RESUMEN

OBJECTIVE: This study aimed to determine the prevalence of polypharmacy, comorbidities and to investigate factors associated with polypharmacy among adult patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS: This was a retrospective single-centre cross-sectional study. Patients with a confirmed diagnosis of COPD according to the GOLD guidelines between 28 February 2020 and 1 March 2023 were included in this study. Patients were excluded if a pre-emptive diagnosis of COPD was made clinically without spirometry evidence of fixed airflow limitation. Population characteristics were presented as frequency for categorical variable. Logistic regression analysis was used to identify predictors of polypharmacy. RESULTS: The study sample included a total of 705 patients with COPD. Most of the study sample were males (60%). The mean age of the study population was 65 years old. The majority of the study population had comorbid diseases (68%), hypertension and diabetes were the most common co-existent diseases. Around 55% of the study sample had polypharmacy. Females were significantly less likely to be on polypharmacy compared to males (OR = 0.68, 95% CI = [0.50-0.92], P-value = 0.012)). On the other hand, older patients aged 65.4 or more (OR = 2.31, 95% CI = [1.71-3.14], P-value ≤ 0.001), those with high BMI (≥ 29.2) (OR = 1.42, 95% CI = [1.05-1.92], P-value = 0.024), current smokers (OR = 1.9, 95% CI = [1.39-2.62], P-value ≤ 0.001), those who are receiving home care (OR = 5.29, 95% CI = [2.46-11.37], P-value ≤ 0.001), those who have comorbidities (OR = 19.74, 95% CI = [12.70-30.68], P-value ≤ 0.001) were significantly more likely to be on polypharmacy (p ≤ 0.05). CONCLUSIONS: Polypharmacy is common among patients with COPD. Patients with high BMI, previous ICU hospitalization and older age are more likely to have polypharmacy. Future analytical studies are warranted to investigate outcomes in patients with COPD and polypharmacy.

Asunto(s)

RESUMEN

Background Work-related injuries (WRIs) are a major occupational health issue among healthcare workers (HCWs) worldwide. HCWs face numerous daily hazards including needlestick injuries, chemical exposures, ergonomic strains, and psychological stressors crucial for their health and healthcare system functionality. In Makkah, Saudi Arabia, healthcare infrastructure advances raise concerns about work-related injuries among HCWs. This study in Makkah hospitals aims to identify, understand, and manage WRIs for improved occupational health guidelines and strategies. Methods This descriptive cross-sectional study on HCWs was conducted at Makkah hospitals using an electronic questionnaire that investigated the demographics, work-related injuries, and occupational hazards. The data collected from the retrieved questionnaires were analyzed using the IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Results Among 379 enrolled HCWs, 172 (49.3%) were physicians and 89 (19.8%) were nurses; 304 (80.2%) of the total participants knew about occupational safety. The total incidence of WRIs was 67.8%. WRIs were significantly associated with age (P˂0.001), gender (P=0.02), educational level (P˂0.001), profession (P˂0.001), working hours (P˂0.001), and shift time (P˂0.001). Conclusion WRIs were highly prevalent among HCWs with varying rates based on the type of injury and the frequency of injury. WRIs were associated with various factors including age, gender, education, profession, working house, and shift time of the participants.

RESUMEN

INTRODUCTION: Poorly differentiated thyroid carcinoma (PDTC) is an uncommon high-grade carcinoma of follicular cell origin that is usually overlooked on preoperative fine-needle aspiration (FNA) due to its rarity and cytomorphological overlap with follicular-patterned neoplasms. Definitive diagnosis of PDTC usually requires histologic examination of the resected thyroid tumor. Herein, we describe the cytological and architectural findings of histologically confirmed PDTC cases. MATERIALS AND METHODS: A search for all thyroid FNAs with a corresponding surgical diagnosis of PDTC was performed. Surgical diagnoses were reviewed and confirmed using the Turin criteria. In addition, the control group consisted of indeterminate thyroid nodules (FLUS [follicular lesion of undetermined significance] and FN [follicular neoplasm]) that were either benign or well-differentiated thyroid tumors on resection. The PDTC and control groups were both subjected to cytological assessment using specific cytological and architectural parameters, which included cellularity, growth pattern, mitoses, necrosis, chromatin change, discohesion, and anisonucleosis. RESULTS: A total of 36 thyroid FNAs were included in the study. This consisted of 12 histologically confirmed PDTC FNAs and 24 indeterminate thyroid FNAs (FLUS and FN, 12 each). The most frequent findings among PDTC groups were hypercellularity (75%), trabecular/insular growth pattern (58%), branching capillaries (67%), and cellular discohesion (92%). Necrosis (25%), ≥3 mitoses (50%), and anisonucleaosis (42%) were less frequently observed. A peculiar finding was the presence of adenoid cystic carcinoma-like globules in 50% of PDTC cases. Certain findings such as colloid, necrosis, mitoses, and cellular discohesion were helpful in differentiating the two groups. CONCLUSIONS: Thyroid fine-needle aspiration remains an essential diagnostic/triage tool for most thyroid nodules/tumors. PDTC can be diagnosed or at least suspected preoperatively based on the demonstration of certain architectural and cytological alterations. Although mitoses and necroses are not always readily identified, an elevated Ki-67 labeling expression could provide additional clues to the diagnosis in some cases.

