Systematic review of e-learning for surgical training

BACKGROUND

Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. Despite widespread use, there is limited evidence to support their effectiveness for surgical training. This study sought to evaluate the effectiveness of e-learning as a teaching tool compared with no intervention and other methods of surgical training.

METHODS

A systematic literature search of bibliographical databases was performed up to August 2015. Studies were included if they were RCTs assessing the effectiveness of an e-learning platform for teaching any surgical skill, compared with no intervention or another method of training.

RESULTS

From 4704 studies screened, 87 were included with 7871 participants enrolled, comprising medical students (52 studies), trainees (51 studies), qualified surgeons (2 studies) and nurses (6 studies). E-learning tools were used for teaching cognitive (71 studies), psychomotor (36 studies) and non-technical (8 studies) skills. Tool features included multimedia (84 studies), interactive learning (60 studies), feedback (27 studies), assessment (26 studies), virtual patients (22 studies), virtual reality environment (11 studies), spaced education (7 studies), community discussions (2 studies) and gaming (2 studies). Overall, e-learning showed either greater or similar effectiveness compared with both no intervention (29 and 4 studies respectively) and non-e-learning interventions (29 and 22 studies respectively).

CONCLUSION

Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training.

Silage effluent management: a review

Silage effluent is a potent wastewater that can be produced when ensiling crops that have a high moisture content (MC). Silage effluent can cause fish-kills and eutrophication due to its high biochemical oxygen demand (BOD) and nutrient content, respectively. It has a high acidity (pH ≈ 3.5-5) making it corrosive to steel and damaging to concrete, which makes handling, storage and disposal a challenge. Although being recognized as a concentrated wastewater, most research has focused on preventing its production. Despite noted imprecision in effluent production models-and therefore limited ability to predict when effluent will flow-there has been little research aimed at identifying effective reactive management options, such as containment and natural treatment systems. Increasing climate variability and intensifying livestock agriculture are issues that will place a greater importance on developing comprehensive, multi-layered management strategies that include both preventative and reactive measures. This paper reviews important factors governing the production of effluent, approaches to minimize effluent flows as well as treatment and disposal options. The challenges of managing silage effluent are reviewed in the context of its chemical constituents. A multi-faceted approach should be utilized to minimize environmental risks associated with silage effluent. This includes: (i) managing crop moisture content prior to ensiling to reduce effluent production, (ii) ensuring the integrity of silos and effluent storages, and (iii) establishing infrastructure for effluent treatment and disposal. A more thorough investigation of constructed wetlands and vegetated infiltration areas for treating dilute silage effluent is needed. In particular, there should be efforts to improve natural treatment system design criteria by identifying pre-treatment processes and appropriate effluent loading rates. There is also a need for research aimed at understanding the effects of repeated land application of effluent on soil quality and crop yields, as spreading is a common disposal practice.

Improving the prognosis of pediatric Hodgkin lymphoma in developing countries: a Moroccan Society of Pediatric Hematology and Oncology study

BACKGROUND

The event-free survival (EFS) of children with Hodgkin lymphoma (HL) exceeds 80% in high income countries (HIC), but little is known about this rate in developing countries.

PROCEDURE

A prospective national protocol for children with classical HL was implemented in Morocco to increase EFS by careful risk stratification, providing each cycle of therapy on time, decreasing treatment abandonment, improving communication among healthcare providers, and improving data collection. Patients were stratified into a favorable risk group (Ann Arbor stages I and II, no B symptoms, no bulky disease, and no contiguous (E) lesions) and received four cycles of vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) or an unfavorable risk group (all others) who received two cycles of vincristine, procarbazine, prednisone, and doxorubicin (OPPA) and four cycles of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP). All patients received involved-field radiotherapy 25.5 Gy after completion of chemotherapy. EFS was calculated counting death, relapse/resistant disease, and abandonment as events.

RESULTS

From February 2004 to December 2007, 160 patients enrolled; 138 (86%) had unfavorable risk features. Twenty patients (12.5%) abandoned treatment, 16 relapsed or had resistant disease, and 6 died (3 unexplained, 2 varicella, and 1 suicide). The estimated 5-year EFS was 70 ± 4% and overall survival 88 ± 3%.

