Eliminating dog-mediated rabies: challenges and strategies

Rabies is an acute encephalitis caused by a lyssavirus. It is primarily transmitted through bites of infected dogs which results in the worldwide death of an estimated 59000 humans every year. The disease is preventable through the application of post-exposure prophylaxis (PEP) and its elimination has been demonstrated in many countries by applying multiple interventions simultaneously. Nonetheless, rabies is still widespread in many developing countries, primarily due to the poor implementation of intervention strategies that include inadequate dog-bite wound management practices, unavailability/unaffordability of PEP by the communities, failure to control the disease in free-roaming dogs and wildlife, improper dog population management, weak surveillance and diagnostic facilities and a lack of a One Health approach to the disease. In this review, strategies to control dog-mediated rabies through a One Health approach were discussed. We recommend applying multiple interventions against the disease by involving all the concerned stakeholders in selected urban and rural areas of the countries where rabies is endemic. An empirical demonstration of disease freedom in the selected areas through a One Health approach is needed to convince policymakers to invest in rabies prevention and control on the national level. This multifaceted One Health control model will enhance the likelihood of achieving the goal of global rabies eradication by 2030.

The effect of multiple interventions to balance healthcare demand for controlling COVID-19 outbreaks: a modelling study

For controlling recent COVID-19 outbreaks around the world, many countries have implemented suppression and mitigation interventions. This work aims to conduct a feasibility study for accessing the effect of multiple interventions to control the COVID-19 breakouts in the UK and other European countries, accounting for balance of healthcare demand. The model is to infer the impact of mitigation, suppression and multiple rolling interventions for controlling COVID-19 outbreaks in the UK, with two features considered: direct link between exposed and recovered population, and practical healthcare demand by separation of infections. We combined the calibrated model with COVID-19 data in London and non-London regions in the UK during February and April 2020. Our finding suggests that rolling intervention is an optimal strategy to effectively control COVID-19 outbreaks in the UK for balancing healthcare demand and morality ratio. It is better to implement regional based interventions with varied intensities and maintenance periods. We suggest an intervention strategy named as “Besieged and rolling interventions” to the UK that take a consistent suppression in London for 100 days and 3 weeks rolling intervention in other regions. This strategy would reduce the overall infections and deaths of COVID-19 outbreaks, and balance healthcare demand in the UK.

Hyperextension Malunion of the Distal Humerus - Chevron Osteotomy: A Case Report

"Treatment of hyperextension malunions of the distal humerus is done by osteotomy, several types being described in the literature. The aim of the paper is to highlight the possibility of using Chevron-type osteotomy in sagittal malunions of the distal humerus shaft. The patient presented in this case report has suffered multiple interventions after a 13C1 AO/OTA fracture of her right arm. When the malunion was identified her range of motion (ROM) was 40-90 degrees flexion. We have performed a supracondylar sagittal Chevron osteotomy at a 30 degrees angle open anteriorly. After the surgery, her ROM improved to 40-135 degrees flexion. The authors chose the Chevron osteotomy because it created an increased area (by 30%) of the interface between the two fragments and offers a good rotational stability. Unfortunately, information in the literature is limited and future studies must be done to endorse the usage of Chevron osteotomy in hyperextension malunion of the distal humerus."

35 Years Angiographic Follow Up Of Atherosclerotic Cardiovascular Disease Including Redo Cabg, Carotid Artery Stenting & Multiple Interventions To Saphenous Venous Grafts

Percutaneous coronary intervention (PCI) has got more benefit as compared to redo CABG in terms of morbidity & mortality in patients presented with degenerated CABG grafts. We report a case of post CABG patient treated successfully with multiple PCI to SVG grafts- a 35 years follow up.

COVID-19 Pandemic - A Review and Assessing Higher Education Institution Undergraduate Student’s Mental Health

Introduction: The current COVID-19 pandemic has sequelae reverberating around Malaysia, particularly in university students, as Malaysian university students are isolated in their university campuses in semi-quarantine status. This article seeks to review the existing literature on the specialized issue of university student-related psychological sequelae of COVID-19, and seeks to offer some recommendations through the process. Methods: Existing literature demonstrates that COVID-19 has affected university students psychosocially, with the rate of anxiety and depression markedly increased. There have been significant alterations of lifestyle related to education, in accordance with the new normal, resulting in isolation and feelings of disengagement with education. Moreover, with the current uncertainties regarding their studies and possible financial depression postpandemic, the future is deeply worrying and will adversely affect their mental health. Results: Quantitatively, recent findings indicate 33.3% of the undergraduates in a higher education institution are noted to be in stress. Therefore, multiple interventions have been implemented; a customized ultra-brief psychological module, an online tele psychiatry hotline (COVID Cares) and tele-counselling, which have received universally positive feedback. Conclusion: In conclusion, the review demonstrates that undergraduates’ psychological health is an aspect that needs urgent attention as it is not merely limited to the fear of COVID-19, but also related to the social aspects of the pandemic. Multiple interventions have been seen to be efficacious in reducing the psychological sequelae.

Concepto de riesco: (dis)continuidades entre corrientes epidemiológicas

In the present study we analyze if the risk concept of the hegemonic epidemiologychanges its nature in purportedly alternative currents as ecoepidemiology and socialepidemiology focused in multilevel analysis.We analyze the way this concept is distinguishedin every current and its relationship with other epidemiologic key notions as cause. We findthat the risk concept and the notion of cause remain relatively unchanged among the differentcurrents even when there is some theoretical discussion about the complexity of multilevelsystems and other explanations for the events. Finally we discuss some consequences aboutthe appropriation of the risk concept in multiple interventions in the health field. We indicatethat the fragmented nature of the risk concept is problematic because it can make thesocial aspects of the disease considered only in a functional perspective. Alternatively to thatwe develop the vulnerability concept as a knowledge framed in a hermeneutical perspective.The vulnerability concept acts as a mediator knowledge between epidemiology and theinterventions in the health field. In the same way we point out some concerns from the anthropologicalfield about the simplification of social senses and omission of meanings aboutthe health of the communities.

Gaining momentum in colorectal surgical site infection reduction through a human factors engineering approach

Surgical site infection (SSI) prevention requires multiple interventions packaged into “bundles.” The implementation of all bundle elements is key to the bundle’s efficacy. A human-factors engineering approach can be used to identify key barriers and facilitators to implementing elements and develop recommendations for bundle implementation within the clinical work system.