Seasonal variability in the incidence of carcinomatous meningitis

OBJECT The aim of the study was to investigate whether there are seasonal differences in the occurrence of carcinomatous meningitis (CM), with a greater prevalence of the disease in months with higher temperatures. METHODS The authors searched the records of all patients with a diagnosis of CM from 1998 until 2013 at the University Hospital of Patras, Greece. The date of hospitalization was extracted for each patient. The cases were divided into 2 categories depending on the time of CM diagnosis. Based on the official data regarding the annual temperature distribution in this region, the authors divided the patients into 2 groups. The first group consisted of cases diagnosed with CM from October 15 to April 15 (cold climate and shorter daytime duration), whereas the second group comprised patients diagnosed between April 15 and October 15 (warm climate and longer daytime duration). RESULTS Overall, 44 confirmed cases of CM were found. The most common type of malignancy associated with the development of CM was breast cancer (27 patients), while the second most common tumor was lung carcinoma (11 patients). The median interval between the time of initial cancer diagnosis and CM was 4.5 years. Thirty-one patients were diagnosed with CM during the period between April 15 and October 15, while the remaining 13 patients developed CM between October 15 and April 15, a significant difference (p = 0.01). CONCLUSIONS Significantly more patients developed CM during the warm season of the year. To the authors' knowledge, this is the first study to provide evidence for the potential seasonal variability in CM incidence. However, these results should be validated prospectively in larger cohorts.

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Comparing the first and second waves of COVID-19 in a tertiary university hospital in Barcelona

F1000Research ◽

10.12688/f1000research.73988.1 ◽

2021 ◽

Vol 10 ◽

pp. 1197

Author(s):

Yolima Cossio ◽

Marta-Beatriz Aller ◽

Maria José Abadias ◽

Jose-Manuel Domínguez ◽

Maria-Soledad Romea ◽

...

Keyword(s):

Tertiary Hospital ◽

Healthcare Systems ◽

University Hospital ◽

Emergency Rooms ◽

Daily Number ◽

Patient Demographics ◽

Significant Difference ◽

The University ◽

Hospital Wards ◽

Second Wave

Background: Hospitals have constituted the limiting resource of the healthcare systems for the management of the COVID-19 pandemic. As the pandemic progressed, knowledge of the disease improved, and healthcare systems were expected to be more adapted to provide a more efficient response. The objective of this research was to compare the flow of COVID-19 patients in emergency rooms and hospital wards, between the pandemic's first and second waves at the University Hospital of Vall d’Hebron (Barcelona, Spain), and to compare the profiles, severity and mortality of COVID-19 patients between the two waves. Methods: A retrospective observational analysis of COVID-19 patients attending the hospital from February 24 to April 26, 2020 (first wave) and from July 24, 2020, to May 18, 2021 (second wave) was carried out. We analysed the data of the electronic medical records on patient demographics, comorbidity, severity, and mortality. Results: The daily number of COVID-19 patients entering the emergency rooms (ER) dropped by 65% during the second wave compared to the first wave. During the second wave, patients entering the ER were significantly younger (61 against 63 years old p<0.001) and less severely affected (39% against 48% with a triage level of resuscitation or emergency; p<0.001). ER mortality declined during the second wave (1% against 2%; p<0.000). The daily number of hospitalised COVID-19 patients dropped by 75% during the second wave. Those hospitalised during the second wave were more severely affected (20% against 10%; p<0.001) and were referred to the intensive care unit (ICU) more frequently (21% against 15%; p<0.001). Inpatient mortality showed no significant difference between the two waves. Conclusions: Changes in the flow, severity and mortality of COVID-19 patients entering this tertiary hospital during the two waves may reflect a better adaptation of the health care system and the improvement of knowledge on the disease.

