Objective: Formulating a comprehensive, practical, and urology-focused ward round checklist to enhance safety, efficiency and clear documentation for the Urology ward team when reviewing in-patients. Design: Identification of important parameters which should be addressed in every patient interaction. FIASCO – VH was coined for ease: • Fluid balance • Investigations • Intravenous access • Antibiotics • Analgesia • Stool • Catheter status • Observations • Venous thromboembolism (VTE) risk assessment • Home and follow up. Baseline measurement followed by implementation of the checklist and completion of three plan-do-study-act (PDSA) cycles. Setting: Single-centre district general hospital within the United Kingdom Participants: 279 ward round interactions with Urology inpatients Intervention: Implementation of the ward round checklist Main outcome measures: Adherence to parameters identified in the urology checklist Results: Stool (23.5%) and pain (30.6%) were worst assessed at baseline, with median 39.3% parameters assessed over all interactions. Significant improvement in assessed parameters after first (median 74.3%), second (median 84.0%), and third cycles (median 100%). These were associated with positive patient outcomes. There was discrepancy between factors verbally addressed and clinically documented (median 84.0% to 57.7% after second cycle). A dedicated third cycle reduced this gap (median 100% to 97%). 100% junior doctors surveyed believed the checklist has enabled addressing of factors which might have otherwise been missed. Conclusion: The use of a comprehensive, urology-focused, easy-to-memorise ward round checklist is feasible and led to sustained, well-documented improvements in all measured aspects of patients’ care, and perceived level of care by the team.
Background: There is inadequate data concerning prevalence and risk factors of asthma among adults, more studies are needed, to support health authorities in asthma management. Methods: This is a cross- sectional study done at Taiba University in Almadinah Almonawarah, Saudi Arabia, in March- April 2014 using a modified translated (ISAAC) questionnaire for adults and respiratory function test. The data was analyzed using Microsoft Excel version 2010. Results: Out of 200 samples 124 were included, the rate of response was 62%, All students who are known cases of asthma and those who had lung function test suspecting asthma were included in the prevalence of asthma which was found to be 12.8%. The prevalence of allergic rhinitis was 21.77%, more among females and associated with asthma.
Background and aim: Demodicosis is a parasitic skin disease caused by D. folliculorum and D. brevis, and is also known as hair follicle mite. The aim of this study was to determine the prevalence of D. folliculorum and D. brevis in hematologic cancer patients and to investigate their relation with chemotherapy. Materials and methods: Sixty-six hematologic cancer patients and 60 healthy individuals with similar age and sex were included in the study. Of the patients with hematological cancer, 50 received chemotherapy and 16 did not receive chemotherapy. The demographic characteristics of the patients were noted. Samples were taken from the cheeks, nose, chin and forehead of the participants with standardized skin surface biopsy and examined in light microscopy at 40x and 100x magnifications to determine the mite density in cm2. Demodicosis was assessed as positive if 5 or more Demodex spp. were seen per cm2. Results: Demodex spp. was positive in 19 (28.78%) of the cancer patients and 3 (5%) of the control group. The prevalence of Demodex spp. was significantly higher in the patient group (p<0.001). The mean mite count (31.31/cm2), in the patient group was also significantly higher than the control group (1.08/cm2), (p<0.001). Demodex spp. density was 38.94/cm2 in patients receiving chemotherapy and 7.50/cm2 in patients not receiving chemotherapy, and the difference between them was statistically significant (p<0.001). Conclusion: In conclusion, our study showed that patients with hematological cancer were infected with Demodex spp. more than controls and that the density of Demodex spp. was significantly increased in chemotherapy group. It should be kept in mind that Demodex spp. increases with weakening of the immune system and may cause skin lesions in hematologic cancer patients, especially in chemotherapy receiving patients.
Microcephaly is characterized by a complex etiology, in addition to being associated with congenital Zika virus infection, being caused by environmental, genetic factors, metabolism diseases, as well as by the use of drugs and maternal diseases during the gestational period. This study aimed to know the microcephaly in the maternal-child life cycle in the Cariri region and its repercussion on maternal mental health. This is a cross-sectional, descriptive research with a quantitative-qualitative approach, delineated through a descriptive study in the formal statistical analysis for quantitative results. Schutze’s narrative was used for qualitative analysis. The study was carried out in inland Ceara in a reference unit for children with microcephaly. Thirteen mothers were interviewed, who have children with microcephaly due to ZIKAV, who had contact with the virus during the fertile period during pregnancy. The profile of the study subject showed that maternal education corresponds to secondary education, 23.1%, with Pardo selfreported colour 92.3%, married marital status 61.5%, with 46.2% as housekeeper occupation, and the mean age of 29.38% (range: 15 to 41 years). The results showed that there is a difference between living conditions of families, knowledge about Zika virus and mothers’ feelings about this pathology. Therefore, public policies and health education should be implemented in relation to ZIKAV, in an attempt to reduce cases of microcephaly in the NE of Brazil.
