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1.
Emergencias ; 32(5): 369-371, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006841
2.
PLoS One ; 15(10): e0239796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002074

RESUMO

Since the end of 2019, an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originating in the Chinese city of Wuhan has spread rapidly worldwide causing thousands of deaths. Coronavirus disease (COVID-19) is supported by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Italy has been the first European country recording an elevated number of infected forcing the Italian Government to call for total lockdown. The lockdown had the aim to limit the spread of infection through social distancing. The purpose of this study is to analyze how the pandemic has affected the patient's accesses to the Ophthalmological Emergency Department of a tertiary referral center in central-northern Italy, during the lockdown period. The charts of all patients that came to the Emergency Department during the lockdown period (March 10 -May 4, 2020) have been retrospectively collected and compared with those in the same period of 2019 and the period from 15 January- 9 March 2020. A significant reduction of visits during the lockdown has been observed, compared with those of pre-lockdown period (reduction of 65.4%) and with those of the same period of 2019 (reduction of 74.3%). Particularly, during the lockdown, minor and not urgency visits decreased whereas the undeferrable urgency ones increased. These pieces of evidence could be explained by the fear of patients to be infected; but also revealed patients misuse of emergency services.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Betacoronavirus , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Classificação Internacional de Doenças , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Adulto Jovem
3.
Medicine (Baltimore) ; 99(37): e21896, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925724

RESUMO

This study aimed to determine the differences in antibiotic usage patterns in the treatment of acute pyelonephritis according to hospital type and region in Korea.The claims database of the Health Insurance Review and Assessment Service in Korea was used to select patients with the International Classification of Diseases, Tenth Revision code N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis in 2010-2014. Usage of each class of antibiotics was expressed as the defined daily dose (DDD)/event.The average antibiotic usage per inpatient event was 11.3 DDD. The average antibiotic usage was the highest among patients admitted to tertiary hospitals (13.8 DDD), followed by those admitted to secondary hospitals (11.5 DDD), clinics (10.0 DDD), and primary hospitals (9.8 DDD). According to the geographic analyses, third-generation cephalosporins were highly prescribed in some southern regions; fluoroquinolones and aminoglycosides were highly prescribed in some centrally located regions of the Korean peninsula. The hotspots for carbapenem usage included Seoul and Gyeonggi province cluster and Busan cluster: these regions include the capital city and the second biggest city in Korea, respectively.In conclusion, the antibiotic usage patterns for acute pyelonephritis in Korea differ according to the hospital type and region.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Pielonefrite/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Aminoglicosídeos/uso terapêutico , Cefalosporinas/uso terapêutico , Bases de Dados Factuais , Feminino , Fluoroquinolonas/uso terapêutico , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
4.
Middle East Afr J Ophthalmol ; 27(2): 105-109, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874043

RESUMO

PURPOSE: Retinopathy of prematurity (ROP) is becoming a leading cause of preventable blindness. The current study aimed to assess ROP and its risk factors in Tabuk City, Northern Kingdom of Saudi Arabia. METHODS: A retrospective study was conducted in King Khalid Hospital, Tabuk City, Saudi Arabia. The premature infants' records during the period of January 2016 to April 2018 were approached. One hundred and eight records were eligible; the infants' gestational age, weight, if received oxygen, surfactant use, blood transfusion, intraventricular hemorrhage, and patent ductus arteriosus were reported. Chi-square test was used to compare premature infants and their counterparts regarding various risk factors. P < 0.05 was considered statistically significant. RESULTS: Out of 108 premature infants, 33.3% had ROP (Many were sightthreatening [stages required treatment] and more than twothirds involving both eyes); a statistically significant difference (P < 0.05) was evident between infants with prematurity, and low birth weight. No significant differences were found regarding other risk factors (P > 0.05). Only 8.3% received interventional therapy. CONCLUSION: ROP is common in King Khalid Hospital, which is the referral tertiary hospital in Tabuk city, KSA . The low birth weight is a significant risk factor to develop ROP. Many of ROP cases were sightthreatening (cases that required treatment) and most cases involving both eyes. Treatment availability at Tabuk city is recommended, instead of referral to another centers especially among those with low weight at birth.


