L’utilisation des ressources numériques au temps de la COVID-19. Les points de vue d’étudiants en médecine au Royaume-Uni

The COVID-19 outbreak halted medical education in its tracks, with medical students across all years finding their upcoming placements and in-person teaching cancelled in a bid to abide to social distancing regulations, for the safety of staff, students and patients alike. As United Kingdom (UK)-based medical students, we have witnessed our medical school’s attempts to preserve our education by turning to digital technology, allowing for remote teaching over the four months. This article describes some of the steps taken across the UK to uphold education during such uncertain times and provides an insight into UK medical students’ perspectives on the prolonged and increased reliance on learning via digital technology, highlighting perceived benefits and areas for improvement. In doing so, we hope to contribute to the discussion of how digital technology may best be used in medical education in the future.L'épidémie de la COVID-19 a entraîné l’arrêt brusque de l’éducation médicale, les cours en présentiel, comme les stages prévus, se trouvant annulés pour les étudiants de tous les niveaux de formation afin de respecter les règles de distanciation sociale et de protéger le personnel, les étudiants et les patients. Étudiants en médecine au Royaume-Uni (RU), nous avons été témoins des tentatives de notre faculté de médecine de préserver notre éducation par un recours à la technologie numérique qui a rendu possible l’enseignement à distance pendant les quatre mois. Cet article décrit certaines mesures prises au Royaume-Uni pour préserver l'éducation en ces temps incertains et donne un aperçu du point de vue des étudiants en médecine de ce pays sur le recours prolongé et accru à l'apprentissage par l’intermédiaire du numérique, en soulignant les avantages perçus et les domaines à améliorer. Ce faisant, nous espérons contribuer à la discussion sur la meilleure façon d'utiliser la technologie numérique en éducation médicale à l'avenir

Management of chronic osteomyelitis of the femur and tibia: a scoping review.

Osteomyelitis refers to an inflammatory process causing bone destruction and necrosis. Managing such a persistent disease is complex, with a number of authors reporting different techniques. This scoping review aims to map and summarize the literature on treatment of chronic femoral and tibial osteomyelitis, in order to improve the reader's understanding of potential treatments and identify areas of further research.The methodological framework of the Joanna Briggs Institute was followed. A computer-based search was conducted in PubMed, EMBASE, MEDLINE, EMCARE and CINAHL, for articles reporting treatment of chronic tibial/femoral osteomyelitis. Two reviewers independently performed title/abstract and full-text screening according to pre-defined criteria.A total of 1230 articles were identified, with 40 finally included. A range of treatments are reported, with the core principles being removal of infected tissue, dead-space management and antibiotic therapy. The majority (84.5%) of patients presented with stage III or IV disease according to the Cierny-Mader classification, and Staphylococcus aureus was the most commonly isolated organism. The proportion of patients achieving remission with no recurrence during follow-up varies from 67.7-100.0%.The majority of studies report excellent outcomes in terms of infection remission and lack of recurrence. However, identifying specific patient or treatment-related factors which may affect outcomes is currently challenging due to the nature of the included studies and unclear reporting of treatment outcomes. It is now important to address this issue and identify such factors using further high-level research methods such as randomized controlled trials and comparative cohort studies. Cite this article: EFORT Open Rev 2021;6:704-715. DOI: 10.1302/2058-5241.6.200136

Genotypic and computational sequence analysis of ALADIN gene causing Allgrove syndrome

Background: Allgrove syndrome is autosomal recessive disorder, the gene involved in this syndrome is known as ALADIN located close to type 2 keratin gene cluster on chromosome 12q13 whose function is to control the nucleocytoplasmic trafficking and also affects the nuclear pore complexes. Mutation in this gene cause triple A syndrome. The aim of research was to analyze the mutational changes in ALADIN gene, formation of 3D Structure of normal and mutated protein and differentiation of normal and mutated protein.Methods: Genotyping by using tetra arm PCR and Sequence analyses of coding region of ALADIN gene was done in two families having affected children with Allgrove’s syndrome.Results: Point mutation in exon 1 and alteration in 3D structure of protein was observed by using VMD (Visual molecular dynamics) that shows truncation, absence of few amino acid and structural modification of proteins which alters in transportation ability.Conclusion: It is concluded from the study that proper structure and function of NPC (nuclear pore complex) binding protein is necessary in normal body function and if any mutation is present in ALADIN gene it can cause symptoms of rare Allgrove’s syndrome.Keywords: ALADIN gene; 3D protein structure; Triple A syndrom

Diagnostic Efficacy of MRCP and Ultrasound on Obstructive Jaundice-A Prospective Study

