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1.
Br J Hosp Med (Lond) ; 82(9): 1-7, 2021 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-34601941

RESUMEN

AIM: This project explored how the implementation of national guidance for investigation and management of patients with suspected cauda equina syndrome impacted on service provision. METHODS: Retrospective analysis of patients with suspected cauda equina syndrome during 12 months before the implementation of the national guidelines were compared with data from the 21 months following. RESULTS: Monthly mean numbers of referrals for suspected cauda equina syndrome increased from 10.1 to 18.9 (P<0.001). Statistically significant increases were also seen in the total number of magnetic resonance imaging scans for suspected cauda equina syndrome, and the number of magnetic resonance imaging scans performed out of hours. The mean time interval, from magnetic resonance imaging scan confirming cauda equina syndrome to starting emergency decompressive surgery, reduced from 14.87 hours to 9.57 hours. CONCLUSIONS: Compliance with the national guidance for suspected cauda equina syndrome is imperative for patients to receive optimal treatment. However, this project has demonstrated challenges related to increased pressure on resources.


Asunto(s)
Síndrome de Cauda Equina , Cauda Equina , Hospitales Generales , Humanos , Estudios Retrospectivos , Reino Unido/epidemiología
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(5): 952-956, 2021 Oct 18.
Artículo en Chino | MEDLINE | ID: mdl-34650301

RESUMEN

OBJECTIVE: To analyze the changes and characteristics of pediatric outpatient visits in a general hospital before and after the coronavirus disease (COVID-19) epidemic. METHODS: Based on the registration data of pediatric outpatient visits in the information system (HIS)of Beijing Tsinghua Changgung Hospital, from January 1 2018 to December 31 2020, aged 0 to 16 years, we analyzed the changes of outpatient visits before and after the epidemic, focusing on respiratory infection including influenza. The relationship between the outpatient visits and age and quarterly distribution were also studied. RESULTS: (1) Respiratory infection accounted for the majority of outpatient visits in 2018 and 2019 (60.6% and 60.5%, respectively). Non-respiratory infection accounted for the main proportion of outpatient visits in 2020, while respiratory infection accounted for only 47.4%. Annual respiratory infection visits, respiratory infectious diseases visits especially influenza visits all decreased significantly in 2020 compared with that in 2018 and 2019 (P < 0.05). (2)Respiratory infection visits were highest in the infant group, lowest in the school age group (P < 0.05) and highest in the fourth quarter each year. It decreased significantly in the second quarter of 2020 with statistical significance when compared with the other quarters of 2020(P < 0.05). (3)Influenza accounted for the highest proportion of respiratory infectious diseases visits in each year. It was highest in first quarter, which was significantly different from the other quarters of the year (P < 0.05). There were different distributions of influenza visits throughout 2018 and 2019, while it was only distributed in the first quarter and 99% in January in 2020. CONCLUSION: The respiratory infection and influenza visits have decreased significantly in our pediatric outpatient department after the COVID-19 epidemic, which is considered closely related to the lifestyle and personal protection after the epidemic. It is recommended that health education on respiratory infection and influenza prevention should be strengthened, especially in winter and spring, to promote the development of good respiratory and hand hygiene habits.


Asunto(s)
COVID-19 , Gripe Humana , Niño , Hospitales Generales , Humanos , Lactante , Gripe Humana/epidemiología , Pacientes Ambulatorios , Pandemias , SARS-CoV-2
3.
Rev Med Chil ; 149(3): 366-377, 2021 Mar.
Artículo en Español | MEDLINE | ID: mdl-34479315

RESUMEN

BACKGROUND: Communication gaps are common in emergency medicine. AIM: To know how the health information was delivered to users and relatives by the health care team in the Emergency Unit of a general hospital and how the standards dictated by the patients' rights and duties law were complied with. MATERIAL AND METHODS: Health care workers, patients and their relatives were subjected to semi-structured interviews, and their behavior was directly observed. RESULTS: Important gaps that violate the right to information of users and family members were detected. There is a paucity of minimal conditions to protect the confidentiality and privacy of the information about diagnosis, treatment, or prognosis. There is no time allocated to deliver information and there are no physical spaces for such purpose. CONCLUSIONS: The health care team is not trained in communication skills, crisis intervention and empathy. Empathy and good communication are essential for users and family members to perceive health care as satisfactory and safe and to comply with indications. The lack of protocols to inform family members about the death of a patient is the finding that most clearly accounts for the observed communication deficiencies.


