Diagnostic accuracy of non-specialist versus specialist health workers in diagnosing hearing loss and ear disease in Malawi.

OBJECTIVE: To determine whether a non-specialist health worker can accurately undertake audiometry and otoscopy, the essential clinical examinations in a survey of hearing loss, instead of a highly skilled specialist (i.e. ENT or audiologist). METHODS: A clinic-based diagnostic accuracy study was conducted in Malawi. Consecutively sampled participants ≥ 18 years had their hearing tested using a validated tablet-based audiometer (hearTest) by an audiologist (gold standard), an audiology officer, a nurse and a community health worker (CHW). Otoscopy for diagnosis of ear pathologies was conducted by an ENT specialist (gold standard), an ENT clinical officer, a CHW, an ENT nurse and a general nurse. Sensitivity, specificity and kappa (κ) were calculated. 80% sensitivity, 70% specificity and kappa of 0.6 were considered adequate. RESULTS: Six hundred and seventeen participants were included. High sensitivity (>90%) and specificity (>85%) in detecting bilateral hearing loss was obtained by all non-specialists. For otoscopy, sensitivity and specificity were >80% for all non-specialists in diagnosing any pathology except for the ENT nurse. Agreement in diagnoses for the ENT clinical officer was good (κ = 0.7) in both ears. For other assessors, moderate agreement was found (κ = 0.5). CONCLUSION: A non-specialist can be trained to accurately assess hearing using mobile-based audiometry. However, accurate diagnosis of ear conditions requires at least an ENT clinical officer (or equivalent). Conducting surveys of hearing loss with non-specialists could lower costs and increase data collection, particularly in low- and middle-income countries, where ENT specialists are scarce

Análise epidemiológica do perfil clínico de pacientes com Hérnia Encarcerada no Hospital Regional da Ceilândia no Distrito Federal

FUNDO: O paciente com o quadro de hérnia inguinal encarcerada está em um estágio de urgência, necessitando de um procedimento cirúrgico de emergência. Buscando avaliar esse quadro, para entender o perfil clínico, para fomentar uma análise clínico-epidemiológica, analisando as variáveis importantes nesse tipo de paciente, definir os fatores de risco e quadros mais comumente encontrados. Se faz necessário também abordar os achados intraoperatórios, complicações e tempo pós-operatório. Assim, poderiam ser tomadas mudanças em relação às condições encontradas, que podem mudar o desfecho clínico de muitos pacientes. MÉTODOS: Um estudo observacional qualitativa descritiva, com 40 pacientes com o quadro clínico de hérnia encarcerada, todos os pacientes foram submetidos a hernioplastia. Seguindo a mesma técnica cirúrgica. O desfecho primário foi que apenas os  pacientes com comorbidades/fatores de risco apresentaram complicações e o segundo desfecho foi que os pacientes submetidos ao procedimento cirúrgico não chegaram a óbito. RESULTADOS: Após o acompanhamento de quadros semelhantes por 12 meses. O primeiro desfecho, foi possível observar que os pacientes com comorbidades/fatores de risco anteriores, 35 (87,5%) dos 40 selecionados, possuíam os quadros de:  14 (35%) pacientes com quadro de obesidade, os 7 (17,5%) eram tabagistas crônicos  e 14 (35%) dos pacientes possuíam quadro de tenesmo prévio e 5 pacientes não possuíam fatores de risco. Dentro das comorbidades, 1 paciente possuía síndrome de Down, 3 paciente apresentava cirrose hepática, 8 com hipertensão arterial sistêmica, sendo que 5 eram definidos como de difícil controle, 4 com diabetes mellitus, 6 pacientes com diverticulose anterior e 6 com constipação crônica. O desfecho secundário aconteceu com 40 pacientes, já que todos do grupo foram operados em caráter de urgência, ademais os pacientes que não são submetidos ao procedimento cirúrgico vão a óbito. CONCLUSÕES: Conclui-se que os 5 pacientes que não apresentavam comorbidades/fatores de risco, chegaram ao hospital em um quadro mais leve em comparação aos outros (35) pacientes, tendo eles uma recuperação melhor e menos dias de internação. Podendo ser implementadas medidas preventivas para os pacientes que possuem hérnia, recomenda-se o acompanhamento dos fatores de risco, visando evitar quadros graves e internações longas

SPINAL ANTINOCICEPTION BY MORPHINE IN RATS IS ANTAGONIZED BY GALANIN RECEPTOR ANTAGONISTS

Galanin, a 29 amino acid peptide, has been reported to possess antinociceptive properties at the spinal site and to potentiate opioid-induced antinociception. Our aim was to investigate whether also endogenous galanin interacts with an exogenously administered opioid, morphine, in the rat spinal cord. This question was investigated by use of the recently developed galanin receptor antagonists galantide [M-15, galanin-(1-13)-substance P-(5-11) amide] and M-35 [galanin-(1-13)-bradykinin-(2-9) amide]. Nociception was assessed in the rat tail-flick test using radiant heat and the rat Randall-Selitto model of inflammatory pain using vocalization as the nociceptive criterion. Intrathecal (i.t.) injections were performed in rats under ether anaesthesia. Morphine was administered either i.t. or intraperitoneally (i.p.), and the antagonists were injected i.t. [I-125]Galanin binding experiments were performed on crude synaptosomal membranes of the rat spinal cord. In the rat tail-flick test, i.t. injection of 3 mu g morphine evoked antinociception of about 75% of the maximal possible effect (% MPE). Co-injection of either 2 mu g galantide or 2 mu g M-35 with morphine almost completely abolished the antinociceptive effect of morphine. I.p. injection of 2.15 mg/kg morphine elicited about 80% MPE when given 10 min prior to i.t. saline injection. Injection of the antagonists instead of saline antagonised the antinociceptive effect of morphine partially thus showing the spinal proportion of the overall antinociceptive effect. In the rat Randall-Selitto test, 3 mu g morphine, injected i.t., produced antinociception of almost 100% MPE. Co-injection of the antagonists reduced the maximum effect partially by about 25-35%. I.p. injection of 7.5 mg/kg morphine 10 min prior to i.t. injection of saline elicited an antinociceptive effect of 90-100% MPE; injection of the antagonists instead of saline reduced the peak effect to a similar degree as after i.t. injection of 3 mu g morphine. To exclude a direct interference by morphine with the galanin receptor, in vitro binding of [I-125]galanin to a spinal synaptosomal fraction was assessed. Morphine, 10 mu M, did not interfere with the specific [I-125]galanin binding. These results provide further evidence that galanin is involved in spinal nociceptive processing. It seems to be involved in the mediation of the effects of morphine at this site, either as a co-transmitter, or subsequent to mu-receptor activation on nerve terminals or on interneurones