scholarly journals Telemedicine versus Physical Examination in Patients’ Assessment during COVID-19 Pandemic: The Dubai Experience

2021 ◽  
pp. 1-6
Author(s):  
Amr Elhennawy ◽  
Fateh Almohammed Alsalem ◽  
Salah Bahri ◽  
Noor Alarfaj
Keyword(s):  
Assessment Tool ◽  
Proper Time ◽  
Close Contact ◽  
Second Phase ◽  
Physical Assessment ◽  
Medical Centers ◽  
History Of ◽  
Initial Action ◽  
Trained Staff ◽  
Isolation Facility

<b><i>Introduction:</i></b> With the large number of cases during the COVID-19 pandemic, a smart tool was urgently needed to handle all the positive cases at proper time such as using the technology and implementing telemedicine for triage. <b><i>Objective:</i></b> The purpose of this study is to detect the accuracy and effectiveness of telemedicine as an assessment tool for triage compared to physical assessment. <b><i>Methods:</i></b> In a random sample of 1,086 COVID-19 positive cases during the pandemic in Dubai, all the patients were initially assessed by trained staff using telemedicine following a standardized guidelines and accordingly action was taken by sending the patient to an isolation facility or for hospital admission; the second phase of assessment was conducted physically at the facility. We compared the accuracy of assessment by telemedicine encounter versus physical assessment by detecting any changes of the initial action within 12 h. <b><i>Results:</i></b> Telemedicine was accurate in 1,080 out of 1,086 screened patients (99.4%). <b><i>Discussion:</i></b> Telemedicine offers fast and convenient response to patients needs with standardization of triage guidelines. Telemedicine has reduced exposure of the medical workers which reduced the possibility of infection as well as reduction of crowds at the medical centers. <b><i>Recommendations:</i></b> Telemedicine is very useful during the COVID-19 pandemic for following up the positive and suspected cases as well as cases with history of close contact with a confirmed positive case.

scholarly journals Chinesisation, adaptation and validation of the Chelsea Critical Care Physical Assessment Tool in critically ill patients: a cross-sectional observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e045550
Author(s):  
Zhigang Zhang ◽  
Guoqiang Wang ◽  
Yuchen Wu ◽  
Jin Guo ◽  
Nannan Ding ◽  
...  
Keyword(s):  
Critical Care ◽  
Observational Study ◽  
Critically Ill ◽  
Content Validity ◽  
Assessment Tool ◽  
Western China ◽  
Validity Index ◽  
Cross Sectional ◽  
Physical Assessment ◽  
Content Validity Index

PurposeTo translate and adapt the Chelsea Critical Care Physical Assessment Tool (CPAx) into Chinese version (‘CPAx-Chi’), test the reliability and validity of CPAx-Chi, and verify the cut-off point for the diagnosis of intensive care unit-acquired weakness (ICU-AW).Study designCross-sectional observational study.MethodsForward and back translation, cross-cultural adaptation and pretesting of CPAx into CPAx-Chi were based on the Brislin model. Participants were recruited from the general ICU of five third-grade class-A hospitals in western China. Two hundred critically ill adult patients (median age: 53 years; 64% men) with duration of ICU stay ≥48 hours and Glasgow Coma Scale ≥11 were included in this study. Two researchers simultaneously and independently assessed eligible patients using the Medical Research Council Muscle Score (MRC-Score) and CPAx-Chi.ResultsThe content validity index of items was 0.889. The content validity index of scale was 0.955. Taking the MRC-Score scale as standard, the criterion validity of CPAx-Chi was r=0.758 (p<0.001) for researcher A, and r=0.65 (p<0.001) for researcher B. Cronbach’s α was 0.939. The inter-rater reliability was 0.902 (p<0.001). The area under the receiver operating characteristic curves of CPAx-Chi for diagnosing ICU-AW based on MRC-Score ≤48 were 0.899 (95% CI 0.862 to 1.025) and 0.874 (95% CI 0.824 to 0.925) for researcher B. The best cut-off point for CPAx-Chi for the diagnosis of ICU-AW was 31.5. The sensitivity was 87% and specificity was 77% for researcher A, whereas it was 0.621, 31.5, 75% and 87% for researcher B, respectively. The consistency was high when taking CPAx-Chi ≤31 and MRC-Score ≤48 as the cut-off points for the diagnosis of ICU-AW. Cohen’s kappa=0.845 (p=0.02) in researcher A and 0.839 (p=0.04) for researcher B.ConclusionsCPAx-Chi demonstrated content validity, criterion-related validity and reliability. CPAx-Chi showed the best accuracy in assessment of patients at risk of ICU-AW with good sensitivity and specificity at a recommended cut-off of 31.