Asunto(s)
Empatía , Hospitales Generales , Comunicación , Servicio de Urgencia en Hospital , Personal de Salud , Humanos
4.
Pan Afr Med J ; 39: 182, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34466203

RESUMEN

Introduction: approximately 6000 Cameroonian women died of cancer in 2018, and the breast is the most affected with 2625 new cases. The aim of this study was to establish a pattern of malignant breast tumours in Yaoundé (Cameroon). Methods: this study was a descriptive and analytical retrospective study of breast cancer between January 2010 and December 2015 in Yaoundé General Hospital (YGH) after the Institutional ethics committee approval. The variables studied were the socio-demographic characteristics, risk factors for breast cancer, types of tumours and type of treatments. The 5-year survival was analyzed by the Kaplan-Meier method. The adjusted hazard ratios and their 95% confidence intervals were calculated to assess the association between studied variables and patient survival through the cox regression using SPSS 23 software. The difference was considered significant at p < 0.05. Results: among the 344 files collected in this study, breast cancer patients were predominantly female (96.64%, n = 288) aged 45.39 ± 13.35 years, with invasive ductal carcinoma (68.03%, n = 270), located in the left breast (52%, n= 147). The average tumour size was ~6.5 ± 0.3 cm and diagnosed in grade II of Scarf Bloom Richardson (SBR) in 60% (n= 150) of cases. The 5-year survival was 43.3%. Factors associated with this poor survival were the religion (aHR 5.05, 95% CI: 1.57 - 16.25; p = 0.007 for animist and aHR 4.2, 95% CI: 1.53 - 11.46; p = 0.005 for protestant), location of the tumour (aHR 6.24, 95% CI: 1.58 - 24.60; p = 0.012), tumor height (aHR 0.21, 95% CI: 0.04 - 1.11; p = 0.011) and the time spent before medical treatment (aHR 5.12, 95% CI: 0.39 - 8.38; p = 0.011). Conclusion: the young age, large tumour size and high histological grade in our studied population suggest a weak awareness of women about breast cancer. Action should be taken in early screening to improve the management of breast cancer in Cameroon.


Asunto(s)
Neoplasias de la Mama Masculina/epidemiología , Neoplasias de la Mama/epidemiología , Carcinoma Ductal de Mama/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Neoplasias de la Mama Masculina/diagnóstico , Neoplasias de la Mama Masculina/patología , Camerún/epidemiología , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patología , Detección Precoz del Cáncer/métodos , Femenino , Hospitales Generales , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Adulto Joven
5.
Ann Biol Clin (Paris) ; 79(4): 325-330, 2021 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-34526289

RESUMEN

Health care workers (HCWs) are at major risk to be infected by SARS-CoV-2 and transmit the virus to the patients. Furthermore, travels are a major factor in the diffusion of the virus. We report our experience regarding the screening of asymptomatic HCWs returning from holidays, following the issue of a national guideline on 08/20/2020. The organization of the occupational health department and the clinical laboratory was adapted in order to start the screening on August, 24, 2020. All HCWs tested for SARS-CoV-2 the week before and 4 weeks after the implementation of the screening were included. The mean number of tests was analyzed per working day and working week. Overall, 502 (31.4%) HCWs were tested for SARS-CoV-2 during the study period. The mean number of HCWs tested per working day was 27.1. HCWs accounted for 36.9% (n = 167) and 11.2% (n = 84) of the tests performed in the 1st and the 4th week following the implementation of the guidelines. The number of tests performed each week in HCWs increased by at least 20-fold after the implementation of the guidelines. No asymptomatic HCW was tested positive. Screening of asymptomatic HCWs was poorly effective in the context of low circulation of the virus. We suggest giving priority to infection prevention and control measures and screening of symptomatic subjects and asymptomatic contacts.


