scholarly journals Tomografia Computadorizada de Abdome na Urgência: o Uso Exagerado das Tecnologias Médicas e a Desvalorização do Diagnóstico Clínico

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 498-504
Author(s):  
Henrique Soares Silva ◽  
Fernanda Kelly Fraga Oliveira ◽  
Lourivania Oliveira Melo Prado ◽  
Marcos Almeida-Santos ◽  
Francisco Prado Reis
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Clinical Diagnosis ◽  
Obstructive Uropathy ◽  
Hospital Costs ◽  
Diagnostic Errors ◽  
Cross Sectional Study ◽  
Urgent Care ◽  
Cross Sectional ◽  
The Difference

ABSTRACT The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

scholarly journals Abdominal Computed Tomography in the Emergency Room: Overuse of Medical Technologies and the Depreciation of Clinical Diagnosis

2019 ◽  
Vol 43 (1 suppl 1) ◽  
pp. 498-504
Author(s):  
Henrique Soares Silva ◽  
Fernanda Kelly Fraga Oliveira ◽  
Lourivania Oliveira Melo Prado ◽  
Marcos Almeida-Santos ◽  
Francisco Prado Reis
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Emergency Room ◽  
Clinical Diagnosis ◽  
Obstructive Uropathy ◽  
Hospital Costs ◽  
Diagnostic Errors ◽  
Urgent Care ◽  
Cross Sectional ◽  
Abdominal Computed Tomography

ABSTRACT The number of computed tomography (CT) examinations performed in urgent care has been increasing since its introduction in the emergency room (ER). This has led to a substantial increase in hospital costs and patient’s exposure to ionizing radiation, which has led to the need for more judicious use of CT in the ER. The aim of this study is to show the difference between clinical (pre-CT), tomographic (post-CT) and definitive diagnoses in patients with abdominal CT in the ER. This is a cross-sectional study, with retrospective data collection through electronic medical records. A total of 834 patients with acute abdominal pain (AAP) lasting less than 7 days, submitted to abdominal computed tomography between January 1, 2016 and December 31, 2017 were selected. Clinical, tomographic and final diagnoses were recorded and submitted to a concordance analysis by calculating the Kappa coefficient, considering p <0.05 as significant. CT scans were considered unnecessary when the clinical diagnosis was concordant when both final and post-CT diagnosis were also concordant. The most frequent diagnoses were nonspecific abdominal pain (NSAP), obstructive uropathy (OU) and appendicitis (AP), corresponding to 73.6%, 58.5% and 61.3% of all diagnoses, respectively. Data analysis showed a moderate Concordance for NSAP (kappa: 0.41, p ¬<0.001) and for OU (kappa: 0.46, p <0.001) and excellent for AP (kappa:0.87, p <0.001). In total, 52.6% of computed tomography were considered unnecessary for NSAP, 82.4% for OU and 91.7% for AP. It was concluded that there are high rates of CT that may be considered unnecessary for the diagnosis of the main emergency conditions, especially appendicitis. The study warns to the exaggerated use of CT in the ER and raise discussions over the possible causes, such as lack of confidence in the clinical diagnosis, fear of diagnostic errors and fear of malpractice lawsuits, of which possible solutions may be more effective when applied since the medical education basis.

Computed Tomography Angiography (CTA) Evaluation of Spontaneous Subarachnoid Hemorrhage

2020 ◽  
Vol 6 (2) ◽  
pp. 78-81
Author(s):  
Md Tauhidul Islam Chowdhury ◽  
Mohammad Shah Jahirul Hoque Chowdhury ◽  
Mohammad Sadekur Rahman Sarkar ◽  
KM Ahasan Ahmed ◽  
Md Nazmul Kabir ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Hemorrhage ◽  
Computed Tomography Angiography ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Multiple Aneurysm ◽  
Traumatic Subarachnoid Hemorrhage ◽  
One Year ◽  
Spontaneous Subarachnoid Hemorrhage

