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1.
J Clin Med ; 10(18)2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34575328

RESUMO

COVID-19 exerts deleterious cardiopulmonary effects, leading to a worse prognosis in the most affected. This retrospective multi-center observational cohort study aimed to analyze the trajectories of key vitals amongst hospitalized COVID-19 patients using a chest-patch wearable providing continuous remote patient monitoring of numerous vital signs. The study was conducted in five COVID-19 isolation units. A total of 492 COVID-19 patients were included in the final analysis. Physiological parameters were measured every 15 min. More than 3 million measurements were collected including heart rate, systolic and diastolic blood pressure, cardiac output, cardiac index, systemic vascular resistance, respiratory rate, blood oxygen saturation, and body temperature. Cardiovascular deterioration appeared early after admission and in parallel with changes in the respiratory parameters, showing a significant difference in trajectories within sub-populations at high risk. Early detection of cardiovascular deterioration of COVID-19 patients is achievable when using frequent remote patient monitoring.

2.
Harefuah ; 159(11): 797-803, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210849

RESUMO

BACKGROUND: Several demographic and medical factors have an established effect on mortality and function after hip fractures, however varying fracture characteristics and surgical factors have been less thoroughly investigated. The study assessed the impact of specific fracture patterns on mortality and mobility one year post hip fracture. Other surgical factors including the type of intervention, major complications and sequential fractures were assessed as well. METHODS: An institutional hip fracture registry was reviewed. Mobility status scores were calculated one year post-operatively. RESULTS: Thirty days mortality was 4.6% and one year mortality was 19.9%. There was no significant effect of fracture type on mortality. However, patients receiving hemiarthroplasty had a significantly higher mortality (28.1%) than other patients receiving internal fixation (18.6%) or total hip arthroplasty (4%). An increased mobility status after intra-capsular fractures over extracapsular fractures was demonstrated. Patients receiving total hip arthroplasty had significantly better mobility at one year than patients with fracture fixation or hemiarthroplasty. Major complications and sequential fractures had no significant effect on outcome. CONCLUSIONS: Critical factors that influence decision making for orthopedic surgeons are revealed to have a lesser effect on the patient's ultimate outcome.


Assuntos
Artroplastia de Quadril , Hemiartroplastia , Fraturas do Quadril , Artroplastia de Quadril/efeitos adversos , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Humanos , Amplitude de Movimento Articular
3.
Quintessence Int ; 51(6): 440-446, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32253393

RESUMO

OBJECTIVES: To compare the microhardness and ion content of three glass-ionomer cements (GICs) during setting and up to 15 days, to composite resin-based material in vitro, and after 5 to 10 years in vivo. METHOD AND MATERIALS: Disks of three GICs, EQUIA Fil, Riva Self Cure, and Ketac Molar were examined in vitro for microhardness using Vickers indentations after 15 to 60 minutes, 24 hours, and 8 and 15 days, and compared to composite material, Spectrum. The ion content of the GIC and composite was analyzed using the energy dispersive spectroscopy program of a scanning electron microscope. A primary second molar restored with GIC normally exfoliated after 5 years, and a third molar restored with GIC extracted due to periodontitis after 10 years, were sliced through the restoration buccolingually, and the microhardness of the restoration and of the dentin was measured. RESULTS: In comparison to composite material, the Vickers value for the GICs were similar or better after 24 hours to 15 days. The amount of fluorine was three times higher in EQUIA Fil and Riva Self Cure in comparison with Ketac Molar, after 20 days. After 5 years in vivo, the microhardness of GICs was similar to dentin and after 10 years it was significantly higher than that of the dentin. CONCLUSION: The microhardness of GICs was comparable to composite material after only 24 hours. In vivo the microhardness of GICs increased and after 10 years in vivo it was higher than that of the dentin. After 20 days the amount of fluorine was still high in Riva Self Cure and EQUIA Fil.