Assuntos
Retinopatia da Prematuridade/epidemiologia , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
5.
Ulus Travma Acil Cerrahi Derg ; 26(5): 685-692, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32946100

RESUMO

BACKGROUND: The novel Coronavirus Disease 2019 (COVID-19) formed the basis for emergency department visits. This study aims to evaluate the effects of the pandemic on emergency department visits of surgical patients. METHODS: The hospital database records of general surgery patients who presented at the emergency department in the period of March 2020-May 2020 (pandemic period) and March 2019-May 2019 (non-pandemic period) were retrospectively analyzed and compared. The primary outcome of this study was the emergency department visit rate of patients requiring a general surgery consultation. Secondary outcomes of this study were patient complaints, diagnosis and treatments, treatment rejection rate, triage category data, the effects of age and gender, and the hospitalization rate. RESULTS: In this study, 618 patients were included: 265 patients from the pandemic period and 353 patients from the non-pandemic period. The analysis and comparison revealed that during the pandemic period, the presentation rate of female patients was lower than that of male patients (45.5% vs. 55.5%, respectively, p=0.045). The triage category rates of patient visits to the hospital during the pandemic period were higher in yellow and red, and lower in green (p<0.01). The incidence of a surgical pathology finding was higher during the pandemic period (p=0.019). The incidence of diseases related to the gastrointestinal tract was higher during the pandemic period (p=0.011). The rate of open surgery in the pandemic period was higher than that of the non-pandemic period (80.5% vs. 32.7%, respectively; p<0.01). The treatment rejection rate was also higher in the pandemic period compared with the non-pandemic period (20% vs. 3.7%, respectively; p<0.01, r). In addition, the hospitalization period was shorter in the pandemic period (p=0.021). CONCLUSION: A 25% reduction in the number of surgical patient visits to the emergency department was observed during the COVID-19 outbreak. The biggest decrease was seen in patients with a green triage code and female patients. It is significant to evaluate the effects of the pandemic on surgical patients visited the emergency department to manage the post-epidemic period and to prepare for possible future epidemic periods.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Idoso , Ansiedade/epidemiologia , Infecções por Coronavirus/psicologia , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/cirurgia , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/psicologia , Estudos Retrospectivos , Transtornos de Estresse Traumático Agudo/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Turquia/epidemiologia
6.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994595

RESUMO

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar/tendências , Hospitais Urbanos/estatística & dados numéricos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Alta do Paciente/tendências , Estudos Prospectivos , Recidiva , Estresse Psicológico/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Centros de Atenção Terciária/estatística & dados numéricos
7.
J Laryngol Otol ; 134(8): 684-687, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32758307

RESUMO

BACKGROUND: The coronavirus disease 2019 pandemic has necessitated almost exclusive National Health Service focus on emergency work and cancer care. There are concerns that increased hospital and community pressures will lead to decreased referrals and worse outcomes for head and neck cancer patients. METHOD: This is a retrospective review of all cases referred for suspected head and neck cancer to our institution in January and April 2020. RESULTS: There was a 55 per cent decrease in referrals but diagnostic yield rose from 2.9 per cent in January to 8.06 per cent in April. In both months, 100 per cent of patients met the 31- and 62-day targets, with similar 14-day wait time success (97.83 per cent for January vs 98.33 per cent for April). Referrals for laryngopharyngeal reflux rose from 27.5 per cent to 41.9 per cent. Referrals for those aged over 60 years fell from 42 per cent to 26 per cent. CONCLUSION: It is suggested that further research be conducted into the reasons why fewer patients were referred, particularly elderly patients, and why laryngopharyngeal reflux is so prevalent in fast-track referrals.


Assuntos
Infecções por Coronavirus/transmissão , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Refluxo Laringofaríngeo/epidemiologia , Pneumonia Viral/transmissão , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Refluxo Laringofaríngeo/diagnóstico , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prevalência , Estudos Retrospectivos , Medicina Estatal/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Ultrassonografia/métodos , Reino Unido/epidemiologia
8.
J Laryngol Otol ; 134(8): 688-695, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32758308

RESUMO

OBJECTIVES: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient. METHODS: Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed. RESULTS: The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8-26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001). CONCLUSION: Performing a tracheostomy in coronavirus disease 2019 positive patients at 8-14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.


