Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was c...Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.展开更多
BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiar...BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiary children's hospital in Guangzhou, China and to investigate the risk factors associated with the mortality.METHODS: The mortality of pediatric patients at the hospital from 2011 to 2013 was retrospectively analyzed using descriptive statistics.RESULTS: Altogether 466 919 patients visited the PED during the period and 43 925 of them were admitted for further observation. In 230 deaths, the ratio of boys to girls was 1.4:1, and their age ranged from 2 hours to 16 years(median, 5 months). The time from admission to death ranged from 0 to 216 hours(median, 1.5 hours). There were 92(40%) patients who died within 24 hours after admission and 104(45.2%) patients who died on arrival. The prominent causes of the deaths were respiratory diseases, neuromuscular disorders, cardiovascular diseases, and sepsis, most of which were ascribed to severe infection. Sixty-five deaths were associated with more than one concomitant problem. The top concomitant problems were congenital malformation, low gestational age, and severe birth asphyxia.CONCLUSIONS: In our center, 40% of the patients in the PED died of fatal acute diseases, and pneumonia was the first leading cause of the deaths. Almost half of the deaths occurred on arrival and the rest were due to end-stage malignant diseases. This study emphasized the importance of prevention of birth deficits by reducing deaths in infants and children.展开更多
The study was conducted to isolate and determine the antibiotic resistance in Escherichia coli and Klebsiella pneumonia from urine samples over a 2-year period (August 2013-September 2015) at the La Paz Medical Center...The study was conducted to isolate and determine the antibiotic resistance in Escherichia coli and Klebsiella pneumonia from urine samples over a 2-year period (August 2013-September 2015) at the La Paz Medical Center, Malabo. A retrospective analysis of 785 urine culture samples over a 2-year period August 2013-September 2015 was carried out according to the routine protocol of urinalysis. Bacterial etiological agents were isolated from 155 (19.7%) samples with highest prevalence of Escherichia coli (55.5%) followed by Klebsiella pneumonia (23.2%), Proteus mirabilis (4.5%), Pseudomonas species (3.2%), Enterobacter species (2.6%), Enterococcus faecalis (2.6%) and others species (8.4%). The E. coli and K. pneumonia represent 78.7% of all isolated bacterial strains. The E. coli and K. pneumoniae isolates possess highly resistant to ampicillin, Trimethoprim/Sulfamethoxazole, Doxycycline, Amoxicicline/Clavulanic acid. Whereas K. pneumonia demonstrated also to be highly resistant to Gentamycin, Cefuroxime and Ceftriaxon, low level of resistance to Piperacilin/Tazobactam, Amikacin and the lowest to Imipenem. The alarming level of MDR strains to the first choice antibiotics treatment was observed.展开更多
AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was established.METHODS:Referral patterns to specialist clinics were optim...AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was established.METHODS:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were opened.Continuing education,guidelines and agreed instructions for referral were promoted by the IGS.Six quality indicators were developed by the Delphi method,rigorously designed and regularly monitored.Improvement was assessed by comparing 2010,2011 and 2012 indicators.RESULTS:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination.In this paper we describe a new integrated gastroenterology service established in April 2010.Waiting time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th 2012.Average cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal cancer.CONCLUSION:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.展开更多
A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign am...A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica,which regressed completely with medical therapy.In Western countries,the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm.Not surprisingly,there have been very few cases reported of this clinical entity within the United States.Moreover,we report a patient that had an extremely rare occurrence of two synchronous lesions,one involving the rectum and the other situated in the cecum.We review the current literature on the pathogenesis of invasive E.histolytica infection and ameboma formation,as well as management of this rare disease entity at a western medical center.展开更多
Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attr...Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attributed to anesthetic care at the Penn State Hershey Medical Center. Methods: Data was collected from retrospective chart review of available dental injury records, incident reports, and filed dental claims from January 2008 to June 2014. Results: Forty seven dental injuries were documented amongst 247,323 general anesthetics representing an overall incidence of 0.019%. Seventy percent of injuries occurred in patients with documented pre-existing prosthodontics or poor dentition and largely involved maxillary teeth (68%). Dental fracture (40%) and avulsion (40%) were the most common types of injury. Direct laryngoscopy was used in 60% of cases reporting dental injury;more than one attempt at securing the airway was required in 36% of cases. Total costs related to the injuries were $24347.65. Conclusions: Dental injury is often attributed to the actions of the anesthesiologist. The injury may be unnoticed until after surgery, what makes it difficult to identify the time and mechanism of injury. Our results suggest that the number of attempts at securing an airway is a risk factor for dental injury. Proper preoperative documentation of poor dentition, discussion with the patient about the increased risk of dental injury and detailed documentation of dental injury when it occurs is advised.展开更多
The analysis of closed claims and litigations can provide an invaluable tool to improve patient safety by minimizing adverse anesthesia-related outcomes. Analysis of collective data describing such claims is integral ...The analysis of closed claims and litigations can provide an invaluable tool to improve patient safety by minimizing adverse anesthesia-related outcomes. Analysis of collective data describing such claims is integral to develop new guidelines aimed to reduce adverse anesthesia-related events. In this study, we give a descriptive analysis of anesthesia-related claims at the Detroit Medical Center, Detroit, MI, USA. The study analyzed different components in anesthesia-related closed claims and litigations such as medical, demographic and socio-economic factors. From 67,000 procedures in anesthesiology care provider, related cases claims were made in 0.057% (38/67,000) of all cases. The majority of claims involved procedures involving Caucasian females aged 51-55 years. The highest risk periods involved early shift times during Monday and Tuesday, particularly of procedures performed during August. About 33% of all cases in which death occurred involved patients who received an Obstetrics/Gynecology or an Orthopedic procedure under general anesthesia. The majority of closed claims and litigations cases were distributed between procedures treating nerves injuries and anoxic encephalopathy. The OR and PACU at urban hospitals had the highest claim rates. MD anesthesiologists constituted the lowest proportion of all anesthesia providers involved in closed claims incidents. The average compensation paid was predominately in the range of $200,000-$250,000. In addition to reporting anesthesia related factors involved in closed claims and litigations this study also includes a series of recommendations which may work as a framework for improving anesthesia practices.展开更多