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Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-0950-9892 ◽

2019 ◽

Vol 128 (10) ◽

pp. 693-698

Author(s):

Sabine Dillenberger ◽

Detlef K. Bartsch ◽

Elisabeth Maurer ◽

Peter Herbert Kann

Keyword(s):

Primary Hyperparathyroidism ◽

Multiple Endocrine Neoplasia ◽

University Hospital ◽

Primary Surgery ◽

Endocrine Neoplasia ◽

Single Centre Experience ◽

Significant Difference ◽

History Of ◽

The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

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Intra-abdominal hypertension in the ICU – a prospective epidemiological study

Medicine and Pharmacy Reports ◽

10.15386/cjmed-455 ◽

2015 ◽

Vol 88 (2) ◽

pp. 188-195 ◽

Cited By ~ 3

Author(s):

Georgi M. Arabadzhiev ◽

Valentina G. Tzaneva ◽

Katya G. Peeva

Keyword(s):

Elective Surgery ◽

Treatment Options ◽

Point Of View ◽

University Hospital ◽

Abdominal Pressure ◽

Medical Patients ◽

Invasive Treatment ◽

Abdominal Hypertension ◽

Significant Difference ◽

The University

The aim of this prospective study is to examine the frequency and the severity of intra-abdominal hypertension in a mixed ICU of the University hospital.Methods: A closed system for intravesical intermittent measurement of IAP was constructed.Results: The frequency and the severity of IAH were examined in the period from June 2009 to December 2012 in 240 ICU patients divided into 3 groups (patients submitted to elective surgery, emergency surgery, and medical patients) in the University Hospital. In the elective surgery group there was 12.5% IAH, while in the emergency group IAH was 43.75%, and in the medical patients it was 42.5%. There was no statistical significant difference in the frequency of IAH among the mixed population of patients we examined and those studied by other authors with the same type of population.Conclusions. The standardized measurement of intra-abdominal pressure is fundamental for defining intra-abdominal hypertension and abdominal compartment syndrome. The measurement of intra-abdominal pressure should be a part of the basic monitoring of patients at risk of intra-abdominal hypertension. Our point of view is that before there are indications for a surgical decompression, less invasive treatment options should be optimized.

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Rhythms and prognosis of patients with cardiac arrest, emphasis on pseudo-pulseless electrical activity: another reason to use ultrasound in emergency rooms in Colombia

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00319-4 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

German Devia Jaramillo ◽

Norberto Navarrete Aldana ◽

Zaira Rojas Ortiz

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Cardiac Activity ◽

Pulseless Electrical Activity ◽

Cardiac Arrest Patient ◽

University Hospital ◽

Bedside Ultrasound ◽

Emergency Rooms ◽

Significant Difference ◽

The University

Abstract Background The cardiac arrest is still an emergency with a bad prognosis. The growing adoption of bedside ultrasound allowed to classify PEA in two groups: the true PEA and the pseudo-PEA. pPEA is used to describe a patient who has a supposed PEA in the absence of pulse, with evidence of some cardiac activity on the bedside ultrasound. Objective This work aims to assess the bedside ultrasound use as a predictor for ROSC and survival at discharge in cardiac arrest patients and compare the pseudo-pulseless electrical activity to other cardiac arrest rhythms, including shockable rhythms. Materials and methods This is an observational, historic cohort study carried out in the emergency room of the University Hospital Mayor Méderi. Data were collected from all the adult patients treated for cardiac arrest from June 2018 to 2019. An ultrasound was performed to every cardiac arrest patient. Results Of a total of 108 patients, the median of the age was 71 years, 65.8% were male subjects, and the most frequent cause for cardiac arrest was the cardiogenic shock (32.4%). ROSC was observed in 41 cases (37.9%) and survival at discharge was 18 cases (16.7%). VF/VT and pPEA were the two rhythms that showed the highest ROSC and survival at discharge. For the pPEA group, we were able to conclude that the cardiac activity type is related to ROSC. Conclusion There is a significant difference for ROSC and survival at discharge prognosis among the cardiac arrest rhythms, with better outcomes for VF/VT and pPEA. Among patients with PEA, a routine ultrasound assessment is recommended. The type of cardiac activity recorded during the ultrasound of the cardiac arrest patient might be related to the ROSC and survival at discharge prognosis.

