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Frugal Surgical Innovations are the Need of the Hour 节约型外科创新是当前的需要
Pub Date : 2023-07-15 DOI: 10.38192/1.8.2.8
D. Sharma
Innovation is defined by the dictionaries as “a new idea, device, or method; or the act or process of introducing new ideas, devices, or methods.” However, Surgical Innovation (SI) is more difficult to define. Common narratives include why-where-how-what-who as well as novelty, degree of change, safety, ethical standards, level of impact and peer acceptance. [1, 2] We have proposed a simpler, more egalitarian and ‘inclusive’ definition: “a SI is ‘any’ new surgical idea which improves patient welfare by solving an existing problem; and which like a three-legged stool is balanced by the three legs which represent surgical-precision, surgical-wisdom and patient-safety”. [3] Frugal Surgical Innovations (FSIs) are low-cost surgical innovations which are designed for economic reasons. These are all about ‘doing more and better with less for more people’. [4] FSIs make up for their lack in sophistication or complexity in affordability, without scrimping on safety or effectiveness. The three constructs of FSIs are: affordability, adaptability and accessibility. [5] The philosophy of FSIs originates from grassroots, resource-constrained settings (RCS), where most abundant of all-natural resources — human ingenuity — is used to optimize limited resources to solve problems. [6] Clinically meaningful inclusive research can be performed ‘only’ by surgeons working in RCS; as ‘only’ they understand the difficulties and nuances of various problems and can provide simple affordable solutions for their patients. [7]
词典对创新的定义是“一种新的想法、装置或方法;或引入新思想、新装置或新方法的行为或过程。”然而,外科创新(SI)更难定义。常见的叙述包括为什么在哪里,怎么做,谁,以及新颖性,变化程度,安全性,道德标准,影响程度和同伴接受程度。[1,2]我们提出了一个更简单、更平等、更“包容”的定义:“SI是通过解决现有问题来改善患者福利的‘任何’新的外科理念;它就像一个三脚凳,由三条腿平衡,代表手术的精确,手术的智慧和病人的安全。”[3]节约型手术创新(FSIs)是一种低成本的手术创新,是出于经济原因而设计的。这些都是关于“用更少的钱为更多的人做更多更好的事情”。b[4]金融稳定机构弥补了它们在可负担性和复杂性方面的不足,而不会在安全性和有效性方面打折扣。金融服务设施的三个结构是:可负担性、适应性和可及性。[5]金融服务机构的理念源于草根、资源受限的环境(RCS),在那里,最丰富的自然资源——人类的聪明才智——被用来优化有限的资源来解决问题。[6]临床有意义的包容性研究只能由在RCS工作的外科医生进行;作为“唯一”,他们了解各种问题的困难和细微差别,并能为患者提供简单、负担得起的解决方案。[7]
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引用次数: 0
An Audit of Hypophosphatemia after Intravenous Iron Therapy 静脉铁治疗后低磷血症的审计
Pub Date : 2023-06-04 DOI: 10.38192/1.8.1.13
M. Shahani, P. Thiagarajah, I. Chakravorty
BackgroundDue to the gastrointestinal side-effects of oral iron supplementation in patients with iron deficiency anaemia, which impairs tolerance - many acute medical and haematology day units provide intravenous iron replacement therapy as day cases. Hypophosphatemia is a frequent side effect following intravenous iron administration, which can persist for weeks or months, is under-recognised in clinical practice and can lead to patients presenting with typical features to the emergency departments.AimWe designed an audit to measure the incidence of symptomatic hypophosphatemia after intravenous iron therapy to develop monitoring, prevention, and treatment strategy in a secondary care hospital setting.MethodsWe audited a convenience sample of consecutive patients who attended an acute day-care assessment unit for intravenous (IV) iron infusion (ferric carboxymaltose). All patients had serum phosphate levels checked after IV iron infusion at different intervals, from 1- 6 weeks. The cohort was divided into two groups based on the occurrence of hypophosphataemia - early (1-3 weeks) and late (>3-6 weeks).ResultsWe included 35 patients referred from primary care, gastroenterology, gynaecology, and acute internal medicine. 19 (55%) developed hypophosphatemia after receiving a single IV iron infusion and almost 100% after more than one dose. Hypophosphatemia in some patients lasted up to 12 weeks.ConclusionHypophosphatemia was frequent after a single dose and almost universal after multiple doses of IV Iron, which can persist for many weeks. Clinicians prescribing ferric carboxymaltose (Ferinject®) should be aware of hypophosphataemia, which could be mild, moderate, or severe and can last for months.
