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Burns represent a major public health problem worldwide, accounting for thousands of deaths annually (World Health Organization). When dealing with large burns we tend to have limited resources when covering up the wound areas because of lack of skin; at that point is where other technologies come into play. Cultured Epidermal Autograft (CEA) and Autologous Spray Cell Suspension (ASCS) are both useful autologous technologies that we use to help patients with limited donor sites. However, we have not identified any published cases where both products are used in the same burn. In this case report we present the methods of treatment and outcomes for 2 cases that were treated with both CEA and ASCS.

Se describe el caso de una mujer de 18 años con trastorno de estrés postraumático, desarrollara a partir de una internación hospitalaria por una enfermedad sin diagnosticar. Su sintomatología, los diversos exámenes y la experiencia hospitalaria, en la que presenció varias muertes, se vio acompañada de ansiedad e irritabilidad. Luego de que se interviniera quirúrgicamente y se le diera el alta, continua la ansiedad, acompañado de sintomatología postraumática. Se procede a la revisión del caso mediante entrevistas y aplicación de pruebas psicométricas para la obtención de un diagnóstico y posterior propuesta psicoterapeuta desde el modelo cognitivo-conductual. Palabras clave: psicología, plan, psicoterapia, trauma.

Background Early treatment for patients with aneurysmal subarachnoid hemorrhage (aSAH) could significantly reduce the risk of re-bleeding and improve clinical outcomes. We assessed the different time intervals from the initial hemorrhage, admission, and endovascular treatment and identified the risk factors contributing to delay. Methods Between February 2017 and December 2019, 422 consecutive aSAH patients treated in a high-volume hospital were collected and reviewed. Risk factors contributing to admission delay and treatment delay were analyzed with univariate and multivariate analysis. Results One hundred twenty-two (28.9%) were admitted to the high-volume hospital at the day of symptom onset and 386 (91.5%) were treated with endovascular management at the same day of admission. The multivariate analysis found that younger age (P = 0.022, OR = 0.981, 95% CI 0.964–0.997) and good Fisher score (P = 0.002, OR = 0.420, 95% CI 0.245–0.721) were independent risk factors of admission delay. None was found to be related with treatment delay. Multivariate analysis (OR (95% CI)) showed that higher age 1.027 (1.004–1.050), poorer Fisher score 3.496 (1.993–6.135), larger aneurysmal size 1.112 (1.017–1.216), and shorter interval between onset to admission 1.845 (1.018–3.344) were independent risk factors of poorer clinical outcome. Conclusion Treatment delay was mainly caused by pre-hospital delay including delayed admission and delayed transfer. Our experience showed that cerebrovascular team could provide early treatment for aSAH patients. Younger age and good Fisher score were significantly related with admission delay. However, admission delay was further significantly correlated with better clinical outcome.

Introduction: The COVID-19 pandemic is a major challenge for health care services including safe and effective surgery. This study aims to analyze gynecological surgery delivery during COVID-19 pandemic. Method: Data on gynecologic surgeries performed at Patan Hospital from 01 Jan to 31 Dec,2020 during pre-lockdown , lockdown and post-lockdown period of the COVID-19 pandemic were analyzed from medical record for surgical procedures, blood transfusion, ICU stay, length of hospital stay, mortality, COVID-19 PCR positive cases. Chi-square and Anova tests were used to compare between three periods, p value

Objective: Hospitalization is a fearful negative experience for children and families. The aim of this study is to learn the feelings and thoughts of school age children hospitalized in the hospital about “illness and hospital”. Material and Method: The study was carried out with 100 children hospitalized in the pediatric ward of a state hospital. In this qualitatively planned study, a sentence completion test was applied with the creative play method aiming to reveal the illness and hospital-related thoughts of hospitalized school-age children. In the sentence completion test, the themes and categories were created by content analysis by the researchers. Ethics committee and necessary permissions were obtained for the study. Results: The Health-illness perception for children consists of four categories, being hospital experience, concerns, and expectations from the hospital. Sick children defined health as feeling good and strong, illness as feeling bad, leaving family, friends and school, and being unable to do anything. They reported staying in the hospital as a bad, sad feeling and a terrible experience. They stated that they regret being separated from their family, school, friends, and teachers in the hospital, and they missed their lessons. Some of the expectations of the children in the hospital are toys in the room, a large playground in the hospital, and an opportunity to follow the lessons they missed at school from their room. Conclusion: In our study, it was determined that the most important concern of school-age children who were hospitalized was their separation from family, school, friends, and lessons.

