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1.
Front Public Health ; 10: 876966, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35677772

RESUMO

Introduction: The year 2020 saw the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which became a great threat to public health worldwide. The exponential spread of the disease with millions of lives lost worldwide saw the emergence of an accelerated vaccine development with emergency approval from well-known regulatory bodies such as the US Food and Drug Administration, followed by widespread vaccine deployment despite a paucity in safety profile data. This issue becomes even more pronounced when it involves expectant mothers considering the possible undesirable effect toward the unborn child. Method: This was a retrospective cohort study which was conducted at six general hospitals in the state of Penang, Malaysia. All the pregnant employees who have consented to take the mRNA COVID-19 vaccine and participate in this study were monitored from the time of their first vaccination and up to 28 days after they delivered their babies. Results: All the participants had adequate maximum vertical pocket (MVP) and no obvious anomalies or detection of intrauterine growth restriction (IUGR) were detected during the second trimester. However, one subject was reported to have miscarried during the second trimester. The reported mean neonate birth weight was 3.0 kg with the mean Apgar score of 8.8 and 9.8 at 1 and 5 min, respectively. Approximately seven (5.8%) neonates were reported to be small for their gestational age. Another three (2.5%) neonates were reported to have anomalies. Conclusion: As a whole, the inference that can be made from this study is that mRNA COVID-19 vaccine appears to be safe in pregnant women regardless of the trimester as the findings did not show obvious safety warning signs.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Pessoal de Saúde , Complicações Infecciosas na Gravidez , Gestantes , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Estudos de Coortes , Atenção à Saúde , Feminino , Hospitais Gerais , Humanos , Malásia , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Retrospectivos , SARS-CoV-2 , Vacinação/efeitos adversos , /efeitos adversos
2.
BMC Emerg Med ; 22(1): 105, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690727

RESUMO

BACKGROUND: With more emergency visits, there is increasing pressure to provide emergency medical services globally and locally. This study aimed to investigate the epidemiological characteristics and the disease spectrum of patients presenting in the last three years to the Department of Emergency Medicine of Tianjin Medical University General Hospital, a tertiary hospital in Tianjin, China, to improve the services of the emergency medicine department. METHODS: A retrospective study was conducted on all patients in the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59, including variables like medical record number, gender, age, date of admission, principal diagnosis. The data were analyzed by SPSS statistical software; statistical charts were prepared by GraphPad Prism9.0 and SPSS 20.0; statistical tables were made by Microsoft Excel. RESULTS: A total of 1,314,916 patients presented to the Department of Emergency Medicine of Tianjin Medical University General Hospital from Jan 1, 2017, 00:00:00 to Dec 31, 2020, 23:59:59. In terms of gender distribution, the male-female ratio was 0.78∶1. As for age distribution, patients aged 60-69 were the most (23.47%), and patients younger than 20 years were the least (2.80%). Concerning monthly data, the number of visits peaked during January and December. The distribution of daily visits showed the feature of three highs and a low. The top three prevalence diseases in the emergency disease spectrum were respiratory, cardiovascular, and digestive diseases. The respiratory system was the most common in patients with infectious diseases (200,912, accounting for 86.97%). Among the patients suffering from infectious diseases, the number of patients with respiratory infections peaked in 2019 (73,530) and was the lowest in 2020 (20,078). CONCLUSIONS: From 2017 to 2019, the demand for emergency services in Tianjin Medical University General Hospital continued to increase, but it was greatly affected by COVID-19 in 2020. This emergency department is mainly for patients with respiratory system, circulatory system and digestive system diseases, and its treatment time is relatively centralized. The prevention of diseases for people of all ages, especially female patients and the elderly, should be strengthened, and emergency medical resources should be allocated reasonably according to the peak months and crowed periods of patients.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência , Idoso , Feminino , Hospitais Gerais , Humanos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
3.
Ethiop J Health Sci ; 32(2): 229-234, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35693572

