), so the challenge for the dermatologist and the pediatrician is to quickly determine the etiology, between benign causes and life-threatening disorders, for a better management of the patient. Clinical presentation can provide orientation for the diagnosis, but skin biopsy is often necessary in determining the cause of blister formations. In this article, we will provide information on the skin biopsy technique and discuss the clinical orientation in the case of a neonate or infant with a blistering eruption, with a focus on the histology for each etiology.

Language and culture in speech-language and hearing professions in South Africa: Re-imagining practice

South African speech-language and hearing (SLH) professions are facing significant challenges in the provision of clinical services to patients from a context that is culturally and linguistically diverse (CLD) due to historic exclusions in higher education training programmes. Over 20 years postapartheid, little has changed in training, research, as well as clinical service provision in these professions. In line with the Health Professions Council of South Africa’s (HPCSA) SLH Professional Board’s quest to transform SLH curriculum and in adherence to its recently published Guidelines for Practice in a CLD South Africa, in this review article, the authors deliberate on re-imagining practice within the African context. They do this within a known demand versus capacity challenge, as well as an existing clinician versus patients CLD incongruence, where even the clinical educators, a majority of whom are not African, are facing the challenge of an ever more diverse student cohort. The authors systematically deliberate on this in undergraduate clinical curriculum, challenging the professions to interrogate their clinical orientation with respect to African contextual relevance and contextual responsiveness (and responsibility); identifying gaps within clinical training and training platforms; highlighting the influencing factors with regard to the provision of linguistically and culturally appropriate SLH clinical training services and, lastly, making recommendations about what needs to happen. The Afrocentric Batho Pele principles, framed around the concept of ubuntu, which guide clinical intervention within the South African Healthcare sector, frame the deliberations in this article.

A Simple Technique for Image-Guided Excision of Non-Palpable Breast Lesions without Needle Localisation in a Low-Resource Environment – a Preliminary Report of 10 Patients

Focus on early diagnosis of non-palpable breast cancers has frequently led to expensive interventions that are more challenging in low-resource environments. We examined the use of a simple, inexpensive technique more suited for these environments, presenting preliminary data on its applicability. In 10 consecutive patients with radiologically suspicious non-palpable breast lesions, we used skin markers and breast reference points generated through ultrasound images and clinical orientation to guide location of surgical incisions for excising these lesions in the operating room. This resulted in accurate localisation and complete excision of these lesions without the need for more sophisticated, expensive interventions, making this technique potentially more applicable in low-resource environments, such as ours.

CLINICAL ORIENTATION OF SOCIAL SUPPORT FOR FAMILIES WITH CHILDREN IN DIFFICULT LIFE SITUATIONS

Рассмотрен феномен социального сопровождения семьи с детьми в контексте концепта клинической направленности социальной работы. Обоснована детерминированность поиска и привлечения ресурсов и способов преодоления сложного жизненного сценария семьи как уникального случая. Охарактеризована интегративная мультидисциплинарная организация помогающей практики, многоаспектность профессиональной деятельности специалиста, реализующего функции социального сопровождения семьи с детьми в трудной жизненной ситуации. The article considers the phenomenon of social support for families with children in the context of the concept of clinical orientation of social work. The determinism of the search and attraction of resources and ways to overcome the complex life scenario of the family as a unique case is justified. The article describes the integrative multidisciplinary organization of the helping practice, the multidimensional nature of the professional activity of a specialist who performs the functions of social support for a family with children in a difficult life situation.

What if HCM Risk-SCD was assessed with CMR maximum LV wall thickness measurements?

Funding Acknowledgements Type of funding sources: None. Introduction The HCM Risk-SCD estimates the risk of sudden cardiac death at 5 years in patients (pts) with hypertrophic cardiomyopathy (HCM). According to ESC Guidelines, in pts with a 5-year risk of SCD <4%, an implantable cardioverter defibrillator (ICD) is generally not indicated, in pts with a risk of 4 to less than 6%, an ICD may be considered and in pts with a 5-year risk ≥6%, an ICD should be considered. The association between the degree of LVH and sudden cardiac death (SCD) has been based on measurements of maximum LVWT by echocardiography which is part of HCM Risk-SCD score. However, cardiac magnetic resonance (CMR) has shown a superior resolution in characterization of cardiac structures, with additional role in SCD risk stratification. Whether measurements of LVWT by echocardiography and CMR are interchangeable has been brought to question. Purpose We sought to evaluate the incidence of discrepant measurements of maximal LVWT between echocardiography and CMR and determine its implication in HCM Risk-SCD score and ICD indication. Methods Unicentric, retrospective analysis of pts submitted to CMR who had HCM as definitive diagnosis, between 1/2013 and 9/2019. CMR and echocardiographic measures were compared, as well as HCM Risk-SCD score calculated with these values (maximum LVWT was the only variable that differed between measures). Subsequently, pts were divided in three groups according to HCM Risk-SCD score: pts with a 5-year risk of SCD <4% (G1), risk of 4 to less than 6% (G2) and risk ≥6% (G3). Results Out of the 781 CMR studies evaluated, 59 pts were found to have HCM (7.6%) with mean age of 62 ± 11 years and female predominance (50.8%). 12 pts had obstructive phenotype (20.3%). Mean LVWT was 20.0 ± 4.6mm when measured by CMR and 18.8 ± 4.6mm by echo; when comparing the measures by echo with CMR, there was a positive correlation between them (p < 0.001; r 0.719). Mean HCM Risk-SCD was 2.80 ± 1.51% when measured by CMR and 2.69 ± 1.53% by echo; there was a positive correlation between these measures too (p < 0.001; r 0.963). Maximum LV thickness evaluated by CMR showed a positive correlation (p = 0.006, r 0.384) with the HCM risk-score assessed by CMR. Only 1 pt changed risk group with CMR measurement of maximum LVWT (from G1 to G2). Conclusion: In this cohort, there was a positive, linear relationship between maximum LVWT and HCM Risk-SCD score measured by CMR and echocardiogram. Only 1 pt changed risk stratification group (5-year risk of SCD <4% to 4 to less than 6%). Although CMR measurements, when interpreted correctly, are more precise compared with echocardiography, in this cohort there was no impact on the patient"s future clinical orientation regarding ICD implantation.

