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1.
Ann Lab Med ; 42(1): 89-95, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34374353

RESUMO

Background: Total laboratory automation (TLA) is an innovation in laboratory technology; however, the high up-front costs restrict its widespread adoption. To examine whether the capital investment for TLA is worthwhile, we analyzed its clinical- and cost-effectiveness for the expected payback period. Methods: Clinical chemistry tests and immunoassays performed in the clinical laboratory of a tertiary care hospital were divided into a post-TLA group, including 1,182,419 tests performed during December 2019, and a pre-TLA group, including 1,151,501 tests performed during December 2018. Laboratory information system data were used to measure clinical effectiveness, and depreciation data were used to calculate TLA costs. Results: Laboratory performance improved after TLA adoption in all four key performance indicators: mean turn-around time (TAT), representing the timeliness of result reporting, decreased by 6.1%; the 99th percentile of TAT, representing the outlier rate, decreased by 13.3%; the TAT CV, representing predictability, decreased by 70.0%; and weighted tube touch moment (wTTM), representing staff safety, improved by 77.6%. Based on these effectiveness results, economic evaluation was performed using two approaches. First, the incremental cost-effectiveness ratio and wTTM were used as the most cost-effective performance indicators. Second, the expected payback period was calculated. Considering only staff cost reduction, it was anticipated that 4.75 yrs would be needed to payback the initial investment. Conclusions: TLA can significantly enhance laboratory performance, has a relatively quick payback period, and can reduce total hospital expenses in the long term. Therefore, the capital investment for TLA adoption is considered to be worthwhile.


Assuntos
Automação Laboratorial , Serviços de Laboratório Clínico , Análise Custo-Benefício , Humanos , Laboratórios , Centros de Atenção Terciária
2.
Ann Lab Med ; 42(2): 188-195, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34635612

RESUMO

Background: Fusobacterium species are obligately anaerobic, gram-negative bacilli. Especially, F. nucleatum and F. necrophorum are highly relevant human pathogens. We investigated clinical differences in patients infected with Fusobacterium spp. and determined the antimicrobial susceptibility of Fusobacterium isolates. Methods: We collected clinical data of 86 patients from whom Fusobacterium spp. were isolated from clinical specimens at a tertiary-care hospital in Korea between 2003 and 2020. In total, 76 non-duplicated Fusobacterium isolates were selected for antimicrobial susceptibility testing by the agar dilution method, according to the Clinical and Laboratory Standards Institute guidelines (M11-A9). Results: F. nucleatum was most frequently isolated from blood cultures and was associated with hematologic malignancy, whereas F. necrophorum was mostly prevalent in head and neck infections. Anti-anaerobic agents were more commonly used to treat F. nucleatum and F. varium infections than to treat F. necrophorum infections. We observed no significant difference in mortality between patients infected with these species. All F. nucleatum and F. necrophorum isolates were susceptible to the antimicrobial agents tested. F. varium was resistant to clindamycin (48%) and moxifloxacin (24%), and F. mortiferum was resistant to penicillin G (22%) and ceftriaxone (67%). ß-Lactamase activity was not detected. Conclusions: Despite the clinical differences among patients with clinically important Fusobacterium infections, there was no significant difference in the mortality rates. Some Fusobacterium spp. were resistant to penicillin G, ceftriaxone, clindamycin, or moxifloxacin. This study may provide clinically relevant data for implementing empirical treatment against Fusobacterium infections.


Assuntos
Anti-Infecciosos , Infecções por Fusobacterium , Fusobacterium , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/tratamento farmacológico , Humanos , República da Coreia , Centros de Atenção Terciária
3.
J Huntingtons Dis ; 10(4): 479-484, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34719505

RESUMO

BACKGROUND: The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington's disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. OBJECTIVE: To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. METHODS: We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. RESULTS: In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. CONCLUSION: Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.


