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2.
Rev Med Liege ; 75(1): 29-36, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-31920041

RESUMEN

Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.


Asunto(s)
Insuficiencia Cardíaca , Trasplante de Corazón , Hospitales Universitarios , Humanos , Tasa de Supervivencia , Donantes de Tejidos
3.
Euro Surveill ; 25(3)2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31992389

RESUMEN

Recognition of measles is crucial to prevent transmissions in the hospital settings. Little is known about the level of recognition of measles and possible causes of not recognising the disease by physicians in the post-vaccine era. We report on a measles outbreak in a paediatric hospital in Austria in January to February 2017 with strikingly high numbers of not recognised cases. The extent and course of the outbreak were assessed via retrospective case finding. Thirteen confirmed measles cases were identified, two with atypical clinical picture. Of eight cases with no known epidemiological link, only one was diagnosed immediately; four were recognised with delay and three only retrospectively. Eleven typical measles cases had four 'unrecognised visits' to the outpatient clinic and 28 on the ward. Two atypical cases had two 'unrecognised visits' to the outpatient clinic and 19 on the ward.Thirteen clinicians did not recognise typical measles (atypical cases not included). Twelve of 23 physicians involved had never encountered a patient with measles before. The direct and indirect costs related to the outbreak were calculated to be over EUR 80,000. Our findings suggest the need to establish regular training programmes about measles, including diagnostic pitfalls in paediatric hospitals.


Asunto(s)
Brotes de Enfermedades/estadística & datos numéricos , Virus del Sarampión/genética , Virus del Sarampión/inmunología , Sarampión/epidemiología , Adolescente , Adulto , Austria/epidemiología , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Hospitales Pediátricos , Hospitales Universitarios , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Lactante , Masculino , Virus del Sarampión/aislamiento & purificación , ARN Viral/análisis , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
4.
J Surg Res ; 245: 569-576, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31494390

RESUMEN

BACKGROUND: Enhanced recovery after surgery (ERAS) following pancreaticoduodenectomy (PD) is popular and safe. This study aimed to describe the incidence, causative factors, and clinical impact of deviation from and failure of an ERAS protocol. MATERIALS AND METHODS: A prospective cohort analysis of elective PD patients managed according to an ERAS protocol between October 2015 and June 2018 was performed. Univariate and multivariate analyses identified variables associated with protocol deviation and failure. The relationship between protocol deviation and failure was also explored. RESULTS: A total of 97 patients were identified comprising of 46 females and 51 males. The median age was 68 y (range 17-85). Twenty-one patients (21.6%) suffered serious complications, whereas two (2.1%) died perioperatively. The median length of stay (LoS) was 14 d (6-36). In total, 73 (75.3%) patients deviated, whereas 39 (40.2%) failed the protocol. On univariate analysis, protocol deviation was associated with male gender, surgery time ≥270 min, and prolonged LoS. On multivariate analysis only prolonged LoS remained significant. Only serious complications were associated with protocol failure on multivariate analysis. Protocol deviation was not associated with significant complications nor ERAS protocol failure. CONCLUSIONS: ERAS protocol deviation does not alter the course of those destined to protocol failure. Greater understanding into the causative factors of either protocol deviation or failure may be the only way to personalize care and realize the maximal benefit of ERAS in this specific group of patients.


Asunto(s)
Procedimientos Quirúrgicos Electivos/efectos adversos , Pancreaticoduodenectomía/efectos adversos , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Incidencia , Israel/epidemiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Insuficiencia del Tratamiento , Adulto Joven
5.
Orv Hetil ; 161(1): 17-25, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31884814

