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2021 ◽  
Vol 23 (6) ◽  
pp. 149-150
Author(s):  
Prasad Panse ◽  
◽  
Sreeja Biswas Roy ◽  
Robert Viggiano

No abstract available. Article truncated after first 150 words. A 76-year-old woman with a past medical history significant for left-sided breast cancer status post lumpectomy recently underwent an extensive dental procedure about 1 month prior to presentation. The dental procedure was prolonged, and the patient reported falling asleep during the procedure several times. She presented with fatigue, right pleuritic chest pain, low-grade fevers, and drenching sweats. She underwent chest radiography at an outside institution which disclosed pneumonia, for which she was treated with cefdinir and doxycycline without improvement. Thoracostomy tube drainage of the pleural effusion was performed and showed empyema. Imaging showed an airway foreign body which was retrieved bronchoscopically. The patient made an uneventful recovery. Aspiration during dental procedures is rare but reported (1). Dental items have been reported as the second most commonly ingested/aspirated foreign objects in adults. If the airway is not compromised, assessment for any lost or missing instrument and its component should be done …


Author(s):  
Hamed H. Alnouri ◽  
Khalifa Alyatama

AbstractSump syndrome is a rare complication of a side to side choledochoduodenostomy (CDD). After the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in 1968 Kozarek (Gastroenterol Hepatol (N Y) 13(10):620-622, 2017), choledochoduodenostomy and its complications are seldom seen. The diagnosis of sump syndrome is further befogged by the lack of characteristic clinical or laboratory findings, the inability of the patient to provide medical records of their CDD, and the fact that sump syndrome only presents decades after a CDD. In this article, we will present a case of a 39-year-old female patient who presented as a case of ascending cholangitis with an initially unknown past surgical history. A detailed medical history was thoroughly taken, and her previous medical reports were presented after which an ERCP was done with extraction of debris was preformed. In a time where choledochoduodenostomy is rarely being chosen as a choice of treatment and its complications are infrequently encountered, this case serves as a reminder that even in the ERCP era, complications of choledochoduodenostomy should still be well understood.


Author(s):  
Дмитрий Валериевич Судаков ◽  
Евгений Владимирович Белов ◽  
Олег Валериевич Судаков ◽  
Ольга Игоревна Гордеева ◽  
Оксана Анатольевна Тюрина

Статья посвящена анализу эффективности электронного документооборота в многопрофильном стационаре на догоспитальном этапе (в условиях приемного отделения). Исследование, проводимое в 2020-2021 гг в БУЗ ВО ВОКБ №1, можно считать актуальным, в виду того, что в последние годы в нашей стране в сфере здравоохранения продолжается ряд реформ, направленных на оптимизацию и модернизацию. Этот процесс был бы невозможен без повсеместно проводимой информатизации и цифрофизации. В настоящее время в Воронежской областной клинической больнице №1 происходит внедрение электронного документооборота и специализированных компьютерных программ, изучение эффективности которых и стала целью работы. Объектами исследования послужило 400 пациентов, мужчин и женщин в возрасте от 18 до 79 лет и их истории болезни. Все больные были разделены на 2 группы по 200 человек, в зависимости от того, использовались ли элементы электронного документооборота и специализированные компьютерные программы при их оформлении и при оказании им диагностических мероприятий (не использовались в 1 группе и использовались во 2). В дальнейшем пациенты каждой группы были также подразделены на 2 подгруппы, в зависимости от профиля (хирургия и терапия). В основу исследования лег анализ времени, затраченного на разные этапы догоспитальной помощи - от первичного осмотра и заполнения первичной документации врачами приемного отделения, до выполнения основного спектра лабораторных и инструментальных методов диагностики. Интересной особенностью работы стало выделение в каждой диагностической процедуре нескольких основных этапов, включающих, в том числе и этапы «доставки» пациента к врачу - диагносту, а также временные рамки ознакомления лечащих врачей (терапевта или хирурга приемного отделения или узких специалистов) с результатами исследования. Представленные в статье данные позволяют судить о существенном уменьшении времени, затрачиваемого на оформление и основные диагностические процедуры, благодаря внедрению электронного документооборота. Полученные в работе данные представляют существенный интерес как для практикующих врачей различного профиля и врачей, участвующих в разработке специализированного медицинского программного обеспечения, так и для организаторов здравоохранения The article is devoted to the analysis of the effectiveness of electronic document management in a multidisciplinary hospital at the prehospital stage (in the conditions of the admission department). The research carried out in 2020-2021 at BUZ VO VOKB № 1 can be considered relevant, in view of the fact that in recent years in our country a number of reforms aimed at optimization and modernization have been continuing in our country. This process would not have been possible without the widespread informatization and digitalization. Currently, the Voronezh Regional Clinical Hospital № 1 is introducing electronic document management and specialized computer programs, the study of the effectiveness of which has become the purpose of the work. The objects of the study were 400 patients, men and women, aged 18 to 79 years and their medical history. All patients were divided into 2 groups of 200 people, depending on whether the elements of electronic document management and specialized computer programs were used in their design and in providing them with diagnostic measures (were not used in group 1 and were used in 2). Subsequently, the patients of each group were also subdivided into 2 subgroups, depending on the profile (surgery and therapy). The study was based on the analysis of the time spent on different stages of prehospital care - from the initial examination and filling out the primary documentation by the doctors of the admission department, to the implementation of the main spectrum of laboratory and instrumental diagnostic methods. An interesting feature of the work was the identification of several main stages in each diagnostic procedure, including the stages of "delivery" of the patient to the doctor - diagnostician, as well as the time frame for familiarizing the attending physicians (therapist or surgeon of the admission department or narrow specialists) with the results of the study. The data presented in the article make it possible to judge a significant reduction in the time spent on registration and basic diagnostic procedures due to the introduction of electronic document management. The data obtained in this work are of significant interest both for practicing doctors of various profiles and doctors involved in the development of specialized medical software, and for healthcare organizers