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Influence of Gender in Selecting Fixed and Removable Prosthesis

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl3.2925 ◽

2020 ◽

Vol 11 (SPL3) ◽

pp. 268-272

Author(s):

Abigail Ranasinghe ◽

Keerthi Sasanka ◽

Raghu Sandhya

Keyword(s):

Tooth Loss ◽

University Hospital ◽

Negative Effects ◽

Chi Square ◽

Fixed Partial Denture ◽

Masticatory Efficiency ◽

Significant Difference ◽

Removable Prosthesis ◽

Chi Square Test ◽

The University

Tooth loss is a common dental problem. Impairment of oral functions and masticatory efficiency is a result of tooth loss. The negative effects of tooth loss can be managed by the fixed and removable prosthesis. This study was conducted to determine the influence of gender in selecting prosthesis. This study was a retrospective observational study conducted in a university hospital in Chennai. Data collection was done with the help of the electronic dental record of the university- Dental information archiving software (DIAS). It records all patients data from initial visit to last visit chronologically. This was followed by Excel tabulation. Data was analysed using SPSS Software. The association of study variables was calculated using the Chi-Square test. Within the limits of the study, female patients were willing for replacement of teeth than male patients (55%). There was a significant difference in choosing the type of prosthetic treatment. It was seen that fixed partial denture was chosen over removable prosthesis (59.8%).

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Incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope

European Heart Journal ◽

10.1093/ehjci/ehaa946.0364 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Lopez Ayala ◽

D Flores ◽

T Zimmermann ◽

J Du Fay De Lavallaz ◽

T Nestelberger ◽

...

Keyword(s):

Cardiac Disease ◽

Vasovagal Syncope ◽

University Hospital ◽

Funding Source ◽

Cardiac Syncope ◽

Significant Difference ◽

Structural Disease ◽

The University ◽

Long Term Mortality

Abstract Background Cardiac syncope has been shown to carry the highest hazard for all-cause death compared to other causes of syncope including vasovagal and orthostatic syncope. However, little is known about the incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope. Purpose To evaluate the incidence, characteristics and prognosis of different cardiac etiologies underlying cardiac syncope. Methods We enrolled patients presenting to the emergency department (ED) with syncope in a large prospective international multicentre study. The cause of syncope (cardiac vs non-cardiac) including the detailed cardiac aetiology (if cardiac) was centrally adjudicated by two independent cardiologists based on detailed in-hospital as well as outpatient cardiac work-up during 360 days following presentation. Cardiac syncope was classified into four groups: bradyarrhythmia, tachyarrhythmia, structural disease and other (cardiopulmonary and great vessels), as recommended in the ESC Syncope Guidelines. All-cause death during 2-years follow-up was the primary outcome. Results Among 2025 patients presenting with syncope to the ED, cardiac syncope was the final adjudicated diagnoses in 318 (15.7%) patients. The incidence rate of all-cause death among cardiac syncope patients was 103 cases per 1000 person-years. Bradyarrhythmia was the most frequent primary cause of cardiac syncope (n=146, 45.9%) followed by tachyarrhythmia (n=75, 23.6%), structural disease (n=64, 20.1%) and other cardiac (n=26, 8.2%). Patients were 37% female with a median age of 77 years (IQR 67–83) showing no statistically significant difference between subgroups. Clinical characteristics differed significantly among the four subgroups. E.g. syncope occurred during exercise in 12 patients (8.2%) with bradyarrhythmia, 10 patients (13.3%) with tachyarrhythmia, 16 patients (25%) with structural disease, and 5 patients (19%) with other cardiac (p<0.01). Likely of most importance, long-term mortality differed significantly among the four different cardiac subgroups. The multivariable-adjusted hazard ratios (HR) among patients with bradyarrhythmia, tachyarrhythmia, structural disease and other cardiac as compared to patients with vasovagal syncope, the HR were 1.3 (95% CI 0.7–2.5), 4.6 (95% CI 2.3–9.1), 3.1 (95% CI 1.5–6.4) and 5.9 (95% CI 2.3–15.2), respectively (Figure 1). Conclusions Bradyarrhythmia, tachyarrhythmia, and structural cardiac disease are the dominant causes of cardiac syncope. Interestingly, with the appropriate therapy initiated long-term mortality of bradyarrhythmia is comparable to that of vasovagal syncope, while long-term mortality of tachyarrhythmia and structural cardiac disease were substantially increased 3 to 5 fold. Figure 1. Kaplan-Meier curve Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swiss National Science Foundation, the Swiss Heart Foundation, the Stiftung für kardiovaskuläre Forschung Basel, the University of Basel and the University Hospital Basel.