Background: In evaluation of non-traumatic subarachnoid hemorrhage CT angiography (CTA) has 97-98% sensitivity and near 100% specificity. Objective: This study was conducted to evaluate the CTA findings of CT positive non traumatic subarachnoid hemorrhage. Methodology: This is an observational cross sectional study performed in Neurology department of National Institute of Neurosciences and Hospital, Dhaka over one year period (January 2019 to December 2019). Total 87 CT positive subarachnoid hemorrhage cases were purposively included in this study. All CT positive patients underwent CTA of Cerebral vessels for further evaluation. The angiography were evaluated by competent neuro-radiologists blinded about the study. Result: Among 87 patients, 40.2% were male and 59.8% were female. The average age was 53.33±11.1 years. Among the studied patient the source of bleeding was found 78.16% aneurysmal and 21.84% non-aneurysmal. 85.30% patients had single aneurysm and 14.70% had multiple aneurysm. The highest number of patient had Acom aneurysm (41.17%) followed by MCA (22.05%), ICA (13.23%), ACA (7.35%) and vertebral artery (1.14%) in order of frequency. Among the multiple aneurysm group most of the patients had combination of Acom, MCA and ICA aneurysm. Conclusion: From this study, we can conclude that CTA can be used as the primary diagnostic tool in evaluation of spontaneous SAH. Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 78-81

Brief Overview and Experience of Visual Evoked Potential of First 67 cases at Referral Neuroscience Hospital in Bangladesh

2020 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
Mohammad Enayet Hussain ◽  
Bithi Debnath ◽  
AFM Al Masum Khan ◽  
Md Ferdous Mian ◽  
Md Nahidul Islam ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Clinical Diagnosis ◽  
Optic Neuropathy ◽  
Cross Sectional Study ◽  
P Value ◽  
Pattern Reversal ◽  
Cross Sectional ◽  
The Mean ◽  
Visual Evoked

Background: The visual evoked potentials (VEP) is a valuable tool to document occult lesions of the central visual channels especially within the optic nerve. Objectives: The purpose of the present study was to observe the findings of first few cases of VEP done in the neurophysiology department of the National Institute of Neurosciences (NINS), Dhaka, Bangladesh. Methodology: This cross-sectional study was conducted in the Department of Neurophysiology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from September 2017 to March 2020. All patients referred to the Neurophysiology Department of NINS for VEP were included. Pattern reversal VEPs were done using standard protocol set by International Federation of Clinical Neurophysiology (IFCN). Results: The mean age of the study population was 30.70 (±12.11) years (6-68 years) with 31 (46.3%) male and 36 (53.7%) female patients. The mean duration of illness was 8.71 (±1.78) months (3 days- 120 months). Most common presenting symptom was blurring of vision (37.3%) and dimness of vision (32.8%). Patterned VEP revealed mixed type (both demyelinating and axonal) of abnormality in most cases [29(43.35)]. The most common clinical diagnosis was multiple sclerosis (29.85%) and optic neuropathy (26.87%). In the clinically suspected cases of multiple sclerosis, optic neuropathy and optic neuritis most of the cases of VEP were abnormal and the p value is 0.04 in optic neuropathy and optic neuritis. Conclusion: The commonest presentation of the patients in this series were blurring of vision and dimness of vision. The most common clinical diagnosis for which VEP was asked for, was optic neuritis and multiple sclerosis. Most abnormalities were of mixed pattern (demyelinating and axonal). Journal of National Institute of Neurosciences Bangladesh, 2020;6(2): 74-77

Perceived social support and burden of care of male and female caregivers of patient with schizophrenia

2017 ◽  
Vol 8 (1) ◽  
pp. 10
Author(s):  
Narendra Kumar Singh ◽  
Nishant Goyal
Keyword(s):  
Social Support ◽  
Perceived Social Support ◽  
Family Members ◽  
Well Being ◽  
Cross Sectional Study ◽  
Burden Of Care ◽  
Cross Sectional ◽  
Male And Female ◽  
The Social ◽  
The Difference