Background: Obstructive jaundice is a common pathological problem that occurs when there is an obstruction to the passage of conjugated bilirubin from liver cells to intestine. Bile, a digestive fluid secreted and produce by the liver. Most common cause of obstructive jaundice is due to gallstones. Objective: The aim of our study was to evaluate the diagnostic Efficacy of MRCP and Ultrasound on obstructive jaundice. Study design: A cross-sectional prospective study was performed. Material & Method: A cross-sectional prospective study was performed in 50 patients who came with the provisional diagnosis of obstructive jaundice were referred to ultrasound for primitive diagnosis and were then shifted to MRCP for a detailed diagnosis. The data was collected from the outpatient department facility of Pakistan Kidney and Liver Institute   Hospital, Lahore. After informed consent, data was collected from MRI GE 1.5 Tesla, Ultrasound Canon Xanio. Results: The results revealed that there are 50 patients of obstructive jaundice. 20 were females’ patients and 30 were males’ patients, with age raging from 20-40 years. There were 17 patients out of  50 in our study which ultrasound showed negative results that were positive on MRCP there were 28 patients that were positive on both ultrasound and MRCP. There were 3 patients that were positive on ultrasound but negative on MRCP and 2 patients that were negative on both modalities Conclusion: Our study concluded that higher ratio of males then females in our sample size, RHC was positive in all the patients with dominant cause of jaundice was stone with in biliary channel. We found that MRCP has better efficiency comparative to ultrasound to detect jaundice and its etiology i.e., 90% true positive. Keywords: Magnetic resonance cholangiopancreatography, Ultrasonography, Obstructive jaundice DOI: 10.7176/JHMN/91-03 Publication date:July 31st 202

Exploration of phenolic acid derivatives as inhibitors of SARS-CoV-2 main protease and receptor binding domain: potential candidates for anti-SARS-CoV-2 therapy

Severe acute respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the etiological virus of Coronavirus Disease 2019 (COVID-19) which has been a public health concern due to its high morbidity and high mortality. Hence, the search for drugs that incapacitate the virus via inhibition of vital proteins in its life cycle is ongoing due to the paucity of drugs in clinical use against the virus. Consequently, this study was aimed at evaluating the potentials of natural phenolics against the Main protease (Mpro) and the receptor binding domain (RBD) using molecular modeling techniques including molecular docking, molecular dynamics (MD) simulation, and density functional theory (DFT) calculations. To this end, thirty-five naturally occurring phenolics were identified and subjected to molecular docking simulation against the proteins. The results showed the compounds including rosmarinic acid, cynarine, and chlorogenic acid among many others possessed high binding affinities for both proteins as evident from their docking scores, with some possessing lower docking scores compared to the standard compound (Remdesivir). Further subjection of the hit compounds to drug-likeness, pharmacokinetics, and toxicity profiling revealed chlorogenic acid, rosmarinic acid, and chicoric acid as the compounds with desirable profiles and toxicity properties, while the study of their electronic properties via density functional theory calculations revealed rosmarinic acid as the most reactive and least stable among the sets of lead compounds that were identified in the study. Molecular dynamics simulation of the complexes formed after docking revealed the stability of the complexes. Ultimately, further experimental procedures are needed to validate the findings of this study

Does parallel projection is suitable in electrical capacitance tomography? -A comparison with common approach

Electrical Capacitance Tomography (ECT) is one of the soft field tomography that widely used for the purpose of measurement and monitoring of multiphase flow. Common problem of the soft field tomography is low quality and unstable images in the pipe especially at the center section of the pipe. In this paper, an ECT system with a comparison between common approach and a parallel approach is presented. Simulation in 2 dimensions with 16-electrode is carried out to observe a potential projection. The COMSOL Multiphysics software is used to investigate the state and response of the electric field with this approach by exporting data with 128x128 pixels. Air bubbles as a phantom in the oil medium have been tested and analyzed. Linear Back-Projection Algorithm (LBP) is implemented using MATLAB software to obtain a tomogram. A Multi Scale Structural Similarity, MSSIM was applied to compare both approaches. Consequently, the resolution and quality of the pictures in the pipes can be distinguished. However, a further investigation is needed to improve the parallel approach for ECT system

Does parallel projection is suitable in electrical capacitance tomography

Electrical Capacitance Tomography (ECT) is one of the soft field tomography that widely used for the purpose of measurement and monitoring of multiphase flow. Common problem of the soft field tomography is low quality and unstable images in the pipe especially at the center section of the pipe. In this paper, an ECT system with a comparison between common approach and a parallel approach is presented. Simulation in 2 dimensions with 16-electrode is carried out to observe a potential projection. The COMSOL Multiphysics software is used to investigate the state and response of the electric field with this approach by exporting data with 128x128 pixels. Air bubbles as a phantom in the oil medium have been tested and analyzed. Linear Back-Projection Algorithm (LBP) is implemented using MATLAB software to obtain a tomogram. A Multi Scale Structural Similarity, MSSIM was applied to compare both approaches. Consequently, the resolution and quality of the pictures in the pipes can be distinguished. However, a further investigation is needed to improve the parallel approach for ECT system

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe