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I n t r o d u c t i o n: Despite increased awareness of malnutrition and improved nutrition-related policies, there are still cases of deterioration of nutritional status during hospitalisation. NutritionDay is an audit organised by the European Society for Clinical Nutrition and Metabolism (ESPEN), the Medical University of Vienna and the Friedrich-Alexander University Erlangen-Nürnberg (FAU) to prevent the onset of malnutrition and to improve hospital policies to deal with this problem. The aim of the study was to analyse the results of the audit with regard to factors that may contribute to the deterioration of a patients' nutritional status in hospital setting. Materials and Methods: This cross-sectional study was performed in a tertiary teaching hospital and was part of an international audit. The questionnaires used were provided by the nutritionDay office, and included information on weight loss, patients' appetite, dietary restrictions, food intake and reasons for food rejection during hospital stay. R e s u l t s: Of the examined patients, 61% reported weight loss prior to the current hospital stay. We identified 25 patients who did not consume a whole portion of their main meal on the day the audit took place. Approximately 17% of the patients' complaints could be resolved within a hospital ward. C o n c l u s i o n s: Hospital patients often eat less than a standard meal portion. Identifying the reasons for meal rejection may be helpful for development of standards for nutritional care in the hospitals.

Asunto(s)

Desnutrición , Estado Nutricional , Humanos , Estudios Transversales , Masculino , Femenino , Persona de Mediana Edad , Desnutrición/epidemiología , Desnutrición/prevención & control , Servicio de Alimentación en Hospital/normas , Polonia , Adulto , Anciano , Hospitales Universitarios , Comidas , Encuestas y Cuestionarios

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BACKGROUND AND OBJECTIVES: The primary objective of this study was to evaluate the influence of operating room nurse (ORN) characteristics on the duration of elective neurosurgical procedures in adults. In addition, we conducted a cost-benefit analysis of various strategies for organizing the workflow of ORNs. METHODS: We collected and analyzed operating times for adult elective neurosurgical procedures, categorizing them by surgeon, procedure complexity (dichotomized as technologically complex and simple), and ORN characteristics (dichotomized as ORN dedicated to neurosurgery [dORN] and ORN not dedicated to neurosurgery [ndORN]). The monetary valuation of operating times is based on the unitary cost per minute of the operating room, including opportunity costs of ORN, as well as their training costs and salaries. Cost-benefit analysis adopted the hospital perspective. RESULTS: Analysis of operating times reveals an approximately 20-minute difference for complex procedures when performed with ndORN. However, there is no significant difference in operating times for simple procedures, whether they are conducted by dORN or ndORN. The additional annual cost incurred by complex procedures performed with ndORN is estimated at CHF 68 144.4 for the Geneva University Hospitals. CONCLUSION: Complex neurosurgical procedures exhibit shorter durations when performed by dORNs. We explore several hypotheses to explain this difference. By adapting available human resources and optimizing workflow organization, hospitals can potentially achieve a net benefit.

Asunto(s)

Análisis Costo-Beneficio , Hospitales Universitarios , Procedimientos Neuroquirúrgicos , Quirófanos , Tempo Operativo , Humanos , Quirófanos/economía , Procedimientos Neuroquirúrgicos/economía , Procedimientos Neuroquirúrgicos/métodos , Hospitales Universitarios/economía , Adulto , Eficiencia Organizacional , Flujo de Trabajo , Neurocirugia/economía

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OBJECTIVE: To understand how nursing care management occurred during the COVID-19 pandemic. METHOD: A qualitative study conducted at a university hospital in São Paulo, Brazil. The sample consisted of eight nurses who worked caring for patients who tested positive for COVID-19. Data collection was carried out through semi structured interviews about experiences in managing care in coping with the pandemic. Thematic analysis and interpretation based on psychodynamics of work were used in data analysis. RESULTS: The results allowed constructing three thematic categories: The invisible that limits: biosafety, distress, uncertainty and fear of the pandemic, protecting oneself and ensuring the protection of others; Management work process instruments: team training, staff sizing, materials management, creative practice in the face of insufficiency; The competencies involved with the team, teamwork and leadership. CONCLUSION: Care management in COVID-19 was permeated by objective and subjective conditions, with situations of distress, pleasure, fear, insecurity and creative adaptation. Teamwork and leadership competencies, when present, can alleviate the distress that occurs in nursing work.

Asunto(s)

COVID-19 , Liderazgo , Personal de Enfermería en Hospital , Humanos , COVID-19/enfermería , Brasil , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/organización & administración , Femenino , Investigación Cualitativa , Adulto , Actitud del Personal de Salud , Hospitales Universitarios , Masculino , Adaptación Psicológica , Entrevistas como Asunto , Persona de Mediana Edad , Miedo

RESUMEN

Introduction: polysensitization is often defined as sensitization to three or more contact allergens. The objectives of our study were to determine the prevalence of polysensitization to allergens patch test and to analyze the factors associated with allergen polysensitization of the European Standard Battery in comparison with cases of oligosensitization. Methods: this is a retrospective descriptive cross-sectional study that included all patients who had undergone patch tests at the Department of Dermato-Allergology of the Department of Occupational Medicine of University Hospital Center Farhat Hached in Sousse spread over 10 years from January 1, 2009 to December 31, 2018. Results: in total, we collected 464 cases of contact dermatitis during the study period. The average age of patients was 38.93 ± 12.52 years with a slight female predominance (52.8% of cases). Among all the patients who consulted during the study period (832 patients), 133 patients had positive reactions to 3 or more allergens 16% of patients. Concerning, the associations of the most frequently noted allergens were those of triplet (chromium, cobalt, and nickel) in 15 patients and triplet (mercaptobenzothiazole, thiuram mix, and IPPD) in 7 cases. The predictive factors of polysensitivity were the personal history of leg ulcers; the site of the lesions in the thorax and the erythematous squamous and dyshidrotic appearance of the lesions. Conclusion: this phenomenon is frequent polysensitization, and close collaboration between dermatologists and occupational physicians to prevent this type of multiple allergies through better management of personal and also professional risk factors.

Asunto(s)

Alérgenos , Dermatitis Alérgica por Contacto , Hospitales Universitarios , Pruebas del Parche , Humanos , Femenino , Estudios Retrospectivos , Masculino , Estudios Transversales , Persona de Mediana Edad , Túnez/epidemiología , Adulto , Alérgenos/inmunología , Dermatitis Alérgica por Contacto/epidemiología , Dermatitis Alérgica por Contacto/etiología , Prevalencia , Adulto Joven , Anciano , Adolescente , Dermatitis Profesional/epidemiología , Dermatitis Profesional/etiología

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Objectives: This study aimed to determine the health-related quality of life (HRQoL) of adult Omani patients with sickle cell disease (SCD). The quality of life of these patients in Oman is unknown. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from June to October 2022 and included patients with SCD. A validated Arabic version of the 36-Item Short-Form Health Survey (SF-36) was used to assess HRQoL in 8 domains. Results: A total of 235 patients with SCD were included in this study, the majority of whom were female (74.9%) and between 18 and 35 years of age (64.6%). The lowest HRQoL was reported for the domain of role limitations due to physical health (median score = 25.0, interquartile range [IQR] = 35.0), while the highest was seen for role limitations due to emotional problems (median score = 66.7, IQR = 100.0). Frequent SCD-related emergency department visits/hospital admissions and the adverse effect of SCD on patients' social lives had a significant negative impact on SF-36 scores for all 8 HRQoL domains (P ≤0.05). Additionally, SCD's impact on academic performance and a history of having been bullied due to SCD had a significant negative impact on SF-36 scores for 7 domains (P ≤0.05). Conclusion: Omani adult patients with SCD reported relatively poor HRQoL in several domains, with various factors found to be significantly associated with this. Healthcare providers and policy makers should consider offering additional clinical, educational and financial support to these patients to enhance their HRQoL.

Asunto(s)

Anemia de Células Falciformes , Hospitales Universitarios , Calidad de Vida , Humanos , Calidad de Vida/psicología , Anemia de Células Falciformes/psicología , Anemia de Células Falciformes/epidemiología , Omán/epidemiología , Masculino , Femenino , Adulto , Estudios Transversales , Adolescente , Hospitales Universitarios/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven , Persona de Mediana Edad

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INTRODUCTION: Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. METHODS: Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. RESULTS: Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p<0.001) and 36.7% vs. 12.9% (p<0.001), respectively. The independent risk factors for C-AKI were chronic kidney disease (CKD), chronic liver disease, age, and hospitalization for cardiovascular disease. Those for H-AKI were CKD, heart failure as comorbidities, hypotension, and edema at hospital admission. H-AKI was an independent risk factor for death in the hospital, but not at 12 months. C-AKI was not a risk factor for death. CONCLUSIONS: AKI occurred in more than half of the admissions to the clinical emergency department of the hospital and was equally distributed between C-AKI and H-AKI. Many patients had correctable risk factors for AKI, such as dehydration and arterial hypotension (44%) at admission. The only independent risk factor for both C-AKI and H-AKI was CKD as comorbidity.