Assuntos
Resinas Compostas , Cimentos de Ionômeros de Vidro , Dentina , Fluoretos , Teste de Materiais , Cimentos de Resina , Dente Decíduo
4.
J Clin Rheumatol ; 26(6): 260-264, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31192858

RESUMO

OBJECTIVE: The aim of this study was to compare the effect of biologic agents and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) on the psychologic status of patients with psoriatic arthritis (PsA) in remission or with low disease activity. METHODS: This is a case-control study of PsA patients in remission or with low disease activity treated at a single-center combined rheumatologic-dermatologic clinic between 2015 and 2017. Patients were assigned to 2 comparison groups according to their treatment (1) biologic drugs and (2) csDMARDs therapy. Psoriatic arthritis disease activity was evaluated by disease activity score-28. Anxiety, somatization, and depression were evaluated by patient health questionnaires (PHQ): generalized anxiety disorder-7, PHQ-15, and PHQ-9, respectively. Disability was assessed by the health assessment questionnaire disability index (HAQ-DI). RESULTS: Thirty PsA patients on biologic treatment (BT) and 14 PsA patients in csDMARDs were enrolled. No significant differences in disease duration and treatment duration between the 2 groups were found. Disease activity score-28 was significantly better in the BT group compared with the csDMARDs group (1.8 ± 0.4 vs 2.1 ± 0.4, respectively, p = 0.028). A nonsignificant tendency toward higher scores in psychologic questionnaires was seen among the non-BT group. Moderate to high correlations between all mental questionnaires and HAQ-DI were found in both groups (0.567 ≤ r ≤ 0.850, p < 0.05). Patients with mental disturbance (generalized anxiety disorder-7/PHQ-15/PHQ-9 ≥ 5) showed significant poorer performance in their HAQ-DI in comparison with patient without physiological comorbidities in both groups. CONCLUSIONS: Tight disease control in PsA patients, achieved with BT, may offer an improvement in psychological outcomes in addition to relieving clinical symptoms.


Assuntos
Antirreumáticos , Artrite Psoriásica , Produtos Biológicos , Antirreumáticos/uso terapêutico , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Estudos de Casos e Controles , Humanos , Morbidade , Resultado do Tratamento
5.
Arch Oral Biol ; 104: 119-122, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31181410

RESUMO

OBJECTIVE: The aim of the study was to compare the neonatal line width as well as the composition of the pre-natal and post-natal enamel in deciduous teeth of children with cerebral palsy (CP) to deciduous teeth of healthy children. DESIGN: 58 extracted or normally exfoliated deciduous teeth were collected for the study, 29 teeth from children with cerebral palsy and 29 pair matched teeth from healthy children who served as controls. The teeth were cut along the bucco-lingual/palatal axis and polished up to a thickness of 50-100 microns. The sections were examined using a light microscope and scanning electron microscope (SEM). The neonatal line was identified in 25 teeth and measured in width and the enamel concentrations of calcium, phosphorus, silicon, magnesium, sodium, oxygen, and carbon were measured in the pre-natal and post-natal enamel using ESD program. RESULTS: The neonatal line was significantly narrower in the deciduous teeth collected from children with cerebral palsy. In both groups, the concentration of magnesium and sodium in the pre-natal enamel was significantly higher than in the post-natal enamel. Magnesium and sodium levels were significantly higher in pre-natal enamel in the CP group compared to the pre-natal enamel of the control group. CONCLUSIONS: The neonatal line was narrower in the deciduous teeth collected from children with cerebral palsy than in those collected from healthy children. Children with cerebral palsy have a higher concentration of magnesium and sodium in the enamel that developed before birth.


Assuntos
Paralisia Cerebral , Esmalte Dentário , Paralisia Cerebral/complicações , Criança , Esmalte Dentário/anatomia & histologia , Esmalte Dentário/química , Humanos , Recém-Nascido , Magnésio/análise , Fósforo , Polônia , Sódio/análise , Dente Decíduo
6.
J Obstet Gynaecol Can ; 41(7): 926-929, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30638834

