Search results for: orthopedic patients
5327 Quality of Life of Patients on Oral Anticoagulant Therapy in Outpatient Cardiac Department Dr. Hasan Sadikin Central General Hospital Bandung
Authors: Mochammad Indra Permana, Andhiani Sharfina Arnellya, Dika Pramita Destiani, Budhi Prihartanto
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Cardiovascular disease is the cause of the highest mortality rates in the world. The number of cardiovascular disease patients is increasing every year. Data obtained from World Health Organization (WHO) that 17,5 million people died from this disease. The condition of cardiovascular diseases such as atrial fibrillation, myocardial infarction, venous thromboembolism, and several other conditions need anticoagulant therapy. Results of the anticoagulant therapy are measured not only by the effectiveness of International Normalized Ratio (INR) value but also by the quality of life of the patients. The purpose of this study was to determine the quality of life of patients on oral anticoagulant therapy in outpatient cardiac department Dr. Hasan Sadikin central general hospital, Bandung, Indonesia. This is a cross-sectional study with collecting data from the quality of life questionnaire and medical record of the patients. The results of this study showed that 28 patients (46,7%) had a good quality of life, 30 patients (50%) had a moderate quality of life, and 2 patients (3,3%) had a poor quality of life with no significant differences in quality of life based on age, gender, diagnosis, and duration of drug use.Keywords: anticoagulant, cardiovascular diseases, INR, quality of life
Procedia PDF Downloads 3035326 Epidemiology of Primary Bronchopulmonary Cancer in Tunisia
Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira
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Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.Keywords: SCLC, NCSLC, ROS1, PDL1
Procedia PDF Downloads 735325 A Comparative Study of Cognitive Functions in Relapsing-Remitting Multiple Sclerosis Patients, Secondary-Progressive Multiple Sclerosis Patients and Normal People
Authors: Alireza Pirkhaefi
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Background: Multiple sclerosis (MS) is one of the most common diseases of the central nervous system (brain and spinal cord). Given the importance of cognitive disorders in patients with multiple sclerosis, the present study was in order to compare cognitive functions (Working memory, Attention and Centralization, and Visual-spatial perception) in patients with relapsing- remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). Method: Present study was performed as a retrospective study. This research was conducted with Ex-Post Facto method. The samples of research consisted of 60 patients with multiple sclerosis (30 patients relapsing-retrograde and 30 patients secondary progressive), who were selected from Tehran Community of MS Patients Supported as convenience sampling. 30 normal persons were also selected as a comparison group. Montreal Cognitive Assessment (MOCA) was used to assess cognitive functions. Data were analyzed using multivariate analysis of variance. Results: The results showed that there were significant differences among cognitive functioning in patients with RRMS, SPMS, and normal individuals. There were not significant differences in working memory between two groups of patients with RRMS and SPMS; while significant differences in these variables were seen between the two groups and normal individuals. Also, results showed significant differences in attention and centralization and visual-spatial perception among three groups. Conclusions: Results showed that there are differences between cognitive functions of RRMS and SPMS patients so that the functions of RRMS patients are better than SPMS patients. These results have a critical role in improvement of cognitive functions; reduce the factors causing disability due to cognitive impairment, and especially overall health of society.Keywords: multiple sclerosis, cognitive function, secondary-progressive, normal subjects
Procedia PDF Downloads 2285324 Evaluation of Postural Stability in Female Patients with Structural Scoliosis
Authors: Ghada M. R. Koura, Ahmed M. F. El Shiwi
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Background: structural scoliosis is a twisting deformity in the curve of vertebral column to the lateral side with simultaneous rotation of the vertebrae, which occurs during the growing years from 10 years to the puberty. Purpose: Studies investigating balance problems specific to scoliotic patients showed that those patients reveal variable balance abnormalities. In this study we evaluated the difference in postural stability responses between female patients (students, office worker and shish weapon players) with structural scoliosis and normal subjects. Methods: sixty subjects participated in this study. Thirty female patients with structural scoliosis with a mean age of (19.5 ± 3.26) years, with Cobb's angle ranged from 20º to 40° in the major curves, and thirty healthy female subjects with a mean age of (19.36 ± 2.41) years. Postural stability of both groups were evaluated by the Biodex Stability System. Results: There was no significant difference between both groups in dynamic balance test. Interpretation/Conclusion: As there was no significant difference between both groups in balance response, it is not recommended to add balance training as an extra physical therapy program for AIS female patients.Keywords: structural scoliosis, postural stability, female patients, evaluation
Procedia PDF Downloads 4545323 Common Causes of Eye Removal Surgery in Turkish Patients: A Review of 226 Cases
Authors: Titap Yazicioglu
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Purpose: To determine the etiological factors responsible for the eye removal surgery and to evaluate our surgical results. Material and Methods: Medical records of 226 patients, who underwent eye removal surgery, were analyzed retrospectively. Demographic information, clinical history, surgical procedure, and histopathological data were all collected. Evisceration surgery was performed under general anesthesia in all patients except tumor cases and one patient with rhino-orbital mucormycosis. The patients were followed for an average of 16.46±10.78 months and checked for the possible complications, cosmesis, and functional results.Results: 144 men, and 82 women,with a mean age of 41.78±22.6 years, were underwent enucleation (n=15) or evisceration (n=211) due to traumatic (n=169) and non-traumatic (n=57) causes. In the traumatic group, 79.8% of 169 patients were injured by penetrating and 14.2% by blunt trauma.3.6% of the patients were injured in a traffic accident, and 2.4% of them were injured by explosives. In the non-traumatic group, 40% of 25 patients had post-traumatic endophthalmitis, 32% had endophthalmitis due to corneal ulceration and melting, and 24% had endophthalmitis after cataract surgery. One patient had panophthalmitis due to rhino-orbital mucormycosis. Another cause in the non-traumatic group was glaucoma, of which 92.3% had neovascular glaucoma, and 8.7% had congenital glaucoma. Of the 14 patients who were enucleated for tumor, 35.7% had retinoblastoma, 14.3% had medulloepithelioma, 42.9% had uveal melanoma, and 7.1% had metastatic tumor from paranasal sinuses.The most common complaint in the follow-up period was discharging, seen in all prosthesis-wearing patients. 13.3% of the patients had itching due to ocular prosthesis. 4.4% of the patients were complaining about deep superior sulcus. 4.4% had pyogenic granuloma, and 17.8% had implant exposure. Conclusion: Etiological factors should be carefully evaluated, and precautions should be taken in order to reduce the devastating effect of the physical loss of the eye.Keywords: enucleation, evisceration, ocular injury, etiology, frequency
Procedia PDF Downloads 1065322 Nutritional Allowance Support Affecting Treatment Compliance among TB Patients in Western, Nepal
Authors: Yadav R. K., Baral S.