Asunto(s)

Lesión Renal Aguda , Servicio de Urgencia en Hospital , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Brasil/epidemiología , Masculino , Femenino , Anciano , Estudios Prospectivos , Factores de Riesgo , Servicio de Urgencia en Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Adulto , Hospitalización/estadística & datos numéricos , Comorbilidad

RESUMEN

INTRODUCTION: Migraine is the second most common type of primary headache disorder in Europe, accounting for 2.8% of visits to emergency departments. Some studies have shown that emergency departments may approach the disorder in ways that may be insufficient or inadequate. MATERIALS AND METHODS: A retrospective observational study was conducted of patients with migraine who were discharged from the adult emergency department of the Hospital Universitario Virgen del Rocio in 2020. Variables related to their healthcare were analysed. RESULTS: 73.9% were women, with a mean age of 38 years. They were not asked about the frequency of their migraines. The mean length of time patients spent in the emergency department before receiving initial medical care was 45 minutes (standard deviation: 41). Computed tomography scans were requested for 27.4% of the patients, and these were not pathological. Nonsteroidal anti-inflammatory drugs were the most commonly used treatment for the symptoms. Opioids were also used. Preventive treatments were prescribed in 6% of cases. CONCLUSIONS: Management of migraines by emergency departments is limited, and as such continuous and updated training is important. The use of triptans and occipital nerve blocks should be encouraged, and the use of opioids, among other drugs, should cease.

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TITLE: Manejo de la migraña en los servicios de urgencias hospitalarios: estudio observacional retrospectivo realizado en el Hospital Universitario Virgen del Rocío.Introducción. La migraña es el segundo tipo de cefalea primaria más frecuente en Europa y supone el 2,8% de las visitas a los servicios de urgencias. Algunos estudios muestran que su abordaje en urgencias puede ser insuficiente o inadecuado. Materiales y métodos. Se realiza un estudio observacional retrospectivo en pacientes con migraña a los que se les dio de alta en 2020 del servicio de urgencias de adultos del Hospital Universitario Virgen del Rocío. Se analizan las variables relacionadas con su atención sanitaria. Resultados. El 73,9% fueron mujeres, con una edad media de 38 años. En ningún caso se preguntó por la frecuencia de las crisis. El tiempo medio de estancia hasta la primera asistencia médica fue de 45 minutos (desviación estándar: 41). Se solicitaron tomografías computarizadas para el 27,4% de los pacientes, que no fueron patológicas. El tratamiento sintomático más usado fueron los antiinflamatorios no esteroideos. También se usaron opioides. Se prescribieron preventivos en el 6% de los casos. Conclusiones. El manejo de las migrañas en los servicios de urgencias es subóptimo, por lo que es importante una formación continuada y actualizada. Debe potenciarse el uso de los triptanes y el bloqueo del nervio occipital, y abandonarse el uso de los opioides, entre otros.

Asunto(s)

Servicio de Urgencia en Hospital , Trastornos Migrañosos , Humanos , Estudios Retrospectivos , Femenino , Trastornos Migrañosos/terapia , Trastornos Migrañosos/tratamiento farmacológico , Masculino , Adulto , Persona de Mediana Edad , Hospitales Universitarios , España , Adulto Joven

RESUMEN

BACKGROUND: Leadership is a critical competency for medical professionals, yet it is often neglected in medical training. For ObGyn residents, leadership training is particularly crucial as it significantly impacts both maternal and newborn outcomes, as well as the operational efficiency of healthcare teams. The main objective of this study was to assess the perceptions of obstetrics and gynecology residents who served as group leaders in the emergency team at the Department of Gynecology, Ward 3, Dr. Ruth K.M. Pfau Civil Hospital Karachi. METHODS: A Cross-sectional survey was conducted with purposively sampled 28 year-4 residents who worked as group leaders during last 3 years (from 2018 to 2020) of their residency program at the emergency team in the department of Gynecology Ward 3 Dr Ruth KM Pfau Civil Hospital Karachi. The perceptions on leadership were assessed on 25 items scale sent through a questionnaire on email. Grading of responses was done using a 4-point ordinal scale where 1 meant little importance and 4 was regarded as having great importance. Data was summarized with relevant descriptive statistics and was analyzed on SPSS version 22. RESULTS: The mean age of residents was 30.36. The mean leadership scores of the group of residents were calculated to be 77.50 (SD ± 9.57) while 14(50%) residents showed good and 14 (50%) showed excellent leadership skills based on cumulative scores. Of the 25 traits examined in this study, the highest reported trait was humility 3.82 (± 0.39) followed by empowerment 3.68 (± 0.77) and effective communication 3.68 (± 0.77). While responding about learning experiences, 89.3% of participants felt that the experience enhanced their decision-making skills and boosted their confidence in dealing with emergencies. CONCLUSION: Our study highlights the critical importance of leadership development in the training of ObGyn residents, particularly in high-pressure emergency settings. The findings reveal that residents value leadership traits such as humility, empowerment, and effective communication, which are essential for building teamwork and ensuring optimal patient outcomes and patient satisfaction.

