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1.
Hu Li Za Zhi ; 67(5): 44-55, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32978765

RESUMO

BACKGROUND: Studies have shown that oral health is closely related to systemic diseases. Poor oral hygiene may lead to dental caries and periodontal disease and also increase the risk of cardiovascular disease. Patients with stroke have a possibility of recurrence, and good oral health is expected to benefit their general health. Nevertheless, nursing research exploring the oral health and oral hygiene behaviors of stroke patients has been rare. PURPOSE: To explore the factors significantly associated with oral health status and oral hygiene behaviors in patients with stroke. METHODS: A cross-sectional research design with convenient sampling was used. Information on health promoting behaviors and oral health status was collected in a teaching hospital in southern Taiwan. A multivariate linear regression model was applied to explore the factors associated with oral health status in patients with stroke. RESULTS: One hundred and eight-five patients with stroke were enrolled in this study. The average number of real teeth was 11.3 and the average score for oral health status was 4. The univariate analysis showed that being 65 years of age or older, having an education level below primary school, having a lower Barthel index score, having a higher modified Rankin scale score, not brushing and flossing, not having a regular tooth cleaning, having a lower of health promotion score, and having insufficient water intake levels were all associated with a worse oral health status. The stepwise regression analysis showed that factors affecting oral health status include health promotion behaviors, age, tooth brushing, and water intake, which, together, accounted for 28.5% of the total variance. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings indicate that oral health status, oral hygiene behaviors, and health promoting behaviors are inadequate among patients with stroke. Clinicians should promote health-related behaviors early to their patients with stroke, specifically in terms of implementing proper oral hygiene behaviors in daily routine care.


Assuntos
Saúde Bucal/estatística & dados numéricos , Higiene Bucal/psicologia , Acidente Vascular Cerebral/terapia , Idoso , Estudos Transversais , Hospitais de Ensino , Humanos , Fatores de Risco , Taiwan
2.
BMC Infect Dis ; 20(1): 668, 2020 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-32919458

RESUMO

BACKGROUND: The study was to evaluate initial antimicrobial regimen and clinical outcomes and to explore risk factors for clinical failure (CF) in elderly patients with community-acquired pneumonia (CAP). METHODS: 3011 hospitalized elderly patients were enrolled from 13 national teaching hospitals between January 1, 2014 and December 31, 2014 initiated by the CAP-China network. Risk factors for CF were screened by multivariable logistic regression analysis. RESULTS: The incidence of CF in elderly CAP patients was 13.1%. CF patients were older, longer hospital stays and higher treatment costs than clinical success (CS) patients. The CF patients were more prone to present hyperglycemia, hyponatremia, hypoproteinemia, pleural effusion, respiratory failure and cardiovascular events. Inappropriate initial antimicrobial regimens in CF group were significantly higher than CS group. Undertreatment, CURB-65, PH < 7.3, PaO2/FiO2 < 200 mmHg, sodium < 130 mmol/L, healthcare-associated pneumonia, white blood cells > 10,000/mm3, pleural effusion and congestive heart failure were independent risk factors for CF in multivariable logistic regression analysis. Male and bronchiectasis were protective factors. CONCLUSIONS: Discordant therapy was a cause of CF. Early accurate detection and management of prevention to potential causes is likely to improve clinical outcomes in elderly patients CAP. TRIAL REGISTRATION: A Retrospective Study on Hospitalized Patients With Community-acquired Pneumonia in China (CAP-China) (RSCAP-China), NCT02489578. Registered 16 March 2015, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005E5S&selectaction=Edit&uid=U0000GWC&ts=2&cx=1bnotb.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/tratamento farmacológico , Pneumonia Associada a Assistência à Saúde/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Incidência , Masculino , Mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Falha de Tratamento
3.
PLoS One ; 15(9): e0239173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931524

