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2.
J Gastrointest Surg ; 26(9): 1863-1872, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35641812

RESUMO

OBJECTIVES: The challenges posed by laparoscopic cholecystectomy (LC) in obese patients and the methods of overcoming them have been addressed by many studies. However, no objective tool of reporting operative difficulty was used to adjust the outcomes and compare studies. The aim of this study was to establish whether obesity adds to the difficulty of LC and laparoscopic common bile duct exploration (LCBDE) and affects their outcomes on a specialist biliary unit with a high emergency workload. METHODS: A prospectively maintained database of 4699 LCs and LCBDEs performed over 19 years was analysed. Data of patients with body mass index (BMI) ≥ 35, defined as grossly obese, was extracted and compared to a control group. RESULTS: A total of 683 patients (14.5%) had a mean BMI of 39.9 (35-63), of which 63.4% met the definition of morbidly obese. They had significantly more females and significantly higher ASA II classifications. They had equal proportions of emergency admissions, similar incidence of operative difficulty grades 4 or 5 and no open conversions and were less likely to undergo LCBDE than non-obese patients. There were no significant differences in median operative times, morbidity, readmission or mortality rates. CONCLUSIONS: This study, the first to classify gall stone surgery in obese patients according to operative difficulty grading, showed no difference in complexity when compared to the non-obese. Refining access and closure techniques is key to avoiding difficulties. Index admission surgery for biliary emergencies prevents multiple admissions with potential complications and should not be denied due to obesity.

3.
Sensors (Basel) ; 22(3)2022 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-35161988

RESUMO

Automatic License Plate Detection (ALPD) is an integral component of using computer vision approaches in Intelligent Transportation Systems (ITS). An accurate detection of vehicles' license plates in images is a critical step that has a substantial impact on any ALPD system's recognition rate. In this paper, we develop an efficient license plate detecting technique through the intelligent combination of Faster R-CNN along with digital image processing techniques. The proposed algorithm initially detects vehicle(s) in the input image through Faster R-CNN. Later, the located vehicle is analyzed by a robust License Plate Localization Module (LPLM). The LPLM module primarily uses color segmentation and processes the HSV image to detect the license plate in the input image. Moreover, the LPLM module employs morphological filtering and dimension analysis to find the license plate. Detailed trials on challenging PKU datasets demonstrate that the proposed method outperforms few recently developed methods by producing high license plates detection accuracy in much less execution time. The proposed work demonstrates a great feasibility for security and target detection applications.


Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador , Inteligência , Projetos de Pesquisa
4.
J Oral Rehabil ; 49(3): 273-282, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34731502

RESUMO

BACKGROUND: Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short-term (<6 months) and long-term (≥ 6 months) painful TMD is not yet clear. OBJECTIVE: The aim of this study was to assess the association between comorbidities and short- and long-term painful TMD among adolescents. METHODS: In this cross-sectional study, adolescents were recruited from Montreal (Canada), Nice (France) and Arceburgo (Brazil). Self-reported painful TMD, comorbidities, school absence and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims. RESULTS: The prevalence of short- and long-term painful TMD was estimated at 22.29% and 9.93% respectively. The number of comorbidities was associated with short- (OR = 1.71, 95%CI = 1.53-1.90) and long-term painful TMD (OR = 1.79, 95%CI = 1.55-2.08) compared to controls. Frequent headaches (ORshort-term  = 4.39, 95%CI = 3.23-5.98, ORlong-term  = 3.69, 95%CI = 2.45-5.57) and back pain (ORshort-term  = 1.46, 95%CI = 1.06-2.03, ORlong-term  = 1.69, 95%CI = 1.11-2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53-3.26) and allergies were only associated with short-term painful TMD (OR = 1.54, 95%CI = 1.13-2.10). Frequent stomach pain was related to long-term (OR = 2.01, 95%CI = 1.35-3.26), and it was the only comorbidity significantly more frequent among the long than short-term TMD (OR = 1.82, 95%CI: 1.14-2.90). These analyses were adjusted by sex, age and city. CONCLUSION: In this multi-centre study, both short- and long-term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short-term and frequent stomach pain with long-term painful TMD.


