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COVID-19 pandemic and medical resident education 新冠肺炎大流行与住院医师教育
Pub Date : 2021-01-27 DOI: 10.53986/ibjm.2021.0001
E. Esteban-Zubero
Article history: Received 21 January 2021 Received in revised form 26 January 2021 Accepted 27 January 2021
文章历史:2021年1月21日收到,2021年1月26日收到,2021年1月27日接受
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引用次数: 0
Pseudo prune belly syndrome: a female case report 假梅干腹综合征1例女性报告
Pub Date : 2021-01-02 DOI: 10.53986/ibjm.2021.0015
G. Oliván-Gonzalvo
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引用次数: 1
COVID-19: Potential role of prophylactic anticoagulation in preventing thrombotic events and mortality. Narrative review COVID-19:预防性抗凝在预防血栓事件和死亡率中的潜在作用复习要点
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0021
M. Castro, G. Cuevas
The COVID-19 pandemic and the limited therapeutic arsenal available strain daily clinical practice. Guidelines have recently recommended routine anticoagulation of hospitalized COVID-19 patients. However, apart from the expert panels’ experience, the provenance of this recommendation is not clear, due to the scarce published evidence. We provide a narrative review with the objective of unraveling the rationale for this practice. First, we analyze the biochemical, histopathological and clinical evidence for a pro-thrombotic profile in COVID-19 patients. Then, we present the clinical data from previous studies and discuss to what extent they aid in clinical decision-making. We conclude that, in the absence of randomized controlled trials, which are of utmost importance, prophylactic-dose anticoagulation should be offered to critically ill patients hospitalized for COVID-19 pneumonia, particularly those with high d-dimer levels, since they are the population most likely to benefit from it.
COVID-19大流行和有限的可用治疗武器库使日常临床实践承压。指南最近建议对住院的COVID-19患者进行常规抗凝治疗。然而,除了专家小组的经验之外,由于发表的证据很少,这项建议的来源尚不清楚。我们提供了一个叙述性的审查,目的是揭示这种做法的基本原理。首先,我们分析了COVID-19患者的促血栓形成特征的生化、组织病理学和临床证据。然后,我们介绍了以往研究的临床数据,并讨论了它们在多大程度上有助于临床决策。我们的结论是,在缺乏最重要的随机对照试验的情况下,应向因COVID-19肺炎住院的危重患者提供预防性剂量抗凝治疗,特别是那些d-二聚体水平高的患者,因为他们最有可能从中受益。
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引用次数: 0
Inappropriate laboratory testing requests: perspectives of clinical laboratory professionals 不适当的实验室检测要求:临床实验室专业人员的观点
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0039
S. Alasmari
Introduction: Laboratory examinations constitute a major factor in achieving the correct clinical diagnosis for patients. However, the ordering of unnecessary or inappropriate laboratory testing remains common, with consequent consumption of laboratory resources whether human or material. The present work evaluated the level of satisfaction of laboratory practitioners toward the appropriateness of laboratory tests ordered by physicians. Methods: This cross-sectional study involved a total of 256 medical laboratory practitioners representing different qualifications and health care sectors, who answered several questions concerning their knowledge and attitudes toward inappropriate laboratory testing ordered by physicians. Results: More than 85% of respondents agreed with the definition provided in the survey, which is substantially consistent with prior studies. More than 90% affirmed the associated drain on time and resources. However, discrepant responses were received concerning physician awareness of test availability, and participants reported laboratory staff arguments with physicians due to orders for unnecessary tests. Data showed that unnecessary orders were mainly requested by physicians of less experience. Conclusions: Ultimately, dissatisfaction was manifest among clinical laboratory professionals, and educational interventions are required to moderate request behaviors.
导读:实验室检查是实现患者正确临床诊断的主要因素。然而,订购不必要或不适当的实验室检测仍然很常见,因此消耗了实验室资源,无论是人力还是物力。目前的工作评估的满意水平的实验室从业人员对适当的实验室测试由医生订购。方法:本横断面研究共涉及256名代表不同资格和卫生保健部门的医学实验室从业人员,他们回答了几个关于他们对医生安排的不适当实验室检测的知识和态度的问题。结果:超过85%的受访者同意调查中提供的定义,这与先前的研究基本一致。超过90%的人肯定了相关的时间和资源消耗。然而,收到的关于医生对可获得测试的认识的不同答复,参与者报告了实验室工作人员与医生因不必要的测试命令而发生的争吵。数据显示,不必要的订单主要是由经验不足的医生提出的。结论:最终,临床实验室专业人员的不满是明显的,需要教育干预来调节请求行为。
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引用次数: 2
Retinitis pigmentosa associated with systemic light chain amyloidosis (AL amyloidosis) 视网膜色素变性合并系统性轻链淀粉样变性(AL淀粉样变性)
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0026
S. Bouomrani, F. Saadaoui, N. Ayadi
Retinitis pigmentosa (RP) or hereditary retinal dystrophy is a rare disease that can be isolated (non-syndromic RP) or associated with other systemic signs (syndromic RP). Kidney damage is exceptionally reported in patients with RP, particularly in syndromic forms. Association with renal amyloidosis remains unusual with only one reported case of RP and hereditary gelsolin amyloidosis due to a G654A gelsolin mutation defining the new syndrome of Ardalan-Shoja-Kiuru. Apart from this publication, no case associating RP and AL amyloidosis has been found. We report an original case of renal damage revealing kappa-type systemic light chains amyloidosis (AL amyloidosis) in 35-year-old man with sporadic RP. Our observation is, to our knowledge, the first to report this association.
