Materia socio-medica最新文献

Background: Patients infected by coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), display various symptoms and severity of the clinical picture. Thus, the therapy and pathophysiology of this disease are a dilemma for health professionals and scientists.

Objective: This paper aims to evaluate the effectiveness of therapeutic protocols (the use of anticoagulants) in the treatment of COVID-19 patients of various severity of the clinical picture by monitoring coagulation markers (PT, INR, aPTT and D-dimer), as well as the impact of the type and number of comorbidities patients had on these markers.

Methods: A total of 200 patients with a mild (n=76), moderate (n=70) or severe (n=54) clinical picture was included. Coagulation markers [PT (prothrombin time), INR (international normalized ratio), aPTT (activated partial thromboplastin time), D-dimer] were examined on three occasions: twice during hospitalization and once after hospital discharge. Anticoagulants used intrahospital were fraxiparine, rivaroxaban or unfractionated heparin. Posthospital, patients were taking either rivaroxaban or did not use any anticoagulants. For statistical analysis, SPSS 26.0 and Microsoft Excel 2019 were used, with a level of significance of α=0.05. Nonparametric tests (Kruskal-Wallis, Wilcoxon Signed-Rank and Bonferroni) were applied and effect size (ES) was calculated.

Results: Three anticoagulants used intrahospital caused a significant decrease in PT, INR and D-dimer and a significant increase in aPTT, especially in patients with a severe clinical picture, but the ES was the biggest with fraxiparine, then rivaroxaban, and lastly unfractionated heparin. Posthospital, rivaroxaban caused a significant decrease in PT, INR and D-dimer and a significant increase in aPTT, especially in patients with a severe clinical picture. Hypertension was the most common comorbidity in all patients, as well as in patients with a severe clinical picture. There was a statistically significant impact of the number of comorbidities patients had on D-dimer, and none on PT, INR and aPTT, but the highest number of comorbidities was in patients with a severe clinical picture.

Conclusion: The use of anticoagulants, especially fraxiparine intrahospital and rivaroxaban posthospital, is justified in most COVID-19 cases as there is a significant correlation between this disease's pathophysiology and the coagulation process. There is also a positive correlation between the severity of the clinical picture and the number of comorbidities patients have.

Background: In the last two decades diagnostic criteria for acute kidney injury (AKI) were developed: Risk, Injury, Failure, Loss of Kidney Function, End-Stage Kidney Disease (RIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO) classifications.

Objective: The study aimed to determine the incidence of AKI based on the RIFLE, AKIN, and KDIGO criteria, as well as analyze their predictive value for mortality and renal function outcome.

Methods: This was a single-center prospective study of patients diagnosed with AKI. Acute kidney injury was defined and classified according to the RIFLE, AKIN, and KDIGO criteria. The outcomes were renal function outcome and in-hospital mortality.

Results: The incidence rates of AKI based on the RIFLE, AKIN, and KDIGO criteria were 13.4%, 14-36%, and 14.64%, respectively. Multiple regression analysis showed that higher stages of AKI according to the KDIGO criteria were independently associated with non-recovery of renal function (p=0.011). However, the predictive ability of RIFLE, AKIN and KDIGO classifications for renal function recovery was poor (Area Under the Receiver Operating Characteristics-AUROC=0.599, AUROC=0.637, AUROC=0.659, respectively). According to the RIFLE and AKIN criteria, in-hospital mortality was statistically significantly higher in stage Failure/3 (p=0.0403 and p=0.0329, respectively) compared to stages Risk/1 and Injury/2. Receiver Operating Characteristics (ROC) analysis showed that all three classifications had poor predictive ability for in-hospital mortality (AUROC=0.675, AUROC=0.66, AUROC=0.681).

Conclusions: KDIGO classification is an independent predictor of renal function non-recovery. However, by ROC analysis, all three classifications have poor predictive ability for renal function outcome and mortality.

