Neck masses in aged patients: etiology and semiological features associated with malignancy / Masas cervicales en adultos mayores: Etiología y características semiológicas asociadas a malignidad

Abstract Introduction: The purposes of our study were to describe the distribution of diagnoses in a series of 273 patients over 65 years of age who presented for neck masses and to identify semiological fea tures associated with malignancy. Methods: Neck masses were categorized as congenital lesions (n = 7, 3%, 95% CI: 1%- 5%), inflammatory masses (n = 67, 25%, 95% CI: 19%- 30%), benign neoplasms (n = 77, 28%, 95% CI: 23%- 34%), and malignant neoplasms (n = 87, 32%, 95% CI: 26%- 38%). Results: A group of patients had discontinued care and, consequently, a definitive diagnosis could not be reached (n = 35, 12%). Age (OR 1.06, 95% CI 1.00-1.12), male sex (OR 2.35, 95% CI 1.11-4.96), prior history of cancer (OR 2.66, 95% CI 1.02-6.92), mass fixation to skin or deep tissues (OR 4.87, 95% CI 2.20-10.76), and the involvement of multiple cervical lymph node levels (OR 4.15, 95% CI 1.64-10.51) were identified as semiological features associated with malignancy. Conclusion: In the case of a neck mass in an elderly patient, its neoplastic origin should be strongly suspected.

Resumen Introducción: El objetivo de nuestro estudio fue describir la distribución de diagnósticos en una serie de 273 pacientes mayores de 65 años que consultaron por masas cervicales e identificar características semiológicas asociadas a malignidad. Métodos: Las masas cervicales fueron categorizadas como lesiones congénitas (n = 7, 3%, 95% CI: 1%- 5%), masas de origen inflamatorio (n = 67, 25%, 95% CI: 19%-30%), neoplasias benignas (n = 77, 28%, 95% CI: 23%- 34%) y neoplasias malignas (n = 87, 32%, 95% CI: 26%-38%). Resultados: Un grupo de pacientes discontinuó el tratamiento y en consecuencia no fue posible alcanzar un diagnóstico defini tivo (n = 35, 12%). La edad (OR 1.06, 95% CI 1.00-1.12), el sexo masculino (OR 2.35, 95% CI 1.11-4.96), los antecedentes de cáncer (OR 2.66, 95% CI 1.02-6.92), la fijación de la masa a los planos profundos o a piel (OR 4.87, 95% CI 2.20-10.76) y la afectación de más de un nivel ganglionar del cuello (OR 4.15, 95% CI 1.64-10.51) fueron identificados como características semiológicas asociadas a malignidad. Conclusión: En presencia de una masa cervical en un paciente adulto mayor debe existir una fuerte sospecha de origen neoplásico.

Applying the Social Cognitive Theory: Relationship between Knowledge, Organizational-Environmental, and Self-Efficacy to Community Pharmacists Compliance with COVID-19 Health Protocols

@#Introduction: The purpose of this research was to analyze the relationships between pharmacists knowledge, work environment, and self-efficacy to their compliance level with the COVID-19 health protocols. Methods: This cross-sectional study was designed with descriptive correlational data collection using a questionnaire. Simple random sampling was used to choose the participants who are pharmacists from the Special Region of Yogyakarta’s Province. The demographic characteristics of the respondent were presented descriptively. The demographic characteristics of the respondent were presented descriptively. A statistical test was used to assess the correlation between compliance level vs each of the three factors from the Social Cognitive Theory. Results: A total of 262 pharmacists were selected with data collection using a questionnaire. Most of them were in a medium level of compliance (65.6%), while only 19.1% in a high level, and the 15,3% in a low level. Correlation values of 0.463 and 0.409 between variables measuring the organization’s environment and self-effciacy were found to be statistically significant at the p value <0.05. Meanwhile, there was no statistically significant relationship between knowledge and compliance (p>0.05) with correlation value was 0.054. There is good compliance to the COVID-19 health protocols among community pharmacists in the Special Region of Yogyakarta. Conclusion: These findings indicate that improving factors from pharmacy organization-environmental and self-efficacy of pharmacists may improve community pharmacists level of compliance to COVID-19 health protocols in pandemic era.

Effectivity of Camellia sinensis Extract with Nano-chitosan to Fibroblast Amounts of Wistar Rats Gingival Wound Healing Process

ABSTRACT@#Green tea (Camellia sinensis) has high level of flavonoids which are proven to have anti-inflammatory activity. Effect of flavonoids can be enhanced by nano-chitosan capsulation as drug carrier. Chitosan is polysaccharide derived from crustacean shells that mostly used as matrix of various drugs and plant extracts. The aim of this study was to determine the effectivity of flavonoids in green tea extract in nanochitosan capsulation towards the number of fibroblasts on proliferative phase of gingival wound healing process. Green tea was extracted, encapsulated with nano-chitosan and then made into gel. Gingiva labial of 24 male white 3-month-old Wistar rats were wounded by punch biopsy (2 mm diameter), then were treated two times a day, and were divided randomly into four groups of topical gel applications: green tea extract gel encapsulated nano-chitosan, green tea extract gel, base gel as negative control, and NSAIDs gel as positive control, starting at 0 day until 7th day. At 5th and 7th day, three rats from each group were decapitated and the mandibular gingiva was taken in order to make histology slides with hematoxylin eosin staining. Under microscope, the number of fibroblasts were examined. The data were analysed using ANOVA test with 95% confidence level. The results showed that the number of fibroblasts on proliferative phase was significantly higher than control negative (p < 0.05) and has no significant differences (p > 0.05) with control positive. In conclusion, topical application of green tea extract gel encapsulated nano-chitosan was effective to accelerate rats gingival wound healing process by increasing the fibroblasts.