色素性视网膜炎(RP)或遗传性视网膜营养不良是一种罕见的疾病,可以是孤立的(非综合征性RP)或与其他系统性体征(综合征性RP)相关。肾损害在RP患者中有特别的报道,特别是在综合征形式中。与肾淀粉样变的关联仍然不常见,仅报道了一例RP和遗传性凝胶淀粉样变,原因是G654A凝胶突变定义了新的Ardalan-Shoja-Kiuru综合征。除了这篇文章,没有发现RP和AL淀粉样变相关的病例。我们报告一个原始的病例肾脏损害揭示kappa型系统性轻链淀粉样变性(AL淀粉样变性)在35岁的男性散发性RP。据我们所知,我们的观察是第一个报告这种联系的。
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引用次数: 0
Prevalence of depression among Libyan medical students 利比亚医科学生抑郁症的流行情况
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0032
Roba F. Sherif, N. M. Saeed, Gofran A. Sherif, Khiria S. Rabab, Fathi M. Sherif
Introduction: Psychological stress is a common psychiatric disorder in medical students and sometimes is associated with depression. Students at university usually met a great pressure that they face in their study life and to the hard circumstances in the everyday life. The aim of this study is to estimate the prevalence of depression and stress among university medical students in Libya. Materials and methods: Data was collected by three different questionnaires: the first questionnaire is 6-ITEM Kutcher Adolescent Depression Scale (KADS), the second questionnaire is Patient Health Questionnaire-9 (PHQ-9) which are used to diagnose and to assess the severity of depression. The third questionnaire is a simplified self-scoring test for evaluating stress and tension levels. The three questionnaires have all been distributed to the medical sciences students at University of Tripoli in March and May, 2019. According to the registered students in the academic year, 2018/2019, the sample size was composed of 170 students. Results: The major finding of screening revealed that 45% of the total students suffering from depression during their study. This high prevalence composed of mild and moderate type of depression among the students (45% and 25%, respectively). On the other hand, about 40% and 50% of the students have identified as mild and moderate stress, respectively. About 10% of the students have detected as severe stress. Conclusions: This study indicates a high prevalence of mild and moderate depression among medical university students in Libya. Results suggest that university mental health services and programs addressing the students are highly recommended.
心理压力是医学生中常见的精神障碍,有时与抑郁症有关。学生在大学里通常会遇到巨大的压力,他们在学习生活和日常生活中的困难情况。本研究的目的是估计在利比亚的大学医学生抑郁和压力的患病率。资料与方法:采用三份不同的问卷收集数据:第一份是6项Kutcher青少年抑郁量表(KADS),第二份是患者健康问卷-9 (PHQ-9),用于诊断和评估抑郁的严重程度。第三份问卷是一个简化的自我评分测试,用于评估压力和紧张程度。这三份调查问卷已于2019年3月和5月分发给的黎波里大学医学院的学生。根据2018/2019学年的在校生,样本量为170名学生。结果:筛选的主要发现显示,45%的学生在学习期间患有抑郁症。这种高患病率由轻度和中度抑郁症组成(分别为45%和25%)。另一方面,大约40%和50%的学生分别被认为是轻度和中度压力。大约10%的学生表现出严重的压力。结论:本研究表明,在利比亚医科大学学生中,轻度和中度抑郁症的患病率很高。结果表明,大学心理健康服务和针对学生的方案是强烈推荐的。
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引用次数: 2
The role of bacterial colonization of ventilator circuit in development of ventilator associated pneumonia in ICU of Medical Center Hospital in Tripoli, Libya 利比亚的黎波里医疗中心医院ICU中呼吸机回路细菌定植在呼吸机相关性肺炎发展中的作用
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0019