RESUMEN

Introduction: Herbal medicine use has become widespread in recent years. This is the first study in Hungary evaluating the use of nutraceutical agents in patients undergoing elective surgery. Aim: The aim of this study was to assess the types, frequency of use and predisposing factors of the most commonly used herbs among patients of an urban hospital and a university clinic. Method: We conducted an anonymous survey questionnaire at the Jávorszky Ödön Hospital and at the 1st Department of Surgery of Semmelweis University. A total of 1000 questionnaires were distributed. Results: In total, 612 questionnaires were returned. 34.3% of patients used herbal remedies, 19.6% of them two weeks prior to surgery. The most commonly used herbs were garlic, chamomile and lemongrass, while in the two-week period before surgery were garlic, ginger and rosehips. 58.5% of the patients had some type of co-morbidity; in this group, the use of herbal remedies was significantly more frequent. 64.4% of patients were expected to undergo general surgical intervention; in this group, the use of herbs was more popular. Analyzing the sociodemographic factors, women, people with a higher level of education, the ones that live in the capital and are over 60 years of age are more likely to use these compounds. Conclusion: One third of patients waiting for surgery used herbal remedies, one fifth of them two weeks prior to surgery. Only one fifth of the patients reported the use of these compounds to their doctors. Orv Hetil. 2020; 161(1): 17-25.


Asunto(s)
Procedimientos Quirúrgicos Electivos , Medicina de Hierbas , Fitoterapia , Femenino , Hospitales Universitarios , Hospitales Urbanos , Humanos , Hungría , Persona de Mediana Edad , Atención Perioperativa , Plantas Medicinales , Encuestas y Cuestionarios
6.
J Surg Res ; 245: 81-88, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31404894

RESUMEN

BACKGROUND: Delayed emergency department (ED) LOS has been associated with increased mortality and increased hospital length of stay (LOS) for various patient populations. Trauma patients often require significant effort in evaluation, workup, and disposition; however, patient and hospital characteristics associated with increased LOS in the ED for trauma patients remain unclear. METHODS: The Trauma Quality Improvement Project database (2014-2016) was queried for all adult blunt trauma patients. Patients discharged from the ED to the operating room were excluded. Univariate and multivariable linear regression analysis was conducted to identify independent predictors of ED LOS, controlling for patient characteristics (age, gender, race, insurance status), hospital characteristics (teaching status, ACS trauma verification level, geographic region), abbreviated injury scale and comorbid status. RESULTS: 412,000 patients met inclusion criteria for analysis. When controlling for covariates, an increase in age by 1 y resulted in 0.63 increased minutes in the ED (P < 0.001). In multivariable linear regression controlling for injury severity and comorbid conditions, non-white race groups, university status, and northeast region were associated with increased ED LOS. Black and Hispanic patients spent on average 41 and 42 more minutes, respectively, in the ED room when compared with white patients (P < 0.001). Patients seen at University hospitals spent 52 more minutes in the ED when compared with community hospitals, whereas patients at nonteaching hospitals spent 31 fewer minutes (P < 0.001). Patients seen in the Midwest spent the least amount of time in the ED, with patients in the South, West, and Northeast spending 45, 36, and 89 more minutes, respectively (P < 0.001). Non-Medicaid patients at level 1 trauma centers and those requiring intensive care admission had significantly decreased ED LOS. Medicaid patients took the longest to move through the ED with Medicare, BlueCross, and Private insurance outpacing them by 17, 23, and 23 min, respectively (P < 0.001). ACS level 1 trauma centers moved patients through the ED fastest, whereas ACS level II trauma centers and level III trauma centers moved patients through 50 and 130 min slower when compared with ACS level 1 trauma centers (P < 0.001). CONCLUSIONS: ED LOS varied significantly by patient and hospital characteristics. Medicaid patients and those patients at university hospitals were associated with significantly higher ED LOS, whereas ACS trauma verification level status had strong correlation with ED LOS. These results may allow targeted quality improvement programs to enhance ED LOS.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Heridas no Penetrantes/terapia , Escala Resumida de Traumatismos , Adolescente , Adulto , Anciano , Femenino , Hospitales Comunitarios/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Medición de Riesgo/métodos , Análisis de Supervivencia , Estados Unidos , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/mortalidad , Adulto Joven
7.
Orv Hetil ; 160(49): 1941-1947, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31786937