Background: Given the higher incidence of psychotic disorders in patients with epilepsy, several neurologists and psychiatrists have attempted to explain this controversial comorbidity. Thus, several hypotheses have been put forward but no link has been established with certainty until today. Objectives: The aim of our work is to draw up a socio-demographic and psychopathological profile of patients with schizophrenia-epilepsy comorbidity as well as to assess the risk of suicide, the management, the reasons for admission and the length of hospitalization. Methodology: we conducted a retrospective cross-sectional study on medical records of patients with schizophrenia and epilepsy who were hospitalized at the Ar-Razi University Psychiatric Hospital in Salé between January 01, 2017 and March 31, 2021. Results: Our study included 56 patients. The average age was 33 + / - 9.83, 55% male. 50% of patients had attempted suicide in the past and 25% had a history of depressive episode, 41.1% had substance use disorder and 26.8% had a family history of psychosis. 85.7% of our patients developed schizophrenia from pre-existing epilepsy the time to onset of schizophrenia compared to epilepsy was 11.08 years +/- 7.71. The mean age of onset of schizophrenia is 23.3 years with a mean duration of progression of 9.18 years, 55.4% of patients were on monotherapy and 8.9% had resistant schizophrenia on clozapine. The average age of onset of epilepsy is 14.73 years, with generalized epilepsy in 84% of cases. The average length of stay is 42 days. The reasons for admission were as follows: hetero-aggression 78.6%, delusional verbalization 85.7% and suicide attempt 23.2%. The majority of our patients have been treated with atypical antipsychotics: Risperidone 30.4%, Amisulpride 21.4% and Aripiprazole 12.5%. Conclusion: The co-occurrence of schizophrenia epilepsy suggests the existence of possible common etiopathogenic factors. The management of this comorbidity requires a multidisciplinary collaboration between neurologist and psychiatrist, in order to confirm the diagnosis, establish a good therapeutic approach and propose a management algorithm taking into account the two pathologies.

Aims and Objectives: The goal of this study was to see the outcome of open reduction and internal fixation for ankle fractures. Methods: A prospective analysis of 40 ankle fractures of adult patients handled surgically using diverse approaches in the period from January 2019 to January 2020 at the Orthopedic department of SMBBIT, Dow University of Medical and Health Sciences. Karachi Pakistan. The ankle grading system developed by Baird and Jackson was used to assess the functional result. Results: We achieved 87.5 percent outstanding to good outcomes, 6.3 percent fair outcomes, and 6.2 percent bad outcomes in our study. The findings were comparable to those of other researchers around the world. Interpretation and Conclusion: In 87.5 percent of patients, the operational results were satisfactory, with good to outstanding functional outcomes. With stable fracture fixation, excellent outcomes are attained. Cancellous screws are better for internal fixation of the medial malleolus, while Malleolar screws are superior for that task. For ankle fractures treated surgically, patients may expect to have satisfactory function thereafter.

This paper relays the findings of the evaluation of an applied theatre project for children in hospital as perceived by hospital teachers. A mixed qualitative approach was used. Data were analysed using thematic analysis to explore the teachers’ views on children’s engagement with learning and the improvement of the hospital experience as a whole through applied theatre. The article presents examples of children’s stories that illustrate the findings. The study concludes that applied theatre in paediatrics can engage children with hospital tuition and learning during treatment; improve the management of emotions; help them relax and communicate with the outside world.

Objective: Penetrating abdominal trauma in children is a life threatening emergency. The objective of this study was to evaluate our experience in the management of penetrating abdominal trauma in children in a tertiary hospital in Enugu, Nigeria. Materials and Methods: This was a retrospective study of children that were managed for penetrating abdominal injury at the pediatric surgery unit of Enugu State University Teaching Hospital, Enugu, Nigeria. Medical records of the patients over a 10-year period were evaluated. Results: During the study period, there were 21 cases of penetrating abdominal injuries with an age range of 9 to15 years (median: 11 years) and male to female ratio of 4.25:1. Fourteen (66.7%) patients presented after 48 hours from the time of the incident. Gunshot injury was the most common mechanism of injury. Five (23.8%) patients were in a clinical state of shock on presentation to the hospital and 10 (47.6%) patients had evisceration of intra-abdominal organ. Small intestine was the most damaged intra-abdominal organ while head injury was the most associated extra-abdominal injury. Surgical site infection was a common post-operative complication and 2 (9.5%) patients expired. Conclusion: Penetrating abdominal trauma in children is uncommon. Late presentation is common in low income countries and the small intestine is the most damaged intra-abdominal organ.

