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1.
BMC Infect Dis ; 21(1): 1016, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583644

RESUMO

BACKGROUND: Anemia is the most common hematologic abnormalities in AIDS patients usually associated with disease progression and poor clinical outcomes. Zidovudine (AZT), which is one of the nucleoside reverse transcriptase inhibitor drug families of the first line antiretroviral therapy regimen for HIV/AIDS patients, causes anemia due to early long-term of higher-dose therapy. This study was aimed to assess the magnitude and associated factors of anemia among AZT containing HAART experienced adult HIV/ADIS patients at University of Gondar Comprehensive Specialized Referral Hospital, northwest, Ethiopia, 2019. METHODS: A retrospective cohort study was conducted among a total of 320 adult AZT based HAART experienced HIV/AIDS patients from January 2016 to December 2018. Systematic random sampling technique was used to select the patients' charts. All required data for this study were extracted from patients' medical charts. Data were coded, cleared and entered into Epi Info version 3.5.3, and transformed to SPSS version 20 for analysis. Descriptive statistics, bivariable and multivariable logistic regression models were fitted to identify associated factors of anemia and P-value < 0.05 was considered as statistically significance. RESULTS: A total of 320 adult AZT based HAART experienced HIV/AIDS patients' charts were assessed. Of the total patients, 198 (61.9%) were females and 133 (41.6%) were within the age range of 35-45 years. More than half, 237(76.9%) of the patients were from the urban area and 186 (58.1%) were on WHO clinical stage III at the baseline. The prevalence of anemia was 50% (95% CI 44.7-55.0%), 44.1% (95% CI 38.4-50.0%), 35.6% (95% CI 30.3-40.6%), 40% (95% CI 34.4-45.6%), 40.6% (95% CI 35.0-46.3) and 39.1% (95% CI 33.4-44.1%) at baseline, 6 months, 12 months, 18 months, 24 months and 30 months of follow-up period, respectively. The overall prevalence of anemia was 41.6%. Anemia had significant association with WHO clinical stage and base line Hgb values. CONCLUSIONS: A significant number of participants were anemic in this study. WHO clinical stage and baseline Hgb value were the contributing factors for anemia among these patients. Therefore, anemia needs an immediate intervention on associated factor to improve the anemic status and living condition of HIV patient.


Assuntos
Anemia , Infecções por HIV , Adulto , Anemia/induzido quimicamente , Anemia/epidemiologia , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Etiópia/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hospitais Especializados , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Zidovudina/efeitos adversos
2.
Medicine (Baltimore) ; 100(32): e26832, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397889

RESUMO

ABSTRACT: Previous studies on hospital specialization in spinal joint disease have been limited to patients requiring surgical treatment. The lack of similar research on the nonsurgical spinal joint disease in specialized hospitals provides limited information to hospital executives.To analyze the relationship between hospital specialization and health outcomes (length of stay and medical expenses) with a focus on nonsurgical spinal joint diseases.The data of 56,516 patients, which were obtained from the 2018 National Inpatient Sample, provided by the Health Insurance Review and Assessment Service, were utilized. The study focused on inpatients with nonsurgical spinal joint disease and used a generalized linear mixed model with specialization status as the independent variable. Hospital specialization was measured using the Inner Herfindahl-Hirschman Index (IHI). The IHI (value ≤1) was calculated as the proportion of hospital discharges accounted for by each service category out of the hospital's total discharges. Patient and hospital characteristics were the control variables, and the mean length of hospital stay and medical expenses were the dependent variables.The majority of the patients with the nonsurgical spinal joint disease were female. More than half of all patients were middle-aged (40-64 years old). The majority did not undergo surgery and had mild disease, with Charlson Comorbidity Index score ≤1. The mean inpatient expense was 1265.22 USD per patient, and the mean length of stay was 9.2 days. The specialization status of a hospital had a negative correlation with the length of stay, as well as with medical expenses. An increase in specialization status, that is, IHI, was associated with a decrease in medical expenses and the length of stay, after adjusting for patient and hospital characteristics.Hospital specialization had a positive effect on hospital efficiency. The results of this study could inform decision-making by hospital executives and specialty hospital-related medical policymakers.