Radiation therapy after conservative breast surgery is an integral part of the treatment of early breast cancer</span><span style="font-family:Verdana;">.</span></span></span>&l...Radiation therapy after conservative breast surgery is an integral part of the treatment of early breast cancer</span><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The aim of radiotherapy is</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> to achieve the best coverage of </span><span style="font-family:Verdana;">the</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Planning</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Target Volume (PTV</span><span style="font-family:Verdana;">),</span><span style="font-family:Verdana;"> while reducing the dose to the Organs at Risk (OAR). Such goals are not always achievable with the conformal three dimensions plans (3DCRT). Recently, </span><span style="font-family:Verdana;">radiation</span><span style="font-family:Verdana;"> oncologist uses Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT)</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">for irradiating the breast. In this study, we compared 3DCRT, IMRT </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> VMAT for left breast cancer patients in terms of PTV coverage, OAR</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">We</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> also revised the different dose distribution in 1) different breast volume categories, 2) nodal irradiation versus breast only, and 3) boost versus no boost. Results</span><span style="font-family:Verdana;">:</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> routinely reported dose </span><span style="font-family:Verdana;">constrains</span><span style="font-family:Verdana;"> for the ipsilateral lung and </span><span style="font-family:Verdana;">for</span><span style="font-family:Verdana;"> the heart were not significantly different on comparing the three techniques. While for the contralateral lung, the difference in mean dose was in favor of 3DCRT.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">In large breast </span><span style="font-family:Verdana;">volume,</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">3DCRT provided a lower Max dose to the contralateral </span><span style="font-family:Verdana;">lung</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the</span></span></span><span><span><span style="font-family:""> <span style="font-family:Verdana;">lowest</span><span style="font-family:Verdana;"> mean dose to the contralateral breast when compared to IMRT p < 0. 046</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In</span></span></span><span><span><span style="font-family:""> <span style="font-family:Verdana;">case</span><span style="font-family:Verdana;"> of no nodal irradiation, the contralateral breast </span><span style="font-family:Verdana;">mean</span><span style="font-family:Verdana;"> dose was lower in 3DCRT in comparison to IMRT and VMAT p < 0.037. When boost dose was given, 3DCRT plans had produced a lower Max dose to the contralateral lung p < 0.017. Conclusion</span><span style="font-family:Verdana;">:</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> three techniques (3DCRT, IMRT, and VMAT) can meet the clinical dosimetry demands of radiotherapy for left breast cancer after conservative surgery, as long as the routinely OARs only (heart and ipsilateral lung) </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">are</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> reported. Our study showed that 3CDRT can provide a lower dose to the contralateral organs (breast and lung), </span><span style="font-family:Verdana;">specially</span><span style="font-family:Verdana;">, in case of large breast volumes, no nodal irradiation </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> when a boost </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">is </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">given</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.展开更多
Severe acute respiratory syndrome coronavirus 2 has thoroughly reshaped the medical landscape. Much has been written and discussed of the adaptations required by this pandemic, particularly in the realm of elective me...Severe acute respiratory syndrome coronavirus 2 has thoroughly reshaped the medical landscape. Much has been written and discussed of the adaptations required by this pandemic, particularly in the realm of elective medical care. While some areas of the country have, in recent weeks, seen a plateau or even a decrease in coronavirus 2019 case-burden, others remain face-to-face with significant ongoing morbidity and mortality. Furthermore, given eased restrictions across numerous states and municipalities, a widespread resurgence of the disease is not precluded. To that end, we have attempted to summarize experiences and best practices in the handling of breast imaging against the backdrop of the novel coronavirus, and we consider future directions.展开更多
Background: The Veterans Administration (VA) has been using telehealth to enhance Veteran access to high quality VA care for over a decade. Clinical video telehealth (CVT) is one such telehealth tool that allows Veter...Background: The Veterans Administration (VA) has been using telehealth to enhance Veteran access to high quality VA care for over a decade. Clinical video telehealth (CVT) is one such telehealth tool that allows Veterans the opportunity to be evaluated by specialists at the Indianapolis VA while they actually remain in their community (in their local healthcare setting). Such tools are reported to improve satisfaction by avoiding the need to make the long, stressful, and often costly trips to the Medical Center. Our goal is to describe the results of CVT implementation at the Indianapolis VA. Methods: A retrospective review of the data from 2011-2014 related to the use of CVT at the Indianapolis VA was undertaken. The data collected during this time period included: the number of CVT visits per year by specialty, the number of miles in travel avoided per visit, and patient satisfaction survey data, which are obtained after each CVT visit. Results: A total of 14,708 Veterans have enrolled in our CVT telehealth program since 2011. There were 23,267 visits in 2013. 486,170 miles related to travel were avoided (calculating the number of miles avoided in travel from home to a local satellite site as compared to having to travel from home to the Indianapolis VA). At the current Government reimbursement rate of $0.42/mile, this is expressed in a cost avoidance of $209,053. In total, since 2011, the telehealth CVT program has saved the Government $331,132, a total of 770,075 miles saved in travel for our Veterans. In addition, the CVT program has been very well received by our Veterans with an overall satisfaction score of 96%. Conclusion: Our results indicate that the implementation of CVT is cost effective and is well received by Veterans. Telehealth modalities such as CVT are viable options that enhance Veteran satisfaction by decreasing the time and the costs related to travel while continuing to offer high quality health care.展开更多
Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This...Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This is a 53-year-old patient received in the emergency department for partial amputation of the penis occurred, whose mechanism of occurrence would be the fall of a sheet metal from the roof of his house, with reception on the proximal end of the shaft leading to a partial rupture of it—here, with total urethral section. He has no medical-surgical history. The physical examination finds a good general condition, a partial tearing of the ventral face of the penis associated with a total rupture of the urethra followed by a hemorrhage, the rest of the examination was without particularity. The emergency assessment carried out was without particularity. The treatment consisted initially of catheterizing the urethra by a urinary tube ch 20, then a urethral replacement, followed by a Peno plastie. The surgical suites were enamelled with parietal suppuration plus necrosis at J 14 post-operative. A more bidaily dressing debridement followed with a favorable evolution at 2 months. Subsequently, a penile graft was performed more urethrolastic, with removal of the flap on the inner side of the thigh, the surgical suites were favorable on the sexual plane gradual resumption of night erections.展开更多
Objectives： Opioid medications consistently rank among the drugs most frequently associated with adverse events. We reviewed cases of naloxone administration to assess our opioid prescribing and administration practi...Objectives： Opioid medications consistently rank among the drugs most frequently associated with adverse events. We reviewed cases of naloxone administration to assess our opioid prescribing and administration practices before and after implementation of a computerized provider order entry （CPOE） system. Our primary measure was the rate of opioid reversal with naloxone in the two time periods. Methods： We systematically reviewed all cases of naloxone administration at our institution from March 2016 through May 2016 （before period） compared with cases from October 2017 through December 2017 （after period）. Results： In the before period, 0.58% of patients who received an opioid required reversal with naloxone compared with 0.16% in the after period （p 〈 0.001）. Subject demographics such as age, sex, BMI, and serum creatinine were not significantly different between the two groups. Similarly large proportions of patients in the before and after groups had at least 2 risk factors for over-sedation （79.5% and 75%, respectively, p = 0.17）. More than 84% and 61% of patients in the before and after groups, respectively, did not have documentation of an opioid on the admission medication history, suggesting they were opioid-naYve （p= 0.10）. Per our institution＇s policy on range orders, nurses should begin with the lowest prescribed opioid dose; this policy was followed in 58.3% in the before period and 69.2% in the after period （p = 0.36）. Conclusions： Doses of naloxone that were required for opioid reversal were significantly reduced after implementation of a CPOE system. Our opioid-reversal rate was comparable to similar studies; however, secondary endpoints indicate that opioid prescribing and administration habits may not account for patient-specific risk factors for over-sedation.展开更多
Background: Programs targeting serodiscordant couples in Africa are not a priority in efforts to prevent Human Immunodeficiency Virus (HIV) infection, although a large proportion of these occur in stable relationships...Background: Programs targeting serodiscordant couples in Africa are not a priority in efforts to prevent Human Immunodeficiency Virus (HIV) infection, although a large proportion of these occur in stable relationships, of which serodiscordance accounts for about two-thirds with a high risk of seroconversion of the seronegative partner. Objective: The objective of this study was to describe the profile of HIV serodiscordant couples followed in Kinshasa, DRC. Methods: Descriptive cross-sectional study to describe the profile of different heterosexual HIV serodiscordant couples followed at the Monkole Medical Center in Kinshasa, DRC, from November 2021 to June 2022. The data were collected from the information sheets elaborated by the research team as well as from the information provided by the computerized files of the patients managed at the Infectious Diseases Unit of the Monkole Medical Center after the signature of the informed consent. An average of 8 cc of blood was taken from a peripheral vein in the patient’s forearm, and was stored in EDTA tubes at −20˚C, of which at least 6 mL were used for biochemical analyses, 2 spots of 200 μL for each partner were stored on filter paper at −20˚C and were used for DNA extraction. Nested PCR confirmed the serological diagnosis. Results: Out of a total of 482 heterosexual couples followed for HIV at the Monkole Medical Center, 28 (5.8%) were HIV serodiscordant, of which 14 (2.9%) couples agreed to participate in the present study. The mean age was 43.39 ± 10 years with extremes ranging from 24 to 62 years. The patients were mainly from the informal sector (53.6%) and weighed between 61 and 71 kg (46.4%). Sexual intercourse continued in all couples, without condom use (85.7%) for desire of procreation (82.1%);although the great majority of HIV-negative partners (85.7%) were not under ARV prophylaxis. Leukopenia was found in 42.9% of HIV-negative partners compared to 21% of HIV-positive partners;all partners had a predominantly lymphocytic white blood cell count. 21.4% of HIV-negative partners had high HDL, 14.3% of HIV-positive partners had low HDL, and 14.3% of HIV-negative partners had high LDL. Chi-square and Pearson correlation tests showed no relationship between the biochemical parameters performed and the couples’ serodiscordance for HIV. Conclusion: The frequency of HIV discordant couples in Kinshasa is significant. Serodiscordance is encountered in young intellectual and entrepreneurial couples with a desire to procreate. It is desirable to carry out further analyses for better management of these couples.展开更多