RESUMO

OBJECTIVES: 1. To assess the performance of an extended questionnaire in identifying cases of SARS-CoV-2 infection among obstetric patients. 2. To evaluate the rate of infection among healthcare workers involved in women's care. STUDY DESIGN: A prospective cohort study of obstetric patients admitted to MBBM Foundation and Buzzi Hospital (Lombardy, Northern Italy) from March 16th to May 22nd, 2020. Women were screened on admission by a questionnaire investigating major and minor symptoms of infection and high-risk contacts in the last 14 days. SARS-CoV-2 assessment was performed by RT-PCR on nasopharyngeal swabs. Till April 7th, a targeted SARS-CoV-2 testing triggered by a positive questionnaire was used; from April 8th, a universal testing approach was implemented. RESULTS: There were 1,177 women screened by the questionnaire, which yielded a positive result in 130 (11.0%) cases. SARS-CoV-2 RT-PCR was performed in 865 (73.5%) patients, identifying 51 (5.9%) infections. During the first period, there were 29 infected mothers, 4 (13.8%) of whom had a negative questionnaire. After universal testing implementation, there were 22 (3%, 95% CI 1.94% - 4.04%) infected mothers, 13 (59.1%) of whom had a negative questionnaire; rate of infection among asymptomatic women was 1.9%. Six of the 17 SARS-CoV-2-positive women with a negative questionnaire reported symptoms more than 14 but within 30 days before admission. Isolated olfactory or taste disorders were identified in 15.7% of infected patients. Rate of infection among healthcare workers was 5.8%. CONCLUSIONS: An exhaustive triage questionnaire can effectively discriminate women at low risk of SARS-CoV-2 infection in the context of a targeted and a universal viral testing approach. In 15.7% of infected women, correct classification as a suspected case of infection was due to investigation of olfactory and taste disorders. Extension of the assessed time-frame to 30 days may be worth considering to increase the questionnaire's performance.


Assuntos
Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Doenças Assintomáticas/epidemiologia , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Pessoal de Saúde/estatística & dados numéricos , Hospitais de Ensino , Humanos , Itália/epidemiologia , Nasofaringe/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , RNA Viral/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Inquéritos e Questionários , Distúrbios do Paladar/diagnóstico , Distúrbios do Paladar/epidemiologia , Distúrbios do Paladar/etiologia , Triagem
4.
J Transl Med ; 18(1): 354, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933530

RESUMO

BACKGROUND: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. METHODS: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020-1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. RESULTS: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p < 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p < 0.001), clinical frailty score > 3 (p < 0.001), hypertension (p < 0.05), heart failure (p < 0.01), national early warning score (NEWS) > 4 (p < 0.01), positive CXR (p < 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP > 80 mg/L (p < 0.05), albumin < 35 g/L (p < 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p < 0.05), lymphocytes < 1.5 109/l (p < 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (< 0.40 L/L (male)/ < 0.37 L/L (female)) (p ≤ 0.01), urea > 7.5 mmol/L (p < 0.001), creatinine > 130 mmol/L (p < 0.05) and elevated urea: albumin ratio (< 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4-8.2, p < 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2-19.3, p < 0.05), NEWS > 4 (O.R. 2.4, 95% C.I. 1.1-4.4, p < 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p < 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1-4.4, p < 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0-11.3, p < 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2-20.5, p < 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1-5.1, p < 0.05) remained independently associated with 30-days mortality. CONCLUSION: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Pandemias , Pneumonia Viral/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino , Hospitais Urbanos , Humanos , Inflamação/fisiopatologia , Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neutrófilos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Prognóstico , Escócia/epidemiologia , Pesquisa Médica Translacional
5.
Acta Biomed ; 91(3): e2020016, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921712

RESUMO

The paper wants to present the data of infection of the Health Care Workers of a research and teaching hospital in Milan, Italy. The majority (2554, 55.9%) of 4572 HCWs were tested for SARS-CoV-2 and 8.8% were found positive. Most of the tested workers were women, but we found higher relative frequency of positivity for men, even after adjustment for age, working area, and occupation. The higher frequency of positive tests in the medicine area is probably explained by the higher concentration in that area of COVID-19 patients. Conversely, the low frequency of positive HCWs in intensive care units is  probably explained by the diffuse and continuous use of PPD. Our results show that HCWs in a research and teaching hospital in the most hit Region in Italy had a similar pattern of infection as all other HCWs all over the world. The problem of SARS-CoV-2 infections among the hospital personnel HCWs should remind us  the concerns about hospital acquired infections both for patients and HCWs.