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Introduction: Nepal is one of the world’s least developed countries and has a high incidence of tuberculosis (TB). The TB prevalence survey in 2019 showed 69,000 Nepalese is developing TB and 4,000 die every year. Given its disproportionate impact on the impoverished segments of society, TB often thrusts patients into extreme poverty or exacerbates their existing economic struggles. Consequently, not only the patients but also their families suffer from the loss of livelihood. This study aims to assess the support of nutritional allowance on treatment compliance among retreatment tuberculosis patients in Nepal. This is a secondary analysis of data from HMIS (Health Management Information System) to investigate treatment compliance among tuberculosis patients and its association with nutritional allowance. The study population consisted of all individuals (N=2972) who had received services from July 16, 2021, to December 14, 2022. The SPSS 21version was used to conduct descriptive and bivariate analysis. Out of the total TB patients (n=2972), a third-fourth (65.9%) of TB patients were male. More than one-tenth (12.3%) of respondents received a nutrition support allowance. The TB treatment compliance rate was more (89.91%) in the nutrition support allowance group compared to the non-nutritional support group (87.98%). TB patients who received the nutritional support allowance were nearly twice as likely to have a higher TB treatment compliance rate compared to those who did not receive the nutritional support allowance. Providing nutritional allowance support to tuberculosis (TB) patients can play a significant role in improving treatment compliance and outcomes. Age and the type of TB are important factors that have shown statistical significance in relation to treatment compliance. Therefore, it is recommended to provide nutritional allowance support to both new and retreatment TB patients. To enhance treatment compliance among TB patients, it is beneficial to provide timely nutrition allowances and arrange home visits by TB focal persons.Keywords: nutrition, support, treatment compliance, TB, Nepal
Procedia PDF Downloads 1295321 Assessment of the Neuroprotective Effect of Oral Hypoglycemic Agents in Patients with Acute Ischemic Stroke
Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares
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Introduction: Diabetes is a chronic health problem and a major risk factor of stroke. A number of therapeutic modalities exist for diabetes management. It’s still unknown whether the different oral hypoglycemic agents would ameliorate the detrimental effect of diabetes on stroke severity. The objective of this work is to assess the effect of pretreatment with oral hypoglycemic agents, insulin and their combination on stroke severity at presentation. Patients and Methods: Patients admitted to the King Abdullah University Hospital (KAUH)-Jordan with ischemic stroke between January 2015 and December 2016 were evaluated and their comorbid diseases, treatment on admission and their neurologic severity was assessed using the National Institute of Health Stroke Scale (NIHSS) were documented. Stroke severity was compared for non-diabetic patients and diabetic patients treated with different antidiabetic agents. Results: Data from 324 patients with acute stroke was documented. The median age of participants was 69 years. Diabetes was documented in about 50% of the patients. Multinomial regression analysis identified diabetes treatment status as an independent predictor of neurological severity of stroke (p=0.032). Patients treated with oral hypoglycemic agents had a significantly lower NIHSS as compared to nondiabetic patients and insulin treated patients (p < 0.02). The positive effect of oral hypoglycemic agents was blunted by insulin co-treatment. Insulin did not alter the severity of stroke as compared to non-diabetics. Conclusion: Oral hypoglycemic agents may reduce the severity of neurologic deficit of ischemic stroke and may have neuroprotective effect.Keywords: diabetes, stroke, neuroprotection, oral hypoglycemic agents
Procedia PDF Downloads 1515320 Diagnostic Accuracy Of Core Biopsy In Patients Presenting With Axillary Lymphadenopathy And Suspected Non-Breast Malignancy
Authors: Monisha Edirisooriya, Wilma Jack, Dominique Twelves, Jennifer Royds, Fiona Scott, Nicola Mason, Arran Turnbull, J. Michael Dixon
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Introduction: Excision biopsy has been the investigation of choice for patients presenting with pathological axillary lymphadenopathy without a breast abnormality. Core biopsy of nodes can provide sufficient tissue for diagnosis and has advantages in terms of morbidity and speed of diagnosis. This study evaluates the diagnostic accuracy of core biopsy in patients presenting with axillary lymphadenopathy. Methods: Between 2009 and 2019, 165 patients referred to the Edinburgh Breast Unit had a total of 179 axillary lymph node core biopsies. Results: 152 (92%) of the 165 initial core biopsies were deemed to contain adequate nodal tissue. Core biopsy correctly established malignancy in 75 of the 78 patients with haematological malignancy (96%) and in all 28 patients with metastatic carcinoma (100%) and correctly diagnosed benign changes in 49 of 57 (86%) patients with benign conditions. There were no false positives and no false negatives. In 67 (85.9%) of the 78 patients with hematological malignancy, there was sufficient material in the first core biopsy to allow the pathologist to make an actionable diagnosis and not ask for more tissue sampling prior to treatment. There were no complications of core biopsy. On follow up, none of the patients with benign cores has been shown to have malignancy in the axilla and none with lymphoma had their initial disease incorrectly classified. Conclusions: This study shows that core biopsy is now the investigation of choice for patients presenting with axillary lymphadenopathy even in those suspected as having lymphoma.Keywords: core biopsy, excision biopsy, axillary lymphadenopathy, non-breast malignancy
Procedia PDF Downloads 2335319 The Association Between Different Body Mass Index Levels And Midterm Surgical Revascularization Outcomes
Authors: Farzad Masoud Kabir, Jamshid Bagheri, Khosro Barkhordari
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This historical cohort study included 17,751 patients patients who underwent isolated CABG at our center between 2007 and 2016. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs.Keywords: body mass index, surgical outcomes, midterm, cardiac surgery patients
Procedia PDF Downloads 655318 Extending ACOSOG Z0011 to Encompass Mastectomy Patients: A Retrospective Review
