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1.
BMC Health Serv Res ; 21(1): 1045, 2021 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-34600531

RESUMEN

BACKGROUND: To analyse the changes in curative care expenditure (CCE) associated with noncommunicable diseases (NCDs) before and after the Beijing healthcare reform, thus providing a reference for the healthcare system. METHODS: A total of 60 medical institutions were selected using multistage stratified cluster random sampling in Beijing, China. The records of approximately 100 million outpatients with NCDs in 2016-2018 were extracted. System of Health Accounts 2011 (SHA2011) was used to estimate the CCE. The segmented regression model was established to observe both the instant change and the slope change of intervention in interrupted time series analysis (ITSA). The study was conducted from December 2019 to May 2020 in Beijing, China. RESULTS: From SHA2011, we found that the CCE for outpatients with NCDs in Beijing were 58.59, 61.46 and 71.96 billion RMB in 2016, 2017 and 2018, respectively. The CCE continued to rise at all hospital levels, namely, tertiary, secondary, and community-level hospitals. However, the proportion of CCE in tertiary hospitals decreased. From ITSA, we can also conclude that the CCE showed a significant increasing trend change at the three hospital levels after the intervention. The drug proportion showed a significant decreasing trend change in secondary and tertiary hospitals. CONCLUSIONS: Beijing healthcare reform does have an impact on the CCE of NCDs.


Asunto(s)
Gastos en Salud , Enfermedades no Transmisibles , Beijing/epidemiología , Reforma de la Atención de Salud , Humanos , Análisis de Series de Tiempo Interrumpido , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Pacientes Ambulatorios , Centros de Atención Terciaria
2.
Front Immunol ; 12: 739037, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34594341

RESUMEN

Background: Transfusion of COVID-19 convalescent plasma (CCP) containing high titers of anti-SARS-CoV-2 antibodies serves as therapy for COVID-19 patients. Transfusions early during disease course was found to be beneficial. Lessons from the SARS-CoV-2 pandemic could inform early responses to future pandemics and may continue to be relevant in lower resource settings. We sought to identify factors correlating to high antibody titers in convalescent plasma donors and understand the magnitude and pharmacokinetic time course of both transfused antibody titers and the endogenous antibody titers in transfused recipients. Methods: Plasma samples were collected up to 174 days after convalescence from 93 CCP donors with mild disease, and from 16 COVID-19 patients before and after transfusion. Using ELISA, anti-SARS-CoV-2 Spike RBD, S1, and N-protein antibodies, as well as capacity of antibodies to block ACE2 from binding to RBD was measured in an in vitro assay. As an estimate for viral load, viral RNA and N-protein plasma levels were assessed in COVID-19 patients. Results: Anti-SARS-CoV-2 antibody levels and RBD-ACE2 blocking capacity were highest within the first 60 days after symptom resolution and markedly decreased after 120 days. Highest antibody titers were found in CCP donors that experienced fever. Effect of transfused CCP was detectable in COVID-19 patients who received high-titer CCP and had not seroconverted at the time of transfusion. Decrease in viral RNA was seen in two of these patients. Conclusion: Our results suggest that high titer CCP should be collected within 60 days after recovery from donors with past fever. The much lower titers conferred by transfused antibodies compared to endogenous production in the patient underscore the importance of providing CCP prior to endogenous seroconversion.


Asunto(s)
COVID-19/terapia , Convalecencia , SARS-CoV-2/inmunología , Seroconversión , Adulto , Anticuerpos Neutralizantes/sangre , Anticuerpos Neutralizantes/inmunología , Anticuerpos Antivirales/sangre , Anticuerpos Antivirales/inmunología , Antígenos Virales/sangre , Donantes de Sangre , COVID-19/sangre , COVID-19/inmunología , Femenino , Humanos , Inmunización Pasiva , Cinética , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , ARN Viral/sangre
3.
Intern Med ; 60(19): 3071-3079, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34602521

