Understanding the Scourge of HIV/AIDS in Sub‐Saharan Africa

Sub‐Saharan Africa is the part of the world that has been hit hardest by the HIV epidemic. To fight the spread of HIV in the continent, it is necessary to know and effectively address the factors that drive the spread of HIV. The purpose of this article is to review the factors associated with the spread of the HIV epidemic in sub‐Saharan Africa and to propose 6 essential activities, which we refer to by the acronym “ESCAPER,” to help curb the spread of HIV/AIDS in Africa.     

IPOM: history of an acronym

IPOM has become a common term used by hernia surgeons. It refers to the treatment of a ventral hernia using an intraperitoneal placed mesh and most consider it an acronym for Intra-Peritoneal Onlay Mesh. Since intraperitoneal placement of mesh has fallen out of favor with some hernia surgeons and key-opinion-leaders recently, this might be the correct time to write down and preserve the history of this intriguing acronym.     

Indications for treatment of asymptomatic carotid stenosis

Atherosclerosis of the carotid bifurcation is an observable sign of systemic disease driven by key risk factors and resulting in an epidemic of stroke, myocardial infarction, and vascular death worldwide. Aggressive integrative preventive interventions of controlling hypertension, hyperlipidemia, diabetes mellitus, smoking, systemic inflammation/infarction, depression, and hyperhomocyst(e)imia are needed in the medical management of these high-risk patients. Surgical indications for asymptomatic surgery may be recalled through the acronym CAROTID, which emphasizes knowledge of risk benefit to a particular patient, adequate disclosure, and physician--patient equipoise.     

TEMPER: an acronym for ankle sprain rehabilitation

As has been previously discussed, the incidence and resultant associated disabilities of ankle sprains have been well documented in the literature. The staggering statistics on long-term disability show that there is no such thing as a simple ankle sprain. The degree of disability is related to the extent of the initial injury as well as the follow-up medical care provided. It is this fact that requires a complete understanding of the injury as well as a proper treatment and rehabilitation program. One of the reasons cited for the long-term disability or lack of consistently good results in treating ankle sprains is the lack of uniformity in treatment. One possible reason is the lack of agreement in diagnostic techniques as well as the end diagnosis of a particular grade of ankle sprain. If a sprain is managed correctly, resultant disability will be kept to a minimum. A proper rehabilitation program may be the most important factor in preventing chronic instability. The acronym RICE falls short of complete ankle management. RICE primarily addresses the ankle edema. Thus, the patient's ankle is only partially rehabilitated. A rational approach to the management of ankle sprains is given. Upon reviewing a complete protocol for ankle sprain rehabilitation, the acronym TEMPER can be used judiciously to remember the key steps in the treatment plan. Through the use of this acronym, one can institute a complete rehabilitation program.     

Enucleation is enucleation is enucleation is enucleation

The latest update of the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction in 2016 announced a novel acronym for transurethral Endoscopic Enucleation of the Prostate (EEP). This was inspired by a meta-analysis on randomized controlled trials on Holmium Laser Enucleation of the Prostate (HolEP) and bipolar enucleation versus open simple prostatectomy. EEP codes for the common ground of both techniques: “anatomical enucleation.” Although study quality with regard to the availability of long-term randomized controlled trials is at the moment mostly available for HoLEP, and bipolar enucleation, the existing data of all other enucleating techniques that have been demonstrated to perform anatomical enucleation as well should also been summarized under the same term. This editorial is a call for embracing this acronym of EEP for all anatomical enucleating techniques in order to serve for the transition from the age of TURP and open prostatectomy toward the age of EEP.     

Toward a cure for osteoporosis: Reversal of excessive bone fragility

While estrogen replacement therapy and calcium supplementation appear to be effective at preventing postmenopausal osteoporosis, therapy for established osteoporosis is far less effective. The reduction of bone fragility should be a goal of a treatment for established osteoporosis. To this end, increases in cortical bone mass by subperiosteal new bone formation may produce the greatest mechanical advantage. Antiresorptive drugs, such as etidronate, have shown potential for reducing the incidence of osteoporotic fracture in the short term, but their ability to produce a long-term benefit may be limited. An alternative approach might be to develop drug therapies that substantially increase cortical bone strength, namely by stimulating periosteal bone formation. Although sodium fluoride has proved to be problematic, there are several other potential osteoporosis therapies. They include treatment with anabolic hormones (e.g. growth hormone and anabolic steroids) and targeted delivery of growth factors. Also, antiresorptive and formation-stimulating drugs might be combined in a new form of ADFR (coherence) therapy where the new acronym means: Activate-Depress-Formation stimulation-Repeat.     

