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1.
Indian Heart J ; 72(6): 599-602, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33357652

RESUMEN

Few studies from various countries have reported decline in Acute Coronary Syndrome (ACS) admissions to hospital during COVID-19 pandemic. We studied the impact of COVID-19 strict lockdown on ACS admission in a tertiary referral hospital in India. This showed 43% decline in admissions (n = 104 vs mean n = 183) and even in those who got admitted, there was a delay in presentation compared to previous year, which was reflected in the outcome of patients. Government and health organizations should educate the public early-on during the pandemic about the consequences of ignoring other acute medical problems such as ACS.


Asunto(s)
Síndrome Coronario Agudo/epidemiología , Hospitalización/tendencias , Pandemias , Centros de Atención Terciaria/estadística & datos numéricos , Síndrome Coronario Agudo/terapia , Comorbilidad , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo
3.
Medicine (Baltimore) ; 99(52): e23845, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350774

RESUMEN

ABSTRACT: COVID-19 pandemic caused a major crisis, affecting and straining health care systems, including some very advanced ones. The pandemic may have also indirectly affected access to health care for patients with other conditions, not related to COVID-19, even in countries not overwhelmed by an outbreak.We analyzed and compared visits to the emergency room (ER) department during the same calendar period of 2019 and 2020 (from March 1 to March 31 of each year) in our hospital, a medium size, tertiary center, located in the center of Athens, which is not a referral center for COVID-19.Total ER visits were reduced by 42.3% and the number of those requiring hospitalization by 34.8%. This reduction was driven by lower numbers of visits for low risk, non-specific symptoms and causes. However, there was a significant decrease in admissions for cardiovascular symptoms and complications (chest pain of cardiac origin, acute coronary syndromes, and stroke) by 39.7% and for suspected or confirmed GI hemorrhage by 54.7%. Importantly, number of ER visits for infections remained unchanged, as well as the number of patients that required hospitalization for infection management; only few patients were diagnosed with COVID-19.During the initial period of the pandemic and lock-down in Greece, there was a major decrease in the patients visiting ER department, including decrease in the numbers of admissions for cardiovascular symptoms and complications. These observations may have implications for the management of non-COVID-19 diseases during the pandemic.


Asunto(s)
/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto , Anciano , Femenino , Grecia/epidemiología , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Pandemias
5.
Medicine (Baltimore) ; 99(45): e23081, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157975

RESUMEN

Few studies have clarified the use of complementary therapies (CTs) in France. The main objective of this preliminary study was to evaluate knowledge of CTs in 4 representative groups of patients: patients suffering from cancer, patients presenting with a chronic noncancerous disease, chronic dialysis patients and nonchronic or cancerous patients needing surgery.A formalized questionnaire was designed by 2 psychologists, an oncologist and an anesthesiologist in charge of the Pain Clinic and Support Care Unit. One-hundred eleven patients were enrolled, and all agreed to complete the questionnaire.Eighty (72%) patients did not know the term "complementary therapies" (patients who were "not aware of CTs"), and 24 (21.6%) patients knew the term "complementary therapies" (patients who were "aware of CTs"), while 7 patients were not sure of the meaning. There were no differences between aware and unaware patients in gender (P = .27), age (P = .24), level of education (p = 0.24) or professional occupation (P = .06). Knowledge about CTs was significantly different among the different categories of patients (P = .03), with the only statistically significant difference between groups being between oncologic patients receiving ambulatory chemotherapy and patients presenting with a chronic noncancerous disease (P = .004).This preliminary study clearly highlights that patients and health caregivers are not aware of CTs and that there is a need for better communication about CTs.


Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Anciano , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Autoinforme
6.
Int J Pediatr Otorhinolaryngol ; 138: 110383, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33152974

RESUMEN

INTRODUCTION: Virtual outpatient clinics (VOPC) have been integrated into both paediatric and based adult outpatient services due to a multitude of factors, including increased demand for services, technological advances and rising morbidity secondary to ageing populations. The novel coronavirus disease (COVID-19) has accentuated pressures on the National Health Service (NHS) infrastructure, particularly elective services, whilst radically altering patterns of practice. AIM: To evaluate the impact of the COVID-19 pandemic on paediatric otolaryngology outpatient services whilst collating patient feedback to elicit long-term sustainability post COVID-19. METHOD: A retrospective analysis of VOPCs was undertaken at a tertiary paediatric referral centre over a 3-month capture period during the COVID-19 pandemic. Demographic, generic clinic (presenting complaint, new vs. follow-up, consultation type), as well as outcome data (medical or surgical intervention, discharge vs. ongoing review, onward referral, investigations, and conversion to face-to-face) was collated. Additionally a modified 15-point patient satisfaction survey was created. The Paediatric Otolaryngology Telemedicine Satisfaction survey (POTSS), was an adaptation of 4 validated patient satisfaction tools including the General Medical Council (GMC) patient questionnaire, the telehealth satisfaction scale (TESS), the telehealth usability questionnaire (TUQ), and the telemedicine satisfaction and usefulness questionnaire (TSUQ). RESULTS: Of 514 patients reviewed virtually over a 3-month period, 225 (45%) were randomly selected to participate, of which 200 met our inclusion criteria. The most common mode of consultation was telephony (92.5%, n = 185). Non-attendance rates were reduced when compared to face-to-face clinics during an equivalent period prior to the COVID-19 pandemic. A significant proportion of patients (29% compared to 26% pre-VOPC) were discharged to primary care. Nine percent were listed for surgery compared to 19% pre-VOPC. A subsequent face-to-face appointment was required in 10% of participants. Overall, the satisfaction when assessing the doctor-patient relationship, privacy & trust, as well as consultation domains was high, with the overwhelming majority of parents' content with the future integration and participation in VOPCs. CONCLUSION: An evolving worldwide pandemic has accelerated the need for healthcare services to reform in order to maintain a steady flow of patients within an elective outpatient setting without compromising patient care. Solutions must be sustainable long-term to account for future disruptions, whilst accounting for evolving patient demographics. Our novel survey has demonstrated the vast potential that the integration of VOPCs can offer paediatric otolaryngology services within a carefully selected cohort of patients.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus , Pandemias , Satisfacción del Paciente , Pediatría/estadística & datos numéricos , Neumonía Viral , Telemedicina , Adolescente , Atención Ambulatoria/métodos , Instituciones de Atención Ambulatoria/organización & administración , Betacoronavirus , Niño , Preescolar , Femenino , Encuestas de Atención de la Salud , Humanos , Lactante , Masculino , Pediatría/métodos , Relaciones Médico-Paciente , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Medicina Estatal , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Reino Unido
7.
Can J Surg ; 63(5): E468-E474, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33107816

RESUMEN

BACKGROUND: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time. METHODS: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend. RESULTS: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening (p = 0.03), the proportion of patients with preoperative liver imaging (p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy (p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes (p = 0.001), and the proportion of patients with pathology reports describing the details on margin status (p = 0.001). CONCLUSION: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.


Asunto(s)
Neoplasias Colorrectales/cirugía , Países en Desarrollo , Recurrencia Local de Neoplasia/epidemiología , Evaluación de Resultado en la Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Implementación de Plan de Salud/organización & administración , Implementación de Plan de Salud/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , México , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven
8.
Indian J Ophthalmol ; 68(11): 2385-2390, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33120624

