Hereditary hemorrhagic telangiectasia with liver cirrhosis: a case report

Background Hereditary hemorrhagic telangiectasia is an autosomal dominant hereditary hemorrhagic disease. Its main feature is an abnormal structure of the blood vessel wall. Cirrhosis of the liver is a common chronic progressive disease with one or more causes in which diffuse liver damage occurs after long-term or repeated injury. Liver cirrhosis can cause dilation of gastrointestinal capillaries. Many patients with hereditary hemorrhagic telangiectasia accompanied by gastrointestinal vascular malformations and liver cirrhosis may be diagnosed only with liver cirrhosis if the clinician does not pay attention to physical examination findings and family history. Moreover, general treatment measures, such as blood transfusion, iron supplementation, and application of hemostatic drugs, are less effective for bleeding in patients with hereditary hemorrhagic telangiectasia than in those with liver cirrhosis alone. Case presentation Here, we report the rare case of a 75-year-old Chinese man who was admitted to the hospital with repeated melena and epistaxis. He was diagnosed with unexplained liver cirrhosis, which was later confirmed as hereditary hemorrhagic telangiectasia. Subsequently, we implemented the treatment intervention of oral thalidomide combined with gastrointestinal argon plasma coagulation. A follow-up of more than 8 months showed that the treatment effect was excellent. Conclusions If patients with liver cirrhosis and gastrointestinal vascular malformations also have a family history of epistaxis, special attention should be paid to targeted physical examination results, and the possibility of hereditary hemorrhagic telangiectasia should be considered. Moreover, for patients with hereditary hemorrhagic telangiectasia and both gastrointestinal bleeding caused by gastrointestinal capillaries and repeated epistaxis, when other general treatment measures are ineffective, thalidomide combined with gastrointestinal argon plasma coagulation may be an effective intervention.

Survival in Patients with Acute Lymphoblastic Leukemia and COVID-19 in Mexico

Aims: To determine the survival of patients with acute lymphoblastic leukemia and COVID-19. Study Design: Prospective, analytical and relational. Place and Duration of Study: Hematology department, Hospital of Specialties, High Specialty Medical Unit, National Medical Center "Gral. Manuel Avila Camacho", Puebla, Mexico, during the period June 2020-April 2021 Methodology: Patients aged 15 to 64 years, both sexes, with acute lymphoblastic leukemia and a confirmed diagnosis of COVID-19 by PCR. The variables included were; sex, age (groups: 15-20; 21-29; 30-39; 40-49; 50-59; and 60-64), comorbidities, general treatment and hematological treatment response. Survival was determined for the diagnosis of COVID-19 for 11 months, using the Kaplan Meier estimator and the Log-Rak test; Cox regression model (univariate and multivariate); as well as Chi square and V-Cramer with a 95% confidence interval and using the statistical program SPSS Ver. 25. Results: The study consisted of 20 patients, of which 33.3% were women, with an average age of 37.75 ± 11.63 years; The men registered an age of 28.50 ± 18.05 years. Overall survival was 50%, with a lower limit of 101.3 and an upper limit of 242.5 days, with a mean of 171.9 days; and median at 17 days. No significant differences were found in survival regarding sex, comorbidities, general treatment and hematological response. However, mortality in patients with comorbidities was higher (p = 0.051). Conclusion: Survival in patients with acute lymphoblastic leukemia and COVID-19 is low, due to complications that increase mortality, mainly owing to hematological suppression, and even more so with the presence of comorbidities.

The influence of patient-centeredness on patient safety perception among inpatients

Purpose This study investigated the influence of patient-centeredness on patient safety perception among inpatients, with particular focus on the relationships between subfactors of patient-centeredness and patient safety perception. Methods Data were collected from 122 inpatients in a university hospital from September 24 to October 8, 2019. Patient-centeredness was evaluated using the Patient-Centeredness Assessment Scale; patient safety perception was evaluated using the Korean version of the Patient Safety Perception Scale. Multiple linear regression analysis was conducted using SPSS for Windows 24.0. Results Average patient-centeredness score among inpatients was 77.14 ± 12.64 (range 0–100), and average patient safety perception score was 99.24 ± 15.90 (range 24–120). Patient-centeredness influenced patient safety perception (R2 = 70%, F = 27.75, p < .001). With respect to subfactors of patient safety perception, the medical team’s activities to ensure safety was affected by the general treatment process and overall evaluation of patient-centeredness (R2 = 54%, F = 13.14, p < .001); patient safety practice was influenced only by the general treatment process (R2 = 39%, F = 7.02, p < .001); and trust in the medical system was affected by nurses’ service, the general treatment process, and the hospital environment (R2 = 44%, F = 8.49, p < .001). Conclusions To enhance patient safety perception, strategies should seek to strengthen patient-centeredness and its related subfactors, particularly the general treatment process, the hospital environment, and nurses’ service.

9 General Treatment Standards

This chapter addresses the general standards of treatment in investment treaties. General treatment standards consist of two types: (a) absolute standards, which are not contingent upon specified factors, happenings, or government behaviour towards other investors or persons; and (b) relative standards, which are dependent upon the host government's treatment of other investments or investors. The chapter discusses the absolute and relative general treatment standards used most frequently in international investment treaties. These include full protection and security, fair and equitable treatment, minimum treatment according to international law, most-favoured-nation treatment, and national treatment. That these standards exist in one form or another in most investment treaties gives the treaties a strong similarity. It must also be acknowledged, however, that not all treaties include all of these general standards and that significant differences exist in the way individual treaties articulate them.

Backward bifurcation in a cholera model with a general treatment function

We consider a general cholera model with a nonlinear treatment function. The treatment function describes the saturated treatment scenario due to the limited availability of resources. The sufficient conditions for the existence of backward bifurcation have been obtained using the central manifold theory. At last, we illustrate the results by considering some special types of treatment functions.