Prevalence and Factors Associated with Opioid Prescription in Swiss Chronic Hemodialysis Patients

Pain is a common symptom in patients on chronic hemodialysis (HD) but the prevalence of opioid prescriptions in this population has been poorly studied outside the United States. This study assesses the prevalence of opioid prescription in two Swiss dialysis centers. Prescriptions and clinical characteristics were retrospectively retrieved from the medical records of patients on HD for at least six months, treated at Lausanne University Hospital (academic center, AC), and the private center Clinique Cecil (PC) for the study. A total of 117 patients were included; 29.1% received at least one opioid prescription during the study period. Significantly more patients received an opioid prescription in the AC (39.1%) than in the PC (14.6%, p = 0.004). Univariate logistic regression analysis showed that center (Odds Ratio (OR) 3.76; Confidence Interval (CI) 1.48–9.6; p = 0.006), neuropathic pain (OR 2.99; CI 1.28–6.98; p = 0.011), benzodiazepine prescription (OR 2.72; CI 1.14–6.46; p = 0.024), polyneuropathy (OR 2.71; CI 1.14–6.46; p = 0.024) and amputation (OR 4.23; CI 1.1–16.1; p = 0.034) were associated with opioid prescription. The center was the only independent predictive factor in the multivariate analysis. Our results show that opioids are regularly prescribed to Swiss dialysis patients, although important differences exist between centers. The latter finding might suggest that opioid prescribing is more related to the prescriber than to the patient’s condition, but larger-scale studies are necessary to confirm this.

Case Report: Cerebral Phaeohyphomycosis Due to Chaetomium strumarium in a Child with Visceral Heterotaxy Syndrome

Chaetomium sp. is a mold, member of the phylum Ascomycota. Clinical disease in humans is rare, particularly in children, for which only five cases have been reported. We report a 7-months-old female patient with a diagnosis of visceral heterotaxy syndrome who was admitted to a private center in Mexico. After two episodes of focal myoclonic seizure, a brain magnetic resonance imaging (MRI) revealed a right porencephalic cyst and a right frontal abscess with ventriculitis. Seventy-two hours after temporal abscesses drainage procedure, the culture showed a rapidly growing pale white fungal colony. Sequencing of ITS and D1/D2 led to the identification of Chaetomium strumarium. Although Chaetomium sp. is a rare fungal infection in humans, clinicians should consider it as a plausible etiologic agent that can form brain abscess.

The Role of FDG-PET/CT in Staging of Breast Cancer

Background Breast cancer is the most common non-skin cancer and the second leading cause of cancer related death in women. Breast cancer strikes women of all ages, races, ethnicities, socioeconomic strata, and geographic locales. Once breast cancer is diagnosed, the tumor stage has to be accurately determined before therapy chosen and the prognosis known. Aim of the Work to highlight the role of PET-CT imaging in staging of patients with breast cancer. Patients and Methods This study was carried out on a total of 51 female patients biopsy-proved to have cancer breast coming to perform PET/CT scans for staging, pre-operative or pre-therapeutic assessment with ages ranging from 27 to 78 years, in specialized private center in Cairo using combined PET-CT machine (Phillips Ingenuity TF PET/CT 128 Slice) from October 2017 to June 2019. Results Combined PET/CT staged 3 patients as stage IA, 10 patients as stage IIA, 6 patients as stage IIB, 2 patients as stage IIIA, 3 patients as stage IIIB, 2 patients as stage IIIC and 25 patients as stage IV. Out of 51 patients, combined PET/CT upgraded the staging of 13 patients compared to initial CT staging. Conclusion PET/CT is the technique of choice and indispensable tool for evaluation of the patients with breast cancer.