RESUMEN

Purpose: The aim of this study was to assess the knowledge, attitude, and practice (KAP) pattern towards COVID-19, among patients presenting to eye care hospitals during the last phase of lockdown period. Methods: A multicenter cross-sectional survey was conducted from May 15 to June 15, 2020 in five tertiary eye care hospitals in South India to assess the KAP towards COVID-19. Each of the hospitals belonged to one of the three different zones assigned in India based on number of infections. Red zones represent hotspots and orange/green zones represent regions with medium and lower caseloads, respectively. A validated questionnaire was administered through telephone and responses were recorded on a Google form. Results: Out of the total (n = 6119) participants, 3081 were from hospitals in green zone, 2110 from the orange zone, and 928 from red zone. Majority of participants were above 50 years of age (42%) and 15.54% were illiterate. The mean (percentage) scores of knowledge, attitude, and practice were 21.26 (82%), 9.37 (92%), and 10.32 (86%), respectively. KAP among patients more than 50 years of age and in illiterate individuals was significantly less (P < 0.01) when compared with all other groups. Participants from red zone had a significantly better attitude (P < 0.01) compared to other centers. Conclusion: Although the overall KAP regarding COVID-19 disease was robust (above 80% in all categories) in our participants, the high risk elderly population (>50 years) and illiterate individuals had a significantly lower KAP. These are populations in which education should be emphasized and appropriately delivered as a way to reduce COVID-19 risk.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Neumonía Viral/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Adolescente , Adulto , Actitud Frente a la Salud , Infecciones por Coronavirus/transmisión , Estudios Transversales , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Encuestas Epidemiológicas , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/transmisión , Encuestas y Cuestionarios , Adulto Joven
9.
Indian J Ophthalmol ; 68(11): 2391-2395, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33120625

RESUMEN

Purpose: To evaluate the impact of 2019 COVID-19 pandemic, national lockdown, and unlocking on ophthalmic care provided by the government-funded apex health institute of India. Methods: Retrospective review of electronic medical records of all patients presenting to the ophthalmology department from March 23, 2020, to July 15, 2020, was compared with that from March 23, 2019, to July 15, 2019. The data between March 23, 2020, to May 31, 2020 (lockdown) and June 06, 2020, to July 15, 2020 (unlock) was compared separately. Parameters evaluated were age, gender, presenting complaints, final diagnosis, treatment advised, and surgical interventions. Results: During the lockdown, routine outpatient flow reduced by 97.14% (P < 0.001), the median age of presentation decreased to 29 years (55 years last year) and males increased by 4.7% (from 61.51% to 66.21%) in 2020. Emergency services decreased by 35.25%, percentage of children decreased by 4.28% (from 34.28% to 30%) and males increased by 13.53% (from 59.97% to 73.5%). Mechanical trauma, microbial keratitis, and conjunctivitis were the most common reasons for presentation. The former lessened by 41.75% while the latter two amplified by 1.25 times and 2 times, respectively. While sanitizer-associated chemical injury increased in proportion, endophthalmitis, and postoperative complications declined. The number of donor corneas collected and emergency therapeutic keratoplasties performed decreased by 99.61% and 92.39%, respectively (P < 0.001). During the unlocking phase, routine patient consultations were 71 ± 19/day, significantly lower than 978 ± 109/day of last year (P < 0.001). No voluntary eye donation was reported during this period. Conclusion: COVID-19 pandemic and national lockdown severely hampered the delivery of ophthalmic care by the apex-ophthalmic institute. Unlike anticipated, lifting of pandemic-associated lockdown served only minimally in improving patient inflow in its initial phases.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud/estadística & datos numéricos , Oftalmopatías/epidemiología , Pandemias , Neumonía Viral/epidemiología , Cuarentena/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Bancos de Ojos/estadística & datos numéricos , Oftalmopatías/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Oftalmología/estadística & datos numéricos , Estudios Retrospectivos , Donantes de Tejidos/estadística & datos numéricos
10.
Indian J Ophthalmol ; 68(11): 2396-2398, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33120626