Assuntos
Transtornos da Articulação Temporomandibular , Adolescente , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Dor Facial/epidemiologia , Dor Facial/etiologia , Humanos , Cervicalgia/epidemiologia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/epidemiologia
5.
Surg Endosc ; 36(1): 550-558, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528666

RESUMO

BACKGROUND: Open conversion rates during laparoscopic cholecystectomy vary depending on many factors. Surgeon experience and operative difficulty influence the decision to convert on the grounds of patient safety but occasionally due to technical factors. We aim to evaluate the difficulties leading to conversion, the strategies used to minimise this event and how subspecialisation influenced conversion rates over time. METHODS: Prospectively collected data from 5738 laparoscopic cholecystectomies performed by a single surgeon over 28 years was analysed. Routine intraoperative cholangiography and common bile duct exploration when indicated are utilised. Patients undergoing conversion, fundus first dissection or subtotal cholecystectomy were identified and the causes and outcomes compared to those in the literature. RESULTS: 28 patients underwent conversion to open cholecystectomy (0.49%). Morbidity was relatively high (33%). 16 of the 28 patients (57%) had undergone bile duct exploration. The most common causes of conversion in our series were dense adhesions (9/28, 32%) and impacted bile duct stones (7/28, 25%). 173 patients underwent fundus first cholecystectomy (FFC) (3%) and 6 subtotal cholecystectomy (0.1%). Morbidity was 17.3% for the FFC and no complications were encountered in the subtotal cholecystectomy patients. These salvage techniques have reduced our conversion rate from a potential 3.5% to 0.49%. CONCLUSION: Although open conversion should not be seen as a failure, it carries a high morbidity and should only be performed when other strategies have failed. Subspecialisation and a high emergency case volume together with FFC and subtotal cholecystectomy as salvage strategies can reduce conversion and its morbidity in difficult cholecystectomies.


Assuntos
Colecistectomia Laparoscópica , Ductos Biliares , Colangiografia , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Humanos
6.
Ann Surg ; 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33856382

RESUMO

OBJECTIVE: This study aims to examine the indications, techniques and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the Wiper Blade Manoeuvre (WBM) for transcystic intrahepatic choledochoscopy. SUMMARY BACKGROUND DATA: Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particulary with the increasing role of transcystic exploration. METHODS: The indications, techniques and operative and postoperative data on choledeochoscopy collected prospectively during 1320 transcystic and choledochotomy explorations were analysed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochocoscopes. RESULTS: Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilised more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. 20 retained stones (2.1%) were encountered but no choledochoscopy related complications. CONCLUSIONS: Choledochoscopy should always be performed during a choledochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilised in over 50% of explorations, increasing their rate of success. When attempted, the transcystic Wiper Blade Manoeuvre achieves intrahepatic access in 70-80%. It should be part of the training curriculum.

7.
J Craniofac Surg ; 32(6): 2050-2052, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33770038

RESUMO

BACKGROUND: Whether a new diagnosis or for ongoing care, the Internet is now an established and massively frequented resource for parents and patients with cleft lip and/or palate. The purpose of this study was to assess the correlation between the first 50 ranked websites for cleft lip and palate via the Google search engine versus those ranked with an objective patient information scoring tool. METHODS: The first 50 websites ranked by Google were recorded for the search items "Cleft Lip," "Cleft Palate" and "Cleft Lip and Palate." Quality assessment was performed using the DISCERN score, an objective and validated patient information website scoring tool. The Google rank was compared to the DISCERN rank to assess for correlation. The top five websites for each search item were then ranked by blinded cleft health professionals for quality. RESULTS: Based on Google ranking, 36% of websites were the same across the search terms used. The DISCERN ranking scores demonstrated no evidence of positive or negative correlation when compared to Google ranking. In the top 10 DISCERN ranked websites for each search item, 4 websites appear in the top 10 Google rankings. CONCLUSION: This is the first study that demonstrates that high-quality information on cleft lip and palate is available on the Internet. However, this may be difficult and confusing for parents and patients to access due to the ranking system used by internet search engines. Cleft healthcare professionals should be aware of these problems when recommending websites to families and patients.