Assuntos
COVID-19 , Doença de Huntington/terapia , Neurologia/normas , Aceitação pelo Paciente de Cuidados de Saúde , Preferência do Paciente , Telemedicina/normas , Adulto , Assistência Ambulatorial , COVID-19/prevenção & controle , Estudos de Coortes , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurologia/organização & administração , Design de Software , Telemedicina/organização & administração , Centros de Atenção Terciária
4.
Heart Surg Forum ; 24(5): E906-E908, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34730492

RESUMO

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease that threatens global health. During the pandemic period of COVID-19, the task for prevention in the general ward of cardiovascular surgery is fairly arduous. The present study intends to summarize our experience with infection control, including ward setting, admission procedures, personnel management, health education, and so on, to provide references for clinical management.


Assuntos
COVID-19/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/normas , Doenças Cardiovasculares/epidemiologia , Guias como Assunto , Pandemias/prevenção & controle , Quartos de Pacientes/normas , Centros de Atenção Terciária , COVID-19/epidemiologia , Doenças Cardiovasculares/cirurgia , China/epidemiologia , Comorbidade , Humanos , Estudos Retrospectivos , SARS-CoV-2
5.
Indian J Med Res ; 154(1): 85-89, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34782533

RESUMO

Background & objectives: Linezolid (LZD) is increasingly being used in tuberculosis (TB) treatment. However, LZD resistance has already been reported, which is highly alarming, given its critical therapeutic role. This study was aimed to phenotypically and genotypically assess LZD resistance in Mycobacterium tuberculosis (MTB) isolates at a laboratory in a tertiary care centre in Mumbai, India. Methods: A sample of 32 consecutive LZD-resistant MTB isolates identified by liquid culture susceptibility testing was subjected to whole-genome sequencing (WGS) on the Illumina NextSeq platform. Sequences were analyzed using BioNumerics software to predict resistance for 12 antibiotics within 15 min. Results: Sixty eight of the 2179 isolates tested for LZD resistance by MGIT-based susceptibility testing (June 2015 to June 2016) were LZD-resistant. Thirty two consecutive LZD-resistant isolates were analyzed by WGS to screen for known mutations conferring LZD resistance. WGS of 32 phenotypically LZD-resistant isolates showed that C154R in the rplC gene and G2814T in the rrl gene were the major resistance determinants. Interpretation & conclusions: LZD resistance poses an important risk to the success of treatment regimens, especially those designed for resistant isolates; such regimens are extensively used in India. As LZD-containing regimens increase in prominence, it is important to support clinical decision-making with an improved understanding of the common mutations conferring LZD resistance and their frequency in different settings.


Assuntos
Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Humanos , Linezolida/farmacologia , Linezolida/uso terapêutico , Testes de Sensibilidade Microbiana , Mutação , Mycobacterium tuberculosis/genética , Centros de Atenção Terciária , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/genética
6.
J Assoc Physicians India ; 69(11): 11-12, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34781606

RESUMO

OBJECTIVES: To evaluate the role of CT Perfusion in Identifying the core and the potentially salvageable penumbra in brain infarcts by observing perfusion maps (CBV, CBF and MTT). Also to identify patients who would benefit from reperfusion therapy and to evaluate the feasibility of identifying the penumbra on noncontrast CT vide comparison with perfusion maps. MATERIALS AND METHODS: A prospective study of 50 patients who presented with acute onset neurological deficit within 6 hours of symptom onset and in whom initial NCCT revealed no evidence of cerebral hemorrhage; evaluated with CT Perfusion was done at tertiary care center in 1 calender year 2014. OBSERVATIONS: In our study, about 68 percent of patients presented within 6 hours of stroke had salvagebale penumbra, were eligible for revascularization therapy. HU less than 25 on NECT significantly correlated with infract core but not with presence of Penumbra. Presence of penumbra cannot be predicted from NECT ASPECT and CBV ASPECT Score. RESULTS AND CONCLUSION: CT Perfusions study being easily available, faster and cost effctive modality to identfy patients of acute ischemic strokes having salvagable penumbra for which further can be subjected to revasculrization therapy. It is strongly recommended that CT Perfusion should be made an integral part of acute non-haemorrhagic stroke management protocol, wherever the facility is available.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Circulação Cerebrovascular , Humanos , Perfusão , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X
7.
J Assoc Physicians India ; 69(11): 11-12, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34781609

