Person-centred care-based crisis management: facing COVID-19 in an oil industry

Background The study aims to present the strategies used in person-centred care, through measures to promote and prevent COVID-19 pandemic in an oil industry in Brazil. The corporate focus is on managing the crisis, converging economic interests, operational security, health and protection of individuals. Methods In March 2020, a ‘Crisis Room’ was structured, based on the Incident Command System (ICS) methodology for managing interventions in the company, covering about 160 000 workers and 1000 health professionals, including physicians, nurses, psychologists, social workers and nutritionists. The main strategies were: production of technical notes on COVID 19, development of software for monitoring cases, call-centre through a specialized centre with medical and psychological support, test implementation, implementation of sanitary barriers with temperature verification and filling of forms, as well as systematic technical forums. Results In the period of 1 year, 46 technical notes were produced, 61 388 cases were recorded and monitored, 30 373 gold standard tests (RT PCR), 484 686 rapid tests, 25 217 workers approached at health barriers and an average of 350 systematic technical forums, were carried out. Conclusions Attention to the presented scenario and the mapping of the particularities in the emergency response are fundamental for decision-making, which can be impacted by the absence of strategies still in the reactive phase of the emergency. Despite the adoption of the ICS methodology in the management of the COVID-19 crisis, the incorporation of instruments aimed at individual-centred care were key strategies and foundations that have guaranteed work safety and the maintenance of productivity in this oil company within pandemic context.

Prevalence of HIV among newly diagnosed tuberculosis patients in Erbil Governorate, Iraq

Objectives: This study was accomplished with a purpose to determine the socio-demographic profile and the prevalence of HIV among TB patients. Methods: This prospective study was carried out in the Department of Microbiology at the Chest and Respiratory Disease Specialized Centre in Erbil City (In collaboration with the Specialist physician) through a period from January 2017 to December 2019. New TB patients were interviewed on a predesigned questionnaire. Collected samples were processed in a special laboratory in TB center. The samples were subjected to microscopy with Ziehl–Neelsen staining and inoculated on solid medium; the third sputum sample was tested directly by GeneXpert test. HIV testing was done using screening test and if the screening result was positive, the diagnosis was confirmed by Western Blot. Results: A total of 397 approved new tuberculosis patients underwent HIV testing. Among them, forty one cases 41 (10.3%) were found to be positive on ELISA screening and subsequently they were all confirmed by the Western Blot test. The highest prevalence of HIV positivity according to gender, age range and occupation, were as follows : male (29 ; 70.7%) , 30-42 years ( 21 ; 51.2%) , laborers ( 13; 31.7%) respectively . The male to female ration is 2.7 statistically, the differences of distribution of the HIV positivity concerning the above‑mentioned demography were as follows: gender: significant (P ≤ 0.05), age range: no significant, occupation: no significant. The highest prevalence of HIV positivity was among pulmonary TB ( 25 ; 61% ) .Rifampicin resistant prevalence was higher among HIV positive in comparison to HIV negative TB case ( 23 ; 56.1% ) (134 ; 37.4%) respectively . Statistically, the differences of distribution of the HIV positivity in relation to both TB pattern & rifampicin mono drug resistant were significant (P ≤ 0.05). Conclusions: The prevalence of HIV infection in TB patients in current study was (10.3%). If HIV testing done by all TB patients then routine reporting of HIV status for all TB patients would provide even better information on which to base future planning.

Clinical case of heart transplantation in the conditions of «the recipient-to-donor» transportation

The main factor limiting the number of heart transplants in Ukraine is the small number of potential donors. In cases when the delivery time of the donor organ is more than 4 hours, the risks of the donor organ ischemic injury are multiplied. Transportation of the recipient to the location of the potential donor in such cases is a forced measure, as it increases the risk of adverse cardiovascular events in the recipient during transportation. Providing medical care to a recipient in such circumstances may be difficult. However, these measures are fully justified by the reduced risk of postoperative complications associated with the time of graft ischemia. The article describes a case of heart transplantation in the conditions of transporting the recipient to the donor. Heart transplantation was performed in a patient with NYHA functional class IV heart failure, refractory to conservative therapy. The postoperative period was uneventful. The time of cardiopulmonary bypass was 90 minutes, the total ischemia time was 180 minutes. On the 3rd day, the patient was transported to the specialized centre to continue treatment and rehabilitation. On the 21st day the patient was discharged in satisfactory condition for outpatient treatment. Key words: heart transplantation, cardiomyopathy, heart failure.