RESUMEN

Purpose: With the outbreak of coronavirus disease 2019 (COVID-19), India went for lockdown-I on March 23, 2020. In this article, we report on the demographic profile and ocular disorders from our 20 rural eye centres during lockdown-I and its comparison with the pre-lockdown period. Methods: A retrospective analysis was conducted for all patients who visited or had teleconsultations at the 20 rural centres in our network between March 23 and April 19, 2020. Demographic and clinical details were collected from electronic medical records (EMR). Subspecialty was decided based on the diagnosis. Patients who needed advanced care were referred to the higher tertiary centres. We report the profile of patients seen and managed at the rural centres and the reasons for referrals. We also compare the data with the pre-lockdown period. Results: During the lockdown-I period, a total of 263 patients were treated including 48 teleconsultations (18.25%). The mean age was 48.16 years (SD: 19.53 years). There were 118 females (44.87%). As compared to pre-lockdown, during the lockdown, the patient visits were highest in the cornea and anterior segment specialty with 114 patients (43.35%), including conjunctivitis (n = 25; 22.32%). Of the 263 patients, 24 patients (9.12%) were referred to tertiary centres. This includes 6/27 (22.22%) patients of microbial keratitis. As compared to this, during pre-lockdown, 28,545 patients were seen. The mean age was 49.03 years (SD: 19.24 years). There were 14,927 (52.29%) females. The referral was 1525 (5.34%), including 34/249 (13.65%) of those with keratitis. Conclusion: Lockdown-I had significantly impacted patient care in rural areas. As compared to the pre-lockdown period, during the lockdown, there was an issue with access to services by females. Despite a higher number of specialty patients (including emergencies) visiting during the lockdown, 91% of the patients who visited rural centres could be managed locally, avoiding long-distance travel.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Oftalmopatías/epidemiología , Neumonía Viral/epidemiología , Cuarentena/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos
11.
Emergencias ; 32(5): 369-371, 2020 09.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33006841
12.
Pediatrics ; 146(5)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33067343

RESUMEN

BACKGROUND: In several states, payers penalize hospitals when an inpatient readmission follows an inpatient stay. Observation stays are typically excluded from readmission calculations. Previous studies suggest inconsistent use of observation designations across hospitals. We sought to describe variation in observation stays and examine the impact of inclusion of observation stays on readmission metrics. METHODS: We conducted a retrospective cohort study of hospitalizations at 50 hospitals contributing to the Pediatric Health Information System database from January 1, 2018, to December 31, 2018. We examined prevalence of observation use across hospitals and described changes to inpatient readmission rates with higher observation use. We described 30-day inpatient-only readmission rates and ranked hospitals against peer institutions. Finally, we included observation encounters into the calculation of readmission rates and evaluated hospitals' change in readmission ranking. RESULTS: Most hospitals (n = 44; 88%) used observation status, with high variation in use across hospitals (0%-53%). Readmission rate after index inpatient stay (6.8%) was higher than readmission after an index observation stay (4.4%), and higher observation use by hospital was associated with higher inpatient-only readmission rates. When compared with peers, hospital readmission rank changed with observation inclusion (60% moving at least 1 quintile). CONCLUSIONS: The use of observation status is variable among children's hospitals. Hospitals that more liberally apply observation status perform worse on the current inpatient-to-inpatient readmission metric, and inclusion of observation stays in the calculation of readmission rates significantly affected hospital performance compared with peer institutions. Consideration should be given to include all admission types for readmission rate calculation.


Asunto(s)
Unidades de Observación Clínica/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Sistemas de Información en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Pacientes Internos/estadística & datos numéricos , Masculino , Calidad de la Atención de Salud , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria/estadística & datos numéricos , Estados Unidos
13.
Can J Surg ; 63(5): E442-E448, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33026310

RESUMEN

BACKGROUND: The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the contribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. METHODS: To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multidisciplinary meetings were prospectively collected. We report data for 365 consecutive days from Dec. 30, 2016, to Dec. 29, 2017. RESULTS: The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. CONCLUSION: Integrating a PA on an ACS team adds value to patient care by providing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consultations and effective organization of the ACS team members.