CONCLUSIONS

Good outcomes for pediatric HL patients can be achieved in LMIC using a multidisciplinary team approach, uniform protocol-based therapy, twinning partnership among oncology units in-country and abroad, and a data collection system to monitor compliance and identify gaps in care.

Vector ecology and susceptibility in a malaria-endemic focus in southern Islamic Republic of Iran

This study aimed to carry out a malaria situation analysis, species composition and susceptibility levels of the main malaria vector, Anopheles stephensi, to different insecticides in Bashagard. A longitudinal survey was conducted in 2 randomly selected villages in Bashagard. Malaria vectors were sampled by dipping method for the larvae and hand catch, night-biting catch, total catch, and shelter pit collection for the adults. Standard WHO susceptibility tests were used for a variety of insecticides on F1 progeny of An. stephensi reared from wild-caught females. In total, 693 adult anopheline mosquitoes and 839 third and fourth-instar larvae were collected and identified. They comprised 7 species; the most abundant adult and larvae anopheline mosquito was An. dthali (40.7% and 30.5% respectively). An. culicifacies (24.2%) and An. stephensi (16.7%) were the next most common species for adult mosquitoes. An. stephensi was fully susceptible to malathion and pyrethroid insecticides but resistant to DDT and tolerant to dieldrin.

Extramedullary plasmocytoma relapsing at differents sites: an unusual presentation

Extramedullary plasmacytoma (EMP) is an uncommon plasma cell neoplasm results from plasma cell proliferation and consists of monoclonal plasmacytic infiltration, without bone marrow involvement and any other systemic characteristics of multiple myeloma. EMP accounts for 3% of all plasma cell neoplasms and approximately 80% to 90% of EMP involve submucosa of the upper aerodigestive, while scrotal, dermis and retroperitoneal infiltration are very rare. There are no consensus guidelines for treatment, but EMP is highly radiosensitive, surgery may be considered for some sites, but 11 at 30% can progress in multiple myeloma. We report here an exceptional case of recurrent EMP in much localization. It's about a man 72 years old with initially testicular plasmocytoma who generalized the plasmacytic infiltration after 16 months in skin and progressively in mediastinal and retroperitoneal plasmacytoma, without any medullar and bone involvement.

Evaluating the resistance of eimeria spp. Field isolates to anticoccidial drugs using three different indices

BACKGROUND

In this study, the presence of resistance to diclazuril, amprolium+ethopabate and salinomycin, representing some of the commonest anticoccidials in Iran's poultry industry, against three mixed Eimeria field isolates were investigated.

METHODS

Three Eimeria field isolates, collected from typical broiler farms in Iran, were propagated once, inoculated to 480 broilers, comprising 30 chicks in each treatment. The non-medicated or medicated diets containing one of the above mentioned anticoccidials were provided ad-lib. Drug efficacy was determined using the Global index (GI), Anticoccidial Sensitivity Test (AST) and Optimum Anticoccidial Activity (OAA).

RESULTS

None of the field isolates were fully sensitive to the selected anticoccidials. All isolates showed reduced sensitivity/partial resistance to salinomycin. Resistance to amprolium+ethopabate was evident and partial to complete resistance was recorded for diclazuril.

CONCLUSION

Limited efficacy of the selected anticoccidials is obvious. Considering the cost of continuous use of anticoccidials in the field, altering the prevention strategy and rotation of the anticoccidials with better efficacy, would prevent further economic losses induced by coccidiosis.

Field evaluation of permethrin long-lasting insecticide treated nets (Olyset(®)) for malaria control in an endemic area, southeast of Iran