RESUMEN

Introduction and aim: To analyse and classify the ocular trauma cases at the in-patient ophthalmological department of the Markusovszky University Teaching Hospital between 2014 and 2018. Method: We analysed the eye injury cases between 01. 01. 2014 and 31. 12. 2018 in the in-patient clinic of our hospital. 98 eyes of 97 patients were included in this study. To classify the injuries, we used the Birmingham Eye Trauma Terminology (BETT) and the new expanded classification of Shukla et al. Results: From the 97 patients, 16 were female and 81 male. The average age was 43.3 ± 22.5 (min.: 3, max.: 92) years; 20 patients were younger than 18 years old. 46.4% of the cases were right eyes, 52.5% were left eyes, and 1% was bilateral. The average time from the injury until the treatment was 1.3 days. The average time spent in hospital because of the injury was 5.2 days. The average observation time was 9.7 months. 95.8% of the injuries were mechanical eye injuries. From this group, 74.2% localized only to the globe, 20.4% were adnexal injuries and 5.4% were destructive eye injuries. From the globe injuries, 15 were closed globe, 60 were open globe injuries, and in 21 cases there were intraocular foreign body present. In 93% of the cases it was possible to keep or improve the best corrected visual acuity during the treatment. Conclusion: With the new classification, we could classify all of the eye injury cases easily. Depending on the type of the eye injury, with appropriate treatment we can keep or improve the visual function of the eye. Orv Hetil. 2019; 160(49): 1941-1947.


Asunto(s)
Lesiones Oculares/clasificación , Pacientes Internos/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Lesiones Oculares/epidemiología , Lesiones Oculares/etiología , Femenino , Departamentos de Hospitales , Hospitales Universitarios , Humanos , Hungría/epidemiología , Masculino , Persona de Mediana Edad , Agudeza Visual
8.
Rev Med Liege ; 74(12): 637-641, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31833273

RESUMEN

Aortic valve replacement is nowadays a safe procedure with low morbidity and mortality. However, the evolution of surgery requires the development of less invasive techniques. Aortic valve replacement through a right mini-thoracotomy, technically more complicated, offers a lower rate of complications including less postoperative pain and less blood loss and transfusion, with a faster recovery. We report our early experience of aortic valve replacement through a right anterior mini-thoracotomy.


Asunto(s)
Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Procedimientos Quirúrgicos Mínimamente Invasivos , Hospitales Universitarios , Humanos , Tiempo de Internación , Estudios Retrospectivos , Esternotomía , Toracotomía , Resultado del Tratamiento
9.
Pan Afr Med J ; 34: 71, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31819787

RESUMEN

Introduction: Inverted Papilloma (IP) is a rare benign tumour of the nose and paranasal sinuses histologically characterized by invagination of the outer layer of the epithelium in the underlying chorion. Its most distinctive feature is a strong local aggressiveness, a tendency to recur and an unpredictable risk of association with epidermoid carcinoma. The purpose of this study was to report the epidemiological, clinical, paraclinical data as well as to assess the outcomes of endoscopic endonasal surgery. Methods: We conducted a retrospective study on a series of 13 patients whose data were collected in the Oto-Rhino-Laryngology at the National University Hospital Center of Fann, from 1st January 2012 to 31st December 2017. All patients followed up for inverted papilloma confirmed by anathomopathological examination were included in the study. Results: The average age of patients was 44 years, the sex-ratio was 2.25. All patients had nasal obstruction; 53% of them had rhinorrhea followed by epistaxis in 30% of cases. Right-sided symptoms were reported by 69% of patients, left-sided symptoms by 23% and bilateral symptoms by 7% of patients. Anterior rhinoscopy showed endonasal mass in all patients. All patients underwent CT scan; the MRI was performed in a single patient. Endoscopic resection of IP was performed in 10 patients (76.9%) while external approach was used in 23% of cases. Surgery helped to clarify where the tumor had originated: in 46% of cases in the maxillary sinus, in 15% in the lower nasal turbinate, in 15% in the mid-turbinate, in 7% in the ethmoid bulla and in 7% in the lateral wall of the nasal fossa. One patient had recurrence after an average period of 26 months. Malignant transformation to squamous cell carcinoma occurred in one patient. Conclusion: Inverted papilloma is a very aggressive tumor. CT scan is essential to highlight its spread, especially to bone. The advent of endoscopic surgery has revolutionised treatment, providing excellent results. But, there is nevertheless a risk of recurrence after surgery which motivates an indication for long term monitoring.