Authors: Ruqayya Naheed Khan, Awais Amjad Malik, Awais Naeem, Amina Khan, Asad Parvaiz
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Introduction: Axillary nodal status in breast cancer patients is a paramount prognosticator, next to primary tumor size and grade. It has been well established that patients with negative sentinel lymph node biopsy can safely avoid axillary lymph node dissection. A positive sentinel lymph node has traditionally required subsequent axillary dissection. According to ACOSOG Z11 trial, patients who underwent axillary dissection with 3 or more positive sentinel nodes or opted for observation in case of negative sentinel lymph node, did not find any difference in Overall Survival (OS) and Disease Free Survival (DFS). The Z11 trial included patients who underwent breast conserving surgery and excluded patients with mastectomies. The purpose of this study is to determine whether Z0011 can be applied to mastectomy patients as well in 1-3 positive sentinel lymph nodes and avoid unnecessary ALND. Methods: A retrospective review was conducted at Shaukat Khanam Memorial Cancer Hospital Pakistan from Jan 2015 to Dec 2017 including patients who were treated for invasive breast cancer and required upfront mastectomy. They were clinically node negative, so sentinel lymph node biopsy was performed. Patients underwent ALND with positive sentinel lymph node. A total of 156 breast cancer patients with mastectomies were reviewed. Results: 95% of the patients were female while 3% were male. Average age was 44 years. There was no difference in race, comorbidities, histology, T stage, N stage, and overall stage, use of adjuvant chemotherapy and radiation therapy. 64 patients underwent ALND for positive lymph node while 92 patients were spared of axillary dissection due to negative sentinel lymph node biopsy. Out of 64 patients, 38 patients (59%) had only 1 lymph node positive which was the sentinel node. 18 patients (28%) had 2 lymph nodes positive including the sentinel node while only 8 patients (13%) had 3 or more positive nodes. Conclusion: Keeping in mind the complications related to ALND, above results clearly show that ALND could have been avoided in 87% of patients in the setting of adjuvant radiation, possibly avoiding the morbidity associated with axillary lymphadenectomy although a prospective randomized trial needs to confirm these results.Keywords: mastectomy, sentinel lymph node biopsy, axillary lymph node dissection, breast cancer
Procedia PDF Downloads 1815317 Outcomes of Using Guidelines for Caring and Referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department of Songkhla Hospital, Thailand
Authors: Thanom Kaeniam
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ST-Elevation Myocardial Infarction (STEMI) is a state of sudden death of the heart muscle due to sudden blockage of the artery. STEMI patients are usually in critical condition and with a potential opportunity for sudden death. Therefore, management guidelines for safety in caring and referring STEMI patients are needed. The objective of this developmental research was to assess the effectiveness of using the guidelines for caring and referring STEMI patients at the Accident and Emergency Department of Songkhla Hospital. The subjects of the study were 22 nurses in the emergency room, and doctors on duty in the accident and emergency room selected using purposive sampling with inclusion criteria. The research instruments were the guidelines for caring and referring STEMI patients, and record forms for the effectiveness of using the guidelines for caring and referring STEMI patients (a general record form for STEMI patients, a record form for SK administering, a referring record form for PCI, and a record form for dead patient in the accident and emergency room and during referring). The instruments were tested for content validity by three experts, and the reliability was tested using Kuder-Richardson 20 (KR20). The descriptive statistic employed was the percentage. The outcomes of using the guidelines for caring and referring ST Elevation Myocardial Infarction (STEMI) Patients at the Accident and Emergency Department revealed that before using the guidelines in 2009, 2010, and 2011, there were 84, 73, and 138 STEMI patients receiving services at the accident and emergency room, of which, only 9, 32, and 48 patients were referred for PCI/SK medications, or 10.74; 43.84; and 34.78 percent, and the death rates were 10.71; 10.95; and 11.59 percent, respectively. However, after the use of the guidelines in 2012, 2013, and 2014, there were 97, 77, and 57 patients, of which, the increases to 77, 72, and 55 patients were referred for PCI /SK medications or 79.37; 93.51; and 96.49 percent, and the death rates were reduced to 10.30; 6.49; and 1.76 percent, respectively. The results of the study revealed that the use of the guidelines for caring and referring STEMI patients at the Accident and Emergency Department increased the effectiveness and quality of nursing, especially in terms of SK medication, caring and referring patients for PCI to reduce the death rate.Keywords: outcomes, guidelines for caring, referring, myocardial infarction, STEMI
Procedia PDF Downloads 3865316 Spectrum of Acute Kidney Injury in Obstetrics
Authors: Seema Chopra, Amandeep Kaur, Vanita Suri, Shalini Gainder, Minakshi Rohilla
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Background: Acute kidney injury (AKI) associated with pregnancy is a serious medical complication which can lead to significant maternal as well as perinatal morbidity and mortality. Material and methods: This prospective observational study was carried out in the Obstetrics and Gynaecology department and dialysis unit of Nephrology department of PGIMER, Chandigarh from July 2013 to June 2014. Forty antenatal/postnatal/postabortal patients who fulfilled the AKIN criteria were enrolled in the study. All patients were followed up till 3 months postpartum. Results: Majority of the patients 23/40 (57.5%) with AKI presented in postpartum period, 14/40 (35%) developed AKI in antenatal period, and 3/40 (7.5%) were postabortal. AKI was attributable mostly to sepsis in 11/40 (27.5%) and PPH in 5/40 (12.5%). Hypertension and its complications causing AKI included eclampsia in 5/40 (12.5%) followed by 3/40 (7.5%) as HELLP syndrome and abruption placentae in 2/40(5%) patients. Three patients each (7.5%) had AFLP, TMA, and HEV as the cause of AKI. Renal replacement therapy in the form of hemodialysis was the treatment in majority of them (28 (70%)). After the acute event, 25 (62.5%) had complete recovery of their renal functions at 3 months follow up. Maternal mortality was seen in 25% (n=10) of the study patients. Conclusion: Timely initiation of RRT in patients with AKI associated with pregnancy has a good maternal outcome in the form of complete recovery of renal functions in 62.5% (25/40) of patients.Keywords: AKI, dialysis, hypertension, sepsis, renal parameters