RESUMEN

Objective Nocturnal desaturation is common in patients with chronic respiratory disease and often worsens the prognosis. Therefore, it should be diagnosed accurately and appropriately treated. The aim of this study was to clarify the diversity of nocturnal desaturation. Methods We prospectively enrolled 58 outpatients diagnosed with chronic respiratory disease receiving home oxygen therapy and measured nocturnal SpO2 using a portable oximeter. We classified nocturnal desaturation (3% decrease in SpO2 from baseline) into three patterns: periodic pattern (desaturation duration of <655 seconds), sustained pattern (desaturation duration of ≥655 seconds), and intermittent pattern (desaturation and recovery of SpO2 repeated with a cycle of several minutes). Results Nocturnal hypoxemia (SpO2≤88% for more than 5 minutes) was found in 23.8% of patients. The percentage of patients with chronic obstructive pulmonary disease (COPD) was significantly higher in the nocturnal hypoxemia group than in the non-hypoxemia group (80% vs. 40.6%, p=0.03). Desaturation with a periodic pattern was found in 81% of patients, desaturation with a sustained pattern was found in 40.5% of patients, and desaturation with an intermittent pattern was found in 59.5% of patients. In patients with COPD, desaturation with a periodic pattern was found in 85.7%, desaturation with a sustained pattern was found in 47.6%, and desaturation with an intermittent pattern was found in 57.1%. Conclusion The SpO2 waveform of nocturnal hypoxemia was able to be classified into three patterns. Suitable treatment for each pattern might improve the prognosis of these patients.


Asunto(s)
Terapia por Inhalación de Oxígeno , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Pacientes Ambulatorios , Oxígeno , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/terapia
4.
Mymensingh Med J ; 30(4): 1060-1066, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34605477

RESUMEN

Osteoporosis is an important systemic manifestation of Chronic Obstructive Pulmonary Disease (COPD). Osteoporosis is a systemic disease of bone which may present as low bone mass and micro-architectural disarray that increases the risk of fracture. The World Health Organization defines osteoporosis as bone density ≥2.5 standard deviations below the bone density of a normal young adult. Osteopenia, a less severe form of bone loss, is defined as a bone density between 1 and 2.5 standard deviations below that reference point. The aetiology of osteoporosis in COPD patients remain unclear, but several factors significantly correspond to reduced bone density in COPD, including older age, female sex and body mass index (BMI). However, the relationship to other factors, such as FEV1, tobacco smoking, physical inactivity and corticosteroid therapy, are still an unresolved issue. This cross-sectional study was done in the Department of Respiratory Medicine, BSMMU from March 2018 to March 2019. A total of 86 patients of which prevalence of osteoporosis is 29.1%, osteopenia 50% and normal BMD in 20.9%, majority of them was belonging to age group 51-60 years. Male were predominant with male-female ratio of 3.5:1. The frequency of osteoporosis was 32.0%, 64.0% and 4.0% in moderate, severe and in very severe COPD patients, respectively. The frequency of osteopenia was 14.0% in mild, 53.5% in moderate, 20.9% in severe and 11.6% were in very severe COPD patients. The p value (p=0.018) was significant for prevalence osteoporosis and osteopenia with increase in severity of COPD. The prevalence of osteoporosis and osteopenia was high in COPD patients under study. The frequency of osteoporosis and osteopenia was more with severity of COPD.


Asunto(s)
Enfermedades Óseas Metabólicas , Osteoporosis , Enfermedad Pulmonar Obstructiva Crónica , Neumología , Absorciometría de Fotón , Anciano , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/etiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/epidemiología , Pacientes Ambulatorios , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores de Riesgo
5.
BMC Health Serv Res ; 21(1): 1063, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34625073

RESUMEN

BACKGROUND: Outpatient child and adolescent mental health services (CAMHS) are faced with the challenge of balancing increasing demands with limited resources. An additional challenge is high rejection rates of referrals which causes frustration for referring agents and families. In order to effectively plan and allocate available resources within CAMHS there is a need for up-to-date knowledge on referral patterns and factors associated with rejection of referrals. METHODS: In this cross-sectional observational study we did a retrospective review of all referrals (n = 1825) for children (0-18) referred for assessment at the outpatient CAMHS of the North Denmark Region in 2018. RESULTS: The most common referral reasons to CAMHS were attention deficit disorder (ADHD/ADD) (27.9%), autism spectrum disorder (22.4%), affective disorders (14.0%) and anxiety disorders (11.6%). The majority of referrals came from general practitioners, but for neurodevelopmental disorders educational psychologists were the primary referral source. Re-referrals constituted more than a third of all referrals (35.9%). Children in care were overrepresented in this clinical sample and had an increased risk (Adj. OR 2.54) of having their referrals rejected by CAMHS. Referrals from general practitioners were also associated with an increased risk of rejection (Adj. OR 3.29). CONCLUSIONS: A high proportion of children with mental disorders have a repeated need for assessment by CAMHS. There is a need for future research on predictors of re-referral to outpatient services to identify potential targets for reducing re-referral rates as well as research on how to optimize service provision for children with a repeated need for assessment. General practitioners are the main gatekeepers to CAMHS and research on interventions to improve the referral process should be aimed towards general practitioners.


