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Brigham, Christopher R., Charles N. Brooks, Stephen Demeter, Lorne Direnfeld, and Randy Soo Hoo. "Is a Condition a Ratable Impairment? Nuances in Assessing Preexisting Conditions." Guides Newsletter 22, no. 3 (May 1, 2017): 3–5. http://dx.doi.org/10.1001/amaguidesnewsletters.2017.mayjun01.
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Abstract In order to answer questions posed by their clients, evaluating physicians must understand the context of a case or jurisdiction, in part because medical and legal perspectives may differ when an evaluator assesses issues such as causation and apportionment. A condition is not necessarily a ratable impairment, nor do symptomatic conditions necessarily prevent an individual from working. Attorneys may pose very specific apportionment questions based on laws unique to a given jurisdiction; for example, a patient may have an occupational injury or illness that results in impairment, but causation of the impairment may be multifactorial and may involve, for example, age-related degeneration, a pre-existing injury or illness, an occupational injury or illness, and/or subsequent trauma or disease. In some states, the presence of a pre-existing condition when an employee is injured may involve Second Injury Funds that were created to relieve a portion of the employer's/insurer's claim costs when the employer hired or retained an employee with a pre-existing medical condition who then suffered a “second” injury. The latter situation requires more extensive treatment and/or a greater disability due to the combined effects of both conditions. Apportionment of causation and impairment may be complex, requiring evaluation of nonoccupational and occupational risk factors and the natural history of the underlying condition.
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Shrestha, Aman, Saruna Ghimire, Bunsi Chapadia, Uday Narayan Yadav, Sabuj Kanti Mistry, Om Prakash Yadav, and Mark Fort Harris. "Nepali Older Adults With Pre-existing Conditions and Their Healthcare Access Amid COVID-19 Pandemic." Innovation in Aging 5, Supplement_1 (December 1, 2021): 946. http://dx.doi.org/10.1093/geroni/igab046.3417.
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Abstract COVID-19 has greatly impacted older adults with pre-existing non-communicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic. A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaire, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors, and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition, and multimorbidity for the analyses. Chi-square tests and binary logistic regressions determined inferences. Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR: 3.06, 95%CI: 2.17-4.32) and multimorbid (OR: 5.62, 95%CI: 3.63-8.71) conditions had three and five-fold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95%CI: 1.71-5.69; OR multimorbid: 3.98, 95%CI: 2.01-7.87) where odds were greater than three-folds. Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.
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Ghimire, Saruna, Aman Shrestha, Uday Narayan Yadav, Sabuj Kanti Mistry, Bunsi Chapadia, Om Prakash Yadav, ARM Mehrab Ali, et al. "Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: a cross-sectional study in eastern Nepal." BMJ Open 12, no. 2 (February 2022): e056342. http://dx.doi.org/10.1136/bmjopen-2021-056342.
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BackgroundCOVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic.MethodsA cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ2 tests and binary logistic regressions determined inferences.ResultsNearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds.ConclusionsOlder adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.
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Darrat, Milad, and Gerard Thomas Flaherty. "International Travel With a Chronic Medical Illness – Health Risks, Practical Challenges and Evidence-Based Recommendations." International Journal of Travel Medicine and Global Health 9, no. 2 (December 12, 2020): 44–59. http://dx.doi.org/10.34172/ijtmgh.2021.09.
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Introduction: Primary care practitioners and travel medicine physicians are primarily responsible for identifying individuals who may be unfit for overseas travel and consulting with them pre-travel. Pre-existing medical conditions such as cardiovascular disease, chronic respiratory conditions and diabetes mellitus (DM) have the potential to complicate travel journeys. A considerable percentage of travel-associated illness may be due to the decompensation of a pre-existing medical condition. This review seeks to address the challenges faced by travellers with each of these conditions, including recently updated and evidence-based practical approaches for travel with comorbidities. Methods: Sources for this review were identified through searches of PubMed/Google Scholar for materials published between 1st January 2000 and 31st December 2019, using combinations of search terms. Results: The volume of literature on travelling with a pre-existing condition exploded with more than 865 associated articles indexed on the PubMed alone as of March 2020. After screening titles, abstracts and, in some cases, the full text version of indexed articles, 121 articles were deemed relevant to the subject matter of this review. Conclusion: Rational approaches to pre-planning for travel with a medical condition will contribute to the prevention of problems while in transit as well as when at the travel destination. It is imperative for health care providers to be aware of the preventative measures and current recommendations that should be taken before and during travel to protect individuals with a chronic illness. Further research and studies should be directed to protect this vulnerable group of travellers.