Background: A traumatic birth experience can affect the breastfeeding process and make it ineffective. The aim of this study was to identify the factors associated with breastfeeding ineffectiveness after birth trauma, through the world literature. There are several factors responsible for a traumatic birth experience, such as obstetric violence, postpartum complications and complications induced by doctors, invasive vaginal deliveries, emergency caesarean sections, admission of a neonate to the Neonatal Intensive Unit, past traumatic life events and mental health problems.

Objective: The aim of this study was to identify the factors associated with breastfeeding ineffectiveness after birth trauma, through the world literature.

Methods: An extended search was conducted to identify relevant for breastfeeding and traumatic birth experiences manuscripts for this study. Databases including PubMed, PsycINFO and Google Scholar. The search was limited to articles published in English the last decade.

Results: Factors that contribute to the ineffectiveness of breastfeeding after a traumatic birth are hormonal, medication, insufficient support from the partner, reliving the traumatic birth experience, past traumatic experiences in the woman's life and her mental state.

Conclusion: The mental trauma during childbirth is complex and multifactorial. Therefore, it is necessary to take measures on the one hand to prevent mental trauma during childbirth and on the other hand to make interventions to deal with the consequences of the trauma on the mental health of the mother and on breastfeeding which is directly affected.

Background: Increasing evidence indicates that COVID-19 may result in cardiac issues in certain individuals, such as myocarditis, arrhythmias, and heart failure. Ongoing research on echocardiographic manifestations is still limited.

Objective: To investigate the incidence and patterns of left and right ventricular dysfunction in COVID-19 patients.

Methods: This study retrospectively observed COVID-19 patients admitted to the Clinical Center of University of Sarajevo during the third wave, with a particular focus on cardiac evaluations.

Results: Our patients, predominantely male 155 (72.4%), with a mean age of 66.2±11.4, having hypertension 86 (40.1%), diabetes mellitus 61 (28.5%), hyperlipidemia 144 (67.3%), were active smokers 87 (40.6%), had family history of cardiovascular diseases 123 (57.5%) and were COVID-19 positive 95 (44.4%), presented because of chest pain 78 (36.4%), dyspnea 103 (48.1%), palpitations 67 (31.3%), fatigue 106 (49.5%) and peripheral oedema 30 (14.0%). COVID-19 patients reported much higher symptoms of dyspnea (65 (68.4%) vs 38 (31.9%)) and fatigue (73 (76.8%) vs 33 (27.7%)) than COVID-19 negative patients. On the initial laboratory report, COVID-19 patients had a significantly (p<0.05) higher mean score of C-reactive protein (24.0±4.8 vs. 6.0±2.1), D-dimer (1.6±2.5 vs 0.8±0.6), ALT (94.8±17.2 vs 36.5±19.9) and creatinine (128.0±80.8 vs. 93.4±40.1) when compared to COVID-19 negative patients. COVID-19 patients had enlarged left atrium diametes (31.6±5.6 vs 27.5±5.3), enlarged left ventricular diameter both in systole (27.9±18.1 vs 23.3±16.3) and diastole (39.3±24.1 vs 34.9±22.7), reduced left ventricular ejection fraction (53.5±9.2 vs 59.8±4.3) and elevated right ventricular systolic pressure (37.0±16.4 vs 35.1±8.6).

Conclusion: COVID-19 patients had enlarged left atrium, enlarged systolic and diastolic left ventricular diameter, reduced left ventricular ejection fraction and elevated right ventricular systolic pressure.

Background: Pertussis is an infectious respiratory disease caused by the bacterium Bordetella pertussis. The bacterium releases toxins that can lead to complications on the respiratory and nervous systems and even death. The disease occurs in people of all ages, but it is most severe in children under the age of five.

Objective: To present epidemiological data on this disease in the Federation of Bosnia and Herzegovina (FB&H) from 2018 to 2022, and from Central Bosnia Canton (CBC) for the period February-June 2018.

Methods: This descriptive epidemiological study collected data from the Institute of Hygiene and Epidemiology of the CBC and the Institute for Public Health of FB&H.