Asunto(s)
Trastorno del Espectro Autista , Servicios de Salud Mental , Adolescente , Niño , Estudios Transversales , Humanos , Pacientes Ambulatorios , Derivación y Consulta , Estudios Retrospectivos
6.
Georgian Med News ; (318): 110-114, 2021 Sep.
Artículo en Ruso | MEDLINE | ID: mdl-34628389

RESUMEN

The purpose of the research is to study therapeutic efficiency of medical rehabilitation of patients with Post-COVID-19 syndrome at outpatient treatment stage including natural therapeutic factors and phyto products in rehabilitation programme. In Nalchik resort 64 patients suffering from corona virus disease COVID-19 have been examined. They were distributed into 2 groups. 30 patients of the group of comparison were prescribed mineral water «Nalchik¼, exercise therapy, foam cocktails and rectal suppositories with thick licorice root extract. 34 patients of the main group additionally had natural aeroionophyto therapy along the route of mid-mountain natural park of Nalchik resort in combination with exercise therapy and group psychotherapy in park curative grounds and nitrogen thermal baths. The effectiveness was assessed with the help of the scale «Medical Research Council¼ (mMRC), the level of glycyrrhic acid in blood serum, functional tests, cardiointervalography in dynamics. The conducted comparative analysis proved the ability of natural therapeutic factors to influence the main life-supporting body systems positively. Therefore, the patients of the main group had a reduction of apnea by 29,4% (p<0,01) in comparison with the primary data, increase in adaptation capacity, on average, by 42,4% (p<0,01), improvement of physical activity, on average, by 36,2% (p<0,01), normalization of hemodynamic parameters. It was significantly better (by 20-25%, p<0,05) compared to the treatment in the group of comparison. There has been developed a new method of medical rehabilitation of patients with Post-COVID-19 syndrome at outpatient treatment stage including phytotherapy with licorice root extract and natural aeroionophyto therapy, exercise therapy, psychotherapy along the route of mid-mountain natural park in Nalchik resort, which significantly promotes (p<0,05) optimization of rehabilitation activities.


Asunto(s)
COVID-19 , Pacientes Ambulatorios , Atención Ambulatoria , COVID-19/complicaciones , Humanos , SARS-CoV-2
7.
Rev Fac Cien Med Univ Nac Cordoba ; 78(3): 249-256, 2021 08 23.
Artículo en Inglés | MEDLINE | ID: mdl-34617705

RESUMEN

Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.


Asunto(s)
COVID-19 , Telemedicina , Servicio de Urgencia en Hospital , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pacientes Ambulatorios , Readmisión del Paciente , Estudios Retrospectivos , SARS-CoV-2
8.
Am J Case Rep ; 22: e931974, 2021 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-34480792

RESUMEN

BACKGROUND Treacher Collins syndrome is a rare autosomal dominant disorder characterized by micrognathia and abnormal development of the zygomatic arch, which may result in significant upper airway obstruction. As patients who have it age, their upper airway obstruction may worsen. Therefore, they typically require several surgeries throughout their lives to correct specific facial abnormalities. Anesthetic and airway management of patients with Treacher Collins syndrome can be challenging for anesthesia providers, especially in ambulatory settings. CASE REPORT A 15-year-old patient with Treacher Collins syndrome presented to our outpatient surgery center for midface fat grafting. He had undergone multiple surgical procedures at Nationwide Children's Hospital, which is affiliated with The Ohio State University Wexner Medical Center. A decision was made to proceed with the grafting surgery after: (1) the literature was thoroughly reviewed; (2) multidisciplinary planning had been done utilizing our comprehensive preoperative screening and assessment process; (3) the scope of care at our ambulatory surgery center, the patient's medical history, and relevant airway notes had been reviewed; (4) the case was discussed with the surgeon; and (5) relevant images of the patient had been gathered. Evaluation of the patient's airway on the day of surgery was reassuring and a plan for managing a potentially difficult airway had been developed. After anesthetic induction, mask ventilation without adjuvants was successful. Video and direct laryngoscopy (for purposes of education) revealed grade 1 views. Supraglottic airway device placement resulted in an effective seal and the remainder of the surgery and the patient's subsequent course were uneventful. CONCLUSIONS Improved airway approaches, combined with thorough preoperative screening and multidisciplinary planning and communication, may make it possible to perform ambulatory surgery on patients with Treacher Collins syndrome, whose condition typically represents a significant challenge to anesthesia providers.