A comparison of four memory strategies with traumatically brain-injured clients

Six traumatically brain-injured clients were trained in four memory improvement strategies. These were written rehearsal, verbal rehearsal, acronym formation, and memory notebook logging. This study showed that only memory notebook logging was effective in increasing recall of classroom material.     

ENT management of a child with CHARGE association

The acronym CHARGE is used to describe specific congenital birth defects in children: colobomata, heart defect, atresia of the choanae, retarded growth or development, genital hypoplasia, and ear anomalies or deafness. CHARGE association with hearing impairment is a challenge to ENT surgeons. We report the case of a child with CHARGE association who underwent cochlear implantation using an unconventional surgical approach and review the postoperative speech perception results. The benefits of cochlear implantation in children with multiple congenital defects are discussed.     

The problem of acquired aplastic anaemia

PURE RED CELL APLASIA: Designated by the acronym PRCA or the term erythroblastopenia, pure red cell aplasia is characterised by severe anaemia with reticulocytopenia. It may occur in acute form induced by infectious agents, following drug toxicity or transplantation of allogeneic haematopoietic cells, associated with autoimmune haemolytic anaemia. The chronic form is rarely constitutional but can be acquired and is usually associated with blood or idiopathic diseases. IMMUNOLOGICAL INHIBITION OF ERYTHROPOIESIS: Among the mechanisms responsible for PRCA is immunological erythropoiesis inhibition. This may be of lymphocyte T cell origin or due to the presence of antibodies in the patient's serum. Although observations of PRCA with presence of neutralising antierythropoietin antibodies in patient's serum have multiplied over the past 5 years, they still remain extremely rare. From a therapeutic point of view, they require withdrawal of epoetin and often the administration of immunosuppressors and transfusion for symptomatic treatment. GROWTH FACTORS: The role of growth factors in restoring aplastic anaemia appears to be only partial, at random and temporary.     

The meaning of it all: evaluating knowledge of Minimal Clinically Important Difference (MCID) among chiropractic students

Introduction:Patient-reported outcome measures are frequently used to monitor patient progress during chiropractic care, yet student interns utilizing such assessments are unfamiliar with what magnitude of change (MCID) is considered beneficial to the patient.Objective:This work seeks to determine chiropractic intern knowledge of MCID.Methods:A five-item survey was administered to 104 chiropractic student interns.Results:Nearly one-third of the interns correctly defined the MCID acronym, and approximately one-third of the interns knew at least one MCID value for the outcome assessments in the EHR. Surprisingly, 20% of the interns reported knowledge of at least one MCID value, but answered incorrectly pertaining to the MCID acronym.Conclusion:Student interns value patient perception, but have limited knowledge of MCID values. Addressing this gap will improve their understanding of patient progress and inform their treatment decisions both in the outpatient clinic and in their practices following graduation.     

Confidential enquiries into anaesthetic deaths

The purpose of confidential enquiries into anaesthetic deathshas been to identify the cause of death and find areas of substandardcare that might be amenable to correction. The enquiries withwhich anaesthetists in the UK have been most familiar with arethe Confidential Enquiries into Maternal Deaths (CEMD), theConfidential Enquiries into Stillbirths and Deaths in Infancy(CESDI), and the National Confidential Enquiries into PerioperativeDeaths (NCEPOD, now an acronym for National Confidential Enquiriesinto Perioperative Outcomes and Death). There is also a ConfidentialEnquiry into suicides and homicides. The organizations of CEMDand CESDI were taken over in 2003 by the Confidential Enquiriesinto Maternal and Child     

Technical aspects of lasers in urology

During the course of history a variety of laser principles have been introduced in surgery. Some erroneous developments probably could have been kept out of the market place if not for the magic which accompanies the acronym LASER and with more understanding for the underlying principles governing the process when light meets tissue. The interaction of light with tissue is exemplified on the basis of natural body chromophores when compared with available lasers at different wavelengths and operational modes. Furthermore the meaning of fibre flexibility and durability is elucidated.     