Results: In the specified period in the FB&H was confirmed 93 cases of Pertussis, 61 cases were reported from CBC, a total of 9 in Bugojno city. Confirmed cases from Bugojno were: 3 newborns, 3 infants, 2 three-year-old children and one 12-year-old child, 5 males and 4 females. Three children received first dose of Diphtheria-Tetanus-Pertussis-Hemophilus influenza type B vaccine, six children were not vaccinated. Children were under the supervision of pediatricians and infectious disease specialists, the disease passed without serious complications.

Conclusions: Pertussis is a highly contagious respiratory disease that lasts for weeks. Recovery can be complete, but more serious complications are possible, especially in young children. With the discovery of the vaccine, morbidity and mortality from this disease has been significantly reduced. However, the disease is still present worldwide, especially in underdeveloped and developing countries. By educating parents and educating the population on the importance of vaccination and achieving herd immunity, this disease can be completely eradicated in the near future. In recent years, many American and European countries recommend the immunization of pregnant women in the second half of pregnancy, which provides significant protection to newborns.

Bartholin's glands are important organs of the female reproductive system. These glands have the function of producing an alkaline mucoid secretion, which helps in vaginal and vulvar lubrication. There are several types of lesions that can be identified in these anatomical structures, where in most cases presented for medical examination, cysts and abscesses predominate. This is the presentation of a clinical case of a 55-year-old patient, who is presented to the surgeon for her complaints. Once the woman is examined, diagnosed, and treated adequately, she is taken into consideration for presenting her case in this study, while maintaining confidentiality. The presented clinical case provides a clinical framework not easy to establish an accurate diagnosis of a Bartholin gland cyst. Careful physical examination by the surgeon and careful preparation with electrosurgery verified the cyst-hematoma left and just above the posterior fornix, where some material was taken from the cyst capsule and hematoma and sent for histological examination. The histological response concluded with cystic hematoma of the Bartholin gland. Cystic lesions of the vagina are relatively common and usually represent a benign condition. Ways of managing Bartholin gland cysts vary depending on the discomfort they bring to the patient as well as the size or even the anatomical extent of the cystic lesion. However, the physical examination, with a careful inspection by the surgeon, combined with the imaging examinations, requires a biopsy examination, which is the confirmation of the diagnosis.

Background: Burnout is increasingly being recognized as a major concern, affecting the physical and mental well-being of Healthcare workers (HCWs).

Objective: The aim of the study was to investigate the incidence of occupational exhaustion in healthcare workers (doctors, nurses, paramedics, assistants, administrative staff) and possible contributing factors during the COVID-19 pandemic.

Methods: This study was conducted from March to September 2022 in seven (7) hospitals in Western Greece. It was carried out using an anonymous questionnaire. The questionnaire was designed based on results of previously published studies and consisted of 22 multiple-choice questions.

Results: There were 259 (60.2%) female and 178 (39.8%) male participants enrolled in the study. The majority of the respondents were nurses (n=207, 48.1%), followed by doctors (n+ 178, 41.4%). There was a marked increase in emotional exhaustion, depersonalization, personal fulfillment and pandemic-related total burnout in participants older than 61 years old (40,05±2,2, 27,16±1,0, 21,11±4,1, 88,32±4,3, respectively). Widow/ers healthcare workers were mostly affected from pandemic related burnout compared to married, unmarried, and divorced healthcare workers. Respondents without postgraduate education demonstrated significantly greater prevalence of emotional exhaustion, depersonalization and pandemic-related total burnout in comparison to those with doctoral/master degree. The prevalence of personal and work-related burnout among paramedics and administrative staff was higher than that seen in doctors and nurses(32,82±3,8 vs32,08±5,0/29,11±4,7 22,33±4,0 vs21,57±3,1/18,89±5,4 19,60±3,9 vs17,26±2,8/15,24±3,7 74,76±10,4 vs70,92±9,5/63,23±12,1).The prevalence of emotional exhaustion and work-related total burnout was significantly higher among doctors, nurses, paramedics, and administrative staff working with direct contact with COVID-19 patients than those among healthcare workers working without direct contact with COVID-19 patients.

Conclusion: The present study highlights the impact of the COVID-19 pandemic on healthcare workers.