RESUMO

OBJECTIVE: This study sought to compare the value of transvaginal ultrasonography (TVUS) and hysteroscopy in premenopausal and postmenopausal women in the diagnosis of endometrial polyp. METHODS: The records of 694 women with an ultrasonographic diagnosis of suspected endometrial polyp who underwent hysteroscopy were studied. Patients were divided into two groups according to menopausal status, and a comparison was made between two groups. RESULTS: There were 299 postmenopausal and 395 premenopausal women in the study. Hysteroscopy confirmed the ultrasonographic diagnosis of endometrial polyp in 212 (71%) and 212 (53%) patients in the postmenopausal and premenopausal groups, respectively (P = 0.001). In postmenopausal patients, 94% of the polyps observed by hysteroscopy were confirmed by histology, whereas in premenopausal patients, the percentage was 85% (P = 0.004). CONCLUSION: In premenopausal patients, the diagnostic value of TVUS and hysteroscopy is lower than in postmenopausal patients. The appropriate time for TVUS and hysteroscopy should be scheduled in premenopausal women, especially in women with abnormal uterine bleeding.


Assuntos
Pólipos/diagnóstico , Pós-Menopausa , Pré-Menopausa , Neoplasias Uterinas/diagnóstico , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Pólipos/patologia , Valor Preditivo dos Testes , Ultrassonografia , Neoplasias Uterinas/patologia
7.
Int J Rheumatol ; 2018: 2586916, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30420888

RESUMO

Objectives: To assess the correlation between prednisone and methotrexate (MTX) treatment duration and dosage with the TST induration diameter of the TST reaction among rheumatoid arthritis (RA) patients. Method: We retrospectively analyzed consecutive cases of RA patients who were TNF-i therapy candidates. TST measurements, prednisone and methotrexate dosages, and treatment durations were recorded. A control group was randomly selected from healthy subjects. We compared TST reaction size between the following three groups: RA patients with current prednisone treatment, RA prednisone naïve patients, and healthy individuals. Results: Our study sample comprised 43 RA patients with prednisone treatment, 22 prednisone naïve patients, and 195 healthy subjects. There was no significant difference in mean TST between the groups (5.3±6.6, 7.8±6.2, and 7.6±7.0, respectively, p=0.149). No correlation was noted between TST size and prednisone u-y (r=0.229, p=0.140) or methotrexate u-y in patients with and without prednisone therapy (r=0.219, p=0.158; and r=-0.293, p=0.186, respectively). Conclusions: Our results show that the TST reaction size among RA patients may not be affected by prednisone therapy. In addition, the TST reaction of RA patients may present similarly to that of healthy individuals. Therefore, we suggest that the criterion of a TST reaction of 5 mm to define latent TB infection in our population should be reevaluated.

8.
Isr Med Assoc J ; 20(9): 553-556, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30221868

RESUMO

BACKGROUND: Mortality and decrease in function after hip fracture are significantly related to patient factors including age, gender, co-morbidities, and mental status. Several studies demonstrated ethnic disparities in incidence, mortality, and functional outcome after hip fractures in the United States. OBJECTIVES: To assess the relationship between ethnicity and hip fracture incidence and outcomes of mortality, functional change, and perioperative complications in the Israeli population. METHODS: We reviewed our institutional hip fracture registry for all patients from 2014-2015. Patients with incomplete data, < 60 years of age, or pathologic and periprosthetic fractures were excluded. Our study comprised 693 patients. Ethnicity was based on country of birth. Specifically, for those born in Israel, the nationality of either Jewish or Arab was further dichotomized. Perioperative complications, mortality, and mobility status at 1 year follow-up were recorded. The ethnicities of 27,130 patients admitted to the medicine and surgical wards during the same time interval served as a control group for the hip fracture cohort. RESULTS: Immigrants from Europe and America had the highest incidence of hip fractures. Fracture types varied in incidence in groups with 70% of extracapsular hip fractures occurring in Arabs and immigrants from Eastern countries, compared to 60% in immigrants from Western countries and the former Soviet Union. Mortality, perioperative complications, and mobility at 1 year were similar in all ethnic groups. CONCLUSIONS: Our study demonstrated significant differences in incidence and fracture characteristic among ethnicities, but no difference in patient outcome. These findings differed from the available North American studies.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Fraturas do Quadril/etnologia , Fraturas do Quadril/mortalidade , Recuperação de Função Fisiológica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos
9.
BMC Musculoskelet Disord ; 19(1): 188, 2018 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-29879934