OBSTRUCTIVE SLEEP APNEA DURING CHILDHOOD IN TERTIARY CARE CENTER IN SAUDI ARABIA

Background:Obstructive sleep apnea (OSA) is a common disorder with the prevalence of 1-5%. OSA in there is a paucity of data regarding OSA in children in our region. This is particularly important as OSA is associated with neurocognitive deficits and cardiovascular complication. The aim of this study is to evaluate the prevalence of OSA among children referred to specialized centre in Saudi Arabia. Methods:A retrospective chart reviewstudy involving children ≤18 years, identified from pediatric tertiary care centrewho had an overnight polysomnography (PSG).OSA was diagnosed if the obstructive apnea-hypopnea index (OAHI) washigher than 1event per hour. Results: There were 12 participants included.The mean age was 8 years (standard deviation [SD] ± 1.7). Of these, 6/12 (50%) had OSA. Compared with the non-OSA group, the OSA group had a lower sleep SpO2 during REM sleep (p = 0.008). Conclusion: Children with clinical symptoms should be referred for OSA diagnosis. A history of snoring may be useful indicators to facilitate a PSG, especially in resource-limited settings.

Surgical treatment of hepatic alveococcosis in highly specialized centre of non-endemic region

Objective. To estimate the results of operative treatment of hepatic alveococcosis in conditions of surgical centre of non-endemic region. Materials and methods. From 2004 to 2020 yr in Department of Transplantation and Hepatic Surgery of Shalimov National Institute of Surgery and Transplantation NAMS of Ukraine 13 patients, suffering hepatic alveococcosis, were radically operated. General characteristic of patients, methods of preoperative preparation, іntraoperative data, the indices of morbidity and lethality were investigated. Results. In 11 (84.6%) patients the disease was diagnosed on late stages: IIIa-IV in accordance to pTNM by WHO classification. Preoperatively in 5 (38.5%) patients transcutaneous transhepatic cholangiostomy and in 8 (615%) patients - roentgenendovascular occlusion of the portal hepatic vein branches - were performed. In 12 (92.3%) patients extended hepatic resections were done, including in 2 (15.3%) - complete vascular hepatic exclusion with hyperthermic perfusion in situ. Postoperative complications rate of IIIa-IV degrees in accordance to Clavien-Dindo classification have constituted 30.7%, while postoperative mortality - 7.7%. Up to the end of follow-up the disease-free period have persisted in all the patients. Conclusion. Aggressive surgical tactics in patients, suffering hepatic alveococcosis, permits to obtain good immediate results in highly specialized centres. Today radical operative intervention continues to be the only one method of treatment in the patients, which may guarantee satisfactory late follow-up results.

BSR guideline on the management of adults with systemic lupus erythematosus (SLE) 2018: baseline multi-centre audit in the UK

Objectives To assess the baseline care provided to patients with SLE attending UK Rheumatology units, audited against standards derived from the recently published BSR guideline for the management of adults with SLE, the NICE technology appraisal for belimumab, and NHS England’s clinical commissioning policy for rituximab. Methods SLE cases attending outpatient clinics during any 4-week period between February and June 2018 were retrospectively audited to assess care at the preceding visit. The effect of clinical environment (general vs dedicated CTD/vasculitis clinic and specialized vs non-specialized centre) were tested. Bonferroni’s correction was applied to the significance level. Results Fifty-one units participated. We audited 1021 episodes of care in 1003 patients (median age 48 years, 74% diagnosed >5 years ago). Despite this disease duration, 286 (28.5%) patients had active disease. Overall in 497 (49%) clinic visits, it was recorded that the patient was receiving prednisolone, including in 28.5% of visits where disease was assessed as inactive. Low documented compliance (<60% clinic visits) was identified for audit standards relating to formal disease-activity assessment, reduction of drug-related toxicity and protection against comorbidities and damage. Compared with general clinics, dedicated clinics had higher compliance with standards for appropriate urine protein quantification (85.1% vs 78.1%, P ≤ 0.001). Specialized centres had higher compliance with BILAG Biologics Register recruitment (89.4% vs 44.4%, P ≤ 0.001) and blood pressure recording (95.3% vs 84.1%). Conclusions This audit highlights significant unmet need for better disease control and reduction in corticosteroid toxicity and is an opportunity to improve compliance with national guidelines. Higher performance with nephritis screening in dedicated clinics supports wider adoption of this service-delivery model.