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Honn, K. A., P. Whitney, J. M. Hinson, A. T. Nusbaum, and H. Van Dongen. "0125 Sleep Deprivation Impairs the Ability to Overcome Pre-Existing Framing Bias." Sleep 43, Supplement_1 (April 2020): A49—A50. http://dx.doi.org/10.1093/sleep/zsaa056.123.
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Abstract Introduction When presented with a choice between sure gains or losses versus gambles, people tend to select sure gains over gambles, but gambles over sure losses. This pre-existing framing bias is embedded in the Framed Gambling Task (FGT), in which subjects choose between a sure option (gain or loss) and a gamble (card from one of two decks). For optimal performance, subjects need to recognize that one deck (‘good deck’) results in better average outcomes than the other deck (‘bad deck’) and select the gamble or sure option depending on the deck (good/bad) rather than the frame (sure loss/gain). A speeded version of the FGT, with 2s response deadlines to induce time pressure, was used in a laboratory total sleep deprivation (TSD) study to determine the impact of sleep loss on the ability to overcome pre-existing framing bias. Methods Eight-six subjects (ages 21–38; 47 females) were randomized (2:1 ratio) to a TSD condition (n=56) or control condition (n=30). They completed the speeded FGT at 11:00 on the baseline day (session 1), and again the following day (session 2) after 27h of wakefulness (TSD group) or 3h of wakefulness (control group). Performance accuracy was defined in terms of optimal task performance, i.e., gambling when the good deck was presented and not gambling when the bad deck was presented. Each test bout had 72 trials across three trial blocks. Results Accuracy improved across trial blocks (F1,84=20.44, p<0.001). In session 2, the TSD group showed lower accuracy (condition by session interaction: F2,84=4.15, p=0.045) and less improvement across trial blocks (condition by session by trial block interaction: F2,168=3.97, p=0.021) than the control group. Even under TSD, the frequency of response timeouts (RT>2s) was low (<3.5% of trials). Conclusion Sleep deprivation degraded FGT performance under time pressure, indicating reduced ability to overcome pre-existing framing bias. Support PRMRP award W81XWH-16-1-0319
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Zheng, Ming, and Lun Song. "Shift in the Distributions of Pre-existing Medical Condition, Gender and Age across Different COVID-19 Outcomes." Aging and disease 12, no. 2 (2021): 327. http://dx.doi.org/10.14336/ad.2020.1222.
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Pardasani, Sapna A. "#44 COVID-19 among pediatric patients with pre-existing pulmonary conditions: Preliminary results from the Pediatric COVID-19 U.S. Registry." Journal of the Pediatric Infectious Diseases Society 11, Supplement_1 (June 14, 2022): S7. http://dx.doi.org/10.1093/jpids/piac041.026.
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Abstract Background COVID-19 is a respiratory infection caused by SARS-CoV-2. Adults with pre-existing pulmonary conditions have been reported to be at higher risk of severe disease, but less is known about COVID-19 in pediatric patients with pre-existing pulmonary conditions. We sought to characterize the clinical course and outcomes of COVID-19 among pediatric patients with pre-existing pulmonary conditions in a national passive surveillance registry. Method Demographic, clinical and COVID-19 related data were obtained from the Pediatric COVID-19 U.S. Registry, a passive surveillance registry of pediatric patients less than 21 years old diagnosed with COVID-19 at inpatient and outpatient facilities across the United States. Centers (n = 170) voluntarily submitted information abstracted from medical records at Days 7- and 28-days post COVID-19 diagnosis. Of the 13,248 cases submitted to the registry, 2143 (16.2%) cases submitted both Days 7 and 28 surveys as well as completed survey questions related to pre-existing pulmonary conditions. Immunocompromised cases, cases missing Day 28 surveys and those missing pre-existing pulmonary condition survey data were excluded from this analysis (n=11,105). Clinical characteristics were summarized descriptively, and chi-square tests (α=0.05) were used to compare COVID-19 clinical course and outcomes between those with and without pre-existing pulmonary