RESUMO

BACKGROUND: Total hip arthroplasty (THA) is considered a successful surgical procedure. It can be performed by several surgical approaches. Although the posterior and anterolateral approaches are the most common, there has been increased interest in the direct anterior approach. The goal of the present study is to compare postoperative leg length discrepancy and acetabular cup orientation among patients who underwent total hip arthroplasty through a direct anterior (DAA) and anterolateral (ALA) approaches. METHODS: The study included 172 patients undergoing an elective THA by a single surgeon at our institution within the study period. Ninety-eight arthroplasties were performed through the ALA and 74 arthroplasties through the DAA. Preoperative planning was performed for all patients. Assessment of the two groups included the following postoperative parameters: abduction angle, cup anteversion angle and leg length discrepancy (LLD). Additional analysis was done to evaluate component positioning by comparing deviation from the Lewinnek zone of safety in both approaches. RESULTS: For the DAA the absolute LLD was 11 mm, ranging from -6 mm to 5 mm. For the ALA, the absolute LLD was 36 mm, ranging from -22 mm to 14 mm. None of the DAA patients had an absolute LLD greater than 6 mm. Comparatively, 7.4% of the ALA group exceeded 6 mm of LLD in addition to 2.1% with LLD greater than 10 mm. 15% of the ALA group resided out of the Lewinnek abduction zone compared to 3% of the DAA group (P = 0.016). 17% of the ALA group were out of the Lewinnek anteversion zone as opposed to 8% of the DAA group (P = 0.094). CONCLUSION: Our study demonstrates good component positioning outcomes and LLD values in patients following THA through the DAA compared to the ALA.


Assuntos
Acetábulo/diagnóstico por imagem , Artroplastia de Quadril/tendências , Procedimentos Cirúrgicos Eletivos/tendências , Desigualdade de Membros Inferiores/diagnóstico por imagem , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Acetábulo/cirurgia , Idoso , Artroplastia de Quadril/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Desigualdade de Membros Inferiores/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia
10.
J Shoulder Elbow Surg ; 27(7): 1263-1267, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29398398

RESUMO

BACKGROUND AND HYPOTHESIS: The diagnostic workup of the painful shoulder after rotator cuff repair (RCR) can be quite challenging. The aim of this study was to assess the reliability of ultrasonography (US) for the detection of recurrent rotator cuff tears in patients with shoulder pain after RCR. We hypothesized that US for the diagnosis of recurrent rotator cuff tear after RCR would not prove to be reliable when compared with surgical arthroscopic confirmation (gold standard). METHODS: In this cohort study (diagnosis), we retrospectively analyzed the data of 39 patients with shoulder pain after arthroscopic RCR who had subsequently undergone US, followed by revision arthroscopy. The rotator cuff was evaluated first using US for the presence of retears. Thereafter, revision arthroscopy was performed, and the diagnosis was either established or disproved. The sensitivity and specificity of US were assessed in reference to revision arthroscopy (gold standard). RESULTS: A rotator cuff retear was indicated by US in 21 patients (54%) and by revision arthroscopy in 26 patients (67%). US showed a sensitivity of 80.8% and specificity of 100% in the diagnosis of rotator cuff retears. Omission of partial rotator cuff retears resulted in a spike in sensitivity to 94.7%, with 100% specificity remaining. CONCLUSION: US imaging is a highly sensitive and specific test for the detection of recurrent rotator cuff tears, as confirmed by revision arthroscopy, in patients with a painful shoulder after primary RCR.