Asunto(s)

Servicio de Urgencia en Hospital , Ginecología , Internado y Residencia , Liderazgo , Obstetricia , Humanos , Estudios Transversales , Pakistán , Obstetricia/educación , Ginecología/educación , Adulto , Femenino , Masculino , Encuestas y Cuestionarios , Hospitales de Enseñanza , Hospitales Universitarios

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There is evidence that antibiotics are sometimes prescribed inappropriately by dental practitioners, which can lead to undesirable outcomes. This study aimed to assess the impact of a clinical audit on antibiotic prescribing practices at Taibah University Dental Hospital in Madina, Saudi Arabia. The study retrospectively analyzed antibiotic-prescribing data for pediatric patients by dental interns and faculty members over a period of 8-months. The data collected revealed that inappropriate antibiotic prescription was prevalent initially, with a total of 119 antibiotic-prescriptions issued. After implementing an action plan that included the use of guidelines and educational sessions, a second cycle of the audit was conducted over a 4-month period. During the second cycle, the number of antibiotic prescriptions significantly decreased to 58, indicating a reduction of 48%. Across both cycles, amoxicillin emerged as the most frequently prescribed antibiotic, closely followed by Augmentin. Notably, pulpal diseases and peri-radical complications were consistently ranked as the conditions with the highest number of antibiotic prescriptions in both study periods. The results suggest that the clinical audit, along with the implementation of guidelines and educational sessions, had a positive impact on antibiotic prescribing practices at Taibah University Dental Hospital, leading to a significant reduction in inappropriate antibiotic prescriptions.

Asunto(s)

Antibacterianos , Prescripción Inadecuada , Pautas de la Práctica en Odontología , Humanos , Antibacterianos/uso terapéutico , Prescripción Inadecuada/estadística & datos numéricos , Prescripción Inadecuada/prevención & control , Pautas de la Práctica en Odontología/estadística & datos numéricos , Estudios Retrospectivos , Arabia Saudita , Niño , Auditoría Clínica , Auditoría Odontológica , Hospitales Universitarios , Prescripciones de Medicamentos/estadística & datos numéricos , Prescripciones de Medicamentos/normas

RESUMEN

We observed at our university-based imaging centers that when prostate-specific membrane antigen (PSMA) PET/CT became available for staging and restaging prostate cancer, the volume of bone scanning on patients with prostate cancer (BS-P) markedly decreased. We aimed to study use patterns of PSMA PET/CT and BS-P at our imaging centers during the 4-y period around U.S. Food and Drug Administration approval of PSMA PET/CT in December 2020. We tested the hypothesis that the rate of decline of BS-P accelerated after U.S. Food and Drug Administration approval, as physicians planned for use of PSMA PET/CT in their patients. Methods: Our clinical report system was searched for BS-P and PSMA PET/CT scans from January 2019 through June 2023. Numbers of scans were tabulated by quarter and year. Quantitative and statistical analyses were performed. Results: Annualized average monthly BS-P peaked at 53.7 scans/mo in 2021 and then decreased over time. There were 552 BS-Ps performed in 2019, 503 in 2020, 614 in 2021, 481 in 2022, and 152 in the first half of 2023. BS-P monthly averages declined by 22% from 2021 to 2022 and by 36% from 2022 to 2023, whereas monthly PSMA PET/CT scan averages increased by 1,416% from 2021 to 2022 and by 69% from 2022 to 2023. There was a significantly greater decline in BS-Ps from 2022 to 2023 than from 2021 to 2022 (36% vs. 22%, P < 0.0001). There were 30 PSMA PET/CT scans performed in 2021, 455 in 2022, and 384 in the first half of 2023. The greatest quarterly increase in these scans (400%) occurred at the outset of PSMA PET/CT implementation in quarter 4 of 2021. In quarter 2 of 2023, the percentage of total studies was higher for PSMA PET/CT than for BS-P (74% vs. 26%, P < 0.0001). Conclusion: At our university-based imaging centers, use of BS-P has declined in correlation with the timing of U.S. Food and Drug Administration approval and implementation of PSMA PET/CT. This study illustrates one instance of workflow changes that occur in the nuclear medicine clinic when new agents are introduced and affect clinical management options.