Assuntos
Tratamento Conservador , Hospitais Especializados , Artropatias , Doenças da Coluna Vertebral , Tratamento Conservador/economia , Tratamento Conservador/métodos , Eficiência Organizacional/normas , Feminino , Custos Hospitalares , Hospitais Especializados/classificação , Hospitais Especializados/estatística & dados numéricos , Humanos , Artropatias/economia , Artropatias/epidemiologia , Artropatias/terapia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/epidemiologia , Doenças da Coluna Vertebral/terapia
3.
Bone Joint J ; 103-B(8): 1373-1379, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334036

RESUMO

AIMS: Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. METHODS: A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. RESULTS: A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). CONCLUSION: Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373-1379.


Assuntos
Artroplastia do Joelho , Articulação do Joelho , Prótese do Joelho/efeitos adversos , Padrões de Prática Médica , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos de Coortes , Feminino , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
4.
BMC Infect Dis ; 21(1): 626, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210269

RESUMO

OBJECTIVE: To quantitatively evaluate the effectiveness of Fangcang shelter hospitals, designated hospitals, and the time interval from illness onset to diagnosis toward the prevention and control of the COVID-19 epidemic. METHODS: We used SEIAR and SEIA-CQFH warehouse models to simulate the two-period epidemic in Wuhan and calculate the time dependent basic reproduction numbers (BRNs) of symptomatic infected individuals, asymptomatic infected individuals, exposed individuals, and community-isolated infected individuals. Scenarios that varied in terms of the maximum numbers of open beds in Fangcang shelter hospitals and designated hospitals, and the time intervals from illness onset to hospitals visit and diagnosis were considered to quantitatively assess the optimal measures. RESULTS: The BRN decreased from 4.50 on Jan 22, 2020 to 0.18 on March 18, 2020. Without Fangcang shelter hospitals, the cumulative numbers of cases and deaths would increase by 18.58 and 51.73%, respectively. If the number of beds in the designated hospitals decreased by 1/2 and 1/4, the number of cumulative cases would increase by 178.04 and 92.1%, respectively. If the time interval from illness onset to hospital visit was 4 days, the number of cumulative cases and deaths would increase by 2.79 and 6.19%, respectively. If Fangcang shelter hospitals were not established, the number of beds in designated hospitals reduced 1/4, and the time interval from visiting hospitals to diagnosis became 4 days, the cumulative number of cases would increase by 268.97%. CONCLUSION: The declining BRNs indicate the high effectiveness of the joint measures. The joint measures led by Fangcang shelter hospitals are crucial and need to be rolled out globally, especially when medical resources are limited.


Assuntos
COVID-19/prevenção & controle , COVID-19/terapia , Simulação por Computador , Unidades Móveis de Saúde , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/mortalidade , China/epidemiologia , Hospitais Especializados , Humanos , Modelos Biológicos , Saúde Pública
5.
J Laryngol Otol ; 135(S1): S1-S12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34240690