conditions. Results Among the 2143 cases included, 1438 (67%) reported a pre-existing pulmonary condition. The majority were male (53.6%), white or Caucasian (41.7%) and non-Hispanic (62.5%). Pulmonary conditions reported included asthma/reactive airway disease (92%) followed by bronchopulmonary dysplasia (4%) and tracheostomy dependence (3%). Approximately one quarter (n=378) of patients with pulmonary conditions were hospitalized and 151 (13%) were admitted to the ICU. Ninety-six (6.7%) experienced respiratory failure, 63 (4%) required mechanical ventilation, and 1 (0.06%) death was reported related to COVID-19. Compared to cases with no pre-existing pulmonary conditions, those with pulmonary pre-existing conditions were significantly (p < 0.05) more likely to experience chest pain (11.7% vs 6.8), wheezing (10.3% vs 1.6%), dyspnea (27.3% vs 10.5%), cough (46.8% vs 30%), and fever (47% vs 34.8%). Patients with pre-existing pulmonary condition were also more likely to be hospitalized for COVID-19 (26% vs 14.8%), admitted to intensive care unit (13% vs 6.4%) and to progress to lower respiratory tract infection (4.1% vs 0.6%). These patients were also more likely to receive oxygen (18% vs 8.2%), steroid treatment (Day 0 to 7) (14% vs 7.7%), and IVIG (7% vs 4.6%). Conclusion When compared to those without pre-existing pulmonary conditions, our data suggests children with pre-existing pulmonary conditions and COVID-19 are more likely to present with symptomatic and severe disease. Future prospective research is needed to fully understand the impact of COVID-19 among this at-risk population.
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Brand, PhD, Michael W., Brandt Wiskur, PhD, MSW, and Julio I. Rojas, PhD. "Assessing fear of COVID-19 at an academic medical center." Journal of Emergency Management 18, no. 7 (July 1, 2020): 91–98. http://dx.doi.org/10.5055/jem.0532.
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Purpose: This study measured the degree of COVID-19-related fear among academic medical center employees, identified subsections with high COVID-19 fear, and validated the Fear of COVID-19 Scale with medical professionals in the United States. Methods: This study is a cross-sectional, inter-net-based survey delivered by Qualtrics. The survey was conducted at the Oklahoma University Health Sciences Center between May 21 and June 18, 2020. The medical center is composed of seven health-care colleges, child and adult hospitals, a Veterans Hospital, and outpatient services clinics across the Oklahoma City area. Faculty, staff, and students (N = 1,761) from the Oklahoma University Health Sciences Center completed the survey. Results: COVID-19 fear is highest among non-clinical employees, smokers, and those with pre-existing conditions. Males and females, both clinicians and non-clinicians, appear to express their COVID-19 fears differently. Employees worried most about their families contracting the virus. The Fear of COVID-19 Scale is a valid and reliable assessment instrument among US healthcare workers. Responses were compared based on pre-existing medical condition(s), patient care or nonpatient care, sex, and occupational specialization. Analyses reveal a strong Cronbach’s α measure of internal consistency (α = 0.87). Significant differences were observed among employees with a nonclinical emphasis (p = 0.02), with a predisposing medical health condition (p 0.001), and with a nonacademic occupational specialization (p 0.01), and by sex (p 0.001). Conclusions and discussion: COVID-19 fear significantly impacts academic medical center employ-ees. Medical centers should address both healthcare and nonhealthcare workers’ COVID-19-related fears. It is important to recognize that men and women may have different types of fears and express them differently, necessitating a gender-specific approach to man-aging COVID-19 fears. Employees with pre-existing conditions or who have vulnerable family members require additional support to remain fully functional and on the job.
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Asseri, Ali Alsuheel, Marei Assiri, Norah Alshehri, Noha Saad Alyazidi, Ahmed Alasmari, Saud Q. Alshabab, and Nada Abdullah Asiri. "High-Altitude Pulmonary Edema in Two Pediatric Patients with Pre-Existing Lung Disease." Pediatric Reports 16, no. 2 (April 5, 2024): 271–77. http://dx.doi.org/10.3390/pediatric16020023.