Introduction: There is a dearth of knowledge on the proportion that occult thyroid carcinoma constitutes amongst patients with thyroid cancer in our practice. This study was therefore conducted to review the cases of occult thyroid carcinoma with a focus on the presentation, management, and the outcome of care in a low resource tertiary hospital setting. Materials and Methods: We conducted a retrospective cross-sectional descriptive study of 62 patients who were managed for thyroid cancer over a 15-year-period at the University College Hospital, Ibadan, Nigeria. The patients who had more than two follow-up visits to the Thyroid Clinic, over the preceding fifteen years were included in this study. The types of surgeries performed on the patients were noted. The data were analyzed using descriptive statistics. We also identified the various limitations that might have hindered the effective care of such patients. Results: Sixty-two consecutive patients, 12 male (19.4%) and 50 females (80.6%) with a median interquartile age range of 45 years, were diagnosed with thyroid cancer. The surgeries performed on the patients were total thyroidectomy, 48 (77.4%), completion-thyroidectomy, 14 (22.6%), near total thyroidectomy, etc. Occult thyroid cancer constituted 38 (61.3%) of the patients managed for thyroid cancer. The most common histology subtype was papillary carcinoma. We identified late presentation, inadequate oncologic surgery, financial constraint etc., as limitations of optimal care. Conclusions: In view of the proportion of occult thyroid cancer in this cohort of patients, the clinically benign goitres might contain carcinoma or micro-carcinoma. Therefore, an aggressive public health campaign to encourage early presentation of our patients and primary reduction through total thyroidectomy is recommended to improve the outcome of care., {"references":["Alegbeleye BJ, Keskin H. 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Background: Acute myocardial infarction (AMI) is one of the major causes of hospitalization and mortality worldwide. There has been limited data available to characterize AMI presentation, contemporary patterns of medical care, and outcomes in Dubai, United Arab Emirates. Methods: A single-center observational registry for patients with AMI was used. All patients admitted to Dubai Hospital with AMI (ST elevation and non-ST elevation) with positive troponin from the mid of August 2017 till the end of April 2018 were included in this registry. Clinical data, prior history, demographics, treatments, and outcomes were recorded from the patient’s electronic medical file of the hospital. Result: A total of 329 patients (male 92%, mean age 53.6 years) were included in our registry. The use of ambulance service was only 25%. Electrocardiogram findings of ST-segment elevation myocardial infarction (STEMI) were found in 57% and non-STEMI in 43%. History of prior ischemic heart disease was present in 21% of all cohort, diabetes in 36%, hypertension in 38%, and the current smoking rate was 35%. Reperfusion therapy was provided to 94% of the patients with STEMI; only 32% of them had primary angioplasty, and medical reperfusion was performed in 68%. One-third of them received thrombolysis within 30 min, and primary percutaneous coronary intervention (PCI) was provided to 38% within 90 min. All the patients received aspirin and adenosine diphosphate inhibitors within the first 24 h. The majority of the patients received other key medicines like beta-blocker, statin, and anticoagulant agents within 24 h. The in-hospital mortality rate was about 3%. Conclusions: Using data from the registry may provide an overview of the current status of AMI in Dubai. Medical reperfusion therapy is the most common reperfusion modality in our center, and this will raise the question of whether we need to launch a 24-h primary PCI program in our center.

After the translating of the worldwide pandemic coronavirus disease 2019 (COVID-19) disease from South East Asia to Europe, North African countries accelerate their steps to follow WHO guidelines to prepare the outbreak response. In March 2020, the Tunisian Ministry of Health switched Abderrahmen Mami Hospital to a COVID-19 center. The main objectives were management of patients but also setting-up new rules to permit enough safety for the staff members and harmony between medical, nonmedical, and administrative departments within the facility. Organization and communication during the fast-paced preparation process were crucial to get enough qualified human resources, material resources, and clear procedural texts in place before cases arrived in huge numbers. A group of medical and administrative experts within a central crisis unit brought this challenge into reality.

Globally the needs of children differ to those of adults; consequently, the “voice” of children in health care delivery is paramount to its effectiveness as a service. This qualitative study aims to present a contemporary “slice” of life in four children’s wards in a typical United Kingdom children’s hospital in the 21st century from the perspective of the service user (child) and significant service giver (Registered Children’s Nurse). Phase one of the study involved the development of a child research advisory group (CRAG) with five local primary school children (aged 10–11 years) to assist in the co-production of research questions and data collection tool for child participants–two talking cartoon characters (Sprinkle Cupcake and Ronaldo Football) via an app/iPad. In phase two (main study), hospitalized children (n = 18) and Registered Children’s Nurses (n = 8) were interviewed on one occasion within their ward setting using a semi-structured approach in July 2017. The emerging broad themes (using thematic analysis), were (1) children–the child’s needs, relationships, fears, and concerns, alongside (2) nurses–children’s nursing, job pressures, safe and effective care. Themes were then presented as tensions in that they represent the relationship between variables where the different elements in the relationship are held in tension, such that a change in one impacts upon the other. Similarities between the children and nurse participants include issues with the environment, lack of time to care (nurse), effects of nurse-led interventions, and valued role of play. Differences are largely around the role of the parent. The development and work of the CRAG and use of “tensions” to more effectively present the complexity of the findings are unique to this study. In conclusion, this study contributes to the development of a generalized knowledge base for policy, nursing education, and clinical practice by shedding light in how the complex hospital environment can be challenging for the child and children’s nurse.

