RESUMO
BACKGROUND: It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery. METHODOLOGY: MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model. RESULTS: 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions. CONCLUSION: Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.
Assuntos
Endoscopia , Epistaxe , Adesivo Tecidual de Fibrina , Procedimentos Cirúrgicos Nasais , Epistaxe/terapia , Adesivo Tecidual de Fibrina/uso terapêutico , Humanos , NarizRESUMO
Introduction: To understand smoking behaviors among ethnic minority groups, studies have largely focused on societal factors, with little attention to family influences. Yet studies among majority groups have identified parental smoking as an important risk factor. It is unknown whether this applies to ethnic minority groups. We investigated the association between parental smoking and adult offspring's smoking behaviors among ethnic minority groups with an immigrant background. Methods: We used data from the Healthy Life in an Urban Setting study from Amsterdam (the Netherlands) from January 2011 to December 2015. The sample consisted of 2184 parent-offspring pairs from South-Asian Surinamese, African Surinamese, Turkish, Moroccan, and Ghanaian origin. We collected self-reported smoking data: current status, duration of exposure to parental smoking, number of daily cigarettes, heavy smoking ( > 10 cigarettes/day), and nicotine dependency (using the Fagerström Test). Analyses were stratified by offspring's age, cohabitation with parent, education (parent/offspring), offspring's cultural orientation, and gender concordance within pairs. Logistic regression was used. Results: Overall, parental smoking was associated with offspring's smoking behaviors (eg, current smoking: odds ratio 2.33; 95% confidence interval 1.79-3.03), with little ethnic variation. We found dose-response associations between exposure to parental smoking and offspring's smoking. The associations were similar across different strata but stronger in gender-concordant pairs (3.16; 2.12-4.51 vs. 1.73; 1.15-2.59 in gender-discordant pairs; p-value for interaction .017). Conclusions: Parental smoking is associated with offspring's smoking behaviors in ethnic minority groups across different strata but particularly in gender-concordant pairs. Similar to majority groups, family influences matter to smoking behaviors in ethnic minority groups. Implications: Our findings have deepened our understanding of smoking behaviors among ethnic minority groups. Future studies should simultaneously consider societal factors and parental influences, to comprehensively understand their impact on smoking among ethnic minority groups. Also, smoking patterns among family members should be addressed in individual counselling, irrespective of ethnicity.
Assuntos
Filhos Adultos/etnologia , Filhos Adultos/psicologia , Relação entre Gerações/etnologia , Grupos Minoritários/psicologia , Pais/psicologia , Fumar/etnologia , Fumar/psicologia , Adolescente , Adulto , Idoso , Estudos Transversais , Etnicidade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/etnologia , Fatores de Risco , Fumantes/psicologia , Fumar/tendências , Tabagismo/diagnóstico , Tabagismo/etnologia , Tabagismo/psicologia , Adulto JovemRESUMO
OBJECTIVE: Ethnic differences in the metabolic syndrome could be explained by perceived ethnic discrimination (PED). It is unclear whether PED is associated with the metabolic syndrome. We assessed this association and quantified the contribution of PED to the metabolic syndrome. METHODS: Baseline data were used from the Healthy Life in an Urban Setting study collected in the Netherlands from 2011 to 2014. The population-based sample included South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan participants (aged 18 to 70 years). PED was measured using the Everyday Discrimination Scale. The metabolic syndrome was determined according to the harmonized definition of the International Diabetes Federation, American Heart Association, and others. Logistic regression was used for analysis. population-attributable fraction was used to calculate the contribution of PED. RESULTS: PED was positively associated with the metabolic syndrome in South-Asian Surinamese, African Surinamese, and Moroccan participants (odds ratio [95% confidence interval] = 1.13 [0.99-1.30], 1.15 [1.00-1.32], and 1.19 [1.03-1.38], respectively) after adjusting for potential confounders and mediators. No significant association was observed among Ghanaian and Turkish participants. For the individual components, the associations were statistically significant for blood pressure, fasting glucose, and waist circumference among Surinamese participants. PED was associated with dyslipidemia in Moroccan participants. The population-attributable fractions were 5% for South-Asian Surinamese and Moroccan participants, and 7% for African Surinamese participants. CONCLUSIONS: We found a positive association of PED with the metabolic syndrome in some ethnic groups, with PED contributing around 5% to 7% to the metabolic syndrome among Surinamese and Moroccans. This suggests that PED might contribute to ethnic differences in the metabolic syndrome.