Asunto(s)
Anestésicos , Disostosis Mandibulofacial , Adolescente , Niño , Cara , Humanos , Laringoscopía , Masculino , Disostosis Mandibulofacial/cirugía , Pacientes Ambulatorios
9.
Nutrients ; 13(9)2021 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-34579134

RESUMEN

BACKGROUND: Healthy eating and physical activity are effective non-pharmacological approaches to boost immune function and contain the pandemic. We aimed to explore the associations and interactions between physical activity and healthy eating behavior with COVID-19-like symptoms (Slike-CV19S). METHODS: A cross-sectional study was conducted on 3947 outpatients, from 14 February to 2 March 2020, at nine health facilities in Vietnam. Data collection included sociodemographic characteristics, healthy eating behavior (using the healthy eating score (HES) questionnaire), physical activity (using the short form international physical activity questionnaire), and Slike-CV19S. The associations and interactions were tested using logistic regression models. RESULTS: Frequent intake of fruits (OR = 0.84; p = 0.016), vegetables (OR = 0.72; p = 0.036), and fish (OR = 0.43; p < 0.001) were associated with a lower Slike-CV19S likelihood, as compared with infrequent intake. Patients with higher HES levels (OR = 0.84; p = 0.033 for medium HES; OR = 0.77; p = 0.006 for high HES) or being physically active (OR = 0.69; p < 0.001) had a lower Slike-CV19S likelihood, as compared to those with low HES or physical inactivity, respectively. Patients with medium HES who were physically active (OR = 0.69; p = 0.005), or with high HES and physically active (OR = 0.58; p < 0.001), had a lower Slike-CV19S likelihood, as compared to those with low HES and physical inactivity. CONCLUSIONS: Healthy eating behavior and physical activity showed single and combinative impacts on protecting people from Slike-CV19S. Strategic approaches are encouraged to improve healthy behaviors, which may further contribute to containing the pandemic.


Asunto(s)
COVID-19/psicología , Dieta Saludable/estadística & datos numéricos , Ejercicio Físico/psicología , Conducta Alimentaria/psicología , Conductas Relacionadas con la Salud , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/terapia , Estudios Transversales , Dieta Saludable/psicología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/psicología , Pacientes Ambulatorios/estadística & datos numéricos , SARS-CoV-2 , Vietnam , Adulto Joven
10.
J R Soc Interface ; 18(182): 20210319, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34583560

RESUMEN

The global pandemic of coronavirus disease 2019 (COVID-19) has challenged healthcare systems worldwide. Lockdown, social distancing, and screening are thought to be the best means of stopping the virus from spreading and thus of preventing hospital capacity from being overloaded. However, it has also been suggested that effective outpatient treatment can control pandemics. We adapted a mathematical model of the beneficial effect of lockdown on viral transmission and used it to determine which characteristics of outpatient treatment would stop an epidemic. The data on confirmed cases, recovered cases, and deaths were collected from Santé Publique France. After defining components of the epidemic flow, we used a Morris global sensitivity analysis with a 10-level grid and 1000 trajectories to determine which of the treatment parameters had the largest effect. Treatment effectiveness was defined as a reduction in the patients' contagiousness. Early treatment initiation was associated with better disease control-as long as the treatment was highly effective. However, initiation of a treatment with a moderate effectiveness rate (5%) after the peak of the epidemic was still better than poor distancing (i.e. when compliance with social distancing rules was below 60%). Even though most of today's COVID-19 research is focused on inpatient treatment and vaccines, our results emphasize the potentially beneficial impact of even a moderately effective outpatient treatment on the current pandemic.


