Cystic fibrosis in black people: a case report from Main Hospital in Dakar

La mucoviscidose, encore appelée fibrose kystique du pancréas (cystic fibrosis) ou "maladie des mucus visqueux", est une maladie génétique transmise selon le mode autosomique récessif. C'est une maladie grave ubiquitaire, très fréquente chez les caucasiens. Dans cette population blanche, les auteurs s'accordent sur une fréquence de 1 sur 2 500 nouveau-nés, correspondant à une fréquence de porteurs hétérozygotes de 1/25. Dans les autres races, la fréquence serait 20 à 40 fois moindre. Si dans les pays développés la prévalence est assez bien établie grâce à des études sans cesse renouvelées, en Afrique, particulièrement la zone subsaharienne, les données sont plutôt rares. Au Sénégal, seuls quelques cas isolés ont été rapportés dont un cas en 1983 par Fall et ses coll. Il s'agit ici d'une étude rétrospective et descriptive d'un cas clinique d'une adolescente atteinte de mucoviscidose colligé et suivi en Pédiatrie à l'Hôpital Principal de Dakar au courant de septembre-octobre 2013. Dans le cadre d'une collaboration, notre patiente a également été suivie en pneumologie pédiatrique à l'hôpital d'Enfants Albert Royer de Dakar. Le diagnostic de Mucoviscidose a été posé devant les arguments cliniques et confirmé sur la base du test de la sueur et des tests génétiques par recherche de mutation du gène CFTR. La Mucoviscidose est une pathologie très rarement diagnostiquée dans les populations noires des pays en développement. Il faut tout de même savoir y penser devant toute pathologie respiratoire trainante associée le plus souvent à une dénutrition.

Is there a Relationship between the Blood Group and the Percentage of Lung Involvement in COVID-19‘S Patients?

As a faculty member who is teaching students in the main hospital of coronavirus - Tohid hospital - in Sanandaj, Iran. I want to share my experiences in confronting the chest CT of COVID-19 patients. What we saw in chest CT of these patients was the different percentage of lung involvement in blood groups. The percentage of lung involvement in patients with blood group O was noticeably higher than other blood groups. Unfortunately, a high percentage of outpatients with high lung involvement in chest CT were old and were unaware of their blood group, therefore we cannot claim that there is a significant relationship between lung involvement and blood group in COVID-19 patients. To the best of our knowledge, clinical presentations and papers have not yet addressed this issue, therefore proof of this relationship requires clinical studies

Labrador Emergencies and St. Anthony Institutional Care: Medical Cases of Donald McI. Johnson for the Grenfell Association, 1928–29

In contemporaneous and retrospective publications, British physician Donald McI. Johnson wrote about medical cases in 1928–29 for the organization founded by Wilfred Grenfell in Newfoundland and Labrador. The availability of one physician’s cases in published and institutional forms allows consideration of discursive representations of patients for general and clinical readers in the two decades of Johnson’s writing. This study places these cases within the context of Johnson’s medical background and his escape to rural practice in a remote locale, one that emphasized emergency operations in Labrador and hospital care in the organization’s main hospital in St. Anthony. In this way, it broadens knowledge of medical care provided by visiting physicians and considers ways in which such physicians represented local patients in publications for the general reader. Although it determines that Johnson was unique, it indicates the value of the fuller study of publications by other physicians associated with the Grenfell organization.

Early evidence of SARS-CoV-2 in Milan, Jan-Feb 2020

Background A few studies have suggested that the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) was present in Northern Italy several weeks before its official detection on February 21, 2020. On the other hand, no clinical data have been provided so far to support such hypothesis. We investigated clinical-epidemiological evidence of SARS-CoV-2 infection among children and adults referring to emergency department (ED) in the main hospital of the center of Milan (Italy) before February 21, 2020. Methods A retrospective analysis of medical records of ED visits at the Fondazione Ca′ Granda Policlinico, Milan between January 11 and February 15 in 2017, 2018, 2019 and in 2020 was performed. The number of subjects referring with fever, cough or dyspnea was compared between the studied period of 2020 and the previous 3 years, by calculating a standardized referral ratio (SRR, number of observed cases in 2020 divided by the number of expected cases according to 2017–2019) and the corresponding 95% confidence interval (CI). Results In the pediatric ED, 7709 (average 2570/year) and 2736 patients were visited during the period 2017–2019 and in the 2020, respectively. Among adults, 13,465 (average 4488/year) and 4787 were visited during the period 2017–2019 and in the 2020, respectively. The SRR was 1.16 (95% CI 1.10–1.23) in children and 1.25 (95% CI 1.16–1.35) in adults. The ratio for the two (children and adults) SRRs was 0.93 (0.84–1.02), suggesting a trend towards a higher frequency in adults compared to children. Conclusions This study suggests that SARS-CoV-2 might have spread in Milan before February 21, 2020 with a minor trend among children.

Advanced Applications of Fuel Cells during the COVID-19 Pandemic

COVID-19 was identified all over the world as a pandemic in December 2019. This novel coronavirus affects the lower respiratory area, which causes pneumonia in the human body and transfers from human to human. Every day, the number of new patients and the number of deaths are increasing immensely, while specific drugs for this virus are still being developed. Hospitals are struggling to accommodate patients, resulting in a large number of temporary hospitals. These makeshift hospitals need an uninterrupted power supply to continuously maintain all the electrical facilities. Fuel cells, especially solid oxide fuel cells, play an essential role in meeting the additional energy needs of humankind during this critical moment. SOFCs are able to supply power to those makeshift hospitals from the main hospital building, as well as supplying electricity to locked-down residential areas to ease the strain on the electrical grid during this pandemic situation. As a result of their extensive applicability and numerous uses, SOFCs can be used to address electrical needs challenges in various sectors.