Assuntos
Artroscopia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Recidiva , Reprodutibilidade dos Testes , Estudos Retrospectivos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/complicações , Sensibilidade e Especificidade , Dor de Ombro/etiologia
11.
Gynecol Endocrinol ; 34(8): 638-643, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29373930

RESUMO

The potential adverse effect of Serum progesterone (SP) elevation on the day of hCG administration is a matter of continued debate. Our study aimed to evaluate the relative value of progesterone to a number of aspirated oocytes ratio (POI) to predict clinical pregnancy (CP) and live birth (LB) in fresh IVF cycles and to review the relevant literature. A retrospective analysis of GnRH Antagonist IVF-ET cycles. POI was calculated by dividing the SP on the day of hCG by the number of aspirated mature oocytes. A multivariate logistic regression analysis was performed to evaluate the predictive value of POI for CP and LB. Cycle outcome parameters included clinical pregnancy, live-birth and miscarriage. A total of 2,693 IVF/ICSI cycles were analyzed. POI was inversely associated with CP adjusted OR 0.063 (95% CI 0.016-0.249, p < .001) and with LB adjusted OR 0.036 (95% CI 0.007-0.199, p < .001). For prediction of LB, the area under the curve (AUC) was 0.68 (95% CI 0.64-0.71, p < .001) for the POI model. POI above the 90th percentile with a value of 0.36 ng/mL/oocyte results in CP and LB rates of 8.0 and 5.9%, respectively. POI is a simple index for the prediction of IVF-ET cycle outcomes, it can advocate a limit above which embryo transfer should be reconsidered.


Assuntos
Fertilização In Vitro/estatística & dados numéricos , Oócitos , Indução da Ovulação , Taxa de Gravidez , Progesterona/sangue , Adulto , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos
12.
J Shoulder Elbow Surg ; 26(12): 2167-2172, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28919000

RESUMO

BACKGROUND: Defining a simple and reliable classification for acromial and bursal impingement lesions is necessary to standardize terminology, to improve communication, and to allow better evaluation of the proper treatment of impingement lesions and rotator cuff tears. The purpose of this study was to assess orthopedic surgeons' intraobserver and interobserver reliability of the Copeland-Levy classification. METHODS: Six fellowship-trained orthopedic surgeons reviewed shoulder arthroscopy videos of 69 consecutive patients who underwent shoulder arthroscopy for rotator cuff tear repair or subacromial decompression. The surgeons were asked to classify impingement lesions according to the Copeland-Levy classification. One month afterward, the surgeons were requested to repeat the evaluation of the same impingement lesions. Intraobserver reliability was calculated using Cohen's weighted κ. Interobserver reliability was calculated using Kendall's W. RESULTS: Overall intraobserver reliability for acromial and bursal lesions was κ = 0.86 (95% confidence interval, 0.82-0.9) and κ = 0.97 (95% confidence interval, 0.95-0.98), respectively. Interobserver reliability for acromial and bursal lesions was W = 0.87 and W = 0.92, respectively. CONCLUSION: Intraobserver and interobserver reliability of the Copeland-Levy classification among senior orthopedic surgeons is excellent. Hence, we suggest the Copeland-Levy classification be used to standardize terminology of the subacromial impingement lesion.


Assuntos
Artroscopia , Ortopedia , Síndrome de Colisão do Ombro/classificação , Acrômio/cirurgia , Idoso , Bolsa Sinovial/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Lesões do Manguito Rotador/cirurgia , Síndrome de Colisão do Ombro/cirurgia , Terminologia como Assunto
13.
J Orthop Trauma ; 31(6): 311-315, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28538452