背景:由于口服补铁对缺铁性贫血患者的胃肠道副作用,会损害耐受性,许多急性医学和血液学日间单位提供静脉补铁治疗作为日间病例。低磷血症是静脉给铁后常见的副作用,可持续数周或数月,在临床实践中未得到充分认识,并可导致患者以典型特征向急诊室就诊。AimWe设计了一项审计来测量静脉铁治疗后症状性低磷血症的发生率,以制定二级护理医院环境中的监测、预防和治疗策略。方法:我们审核了在急性日托评估单位连续接受静脉(IV)铁输注(三羧基麦芽糖铁)的患者的方便样本。所有患者在静脉输铁后1- 6周的不同时间间隔检查血清磷酸盐水平。根据低磷血症的发生情况将该队列分为早期(1-3周)和晚期(>3-6周)两组。结果我们纳入了来自初级保健、胃肠病学、妇科和急症内科的35例转诊患者。19例(55%)在接受单次静脉铁输注后出现低磷血症,在接受一次以上剂量输注后几乎100%。一些患者的低磷血症持续时间长达12周。结论单次给药后低磷血症发生率高,多次给药后低磷血症发生率高,可持续数周。开具羧基麦芽糖铁(Ferinject®)处方的临床医生应注意低磷血症,可分为轻度、中度或重度,并可持续数月。
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引用次数: 0
A Hitchhikers Guide to Anxiety Disorders 《焦虑症搭便车指南》
Pub Date : 2023-05-24 DOI: 10.38192/1.8.1.12
J. Bamrah, Freya Dow, R. Ramkisson, S. Dave
AD is the commonest mental disorder with a lifetime prevalence rate of 21.1% in Europe, 31.0% in the United States2,3, a point prevalence of 5%, and a greater preponderance amongst women4. Living with ADs can be a long-term challenge. In many cases, it occurs along with other mood disorders5,6. In most cases, AD improves with psychological therapies and medication. Making lifestyle changes, learning coping skills and using relaxation techniques also can help. However, failure to treat AD and its consequences can be economically and socially costly.Therefore, early recognition of the disorder is imperative as that improves the scope for treatment and the prognosis. This guide describes critical aspects of the various subtypes of AD and how to manage them. 
AD是最常见的精神障碍,其终生患病率在欧洲为21.1%,在美国为31.0% 2,3,点患病率为5%,在女性中更占优势4。患有ad可能是一个长期的挑战。在许多情况下,它与其他情绪障碍一起发生5,6。在大多数情况下,阿尔茨海默病通过心理治疗和药物治疗得到改善。改变生活方式、学习应对技巧和使用放松技巧也会有所帮助。然而,未能治疗阿尔茨海默病及其后果可能会在经济和社会上付出高昂代价。因此,早期识别这种疾病是必要的,因为这可以提高治疗的范围和预后。本指南介绍了AD各种子类型的关键方面以及如何管理它们。
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引用次数: 0
Aspergillus Endocarditis in a prosthetic Valve following COVID-19 Infection COVID-19感染后人工瓣膜的曲霉菌心内膜炎
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.6
Sai Manogna Vegiraju
Endocarditis of a prosthetic valve is a known but rare occurrence. Fungal endocarditis is extremely rare. However, in the COVID-19 pandemic, there has been increasing recognition of fungal or yeast-related infections, often due to the combination of immune paresis, concurrent use of corticosteroids or underlying chronic conditions such as diabetes or neoplasms.We present a patient with fulminating, invasive aspergillosis of a prosthetic aortic valve who presented with catastrophic cardiovascular failure needing intensive care management. Early recognition and prompt therapy is the cornerstone of success in such presentations with high mortality.
人工瓣膜心内膜炎是一种已知但罕见的情况。真菌性心内膜炎极为罕见。然而,在2019冠状病毒病大流行期间,人们越来越多地认识到真菌或酵母相关感染,这通常是由于免疫麻痹、同时使用皮质类固醇或糖尿病或肿瘤等潜在慢性疾病共同导致的。我们提出了一个病人的暴发性,侵袭性曲菌病的假主动脉瓣谁提出了灾难性的心血管衰竭需要重症监护管理。早期识别和及时治疗是这种高死亡率的表现成功的基石。
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引用次数: 0
Legacy of the Crown for the NHS? 王室对NHS的遗产?