Gastric outlet obstruction is commonly associated with malignancy and peptic ulcer disease. Duodenal tuberculosis as a cause of Gastric outlet obstruction is a rare clinical entity and poses a great diagnostic dilemma. We report cases of two young adults presenting with long-standing gastric outlet obstruction due to Duodenal Tuberculosis. Patients were evaluated using UGI endoscopy and USG scan. Exploratory Laparotomy was done in both cases, tissue biopsy was taken, and gastrojejunostomy was done to relieve the obstruction. Histopathology was positive for tuberculosis in both cases, and patients were started on antituberculous medication. At present, the patients have responded to antituberculous medications, and are asymptomatic.
Background: Diabetes mellitus represents a public health problem worldwide; in 2014, 422 million people were reported with this disease. Objective: Assess the risk to develop type 2 diabetes mellitus through the Finnish Diabetes Risk Score (FINDRISK) in people from ages from 20 to 35 years old. Methods: We conducted a quantitative, descriptive, and transversal study with a sample of 59 patients, randomly selected with a non-probabilistic sampling by convenience. We provided a consent form, followed by the FINDRISK, assessing age, body max index, abdominal perimeter, daily exercise, fruit and vegetable ingestion, hypertension treatment, the background of hyperglycaemia and family history of T2DM. We categorized them as low risk, slightly elevated risk, moderate risk, high risk and extremely high risk according to the test score. Results: The prevalent risk factors were sedentarism 64% (38), unhealthy diet 51% (30) and obesity according to their BMI of 20% (12). 40% (24) of the patients were classified as low risk, 46% (27) slightly elevated risk, 12% (7) moderate risk, 2% (1) high risk and 0% (0) extremely high risk. Conclusion: The use of the FINDRISK test in Primary Health Care is a useful tool for the early detection of patients with high risk to develop diabetes mellitus type 2 and intervene promoting healthy lifestyles.
During SARS-CoV-1 and Middle East Respiratory Distress Syndrome (MERS) outbreaks it was observed a particularly elevated incidence of cardiovascular disease among patients. With COVID-19, this correlation becomes evident again. However, the cardiovascular impacts by COVID-19 pandemic are not yet well established although publications about its potential deleterious effects are constant. Thus, aimed to carry a systematic review of the literature with meta-analysis, the following question was used as a guide: what practical contributions does the scientific literature produced in the period of 2019-2020 has to offer about the impact of the COVID-19 on cardiovascular system? A systematic review of the literature using the Virtual Health Library (VHL) and PubMed with the following descriptors: #1 “cardiovascular disease” [MeSH] AND #2 “COVID-19” [keyword], as well as their equivalents in the Portuguese and Spanish language, during the period from December 2019 to March 2020 was performed. One hundred articles were found in Pubmed and twenty-seven were selected. In VHL there are 59 articles and four were selected totaling thirty-one papers. The findings were then divided into three subcategories: Etiology, Physiopathology and Risk factors of SARS-CoV-2 in Cardiovascular System; Clinical presentation, laboratory markers and imagenological aspects of SARS-CoV-2 in cardiovascular system; and Anti-Hypertensive Drugs, Cardiovascular System and SARS-CoV-2. When it comes to the cardiovascular system, these issues are aggravated and urge as a joint commitment from researchers, medical and governmental organizations to carry out more robust studies with bold methodologies aimed at mapping prognostic factors and assertive therapeutic approaches in the management of cardiovascular complications of COVID- 19.