Role of Susceptibility Weighted Images (SWI) in Grading of Brain Glioma

Background Glioma is the most common intracranial primary tumor of central nervous system (CNS) and accounts for about 70% of primary adult malignant brain tumors. The optimum therapeutic treatment and prognosis evaluation largely depends on the tumor pathological grades. Objective To evaluate the role of susceptibility weighted imaging (SWI) in grading of cerebral gliomas. The magnetic resonance imaging (MRI) results were compared and correlated to the pathology results to evaluate its role. The pathological grading of the glioma was done according to WHO 2007 classification system. Patients and Methods This was a retrospective study that included 35 adult patients, (11females & 24 males), their ages ranging from 18 years to 73 years. They were pathologically proven glioma patients ranging from grade I to grade IV. All the patients were referred from neurosurgeon to our radiology center (private center). This study was carried out during the period between January 2017 and November 2018. Results In our study, there were a strong positive correlation between both conventional imaging and pathological grading and between pathological and SWI grading. Using SWI sequence in grading of glioma will be very beneficial in patients with contraindication to contrast. Conclusion SWI using 3T MR system may provide quite useful information for preoperative glioma grading. There seems to be a strong positive correlation between pathological grading and SWI grading system for glioma. The main disadvantage for SWI is the extra time added to the usual time of routine MRI protocol used in cases of intra cranial space occupying lesions (SOL).

Changes in the Care of Neurological Diseases During the First Wave of the COVID-19 Pandemic: A Single Private Center Study in Argentina

Introduction: Healthcare systems are struggling to cope with the rapid evolution of the COVID-19 pandemic. In Argentina, the pandemic is advancing despite prolonged lockdown measures. We aim to analyze the impact of the easing of lockdown measures in the number of visits to the emergency department (ED), and outpatient consultations (OC) to a tertiary neurological center.Methods: We compared the number of ED visits with the social mobility overtime. We also compared the number of OC, and the geographic distribution of patients' addresses between 2019 and 2020.Results: ED visits decreased 48.33% (n = 14,697 in 2019 vs. n = 7,595 in 2020). At the beginning of the lockdown, the social mobility decreased in pharmacies/groceries, and workplaces, along with a reduction in the number of ED visits. With the easing of lockdown restrictions, the social mobility decreased in residential places, slightly increased in workplaces and almost return to normal in pharmacies/groceries. Variations in ED visits correlate better with social mobility in workplaces (coef. =0.75, p < 0.001) than in groceries/pharmacies (coef. =0.68, p < 0.001). OC decreased 43%. Fourteen percent of OC were tele consults. This was associated with an increase of the geographical area of influence of our center (standard distance of 109 km in 2019 and 127 km in 2020).Conclusions: Despite an increase in social mobility, the number of ED visits and OC to an Argentinian tertiary neurological center remain worrisomely low. The pandemic catalyzed the introduction of telemedicine in our country. This has also allowed patients from distant zones to gain access to specialized neurological care.

Risk Assessment of Covid-19 in the Iranian Health System: A Brief Report

Objective: The outbreak of Covid-19 has exerted unprecedented pressure on healthcare systems throughout the world. This study was designed to develop a national health emergency management program based on risk assessment for COVID-19. Method: Mixed-methods research was used. Based on recommendations of the national epidemiology committee, two risk scenarios were used as basic scenarios for risk assessment. Two rounds of Focus Group Discussions (FGDs) were conducted between January and May 2020 with thirty representatives of the health system. The data were collected, analyzed, and Integrated by the research team. Findings: In the risk matrix, “Contamination of environment and Individuals” and “Burn out of Medical staff” occupied the red zone (Intolerable risk). “Defects in screening and admissions”, “Process disruption in Medical care and Rehabilitation”, “Increased mental disorders”, “Social dissatisfaction”,” The decline in healthcare Services”, and “Loss of medical staff” were identified as the orange zone (Significant risk) of the matrix. Conclusion: The risk of environmental, individual contamination, and healthcare workers’ burnout is the priority in Iran. Attention to intersectoral cooperation, the involvement of NGOs and private center capacities, integration of information health systems, and develop evidence-based protocols are other measures that can improve the health system’s capacity in the response COVID-19.

Accelerated Idioventricular Rhythm and Hypokalemia, Atypical Presentation in the Midst of a Pandemic

A 34-year-old female patient was referred to a private center from a rural population due to exertional dyspnea and palpitations for 15 days being previously asymptomatic, a surface electrocardiogram diagnoses sinus rhythm alternating with accelerated idioventricular rhythm with episodes of short-coupling intervals. When conducting a diagnostic investigation, hypokalemia and decreased serum magnesium were evidenced and, after correction of the water-electrolyte imbalance, the electrocardiographic disorders disappeared.