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1.
Isr Med Assoc J ; 22(3): 164-168, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32147981

RESUMEN

BACKGROUND: The number of investigative esophagogastroduodenoscopies (EGD) in children has increased over several decades, despite their unclear diagnostic yields. OBJECTIVES: To evaluate the indications for performing EGD, their diagnostic yields, and consequences on pediatric patient management. METHODS: A retrospective chart review was performed of consecutive pediatric patients aged 0-18 years, who underwent EGD between January and August 2014. RESULTS: During the study period, 547 EGD were performed on 478 children. The most frequent indications were suspected celiac disease, chronic non-specific abdominal pain, persistent Helicobacter pylori infection, and gastrointestinal hemorrhage. The yield of the diagnostic EGD was 59.2%, and the most common new diagnoses were celiac disease (28%), Helicobacter pylori-positive gastritis (16.5%), and Crohn's disease (5.4%). Of the patients with documented follow-up, 74.1% reported improved symptoms. Procedures performed for chronic unexplained abdominal pain had significantly lower yields (26.2%) and only 39.3% improved at follow-up. CONCLUSIONS: Our findings suggest a general high diagnostic yield for EGD in pediatric patients, stemming mainly from patients in whom a specific condition was suspected a priori. However, the role of the procedure in the diagnosis and management of non-specific gastrointestinal complaints was minor suggesting that EGD may be superfluous for some of these patients.


Asunto(s)
Endoscopía del Sistema Digestivo/métodos , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/epidemiología , Adolescente , Niño , Preescolar , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Endoscopía del Sistema Digestivo/estadística & datos numéricos , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiología , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Humanos , Lactante , Israel/epidemiología , Masculino , Estudios Retrospectivos , Centros de Atención Terciaria
3.
J Assoc Physicians India ; 68(3): 20-22, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138477

RESUMEN

Aim: To study the clinical profile and outcome of the patients with kidney biopsy diagnosis of IgA Nephropathy (IgAN). Methods: A retrospective study of the patients diagnosed IgAN over a period of three and half years. Results: Sixty (13.5%) had a diagnosis of IgAN. Twenty four (40%) had a clinical diagnosis of rapidly progressive glomerulonephritis (RPGN), 20 (33.3%) chronic kidney disease (CKD), 11 (18.3%) nephrotic syndrome, three (5%) acute glomerulonephritis and two (3.3%) asymptomatic urinary abnormalities. Fifty-six (93.4%) patients had hypertension; 15 (25%) patients were presenting as a hypertensive crisis with malignant hypertension in two. Fifteen of the RPGN patients presented with the hypertensive crisis, and all of them had evidence of thrombotic microangiopathy (TMA) on biopsy. Three (5%) patients had secondary IgAN. Patients with the nephrotic syndrome responded to treatment and had a significantly higher renal survival. Patients with interstitial fibrosis and tubular atrophy (IFTA) ≥25% and mesangial hypercellularity score of >0.5 did not respond to treatment. Conclusion: RPGN, CKD, and nephrotic syndrome were the typical manifestation of IgAN. Hypertension and hypertensive crisis were common. Response to treatment was seen in nephrotic syndrome whereas those with IFTA ≥25% and mesangial hypercellularity score of > 0.5 did not respond to treatment.


Asunto(s)
Glomerulonefritis por IGA , Biopsia , Humanos , India , Riñón , Estudios Retrospectivos , Centros de Atención Terciaria
4.
J Assoc Physicians India ; 68(3): 54-58, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32138485