Assuntos
Síndrome Metabólica/etnologia , Grupos Minoritários/estatística & dados numéricos , Preconceito/etnologia , Sistema de Registros/estatística & dados numéricos , Adulto , Ásia Ocidental/etnologia , População Negra/etnologia , Feminino , Gana/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos/etnologia , Racismo/etnologia , Suriname/etnologia , Turquia/etnologia , População Urbana/estatística & dados numéricosRESUMO
BACKGROUND: Previous studies from the US and UK suggest that neighbourhood ethnic composition is associated with health, positive or negative, depending on the health outcome and ethnic group. We examined the association between neighbourhood ethnic composition and self-reported health in these groups in Amsterdam, and we aimed to explore whether there is spatial variation in this association. METHODS: We used micro-scale data to describe the ethnic composition in buffers around the home location of 2701 Turks and 2661 Moroccans. Multilevel regression analysis was used to assess the association between three measures of ethnic composition (% co-ethnics, % other ethnic group, Herfindahl index) and three measures of self-reported health: self-rated health, Physical and Mental Component Score (PCS, MCS). We adjusted for socioeconomic position at individual and area level. We used geographically weighted regression and spatially stratified regression analyses to explore whether associations differed within Amsterdam. RESULTS: Ethnic heterogeneity and own ethnic density were not related to self-rated health for both ethnic groups. Higher density of Turks was associated with better self-rated health among Moroccans at all buffer sizes, with the most significant relations for small buffers. Higher heterogeneity was associated with lower scores on PCS and MCS among Turks (suggesting worse health). We found spatial variation in the association of the density of the other ethnic group with self-rated health of Moroccans and Turks. We found a positive association for both groups, spatially concentrated in the sub-district Geuzenveld. CONCLUSIONS: Our study showed that the association of ethnic composition with self-reported health among Turks and Moroccans in Amsterdam differed between the groups and reveals mainly at small spatial scales. Among both groups, an association of higher density of the other group with better self-rated health was found in a particular part of Amsterdam, which might be explained by the presence of a relatively strong sense of community between the two groups in that area. The study suggests that it is important to pay attention to other-group density, to use area measurements at small spatial scales and to examine the spatial variation in these associations. This may help to identify neighbourhood characteristics contributing to these type of area effects on urban minority health.
Assuntos
Planejamento Ambiental , Etnicidade , Nível de Saúde , Características de Residência , Autorrelato , População Urbana , Adolescente , Adulto , Idoso , Estudos Transversais , Etnicidade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos/etnologia , Turquia/etnologia , Adulto JovemRESUMO
PURPOSE: We aimed to study whether country integration policy models were related to inequalities by immigrant status in depressive symptoms in Europe. METHODS: This is a cross-sectional study using data from 17 countries in the sixth wave of the European Social Survey (2012), comparing subjects born either in the country of residence (non-immigrants, N = 28,333) or in a country not classified as "advanced economy" by the IMF (immigrants, N = 2041). Depressive symptoms were assessed with the eight-item version of the Center for Epidemiologic Studies Depression scale. Countries were grouped into three integration policy regimes (inclusive, assimilationist, and exclusionist). Linear regressions were fitted adjusting first by age, sex, and education level, then sequentially by citizenship, perceived discrimination, and socio-economic variables. RESULTS: In all integration regimes, immigrants report significantly more depressive symptoms than non-immigrants. The gap is the largest in exclusionist countries (immigrants score 1.16, 95% CI 0.65-1.68, points higher than non-immigrants in the depression scale), followed by assimilationist countries (0.85 and 0.57-1.13) and inclusive countries (0.60 and 0.36-0.84). Financial strain explains all the associations in inclusive countries, most of it in assimilationist countries, but only a small part in exclusionist countries. CONCLUSIONS: Across most European countries, immigrants seem to experience more depressive symptoms than the population born in the country, mostly reflecting their poorer socio-economic situation. Inequalities are larger in countries with more restrictive policies. Despite some limitations, this study adds new evidence to suggest that immigrants' health is shaped by integration policies in their host country.