Asunto(s)
COVID-19 , Pandemias , Control de Enfermedades Transmisibles , Humanos , Pacientes Ambulatorios , Pandemias/prevención & control , SARS-CoV-2
11.
J Pak Med Assoc ; 71(9): 2143-2147, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34580503

RESUMEN

OBJECTIVE: To identify the association among suicidal ideation, deliberate self-harm, and psychopathological distress in normal and deliberate self-harm adults. METHODS: The cross-sectional study was conducted at the Department of Psychiatry, Military Hospital, Rawalpindi, Pakistan, from January to July 2017, and comprised deliberate self harm and normal adults aged 18-25 years. Psychiatric evaluation involved a semi-structured interview based on mental status examination. The self-harm tendency was assessed on the basis of self-harm inventory of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Beck scale for suicide ideation and he depression anxiety and stress scale were also used for data collection. Data was analysed using SPSS 22. RESULTS: There were 200 subjects with a mean age of 20.89±9.06 years; 100(50%) each in deliberate self-harm and normal groups. Deliberate self-harm was significantly positively associated with suicidal ideation and mental health problems, including depression, anxiety and stress (p<0.05). Deliberate self-harm tendency was also positively associated with mental health problems in normal adults (p<0.05). Normal adults had higher level of mental health problems, such as depression and stress, compared to deliberate self harm adults (p<0.05). Adults having self-harm behaviour were more inclined to have suicidal ideation compared to normal adults behaviour (p<0.05). CONCLUSIONS: Deliberate self-harm was found to be strongly related to suicidal behaviour and mental health issues in both normal and deliberate self-harm adults.


Asunto(s)
Trastornos Mentales , Conducta Autodestructiva , Adolescente , Adulto , Niño , Estudios Transversales , Humanos , Masculino , Pacientes Ambulatorios , Factores de Riesgo , Conducta Autodestructiva/epidemiología , Ideación Suicida , Adulto Joven
12.
Health Aff (Millwood) ; 40(9): 1395-1401, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34495715

RESUMEN

The prices paid in 2019 by Blue Cross Blue Shield health plans in hospital outpatient departments were double those paid in physician offices for biologics, chemotherapies, and other infused cancer drugs (99-104 percent higher) and for infused hormonal therapies (68 percent higher). Had these plans excluded hospital clinics from their networks, channeling all of the infusions to physician offices, they would have saved $1.28 billion per year, or 26 percent of what they actually paid. Had they relied on cost-sharing incentives to channel infusions to physician offices-with either uniform 20 percent coinsurance or reference pricing-they would have realized savings but increased the financial burden on patients who received care at the higher-price hospital clinics. Under 20 percent coinsurance, patients' payment obligations for care at hospital clinics would have exceeded those for care in physician offices by a median of 67 percent for biologics, 72 percent for chemotherapies, 87 percent for hormonal therapies, and 75 percent for other cancer drugs. Large savings are potentially available to commercial insurers from shifting cancer infusion care to nonhospital settings, but cost-sharing burdens could become very high for patients.


Asunto(s)
Antineoplásicos , Neoplasias , Servicio de Urgencia en Hospital , Hospitales , Humanos , Aseguradoras , Neoplasias/tratamiento farmacológico , Pacientes Ambulatorios , Consultorios Médicos , Estados Unidos
13.
Int J Chron Obstruct Pulmon Dis ; 16: 2397-2406, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34465987

RESUMEN

Background: Beta-blockers have been proposed to improve COPD-related outcomes, yet studies report conflicting results. We aimed to investigate the effect of beta blockers on time-to-first exacerbation and all-cause mortality in high-risk COPD outpatients. Methods: All COPD outpatients managed at the Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Denmark in 2016 were followed for 3.5 years in this retrospective, registry-based cohort study. Outcomes were time-to-first acute exacerbation of COPD (AECOPD) or death. The association was estimated using time-varying crude and multivariable Cox proportional hazard regression adjusted for age, sex, BMI, use of COPD medication, smoking status, cardiovascular disease and COPD severity. Results: The cohort comprised 950 COPD outpatients, mean age 71 (SD 11) years, and FEV1 44% predicted (IQR 33%; 57%). The annual exacerbation rate was 0.88 (SD 1.68) and 211 patients (22%) had a history of hospitalization requiring AECOPD within 12 months. Of the enrolled patients, 247 (26%) were prescribed beta blockers. Beta-blocker use was associated, although with borderline significance, with increased all-cause mortality (HR 1.37 (95% CI, 0.99 to 1.89, p = 0.059)). On the other hand, beta blocker use did not reduce the risk of AECOPD (HR = 0.89 (95% CI 0.71 to 1.10; p = 0.270)), which remained non-significant after stratifying for severity of exacerbations. Conclusion: We found an association between beta blocker use and all-cause mortality in high-risk COPD outpatients. No association was found between beta blocker use and risk of AECOPD.