Asunto(s)
Neoplasias del Seno Maxilar/epidemiología , Neoplasias Nasales/epidemiología , Papiloma Invertido/epidemiología , Neoplasias de los Senos Paranasales/epidemiología , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico , Femenino , Hospitales Universitarios , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias del Seno Maxilar/diagnóstico , Neoplasias del Seno Maxilar/patología , Persona de Mediana Edad , Obstrucción Nasal/etiología , Neoplasias Nasales/diagnóstico , Neoplasias Nasales/patología , Papiloma Invertido/diagnóstico , Papiloma Invertido/patología , Neoplasias de los Senos Paranasales/diagnóstico , Neoplasias de los Senos Paranasales/patología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
10.
Medicine (Baltimore) ; 98(51): e18036, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860954

RESUMEN

Cullin 4A (CUL4A) is a protein of E3 ubiquitin ligase with many cellular processes. CUL4A could regulate cell cycle, development, apoptosis, and genome instability. This study aimed to analyze the expression of CUL4A in nasopharyngeal carcinoma (NPC) tissues and the associations of CUL4A expression with prognostic significance. A total of 115 NPC patients were collected to assess the protein expression of CUL4A by immunohistochemistry, so as to analyze the relationships between CUL4A expression and clinicopathological and prognostic parameters. All patients were followed-up until death or 5 years. The results showed that high expression of CUL4A was significantly associated with larger primary tumor size (P = .026), higher nodal status (P = .013), more distant metastasis (P = .020), and higher TNM stage (P = .005). Kaplan-Meier curves showed that patients with higher CUL4A expression had significantly shorter overall survival (OS) and progression-free survival (PFS) (both P < .001). In multivariate Cox analysis, CUL4A is an independent prognostic factor for OS (P = .016; hazard ratio [HR] = 2.770, 95% CI: 1.208-6.351) and PFS (P = .022; HR = 2.311, 95% CI: 1.126-4.743). In conclusion, high expression of CUL4A was associated with advanced disease status of NPC, and might serve as an independent prognostic factor.


Asunto(s)
Proteínas Cullin/genética , Carcinoma Nasofaríngeo/genética , Carcinoma Nasofaríngeo/mortalidad , Neoplasias Nasofaríngeas/genética , Neoplasias Nasofaríngeas/mortalidad , Adulto , Anciano , China , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica , Hospitales Universitarios , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Carcinoma Nasofaríngeo/patología , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/patología , Neoplasias Nasofaríngeas/radioterapia , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia
11.
Vasc Health Risk Manag ; 15: 551-558, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31853180

RESUMEN

Introduction: As hypertension is a chronic cardiovascular disease that contributes to a high proportion of morbidity and mortality worldwide, favorable knowledge is crucial to control it. Objective: The objective of this study was thus to assess knowledge and associated factors of blood pressure control among hypertensive patients at the chronic illness follow-up Clinic of the University of Gondar comprehensive-specialized hospital, Gondar, Ethiopia. Methods: An institution-based cross-sectional study was conducted from March to April 2018. A systematic random sampling technique was used to select participants. Bi-variable and multivariable logistic regressions were done to assess the relationship between dependent and independent variables. The adjusted odds ratio with a 95% confidence interval was used to determine the presence and strength of association between covariates and the outcome variable. Results: A total of 404 participants took part in the study with a response rate of 97.3%. The overall good knowledge about blood pressure control was 51.7% (95% CI=46.3-56.8). Females were 3.79 (AOR= 3.79, 95% CI: (1.55, 9.28)) more knowledgeable about blood pressure control than males. In the multivariable analysis, the odds of being knowledgeable were 2.80 (AOR= 2.80, 95% CI (1.44, 5.46)), 8.05 (AOR=8.05, 95% CI (2.93, 22.10)), and 7.53 (AOR=7.53, 95% CI (2.52, 22.49)) for can read and write, secondary, preparatory and above education, respectively, compared to cannot read and write. Occupation was significantly associated with the knowledge of plod pressure control. For example, merchants 7.66 (AOR=7.66, 95% CI (3.01, 19.47)), government employee 6.33 (AOR=6.33, 95% CI (1.90, 22.07)), and self-employed 4.58 (AOR=4.58, 95% CI (1.80, 11.70)) times more likely to be knowledgeable than farmers, respectively. Participants with family history of hypertension were 2.36 (AOR=2.36, 95% CI (1.42, 3.92)) times more knowledgeable than their counterparts. Conclusion: In this study, knowledge of blood pressure control was lower compared to the finding of a study done at Bishoftu hospital, Ethiopia. But it is higher than studies in other African countries. Both pharmacological and non-pharmacological awareness is vital for blood pressure control.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Conocimientos, Actitudes y Práctica en Salud , Estilo de Vida Saludable , Hospitales Universitarios , Hipertensión/terapia , Servicio Ambulatorio en Hospital , Conducta de Reducción del Riesgo , Adulto , Anciano , Estudios Transversales , Escolaridad , Etiopía , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hipertensión/psicología , Masculino , Persona de Mediana Edad , Ocupaciones , Factores de Riesgo , Factores Sexuales
12.
Int. arch. otorhinolaryngol. (Impr.) ; 23(4): 403-407, Out.-Dez. 2019. tab
Artículo en Inglés | LILACS | ID: biblio-1024212