SUMMARY STATEMENT Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.

Background: Hernia repair is one of the most common procedures performed by general surgeons, mostly in an elective setting. The true incidence/prevalence of hernias in Nigeria is unknown, however, suture (tissue) repair is predominantly reported. Aims: To study the distribution of adult abdominal wall hernia and the surgical and anaesthetic techniques for elective repair in a Nigerian tertiary hospital. Methods: A retrospective cross-sectional study of surgical patients undergoing elective abdominal wall hernia repair in University of Port Harcourt Teaching Hospital Nigeria from January 2009 to December 2014. Data extracted from the theatre records were patients’ demographic, type of hernia, repair technique, anaesthesia, operating time, and cadre of performing surgeon. Statistical analysis was performed using SPSS version 20. Results: A total of 400 adult patients had elective repair of abdominal wall hernias during study period. The age range was from 17- 85 years (mean 39.3 ± 6.0) and M: F ratio of 1.9:1. There were 287(70.9%) inguinal, 43(10.6%) incisional and 36(8.9%) epigastric hernias. Mesh repair was recorded in 11(2.7%) cases with laparoscopic technique in 2 cases. Subarachnoid block was the choice anaesthesia in 365(85.4%) cases. The least mean operating time (38.6 mins) recorded was in repair of femoral hernia and longest (105.3mins) with incisional hernia repair. Conclusions: Suture repair is the predominant repair technique. Routine hernioplasty and laparoscopic hernia repair need to be encouraged.

Background: The platelet transfusions help in prevention of bleeding related complications and thus prevents morbidity and mortality in thrombocytopenic patients. Platelet transfusion plays an important role in the treatment of haematological, oncological, surgical, and transplant patients. Platelets are transfused by two methods i) by fractionation of whole blood and ii) by platelet apheresis. Over the last decade there has been a trend towards the use of SDPs rather than pooled random donor platelets in thrombocytopenic patients. Optimization of platelet yield is an emerging issue to identify factors which may help in selecting donors to obtain higher platelet yields in shorter time and consequently better clinical outcome. Objective: The quality of single donor platelets (SDP) in terms of yield influences the platelet recovery in the recipient. The aim was to identify the SDP donor factors that influence platelet yield. Methods: The study was undertaken at transfusion medicine department, DMCH from 1st January 2017 to 31st December 2017. The study included 350 plateletpheresis procedures. All procedures were performed according to manufacturer’s manual and standard operating procedure. Results: During the period of study, 350 platelet pheresis donors were studied. All of the donors were male. Platelet yield showed high statistical significance with pre donation platelet count and its indices. (p=0.000). Statistical significant negative correlation was seen between pre donation Hb concentration and the platelet yield. (p =0.005). No statistical significance was seen height (p=0.933), weight (p=0.760) of donor on platelet yield. Conclusion: Platelet recovery in the patient is influenced by the transfused dose of platelets, which in turn is dependent on the quality of the platelet product in terms of yield. Various donor factors such as pre donation platelet count and haemoglobin concentration may affect platelet yield. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 179-183

The COVID-19 pandemic has dramatically changed the lives of people and the work of hospitals and the health system. The rapid spread of infection, high mortality and congestion in hospitals are of high concern. Due to insufficiently causes, the number of admissions of patients with acute coronary syndrome (ACS) has significantly decreased in many centers, while timely intervention significantly improves the prognosis of AMI patients with ST segment elevation. Aim. To assess the clinical characteristics of patients with ST-segment elevation AMI during the re-profiling of the center for patients with COVID-19. Materials and methods. In total, the center worked to receive patients with COVID-19 and ACS for one month, during which 8 AMI patients with ST segment elevation were hospitalized. SARS-CoV-2 was diagnosed on the basis of nasopharyngeal or oropharyngeal smear PCR, serum IgM and IgG, or lung CT, which were performed on the day of admission, regardless of the severity of the condition. Segment elevation AMI was diagnosed based on typical clinical presentations accompanied by ST-segment elevation or newly diagnosed LBBB. Stenosis was considered as an infarction-related lesion in the presence of angiographic signs of thrombotic occlusion or subocclusion. Obstructive coronary artery disease was defined as >50% stenosis based on visual assessment of angiography. Results. All patients had ST-segment elevation, 6 (75%) patients had typical pain syndrome, 2 (25%) patients had pain syndrome accompanied by shortness of breath. SARS-CoV-2 was detected by PCR in 4 (50%), in 2 (25%) – an increased titer of IgM and IgG. CT scan showed 7 (87.5%) changes characteristic of COVID-19. Severe (CT3) and moderately severe (CT2) lesions were found in 4 (50%) patients. All patients underwent coronary angiography, thrombolysis was not performed. All patients had obstructive coronary artery disease requiring revascularization. When compared with the same calendar interval of the previous 3 years, the decrease in hospitalization for AMI with ST elevation was 50% or more. However, when comparing pain-door and door-balloon time intervals, no significant differences were found (p=0.786 and p=0.300, respectively). Conclusion. All patients with suspected ST-segment elevation AMI had obstructive coronary artery disease requiring revascularization. There was a significant decrease in the number of patients with AMI with ST-segment elevation without changing the time intervals before hospitalization and intervention. Keywords: acute myocardial infarction, COVID-19, revascularization For citation: Safaryan VI, Savostyanov KA, Sizgunov DS, Sargsyan AZ, Birukov PA. Acute ST-segment elevation myocardial infarction in COVID-19 patients: a single hospital experience. Consilium Medicum. 2021; 23 (1): 43–47. DOI: 10.26442/20751753.2021.1.200574