Background: Schizophrenia is associated with a high familial, social and economic burden. Schizophrenia is also associated with a high level of disability which may create impediments on the social and economic areas of the patients as well as on their respective family networks. Families with schizophrenia may encounter problems such as impairment of health and well being of other family members, restriction of social activities of the family members and shrinking of support from the social network. Aims: The present study examined the difference in perceived social support and burden of care between the male and female caregivers of patients with schizophrenia. Methods: This was a cross-sectional study examining the difference in perceived social support and burden of care between the male and female caregivers of patients with schizophrenia. The sample consisted of 60 (30 male and 30 female) caregivers of the patients with the diagnosis of schizophrenia as per ICD-10-DCR. Results and Conclusion: This study revealed that male caregivers perceived more social support and less burden of care as compared to female caregivers. Key words: Gender, social support, burden

Hepatitis A Seroprevalence Among Patients with Chronic Hepatitis B Infection: A Cross-Sectional Study in Iran During 2016-2017

2020 ◽  
Vol 20 (5) ◽  
pp. 748-751
Author(s):  
Seyed Ali Dehghan Manshadi ◽  
Neda Alijani ◽  
Mohammadreza Salehi ◽  
Omid Dadras ◽  
SeyedAhmad SeyedAlinaghi ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Hepatitis A ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cross Sectional ◽  
Reasonable Approach ◽  
The Difference ◽  
Prevention Method

Introduction: The aim of this study was to determine the prevalence of exposure to hepatitis A by means of serologic markers in chronic hepatitis B patients, with the secondary aim of finding the best prevention method for hepatitis A infection in susceptible groups of our setting. Methods: During the period between 2016 and 2017, we recruited 403 hepatitis B patients aged more than 14 years and regularly attending the infectious diseases clinic at a referral university hospital, Tehran, Iran. A blood sample was collected from all the patients and tested for hepatitis A IgG. The data was analyzed by SPSS v.19. Results: Although none of the patients had previously received hepatitis A vaccine, the results for serologic level of hepatitis A IgG, demonstrated positive results in 379 (94%) cases. The mean age of patients with negative and positive IgG was 29.17 and 42.46 years, respectively; the difference was statistically significant (P≤0.001). The majority of seronegative patients were young adults aged < 25 years and 25 to 35 years (P <0.001). Conclusion: Seroprevalence of hepatitis A in chronic HBV patients in Iran is high. As HBV infected patients younger than 35 years could be seronagative for HAV infection, evaluation of these patients for HAV infection and vaccination of seronegative patients would be a reasonable approach.

Quality of life in Hungarian polio survivors

2021 ◽  
Author(s):  
Erika Viktória Miszory ◽  
Melinda Járomi ◽  
Annamária Pakai
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Sample Selection ◽  
Cross Sectional Study ◽  
Two Dimensions ◽  
Cross Sectional ◽  
Emotional Role ◽  
The Difference ◽  
Polio Survivors

Abstract Aim The number of Hungarian polio patients can be estimated at approximately 3000. Polio infection is currently affecting people 56–65 years of age. The aim of the study was to reveal the quality of life of patients living with polio virus in Hungary. Subject and methods The quantitative cross-sectional study was conducted in January–April 2017 among polyomyelitis patients living in Hungary. In the non-random, targeted, expert sample selection, the target group was composed of patients infected with poliovirus (N = 268). We have excluded those who refused to sign the consent statement. Our data collection method was an SF-36 questionnaire. Using the IBM SPSS Statistics Version 22 program, descriptive and mathematical statistics (χ2-test) were calculated (p < 0.05). Results The mean age of the members of the examined population is 63.5 years; 68.1% were women and 31.90% were men. The majority of the respondents were infected by the polyovirus in 1956 (11.9%), 1957 (24.3%), and 1959 (19.5%). Polio patients, with the exception of two dimensions (mental health, social operation), on the scale of 100 do not reach the “average” quality of life (physical functioning 23 points, functional role 36 points, emotional role 47 points, body pain 48 points, general health 42 points, vitality 50 points, health change 31 points). Conclusion The quality of life of polio patients is far below the dimensions of physical function, while the difference in mental health compared to healthy people is minimal. It would be important to educate health professionals about the existing disease, to develop an effective rehabilitation method.