RESUMEN

Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective: The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods: A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results: A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion: The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Tonsilectomía/efectos adversos , Hemorragia Posoperatoria/etiología , Pulso Arterial , Estudios Retrospectivos , Factores de Riesgo , Pérdida de Sangre Quirúrgica , Hemorragia Posoperatoria/terapia , Tempo Operativo , Presión Arterial , Hospitales Universitarios , Periodo Intraoperatorio
13.
Rev. Esc. Enferm. USP ; 53: e03486, Jan.-Dez. 2019. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1020393

RESUMEN

RESUMO Objetivo Avaliar o impacto das Infecções Relacionadas à Assistência à Saúde no custo da hospitalização de crianças. Método Estudo de coorte, prospectivo, quantitativo, envolvendo crianças admitidas nas Unidades de Internação e de Terapia Intensiva Pediátrica de um hospital universitário público. Os dados foram analisados por meio do software SPSS por distribuição de frequências, medidas de tendência central e dispersão. Para todas as análises foi considerado o nível de significância estatística de p<0,05. Resultados A amostra foi composta de 173 crianças, destas, 18,5% desenvolveram infecção relacionada à assistência à saúde, que aumentou em 4,2 vezes (p<0,001) o custo da hospitalização. Maior impacto de custo foi observado entre pacientes com dois ou mais sítios infecciosos (R$ 81.037,57, p=0,010) e sepse (R$ 46.315,63 p<0,001). Crianças colonizadas por microrganismos multirresistentes, com prevalência de E. coli e A. baumannii ESBL, geraram custos maiores, R$ 35.206,15 e R$ 30.692,52, respectivamente. Conclusão As infecções relacionadas à assistência à saúde aumentaram significativamente os custos da hospitalização de crianças, em especial entre aquelas com mais de dois sítios infecciosos, que desenvolveram sepse e colonizadas por microrganismos multirresistentes.


RESUMEN Objetivo Evaluar el impacto de las Infecciones Relacionadas con la Asistencia Sanitaria en el costo de la hospitalización de niños. Método Estudio de cohorte, prospectivo, cuantitativo, involucrando a niños ingresados en las Unidades de Hospitalización y de Cuidados Intensivos Pediátricos de un hospital universitario público. Los datos fueron analizados mediante el software SPSS por distribución de frecuencias, medidas de tendencia central y dispersión. Para todos los análisis, se consideró el nivel de significación estadística de p<0,05. Resultado La muestra estuvo compuesta de 173 niños, de estos el 18,5% desarrollaron infección relacionada con la asistencia sanitaria, que aumentó 4,2 veces (p<0,001) el costo de la estancia hospitalaria. Mayor impacto de costo fue observado entre pacientes con dos o más sitios infecciosos (R$ 81.037,57, p=0,010) y sepsis (R$ 46.315,63 p<0,001). Niños colonizados por microorganismos multirresistentes, con prevalencia de E. coli y A. baumannii ESBL, generaron costos mayores, R$ 35.206,15 y R$ 30.692,52, respectivamente. Conclusión Las infecciones relacionadas con la asistencia sanitaria aumentaron significativamente los costos de la hospitalización de niños, en especial entre los con más de dos sitios infecciosos, que desarrollaron sepsis y colonizados por microorganismos multirresistentes.