Background The number of pediatric cases of infection with the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant has increased.Here,we describe the clinical characteristics of children in a te...Background The number of pediatric cases of infection with the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant has increased.Here,we describe the clinical characteristics of children in a tertiary children's medical center in Shanghai.Methods A total of 676 pediatric coronavirus disease 2019(COVID-19)cases caused by the Omicron variant who were admitted to the Shanghai Children's Medical Center from March 28 to April 30,2022 were enrolled in this single-center,prospective,observational real-world study.Patient demographics and clinical characteristics,especially COVID-19 vaccine status,were assessed.Results Children of all ages appeared susceptible to the SARS-CoV-2 Omicron variant,with no significant difference between sexes.A high SARS-CoV-2 viral load upon admission was associated with leukocytopenia,neutropenia,and thrombocytopenia(P=0.003,P=0.021,and P=0.017,respectively)but not with physical symptoms or radiographic chest abnormalities.Univariable linear regression models indicated that comorbidities(P=0.001)were associated with a longer time until viral clearance,and increasing age(P<0.001)and two doses of COVID-19 vaccine(P=0.001)were associated with a shorter time to viral clearance.Multivariable analysis revealed an independent effect of comorbidities(P<0.001)and age(P=0.003).The interaction effect between age and comorbidity showed that the negative association between age and time to virus clearance remained significant only in patients without underlying diseases(P<0.001).Conclusion This study describes the clinical characteristics of children infected with the Omicron variant of SARS-CoV-2 and calls for additional studies to evaluate the effectiveness and safety of vaccination against COVID-19 in children.展开更多
Background: This study was undertaken to investigatethe intraoperative and postoperative complications,efficacy and outcome of two laparoscopic fundoplicationsfor the treatment of esophageal hiatal hernia in children....Background: This study was undertaken to investigatethe intraoperative and postoperative complications,efficacy and outcome of two laparoscopic fundoplicationsfor the treatment of esophageal hiatal hernia in children.Methods: To find a rational procedure, we performeda retrospective analysis of 136 children with esophagealhiatal hernia who underwent laparoscopic Nissen-Rossettior Thal fundoplication at two children's hospitals inShanghai over 13 years. The median follow-up time of thechildren was 42 months (range: 1-138 months). Their agevaried from 1 month to 11 years (median: 18.6 months).Results: All the children underwent laparoscopicfundoplications (72 cases of Nissen-Rossetti and 60 casesof Thal fundoplication) and 4 children converted to opensurgery. The mean age of the children at the time ofoperation was 1.6±1.9 years, and the mean weight was9.1±5.6 kg. Gastroesophageal refl ux was signifi cantly moresevere after a Thal fundoplication (P=0.003) and slightesophageal stenosis was signifi cant after a Nissen-Rossettifundoplication (P=0.02). The recurrent rate of hiatal herniawas 2.8% (2/72) after Nissen-Rossetti fundoplication incontrast to 5% (3/60) after Thal fundoplication. No deathoccurred after surgery.Conclusions: There was no statistical difference ofrecurrence between laparoscopic Nissen-Rossetti and Thalfundoplication in the long-term outcomes. The rate of slightdysphagia was higher in the Nissen-Rossetti group. TheThal group had a significantly higher recurrence rate ofgastroesophageal reflux. There still exited learning curvefor this procedure. The incidence rate of complications issignifi cantly related to the profi ciency of pediatric surgeon.展开更多
Having pre-existing comorbidities is described as a risk factor for more severe disease in adult corona virus disease 2019(COVID-19)and in infections with SARS-CoV-1 and MERS-CoV[1].In adult SARS-CoV-2 infections,pati...Having pre-existing comorbidities is described as a risk factor for more severe disease in adult corona virus disease 2019(COVID-19)and in infections with SARS-CoV-1 and MERS-CoV[1].In adult SARS-CoV-2 infections,patients with pre-existing underlying comorbidities,such as chronic obstructive pulmonary disease,cardiovascular disease,diabetes and obesity,are more likely to have severe disease compared to healthy adults[2].An inconsistency is seen in current fndings on the association with comorbidities and pediatric COVID-19 severity.An important limitation in currently available studies is limited data:severe disease is rare in children compared to adults,and most studies describe COVID-19 severity merely by reporting intensive care unit(ICU)admission or mortality rates instead of detailed data on clinical presentation and outcomes.展开更多
In living donor liver transplantation(LDLT),early bifurcation of hepatic artery(HA)relative to the cutting line of bile duct(BD)requires additional skeletonization of the hilar plate,especially around BD,compared to o...In living donor liver transplantation(LDLT),early bifurcation of hepatic artery(HA)relative to the cutting line of bile duct(BD)requires additional skeletonization of the hilar plate,especially around BD,compared to opposite condition.Subsequently,it may preclude higher chances of biliary complications such as bile leak and biliary stenosis in the donor.Hence,donor surgeons should be well aware of the anatomical correlations among HA,BD,and portal vein(PV),based on preoperative 3-dimensional(3D)images,and also intraoperatively perform meticulous dissection of HA from the surrounding tissues and minimize the damage of microcirculation to the BD without using energy devices such as electrocautery(1).When extensive dissection around BD&its ischemic damage in the donor is expected to obtain single HA opening of the harvesting graft,we prefer separate two HA openings including right anterior and posterior HAs to single right HA(RHA)opening without skeletonization of donor’s BD.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
文摘Introduction: In Africa, care during childbirth depends on routine practices to the detriment of quality. The aim of this study was to assess the quality of delivery care at the Coronthie CMC. Methods: The study was carried out at the Coronthie Community Medical Center. It was a cross-sectional, descriptive and analytical study lasting 6 months, from July 01 to December 31, 2021. Parturients whose term was ≥28 SA and who agreed to participate in the study were included. Excluded were those with a term Results: The frequency of quality care is 36.7%. The average age of parturients was 28.6 ± 5 years. Most parturients (89.7%) were married women with secondary education (35%) and self-employed (32%). Pauciparous women accounted for 43.80%, and most parturients (59.8%) were delivered by Caesarean section. We found that 21.5% of parturients had developed complications. These complications were perineal trauma and post-partum haemorrhage. There were no maternal deaths, and the neonatal mortality rate was 20/1000 NV. Acute fetal distress was the main cause of perinatal death. Conclusion: Correct management of factors influencing childbirth could improve maternal and neonatal prognosis.