Assuntos
Fenda Labial , Fissura Palatina , Criança , Humanos , Internet , Pais , Ferramenta de Busca
8.
J Med Virol ; 93(2): 995-1001, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32729937

RESUMO

Socioeconomic status (SES) impacts outcome in a number of diseases. Our aim was to compare the outcome of hospitalized coronavirus disease 219 (COVID-19) patients in low and high SES group. Prospective cohort study of hospitalized patients with confirmed COVID-19 in three acute hospitals. Electronic case notes were analyzed for baseline characteristics and admission investigations. Scottish index for multiple deprivation (SIMD) was used to divide patients into two groups: more deprived (SIMD 1-5) and less deprived (SIMD 6-10) and results compared. Poor outcome was defined as either need for intubation and/or death. One hundred and seventy-three patients were identified, one was excluded. One hundred and eight (62.8%) were males, mean age was 68.5 ± 14.7 years. Commonest comorbidity was hypertension 87 (50.6%). One hundred and seventeen (68.0%) patients were in more deprived group. Baseline characteristics, admission blood profile and reason for admission were evenly matched in both groups. Outcomes were comparable in both groups: transfer to critical care (27.4% vs 27.3%; P = .991), intubation (18.8% vs 20.2%; P = .853), 30-day all-cause mortality (19.7% vs 14.5%; P = .416) and overall poor outcome (30.8% vs 30.9%; P = .985). Median time to discharge was 7 days longer (17 vs 10 days; P = .018) and median time to death was 4.5 days longer in more deprived group (17 vs 12.5 days; P = .388). Contrary to recent literature on COVID-19 in other geographical areas, our study suggests that the SES does not have any impact on outcome of hospitalized patients with COVID-19, however it negatively impacts length of stay.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Classe Social , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Hipertensão , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escócia/epidemiologia
9.
Surg Endosc ; 35(11): 6039-6047, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33067645

RESUMO

BACKGROUND: Bile duct injury rates for laparoscopic cholecystectomy (LC) remain higher than during open cholecystectomy. The "culture of safety" concept is based on demonstrating the critical view of safety (CVS) and/or correctly interpreting intraoperative cholangiography (IOC). However, the CVS may not always be achievable due to difficult anatomy or pathology. Safety may be enhanced if surgeons assess difficulties objectively, recognise instances where a CVS is unachievable and be familiar with recovery strategies. AIMS AND METHODS: A prospective study was conducted to evaluate the achievability of the CVS during all consecutive LC performed over four years. The primary aim was to study the association between the inability to obtain the CVS and an objective measure of operative difficulty. The secondary aim was to identify preoperative and operative predictors indicating the use of alternate strategies to complete the operation safely. RESULTS: The study included 1060 consecutive LC. The median age was 53 years, male to female ratio was 1:2.1 and 54.9% were emergency admissions. CVS was obtained in 84.2%, the majority being difficulty grade I or II (70.7%). Displaying the CVS failed in 167 LC (15.8%): including 55.6% of all difficulty grade IV LC and 92.3% of difficulty grade V. There were no biliary injuries or conversions. CONCLUSION: All three components of the critical view of safety could not be demonstrated in one out of 6 consecutive laparoscopic cholecystectomies. Preoperative factors and operative difficulty grading can predict cases where the CVS may not be achievable. Adapting instrument selection and alternate dissection strategies would then need to be considered.


Assuntos
Doenças dos Ductos Biliares , Colecistectomia Laparoscópica , Doenças dos Ductos Biliares/cirurgia , Colangiografia , Colecistectomia , Colecistectomia Laparoscópica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
Scott Med J ; 65(4): 149-153, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32873147

RESUMO

BACKGROUND AND AIMS: Hypertension is associated with an increased risk of severe outcomes with COVID-19 disease. Angiotensin Converting Enzyme (ACE) inhibitors are widely used as a first line medication for the treatment of hypertension in the UK, although their use was suggested in early reports to increase the risk associated with SARS-CoV-2 infection. METHODS: A prospective cohort study of hospitalised patients with laboratory confirmed COVID-19 was conducted across three hospital sites with patients identified on the 9th April 2020. Demographic and other baseline data were extracted from electronic case records, and patients grouped depending on ACE inhibitor usage or not. The 60-day all-cause mortality and need for intubation compared. RESULTS: Of the 173 patients identified, 88 (50.8%) had hypertension. Of these 27 (30.7%) used ACE inhibitors. We did not find significant differences in 60-day all-cause mortality, the requirement for invasive ventilation or length of stay between our patient cohorts after adjusting for covariates. CONCLUSION: This study contributes to the growing evidence supporting the continued use of ACE inhibitors in COVID-19 disease, although adequately powered randomised controlled trials will be needed to confirm effects.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/mortalidade , Hipertensão/tratamento farmacológico , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/mortalidade , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Estudos Prospectivos , SARS-CoV-2 , Escócia , Taxa de Sobrevida
11.
JSLS ; 24(3)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32831544