Background: Little is known about differences and changes in hemodynamic in patients with Low-gradient (LG) and Non-Low-Gradient (NLG-) Aortic valve Stenosis (AS). Our current observation reveals such specific changes using the non-invasive NICaS® electrical bio-impedance monitoring system. Aim: Primary goal was to illustrate possible differences in subgroups of LG-AS and NLG-AS patients and to discriminate post-procedural adaptive mechanisms for the two subgroups. Methods and findings: In 99 unselected patients subjected to TAVI, NICaS® measurements were performed at baseline, 6 to 8 hours after TAVI and before discharge. 46 patients had a mean pressure gradient <40 mmHg corresponding to a LG-AS. Primary endpoint was defined as the change in cardiac index between the LG-AS and NLG-AS group at discharge. Cardiac index increased in both groups as compared with baseline [from 2.52 ± 0.75 to 3.45 ± 1.15 L/min/m2 (P=0.00014) in LG-AS and form 2.70 ± 0.97 to 3.08 ± 0.94 L/min/m2 (P=0.0198) in NLG-AS]. Increase in cardiac index was more pronounced in LG-AS with a difference between the groups of 0.52 ± 0.32 L/min/m2 (P=0.041) at discharge. Additionally, LG-AS patients showed higher increase in stroke volume index, cardiac power index, and Granov-Goor index and decrease of total peripheral resistance and total peripheral resistance index as secondary parameters. One limitation of our study is the observational design in a small cohort of patients. Therefore, larger trials are warranted to confirm our findings and to show whether there is prognostic relevance for long term outcomes of the different subgroups. Conclusion: NICaS® monitoring represents an accurate non-invasive bedsidetool to discriminate adaptive circulatory changes in subgroups of aortic stenosis patients subjected to TAVI. Hemodynamic parameters recovered more effectively in LG-AS patients after procedure. Whether a measurement-guided approach might be used for tailored peri-procedural management and could have long-term prognostic influence for AS subgroups remains to be elucidated.
Background: Anemia is defined as reduction in red cell mass which, will decreases oxygen-carrying capacity of red blood cells to tissues that can be determined in the laboratory by reduction in haemoglobin concentration (haemoglobin level of less than 11 gm/dl) or haematocrit value is less than 33%. Anemia in pregnant women is often caused by iron deficiency, which is the most common nutrient deficiency in the world, affecting more than two billion people globally. Inadequate intake or absorption of iron conjunction with blood loss during pregnancy may contribute to anemia. Iron deficiency and consequent anemia during pregnancy could be associated with severe complication like increase risks of maternal mortality and morbidity, premature delivery and low birth weight. In pregnant women, an adequate iron status is important to ensure a complication related to pregnancy as well as a normal development of the embryo, foetus and maturity of the new born child. Objectives: To assess the prevalence of iron deficiency anemia and associated factors among pregnant women attending Antenatal care (ANC) follow up at Dodola General Hospital, West Arsi zone, Oromia Region, south East Ethiopia 2018 G.C. Methods: An institutional based cross-sectional study was conducted from February 5 to March 30, 2018 G.C. Systematic random sampling technique was employed to select each participant. Data was checked, coded and analyzed by using SPSS version 20 Software, Odds ratio with corresponding 95% confidence interval was used to determine the association between independent and dependent variables. Multivariate logistic regression analysis was performed to determine the independent factors associated with iron deficiency anemia in these pregnant women and finally presented by tables and chart. Results: The prevalence of iron deficiency anemia was 19.3%. Multivariate logistic regression analysis revealed that pregnant women who had monthly income less than or equal to one thousand birr, Antenatal care visit one times, History of vaginal bleeding, Women who ate only injera with shiro and women who drunks caffeine containing drinks with food during their pregnancy were factors significantly associated with iron deficiency anemia. Conclusion and Recommendations: The prevalence of iron deficiency anemia among pregnant women in this study was relatively low. The hospitals should give special attention for pregnant women to attend Ante natal care and health professionals should advice the pregnant women on nutrition as well as effects of taking caffeine containing drinks during their pregnancy.
Understanding the SARS-CoV-2 pathophysiology regarding neural system contamination and damage is necessary for clinical and therapeutic approaches, which may reduce the damage caused by the disease. In this regard, it is important to highlight that, besides the direct effect on neurons, the inflammatory state caused by a dysregulation of the immune system due to infection are both factors responsible for neurological phenomena of the disease. The presence of the virus in the bloodstream, its ability to directly penetrate the NS through peripheral nerves and the weakening of the blood-brain barrier are added to the tropism of SARS-CoV-2 by ACE-2 receptors, which favours the appearance of brain manifestations, associated with metabolic complications in the autoimmune processes induced by viral clinical condition. It is essential to remember that the cerebrovascular events have been increasingly reported in infected patients and are associated with the hypercoagulability caused by the disease. The activation of the coagulation cascade and deregulation of physiological anticoagulant mechanisms, such as protein C system and the disintegration of fibrin, are possible causes of this hypercoagulable state present in COVID-19. Even though it is still not evident whether the impairment of the nervous system is a result of direct infection by SARS-CoV-2 or of a diffuse inflammatory process affecting various organs and systems generating multiple manifestations, including those of the nervous system, we highlight that the quantity of drugs administered in intensive care units also can interfere with neurological conditions.