Background: Dental anomalies (DAs) represent a significant chapter in pediatric dentistry with a lot of practical relevance. Both primary and permanent dentitions may be affected.

Objective: The main objective of our study was to evaluate, using digital panoramic radiographs, the prevalence, distribution, and patterns of DAs in a sample of Lebanese children aged between 8 and 15 years old.

Methods: 112 digital panoramic radiographs of patients aged between 8 and 15 years (60 males and 52 females) from the year 2017 till 2022 attending the department of Pediatric Dentistry and Dental Public Health at the Faculty of Dental Medicine at the Lebanese University were assessed for DAs of number (hypodontia, oligodontia, hyperdontia), of size (microdontia, macrodontia), of shape (fusion, gemination, dilaceration, taurodontism), of position (transposition, ectopia, impaction), and of structure (dentin dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta). The data were analyzed statistically using Chi-square and Fisher's exact tests.

Results: Out of 112 patient radiographs, 84 showed at least one DA, which suggests a very high prevalence (75%). Among them, 36.9% exhibited multiple types of anomalies. These 84 patients showed a total of 274 DAs, distributed equally among males and females.

Conclusion: Dentists should be alerted to the presence of DAs. Their high prevalence requires careful clinical and radiological examinations for early detection. Regular monitoring is mandatory and could guide preventive approaches to minimize associated dental complications.

Background: Complementary and Alternative Medicine (CAM) is a popular practice among Saudis. CAM refers to drugs and medical procedures that doctors do not typically employ.

Objective: The study's goal was to determine the prevalence of CAM and the most prevalent form used among patients with diabetes in Al Ahsa, Saudi Arabia.

Methods: This cross-sectional study enrolled individuals with diabetes mellitus (DM) in Al Ahsa, Saudi Arabia. Online questionnaires were employed between March to July 2023 to collect data on sociodemographic characteristics, information about diabetes, knowledge and use of CAM, and the different types of herbal supplements used.

Results: Of the 386 patients, 54.1% were males, 45.9% were aged between 46 and 60 years old, and 45.9% had heard of CAM. The most popular CAM treatment for diabetes was biologically based, and the most common reason for using CAM was its accessibility (27.1%). The majority (82.1%) of diabetic patients reported using CAM as a treatment. Independent predictors of CAM use were diabetes complications, having heard of CAM, and social media.

Conclusion: CAM use has a high prevalence in the treatment of diabetes. Independent predictors of CAM use were a shorter disease duration, diabetes complications, having heard of CAM, and social media. To avoid negative and unnecessary side effects, patients must be informed about CAM use.

Background: The association between diabetes mellitus type 2 (T2DM) and pulmonary embolism (PE) is still unclear.

Objective: The aim of this study was to determine the prognostic value of prothrombotic, proinflammatory markers, and troponin for pulmonary embolism and its complications in patients with type 2 diabetes mellitus.

Methods: The retrospective cohort study included 294 patients with type 2 diabetes mellitus divided into two groups: (a) the first group with pulmonary embolism (n=165); (b) the control group without pulmonary embolism (n=129). The data were collected from May 2018 to May 2023. In all patients we analyzed: anthropometric parameters, laboratory parameters (troponin, D-dimer, CRP, fibrinogen, uric acid, glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides), arterial blood pressure, antiphospholipid antibodies, HOMA-IR index, CT angiography of the pulmonary artery, rate of adverse clinical events in pulmonary embolism (need for inotropic catecholamine support, fibrinolysis, cardiopulmonary resuscitation) and rate of intrahospital mortality from pulmonary embolism.

Results: Troponin levels were significantly higher in the PE group compared to the non-PE group (p = 0.002). D-dimer, CRP, uric acid, fibrinogen and HOMA- IR were significantly elevated in the PE group compared to the non-PE group (p < 0.001). Patients with pulmonary embolism in T2DM proved to have significantly more in-hospital death within 10 days of hospital admission (p<0.001), compared to patients with T2DM, without pulmonary embolism.

Conclusion: Prothrombotic, proinflammatory markers, and troponin have good prognostic value for short-term outcomes in PE among patients with T2DM.