Asma Elkammoshi, Abir Ben Ashur, Hamida El Magrahi, Aya Abdulatif, Malak Almarouq
Introduction: In mechanically ventilated patients, ventilator-associated pneumonia (VAP) is a major cause of prolonged hospitalization with increased morbidity and mortality. There is a lack of studies on the relationship between bacterial colonization of the ventilator circuit (VC) and VAP. This study aimed to investigate the role of bacterial colonization of VC in the development of VAP and identify antibiotic susceptibility trends for isolated strains. Methods: A prospective study of the bacterial culture has been performed between February 2021 to March 2021 on a total of 100 mechanically ventilated patients, (n =50) samples have been obtained from patient's lower respiratory tract (LRT) and (n =50) were taken from mechanical ventilator equipment VC. Paired samples of bacteria isolated from VC and LRT, where VC was colonized before LRT. Results: A total of 58 samples were cultured positively, while 42 specimens showed negative bacterial growth. However, there was no substantial difference in comparing between the bacterial colonization of the ventilator system and the patient samples. Most isolated organisms were gram-negative bacteria which were found in the ventilator circuit with 26 (68.4%), and 14 (70%) in patient’s LRT. Gram-positive was detected in 12 (31.6%) and 6 (30%) of the ventilator circuit, and patient's LRT, respectively. The predominant bacterial type was Acinetobacter baumannii organism at the VC with 10 (26.3%) and LRT at 4 (20%) followed by Klebsiella pneumoniae (8 (21.1%) in VC and 4 (20%) in LRT). Moreover, A. baumannii showed a full resistance to amoxicillin and the first generation of cephalosporins, while the other bacterial types were resistant to the most antibiotics used in this research. Conclusions: Bacterial colonization of ventilator circuit VC is a significant cause of VAP development in mechanically ventilated patients. Preventive strategies for the early detection and decontamination of contaminated VC can play a crucial role in ventilator-associated pneumonia prevention.
简介:在机械通气患者中,呼吸机相关性肺炎(VAP)是延长住院时间的主要原因,发病率和死亡率增加。关于呼吸机回路(VC)细菌定植与VAP之间关系的研究尚缺乏。本研究旨在探讨VC定殖在VAP发展中的作用,并确定分离菌株的抗生素敏感性趋势。方法:于2021年2月至2021年3月对100例机械通气患者进行细菌培养的前瞻性研究,从患者下呼吸道(LRT)采集样本(n =50),从机械呼吸设备VC采集样本(n =50)。从VC和LRT中分离的成对细菌样本,其中VC在LRT之前定植。结果:阳性培养58份,阴性培养42份。然而,在比较呼吸机系统的细菌定植和患者样本之间没有实质性的差异。革兰氏阴性菌多见于呼吸机回路,26株(68.4%),下呼吸道14株(70%)。在呼吸机回路和患者LRT中分别检测到革兰氏阳性12例(31.6%)和6例(30%)。主要细菌类型为鲍曼不动杆菌(vvc) 10株(26.3%),LRT 4株(20%),其次为肺炎克雷伯菌(vvc 8株(21.1%),LRT 4株(20%))。此外,鲍曼不动杆菌对阿莫西林和第一代头孢菌素具有完全耐药性,而其他细菌类型对本研究中使用的大多数抗生素均具有耐药性。结论:呼吸机回路VC的细菌定植是机械通气患者发生VAP的重要原因。早期发现和净化被污染VC的预防策略可在呼吸机相关性肺炎预防中发挥关键作用。
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引用次数: 3
Occult Thyroid Carcinoma: A Tertiary Hospital Experience in Ibadan, Nigeria 隐匿性甲状腺癌:尼日利亚伊巴丹三级医院的经验
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0034
A. Afolabi, B. Alegbeleye, Naomi Olagunju
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.
