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The Value of Different Electrocardiographic Patterns at Hospital Admission in Predicting Clinical Outcome in Pulmonary Embolism 住院时不同心电图对预测肺栓塞临床预后的价值
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.31
Darko Angjushev, Marija Kotevska Angjushev, M. Srceva, A. Kartalov
Background: Literature reports the presence of several Electrocardiographic (ECG) patterns of Right Ventricular (RV) strain in acute Pulmonary Embolism (PE). These reports are inconsistent considering the prognostic value of these patterns. Aim: to evaluate the significance of ECG RV strain patterns, as well as the total number of these ECG patterns in predicting short-term (in-hospital) clinical outcome. Methods: This retrospective study was consisted of 183 patients (107 male, age: 61±14 years) with acute PE. The 12-lead ECG done at hospital admission was analysed. ECG RV strain was diagnosed in presence of one or more of following 12 patterns: tachycardia, atrial fibrillation, low QRS voltage, S1Q3T3, Q in III, aVF, right axis deviation, right bundle branch block, Qr in V1, negative T wave in inferior, precordial leads, ST elevation in inferior leads, aVR, V1 and ST depression. The outcome was defined as experience of an adverse event (in-hospital complications and death all-cause). The association of ECG patterns with outcome was evaluated by multivariable Cox hazards regression analysis. Results: During a median hospitalization time of 15 days, 41 (22.4%) adverse events occurred. Event rate was higher in patients with ≥5 ECG patterns than in <5 (63.4% vs. 0.7%; p<0.0001). Number of ECG RV strain patterns (Hazard Ratio (HR):1.7 per pattern; 95% Confidence Interval (CI): 1.1-2.6; p=0.009), ST elevation in inferior leads (HR: 8.4; 95% CI: 6.0-68.3; p=0.001) and ST depression (HR: 0.1; 95% CI: 0.03-0.6; p=0.01) were independently associated with adverse outcome. Conclusion: Number of ECG RV strain patterns, ST elevation in inferior leads, ST depression has independent value in predicting in-hospital adverse outcome in acute PE.
背景:文献报道了急性肺栓塞(PE)患者右心室(RV)应变的几种心电图(ECG)模式。考虑到这些模式的预测价值,这些报告并不一致。目的:评价心电图RV应变型及其总次数对预测短期(院内)临床转归的意义。方法:对183例急性肺心病患者进行回顾性研究,其中男性107例,年龄61±14岁。对住院时12导联心电图进行分析。心电图RV张力表现为心动过速、房颤、QRS低电压、S1Q3T3、III期Q、aVF、右轴偏移、右束支阻滞、V1期Qr、下导联负T波、心前导联ST段抬高、aVR、V1、ST段压低等12种表现中的一种或多种。结果定义为不良事件的经历(院内并发症和全因死亡)。通过多变量Cox风险回归分析评估心电图模式与预后的关系。结果:在15天的中位住院时间内,发生了41例(22.4%)不良事件。≥5种ECG模式患者的事件发生率高于<5种ECG模式患者(63.4% vs 0.7%;p < 0.0001)。心电图RV应变型数(风险比(HR):1.7 /型;95%置信区间(CI): 1.1-2.6;p=0.009),下导联ST段抬高(HR: 8.4;95% ci: 6.0-68.3;p=0.001)和ST段下降(HR: 0.1;95% ci: 0.03-0.6;P =0.01)与不良结局独立相关。结论:心电图RV应变型数、下导联ST段抬高、ST段降低对急性PE患者院内不良预后有独立预测价值。
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引用次数: 0
Brief Note on Pulmonary Hypertension 简述肺动脉高压
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.39
Dogan Zeytun
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引用次数: 0
The Systematic Review and Implications of Organoid Technology 类器官技术的系统综述及其意义
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.29
Giovana Macêdo Egídio Cavalcante, Taysa Leite de Aquino, Jaiany Rodrigues Libório, Dara Fern, A. Duarte, Juliana Oliveira Duarte Rebouças, Eugenia Machado Couto, Pablo de Oliveira Saraiva Bezerra, Gabriela Macedo Egidio Cavalcante, Maria Águeda Brito Leite Duarte, M. L. Neto