Asunto(s)
Pacientes Ambulatorios , Enfermedad Pulmonar Obstructiva Crónica , Anciano , Estudios de Cohortes , Progresión de la Enfermedad , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Estudios Retrospectivos
14.
Z Kinder Jugendpsychiatr Psychother ; 49(5): 334-348, 2021 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-34503362

RESUMEN

Diagnostic work with the conflict axis of the OPD-CA: Empirical results on inpatients and outpatients Abstract. In recent years, the Operationalized Psychodynamic Diagnostics (OPD-CA) is increasingly being used in child and adolescent psychiatry and psychotherapy. This article presents the conflict axis of the OPD-CA, which contains an operationalization of seven psychodynamic conflicts and the processing modes assigned to them. It describes empirical comparisons of the conflict axis ratings and the structure rating in a group of outpatient and inpatient children and adolescents (total N = 186, 12.7 years, 54 % female). The findings in the total sample show that diagnosis-specific gender differences are disappearing, and that male and female patients have largely similar intrapsychic development-impairing conflicts. Patients in inpatient treatment in a child and adolescent psychiatry institution, however, more often show a self-conflict and, as expected, have a lower structural level than patients of the same age in outpatient psychotherapy. The number of highly stressful events before the start of therapy is also significantly higher in this group, which may have contributed to the structural deficits. For outpatients, there is a strikingly higher level of guilt and identity conflicts. In both samples, the mode of processing the conflicts is largely passive. Based on these findings, possible implications for therapeutic practice are discussed.


Asunto(s)
Pacientes Internos , Terapia Psicoanalítica , Adolescente , Psiquiatría del Adolescente , Niño , Femenino , Hospitalización , Humanos , Masculino , Pacientes Ambulatorios , Psicoterapia
15.
Front Immunol ; 12: 709861, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34475873

RESUMEN

Background: Immune hyperactivity is an important contributing factor to the morbidity and mortality of COVID-19 infection. Nasal administration of anti-CD3 monoclonal antibody downregulates hyperactive immune responses in animal models of autoimmunity through its immunomodulatory properties. We performed a randomized pilot study of fully-human nasal anti-CD3 (Foralumab) in patients with mild to moderate COVID-19 to determine if its immunomodulatory properties had ameliorating effects on disease. Methods: Thirty-nine outpatients with mild to moderate COVID-19 were recruited at Santa Casa de Misericordia de Santos in Sao Paulo State, Brazil. Patients were randomized to three cohorts: 1) Control, no Foralumab (n=16); 2) Nasal Foralumab (100ug/day) given for 10 consecutive days with 6 mg dexamethasone given on days 1-3 (n=11); and 3) Nasal Foralumab alone (100ug/day) given for 10 consecutive days (n=12). Patients continued standard of care medication. Results: We observed reduction of serum IL-6 and C-reactive protein in Foralumab alone vs. untreated or Foralumab/Dexa treated patients. More rapid clearance of lung infiltrates as measured by chest CT was observed in Foralumab and Foralumab/Dexa treated subjects vs. those that did not receive Foralumab. Foralumab treatment was well-tolerated with no severe adverse events. Conclusions: This pilot study suggests that nasal Foralumab is well tolerated and may be of benefit in treatment of immune hyperactivity and lung involvement in COVID-19 disease and that further studies are warranted.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , COVID-19/inmunología , COVID-19/prevención & control , Neumonía/terapia , Administración Intranasal , Adolescente , Adulto , Anticuerpos Monoclonales/administración & dosificación , Biomarcadores , Proteína C-Reactiva/análisis , COVID-19/fisiopatología , COVID-19/terapia , Estudios de Cohortes , Femenino , Humanos , Inmunidad/efectos de los fármacos , Interleucina-6/sangre , Pulmón/efectos de los fármacos , Pulmón/inmunología , Pulmón/patología , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Proyectos Piloto , Neumonía/prevención & control , Adulto Joven
16.
JNMA J Nepal Med Assoc ; 59(238): 564-570, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-34508405