在我们的实践中,关于隐匿性甲状腺癌在甲状腺癌患者中所占比例的知识缺乏。因此,本研究旨在回顾隐匿性甲状腺癌的病例,重点关注低资源三级医院的表现、管理和护理结果。材料和方法:我们对尼日利亚伊巴丹大学学院医院治疗甲状腺癌15年的62例患者进行了回顾性横断面描述性研究。在过去的15年里,在甲状腺诊所进行过两次以上随访的患者被纳入了这项研究。对患者进行的手术类型进行了记录。数据采用描述性统计进行分析。我们还发现了各种可能阻碍对这些患者进行有效护理的限制。结果:连续62例患者诊断为甲状腺癌,其中男性12例(19.4%),女性50例(80.6%),年龄中位数为45岁。其中全甲状腺切除术48例(77.4%),全甲状腺切除术14例(22.6%),近全甲状腺切除术等。隐匿性甲状腺癌占治疗甲状腺癌患者的38例(61.3%)。最常见的组织学亚型为乳头状癌。我们确定了迟发,肿瘤手术不充分,经济拮据等,作为最佳治疗的限制。结论:从本组患者隐匿性甲状腺癌的比例来看,临床良性甲状腺肿可能含有癌或微癌。因此,我们建议开展积极的公共卫生运动,鼓励患者早期就诊,并通过甲状腺全切除术进行初级复位,以改善治疗结果。
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引用次数: 0
Change Management in Medical Institutions: Implementation View 医疗机构变革管理:实施视角
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0024
Said Said Elshama
Change is a learning process modeling the attitudes and values of the involved staff to adapt and show the change in daily work life. Leading the change in medical schools or in the health care system is considered one of the assignments of successful leadership that can achieve an effective organizational change under complex conditions. This review aims to show an implementation view about how to manage the change in medical institutions and how to overcome obstacles, and how to face the challenges. The resistance to change represents a major obstacle to the change process in any medical school or health care system. Thus, it should address this resistance by creating a suitable climate for carrying out the change based on a flexible strategy that may be translated into practical steps during the implementation. Moreover, the change should be institutionalized wherein new behaviors are persisting and generalizing in the medical school or the health care system as a result of the change application. In addition, the successful management of change in any medical school or system requires a well-functioning and efficient management system for achieving the intended results. Therefore, many benefits may be gained as a result of the success of a change process in any organization wherein it improves the effectiveness and efficiency of organizational and staff performance besides creating an opportunity for getting the best practices.
改变是一个学习的过程,塑造员工的态度和价值观,以适应和展示日常工作生活中的变化。领导医学院或卫生保健系统的变革被认为是成功领导的任务之一,可以在复杂的条件下实现有效的组织变革。本综述旨在展示如何管理医疗机构的变化,如何克服障碍,以及如何面对挑战的实施观点。对变革的抵制是任何医学院或卫生保健系统变革过程的主要障碍。因此,它应该通过创造一种适当的气氛来解决这种阻力,以便根据一种灵活的战略来进行变革,这种战略可以在执行过程中转化为实际步骤。此外,这种变化应该制度化,其中新的行为在医学院或医疗保健系统中持续存在并普遍化,这是变化应用的结果。此外,任何医学院或系统的成功管理变革都需要一个运作良好、效率高的管理系统来实现预期的结果。因此,在任何组织中,由于变更过程的成功,除了创造获得最佳实践的机会之外,还可以提高组织和员工绩效的有效性和效率,从而获得许多好处。
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引用次数: 0
Knowledge and attitudes of Saudi medical laboratory professionals concerning non-pathological factors influencing test results 沙特医学实验室专业人员对影响检测结果的非病理因素的知识和态度
Pub Date : 2021-01-01 DOI: 10.53986/ibjm.2021.0037
Mohammed Makkawi
Introduction: Successful medical decisions are highly reliant on medical laboratory results; as such, laboratory results are essential to patient health management, and errors in those results may lead to serious complications and death. The aim of the present study was to assess the knowledge of medical laboratory practitioners in Saudi Arabia regarding factors that may influence medical laboratory testing results and the correct actions for troubleshooting. Methods: A total of 256 practitioners participated, representing diverse qualifications and various healthcare sectors. The study utilized a pretested questionnaire comprised of three sections: socio-demographic characteristics, knowledge, and attitudes. Results: The responses demonstrated participants to possess outstanding knowledge of factors that may affect laboratory test results, including biological and pathological factors, diet, and personal habits. Furthermore, participants demonstrated satisfactory attitudes toward such factors. Conclusions: Thus, this study reveals a magnificent image concerning Saudi practitioners’ knowledge and capacity for suitable actions given unexpected test results, and hence their ability to provide correct healthcare services. This constitutes an acceptable overview, particularly as a first pass; nonetheless, more studies on larger cohorts remain required.
导言:成功的医疗决策高度依赖于医学实验室的结果;因此,实验室结果对患者健康管理至关重要,而这些结果的错误可能导致严重的并发症和死亡。本研究的目的是评估沙特阿拉伯医学实验室从业人员的知识,了解可能影响医学实验室检测结果的因素和排除故障的正确行动。方法:共有256名从业人员参与,他们代表了不同的资格和不同的医疗保健行业。该研究使用了一份预先测试的问卷,包括三个部分:社会人口特征、知识和态度。结果:这些回答表明参与者对可能影响实验室测试结果的因素具有出色的知识,包括生物和病理因素、饮食和个人习惯。此外,参与者对这些因素表现出满意的态度。结论:因此,这项研究揭示了一个宏伟的形象关于沙特从业人员的知识和适当的行动能力给予意外的测试结果,因此他们有能力提供正确的医疗保健服务。这构成了一个可接受的概述,特别是作为第一次;尽管如此,仍需要对更大的人群进行更多的研究。
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引用次数: 0
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Iberoamerican Journal of Medicine
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