Asunto(s)
Prueba de COVID-19 , COVID-19/diagnóstico , Personal de Salud , Infecciones Asintomáticas , COVID-19/epidemiología , COVID-19/prevención & control , Prueba de COVID-19/métodos , Prueba de COVID-19/normas , Infección Hospitalaria/prevención & control , Francia/epidemiología , Adhesión a Directriz/organización & administración , Adhesión a Directriz/normas , Adhesión a Directriz/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Hospitales Generales , Humanos , Ciencia de la Implementación , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Tamizaje Masivo/normas , Servicios de Salud del Trabajador/organización & administración , Servicios de Salud del Trabajador/normas , Servicios de Salud del Trabajador/estadística & datos numéricos , Reinserción al Trabajo/estadística & datos numéricos , SARS-CoV-2/genética , SARS-CoV-2/aislamiento & purificación
6.
Psychiatr Danub ; 33(Suppl 9): 75-79, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34559782

RESUMEN

BACKGROUND: Candidates for bariatric surgery undergo a multidisciplinary evaluation in the pre-operative phase, including a psychiatric visit aimed at the screening for psychiatric comorbidities, including feeding and eating disorders (FEDs), which are shortcomings to the intervention or predictors of worse prognosis. The presence of FEDs, such as Binge Eating Disorder (BED) and Bulimia Nervosa (BN), is associated with higher rates of other psychiatric disorders. Furthermore, there is evidence of the association between obesity and Depressive Disorders, as well as B and C Cluster Personality Disorders. The aim of this study was to evaluate the presence of psychiatric comorbidities among a population of candidates for bariatric surgery. SUBJECTS AND METHODS: Subjects were recruited at the outpatient service of the Section of Psychiatry, Clinical Psychology and Rehabilitation of the General Hospital/University of Perugia after being referred by surgeons. Psychiatric comorbidities were investigated by means of the Structured Clinical Interview for DSM-5 Disorders. Subjects underwent specific assessment with scales for the evaluation of FEDs, namely Binge Eating Scale, Obesity Questionnaire, Bulimia Test-Revised and Body Shape Questionnaire. RESULTS: The sample consisted of 101 subjects: 43 (42.6%) were diagnosed with at least one psychiatric disorder, including FEDs. In particular, 30 subjects (29.7%) presented at least one FED, among which the most frequent were FED not otherwise specified (24.1%) and BED (6.8%). Moreover, 26 subjects (25.7%) were diagnosed with at least one psychiatric disorder other than FEDs, such as Personality Disorders (17.1%), with a higher prevalence of B and C Cluster Disorders. Depressive Disorders were detected in 5% of the sample. CONCLUSIONS: Subjects undergoing bariatric surgery often display psychiatric comorbidities, more frequently one or more FEDs. The systematic screening of these conditions should be implemented in the clinical practice in order to provide early intervention strategies and adequate monitoring.


Asunto(s)
Cirugía Bariátrica , Hospitales Generales , Comorbilidad , Humanos , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos
7.
BMJ Case Rep ; 14(9)2021 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-34535492

RESUMEN

A 47-year-old woman presented with a headache to the acute medical unit, 10 days after receiving AstraZeneca vaccination for COVID-19. Brain imaging was normal, but her blood tests showed a remarkably low platelet count, mildly deranged liver function tests and a high D-dimer. Further within her hospital admission, she developed right-sided abdominal pain and chest pain, and subsequent cross-sectional imaging confirmed a small segmental pulmonary embolism, and an acute portal vein thrombosis extending to the splenic and superior mesenteric veins. On the basis of her investigations, she was diagnosed as a case of vaccine-induced thrombotic thrombocytopenia and was treated with intravenous immunoglobulins. In a time where there is a strategic goal to vaccinate the global population from COVID-19 to inhibit the spread of infection and reduce hospitalisation, this particular clinical scenario emphasises the need of all clinicians to remain vigilant for rare complications of the COVID-19 vaccination.