Asunto(s)
Cuidados Críticos/organización & administración , Quirófanos/organización & administración , Grupo de Atención al Paciente/organización & administración , Asistentes Médicos/organización & administración , Rol Profesional , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Canadá , Cuidados Críticos/estadística & datos numéricos , Prestación Integrada de Atención de Salud/organización & administración , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Quirófanos/estadística & datos numéricos , Grupo de Atención al Paciente/estadística & datos numéricos , Asistentes Médicos/estadística & datos numéricos , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricos
14.
PLoS One ; 15(10): e0239796, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33002074

RESUMEN

Since the end of 2019, an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originating in the Chinese city of Wuhan has spread rapidly worldwide causing thousands of deaths. Coronavirus disease (COVID-19) is supported by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Italy has been the first European country recording an elevated number of infected forcing the Italian Government to call for total lockdown. The lockdown had the aim to limit the spread of infection through social distancing. The purpose of this study is to analyze how the pandemic has affected the patient's accesses to the Ophthalmological Emergency Department of a tertiary referral center in central-northern Italy, during the lockdown period. The charts of all patients that came to the Emergency Department during the lockdown period (March 10 -May 4, 2020) have been retrospectively collected and compared with those in the same period of 2019 and the period from 15 January- 9 March 2020. A significant reduction of visits during the lockdown has been observed, compared with those of pre-lockdown period (reduction of 65.4%) and with those of the same period of 2019 (reduction of 74.3%). Particularly, during the lockdown, minor and not urgency visits decreased whereas the undeferrable urgency ones increased. These pieces of evidence could be explained by the fear of patients to be infected; but also revealed patients misuse of emergency services.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Oftalmología/estadística & datos numéricos , Neumonía Viral/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Adolescente , Adulto , Anciano , Betacoronavirus , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Clasificación Internacional de Enfermedades , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Adulto Joven
15.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(8): 683-687, oct. 2020. tab
Artículo en Español | IBECS | ID: ibc-197156

RESUMEN

El eritema nudoso (EN) es la paniculitis más frecuente y aunque puede ser idiopático, presenta múltiples procesos causales. Elaboramos un estudio retrospectivo, observacional y descriptivo de las causas de EN en pacientes ingresados en un hospital español de tercer nivel durante un período de 11 años, y comparamos los resultados obtenidos con los publicados en otros trabajos. Comparamos los marcadores analíticos de inflamación entre causas inflamatorias y no inflamatorias de EN. La cohorte final quedó compuesta por 52 pacientes, con un 20% de casos idiopáticos, un 34% de casos secundarios a infecciones y otro 34% de casos secundarios a enfermedades autoinmunes. No hubo casos secundarios a fármacos o linfomas. No observamos diferencias significativas en los parámetros analíticos de inflamación en función de causa inflamatoria o no inflamatoria de EN


Erythema nodosum (EN) is the most frequent panniculitis, and although it can be idiopathic, it presents multiple causal processes. We made a retrospective, observational and descriptive study about causes of EN in patients admitted to a third-level Spanish hospital over a period of 11 years, and we compared the results obtained with those published in other studies. We compared the analytical markers of inflammation between inflammatory and non-inflammatory causes of EN. The final cohort was composed by 52 patients, with 20% of idiopathic cases, 34% of cases secondary to infections and another 34% of cases secondary to autoimmune diseases. There were no cases secondary to drugs or lymphomas. We did not observe significant differences in the analytical parameters of inflammation between inflammatory or non-inflammatory cause of EN


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Eritema Nudoso/etiología , Eritema Nudoso/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Estudios Retrospectivos , Distribución por Edad y Sexo , Estadísticas no Paramétricas , España/epidemiología
16.
Middle East Afr J Ophthalmol ; 27(2): 105-109, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32874043

RESUMEN

PURPOSE: Retinopathy of prematurity (ROP) is becoming a leading cause of preventable blindness. The current study aimed to assess ROP and its risk factors in Tabuk City, Northern Kingdom of Saudi Arabia. METHODS: A retrospective study was conducted in King Khalid Hospital, Tabuk City, Saudi Arabia. The premature infants' records during the period of January 2016 to April 2018 were approached. One hundred and eight records were eligible; the infants' gestational age, weight, if received oxygen, surfactant use, blood transfusion, intraventricular hemorrhage, and patent ductus arteriosus were reported. Chi-square test was used to compare premature infants and their counterparts regarding various risk factors. P < 0.05 was considered statistically significant. RESULTS: Out of 108 premature infants, 33.3% had ROP (Many were sightthreatening [stages required treatment] and more than twothirds involving both eyes); a statistically significant difference (P < 0.05) was evident between infants with prematurity, and low birth weight. No significant differences were found regarding other risk factors (P > 0.05). Only 8.3% received interventional therapy. CONCLUSION: ROP is common in King Khalid Hospital, which is the referral tertiary hospital in Tabuk city, KSA . The low birth weight is a significant risk factor to develop ROP. Many of ROP cases were sightthreatening (cases that required treatment) and most cases involving both eyes. Treatment availability at Tabuk city is recommended, instead of referral to another centers especially among those with low weight at birth.