RESUMO

BACKGROUND: It was in twentieth-century Britain that the two distinct surgical disciplines, otology and laryngology, became united under the title oto-laryngology. Aural departments were established in general hospitals in the hands of specialists long before throat departments. The development and politics of the specialty occurred in London, while provincial services commenced in the early eighteenth century, with ophthalmologists, setting up a clinic or dispensary, progressing onto a hospital. METHODS: The following resources were used: the Nottinghamshire Archives; Manuscripts and Special Collections at the University of Nottingham Libraries and The Local Studies Library, Nottingham Central Library. RESULTS: The Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose was established in 1886, staffed by part-time general practitioners. The Nottingham Children's Hospital appointed two qualified surgeons in the 1910s and subsequently the General Nottingham Hospital appointed them as honorary assistant surgeons. Both hospitals provided access to beds, not available to the Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose. Following The Education Act of 1907, Nottingham created a School Health Services. By the 1920s, Nottingham had four institutions providing clinical and surgical ENT services. The National Hospitals Survey conducted in 1945 recommended that the Nottingham and Nottinghamshire Hospital for Diseases of the Throat, Ear and Nose be closed and amalgamated with The General Hospital Nottingham. CONCLUSION: The General Hospital Nottingham was slow to create a service for the diagnosis and treatment of ENT diseases and disorders, but established a Departmental Service by 1927. The surgical staffing was common to all four of the ENT services from mid-1930.


Assuntos
Instituições de Assistência Ambulatorial/história , Hospitais Especializados/história , Otolaringologia/história , Medicina Estatal/história , Serviços Urbanos de Saúde/história , História do Século XIX , História do Século XX , Humanos , Reino Unido
7.
J Ayub Med Coll Abbottabad ; 33(2): 299-302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137549

RESUMO

BACKGROUND: The permanent maxillary lateral incisor (PMLI) shows morphological variations, in the form of different crown shapes such as peg-shaped, cone-shaped, barrel-shaped and canine-shaped. The frequency of developmentally malformed permanent maxillary lateral incisors varies among different populations. The aim of this study was to document the frequency of different shapes of developmentally malformed permanent maxillary lateral incisors in patients visiting the three teaching dental hospitals of Peshawar. METHODS: It was a cross-sectional study conducted in the Oral Diagnosis department of Peshawar Dental College, Sardar Begum Dental College, and Khyber College of Dentistry from 1st Sep 2018 to 15th June 2019. A total of 82 subjects were included that fulfilled the inclusion criteria. Shape of the malformed PMLI was determined using Computer-aided design/Computer-aided manufacturing software. Descriptive statistics including frequencies and percentages for observed developmental malformation and their types were computed and Chi-square test was applied to see the relation between various shapes and their occurrence with respect to site and position within the jaws. RESULTS: The peg shaped PMLI was seen in 81 (98.87%) patients and barrel shaped was present in 1 (1.22%) patient. The malformed PMLIs was found to be unilateral in 38 (46.3%) and bilateral in 44 (53.7%) patients, with more common presence on both sides 44 (53.7%) followed by right side 20 (24.4%) and left side 18 (22.0%). CONCLUSIONS: The subjects having predominant developmental malformation in case of permanent maxillary lateral incisor was peg-shaped permanent maxillary lateral incisor.


Assuntos
Incisivo/patologia , Maxila/patologia , Adulto , Distribuição de Qui-Quadrado , Desenho Assistido por Computador , Estudos Transversais , Odontologia , Hospitais Especializados , Hospitais de Ensino , Humanos , Masculino , Paquistão , Adulto Jovem
9.
CMAJ Open ; 9(2): E460-E465, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33958381

RESUMO

BACKGROUND: People living with HIV and multiple comorbidities have high rates of health service use. This study evaluates system usage before and after admission to a community facility focused on HIV care. METHODS: We used Ontario administrative health databases to conduct a pre-post comparison of rates and costs of hospital admissions, emergency department visits, and family physician and home care visits among medically complex people with HIV in the year before and after admission to Casey House, an HIV-specific hospital in Toronto, for all individuals admitted between April 2009 and March 2015. Negative binomial regression was used to compare rates of health care utilization. We used Wilcoxon rank sum tests to compare associated health care costs, standardized to 2015 Canadian dollars. To contextualize our findings, we present rates and costs of health service use among Ontario residents living with HIV. RESULTS: During the study period, 268 people living with HIV were admitted to Casey House. Emergency department use declined from 4.6 to 2.5 visits per person-year (p = 0.02) after discharge from Casey House, and hospitalization rates declined from 1.4 to 1.1 admissions per person-year (p = 0.05). Conversely, home care visits increased from 24.3 to 35.6 visits per person-year (p = 0.01) and family physician visits increased from 18.3 to 22.6 visits per person-year (p < 0.001) in the year after discharge. These changes were associated with reduced overall costs to the health care system. The reduction in overall costs was not significant (p = 0.2); however, costs of emergency department visits (p < 0.001) and physician visits (p < 0.001) were significantly less. INTERPRETATION: Health care utilization by people with HIV was significantly different before and after admission to a community hospital focused on HIV care. This has implications for health care in other complex patient populations.