RESUMO

BACKGROUND & OBJECTIVE: Hartmann's pouch stones (HPS) encountered during laparoscopic cholecystectomy (LC) may hinder safe dissection of the cystic pedicle or be complicated by mucocele, empyema, or Mirizzi syndrome; distorting the anatomy and increasing the risk of bile duct injury. We studied the incidence, presentations, operative challenges, and outcomes of HPS. METHODS: A cohort study of a prospectively maintained database of LCs and bile duct explorations performed by a single surgeon. Patients were divided into two groups: those with HPS and those without. Patients' demographics, clinical presentation, intra-operative findings, and postoperative outcomes were compared. RESULTS: Of the 5136 patients, 612 (11.9%) had HPS. The HPS group were more likely to present with acute cholecystitis (27.9% vs 5.9%, P = .000) and more patients underwent emergency LC (50.7% vs 41.5%, P = .000). The HPS group had more difficult cholecystectomies, with 46.1% vs 11.8% in the non-HPS group being operative difficulty grade 4 and 5. Mucocele, empyema, and Mirizzi syndrome were more common in the HPS group (24.0% vs 3.7% P = .000, 30.9% vs 3.7% P = .000, 1.8% vs 0.9% P = .000, respectively). There was no significant difference in the open conversion rate or complications. CONCLUSION: HPS increase the difficulty of LC. Surgeons should be aware of their presence and should employ appropriate dissection strategies. Sharp or diathermy dissection should be avoided. Dislodging the stone into the gall bladder, stone removal, swab dissection, and cholangiography are useful measures to avoid ductal injury and reduce the conversion rate.


Assuntos
Colecistectomia Laparoscópica/métodos , Vesícula Biliar/anormalidades , Cálculos Biliares/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Coortes , Bases de Dados Factuais , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Cálculos Biliares/diagnóstico , Cálculos Biliares/epidemiologia , Cálculos Biliares/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
Scott Med J ; 65(4): 133-137, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32772846

RESUMO

BACKGROUND AND AIMS: COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. METHODS: All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. RESULTS: 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. CONCLUSION: COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação Médica/organização & administração , Pneumonia Viral/epidemiologia , Especialidades Cirúrgicas/educação , COVID-19 , Competência Clínica , Humanos , Pandemias , SARS-CoV-2 , Escócia , Inquéritos e Questionários
13.
J Clin Gastroenterol ; 54(6): 493-502, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32091447

RESUMO

BACKGROUND: Acute lower gastrointestinal bleeding (LGIB) is a common indication for hospitalization. However, the optimum timing of colonoscopy following patient presentation remains unclear. This systematic review and meta-analysis aims to evaluate the effect of urgent versus standard colonoscopy timing on management of acute LGIB. MATERIALS AND METHODS: Medline, EMBASE, CENTRAL, and PubMed were searched up to January 2020. Randomized controlled trials were eligible for inclusion if they compared patients with hematochezia receiving urgent (<24 h) versus standard (>24 h) colonoscopy. Nonrandomized observational studies were also included based on the same criteria for additional analysis. Pooled estimates were calculated using random effects meta-analyses and heterogeneity was quantified using the inconsistency statistic. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS: Of 3782 potentially relevant studies, 4 randomized controlled trials involving 463 patients met inclusion criteria. Urgent colonoscopy did not differ significantly to standard timing with respect to length of stay (LOS), units of blood transfused, rate of additional intervention required, or mortality. Colonoscopy-related outcomes such as patient complications, rebleeding rates, and diagnosis of bleeding source did not differ between groups. However, meta-analysis including nonrandomized studies (9 studies, n=111,950) revealed a significantly higher rate of mortality and complications requiring surgery in the standard group and shorter LOS in the urgent group. Overall GRADE certainty of evidence was low in the majority of outcomes. CONCLUSIONS: Timing of colonoscopy in acute LGIB may not significantly affect patient outcomes. Timing should therefore be decided on a case-by-case basis.


