Support infrastructure available to Canadian residents completing post-graduate global health electives: current state and future directions

Background: Global health electives offer medical trainees the opportunity to broaden their clinical horizons. Canadian universities have been encouraged by regulatory bodies to offer institutional support to medical students going abroad; however, the extent to which such support is available to residents has not been extensively studied.Methods: We conducted a survey study of Canadian universities examining the institutional support available to post-graduate medical trainees before, during, and after global health electives.Results: Responses were received from 8 of 17 (47%) Canadian institutions. Results show that trainees are being sent to diverse locations around the world with more support than recommended by post-graduate regulatory bodies. However, we found that the content of the support infrastructure varies amongst universities and that certain components—pre-departure training, best practices, risk management, and post-return debriefing—could be more thoroughly addressed.Conclusion: Canadian universities are encouraged to continue to send their trainees on global health electives. To address the gaps in infrastructure reported in this study, the authors suggest the development of comprehensive standardized guidelines by post-graduate regulatory/advocacy bodies to better ensure patient and participant safety. We also encourage the centralization of infrastructure management to the universities’ global health departments to aid in resource management. 

Terretonin N: A New Meroterpenoid from Nocardiopsis sp.

Hamed A, Abdel-Razek AS, Frese M, et al. Terretonin N: A New Meroterpenoid from Nocardiopsis sp. Molecules. 2018;23(2): 299.Terretonin N (1), a new highly oxygenated and unique tetracyclic 6-hydroxymeroterpenoid, was isolated together with seven known compounds from the ethyl acetate extract of a solid-state fermented culture of Nocardiopsis sp. Their structures were elucidated by spectroscopic analysis. The structure and absolute configuration of 1 were unambiguously determined by X-ray crystallography. The isolation and taxonomic characterization of Nocardiopsis sp. is reported. The antimicrobial activity and cytotoxicity of the strain extract and compound 1 were studied using different microorganisms and a cervix carcinoma cell line, respectively

Bacterial Diseases Affecting the Cultured Sepia Officinalis Leading to Increase Mortality Rates in The Laboratory

The early growth, mortality rates and bacterial infections of the cultured Sepia Officinalis were experimentally studied in the laboratory. Two hundred eighty-five sepia larvae were hatched and placed in a 100-liter capacity rectangular glass aquarium (filled with seawater) in the laboratory. The Sepia individuals (285 individuals) were divided into two groups the first fed on a mixture of amphipods, rotifers and artemia and the second group fed only on amphipods to follow their growth and mortality. The second group was observed to grow faster with length 6.76 ± 0.06mm and weight 0.11 ± 0.01gm than the first one. The survival rate was 100% by the end of the first week and decreased gradually by the end of the second week. The recorded mortality rate reached 49% by the day 15th, where they infected with bacterial disease of Vibrio alginolyticus. The clinical signs of the diseased S. Officinalis were lethargic condition, food fasting and multiple skin ulcers with white-gray discoloration were observed and appeared on the body. The main postmortem lesions were congestion of the internal organ, beside the presence of ascetic fluid. The mortality among the diseased Sepia was increased by age; however, it may cause death of most individuals by increasing time more than two weeks. The findings of antibiotic sensitivity test cleared that the isolated V. alginolyticus was sensitive to amoxiclav (amoxicillin-clavulanate), streptomycin, ciprofloxacin and chloramphenicol. Controversially, it was resistant to oxytetracycline, tobramycin, gentamycin and enrofloxacin

Bacterial Diseases Affecting the Cultured Sepia Officinalis Leading to Increase Mortality Rates in The Laboratory

The early growth, mortality rates and bacterial infections of the cultured Sepia Officinalis were experimentally studied in the laboratory. Two hundred eighty five sepia larvae were hatched and placed in a 100 liter capacity rectangular glass aquarium (filled with seawater) in the laboratory. The Sepia individuals (285 individuals) were divided into two groups the first fed on a mixture of amphipods, rotifers and artemia and the second group fed only on amphipods to follow their growth and mortality. The second group was observed to grow faster with length 6.76 ± 0.06mm and weight 0.11 ± 0.01gm than the first one. The survival rate was 100% by the end of the first week and decreased gradually by the end of thesecond week. The recorded mortality rate reached 49% by the day 15th, where they infected with bacterial disease of Vibrio alginolyticus. The clinical signs of the diseased S. Officinalis were lethargic condition, food fasting and multiple skin ulcers with white-gray discoloration were observed and appeared on the body. The main post mortem lesions were congestion of the internal organ, beside the presence of ascetic fluid. The mortality among the diseased Sepia was increased by age; however it may causes death of most individuals by increasing time more than two weeks. The findings of antibiotic sensitivity test cleared that the isolated V. alginolyticus was sensitive to amoxiclav (amoxicillin-clavulanate), streptomycin, ciprofloxacin and chlormphinicol. Controversially, it was resistant to oxytetracycline, tobramycin, gentamycine and enrofloxacin.Keywords: Sepia Officinalis - growth rate - mortality rate - bacterial infection

The open abdomen in trauma and non-trauma patients : WSES guidelines

Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a "planned second-look" laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.Peer reviewe

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112