Procedia PDF Downloads 1525315 Do Patients with Neck of Femur Fractures Receive Adequate Anticoagulation? A West Midlands Study
Authors: U. N. Bhatty, A. Bhatia, A. George, F. Fiaz
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Post-operatively, patients with the neck of femur fractures are the high-risk of venous thromboembolic events (VTE). NICE have issued guidelines in this regard. We investigated whether these guidelines were being followed. 124 patients undergoing neck of femur fracture surgery were retrospectively analysed at a major orthopaedic centre in England. 9% of patients received adequate anticoagulation (16.5% mortality). An education campaign subsequently took place, circular emails were sent to junior doctors and posters advertised. A reaudit 4 months later showed only 12% of the 68 patients received adequate anticoagulation (11.8% mortality). The education campaign failed to improve prescribing behaviours. Furthermore, as morbidity was not measured, the consequence of poor prescription is underestimated. Perhaps, poor prescribing is because of the silent nature of effective thromboprophylaxis; reducing its perceived effectiveness. Simple interventions are insufficient to change these habits and more intense work is needed; such as compulsory proformas for all high-risk patients.Keywords: fracture, hip, orthopaedics, thromboembolism
Procedia PDF Downloads 3295314 Whitnall’s Sling Will Be an Alternative Method for the Surgical Correction of Poor Function Ptosis
Authors: Titap Yazicioglu
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To examine the results of two different surgery in patients with severe ptosis and poor levator function. The records of 10 bilateral congenital ptosis patients, who underwent Whitnall’s sling surgery on one eyelid and frontalis sling surgery on the other were analyzed retrospectively. All patients had severe congenital ptosis(>4mm) and poor levator function (LF<4mm). Data regarding eyelid position, cosmetic outcomes, and postoperative complications were evaluated. All patients were assessed for a minimum of one year with regard to the amount of correction, residual ptosis and lagophthalmos. The study consisted of 10 patients, with an average age of 9.2±2.4 years. Preoperative diagnosis for all patients was noted as, the average LF was 3.4±0.51mm, vertical lid height was 3.5±0.52 mm and margin reflex distance-1 (MRD-1) was 0.4±0.51mm. The mean vertical lid height was measured as 7.1±0.73 mm in the frontalis sling group and 7.2±0.63 mm in the Whitnall’s sling group at the postoperative 1st month control. However, in patients with Whitnall’s sling, revision was performed with frontalis sling surgery due to failure in vertical lid height in the late postoperative period, and an average of 7.5±0.52 mm was achieved. Satisfactory results were obtained in all patients. Although postoperative lagophthalmitis developed in the frontalis sling group, none of them developed exposure keratitis. Granuloma was observed as sling infection in 2(20%) of the patients. Although Whitnall’s sling technique provides a natural look appearance without interfering with the functional result, we did not find it as successful as frontalis sling surgery in severe ptosis.Keywords: congenital ptosis, frontalis suspension, Whitnall ligament, complications
Procedia PDF Downloads 975313 Propranalol is Not Effective in Preventing the Progression to Severe Portal Hypertensive Gastropathy in Cirrhotic Patients who Had Undergone Variceal Eradication: A Randomised Controlled Trial
Authors: Jeffey George, Varghese Thomas
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Background and Objectives: PHG is an important source of gastrointestinal bleeding in patients with portal hypertension. Aim: To assess the progression to severe portal hypertensive gastropathy(PHG) in patients with cirrhosis who were treated with maximum tolerated dose of propranalol, after variceal eradication to grade II or below. Methods: Cirrhotic patients(child A and B) presenting with upper gastrointestinal bleeding with endoscopic findings of mild or no PHG were followed up over 6 months after variceal eradication to assess the progression to severe PHG. Included patients were randomised to either maximum tolerated doses of propranalol (group A) or to no treatment (group B). Primary end point of the study were the development of gastrointestinal bleed, evidence of hepatic decompensation and death. Progression to severe PHG were compared between the two groups. Results: 56 patients (49 males) were enrolled (group A = 28, group B = 28). 8 patients were excluded from final analysis (gi bleed=5, encephalopathy=2,HCC=1 including 4 deaths).3 patients were lost to follow-up, and 1 developed intolerance to propranalol. Mean dose of propranalol used was 60 mg per day. Progression to severe PHG in the fundus over 6 months was 23.8% in group A versus 15.8 % in group B (p = 0.52). Severe PHG was noted in body in 14.3% in group A versus 21.1% in group B (p = 0.57). 23.8 % in group A had progression to severe PHG compared with 15.8 % in group B (p =0.52). There was no statistically significant difference in the progression of PHG between the two groups(p=0.43). Conclusion: In this short term study propranalol was found not to prevent the progression to severe portal hypertensive gastropathy in cirrhotic patients who had undergone endotherapy for esophageal varices.Keywords: propranalol, portal hypertensive gastropathy, cirrhotic patients, gastroenterology
Procedia PDF Downloads 3345312 Patients’ Trust in Health Care Systems
Authors: Dilara Usta, Fatos Korkmaz
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Background: Individuals who utilise health services maintain relationships with health professionals, insurers and institutions. The nature of these relationships requires service receivers to have trust in the service providers because maintaining health services without reciprocal trust is very difficult. Therefore, individual evaluations of trust within the scope of health services have become increasingly important. Objective: To investigate patients’ trust in the health-care system and their relevant socio-demographical characteristics. Methods: This research was conducted using a descriptive design which included 493 literate patients aged 18-65 years who were hospitalised for a minimum of two days at public university and training&research hospitals in Ankara, Turkey. Patients’ trust in health-care professionals, insurers, and institutions were investigated. Data were collected using a demographic questionnaire and the Multidimensional Trust in Health-Care Systems Scale between September 2015 and April 2016. Results: The participants’ mean age was 47.7±13.1; 70% had a moderate income and 69% had a prior hospitalisation and 63.5% of the patients were satisfied with the health-care services. The mean Multidimensional Trust in Health-Care Systems Scale score for the sample was 61.5±8.3; the provider subscale had a mean of 38.1±5, the insurers subscale had a mean of 12.9±3.7, and institutions subscale had a mean of 10.6±1.9. Conclusion: Patients’ level of trust in the health-care system was above average and the trust level of the patients with higher educational and socio-economic levels was lower compared to the other patients. Health-care professionals should raise awareness about the significance of trust in the health-care system.Keywords: delivery of health care, health care system, nursing, patients, trust