Asunto(s)
COVID-19 , Hipertensión Pulmonar , Trombocitopenia , Trombosis , Vacunas , Vacunas contra la COVID-19 , Femenino , Hospitales Generales , Humanos , Persona de Mediana Edad , Arteria Pulmonar , SARS-CoV-2 , Reino Unido
8.
BMC Gastroenterol ; 21(1): 323, 2021 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-34418977

RESUMEN

BACKGROUND: This study aimed to review and evaluate the surgical outcomes, particularly intraoperative severe blood loss and postoperative blood complications, of emergency gastrointestinal surgery in patients undergoing antithrombotic therapy (AT). Emergency surgeries for patients with antithrombotic medication have been increasing in the aging population. However, the effect of AT on intraoperative blood loss and perioperative complications remains unclear. METHODS: We retrospectively reviewed 732 patients who underwent emergency gastrointestinal surgery between April 2014 and March 2019. Patients were classified into AT group and Non-AT group, and propensity score-matched analysis was performed to compare the short surgical outcomes between the groups. Additionally, risk factors in severe estimated blood loss (EBL) and postoperative bleeding complications were assessed. RESULTS: Altogether, 64 patients received AT; 50 patients and 12, and 2 were given antiplatelet and anticoagulant, and both drugs, respectively. After propensity score matching, EBL (101 vs. 99 mL; p = 0.466) and postoperative complications (14 vs. 16 patients; p = 0.676) were similar between the groups (63 patients matched paired). Intraoperative severe bleeding (EBL ≥ 492 mL) occurred in 44 patients. Multivariate analysis using the full cohort revealed that antithrombotic drug use was not an independent risk factor for severe bleeding and postoperative bleeding complications. CONCLUSIONS: This study demonstrated antithrombotic drugs do not adversely affect the perioperative outcomes of emergency gastrointestinal surgery.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Fibrinolíticos , Anciano , Fibrinolíticos/efectos adversos , Hospitales Generales , Humanos , Puntaje de Propensión , Estudios Retrospectivos
9.
Cir Cir ; 89(4): 435-442, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34352870