文摘BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiary children's hospital in Guangzhou, China and to investigate the risk factors associated with the mortality.METHODS: The mortality of pediatric patients at the hospital from 2011 to 2013 was retrospectively analyzed using descriptive statistics.RESULTS: Altogether 466 919 patients visited the PED during the period and 43 925 of them were admitted for further observation. In 230 deaths, the ratio of boys to girls was 1.4:1, and their age ranged from 2 hours to 16 years(median, 5 months). The time from admission to death ranged from 0 to 216 hours(median, 1.5 hours). There were 92(40%) patients who died within 24 hours after admission and 104(45.2%) patients who died on arrival. The prominent causes of the deaths were respiratory diseases, neuromuscular disorders, cardiovascular diseases, and sepsis, most of which were ascribed to severe infection. Sixty-five deaths were associated with more than one concomitant problem. The top concomitant problems were congenital malformation, low gestational age, and severe birth asphyxia.CONCLUSIONS: In our center, 40% of the patients in the PED died of fatal acute diseases, and pneumonia was the first leading cause of the deaths. Almost half of the deaths occurred on arrival and the rest were due to end-stage malignant diseases. This study emphasized the importance of prevention of birth deficits by reducing deaths in infants and children.
文摘The study was conducted to isolate and determine the antibiotic resistance in Escherichia coli and Klebsiella pneumonia from urine samples over a 2-year period (August 2013-September 2015) at the La Paz Medical Center, Malabo. A retrospective analysis of 785 urine culture samples over a 2-year period August 2013-September 2015 was carried out according to the routine protocol of urinalysis. Bacterial etiological agents were isolated from 155 (19.7%) samples with highest prevalence of Escherichia coli (55.5%) followed by Klebsiella pneumonia (23.2%), Proteus mirabilis (4.5%), Pseudomonas species (3.2%), Enterobacter species (2.6%), Enterococcus faecalis (2.6%) and others species (8.4%). The E. coli and K. pneumonia represent 78.7% of all isolated bacterial strains. The E. coli and K. pneumoniae isolates possess highly resistant to ampicillin, Trimethoprim/Sulfamethoxazole, Doxycycline, Amoxicicline/Clavulanic acid. Whereas K. pneumonia demonstrated also to be highly resistant to Gentamycin, Cefuroxime and Ceftriaxon, low level of resistance to Piperacilin/Tazobactam, Amikacin and the lowest to Imipenem. The alarming level of MDR strains to the first choice antibiotics treatment was observed.
文摘AIM:To combine community and hospital services inorder to enable improvements in patient management,an integrated gastroenterology service(IGS)was established.METHODS:Referral patterns to specialist clinics were optimized;open access route for endoscopic procedures(including esophago-gastro-duodenoscopy,sigmoidoscopy and colonoscopy)was established;family physicians’knowledge and confidence were enhanced;direct communication lines between experts and primary care physicians were opened.Continuing education,guidelines and agreed instructions for referral were promoted by the IGS.Six quality indicators were developed by the Delphi method,rigorously designed and regularly monitored.Improvement was assessed by comparing 2010,2011 and 2012 indicators.RESULTS:An integrated delivery system in a specific medical field may provide a solution to a fragmented healthcare system impaired by a lack of coordination.In this paper we describe a new integrated gastroenterology service established in April 2010.Waiting time for procedures decreased:3 mo in April 30th 2010 to 3 wk in April 30th 2011and stayed between 1-3 wk till December 30th 2012.Average cost for patient’s visit decreased from 691 to638 NIS(a decrease of 7.6%).Six health indicators were improved significantly comparing 2010 to 2012,2.5%to 67.5%:Bone densitometry for patients with inflammatory bowel disease,preventive medications for high risk patients on aspirin/NSAIDs,colonoscopy following positive fecal occult blood test,gastroscopy in Barrett’s esophagus,documentation of family history of colorectal cancer,and colonoscopy in patients with a family history of colorectal cancer.CONCLUSION:Establishment of an IGS was found to effectively improve quality of care,while being costeffective.
文摘A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated,necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy.These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica,which regressed completely with medical therapy.In Western countries,the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm.Not surprisingly,there have been very few cases reported of this clinical entity within the United States.Moreover,we report a patient that had an extremely rare occurrence of two synchronous lesions,one involving the rectum and the other situated in the cecum.We review the current literature on the pathogenesis of invasive E.histolytica infection and ameboma formation,as well as management of this rare disease entity at a western medical center.
文摘Background: Dental injury is the most common cause of malpractice claims against anesthesiologists in the United States. This study analyzed the incidence, risk factors, and consequences of dental injury directly attributed to anesthetic care at the Penn State Hershey Medical Center. Methods: Data was collected from retrospective chart review of available dental injury records, incident reports, and filed dental claims from January 2008 to June 2014. Results: Forty seven dental injuries were documented amongst 247,323 general anesthetics representing an overall incidence of 0.019%. Seventy percent of injuries occurred in patients with documented pre-existing prosthodontics or poor dentition and largely involved maxillary teeth (68%). Dental fracture (40%) and avulsion (40%) were the most common types of injury. Direct laryngoscopy was used in 60% of cases reporting dental injury;more than one attempt at securing the airway was required in 36% of cases. Total costs related to the injuries were $24347.65. Conclusions: Dental injury is often attributed to the actions of the anesthesiologist. The injury may be unnoticed until after surgery, what makes it difficult to identify the time and mechanism of injury. Our results suggest that the number of attempts at securing an airway is a risk factor for dental injury. Proper preoperative documentation of poor dentition, discussion with the patient about the increased risk of dental injury and detailed documentation of dental injury when it occurs is advised.