Procedia PDF Downloads 3575311 Prognosis, Clinical Outcomes and Short Term Survival Analyses of Patients with Cutaneous Melanomas
Authors: Osama Shakeel
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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses
Procedia PDF Downloads 1585310 Culturally Adapting Videos to Involve Nigerian Patients with Cancer in Clinical Trials
Authors: Abiola Falilat Ibraheem, Akinyimika Sowunmi, Valerie Otti
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Background: Introduction of innovative cancer clinical trials to Nigeria is a critical step in addressing global inequities of cancer burden. Low health and clinical trial literacy among Nigerian patients have been sighted as a significant barrier to ensuring that patients enrolled in clinical trials are truly informed. Video intervention has been shown to be the most proactive method to improving patient’s clinical trial knowledge. In the US, video interventions have been successful at improving education about cancer clinical trials among minority patients. Thus, this study aimed to apply and adapt video interventions addressing attitudinal barriers peculiar to Nigerian patients. Methods: A hospital-based representative mixed-method study was conducted at the Lagos State University Teaching Hospital (LASUTH) from July to December 2020, comprising of cancer patients aged 18 and above. Patients were randomly selected during every clinic day, of which 63 patients volunteered to participate in this study. We first administered a cancer literacy survey to determine patients’ knowledge about clinical trials. For patients who had prior knowledge, a pre-intervention test was administered, after which a 15-minute video (attitudes and intention to enroll in therapeutic clinical trials (AIET)) to improve patients’ knowledge, perception, and attitudes towards clinical trials was played, and then ended by administering a post-intervention test to the patients. For patients who had no prior knowledge, the AIET video was played for them, followed by the post-intervention test. Results: Out of 63 patients sampled, 43 (68.3%) had breast cancer. On average, patients agreed to understand their cancer diagnosis and treatment very well. 84.1% of patients had never heard about cancer clinical trials, and 85.7% did not know what cancer clinical trials were. There was a strong positive relationship (r=0.916) between the pretest and posttest, which means that the intervention improved patients’ knowledge, perception, and attitudes about cancer clinical trials. In the focus groups, patients recommended adapting the video in Nigerian settings and representing all religions in order to address trust in local clinical trialists. Conclusion: Due to the small size of patients, change in clinical trial knowledge was not statistically significant. However, there is a trend suggesting that culturally adapted video interventions can be used to improve knowledge and perception about cancer clinical trials.Keywords: clinical trials, culturally targeted intervention, patient education, video intervention
Procedia PDF Downloads 1295309 Establishment of Virtual Fracture Clinic in Princess Royal Hospital Telford: Experience and Recommendations during the First 9 Months
Authors: Tahir Khaleeq, Patrick Lancaster, Keji Fakoya, Pedro Ferreira, Usman Ahmed
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Introduction: Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety. Materials and Methods: A protocol was developed by the clinical team in collaboration with Advanced Physiotherapy Practitioners (APP) on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes. Results: In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately. Discussion: BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.Keywords: virtual fracture clinic, lockdown, trauma and orthopaedics, Covid- 19
Procedia PDF Downloads 1935308 Attitude and Perception of Multiple Sclerosis Patients toward Exercise
Authors: Ali Fuad Ashour
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Introduction: Contrary to the common belief that physical training for multiple sclerosis (MS) patients might exacerbate fatigue and provoke other symptoms of the illness, it is now widely accepted that exercise can be actually beneficial in terms of activities of daily living, reduced fatigue, and improved quality of life. The aim of this study was to assess the attitude of MS patients toward exercise. Methodology: 112 MS patients who were recruited from the local community participated in this study. We utilised a self-developed questionnaire targeting attitudes and perceptions of MS patients towards physical exercise. The questionnaire was piloted and tested for validity and reliability. Results: Before being diagnosed with MS, 49.9% of our MS patients’ respondents used to engage in different types of physical activities and sports, namely aerobics/walking (35.3%), stretching exercise (18.7%), and strengthening exercise (11.4%). After being diagnosed with MS, 40.8% of our sample showed determination to remain physically active. The interest in sports activities was consistent after the diagnoses with MS and included aerobics/walking (33.8%), stretching exercise (22.6%), and strengthening exercise (19.7%). Discussion: The Kuwaiti respondents thought that lack of encouragement was the main reason for them not exercise. Aptly put, if they try to exercise, they will be discouraged by the loved ones lest the worse happens. On the other side, British patients are generally aware of the benefits of physical and mental health-promoting activities; they can seek help from a wide range of professionals and are more actively involved in the management of their condition. It is therefore important that the benefits of physical activity are promoted among MS patients, and that attitude towards MS and MS patients is changed through education.Keywords: perception, multiple sclerosis, exercise, physical training