Assuntos
Infecções por HIV , Serviços de Assistência Domiciliar , Hospitais Comunitários , Hospitais Especializados , Múltiplas Afecções Crônicas , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Feminino , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Custos de Cuidados de Saúde , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Hospitais Comunitários/economia , Hospitais Comunitários/estatística & dados numéricos , Hospitais Especializados/economia , Hospitais Especializados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/economia , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Ontário/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/estatística & dados numéricos
10.
Bull World Health Organ ; 99(5): 374-380, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33958825

RESUMO

A surge in the number of international arrivals awaiting coronavirus disease 2019 (COVID-19) screening overwhelmed health-care workers and depleted medical resources in designated hospitals in Beijing, China in March 2020. The People's Government of Beijing Municipality therefore issued a policy which required the mandatory transfer of all asymptomatic passengers arriving from a foreign country to designated quarantine hotels, and the transfer of passengers with fever or respiratory symptoms to designated hospitals. Xiaotangshan Designated Hospital, a severe acute respiratory syndrome hospital in 2003, was rapidly renovated and put into operation with the main tasks of screening and isolating symptomatic international arrivals at Beijing Capital International Airport, providing basic medical care for mild to moderate COVID-19-positive cases, and rapidly referring severe to critical COVID-19-positive cases to higher-level hospitals. During the month-long period of its operation, 2171 passengers were screened and 53 were confirmed as having COVID-19 (six severe to critical). We describe how the use of Xiaotangshan Designated Hospital in this way enabled the efficient grouping and assessment of passengers arriving from a foreign country, the provision of optimal patient care without compromising public safety and the prioritization of critically ill patients requiring life-saving treatment. The designated hospital is a successful example of the World Health Organization's recommendation to renovate existing medical infrastructures to improve the COVID-19 response capacity. The flexible design of Xiaotangshan Designated Hospital means that it can be repurposed and reopened at any time to respond to the changing pandemic conditions.


Assuntos
Aeroportos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Hospitais Especializados/organização & administração , Programas de Rastreamento/organização & administração , China/epidemiologia , Humanos , Internacionalidade , Pandemias , SARS-CoV-2 , Índice de Gravidade de Doença
11.
PLoS One ; 16(5): e0251295, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33999930

RESUMO

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics.


Assuntos
COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Hospitais Especializados/organização & administração , Hospitais Especializados/tendências , Pandemias/prevenção & controle , SARS-CoV-2/genética , Triagem/métodos , Adulto , Idoso , Inteligência Artificial , COVID-19/prevenção & controle , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Equador/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Radiografia Pulmonar de Massa/métodos , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
12.
Clin Chest Med ; 42(2): 347-355, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34024409

RESUMO

Comprehensive interstitial lung disease (ILD) care delivery models have several key components including diagnosis, treatment, monitoring, coordination with other health care providers, patient support/advocacy, education, and research. ILD is rapidly evolving, and specialized centers with ILD-specific expertise have emerged as ways to care for complex patients. The role of the specialized center in care delivery is multifaceted and aimed at improving patient care and advancing the field of ILD. Widespread access to specialized centers is a barrier to ILD care delivery worldwide. Creative and innovative strategies that leverage technology are needed to bridge gaps in ILD care.