scholarly journals Bone quality and quantity of the mandibular symphyseal region in autogenous bone grafting using cone-beam computed tomography: a cross-sectional study

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Yaser Safi ◽  
Reza Amid ◽  
Mahdi Kadkhodazadeh ◽  
Hamed Mortazavi ◽  
Mohamad Payam Sharifi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cross Sectional Study ◽  
Cone Beam ◽  
Autogenous Bone ◽  
Loop Length ◽  
Sectional Study ◽  
Cross Sectional ◽  
Anterior Loop ◽  
Bone Graft Harvesting

Abstract Background Bone volume plays a pivotal role in the success of dental implant treatment. Autogenous bone grafts should be harvested from reliable sites in the maxillofacial region. This study sought to assess the quantity and quality of bone in the mandibular symphysis for autogenous bone graft harvesting using cone-beam computed tomography (CBCT). Methods This cross-sectional study evaluated the CBCT scans of 78 adults presenting to three oral and maxillofacial radiology centers. The vertical (VD) and horizontal (HD) alveolar bone dimensions, cortical thickness (CT), and cancellous to cortical bone ratio (C/C) were measured in the interforaminal region of the mandible at the sites of central incisor to first premolar teeth. The interforaminal distance (ID) and the anterior loop length were also measured. Nonparametric statistical tests were used to analyze the data with respect to sex, age, and tooth position. Results The median VD, HD, and CT of the symphysis were 20.21 (3.26), 4.13 (0.37), and 2.25 (0.23) mm, respectively. The median C/C was 1.51 (0.11). The median ID was 52.24 (8.24) mm, and the median anterior loop length was 1.82 (1.06) mm. Significant differences were observed in all parameters among different teeth. Most of the measured parameters were greater in males compared with females. There were significant differences in ID, VD, and CT between different age groups. Conclusions The quantity and quality of the available bone in the mandibular symphysis for bone graft harvesting vary by gender, age, and harvesting site, necessitating careful preoperative evaluation.

scholarly journals The Pandemic and Changes in the Self-Perception of Teacher Digital Competences of Infant Grade Students: A Cross Sectional Study

2021 ◽  
Vol 18 (9) ◽  
pp. 4756
Author(s):  
Rosalía Romero-Tena ◽  
Carmen Llorente-Cejudo ◽  
María Puig-Gutiérrez ◽  
Raquel Barragán-Sánchez
Keyword(s):  
Intervention Group ◽  
Cross Sectional Study ◽  
Self Perception ◽  
Digital Competence ◽  
Cross Sectional ◽  
Self Perceptions ◽  
Group A ◽  
Different Dimensions ◽  
The Difference ◽  
Group B

Without having a reaction time, the pandemic has caused an unprecedented transformation in universities around the world, leading to a revolution from structured models anchored in the conception of transmission of training towards a teaching approach-learning saved thanks to the incorporation of technology. This study aims to verify whether the pandemic situation has influenced the digital competence self-perception of students. Comparing two groups during the academic years 2019/2020 and 2020/2021, the instrument used is the questionnaire for digital competence “DigCompEdu Check-In” for future teachers. After the educational intervention, group A (before COVID-19) presented higher self-perceptions of competence than group B (during COVID-19); the pandemic situation caused by COVID-19 has negatively influenced students’ self-perception of their digital skills in the pretest in the different dimensions under study. Before receiving the training, the group that did not experience the pandemic enjoyed a higher self-perception of their competencies than the group that experienced the pandemic. The data obtained indicate that the difference exists, and that it is statistically significant, and may be a consequence of the clear relationship between self-perception and the way in which students face reality through their personal and subjective vision.