RESUMO

BACKGROUND: Dermatological disorders are common in patients being treated in intensive care units (ICU). However, they are often neglected in context of a critically ill patient. Very few studies focusing on these dermatoses have been undertaken. OBJECTIVES: To determine the prevalence and spectrum of dermatological disorders in patients being treated in medical ICU of a tertiary care centre. METHODS: This was a descriptive study conducted over a period of one year. All the patients admitted in the medical ICU were examined for the presence of any preexisting or newly developed dermatological disorder. Dermatological disorders were initially classified into infective and non-infective disorders. Patients with dermatological findings were classified into two groups: those who survived and those who died; which were compared with each other with respect to age and sex distribution, length of ICU stay and dermatological findings. RESULTS: Out of 776 cases admitted in ICU during the study period, dermatological disorders were observed in 164 (21.13%) cases. Life-threatening dermatological disorders were seen in 3.05% cases. Twenty nine (17.68%) patients with dermatological findings died. Amongst these cases, infectious dermatological disorders were significantly less common; while no significant difference was noticed in context of reactive dermatological disorders. CONCLUSION: Dermatological disorders in ICU are common and have a wide spectrum. They often need treatment and may be indicative of underlying potentially fatal systemic illness. Besides, a subset of cutaneous lesions may develop in response to various medical interventions, immunosuppression and immobility. Knowledge of such dermatoses is thus, essential, both for the intensivist and dermatologist.


Assuntos
Dermatopatias , Cuidados Críticos , Estado Terminal , Hospitalização , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Dermatopatias/epidemiologia , Centros de Atenção Terciária
8.
J Assoc Physicians India ; 69(10): 11-12, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34781658

RESUMO

BACKGROUND: In the current era of effective Anti retroviral therapy (ART), and Human Immunodeficiency Virus (HIV) infection becoming a chronic illness, there has been a gradual rise in the prevalence of rheumatic manifestations associated with this disease. These are characterized by a modified clinical course and widened spectrum of a few emerging rheumatic manifestations seen with HIV infection. AIMS AND OBJECTIVES: To assess the type, frequency, prevalence and clinical spectrum of rheumatic manifestations among &male patients followed at an HIV clinic of a tertiary care defence hospital. MATERIALS AND METHODS: All male patients with confirmed HIV infection at the study centre were studied after obtaining informed consent. A detailed history was taken including the date of seropositivity, symptoms of rheumatic disease, family history of rheumatic illness, and treatment history with ART. A detailed general and systemic examination was performed and rheumatic symptoms guided appropriate investigations were carried out on as required basis. RESULTS: 879 confirmed HIV cases were evaluated for rheumatic manifestations during the study period. Of these 499 cases were newly detected HIV cases and the rest 380 were old cases on follow up. Rheumatic disorders were diagnosed in 16 cases (1.82%). Spondyloarthropathy was the commonest presentation i.e. 5 out of 16 cases (31.25 % of the rheumatic disorders). Mean age was 37 years (range 27-52 yrs). 2 patients of the study group had the rheumatic illness prior to detection of HIV. Psoriatic Arthritis (0.114 %) was seen in 1 patient who was HLA B-27 negative. Reactive arthritis (0.227 %) was noted in 2 patients. 1 patient had cutaneous small vessel vasculitis (0.114 %), whereas 1 of the patient developed DLE (0.114 %) over neck. HIV related non specific polyarthritis (0.114 %) of the large joints was noted in 1 patient who was RF negative, while polyarthralgia (0.340 %) was noted in 3 patients. 10 patients (60 %) had CD 4 count < 200 cells/ µL, whereas 6 patients had a CD 4 count between 200 and 500 cells/µL. 13 out of 16 patients detected to have rheumatic illnesses were on ART. CONCLUSION: With the advent of ART, the clinical spectrum of HIV infection is changing as a chronic treatable disease. Present study consisting mainly adult males, showed only 1.82 % prevalence of rheumatic disorders in HIV infection. Early diagnosis, availability of ART and prompt treatment of opportunistic infections have changed the clinical profile of HIV patients. Impact of ART in producing and affecting the clinical spectrum of rheumatic disease has to be kept in mind while treating HIV-infected patients.