Assuntos
Hospitais Especializados , Doenças Pulmonares Intersticiais/terapia , Animais , Atenção à Saúde , Humanos , Modelos Biológicos
13.
Rev Gaucha Enferm ; 42(spe): e20200214, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34037181

RESUMO

OBJECTIVE: To report the experience of adapting the stomatherapy service during the COVID-19 pandemic. METHOD: Experience report related to adaptations in the work routine in times of COVID-19 pandemic, from March to May 2020, in a specialized stomatherapy center in a city in the South of Brazil. RESULTS: The work routines were adapted to suit the protection measures for workers and users who used stomatherapy services. Some assistance processes were implemented to make users' access to care more flexible, and to modify routines to increase the safety of health professionals and users. CONCLUSION: The need to adapt the physical area, rethink the dynamics of care, use personal protective equipment, and guidance for servers and patients were of fundamental importance to continue attending the population safely in times of pandemic.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde/organização & administração , Estomia , Pandemias , Estomas Cirúrgicos , Bandagens/provisão & distribuição , Brasil/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Atenção à Saúde/estatística & dados numéricos , Hospitais Especializados/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Estomia/enfermagem , Equipamento de Proteção Individual
14.
Am J Emerg Med ; 47: 90-94, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33794475

RESUMO

BACKGROUND & PURPOSE: Alteplase is the standard of care for early pharmacologic thrombolysis after acute ischemic stroke (AIS). Alteplase is also considered a high-alert medication and is fraught with potential for error. We sought to describe the difference in medication error rates in in patients receiving alteplase for acute ischemic stroke from regional hospitals compared to patients receiving alteplase at the Comprehensive Stroke Center. METHODS: This was a retrospective cohort comparison of patients who were greater than 18 years old that received intravenous alteplase for the treatment of AIS from June 2015 to June 2018. Several institution specific databases were utilized to obtain pertinent data. A standardized taxonomy was utilized to classify medication errors. Patients were excluded if they received any fibrinolytic other than alteplase or if alteplase was used for a non-stroke indication. Two cohorts (from regional hospitals or the Comprehensive Stroke Center (CSC)) were compared. RESULTS: A total of 676 patients received alteplase during the study period (34% from the CSC and 66% from regional hospitals). There were 133 (19.8%) errors identified. Ten errors (1.6%) occurred at the CSC and 123 (18.2%) errors occurred at regional hospitals. More patients who had an error with alteplase administration (12.7%) experienced a hemorrhagic conversion compared to those with no error in administration (7.2%, p= 0.04). CONCLUSION: The error rate of alteplase infusion for ischemic stroke is high, particularly in patients from referring centers. Errors may be associated with adverse events. Further education and administration safeguards should be implemented to decrease the risk of medication errors.


Assuntos
Fibrinolíticos/administração & dosagem , AVC Isquêmico/tratamento farmacológico , Erros de Medicação/estatística & dados numéricos , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Fibrinolíticos/efeitos adversos , Hospitais Especializados/estatística & dados numéricos , Humanos , AVC Isquêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/efeitos adversos
15.
PLoS One ; 16(4): e0249252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33826648