Assuntos
Infecções por Coronavirus/transmissão , Estado Terminal/epidemiologia , Pneumonia Viral/transmissão , Respiração Artificial/efeitos adversos , Traqueostomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos , Traqueostomia/métodos , Traqueostomia/estatística & dados numéricos , Reino Unido/epidemiologia
9.
PLoS One ; 15(8): e0237781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857798

RESUMO

BACKGROUND: Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH). METHODS: A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association. RESULTS: Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). ß blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5). CONCLUSION: Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.


Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Insuficiência Cardíaca/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Antagonistas Adrenérgicos beta/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/farmacocinética , Estudos Transversais , Interações Medicamentosas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação/psicologia , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
10.
BMJ Open ; 10(8): e039177, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819955

RESUMO

OBJECTIVE: COVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH). DESIGN: A retrospective cohort study. PARTICIPANTS: A total of 6365 patients were screened in the FC. METHODS: The FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed. RESULTS: 6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected. CONCLUSION: The workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.


Assuntos
Infecções por Coronavirus/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Febre/virologia , Ambulatório Hospitalar/organização & administração , Pneumonia Viral/diagnóstico , Centros de Atenção Terciária/organização & administração , Carga de Trabalho , Adulto , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Transferência de Pacientes/estatística & dados numéricos , Pneumonia Viral/transmissão , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
11.
Handchir Mikrochir Plast Chir ; 52(4): 272-279, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32823363

RESUMO

BACKGROUND: To manage the expected COVID-19 patient load major restrictions in in- and outpatient treatment had to be made. Depending on local conditions and order supply differences SARS-CoV-2 restrictions had a massive impact on medical care. To show the impact of plastic surgery on emergency surgery during SARS-CoV-2 pandemic, the amount of surgical emergencies in a single center plastic surgery division were evaluated. METHOD: The number of plastic surgery cases in a university hospital was evaluated during 16.03.2020 to 27.04.2020 and compared with previous years. RESULTS: Due to cancelling of elective surgery the number of cases dropped to 57,3 % of the caseload of previous years. There was no change in ratio of emergency (2020: 56,4 %; 2017-2019: 54,9 %) and urgent (2020: 44,6 %; 2017-2019: 45 %) surgery. No changes in regard to the etiology of trauma cause nor insurance status (occupational insurance/health insurance) were noted. CONCLUSION: Based on the data of this evaluation there is a clear relevance of Plastic Surgery in the setting of general medical care. Even during the pandemic crises a sufficient plastic surgery service is mandatory in a tertiary referral center.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Cirurgia Plástica/estatística & dados numéricos , Betacoronavirus , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Hospitais Universitários , Humanos , Pandemias , Centros de Atenção Terciária/estatística & dados numéricos
12.
BMC Infect Dis ; 20(1): 557, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736605

RESUMO

BACKGROUND: Multi-drug resistance pathogens such as Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (ESBL-PE) are of great global health concern, since they are associated with increased morbidity and mortality. Even in the absence of infections caused by these pathogens, colonization is a great threat and can lead to cross transfer among hospitalized patients. To date data on carriage of these pathogens is still limited in Tanzania. Therefore, this study aimed to determine ESBL-PE fecal carriage rate and associated factors among hospitalized patients at Referral hospitals in Dar es Salaam. METHODS: This was a cross sectional study conducted from May to July 2017 among patients admitted in three referral hospitals in Dar es Salaam, Tanzania. Rectal swabs were collected and screened for ESBL production using MacConkey agar supplemented with Ceftazidime 2 µg/ml. Phenotypic confirmation of ESBL-PE was done by double disk diffusion method. Statistical analysis was performed using Statistical Package for Social Sciences (SPPS) software version 20. RESULTS: Of the 196 enrolled participants, 59.7% (117/196) were confirmed to carry ESBL-PE. Diarrheic patients (57/79) had statistically significant high prevalence of ESBL colonization compared to those without diarrhea (60/117) (p = 0.01). A total of 131 ESBL-PE were isolated from 117 patients, whereby, Escherichia coli accounted for 68.7%, Klebsiella pneumoniae 28.2% and Citrobacter species 0.8%. ESBL-PE carriage was significantly higher in patients with diarrhea compared to those without diarrhea (72% vs 53.1%, p = 0.01). Recent antibiotic use was independently associated with carriage of ESBL-PE (aOR 14.65, 95%CI 3.07-69.88, p = 0.01). CONCLUSIONS: High prevalence of fecal carriage of ESBL-PE was observed in patients admitted in tertiary hospitals in Dar es Salaam, Tanzania. The use of antibiotics was associated with carriage of ESBL producers among the study population.