RESUMO

Background: Acute ischemic stroke has been reported to occur in a significantly higher number of COVID-19 patients as compared to healthy controls with variable proposed pathophysiologic mechanisms. To our knowledge, sufficient data regarding this subject is lacking in Ethiopia and the African continent at large. In this case series, we report the clinical characteristics and management of 5 cases with COVID-19 infection and acute ischemic stroke to shed light on the diagnostic and therapeutic challenges in resource-limited setups. Methods: This is a case series including data collected from the medical records of 5 participants with confirmed RT-PCR positive COVID-19 infection and radiologically confirmed acute ischemic stroke, admitted at Eka Kotebe General Hospital Intensive Care Unit (ICU) in Addis Ababa, Ethiopia from June 10, 2020, to November 04, 2020. Results: Cryptogenic stroke was documented in 4/5 participants included in this series with the most common vascular risk factors identified for stroke being hypertension and diabetes mellitus. The median time from onset of COVID-19 symptoms to the identification of stroke was 07 days. Two fifth of the participants in this series died during their ICU admission with the immediate cause of deaths reported to be related to the severe COVID-19 infection but not stroke. Conclusion: Cryptogenic stroke was documented in 4/5 patients in this series despite the presence of vascular risk factors for other stroke subtypes. The overall prevalence, subtypes, and outcomes of stroke in COVID-19 patients in Ethiopia and the African continent as a whole needs additional research to elucidate the local burden of the disease and define the predominant pathophysiologic mechanisms for stroke in COVID-19 in the region.


Assuntos
COVID-19 , AVC Isquêmico , Acidente Vascular Cerebral , COVID-19/epidemiologia , Etiópia/epidemiologia , Hospitais Gerais , Humanos , AVC Isquêmico/epidemiologia , AVC Isquêmico/etiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia
4.
Subst Abus ; 43(1): 1225-1230, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35670771

RESUMO

Background: While associations between cannabis and cocaine use, and heavy drinking and quality of life (QOL), are well-established in the general population, it is unclear whether they are present in hospital inpatients with alcohol use disorder (AUD). The aim of the study was to assess associations between cannabis and cocaine use and two outcomes [heavy drinking days (HDDs) and QOL] among hospital inpatients with AUD. Methods: Hospitalized patients with AUD and at least one past-month HDD participated in this cross-sectional study. Cannabis and cocaine use were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test. HDDs were assessed using the Timeline Followback. QOL was assessed by the WHOQOL-BREF instrument. Multivariable regression models assessed associations. Results: Of 248 participants, 225 (91%) had severe AUD. There were no statistically significant associations between: recent cannabis use and HDDs [Incidence Rate Ratio (IRR) = 0.95; 95% Confidence Interval (95% CI): 0.80, 1.14], cocaine use and HDDs [IRR = 0.88; 95% CI: 0.66, 1.18], or both cannabis and cocaine use and HDDs [IRR = 0.87; 95%CI: 0.70, 1.09], as compared to use of neither cannabis nor cocaine. Use of cannabis, cocaine, and both, were not associated with QOL [(odds ratio (OR) = 0.98; 95% CI:0.55, 1.74), (OR = 0.76; 95% CI:0.30, 1.93), (OR = 1.00; 95%CI: 0.49, 2.03), respectively]. Conclusions: Among hospital inpatients with AUD, there were no significant associations between cannabis and cocaine use, heavy drinking, or QOL. Our findings raise questions regarding how drug use affects AUD and whether similar results would be found among those with milder AUD and in prospective studies.


Assuntos
Alcoolismo , Cannabis , Transtornos Relacionados ao Uso de Cocaína , Cocaína , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/diagnóstico , Agonistas de Receptores de Canabinoides , Cocaína/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos Transversais , Hospitais Gerais , Humanos , Pacientes Internados , Estudos Prospectivos , Qualidade de Vida
5.
Pan Afr Med J ; 41: 212, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35721657