Does bicarbonate concentration predict hospitalization among children with gastroenteritis?

To determine the relationship between bicarbonate concentration and hospitalization among children with gastroenteritis. This study was conducted at Prince Ali Bin Al-Hussein Hospital over a period of 6 months between August 2008 and February 2009. A total of 84 children aged 6 months to 5 years were included in the study. All patients included in this study were evaluated in our Pediatric Outpatient Clinic and they had acute gastroenteritis with mild to moderate dehydration, associated with vomiting at least 5 times per day for less than 48 hours duration. Blood gases either arterial or venous and serum electrolytes were measured for all patients as ordered by an attended pediatric physician after initial evaluation. Each patient was given 20-30 ml / kg dextrose 5% saline over a period of two hours, followed by the oral administration of small and frequent amount of clear fluids [about 30-50 ml / 30 minutes for two hours]. Patients who developed vomiting during or after oral rehydration were hospitalized for prolonged intravenous fluid therapy while patients who tolerated oral fluids were discharged and their caregivers were advised to come back to hospital if vomiting persisted, diarrhea increased or any new complaint was noticed by the family. We extend the period of observation for patients with bicarbonate measurements

Application of flow cytometry in the diagnosis of primary immunodeficiency disease [PID]: King Hussein Medical Center experience

To highlight some of the significant applications of flow cytometric immunophenotyping in the diagnosis of Primary Immunodeficiency Disease. We reviewed the medical records of 135 consecutive patients who were referred to the Immunology Clinic at King Hussein Medical Center with a flow cytometry based diagnosis of Primary Immunodeficiency Disease between January 2000 to August 2009. The medical records of fl5 patients with history of recurrent or persistent infections were reviewed. Seventy seven [57%] patients were males and 58[43%] were females. They aged between 2 and 120 months with a mean age of 13 months. Flow cytomerty-based diagnosis was identified in 68 [50.3%] patients. Predominant antibody deficiency was diagnosed in 114 [10.3%] patients. There were 35[26%] patients with T and B cell immunodeficiency. There were 6 patients' satisfied diagnostic criteria of possible HyperlgM lmmunodeficiency syndrome. Diagnosis of severe combined immunodeficiency was retrieved in 22[16.2%] patients. Primary phagocytic disorder was the diagnosis in 34 [25%] patients. Dihydrorhodamine flow cytomerty-based burst test was confirmatory for Chronic Granulomatous Diseases in one patient while in the other 14 patients diagnosis was based on nitroblue tetrazoleoum test and genetic mutation study. There were 8 [6%] patients with other well defined immunodeficiency syndromes; one patient with Wiskott Aldrich Syndrome, 5 patients with Ataxia Telangectasia, one with Bloom syndrome, and one with DiGeorge anomaly. Eight [6%] patients were found to have an immunedysregulation syndrome. There were 8[6%] patients with an undefined primary immunodeficiency. Post Bone marrow transplantation Immunereconstitution of T-, B-cells and Leukocyte adhesion molecules were identified in 14 patients with appropriate Flow cytomerty immunophenotyping assay. Flow cytometric immunophenotyping of leucocytes appears to be an efficient and rapid tool in the diagnosis and follow-up of immunodeficient patients, supporting early recognition, which is reflected on reduced morbidity and improved survival

Inappropriate utilization of emergency medical services at Prince Ali military hospital

To study the demographic characteristics of patients attending the emergency department and study the factors associated with inappropriate use of emergency department. A total of 4,950 patients' charts who attended the accident and emergency department of Prince Ali Military Hospital in the 1[st] [8 am- 4pm] and 2[nd] shifts [4 pm-10 pm] from the 1[st] to 31[st] of March 2008 were reviewed. A sample of 495 patients was randomly selected through systemic sampling method. A specially designed medical record abstract form was used to collect data related to inappropriate use and misuse of the emergency medical services in the hospital. Simple descriptive statistics were used to describe the relevant study variables. Out 495 patients 38 [7.7%] were admitted to different hospital wards. Of these patients 309 were males and 186 were females. Eleven [2.2%] cases were classified as life threatening cases, 58 [32%] as urgent cases and 326 [65.8%] were non urgent cases. Only 99 [20%] cases were having their complaints 24 hours prior to presentation. Large numbers of attendees were non urgent cases. To overcome this managerial problem, there is a need to utilize the primary health care/walk-in clinics served by family or general practitioners who provide primary health care services. In addition there is a need to promote public health education through community involvement

A Case of Esophago-mediatinal Fistula Due to Esophageal Tuberculosis / 결핵및호흡기질환

The esophagus is a rate site for rarely involved site of tuberculosis. The most common cause of esophageal tuberculosis is secondary involvement from adjacent tuberculous lymphadenitis. Esophago-nodal or esophagobronchial fistulas may be formed when tuberculous lymph nodes erode the adjacent esophageal or bronchial wall. We report a patient diagnosed with esophageal tuberculosis, which was complicated by an esophago-mediastinal fistula, by endoscopy, sputum acid fast bacilli (AFB) stain, chest computed tomography (CT), and an esophagogram. The patient was treated with antituberculous agents and chest CT and endoscopy showed that the fistula had closed completely.