Introduction: Maternal death by suicide raises serious perplexities. The ICD-10 classifies maternal suicide as an indirect form of maternal death. Due to this current misclassification, a classificatory consensus of maternal suicide as a direct form of maternal death is urgent. Objective: Analyze the psychological that permeate the phenomenon of maternal suicide, to define the profile of mothers in the postpartum period and pregnant women who commit suicide, with the purpose of elucidating ways of preventing maternal suicide. Method: A systematic review was made following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Results: Twenty-one studies reported the urgent need to implement interventions in order to prevent or reduce mental health problems caused by mothers and pregnant women who commit suicide. Twenty studies demonstrate the need for interventions to organizational adjustments, especially related to the emotional conflicts involved suicide and maternity. Conclusion: Maternal suicide is mainly caused by severe psychiatric disorders, however, higher suicide rates are seen due to psychosocial factors, such as poor familial support and domestic violence, illegal substance abuse and alcoholism, history of sexual or physical violence, racial oppression, economic instability, unwanted pregnancy, difficulty in accessing intentional abortion, and trauma related to past maternity experiences..
Background: Severe acute respiratory syndrome coronavirus 2 in association with other pathologies can trigger systemic alterations that can compromise life in pediatric patients. A multidisciplinary management for this case is required since the information available from severe acute respiratory syndrome coronavirus 2 is constantly updated. Case presentation: We describe the first case in Ecuador of bilateral forefoot and left-hand amputation due to vascular complication with necrosis in an Afrodescendant pediatric patient with Kawasaki-like disease caused by the association of Corona virus disease 2019 and Dengue. Conclusion: The identification of progression of the syndrome is important for the correct therapeutical management.
Background: Literature reports the presence of several Electrocardiographic (ECG) patterns of Right Ventricular (RV) strain in acute Pulmonary Embolism (PE). These reports are inconsistent considering the prognostic value of these patterns. Aim: to evaluate the significance of ECG RV strain patterns, as well as the total number of these ECG patterns in predicting short-term (in-hospital) clinical outcome. Methods: This retrospective study was consisted of 183 patients (107 male, age: 61±14 years) with acute PE. The 12-lead ECG done at hospital admission was analysed. ECG RV strain was diagnosed in presence of one or more of following 12 patterns: tachycardia, atrial fibrillation, low QRS voltage, S1Q3T3, Q in III, aVF, right axis deviation, right bundle branch block, Qr in V1, negative T wave in inferior, precordial leads, ST elevation in inferior leads, aVR, V1 and ST depression. The outcome was defined as experience of an adverse event (in-hospital complications and death all-cause). The association of ECG patterns with outcome was evaluated by multivariable Cox hazards regression analysis. Results: During a median hospitalization time of 15 days, 41 (22.4%) adverse events occurred. Event rate was higher in patients with ≥5 ECG patterns than in <5 (63.4% vs. 0.7%; p<0.0001). Number of ECG RV strain patterns (Hazard Ratio (HR):1.7 per pattern; 95% Confidence Interval (CI): 1.1-2.6; p=0.009), ST elevation in inferior leads (HR: 8.4; 95% CI: 6.0-68.3; p=0.001) and ST depression (HR: 0.1; 95% CI: 0.03-0.6; p=0.01) were independently associated with adverse outcome. Conclusion: Number of ECG RV strain patterns, ST elevation in inferior leads, ST depression has independent value in predicting in-hospital adverse outcome in acute PE.
Background: The induction of the formation of organoids derived from induced pluripotent stem cells (iPSC) is a new technology that is being well studied and aims to improve the clinical condition of patients with various diseases and even patients undergoing certain types of procedures. Methods: A systematic review, using the PRISMA protocol. The study period was from 2010 to 2020 and the keywords included “Organoids”, “iPSC”, “Ethic” and “Evidence-Based Medicine”, one at a time and then combined with the Boolean operator “AND”. Results: A total of 44 registrations were found. Of this total, 15 articles were excluded because they have not approached organoids and stem cells objectively, often attending to other phenomena or details that are not of interest to the review. Limitations: Discoveries about organoids and new methods to promote their generation and growth are constantly being tested and developed around the world, this implies a constant renewal of sources of information. The article was based on current and highly respected sources in the scientific community. Conclusion: Organoids are unquestionably a technology capable of changing many concepts and guidelines in the medical environment. Faced with this enormous capacity, it is necessary that studies are constantly made and that the use of this new technology is widely discussed, since it addresses not only the scientific sphere, but also the ethical sphere, the social sphere. Improving this already existing technology so that it will increasingly mimic the human body is the challenge that exists and needs to be addressed by many professionals in different areas in harmony.