Pathological Study of Stillbirths Placentas at Muhimbili National Hospital, Tanzania

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S22-S23
Author(s):  
A E Malango
Keyword(s):  
Clinical Diagnosis ◽  
Clinical Assessment ◽  
Gestational Age ◽  
Fetal Death ◽  
Consensus Statement ◽  
Cross Sectional Study ◽  
Pathological Examination ◽  
Pathological Study ◽  
Cross Sectional ◽  
Placenta Pathology

Abstract Introduction/Objective Stillbirth is defined as fetal death that occurs at gestational age of ≥28 weeks. In our setting clinical assessment is the only method used to determine cause of stillbirths, with no reported proportion of unknown clinical diagnosis. Studies showed that unknown cause of stillbirths can be reduced by examination of placenta. Causal identification aids in the mourning process and identifying recurrence risks. The study aimed to describe pathological changes in the placentas of stillbirths which have risk to cause fetal death Methods A descriptive cross-sectional study done for the period of 6 months, it involved examination of 80 placentas of stillbirths born at gestational age of ≥ 28 weeks, placentas were fixed in 10% neutral buffered formalin for 8–12 hours. Grossing and interpretation of placenta pathology was according to Amsterdam Placental Workshop Group Consensus Statement. Results Out of 80 stillbirths, 32(40%) had unknown clinical diagnosis. Majority of stillbirth placentas 71(91%) found with either one or combined pathologies with the risk to cause stillbirth. Maternal vascular malperfusion was the commonest pathology and was significantly associated with preterm stillbirths. Maternal floor infarction, a placenta pathology with risk to cause fetal death and high risk of recurrence was among the pathologies found, was seen in 4(5%) of stillbirth placentas. Conclusion Findings in this study clearly indicated the importance of pathological examination of placenta in determining cause of stillbirth. Placenta examination in stillbirths can identify more pathology related to stillbirths than clinical assessment alone.

scholarly journals Six ultraviolet minutes for cleaner operating theatres

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Bosco ◽  
S Gambelli ◽  
V Urbano ◽  
G Cevenini ◽  
G Messina
Keyword(s):  
Cross Sectional Study ◽  
Cross Sectional ◽  
Before And After ◽  
Operating Theatres ◽  
Cleaning Procedures ◽  
The Difference ◽  
Contamination Levels ◽  
Different Levels ◽  
Better Than ◽  
Final Cleaning

Abstract Background Sanitizing the operating theatres (OT) is important to minimize risk of post-operative infections. Disinfection procedures between one operation and another is less aggressive than final cleaning procedures, at the end of the day. Aim was assessing the difference of contamination: i) between different levels of disinfection; ii) before and after the use of a UVC Device (UVC-D). Methods Between December 2019/February 2020 a cross sectional study was conducted in OT in a real clinical context. 94 Petri dishes (PD) were used in 3 OT. Three different sanitation levels (SL1-3) were compared pre- and post-use of UVC-D: i) No cleaning after surgery (SL1); ii) after in-between cleaning (SL2); iii) after terminal cleaning (SL3). UVC-D was employed for 6 minutes, 3 minutes per bed side. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic, Wilcoxon and Mann-Whitney tests were performed to assess the contamination levels in total, pre/post use of UVC-D, and between different sanitation levels, respectively. Results In total we had a mean of 3.39 CFU/PD (C.I. 2.05 - 4.74) and a median of 1 CFU/PD (Min. 0 - Max. 39), after UVC-D use we had a mean of 2.20 CFU/PD (C.I. 0.69 - 5.09) and a median of 0 CFU/PD (Min. 0 - Max. 133). The UVC-D led to a significant reduction of CFU (p &lt; 0.001). Without UVC-D we had a significant CFU drop (p &lt; 0.05) between SL1 and SL3. Using UVC-D, we observed significant reductions of contamination (p &lt; 0.05) between SL3 and SL1. Comparing SL1 (median 0) post UVC-D use vs SL2 pre UVC-D use (median 0.5), and SL2 post UVC-D use (median 0) vs SL3 pre UVC-D use (median 1) we had a significant reduction of contamination (p &lt; 0.05). Conclusions UVC-D improved environmental contamination in any of the three sanitation levels. Furthermore, the use of UVC-D alone was better than in-between and terminal cleaning. Although these encouraging results, the cleaning procedures executed by dedicated staff has to be considered. Key messages UVC are efficient to decrease contamination in operating theatres regardless of sanitation levels. The additional use of UVC technology to standard cleaning procedures significantly improves sanitation levels.

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