Asunto(s)
Retinopatía de la Prematuridad/epidemiología , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Incidencia , Lactante , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Masculino , Estudios Retrospectivos , Factores de Riesgo , Arabia Saudita/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos
17.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artículo en Inglés | MEDLINE | ID: mdl-32994595

RESUMEN

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Asunto(s)
Síndrome Coronario Agudo/diagnóstico , Mortalidad Hospitalaria/tendencias , Hospitales Urbanos/estadística & datos numéricos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/mortalidad , Síndrome Coronario Agudo/fisiopatología , Anciano , Angiografía Coronaria/métodos , Diagnóstico Diferencial , Ecocardiografía/métodos , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Nueva Zelanda/etnología , Alta del Paciente/tendencias , Estudios Prospectivos , Recurrencia , Estrés Psicológico/epidemiología , Cardiomiopatía de Takotsubo/epidemiología , Cardiomiopatía de Takotsubo/fisiopatología , Centros de Atención Terciaria/estadística & datos numéricos
18.
Geriatr Gerontol Int ; 20(11): 1044-1049, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32924229

RESUMEN

AIM: We aimed to describe the clinical characteristics, treatment and outcomes of patients with COVID-19 pneumonia, in particular older patients, admitted to tertiary and partner hospitals in Saitama, Japan. METHODS: We retrospectively reviewed the medical records of patients with COVID-19 pneumonia admitted to tertiary and partner hospitals in Saitama, Japan. Twenty-six patients with COVID-19 were categorized into two groups, i.e., older (≥75 years) and younger adults (≤74 years). We evaluated the clinical characteristics, comorbidities, symptoms, laboratory test results, treatments and outcomes of the patients. RESULTS: The majority of the older patients had comorbidities, such as dementia, cardiovascular disease and bone fractures. Comorbidities were significantly more frequent in older patients than younger patients. No association was found between age and body temperature or the incidence of respiratory failure. White blood cell count was significantly lower in older patients (P = 0.018) and the decrease in lymphocytes was greater in younger patients (P = 0.009). Computed tomography (CT) of all patients showed non-segmental, peripherally dominant ground-glass opacities consistent with COVID-19 pneumonia. In older patients, antiviral drugs, anticoagulants and anti-inflammatory drugs were administered on a compassionate use basis. The difference in mortality between the older and the younger patients was not statistically significant. CONCLUSIONS: In older patients, typical clinical symptoms and blood test changes were often absent; however, CT always contained typical findings of COVID-19, suggesting that CT may be a useful diagnostic tool. Our report illustrates that appropriate treatment, taking patient background into consideration, may improve their condition regardless of age. Geriatr Gerontol Int 2020; 20: 1044-1049.


Asunto(s)
Infecciones por Coronavirus , Enfermedades no Transmisibles/epidemiología , Pandemias , Neumonía Viral , Tomografía Computarizada por Rayos X , Factores de Edad , Anciano , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Japón/epidemiología , Recuento de Leucocitos/métodos , Recuento de Leucocitos/estadística & datos numéricos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Neumonía Viral/sangre , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Factores de Riesgo , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Tomografía Computarizada por Rayos X/métodos , Tomografía Computarizada por Rayos X/estadística & datos numéricos
19.
Anesth Analg ; 131(4): 1070-1079, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32925326