RESUMEN

INTRODUCCIÓN: en la actual pandemia de COVID-19, existe evidencia creciente que ha identificado el neurotropismo del virus SARS-CoV-2 y sus complicaciones neurológicas, incluida la enfermedad cerebrovascular isquémica y escasamente hemorragia cerebral (HC). OBJETIVO: describir las características clínicas, radiológicas, de laboratorio y pronósticas de los pacientes con HC asociada al SARS-CoV-2. MÉTODOS: se incluyeron pacientes consecutivos con prueba de PCR confirmatoria para infección por SARS-CoV-2 y HC. RESULTADOS: en un período de 90 días, en un centro de referencia COVID-19 en México, de 1108 pacientes con infección por SARS-CoV-2, se encontraron 4 pacientes (0.36%) con HC. Tenían una edad de 71(±12.2) años, 2 eran mujeres. Se encontró que dos tenían factores de riesgo cardiovascular previos. En dos casos se encontró el origen en el núcleo dentado mientras que los otros dos correspondieron al tálamo. Tres de los cuatro pacientes murieron. Postulamos que el descontrol hipertensivo, coagulopatía, trombocitopenia y la respuesta inmune inducida por el virus SARS-CoV-2 podrían desencadenar HC en un paciente con riesgo previo. CONCLUSIONES: la HC se asocia a la infección por SARS-CoV-2 con mal pronóstico cuando se presenta. Los equipos de neurocirugía deben estar preparados para el tratamiento oportuno de estos pacientes. INTRODUCTION: In the current COVID-19 pandemic, there is a growing body of evidence that has identified the neurotropism of the SARS-CoV-2 virus and its neurological complications, including cerebrovascular disease, focusing mainly in ischemic and scarcely about hemorrhagic stroke (HS). OBJECTIVE: The objective of the study was to describe clinical, radiological, laboratory tests, and prognostic characteristics of patients with SARS-CoV-2 associated HS. METHODS: Consecutive patients with a confirmatory PCR test for SARS-CoV-2 infection and a HS demonstrated by head CT were included in the study. RESULTS: Over a period of 90 days, in a COVID-19 reference center in Mexico, out of a total of 1108 patients with SARS-CoV-2 infection, it found 4 patients (0.36%) who meet criteria. They had an age of 71 (±12.2) years, 2 were women. It was found that two had prior cardiovascular risk factors. Two of the HS originated in the dentate nucleus while the other two corresponded to the thalamus. Three of the four patients died. We suggest that catastrophic uncontrolled blood pressure, coagulopathy, thrombocytopenia, and immune response induced by SARS-CoV-2 could in a specific patient trigger HS. CONCLUSIONS: HS is associated to SARS-CoV-2 infection with poor prognosis when it presented. Neurosurgery teams should prepare for the timely and appropriate treatment of this patients.


Asunto(s)
COVID-19/complicaciones , Accidente Cerebrovascular Hemorrágico/etiología , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Prueba de Ácido Nucleico para COVID-19 , Resultado Fatal , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Accidente Cerebrovascular Hemorrágico/diagnóstico , Accidente Cerebrovascular Hemorrágico/diagnóstico por imagen , Hospitales Generales , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , SARS-CoV-2 , Tomografía Computarizada por Rayos X
10.
Pan Afr Med J ; 38: 405, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34381549

RESUMEN

Introduction: thyroid cancer (TC) is considered to have become the fastest growing cancer in terms of incidence worldwide. Despite literature reporting a prevalence of 5-10% in clinically identified thyroid nodules, Cameroon still has limited data on the profile of TCs in patients with Nodular Goitres (NGs). The Objective were to describe the epidemiological, diagnostic and therapeutic profiles of TCs in patients with nodular goitres at the Douala General Hospital (DGH). Methods: this was a retrospective cross-sectional analysis of patient records with diagnoses of NGs, over 11 years (2006 to 2016) at the DGH. Results: overall, 187 patients (mean age= 46.8±13.9 years, men=27 (14.4%)) were included; 43 (23%) cancers were identified. The most common histological type was papillary cancer (50%). Nodule size of >4cm and hypoechogenicity were independently associated with malignancy. Most patients presented with TNM stage II (47.4%) and well-differentiated cancers were considered to be predominantly at low-risk according to MACIS (55%) and AMES (74%) scores. Surgery was offered to 95.3% of patients. Conclusion: TCs are frequent in patients with NGs with papillary cancer dominating. A high index of suspicion should be held if a nodule is >4cm and/or is hypoechogenic. Prognostic studies are needed to describe the outcome of TCs in our setting.


Asunto(s)
Carcinoma Papilar/patología , Bocio Nodular/patología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Camerún , Carcinoma Papilar/epidemiología , Estudios Transversales , Femenino , Hospitales Generales , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias de la Tiroides/epidemiología , Nódulo Tiroideo/epidemiología , Adulto Joven
11.
Arch. argent. pediatr ; 119(4): 224-229, agosto 2021. tab, ilus
Artículo en Inglés, Español | LILACS, BINACIS | ID: biblio-1280889

RESUMEN

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.


Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Apendicectomía/tendencias , Apendicitis/cirugía , Apendicitis/diagnóstico , Apendicitis/epidemiología , Pautas de la Práctica en Medicina/tendencias , Diagnóstico Tardío/tendencias , COVID-19/prevención & control , Accesibilidad a los Servicios de Salud/tendencias , Apendicectomía/métodos , Argentina/epidemiología , Enfermedad Aguda , Incidencia , Estudios Retrospectivos , Laparoscopía/tendencias , Pandemias/prevención & control , Centros de Atención Terciaria , COVID-19/diagnóstico , COVID-19/epidemiología , Hospitales Generales
13.
Orphanet J Rare Dis ; 16(1): 357, 2021 08 10.
Artículo en Inglés | MEDLINE | ID: mdl-34376220

RESUMEN

Ehlers-Danlos Syndrome (EDS) are a heterogeneous group of genetic connective tissue disorders, and typically manifests as weak joints that subluxate/dislocate, stretchy and/or fragile skin, organ/systems dysfunction, and significant widespread pain. Historically, this syndrome has been poorly understood and often overlooked. As a result, people living with EDS had difficulty obtaining an accurate diagnosis and appropriate treatment, leading to untold personal suffering as well as ineffective health care utilization. The GoodHope EDS clinic addresses systemic gaps in the diagnosis and treatment of EDS. This paper describes a leap forward-from lack of awareness, diagnosis, and treatment-to expert care that is tailored to meet the specific needs of patients with EDS. The GoodHope EDS clinic consists of experts from various medical specialties who work together to provide comprehensive care that addresses the multi-systemic nature of the syndrome. In addition, EDS-specific self-management programs have been developed that draw on exercise science, rehabilitation, and health psychology to improve physical and psychosocial wellbeing and overall quality of life. Embedded into the program are research initiatives to shed light on the clinical presentation, underlying mechanisms of pathophysiology, and syndrome management. We also lead regular educational activities for community health care providers to increase awareness and competence in the interprofessional management of EDS beyond our doors and throughout the province and country.


Asunto(s)
Enfermedades del Tejido Conjuntivo , Síndrome de Ehlers-Danlos , Inestabilidad de la Articulación , Tejido Conectivo , Enfermedades del Tejido Conjuntivo/diagnóstico , Síndrome de Ehlers-Danlos/diagnóstico , Hospitales Generales , Humanos , Calidad de Vida
14.
BMC Psychiatry ; 21(1): 349, 2021 07 12.
Artículo en Inglés | MEDLINE | ID: mdl-34253168

RESUMEN

BACKGROUND: Mental-somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel's perceived importance of and experiences with mental-somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. METHODS: Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. RESULTS: Four themes emerged from the data analysis: 1) the relevance of mental-somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental-somatic multimorbidity, and 4) interprofessional collaboration for handling mental-somatic multimorbidity in hospital settings.The mental-somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental-somatic multimorbidity in general hospitals. CONCLUSION: To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental-somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.


Asunto(s)
Hospitales Generales , Multimorbilidad , Humanos , Personal de Hospital , Investigación Cualitativa , Suiza
16.
Arch Argent Pediatr ; 119(4): 224-229, 2021 08.
Artículo en Inglés, Español | MEDLINE | ID: mdl-34309297

RESUMEN

INTRODUCTION: Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. METHODS: Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. RESULTS: The total number of appendicitis cases went down by 25% (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44% (n = 22) versus 37% (n = 22) (p = 0.22) in 2019. No differences were observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42% (n = 21). The incidence of complications was 6% versus 7.5% in the previous period (p = 0.75). One patient was COVID-19 positive. CONCLUSION: Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.


