scholarly journals Repatriations of Ill and Injured Travelers and Emigrants to Switzerland: A Retrospective Analysis at a Tertiary Emergency Department from 2013–2018

2021 ◽  
Vol 18 (5) ◽  
pp. 2777
Author(s):  
Lara Brockhus ◽  
Anne-Sophie Eich ◽  
Aristomenis Exadaktylos ◽  
Anne Jachmann ◽  
Jolanta Klukowska-Rötzler
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Mortality Rate ◽  
Surgical Intervention ◽  
Mean Value ◽  
University Hospital ◽  
Health Concern ◽  
Median Cost ◽  
The University ◽  
Public Health Promotion

Background: As more and more people are travelling abroad, there are also increasing numbers who fall ill or have accidents in foreign countries. Some patients must be repatriated. While it has been reported that the number of repatriations is rising steadily, little is known about patients’ characteristics, calling for in depth investigations of this patient group. Methods: We have conducted a retrospective study including 447 patients repatriated to the Emergency Department at the University Hospital (Inselspital) in Bern, Switzerland from 2013–2018. Results: Between 2013 and 2018, the number of repatriated patients increased by 42.6%, from 54 to 77 cases. In total, 59% of these patients were male and the median age was 60 years. Overall, 79% of patients were repatriated from European countries, with the top five countries being Italy, France, Spain, Germany and Austria. About half the cases (51.9%) were caused by illness, the other half by accidents. In total, 127 patients had to undergo surgical intervention abroad; another 194 patients underwent surgery after repatriation. The hospitalization rate was 81.4%, with a median length of in-hospital stay of 9 days (IQR 5–14) at the Inselspital. The mortality rate of at the Inselspital hospitalized patients was 4.4%, with 16 patients dying within the first 30 days after repatriation. The median cost per case was 12,005.79 CHF (IQR 4717.66–24,462.79). A multiple regression analysis showed a significant association of total costs with hospitalization (p = 0.001), surgical intervention (p = 0.001), as well as treatment in the intensive care unit (p = 0.001). Conclusions: The number of repatriations has been continuously increasing in recent years and reached a mean value of more than one case per week at the Inselspital (77 cases per year in 2018). The 30 day-mortality rate of 4.4% and the median cost per case are relatively high, demonstrating a neglected Public Health concern. These findings may provide impetus—not only for further research into repatriations but also for Public Health Promotion strategies.

Serum microRNA-122 Levels in Egyptian Patients with Chronic Hepatitis C virus Genotype 4 Infection before and after treatment with Direct Acting Antiviral Drugs

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Essam Mohammad Bayoumy Helal ◽  
Moataz Mohammad Sayed ◽  
Tari Magdy Aziz George ◽  
Christina Alfons Anwar ◽  
Sara Hassan Agwa ◽  
...  
Keyword(s):  
Public Health ◽  
Viral Hepatitis ◽  
Large Scale ◽  
Antiviral Drug ◽  
University Hospital ◽  
Health Concern ◽  
Virus Genotype ◽  
Genotype 4 ◽  
Hcv Therapy ◽  
Therapeutic Value