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.4
I. Chakravorty
The sixth of May 2023 marked the first Coronation in the United Kingdom after seventy years since Queen Elizabeth was coronated on 2 June 1953. King Charles III took oath for service and perfect justice. During his crowning ceremony, the Coronation Oath Act of 1688 required the King to declare that he would maintain the established Anglican Protestant Church, rule according to laws agreed upon in Parliament, and case law, with justice and mercy to be executed in his judgment. However, for the first time, a preface was added to the coronation oath in which the Archbishop said the Church of England “will seek to foster an environment where people of all faiths and beliefs may live freely”. King Charles III has enormous responsibilities as Head of State for the United Kingdom of 19 countries and the Commonwealth of Nations. What does his legacy mean for the diversity of people of the UK and the Commonwealth? What can the National Health Service expect from his legacy and vision?
2023年5月6日是英国自1953年6月2日伊丽莎白女王加冕70年后的第一次加冕典礼。国王查理三世宣誓为国效力,伸张正义。在他的加冕仪式上,1688年的《加冕誓言法案》要求国王宣布他将维持已建立的英国国教新教教会,根据议会商定的法律和判例法进行统治,并在他的判决中执行正义和仁慈。然而,这是首次在加冕誓言中增加了一个序言,大主教在前言中表示,英格兰教会“将努力营造一个各种信仰和信仰的人都可以自由生活的环境”。作为19个国家组成的联合王国和英联邦的国家元首,查理三世肩负着巨大的责任。他的遗产对英国和英联邦人民的多样性意味着什么?英国国民医疗服务体系能从他的遗产和远见中得到什么?
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引用次数: 0
COVID-19 Associated Mucormycosis COVID-19相关毛霉病
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.3
Betsy Francis, V. Goel, Pramod D Gandhi, S. Gathe, Harshwardhan S Bora, R. Atara, Sweta S. Lohiya, Ashish P Kamble, Rajan Barokar, Ashwini Tayade, V. Dehane, D. Raje
AbstractThis case series explores Covid-19 associated Mucormycosis (CAM), its risk factors, clinical features and outcomes from a tertiary centre in Maharashtra, India, during the second wave of COVID-19.Methods: A retrospective, observational case series of 104 consecutive patients admitted to the hospital at various stages of complications of CAM, during the second wave of the COVID-19 pandemic (Jan’21-Apr’21). The diagnosis was confirmed using Potassium hydroxide wet mount (KOH), histopathology, fungal culture, and Cone-Beam Computed Tomography(CBCT).Results: There were 81% men, mean age of 49 ± 12.4 years, and all patients had a history of corticosteroids usage, 82% had a prior diagnosis of diabetes mellitus (DM) and the rest were newly diagnosed. Diagnosis of mucormycosis was confirmed on 2 modalities in 71%; KOH and histopathology in 31 (30%), and fungal culture with KOH and histopathology together detected 25 (24%). 9% were diagnosed exclusively with CBCT. Patients with prior DM had higher morbidity OR 8.30 [95% CI: 2.12, 32.5; p=0.002] and mortality OR 13.23 [95% CI: 1.67, 104.7; p=0.014] than non-DM patients. Mortality was higher in patients with rhino + orbital involvement than patients with rhino + maxillary involvement [OR 8.37 [95% CI: 1.52, 46.09; p=0.014].Conclusion: Diabetes remained the highest risk factor for the development of CAM in patients with COVID-19 on corticosteroids, with high mortality and morbidity. Timely medical and surgical interventions and multi-disciplinary approaches could potentially reduce mucormycosis-associated mortality. Among the diagnostic modalities, detection using CBCT may increase the diagnostic yield in patients not detected in other modalities.
