Mucormycosis: A challenge with COVID-19

Mucormycosis is an aggressive opportunistic fungal infection caused by fungi of the Phycomycetes class including Rhizopus species and Mucor species. The pathogen can be present in the environment, on the skin, and in the orifices of the body. There are several types including Rhinocerebral, Pulmonary, Gastrointestinal, Cutaneous, and Disseminated Mucormycosis.1 The spores infect the paranasal sinuses and nasopharynx, extending to the orbit and brain cavity in persons who have reduced cellular and humoral defenses. During the ongoing COVID-19 pandemic, a surge in the cases of rhino-orbital mucormycosis has become a life-threatening combination. Early diagnosis and intervention in the only way to save the vision and life of the affected patient.

Causes, diagnosis and treatment of occupational asthma

Occupational asthma is usually characterized by airway hyperresponsiveness, airway obstruction, and airway inflammation that usually result from exposure to specific irritants in the workplace and is not usually associated with any evidence of exacerbation outside the workplace. Occupational asthma can be associated with complicated long-term outcomes because affected patients are not usually aware of the hazards of the condition. Therefore, applying adequate diagnostic and management approaches is essential to enhance the outcomes among high-risk workers. In the present literature review, we have discussed the causes, diagnosis, and management of occupational asthma based on the evidence obtained from the current studies in the literature. Our findings indicated the presence of various environmental triggers that can lead to the development of asthma in the workplace, including HMW and LMW compounds. The diagnosis of asthma is based on obtaining a thorough personal and clinical history from the affected patient. However, such approaches have been reported to have low specificity rates, and therefore, the diagnosis should be established by other measures as lung function tests. The management of asthma is hugely dependent on the clinical phenotypes of occupational asthma. Nevertheless, applying adequate interventions can significantly enhance the outcomes in the affected patients, in addition to the other measures that have been adequately discussed in the manuscript.

Virtual Evaluation of a Hospital Congestion Prevention Method

Background: Hospital congestion is a common problem for the healthcare sector. Numerous studies explored reasons for crowding within some parts of the hospital. However, to deal with more general, hospital-wide problems, examining the hospital as a connected whole is necessary. The purpose of this study was to evaluate de-congestion interventions through a whole hospital simulation model and offer objective reasoning to support hospital management decisions.Method: This study tested a congestion prevention method that estimates the current day’s hospital congestion risk level R at a set time every morning, and activates minimum intervention when R is above certain threshold R(C), using a virtual hospital created by simulation modelling. The color-coding system was adopted to demonstrate the impact and the extent of effectiveness of this method in preventing hospital congestions.Results: The results indicated that adding 8 flex beds to the medical department resulted in more reductions (70.93%) of red-days comparing with the surgical ward (37.15%). Red days reduction per affected patient when discharging two medical patients was 0.1 which was higher than when discharging two surgical (0.04) or two long-stay patients (0.07). Also, the efficiency of red days reduction per affected patient is always greater if removing 2 patients than if discharging more patients. Conclusions: The expected outcome based on theoretical prediction of this method was confirmed, that is, applying a less disruptive intervention is often enough, and more cost effective, to reduce the risk level of hospital congestion. Making a small number of extra beds available was a superior solution compared to discharging approaches to reduce crowding in hospitals. In addition, the virtual implementation approach enabled testing of the method at a more detailed level, thereby revealed some interesting findings difficult to achieve theoretically, such as discharging extra two medical inpatients, rather than surgical inpatients, a day earlier on days when R>R(C), would bring more benefits in terms of congestion reduction for the hospital.

Factors Influencing Patient-Centeredness among Korean Nursing Students: Empathy and Communication Self-Efficacy

In recent years, there is a growing tendency in the extent to which patients wish to be actively involved in processes related to their healthcare and relevant decision-making. This was a cross sectional study. We examined undergraduate nursing students’ patient-centeredness and investigated its associated factors including empathy and communication self-efficacy using a structured questionnaire. A total of 201 undergraduate nursing students who provided written consent to participate in the study completed measures on patient-centeredness (sharing and caring), empathy (fantasy, perspective taking, personal distress, and empathic concern), and communication self-efficacy. The factors affecting patient-centeredness were analyzed using multiple regression. Communication self-efficacy affected patient-centered sharing, while age, empathy (fantasy, personal distress, empathic concern), and communication self-efficacy affected patient-centered caring. Empathy and communication self-efficacy positively affected patient-centeredness. Therefore, strategies that promote empathy and communication self-efficacy are needed to increase patient-centered care competency.