Assuntos
Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/metabolismo , Fezes/microbiologia , beta-Lactamases/biossíntese , Adolescente , Adulto , Antibacterianos/uso terapêutico , Ceftazidima , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Encaminhamento e Consulta , Tanzânia/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
13.
PLoS One ; 15(8): e0237407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764806

RESUMO

BACKGROUND: Uganda ranks third in the number of deaths attributable to malaria and has some of the highest recorded malaria transmission rates in the general population. Malaria in Pregnancy is associated with detrimental effects for the mother and unborn baby and these effects seem to have long term effects and consequences on the life of the baby. Despite the preventive measures put in place by the World Health Organization in antenatal care, the burden of malaria in pregnancy is still high. We determined the use of malaria preventive strategies during pregnancy and the presence of plasmodium infection, anemia, and low birth weight babies at delivery among parturient women at Mbale regional referral hospital in eastern Uganda. METHODS: A cross-sectional study was conducted among 210 women delivering at MRRH between July 2017 and January 2018. Information on demographics, antenatal care, and prevention practices was collected using an interviewer-administered questionnaire. Maternal venous blood and cord blood samples were screened for Plasmodium infection by both microscopy of Giemsa-stained blood films and Plasmodium falciparum rapid diagnostic test (pf. HPR2 mRDT). Polymerase Chain Reaction (PCR) was done on cord blood. The presence of anemia was determined by the use of an automated hemoglobin analyzer. Data were analyzed using descriptive and analytical statistics. RESULTS: Of the 210 women, 3 (1.4%) and 19(9.1%) tested positive for malaria by using Giemsa stained blood smear microscopy and malaria rapid diagnosticMRDT tests respectively. PCR detected 4(%) of Plasmodium in cord blood. Twenty-nine percent of the women had anaemia and 11 (5.2%) had low birth weight babies. Only 23.3% of the women received at least three doses of IPTp-SP and 57.9% reported sleeping under an Insecticide Treated Net the night before the survey. The women who reported sleeping under a mosquito net the previous night (OR 0.67, 95% CI: 0.24-1.86) and those who reported taking fansidar as a directly observed therapy (OR 0.31, 95% CI: 0.04-2.39) appeared to have few chances of getting plasmodium infection though the findings were not statistically significant. CONCLUSION: The effective use of malaria preventive strategies (IPT-SP and Insecticide Treated Nets) was generally low. Most of the women took less than three doses of SP and there was no strict adherence to the recommended directly observed therapy. The prevalence of Plasmodium infection during pregnancy was low though maternal anaemia and low birth weight were relatively high.


Assuntos
Parto Obstétrico , Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Antimaláricos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Malária/tratamento farmacológico , Malária/epidemiologia , Mães , Gravidez , Complicações Parasitárias na Gravidez/tratamento farmacológico , Complicações Parasitárias na Gravidez/epidemiologia , Uganda/epidemiologia , Adulto Jovem
14.
Am J Gastroenterol ; 115(10): 1617-1623, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32852338

RESUMO

INTRODUCTION: To compare outcomes in patients hospitalized with coronavirus (COVID-19) receiving famotidine therapy with those not receiving famotidine. METHODS: Retrospective, propensity-matched observational study of consecutive COVID-19-positive patients between February 24, 2020, and May 13, 2020. RESULTS: Of 878 patients in the analysis, 83 (9.5%) received famotidine. In comparison to patients not treated with famotidine, patients treated with famotidine were younger (63.5 ± 15.0 vs 67.5 ± 15.8 years, P = 0.021), but did not differ with respect to baseline demographics or preexisting comorbidities. Use of famotidine was associated with a decreased risk of in-hospital mortality (odds ratio 0.37, 95% confidence interval 0.16-0.86, P = 0.021) and combined death or intubation (odds ratio 0.47, 95% confidence interval 0.23-0.96, P = 0.040). Propensity score matching to adjust for age difference between groups did not alter the effect on either outcome. In addition, patients receiving famotidine displayed lower levels of serum markers for severe disease including lower median peak C-reactive protein levels (9.4 vs 12.7 mg/dL, P = 0.002), lower median procalcitonin levels (0.16 vs 0.30 ng/mL, P = 0.004), and a nonsignificant trend to lower median mean ferritin levels (797.5 vs 964.0 ng/mL, P = 0.076). Logistic regression analysis demonstrated that famotidine was an independent predictor of both lower mortality and combined death/intubation, whereas older age, body mass index >30 kg/m, chronic kidney disease, National Early Warning Score, and higher neutrophil-lymphocyte ratio were all predictors of both adverse outcomes. DISCUSSION: Famotidine use in hospitalized patients with COVID-19 is associated with a lower risk of mortality, lower risk of combined outcome of mortality and intubation, and lower levels of serum markers for severe disease in hospitalized patients with COVID-19.(Equation is included in full-text article.).