Long lasting insecticide treated nets (LLINs) have been advocated as an effective tool for prevention and control of malaria. Olyset net was the first LLINs which became commercially available and obtained WHO approval. According to the national strategic plan on evaluation of Olyset net, a field trial was conducted to determine the efficacy of these nets against malaria vectors in an endemic area in the southeast of Iran. Fourteen villages with similar topographical and epidemiological situations were selected and randomly assigned to two clusters of the study: Olyset net and untreated net. Distribution of nets was carried out to cover 100% of the population in Olyset net and untreated net cluster. Anopheline mosquitoes were collected monthly using different WHO standard methods in both areas to determine their abundance, feeding pattern and resting behaviour. Human blood index was determined using ELISA test. Additionally, Olyset nets were evaluated for their biological activity using WHO cone bioassay test by susceptible colony of Anopheles stephensi (Beech strain) and then for insecticide residues by employing high performance thin layer chromatography. Malaria incidence was measured by passive and active case detection from all study population. In total 2115 adult anopheline mosquitoes were collected and identified using morphological characters. They comprised of seven species: Anopheles dthali (Liston), A. culicifacies (Giles), A. stephensi (Liston), A. superpictus (Grassi), A.fluviatilis (James), A. moghulensis (Christophers) and A. turkhudi (Liston). A. dthali, A. culicifacies and A. stephensi were most prevalent species in both areas. In the Olyset net study area, there was a significant reduction of 41.1%, 54.4%, 59.39% and 64.1% in the indoor-resting density of A. culicifacies, A. stephensi, A. dthali and A. superpictus, respectively, with an overall reduction of 39.3% in total mosquitoes in comparison with untreated net area. A significant reduction was also observed in human blood index of vector species in the Olyset net villages. Bioefficacy test results of Olyset nets showed that the median knockdown time was 1.48 and 3.25min, while the average mortality rate was 100% and 72.3%±7.07 in baseline and after 1 year of intervention, respectively. The average permethrin content reached to 68.31% (683.1mg/m(2)) of the initial insecticide dose of 937±21.69mg/m(2) (nearly 1000mg/m(2)) at the end of intervention. Malaria incidence was reduced by 96.6% and 64.8% in the village with Olyset nets and in the villages with untreated nets, respectively. During intervention period, there was a reduction of 93.2% in malaria incidence in Olyset net area as compared to the untreated area. This study indicated that Olyset nets have a major impact on malaria vectors and disease burden; therefore it could be recommended as an effective personal protection tool for malaria control in malarious areas.

Relationships between dairy slurry total solids, gas emissions, and surface crusts

Livestock slurry storages are sources of methane (CH₄), nitrous oxide (NO₂), and ammonia (NH₃) emissions. Total solids (TS) content is an indicator of substrate availability for CH₄ and N₂O production and NH₃ emissions and is related to crust formation, which can affect these gas emissions. The effect of TS on these emissions from pilot-scale slurry storages was quantified from 20 May through 16 Nov. 2010 in Nova Scotia, Canada. Emissions from six dairy slurries with TS ranging from 0.3 to 9.5% were continuously measured using flow-through steady-state chambers. Methane emissions modeled using the USEPA methodology were compared with measured data focusing on emissions when empty storages were filled, and retention times were >30 d with undegraded volatile solids (VS) remaining in the system considered available for CH₄ production (VS carry-over). Surface crusts formed on all the slurries. Only the slurries with TS of 3.2 and 5.8% were covered completely for ∼3 mo. Nitrous oxide contributed <5% of total greenhouse gas emissions for all TS levels. Ammonia and CH₄ emissions increased linearly with TS despite variable crusting, suggesting substrate availability for gas production was more important than crust formation in regulating emissions over long-term storage. Modeled CH₄ emissions were substantially higher than measured data in the first month, and accounting for this could improve overall model performance. Carried-over VS were a CH₄ source in months 2 through 6. The results of this study suggest that substrate availability regulates emissions over long-term storage and that modifying the USEPA model to better describe carbon cycling is warranted.

[Askin tumor: a case report with literature review]

Askin tumor is a rare malignant tumor arising from soft tissues of the chest wall, rarely in the lung. It occurs predominantly in young adults. It still raises many questions about its individualisation and its links with Ewing's sarcoma. We report a case of Askin tumor in a 5-year-old child with reviewing the different data from the literature.