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Background: The illnesses associated with changes in barometric pressure can be classified into three types: acute mountain sickness, high-altitude pulmonary edema (HAPE), and high-altitude cerebral edema. HAPE is a rare form of pulmonary edema that occurs in susceptible individuals after arriving at altitudes over 2500 m above sea level (m). Only a few studies have reported classical HAPE among children with underlying cardiopulmonary comorbidities. In this study, we report two pediatric cases of classical HAPE that occurred immediately upon arriving at Abha city (with an average elevation of 2270 m above sea level). Notably, both patients possessed underlying chronic lung diseases, raising crucial questions about susceptibility factors and the early onset manifestations of HAPE. Case: Two pediatric cases of HAPE are presented. The first patient, with a medical history of repaired right congenital diaphragmatic hernia and subsequent right lung hypoplasia, developed HAPE following their ascent to a high altitude. The second patient, diagnosed with diffuse lung disease of unknown etiology, experienced HAPE after a rapid high-altitude ascent. Both patients resided in low-altitude areas prior to ascent. The initial emergency room assessment revealed that both patients had severe hypoxia with respiratory distress that mandated the initiation of respiratory support and 100% oxygen therapy. They required intensive care unit admission, improved after 5 days of hospitalization, and were sent home in good condition. Conclusion: HAPE is a complex, potentially life-threatening high-altitude illness with diverse clinical presentations and variable risk factors. This case report sheds light on a potential predisposition factor—pre-existing lung disease—in children experiencing severe HAPE. While further validation is crucial, this valuable insight opens doors for improved preventative strategies and informed medical decisions for children with pre-existing lung conditions traveling to high altitudes.
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Husain, Entesar H., Ahmad AlKhabaz, Hanan Y. Al-Qattan, Nufoud Al-Shammari, and Abdullah F. Owayed. "Hospitalization patterns and outcomes of infants with Influenza A(H1N1) in Kuwait." Journal of Infection in Developing Countries 6, no. 08 (August 21, 2012): 632–36. http://dx.doi.org/10.3855/jidc.2339.
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Introduction: Infants represent an important risk group for influenza associated hospitalizations and mortality. This study evaluated the clinical presentations, hospitalization course and outcome of infants hospitalized with the pandemic influenza A H1N1 [Influenza A(H1N1)pdm09] in relation to their previous health status. Methodology: We conducted a retrospective chart review of hospitalized infants with laboratory-confirmed Influenza A(H1N1)pdm09 infection in two hospitals in Kuwait. Demographic characteristics, pre-existing high-risk medical conditions, clinical presentations, complications and mortality were analyzed. Previously healthy infants’ data were compared with infants with pre-existing high-risk medical conditions for severity of the illness and outcome. Results: We identified 62 infants comprising 32% of all admissions with Influenza A(H1N1)pdm09. The median age ± SD was 7 ± 4 months. Nineteen (31%) had pre-existing high-risk medical conditions. Complications were documented in 53% of previously healthy infants compared to 47% in high-risk infants. Mean duration of hospitalization was 4.9 days in healthy infants and 6.7 for infants with high-risk medical conditions. Bacterial pneumonia complicated 7% of previously healthy infants compared to 26% with high-risk conditions (P = 0.03). Four infants (6.5%) required admission to the intensive care unit (ICU), of whom three had high risk medical condition. Conclusion: The majority of hospitalized infants with Influenza A(H1N1)pdm09 were previously healthy. Prolonged hospitalization, ICU admission and mortality were more observed in infants with high-risk medical conditions. According to the latest Advisory Committee on Immunization Practices (ACIP) recommendations, annual influenza vaccination is recommended for any child six months of age and older, particularly those with risk factors.
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Nguyen, Tu Q., Pamela M. Simpson, and Belinda J. Gabbe. "The prevalence of pre-existing mental health, drug and alcohol conditions in major trauma patients." Australian Health Review 41, no. 3 (2017): 283. http://dx.doi.org/10.1071/ah16050.