Assuntos
Depressão/etnologia , Emigrantes e Imigrantes/psicologia , Política Pública , Adolescente , Adulto , Idoso , Estudos Transversais , Europa (Continente)/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: This study examined the mediating and moderating role of one's sense of mastery in the relationship between perceived ethnic discrimination and depression. METHOD: Questionnaire data from participants of the Healthy Life in an Urban Setting (HELIUS) study were used, containing responses from 9,141 Surinamese, Turkish, Moroccan, and Ghanaian immigrant adults, aged 18 to 70, living in Amsterdam, the Netherlands. RESULTS: Results of path modeling indicated that perceptions of ethnic discrimination were positively related to depression symptomatology, and this relationship was moderated and partially mediated by mastery. Results remained fairly robust across sex, educational level, immigrant generation, and ethnicity. CONCLUSION: This study indicated that mastery may both serve a moderating and mediating role in the relationship between perceived ethnic discrimination and depression, suggestive of a process in which the impact of perceiving discrimination becomes increasingly more deteriorating over time. Thus, interventions focused on mastery may potentially be beneficial to improve ethnic minority mental health. (PsycINFO Database Record
Assuntos
Etnicidade/psicologia , Racismo/psicologia , Adulto , Idoso , Transtorno Depressivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/etnologia , Inquéritos e Questionários , Adulto JovemRESUMO
This study aimed to examine differences in all-cause mortality and main causes of death across different migrant and local-born populations living in six European countries. We used data from population and mortality registers from Denmark, England & Wales, France, Netherlands, Scotland, and Spain. We calculated age-standardized mortality rates for men and women aged 0-69 years. Country-specific data were pooled to assess weighted mortality rate ratios (MRRs) using Poisson regression. Analyses were stratified by age group, country of destination, and main cause of death. In six countries combined, all-cause mortality was lower for men and women from East Asia (MRRs 0.66; 95 % confidence interval 0.62-0.71 and 0.76; 0.69-0.82, respectively), and Other Latin America (0.44; 0.42-0.46 and 0.56; 0.54-0.59, respectively) than local-born populations. Mortality rates were similar for those from Turkey. All-cause mortality was higher in men and women from North Africa (1.09; 1.08-1.11 and 1.19; 1.17-1.22, respectively) and Eastern Europe (1.30; 1.27-1.33 and 1.05; 1.01-1.08, respectively), and women from Sub-Saharan Africa (1.34; 1.30-1.38). The pattern differed by age group and country of destination. Most migrants had higher mortality due to infectious diseases and homicide while cancer mortality and suicide were lower. CVD mortality differed by migrant population. To conclude, mortality patterns varied across migrant populations in European countries. Future research should focus both on migrant populations with favourable and less favourable mortality pattern, in order to understand this heterogeneity and to drive policy at the European level.
Assuntos
Causas de Morte , Emigrantes e Imigrantes/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Mortalidade , Migrantes/estatística & dados numéricos , Adolescente , Adulto , África do Norte , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Europa (Continente)/epidemiologia , Europa Oriental/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
PURPOSE: Perceived ethnic discrimination (PED) is positively associated with depressive symptoms in ethnic minority groups in Western countries. Psychosocial factors may buffer against the health impact of PED, but evidence is lacking from Europe. We assessed whether ethnic identity, religion, and ethnic social network act as buffers in different ethnic minority groups in Amsterdam, the Netherlands. METHODS: Baseline data were used from the HEalthy Living In a Urban Setting study collected from January 2011 to June 2014. The random sample included 2501 South-Asian Surinamese, 2292 African Surinamese, 1877 Ghanaians, 2626 Turks, and 2484 Moroccans aged 18-70 years. Depressive symptoms were assessed using the Patient Health Questionnaire-9. PED was measured with the Everyday Discrimination Scale. Ethnic identity was assessed using the Psychological Acculturation Scale. Practicing religion was determined. Ethnic social network was assessed with the number of same-ethnic friends and amount of leisure time spent with same-ethnic people. RESULTS: PED was positively associated with depressive symptoms in all groups. The association was weaker among (a) those with strong ethnic identity in African Surinamese and Ghanaians, (b) those practicing religion among African Surinamese and Moroccans, (c) those with many same-ethnic friends in South-Asian Surinamese, Ghanaians, and Turks, and (d) those who spend leisure time with same-ethnic people among African Surinamese and Turks. CONCLUSIONS: Ethnic identity, religion, and ethnic social network weakened the association between PED and depressive symptoms, but the effects differed by ethnic minority group. These findings suggest that ethnic minority groups employ different resources to cope with PED.