Intraoperative Midflexion Medial Laxity Affects Patient Expectations Following Total Knee Arthroplasty

Background: Patient satisfaction and expectations are now recognized as an outcome measure for successful total knee arthroplasty (TKA). The purpose of this study was to determine which factors including soft tissue balance during surgery affect patient satisfaction and expectations after TKA.Methods: A total of 135 patients (157 knees) with knee osteoarthritis who underwent primary TKA with a posterior stabilized design were studied. After implantation of all components, varus/valgus laxity of the knee was measured intraoperatively with the knee at 0°, 30°, 60°, 90°, and 120° guided by an image-free navigation system. Factors that affected patient satisfaction and expectations, including lateral and medial laxities, were evaluated using the 2011 Knee Society score.Results: The mean intraoperative lateral laxity was 1.1°, 1.6°, 0.9°, 1.3°, and 1.7° with the knee at 0°, 30°, 60°, 90°, and 120°, respectively. The mean intraoperative medial laxity was 1.1°, 1.4°, 1.1°, 1.1°, and 1.7° with the knee at 0°, 30°, 60°, 90°, and 120°, respectively. Patient satisfaction after TKA correlated positively with symptom (R = 0.61, P < 0.01) and functional activity (R = 0.47, P < 0.01) scores. Patient expectations after TKA correlated positively with symptom (R = 0.29, P < 0.01) and functional activity (R = 0.20, P = 0.01) scores, and negatively with medial laxity at 30° (R = -0.21, P < 0.01).Conclusion: Midflexion medial laxity was associated with worse patient expectations after TKA. Avoiding medial laxity could be one of the important techniques during TKA.

Case Report: Hemophagocytic Lymphohistiocytosis and Non-Tuberculous Mycobacteriosis Caused by a Novel GATA2 Variant

Hemophagocytic lymphohistiocytosis (HLH) is a disorder of uncontrolled immune activation with distinct clinical features including fever, cytopenia, splenomegaly, and sepsis-like symptoms. In a young adolescent patient a novel germline GATA2 variant (NM_032638.5 (GATA2): c.177C&gt;G, p.Tyr59Ter) was discovered and had resulted in non-tuberculous mycobacterial (NTM) infection and aggressive HLH. Strikingly, impaired degranulation of cytotoxic T-lymphocytes (CTL) and natural killer (NK)-cells was detected in CD107a-analyses. The affected patient was treated with HLA-matched unrelated alloHSCT, and subsequently all hematologic and infectious abnormalities including HLH and NTM resolved. This case supports early alloHSCT in GATA2 deficiencies as curative approach regardless of active NTM infection. Future studies on GATA2 c.177C&gt;G, p.Tyr59*Ter might unravel its potential role in cytotoxic effector cell function and its contribution to HLH pathogenesis.

Anton’s Syndrome in Occipital Lobe Infarction

Anton's syndrome implies the situation when affected patient contradicts blindness in spite of objective documentation of loss of vision, and often confabulate to assert their bearing. It is an infrequent sequel of cortical blindness affecting both occipital cortex and other cortical centers, while patients genuinely act as if they are sighted. Our case report is of a lady, 55 years old, who presented to us with history of uncontrolled diabetes, hypertension and visual loss as a consequence of occipital lobe infarction bilaterally. In patients with evidence of occipital lobe injury and atypical visual loss, an assessment for cortical blindness and Anton's syndrome must be included. Anton's syndrome is most frequently caused by cerebrovascular disease. Any condition that causes cortical blindness may, however, lead to Anton's syndrome. Improvement in visual function after occipital lobe infarction due to cerebrovascular events is limited. Therefore, the management should be focused on rehabilitation and secondaryprevention. Keywords: Anton’s syndrome, Occipital lobe infarct, Diabetes mellitus, Hypertension.

PENGARUH EXPERIENTIAL MARKETING TERHADAP KEPUASAN DAN LOYALITAS PASIEN

This study aimed to examine the effect of experiential marketing on patient satisfaction and patient loyalty. It also attempted to discover the experiential-marketing dimension with the predominant effect. It is a quantitative study with a cross-sectional approach. The study population was all inpatients in Rumah Sakit Islam (RSI) Unisma Malang between February and March 2017. The researchers selected 197 respondents as samples using the purposive sampling method from all ward classes except VVIP class. This study’s exogenous variable was experiential marketing, whereas the endogenous variable was patient satisfaction and loyalty. As the instrument, the researchers used a questionnaire to reveal the patients’ perceptions and hopes about experiential marketing applied by the hospital and their satisfaction and loyalty. The researchers used Partial Least Square (PLS) as a data analysis method. The study showed that experiential marketing dimensions (consisting of sense, feel, think, act, and relate) positively and significantly affected patient satisfaction. Experiential marketing insignificantly and indirectly affected patient loyalty through patient satisfaction, and ‘relate’ was the most dominant dimension of experiential marketing in building patient satisfaction. Keywords: experiential marketing; patient satisfaction; patient loyalty.