Abstract Background Viral hepatitis was estimated to be the 7th leading cause of mortality globally. About half of this mortality is attributed to HCV, a primary cause for liver fibrosis, cirrhosis and cancer. The recent development of highly efficacious oral DAAs provides opportunities for reducing HCV disease burden and its onward transmission, with the potential for eliminating this blood-borne virus as a public health concern. WHO has recently formulated the ‘Global Health Sector Strategy on Viral Hepatitis, 2016– 2021 with service coverage targets to eliminate HCV as a public health threat by 2030. Objective To asses the possible relation of miRNA 122 to HCC development after HCV therapy with direct antiviral drug. Patients and Methods Previous studies suspect that HCV therapy by DAAS may increase risk of HCC so the aim of our study is to evaluate miR-122level at end of HCV treatment by DAAS and compare the results with miR-122level in HCC patients. The study was performed as a case control study in Ain Shams University hospital and Suez Canal authority hospital (Outpatient Clinic), at Ismailia Egypt in the period between Augusts to October 2018. Results These results revealed an effect of treatment by DAAs in HCV infected patients leading to miRNA 122 reduction and this may be related to hepatocarcinogenesis. However, further studies on a large patients number are needed to clarify this point and determine the diagnostic and possible therapeutic value of miRNA 122 in HCV infected patients. Conclusion Baseline MiR-122 level at cutoff value ≤0.26 was significantly lower in HCC patients than chronic HCV patients and normal controls, with a sensitivity of 80%, a specificity of 70%. MiR-122 was significantly reduced at end of HCV therapy with DAAs and became similar to values in HCC patients. Whether this observed reduction is mechanistically related to hepatocarcinogenesis is still a possibility, to be clarified in furtur large scale studies. The reduction of MiR-122 at the end of HCV therapy with DAAs was significantly observed in (F3,F4) patients than those with early fibrosis stages(F1,F2).This again gives a possible explanation of HCC development in HCV patients with advanced fibrosis(cirrhosis)and raises the question about the diagnostic and therapeutic value of miRNA 122 (and possibly other miRNAs)in the management strategy of HCV infected patients.

scholarly journals A machine learning approach for identification of gastrointestinal predictors for the risk of COVID-19 related hospitalization

2021 ◽  
Author(s):  
Peter Liptak ◽  
Peter Banovcin ◽  
Robert Rosolanka ◽  
Michal Prokopic ◽  
Ivan Kocan ◽  
...  
Keyword(s):  
Machine Learning ◽  
Emergency Department ◽  
Random Forest ◽  
Gastrointestinal Symptoms ◽  
Machine Learning Algorithms ◽  
Important Predictor ◽  
University Hospital ◽  
Home Based ◽  
Severity Of The Disease ◽  
The University

Background and aim: COVID-19 can be presented with various gastrointestinal symptoms. Shortly after the pandemic outbreak several machine learning algorithms have been implemented to assess new diagnostic and therapeutic methods for this disease. Aim of this study is to assess gas-trointestinal and liver related predictive factors for SARS-CoV-2 associated risk of hospitalization. Methods: Data collection was based on questionnaire from the COVID-19 outpatient test center and from the emergency department at the University hospital in combination with data from inter-nal hospital information system and from the mobile application used for telemedicine follow-up of patients. For statistical analysis SARS-CoV-2 negative patients were considered as controls to three different SARS-CoV-2 positive patient groups (divided based on severity of the disease). Results: Total of 710 patients were enrolled in the study. Presence of diarrhea and nausea was significantly higher in emergency department group than in the COVID-19 outpatient test center. Among liver enzymes only aspartate transaminase (AST) has been significantly elevated in the hospitalized group compared to patients discharged home. Based on random forest algorithm, AST has been identified as the most important predictor followed by age or diabetes mellitus. Diarrhea and bloating have also predictive importance although much lower than AST. Conclusion: SARS-CoV-2 positivity is connected with isolated AST elevation and the level is linked with the severity of the disease. Furthermore, using machine learning random forest algo-rithm, we have identified elevated AST as the most important predictor for COVID-19 related hos-pitalizations.

scholarly journals Separating the wheat from the chaff – COVID-19 in a German emergency department: A Case-control study

2020 ◽  
Author(s):  
David Fistera ◽  
Dirk Pabst ◽  
Annalena Härtl ◽  
Benedikt Michael Schaarschmidt ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Systems ◽  
University Hospital ◽  
Nasopharyngeal Swab ◽  
Workflow Model ◽  
Manchester Triage System ◽  
Efficient Management ◽  
Care Systems ◽  
To Come ◽  
The University

Abstract Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the Emergency Department. Especially the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved?Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia.Results: 43 of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.Trial registration: URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021675