Assuntos
Transtorno Depressivo/etnologia , Transtorno Depressivo/psicologia , Grupos Minoritários/psicologia , Racismo/psicologia , Religião e Psicologia , Identificação Social , Apoio Social , Adolescente , Adulto , Idoso , Feminino , Gana/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos , Suriname/etnologia , Turquia/etnologia , Adulto JovemRESUMO
BACKGROUND: European research on the association between perceived ethnic discrimination (PED) and health is importantly lacking. It is also unknown how much PED contributes to disease prevalence. In this study, we quantified the contribution of PED to depression in five ethnic groups in a middle-size European city. METHODS: We used cross-sectional data from the HELIUS study (Healthy Life in an Urban Setting), collected from January 2011 to June 2013 in Amsterdam, The Netherlands. We included a random sample of 1753 ethnic Dutch, 1143 South-Asian Surinamese, 1794 African Surinamese, 1098 Ghanaians and 850 Turks, aged 18-70 years. PED was assessed using the Everyday Discrimination Scale. Patient Health Questionnaire-9 was used for assessing depressive symptoms and major depressive disorder (MDD). We used logistic regression and calculated the contribution of PED to depressive symptoms and MDD using the population attributable fractions. RESULTS: Depressive symptoms and MDD were most common in Turks and South-Asian Surinamese, and lowest in ethnic Dutch. PED had a positive association with depressive symptoms and MDD in only the ethnic minority groups. The contributions of PED to depressive symptoms and MDD were around 25% in both the Surinamese groups, and Turks, and â¼15% in Ghanaians. CONCLUSION: We conclude that PED contributes considerably to depression in ethnic minority groups in a European context. As such, ethnic inequalities in depression could be reduced substantially if ethnic minority groups would not perceive any ethnic discrimination. We encourage more European research on the health impact of PED.
Assuntos
Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Etnicidade/psicologia , Etnicidade/estatística & dados numéricos , Preconceito/psicologia , Preconceito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Prevalência , Adulto JovemRESUMO
BACKGROUND: Language barriers may lead to poorer healthcare services for patients who do not speak the same language as their care provider. Despite the benefits of professional interpreters, care providers tend to underuse professional interpretation. Evidence suggests that students who received training on language barriers and interpreter use are more likely to utilize interpretation services. AIMS: We developed an e-learning module for medical students on using professional interpreters during the medical interview, and evaluated its effects on students' knowledge and self-efficacy. METHODS: In the e-learning module, three patient-physician-interpreter video vignettes were presented, with three different types of interpreters: a family member, an untrained bilingual staff member, and a professional interpreter. The students answered two questions about each vignette, followed by feedback which compared their responses with expert information. In total, 281 fourth-year medical students took the e-learning module during the academic year 2012-2013. We assessed their knowledge and self-efficacy in interpreter use pre- and post-test on 1 (lowest)-10 (highest) scale, and analysed the differences in mean scores using paired t-tests. RESULTS: Upon completing the e-learning module, students reported higher self-efficacy in using professional interpretation. The mean knowledge score on the pre-test was 5.5 (95% confidence interval 5.3-5.8), but on the post-test this increased to 8.4 (95% CI 8.2-8.6). The difference was highly significant (p < 0.001). For self-efficacy, the mean score on the pre-test was 4.9 (95% CI 4.7-5.1), and on the post-test 7.0 (95% CI 6.8-7.1); p < 0.001. CONCLUSION: This e-learning module improved students' knowledge and self-efficacy in using professional interpreters during the medical interview. Using such tools in medical curricula might encourage future doctors to use professional interpretation services to overcome language barriers, thereby potentially contributing to equitable healthcare services for a linguistically diverse patient population.