Left ventricular diastolic dysfunction in chronic renal failure patients on chronic hemodialysis in Dr. Cipto-Mangunkusumo Hospital : the association with left ventricular mass.

Fourty three patients with chronic renal failure undergoing chronic hemodialysis in Division of Nephrology and Hypertension, Faculty of Medicine, University of Indonesia/Cipto-Mangunkusumo Hospital, Jakarta, since October 2003 until February 2004, were examined for echocardiography (2-D, M-mode, Doppler imaging).Diastolic dysfunction was found in 58.1 % of chronic renal failure patients on hemodialysis. There was no significant difference between left ventricular mass in the group with or without left ventricular diastolic dysfunction.

Left ventricular diastolic dysfunction in type 2 diabetes mellitus patient without cardiovascular disease: the association with microalbuminuria.

Twenty-eight cases of type 2 diabetes mellitus (DM) without any cardiovascular disease were recruited from the Department of Metabolic-Endocrine, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta. Recruitment of the study began in October 2001 and was completed by December 2001. Participants were examined for echocardiography and microalbuminuria urinary examination. Diastolic dysfunction was found in 73.7% of type 2 diabetic patients without microalbuminuria and 66.7% in type 2 diabetic patients with microalbuminuria. Neither type 2 diabetic groups with nor without microalbuminuria indicated any significant association to the occurrence of diastolic dysfunction.

Renal transplantation: experience in Australia.

OBJECTIVE: Outcome of renal transplantation in children under the age of 15 years, who received a renal allograft at The New Children's Hospital between January 1983 to June 1997 was studied. METHODS: Retrospective review of patients records and access to data collected from Renal Registry of the Hospital. 64 renal transplants were undertaken in 57 children during this period. Prednisone and Azathioprine were the mainstay of the immunosuppressive regimen up to 1983, then Cyclosporine A was introduced. Median age of first grafts was 10 years (range 1 month-14 years). There were 41 living related and 23 cadaveric grafts. 37 (64%) children had a congenital disorder as the cause of renal failure. Among them 14 (37%) had congenital renal dysplasia/hypoplasia, 20 (36%) had primary glomerular disorder as the cause of renal failure. RESULTS: Survival analysis at 12 month, 5 yr and 10 yr showed functioning grafts in 85%, 67% and 64% case respectively. Longest surviving transplant was 14 years. 6 children had died. Cumulative patient survival was 92.9% at 1 year, 90% at 5 year and 87% at 10 year. Sixteen primary grafts were lost with most common cause being chronic rejection accounting for 68% of all transplant lost. Recurrence of primary disease was the second most common cause of graft failure. There was one malignancy in this series. 25 of the 29 children of school age with functioning transplant attended school full time in a class appropriate for their age and nine of 13 years older patients were working full time, two worked part time. CONCLUSION: Renal transplantation is a successful treatment of end stage renal failure in children with high survival and normally functioning life. Chronic rejection remains a major cause of graft loss.

Heart Rate Variability after Acute Myocardial Infarction

BACKGROUND: Several abnormalities of the autonomic regulation of the heart have been noted after acute myocardial infarction(AMI). Measurement of heart rate(HR) variability has been reported to provide indirect, noninvasive estimate of the cardiac efferent parasympathetic activity. The purposes of this study were to get the information on heart rate variability after AMI and to determine its relation to clinical and hemodynamic data. METHODS: We measured HR variability in 28 patients(23 men and 5 women : mean age, 56.6+/-10.4 years) 3-15days after AMI, in 25 patients with unstable angina and in 21 normal subjects by using triangular interpolation of the frequency distribution histogram om normalto-normal RR intervals from Holter tapes. RESULTS: HR variability was lower in AMI than unstable angina patients(357.9+/-118.6 versus 426.1+/-122.5 msec : p<0.05) and normal subjects(525.1+/-137.4 msec : p<0.025). There was no difference for infarct site, thrombolytic therapy, presence of Q-wave. HR variability was significantly related to mean 24-hour HR, left ventricular ejection fraction(all p<0.0001), left ventricular end diastolic diameter(p<0.05). HR varability was lower in patients belonging to Killip class 2-4 and who reqired the use of diuretics or digitalis(all p<0.05). CONCLUSION: After AMI, HR variabillity was reduced and significantly related to clinical and hemodynamic indexes of severity. Measurement of HR variability early after AMI may offer important clinical information for the early high stratification of patients.