RESUMO

Introduction: hyperhomocysteinemia (HHcy) may contribute to an increased risk of coronary artery disease (CAD). The underlying mechanisms are not well understood, but other than dietary intake factors, hyperhomocysteinemia may genetically result from a methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism. A cross-sectional study was performed to assess whether this mutation was a potential genetic risk factor for CAD. Methods: this cross-sectional study was performed on 30 CAD patients and 30 normal healthy controls at Sidoarjo Regional General Hospital. The polymorphisms of the MTHFR C677T gene was assessed by polymerase chain reaction (PCR), and plasma homocysteine was measured by chemiluminescence immunoassay (CLIA) and then compared between CAD patients and control subjects by the multivariate logistical regression model. Results: results from an independent sample t-test analysis showed that plasma homocysteine concentrations were significantly higher in CAD patients compared to the control group individuals (13.91 ± 4.55 µmol/L vs 10.97 ± 3.45 µmol/L; p<0.05). There were no significant correlations between MTHFR C677T gene polymorphism and other risk factors, such as age at diagnosis with acute coronary syndrome, sex, smoking, lipid profile, diabetes, hypertension, C-reactive protein (CRP), creatinine, and homocysteine (p>0.05). In multivariate analysis models, the C677T genotype frequencies were insignificantly different between CAD patients and control subjects (p>0.05). Meanwhile, the results of adjusted odds ratio (aOR), 95% confidence interval (CI), and p-value for homocysteine, age, and smoking were aOR: 1.264, 95% CI : 1.042-1.535, p = 0.018; aOR: 0.916, 95% CI: 0.842-0.997, p = 0.043, and aOR: 5.428, 95% CI 1.532-19.226, p = 0.009, respectively. Homocysteine, age, and smoking were significantly different between CAD patients and control subjects (p<0.05). Conclusion: hyperhomocysteinemiais significantly correlated with an increased risk of CAD, but MTHFR C677T gene polymorphism might not contribute to increased CAD risk.


Assuntos
Doença da Artéria Coronariana , Hiper-Homocisteinemia , Doença da Artéria Coronariana/genética , Estudos Transversais , Genótipo , Homocisteína/genética , Hospitais Gerais , Humanos , Hiper-Homocisteinemia/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético , Fatores de Risco
6.
Sci Rep ; 12(1): 9035, 2022 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-35641604

RESUMO

In 2019 among all populous countries in Africa, Ethiopia has the fourth-highest number of people with diabetes (1.7 million). This aggravated prevalence figure implies that diabetes mellitus is a major public health problem in Ethiopia. Due to urbanization, this problem is very critical in the Amhara region, Ethiopia. The study aimed to identify factors that affect the longitudinal fasting blood sugar among T1DM (Type I diabetes mellitus) patients in Debre Tabor General Hospital (DTGH); North-west Ethiopia. A retrospective study design was conducted from 210 randomly selected T1DM patients in the clinic (Outpatient Department) at Debre Tabor General Hospital under the follow-up period from September 2019 to August 2021. To fit these retrospective data records, we used Random intercept and slope models. In this study, the unstructured variance-covariance structure was the appropriate structure for the random intercept and slope model. At a 5% level of significance, family history of diabetes mellitus, age, comorbidity, hemoglobin, and visit time in months were significant factors. Also, all the random effect parameters were statistically significant. It implies that the variability within and between T1DM patients in FBS over time was statistically significant. The mean fasting blood sugar level at baseline was 5.4944 mg/dl and decreased to 5.0679 mg/dl at the final follow-up time. Major contributors for the increment of fasting blood sugar level were increasing age, decreasing haemoglobin, having comorbidity, and belonging from a family with diabetes history. The overall within and between variability in fasting blood sugar level among T1DM patients in DTGH were high. Intervention measures at DTGH level should be undertaken using health education and other measures by providing an emphasis on the prevention, early detection, and treatment of diabetes mellitus.


Assuntos
Diabetes Mellitus Tipo 1 , Hospitais Gerais , Glicemia , Diabetes Mellitus Tipo 1/epidemiologia , Etiópia/epidemiologia , Humanos , Estudos Longitudinais , Estudos Retrospectivos
7.
PLoS One ; 17(5): e0268032, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35536856