scholarly journals Multicenter point prevalence evaluation of the utilization and safety of drug therapies for COVID-19 at the onset of the pandemic timeline in the United States

2021 ◽  
Author(s):  
Nathaniel J Rhodes ◽  
Atheer Dairem ◽  
William J Moore ◽  
Anooj Shah ◽  
Michael J Postelnick ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Drug Therapy ◽  
Supportive Care ◽  
The United States ◽  
Primary Objective ◽  
Point Prevalence ◽  
Medical Centers ◽  
Academic Medical ◽  
History Of ◽  
Secondary Objective

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There are currently no FDA-approved medications for the treatment of coronavirus disease 2019 (COVID-19). At the onset of the pandemic, off-label medication use was supported by limited or no clinical data. We sought to characterize experimental COVID-19 therapies and identify safety signals during this period. Methods We conducted a non-interventional, multicenter, point prevalence study of patients hospitalized with suspected/confirmed COVID-19. Clinical and treatment characteristics within a 24-hour window were evaluated in a random sample of up to 30 patients per site. The primary objective was to describe COVID-19–targeted therapies. The secondary objective was to describe adverse drug reactions (ADRs). Results A total of 352 patients treated for COVID-19 at 15 US hospitals From April 18 to May 8, 2020, were included in the study. Most patients were treated at academic medical centers (53.4%) or community hospitals (42.6%). Sixty-seven patients (19%) were receiving drug therapy in addition to supportive care. Drug therapies used included hydroxychloroquine (69%), remdesivir (10%), and interleukin-6 antagonists (9%). Five patients (7.5%) were receiving combination therapy. The rate of use of COVID-19–directed drug therapy was higher in patients with vs patients without a history of asthma (14.9% vs 7%, P = 0.037) and in patients enrolled in clinical trials (26.9% vs 3.2%, P &lt; 0.001). Among those receiving drug therapy, 8 patients (12%) experienced an ADR, and ADRs were recognized at a higher rate in patients enrolled in clinical trials (62.5% vs 22%; odds ratio, 5.9; P = 0.028). Conclusion While we observed high rates of supportive care for patients with COVID-19, we also found that ADRs were common among patients receiving drug therapy, including those enrolled in clinical trials. Comprehensive systems are needed to identify and mitigate ADRs associated with experimental COVID-19 treatments.

Effects on insulin secretion and insulin action of a 48-h reduction of plasma free fatty acids with acipimox in nondiabetic subjects genetically predisposed to type 2 diabetes

2007 ◽  
Vol 292 (6) ◽  
pp. E1775-E1781 ◽  
Author(s):  
Kenneth Cusi ◽  
Sangeeta Kashyap ◽  
Amalia Gastaldelli ◽  
Mandeep Bajaj ◽  
Eugenio Cersosimo
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Secretion ◽  
Family History ◽  
Second Phase ◽  
Β Cell ◽  
C Peptide ◽  
Hyperglycemic Clamp ◽  
History Of ◽  
Plasma Ffa