RESUMEN

Introduction: Cerebrovascular disorders (CVD) are increasing in prevalence and incidence in Indian population. Global burden of disease study shows that of the 9.4 million deaths in India, 619,000 were due to stroke. A matter of concern is that in the last two decades there is a significant increase in prevalence rate of stroke. Aim: To find the demographic characteristics along with clinico-radiological profile and of patients presenting with stroke in a tertiary care hospital in Rajasthan. Methodology: This cross sectional study was conducted for a period of 6 months from Aug 2015 to Jan 2016 in a tertiary care hospital .A sample size of 360 patients with aged >18 years were recruited after obtaining written consent from those who attended the medical OPD or were admitted to the government hospital with the newly diagnosed stroke and confirmed by neuroimaging. Result: The mean age of stroke in present study was 60.46 ± 14.84 years. The stroke in the young age group defined as 40 years or less comprised only 6%. Hypertension as a risk factor was present in 52.5% of our patients followed by Dyslipidaemia (25.8%). 79.4% had ischemic stroke and 19.4 % haemorrhagic stroke. Supratentorial lesions were seen in 86.4% patients, infratentorial lesions in only 10% anterior circulation strokes (MCA>ACA) are more common than posterior circulation strokes. Motor and sensory symptoms are common in acute strokes rather than change in consciousness or speech abnormalities. 70.2% patients had moderate disability at the end of 28 days. Early presentation to hospital (<3hrs) is associated with better outcome and less morbidity in a stroke patient.


Asunto(s)
Accidente Cerebrovascular/epidemiología , Adolescente , Adulto , Anciano , Estudios Transversales , Humanos , India/epidemiología , Persona de Mediana Edad , Radiografía , Factores de Riesgo , Factores Socioeconómicos , Centros de Atención Terciaria , Atención Terciaria de Salud , Adulto Joven
6.
Biosci Trends ; 14(1): 16-22, 2020 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-32092747

RESUMEN

Irrational use of drugs remains a major challenge especially in developing countries, which contributed to a heavy pharmaceutical expenditure burden. Price regulation has been taken to curb the growth of pharmaceutical expenditures in many countries. This study aimed to investigate the impact of different mark-up drug policies on drug-related expenditures in tertiary public hospitals in Shanghai, China. Data were drawn from the audited financial statement in 24 tertiary public hospitals in Shanghai from January 2015 to December 2018. Drug-related revenue data and per capita cost data pre- and post-intervention were included. Interrupted time series design was applied to assess the actual effects of Fixed Percent Mark-up Drug (FPM) policy and Zero Mark-up Drug (ZMD) policy respectively. Results showed that ZMD policy achieved better intervention effects on declining drug-related expenditures than FPM policy. Apart from a declining trend in drug proportion (coefficient = -0.0017, p = 0.031), no other significant changes were found during FPM implementation. However, ZMD policy was associated with a level decline in per capita outpatient drug cost (coefficient = -12.21, p = 0.025) and a trend decline in per capita inpatient drug cost (coefficient = -25.12, p < 0.001), as well as a level decrease (coefficient = -0.0256, p = 0.001) and a downward tendency (coefficient = -0.0018, p < 0.001) in drug proportion. ZMD policy was effective in regulating drug-related expenditures, while FPM policy was difficult to achieve expected results due to the existence of profit space. Further regulation should be strengthened in the future, especially on drug revenue and per capita drug cost.


Asunto(s)
Costos de los Medicamentos/tendencias , Hospitales Públicos/economía , Centros de Atención Terciaria/economía , China , Política de Salud , Análisis de Series de Tiempo Interrumpido
7.
Rev Soc Bras Med Trop ; 53: e20190175, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32049199

RESUMEN

INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.


Asunto(s)
Costos y Análisis de Costo/estadística & datos numéricos , Mycobacterium tuberculosis/genética , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/economía , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/economía , Brasil , Genotipo , Humanos , Mycobacterium tuberculosis/aislamiento & purificación , Sensibilidad y Especificidad , Centros de Atención Terciaria
9.
Medicine (Baltimore) ; 99(5): e18927, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000406

RESUMEN

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.


Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/epidemiología , Gastritis/diagnóstico , Gastritis/epidemiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Adulto , Anciano , Biomarcadores/sangre , Biopsia , Infecciones por Citomegalovirus/tratamiento farmacológico , Infecciones por Citomegalovirus/patología , Femenino , Gastritis/tratamiento farmacológico , Gastritis/patología , Gastroscopía , Humanos , Masculino , Persona de Mediana Edad , Náusea/diagnóstico , Náusea/tratamiento farmacológico , Náusea/epidemiología , Náusea/etiología , Pronóstico , Estudios Retrospectivos , Estómago/diagnóstico por imagen , Estómago/patología , Centros de Atención Terciaria , Vómitos/diagnóstico , Vómitos/tratamiento farmacológico , Vómitos/epidemiología , Vómitos/etiología
10.
Can Assoc Radiol J ; 71(1): 63-67, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32062987

RESUMEN

PURPOSE: Endovascular thrombectomy (EVT) treatment for acute ischemic stroke is now recommended as a standard of care. However, implementing EVT in routine clinical practice poses many challenges, even in countries with advanced health-care systems. The aim of the current study is to delineate if EVT at our institution is an effective treatment for acute ischemic stroke. METHODS: All patients who underwent EVT at our institution between December 2011 and July 2017 were retrospectively assessed from our prospective registry. Clinical and imaging (including the Alberta Stroke Program Early CT [ASPECT] score, single-phase computed tomography angiography, and computed tomography perfusion) criteria were utilized to determine EVT suitability. Primary outcomes included modified Rankin score (mRS) at 90 days and recanalization determined by the modified Treatment in Cerebral Infarction score. Effectiveness was assessed by comparing our cohort with patients receiving EVT in the ESCAPE (Endovascular Treatment for Small Core and Proximal Occlusion Ischemic Stroke) trial. RESULTS: Eighty-eight patients presented to our hospital after a median of 87 minutes last seen normal. Of these, median ASPECT score was 9. A majority (72%) also received intravenous alteplase. Successful recanalization (≥TICI 2b) was achieved in 79%. At 90 days, 48% (36/75) were functionally independent (mRS score of 0-2) and 28% (21/75) were disabled (mRS score of 3-5); 24% (18/75) died (mRS of 6) within 90 days. CONCLUSIONS: An audit of our initial experience with EVT for the treatment of acute ischemic stroke in a small tertiary care center yielded similar results compared to the ESCAPE trial, which is encouraging for implementing this treatment in routine clinical practice.


Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/cirugía , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/etiología , Centros de Atención Terciaria
11.
Medicine (Baltimore) ; 99(7): e18570, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049777

RESUMEN

Acute conjunctivitis is inflammation of conjunctiva of less than 3 to 4 weeks duration, characterized by cellular infiltration and exudation. It may also result into corneal, lid or orbital involvement which may lead to various complications.A hospital based prospective study was conducted in Assam Medical College and Hospital with 110 culture proven acute bacterial conjunctivitis cases. Primary objective was to evaluate the bacteriological pattern and secondary objectives were to evaluate seasonal variation, association of different organisms with various complications and antibiotic sensitivity pattern of the isolates.Maximum frequency of bacterial conjunctivitis observed from May to September. SA was the predominant organism isolated throughout the year (32.1%). Commonest single organism isolates were SE (26.1%) and SA (21.6%). True membrane formation was significantly associated with CD (P < .05), whereas pseudo-membrane formation was associated with SA and STBH isolation (P < .05). Isolation of SE, SA, and PA was associated with corneal involvement (P < .05). Lid involvement was seen with SA and Diphtheroid, whereas SP isolation was associated with concomitant dacryocystitis (P < .05). All the major organisms were (SE, SA, D, STBH, SP) highly sensitive to amino-glycosides, cephalosporins, chloromphenicol, vancomycin and linezolid, whereas high level of resistance was seen towards fluroquinolones (ciprofloxacin and moxifloxacin).All acute bacterial conjunctivitis cases don't require antibiotic therapy. In case if required, periodical culture and sensitivity may guide initial pre-emptive antibiotic therapy. Further choice of antibiotic should be govern by culture and sensitivity status.