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Antígenos de Superficie , Glutamato Carboxipeptidasa II , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata , Humanos , Masculino , Antígenos de Superficie/metabolismo , Huesos/diagnóstico por imagen , Neoplasias Óseas/diagnóstico por imagen , Glutamato Carboxipeptidasa II/metabolismo , Hospitales Universitarios , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata/diagnóstico por imagen

RESUMEN

OBJECTIVE: to detect the incidence of postoperative delirium in critically ill patients admitted to a surgical intensive care unit and to evaluate the predisposing and precipitating factors associated with postoperative delirium in critically ill patients admitted to a surgical intensive care unit. METHOD: this is a prospective cohort study of 157 critically ill surgical patients. Fisher's exact test and Chi-square test were used for the association between factors and the occurrence of delirium, the Wilcoxon test for numerical variables, and the logistic regression model for the analysis of predisposing and precipitating factors. RESULTS: the incidence of delirium was 28% (n=44). Age was a significant predisposing factor (p=0.001), followed by the length of surgery (p<0.001), blood transfusion (p=0.043), administration of crystalloids (p=0.008), and anti-inflammatory drugs (p=0.037), which were the precipitating factors identified. The best-adjusted models were: age, length of surgery, non-administration of anti-emetics, use of sufentanil, and blood transfusion. CONCLUSION: delirium is a frequent condition in critically ill adults undergoing surgery and the existence of precipitating and predisposing factors is relevant to the outcome, with the anesthetic-surgical procedure as the catalyst event.

Asunto(s)

Enfermedad Crítica , Delirio , Unidades de Cuidados Intensivos , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Delirio/epidemiología , Delirio/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Factores Desencadenantes , Hospitales Universitarios , Adulto , Incidencia , Factores de Riesgo , Estudios de Cohortes

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Coinfección , Hospitales Universitarios , Malaria , Fiebre Tifoidea , Nigeria/epidemiología , Humanos , Fiebre Tifoidea/epidemiología , Fiebre Tifoidea/complicaciones , Estudios Retrospectivos , Coinfección/epidemiología , Coinfección/parasitología , Masculino , Femenino , Adulto , Hospitales Universitarios/estadística & datos numéricos , Adolescente , Niño , Preescolar , Adulto Joven , Persona de Mediana Edad , Lactante , Anciano

RESUMEN

BACKGROUND: Among chronic condition problems, tuberculosis still represents a serious public health problem globally. OBJECTIVE: To investigate latent tuberculosis infection in patients with Crohn's disease. Retrospective, descriptive cross-sectional study of quantitative analysis. METHODS: The research was conducted on diagnosed cases of Crohn's disease at the University Hospital located in a city in Northeastern Brazil. All cases of patients with Crohn's disease undergoing isoniazid or rifampicin therapy for latent tuberculosis (LTBI) were included in the study. The data obtained were subsequently subjected to statistical analysis using the Statistical Package for the Social Sciences (SPSS) program. RESULTS: We analyzed 235 medical records, and it was observed that 56% were male, with a mean age of 42.7. Among these, 54% declared themselves as brown, 31% had completed high school, and 47% were residents of the city of Teresina. Regarding the clinical and epidemiological characteristics of the studied patients classified as having ILTB, 34% of the medical records were diagnosed by tuberculin test, 48.51% were investigated by x-ray examination, and the recent location affected the colon with 27%. CONCLUSION: Overall, the health profile of the participants in this study aligns with findings previously established in the literature, particularly studies conducted in other Brazilian states, as well as in other developing countries.