Assuntos
Artrite , Infecções por HIV , Doenças Reumáticas , Adulto , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Doenças Reumáticas/epidemiologia , Centros de Atenção Terciária
9.
Artigo em Inglês | MEDLINE | ID: mdl-34770105

RESUMO

Atopic dermatitis (AD) is the foremost non-fatal skin-related disease that affects all age groups. Despite the growing prevalence of AD in low- and middle-income countries, its physiological consequences remain overlooked in countries like Bangladesh. Therefore, we aim to assess and characterize the influence of AD on the health-related quality of life (HRQoL) in Bangladeshi patients. A cross-sectional study comprising 184 eligible adults (83 men and 101 women; mean age, 33.46 ± 15.44 years) was conducted at the dermatology outpatient department of Shaheed Suhrawardy Medical College Hospital (a tertiary hospital in Dhaka, Bangladesh). AD was determined using the UK Working Party criteria. A structured questionnaire, Eczema Area and Severity Index (EASI), and Dermatology Life Quality Index (DLQI) were administered to obtain information on patient characteristics, AD severity, and HRQoL. The mean DLQI score for the entire sample was 11.29 ± 5.27 (range, 1-26), and 51.60% reported the disease greatly affected their lives. Bivariate analysis revealed significant differences in self-rated health measures of DLQI scores in terms of self-reported AD severity, overall health, and the EASI. In multivariable regression models adjusted for patient characteristics, the self-perceived severe AD group reported significantly higher DLQI scores (coefficient = 2.72; 95% confidence interval (CI) = 0.38-5.05; p = 0.022) than the mild group. Concurrently, we observed a substantial increase in the DLQI scores among patients with moderate and severe EASI scores (coefficient = 1.96, 95% CI = 0.08-3.92, p < 0.05 and coefficient = 4.35, 95% CI = 1.98-6.72, p < 0.001, respectively) than in those with mild EASI scores, suggesting that HRQoL was markedly influenced by greater AD severity. These findings highlight the need for a more patient-centric approach to the management of AD in order to alleviate patient suffering and, thereby, improve HRQoL.


Assuntos
Dermatite Atópica , Eczema , Adolescente , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Dermatite Atópica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Índice de Gravidade de Doença , Centros de Atenção Terciária , Adulto Jovem
10.
J Med Case Rep ; 15(1): 559, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34782012

RESUMO

BACKGROUND: Carney's triad is a rare syndrome comprising gastrointestinal stromal tumor, extra-adrenal paraganglioma, and pulmonary chondroma along with newer additions of adrenal adenoma and esophageal leiomyoma. The triad is completely manifest in only 25-30% cases, with most patients presenting with two out of three parts of the syndrome. Wild-type succinate-dehydrogenase-deficient gastric gastrointestinal stromal tumor forms the most common component of Carney's triad and is usually multicentric and multifocal. It usually demonstrates indolent behavior and resistance to imatinib; hence, the management remains predominantly surgical. Pulmonary chondromas are commonly unilateral and multiple with slow-growing nature, which allows for conservative management. Adrenocortical adenomas are found in 20% of patients and are usually detected as incidentalomas. CASE PRESENTATION: A 49-year-old Asian male presented with upper gastrointestinal bleed and was diagnosed with multiple gastric succinate-dehydrogenase-deficient gastrointestinal stromal tumors. On evaluation, he was found to have left pulmonary chondroma and non-secretory adrenal adenoma, thus completing the Carney's triad. He underwent surgery with sleeve gastrectomy and excision of the antral tumor nodule, while the adrenal and pulmonary tumors have been under close follow-up. CONCLUSION: Literature regarding Carney's triad is scarce, especially from the Indian setting. Our report aims to highlight the various manifestations of this syndrome with emphasis on management of wild-type succinate-dehydrogenase-deficient gastrointestinal stromal tumor. Radical gastric surgeries do not offer a survival advantage in this condition; hence, more conservative modalities of resection can be adopted.