摘要本病例系列探讨了印度马哈拉施特拉邦一家三级中心在第二波Covid-19期间的Covid-19相关毛霉菌病(CAM)、其危险因素、临床特征和结果。方法:对第二次冠状病毒大流行(1月21日- 4月21日)期间连续住院的104例不同阶段CAM并发症患者进行回顾性观察病例系列。诊断通过氢氧化钾湿mount (KOH)、组织病理学、真菌培养和锥形束计算机断层扫描(CBCT)得到证实。结果:81%的患者为男性,平均年龄(49±12.4)岁,所有患者均有糖皮质激素使用史,82%的患者既往诊断为糖尿病(DM),其余为新诊断。2种方式确诊毛霉病的占71%;KOH和组织病理学检出31例(30%),KOH和组织病理学联合培养检出25例(24%)。9%的患者仅通过CBCT诊断。既往糖尿病患者的发病率较高,OR为8.30 [95% CI: 2.12, 32.5;p=0.002]和死亡率OR 13.23 [95% CI: 1.67, 104.7;p=0.014]。鼻窦+眼眶受累患者的死亡率高于鼻窦+上颌受累患者[OR 8.37] 95% CI: 1.52, 46.09;p = 0.014)。结论:糖尿病仍是使用糖皮质激素的COVID-19患者发生CAM的最高危险因素,且死亡率和发病率均较高。及时的医疗和手术干预以及多学科的方法可能会降低毛霉病相关的死亡率。在诊断方式中,使用CBCT检测可能会增加其他方式未检测到的患者的诊断率。
{"title":"COVID-19 Associated Mucormycosis","authors":"Betsy Francis, V. Goel, Pramod D Gandhi, S. Gathe, Harshwardhan S Bora, R. Atara, Sweta S. Lohiya, Ashish P Kamble, Rajan Barokar, Ashwini Tayade, V. Dehane, D. Raje","doi":"10.38192/1.8.1.3","DOIUrl":"https://doi.org/10.38192/1.8.1.3","url":null,"abstract":"Abstract\u0000This case series explores Covid-19 associated Mucormycosis (CAM), its risk factors, clinical features and outcomes from a tertiary centre in Maharashtra, India, during the second wave of COVID-19.\u0000Methods: A retrospective, observational case series of 104 consecutive patients admitted to the hospital at various stages of complications of CAM, during the second wave of the COVID-19 pandemic (Jan’21-Apr’21). The diagnosis was confirmed using Potassium hydroxide wet mount (KOH), histopathology, fungal culture, and Cone-Beam Computed Tomography(CBCT).\u0000Results: There were 81% men, mean age of 49 ± 12.4 years, and all patients had a history of corticosteroids usage, 82% had a prior diagnosis of diabetes mellitus (DM) and the rest were newly diagnosed. Diagnosis of mucormycosis was confirmed on 2 modalities in 71%; KOH and histopathology in 31 (30%), and fungal culture with KOH and histopathology together detected 25 (24%). 9% were diagnosed exclusively with CBCT. Patients with prior DM had higher morbidity OR 8.30 [95% CI: 2.12, 32.5; p=0.002] and mortality OR 13.23 [95% CI: 1.67, 104.7; p=0.014] than non-DM patients. Mortality was higher in patients with rhino + orbital involvement than patients with rhino + maxillary involvement [OR 8.37 [95% CI: 1.52, 46.09; p=0.014].\u0000Conclusion: Diabetes remained the highest risk factor for the development of CAM in patients with COVID-19 on corticosteroids, with high mortality and morbidity. Timely medical and surgical interventions and multi-disciplinary approaches could potentially reduce mucormycosis-associated mortality. Among the diagnostic modalities, detection using CBCT may increase the diagnostic yield in patients not detected in other modalities.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89939524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sequential bilateral facial nerve palsy and gait ataxia – a rare presentation of neurosyphilis 序贯性双侧面神经麻痹和步态共济失调-一种罕见的神经梅毒表现
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.2
Shafiah Abdul Gafoor, Russel Tilney, Pablo Garcia Reitboeck
A middle-aged gentleman presented with sequential bilateral facial nerve palsy and ataxia. A diagnostic workup revealed positive blood serology for active syphilis infection. Interestingly, his cerebrospinal fluid was negative for syphilis. The patient responded to treatment with benzylpenicillin and made a complete recovery. Unfortunately, the diagnosis of neurosyphilis ‘still’ poses a challenge to clinicians due to insufficient ‘sensitive’ testing modalities and diagnostic criteria. We highlight the need for a low threshold to test for syphilis in patients presenting with neurological sequelae whose diagnosis is not precise.