Asunto(s)
Antibacterianos/farmacología , Bacterias/aislamiento & purificación , Conjuntivitis Bacteriana/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Bacterias/clasificación , Bacterias/efectos de los fármacos , Niño , Preescolar , Conjuntivitis Bacteriana/tratamiento farmacológico , Estudios Transversales , Farmacorresistencia Bacteriana , Femenino , Humanos , Lactante , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Prospectivos , Centros de Atención Terciaria , Adulto Joven
12.
Nephrol Nurs J ; 47(1): 67-98, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083438

RESUMEN

Chronic kidney disease (CKD) diagnosis is often associated with stress, depression, and major lifestyle changes. The aim of this qualitative study was to explore patients' experiences of living with CKD. A non-random purposeful sampling strategy was used to recruit 10 patients with CKD undergoing hemodialysis, from a tertiary care hospital in Crete, Greece. Semi-structured, face-to-face interviews were conducted with open-ended questions aiming to assess different aspects of their life after CKD diagnosis. Four main themes were revealed portraying participants' experience, including facing a new reality, 2) confronting changes, 3) finding ways to cope, and 4) continuing life.


Asunto(s)
Adaptación Psicológica , Insuficiencia Renal Crónica/psicología , Grecia , Humanos , Investigación Cualitativa , Diálisis Renal , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Centros de Atención Terciaria
13.
West Afr J Med ; 37(1): 19-25, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030707

RESUMEN

BACKGROUND AND OBJECTIVES: Healthcare workers are exposed to accidental infections from contaminated body fluids in the course of their duties. HIV post-exposure prophylaxis (PEP) is the measure instituted to manage exposure to potentially contaminated body fluids and prevent HIV infection. Ignorance of the appropriate measures to take may increase the risk of acquiring HIV infection from accidental exposure. This survey was conducted to assess the knowledge, attitude and practice of HIV PEP among doctors in a tertiary hospital. METHODS: This was a cross-sectional survey. A pretested structured questionnaire was administered on randomly selected doctors from all clinical departments of a tertiary hospital. The questionnaire assessed the knowledge, attitude and practice of HIV PEP according to the WHO guidelines. A score of > 75% was adequate for each area. RESULTS: Fifty-one completed questionnaires were returned out of 56 giving a response rate of 91%. The total knowledge score was 60.0 ± 10.2% (mean ± SD). The total score in attitude towards PEP was 66.5 ± 12.2% while for practice it was 47.5 ± 27.0%. There was a significant correlation between participant's knowledge and practice (rho = 0.316, p <0.05) as well as between attitude and practice (rho= 0.393, p< 0.01). There was no significant difference in scores in relation to the cadre or department. CONCLUSION: This study reveals that the knowledge, attitude and practice of HIV PEP among doctors is generally not adequate. Enhanced education will reduce the risk of accidental HIV infection among doctors.


Asunto(s)
Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Exposición Profesional/prevención & control , Médicos , Profilaxis Posexposición , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Encuestas y Cuestionarios , Centros de Atención Terciaria
14.
West Afr J Med ; 37(1): 40-47, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030710

RESUMEN

BACKGROUND: Haematological abnormalities such as anaemia, leucopenia, and thrombocytopenia are common complications of Human Immunodeficiency Virus (HIV) infection. Few researchers have studied the changes in HIV positive patients before and during antiretroviral therapy (ART) in Ghana. This study is aimed at determining the haematological profile of people living with HIV (PLHIV) at baseline and whilst on ART in a tertiary facility in Cape Coast, Ghana. METHODS: This was an analytical cross-sectional study with a retrospective component among PLHIV assessing ART services at the Cape Coast Teaching Hospital, Ghana. Full blood count (FBC) test was performed on blood samples and the results were analyzed and categorized based on WHO definitions. RESULTS: A total of 440 participants were included. The mean haemoglobin level (g/dL) for females at baseline, 6 months after ART and during this study were 9.6 (±1.8), 10.9 (±1.4) and 11.6 (±1.4); and 10.2 (±2.1), 11.6 (±1.7) and 11.8 (±1.6) for males. At baseline, the commonest type of anaemia for both females and males was microcytic hypochromic anaemia. The mean platelet count was 382 x 109/l at baseline but reduced to 298 x 109/L after 6 months on ART. Among male participants in this study, the main factor associated with being anaemic after 6 months on ART was the ART regimen with non-Zidovudine based regimen, having reduced odds of anaemia of OR 0.3 (95%CI 0.1 - 0.9), p-value of 0.04. Among females, having plasma viral load >1000 copies per ml was found to have increased odds of being anaemic (OR 1.4, 95%CI 0.7 - 2.6), though not statistically significant (P-value of 0.32). CONCLUSION: The prevalence of anaemia, though improved on ART, was high among PLHIV. It is essential to ensure that full blood count of PLHIV in Ghana are done regularly, at all levels of service provision, with appropriate referral systems in place. The change to the current TDF based preferred first line ART regimen must also be enforced to reduce the potential risks associated with AZT use. This will improve outcome for PLHIV.