Elevated plasma FFA cause β-cell lipotoxicity and impair insulin secretion in nondiabetic subjects predisposed to type 2 diabetes mellitus [T2DM; i.e., with a strong family history of T2DM (FH+)] but not in nondiabetic subjects without a family history of T2DM. To determine whether lowering plasma FFA with acipimox, an antilipolytic nicotinic acid derivative, may enhance insulin secretion, nine FH+ volunteers were admitted twice and received in random order either acipimox or placebo (double-blind) for 48 h. Plasma glucose/insulin/C-peptide concentrations were measured from 0800 to 2400. On day 3, insulin secretion rates (ISRs) were assessed during a +125 mg/dl hyperglycemic clamp. Acipimox reduced 48-h plasma FFA by 36% ( P < 0.001) and increased the plasma C-peptide relative to the plasma glucose concentration or ΔC-peptide/Δglucose AUC (+177%, P = 0.02), an index of improved β-cell function. Acipimox improved insulin sensitivity (M/I) 26.1 ± 5% ( P < 0.04). First- (+19 ± 6%, P = 0.1) and second-phase (+31 ± 6%, P = 0.05) ISRs during the hyperglycemic clamp also improved. This was particularly evident when examined relative to the prevailing insulin resistance [1/(M/I)], as both first- and second-phase ISR markedly increased by 29 ± 7 ( P < 0.05) and 41 ± 8% ( P = 0.02). There was an inverse correlation between fasting FFA and first-phase ISR ( r2 = 0.31, P < 0.02) and acute (2–4 min) glucose-induced insulin release after acipimox ( r2 =0.52, P < 0.04). In this proof-of-concept study in FH+ individuals predisposed to T2DM, a 48-h reduction of plasma FFA improves day-long meal and glucose-stimulated insulin secretion. These results provide additional evidence for the important role that plasma FFA play regarding insulin secretion in FH+ subjects predisposed to T2DM.

Topical interferon in recurrent inflammatory macular edema following a cat bite

2021 ◽  
pp. 112067212110248
Author(s):  
Ankush Kawali ◽  
Sanjay Srinivasan ◽  
Padmamalini Mahendradas ◽  
Rohit Shetty
Keyword(s):  
Macular Edema ◽  
Interferon Therapy ◽  
Close Contact ◽  
Invasive Treatment ◽  
Intravitreal Therapy ◽  
Therapeutic Trials ◽  
Anti Vegf ◽  
Vascular Growth Factor ◽  
History Of ◽  
Steroid Responsiveness

Introduction: Treating chronic macular edema (CME) post endophthalmitis is a challenge. Use of steroids may reactivate the infection and repeated intravitreal therapy with anti-vascular growth factor inhibitors (Anti-VEGF) puts the patient again at the risk of exacerbation of inflammation or endophthalmitis. We describe a case of CME post traumatic endophthalmitis successfully treated with topical interferon therapy. Case description: A 34-year-old Asian Indian lady with a history of cat bite to her right eye and treated elsewhere as traumatic endophthalmitis with recurrent macular edema, presented to us 1 year after the injury. She had received anti-VEGF injection for same. Her medical history was non-contributory except for close contact with her cat. Therapeutic trials with oral doxycycline followed by oral albendazole with steroids, as well as repeated anti-VEGF therapy failed to prevent recurrence of CME. Patient’s steroid responsiveness and reluctance for injections, made us to opt for a novel topical Interferon therapy. Macular edema resolved in 2 months. Interruption of interferon therapy due to COVID-lock down resulted in recurrence of the CME, which again responded well to interferon monotherapy. Conclusion: Topical interferon may have a role in the treatment of inflammatory macular edema and can serve as a, safer, economical and non-invasive treatment option compared to intravitreal steroids and anti-VEGFs.