RESUMO

BACKGROUND: Globally, studies have shown conflicting results regarding the association of blood groups with SARS CoV-2 infection. OBJECTIVE: To observe the association between ABO blood groups and the presentation and outcomes of confirmed COVID-19 cases. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study of patients with mild-to-moderately severe COVID-19 infections who presented in the COVID-19 unit of Dhaka Medical College Hospital and were enrolled between 01 June and 25 August, 2020. Patients were followed up for at least 30 days after disease onset. We grouped participants with A-positive and A-negative blood groups into group I and participants with other blood groups into group II. RESULTS: The cohort included 438 patients; 52 patients were lost to follow-up, five died, and 381 completed the study. The prevalence of blood group A [144 (32.9%)] was significantly higher among COVID-19 patients than in the general population (p < 0.001). The presenting age [mean (SD)] of group I [42.1 (14.5)] was higher than that of group II [38.8 (12.4), p = 0.014]. Sex (p = 0.23) and co-morbidity (hypertension, p = 0.34; diabetes, p = 0.13) did not differ between the patients in groups I and II. No differences were observed regarding important presenting symptoms, including fever (p = 0.72), cough (p = 0.69), and respiratory distress (p = 0.09). There was no significant difference in the median duration of symptoms in the two group (12 days), and conversion to the next level of severity was observed in 26 (20.6%) and 36 patients (13.8%) in group I and II, respectively. However, persistent positivity of RT-PCR at 14 days of initial positivity was more frequent among the patients in group I [24 (19%)] than among those in group II [29 (11.1%)]. CONCLUSIONS: The prevalence of blood group A was higher among COVID-19 patients. Although ABO blood groups were not associated with the presentation or recovery period of COVID-19, patients with blood group A had delayed seroconversion.


Assuntos
Sistema ABO de Grupos Sanguíneos/sangue , COVID-19/sangue , COVID-19/mortalidade , Hospitais Especializados , SARS-CoV-2/metabolismo , Adulto , Bangladesh/epidemiologia , COVID-19/terapia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
16.
BMC Infect Dis ; 21(1): 378, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33888090

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) such as Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Syphilis have continued a significant public health problem, especially in areas with substandard infection prevention and control programs. It is known that STIs are largely associated with the increased occurrence of cervical cancer. To date, little is known about the burden of STIs among cervical cancer suspected women in Ethiopia. OBJECTIVES: To assess the seroprevalence of STIs and associated risk factors among cervical cancer suspected women with special emphasis on HIV, HBV, HCV, and Syphilis. METHODS: A hospital-based cross-sectional study was conducted among cervical cancer suspected women at the University of Gondar Comprehensive Specialized Hospital from February to April 2017. A pre-tested and structured questionnaire was used to collect data on patients' characteristics. The patient's serum or plasma samples were tested for HIV, HBV, HCV, and syphilis using enzyme-linked immunosorbent assay. In all aspects, the standard operational procedure was strictly followed. Data were analyzed using SPSS version 20 software and presented using tables. Statistical associations were measured using bivariate and multivariable logistic regression. A p-value of below 0.05 was considered statistically significant. RESULT: A total of 403 cervical cancer suspected women with the mean age of 42.54 (SD + 11. 24) years were enrolled in the study. The overall prevalence of STIs was 16.6% (67/403) and the prevalence of HIV, HBV, HCV, and syphilis was 36/403 (8.9%), 10/403 (2.5%), 4/403 (1%), and 29/403 (7.2%) respectively. History of multiple sexual partners (Adjusted OR = 3.02, 95%CI 1.57-5.79, P = 0.001), alcohol addiction (Adjusted OR = 2.2, 95%CI 1.07-4.5, P = 0.031), history of STI (Adjusted OR = 3.38; 95% CI: 1.76-6.47, P = 0.00) and not use of condom (Adjusted OR = 4.99; 95% CI: 1.5-16.16, P = 0.007) were significantly associated with STIs. CONCLUSION: The prevalence of STIs was generally higher among cervical cancer suspected patients. Health education is encouraged to promote awareness about the prevention of STIs.


Assuntos
Doenças Sexualmente Transmissíveis/diagnóstico , Neoplasias do Colo do Útero/patologia , Adulto , Alcoolismo/complicações , Estudos Transversais , Etiópia/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Hepatite B/diagnóstico , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hospitais Especializados , Humanos , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Fatores de Risco , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/complicações , Doenças Sexualmente Transmissíveis/epidemiologia , Inquéritos e Questionários , Sífilis/diagnóstico , Sífilis/epidemiologia
17.
Emerg Med J ; 38(5): 373-378, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33771818