Asunto(s)
Anemia/inducido químicamente , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Anemia/epidemiología , Estudios Transversales , Femenino , Ghana , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria
15.
J Nurs Adm ; 50(2): 66-71, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31929347

RESUMEN

A quality improvement process was implemented within a large, tertiary healthcare organization to develop and implement a roundtable culture as part of a fatigue risk management system focused on mitigating nurse leader fatigue and stress. Strategies to form trusting collaboration and reduce leader attrition were initiated and assessed for effectiveness. Results show measurable decreases in reported levels of stress and attrition. Acute, chronic, and persistent fatigue continue to challenge those in leadership roles.


Asunto(s)
Fatiga/prevención & control , Enfermeras Administradoras/psicología , Atención de Enfermería/organización & administración , Mejoramiento de la Calidad/organización & administración , Centros de Atención Terciaria/organización & administración , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Mymensingh Med J ; 29(1): 37-42, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915333

RESUMEN

Uropathogenic Escherichia coli is frequently resistant to different antibiotic leading to a critical condition of the patients. The purpose of the present study was to see antibiotic resistance pattern and genetic characteristics of ESBL and Carbapenemase-producing Escherichia coli. This cross sectional study was conducted in the Department of Microbiology at Mymensingh Medical College, Mymensingh, Bangladesh from October 2014 to December 2015. Patients presented with clinically diagnosed urinary tract infection at any age with both sexes who attended in the OPD of Mymensingh Medical College Hospital and the Doctors Diagnostic Centre in Mymensingh, Bangladesh was selected as study population. Non duplicate clinical isolates from urine were collected in full aseptic precaution for culture of bacteria. Escherichia coli were confirmed by PCR Stargetingadk. Antimicrobial susceptibility was measured by broth microdilution test. Minimum inhibitory concentrations against 18 antimicrobial agents were measured. Beta-lactamase genes were detected by multiplex PCR. For all the isolates showing resistance to imipenem and/or meropenem, presence of carbapenemase genes was confirmed by multiplex/uniplex PCR using primers. A total of 233 non-duplicate clinical isolates of Escherichia coli were collected from patients of which dominant phylogenetic group was B2 which was 78(33.5%) isolates of which 71 isolates were B2a and 7 isolates were B2b. Furthermore, Group A was in 29.6% isolates and Group D was in 26.6% isolates. E. coli showed significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials. Meropenem-resistance was detected in 8.2% of E. coli. The detection rate of blaTEM was 41.6% in E. coli. Carbapenemase genes were detected in 9(3.9%) isolates of E. coli and identified as genes encoding NDM-1, -5, and 7 and OXA-181. All the blaNDM-positive E. coli isolates carried also blaCTX-M-15, except for a group B1 isolate. E. coli is significantly higher resistance rates to piperacillin, cephalosporins, and some other antimicrobials and possesses different ESBL and carbapenemase genes.


Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/genética , Farmacorresistencia Bacteriana/genética , Infecciones por Escherichia coli/tratamiento farmacológico , Escherichia coli/genética , beta-Lactamasas/genética , Bangladesh , Estudios Transversales , Escherichia coli/clasificación , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Infecciones por Escherichia coli/microbiología , Femenino , Genes Bacterianos , Humanos , Masculino , Pruebas de Sensibilidad Microbiana/métodos , Filogenia , Reacción en Cadena de la Polimerasa , Centros de Atención Terciaria , beta-Lactamasas/metabolismo
17.
Can J Surg ; 63(1): E46-E51, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-31995336

RESUMEN

Background: Oncoplastic surgery (OPS) is becoming the new standard of care for breast-conserving surgery (BCS). It has become increasingly popular in Europe; however, it has not yet been widely accepted in North America. This study aims to describe the experience with OPS at a Canadian tertiary care centre. Methods: This study is a retrospective case series consisting of consecutive OPS cases at a single Canadian centre, the Royal Victoria Regional Health Centre in Barrie, Ontario, between 2009 and 2015. Results: A total of 275 women who consecutively underwent OPS were included. The average size of the tumour was 17 mm (standard deviation [SD] 13 mm; range 0­110 mm). The average specimen weight was 155 g (SD 146 g; range 15­1132 g). Invasive ductal carcinoma was the most common diagnosis (237 patients, 86.2%), followed by ductal carcinoma in situ (18 patients, 6.6%) and then invasive lobular carcinoma (15 patients, 5.5%). A positive margin was recorded in 37 (13.5%) patients. Immediate postoperative complications included seroma and edema (32.7%), wound infection (13.1%), hematoma (8.7%) and delayed wound healing (6.5%). A delay to adjuvant therapy due to postoperative complications occurred in 7 of 217 (3.2%) patients. The median follow-up was 18 months. There were local and distant recurrences in 9 (3.3%) and 2 (0.7%) patients, respectively. Overall survival was 99.3%. Conclusion: The findings of this study are comparable to results in the literature on OPS and demonstrate that OPS is an attractive alternative to standard lumpectomy for Canadian general surgeons who treat breast cancer.


Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Mastectomía Segmentaria/métodos , Neoplasias de la Mama/terapia , Femenino , Humanos , Márgenes de Escisión , Mastectomía Segmentaria/normas , Ontario , Estudios Retrospectivos , Centros de Atención Terciaria
18.
Br J Nurs ; 29(2): S18-S23, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972104

RESUMEN

BACKGROUND: Intravenous therapy is an integral part of professional nursing practice. Nurses have a responsibility to recognise risk factors for phlebitis. AIMS: To investigate nurses' perceptions of risk factors for phlebitis in a tertiary teaching hospital in north-east Peninsular Malaysia. METHODS: A cross-sectional study of 199 randomly selected nurses were surveyed for their perceptions of risk factors for phlebitis using a self-administered questionnaire. FINDINGS: More than half of the nurses (56.8%) had a good perception levels of risk factors for phlebitis. There was a significant association between the clinical area and nurses' perceptions of risk factors for phlebitis (p=0.04). Nurses working in medical, orthopaedic, and surgical areas had slightly better perceptions than nurses working in multidisciplinary and oncology areas. CONCLUSION: These findings suggest that nurses need to continually improve their knowledge about risk factors for phlebitis to ensure safer nursing practice.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Enfermería en Hospital/psicología , Flebitis/enfermería , Adulto , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Malasia , Masculino , Persona de Mediana Edad , Personal de Enfermería en Hospital/estadística & datos numéricos , Factores de Riesgo , Encuestas y Cuestionarios , Centros de Atención Terciaria , Adulto Joven
19.
J Surg Res ; 246: 236-242, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31610351