Procedia PDF Downloads 1475307 Challenges in the Management of Her2 Neu Positive Breast Cancer Patients: Real World Data from India
Authors: Praveen Adusumilli, Meher Lakshmi Konatam, Sadashivudu Gundeti, Stalin Bala
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The invention of trastuzumab has changed the treatment of breast cancer and lives of many patients all over the world. Despite many patients getting benefitted from the drug, it is out of reach for most of the patients. There is very limited real world data regarding the epidemiology and clinical outcome of Her2neu positive breast cancer patients. Materials and Methods: This is a retrospective analysis of breast cancer patients presenting to a tertiary care cancer centre in Southern India from 2007 to2013. All early and locally advanced breast cancer patients, who were Her2neu 3+ on IHC are included in the study and evaluated in terms of epidemiology, 3-year disease free survival (DFS)and 5-year overall survival(OS). Chemotherapy regimens used were-FAC 6 cycles or AC 4 cycles followed by 12 cycles of weekly paclitaxel . Trastuzumab was given after 6 cycles of FAC or weekly with paclitaxel followed by 3weekly maintenance until 1 year. Results: Over the period of this study there were 885 newly diagnosed cases of carcinoma breast, of which 242 (27%) were Her2neu positive, 360(40%) were hormone receptor positive, and 212(24%) were triple negative. A total of 71(8%) were Her2neu equivocal of which only 10 patients got FISH test done. Of the 212 newly diagnosed patients, only 74 (29%) opted to have standard of care therapy with trastuzumab at our centre, out of which 52(24%), 8(3%), received under insurance, paying basis respectively. 14(9%) patients received the care as part of clinical trial program (ALTTO trial). 7 (9.72%) patients developed decrease of ejection fraction by greater than 10%, requiring stoppage of trastuzumab out of which 5 were restarted in 2 months. Patients receiving trastuzumab along with chemotherapy had longer 3year DFS 92% vs. 60% (p value<0.0001) when compared to chemotherapy alone. 5 year OS was 87% vs 44% (p-value <0.0001) compared to chemotherapy alone. Conclusion: Trastuzumab with chemotherapy improves the DFS and OS in Her2neu positive patients. The biggest constraint is the cost of the treatment and absence of universal health security net to treat all patients with this diagnosis.Keywords: breast cancer, Her 2 neu positive, real world data, Trastuzumab
Procedia PDF Downloads 1595306 Chronically Ill Patient Satisfaction: An Indicator of Quality of Service Provided at Primary Health Care Settings in Alexandria
Authors: Alyaa Farouk Ibrahim, Gehan ElSayed, Ola Mamdouh, Nazek AbdelGhany
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Background: Primary health care (PHC) can be considered the first contact between the patient and the health care system. It includes all the basic health care services to be provided to the community. Patient's satisfaction regarding health care has often improved the provision of care, also considered as one of the most important measures for evaluating the health care. Objective: This study aims to identify patient’s satisfaction with services provided at the primary health care settings in Alexandria. Setting: Seven primary health care settings representing the seven zones of Alexandria governorate were selected randomly and included in the study. Subjects: The study comprised 386 patients attended the previously selected settings at least twice before the time of the study. Tools: Two tools were utilized for data collection; sociodemographic characteristics and health status structured interview schedule and patient satisfaction scale. Reliability test for the scale was done using Cronbach's Alpha test, the result of the test ranged between 0.717 and 0.967. The overall satisfaction was computed and divided into high, medium, and low satisfaction. Results: Age of the studied sample ranged between 19 and 62 years, more than half (54.2%) of them aged 40 to less than 60 years. More than half (52.8%) of the patients included in the study were diabetics, 39.1% of them were hypertensive, 19.2% had cardiovascular diseases, the rest of the sample had tumor, liver diseases, and orthopedic/neurological disorders (6.5%, 5.2% & 3.2%, respectively). The vast majority of the study group mentioned high satisfaction with overall service cost, environmental conditions, medical staff attitude and health education given at the PHC settings (87.8%, 90.7%, 86.3% & 90.9%, respectively), however, medium satisfaction was mostly reported concerning medical checkup procedures, follow-up data and referral system (41.2%, 28.5% & 28.9%, respectively). Score level of patient satisfaction with health services provided at the assessed Primary health care settings proved to be significantly associated with patients’ social status (P=0.003, X²=14.2), occupation (P=0.011, X²=11.2), and monthly income (P=0.039, X²=6.50). In addition, a significant association was observed between score level of satisfaction and type of illness (P=0.007, X²=9.366), type of medication (P=0.014, X²=9.033), prior knowledge about the health center (P=0.050, X²=3.346), and highly significant with the administrative zone (P=0.001, X²=55.294). Conclusion: The current study revealed that overall service cost, environmental conditions, staff attitude and health education at the assessed primary health care settings gained high patient satisfaction level, while, medical checkup procedures, follow-up, and referral system caused a medium level of satisfaction among assessed patients. Nevertheless, social status, occupation, monthly income, type of illness, type of medication and administrative zones are all factors influencing patient satisfaction with services provided at the health facilities.Keywords: patient satisfaction, chronic illness, quality of health service, quality of service indicators
Procedia PDF Downloads 3385305 Functional Outcome and Quality of Life of Conservative versus Surgical Management of Adult Potts Disease: A Prospective Cohort Study
Authors: Mark Angelo Maranon, David Endriga
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Objective: The aim of the study is to determine the differences in functional outcome and quality of life of adult patients with Potts disease who have undergone surgical versus non-surgical management. Methods: In this prospective cohort study, 45 patients were followed up for 1 year after undergoing pharmacologic treatment alone versus a combination of anti-Kochs and surgery for Potts disease. Oswestry Disability Index (ODI) and Short Form-36 (SF-36) were obtained on initiation of treatment, after three months, six months and one year. Results: ASIA scores from the onset of treatment and after 1 year significantly improved (p<0.001) for both non-surgical and surgical patients. ODI scores significantly improved after 6 months of treatment for both surgical and non-surgical patients. Both surgical and non-surgical patients showed significant improvement in their SF-36 scores, but scores were noted to be higher in patients who underwent surgery. Conclusions: Significant improvement with regards to functional outcome and quality of life was noted from both surgical and non-surgical patients after 1 year of treatment, with earlier improvements and better final scores in SF 36 and ODI in patients who underwent surgery.Keywords: tuberculosis, spinal, potts disease, functional outcome