Background: Patients with lung cancer are at high risk for hospitalizations and death, although causes for admission in these patients are elusive. Also, the hospitalizations rates of patients with lung cancer in the COVID-19 pandemic are unclear. Methods: The objectives of this study are to evaluate causes for admission in lung cancer patients and to follow this group into 2020 to see if COVID-19 was a contributor to their hospitalizations. The design is a cohort, retrospective chart review. Participants were patients with an established diagnosis of lung cancer, pursing treatment, ages 19-89 at Creighton University Medical Center- Bergan Mercy (CUMC-B) Hospital Internal Medicine Department from January 1, 2019 through December 31, 2020. Measurements include basic demographics as well as causes for admission and COVID-19 status. Results and Discussion: Out of 37 patients, selected from 311 candidates, there were 47 causes for admission. Of total admissions from this cohort in 2019, 16.88% were due to pneumonia, 11% with acute respiratory failure with hypoxia. The top 14 causes for admission were responsible for 71.4% of the admissions of lung cancer patients in 2019. Of the surviving patients from 2019 into 2020, 1 had confirmed COVID-19. None were hospitalized for COVID-19 within this cohort. Although there were not COVID-19 related hospitalizations in this cohort, the percentage of overall people who died increased (10 deaths out of 37 (27%) from Jan 1, 2019-Feb 29, 2020 in comparison to 13 deaths out of 26 (50%) after March 1, 2020). Conclusion: Despite pneumonia being a leading cause for hospitalization in patients with lung cancer, nobody in this cohort was admitted with COVID-19. Although sample size is a limiting factor in this study, further investigation is warranted into why lung cancer patients in this cohort appear to have a steady or increased death rate, but did not contract COVID-19t.
This paper introduced a novel computer-aided diagnosis method to detect the Parkinson Disease (PD). A novel Pooling-based Deep Recurrent Neural Network (PDRNN) is used in this proposed algorithm as an efficient deep learning method. Parkinson disease gradually degrades the functionality of the brain. Because of its relevance to the abnormality of the brain, EEG (denoting the electroencephalogram) signal is used for early detection of this disease. The electroencephalogram signals of 20 Parkinson and 20 healthy cases are studied in this paper. Also, a PDRNN learning method is applied on the used dataset for tackling the demand for the traditional feature presentation step. The proposed method of this paper could obtain proper precision, sensitivity and specificity (88.31, 84.84 and 91.81 percent, respectively). In addition, our derived classification method has potential to be employed for high populations prior to be installed for clinical applications.
Introduction: Community-Based Health Insurance (CBHI) schemes are emerging tool for providing financial protection for poor people living developing countries like Ethiopia. In Ethiopia, Community-Based Health Insurance (CBHI) was piloted in 13 districts and finally expanded to 427 districts, but satisfaction of community for the scheme and health service delivery is yet limited. Therefore, this study aimed to assess the satisfaction level of Community for health insurance. Methods: A facility based cross-sectional study design was conducted from March and April, 2019 in Arsi Nagele Woreda health centers. Three hundred ninety eight participants who visited the health care facility during the study period were included for the study. The data was entered to Epi-data version 3.1 and exported to Statistical Packages for Social Sciences (SPSS) version 21.0 for analysis Results: A total of 399 patients were participated in the study, yielding a response rate of 95%. 63.1% were male and 36.9% were females. The findings of the study showed that the overall client satisfaction level of CBHI with the health services received from the targeted health centers were 63.4%. Age, educational status, waiting time, drugs availability and knowledge were predictors for Clients satisfaction regarding service of community based health insurance. Qualitative dimension showed that the most unsatisfactory aspects for the Community Based Health Insurance (CBHI) health service were lack of skill personnel and availability of drugs at health facilities. Conclusion and recommendations: This study showed higher clients’ satisfaction level when compared to similar studies in the country. Young age, lack of drugs and supplies, poor information provision, long waiting time at consultation, were found to be the major predictors of dissatisfaction. Therefore, the district health offices should address and work on this predictor to regulate clients’ satisfaction for Community Based Health Insurance (CBHI).