ABSTRACT Objective To evaluate the impact of Healthcare-Associated Infections on the hospitalization cost of children. Method A prospective, quantitative cohort study involving children admitted to the Inpatient and Pediatric Intensive Care Units of a public university hospital. The data were analyzed through SPSS software by frequency distribution, central tendency measures and dispersion. The level of statistical significance was set at p<0.05 for all analyzes. Results The sample consisted of 173 children, of whom 18.5% developed Healthcare-Associated Infections, which increased the hospitalization costs 4.2 times (p<0.001). A greater cost impact was observed among patients with two or more infectious sites (R$81,037.57; p=0.010) and sepsis (R$46,315.63; p<0.001). Children colonized by multiresistant microorganisms with a prevalence of E. coli and A. baumannii ESBL also generated higher costs of R$35,206.15 and R$30,692.52, respectively. Conclusion Healthcare-Associated Infections significantly increased the hospitalization costs for children, especially among those with more than two infectious sites, who developed sepsis or were colonized by multiresistant microorganisms.


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Niño Hospitalizado , Infección Hospitalaria , Costos de la Atención en Salud , Farmacorresistencia Microbiana , Unidades de Cuidado Intensivo Pediátrico , Estudios de Cohortes , Hospitales Universitarios
14.
Afr J Reprod Health ; 23(3): 42-48, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31782630

RESUMEN

Sickle cell disease (SCD) is a chronic genetic hematological disorder with multiorgan involvement and is associated with complications during the pregnancy. This is a well-known disorder in Saudi Arabia, but no study has reported its outcomes in pregnant Saudi females of the Eastern region. This study was carried out to compare the fetomaternal outcome in patients with SCD with those without SCD. This was a retrospective cohort study done in the Eastern Province of Saudi Arabia in a tertiary care, teaching hospital, by retrieving the data through the code ICD-9 for SCD, the control group was also selected with comparable characteristics. A total of 302 SCD pregnant patients were included for comparison with 600 pregnant women without SCD as control, during the period of Jan 1, 2008 to December 31, 2018. After the data retrieval, percentages of complications were calculated between the study and control groups. Fischer's exact test and t-test were used for statistical analysis by using SPSS version 22. The results showed higher complication rates in pregnancies of patients with SCD. Hypertensive disorders (13.3%), abruptio placenta (1.6%), intrauterine growth restriction (19.2%), thromboembolism (6.6%) and stroke (2.6%) were all higher in SCD as compared to the control group .The complications of SCD itself including anemia (89.4%), acute chest syndrome (13.2%) and sickle cell crisis (39.2%) were also increased during the pregnancy. Both still birth (3.3%) and neonatal intensive care unit admission (1.6%) were also higher in SCD. SCD during the pregnancy is a high-risk situation and can lead to many fetomaternal complications; however, preconceptional counselling, early booking, a careful monitoring during pregnancy and multidisciplinary management approach can prevent potential adverse outcome in this regard.


Asunto(s)
Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/fisiopatología , Complicaciones Hematológicas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Adolescente , Adulto , Anemia de Células Falciformes/epidemiología , Estudios de Casos y Controles , Femenino , Hospitales Universitarios , Humanos , Hipertensión Inducida en el Embarazo , Embarazo , Complicaciones Hematológicas del Embarazo/etnología , Estudios Retrospectivos , Arabia Saudita/epidemiología , Mortinato/epidemiología , Mortinato/etnología , Tromboembolia/epidemiología , Resultado del Tratamiento , Adulto Joven
15.
Rev Infirm ; 68(255): 42-44, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31757331

RESUMEN

A study focusing on therapeutic education sessions for patients with psoriasis receiving subcutaneous biotherapy was carried out in a dermatology department of a university hospital. To meet the needs identified by the research, multi-professional collaboration around a therapeutic patient education approach resulted in the creation and implementation of specific information tools and the organisation of training sessions for the nurses. A subsequent survey showed a 100% satisfaction rate among patients and nurses.