RESUMO

While interest in antimicrobial stewardship programmes (ASPs) is growing in most low- and middle-income countries (LMICs), there is a paucity of information on their adoption or implementation in Africa, particularly Uganda. The study assessed the presence and characteristics of ASPs, implemented antimicrobial stewardship (AMS) strategies and the challenges to their implementation in hospitals in Uganda. We conducted a cross-sectional study among heads of infection prevention committees (IPCs) in regional referral hospitals, general hospitals, and private-not-for-profit (PNFP) hospitals from November 2019 to February 2020. An interviewer-administered questionnaire was used to collect data. We analysed data using descriptive statistics. A total of 32 heads of IPCs were enrolled in the study. Of these, eight were from regional referral hospitals, 21 were from general hospitals, and three were from PNFPs. Most heads of IPC were pharmacists (17/32, 53.1%) with a mean age and standard deviation (sd) of 36.1 (±1.1) years. A formal ASP was adopted or implemented in 14 out of the 32 (44%, 95% CI 26-62) studied hospitals. Thirty out of 32 hospitals implemented at least one type of AMS strategy. Sixty-eight percent (22/32) of the hospitals implemented pre-authorisation and approval as their primary AMS core strategy to optimise antibacterial use. The most commonly reported challenges to the implementation of ASP across all 32 hospitals (with or without ASP) were lack of time for the ASP team (29/32, 90.6%) and lack of allocated funding for antimicrobial stewardship team (29/32, 90.6%). In this study, most hospitals in Uganda implemented at least one AMS strategy despite the low implementation of ASPs in hospitals. The ministry of health needs to sensitise and support the establishment of ASP in hospitals across the country.


Assuntos
Gestão de Antimicrobianos , Antibacterianos/uso terapêutico , Estudos Transversais , Hospitais Gerais , Humanos , Farmacêuticos , Uganda
8.
Clin Med (Lond) ; 22(3): 197-202, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35584838

RESUMO

BACKGROUND: There is a lack of data on the safety of providing oxygen at home to stable patients recovering from COVID-19. METHODS: A retrospective analysis of patients discharged to a COVID-19 virtual ward (CVW) between January 2021 and March 2021 at a UK district general hospital was performed. Patients with improving clinical trajectories and oxygen requirements up to 4 L/minute were eligible. Outcomes measured were 30-day mortality and readmission rate. RESULTS: From 02 January 2021 to 16 March 2021 (74 days), 147 patients discharged to the CVW were included: 71 received continuous or ambulatory oxygen, and 76 received pulse oximetry monitoring only. Five patients were readmitted within 30 days and two patients died. There were no significant differences between readmission and mortality rates between those discharged with or without oxygen. CONCLUSION: Provision of oxygen at home for selected patients recovering from COVID-19 is safe with low risk of readmission and death.


Assuntos
COVID-19 , Hospitais Gerais , Humanos , Oxigênio/uso terapêutico , Alta do Paciente , Readmissão do Paciente , Estudos Retrospectivos
9.
Artigo em Inglês | MEDLINE | ID: mdl-35627866

RESUMO

(1) Backgroud: For future national digital healthcare policy development, it is vital to collect baseline data on the infrastructure and services of medical institutions' information and communication technology (ICT). To assess the state of medical ICT across the nation, we devised and administered a comprehensive digital healthcare survey to medical institutions across the nation. (2) Methods: From 16 November through 11 December 2020, this study targeted 42 tertiary hospitals, 311 general hospitals, and 1431 hospital locations countrywide. (3) Results: Since 2015, most hospitals have implemented electronic medical record (EMR) systems (90.5 percent of hospitals, which is the smallest unit, and 100 percent of tertiary hospitals). The rate of implementation of personal health records (PHRs) varied significantly between 61.9 percent and 2.4 percent, depending on the size of the hospital. Hospitals have implemented around three to seven government-sponsored information/data transmission and receiving systems for statistical or investigative objectives. For secondary usage of medical data, more than half of tertiary hospitals have implemented a clinical data warehouse or shared data model. However, new service establishments utilizing modern medical technologies such as artificial intelligence or lifelogging were scarce and in the planning stages. (4) Conclusion: This study shows that the level of digitalization in Korean medical institutions is significant, despite the fact that the development and spending in ICT infrastructure and services provided by individual institutions imposes a significant cost. This illustrates that, in the face of a pandemic, strong government backing and policymaking are essential to activate ICT-based medical services and efficiently use medical data.


