Background: and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Introduction

  The Direction Office of Healthcare Activities (DOHA) started around 1998 in Vietnam offers training provision for all lower- and higher-ranked hospitals. An understanding of the factors responsible for the success of this unique training provision system can be useful in implementing appropriate human resource development strategies in the health sector. Furthermore, the reviews about the changes in the training provision styles can offer us clues on how to connect training provision with visible clinical improvement.

Method

  We reviewed the policy papers from the ministry of health in Vietnam, the activity reports of DOHA in the training center of Bach Mai hospital, which is a high-ranking hospital, JICA (Japan International Cooperation Agency) reports, and NCGM (National Center For Global Health and Medicine) reports from 1997 to 2015.

Results

  DOHA was founded as a government-led health provision system in Vietnam with strong policy guidelines. However, to expand their activities, strengthen the capacity of training in hospitals, and establish a financial mechanism for training, there was a need to empower lower-ranked hospitals.

  To enhance the training impact of the clinical field in lower-ranked hospitals after training provision, staff of higher-ranked hospitals were dispatched to lower-ranked hospitals to provide on-the-job training (1816 project) and training provision with equipment preparation in lower-level hospitals to overcome environmental difficulties in implementing techniques that they had learned (Satellite hospital project).

Conclusion

  “Strong policy commitments”, “a viable financial system”, and “bottom-up empowerment” were needed to establish nation-wide continuous medical education system in Vietnam. To connect training provision with improvement in the clinical field, “integrated approaches for multiple factors in clinical fields like clinical environment changes and extended follow-ups“ by providing training are needed.

Objective: Adequate periconceptional folic acid intake decreases the risk of neural tube defects in infants.  The present study aimed to investigate the awareness of pharmacy students regarding the importance of folic acid intake for the prevention of neural tube defects.
Design: Questionnaire survey.
Methods: A self-administered questionnaire regarding the importance of folic acid intake for the prevention of neural tube defects was distributed to 750 pharmacy students at Tohoku and Ohu Universities.
Results: Among the 685 respondents (response rate; 91.3%), 74 (10.8%) were aware that folic acid intake decreases the risk of neural tube defects.  In multivariate logistic regression analysis, awareness of the importance of folic acid intake was evident among 5th- and 6th-year pharmacy students (odds ratio=3.352, 95% confidence interval=1.797-6.253) and among those who used dietary supplements (2.275, 1.306-3.966).  Among the 74 pharmacy students who recognized the importance of folic acid intake, 17 (23.0%) and 3 (4.1%) were aware that women should begin taking a folic acid supplement before conception and should take about 400 μg per day during pregnancy, respectively.
Conclusion: Only about 10% of the pharmacy students in this study recognized that folic acid intake decreases the risk of neural tube defects, and many were unaware of the recommended intake amount.  Therefore, awareness of the importance of folic acid intake must be more aggressively promoted among pharmacy students.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.

Depression and pain are common and often early non-motor symptoms of Parkinson disease (PD). The relationship between pain and depression in PD has been unsettled, with conflicting findings. The PD patients followed up at the general neurology outpatient clinics were requested to complete Beck Depression Inventory (BDI) and McGill pain questionnaire. The patients were categorized in three groups according to the Hoehn-Yahr (H-Y) stage of PD; mild (stage I&II), moderate (stage III) and advanced stage (stage IV&V), and group comparisons were performed in each group between those with and without pain. A total of 186 patients completed the questionnaires. Their mean age was 74±9.3 years, and the mean H-Y stage was 2.8±0.8.Sixty-nine percent of the patients reported pain symptoms of various natures. The BDI scores were significantly higher in the pain group (P< 0.0001) despite the absence of statistically significant differences in the mean age, H-Y stage, and duration of illness. Only PD patients of mild stage revealed significant difference of BDI scores between those with pain and without pain (P <0.001). Our results showed that pain is a common symptom in patients with PD and suggest that it may be related to depression in the early stage of the disease.
Parkinson Disease

The purpose of this study was to investigate the actual conditions of nosocomial infection control in Kathmandu City, Nepal as a basis for the possible contribution to its improvement. The survey was conducted at 17 hospitals and the methods included a questionnaire, site visits and interviews. Nine hospitals had manuals on nosocomial infection control, and seven had an infection control committee (ICC). The number of hospitals that met the required amount of personal protective equipment preparation was as follows: gowns (13), gloves (13), surgical masks (12). Six hospitals had carried out in-service training over the past one year, but seven hospitals responded that no staff had been trained. Eight hospitals were conducting surveillance based on the results of bacteriological testing. The major problems included inadequate management of ICC, insufficient training opportunities for hospital staff, and lack of essential equipment. Moreover, increasing bacterial resistance to antibiotics was recognized as a growing issue. In comparison with the results conducted in 2003 targeting five governmental hospitals, a steady improvement was observed, but further improvements are needed in terms of the provision of high quality medical care. Particularly, dissemination of appropriate manuals, enhancement of basic techniques, and strengthening of the infection control system should be given priority.

BACKGROUND/AIMS: In Japan, it is customary to take a daily bath during which the body is immersed in water to the neck. During full-body immersion, hydrostatic pressure is thought to compress the chest and abdomen, which might influence esophageal motor function and intra-gastric pressure. However, whether water immersion has a significant influence on esophageal motor function or intragastric pressure has not been shown. The aim of this study was to clarify the influence of full-body water immersion on esophageal motor function and intragastric pressure. METHODS: Nine healthy male volunteers (mean age 40.1 +/- 2.8 years) were enrolled in this study. Esophageal motor function and intragastric pressure were investigated using a high-resolution 36-channel manometry device. RESULTS: All subjects completed the study protocol. Intragastric pressure increased significantly from 4.2 +/- 1.1 to 20.6 +/- 1.4 mmHg with full-body water immersion, while the lower esophageal high pressure zone (LEHPZ) value also increased from 20.5 +/- 2.2 to 40.4 +/- 3.6 mmHg, with the latter being observed regardless of dietary condition. In addition, peak esophageal peristaltic pressure was higher when immersed as compared to standing out of water. CONCLUSIONS: Esophageal motor function and intragastric pressure were altered by full-body water immersion. Furthermore, the pressure gradient between LEHPZ and intragastric pressures was maintained at a high level, and esophageal peristaltic pressure was elevated with immersion.
Abdomen ; Baths ; Esophageal Sphincter, Lower ; Gastroesophageal Reflux ; Humans ; Hydrostatic Pressure ; Immersion ; Japan ; Male ; Manometry ; Neck ; Peristalsis ; Thorax ; Water