TETANUS OF THE NEWBORN INFANT

PEDIATRICS ◽  
1964 ◽  
Vol 34 (1) ◽  
pp. 32-37
Author(s):  
Dacio Pinheiro
Keyword(s):  
Public Health ◽  
Newborn Infant ◽  
Public Health Problem ◽  
Clinical Severity ◽  
University Hospital ◽  
Important Public Health Problem ◽  
Important Public Health ◽  
Pediatric Service ◽  
The Central Nervous System ◽  
The University

Tetanus in the newborn infant is still a most important public health problem in Brazil. An analysis of 238 cases, admitted in a two-year period to the pediatric service of the University Hospital in Sao Paulo, is presented. It is suggested that prognosis is related more closely to amount of tetanospasmin produced and absorbed by the central nervous system than to some of the more traditional indices of clinical severity. The plan of treatment in use is presented, since the over-all recovery rate compares very favorably with other published reports.

Prevalence of abuse of alcohol and other drugs among injured drivers presenting to the emergency department of the University Hospital of Modena, Italy

2005 ◽  
Vol 80 (1) ◽  
pp. 135-138 ◽  
Author(s):  
Daniele Giovanardi ◽  
Carmela Nives Castellana ◽  
Stefania Pisa ◽  
Brunella Poppi ◽  
Diego Pinetti ◽  
...  
Keyword(s):  
Emergency Department ◽  
University Hospital ◽  
The University ◽  
Alcohol And Other Drugs

scholarly journals Acute Polyhydramnios Complicating Twin Pregnancies

1985 ◽  
Vol 34 (3-4) ◽  
pp. 179-184 ◽  
Author(s):  
K.T.M. Schneider ◽  
K. Vetter ◽  
R. Huch ◽  
A. Huch
Keyword(s):  
Mortality Rate ◽  
Amniotic Fluid ◽  
Bed Rest ◽  
Positive Influence ◽  
University Hospital ◽  
Monozygous Twin ◽  
The Mean ◽  
The University ◽  
Twin Pregnancies ◽  
Placental Vessel

AbstractAcute polyhydramnios in the second trimestr is a typical complication in monozygous twin pregnancies. It is caused by a feto-fetal transfusion with anemia on the donor and polycytemia on the recipient twin. Contrary to the chronic hydramnios, there is no increase in malformations. In view of the high mortality rate (100%, according to most authors), the clinical management has to be reconsidered. During the years 1979 to 1983, 10 cases of acute polyhydramnios have been observed at the University Hospital in Zurich. This corresponds to an incidence of 9% in our twin population. All cases investigated were MZ twin pregnancies. With the exception of one patient, who underwent an abortion, all women were hospitalized, had bed rest and received recurrent removals of amniotic fluid and prophylactic tocolysis. The mean gestational age at the time of diagnosis was 23 4/7 weeks and at delivery 30 3/7 weeks. In two cases – one of which is presented in detail – with an unintentional puncture of a placental vessel, the recurrence of the hydramnios did not appear. Eight of 18 newborns survived. No malformations were found. Bed rest, tocolysis and recurrent amniocenteses seem to have a positive influence on the prolongation and outcome of the gestation in acute polyhydramnios.

scholarly journals Dog Bite Injuries: Primary and Secondary Emergency Department Presentations—A Retrospective Cohort Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Carmen A. Pfortmueller ◽  
Anastasios Efeoglou ◽  
Hansjakob Furrer ◽  
Aristomenis K. Exadaktylos
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Antibiotic Therapy ◽  
Retrospective Cohort ◽  
Complex Problem ◽  
Infectious Complications ◽  
University Hospital ◽  
Dog Bite ◽  
Increased Risk ◽  
Bite Injuries