Assuntos
Condroma , Leiomiossarcoma , Neoplasias Pulmonares , Neoplasias Primárias Múltiplas , Paraganglioma Extrassuprarrenal , Neoplasias Gástricas , Adulto , Condroma/diagnóstico por imagem , Condroma/cirurgia , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Paraganglioma Extrassuprarrenal/diagnóstico , Paraganglioma Extrassuprarrenal/cirurgia , Centros de Atenção Terciária
11.
J Pak Med Assoc ; 71(11): 2576-2581, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34783740

RESUMO

OBJECTIVE: To evaluate carbapenem resistance and to detect blaOXA-23 and blaOXA-51 genes in carbapenem-resistant Acinetobacter baumanii isolates recovered from patients having pneumonia secondary to ventilation. METHODS: The cross-sectional study was conducted from July 2017 to June 2018 at the Department of Microbiology, University of Health Sciences, Lahore, Pakistan, and comprised endotracheal aspirates / tracheobroncheal lavage samples from patients irrespective of age and gender who developed pneumonia after being on the ventilator for 48 hrs at the Combined Military Hospital, and Jinnah Hospital, Lahore. The samples were inoculated on MacConkey and blood agar and aerobically incubated at a temperature of 370C for 18-24 hours. The isolated organisms were further assessed by standard morphological, cultural and biochemical profile. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method. Carbapenem-resistant Acinetobacter baumannii were checked for carbapenemase production using Modified Hodge Test. Conventional polymerase chain reaction and agarose gel electrophoresis were performed to detect blaOXA-23 and blaOXA-51 genes. Data was analysed using SPSS 17. RESULTS: Out of 157 samples, 92(58.6%) yielded growth of bacteria, and, among them, 39(42.4%) were identified as Acinetobacter baumannii. All (100%) Acinetobacter baumannii cases showed resistance to carbapenem, were producing carbapenemase enzyme, and were positive for blaOXA-51 gene. The blaOXA-23 gene was amplified in 38(97.4%) isolates. CONCLUSIONS: BlaOXA-23 gene appeared to be the major cause of carbapenem resistance.


Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Pneumonia Associada à Ventilação Mecânica , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/genética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Carbapenêmicos/farmacologia , Estudos Transversais , Humanos , Testes de Sensibilidade Microbiana , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Centros de Atenção Terciária , beta-Lactamases/genética
12.
J Pak Med Assoc ; 71(11): 2645-2647, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34783751

RESUMO

To assess the knowledge, behaviours and attitudes towards Patient Safety (PS) among interns of a tertiary care hospital, a cross sectional survey was conducted among 126 interns of Combined Military Hospital, Lahore (CMH Lhr), using Questionnaire (APSQ -4) in December 2019. Statistical analysis was done on SPSS 23. The interns exhibited good PS knowledge. The highest response was evident for "Attitude to Medical Error Reporting" domain (53.34±7.62) followed by "PS Knowledge" (50.88±6.85) with lowest response for "Attitude to PS Skills" domain (Mean = 16.34 ± 3.46). Independent Sample T Tests for comparison of mean responses of civilian and military interns revealed significant difference for PS Attitude to PS Training only, T Test (df)1.940 (124) p-value = 0.055. PS knowledge exists among the interns with limited training and practices. Medical educationists and supervisors should incorporate PS culture in junior doctors through rigorous training.


Assuntos
Corpo Clínico Hospitalar , Segurança do Paciente , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Centros de Atenção Terciária
13.
Clin Lab ; 67(11)2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34758226