Background: The induction of the formation of organoids derived from induced pluripotent stem cells (iPSC) is a new technology that is being well studied and aims to improve the clinical condition of patients with various diseases and even patients undergoing certain types of procedures. Methods: A systematic review, using the PRISMA protocol. The study period was from 2010 to 2020 and the keywords included “Organoids”, “iPSC”, “Ethic” and “Evidence-Based Medicine”, one at a time and then combined with the Boolean operator “AND”. Results: A total of 44 registrations were found. Of this total, 15 articles were excluded because they have not approached organoids and stem cells objectively, often attending to other phenomena or details that are not of interest to the review. Limitations: Discoveries about organoids and new methods to promote their generation and growth are constantly being tested and developed around the world, this implies a constant renewal of sources of information. The article was based on current and highly respected sources in the scientific community. Conclusion: Organoids are unquestionably a technology capable of changing many concepts and guidelines in the medical environment. Faced with this enormous capacity, it is necessary that studies are constantly made and that the use of this new technology is widely discussed, since it addresses not only the scientific sphere, but also the ethical sphere, the social sphere. Improving this already existing technology so that it will increasingly mimic the human body is the challenge that exists and needs to be addressed by many professionals in different areas in harmony.
背景:诱导多能干细胞(iPSC)形成类器官是一项正在研究的新技术,旨在改善各种疾病患者甚至接受某些类型手术的患者的临床状况。方法:采用PRISMA方案进行系统评价。研究时间为2010年至2020年,关键词为“类器官”、“iPSC”、“伦理”和“循证医学”,每次一个,然后结合布尔运算符“and”。结果:共登记44例。在这一总数中,有15篇文章被排除,因为它们没有客观地讨论类器官和干细胞,经常关注其他现象或细节,而这些现象或细节对综述不感兴趣。局限性:关于类器官的发现和促进其产生和生长的新方法在世界各地不断得到测试和发展,这意味着信息来源的不断更新。这篇文章是基于科学界当前和高度尊重的来源。结论:类器官无疑是一项能够改变医疗环境中许多概念和指导方针的技术。面对这种巨大的能力,有必要不断进行研究,并广泛讨论这种新技术的使用,因为它不仅涉及科学领域,而且涉及伦理领域和社会领域。改进这种已经存在的技术,使其越来越多地模仿人体是存在的挑战,需要许多不同领域的专业人士和谐地解决。
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引用次数: 0
The Burden of Diabetic Kidney Disease in Nigeria - A Systematic Review and Meta-Analysis 尼日利亚糖尿病肾病的负担——系统回顾和荟萃分析
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.35
Adegoke Azeez Taoreed
Background: Diabetic Kidney Disease (DKD) is a micro vascular complication of diabetes mellitus. Considering that the burden of diabetes mellitus is rising in Nigeria, there is a need to ascertain the burden of one of its most common complications. The objective of the meta-analysis was to determine the pooled prevalence of DKD in Nigeria and identify its risk factors. Methods: The study is a meta-analysis and it followed the PRISMA guidelines. Google scholar, PubMed, AJOL, SCOPUS, medRxiv and the grey literature were systematically searched using appropriate key terms. Statistical analysis was done with MetaXL. The inverse variance heterogeneity model was used for the metaanalysis and heterogeneity was determined using the I2 statistic and the Cochran’s Q test. Publication bias was checked with the Doi plot and LFK index. Results: Nineteen studies met the eligibility criteria. The total sample size was 56 571. The pooled prevalence of diabetic kidney disease in Nigeria was 28% (95% CI 3-58). The Cochran’s Q was 747 (p<0.001) while the I2 statistic was 97.6%. The Doi plot was drawn and the LFK index was 6.22. The most common risk factors for DKD were suboptimal glycaemic control, hypertension and obesity, duration of diabetes, male gender and advancing age. Conclusion: The prevalence of DKD in Nigeria is high and greater attention should be focused on managing the risk factors so as to alleviate the burden of the disease.