Assuntos
Barreiras de Comunicação , Educação a Distância/métodos , Multilinguismo , Estudantes de Medicina , Tradução , Competência Cultural , Feminino , Humanos , Internet , Conhecimento , Masculino , Relações Médico-Paciente , AutoeficáciaRESUMO
BACKGROUND: Current disease burden estimates do not provide evidence across different ethnic groups. This study aims to assess the disease burden as measured by the disability-adjusted life years (DALYs) for six ethnic groups in Amsterdam, the Netherlands, for 2011 and 2030. METHODS: The DALYs were calculated by combining three components: disease-/sex-/age-specific DALYs per person; disease-specific relative risks (RRs) by ethnicity; and sex-/age-specific population sizes by ethnicity in Amsterdam in 2011 and 2030. Disease-specific DALYs were derived from the National Institute of Public Health. The RRs were obtained through a systematic review of studies published in 1997-2008. The population figures were gathered from the Statistics Netherlands and municipality of Amsterdam. RESULTS: The findings suggest that cardiovascular diseases and anxiety and depressive disorders dominate disease burden in all ethnic groups in 2011 and 2030. In most of the non-Western ethnic minorities, diabetes mellitus is the strongest contributor to the disease burden. The total disease burden will increase more strongly in non-Western ethnic minorities than ethnic Dutch. The 2030 disease burden is estimated to be highest among Surinamese and Antilleans. CONCLUSIONS: In ethnic minorities, diabetes plays an important role in the disease burden, and the total disease burden will grow stronger than ethnic Dutch, resulting in a higher total disease burden for some ethnic groups in 2030. We encourage researchers to estimate the disease burden by ethnicity so that health priorities can be set in the fields of policy, health care and research.
Assuntos
Etnicidade/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Marrocos/etnologia , Países Baixos/epidemiologia , Antilhas Holandesas/etnologia , Fatores Sexuais , Suriname/etnologia , Turquia/etnologia , Adulto JovemRESUMO
Epidermoid cyst is a rare, slow growing lesion of head and neck region. Its rarest site of presentation is intra-oral. It presents later in life, while taking its time to grow to a significant size, causing other complaints as dyspnoea and dysphagia. We present here a case report of epidermoid cyst at a very rare and unexpected site of presentation. Patient presented in ENT OPD with complaints of large intra-oral midline swelling and associated complaints of dyspnoea and dysphagia. Patient was admitted and operated upon with intra-oral approach, producing good results. It should be kept in mind as one of the differential diagnoses when dealing with long standing intra-oral swellings.
Assuntos
Cisto Epidérmico/patologia , Doenças da Boca/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Doenças da Boca/cirurgia , Soalho Bucal , Adulto JovemRESUMO
BACKGROUND: Transvaginal sonography (TVS) is one of the diagnostic modalities used to evaluate endometrial pathologies in women with abnormal uterine bleeding. It permits use of high frequency ultrasound waves at greater proximity to the uterus. This study aimed at determining the diagnostic accuracy of TVS in identifying endometrial hyperplasia by comparing with histologic findings in perimenopausal women with abnormal uterine bleeding. METHODS: This cross-sectional study was conducted in Department of Obstetrics & Gynaecology, Unit II, Fauji Foundation Hospital, from Sep 2011 to Mar 2012. A total of 263 perimenopausal women aged 40-50) years with abnormal uterine bleeding in the form of menorrhagia, metrorrhagia and polymenorrhagia were enrolled. Thickness of the endometrium was first measured by ultrasound and then was later confirmed by sampling of endometrium. The outcome was measured in terms of accurately diagnosing endometrial hyperplasia by TVS and then using histologic findings as gold standard to confirm. RESULTS: The mean age of selected patients was 45.3 +/- 3.2 years. Out of total 263 cases, 129 (49.0%) presented with menorrhagia. 120 (45.6%) presented as metrorrhagia while 14 (5.3%) had polymenorrhagia. The sensitivity and specificity of TVS was 100.0% and 63.7% respectively. Similarly positive predictive value (PPV) and negative predictive value (NPV) were 56.3% and 100.0% respectively. Diagnostic accuracy of TVS in identifying endometrial hyperplasia using histopathology as gold standard was found to be 75.6%. CONCLUSION: TVS has a moderate diagnostic accuracy in detecting endometrial hyperplasia. Due to the fact that transvaginal ultrasound is safe, acceptable and easily available in most secondary and tertiary care settings and is non-invasive in nature, in our opinion TVS is to be used as a 1st line diagnostic tool in patients who present with abnormal uterine bleeding.