RESUMO

OBJECTIVE: To assess the incidence of proximal femoral shortening (PFS) and its effect on the patient outcomes when intertrochanteric fractures were treated with a cephalomedullary nail (CMN). DESIGN: Retrospective cohort study. SETTINGS: Level II trauma center. PATIENTS: Forty-eight consecutive patients with OTA/AO 31-A intertrochanteric fractures. INTERVENTION: All patients were treated with a Gamma3 CMN (Stryker, Kalamazoo, MI). METHODS: PFS was assessed for abductor lever arm (x vector), femoral height (y vector), and overall shortening (z vector) on anteroposterior radiographs. Fixation success and retained ambulatory capacity were noted. RESULTS: Shortening of >5 mm of the x, y, and z vectors was evident in 18, 20, and 29 patients, respectively. Shortening of >10 mm of the x, y, and z vectors was measured in 5, 6, and 8 patients, respectively. Mean shortening of the x, y, and z vectors was 4.5, 5.5, and 7 mm, respectively. Greater PFS was found to be associated with fixation failure and inability to retain ambulatory capacity, independently (P ≤ 0.05 and P ≤ 0.025, respectively). Of note, an unstable fracture pattern was not found to be associated with greater PFS. CONCLUSIONS: PFS is a common phenomenon after CMN of intertrochanteric fractures with a Gamma CMN. In addition, greater PFS seems to be associated with fixation failure and inability to retain ambulatory capacity postoperatively. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Pinos Ortopédicos/estatística & dados numéricos , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Desigualdade de Membros Inferiores/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Causalidade , Estudos de Coortes , Comorbidade , Feminino , Fêmur/anormalidades , Fêmur/diagnóstico por imagem , Fixação Interna de Fraturas/estatística & dados numéricos , Fixação Intramedular de Fraturas/métodos , Humanos , Incidência , Israel/epidemiologia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco
14.
Acta Ophthalmol ; 95(8): e686-e692, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28342227

RESUMO

PURPOSE: To determine the efficacy of combination povidone-iodine (PVP-I) 1.0% eyedrops and dexamethasone 0.1% eyedrops in the treatment of adenoviral keratoconjunctivitis. MATERIALS AND METHODS: In a prospective, randomized, controlled, double-blinded clinical trial patients with recent adenoviral keratoconjunctivitis (diagnosed clinically and confirmed by PCR), we randomly divided into three treatment groups: study group - received PVP-I 1.0% and dexamethasone 0.1%, control 1 group - received dexamethasone 0.1% and control 2 group - received lubricating eyedrops (hypromellose 0.3%). The treatment was administered four times a day in each group. All patients were examined and filled a questionnaire before treatment and on the 3rd, 5th and 7th days of treatment. RESULTS: We included in the study 78 eyes (26 in each group). Adenovirus type 8 was the most common pathogen (83% of cases). The fastest improvement in patients red eyes, discharge, superficial punctate keratitis and pseudomembranes was observed in the study group (p < 0.001). Those patients reached a near complete recovery in 5-7 days, which was also confirmed by reduction in Adenovirus titres by PCR. The slowest improvement was in the control 2 group. Subepithelial infiltrates (SEI) were observed in 44% of the control 1 group, 20% of the control 2 group and in 0% of the study group. The rate of reduction in Adenovirus titres was the slowest in the control 1 group. CONCLUSION: The combination of PVP-I 1.0% and dexamethasone 0.1% four times a day can reduce symptoms and expedite recovery in epidemic keratoconjunctivitis patients.


Assuntos
Infecções por Adenoviridae/tratamento farmacológico , Dexametasona/administração & dosagem , Infecções Oculares Virais/tratamento farmacológico , Ceratoconjuntivite/tratamento farmacológico , Povidona-Iodo/administração & dosagem , Doença Aguda , Adenoviridae/genética , Infecções por Adenoviridae/virologia , Adulto , Anti-Infecciosos Locais/administração & dosagem , DNA Viral/análise , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Infecções Oculares Virais/virologia , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Humanos , Ceratoconjuntivite/virologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Resultado do Tratamento
15.
Int Orthop ; 41(4): 831-836, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27271723

RESUMO

PURPOSE: The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. METHODS: We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. RESULTS: The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. CONCLUSION: The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.