Intestinal malrotation is a congenital disorder resulting from abnormal rotation of the intestine during fetal development. The aim of this study was to evaluate our experience in the management of pediatric patients with intestinal malrotation.

Introduction: Thrombocytopenia defined as platelet count below 1,50,000ul. This fall in platelet count may be due to decreased production, increased destruction and pooling of platelets. The platelet parameters include platelet count, mean platelet volume (MPV), platelet distribution width (PDW) obtained by automated cell counters. These help in knowing the pathomechanism of myriad cases of TCPs. Hence the present study was undertaken to know the variations and correlations of platelet parameters in various causes of TCPs. Materials and Methods: 700 blood samples of patients with platelet count 1,50,000 ul were studied. Hematological analysis was done by Sysmex KX-21. Platelet parameters of all the cases and control group were noted. The cases were grouped into various categories of A, B or C depending on mechanism of decrease in platelets. Data was analyzed and tested for statistical significance using one-way ANOVA and post hoc testing using Tukey’s test. Results: Majority of the cases in the present study were in group A (75.3%), followed by group B (23.9%) and group C (0.6%). A higher value of MPV (10.15±1.30 fl) and PDW (14.44±2.35%) was found in group A compared to other categories. Significant results of MPV and PDW values were seen in group A and group B category. Conclusion: Platelet parameters like MPV and PDW obtained by automated cell counters together with platelet counts help us to know the pathomechanism of various causes of TCPs which inturn provides pivotal information for better management. Keywords: Thrombocytopenia, Platelet count, Mean platelet count, Platelet distribution width.

Objectives: To review our experience in the management of iatrogenic ureter injuries caused by different urological procedures. Study Design: Descriptive Case series. Setting: Department of Urology, Jinnah Postgraduate Medical Centre Karachi. Period: January 2011 to December 2018. Material & Methods: We included all cases of iatrogenic ureteric injuries induced by urology department only. Gynecological and general surgical iatrogenic injuries were excluded in this study. All pertinent details like indication for surgery, type of surgery, location of injury, laterality, type of injury, time of recognition of injury (i-e intra-operative, early and late), treatment modality and their surgical outcomes were recorded. Results: We managed 56 iatrogenic ureteric injuries in 47 patients during study period. Mean age was 43.14+ 8.86 years. There were 31 males (66%) and 16 females (34%). Right sided injury was observed in 29 patients (61.7%), left sided injury in 16 patients (34.0%) while bilateral injuries were seen in 2 patients (4.3%). Regarding site of injury proximal ureteric injuries were the most common accounting for 32 patients (68.1%). Intraoperative diagnosis was the most common time for diagnosis seen in 30 patients (63.8%). The endoscopic urological surgeries were the most common cause of urological iatrogenic ureteric injury accounts for 71.4% of cases. Open upper tract surgeries were responsible for 8 cases (14.2%). One patient sustained proximal ureteric injury during retro-peritoneal lymph node dissection (RPLND). Laparoscopic urological surgeries were responsible for four cases of injury. One patient developed ureteric avulsion. 13 patients presented with late Ureteric stricture. We have five nephrectomies while three patients needed permanent nephrostomies. Our success rate was 83%. Conclusions: Endo-urological procedures are the commonest causes of ureteric injuries in our study. Prompt diagnosis and early corrective intervention can result in satisfactory outcome in about 83% of cases.