2021 ◽  
Vol 6 (2) ◽  
pp. 50-56
Author(s):  
Je Hoon Park

There are many causes of leg swelling or edema. Leg edema due to systemic condition or disease demonstrates chronic, bilateral features, whereas leg edema caused by vascular disease shows more complex clinical features including secondary skin changes and ulcerative lesion, resulting in more complicated clinical outcomes with less frequent early diagnosis and appropriate management. Definite differential diagnosis might not be possible by medical history, clinical features, and physical findings. Vascular ultrasonography (Duplex ultrasound) can be used easily as a bedside diagnostic procedure and is a recommended diagnostic tool for differentiation of a non-vascular from vascular etiology in patients with leg swelling.


Author(s):  
Nicole Koehler ◽  
Erica Schmidt ◽  
Matthew A Roberts ◽  
Jenepher Ann Martin

Background: Medical students are predominantly exposed to patients with chronic conditions during acute episodes requiring hospitalisation. Consequently, this limits students’ opportunities to learn about continuity of patient care. Unlike hospitalised patients, patients undergoing haemodialysis attend dialysis clinics in ambulatory/outpatient settings multiple times per week over long time periods. Patients undergoing dialysis would be well placed to share their knowledge of their own chronic illness and their experience of patient-centred care. This study explored the willingness of patients undergoing haemodialysis to interact with the same medical student throughout the academic year. Methods: Twenty-seven patients undergoing dialysis at four dialysis units were interviewed.Results: Twenty-five patients indicated that they would be willing to regularly interact with students. Patients indicated that they would permit students to conduct a range of activities (e.g., taking a medical history). All 25 were willing to provide students with verbal feedback. Twelve were willing to provide written feedback. In terms of interacting with students, there were two predominant groups: 1) those who focus on the students’ needs and are prepared to interact with students frequently and over a long duration and 2) those who have had “enough” after a while and are prepared to interact with students over a shorter duration. Conclusions: Patients undergoing haemodialysis could provide students with opportunities to follow a patient’s journey, provided the length and frequency of the patient–student interaction is matched with patient preferences. 


Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2223
Author(s):  
Alexandros Pergaris ◽  
Dimitra Stefanou ◽  
Panagiota Keramari ◽  
Stylianos Sousouris ◽  
Nikolaos Kavantzas ◽  
...  