Growing season surface water loading of fecal indicator organisms within a rural watershed

The loading of microbial contaminants was examined within the Thomas Brook watershed, a 784 ha mixed land-use catchment located in the headwaters of the Cornwallis River drainage basin (Nova Scotia, Canada). The objectives were to: (i) examine spatial and temporal characteristics of fecal bacteria loading during the growing season from five subwatersheds, and (ii) develop areal fecal indicator organism export coefficients for rural landscapes. Fecal coliform, Escherichia coli, total suspended solids (TSS) concentrations and stream flow were monitored at five locations in the watershed over six consecutive growing seasons (May-Oct, 2001-2006). A nested watershed monitoring approach was used to determine bacterial loading from distinct source types (residential vs. agricultural) during both baseflow and stormflow periods. Areal bacterial loading rates increased in each nested watershed moving downstream through the watershed and were highest in the three subcatchments dominated by agricultural activities. Upper watershed bacterial loading throughout the growing season from an agricultural subcatchment (Growing Season Avg 8.92 x 10(10) CFU ha(-1)) was consistently higher than a residential subcatchment (Growing Season Avg 8.43 x 10(9) CFU ha(-1)). As expected, annual average stormflow bacterial loads were higher than baseflow loads, however baseflow loads still comprised between 14 and 35% of the growing season bacterial loads in the five subwatersheds. Fecal bacteria loads were greater during years with higher annual precipitation. A positive linear relationship was observed between E. coli and TSS loading during the 2005 and 2006 growing seasons when both parameters were monitored, indicating that the processes of sediment transport and bacterial transport are linked. It is anticipated that computed areal microbial loading coefficients will be useful in developing watershed management plans. More intensive sampling during stormflow events is recommended for improving these coefficients.

Anti-Salmonella activity of Terminalia belerica: in vitro and in vivo studies

To search for an herbal remedy for protection against and treatment for typhoid fever, a number of plants were screened. Anti-Salmonella activity of Terminalia belerica, an ingredient of Ayurvedic preparation 'triphala' used for treatment of digestive and liver disorders, has been reported. Fruits of T. belerica were extracted with petroleum ether, chloroform, acetone, alcohol and water and efficacy of extracts against Salmonella typhi and Salmonella typhimurium was evaluated. Alcoholic and water extracts of T. belerica showed significant anti-Salmonella activity and MIC was 12.5 mg/ml against S. typhimurium. Aqueous extracts of Picrohiza kurroa and Vitits vinefera also showed low anti-Salmonella activity where as aqueous extracts of Asparagus racemosus and Zingiber officinale showed no anti-Salmonella activity. Extracts of T. belerica, Picrohiza kurroa and Vitits vinefera with other solvents such as chloroform and petroleum ether showed insignificant activity. Results showed that aqueous extract of T. belerica was bactericidal at high concentrations where as low concentrations showed bacteriostatic property. In vitro cellular toxicity studies showed no cyto-toxicity associated with T. belerica extracts. Pretreatment of mice with aqueous extract of T. belerica conferred protection against experimental Salmonellosis and 100% survival of animals has been reported when challenged with lethal doses of S. typhimurium.

Present and future of hematology and stem cell transplantation in Morocco

The first hematology department in Morocco was created in Casablanca in 1980 and it is still the only public facility where adult patients can be treated for hematological diseases. Two other units treat pediatric hematological disorders and cancer. Some patients are treated in private clinics located primarily in Casablanca and Rabat. The public hospitals have very limited resources and rely heavily on nongovernmental organizations (NGOs) for the care of these patients. The NGOs have also played an important role in developing successful cooperative programs with hospitals and groups in Europe and the United States. Till 2004, all patients who needed BMT and could afford the cost went to Europe. In 2004, SCT was initiated in Casablanca, with a four-bed ward set up and properly equipped. By May 2007, 27 patients have received autologous PBSCs. With 15 patients in continuous CR, the program is considered a success so far. The development of allogeneic transplantation in Morocco planned in the current year is also considered a real challenge.

Comparison of oral ibuprofen and indomethacin on closure of patent ductus arteriosus in preterm infants

Although intravenous indomethacin and ibuprofen are widely used for closure of patent ductus arteriosus in premature infants, these formulations are unavailable in the Islamic Republic of Iran. In this study of the therapeutic effects of oral treatments, 20 preterm infants were randomized to oral ibuprofen (1 x 10 mg/kg, then 2 x 5 mg/kg at 24-hour intervals) or oral indomethacin (3 x 0.2 mg/kg at 24-hour intervals). Complete ductal closure was seen in 7/10 of the indomethacin and 8/10 of the ibuprofen group. The difference was not significant. There was no reopening after the ductal closure during the hospital stay or in the follow-up visits in either group and no excessive increases in the blood urea nitrogen or serum creatinine levels were observed.