Assuntos
Hiperplasia Endometrial/diagnóstico por imagem , Adulto , Estudos Transversais , Feminino , Humanos , Menorragia/etiologia , Distúrbios Menstruais/etiologia , Metrorragia/etiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , UltrassonografiaRESUMO
Eisenmenger syndrome, the most advanced form of pulmonary arterial hypertension (PAH), poses a considerable risk to the survival and quality of life of patients. It is more commonly seen in large intra-cardiac defects like ventricular septal defects (VSD) or patent ductus arteriosus (PDA), and rarely in atrial septal defects (ASD). Early diagnosis is the single most important step in the definitive management of the condition; otherwise, only conservative treatment can be offered. In this report, we present the case of a 20-year-old female patient diagnosed with Eisenmenger syndrome secondary to a large secundum ASD. The patient responded well to medical treatment.
RESUMO
Churg-Strauss syndrome (CSS) is a rare disease of multiple organ involvement attributed to asthma, eosinophilia, and vasculitis as a diagnostic criterion. Here we report a case of CSS presenting with left leg weakness and chest pain with a diagnosis of myocarditis and neuropathy. Eosinophilia, history of asthma, peripheral neurological damage led to the diagnosis of CSS. Transthoracic echo showed a full-sized segmental wall motion abnormality with normal CT angiography. He responded well to steroid therapy.
RESUMO
The ongoing outbreak of coronavirus disease 2019 (COVID-19) that began in Wuhan, China, became an international emergency when thousands of people were infected around the world. COVID-19 emerged in Pakistan in April 2020, precipitating a nationwide lockdown. While some countries are now recovering from the pandemic, its peak is not estimated to occur in Pakistan until August 2020. We present a case of rheumatic heart disease with fever, myalgia and an unusual radiological finding of the virus. LEARNING POINTS: Unusual radiological findings are being seen in COVID-19 patients.Pleural effusion in a mildly symptomatic patient is a rare presentation of the disease.Early aggressive treatment can produce dramatic improvement in COVID-19 pneumonia.
RESUMO
Background and objectives Salmonella typhi is involved in one of the most prevalent infectious diseases of South East Asia, typhoid fever, but diagnostic tests cannot be performed regularly in developing countries. The objective of the study is to determine the association of eosinopenia with culture or serology-proven typhoid fever in patients, to determine the association of leukopenia with culture or serology-proven typhoid fever in patients and to determine independent predictors of eosinopenia. Methods This case-control study, done at Fauji Foundation Hospital, Pakistan, included patients with symptoms suggestive of typhoid fever, culture, or serology positive for typhoid fever and excluded patients who had been previously diagnosed with malaria and dengue hemorrhagic fever. After flagging cultures and serology, the records were viewed for leukocyte counts. Data, including age, gender, and clinical symptoms, were also recorded for analysis. Results Out of 200 participants, 59 participants with diagnosed typhoid fever had eosinopenia. There were 29 participants who had been diagnosed with typhoid fever via culture or serology and had leukopenia. Eosinopenia and leukopenia were more likely to be present in patients with a diagnosis of typhoid (OR: 9.60, 20.00). The independent predictors for eosinopenia were DOT enzyme immunoassay (DOT EIA) positive for Salmonella typhi, culture positive for Salmonella typhi and leukopenia (p<0.05). Conclusion The presence of eosinopenia and features or serology suggestive of typhoid would most likely be associated with cultures being positive and, therefore, might provide an efficient means to begin treatment.