Assuntos
Infecções por Coronavirus/terapia , Famotidina/uso terapêutico , Intubação Intratraqueal/estatística & dados numéricos , Pneumonia Viral/terapia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Pontuação de Propensão , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento
15.
Acta Orthop Traumatol Turc ; 54(4): 355-363, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32812872

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the types and the frequency of fractures, both in the pediatric and adult population during the COVID-19 pandemic and to find out the differences in comparison to the non-pandemic period. METHODS: Patients who were admitted to the hospital with a new fracture during pandemic period (March 16 to May 22, 2020) were evaluated. Control group consisted of patients with new fractures admitted to the hospital in the same date range in 2018 and 2019. The patients were divided into two groups as ≤16 years old (group 1) and >16 years old (group 2). The evaluation was based on the age and gender of the patients and localization of the fractures. Hospitalized and surgically treated patients were evaluated as well. RESULTS: A total of 1794, 1747, and 670 fractures were observed in 2018, 2019, and 2020, respectively. Mean age of the patients in group 1 was found to have decreased in the pandemic period (p<0.001). The most common fracture sites in the pediatric population were the distal forearm and distal arm, whereas hand, distal forearm, and foot were most common fracture sites in adults, in both pandemic and non-pandemic periods. The proportional increase in femoral and tibial shaft fractures in group 1, and toe, tibial shaft, and metacarpal fractures in group 2 was found to be statistically significantly (p<0.05). In group 1; 6.8%, 7.7%, and 14.6% of the fractures were treated surgically in 2018, 2019, and 2020, respectively (p<0.001). For group 2, these rates were 20.1%, 18.6%, and 18.1%, respectively (p=0.67). There were 48, 29, and 26 open fractures in 2018, 2019 and 2020, respectively (p=0.066). In pandemic period, duration of the hospital stay was significantly shorter for distal humerus and proximal femur fractures (p values= 0.001 and 0.017, respectively). CONCLUSION: We observed that the frequency of fractures decreased by approximately one-third during the pandemic period compared with that in the non-pandemic period. The mean age of the patients with a fracture in the pediatric group was found to have decreased also. Finger fractures in pediatric patients and metatarsal fractures in adult patients were found to have significantly decreased during the pandemic. LEVEL OF EVIDENCE: Level III, Diagnostic study.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Fraturas Ósseas/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Criança , Infecções por Coronavirus/complicações , Feminino , Fraturas Ósseas/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Estudos Retrospectivos , Turquia/epidemiologia
16.
Pediatr Infect Dis J ; 39(9): e221-e225, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32639459

RESUMO

BACKGROUND: In Italy, the response to coronavirus disease 2019 (COVID-19) pandemic upgraded from social distancing on February 23, 2020, to national lockdown on March 11, 2020. We described how the pandemic affected a tertiary care children hospital with a dedicated COVID-19 regional center. METHODS: We analyzed the characteristics of emergency department (ED) visits, urgent hospitalizations and severe acute respiratory syndrome (SARS)-COV-2 reverse transcription-polymerase chain reaction testing, and COVID-19 patients across 3 response phases: before the first Italian case, before national lockdown and during lockdown. RESULTS: ED visits decreased from a daily mean of 239.1 before the first COVID-19 Italian case, to 79.6 during lockdown; urgent hospitalizations decreased from 30.6 to 21.2. As of April 20, 2020, 1970 persons were tested for SARS-CoV-2 reverse transcription-polymerase chain reaction and 2.6% were positive. Positive rates were 1.2% in the ED, 21.1% in the COVID center and 0.5% in other wards. The median age of COVID-19 patients (N = 33) was 6.7 years, 27% had coexisting conditions and 79% were related to family clusters. CONCLUSIONS: The pandemic strongly impacted on the use of hospital services, with a 67% reduction in ED visits and a 31% reduction in urgent hospitalizations. Separating the flows of suspected patients from all other patients, and centralization of suspected and confirmed cases in the COVID center enabled to control the risk of nosocomial SARS-CoV-2 transmission. Delay in hospital use for urgent care must be avoided, and clear communication on infection prevention and control must be provided to families. Further studies are needed to assess how the reduction in hospital use affected children healthcare needs during the pandemic.