Recovery from corona virus 19

The extreme intense breathing disorder coronavirus 2 pandemic features phenomenal emergency care utilities. The gigantic number of coronavirus sickness (coronavirus) case in the US had brought about a huge populace of survivor with delayed after septic indications. The making of integrative present coronavirus facilities on location both diligent manifestations and potential long hau care requirement needed comprehension of the intense sickness and the awakening information with respect to coronavirus results. Involvement in serious, intense breathing disorder and mid breathing state, after-intense breathing trouble disorder intricacies, and after-escalated care state additionally adverses foreseen sequelae and clinical orientation plan. After-corona virus clinical projects should be set up to think about people recently hospital with coronavirus (counting the individuals who needed basic consideration to uphold), nonhospital people with determined breathing side effects following coronavirus, and people with previous lung infection confounded by a coronavirus. Viable integrative joint effort models influence caretaking picked up at the time of the beginning stages of the pandemic to beat the exceptional strategic emergency care requirement presented by pandemic states. A coordinated effort among doctors and analysts across orders will give understanding into outlastership that may shape the therapy of both intense sickness and ongoing emergency care requirement. In a survey, we examine the points, general standards, components of a plan, and emergency care requirement of a fruitful integrative model to address the needed menus of coronavirus outlasts. Coordinated efforts required by doctors and survivors to overcome the extreme intense situation. Recovery of outlasters depends upon coordinated efforts of doctors and survivors. Recovery from the coronavirus is a delayed course of action. Risk factors and comorbidities are equally prime.

Escape Room Blueprint: Central Orientation Contagion Crisis

Background: Turnover rate for new graduate nurses at a midwestern community hospital was 30% for the first two years. Central clinical orientation for new hire registered nurses and care assistants was heavily executed via didactic format. Feedback from instructors suggested boredom and disengagement of learners during these sessions. Post central orientation evaluations resulted in 49% of attendees feeling not “very confident” to apply skills in clinical practice. Methods: Clinical educators created an escape room to improve learner satisfaction, interprofessional communication, and confidence in applying skills in practice. A convenience sample of twenty-three (23) registered nurses and care assistants participated in an escape room, Contagion Crisis, covering basic knowledge of infection control, emergency response, restraints, and drug calculation. Results: Average Likert scores on the post survey for satisfaction and communication were 4.67 and 4.0 respectively. Confidence in applying skills to practice averaged 4.72. Subjective feedback from participants included enjoyment of a fun, non-pressure environment. Conclusion: Multiple clinical disciplines can use this escape room, as it covers topics from central hospital orientation. Learners preferred the escape room format versus a high-fidelity simulation, due to it being less “high stakes” and not a judgement of individual performance.

TO THE 100th ANNIVERSARY OF THE DEPARTMENT OF THE HUMAN ANATOMY OF THE OMSK STATE MEDICAL UNIVERSITY

The article describes the history of the Department of Human Anatomy at Omsk State Medical University. At the stages of its formation, the continuity, preservation and enhancement of the traditions of the Russian anatomical school are traced. It is noted that in the training of doctors, the staff of the department adheres to a reasonable combination of traditional anatomical methods with innovations and modernization of the educational process. Brief biographies, scientific and pedagogical staffs of the heads of the department are presented and the team of teachers at each stage during the centuries-old history is characterized. In teaching of students, the department implements onto- and phylogenetic principles, a functional approach, the doctrine of individual variability, and the clinical orientation of teaching. The main scientific areas of research of the department staff are the study of individual, age-related topographic and projection features of organs and other anatomical structures on the skeleton and skin of the human body, experimental and clinical lymphology and angiology, and the development of the museum.