RESUMO

BACKGROUND: An accurate interpretation of the ABO blood group of an individual is of utmost importance to ensure patient safety and good transfusion practices. The aim of the study was to determine the incidence and causes of ABO typing discrepancies among patients and analysis of the clinical characteristics as well. METHODS: A retrospective observational study was carried out in the Department of Laboratory Medicine in the General Hospital of Chinese PLA from March 2018 to December 2020. Records of patients were collected and analyzed for frequency, clinical characteristics, and influencing factors of ABO typing discrepancies. RESULTS: There were 132 ABO typing discrepancies patients (57 females, 75 males), aged from 3 to 84 (50.3 ± 19.3) years, with history of operation 89 cases (67.42%) and blood transfusion 23 cases (17.42%). In the control group, there were 142 cases (63 females and 79 males), aged 10 - 78 years (50.5 ± 15.55), with operation history 68 cases (47.88%) and blood transfusion history 2 cases (1.40%). Among the inconsistent blood types group, there were 59 cases (44.7%) type B, 38 cases (28.8%) type A, 28 cases (21.2%) type AB, and 7 cases (5.3%) type O. There were 21 cases (15.9%) in the department of hematology, 15 cases (11.36%) in the department of orthopedics, 14 cases (10.6%) in the department of hepatobiliary surgery, 11 cases (8.33%) in the department of general surgery, 11 cases (8.33%) in the department of vascular surgery, and less than 5% in other departments. The common cause of ABO typing discrepancies was due to low/weak affinity antibody (3.79%), low/weak affinity antibody B (18.18%), weak A antigen (3.03%), weak B antigen (12.12%), hematopoietic stem cell transplantation (10.60%), irregular antibody (46.70%), subtype (3.79%), and cold agglutination (1.51%). The diseases in the ABO discrepancy group mainly included hematological disorders, malignant tumors, osteoarthritis and so on. Binary logistic regression showed that hematological disorders, malignant tumors, history of operation (p = 0.01), and history of blood transfusion (p = 0.017) were the influencing factors of ABO typing discrepancies. CONCLUSIONS: It is possible that the antibody of ABO blood group system could not be detected. The independent influence factors were hematological disorders, malignant tumor, blood transfusion history and operation history for ABO typing discrepancies. It was necessary to analyze the causes correctly and judge the correct blood group by serological methods.


Assuntos
Sistema ABO de Grupos Sanguíneos , Tipagem e Reações Cruzadas Sanguíneas , Transfusão de Sangue , Análise Fatorial , Feminino , Humanos , Masculino , Centros de Atenção Terciária
14.
Saudi Med J ; 42(11): 1201-1208, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732552

RESUMO

OBJECTIVES: To investigate the clinical profiles and outcomes of young adults presenting with ST-segment elevation myocardial infarction (STEMI). METHODS: We retrospectively reviewed King Saud Medical City, Riyadh, Saudi Arabia, registry between January 2016 and November 2017 for all patients younger than 45 years old who were admitted with STEMI. We compared this study population to a control group of patients aged 45 years and older who were enrolled in the same period. RESULTS: In total, 402 patients were enrolled; 197 were younger than 45 years. The incidence of newly diagnosed dyslipidemia was higher in younger patients (44% vs. 32%, p=0.01). Smoking was significantly more prevalent in the younger group (52% vs. 35%, p=0.001). The prevalence of pulmonary edema and cardiogenic shock on presentation was significantly higher in the older group (3% vs. 10; odds ratio, 4.43; 95% confidence interval, 1.750-10.94; p=0.002). Hospital stay was also longer in the older group (4±2 vs. 5±2 days, p=0.03). CONCLUSION: ST-segment elevation myocardial infarction in young patients has a favorable outcome. Smoking and dyslipidemia are the main risk factors for STEMI in young individuals. The majority of young patients with dyslipidemia were not aware of their pre-existing condition. Our findings recommend local adaptation and implementation of screening programs for dyslipidemia in the young and the reinforcement of smoking prevention programs.


Assuntos
Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Arritmias Cardíacas , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Arábia Saudita/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
15.
Saudi Med J ; 42(11): 1229-1236, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732556

RESUMO

OBJECTIVES: To detect single nucleotide polymorphism in toll-like receptor 2 (TLR2) gene in complicated cases of measles, in order to understand the genetic basis of complex human immune responses against measles complications. METHODS: A total of 100 children consisted of 50 measles complicated cases while rest were gender matched disease-free individuals who served as controls for this study. Patient demographic data and clinical information were recorded on a separate pre-designed model form. All exonic regions of TLR2 gene of the patients and control samples were amplified through polymerase chain reaction. Various in-silico mutation verification tools like protein variation effect analyzer, MUPRO, sorting intolerant from tolerant, functional analysis through hidden Markov models, and polymorphism phenotyping v2 to study the effect of novel non-synonymous polymorphism on structure and function of TLR2 protein. RESULTS: Synonymous and novel non-synonymous polymorphisms were identified in measles complicated cases. Among these, rs1816702 was marked to 5 untranslated region section of TLR2 gene, while rs3804099 and rs3804100 were identified in the coding region. Novel non-synonymous polymorphisms were shown in the coding region of TLR2 gene. No significant association was established between the observed genetic polymorphisms and measles complications. However, rs3804100 increased the risk of lower respiratory tract infection. CONCLUSION: The overall impact of novel non-synonymous polymorphism of TLR2 protein structure and functions was neutral and tolerated.