Assuntos
Defesa Civil , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Adolescente , Assistência Ambulatorial , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos/organização & administração , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Itália/epidemiologia , Masculino , Pandemias , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
17.
Swiss Med Wkly ; 150: w20316, 2020 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-32668007

RESUMO

AIMS OF THE STUDY: To describe admission characteristics, risk factors and outcomes of patients with coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the early phase of the pandemic. METHODS: This retrospective cohort study included adult patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction (PCR) testing and hospitalised at the cantonal hospital Aarau (Switzerland) between 26 February 2020 and 30 April 2020. Our primary endpoint was severe COVID-19 progression defined as a composite of transfer to the intensive care unit (ICU) and in-hospital mortality. RESULTS: A total of 99 patients (median age 67 years [interquartile range 56–76], 37% females) were included and 35% developed severe COVID-19 progression (24% needed ICU treatment, 19% died). Patients had a high burden of comorbidities with a median Charlson comorbidity index of 3 points and a high prevalence of hypertension (57%), chronic kidney disease (28%) and obesity (27%). Baseline characteristics with the highest prognostic value for the primary endpoint by means of area under the receiver operating characteristic curve were male gender (0.63) and initial laboratory values including shock markers (lactate on ambient air 0.67; lactate with O2 supply 0.70), markers of inflammation (C-reactive protein 0.72, procalcitonin 0.80) and markers of compromised oxygenation (pO2 0.75 on ambient air), whereas age and comorbidities provided little prognostic information. CONCLUSION: This analysis provides insights into the first consecutively hospitalised patients with confirmed COVID-19 at a Swiss tertiary care hospital during the initial period of the pandemic. Markers of disease progression such as inflammatory markers, markers for shock and impaired respiratory function provided the most prognostic information regarding severe COVID-19 progression in our sample.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Causalidade , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Progressão da Doença , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Inflamação/sangue , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
18.
Indian J Ophthalmol ; 68(8): 1540-1544, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32709770

RESUMO

Purpose: To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute. Methods: Records of all the patients who presented from March 25th to May 3rd, 2020 were scanned to evaluate the details regarding the presenting complaints, diagnosis, advised treatment and surgical interventions. Results: The number of outpatient department visits, retinal laser procedures, intravitreal injections and cataract surgeries during this lockdown decreased by 96.5%, 96.5%, 98.7% and 99.7% respectively compared from the corresponding time last year. Around 38.8% patients could be triaged as non-emergency cases based on history alone while 59.5% patients could be triaged as non-emergency cases after examination. Only eighty-four patients opted for video-consultation from April 15th to May 3rd, 2020. Nine patients presented with perforated corneal ulcer, but could not undergo penetrating keratoplasty due to the lack to available donor corneal tissue. One of these patients had to undergo evisceration due to disease progression. Two patients with open globe injury presented late after trauma and had to undergo enucleation. Around 9% patients could not undergo the advised urgent procedure due to logistical issues related to the lockdown. Conclusion: A significant number of patients could not get adequate treatment during the lockdown period. Hospitals need to build capacity to cater to the expected patient surge post-COVID-19-era, especially those requiring immediate in-person attention. A large number of patients can be classified as non-emergency cases. These patients need to be encouraged to follow-up via video-consultation to carve adequate in-person time for the high-risk patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oftalmopatias/terapia , Oftalmologia/estatística & dados numéricos , Pandemias , Assistência ao Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Quarentena , Academias e Institutos/organização & administração , Academias e Institutos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Hospitais Especializados/organização & administração , Hospitais Especializados/estatística & dados numéricos , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Oftalmologia/organização & administração , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
19.
S Afr Med J ; 110(5): 374-376, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657720