Procedia PDF Downloads 1415304 Single Stage “Fix and Flap” Orthoplastic Approach to Severe Open Tibial Fractures: A Systematic Review of the Outcomes
Authors: Taylor Harris
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Gustilo-anderson grade III tibial fractures are exquisitely difficult injuries to manage as they require extensive soft tissue repair in addition to fracture fixation. These injuries are best managed collaboratively by Orthopedic and Plastic surgeons. While utilizing an Orthoplastics approach has decreased the rates of adverse outcomes in these injuries, there is a large amount of variation in exactly how an Orthoplastics team approaches complex cases such as these. It is sometimes recommended that definitive bone fixation and soft tissue coverage be completed simultaneously in a single-stage manner, but there is a paucity of large scale studies to provide evidence to support this recommendation. It is the aim of this study to report the outcomes of a single-stage "fix-and-flap" approach through a systematic review of the available literature. Hopefully, this better informs an evidence-based Orthoplastics approach to managing open tibial fractures. Systematic review of the literature was performed. Medline and Google Scholar were used and all studies published since 2000, in English were included. 103 studies were initially evaluated for inclusion. Reference lists of all included studies were also examined for potentially eligible studies. Gustilo grade III tibial shaft fractures in adults that were managed with a single-stage Orthoplastics approach were identified and evaluated with regard to outcomes of interest. Exclusion criteria included studies with patients <16 years old, case studies, systemic reviews, meta-analyses. Primary outcomes of interest were the rates of deep infections and rates of limb salvage. Secondary outcomes of interest included time to bone union, rates of non-union, and rates of re-operation. 15 studies were eligible. 11 of these studies reported rates of deep infection as an outcome, with rates ranging from 0.98%-20%. The pooled rate between studies was 7.34%. 7 studies reported rates of limb salvage with a range of 96.25%-100%. The pooled rate of the associated studies was 97.8%. 6 reported rates of non-union with a range of 0%-14%, a pooled rate of 6.6%. 6 reported time to bone union with a range of 24 to 40.3 weeks and a pooled average time of 34.2 weeks, and 4 reported rates of reoperation ranging from 7%-55%, with a pooled rate of 31.1%. A few studies that compared a single stage to a multi stage approach side-by-side unanimously favored the single stage approach. Outcomes of Gustilo grade III open tibial fractures utilizing an Orthoplastics approach that is specifically done in a single-stage produce low rates of adverse outcomes. Large scale studies of Orthoplastic collaboration that were not completed in strictly a single stage, or were completed in multiple stages, have not reported as favorable outcomes. We recommend that not only should Orthopedic surgeons and Plastic surgeons collaborate in the management of severe open tibial fracture, but they should plan to undergo definitive fixation and coverage in a single-stage for improved outcomes.Keywords: orthoplastic, gustilo grade iii, single-stage, trauma, systematic review
Procedia PDF Downloads 805303 Transarterial Chemoembolization (TACE) in Hepatocellular Carcinoma (HCC)
Authors: Ilirian Laçi, Alketa Spahiu
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Modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the preferred staging system. There are many patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process, which have shown promising initial results but have failed external evaluation and have not been translated to the clinic aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.Keywords: hepatocellular carcinoma, transarterial chemoembolization, TACE, liver
Procedia PDF Downloads 875302 Importance of Prostate Volume, Prostate Specific Antigen Density and Free/Total Prostate Specific Antigen Ratio for Prediction of Prostate Cancer
Authors: Aliseydi Bozkurt
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Objectives: Benign prostatic hyperplasia (BPH) is the most common benign disease, and prostate cancer (PC) is malign disease of the prostate gland. Transrectal ultrasound-guided biopsy (TRUS-bx) is one of the most important diagnostic tools in PC diagnosis. Identifying men at increased risk for having a biopsy detectable prostate cancer should consider prostate specific antigen density (PSAD), f/t PSA Ratio, an estimate of prostate volume. Method: We retrospectively studied 269 patients who had a prostate specific antigen (PSA) score of 4 or who had suspected rectal examination at any PSA level and received TRUS-bx between January 2015 and June 2018 in our clinic. TRUS-bx was received by 12 experienced urologists with 12 quadrants. Prostate volume was calculated prior to biopsy together with TRUS. Patients were classified as malignant and benign at the end of pathology. Age, PSA value, prostate volume in transrectal ultrasonography, corpuscle biopsy, biopsy pathology result, the number of cancer core and Gleason score were evaluated in the study. The success rates of PV, PSAD, and f/tPSA were compared in all patients and those with PSA 2.5-10 ng/mL and 10.1-30 ng/mL tp foresee prostate cancer. Result: In the present study, in patients with PSA 2.5-10 ng/ml, PV cut-off value was 43,5 mL (n=42 < 43,5 mL and n=102 > 43,5 mL) while in those with PSA 10.1-30 ng/mL prostate volüme (PV) cut-off value was found 61,5 mL (n=31 < 61,5 mL and n=36 > 61,5 mL). Total PSA values in the group with PSA 2.5-10 ng/ml were found lower (6.0 ± 1.3 vs 6.7 ± 1.7) than that with PV < 43,5 mL, this value was nearly significant (p=0,043). In the group with PSA value 10.1-30 ng/mL, no significant difference was found (p=0,117) in terms of total PSA values between the group with PV < 61,5 mL and that with PV > 61,5 mL. In the group with PSA 2.5-10 ng/ml, in patients with PV < 43,5 mL, f/t PSA value was found significantly lower compared to the group with PV > 43,5 mL (0.21 ± 0.09 vs 0.26 ± 0.09 p < 0.001 ). Similarly, in