RESUMO

Anticipating the need for a COVID-19 treatment centre in Israel, a designated facility was established at Sheba Medical Center-a quaternary referral centre. The goals were diagnosis and treatment of patients with COVID-19 while protecting patients and staff from infection and ensuring operational continuity and treatment of patients with non-COVID. Options considered included adaptation of existing wards, building a tented facility and converting a non-medical structure. The option chosen was a non-medical structure converted to a hospitalisation facility suited for COVID-19 with appropriate logistic and organisational adaptations. Operational principles included patient isolation, unidirectional workflow from clean to contaminated zones and minimising direct contact between patients and caregivers using personal protection equipment (PPE) and a multimodal telemedicine system. The ED was modified to enable triage and treatment of patients with COVID-19 while maintaining a COVID-19-free environment in the main campus. This system enabled treatment of patients with COVID-19 while maintaining staff safety and conserving the operational continuity and the ability to continue delivery of treatment to patients with non-COVID-19.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Serviço Hospitalar de Emergência/organização & administração , Hospitais Especializados/organização & administração , Controle de Infecções/organização & administração , Serviço Hospitalar de Emergência/normas , Humanos , Controle de Infecções/normas , Israel/epidemiologia , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/provisão & distribuição , SARS-CoV-2 , Telemedicina , Triagem/organização & administração , Fluxo de Trabalho
19.
BMC Surg ; 21(1): 109, 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33657993

RESUMO

BACKGROUND: Sigmoid volvulus is an uncommon problem in children and adolescents, and is rarely considered a diagnosis in this group. A high index of suspicion is necessary to reach a diagnosis and avoid morbidity and mortality. Sigmoid volvulus is a rare complication of Hirschsprung's disease, which has been reported in neonates, children, and adults. Here we report a case of sigmoid volvulus accompanied by undiagnosed Hirschsprung's disease. CASE PRESENTATION: A 9 years old boy who presented with sudden onset of colicky abdominal pain of 4 h duration associated with gross abdominal distension and 2 episodes of non-bilious vomiting. A plain abdominal radiographs showed single hugely dilated bowel loops in the left lower quadrant with single air fluid level. Sigmoid volvulus was considered and rectal tube deflation was done and it was successful. Full thickness rectal biopsy was done and it was consistent with aganglionic megacolon. A primary trans-anal Soave endo-rectal pull through was done 3 weeks later, after biopsy result arrived, which yielded loss of symptoms and regular bowel movement. CONCLUSIONS: Sigmoid volvulus should be considered in the differential for children presenting with acute onset of abdominal obstruction. It should be known that when its's diagnosed in children, it is often associated with Hirschsprung's disease. Therefore, a proper diagnostic and treatment algorithm should be followed in order not to miss associated HD and to give optimum care to such patients.


Assuntos
Doença de Hirschsprung , Volvo Intestinal , Doenças do Colo Sigmoide , Biópsia , Criança , Etiópia , Doença de Hirschsprung/complicações , Doença de Hirschsprung/diagnóstico , Hospitais Especializados , Humanos , Volvo Intestinal/diagnóstico , Masculino , Doenças do Colo Sigmoide/diagnóstico
20.
Clin Orthop Relat Res ; 479(6): 1311-1319, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33543875