Assuntos
Anticorpos Antivirais/análise , Betacoronavirus/imunologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Pneumonia Viral/transmissão , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia
6.
Acta Biomed ; 91(3): e2020027, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921746

RESUMO

In order to continue the oncological surgical activity and the surgical emergencies, we have elaborated a reorganization of the surgical department. In particular, differentiated pathways for COVID-19 and NON-COVID-19 patients were promptly planned. This arrangement has involved structural and organizational changes almost daily, with great efforts of the health personnel, but allowing our hospital to be the only one in the area still able to guarantee patients safe access to surgical treatment.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Emergências , Hospitais de Ensino/organização & administração , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar/organização & administração , Comorbidade , Humanos , Itália/epidemiologia , Pandemias
7.
Am Surg ; 86(8): 1005-1009, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997953

RESUMO

INTRODUCTION: Interteam performance and Clavien-Dindo (C-D) complications in renal cell carcinoma with inferior vena cava thrombectomy (RCC-IVCT) have not been reported. We aimed to describe complications by the degree of complexity and surgical teams in a collaborative effort between a National Cancer Institute-designated Comprehensive Cancer Center and a Quaternary Care Teaching Hospital. METHODS: Between January 2011 and May 2019, 73 consecutive RCC-IVCT were included. C-D grades III or higher were captured. Teams involved were urologic-oncology, vascular, hepatobiliary/transplant, and cardiothoracic. The Mayo Clinic tumor thrombus classification was used. RESULTS: Overall complication rate was 42% (n = 31). Nineteen percent had grade III, 18% had grade IV, and 6% had grade V complications. Patients with level IV thrombus had the highest in-hospital mortality rate (75%). Thrombus level did not show a correlation to complication rates (14% level I, 45% level II, 32% level III, 42% level IV). A positive correlation found between the number of teams involved and complication rates (35% with 2-team, 59% with 3-team, P = .059). Thromboembolic events (6% vs 24%, P = .02) and disposition other than home (22% vs 48%, P = .01) were statistically lower for the 2-team groups. Two-team in-hospital mortality was 1/51 (2%) versus 3-team (3/22,14%, (P = .07). No statistical differences were found in infections, thromboembolic events, and grades of complications between surgical teams. CONCLUSIONS: Despite similar interteam performance, the consistency of surgeons in high complexity cases could improve outcomes further. Complexity was higher for hepatobiliary/transplant and cardiothoracic teams. A combination of intraoperative events and patient selection (comorbidities and age) contributed to death. Overall, in-hospital mortality was lower than in most reported series.


Assuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Equipe de Assistência ao Paciente , Trombectomia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Adulto , Idoso , Institutos de Câncer , Florida , Mortalidade Hospitalar , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento , Trombose Venosa/etiologia
8.
PLoS One ; 15(8): e0237518, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810136

RESUMO

The study assessed the prevalence and determinants of non-fistulous urinary incontinence among gynaecologic care seekers as well as its interference with everyday life activities of affected women. A cross-sectional study involving 400 women was conducted in a tertiary facility in Ghana. Urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) which has not been validated locally. The questionnaire was administered mostly in the Asante Twi language with translation done at the time of the interview. The data was analysed for proportions and associations between selected variables. The prevalence of urinary incontinence was 12%, the common types being urgency (33.3%), stress (22.9%), and mixed (20.8%). Age ≥60 years compared to 18-39 years (OR 3.66 95%CI 1.48-9.00 P = 0.005), and a history of chronic cough (OR 3.80 95% CI 1.36-10.58 P = 0.01) were associated with urinary incontinence. Women with education beyond the basic level were 72% less likely to experience urinary incontinence (OR 0.28 95%CI 0.08-0.96 P = 0.04). Urinary incontinence interferes with everyday life activities of most affected women. Non-fistulous urinary incontinence is relatively common among gynaecologic care seekers yet very few women were referred with such a diagnosis. Advocacy measures aimed at urging affected women to report the condition and educating the general population on potential causes, prevention and treatment are needed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Gana/epidemiologia , Ginecologia/estatística & dados numéricos , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/diagnóstico , Adulto Jovem
9.
Crit Care Nurs Q ; 43(4): 468-479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833781