RESUMO
Objective To evaluate characteristics and outcomes of patients presenting with mechanical prosthetic valve thrombosis in a tertiary cardiac center in Pakistan. Methods This was a prospective and interventional study conducted at Rawalpindi Institute of Cardiology over a period of two years. The clinical characteristics of patients presenting with clinical suspicion of prosthetic valve thrombosis were recorded. They were, then, subjected to streptokinase, redo surgery and heparin based on their hemodynamic stability, thrombus burden and surgical risk. The patients were then followed for the outcomes of the study. Results Out of 576 patients with mechanical valve replacement during the study period, 70 patients had developed prosthetic valve thrombosis. Out of 70 patients, there were 41 female (58.50%) and 29 male (41.50%) participants. The mean age of the participants was 48.40±15.00 years. The overall incidence of mechanical prosthetic valve thrombosis was 12.15%. There were 30 patients (42.80%) with a suboptimal international normalized ratio (INR) and 28 patients (40.00%) were non-compliant to warfarin therapy. The overall incidence of adverse clinical outcome was 18.00%, while the overall mortality rate was 10.00%. The mortality was higher for patients who underwent redo surgery (16.60%) as compared to patients who had received fibrinolytic therapy (9.60%). Conclusion Poor compliance with warfarin and suboptimal INR are the important factors causing mechanical prosthetic valve. Because of lower mortality rate, fibrinolysis with streptokinase is a reasonable treatment option for mechanical prosthetic valve thrombosis.
RESUMO
BACKGROUND: Discrimination is associated with obesity, but this may differ according to the type of obesity and ethnic group. This study examines the association of perceived ethnic discrimination (PED) with general and abdominal obesity in 5 ethnic minority groups. METHODS: We used cross-sectional data from the HELIUS study, collected from 2011 to 2015. The study sample included 2297 Ghanaians, 4110 African Surinamese, 3021 South-Asian Surinamese, 3562 Turks and 3868 Moroccans aged 18-70â years residing in Amsterdam, the Netherlands. Body mass index (BMI) was used as a measure for general obesity, and waist circumference (WC) for abdominal obesity. PED was measured using the Everyday Discrimination Scale. We used linear regression models adjusted for sociodemographics, psychosocial stressors and health behaviours. In additional analysis, we used standardised variables to compare the strength of the associations. RESULTS: In adjusted models, PED was significantly, positively associated with BMI in the South-Asian Surinamese (ß coefficient 0.338; 95% CI 0.106 to 0.570), African Surinamese (0.394; 0.171 to 0.618) and Turks (0.269; 0.027 to 0.510). For WC, a similar pattern was seen: positive associations in the South-Asian Surinamese (0.759; 0.166 to 1.353), African Surinamese (0.833; 0.278 to 1.388) and Turks (0.870; 0.299 to 1.440). When stratified by sex, we found positive associations in Surinamese women, Turkish men and Moroccan men. The strength of the associations with BMI and WC was comparable in the groups. Among the Ghanaians, no significant associations were observed. CONCLUSIONS: Ethnic and sex variations are observed in the association of PED with both general and abdominal obesity. Further research on psychosocial buffers and underlying biological mechanisms might help in understanding these variations.
Assuntos
Etnicidade/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Obesidade Abdominal/etnologia , Circunferência da Cintura/etnologia , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares/etnologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVES: We examined the associations of perceived ethnic discrimination (PED) with smoking and alcohol consumption in ethnic minority groups residing in a middle-sized European city. METHODS: Data were derived from the HELIUS study in Amsterdam, The Netherlands. We included 23,126 participants aged 18-70 years of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan origin. We collected self-reported data on PED, current smoking, heavy smoking, nicotine dependence, current drinking, excessive drinking, and alcohol dependence. Logistic regression was used. RESULTS: In general, we observed positive associations in participants of African Surinamese and Ghanaian origin, but no associations in those of South-Asian Surinamese, Turkish, or Moroccan origin. In African Surinamese, the associations were positive for current smoking, nicotine, and alcohol dependence (odds ratios of 1.16; 95% confidence interval: 1.06-1.27, 1.34; 1.15-1.57 and 1.40; 1.20-1.64, respectively). In Ghanaians, positive association was observed for current drinking (1.21; 1.08-1.36). CONCLUSIONS: The associations of PED with smoking and alcohol consumption considerably varied by ethnicity and outcome measure. This suggests that ethnic minority groups in Europe might use different behavioural strategies to cope with PED.