Asunto(s)

Enfermedad de Crohn , Hospitales Universitarios , Tuberculosis Latente , Humanos , Masculino , Estudios Retrospectivos , Enfermedad de Crohn/complicaciones , Femenino , Adulto , Estudios Transversales , Tuberculosis Latente/epidemiología , Tuberculosis Latente/complicaciones , Tuberculosis Latente/diagnóstico , Brasil/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Persona de Mediana Edad , Adulto Joven , Adolescente , Rifampin/uso terapéutico , Anciano , Isoniazida/uso terapéutico , Antituberculosos/uso terapéutico

RESUMEN

OBJECTIVE: To evaluate the prevalence of burnout among the intensive care unit team of a university hospital after the second wave of COVID-19 and identify the key factors associated with its development. METHODS: This single-center study included 395 employees from a multidisciplinary team. The participants completed a questionnaire based on the Maslach Burnout Inventory. Multivariate analysis was used to identify the factors associated with burnout. RESULTS: Of 395 participants, 220 responded to the questionnaire (response rate: 56%). The prevalence of Burnout syndrome, defined as a severe score in at least one dimension, was 64.5% (142/220). Emotional distress was the most prevalent dimension, with a severe score affecting 50.5% (111/220) of the participants, followed by depersonalization at 39.1% (86/220). Only 5.9% (13/220) had severe scores in all three dimensions. Multivariate analysis revealed that being a physician was significantly associated with severe burnout symptoms in at least one dimension (odds ratio (OR), 1.32; 95% confidence interval (95%CI): 1.57-9.05; p=0.003). Additionally, having two or more jobs was associated with burnout in the three dimensions (OR=1.65; 95%CI=1.39-19.59; p=0.01). CONCLUSION: This study highlights the alarming prevalence of burnout among intensive care unit teams, particularly among physicians, following the second wave of COVID-19. This emphasizes the need for targeted interventions and support systems to mitigate burnout and reduce its negative impact on healthcare professionals' well-being and patient care.

Asunto(s)

Agotamiento Profesional , COVID-19 , Unidades de Cuidados Intensivos , Humanos , COVID-19/epidemiología , COVID-19/psicología , Agotamiento Profesional/epidemiología , Agotamiento Profesional/psicología , Femenino , Masculino , Unidades de Cuidados Intensivos/estadística & datos numéricos , Prevalencia , Adulto , Factores de Riesgo , Persona de Mediana Edad , Brasil/epidemiología , Encuestas y Cuestionarios , SARS-CoV-2 , Estudios Transversales , Pandemias , Hospitales Universitarios/estadística & datos numéricos

RESUMEN

Mycetoma can be caused either by fungi or aerobic Actinomycetes. A precise identification of the causal agents is critical for the therapeutic outcome. Thus, this study aimed to identify the pathogens of mycetoma using 16S/ITS rRNA gene polymerase chain reaction (PCR) followed by Sanger sequencing directly on grains. In sum, 32 samples including 15 black grains, 12 red grains, and five white/yellow grains collected from patients with mycetoma at the Aristide Le Dantec University Hospital in Dakar, Senegal, between October 2014 and September 2020 were submitted to PCR/sequencing. For black grain eumycetoma, the ITS rRNA region was targeted. Similarly, the 16S rRNA gene was targeted for red grain actinomycetoma. These two regions were targeted in parallel for white/yellow grains, which could be of either bacterial or fungal origin. The age of the patients ranged from 14 to 72 years with a mean age of 36 ± 14 years. Thirteen (86%) of the 15 samples with black grains, were successfully sequenced with only one established eumycetoma pathogen, Madurella mycetomatis identified in 11 (73%). Cladosporium sphaerospermum was identified in one sample. For the 16S rRNA sequencing of red grains, a 58.3% (7/12) success rate was obtained with Actinomadura pelletieri identified in six samples. Among the five samples sequenced twice, the 16S rRNA allowed us to identify the causative agent in 2 cases, A. madurae in one, and A. geliboluensis in the other. The ITS rRNA identified 3 fungi, of which none was a mycetoma agent. Overall, direct 16S/ITS rRNA sequencing of the grains for detecting and identifying mycetoma pathogens was successful in 59.4% of cases. Fungi, led by M. mycetomatis, were the predominant pathogens identified. Two probable new mycetoma agents, C. sphaerospermum, and A. geliboluensis were identified and both deserve to be confirmed in further studies.