背景:糖尿病肾病(DKD)是糖尿病的微血管并发症。考虑到尼日利亚的糖尿病负担正在上升,有必要确定其最常见并发症之一的负担。荟萃分析的目的是确定尼日利亚DKD的总患病率并确定其危险因素。方法:本研究采用meta分析,遵循PRISMA指南。谷歌scholar、PubMed、AJOL、SCOPUS、medRxiv和灰色文献使用合适的关键词进行系统检索。使用MetaXL进行统计分析。meta分析采用逆方差异质性模型,采用I2统计量和Cochran’s Q检验确定异质性。用Doi图和LFK指数检查发表偏倚。结果:19项研究符合入选标准。总样本量为56 571。尼日利亚糖尿病肾病的总患病率为28% (95% CI 3-58)。Cochran’s Q为747 (p<0.001), I2统计量为97.6%。绘制Doi图,LFK指数为6.22。DKD最常见的危险因素是血糖控制欠佳、高血压和肥胖、糖尿病病程、男性和高龄。结论:尼日利亚DKD患病率较高,应加强对危险因素的管理,以减轻疾病负担。
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引用次数: 0
Antibody Response in COVID-19 among Healthcare Workers 医护人员COVID-19抗体反应
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.10
M. Younas, K. Afzal, H. Iqbal, Asma Khan, Kainat Younas, Asma N. Cheema, Muskan Younas
Objectives: To determine association between Polymerase Chain Reaction (PCR) and antibody positivity by assessing the antibody response in PCR positive Versus PCR negative COVID-19 exposed symptomatic/ asymptomatic healthcare workers. Methods: A Total of 102 healthcare workers (HCW) were included in this crosssectional study after written informed consent including doctors, nurses, laboratory and janitorial staff who were working in isolation ward admitted with symptomatic COVID-19 patients and their samples. Specimen swabs from posterior oropharyngeal wall and nasopharynx were taken and kept in viral transport medium to perform Polymerase Chain Reaction (PCR) testing of SARS-CoV-2 either at onset of symptoms or at 6 weeks (42 days) after first day of duty with COVID-19 patient and blood samples were drawn to measure the serum antibody response after recovery or at completion of 6 weeks (42 days) of their first duty in COVID-19 wards. Serum C- reactive protein (CRP) in mg/L was measured by immuno-turbidimetry in both groups at the time of PCR. Results: Mean age of our study participants was 31 ± 8.9 years. Of 102 HCW, 60(58.8%) were males and 42(41.2%) were males; 42 (36.23%) were PCR positive and 60(63.76%) were PCR negative, 57(50.72%) had reactive antibodies and 45(49.28%) had non-reactive antibodies. Of 35 PCR positive subjects, 11 remained asymptomatic. There were 76% subjects who had positive PCR & reactive antibodies, 63.6% subjects with negative PCR and Non-reactive antibodies. Interestingly, (22)36.4% subjects had negative PCR but reactive antibodies. Likewise, 16.7% subjects had positive PCR but non-reactive antibodies. However, statistically moderate significant association (x2(1) =10.02; P=0.00) was found between PCR positivity and antibody positivity. Serum CRP in PCR positive and negative HCWs was 1.5 mg/L and 1 mg/L correspondingly. Conclusion: Antibody response may be used as a screening tool for COVID-19 infection particularly in asymptomatic exposed subjects.