文摘The analysis of closed claims and litigations can provide an invaluable tool to improve patient safety by minimizing adverse anesthesia-related outcomes. Analysis of collective data describing such claims is integral to develop new guidelines aimed to reduce adverse anesthesia-related events. In this study, we give a descriptive analysis of anesthesia-related claims at the Detroit Medical Center, Detroit, MI, USA. The study analyzed different components in anesthesia-related closed claims and litigations such as medical, demographic and socio-economic factors. From 67,000 procedures in anesthesiology care provider, related cases claims were made in 0.057% (38/67,000) of all cases. The majority of claims involved procedures involving Caucasian females aged 51-55 years. The highest risk periods involved early shift times during Monday and Tuesday, particularly of procedures performed during August. About 33% of all cases in which death occurred involved patients who received an Obstetrics/Gynecology or an Orthopedic procedure under general anesthesia. The majority of closed claims and litigations cases were distributed between procedures treating nerves injuries and anoxic encephalopathy. The OR and PACU at urban hospitals had the highest claim rates. MD anesthesiologists constituted the lowest proportion of all anesthesia providers involved in closed claims incidents. The average compensation paid was predominately in the range of $200,000-$250,000. In addition to reporting anesthesia related factors involved in closed claims and litigations this study also includes a series of recommendations which may work as a framework for improving anesthesia practices.
文摘Radiation therapy after conservative breast surgery is an integral part of the treatment of early breast cancer</span><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The aim of radiotherapy is</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> to achieve the best coverage of </span><span style="font-family:Verdana;">the</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Planning</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> Target Volume (PTV</span><span style="font-family:Verdana;">),</span><span style="font-family:Verdana;"> while reducing the dose to the Organs at Risk (OAR). Such goals are not always achievable with the conformal three dimensions plans (3DCRT). Recently, </span><span style="font-family:Verdana;">radiation</span><span style="font-family:Verdana;"> oncologist uses Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT)</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">for irradiating the breast. In this study, we compared 3DCRT, IMRT </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> VMAT for left breast cancer patients in terms of PTV coverage, OAR</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">We</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> also revised the different dose distribution in 1) different breast volume categories, 2) nodal irradiation versus breast only, and 3) boost versus no boost. Results</span><span style="font-family:Verdana;">:</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> routinely reported dose </span><span style="font-family:Verdana;">constrains</span><span style="font-family:Verdana;"> for the ipsilateral lung and </span><span style="font-family:Verdana;">for</span><span style="font-family:Verdana;"> the heart were not significantly different on comparing the three techniques. While for the contralateral lung, the difference in mean dose was in favor of 3DCRT.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">In large breast </span><span style="font-family:Verdana;">volume,</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">3DCRT provided a lower Max dose to the contralateral </span><span style="font-family:Verdana;">lung</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the</span></span></span><span><span><span style="font-family:""> <span style="font-family:Verdana;">lowest</span><span style="font-family:Verdana;"> mean dose to the contralateral breast when compared to IMRT p < 0. 046</span><span style="font-family:Verdana;">.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In</span></span></span><span><span><span style="font-family:""> <span style="font-family:Verdana;">case</span><span style="font-family:Verdana;"> of no nodal irradiation, the contralateral breast </span><span style="font-family:Verdana;">mean</span><span style="font-family:Verdana;"> dose was lower in 3DCRT in comparison to IMRT and VMAT p < 0.037. When boost dose was given, 3DCRT plans had produced a lower Max dose to the contralateral lung p < 0.017. Conclusion</span><span style="font-family:Verdana;">:</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> three techniques (3DCRT, IMRT, and VMAT) can meet the clinical dosimetry demands of radiotherapy for left breast cancer after conservative surgery, as long as the routinely OARs only (heart and ipsilateral lung) </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">are</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> reported. Our study showed that 3CDRT can provide a lower dose to the contralateral organs (breast and lung), </span><span style="font-family:Verdana;">specially</span><span style="font-family:Verdana;">, in case of large breast volumes, no nodal irradiation </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> when a boost </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">is </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">given</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.
文摘Severe acute respiratory syndrome coronavirus 2 has thoroughly reshaped the medical landscape. Much has been written and discussed of the adaptations required by this pandemic, particularly in the realm of elective medical care. While some areas of the country have, in recent weeks, seen a plateau or even a decrease in coronavirus 2019 case-burden, others remain face-to-face with significant ongoing morbidity and mortality. Furthermore, given eased restrictions across numerous states and municipalities, a widespread resurgence of the disease is not precluded. To that end, we have attempted to summarize experiences and best practices in the handling of breast imaging against the backdrop of the novel coronavirus, and we consider future directions.