RESUMO

BACKGROUND: The Alliance of Dedicated Cancer Centers is an organization of 11 leading cancer institutions and affiliated hospitals that are exempt from the Medicare prospective system hospital reimbursement policies. Because of their focus on cancer care and participation in innovative cancer treatment methods and protocols, these hospitals are reimbursed based on their actual billings. The perceived lack of incentive to meet a predetermined target price and reduce costs has spurred criticism of the value of cancer care at these institutions. The rationale of our study was to better understand whether dedicated cancer centers (DCCs) deliver high-value care for patients undergoing surgical treatment of spinal metastases. QUESTION/PURPOSE: Is there a difference in 90-day complications and reimbursements between patients undergoing surgical treatment (decompression or fusion) for spinal metastases at DCCs and those treated at nonDCC hospitals? METHODS: The 2005 to 2014 100% Medicare Standard Analytical Files database was queried using ICD-9 procedure and diagnosis codes to identify patients undergoing decompression (03.0, 03.09, and 03.4) and/or fusion (81.0X) for spinal metastases (198.5). The database does not allow us to exclude the possibility that some patients were treated with fusion for stabilization of the spine without decompression, although this is likely an uncommon event. Patients undergoing vertebroplasty or kyphoplasty for metastatic disease were excluded. The Medicare hospital provider identification numbers were used to identify the 11 DCCs. The study cohort was categorized into two groups: DCCs and nonDCCs. Although spinal metastases are known to occur among nonMedicare and younger patients, the payment policies of these DCCs are only applicable to Medicare beneficiaries. Therefore, to keep the study objective relevant to current policy and value-based discussions, we performed the analysis using the Medicare dataset. After applying the inclusion and exclusion criteria, we included 17,776 patients in the study, 6% (1138 of 17,776) of whom underwent surgery at one of the 11 DCCs. Compared with the nonDCC group, DCC group hospitals operated on a younger patient population and on more patients with primary renal cancers. In addition, DCCs were more likely to be high-volume facilities with National Cancer Institute designations and have a voluntary or government ownership model. Patients undergoing surgery for spinal metastases at DCCs were more likely to have spinal decompression with fusion than those at nonDCCs (40% versus 22%; p < 0.001) and had a greater length and extent of fusion (at least four levels of fusion; 34% versus 29%; p = 0.001). Patients at DCCs were also more likely than those at nonDCCs to receive postoperative adjunct treatments such as radiation (16% versus 13.5%; p = 0.008) and chemotherapy (17% versus 9%; p < 0.001), although this difference is small and we do not know if this meets a minimum clinically important difference. To account for differences in patients presenting at both types of facilities, multivariate logistic regression mixed-model analyses were used to compare rates of 90-day complications and 90-day mortality between DCC and nonDCC hospitals. Controls were implemented for baseline clinical characteristics, procedural factors, and hospital-level factors (such as random effects). Generalized linear regression mixed-modeling was used to evaluate differences in total 90-day reimbursements between DCCs and nonDCCs. RESULTS: After adjusting for differences in baseline demographics, procedural factors, and hospital-level factors, patients undergoing surgery at DCCs had lower odds of experiencing sepsis (6.5% versus 10%; odds ratio 0.54 [95% confidence interval 0.40 to 0.74]; p < 0.001), urinary tract infections (19% versus 28%; OR 0.61 [95% CI 0.50 to 0.74]; p < 0.001), renal complications (9% versus 13%; OR 0.55 [95% CI 0.42 to 0.72]; p < 0.001), emergency department visits (27% versus 31%; OR 0.78 [95% CI 0.64 to 0.93]; p = 0.01), and mortality (39% versus 49%; OR 0.75 [95% CI 0.62 to 0.89]; p = 0.001) within 90 days of the procedure compared with patients treated at nonDCCs. Undergoing surgery at a DCC (90-day reimbursement of USD 54,588 ± USD 42,914) compared with nonDCCs (90-day reimbursement of USD 49,454 ± USD 38,174) was also associated with reduced 90-day risk-adjusted reimbursements (USD -14,802 [standard error 1362] ; p < 0.001). CONCLUSION: Based on our findings, it appears that DCCs offer high-value care, as evidenced by lower complication rates and reduced reimbursements after surgery for spinal metastases. A better understanding of the processes of care adopted at these institutions is needed so that additional cancer centers may also be able to deliver similar care for patients with metastatic spine disease. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Hospitais Especializados/economia , Oncologia/economia , Medicare/estatística & dados numéricos , Procedimentos Ortopédicos/economia , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/economia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/economia , Estudos Retrospectivos , Fusão Vertebral/economia , Fusão Vertebral/métodos , Estados Unidos
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