ObjectivesAlthough healthcare workers (HCWs) have been particularly affected by SARS-CoV-2, detailed data remain scarce. In this study, we investigated infection rates, clinical characteristics, occupational exposure and household transmission among all symptomatic HCWs screened by SARS-CoV-2 RT-PCR between 17 March (French lockdown) and 20 April.MethodsSARS-CoV-2 RT-PCR was proposed to symptomatic (new cough or dyspnoea) HCWs at Creteil Hospital in one of the Parisian suburbs most severely affected by COVID-19. Data on occupational profile, living situation and household, together with self–isolation and mask use at home were collected, as well as the number of cases in the household.ResultsThe incidence rate of symptomatic SARS-CoV-2 was estimated to be 5% (110/2188). A total of 110 (35%) of the 314 HCWs tested positive and 9 (8%) were hospitalised. On multivariate analysis, factors independently associated with positive RT-PCR were occupational profile with direct patient facing (OR 3.1, 95% CI 1.1 to 8.8), pConclusionThis is the first study to report infection rates among HCWs during the peak of the SARS-CoV-2 epidemic in France and the lockdown period, highlighting the risk related to occupational profile and household transmission.

Background and Objective While highly effective hepatitis C virus (HCV) therapies exist, gaps in the cascade of care remain. Disparities in the HCV cascade are prominent among underserved safety-net populations. We aim to evaluate the HCV cascade among an urban safety-net cohort of HCV patients. Methods We retrospectively evaluated adults with chronic HCV to determine rates of linkage to care (LTC), retention to care, and receiving HCV treatment from 2002 to 2018. Comparisons between groups utilized Chi-square testing; comparisons of median time to LTC and HCV treatment were evaluated with Student’s t-test and analysis of variance. Results Among 600 chronic HCV patients (60.7% male, 20.7% non-Hispanic white, 49.2% African American, 92.5% treatment naïve, 26.8% cirrhosis), successful LTC within one year of HCV diagnosis was 57.7%, among which, 91.6% were successfully retained into care. In those with successful LTC, 72.6% received HCV treatment, 91.8% completed treatment, and 89% achieved SVR12. Women with HCV experienced longer delays from LTC to HCV treatment (331 vs. 206 days in men, P < 0.05), as did African Americans (280 vs. 165 days in non-Hispanic whites, P < 0.05). Compared to the non-Hispanic whites, HCV treatment was lower in African Americans (70.4% vs. 74.4%, P < 0.05). Conclusion Women with HCV experienced significant delays along the HCV cascade, with median time of over 2 years from diagnosis to treatment. African Americans also experienced significant delays along the HCV cascade of care. However, sex and race/ethnicity were not found to be significant predictors of overall LTC or treatment.

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

BACKGROUND AND OBJECTIVES: To investigate caregivers’ perceptions of physician communication and hospital ratings for hospitalized children with and without autism and assess associations between perceived quality of physician communication and overall ratings of the hospital. METHODS: We studied survey data from caregivers of 543 patients with autism compared with a 2:1 matched control sample of 1086 patients with similar characteristics but without autism from a single children’s hospital. We analyzed survey items related to physician communication and hospital ratings from the Consumer Assessment of Healthcare Physicians and Systems Child Hospital Survey. We constructed multivariable regression models to examine the relationship between caregiver-perceived physician communication and caregivers’ overall ratings of the hospital. RESULTS: A similar proportion of caregivers of children with and without autism reported that doctors “always” listened carefully to them (71.4% vs 74.3%; adjusted prevalence ratio 0.96; 95% confidence interval 0.90–1.03) and “always” treated them with respect (80.0% vs 84.1%; adjusted prevalence ratio 0.95; 95% confidence interval 0.90–1.00). Caregivers of children with autism were less likely to “definitely” recommend the hospital (87.0% vs 92.3%; adjusted prevalence ratio 0.94; 95% confidence interval 0.91–0.98). All items related to caregiver-perceived physician communication were associated with the highest hospital rating and the highest recommendation of the hospital in both groups. CONCLUSIONS: When matched on the basis of medical and social factors, caregivers of children with and without autism reported similar frequencies of highest-quality physician communication. Improvement of physician communication with caregivers of medically and socially complex children with and without autism may improve caregivers’ overall ratings of the hospital.

AAbstract:Background: Zygomatic complex and arch fractures remain one of the most common maxillofacial fractures. Epidemiological studies of theses fractures vary by geographic region, socioeconomic, environmental and cultural factors. Its importance is confirmed by their implication in the clinical practice and prevention.Patients and Methods: Five-year retrospective study; from May 2015 to April 2020; was conducted on 120 patients with zygomatic fractures in our department. Fracture sites were classified into five types (I-V) based on the number of fractured processes and comminution. Data collected in a clinical sheet and analyzed using Statistical Package for Social Sciences version 20. P- value < 0.05 was considered significant. Chi square test was used to compare between 2 or more qualitative variables.Results: Patients aged from 15-78 years old and divided into 4 age groups (A-D). Group B (21- 40 years) was the commonest affected. Males were predominant than females with ratio M: F = (7:1). Motor car accidents was the commonest etiology of trauma (56.60%). Left sided fracture (52.5%) was involved more than right sided one (45%) and fracture was bilateral in 2.5% of cases. Type-IV fracture (classic tetrapod) was the commonest type reported (42 cases, 35 %). Most common fractured process was zygomatic-maxillary buttress (ZM) in 90 cases (75%). Mandibular fracture (15%) was the most common associated facial fractures. Most common accessed approach was the upper buccal in 80 cases (66.6 %). Access through a pre-existing wound was encountered in 10 cases (8.3 %). Four-point fixation (40%) was the commonest point fixation for these fractures. Infra orbital paresthesia (42 cases) was the most common complications encountered.Conclusion: Zygomatic fractures have high morbidity and cost of life. Use of protective devices, strict laws and severe punishments must be implemented to reduce its frequency.

Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.

Background: Leaving against medical advice (LAMA) can be defined broadly as a patient’s insistence upon leaving the hospital against the treating team has expressed advice, which is both a challenge and concern for physicians, as these patients lost to follow-up, and their outcomes remain unknown. There is no previous study conducted to find the prevalence and causes of LAMA in brain tumors patients in the Middle East to the best of our knowledge. Methods: Patients studied in this research are those who were diagnosed with any type of brain tumors and were admitted to the Neurosurgical Department in Khoula Hospital (KH) but signed LAMA in the two years between January 2017 to December 2018 by going through the electronic medical records. Data obtained from the health information system includes socioeconomic characteristics, health status-related data, diagnosis-related data, and the reasons for LAMA. Results: A total number of 302 patients with brain tumors included in this study. Twenty-eight patients (9.2%) signed LAMA with a majority of those who signed LAMA were in the young adult’s group (3-39 years) and represented 18 (64%). Eight patients (28.57%) among the LAMA group and 43 patients (15.69%) in the non-LAMA group have tumors in the frontal lobe, which has found to be the most familiar location (29%). There was a significant relationship between the reason for LAMA and gender (P=0.020). Conclusion: Younger patients, male, Omani, newly diagnosed tumors, and tumors in the frontal lobe were all risk factors for LAMA. Education and awareness about LAMA recommended in order to avoid readmission and loss of follow up.

Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection.A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection.Six patients were identified (5 men); median age was 69 years (range 57-82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4).Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.

The coronavirus disease 2019 (COVID-19) has rapidly spread across the world since first being identified in Wuhan, China, in late 2019. In order to prepare for the surge of patients and the corresponding increase in radiology exams, clear and detailed policies need to be implemented by hospitals and radiology departments. In this article, we highlight the experiences and policies at LAC+USC Medical Center, the largest single provider of healthcare in LA County. Our policies aim to reduce the risk of transmission, guide patient management and workflow, preserve and effectively allocate resources, and be responsive to changing dynamics. We hope this communication may help other institutions in dealing with this pandemic as well as future outbreaks.

Background: Repair of inguinal hernia is one of the most frequently performed procedures in pediatric surgery. Objective: The aim of this study was to evaluate the complications we encountered following repair of inguinal hernia in children. Methodology: This was a retrospective study done in children aged 15 years and below who had complications following inguinal hernia repair (both emergency and elective) at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria, between January 2014 and December 2018. Results: A total of 1243 cases of pediatric inguinal hernia repairs were performed during the study period. Out of this, 123 patients developed complications, accounting for 9.9% of the total cases. There was male predominance with a median age of 1 year. Most of the complications were noted in infants undergoing emergency repairs. Scrotal complications were the most common complications which resolved on non-operative treatment. Other complications in descending order of frequency included wound infection, hernia recurrence, testicular atrophy and sensory disturbances in the inguinal region. There was no mortality following the surgeries. Conclusion: Pediatric inguinal hernia repair is a procedure with potential complications more so in infants following an emergency repair. Preoperative parental counseling and timely referral are mandatory.

PURPOSE: Lung cancer remains the leading cause of cancer death in the United States, with outcomes likely worsened by the presence of poorer outcomes among vulnerable populations such as the homeless. We hypothesized that homeless patients experience delays in biopsy, decreased appointment adherence, and increased overall mortality rates. METHODS: We conducted a retrospective electronic medical record–based review of all patients with non–small-cell lung cancer (NSCLC; N = 133) between September 2012 and September 2018 at an academic county hospital in Seattle, Washington. RESULTS: Of the 133 patients treated for NSCLC, 22 (17%) were homeless at the time of their treatment. Among homeless patients with localized lung cancer, the mean time from radiographic finding to biopsy was 248 days, compared with 116 days among housed patients ( P = .37). Homeless patients with advanced disease missed a mean of 26% of appointments in the year after diagnosis, compared with 16% among housed patients ( P = .03). Homeless patients with advanced NSCLC had a median survival of 0.58 years, versus 1.30 years in housed patients ( P = .48). CONCLUSION: To our knowledge, this is the first US study comparing outcomes among homeless and housed patients with NSCLC within the same institution; we found homeless patients had longer delays to biopsy, increased rates of missed appointments, and a trend toward decreased survival. This study shows potential areas where interventions could be implemented to improve lung cancer outcomes in this patient population.