Asunto(s)
Apendicectomía/tendencias , Apendicitis , COVID-19/prevención & control , Diagnóstico Tardío/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Enfermedad Aguda , Adolescente , Apendicectomía/métodos , Apendicitis/diagnóstico , Apendicitis/epidemiología , Apendicitis/cirugía , Argentina/epidemiología , COVID-19/diagnóstico , COVID-19/epidemiología , Niño , Preescolar , Femenino , Hospitales Generales , Humanos , Incidencia , Lactante , Recién Nacido , Laparoscopía/tendencias , Masculino , Pandemias/prevención & control , Estudios Retrospectivos , Centros de Atención Terciaria
17.
Am J Otolaryngol ; 42(5): 103157, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34246025

RESUMEN

BACKGROUND: Dysphonia is a feature of the COVID-19 disease with different prevalence rates of occurrence among various nations. OBJECTIVES: To determine the prevalence of dysphonia in hospitalized patients with COVID-19 disease. MATERIALS AND METHODS: The study was conducted at Salahaddin General Hospital during the period from January to March 2021. Hospitalized COVID-19 patients with or without dysphonia were enrolled in the study. Demographic and clinical data were recorded. The severity, duration, laryngoscopic finding, and fate of the dysphonia were registered too. RESULTS: Out of 94 subjects, there were 21 (22.3%) with dysphonia. The age was ranged from 23 to 101 years, with nearly equal gender distribution. Non-smokers were found in 52.1% of the cases. Dyspnea (100%), fever (100%), and cough (98.9%) were the most common presenting symptoms. There was a statistically significant difference between the dysphonic and non-dysphonic groups regarding fatigue, nasal obstruction, and diarrhea (P-value<0.05). Mild dysphonia was found in 10 (47.6%) of the dysphonic cases. The most common laryngoscopic finding was the bowing of the vocal cords (5/18). Most of the patients (11/18) were with dysphonia for more than a month duration. Similar numbers were not recovered for a one-month follow-up. CONCLUSION: The prevalence of dysphonia was 22.3%. Dyspnea, fever, and cough were the commonest symptoms. Fatigue, nasal obstruction, and diarrhea affected dysphonia. Bowing of the vocal cords was the most common abnormality. Most of the cases were with mild dysphonia, persisting for more than a month, and were not resolved during the follow-up period of one month.


Asunto(s)
COVID-19/complicaciones , Disfonía/epidemiología , Disfonía/virología , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/terapia , Disfonía/diagnóstico , Femenino , Hospitalización , Hospitales Generales , Humanos , Irak , Laringoscopía , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Adulto Joven
18.
BMJ Open ; 11(7): e045081, 2021 07 21.
Artículo en Inglés | MEDLINE | ID: mdl-34290061

RESUMEN

OBJECTIVES: Blood transfusion is a life-saving procedure and is also associated with a range of risks including the occurrence of symptoms of acute transfusion reactions (ATRs). Very few studies in sub-Saharan Africa have reported on ATRs. The present study addresses this gap in the literature by documenting the prevalence of and factors associated with ATRs in the Democratic Republic of Congo (DRC). DESIGN: This is a cross-sectional descriptive and analytical study using blood bank data from a general referral hospital. SETTING: Centre Hospitalier Mère-Enfant (CHME) Monkole, a general referral hospital in Kinshasa, DRC. PARTICIPANTS: General population who have received blood transfusion in CHME Monkole between 2014 and 2019. RESULTS: The data set included a total of 7166 patients; 3153 (44%) men and 4013 (56%) women. The overall prevalence of symptoms of ATRs was 2.6%; the lowest prevalence was in 2017 (2.34%) and highest in 2018 (2.95%) and 2019 (2.94%). The documented symptoms included 74 (39.6%) cases of dyspnoea/respiratory distress, 60 (32.1%) cases of fever, 36 (19.2%) cases of pruritus/urticaria and 17 (9.1%) cases of vomiting. None of the studied factors was associated with symptoms of ATRs. CONCLUSION: Symptoms of ATRs were not uncommon in the studied population. Dyspnoea and respiratory distress, fever and pruritus/urticaria were the most common symptoms of ATRs. This study highlights the need for a clinical and biological surveillance to detect, prevent and manage ATRs in the context of the DRC.