Epidemiological Characteristics of Sport-Related Concussion in Athletes of Brazilian Jiu-Jitsu and Muay Thai

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S23.1-S23
Author(s):  
Carlos Pinheiro ◽  
Francisca Taciane Nascimento Sousa
Keyword(s):  
Close Contact ◽  
Cross Sectional Study ◽  
Self Report ◽  
Combat Sports ◽  
Cross Sectional ◽  
Brazilian Sample ◽  
Individual Interviews ◽  
History Of ◽  
The Moment ◽  
Epidemiological Characteristics

ObjectiveTo evaluate the self-reported history of concussion in athletes of both Brazilian Jiu-Jitsu (BJJ) and Muay Thai.BackgroundCombat sports are widely practiced around the world. They include modalities that involves punches or kicks directed at the opponent's head (Striking sports) or that consists of grabbing an opponent and taking him to the ground (Grappling sports). Due to the objectives and close contact in combat sports, the risk of concussion is significant.Design/MethodsThis was a cross-sectional study involving a Brazilian sample of BJJ athletes (n-18) and Muay Thai athletes (n-22). The sample was consisted of both professional and amateur athletes (Women constituted 20% of sample). Through individual interviews with a researcher the following data were collected: self-report of concussion and the moment of the injury (whether in practice or in the fight). The Post-Concussion Symptoms Scale (PCSS) was also applied. In the present study, a concussion was considered as a direct impact on the head followed by symptoms. This study was approved by a local Ethics Committee.ResultsAmong BJJ athletes, 61% reported a history of concussion, while among Muay Thai athletes the percentage was more higher (86%). The main mechanisms of head impact were the throw/takedown and elbow-hits to the head in BJJ and punches and knee-hits to the head in Muay Thai. There was no difference in the symptom score between BJJ and Muay Thai concussed athletes (average of 11 vs 10.7, respectively). The most common symptoms were dizziness, headache and nausea in BJJ athletes, and headache, nausea, drowsiness and brain fogginess in Muay Thai ones.ConclusionsThe results presented herein suggest that concussions in Muay Thai and BJJ occur through different mechanisms. The clinical profile of post-concussion symptoms appears to be different between BJJ and Muay Thai athletes.

A Pretest – Posttest Pilot Study for the Development and Preliminary validation of a tool for the clinical assessment of Radioiodine Induced Sialadenitis

2021 ◽  
Author(s):  
ANDRI CHRISTOU ◽  
Evridiki Papastavrou ◽  
Anastasios Merkouris ◽  
Andreas Charalambous
Keyword(s):  
Clinical Assessment ◽  
Assessment Tool ◽  
Internal Validity ◽  
Preliminary Evidence ◽  
Second Phase ◽  
Systematic Assessment ◽  
Reliable Tool ◽  
Kappa Test ◽  
Validity Tests ◽  
Eortc Qlq

Abstract Background: The clinical assessment of radioiodine -induced sialadenitis is relied on the observer-defined toxicity grading model. However, this model has significant limitations, the major one being the lack of systematic assessment based on objective criteria. The main aim of this study was the development and testing of an assessment tool which could examine the severity of post irradiation sialadenitis.Methods: The development of the Sialadenitis Assessment Tool proceeded through three phases. The first and second phase included a literature review and the development of the tool which derived from the review, respectively. The third phase involved a pilot testing of the Assessment Tool to a sample of 34 patients undergoing I131. The assessment was carried out by two independent HCPs, pre- and post-radioiodine therapy. The results of the assessment tool were compared to other scales, including the DIRIX and EORTC H&N35.Results: The Cohen’s kappa test, suggested that the Sialadenitis Assessment Tool (SAT) is a reliable tool for the assessment of sialadenitis (Cohen’s K =1). The concurrent and internal validity tests, showed a tendency of association with most variables (p <0.001) in the DIRIX s and EORTC QLQ-HN35 scales.Conclusions: Preliminary evidence show that Sialadenitis Assessment Tool is a valid and reliable tool to assess radioiodine-induced sialadenitis in patients undergoing I131 therapy post thyroidectomy.