RESUMEN

INTRODUCTION: Adolescence is the time when most mental illness begins most of the time these problems are overlooked leading to increased morbidity and mortality. The study is undertaken to find out the prevalence of psychiatric disorders in adolescents attending psychiatry outpatient department in a tertiary hospital. METHODS: A descriptive cross-sectional study was done from 1st December 2019 to 29th November 2020 at a tertiary care centre of Kathmandu. Ethical approval (Ref No.: 012-076/077) was taken from the Institution Review Committee. A semi-structured proforma was used for the socio-demographic profile of patients and International Classification of Diseases-10 was used to make the diagnosis. Data were analyzed using Statistical Package for the Social Sciences version 16. RESULTS: A total of 174 adolescents were included in the study. Out of the total cases 141 (81.03%) (75.1-86.8 at 95% Confidence Interval) were diagnosed with psychiatric disorders, among them 73 (51.77%) were males and 68 (48.23%) were females. The common diagnoses were anxiety disorders 63 (36.20%), mood disorders 34 (19.54%), psychotic disorders 26 (14.94%), substance use disorders 8 (4.59%), non-organic sleep disorders 5 (2.87%), behavioral and emotional disorders 3 (1.72%) and mental retardation 2 (1.149%). CONCLUSIONS: Prevalence of psychiatric illnesses is high in the adolescent population compared to the similar studies.


Asunto(s)
Trastornos Mentales , Psiquiatría , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Pacientes Ambulatorios , Centros de Atención Terciaria
17.
JNMA J Nepal Med Assoc ; 59(237): 432-436, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34508420

RESUMEN

INTRODUCTION: The nose is the central most part of the face, so any nasal deformities may cause a high level of psychological distress on one's quality of life. Septorhinoplasty is a surgical procedure used to correct both functional as well as aesthetic problems of the nose. It enhances facial harmony and increases self-confidence. The objective of this study is to find out the prevalence of out-patients who underwent septorhinoplasty in a tertiary care centre in Nepal. METHODS: A descriptive cross-sectional study among 5,760 patients who visited the outpatient department of Otolaryngology-Head and Neck Surgery of Kathmandu Medical College from April 2019 to September 2020. Ethical approval was taken from the Institutional Committee of Kathmandu Medical College. A convenient sampling technique was used. The preoperative and postoperative assessment was done with the help of a rhinoplasty outcome evaluation questionnaire. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: The prevalence of septorhinoplasty was 117 (2.03%) during the study period (95% Confidence Interval= 1.66-2.40). Among 117 patients, 67 (57.3%) were males and 50 (42.7%) were females. Among 117 patients, 85 (72.6%) patients underwent an open approach, while 32 (27.4%) patients underwent closed approach rhinoplasty for the correction of both aesthetic and functional problems. CONCLUSIONS: This study concludes the prevalence of septorhinoplasty is low which may be due to the COVID-19 pandemic during the study period.


Asunto(s)
COVID-19 , Otolaringología , Rinoplastia , Estudios Transversales , Femenino , Humanos , Masculino , Pacientes Ambulatorios , Pandemias , Calidad de Vida , SARS-CoV-2 , Centros de Atención Terciaria
18.
JNMA J Nepal Med Assoc ; 59(237): 450-453, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34508426

RESUMEN

INTRODUCTION: Onychomycosis is a fungal disease of the nail apparatus caused by dermatophytes, non-dermatophytes and yeasts. Although onychomycosis is rarely life threatening, its high incidence and the associated morbidity makes it an important public health problem. This study was aimed to find the prevalence of onychomycosis among clinically suspected patients attending the outpatient department of Dermatology and Venereology. METHODS: A descriptive cross-sectional study was done in a total of 200 clinically suspected cases of onychomycosis attending the Dermatology outpatient department of a tertiary care hospital within the period of one year from 1st September 2019 to 31st August 2020. Ethical approval (Reference: 150320196) was taken and convenience sampling was done. Data were analyzed using Statistical Package for Social Sciences version 19. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 200 clinically suspected cases prevalence of onychomycosis was found to be 40 (20%) (Confidence Interval = 19.94-20.06) by both direct microscopy and culture. Onychomycosis was commonest among age group of 21-40 years and more predominant among male patients 60 (65.21%). The fingernails were frequently involved i.e., 58 (63%) cases followed by toenails 34 (21%). Dermatophytes were the most common type of fungal infection accounting for 25 (62.5%). CONCLUSIONS: The study highlighted dermatophytes as the most common clinical pattern of onychomycosis and Trichophyton rubrum as the most common aetiological agent causing onychomycosis.