Assuntos
Inteligência Artificial , Registros Eletrônicos de Saúde , Estudos Transversais , Hospitais Gerais , República da Coreia
10.
Artigo em Inglês | MEDLINE | ID: mdl-35605259

RESUMO

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.


Assuntos
Transtornos Mentais , Psiquiatria , Abandono do Hábito de Fumar , Hospitais Gerais , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Atenção Primária à Saúde , Encaminhamento e Consulta
11.
Nutrients ; 14(9)2022 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-35565928

RESUMO

Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.


Assuntos
Doenças Cardiovasculares , Motivação , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Hospitais Gerais , Humanos , Masculino , Fatores de Risco , Comportamento Sedentário
12.
Artigo em Inglês | MEDLINE | ID: mdl-35564824

RESUMO

Many studies have shown that the new round of healthcare reform launched by the Chinese government in 2009 has not effectively solved the problem in which patients more readily choose large general hospitals. We aimed to find out if this situation exists in every department of a large general hospital. This study collected the outpatient data of 24 departments for a large general hospital in Beijing. By calculating the average growth rate of outpatients in each department from 2014 to 2019, and the utilization rate of outpatient appointments in different departments in 2020, we found that the average growth rate of outpatients in 4 departments (16.6%) was negative, and the utilization rate of outpatient appointments in 13 departments (54.16%) was less than 80%. This shows that the number of patients in some departments is declining, and that there is an inefficient use of doctor resources. Obviously, this is inconsistent with people's current beliefs. Therefore, it is not entirely true that China's healthcare reform has not reduced the number of patients in large general hospitals. At the same time, the inefficient use of outpatient doctor resources is a phenomenon worthy of attention; if it persists, it will result in significant waste in the healthcare system. We suggest that policy makers and hospital managers in China, and countries similar to China, can attract attention and take measures.


Assuntos
Reforma dos Serviços de Saúde , Hospitais Gerais , China , Atenção à Saúde , Humanos , Pacientes Ambulatoriais
13.
Artigo em Inglês | MEDLINE | ID: mdl-35561326

RESUMO

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.


Assuntos
Transtornos Mentais , Psiquiatria , Tomada de Decisões , Hospitais Gerais , Humanos , Pacientes Internados , Transtornos Mentais/complicações , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Encaminhamento e Consulta
14.
Artigo em Inglês | MEDLINE | ID: mdl-35564552

RESUMO

Resilience and working environment are variables that affect turnover. However, how these two variables impact each other is unclear. This study is a descriptive correlation study to identify the factors of the nursing working environment affecting the resilience of new nurses in general tertiary hospitals. This study was conducted by convenience sampling of 233 new nurses with less than 1 year of working experience. Data were collected through questionnaires from 20 to 27 October 2019, and analyzed using correlation analysis and stepwise multiple regression analysis. The results show that the work environment impacts the resilience of new nurses by 30.2%. Specifically, the following qualities of a work environment were found to affect new nurses' resilience, including "nursing foundation for quality of care", "nurse participation in hospital affairs", "nurse manager ability, leadership, and support of nurses", "collegial nurse-physician relations", and "staffing and resource adequacy". These findings imply that a satisfactory working environment improves new nurses' resilience and reduces their intent to leave their workplace. Further studies are needed to elucidate this relationship, especially considering the ever-changing work environments.


Assuntos
Enfermeiras e Enfermeiros , Recursos Humanos de Enfermagem no Hospital , Estudos Transversais , Hospitais Gerais , Humanos , Satisfação no Emprego , Reorganização de Recursos Humanos , Inquéritos e Questionários , Local de Trabalho
15.
Mayo Clin Proc ; 97(5): 862-870, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35410751