Assuntos
Sarampo , Receptor 2 Toll-Like , Estudos de Casos e Controles , Criança , Predisposição Genética para Doença , Humanos , Sarampo/genética , Paquistão , Polimorfismo de Nucleotídeo Único , Centros de Atenção Terciária , Receptor 2 Toll-Like/genética
16.
Saudi Med J ; 42(11): 1243-1246, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34732558

RESUMO

OBJECTIVES: To calculate the seroprevalence of asymptomatic healthcare workers (HCWs) in our institution. METHODS: We conducted a cross-sectional study among asymptomatic HCWs in a large hospital during the peak of the pandemic (from July to August 2020 and followed them up until February 2021) in Riyadh, Saudi Arabia. We collected the data in a Microsoft Word document after collecting a single serum sample for detection of antibodies from each participant then we compared the results statically in Microsoft Excel tables. RESULTS: We enrolled 188 participants and measured their IgG antibodies from venous blood samples using CLIA. Six (3.2%) had positive antibodies despite being asymptomatic. Most of these were from non-COVID-19 working areas (4 out of 6), but all had an exposure with a positive COVID-19 patient at some point in the preceding 2 months. CONCLUSIONS: Our results are consistent with similar local studies showing low seroprevalence among HCWs while most positive cases are from non-COVID-19 areas. Despite this low seroprevalence, HCWs are still considered a high-risk group; hence, there is a need to encourage strict implementation and adherence to infection control measures and vaccination among HCWs, especially when these measures are relaxed on the national level.


Assuntos
COVID-19 , SARS-CoV-2 , Anticorpos Antivirais , Estudos Transversais , Pessoal de Saúde , Humanos , Arábia Saudita/epidemiologia , Estudos Soroepidemiológicos , Centros de Atenção Terciária
17.
Acta Biomed ; 92(5): e2021304, 2021 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-34738588

RESUMO

OBJECTIVE: Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in a General Surgery Unit of a tertiary Covid-Hospital. METHODS: We report and compared all the surgical procedures performed between two periods (March and April 2019 and March and April 2020) at General Surgery Department of Parma University Hospital, a tertiary Covid-Hospital. RESULTS: Between March and April 2019, a total of 232 surgical procedures were performed. Between March and April 2020 only 61 surgical procedures were performed. In 2019 84 patients underwent surgery for cancer and 171 underwent surgery for benign diseases. In 2020 only 37 patients underwent surgery for oncological reasons and 24 underwent surgery for benign diseases. CONCLUSIONS: During pandemic Covid-19 the access to health services was limited and poor. Limited access to health services and the fear of Covid-19 infection can explain the lower number of elective surgical procedures for cancer in 2020 compared to the same period in the 2019.


Assuntos
COVID-19 , Pandemias , Procedimentos Cirúrgicos Eletivos , Humanos , SARS-CoV-2 , Centros de Atenção Terciária
18.
J Nepal Health Res Counc ; 19(2): 396-401, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34601537

RESUMO

BACKGROUND: Corona virus disease 2019 has become a global health issue. The goal of this study was to investigate the characteristics and outcomes of patients with corona virus disease 2019 undergoing invasive mechanical ventilation and identify factors associated with mortality. METHODS: Ninety four consecutive critically ill patients with confirmed corona virus disease 2019 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study. The outcome variable was mortality of patients undergoing invasive mechanical ventilation and factors associated with it during intensive care unit stay. RESULTS: Seventy nine (84%) out of 94 patients with confirmed corona virus disease 2019 who underwent invasive mechanical ventilation didn't survive. Ninety four percent of patients who had Type 2 Diabetes Mellitus did not survive in comparison to 72 percent of patients who didn't have Type 2 Diabetes Mellitus. Similarly, 48 (94.1%) out of 51 patients with a positive C-reactive protein value didn't survive in comparison to 31 (72%) out of 43 patients with a negative C-reactive protein. CONCLUSIONS: The presence of Type 2 Diabetes Mellitus and a positive C-reactive protein value were strongly associated with mortality. Patients with a Sequential organ failure assessment score of more than eight at intensive care unit admission and peak D-dimer level of more than or equal to two during intensive care unit stay didn't show significant association with mortality. These findings need further exploration through larger prospective studies.