RESUMO

The COVID-19 pandemic presented an unprecedented opportunity to test the emergency management plan of one large urban teaching hospital. In this article, a detailed description of the hospital's surge planning process with lessons learned has been provided.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitais de Ensino/organização & administração , Hospitais Urbanos/organização & administração , Enfermeiras Administradoras/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Capacidade de Resposta ante Emergências/organização & administração , Humanos , Pennsylvania/epidemiologia
10.
Crit Care Nurs Q ; 43(4): 480-483, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833782

RESUMO

The coronavirus pandemic has impacted global health care delivery within a short period of time and has spotlighted the needs of vulnerable patient populations. The recommended initiatives to prevent the viral spread have included strategies such as social distancing, hand hygiene, and wearing protective personal equipment. These activities are community-wide focused, however, may be difficult to achieve for those individuals with intellectual disabilities, thus making this population susceptible to viral spread of infection. This article discusses the experience at a large urban teaching hospital in regard to the care of intellectually disadvantaged patients with COVID-19 infection.


Assuntos
Infecções por Coronavirus/enfermagem , Deficiência Intelectual , Pandemias , Pneumonia Viral/enfermagem , Qualidade da Assistência à Saúde , Adulto , Infecções por Coronavirus/epidemiologia , Hospitais de Ensino , Hospitais Urbanos , Humanos , Pennsylvania/epidemiologia , Pneumonia Viral/epidemiologia , Populações Vulneráveis
11.
Resuscitation ; 155: 172-179, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32827587

RESUMO

BACKGROUND: The COVID-19 pandemic has introduced further challenges into Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Existing evidence suggests success rates for CPR in COVID-19 patients is low and the risk to healthcare professionals from this aerosol-generating procedure complicates the benefit/harm balance of CPR. METHODS: The study is based at a large teaching hospital in the United Kingdom where all DNACPR decisions are documented on an electronic healthcare record (EHR). Data from all DNACPR/TEAL status forms between 1st January 2017 and 30th April 2020 were collected and analysed. We compared patterns of decision making and rates of form completion during the 2-month peak pandemic phase to an analogous period during 2019. RESULTS: A total of 16,007 forms were completed during the study period with a marked increase in form completion during the COVID-19 pandemic. Patients with a form completed were on average younger and had fewer co-morbidities during the COVID-19 period than in March-April 2019. Several questions on the DNACPR/TEAL forms were answered significantly differently with increases in patients being identified as suitable for CPR (23.8% versus 9.05%; p < 0.001) and full active treatment (30.5% versus 26.1%; p = 0.028). Whilst proportions of discussions that involved the patient remained similar during COVID-19 (95.8% versus 95.6%; p = 0.871), fewer discussions took place with relatives (50.6% versus 75.4%; p < 0.001). CONCLUSION: During the COVID-19 pandemic, the emphasis on senior decision making and conversations around ceilings of treatment appears to have changed practice, with a higher proportion of patients having DNACPR/TEAL status documented. Understanding patient preferences around life-sustaining treatment versus comfort care is part of holistic practice and supports shared decision making. It is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Tomada de Decisão Clínica/ética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Ordens quanto à Conduta (Ética Médica)/ética , Idoso , Reanimação Cardiopulmonar/métodos , Estudos de Coortes , Estado Terminal/mortalidade , Bases de Dados Factuais , Assistência à Saúde/tendências , Feminino , Mortalidade Hospitalar/tendências , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Estudos Retrospectivos , Reino Unido
12.
Indian J Med Res ; 152(1 & 2): 100-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32811801