Assuntos
Artroplastia de Quadril/métodos , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/cirurgia , Fraturas Ósseas/etiologia , Luxação do Quadril/etiologia , Humanos , Desigualdade de Membros Inferiores/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Harefuah ; 155(8): 466-469, 2016 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-28530325

RESUMO

INTRODUCTION: Many premature and full-term newborns receive prophylactic platelet transfusions to prevent bleeding, particularly the most prevalent one, i.e, intracranial hemorrhages. However, the platelet count threshold above which bleeding is prevented and the efficacy of platelet transfusion in thrombocytopenic neonates, have yet to be established. Therefore, inter-Neonatal Intensive Care Units (NICU) variations in treatment indications and practices are expected. Considerable inter-NICU variations will emphasize the need for guidelines on platelet transfusions to neonates and premature infants. AIMS: To examine platelet products selection and indications for transfusion among neonatologists in Israel. Research and Methods: Electronic questionnaires addressing the choice of platelet products and the platelet count threshold for transfusion in various clinical settings were sent to 25 neonatal units. RESULTS: All 25 neonatal units responded (100% response rate). There was considerable variation in product selection among the different neonatal units. Up to 24% of the participating units reported selecting nontraditional products. Variation was also found in thresholds for platelet transfusion - several units used high thresholds while others used low ones. Traditional guidelines were followed in up to 64% of cases in selected clinical scenarios. CONCLUSIONS: There is considerable variation in both platelet product selection and platelet count thresholds for transfusion among the different neonatal units. DISCUSSION: A low threshold for platelet transfusion increases the risk for bleeding, whereas a high threshold increases the prevalence of complications from transfusion of blood products. Adherence to guidelines may prevent both such sequelae. Summary: Such variation in platelet transfusion among neonatologists emphasizes the need for an accepted policy. We recommend setting up a committee of neonatologists, pediatric hematologists and blood service experts which aims to establish an appropriate policy regarding the prevention of platelet transfusion sequelae in newborns.


Assuntos
Transfusão de Plaquetas/métodos , Trombocitopenia/terapia , Plaquetas , Criança , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Israel , Contagem de Plaquetas
17.
Harefuah ; 155(8): 475-477, 2016 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-28530329

RESUMO

AIMS: The single incision laparoscopic technique is an emerging modality. The aim of our study was to compare the intra-operative and short term post-operative outcomes of single incision versus multi-incision laparoscopy for right hemicolectomy. METHODS: We retrospectively reviewed the charts of all patients who underwent right hemicolectomy from October 2010 till December 2012. RESULTS: Thirty six patients underwent laparoscopic right hemicolectomy, of which, twenty five were performed with the traditional multi-incision technique and eleven were conducted with a single incision. From the parameters that were evaluated, we found that in the single incision technique there was a statistical trend [p=0.08] of better oncological results with a higher mean lymph node extraction. In addition, there was a statistically significant [p=0.05] advantage of decreased length of hospitalization. CONCLUSIONS: The single incision technique is feasible and safe for right hemicolectomy. Given our findings, we believe that it can be an effective alternative to the traditional multi-port technique.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Hospitalização , Humanos , Período Pós-Operatório
18.
Harefuah ; 155(8): 478-481, 2016 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-28530330

RESUMO

BACKGROUND: The drug inventory in the hospital consumes a large part of the hospital's budget. Classic drug management is based on weekly visits of the pharmacist in the departments, writing an order and dispensing it. This method is wasteful in terms of sending a bulk of drugs that will not necessarily be utilized, and it is also inefficient in terms of human resources. The unit-dose method, which is more advanced, is based on filling out individual prescriptions for each of the inpatients in the department. This minimizes the potential of making an error on administration of the drug to the patient, while reducing the shelf-inventory in the department. A new method has been initiated at Barzilai Medical Center, starting January 2013, based on the implantation of the NAMER computerized clinical record system. This method, called SHERLOCK, which transforms the physician orders into logistic information for the pharmacist, holds all the unit-dose method advantages without the heavy costs. The system is an innovative development of the pharmacy staff in cooperation with the computer department. OBJECTIVES: To design a computerized system to make drug inventory management more efficient. Methods: We started using the SHERLOCK system in the two computerized internal departments. RESULTS: The data for 9 months was collected during January- September 2013 and was compared to data for the same period in 2012. This showed a significant reduction in the cost of drug distribution (p<0.05). This reduction projects an almost 20% decrease in the yearly budget at the research department. In the control departments, no significant reduction has been demonstrated. CONCLUSIONS: In light of these results, it is visible that the SHERLOCK system is an efficient tool to improve drug inventory management and medication safety.