Aim:Our work is aim at sharing our experiences in suicide cases which constitute a significant part of the psychiatric emergency cases. We hope to draw attention to the factors involved in suicide attempts. This is intended to contribute to taking precautions and prevent suicide attempts by determining the possible risk factors.Materials and Methods:This study was conducted by retrospectively reviewing records of 292 cases filed at Dumlupınar University, Kütahya Training Research Hospital Emergency Service as suicide attempts between January 01 and December 31, 2016, in which the “Suicide Attempt Registration Form” was completed.Results:Suicide attempts were found to occur more frequently in females within the ages of 15-24 years, particularly in cases with family problems, psychiatric diseases, and problems with the opposite sex.Conclusion:In this study, we evaluated demographic and risk factors of suicide attempts in our hospital. Local government, non-governmental organizations, and health service providers need to cooperate in developing policies which seeks to prevent suicidal behavior. In addition, because psychiatric diseases has an important place in the etiology of suicide attempts, it is important that these patients are followed up closely and that symptoms indicative of suicide are treated and an absolute psychiatric evaluation and follow-up be done before discharge of the emergency patients.

Albeit the importance of patient experience, most questionnaires are only available in English. To understand the hospital experience of Filipino patients, a psychometrically sound instrument in Filipino is warranted. This study culturally adapted and validated the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) into Filipino. A 5-step cross-cultural validation process was conducted. Forward translation, back-translation, and panel reconciliation involved 7 language experts. Pretesting included content validation and pretesting of the Filipino HCAHPS, while field testing involved 64 purposively selected hospitalized patients who completed a 4-part survey from July to December 2018. Content, linguistic, and conceptual equivalence and internal consistency were statistically appraised. Content validation yielded a scale content validity index/average of 1.00. Comparative analysis and Bland-Altman plots indicated good linguistic equivalence. All correlation coefficients were ≥.30, denoting good conceptual equivalence. Cronbach’s α for both versions of HCAHPS were ≥0.80, suggestive of good internal consistency. The Filipino HCAHPS is a psychometrically sound and culturally appropriate tool to measure patient experience among Filipinos. This understanding can be utilized for quality improvements on both practice and policy levels.

Background: Intramuscular injection (IM) is one of the most frequently use practices in nurs­ing. Lack of knowledge can make the procedure ineffective resulting in lot of complications. The objective of the study was to find out the knowledge of IM injection among the nurses of Chitwan Medical College Teaching Hospital (CMCTH), Bharatpur, Chitwan. Methods: A descriptive, cross-sectional study design was used among 220 nurses of CMCTH who were selected by using non- probability purposive sampling technique. Self-adminis­tered questionnaires were used to collect the data. The data was analyzed using IBM SPSS version 20.0 and descriptive, inferential test was applied. Results: The age study findings revealed that 60% of respondents belonged to group 21 to 25 years and the mean age was 22.20±2.57 years, 72.3% respondents had completed Proficiency Certificate Level (PCL) Nursing, 90% of respondents were working as staff nurse, 57.3% of respondents were working in general wards, 48.2% of the respondents had hos­pital experience less than 12 months. Majority of the respondents (71.8%) had inadequate knowledge regarding IM injection. There was statistical significant association between re­spondents’ knowledge regarding IM injection and their age (p

BACKGROUND: Geriatric patients require specialized perioperative care, yet the impact of geriatric surgery proportion (a measure of experience) and geriatric surgery volume, on clinical outcomes is unknown. This study analyzes the association between proportion and volume and clinical outcomes after high-risk geriatric surgery. METHODS: Using the 2014 National Inpatient Sample, hospital encounters for older adults (≥65 years) undergoing high-risk geriatric surgery were identified. Geriatric surgery volume was defined as a hospital’s annual volume of geriatric patients undergoing high-risk geriatric surgery. Geriatric surgery proportion was calculated as volume divided by the sum of high-risk surgeries in all ages. Hierarchical multivariable regression models identified predictors of inpatient mortality, postoperative length of stay (LOS), and discharge to nursing facility. RESULTS: There were an estimated 514,950 hospital encounters for older adults undergoing high-risk geriatric surgery from 3,115 hospitals. Mean proportion was 0.53±0.19; median volume was 60 cases/year, ranging from 5 to 3,235. After adjustment, comparing the 90(th) to 10(th) percentiles, higher proportion was associated with decreased mortality (odds ratio (95% CI) 0.81 (0.73-0.88); p