RESUMO

Background & objectives: In this study we describe the epidemiological data, comorbidities, clinical symptoms, severity of illness and early outcome of patients with coronavirus disease 2019 (COVID-19) from a tertiary care teaching hospital in New Delhi, India. Methods: In this preliminary analysis of a prospective observational study, all adult patients admitted to the screening intensive care unit (ICU) of the institute who fulfilled the WHO case definition of COVID-19 and confirmed to have SARS-CoV-2 infection by reverse transcription-polymerase chain reaction were included. Demographics, clinical data and 24 h outcome were assessed. Results: The preliminary analysis of 235 patients revealed that the mean age was 50.7±15.1 yr and 68.1 per cent were male. Fever (68.1%), cough (59.6%) and shortness of breath (71.9%) were the most common presenting symptoms. Hypertension (28.1%) and diabetes mellitus (23.3%) were the most common associated comorbid illnesses. Patients with mild, moderate, severe and critical illness were 18.3, 32.3, 31.1 and 18.3 per cent, respectively, at the time of ICU admission. The proportions (95% confidence interval) of patients requiring any form of oxygen therapy, oxygen therapy by high-flow nasal cannula and invasive mechanical ventilation were 77, 21.7 and 25.5 per cent, respectively, within 24 h of hospital admission. The 24 h ICU mortality was 8.5 per cent, and non-survivors had higher respiratory rate (P <0.01, n=198) and lower baseline oxyhaemoglobin saturation (P <0.001, n=198) at presentation and higher baseline serum lactate (P <0.01, n=122), total leucocyte count (P <0.001, n=186), absolute neutrophil count (P <0.001, n=132), prothrombin time (P <0.05, n=54) and INR (P <0.05, n=54) compared to survivors. Interpretation & conclusions: Nearly half of the patients presented with severe and critical disease and required high-flow nasal oxygen or invasive mechanical ventilation at admission. Severity of the presenting respiratory illness, haematological parameters and lactate rather than age or presence of comorbidity predicted early death within 24 h.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária , Atenção Terciária à Saúde , Adulto , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Hospitalização , Hospitais de Ensino , Humanos , Índia/epidemiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Respiração Artificial/métodos , Resultado do Tratamento
13.
Ann Afr Med ; 19(3): 191-197, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820732

RESUMO

Background: Sinonasal neoplasia comprises approximately 3% of all head-and-neck tumors. However, the incidence of these tumors may be greater in some parts of the world including Asia and Africa. Aim and Objective: The study aimed to review the clinical and histopathological pattern of sinonasal neoplasms in Kano, Nigeria. Materials and Methods: The records of patients managed for sinonasal neoplasia at the Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria, over a period of 10 years were reviewed. Information obtained from the case files included demographic characteristics, tumor characteristics, and clinical information. The data obtained were analyzed using SPSS version 23. Results: A total of 245 patients were reviewed with sinonasal neoplasms. Among these, 168 (68.57%) were males, with a sex ratio (M:F) of 2.18:1. The mean age was 40.2 ± 18.9 years. Malignant sinonasal neoplasm constituted 55.92%% of the sinonasal neoplasia, with peak age at the fifth decade. Squamous cell carcinoma was the most common histological subtypes seen in 50.36% of the patients. Inverted papilloma was the most common benign sinonasal neoplasia (42.59%). The most common symptom presented by the patients was nasal obstruction (77.55%), mostly presented within 6 months of onset of symptoms (63.67%), and farmers were the predominant (27.76%). The most common treatment modality was surgical extirpation (54%), and most of the patients presented with Stage IV disease (88%). The site of tumor was found to statistically correlate with the type of tumor among the patients (P ≤ 0.0001), whereas the type of tumor and site of tumor correlated significantly with the duration of symptoms before the presentation. Conclusion: Malignant sinonasal disease is the predominant sinonasal neoplasm in this environment, and most of the patients presented with advanced disease.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Epistaxe/etiologia , Obstrução Nasal/etiologia , Neoplasias dos Seios Paranasais/cirurgia , Seios Paranasais/patologia , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Feminino , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Neoplasias dos Seios Paranasais/epidemiologia , Neoplasias dos Seios Paranasais/patologia , Estudos Retrospectivos , Adulto Jovem
14.
Ann Afr Med ; 19(3): 203-206, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32820734

RESUMO

Background: Chronic lymphocytic leukemia (CLL) is a heterogeneous group of monoclonal forms of lymphoproliferative disorder, which is usually common among older adults. There is an increasing trend in the number of patients presenting with the disease. Aim: This study aims to determine the epidemiology pattern of CLL in Cross River state. Methodology: A retrospective study with 10-years data (2010-2019) obtained from the register of the Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar. The data collected include the date of presentation, the age, gender, location of residence, and occupations of the patients. Results: A total of 47 cases were seen during the 10-year period, with a male: female ratio of 1:1. The mean age at presentation was 59 years. The majority of the patients were in their fifth and sixth decades of life. Most patients (44.68%) practice farming as their profession. Conclusion: The study has reawaken our consciousness on the increasing trend on the epidemiological burden of CLL in our environment and will help to enhance further investigation into the relationship between the rising trend and available possible risk factors in our environment.