Assuntos
Colonoscopia , Hemorragia Gastrointestinal , Doença Aguda , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Tempo de Internação , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
J Clin Ultrasound ; 48(1): 59-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31774180

RESUMO

We report and discuss a case that illustrate the clinical utility of transcranial Doppler (TCD) ultrasound in a patient with cirrhosis. A 43-year-old female presented with acute decompensation of cirrhosis with hepatic encephalopathy, requiring mechanical ventilation. TCD showed low diastolic flow velocities and high pulsatility index (PI) consistent with increased cerebrovascular resistance (CVR). The flow velocities and PI normalized over a period of few days and correlated well with neurological improvement after treatment. Subsequently, the patient developed a large intracerebral hemorrhage with mass effect. The TCD measurements in intracranial hypertension were similar to those with cirrhosis and hepatic encephalopathy. However, the windkessel notch in the systolic phase of TCD waveform, related to the distensibility of arterial wall, was absent during raised intracranial pressure (ICP). The absence of a windkessel notch may help to differentiate a high downstream resistance due to raised ICP from increased CVR.


Assuntos
Hipertensão Intracraniana/diagnóstico por imagem , Pressão Intracraniana , Cirrose Hepática/fisiopatologia , Ultrassonografia Doppler Transcraniana , Resistência Vascular , Adulto , Circulação Cerebrovascular , Feminino , Humanos , Hipertensão Intracraniana/etiologia
15.
J Oral Rehabil ; 47(4): 417-424, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31834958

RESUMO

BACKGROUND: Painful temporomandibular disorder (TMD) is common among adolescents. Presence of painful comorbidities may worsen painful TMD and impact treatment effectiveness. OBJECTIVE: The aim of this study was to assess the association between painful TMD and comorbidities. METHODOLOGY: In this cross-sectional study, adolescents were recruited in Montreal (Canada), Nice (France) and Arceburgo (Brazil). Reliable instruments were used to assess painful TMD and comorbidities. Multivariable logistic and linear regression analyses were conducted to assess the study aims. RESULTS: The prevalence of self-reported painful TMD was estimated at 31.6%; Arceburgo (31.6%), Montreal (23.4%) and Nice (31.8%). Painful TMD was more common among girls than boys (OR = 1.96). Painful TMD was associated with a higher number of comorbidities (OR = 1.77); Arceburgo (OR = 1.81), Montreal (OR = 1.80) and Nice (OR = 1.72). A stronger association was found between painful TMD and headaches (OR = 4.09) and a weaker one with stomach pain (OR = 1.40). Allergies were also related to painful TMD (OR = 1.43). CONCLUSION: Painful TMD was associated with comorbidities. Headaches were consistently associated with painful TMD. Other associations were modified by sex and/or covariates related to the cities where participants were recruited.


Assuntos
Transtornos da Articulação Temporomandibular , Adolescente , Brasil , Canadá , Estudos Transversais , Dor Facial , Feminino , França , Humanos , Masculino , Dor
16.
J Oral Maxillofac Surg ; 78(3): 401-413, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31816277

RESUMO

PURPOSE: The purpose was to determine the incidence, etiologic factors leading to injury, and demographic composition of patients sustaining dog-bite injuries of the craniofacial region at a regional referral level 1 trauma center. These findings may assist primary and affiliated health care providers, educators, and policy makers in developing and implementing strategies to prevent serious dog-bite injuries, particularly in the individuals most vulnerable-children and elderly persons. PATIENTS AND METHODS: We performed a retrospective observational and descriptive review of dog bite-related injuries solely managed by the Section of Maxillofacial Surgery at Charleston Area Medical Center in West Virginia. Patient information was derived from an existing database on dog-bite injuries of the craniofacial region, electronic health records, and animal encounter records. RESULTS: We reviewed 182 patient records distributed among several breed categories. The results showed a disturbing trend toward more severe injuries, especially in younger children, and a reversal in gender, with girls bitten more than boys. Young children incurred more extensive facial injuries, including fractures. The data showed that compared with other dog breeds, pit bull terriers inflicted more complex wounds, were often unprovoked, and went off property to attack. Other top-biting breeds resulting in more unprovoked and complex wounds included German shepherds, Rottweilers, and huskies. Management of facial wounds took place more often in the operating room, especially in younger children, with increased hospital stays. Of the patients, 19 (10.4%) had fractures and 22 (12%) underwent a rabies vaccination protocol. CONCLUSIONS: This study showed a disturbing trend toward more severe dog-bite injuries in young children and a greater incidence of bites in girls than in boys among several biting breeds of dogs. The public health implications of aggressive biting breeds and risks of severe injury in the home environment were discussed.