RESUMEN

BACKGROUND: We report hospitalization patterns from 2000 to 2016 for young children (ages 0-5 years old) in California who underwent 1 of the 20 most common inpatient procedures that required general anesthesia and evaluate the estimated probability of treatment at a tertiary care children's hospital (CH) by year. METHODS: We hypothesized that children ≤5 years old increasingly undergo care at tertiary care CHs for common inpatient surgeries or other procedures that require general anesthesia. Data from the California Office of Statewide Health Planning and Development dataset were used to determine procedure, patient age, year of procedure, and hospital name. Hospitals were designated as either tertiary care CHs, children's units within general hospitals (CUGHs), or general hospitals (GHs) based on the California Children's Services Provider List. A tertiary care CH was defined using the California Children's Services definition as a referral hospital that provides comprehensive, multidisciplinary, regionalized pediatric care to children from birth up to 21 years of age with a full range of medical and surgical care for severely ill children. We report the unadjusted percentage of patients treated at each hospital type and, after controlling for patient covariates and comorbidities, the estimated probability of undergoing care at a tertiary care CH from 2000 to 2016. RESULTS: There were 172,318 treatment episodes from 2000 to 2016. The estimated probability of undergoing care at a tertiary care CH increased from 63.4% (95% confidence interval [CI], 62.4%-64.4%) in 2000 to 78.3% (95% CI, 77.3%-79.4%) in 2016. CONCLUSIONS: Children ≤5 years old undergoing common inpatient procedures that require general anesthesia increasingly receive care at tertiary care CHs in California.


Asunto(s)
Cirugía General/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Pacientes Internos , Pediatría/estadística & datos numéricos , Anestesia General , California , Preescolar , Comorbilidad , Bases de Datos Factuales , Demografía , Femenino , Hospitales/clasificación , Hospitales/estadística & datos numéricos , Hospitales Generales/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos
20.
Ulus Travma Acil Cerrahi Derg ; 26(5): 685-692, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32946100

RESUMEN

BACKGROUND: The novel Coronavirus Disease 2019 (COVID-19) formed the basis for emergency department visits. This study aims to evaluate the effects of the pandemic on emergency department visits of surgical patients. METHODS: The hospital database records of general surgery patients who presented at the emergency department in the period of March 2020-May 2020 (pandemic period) and March 2019-May 2019 (non-pandemic period) were retrospectively analyzed and compared. The primary outcome of this study was the emergency department visit rate of patients requiring a general surgery consultation. Secondary outcomes of this study were patient complaints, diagnosis and treatments, treatment rejection rate, triage category data, the effects of age and gender, and the hospitalization rate. RESULTS: In this study, 618 patients were included: 265 patients from the pandemic period and 353 patients from the non-pandemic period. The analysis and comparison revealed that during the pandemic period, the presentation rate of female patients was lower than that of male patients (45.5% vs. 55.5%, respectively, p=0.045). The triage category rates of patient visits to the hospital during the pandemic period were higher in yellow and red, and lower in green (p<0.01). The incidence of a surgical pathology finding was higher during the pandemic period (p=0.019). The incidence of diseases related to the gastrointestinal tract was higher during the pandemic period (p=0.011). The rate of open surgery in the pandemic period was higher than that of the non-pandemic period (80.5% vs. 32.7%, respectively; p<0.01). The treatment rejection rate was also higher in the pandemic period compared with the non-pandemic period (20% vs. 3.7%, respectively; p<0.01, r). In addition, the hospitalization period was shorter in the pandemic period (p=0.021). CONCLUSION: A 25% reduction in the number of surgical patient visits to the emergency department was observed during the COVID-19 outbreak. The biggest decrease was seen in patients with a green triage code and female patients. It is significant to evaluate the effects of the pandemic on surgical patients visited the emergency department to manage the post-epidemic period and to prepare for possible future epidemic periods.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Adulto , Anciano , Ansiedad/epidemiología , Infecciones por Coronavirus/psicología , Femenino , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/cirugía , Hospitalización , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía Viral/psicología , Estudios Retrospectivos , Trastornos de Estrés Traumático Agudo/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Turquia/epidemiología
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