文摘Background: The Veterans Administration (VA) has been using telehealth to enhance Veteran access to high quality VA care for over a decade. Clinical video telehealth (CVT) is one such telehealth tool that allows Veterans the opportunity to be evaluated by specialists at the Indianapolis VA while they actually remain in their community (in their local healthcare setting). Such tools are reported to improve satisfaction by avoiding the need to make the long, stressful, and often costly trips to the Medical Center. Our goal is to describe the results of CVT implementation at the Indianapolis VA. Methods: A retrospective review of the data from 2011-2014 related to the use of CVT at the Indianapolis VA was undertaken. The data collected during this time period included: the number of CVT visits per year by specialty, the number of miles in travel avoided per visit, and patient satisfaction survey data, which are obtained after each CVT visit. Results: A total of 14,708 Veterans have enrolled in our CVT telehealth program since 2011. There were 23,267 visits in 2013. 486,170 miles related to travel were avoided (calculating the number of miles avoided in travel from home to a local satellite site as compared to having to travel from home to the Indianapolis VA). At the current Government reimbursement rate of $0.42/mile, this is expressed in a cost avoidance of $209,053. In total, since 2011, the telehealth CVT program has saved the Government $331,132, a total of 770,075 miles saved in travel for our Veterans. In addition, the CVT program has been very well received by our Veterans with an overall satisfaction score of 96%. Conclusion: Our results indicate that the implementation of CVT is cost effective and is well received by Veterans. Telehealth modalities such as CVT are viable options that enhance Veteran satisfaction by decreasing the time and the costs related to travel while continuing to offer high quality health care.
文摘Penis amputations are rare, they are most often observed in a criminal context or in the context of self-mutilation. We present the case of a partial amputation of the shaft in the context of a domestic accident. This is a 53-year-old patient received in the emergency department for partial amputation of the penis occurred, whose mechanism of occurrence would be the fall of a sheet metal from the roof of his house, with reception on the proximal end of the shaft leading to a partial rupture of it—here, with total urethral section. He has no medical-surgical history. The physical examination finds a good general condition, a partial tearing of the ventral face of the penis associated with a total rupture of the urethra followed by a hemorrhage, the rest of the examination was without particularity. The emergency assessment carried out was without particularity. The treatment consisted initially of catheterizing the urethra by a urinary tube ch 20, then a urethral replacement, followed by a Peno plastie. The surgical suites were enamelled with parietal suppuration plus necrosis at J 14 post-operative. A more bidaily dressing debridement followed with a favorable evolution at 2 months. Subsequently, a penile graft was performed more urethrolastic, with removal of the flap on the inner side of the thigh, the surgical suites were favorable on the sexual plane gradual resumption of night erections.
文摘Objectives： Opioid medications consistently rank among the drugs most frequently associated with adverse events. We reviewed cases of naloxone administration to assess our opioid prescribing and administration practices before and after implementation of a computerized provider order entry （CPOE） system. Our primary measure was the rate of opioid reversal with naloxone in the two time periods. Methods： We systematically reviewed all cases of naloxone administration at our institution from March 2016 through May 2016 （before period） compared with cases from October 2017 through December 2017 （after period）. Results： In the before period, 0.58% of patients who received an opioid required reversal with naloxone compared with 0.16% in the after period （p 〈 0.001）. Subject demographics such as age, sex, BMI, and serum creatinine were not significantly different between the two groups. Similarly large proportions of patients in the before and after groups had at least 2 risk factors for over-sedation （79.5% and 75%, respectively, p = 0.17）. More than 84% and 61% of patients in the before and after groups, respectively, did not have documentation of an opioid on the admission medication history, suggesting they were opioid-naYve （p= 0.10）. Per our institution＇s policy on range orders, nurses should begin with the lowest prescribed opioid dose; this policy was followed in 58.3% in the before period and 69.2% in the after period （p = 0.36）. Conclusions： Doses of naloxone that were required for opioid reversal were significantly reduced after implementation of a CPOE system. Our opioid-reversal rate was comparable to similar studies; however, secondary endpoints indicate that opioid prescribing and administration habits may not account for patient-specific risk factors for over-sedation.
文摘Background: Programs targeting serodiscordant couples in Africa are not a priority in efforts to prevent Human Immunodeficiency Virus (HIV) infection, although a large proportion of these occur in stable relationships, of which serodiscordance accounts for about two-thirds with a high risk of seroconversion of the seronegative partner. Objective: The objective of this study was to describe the profile of HIV serodiscordant couples followed in Kinshasa, DRC. Methods: Descriptive cross-sectional study to describe the profile of different heterosexual HIV serodiscordant couples followed at the Monkole Medical Center in Kinshasa, DRC, from November 2021 to June 2022. The data were collected from the information sheets elaborated by the research team as well as from the information provided by the computerized files of the patients managed at the Infectious Diseases Unit of the Monkole Medical Center after the signature of the informed consent. An average of 8 cc of blood was taken from a peripheral vein in the patient’s forearm, and was stored in EDTA tubes at −20˚C, of which at least 6 mL were used for biochemical analyses, 2 spots of 200 μL for each partner were stored on filter paper at −20˚C and were used for DNA extraction. Nested PCR confirmed the serological diagnosis. Results: Out of a total of 482 heterosexual couples followed for HIV at the Monkole Medical Center, 28 (5.8%) were HIV serodiscordant, of which 14 (2.9%) couples agreed to participate in the present study. The mean age was 43.39 ± 10 years with extremes ranging from 24 to 62 years. The patients were mainly from the informal sector (53.6%) and weighed between 61 and 71 kg (46.4%). Sexual intercourse continued in all couples, without condom use (85.7%) for desire of procreation (82.1%);although the great majority of HIV-negative partners (85.7%) were not under ARV prophylaxis. Leukopenia was found in 42.9% of HIV-negative partners compared to 21% of HIV-positive partners;all partners had a predominantly lymphocytic white blood cell count. 21.4% of HIV-negative partners had high HDL, 14.3% of HIV-positive partners had low HDL, and 14.3% of HIV-negative partners had high LDL. Chi-square and Pearson correlation tests showed no relationship between the biochemical parameters performed and the couples’ serodiscordance for HIV. Conclusion: The frequency of HIV discordant couples in Kinshasa is significant. Serodiscordance is encountered in young intellectual and entrepreneurial couples with a desire to procreate. It is desirable to carry out further analyses for better management of these couples.