目的:通过对COVID-19暴露有症状/无症状医护人员PCR阳性和PCR阴性的抗体反应进行评估,确定聚合酶链反应(PCR)与抗体阳性的相关性。方法:经书面知情同意,将在有症状的COVID-19患者的隔离病房工作的医生、护士、实验室和清洁工共102名医护人员及其样本纳入本横断面研究。在症状出现时或COVID-19患者第一天值勤后6周(42天)采集口咽后壁和鼻咽拭子标本,保存在病毒转运介质中,进行SARS-CoV-2聚合酶链反应(PCR)检测,并在恢复后或COVID-19病房首次值勤6周(42天)采集血样,测量血清抗体反应。采用免疫比浊法测定两组小鼠PCR时血清C反应蛋白(CRP)含量(mg/L)。结果:研究对象的平均年龄为31±8.9岁。102例HCW中,男性60例(58.8%),男性42例(41.2%);PCR阳性42例(36.23%),阴性60例(63.76%),反应性抗体57例(50.72%),非反应性抗体45例(49.28%)。35例PCR阳性受试者中,11例无症状。PCR阳性和反应性抗体阳性率为76%,PCR阴性和非反应性抗体阳性率为63.6%。有趣的是,(22)36.4%的受试者PCR阴性但抗体反应性。同样,16.7%的受试者PCR阳性但无反应性抗体。但统计学上有中度显著相关性(x2(1) =10.02;PCR阳性与抗体阳性之间P=0.00)。PCR阳性和阴性HCWs血清CRP分别为1.5 mg/L和1 mg/L。结论:抗体反应可作为COVID-19感染的筛查工具,特别是在无症状暴露者中。
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引用次数: 0
Pharmacological Treatments for Coronavirus Disease (COVID-19) 冠状病毒病(COVID-19)的药物治疗
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.20
Dogan Zeytun
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引用次数: 1
Gastric Outlet Obstruction Due to Primary Duodenal Tuberculosis - A Case Report on Rare Presentation of an Uncommon Condition 原发性十二指肠结核致胃出口梗阻1例
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.24
P. AjayKumar, Ey
Gastric outlet obstruction is commonly associated with malignancy and peptic ulcer disease. Duodenal tuberculosis as a cause of Gastric outlet obstruction is a rare clinical entity and poses a great diagnostic dilemma. We report cases of two young adults presenting with long-standing gastric outlet obstruction due to Duodenal Tuberculosis. Patients were evaluated using UGI endoscopy and USG scan. Exploratory Laparotomy was done in both cases, tissue biopsy was taken, and gastrojejunostomy was done to relieve the obstruction. Histopathology was positive for tuberculosis in both cases, and patients were started on antituberculous medication. At present, the patients have responded to antituberculous medications, and are asymptomatic.
胃出口梗阻通常与恶性肿瘤和消化性溃疡疾病有关。十二指肠结核作为胃出口梗阻的原因是一个罕见的临床实体,造成了很大的诊断困境。我们报告的情况下,两个年轻人提出长期胃出口梗阻由于十二指肠结核。采用UGI内窥镜和USG扫描对患者进行评估。两例均行剖腹探查,组织活检,并行胃空肠吻合术以解除梗阻。两例患者的组织病理学检查均为结核阳性,并开始接受抗结核药物治疗。目前,患者对抗结核药物有反应,无症状。
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引用次数: 0
Risk of Developing Diabetes Mellitus Type 2: San Matías, Francsico Morazan, Honduras 患2型糖尿病的风险:San Matías,弗朗西斯科·莫拉赞,洪都拉斯
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.43
Jhiamluka Solano, Alcides Alvarez, Ada Valenzuela, Italia Laitano
Background: Diabetes mellitus represents a public health problem worldwide; in 2014, 422 million people were reported with this disease. Objective: Assess the risk to develop type 2 diabetes mellitus through the Finnish Diabetes Risk Score (FINDRISK) in people from ages from 20 to 35 years old. Methods: We conducted a quantitative, descriptive, and transversal study with a sample of 59 patients, randomly selected with a non-probabilistic sampling by convenience. We provided a consent form, followed by the FINDRISK, assessing age, body max index, abdominal perimeter, daily exercise, fruit and vegetable ingestion, hypertension treatment, the background of hyperglycaemia and family history of T2DM. We categorized them as low risk, slightly elevated risk, moderate risk, high risk and extremely high risk according to the test score. Results: The prevalent risk factors were sedentarism 64% (38), unhealthy diet 51% (30) and obesity according to their BMI of 20% (12). 40% (24) of the patients were classified as low risk, 46% (27) slightly elevated risk, 12% (7) moderate risk, 2% (1) high risk and 0% (0) extremely high risk. Conclusion: The use of the FINDRISK test in Primary Health Care is a useful tool for the early detection of patients with high risk to develop diabetes mellitus type 2 and intervene promoting healthy lifestyles.