Assuntos
COVID-19 , Diabetes Mellitus Tipo 2 , Insuficiência Respiratória , Diabetes Mellitus Tipo 2/terapia , Humanos , Nepal , Respiração Artificial , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção Terciária
19.
Medicine (Baltimore) ; 100(40): e27325, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622831

RESUMO

ABSTRACT: The National Early Warning Score (NEWS)-2 is an early warning scale that is used in emergency departments to identify patients at risk of clinical deterioration and to help establish rapid and timely management. The objective of this study was to determine the validity and prediction of mortality using the NEWS2 scale for adults in the emergency department of a tertiary clinic in Colombia.A prospective observational study was conducted between August 2018 and June 2019 at the Universidad de La Sabana Clinic.The nursing staff in the triage classified the patients admitted to the emergency room according to Emergency Severity Index and NEWS2. Demographic data, physiological variables, admission diagnosis, mortality outcome, and comorbidities were extracted.Three thousand nine hundred eighty-six patients were included in the study. Ninety-two (2%) patients required intensive care unit management, with a mean NEWS2 score of 7. A total of 158 patients died in hospital, of which 63 were women (40%). Of these 65 patients required intensive care unit management. The receiver operating characteristic curve for NEWS2 had an area of 0.90 (CI 95%: 0.87-0.92). A classification and score equivalency analysis was performed between triage and the NEWS2 scale in terms of mortality. Of the patients classified as triage I, 32.3% died, and those who obtained a NEWS2 score greater than or equal to 10 had a mortality of 38.6%.Among our population, NEWS2 was not inferior in its area under the receiver operating characteristic curve when predicting mortality than triage, and the cutoff point for NEWS2 to predict in-hospital mortality was higher.


Assuntos
Escore de Alerta Precoce , Serviço Hospitalar de Emergência/organização & administração , Adulto , Idoso , Deterioração Clínica , Colômbia/epidemiologia , Estado Terminal/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Centros de Atenção Terciária/estatística & dados numéricos , Triagem/métodos
20.
J Pak Med Assoc ; 71(Suppl 5)(8): S45-S50, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34634015

RESUMO

OBJECTIVE: To evaluate the oncological and functional outcomes of bone tumour patients who underwent reconstruction with mega prosthesis. Methodology: A retrospective study was conducted in the department of Orthopaedics Aga Khan University Hospital, Karachi. All the paediatric and adult age group patients diagnosed with malignant, benign and metastatic bone tumours and meeting the inclusion criteria were selected and analysed. Retrospective data was collected from January 2008-January 2018. RESULTS: Sixty-two patients, 30 (48.4%) females and 32 (51.6%) males. were included in the study. Of these 57 (92%) cases had involvement of the lower limb. The mean age was 36.95±19.1 years with a range of 9-81 years. The duration of patients follow up was from 1-124 months (mean 32.7±36.43 months). There were 29 (47%) malignant cases. The most commonly occurring tumour site was distal femur and proximal femur. There were 53 (85%) primary surgeries (first time conducted surgeries) while 9(15%) revision surgeries were done. Major complications were encountered in 19 (30.6%) patients and 13 (20.9%) had minor complications. Post-surgery local recurrence occurred in 2 (3.2%) patients while 7 (11.2%) had distant metastasis. In functional outcomes the mean MSTS score of our patients was 72.09±26.43. The survival rate was 69.8% with 45 patients recovered. CONCLUSIONS: With a good patient selection, adherence to the principles of tumour surgery and an adequate applied knowledge of mega prosthesis insertion, a good functional outcome was achieved.


Assuntos
Neoplasias Ósseas , Recidiva Local de Neoplasia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/cirurgia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Adulto Jovem
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