基金This work was funded by the Innovative Research Team of High-Level Local Universities in Shanghai(SHSMUZDCX20212800)Science and Technology Commission Shanghai Municipality(20JC1410200,20JC1410204)+2 种基金2021 Shanghai University Teacher Training Plan-Industry University Research Practice Plan Project(EYJ26.RLO17)Shanghai Municipal Health Commission(2019SY049)Shanghai Medical Leading Talents Program(2019LJ22).
文摘Background The number of pediatric cases of infection with the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variant has increased.Here,we describe the clinical characteristics of children in a tertiary children's medical center in Shanghai.Methods A total of 676 pediatric coronavirus disease 2019(COVID-19)cases caused by the Omicron variant who were admitted to the Shanghai Children's Medical Center from March 28 to April 30,2022 were enrolled in this single-center,prospective,observational real-world study.Patient demographics and clinical characteristics,especially COVID-19 vaccine status,were assessed.Results Children of all ages appeared susceptible to the SARS-CoV-2 Omicron variant,with no significant difference between sexes.A high SARS-CoV-2 viral load upon admission was associated with leukocytopenia,neutropenia,and thrombocytopenia(P=0.003,P=0.021,and P=0.017,respectively)but not with physical symptoms or radiographic chest abnormalities.Univariable linear regression models indicated that comorbidities(P=0.001)were associated with a longer time until viral clearance,and increasing age(P<0.001)and two doses of COVID-19 vaccine(P=0.001)were associated with a shorter time to viral clearance.Multivariable analysis revealed an independent effect of comorbidities(P<0.001)and age(P=0.003).The interaction effect between age and comorbidity showed that the negative association between age and time to virus clearance remained significant only in patients without underlying diseases(P<0.001).Conclusion This study describes the clinical characteristics of children infected with the Omicron variant of SARS-CoV-2 and calls for additional studies to evaluate the effectiveness and safety of vaccination against COVID-19 in children.
基金supported by Foundation for Joint Research Project of the Emerging Cutting-edge Technology of Shanghai Shen Kang Hospital Development Center(No.SHDC12012110).
文摘Background: This study was undertaken to investigatethe intraoperative and postoperative complications,efficacy and outcome of two laparoscopic fundoplicationsfor the treatment of esophageal hiatal hernia in children.Methods: To find a rational procedure, we performeda retrospective analysis of 136 children with esophagealhiatal hernia who underwent laparoscopic Nissen-Rossettior Thal fundoplication at two children's hospitals inShanghai over 13 years. The median follow-up time of thechildren was 42 months (range: 1-138 months). Their agevaried from 1 month to 11 years (median: 18.6 months).Results: All the children underwent laparoscopicfundoplications (72 cases of Nissen-Rossetti and 60 casesof Thal fundoplication) and 4 children converted to opensurgery. The mean age of the children at the time ofoperation was 1.6±1.9 years, and the mean weight was9.1±5.6 kg. Gastroesophageal refl ux was signifi cantly moresevere after a Thal fundoplication (P=0.003) and slightesophageal stenosis was signifi cant after a Nissen-Rossettifundoplication (P=0.02). The recurrent rate of hiatal herniawas 2.8% (2/72) after Nissen-Rossetti fundoplication incontrast to 5% (3/60) after Thal fundoplication. No deathoccurred after surgery.Conclusions: There was no statistical difference ofrecurrence between laparoscopic Nissen-Rossetti and Thalfundoplication in the long-term outcomes. The rate of slightdysphagia was higher in the Nissen-Rossetti group. TheThal group had a significantly higher recurrence rate ofgastroesophageal reflux. There still exited learning curvefor this procedure. The incidence rate of complications issignifi cantly related to the profi ciency of pediatric surgeon.
文摘Having pre-existing comorbidities is described as a risk factor for more severe disease in adult corona virus disease 2019(COVID-19)and in infections with SARS-CoV-1 and MERS-CoV[1].In adult SARS-CoV-2 infections,patients with pre-existing underlying comorbidities,such as chronic obstructive pulmonary disease,cardiovascular disease,diabetes and obesity,are more likely to have severe disease compared to healthy adults[2].An inconsistency is seen in current fndings on the association with comorbidities and pediatric COVID-19 severity.An important limitation in currently available studies is limited data:severe disease is rare in children compared to adults,and most studies describe COVID-19 severity merely by reporting intensive care unit(ICU)admission or mortality rates instead of detailed data on clinical presentation and outcomes.
文摘In living donor liver transplantation(LDLT),early bifurcation of hepatic artery(HA)relative to the cutting line of bile duct(BD)requires additional skeletonization of the hilar plate,especially around BD,compared to opposite condition.Subsequently,it may preclude higher chances of biliary complications such as bile leak and biliary stenosis in the donor.Hence,donor surgeons should be well aware of the anatomical correlations among HA,BD,and portal vein(PV),based on preoperative 3-dimensional(3D)images,and also intraoperatively perform meticulous dissection of HA from the surrounding tissues and minimize the damage of microcirculation to the BD without using energy devices such as electrocautery(1).When extensive dissection around BD&its ischemic damage in the donor is expected to obtain single HA opening of the harvesting graft,we prefer separate two HA openings including right anterior and posterior HAs to single right HA(RHA)opening without skeletonization of donor’s BD.
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