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Hospitales Universitarios , Micetoma , Reacción en Cadena de la Polimerasa , ARN Ribosómico 16S , Micetoma/microbiología , Micetoma/diagnóstico , Humanos , ARN Ribosómico 16S/genética , Adulto , Senegal , Persona de Mediana Edad , Masculino , Adolescente , Adulto Joven , Anciano , Femenino , Reacción en Cadena de la Polimerasa/métodos , Proyectos Piloto , Análisis de Secuencia de ADN , ADN Espaciador Ribosómico/genética , Madurella/genética , Madurella/aislamiento & purificación , Hongos/genética , Hongos/aislamiento & purificación , Hongos/clasificación , ADN de Hongos/genética , Actinobacteria/genética , Actinobacteria/aislamiento & purificación , Actinobacteria/clasificación

RESUMEN

Introduction: the present study aimed to establish an epidemiological profile of patients consulting the unit of maxillofacial prosthodontics in Rabat. Results deriving from this study will help enhance the quality of patient care in our center and can also serve as a comparison tool with other maxillofacial teams around the world. Methods: during 11 months all patients consulting the unit of maxillofacial prosthodontics in our center were included. We opted for a questionnaire with 3 variables: socio-demographics, clinical examination data, and the type of prosthetic treatment adopted. The study was conducted in the Department of Removable Prosthodontics in the Center of Consultation and Dental Treatment of Rabat Morocco (CCDTR) from September 2020 to July 2021. Results: the study population consisted of 91 patients, with a majority of male patients at 53% (n=48). During our study period, the proportion of patients under one-year-old was predominant, accounting for 38.4% (n=35) of the total sample. Among the patients in the sample, 72.5% (n=66) had no profession, while 66% (n=60) had a low income. Regarding medical insurance, the majority of our patients, 85.5% (n=78), were covered by Public Health Insurance for the Low-income Population (PHILP). Among the total sample, 57.1% (n=52) consulted for a combination of pain function and aesthetics. Additionally, 61.5% (n=56) were referred by teaching hospitals. For the type of oro-facial defect, 52.7% (n=48) of the sample consisted of newborns with congenital facial cleft. Out of the 91 patients, 36 had maxillofacial tumors, with 47.6% (n=17) of them presenting squamous cell carcinoma. Furthermore, 63.7% (n=58) of the prosthetic treatments adopted involved presurgical orthopedic treatments for newborns with facial cleft. Conclusion: the study on the epidemiological profile of patients attending the maxillofacial prosthodontics unit at Ibn Sina University Hospital in Rabat, Morocco provides important insights. The findings highlight the predominance of male patients and the prevalence of oro-facial defects in newborns. Socioeconomic factors, such as low income and lack of profession, are significant considerations. The majority of patients are covered by the PHILP, indicating the importance of medical insurance. These findings contribute to improving healthcare planning and specialized care for this patient population.

Asunto(s)

Hospitales Universitarios , Humanos , Marruecos/epidemiología , Masculino , Estudios Transversales , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Adolescente , Niño , Preescolar , Lactante , Encuestas y Cuestionarios , Anciano , Prostodoncia

RESUMEN

BACKGROUND: The neurological, airway, respiratory, cardiovascular and other, with a subscore of surgical severity (NARCO-SS) is a scoring system which assesses the presence of systemic disease and the risk the operation poses to the patient. A number of patients that undergo major abdominal surgery suffer adverse events. The aim of the study was to determine the reliability of NARCO-SS in predicting peri-operative adverse events and to determine the risk factors for peri-operative adverse events in paediatric patients undergoing elective abdominal surgery. MATERIALS AND METHODS: Prospective cohort study. Consecutively sampled patients from December 2019 to December 2020 were used. Patients scheduled for elective abdominal surgery were scored pre-operatively and end points were; when an adverse event occurred or up to day 30. Analysis of the reliability of the tool, bivariate and multivariate logistics regression was done. RESULTS: One hundred and nineteen patients were enrolled and 49% of them had adverse events. Both bivariate and multivariate analyses showed no significant association between the NARCO-SS score and the occurrence of adverse events. The area under the receiver operating characteristics curve (area under the curve) of the NARCO-SS for adverse events was 0.518; there was a significant correlation between high scores and mortality. Longer duration of surgery and complex surgery were the risk factors for adverse events. CONCLUSIONS: The NARCO-SS score was found to be a poor predictor of adverse events with a fair inter-rater reliability as a scoring tool. Future research could evaluate a modification of neurological and airway categories.