Assuntos
Mordeduras e Picadas , Traumatismos Faciais , Idoso , Animais , Criança , Pré-Escolar , Cães , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Centros de Traumatologia
17.
Wounds ; 32(suppl 11): S1-S25, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33477105

RESUMO

The authors propose a new acronym to promote teaching and learning evidence-based care for wounds of the lower extremity, maximizing healing potential, and assuring the ability to adapt to everchanging new technologies. ABCESS is a comprehensive framework for the assessment of a patient with a lower extremity wound. Wound care clinicians benefit from a system that is broad enough to include new guidelines and technologies as they appear. The TIME/DIME model has been used for many years to assist clinicians in thorough wound bed management. In order to expand the model to be able to address all aspects of lower extremity wound healing, ABCESS was developed. TIME has recently also been expanded to TIMERS in an attempt to address this. The ABCESS acronym was originally developed at the Temple University School of Podiatric Medicine to use as a teaching tool and organizational aid for students of wound healing. Each letter was used as a framework to aid the wound care clinician in performing a complete assessment of the patient with chronic wounds of the lower extremity: All of the patient, including a complete history, physical assessment, and systemic disease overview (with nutrition) to assess the physical aspects of the patient presenting with a wound; wound Bed management to include Bioload, Biofilm, cellular assessment of Biomarkers using polymerase chain reaction/DNA analysis, and wound Biopsy; Circulation to include arterial, venous, and lymphatic circulation; Edema, Exudate, and Erythema management focusing on dressing and compression choices; Skin protection and treatment to include wound edge, periwound skin, and offloading management; Social, Societal, and Spiritual factors, including assessment of the immediate social environment, the wider societal limiting factors, and personal, spiritual, and psychological issues affecting this patient's wound care.


Assuntos
Bandagens , Cicatrização , Exsudatos e Transudatos , Humanos , Extremidade Inferior , Pele
18.
Pan Afr Med J ; 35(Suppl 2): 28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33623553

RESUMO

We report the incidental finding of COVID-19 in a 59-year-old male, with no significant cardiorespiratory past medical history who underwent a fluorodeoxyglucose positron emission tomography (FDG-PET) scan for investigation of a likely gastric gastrointestinal stromal tumor (GIST). There may be significant discrepancies between clinical symptoms and radiological severity with COVID-19 infection. FDG-PET scanning has the potential to complement traditional radiological imaging in COVID-19 in diagnosis of subclinical diagnosis or early stage disease, as well as monitoring disease progression.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Fluordesoxiglucose F18 , Tumores do Estroma Gastrointestinal/patologia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Radiografia , Neoplasias Gástricas/patologia
20.
Pan Afr Med J ; 32: 205, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312317

RESUMO

To test the hypothesis claimed in recent studies that quality of bowel preparation for colonoscopy could be influenced by the time of the day colonoscopy is performed. Do patients in morning list have better bowel preparation than those on the afternoon list? Retrospective analysis of 736 consecutive patients who had colonoscopy from 1st August to 31st December 2012. Patients with poor bowel preparation (Boston Bowel Prep Score 6 or less) were identified (n = 242). Colonoscopy reports of these patients analysed. Patients were stratified into two groups (am and pm) and results compared. Mean patient age 63.9 years (range 19-89). Male to female ratio 1:1. 92% of patients were given Moviprep. for bowel preparation. 32.9% (242/736) of patients were identified as having inadequate bowel preparation. 37.7% of morning list patients had poor bowel preparation. 26.7% of afternoon list patients had poor bowel preparation. 14.7% (108/736) had incomplete colonoscopy, of which 26.9% (29/108) were due to poor bowel preparation. The commonest reasons for incomplete examination were patient discomfort & bowel looping. Our study demonstrates that morning session patients had poorer bowel preparation than the afternoon session patients in contrast to published evidence in recent literature. This implies that timing of bowel preparation is probably more important than timing of colonoscopy. Poor bowel preparation does not seem to have a significant impact on the colonoscopy failure rate in this series.


Assuntos
Catárticos/administração & dosagem , Colonoscopia/métodos , Polietilenoglicóis/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento , Adulto Jovem
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