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PURPOSE: Although there exists some literature on the psychosocial elements of health between patients with and without spiritual care, less information is available on hospital health outcomes. Hence, we aimed to describe and compare health care utilization and outcomes among medical oncology patients who received and did not receive spiritual care consultation during inpatient admission. METHODS: We conducted a retrospective chart review of medical oncology patients admitted to Yale New Haven Hospital between January 1, 2018, and December 31, 2020, to compare hospital outcomes between patients with and without spiritual care. RESULTS: Thirty-one thousand six hundred twenty-three patients were included, of whom 11,053 (35%) received a chaplain spiritual care visit and had a spiritual care note. Patients who received spiritual care were older and sicker. Readmission rates within 30 days were greater in the spiritual care group (OR = 1.07; P = .018). In addition, patients receiving spiritual care were at greater odds of increased length of stay (β = 4.92; P < .0001), intensive care unit admission (OR = 2.98; P < .0001), hospital death (OR = 1.46; P < .0001), and emergency department visit within 30 days of discharge (OR = 1.17; P < .0001). CONCLUSION: Patients who were older and sicker had greater spiritual care utilization than their younger and healthier counterparts. Spiritual care assessment of existential distress, complex grief, and faith-based support may be positively associated not only with patient care and quality of life but also with health care utilization and outcomes.

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.

OBJECTIVE The objective of this study was to compare results of using web-based and mail (postal) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data collection protocols. RESEARCH DESIGN Patients who had been hospitalized in a New England Hospital were surveyed about their hospital experience. Patients who provided email addresses were randomized to 1 of 3 data collection protocols: web-alone, web with postal mail follow-up, and postal mail only. Those who did not provide email addresses were surveyed using postal mail only. Analyses compared response rates, respondent characteristics, and patient-reported experiences. SUBJECTS For an 8-week period, patients were discharged from the study hospital to home. MEASURES Measures included response rates, characteristics of respondents, 6 composite measures of their patient experiences, and 2 ratings of the hospital. RESULTS Response rates were significantly lower for the web-only protocol than the mail or combined protocols, and those who had not provided email addresses had lower response rates. Those over 65 were more likely than others to respond to all protocols, especially for the mail-only protocols. Respondents without email addresses were older, less educated, and reported worse health than those who provided email addresses. After adjusting for respondent differences, those in the combined protocol differed significantly from the mail (postal) only respondents on 2 measures of patient experience; those in the web-only protocol differed on one. Those not providing an email address differed from those who did on one measure. CONCLUSION If web-based protocols are used for HCAHPS surveys, adjustments for a mode of data collection are needed to make results comparable.

Purpose To determine whether nurses' workaholic tendencies and demographic variables predict their professional quality of life. Design A cross-sectional design was utilized among 427 Saudi nurses which conveniently selected in four tertiary public hospitals in Saudi Arabia. Findings Nurses' have higher workaholic tendencies level and moderate professional quality of life levels. Working more than 40 h per week correlates with one's risk of workaholism. Certain professional quality of life subscales is associated with gender, marital status, hospital experience, and work addiction tendencies. Practice implications The present study contributes to the development of new clinical practices by enlightening readers of the implications of workaholism for nurses' professional quality of life, so that this can be addressed and managed properly.

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 study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients’ access to proactive care.

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 The purpose of this qualitative research study was to ascertain which nurse behaviors a subsection of adults 50 years and older who had had a recent inpatient admission believed conveyed nurse listening. Background Listening by nurses has been identified as one of the factors with the greatest impact on patients' overall rating of their hospital experience. The behaviors of nurses that lead to patients' perceptions that listening has occurred have been unexamined, thus hampering attempts at improvement. Methods Because of lack of literature support, a qualitative study using interpretative phenomenological analysis was undertaken to elicit a rich description of patients' lived experiences related to nurse listening behaviors. Results Study participants provided specific behaviors, both verbal and nonverbal, which led them to believe the nurse was either listening or not. These perceptions affected their sense of safety and ability to trust. Conclusions Embracing these described behaviors could significantly impact patients' safety and recovery.

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.

Frontoethmoidal encephalomeningocele (FEEM) is a congenital anomaly involving herniation of the glial tissues and the meninges. Our unit implemented single-stage repair in 1996, and this was followed by the introduction of the medial orbital composite-unit translocation (MOCUT) technique for encephalocele repair in 2001. This report describes the long-term outcomes of patients who underwent the MOCUT technique. Data were collected on 32 patients operated on between 2005 and 2018. A full analysis was subsequently made of the data from 4 selected patients who had been monitored for at least 5 years, and their age-related anterior interorbital distances were compared. Two of the patients, who had simple forms of FEEM, demonstrated improvements in their intercanthal and anterior interorbital distances, whereas telecanthus was experienced by the 2 other cases, both of whom had complex FEEM types. We recommend using the MOCUT technique for simple types of FEEM (especially Type IA) and patients whose medial canthal ligaments are still anatomically attached to the medial orbits.