Dog bites in humans are a complex problem, embracing both public health and animal welfare. The primary aim of this study is to examine primary and secondary presentations related to dog bite injuries in adults.Methods. We retrospectively assessed all adult patients admitted with a dog bite injury to the Emergency Department of Bern University Hospital.Results. A total of 431 patients were eligible for the study. Forty-nine (11.4%) of all patients were admitted with secondary presentations. Bites to the hands were most common (177, 41.1%). All patients (47, 100%) with secondary presentations were admitted because of signs of infection. The median time since the dog bite was 3.8 days (SD 3.9, range 1–21). Thirty-one patients had already been treated with antibiotic; coamoxicillin was the most common primary antibiotic therapy (27/47 patients, 57.4%). Patients with injuries to the hand were at increased risk of secondary presentations (OR 2.08, 95% CI 1.21–3.55,P<0.006).Conclusion. Dog bite injuries to the hands are a major problem. They often lead to infectious complications. Immediate antibiotic therapy should carefully be evaluated for each patient.

Odontogenic phlegmon of the mouth floor: a case report

2016 ◽  
Vol 6 (2) ◽  
pp. 0-0
Author(s):  
P. Bortnik ◽  
P. Wieczorek ◽  
P. Załęski ◽  
P. Kosierkiewicz ◽  
A. Siemiątkowski ◽  
...  
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Plastic Surgery ◽  
Successful Treatment ◽  
Surgical Intervention ◽  
University Hospital ◽  
Local Complication ◽  
Life Threatening ◽  
Ludwig’S Angina ◽  
The University

Odontogenic phlegmon of the mouth floor—Ludwig's angina (phlegmonae fundi cavi oris seu angina Ludovici)—is a rare, life-threatening, local complication in most cases of odontogenic inflammation. This study presents the case of a patient treated in the Department of Maxillofacial and Plastic Surgery of the University Hospital in Białystok due to phlegmon of the mouth floor resulting from odontogenic inflammation with a dynamic course. Quick diagnostics, surgical intervention as well as antibiotic therapy contributed to its efficient and successful treatment.

Patterns and Results of Triage Advice Before Emergency Department Visits Made by Patients With Cancer

2021 ◽  
pp. OP.20.00617
Author(s):  
Arthur S. Hong ◽  
Hannah Chang ◽  
D. Mark Courtney ◽  
Hannah Fullington ◽  
Simon J. Craddock Lee ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Urgent Care ◽  
Telephone Triage ◽  
Patients With Cancer ◽  
Oncology Care ◽  
Ed Visits ◽  
The University

PURPOSE: Patients with cancer undergoing treatment frequently visit the emergency department (ED) for commonly anticipated complaints (eg, pain, nausea, and vomiting). Nearly all Medicare Oncology Care Model (OCM) participants prioritized ED use reduction, and the OCM requires that patients have 24-hour telephone access to a clinician, but actual reductions in ED visits have been mixed. Little is known about the use of telephone triage for acute care. METHODS: We identified adults aged 18+ years newly diagnosed with cancer, linked to ED visits from a single institution within 6 months after diagnosis, and then analyzed the telephone and secure electronic messages in the preceding 24 hours. We coded interactions to classify the reason for the call, the main ED referrer, and other attempted management. We compared the acuity of patient self-referred versus clinician-referred ED visits by modeling hospitalization and ED visit severity. RESULTS: From 2011 to 2018, 3,247 adults made 5,371 ED visits to the university hospital and self-referred to the ED 58.5% of the time. Clinicians referred to outpatient or oncology urgent care for 10.3% of calls but referred to the ED for 61.3%. Patient self-referred ED visits were likely to be hospitalized (adjusted Odds Ratio [aOR], 0.89, 95% CI, 0.64 to 1.22) and were not more severe (aOR, 0.75, 95% CI, 0.55 to 1.02) than clinician referred. CONCLUSION: Although patients self-referred for six of every 10 ED visits, self-referred visits were not more severe. When patients called for advice, clinicians regularly recommended the ED. More should be done to understand barriers that patients and clinicians experience when trying to access non-ED acute care.

Sign in / Sign up

Export Citation Format

Share Document