Assuntos
Leucemia Linfocítica Crônica de Células B/epidemiologia , Idoso , Feminino , Hospitais de Ensino , Humanos , Incidência , Leucemia Linfocítica Crônica de Células B/diagnóstico , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Fatores de Risco
15.
Niger J Clin Pract ; 23(8): 1061-1067, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788482

RESUMO

Background: Atopy is poorly researched in HIV children living in the developing countries. There is no previous report on this subject in Nigeria and this pioneering study is undertaken to create an awareness of the burden of this disease among health practitioners. Aims: The aim of this study was to document the atopic diseases present among HIV-infected children attending the antiretroviral (ARV) clinic of a Nigerian tertiary hospital. Methods: Information was obtained from consecutive consenting caregiver/HIV-infected child attending the pediatric ARV clinic, by the use of a proforma specifically designed for the study. The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 16.0. Results: Seventy patients were studied and their ages ranged between 2 and 17 years. These 70 were constituted by 34 (48.6%) boys and 36 (51.4%) girls. Ten (14.3%) of the 70 studied, had atopic diseases. Nine (12.9%) patients had allergic conjunctivitis and 1 (1.4%) had allergic rhinitis. The single patient with allergic rhinitis also had bronchial asthma. No case of atopic eczema, or food allergy was recorded. Atopic disease conditions were more commonly recorded among the male sex and those whose parents have atopic diseases (P < 0.05). Atopic diseases were also more common among children without advanced HIV diseases and those with eosinophilia. Cosmetic and psychological embarrassment from eye discoloration and itching were the negative impacts on the quality of living. Conclusion: Allergic conjunctivitis is common in HIV-infected Nigerian children. Atopies are more common in boys and children with parental atopies.


Assuntos
Dermatite Atópica/complicações , Infecções por HIV/complicações , Hipersensibilidade/epidemiologia , Rinite Alérgica/complicações , Adolescente , Instituições de Assistência Ambulatorial , Fármacos Anti-HIV/uso terapêutico , Asma/epidemiologia , Criança , Pré-Escolar , Conjuntivite Alérgica/epidemiologia , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Hospitais de Ensino , Humanos , Masculino , Nigéria/epidemiologia , Prevalência , Qualidade de Vida , Rinite Alérgica/diagnóstico , Rinite Alérgica/epidemiologia
17.
Elife ; 92020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32820721

RESUMO

We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Infecções Assintomáticas/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Incidência , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Risco , Inquéritos e Questionários , Reino Unido/epidemiologia , Adulto Jovem
20.
West Afr J Med ; 37(4): 342-348, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32835394

RESUMO

BACKGROUND AND OBJECTIVES: Due to the prevailing socio-cultural and religious affiliations, Paediatricians in sub-Saharan Africa face unique ethical dilemmas. An understanding and application of the ethical principles can help prevent and resolve these dilemmas, and improve child health indices. The objective is to determine the knowledge, attitude and practical applications of non-maleficence and beneficence by child-care doctors at a Teaching Hospital. METHODS: This is a questionnaire-based study. Socio-demographics, knowledge and attitude towards the ethical principles, and its utilisation by doctors in childcare was sought. Data were analyzed using descriptive statistics. RESULTS: 294 doctors participated. The mean percentage knowledge score of nonmaleficence and beneficence was 31.00±21.14, significantly higher among doctors in Paediatrics (39.35±23.44, p=0.0001). For every decrease in professional rank, knowledge score decreased by 3.8224 (95% CI -5.824 - -1.819; p=0.0001). The doctors had a high mean percentage score on attitude towards ethics of 74.79±16.34, and for every increase in years of practice, attitude towards ethics score would increase by 2.922 (95% CI 1.133 to 4.711, p=0.001). There was a low practice score of 34.27±20.07. Majority (69%) encountered less than one dilemma a month. More than 90% of doctors had encountered dilemmas involving the principle of non-maleficence [184 (90.6%)], while 154 (75.9%) involved beneficence. CONCLUSION: Most respondents have a low level of knowledge and practice of the principles of nonmaleficence and beneficence. Their excellent attitude implies their willingness at improving their knowledge and practice.


Assuntos
Compreensão , Hospitais de Ensino , Atitude do Pessoal de Saúde , Criança , Humanos , Nigéria , Médicos
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