背景:糖尿病是一个全球性的公共卫生问题;2014年,据报告有4.22亿人患有这种疾病。目的:通过芬兰糖尿病风险评分(FINDRISK)评估20 - 35岁人群发生2型糖尿病的风险。方法:我们对59例患者进行了定量、描述性和横向研究,为方便起见,随机选择非概率抽样。我们提供了一份同意书,然后是FINDRISK,评估年龄、身体最大指数、腹部周长、日常运动、水果和蔬菜摄入、高血压治疗、高血糖背景和2型糖尿病家族史。我们根据测试分数将他们分为低风险、轻度高风险、中度风险、高风险和极高风险。结果:主要危险因素为久坐不动占64%(38),不健康饮食占51%(30),肥胖占20%(12)。40%(24)例为低危,46%(27)例为微危,12%(7)例为中度危,2%(1)例为高危,0%(0)例为极危。结论:在初级卫生保健中使用FINDRISK试验是早期发现2型糖尿病高危患者并促进健康生活方式干预的有效工具。
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引用次数: 0
Microcephaly in the Maternal-Child Life Cycle 母婴生命周期中的小头畸形
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.21.13.42
Sarah Ellen Ribeiro Grangeiro, Lucas de Alencar Viana Melo, Wantuil Matias Neto, Luis Luciano Neto, A. Moreira, M. L. Neto
Microcephaly is characterized by a complex etiology, in addition to being associated with congenital Zika virus infection, being caused by environmental, genetic factors, metabolism diseases, as well as by the use of drugs and maternal diseases during the gestational period. This study aimed to know the microcephaly in the maternal-child life cycle in the Cariri region and its repercussion on maternal mental health. This is a cross-sectional, descriptive research with a quantitative-qualitative approach, delineated through a descriptive study in the formal statistical analysis for quantitative results. Schutze’s narrative was used for qualitative analysis. The study was carried out in inland Ceara in a reference unit for children with microcephaly. Thirteen mothers were interviewed, who have children with microcephaly due to ZIKAV, who had contact with the virus during the fertile period during pregnancy. The profile of the study subject showed that maternal education corresponds to secondary education, 23.1%, with Pardo selfreported colour 92.3%, married marital status 61.5%, with 46.2% as housekeeper occupation, and the mean age of 29.38% (range: 15 to 41 years). The results showed that there is a difference between living conditions of families, knowledge about Zika virus and mothers’ feelings about this pathology. Therefore, public policies and health education should be implemented in relation to ZIKAV, in an attempt to reduce cases of microcephaly in the NE of Brazil.