Asunto(s)
Reacción a la Transfusión , Estudios Transversales , República Democrática del Congo/epidemiología , Femenino , Hospitales Generales , Humanos , Masculino , Derivación y Consulta
19.
Ethiop J Health Sci ; 31(2): 371-380, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34158789

RESUMEN

Background: Being overweight and obese represents a severe public health deterioration affecting all population in general and vulnerable groups, such as pregnant women in particular. This study aimed to assess the knowledge, perception and practice towards the risks of excessive weight gain during pregnancy among pregnant mothers at Myung Sung Christian Medical General Hospital. Methods: An institution based cross-sectional study was conducted from July to August, 2019. A systematic random sampling technique was employed to select participants. A total of 176 respondents were included in the study. Data was collected using interviewer administered questionnaire, observation checklist, and measurements of weight and height. Statistical product and service solution version 20.0 was employed for analysis. Descriptive statistics, using tables and charts, was used to present results. Results: Gestational diabetes mellitus (83.5%) and high blood pressure (80.7%) were the major known risks associated with excessive weight gain during pregnancy. Based on the mean score, 96(54.5%) had poor knowledge while 80(45.5%) had good knowledge about the risks of excessive weight gain. The majority (92.0%) overweight and all obese pregnant mothers did not know their actual weight status. Similarly, 134(76.1%) of the study participants were not engaged in regular physical exercise during the current pregnancy. Conclusion: This study revealed that pregnant mothers attending in Korean General Hospital were generally poorly knowledgeable on the risks of excessive weight gain during pregnancy, had poor perception on current weight status and poor practices on their weight gain management. Facility based education and community awareness creation should accompany antenatal care services.


Asunto(s)
Hospitales Generales , Madres , Estudios Transversales , Etiopía , Femenino , Humanos , Percepción , Embarazo , Aumento de Peso
20.
Colorectal Dis ; 23(8): 1961-1970, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34157214

RESUMEN

AIM: Robotic surgery for colorectal cancer has become established more slowly than in other specialities. The aim of this study was to assess the risks and benefits of the use of robotic rectal cancer surgery in comparison with laparoscopic surgery within the confines of a subspecialist rectal cancer service in a district general hospital. METHOD: Outcomes from consecutive patients undergoing minimal access rectal cancer surgery between July 2008 and January 2020 were analysed. Comparisons were made between short-term outcomes including conversion rates, anastomotic leakage and pathological outcomes as well as long-term survival and cancer recurrence. RESULTS: A total of 337 patients were included in the analysis, 204 (60.5%) of whom underwent robotic surgery. Demographic characteristics and use of neoadjuvant chemoradiotherapy were similar between groups. However, patients having robotic surgery had significantly lower tumours than in the laparoscopic group (7.6 cm vs. 9.8 cm, p = 0.003). Conversion to open surgery in the robotic group was significantly less likely (9.8% vs. 22.6%, p = 0.001). Operative mortality, clinical leakage and major complications were similar between groups. While asymptomatic 'radiological' leaks were significantly more common following robotic surgery (13.7% vs. 5.3%, p = 0.017) this did not affect the long-term stoma closure rate. Pathological outcomes were similar with the exception of shorter mean distal resection margins (25.9 mm vs. 32.8 mm, p = 0.001) for the robotic group of patients. There was no statistical difference in 5-year survival between groups (78.7% robotic vs. 85.4% laparoscopic, p = 0.263) nor local recurrence (2.0% robotic vs. 3.8% laparoscopic, p = 0.253). CONCLUSIONS: These results illustrate how the selective use of robotic surgery by a dedicated rectal cancer team can achieve low rates of cancer recurrence and low permanent stoma rates.


Asunto(s)
Laparoscopía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Hospitales Generales , Humanos , Recurrencia Local de Neoplasia , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
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