RESUMO

BACKGROUND: Previous work from KwaZulu-Natal (KZN) Province, South Africa, has suggested that public sector district hospitals are not providing adequate access to surgical care in the form of bellwether operations (caesarean section (CS), open reduction of fractures (ORF) and laparotomy). OBJECTIVES: To review the surgical output of regional and tertiary institutions, to quantify their contribution to providing bellwether procedure coverage for the province. METHODS: Data on bellwether operations conducted at all district, regional, tertiary and central hospitals in the public health sector of KZN for the period 1 July - 31 December 2015 were collected from operating theatre registers. RESULTS: Between 1 July and 31 December 2015, a total of 20 926 CSs, 3 947 laparotomies and 3 098 ORFs were performed in KZN provincial hospitals. This translates to a provincial rate for each bellwether procedure of 192/100 000 (CS), 36/100 000 (laparotomy) and 28/100 000 (ORF). The rate of  bellwether operations across the province during the study period was 256/100 000, with numbers as follows: CSs - 10 542 in district hospitals, 8 712 in regional hospitals, 1 538 in tertiary hospitals and 134 in the central hospital; laparotomies - 235 in district hospitals, 2 314 in regional hospitals, 1 259 in tertiary hospitals and 139 in the central hospital; and ORFs - 196 in district hospitals, 1 660 in regional hospitals, 1 201 in tertiary hospitals and 41 in the central hospital. CONCLUSIONS: Regional and tertiary hospitals are performing the bulk of non-obstetric bellwether operations in KZN. This imbalance has major implications for planning future delivery of surgical care in the province.


Assuntos
Cesárea/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Redução Aberta/estatística & dados numéricos , Programas Médicos Regionais/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Feminino , Fraturas Ósseas/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais de Distrito/estatística & dados numéricos , Humanos , Gravidez , África do Sul
20.
Neurology ; 95(6): e643-e652, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32690794

RESUMO

OBJECTIVE: To investigate the hypothesis that patients diagnosed with psychogenic nonepileptic seizures (PNES) on video-EEG monitoring (VEM) have increased mortality by comparison to the general population. METHODS: This retrospective cohort study included patients evaluated in VEM units of 3 tertiary hospitals in Melbourne, Australia, between January 1, 1995, and December 31, 2015. Diagnosis was based on consensus opinion of experienced epileptologists and neuropsychiatrists at each hospital. Mortality was determined in patients diagnosed with PNES, epilepsy, or both conditions by linkage to the Australian National Death Index. Lifetime history of psychiatric disorders in PNES was determined from formal neuropsychiatric reports. RESULTS: A total of 5,508 patients underwent VEM. A total of 674 (12.2%) were diagnosed with PNES, 3064 (55.6%) with epilepsy, 175 (3.2%) with both conditions, and 1,595 (29.0%) received other diagnoses or had no diagnosis made. The standardized mortality ratio (SMR) of patients diagnosed with PNES was 2.5 (95% confidence interval [CI] 2.0-3.3). Those younger than 30 had an 8-fold higher risk of death (95% CI 3.4-19.8). Direct comparison revealed no significant difference in mortality rate between diagnostic groups. Among deaths in patients diagnosed with PNES (n = 55), external causes contributed 18%, with 20% of deaths in those younger than 50 years attributed to suicide, and "epilepsy" was recorded as the cause of death in 24%. CONCLUSIONS: Patients diagnosed with PNES have a SMR 2.5 times above the general population, dying at a rate comparable to those with drug-resistant epilepsy. This emphasizes the importance of prompt diagnosis, identification of risk factors, and implementation of appropriate strategies to prevent potential avoidable deaths.


Assuntos
Transtorno Conversivo/mortalidade , Convulsões/mortalidade , Adolescente , Adulto , Distribuição por Idade , Transtornos de Ansiedade/mortalidade , Causas de Morte , Criança , Pré-Escolar , Comorbidade , Transtorno Conversivo/fisiopatologia , Transtorno Depressivo/mortalidade , Grupos Diagnósticos Relacionados , Transtornos Dissociativos/mortalidade , Eletroencefalografia , Epilepsia/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Convulsões/fisiopatologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Suicídio/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Vitória/epidemiologia , Gravação em Vídeo , Adulto Jovem
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