Assuntos
Orçamentos , Sistemas de Medicação no Hospital/organização & administração , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/organização & administração , Computadores/estatística & dados numéricos , Humanos , Israel , Preparações Farmacêuticas/economia
19.
Harefuah ; 155(8): 482-484, 2016 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-28530332

RESUMO

BACKGROUND: Over recent years the number of mechanically ventilated patients in internal medicine departments has grown. These patients are elderly, mostly disabled and suffer from many chronic illnesses. Most of them require prolonged mechanical ventilation. OBJECTIVES: The study aimed to evaluate the population of mechanically ventilated patients in an internal department, the treatment and outcomes, particularly the morbidity in hospitalization and to identify the prognostic causes of death. METHODS: A retrospective study was conducted to check the medical records of ventilated patients between the years 2012- 2013 in internal medicine departments including demographic information, chronic illnesses, cause of hospitalization and ventilation, complications and results of treatment. RESULTS: The study includes 97 patients over the age of 60, 50% of them disabled, average Apache score was 29.9; 65% of the patients required ventilation for over 3 days and 35% for over 10 days; 71% of the patients died. The most common causes of death were pneumonia, sepsis, cerebrovascular accident, cardiac event, worsening of heart failure, worsening of chronic obstructive pulmonary disease or a combination of these. The patients who died displayed an Apache score significantly higher at admittance to the hospital. Significant risk factors for mortality included chronic diabetes, sepsis, pneumonia and renal failure. CONCLUSIONS: The results raise the question of whether to increase the number of beds for internal intensive care. A discussion is required among medical personnel and laymen to define a group of patients who should not deteriorate to mechanical ventilation or any other invasive procedures.


Assuntos
Mortalidade Hospitalar , Medicina Interna , Respiração Artificial , APACHE , Humanos , Israel , Tempo de Internação , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco
20.
J Interv Card Electrophysiol ; 45(1): 63-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26552799

RESUMO

PURPOSE: Previous data showed that pain sensation was common during pulmonary vein isolation (PVI) using an 8-mm radiofrequency (RF) ablation catheter. Pain was more common in the left pulmonary veins (PVs). We characterized the location of pain during PVI using circular multi-electrode ablation catheters. METHODS: Included are all consecutive patients with atrial fibrillation (AF) who underwent PVI using the phased RF PVAC® catheter (Medtronic) or the irrigated nMARQ™ catheter (Biosense Webster) under conscious sedation between July 2011 and March 2015. Site of pain reaction was marked for each patient. RESULTS: A total of 251 patients (141 PVAC®, 110 nMARQ™) were studied; 214 (85 %) had at least one lesion associated with pain. Gender (r = 0.084, p = 0.186), type of AF (r = 0.048, p = 0.452), age (r = 0.078, p = 0.216), and repeat procedure (r = 0.018, p = 0.78) were not correlated with pain. There was no association between site of pain and catheter type; only 33% of the painful PVs were also the largest ones (p = 0.5, kappa = 0.03, R = -0.083). One-year freedom from AF was similar for patients with and without painful PVs (p = 0.6). The distribution of pain was as follows: 126 (59%) left superior PV (LSPV), 28 (13%) left inferior, 28 (13%) all PVs, 12 (5.6%) right superior, 12 (5.6%) right inferior, 18 (8.4%) left common, and 2 (0.9%) right common PV. CONCLUSIONS: PVI using multi-electrode catheters more commonly caused pain sensation in LSPV. There was no influence of catheter type or PV size on pain localization. Our findings, which are similar to those using an 8-mm ablation catheter, imply that location of pain is not catheter dependent but rather a reflection of autonomic physiology.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Veias Pulmonares/cirurgia , Fibrilação Atrial/diagnóstico , Ablação por Cateter/métodos , Ablação por Cateter/estatística & dados numéricos , Causalidade , Sedação Consciente , Eletrodos/estatística & dados numéricos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Sistema de Condução Cardíaco/cirurgia , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/classificação , Prevalência , Fatores de Risco , Resultado do Tratamento
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