Effect of Different Methods for the Overhang Amalgam Restorations Removal on Periodontal Health Status

Overhanging tooth restorations due to environmental change of the balance between beneficial bacteria and periodontopathogens lead to periodontal breakdown. This study aim was to evaluate the periodontal status after using different techniques for amalgam overhang removal. The proximal restorations were examined clinically and then radiographically by taking bitewing radiograph. From a total of 1200 patients examined in College of Dentistry, Hawler Medical University and (Khanzad) Specialized Centre for Dentistry for presence of proximal amalgam restoration, for this interventional and prospective study, 45 patients with amalgam overhang were divided into three groups each 15 patients according to size and position of amalgam overhang each had one type of the following treatment (Refilling, Diamond Bur, EVA system) and 15 patients without amalgam overhang (control group) selected completed the trial. Clinical periodontal parameters were measured in teeth with amalgam overhang at baseline, 2 week, 1 and 3 months after removal of amalgam overhang. The results showed that the periodontal parameters showed a gradual decrease in all groups throughout the follow-up visits (except calculus index) and became a statistically significant in the 3 months follow-up following treatment (P < 0.001), with more reduction found in refilling group followed by EVA system then diamond bur group. In conclusion that it is better to replace the restoration rather than to use the other methods of treatment according to periodontal health which recorded by periodontal parameters.

A Comparison between High Ablative Versus Usual Dosages of Iodine-131 in Inducing Hypothyroidism After One Year of Therapy in Hyperthyroid Patients

Background: Radioactive iodine-131 therapy is highly effective in treating patients with hyperthyroidism. An ablative dose is preferred by a number of endocrinologists, and, a fixed dose protocol seems to be better than a calculated dose in real practice. Objective: To check for hypothyroidism in hyperthyroid patients one year after RAI therapy, comparing between the results of high ablative versus usual dosages of RAI-131. Methods: This study included 174 hyperthyroid patients, 101 males and 73 females, divided into 2 groups, the first consisted of 162 patients given a usual fixed dose of RAI while the second consisted of 12 patients given a high fixed ablative dose of RAI. The study lasted about 2 years from August 2000 till July 2002 in the Specialized Centre for Endocrinology & Diabetes, Baghdad. Results: Out of 162 patients in the first group, 11 patients (6.8%), developed hypothyroidism compared to 4 patients out of 12 (33.3% ) in the second group ( p < 0.05). Conclusion: A high ablative dose RAI has a better outcome regarding hypothyroidism than a usual dose, although, endocrinologists have different opinions regarding this issue.

Limitations in Total Laparoscopic Hysterectomy in Bangladesh

Laparoscopic Hysterectomy is achieving great popularity nowadays. Our people are becoming increasingly interested in new advances in this field of surgery. Highly skilled surgical technique, longer operative time and expensive technology are observed to be the factors that impede the advancements in laparoscopic surgery1.Objective: The aim of our study is to analyze the limitations of laparoscopic hysterectomy in our country.Methods: This is a retrospective observational study where we have reviewed demographic data, compliance of the patients, quality of anaesthesia, efficiency of supportive staffs, adequacy of appropriate instruments, continuous training of surgeons and surgical risk factors. Total 80 Total Laparoscopic Hysterectomy (TLH) were done between January’ 2016 to December’2017 in Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka.Result: In this study, we analyzed eighty patients who underwent total laparoscopic hysterectomy for fibroid uterus, adenomyosis, recurrent post-menopausal bleeding, abnormal Uterine bleeding(AUB) etc. We tried to analyze some limitations and challenges which we can overcome. In spite of lack of appropriate instruments, adequate ICU support and repeated training in specialized centre at home and abroad, 87.5% patients recovered well. The aim of our study was to identify the surgical risk factors of the patients and limitations in our theatre environmentJ Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 3-5