Asunto(s)
Dermatología , Onicomicosis , Adulto , Arthrodermataceae , Estudios Transversales , Humanos , Masculino , Onicomicosis/diagnóstico , Onicomicosis/epidemiología , Pacientes Ambulatorios , Centros de Atención Terciaria , Adulto Joven
19.
Am J Manag Care ; 27(9): e301-e307, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34533912

RESUMEN

OBJECTIVES: Reducing hospital admissions in patients with multiple complex chronic conditions is both a quality indicator and cost-effective to health care systems. This study assesses and compares utilization rates and cost of encounters between patients referred and seen in an outpatient critical care transition clinic (Healthy Transitions Clinic [HTC]) and those referred and not seen. STUDY DESIGN: Retrospective cohorts. METHODS: Patients with complex chronic conditions discharged from a tertiary/quaternary acute care hospital or emergency department (March 1, 2015, to February 29, 2016) were referred to an outpatient critical care transition clinic. Comparative cohorts were those patients who attended this transition clinic and those who did not. Pre- and post-HTC referral visits, with health care utilization evaluations including admissions/readmissions, attention to social determinants of health, and cost assessments, were compared among the cohorts. RESULTS: Insurance coverage differed significantly in its distribution between the groups (χ2 = 22.99; P < .001); therefore, an adjusted relative risk model was used. Inpatient admissions significantly increased, by 31%, in the non-HTC cohort (P = .03); a significant increase in the rate of 30-day readmissions (69%) occurred in the HTC group (P < .001) at 6 months post index admission. Length of stay did not differ pre- and post HTC visit. Although not statistically significant, visits to the HTC reduced median all-cost and HTC cohort cost by more than $1 million. CONCLUSIONS: In patients with complex chronic medical conditions with recent hospital admissions, the HTC model appears to reduce both admissions and encounter costs. Further community/regional studies are needed to better define this observation on a longitudinal basis.


Asunto(s)
Readmisión del Paciente , Transferencia de Pacientes , Hospitalización , Humanos , Pacientes Ambulatorios , Estudios Retrospectivos
20.
Rev Cardiovasc Med ; 22(3): 1063-1072, 2021 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-34565108

RESUMEN

We evaluated the age-specific mortality of unselected adult outpatients infected with SARS-CoV-2 treated early in a dedicated COVID-19 day hospital and we assessed whether the use of hydroxychloroquine (HCQ) + azithromycin (AZ) was associated with improved survival in this cohort. A retrospective monocentric cohort study was conducted in the day hospital of our center from March to December 2020 in adults with PCR-proven infection who were treated as outpatients with a standardized protocol. The primary endpoint was 6-week mortality, and secondary endpoints were transfer to the intensive care unit and hospitalization rate. Among 10,429 patients (median age, 45 [IQR 32-57] years; 5597 [53.7%] women), 16 died (0.15%). The infection fatality rate was 0.06% among the 8315 patients treated with HCQ+AZ. No deaths occurred among the 8414 patients younger than 60 years. Older age and male sex were associated with a higher risk of death, ICU transfer, and hospitalization. Treatment with HCQ+AZ (0.17 [0.06-0.48]) was associated with a lower risk of death, independently of age, sex and epidemic period. Meta-analysis evidenced consistency with 4 previous outpatient studies (32,124 patients-Odds ratio 0.31 [0.20-0.47], I2 = 0%). Early ambulatory treatment of COVID-19 with HCQ+AZ as a standard of care is associated with very low mortality, and HCQ+AZ improve COVID-19 survival compared to other regimens.


Asunto(s)
Atención Ambulatoria , Antivirales/uso terapéutico , Azitromicina/uso terapéutico , COVID-19/tratamiento farmacológico , Intervención Médica Temprana , Hidroxicloroquina/uso terapéutico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antivirales/efectos adversos , Azitromicina/efectos adversos , COVID-19/diagnóstico , COVID-19/mortalidad , Quimioterapia Combinada , Femenino , Francia , Hospitalización , Humanos , Hidroxicloroquina/efectos adversos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
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