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On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions

Rhinology Journal ◽

10.4193/rhino10.313 ◽

2011 ◽

Vol 49 (4) ◽

pp. 474-478

Author(s):

M.B. Soyka ◽

G. Nikolaou ◽

K. Rufibach ◽

D. Holzmann

Keyword(s):

Retrospective Cohort ◽

Health Care Systems ◽

Financial Burden ◽

Treatment Options ◽

University Hospital ◽

Level Of Evidence ◽

Significant Difference ◽

The World ◽

Care Systems ◽

The University

Background: Epistaxis represents one of the most common emergencies in ENT clinics around the world. It creates great physical and emotional stress to the patient as well as a financial burden on health-care systems. A lot of research has been performed with regard to aetiology and possible treatment, however, not much effort has been put into analysing the effectiveness of common treatment forms. It is the objective of this study to clarify which of these treatment forms is reliable. Study design: Retrospective cohort study. Level of evidence: 2b. Methods: Between 03/2007 and 04/2008, all epistaxis therapies including relapses and treatment failures at the University Hospital of Zurich have been documented using a computerised questionnaire. Different treatments were compared to each other. Results: An analysis of 678 interventions in 537 patients was performed with emphasis on failure proportions and time to occurrence. The estimated failure proportions of coagulation in anterior epistaxis accounts for 14%. Successful treatment of epistaxis in posterior bleedings could be achieved in 62% by packing and in 97% by surgery with a statistically significant difference between the respective groups. Conclusion: Using our treatment options, anterior epistaxis can be cured reliably by cauterisation. Surgical therapies in posterior bleedings are able to successfully salvage failed packing therapies.

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Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study

International Cardiovascular Forum Journal ◽

10.17987/icfj.v3i0.113 ◽

2015 ◽

Vol 3 ◽

pp. 14 ◽

Cited By ~ 1

Author(s):

Robert Erich Michael Weitemeyer ◽

Shane Peter Murphy ◽

Ruth Gillen ◽

Catriona Ahern ◽

Yousif Abusalma ◽

...

Keyword(s):

Medical Management ◽

University Hospital ◽

Cardiac Events ◽

Index Procedure ◽

Adverse Cardiac Events ◽

Significant Difference ◽

St Elevation ◽

Percutaneous Revascularization ◽

The University

BACKGROUND In the setting of ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), guidelines recommend revascularization of the culprit lesion (CL) only, due to poor evidence supporting intervention in non-culprit lesions (non-CLs) during the same index procedure. Debate over management for significant non-CLs is of interest i.e. medical management vs. percutaneous revascularization. We describe a cohort of patients with STEMI and MVD and compare the occurrence of major adverse cardiac events (MACE) by therapeutic strategies for non-CLs with regard to follow-up outcomes.METHODS 86 patients with STEMI and MVD were identified from a database of STEMI presentations to the University Hospital Limerick from Jan 2011 to April 2013. The occurrence of MACE was established by follow up with patients’ general practitioners.RESULTS 48% of presentations had MVD. Predominant management for non-CLs was medical therapy alone comprising 58% (n=50) of patients, while 23% (n=20) of patients underwent PCI for non-CL, and 19% (n=16) had CABG.Median follow up was 1.8 years (range 9–36 months). We found no significant difference in the occurrence of MACE between medical management of non-CLs and PCI of non-CLs (OR 1.10 95%CI 0.34, 3.56; p= 0.88). CABG however does show a trend to be superior to both PCI (OR 3.10 95%CI 0.54, 17.88; p= 0.21) and medical management (OR 2.83 95%CI 0.65, 12.27; P= 0.17) in non-CLs.CONCLUSIONS CABG appears superior to both PCI or medical management in preventing MACE over time, and PCI is not superior to medical management alone.