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. Atypical Presentations of Thyroid Cancer: Analysis of Forty-Eight Cases from a Tertiary Hospital in Cameroon. WW Med. 2019;1(3):68-78. doi: 10.5455/ww.302644239.","Alwaheeb S, Ghazarian D, Boerner SL, Asa SL. Cutaneous manifestations of thyroid cancer: a report of four cases and review of the literature. J Clin Pathol. 2004;57(4):435-8. doi: 10.1136/jcp.2003.012922.","Strate SM, Lee EL, Childers JH. Occult papillary carcinoma of the thyroid with distant metastases. Cancer. 1984;54(6):1093-100. doi: 10.1002/1097-0142(19840915)54:63.0.co;2-r.","Laskin WB, James LP. Occult papillary carcinoma of the thyroid with pulmonary metastases. Hum Pathol. 1983;14(1):83-5. doi: 10.1016/s0046-8177(83)80050-1.","Koller EA, Tourtelot JB, Pak HS, Cobb MW, Moad JC, Flynn EA. Papillary and follicular thyroid carcinoma metastatic to the skin: a case report and review of the literature. Thyroid. 1998;8(11):1045-50. doi: 10.1089/thy.1998.8.1045.","Dahl PR, Brodland DG, Goellner JR, Hay ID. Thyroid carcinoma metastatic to the skin: a cutaneous manifestation of a widely disseminated malignancy. J Am Acad Dermatol. 1997;36(4):531-7. doi: 10.1016/s0190-9622(97)70239-1.","Iftikhar H, Ikram M, Muhammad AY, Nathani KR. Unusual Presentation of Differentiated Thyroid Cancer Metastasis. Int Arch Otorhinolaryngol. 2018;22(2):167-70. doi: 10.1055/s-0037-1604038.","Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE, Devesa SS. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980-2005. Cancer Epidemiol Biomarkers Prev. 2009;18(3):784-91. doi: 10.1158/1055-9965.EPI-08-0960.","Boucek J, Kastner J, Skrivan J, Grosso E, Gibelli B, Giugliano G, et al. Occult thyroid carcinoma. Acta Otorhinolaryngol Ital. 2009;29(6):296-304.","Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338(5):297-306. doi: 10.1056/NEJM199801293380506.","Udelsman R. Is total thyroidectomy the procedure of choice for papillary thyroid cancer? Nat Clin Pract Oncol. 2008;5(4):184-5. doi: 10.1038/ncponc1067.","Merriam-Webster on-line dictionary. Available from: http://www.merriam-webster.com/ (accessed March 2021).","Segen JC. Concise Dictionary of Modern Medicine. New York: McGraw-Hill; 2002.","Moosa M, Mazzaferri EL. Occult thyroid carcinoma. Cancer J. 1997;10:180-8.","Stedman's Medical Dictionary. Philadelphia, PA: Lippincott Williams & Wilkins; 2006.","Sobin LH, Wittekind C. TNM Classification of malignant tumours. 6th ed. New York: John Wiley & Sons; 2002.","Shaha AR. TNM classification of thyroid carcinoma. World J Surg. 2007;31(5):879-87. doi: 10.1007/s00268-006-0864-0.","Russ G, Leboulleux S, Leenhardt L, Hegedüs L. Thyroid incidentalomas: epidemiology, risk stratification with ultrasound and workup. Eur Thyroid J. 2014;3(3):154-63. doi: 10.1159/000365289.","Kaliszewski K, Diakowska D, Ziętek M, Knychalski B, Aporowicz M, Sutkowski K, et al. Thyroid incidentaloma as a \"PAIN\" phenomenon- does it always require surgery? Medicine (Baltimore). 2018;97(49):e13339. doi: 10.1097/MD.0000000000013339.","Roti E, Rossi R, Trasforini G, Bertelli F, Ambrosio MR, Busutti L, et al. Clinical and histological characteristics of papillary thyroid microcarcinoma: results of a retrospective study in 243 patients. J Clin Endocrinol Metab. 2006;91(6):2171-8. doi: 10.1210/jc.2005-2372.","Fink A, Tomlinson G, Freeman JL, Rosen IB, Asa SL. Occult micropapillary carcinoma associated with benign follicular thyroid disease and unrelated thyroid neoplasms. Mod Pathol. 1996;9(8):816-20.","Behar R, Arganini M, Wu TC, McCormick M, Straus FH 2nd, DeGroot LJ, et al. Graves' disease and thyroid cancer. Surgery. 1986;100(6):1121-7.","Yamamoto Y, Maeda T, Izumi K, Otsuka H. Occult papillary carcinoma of the thyroid. A study of 408 autopsy cases. Cancer. 1990;65(5):1173-9. doi: 10.1002/1097-0142(19900301)65:53.0.co;2-2.","Vanderlaan WP. The occurrence of carcinoma of the thyroid gland in autopsy material. N Engl J Med. 1947;237(7):221. doi: 10.1056/NEJM194708142370703.","Sampson RJ, Woolner LB, Bahn RC, Kurland LT. Occult thyroid carcinoma in Olmsted County, Minnesota: prevalence at autopsy compared with that in Hiroshima and Nagasaki, Japan. Cancer. 