555 The Unintended Consequences Of COVID-19 on the Quality of Documentation of Operation-Notes

Introduction Operation-notes are crucial as they impact on the care of patients post-operatively. During COVID-19, a sizeable proportion of General Surgical procedures were performed at a local “cold” site private hospital. This study aims to determine the direct impact of COVID-19 on the standard of operation-note documentation at a non-routine site compared to our routine site. Method The Royal College of Surgeons Good Surgical Practice guidance highlights 19 key-variables to record within operation-notes. 300 consecutive operations were identified between May and August 2020 and details of electronic operation-notes collected. Throughout this study period, educational emails and posters were introduced at both sites secondary to ongoing audit. Results 228/300 (76%) operations took place at our main hospital. The remainder were commissioned to the other. Operating surgeons and anaesthetists were similar at both sites. Quality of documentation was poorer for many key variables at the cold site when compared with the main site (operating-surgeons (22% vs 91%), urgency of operation (62% vs 99%), antibiotic prophylaxis (72% vs 99%) and DVT prophylaxis (21% vs 98%)). Conclusions COVID-19 has resulted in many unintended consequences including a reduction in the quality of operation-notes. Moving forward, this may be reduced by improving information technology resources and increasing awareness and education.

Measuring prevailing practices of healthcare professional on electronic health record through the lens of Iraq

Paper based approach to clinical documentation such as handwritten notes among health care providers are cause of errors in medical field. Therefore, health record system needs to be replaced with electronic health record (EHR). Many health professionals in developing countries specifically in Iraq refuse to use the systems implemented for their benefits due to many reasons. Thus, the use of electronic services is important for successful electronic health implementations. Therefore, this study is intended to identify the main factors affecting the intention of use of the electronic health record in Iraq. Health professional staff who work in the main hospital in Dhi-Qar is chosen because this province is the first local province that implemented many electronic projects. The present study examined use of user acceptance of technology, based on the technology acceptance model (TAM). Moreover, the quantitative method approach for data collection using survey from staff who work in the main hospital in Dhi-Qar. Data was analyzed using Structural Equation Modeling using AMOS. The results indicated significant relationship between Ease of Use, Usefulness, Usefulness, Attitude, and Intention of use of EHR. These finding have implementation for decision makers in Iraq government to improve future implementation of e-health services.

Abstract 319: A Multi-faceted Programmatic Approach Associated with Over 50% Reduction in In-hospital Mortality

Introduction: In the United States, the chance of dying in the hospital widely varies by hospital, with bottom-decile hospitals having twice the rates of risk-adjusted mortality when compared to top-decile hospitals. This suggests a need for improvement in health systems nationwide. Here, we describe the implementation of, and associated outcomes for a multi-faceted, evidence-based approach to reducing in-hospital mortality. Methods: This is a retrospective interrupted time-series conducted at a large, urban, academic health system. Specifically, we describe the implementation of the following evidence-based methods: 1) escalation of communication guidelines, 2) proactive rounding with nurse response teams, and 3) rapid response teams with dedicated staff. We then quantify the associated observed-to-expected (O:E) in-hospital mortality over a 12-year period at our main hospital, and subsequently over a 3-year period at an affiliated hospital where the same interventions were later implemented. Results: Over 12 years, 445,308 patients were discharged from our main hospital, with 3,948 (0.9%) being discharged to an acute care facility, 4,558 (1.0%) discharged to hospice, and 4,648 (1.0%) expiring in the hospital. Patients had an average age of 53.1 years (std.dev 22.8 years), with the majority being female (59.0%), non-Hispanic white (66.1%), and admitted from the outpatient setting (93.3%). From the years 2010 to 2013, there was decline in O:E mortality by 59.0% (Figure 1A). This effect was sustained from 2014-2018. At the affiliate hospital, there was a similar decline in O:E mortality after implementation of the same interventions (60.5%, Figure 1B). Conclusion: Our multi-faceted, programmatic approach was associated with over 50% reductions in in-hospital mortality that were sustained for several years after implementation, and were reproduced at an affiliated hospital.

CLINICO-PATHOLOGICAL STUDY OF SINONASAL MASSES

INTRODUCTION The nose is the most prominent part of the face with substantial aesthetic and functional significance. It is one of the few organs of body invested with an aura of emotional and cultural importance. Anatomical location of the nose and it passage have been regarded as the direct avenue to the brain, man’s source of intelligence and spirituality. AIMS AND OBJECTIVES To study the incidence, clinical presentation and pathological profile of various types of sinonasal masses at Tata Main Hospital, Jamshedpur, Jharkhand. To detect the variation of clinical presentation of sinonasal masses in relation to Age, Sex, Risk factors and Occupation, clinical presentation and the histopathological diagnosis of sinonasal masses. Compare the results of this study with the results of the previous workers. MATERIAL & METHODS: This Prospective, observational study was done in the department of Otorhinolaryngology, Tata Main Hospital, Jamshedpur, Jharkhand. 90 patients presenting with the features of nasal obstruction, nasal discharge, headache, anosmia / hyposmia, epistaxis, facial deformity, ear & eye symptoms will be evaluated by taking history and thorough ENT and head and neck examination(including nasal endoscopy) and subjecting them for the procedure. RESULT Out of 90 patients, 59(65.56%) were males and 31(34.44%) were females. In our study, among non neoplastic masses 34 were male and 26 were female. For non-neoplastic lesions the average age of presentation was 36.2 years. Mean age of presentation was 37.21 years. CONCLUSION Emergence of newer surgical, medical and radiological intervention have open up a new chapter with these type of patients. . Awareness regarding the disease process and health education should be provided to people regarding smoking, maintenance of hygienic condition and utilization of health facilities.