小头症的特点是病因复杂,除了与先天性寨卡病毒感染有关外,还与环境、遗传因素、代谢疾病以及在妊娠期使用药物和母体疾病有关。本研究旨在了解卡里里地区母婴生命周期中的小头症及其对产妇心理健康的影响。这是一项采用定量定性方法的横断面描述性研究,通过描述性研究在定量结果的正式统计分析中进行描述。Schutze的叙述被用于定性分析。这项研究是在澳大利亚内陆的一个小头症儿童参考单位进行的。采访了13位母亲,她们的孩子因寨卡病毒而患有小头症,她们在怀孕期间的生育期接触过病毒。研究对象的资料显示,母亲教育程度与中等教育程度相对应,占23.1%,Pardo自我报告的肤色占92.3%,已婚婚姻状况占61.5%,管家职业占46.2%,平均年龄为29.38%(范围:15至41岁)。结果显示,家庭的生活条件、对寨卡病毒的认识和母亲对这种疾病的感受存在差异。因此,应实施与寨卡病毒有关的公共政策和卫生教育,以减少巴西东北部的小头症病例。
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引用次数: 0
The Urology Checklist towards a Structured Consultant-Led Ward Round 面向结构化会诊医生主导的病房查房的泌尿外科检查表
Pub Date : 2021-01-01 DOI: 10.36648/1989-5216.13.1.5
Jennie Han, J. Gibbard, C. Cutting, Elsawi Osman
Objective: Formulating a comprehensive, practical, and urology-focused ward round checklist to enhance safety, efficiency and clear documentation for the Urology ward team when reviewing in-patients. Design: Identification of important parameters which should be addressed in every patient interaction. FIASCO – VH was coined for ease: • Fluid balance • Investigations • Intravenous access • Antibiotics • Analgesia • Stool • Catheter status • Observations • Venous thromboembolism (VTE) risk assessment • Home and follow up. Baseline measurement followed by implementation of the checklist and completion of three plan-do-study-act (PDSA) cycles. Setting: Single-centre district general hospital within the United Kingdom Participants: 279 ward round interactions with Urology inpatients Intervention: Implementation of the ward round checklist Main outcome measures: Adherence to parameters identified in the urology checklist Results: Stool (23.5%) and pain (30.6%) were worst assessed at baseline, with median 39.3% parameters assessed over all interactions. Significant improvement in assessed parameters after first (median 74.3%), second (median 84.0%), and third cycles (median 100%). These were associated with positive patient outcomes. There was discrepancy between factors verbally addressed and clinically documented (median 84.0% to 57.7% after second cycle). A dedicated third cycle reduced this gap (median 100% to 97%). 100% junior doctors surveyed believed the checklist has enabled addressing of factors which might have otherwise been missed. Conclusion: The use of a comprehensive, urology-focused, easy-to-memorise ward round checklist is feasible and led to sustained, well-documented improvements in all measured aspects of patients’ care, and perceived level of care by the team.
目的:制定一个全面的、实用的、以泌尿科为重点的查房清单,以提高泌尿科病房团队在审查住院患者时的安全性、效率和清晰的文件记录。设计:确定在每次患者互动中应处理的重要参数。FIASCO - VH是为了方便而创造的:•液体平衡•检查•静脉通路•抗生素•镇痛•大便•导管状态•观察•静脉血栓栓塞(VTE)风险评估•家庭和随访。基线测量,随后实施检查表并完成三个计划-做-研究-行动(PDSA)周期。环境:英国单中心地区综合医院参与者:279个与泌尿科住院患者的查房互动干预:查房清单的实施主要结果测量:遵守泌尿科核对表中确定的参数结果:粪便(23.5%)和疼痛(30.6%)在基线时评估最差,在所有互动中评估的参数中位数为39.3%。第一周期(中位数74.3%)、第二周期(中位数84.0%)和第三周期(中位数100%)后评估参数显著改善。这些与积极的患者预后相关。口头陈述的因素与临床记录的因素之间存在差异(第二周期后中位数为84.0%至57.7%)。专门的第三个周期减少了这一差距(中位数为100%至97%)。100%接受调查的初级医生认为,检查表能够解决可能被遗漏的因素。结论:使用全面的、以泌尿科为重点的、易于记忆的查房清单是可行的,并在患者护理的所有测量方面带来了持续的、有充分记录的改善,以及团队的护理水平。
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引用次数: 0
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Archives of medicine
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