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Evaluation of the Tendencies of Urology Residents in Different Training Centers in Turkey on the Use of Fluoroscopy in Operations

10.22541/au.162444324.40160935/v1 ◽

2021 ◽

Author(s):

Samet Senel ◽

Fatih Sandikci ◽

Ali Yasin Ozercan ◽

Emin Gurtan ◽

Salih Zeki Sonmez ◽

...

Keyword(s):

Daily Practice ◽

University Hospital ◽

University Hospitals ◽

Study Results ◽

Significant Difference ◽

Training And Research ◽

Harmful Radiation ◽

And Behavior ◽

The University ◽

Harmful Effects

Aim: To evaluate the tendency, knowledge, awareness and behavior patterns of urology residents training at different institutions in Turkey about the use of fluoroscopy in operations. Methods: The 13-questioned survey prepared using “Google Forms©” as of 01.03.2021 was shared for four weeks in the “WhatsApp®” application group, which includes 279 urology residents studying with university hospitals and training and research hospitals in Turkey. One hundred and thirteen participants, who completed the questionnaire were included in the study. Results: Of the 113 urology residents included in the study, 56 (49.6%) were studying in university hospitals and 57 (50.4%) were in training and research hospitals. 67.3% of the residents stated that they never hesitated to participate in the operations which fluoroscopy was used. Additionally, the residents stated that, also 43.4% of the auxiliary healthcare staff frequently refrain from being involved in these cases(p <0.001). While 21 (37.5%) of the residents trained in the university hospital reported that they hesitated from these cases, this rate was found that 16 (28.2%) of the residents who were trained in the training and research hospitals and a significant difference was observed between two groups (p <0.016). Among residents, the rate of using radioprotective lead apron was 94.7%, and the rate of thyroid shield use was 98.2%. While the rate of using radiation protective glasses was 1.8%, it was learned that none of the residents used radioprotective gloves. Only 5.3% of the residents stated that they are trained in subjects about the harmful radiation effect. Conclusion: Urology residents in Turkey do not receive sufficient training on the harmful effects of fluoroscopy, which they frequently use in their daily practice. In addition, the residents whom training in university hospitals are more scared of the radiation exposure from fluoroscopy than their colleagues working in training and research hospitals.

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Psychometric Properties of the Brazilian Version of the Nurses' Knowledge of High-Alert Medications Scale: A Pilot Study

Research and Theory for Nursing Practice ◽

10.1891/1541-6577.33.1.23 ◽

2019 ◽

Vol 33 (1) ◽

pp. 23-38

Author(s):

Priscila Peruzzo Apolinário ◽

Juliana Bastoni da Silva ◽

Deborah Cristina de Oliveira ◽

Natália Gonçalves ◽

Roberta Cunha Matheus Rodrigues ◽

...

Keyword(s):

Pilot Study ◽

Nursing Students ◽

Registered Nurses ◽

University Hospital ◽

Significance Level ◽

Brazilian Version ◽

Study Results ◽

Significant Difference ◽

The University ◽

Nurses Knowledge

Background and Purpose:High-alert medication is considered to be a medication that presents a high risk of causing significant patient harm when used erroneously and its consequences can be fatal. The Nurses' Knowledge of High-Alert Medication scale (NKHAM) is a tool available to evaluate the knowledge of nurses in practice about this issue.Aim:This pilot study aimed to measure the reliability and known-groups validity of the Brazilian version of the NKHAM.Methods:This pilot psychometric study was carried out at the Faculty of Nursing and University Hospital of the University of Campinas, São Paulo, Brazil. Forty nursing students and 44 registered nurses working in complex clinical or surgical settings completed a sociodemographic questionnaire and the Brazilian version of the NKHAM. The Kuder–Richardson 20 (KR-20) coefficient and Mann–Whitney test were used to establish reliability and known-groups validity. A significance level of ≤ 0.05 was adopted for all the analyses.Results:Analyses demonstrated preliminary acceptable reliability scores of 0.55 and 0.60 in domains A and B of NKHAM, respectively. A significant difference was found between the nursing students' and the registered nurses' knowledge of high-alert medications, demonstrating the scale's ability to discriminate between the two groups.Implications for Practice:Although this is pilot study, results suggest that the Brazilian version of the NKHAM might be a reliable and valid tool to measure nurses' knowledge of high-alert medications.

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