Asunto(s)

Abdomen , Procedimientos Quirúrgicos Electivos , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Procedimientos Quirúrgicos Electivos/efectos adversos , Estudios Prospectivos , Complicaciones Posoperatorias/epidemiología , Niño , Preescolar , Abdomen/cirugía , Zambia , Hospitales de Enseñanza , Medición de Riesgo/métodos , Factores de Riesgo , Lactante , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Hospitales Universitarios , Adolescente , Curva ROC

RESUMEN

BACKGROUND: Nephroblastoma is the most common primary malignant renal tumour of childhood. The survival rates in high-income countries are approximately 90%. However, low-income countries have low survival rates of 20%-50%. This study assessed factors associated with treatment outcomes of children post-nephrectomy for nephroblastoma at the University Teaching Hospital and Cancer Diseases Hospital in Lusaka, Zambia. MATERIALS AND METHODS: A retrospective observational cohort study was conducted, where all children diagnosed with unilateral Wilms tumour below the age of 16 years who had nephrectomy from July 2016 to June 2019 were enrolled. Sociodemographic, clinical characteristics and treatment outcomes were noted. All data were coded and stored in a tabular format using Microsoft Excel. Statistical software STATA version 13 was used for analysis. RESULTS: Thirty patients were enrolled. The male-to-female ratio was 1:1. The 1-year event-free survival was 46.7%. Treatment abandonment accounted for 36.6% of the participants. 16.7% of the patients had disease progression. No patient had a relapse or died during the 1-year follow-up period. 66.7% had advanced disease stages III and IV. Advancement in age (above 4.3 years), living in a rural environment more than 100 km away from Lusaka and advanced disease stage were all associated with a poor outcome. CONCLUSIONS: Factors associated with a poor outcome in this study were advanced age and late presentation.

Asunto(s)

Neoplasias Renales , Nefrectomía , Tumor de Wilms , Humanos , Tumor de Wilms/cirugía , Tumor de Wilms/mortalidad , Masculino , Femenino , Zambia , Neoplasias Renales/cirugía , Estudios Retrospectivos , Preescolar , Niño , Lactante , Hospitales de Enseñanza , Adolescente , Resultado del Tratamiento , Hospitales Universitarios , Tasa de Supervivencia/tendencias

RESUMEN

RUNX1 is essential during human hematopoiesis. Numerous RUNX1 deregulations have been described, including translocations and germline or somatic mutations. Recurrent de novo RUNX1 mutations in acute myeloid leukemias (AML) prompted the creation of a provisional entity of AML with mutated RUNX1 in the 2016 WHO. In addition, recent genomic studies underlined rare AML patients with plasmacytoid dendritic cell (pDC) expansion and high RUNX1 mutations frequency. To better characterized AML with RUNX1 mutations, we retrospectively investigated a cohort of 32 patients diagnosed at Strasbourg University Hospital. Detailed clinical and biological features were aggregated. The presence of a pDC contingent was assessed by cytology and flow cytometry. In our cohort, no common features were identified either in term of cytology, stage of leukemia arrest or mutational features. Based on our observations, mutated RUNX1 AMLs do not appear to be a distinct AML entity. The new 2022 WHO classification includes AML with mutated RUNX1 within AML myelodysplasia-related category. We also identified within our cohort a patient whose AML fulfilled AML-pDC criteria, a rare and newly included entity in the last WHO classification.

Asunto(s)

Subunidad alfa 2 del Factor de Unión al Sitio Principal , Hospitales Universitarios , Leucemia Mieloide Aguda , Mutación , Humanos , Subunidad alfa 2 del Factor de Unión al Sitio Principal/genética , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/patología , Masculino , Femenino , Estudios Retrospectivos , Hospitales Universitarios/organización & administración , Persona de Mediana Edad , Anciano , Adulto , Francia/epidemiología , Adulto Joven , Anciano de 80 o más Años , Estudios de Cohortes

RESUMEN

This study analyzed hospital safety and the risk of falls in elderly people in a university hospital in Brazil. The Morse Falls Scale was used to stratify the risk of falls in 45 hospitalized elderly individuals, and two checklists were used to analyze the hospital environment. The analysis was based on the Chi-square test and multiple regression. The moderate risk of falls was predominant (51.1%). The variable age group (p-value = 0.024) showed statistical evidence of association with the risk of falls. However, the multiple regression analysis showed no difference between the age groups and the risk situation for falls. The hospital wards showed an adequate arrangement of furniture, but some aspects had inadequacies, such as objects in the corridors, non-functional bells in some beds, inadequacy of the toilet bowls in terms of the recommended height, and an absence of non-slip flooring and the support bar in some bathrooms. In conclusion, the moderate risk of falls among the elderly and the adequacy of the hospital environment to technical standards were evident with the exception of failures in the emergency communication system and sanitary installation.

Asunto(s)

Accidentes por Caídas , Accidentes por Caídas/estadística & datos numéricos , Humanos , Brasil , Anciano , Estudios Transversales , Femenino , Masculino , Anciano de 80 o más Años , Persona de Mediana Edad , Factores de Riesgo , Hospitales Universitarios , Hospitales/estadística & datos numéricos