Rationale and design of the MASTERPLAN study: Multifactorial approach and superior treatment efficacy in renal patients with the aid of nurse practitioners

BACKGROUND: Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease (CVD). In addition, patients with renal disease are exposed to a myriad of risk factors that increase their risk even further. The treatment of risk factors in these patients is paramount to reducing cardiovascular risk and for attenuating renal failure progression. It is well known that lifestyle interventions are difficult, and that medical treatment targets are seldom met. A multifactorial approach with the aid of nurse practitioners has shown to be beneficial for achieving treatment goals and reducing events in patients with diabetes mellitus and with heart failure. We propose that this will also hold for the CKD population. TRIAL DESIGN: A multicenter randomized clinical trial will be performed to study whether intensive medical care delivered by a nurse practitioner and a nephrologist will reduce cardiovascular risk compared to care provided by the nephrologist alone. The acronym MASTERPLAN describes the study: Multifactorial approach and superior treatment efficacy in renal patients with the aid of nurse practitioners. Eight hundred patients will be randomized to physician care or nurse practitioner support. For all patients the same set of guidelines and treatment goals will apply. Both groups will receive treatment according to current guidelines and have access to specific cardioprotective medication. Nurse practitioners will intensify therapy by promoting lifestyle intervention, and meticulous implementation of relevant guidelines. Patients will be followed-up for 5 yrs after baseline. Primary endpoints are all-cause mortality, cardiovascular morbidity and cardiovascular mortality.     

Assessment of lower extremity nerve block: reprise of the Four P's acronym

BACKGROUND AND OBJECTIVES: Successful performance of lower-extremity regional anesthesia includes sensory and/or motor block assessment of up to 4 major peripheral nerves. This brief report describes a methodology for the rapid evaluation of lower-extremity anesthesia before surgical incision. METHODS: Illustrations highlight the techniques for evaluation of sciatic, obturator, lateral femoral cutaneous, and femoral nerve anesthesia. This methodology is based on a Four P's acronym: push, pull, pinch, punt. CONCLUSIONS: Accurate assessment of lower-extremity regional anesthesia can be achieved rapidly using The Four Ps evaluation tool.     

Wound bed preparation and a brief history of TIME

Management of chronic wounds has progressed from merely assessing the status of a wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation has simultaneously evolved to provide a systematic approach to removing these barriers to natural healing and enhancing the effects of advanced therapies. This brief review of wound bed preparation traces the development of these concepts and explains how to apply systematic wound management using the TIME acronym - tissue (non viable or deficient), infection/inflammation, moisture (imbalance) and edge (non advancing or undermined).     

CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability

We have developed a neonatal pain assessment tool CRIES. The tool is a ten point scale similar to the APGAR score (Apgar 1953). It is an acronym of five physiological and behavioural variables previously shown to be associated with neonatal pain. C—Crying; R—Requires increased oxygen administration; I—Increased vital signs; E—Expression; S—Sleeplessness. We have tested CRIES for validity and reliability. This report is the result of that testing. We have found CRIES to be valid, reliable and well accepted by neonatal nurses.     

LEOPARD syndrome: a new polyaneurysm association and an update on the molecular genetics of the disease

LEOPARD syndrome, one of many cardiocutaneous syndromes, is an acronym for some of the obvious manifestations of the disease, such as lentigines or ocular hypertelorism. The synonymous name progressive cardiomyopathic lentiginosis better indicates the morbid cardiac features that patients with the syndrome have. A patient with LEOPARD syndrome is presented. He had recurrent upper extremity aneurysms requiring multiple operations and finally PTFE reinforced venous grafts to prevent further aneurysmal degeneration. He has multiple other peripheral aneurysms, thus far asymptomatic. His diagnosis of LEOPARD syndrome was confirmed on a genetic basis. Review of the literature reveals no previous reports of severe aneurysmal disease in these patients.     

Anaesthetic implications of LEOPARD syndrome

LEOPARD syndrome is a neuroectodermal disorder presumed to result from an abnormality in neural crest cells. The acronym 'LEOPARD' is derived from the clinical features which include multiple lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retarded growth, and deafness. Given the multisystem nature of the disease process, several issues may affect the perioperative care of these patients. Of primary importance are associated conditions of the cardiovascular system including congenital heart disease, conduction disturbances, and progressive hypertrophic obstructive cardiomyopathy. The authors present a 4-year old boy who presented for anaesthetic care for repair of a ventricular septal defect and pulmonary valvotomy for congenital pulmonary stenosis. The potential perioperative implications of LEOPARD syndrome are discussed.     

Primitive neuroectodermal tumors

The primitive neuroectodermal tumors (PNETs) of Hart and Earle constitute an important fraction of pediatric brain tumors that are clinically characterized by their aggressive behavior. In 1983, Rorke expanded the term “PNET” to include all small cell embryonal neoplasms of neuroectodermal origin, regardless of the location of the tumor. More recently, Dehner also proposed the terms “central” and “peripheral” PNETs, and the provocative concept of “PNET” has now come to encompass a diverse group of tumors in both the central and peripheral nervous systems. The acronym “PNET” has thus become a confusing and controversial term in the diagnosis and classification of pediatric embryonal tumors. We reviewed ten papers concerning the various aspects of PNETs.