1974;34(6):2072-6. doi: 10.1002/1097-0142(197412)34:63.0.co;2-#.","Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A \"normal\" finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531-8. doi: 10.1002/1097-0142(19850801)56:33.0.co;2-3.","Fukunaga FH, Yatani R. Geographic pathology of occult thyroid carcinomas. Cancer. 1975;36(3):1095-9. doi: 10.1002/1097-0142(197509)36:33.0.co;2-9.","Bondeson L, Ljungberg O. Occult thyroid carcinoma at autopsy in Malmö, Sweden. Cancer. 1981;47(2):319-23. doi: 10.1002/1097-0142(19810115)47:23.0.co;2-a.","Bondeson L, Ljungberg O. Occult papillary thyroid carcinoma in the young and the aged. Cancer. 1984;53(8):1790-2. doi: 10.1002/1097-0142(19840415)53:83.0.co;2-9.","Fukunaga FH, Lockett LJ. Thyroid carcinoma in the Japanese in Hawaii. Arch Pathol. 1971;92(1):6-13.","Olurin EO, Itayemi SO, Oluwasanmi JO, Ajayi OO. The pattern of thyroid gland diseases at Ibadan. Nigerian Medical J. 1973;3(2):58-65.","Block MA. Management of carcinoma of the thyroid: Surgical Progress. Ann Surg. 1976;185:133-44.","Clarke OA. Endocrine Surgery of the Thyroid and Parathyroid Glands. St Louis: The CB Mosby Co; 1985.","Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1998. CA Cancer J Clin. 1998;48(1):6-29. doi: 10.3322/canjclin.48.1.6.","Afolabi AO, Akute OO, Ogundiran TO. Late Presentation of Goitre Patients in the University College Hospital, Ibadan, Nigeria. Niger J Surg. 2004;10(2):59-62.","Ito Y, Higashiyama T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, et al. Prognosis of patients with benign thyroid diseases accompanied by incidental papillary carcinoma undetectable on preoperative imaging tests. World J Surg. 2007;31(8):1672-6. doi: 10.1007/s00268-007-9131-2.","Botrugno I, Lovisetto F, Cobianchi L, Zonta S, Klersy C, Vailati A, et al. Incidental carcinoma in multinodular goiter: risk factors. Am Surg. 2011;77(11):1553-8.","Afolabi AO, Oluwasola AO, Akute OO, Akang EE, Ogundiran TO, Ogunbiyi JO, et al. Review of fine needle aspiration cytology in the management of goitres in Ibadan, Nigeria. Niger J Clin Pract. 2010;13(2):163-6.","Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am. 1997;26(1):189-218. doi: 10.1016/s0889-8529(05)70240-1.","Phitayakorn R, McHenry CR. Incidental thyroid carcinoma in patients with Graves' disease. Am J Surg. 2008;195(3):292-7; discussion 297. doi: 10.1016/j.amjsurg.2007.12.006.","Lawal O, Agbakwuru A, Olayinka OS, Adelusola K. Thyroid malignancy in endemic nodular goitres: prevalence, pattern and treatment. Eur J Surg Oncol. 2001;27(2):157-61. doi: 10.1053/ejso.2000.1085.","Osime U. A study of 150 thyroidectomics in University of Benin Teaching Hospital. Ind J Surg. 1984;46:41-50.","Franssila KO, Harach HR. Occult papillary carcinoma of the thyroid in children and young adults. A systemic autopsy study in Finland. Cancer. 1986;58(3):715-9. doi: 10.1002/1097-0142(19860801)58:33.0.co;2-p.","Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000;90(2):161-5. doi: 10.1006/jsre.2000.5875.","Barakate MS, Agarwal G, Reeve TS, Barraclough B, Robinson B, Delbridge LW. Total thyroidectomy is now the preferred option for the surgical management of Graves' disease. ANZ J Surg. 2002;72(5):321-4. doi: 10.1046/j.1445-2197.2002.02400.x.","Gelmini R, Franzoni C, Pavesi E, Cabry F, Saviano M. Incidental thyroid carcinoma (ITC): a retrospective study in a series of 737 patients treated for benign disease. Ann Ital Chir. 2010;81(6):421-7.","Adewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria. Am J Trop Med Hyg. 2015;93(3):648-54. doi: 10.4269/ajtmh.14-0245.","Alawode GO, Adewole DA. Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub-national level actors, healthcare and insurance providers. BMC Public Health. 2021;21(1):124. doi: 10.1186/s12889-020-10133-5.","Eboh A, Akpata GO, Akintoye AE. Health Care Financing in Nigeria: An Assessment of the National Health Insurance Scheme (NHIS). Eur J Bus Manag. 2016;8(27):24-34.","Andresen NS, Buatti JM, Tewfik HH, Pagedar NA, Anderson CM, Watkins JM. Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity. Eur Thyroid J. 2017;6(4):187-196. doi: 10.1159/000468927.","Goldsmith SJ. Radioactive Iodine Therapy of Differentiated Thyroid Carcinoma: Redesigning the Paradigm. Mol Imaging Radionucl Ther. 2017;26(Suppl 1):74-79. doi: 10.4274/2017.26.suppl.08."]}

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.