Asunto(s)
Departamentos de Hospitales , Hospitales Universitarios , Grupo de Atención al Paciente , Humanos , Encuestas y Cuestionarios
16.
BMC Infect Dis ; 19(1): 975, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747887

RESUMEN

BACKGROUND: The current evidence of extra length of stay (LOS) attributable to healthcare-associated infection (HCAI) scarcely takes time-dependent bias into consideration. Plus, limited evidences were from developing countries. We aim to estimate the extra LOS and risk factors of mortality attributable to HCAI for inpatients. METHODS: Multi-state model (MSM) was adopted to estimate the extra LOS attributable to HCAI of each type and subgroup. COX regression model was used to examine the risk of mortality. RESULTS: A total of 51,691 inpatients were included and 1709 (3.31%) among them developed HCAI. Lower respiratory tract infection and Acinetobacter baumannii were the most prevalent HCAI and causative pathogen in surveyed institute. Generally, the expected extra LOS attributable to HCAI was 2.56 days (95% confidence interval: 2.54-2.61). Patients below 65 had extra LOS attributable to HCAI longer about 2 days than those above. The extra LOS attributable to HCAI of male patients was 1.33 days longer than female. Meanwhile, age above 65 years old and HCAI were the risk factors of mortality for inpatients. CONCLUSIONS: HCAI contributes to an increase in extra LOS of inpatients in China. The effect of HCAI on extra LOS is different among subgroups, with the age below 65, male and medicine department more sensitive.


Asunto(s)
Infección Hospitalaria/diagnóstico , Tiempo de Internación , Infecciones del Sistema Respiratorio/diagnóstico , Acinetobacter baumannii/aislamiento & purificación , Factores de Edad , Anciano , China , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/mortalidad , Factores de Riesgo , Factores Sexuales , Tasa de Supervivencia
17.
Medicine (Baltimore) ; 98(44): e17704, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689800

RESUMEN

For early diagnosis and treatment of invasive candidiasis (IC), the well-known risk factors may not apply in the intensive care unit (ICU). This retrospective study identified the risk factors predicting IC and candidemia in cancer patients under intensive care after gastrointestinal surgery.Enrolled were 229 cancer patients admitted to our oncology surgical ICU after gastrointestinal surgery between January 1, 2010 and October 31, 2014.The most common types of solid gastrointestinal cancers were gastric (49.8%), colon (20.1%), and esophageal (18.3%). The percentage of patients with corrected Candida colonization index (CCI) ≥0.4 was 31.9%. IC was confirmed in 19 patients (8.3%), and the ICU mortality was 15.8%. Candida albicans accounted for 52.6% of the total number of pathogenic Candida isolates. Among patients with CCI ≥0.4, the cancers with the highest prevalence were cardiac (45%) and gastric (36%), with ICU mortalities of 20% and 4.9%, respectively. For the diagnosis of candidemia, (1-3)-ß-D-glucan (BDG) ≥80 pg/mL showed a sensitivity and specificity of 25% and 82.7%, respectively, positive and negative predictive values 6.7% and 95.7%, and area under the receiver operating characteristic curve 0.512. CCI ≥0.4 was the only significant predictor of IC, and number of organ failures was the only predictor of candidemia (P = .000 and .026).CCI ≥0.4 was the only significant risk factor predicting IC, with greater prediction of intra-abdominal candidiasis but failure to predict candidemia. Blood culture and BDG detection are recommended to supplement diagnosis. Patients may have multifocal and high-grade Candida colonization after cardiac surgery, and; therefore, are at high risk of IC, which should be taken seriously.


Asunto(s)
Candidemia/epidemiología , Candidiasis Invasiva/epidemiología , Neoplasias Gastrointestinales/epidemiología , Neoplasias Gastrointestinales/cirugía , APACHE , Factores de Edad , Anciano , Candida/crecimiento & desarrollo , Enfermedad Crítica , Femenino , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Técnicas Microbiológicas , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Estudios Retrospectivos , Factores de Riesgo , Sepsis/epidemiología
18.
Virchows Arch ; 475(6): 781-788, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31691009

RESUMEN

The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline.