RESUMO

OBJECTIVE: To explore the handling of psychiatric patients in medical hospitals and emergency departments (EDs) as well as hospital characteristics associated with the availability of psychiatric services in these settings. METHODS: From October 1, 2017, to April 1, 2018, a telephone survey regarding the presence and nature of psychiatric services was attempted among all US registered Medicare hospitals. RESULTS: Of the included 4812 US hospitals, 2394 (50%) were surveyed. Of these hospitals, 1108 (46%) have some psychiatric services available, either in medical EDs or through psychiatric consultation on general medical inpatient wards. If medical ED patients with active psychiatric issues need admission, 59% of hospitals transfer the patient to a different hospital and 28% admit the patient to a medical ward. Exploration by logistic regression analysis of the association of selected variables and available psychiatric expertise suggested that larger hospitals, nonprofit services, or hospitals in urban settings were more likely to have psychiatrists on staff or available for consultation. CONCLUSION: Despite the growing number of psychiatric patients seeking help in medical EDs and general hospitals, more than 50% of the EDs and general hospitals lack psychiatric services. These results suggest that accessibility to psychiatric care in medical settings requires improvement.


Assuntos
Hospitais Gerais , Serviços de Saúde Mental , Idoso , Serviço Hospitalar de Emergência , Humanos , Medicare , Inquéritos e Questionários , Estados Unidos
16.
J Pediatric Infect Dis Soc ; 11(6): 300-302, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35395086

RESUMO

We reviewed autopsy data from general hospitals in Lviv, Ukraine to understand pediatric mortality due to tuberculosis (TB). We identified 14 (0.6%) of 2345 autopsied children with unrecognized or untreated TB. More sensitive TB diagnostics for children and improved strategies for identifying which children require TB evaluation are urgently needed.


Assuntos
Hospitais Gerais , Tuberculose , Autopsia , Criança , Humanos , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Ucrânia/epidemiologia
17.
Arch Med Res ; 53(4): 399-406, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35370011

RESUMO

BACKGROUND: The Radiographic Assessment of Lung Edema (RALE) score has been used to estimate the extent of pulmonary damage in patients with acute respiratory distress syndrome and might be useful in patients with COVID-19. AIM OF THE STUDY: To examine factors associated with the need for mechanical ventilation in hospitalized patients with a clinical diagnosis of COVID-19, and to estimate the predictive value of the RALE score. METHODS: In a series of patients admitted between April 14 and August 28, 2020, with a clinical diagnosis of COVID-19, we assessed lung involvement on the chest radiograph using the RALE score. We examined factors associated with the need for mechanical ventilation in bivariate and multivariate analysis. The area under the receiver operating curve (AUC) indicated the predictive value of the RALE score for need for mechanical ventilation. RESULTS: Among 189 patients, 90 (48%) were judged to need mechanical ventilation, although only 60 were placed on a ventilator. The factors associated with the need for mechanical ventilation were a RALE score >6 points, age >50 years, and presence of chronic kidney disease. The AUC for the RALE score was 60.9% (95% CI 52.9-68.9), indicating it was an acceptable predictor of needing mechanical ventilation. CONCLUSIONS: A score for extent of pulmonary oedema on the plain chest radiograph was a useful predictor of the need for mechanical ventilation of hospitalized patients with COVID-19.


Assuntos
COVID-19 , Edema Pulmonar , COVID-19/complicações , COVID-19/terapia , Hospitais Gerais , Humanos , Pessoa de Meia-Idade , Prognóstico , Edema Pulmonar/etiologia , Respiração Artificial , Sons Respiratórios
18.
BMJ Case Rep ; 15(4)2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428661

RESUMO

A 25-year-old woman presented with cardiogenic shock following intentional overdose of Common Yew (Taxus baccata). The pharmacological mechanisms underlying yew toxicity resulted in failure of multiple treatment modalities including inotropes, vasopressors and attempted pacing. Resuscitation was ultimately unsuccessful. The limited literature available on this kind of overdose suggests that early extracorporeal membrane oxygenation (ECMO) is the mainstay of treatment in severe cases presenting with hypotension and arrhythmias. However, there may be a role for digoxin antibody fragments in maintaining patients presenting to remote sites, to allow transfer to a specialist centre.