Asunto(s)

RESUMEN

OBJECTIVE: Our study aims to compare the effects of blood pressure variability (BPV) during ambulatory blood pressure measurement (ABPM) and visit-to-visit measurements to predict future cardiovascular complications among hypertensive patients. METHODS: This is a retrospective case-control study of patients with hypertension over 10 years. All adult patients with at least one recorded ABPM, and at least three recorded visit measurements were included. Patients with incomplete ABPM readings, a history of a tested outcome, or the occurrence of any of the tested outcomes within the measurement period were excluded. The outcome was the development of any of the following: acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), or stroke. RESULTS: Of the 305 cases reviewed, 152 were included. The mean follow-up was 6.6±2.3 years. The mean age was 53.5±14.3 years. Eighty-two (53.9%) patients were male, while 70 (46.1%) were female. Risk factors included diabetes mellitus (53.9%), dyslipidemia (39.5%), obesity (16.4%), and smoking (8.6%). Comorbidities included stroke (2%), ACS (8.6%), IHD (20.4%), HF (2.6%), and renal failure (1.3%). One or more complications were seen in 22.4 % of the included patients. The variation of the daytime systolic ABP had been found to predict the future risk of developing IHD (OR=1.94; 95% CI=1.09-3.45; p=0.025). Moreover, IHD was associated with night-time systolic standard deviation (SD) in ABPM (OR=1.23; 95% CI=1.00-1.51; p=0.048). On the other side, ACS was found to be associated with systolic SD in visit-to-visit measurement (OR=1.10; 95% CI=1.01-1.21; p=0.04). CONCLUSION: Hypertensive patients with high variability of daytime and night-time SD in ABPM are more likely to have IHD. Whereas, having high variability in systolic SD in visit-to-visit measurements is associated with developing ACS.

Asunto(s)

RESUMEN

Gastroparesis is a complex, debilitating dysmotility disorder with challenging symptom management. A diagnosis of gastroparesis is based on objectively delayed gastric emptying in the absence of mechanical obstruction. Given the limited efficacy of treatment options and serious side effects, significant research continues for therapeutic options for gastroparesis. Promising investigational pharmacologic therapies include relamorelin, prucalopride, and aprepitant. A novel endoscopic therapy is gastric peroral endoscopic pyloromyotomy, which is associated with improved gastric emptying. This article reviews both current and emerging therapeutic options for gastroparesis, including dietary modification and pharmacologic, electrical stimulation, endoscopic, and surgical therapies. Further research and novel treatment options are needed to address the substantial morbidity of gastroparesis.

RESUMEN

Although there are many articles in the literature on the etiology, classification, and management of gynecomastia, the entity of unilateral gynecomastia has not received much attention. In this article, 15 consecutive males (seen over a 10-year period) with unilateral gynecomastia were retrospectively reviewed. The study showed the unique presentation in this group of patients. One third of the patients (n = 5) had "cancer phobia" and were worried either because of the presence of a mass (n = 2) or because of the unilaterality of their disease (n = 3). The study also showed the predominance of true (glandular) gynecomastia, and this has also been observed in other cases of unilateral involvement in the literature. All patients underwent preoperative mammography. Mammographic findings were consistent with gynecomastia in all patients, including the 2 patients with concurrent breast masses. All patients underwent subcutaneous mastectomy, and histologic examination confirmed the diagnosis. Finally, the literature on unilateral gynecomastia was reviewed.

Asunto(s)