Asunto(s)
Autopsia , Causas de Muerte , Errores Diagnósticos/estadística & datos numéricos , Infarto del Miocardio/mortalidad , Autopsia/métodos , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Prevalencia , Estudios Retrospectivos , Suecia
19.
Pan Afr Med J ; 33: 193, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692677

RESUMEN

Introduction: Blood cultures are the best diagnostic tool for the detection of bacteremia. However, false positive results may lead to confusion about antibiotic regimens, putting the lives of patients at risk. The main purpose of this study was to assess the prevalence of coagulase negative Staphylococci (CoNS) as well as of Corynebacterium spp and Bacillus spp in the bags of blood culture analyzed in the microbiology laboratory at the Ibn-Rochd University Hospital in Casablanca. This prevalence was evaluated according to various Hospital Departments over the year 2016. Methods: We conducted a descriptive, retrospective study by analysing the computerized database of the Laboratory of bacteriology and virology at the Ibn-Rochd University Hospital in Casablanca over a 12-month period from 1st January to 31st December 2016. Our study focused on bacteria forming part of the commensal flora (coagulase negative Staphylococcus, Corynebacteria spp and Bacillus spp). The blood culture bags were incubated in the automated blood culture system (Bactec FX). The identification of the germs from a positive culture was performed according to the standard techniques of bacteriology and susceptibility testing was performed according to EUCAST 2015. We conducted an analysis of the computerized database of KALISIL system (Netika) version (2.2.10.) of the Microbiology Laboratory at the Ibn-Rochd University Hospital in Casablanca. Results: Out of 7959 requests for blood cultures obtained from 5801 patients addressed to the laboratory of bacteriology, 2491 were positive, of which 848, reflecting a rate of 34% of positive bags or 10.6% of the whole of bags received over the year 2016, were positive for coagulase negative Staphylococcus, 56 bags of blood cultures, reflecting a rate of 2.2%, were positive for Corrynébacteruim SP, followed by 60 bags of blood cultures, reflecting a rate of 2.4%, which were positive for Bacillus sp. The frequency of isolation of coagulase negative Staphylococcus compared to other bacteria according to Clinical Departments showed a higher frequency in the Paediatric Department (47.2%) followed by the Medicine Department (44.1%). Conclusion: This study shows that coagulase negative Staphylococci are the organisms most frequently isolated from blood cultures. They are a non-negligible cause of nosocomial infections, but they are also the most common blood culture contaminants.


Asunto(s)
Bacteriemia/epidemiología , Infecciones Estafilocócicas/epidemiología , Staphylococcus/aislamiento & purificación , Bacteriemia/diagnóstico , Bacteriemia/microbiología , Cultivo de Sangre , Coagulasa , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Hospitales Universitarios , Humanos , Marruecos/epidemiología , Prevalencia , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Staphylococcus/enzimología
20.
Pan Afr Med J ; 33: 198, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692732

RESUMEN

Introduction: Epidemiology of these disorders, mainly caused by mycosis, is little known in the Ivory Coast. The aim of this study was to determine the different clinical aspects of intertrigos caused by fungal infections. Methods: We conducted a cross-sectional study in the Department of Clinical Dermatology at the University Hospital in Yopougon (Abidjan, Ivory Coast) from April to October 2012. The study involved the patients come to consultation with lesions in the folds suggesting a mycosis. Samples of serous fluid by swabbing or of scales by scrape cutting with the scalpel blade were performed at the level of the lesions. The fungal agents responsible for these lesions were identified after biological culture. Results: A total of 200 patients had lesions suggesting intertrigo caused by fungal infection. The average age of patients was 29.8 years (with a standard deviation of 11.1 years). Mycosis-related intertrigos accounted for 6.7% of reasons for consultation. A female predominance was observed (76.7%). Lesions mainly occurred in the groin area (40.8%) and in the intergluteal clefts (36.9%). The most observed symptoms were maceration (52.4%) followed by burning (18.4%). In 89.3% of cases, intertrigos were caused by yeasts, including Candida albicans (33%), and Candida parapsilosis(19.4%) which were predominant. Conclusion: Mycosis-related intertrigos mainly affect the young adults of female sex. Lesions mainly occur at the level of the inguinal folds and intergluteal clefts. The main etiological agents are yeasts (Candida).


Asunto(s)
Candidiasis/epidemiología , Intertrigo/epidemiología , Micosis/epidemiología , Adolescente , Adulto , Candida/aislamiento & purificación , Candidiasis/microbiología , Niño , Preescolar , Costa de Marfil , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Lactante , Intertrigo/microbiología , Masculino , Persona de Mediana Edad , Micosis/microbiología , Factores Sexuales , Adulto Joven
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