the group with PSA value of 10.1-30 ng/mL, f/t PSA value was found significantly lower in patients with PV < 61,5 mL (0.16 ± 0.08 vs 0.23 ± 0.10 p=0,003). In the group with PSA 2.5-10 ng/ml, PSAD value in patients with PV < 43,5 mL was found significantly higher compared to those with PV > 43,5 mL (0.17 ± 0.06 vs 0.10 ± 0.03 p < 0.001). Similarly, in the group with PSA value 10.1-30 ng/mL PSAD value was found significantly higher in patients with PV < 61,5 mL (0.47 ± 0.23 vs 0.17 ± 0.08 p < 0.001 ). The biopsy results suggest that in the group with PSA 2.5-10 ng/ml, in 29 of the patients with PV < 43,5 mL (69%) cancer was detected while in 13 patients (31%) no cancer was detected. While in 19 patients with PV > 43,5 mL (18,6%) cancer was found, in 83 patients (81,4%) no cancer was detected (p < 0.001). In the group with PSA value 10.1-30 ng/mL, in 21 patients with PV < 61,5 mL (67.7%) cancer was observed while only in10 patients (32.3%) no cancer was seen. In 5 patients with PV > 61,5 mL (13.9%) cancer was found while in 31 patients (86.1%) no cancer was observed (p < 0.001). Conclusions: Identifying men at increased risk for having a biopsy detectable prostate cancer should consider PSA, f/t PSA Ratio, an estimate of prostate volume. Prostate volume in PC was found lower.Keywords: prostate cancer, prostate volume, prostate specific antigen, free/total PSA ratio
Procedia PDF Downloads 1385301 The Role of Surgery to Remove the Primary Tumor in Patients with Metastatic Breast Cancer
Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko
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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor
Procedia PDF Downloads 4055300 Effects of the Treatment by Polypill Combinations vs Identical Monopill Therapies in Patients with Cardiovascular Comorbid Diseases
Authors: Denys Sebov, Viktoriia Korotaieva, Kateryna Markina
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The clinical advantage of the multipill combination drugs administration (polypill-strategy) over single-component drugs (monopill-strategy) has been established in patients with comorbid arterial hypertension, heart failure, chronic coronary syndrome, diabetes. It was found that polypill-strategy provides better treatment adherence in 33.4% of the patients. It was proven a significant decrease in systolic and diastolic blood pressure, as well as a decrease in dispersion index due to the stability of the blood pressure profile in patients with the polypill-strategy treatment.Keywords: polypill, artetial hypertension, cardiovascular disease, compliance
Procedia PDF Downloads 525299 Acute Asthma in Emergency Department, Prevalence of Respiratory and Non-Respiratory Symptoms
Authors: Sherif Refaat, Hassan Aref
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Background: Although asthma is a well-identified presentation to the emergency department, little is known about the frequency and percentage of respiratory and non-respiratory symptoms in patients with acute asthma in the emergency department (ED). Objective: The aim of this study is to identify the relationship between acute asthma exacerbation and different respiratory and non-respiratory symptoms including chest pain encountered by patients visiting the emergency department. Subjects and methods: Prospective study included 169 (97 females and 72 males) asthmatic patients who were admitted to emergency department of two tertiary care facility hospitals for asthma exacerbation from the period of September 2010 to August 2013, an anonyms questionnaire was used to collect symptoms and analysis of symptoms. Results: Females were 97 (57%) of the patients, mean age was 35.6 years; dyspnea on exertion was the commonest symptom accounting for 161 (95.2%) of patients, followed by dyspnea at rest 155 (91.7%), wheezing in 152 (89.9%), chest pain was present in 82 patients (48.5%), the pain was burning in 36 (43.9%) of the total patients with chest pain. Non-respiratory symptoms were seen frequently in acute asthma in ED. Conclusions: Dyspnea was the commonest chest symptoms encountered in patients with acute asthma followed by wheezing. Chest pain in acute asthma is a common symptom and should be fully studied to exclude misdiagnosis as of cardiac origin; there is a need for a better dissemination of knowledge about this disease association with chest pain. It was also noted that other non-respiratory symptoms are frequently encountered with acute asthma in emergency department.Keywords: asthma, emergency department, respiratory symptoms, non respiratory system
Procedia PDF Downloads 4155298 Correlation Between Diastolic Function and Lower GLS in Hypertensive Patients
Authors: A. Kherraf, S. Ouarrak, L. Azzouzi, R. Habbal
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Introduction: Preserved LVEF heart failure is an important cause of mortality and morbidity in hypertensive patients. A strong correlation between impaired diastolic function and longitudinal systolic dysfunction. could have several explanations, first, the diastole is an energy dependent process, especially during its first phase, it also includes active systolic components during the phase of iso volumetric relaxation, in addition, the impairment of the intrinsic myocytic function is part of hypertensive pathology as evidenced by recent studies. METHODS AND MATERIALS: This work consists of performing in a series of 333 hypertensive patients (aged 25 to 75 years) a complete echocardiographic study, including LVEF by Simpson biplane method, the calculation of the indexed left ventricular mass, the analysis of the diastolic function, and finally, the study of the longitudinal deformation of the LV by the technique of speckletracking (calculation of the GLS). Patients with secondary hypertension, leaky or stenosing valve disease, arrhythmia, and a history of coronary insufficiency were excluded from this study. RESULTS: Of the 333 hypertensive patients, 225 patients (67.5%) had impaired diastolic function, of which 60 patients (18%) had high filling pressures. 49.39% had echocardigraphic HVG, Almost all of these patients (60 patients) had low GLS. There is a statistically very significant relationship between lower GLS and increased left ventricular filling pressures in hypertensive patients. These results suggest that increased filling pressures are closely associated with atrioventricular interaction in patients with hypertension, with a strong correlation with impairment of longitudinal systolic function and diastolic function CONCLUSION: Overall, a linear relationship is established between increased left ventricular mass, diastolic dysfunction, and longitudinal LV systolic dysfunctionKeywords: hypertension, diastolic function, left ventricle, heart failure
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