The International System for Reporting Serous Fluid Cytopathology (TIS) classifies serous effusions into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM) and malignant (MAL). The main objectives of this classification comprise the establishment of a universal code of communication between cytopathologists and clinicians and histopathologists, as well as between different laboratories worldwide, paving the way for the setting of clinical management guidelines based on the risk of malignancy assessment for each diagnostic category. We retrieved the total number of pleural and peritoneal effusion cases of our department for the three-year time period between 2018 and 2020, yielding a total of 528 and 500 cases, respectively. We then proceeded to reclassify each specimen according to TIS guidelines and calculate the risk of malignancy (ROM) for each category by searching each patients’ histology records, medical history and clinical follow-up. For pleural effusions, 3 (0.57%) cases were classified as ND, 430 (81.44%) cases as NFM, 15 (2.84%) as AUS, 15 (2.84%) as SFM and 65 (12.31%) as MAL. ROM amounted to 0%, 5.3%, 33.33%, 93.33% and 100% for each category, respectively. As far as peritoneal effusions are concerned, 6 (1.2%) were categorized as ND with ROM estimated at 16.66%, 347 (69.4%) as NFM (ROM = 9%), 13 (2.6%) as AUS (ROM = 38.46%), 12 (2.4%) as SFM (ROM = 83.33%) and 122 (24.4%) as MAL (ROM = 100%). Our results underline the utility of the current classification, both as a means of communication between doctors of different specialties and as general guidelines for the further clinical management of patients.


Author(s):  
Constantin Lux ◽  
Miriam Klinger ◽  
Patrick Sauer ◽  
Marcel A. Verhoff ◽  
Mattias Kettner

AbstractWithin the scope of this technical report, the feasibility of indocyanine green (ICG) as a fluorescent agent for postmortem angiography of the heart is tested. The study included 4 deceased persons with no respective medical history of heart diseases. The basic patterns of findings in ICG fluorescence angiography associated with healthy hearts are presented. The method can easily be integrated into a workflow without restricting the macroscopic or histologic diagnostics. This paper represents the fundamental technical and analytical basis for upcoming studies concerning the possibilities and limitations of fluorescence angiography in the diagnosis of heart pathology.


Author(s):  
Magdalena Beata Skarzynska ◽  
Elżbieta Gos ◽  
Natalia Czajka ◽  
Milaine Dominici Sanfis ◽  
Piotr Henryk Skarzynski

(1) Background: Otitis media with effusion (OME) is one of the most common diseases in childhood. The objective was to assess clinically the effectiveness of the surgical approach (tube insertion with adenoidectomy) in comparison with the non-surgical approach (watchful waiting) during a 12-month observation period. (2) Methods: This study was retrospective and obtained approval from the bioethics committee. The criteria of inclusion in the first group (surgical approach) were: (1) a diagnosis of chronic otitis media with effusion in children aged between 1 and 6 years; (2) their medical history showed that they had undergone adenoidectomy and tympanostomy with the insertion of ventilation tubes (VTs). The criteria for inclusion in the second group (non-surgery) were similar to the first group except that their medical history showed they had not undergone adenoidectomy or tympanostomy with the insertion of VTs. There were 422 children included in the surgical group and 50 children in the non-surgical group, and the period of observation was 12 months. (3) Results: For the entire surgical group, the number of healthy days ranged from 20 to 365, with a mean of 328.0 days (SD = 91.4).In the non-surgical group, the number of healthy days ranged from 13 to 365, with a mean of 169.2 days (SD = 127.3). The difference in the number of healthy days was statistically significant (p < 0.001). The certainty of treatment in the first group was higher than in the second group, and the number of days without recurrence was significantly higher than in the second group. In the first group, there were 71 recurrences from 422 children (16.8%), and, in the second subgroup, there were 40 recurrences of acute otitis media (AOM) from 50 children (80%). The RR was 0.21. (4) Conclusions: The surgical approach in children aged 1–6 years who have been diagnosed with otitis media with effusion is reasonable and beneficial for the child.


Author(s):  
Paula M. Marinho ◽  
Alléxya A. A. Marcos ◽  
Ana M. C. Branco ◽  
Walid M. Mourad ◽  
Victoria Sakamoto ◽  
...  

AbstractThe main purpose of this study was to investigate the presence of retinal autofluorescence findings in COVID-19 patients. Observational study conducted in São Paulo in 2020. Demographic, medical history, and concomitant events, as well as medications used, hospitalization details, and laboratory test results, were obtained. Patients underwent eye examination and multimodal imaging, including color, red-free, autofluorescence fundus photography and optical coherence tomography. Eighteen patients had autofluorescence findings (6 females; average age 54 years, range 31 to 86 years; 26 eyes). Hyper-autofluorescence findings were present in 6 patients, Hypo-autofluorescence in 14 patients, and 6 patients had mixed pattern lesions. Retinal autofluorescence abnormalities were present in COVID-19 patients and may be secondary to primary or secondary changes caused by the SARS-CoV-2.


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