Consequences of Migrating U.S. Contagious Facilities Into General Hospitals, 1900–1950

2021 ◽  
pp. 193758672110498
Author(s):  
Jeanne Kisacky
Keyword(s):  
General Hospital ◽  
Disease Incidence ◽  
Spatial Separation ◽  
General Hospitals ◽  
Hospital Facility ◽  
Contagious Disease ◽  
Contact Transmission ◽  
History Of ◽  
Isolation Facilities ◽  
Isolation Facility

Until the 1880s, hospitals excluded contagious disease patients from admission because of the danger they posed to other patients; by the 1950s, contagious disease care had literally moved into the general hospital. This article correlates the changing isolation facility designs with changing disease incidence and prevention strategies. It argues that isolation moved into the hospital in stages that have consequence for isolation facility design today. Between the 1890s and 1940s, contagious disease care shifted from remote isolation hospitals (commonly known as pest houses) to separate contagious disease hospitals, to contagious disease “units” adjacent to or within a general hospital facility, and to isolation rooms included in nursing units. The architectural history of isolation facility designs shows that the integration of isolation facilities into general hospitals relied on the success of new aseptic nursing procedures that prevented contact transmission but which downgraded the need for spatial separation to prevent airborne transmission. In the second half of the 20th century, federal funding and standards made isolation rooms in the hospital the norm. This migration coincided with a historically unprecedented reduction in contagious disease incidence produced by successful vaccines and antibiotics. By the 1980s, the rise of new and antibiotic resistant diseases led to extensive redesigns of the in-house isolation rooms to make them more effective. This article suggests that it is time to rethink isolation not just at the detail level but in terms of its location in relation to the general hospital.

Cefazolin and rifampin: A coagulopathy-inducing combination

2021 ◽  
Author(s):  
Natalia E Castillo Almeida ◽  
Ryan W Stevens ◽  
Pooja Gurram ◽  
Christina G Rivera ◽  
Gina A Suh
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Assessment Tool ◽  
International Normalized Ratio ◽  
Medication Therapy ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
History Of

Abstract Purpose To identify risk factors that may predispose patients to rifampin- and cefazolin-induced coagulopathy. Summary An 86-year-old man with a history of rheumatoid arthritis on chronic prednisone and stage 3 chronic kidney disease, notably not on warfarin, presented to the hospital with a 10-day history of right hip pain, swelling, and drainage after a recent right total-hip arthroplasty. The patient underwent a combination of surgical intervention and medication therapy with rifampin and ceftriaxone. After discharge and at postoperative day 9, ceftriaxone was changed to cefazolin due to increasing alkaline phosphatase levels. Four weeks after the initial debridement, antibiotics, and implant retention, the patient underwent a second irrigation and debridement due to persistent infection. Cefazolin and rifampin therapy was extended. Three days later, the patient presented to the emergency room with significant bleeding at the surgical site and a profoundly elevated prothrombin time and international normalized ratio (INR). No potential contributors were identified. The Naranjo adverse drug reaction probability scale identified cefazolin and rifampin as the probable cause of elevated INR. The Liverpool adverse drug reaction avoidability assessment tool classified this adverse event as “definitely avoidable.” Conclusion Rifampin-containing regimens are often recommended to treat staphylococcal prosthetic joint infections when the implant is retained. In methicillin-susceptible staphylococcal infections, cefazolin is routinely employed as the β-lactam backbone of definitive antimicrobial regimens. Although rifampin- and cefazolin-induced hypoprothrombinemia seems to be rare, adverse consequences of its occurrence may be prevented with appropriate monitoring.

scholarly journals TOWARDS A PANEVOLUTIONARY THEORY (PANEVO THEORY), FOLLOWING THE ACADEMIC OF FISIOCRITICI ENZO TIEZZI

2017 ◽  
Vol 8 (1-IT) ◽  
Author(s):  
Mario Tanga ◽  
Giacomo Gelati ◽  
Marco Casazza
Keyword(s):  
Charles Darwin ◽  
Current Knowledge ◽  
Close Contact ◽  
Rachel Carson ◽  
Starting Point ◽  
Science And Culture ◽  
History Of ◽  
Living Species ◽  
Definition Of ◽  
Scientific Fields

