A Narrative Review on Disinfection Tunnel for Covid-19: A Friend or Foe?

Abstract T The use of a disinfection tunnel has become increasingly popular to eliminate the Covid-19 on the body particularly during the pandemic, however insufficient attention paid to its effectiveness and safety. We undertake a narrative review on the disinfection tunnel and evaluate their effectiveness and safety. The keyword searches of Medline, EMBASE, PubMed, EBM reviews database and manual searches of Google Scholar and US Food and Drug Administration (USFDA) was used. An analysis of the papers reviewed were categorized into three main themes: technical design of disinfection tunnel; effectiveness of disinfectant used; and safety or harmful effect. To date, no relevant specific scientific studies or evidence retrieved about disinfection tunnel for public usage including effectiveness and safety. We found a various designs of disinfection in the market today. It mainly originated from an innovative idea to assist in limiting the spread of Covid-19. However, current available evidence does not support its effectiveness and safety. Although it may lead to a false sense of security, this potential approach appears attractive thus creates an opportunity for further research

The Role of Technology Advancement in Improving the Current Practice of Ambulance Decontamination in Malaysia: A Scoping Review

Abstract In Malaysia, the current methodology for decontaminating ambulances is by manually cleaning surfaces with Environmental Protection Agency (EPA) approved disinfecting solutions as contrast to previous practice using water and soap. The solutions used are registered with National Pharmaceutical Regulatory Agency (NPRA) Ministry of Health Malaysia (NPRA) to ensure adherence to international standard of practice.  The manual decontamination practices are effective if strictly conducted following guidelines. However, the proper cleaning and decontamination of an ambulance is an important task that frequently overlooked. It creates a risk to healthcare providers and their patients for subsequent ambulance trip. To ensure the patient compartment is absent from multitudes of infectious pathogen especially Covid-19, is not only an escalating challenge for healthcare providers as it is an unseen, but also poses a real threat to them and their patient. The healthcare managers should consider technologies that can provide a safer, effective and more efficient cleaning and decontamination of an ambulances. We proposed to adapt a new approach of decontamination by using a vapour based disinfection method coupled with germicidal enhancement using ultra violet. It utilizes an EPA-approved hospital disinfectant to decontaminate surfaces in the patient care compartment after every patient transport. A nozzle, placed inside the patient care compartment, disperses a mist of disinfectant solution that designed to meet standard requirement. The enhancement of germicidal effect using an ultra violet ray will disinfect and ensure a free patient compartment from an infectious organism. This decontamination system directly integrated into a new or existing ambulance. It is convenient, timesaving, hands-off solution for decontaminating of an ambulance and importantly creates a safer practice. Keywords: Ambulance service, decontamination, Vapour-based, safe practice

A Potentially Disastrous Life -Threatening Complication of Emergency Tube Thoracostomy in A Simple Case of Spontaneous Pneumothorax

Emergency tube thoracostomy carries risks of infective and technical complications. The aseptic technique is essential to prevent infections, while blunt dissection method can minimise the associated technical complications. Preparation and adherence to protocols as well as appropriate knowledge and skills, however, are of utmost importance to reduce risks of complications. Physicians must have adequate knowledge of anatomy and the procedure to ensure for accurate site tube placement without any complication. This case illustrates how a failure to appropriately use the instrument resulted in a displaced scalpel blade inside the thoracic cavity. It caused an unnecessary thoracotomy for blade retrieval. The mishap escalated a simple procedure to the potentially disastrous life-threatening event

Nafas.Co: Pico Paint / Mohd Najib Kamarudin ...[et al.]

Our company sells Pico Paint to reduce burden that students facing while doing their project. Our project is made up from a mixture of 50 ml of acrylic paint with 50 ml of water which widely used to spray paint onto small surface area object

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The Beautiful Mind : A Case Report

Caring for a family member diagnosed with schizophrenia will not only impart a lifetime of emotional distress but also social and financial challenges. Failure to anticipate and cope with the burden of care responsibilities will add unnecessary risk to permanent injury resulting in substandard management of the patient and even death. We describe a case of successful removal of nine (9) constricting rings from the finger of both hands in a poorly taken care of an abusive relapse schizophrenia patient using an oscillating saw and ring cutter under procedural sedation combined with wrist block in the emergency department (ED). Early recognition and definitive treatment are of paramount importance to avoid irreversible ischemia and gangrene. The possible risk of negligence should be kept in mind bearing a link with depression among members caring for schizophrenia. Keywords: Schizophrenia, Emergency Department, Negligence, Early recognitio

A case report: The beautiful mind

Caring for a family member diagnosed with schizophrenia will not only impart a lifetime emotional distress but also social and financial challenge. Failure to anticipate and cope with the burden of care responsibilities will add an unnecessary risk to permanent injury resulting in a substandard management of the patient and even death. We describe a case of successful removal of nine (9) constricting rings from the finger of both hands in a poorly taken care of an abusive relapse schizophrenia patient using an oscillating saw and ring cutter under prosedural sedation combined with wrist block in emergency department (ED). Early recognition and a definitive treatment are of paramount importance in order to avoid irreversible ischemia and gangrene. The possible risk of negligence should be kept in mind bearing a link with depression among members caring for schizophrenia

Psychological impact of polygamous marriage on women and children: a systematic review and meta-analysis

Background: Over the last two decades, there has been significant growth in public, political, and academic awareness of polygamy. Polygamous families have distinct household problems, usually stemming from jealousy between co-wives over the husband’s affections and resources. This study aimed to ascertain the psychological impact of polygamous marriage on women and children worldwide. Methods: A systematic search was performed in MEDLINE (PubMed), Scopus, CINAHL (EBSCOhost), Google Scholar, and ProQuest using search terms such as “marriage” and “polygamy.” Studies published from the inception of the respective databases until April 2021 were retrieved to assess their eligibility for inclusion in this study. The Joanna Briggs Institute Critical Appraisal Checklist was used for data extraction and the quality assessment of the included studies. The generic inverse variance and odds ratios with 95% confidence intervals (CI) were calculated using RevMan software. Results: There were 24 studies fulfilling the eligibility criteria, and 23 studies had a low risk of bias. The pooled meta-analysis showed women in polygamous marriages had a 2.25 (95% CI: 1.20, 4.20) higher chance of experiencing depression than in monogamous marriages. Children with polygamous parents had a significantly higher Global Severity Index with a mean difference of 0.21 (95% CI: 0.10, 0.33) than those with monogamous parents. Conclusions: The psychological impact of polygamous marriage on women and children was found to be relatively higher than monogamous marriage. Awareness of the proper practices for polygamy should be strengthened so that its adverse effects can be minimized. The agencies involved in polygamous practices should broaden and enhance their understanding of the correct practice of polygamy