一位中年绅士表现为连续的双侧面神经麻痹和共济失调。诊断检查显示血清学阳性活动性梅毒感染。有趣的是,他的脑脊液梅毒检测呈阴性。病人对青霉素治疗有反应,完全康复。不幸的是,由于缺乏“敏感”的检测方式和诊断标准,神经梅毒的诊断“仍然”对临床医生构成挑战。我们强调在诊断不准确的神经系统后遗症患者中需要低阈值检测梅毒。
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引用次数: 0
Pituitary Apoplexy causing Panhypopituitarism 垂体中风引起的全垂体功能减退
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.5
Mahesh Mutuerulan
We present an atypical presentation of pituitary apoplexy as a pontine mimic with drowsiness and pin-point pupils. The patient had a known pituitary macroadenoma with suprasellar extension with hypogonadism and hypothyroidism.Initial investigations revealed hyponatraemia and imaging suggested a localised cerebral ischaemia in the basal ganglia and no change in the pituitary adenoma. Only further assessment with MRI showed the extent of the haemorrhage. Management was conservative, although close involvement of neurosurgery and ophthalmology teams is essential.We believe, that awareness of such unusual association is important for clinicians to consider apoplexy in the differential, even if the initial CT imaging is not suspicious.
我们提出一个不典型的脑垂体中风的表现,作为一个脑桥模拟嗜睡和针尖瞳孔。患者有已知的垂体大腺瘤伴鞍上延伸并性腺功能减退和甲状腺功能减退。初步调查显示低钠血症,影像学提示基底节区局部脑缺血,垂体腺瘤无变化。只有进一步的MRI评估才能显示出血的程度。治疗是保守的,尽管神经外科和眼科团队的密切参与是必不可少的。我们认为,即使最初的CT图像没有可疑,认识到这种不寻常的关联对于临床医生在鉴别中风时考虑中风是很重要的。
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引用次数: 0
Aneurysmal Bone Cyst presenting Incidentally as a Traumatic Foot Injury 动脉瘤性骨囊肿偶然表现为外伤性足部损伤
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.7
T. Jose, T. Mathew, A. Oguntade, Rajinder Tripathy, Awais Iqbal
Introduction: Aneurysmal bone cyst is a rare, non-neoplastic lesion affecting the metaphysis of long bones and vertebrae, characterized by blood-filled spaces separated by fibrous septae.Aims and objectives: In this study, we present a case of an aneurysmal bone cyst in a 7-year-old child with characteristic X-ray findings to increase awareness as early diagnosis and treatment can limit disability.An aneurysmal bone cyst is a rare, benign neoplastic lesion affecting the metaphysis of long bones and vertebrae, characterized by blood-filled spaces separated by fibrous septae.[1] Diagnosis depends on typical features of magnetic resonance imaging, and confirmation by biopsy is essential before surgery is considered.  We present an aneurysmal bone cyst in a 7-year-old child with characteristic X-ray findings. Diagnosis of ABC should be suspected in young patients presenting with limb pain or swelling, and pain disproportionate to the mechanism of injury could indicate pathologic fracture. Early detection of ABC is possible as an incidental finding by closely examining routine X-rays so that appropriate treatment can be instituted early and complications like pathologic fractures can be avoided. This case will help to increase awareness as early diagnosis and treatment can limit disability.
动脉瘤性骨囊肿是一种罕见的非肿瘤性病变,影响长骨和椎骨干骺端,其特征是由纤维隔膜分隔的充血间隙。目的和目的:在本研究中,我们报告一例7岁儿童的动脉瘤性骨囊肿,其x线表现具有特征性,以提高人们对早期诊断和治疗可以限制残疾的认识。动脉瘤性骨囊肿是一种罕见的良性肿瘤病变,影响长骨和椎骨的干骺端,其特征是由纤维隔膜分隔的充血间隙。[1]诊断依赖于磁共振成像的典型特征,手术前活检确认是必要的。我们报告一位7岁儿童的动脉瘤性骨囊肿,其x线表现具有特征性。出现肢体疼痛或肿胀的年轻患者应怀疑ABC的诊断,与损伤机制不成比例的疼痛可能提示病理性骨折。通过仔细检查常规x光片,早期发现ABC是可能的,因此可以及早进行适当的治疗,避免病理性骨折等并发症。这种情况将有助于提高认识,因为早期诊断和治疗可以限制残疾。
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引用次数: 0
The First National Conference for Locally Employed Doctors in the UK NHS 英国国民健康保险制度第一届全国本地雇用医生会议
Pub Date : 2023-05-09 DOI: 10.38192/1.8.1.1
Shubhangi Barnwal, Biju Simon
Abstracts selected for presentation at the Conference in the Research and QI session by BAPIO Institute for Health Research, Leicester, UK
英国莱斯特BAPIO健康研究所在研究和QI会议上发表的摘要
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引用次数: 0
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The Homoeopathic physician
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