RESUMEN

BACKGROUND: Peritonitis is an emergency which frequently requires surgical intervention. The aim of this study was to describe factors influencing seeking and reaching care for patients with peritonitis presenting to a tertiary referral hospital in Rwanda. METHODS: This was a cross-sectional study of patients with peritonitis admitted to University Teaching Hospital of Kigali. Data were collected on demographics, prehospital course, and in-hospital management. Delays were classified according to the Three Delays Model as delays in seeking or reaching care. Chi square test and logistic regression were used to determine associations between delayed presentation and various factors. RESULTS: Over a 9-month period, 54 patients with peritonitis were admitted. Twenty (37%) patients attended only primary school and 15 (28%) never went to school. A large number (n = 26, 48%) of patients were unemployed and most (n = 45, 83%) used a community-based health insurance. For most patients (n = 44, 81%), the monthly income was less than 10,000 Rwandan francs (RWF) (11.90 U.S. Dollars [USD]). Most (n = 51, 94%) patients presented to the referral hospital with more than 24 h of symptoms. More than half (n = 31, 60%) of patients had more than 4 d of symptoms on presentation. Most (n = 37, 69%) patients consulted a traditional healer before presentation at the health care system. Consultation with a traditional healer was associated with delayed presentation at the referral hospital (P < 0.001). Most (n = 29, 53%) patients traveled more than 2 h to reach a health facility and this was associated with delayed presentation (P = 0.019). The cost of transportation ranged between 5000 and 1000 RWF (5.95-11.90 USD) for most patients and was not associated with delayed presentation (P = 0.449). CONCLUSIONS: In this study, most patients with peritonitis present in a delayed fashion to the referral hospital. Factors associated with seeking and reaching care included sociodemographic characteristics, health-seeking behaviors, cost of care, and travel time. These findings highlight factors associated with delays in seeking and reaching care for patients with peritonitis.


Asunto(s)
Medicina Tradicional Africana/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Peritonitis/cirugía , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Gastos en Salud/estadística & datos numéricos , Hospitales Universitarios/economía , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Medicina Tradicional Africana/psicología , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Peritonitis/economía , Rwanda , Factores Socioeconómicos , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/psicología , Centros de Atención Terciaria/economía , Centros de Atención Terciaria/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adulto Joven
20.
Ann Otol Rhinol Laryngol ; 129(2): 115-121, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31526031

RESUMEN

OBJECTIVE: Identify knowledge deficits about alternate airways (AAs) (tracheostomy and laryngectomy) among physicians across multiple specialties a tertiary institution and to assess the impact of an educational lecture on improving deficits. METHODS: Study Design: Cross-sectional assessment. Setting: Academic medical center. Subjects and Methods: An anonymous 10-item, multiple choice assessment was given to physicians at a tertiary care center in the departments of Otolaryngology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, and Pediatrics. An educational lecture on AAs was presented. Scores between a pre-lecture and a 3-month post-lecture assessment were compared. Data was analyzed using ANOVA and chi-squared analysis. RESULTS: Otolaryngology physicians scored an average of 97.8%, while non-otolaryngology physicians scored 58.3% (P < .05). Non-otolaryngology surgical physicians scored 68.4% while non-surgical physicians were lower at 55.1% (P < .0001). Comparing pre-lecture to post-lecture scores, all non-otolaryngology physicians improved their scores significantly from 58.3% to 86.5% (P < .005). Non-surgical physicians had significant improvement after the instructional lecture, closing the score gap with surgical physicians for the post-lecture assessment. DISCUSSION: The care of patients with AAs requires an understanding of their basic principles. Our findings identify significant knowledge deficits among non-otolaryngologists. Through an instructional lecture, we demonstrated improvement in knowledge among non-otolaryngology physicians and durability of the knowledge after 3 months. CONCLUSIONS: Through an instructional lecture, we found tracheostomy and laryngectomy knowledge deficits can be identified and improved upon. Periodic reinforcement of basic principles for non-otolaryngology physicians may be a promising strategy to ensure the proper care of patients with AAs.


Asunto(s)
Competencia Clínica , Conocimientos, Actitudes y Práctica en Salud , Laringectomía/educación , Traqueostomía/educación , Estudios Transversales , Humanos , Medicina , Autoinforme , Centros de Atención Terciaria
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