Assuntos
Overdose de Drogas , Oxigenação por Membrana Extracorpórea , Intoxicação por Plantas , Taxus , Adulto , Overdose de Drogas/terapia , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Hospitais Gerais , Humanos , Folhas de Planta , Intoxicação por Plantas/terapia , Choque Cardiogênico/induzido quimicamente , Choque Cardiogênico/terapia
19.
Med Sci Monit ; 28: e935697, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35466284

RESUMO

BACKGROUND Cerebral hypoperfusion syndrome (CHS) includes a spectrum of clinical symptoms, ranging from focal neurologic deficit to intracerebral hemorrhage. CHS was initially described as a complication of carotid endarterectomy but also occurs following carotid artery stenting. This retrospective study included 320 patients treated with carotid artery stenting at 4 general hospitals in Zhejiang Province between June 2019 and June 2021 and aimed to establish a risk score for CHS. MATERIAL AND METHODS Through retrospective case analysis, a risk model and scoring model for CHS were established and evaluated. RESULTS Poor integrity of the circle of Willis, preoperative cerebrovascular resistance, mean transit time, peak time at CTP, and preoperative cerebral circulation time were significant in the univariate analysis and were entered into the regression equation to establish the logistic and additive scoring model for predicting the risk of CHS after carotid stenting. The area under the receiver operating characteristic (ROC) curve of the logistic scoring system for the early warning risk of CHS after carotid stenting was 0.964 (95% confidence interval [CI] [0.931-0.996]), and the area under the ROC curve of the CHS early risk additive scoring model after carotid stenting was 0.968 (95% CI [0.936-1.000]), The Hosmer-Lemeshow test chi-square values were 0.037 (P=0.848) and 2.671 (P=0.102). CONCLUSIONS Two methods of scoring risk for CHS were developed from a retrospective analysis of 320 patients treated with carotid artery stenting at 4 general hospitals in Zhejian Province between June 2019 and June 2021.


Assuntos
Estenose das Carótidas , Transtornos Cerebrovasculares , Endarterectomia das Carótidas , Artérias Carótidas/cirurgia , Estenose das Carótidas/complicações , Circulação Cerebrovascular , Transtornos Cerebrovasculares/etiologia , Endarterectomia das Carótidas/efeitos adversos , Hospitais Gerais , Humanos , Estudos Retrospectivos , Fatores de Risco , Stents/efeitos adversos , Síndrome
20.
Nagoya J Med Sci ; 84(1): 19-28, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35392005

RESUMO

Evaluation of liver fibrosis is necessary to make the therapeutic decision and assess the prognosis of CHB patients. The current study aimed to describe the progression and identify some influencing factors in patients with chronic hepatitis B at a General Hospital in Northern Vietnam. The longitudinal study included 55 eligible subjects diagnosed Hepatitis-B-virus. Dependent variable was the aspartate aminotransferase/platelet ratio index and we collected some demographic variables and disease related and behaviour variables. Bayesian Model Averaging was used to select variables into model. Mixed-effect linear models were used to evaluate the change of the aspartate aminotransferase/platelet ratio index over time and identify related factors. the aspartate aminotransferase/platelet ratio index differences between examinations, age of participants, working status were statistically significant. This pattern indicated that the average the aspartate aminotransferase/platelet ratio index of the population decreased by 0.005 (95% CI=-0.009; -0.001) after each patient's visit, and increased by 0.013 if the patient's age increased by 1 year (95% CI=0.005; 0.0219). For non-working patients, the aspartate aminotransferase/platelet ratio index was lower, coefficient was -0.054 (95% CI=-0.108; 0.001). Other variables such as gender, education level, time for disease detection, drinking tea, alcohol consumption, forgetting to take medicine and the aspartate aminotransferase/platelet ratio index were not significantly different. The study showed that the majority of study subjects had average the aspartate aminotransferase/platelet ratio index, and were relatively well controlled and treated during the study. Age and working status are factors that influence the the aspartate aminotransferase/platelet ratio index.


Assuntos
Hepatite B Crônica , Aspartato Aminotransferases , Teorema de Bayes , Biomarcadores , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Hepatite B Crônica/epidemiologia , Hospitais Gerais , Humanos , Cirrose Hepática/epidemiologia , Estudos Longitudinais , Contagem de Plaquetas , Estudos Retrospectivos , Índice de Gravidade de Doença , Vietnã/epidemiologia
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