6Contemporary science and culture show more and more extended and meaningful signs about the increasing explaining power of evolutionary paradigm. This power overcomes the field of the history of living species. We consider “On the Origin of Species” of 1859 by Charles Darwin as the establishment of this paradigm, but this original and fruitful idea has received the several and different contributions from near and (seemingly) far scientific fields. This process happened according distinguishable waves and leaded the evolutionary theory very far from its starting point, making it something wider and different. The current knowledge of this theory involves many kinds of scholars: biologists, zoologists, botanists, development biologists, genetics/genomics scholars and also scholars of many other disciplines, as statistics, mathematics, ecology, environmental sciences, physics, chemistry, linguistics, sociology, neuro-sciences, epidemiology, informatics, immunology. During the end of XX Century, the study of complexity, of self-organization and of emerging properties has been a decisive factor to extend evolution until beyond the boundaries of Biology. These phenomena, or properties, or features, that are shown by “living” and “not-living” systems (so called basing ourselves on traditional definitions), have deeply modified even the “properly” biologic evolution itself and besides this has demonstrated that, mutatis mutandis, evolutionary processes or phenomena happen also out of biologic dominion, referring “biologic” to “wet-ware world”. This is to say the class of evolutionary phenomena is more widely and more inclusively extended than our opinion. We can mean this as a revolution (according to Kuhn’s definition) that imposes us to restructure the definition of evolution itself and even to redraw the boundaries and the map of Biology itself. Aiming to establish a name of this field of study we propose “PanEvolutionary Theory” (PanEvo Theory). No doubt Prigogine offered an important contribution to this area. The thinking and the work of Enzo Tiezzi can be placed seen in the same perspective. Disregarding direct connections and contacts with the Nobel Prize Prigogine, however the studies of Enzo Tiezzi are neither a fully unexpected work nor a theory lacking of important potentialities: it is not a strange or eccentric academic exercise. Except the close contact and the dense exchanges with Prigogine, we collocate Enzo Tiezzi in the same context of Gregory Chaitin, of Rachel Carson, of John Harte and Robert H. Socolow, of James Paul Wesley, of Sertorio, of Oort and Peixoto, just to cite the most strictly related. Our Academy had the privilege and the honor of having Enzo Tiezzi in its ranks. We think that merits and developments of the thinking of this scholar have to produce important and lasting fruits in the future.

scholarly journals Milestones in the History of Pediatric Surgery During the Byzantine Times

2020 ◽  
Vol 18 (1) ◽  
pp. 115-128
Author(s):  
Anastasia Oikonomou-Koutsiari ◽  
Georgios Zografos ◽  
Epameinondas Koutsiaris ◽  
Evangelos Menenakos ◽  
Effie Poulakou-Rebelakou
Keyword(s):  
Pediatric Surgery ◽  
Medical Specialty ◽  
Major Improvement ◽  
Surgical Disease ◽  
Medical Centers ◽  
The Status ◽  
Comprehensive Picture ◽  
History Of ◽  
Adults And Children ◽  
To Come

During the Byzantine Times, medicine and surgery developed as Greek physicians continued to practice in Constantinople. Healing methods were common for both adults and children, and pediatrics as a medical specialty did not exist. Already Byzantine hospitals became institutions to dispense medical services, rather than shelters for the homeless, which included doctors and nurses for those who suffered from the disease. A major improvement in the status of hospitals as medical centers took place in this period, and physicians were called archiatroi. Several sources prove that archiatroi were still functioning in the late sixth century and long afterward, but now as xenon doctors. Patients were averse to surgery due to the incidence of complications. The hagiographical literature repeated allusions to doctors. Concerns about children with a surgical disease often led parents to seek miraculous healings achieved by Christian Protectors – Saints. This paper is focused on three eminent Byzantine physicians and surgeons, Oribasius, Aetius of Amida, Paul of Aegina, who dealt with pediatric operations and influenced the European Medicine for centuries to come. We studied historical and theological sources in order to present a comprehensive picture of the curative techniques used for pediatric surgical diseases during the Byzantine Times.

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