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Objective Capturing information about mental health, drug and alcohol conditions in injury datasets is important for improving understanding of injury risk and outcome. This study describes the prevalence of pre-existing mental health, drug and alcohol conditions in major trauma patients based on routine discharge data coding. Methods Data were extracted from the population-based Victorian State Trauma Registry (July 2005 to June 2013, n = 16 096). Results Seventeen percent of major trauma patients had at least one mental health condition compared with the Australian population prevalence of 21%. The prevalence of mental health conditions was similar to the Australian population prevalence in men (19% v. 18%), but lower in women (14% v. 25%) and across all age groups. Mental health conditions were more prevalent in intentional self-harm cases (56.3%) compared with unintentional (13.8%) or other intentional (31.2%) cases. Substance use disorders were more prevalent in major trauma patients than the general population (15% v. 5%), higher in men than women (17% v. 10%) and was highest in young people aged 25–34 years (24%). Conclusions Under-reporting of mental health conditions in hospital discharge data appears likely, reducing the capacity to characterise the injury population. Further validation is needed. What is known about the topic? Medical record review, routine hospital discharge data and self-report have been used by studies previously to characterise mental health, drug and alcohol conditions in injured populations, with medical record review considered the most accurate and reliance on self-report measures being considered at risk of recall bias. The use of routinely collected data sources provides an efficient and standardised method of characterising pre-existing conditions, but may underestimate the true prevalence of conditions. What does this paper add? No study to date has explored the prevalence of Abbreviated Injury Scale and International Classification of Diseases and Health Related Problems, Tenth Revision, Australian Modification (ICD-10-a.m)-coded mental health, alcohol and drug conditions in seriously injured populations. The results of this study show the incidence of mental health conditions appeared to be under-reported in major trauma patients, suggesting limitations in the use of ICD-10-a.m. to measure mental health comorbidities. What are the implications for practitioners? In order to achieve improvements in measuring mental health, drug and alcohol comorbidities, we suggest the use of a series of different diagnostic systems to be used in conjunction with ICD-10-a.m., such as medical record review and self-reporting as well as linkage to other datasets. When applied simultaneously, diagnosis and outcomes of mental health may be compared and validated across diagnostic systems and deviations in diagnoses could be more readily accounted for.
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Lam, Nguyen Nhu, Ngo Minh Duc, and Ngo Tuan Hung. "Influence of pre-existing medical condition and predicting value of modified Elixhauser comorbidity index on outcome of burn patients." Burns 46, no. 2 (March 2020): 333–39. http://dx.doi.org/10.1016/j.burns.2019.08.004.
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Santoro, Maya S., Dhwani J. Kothari, Charles Van Liew, and Terry A. Cronan. "Health Care Advocacy." Californian Journal of Health Promotion 12, no. 3 (December 1, 2014): 46–55. http://dx.doi.org/10.32398/cjhp.v12i3.1580.
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Background and Purpose: The U.S. population is living longer; therefore, a relatively large proportion of the population is likely to experience chronic illnesses within their lifetime. An experimental study was conducted to examine factors influencing the likelihood of hiring a Health Care Advocate (HCA). Methods: Survey data were collected from a randomly selected community sample of participants (N = 470) over the age of 18 who were provided with a description of an HCA and a written vignette describing a medical scenario. Participants read one of eight vignettes in which they were asked to imagine they were in a car accident and required medical care. Age, injury (chronic vs. acute), and presence of comorbid chronic condition were manipulated. Results: A significant interaction indicated that when there was no pre-existing chronic health condition, sustaining a chronic injury increased the likelihood of hiring an HCA. In addition, younger adults with comorbid conditions were perceived as having greater need for an HCA than younger adults without comorbid conditions. Older adults were perceived as benefiting from HCAs regardless of comorbid conditions. Conclusion: This study demonstrates the need for patient-centered support for older adults following an injury, and for younger adults when a pre-existing chronic condition exists. Efforts should be made to target services to these populations of interest.
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Bauchmuller, Kris, Robin Condliffe, Jennifer Southern, Catherine Billings, Athanasios Charalampopoulos, Charlie A. Elliot, Abdul Hameed, et al. "Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry." ERJ Open Research 7, no. 2 (February 18, 2021): 00046–2021. http://dx.doi.org/10.1183/23120541.00046-2021.
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Pulmonary hypertension (PH) is a life-shortening condition characterised by episodes of decompensation precipitated by factors such as disease progression, arrhythmias and sepsis. Surgery and pregnancy also place additional strain on the right ventricle. Data on critical care management in patients with pre-existing PH are scarce.We conducted a retrospective observational study of a large cohort of patients admitted to the critical care unit of a national referral centre between 2000–2017 to establish acute mortality, evaluate predictors of in-hospital mortality and establish longer term outcomes in survivors to hospital discharge.242 critical care admissions involving 206 patients were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons, respectively. Medical patients had more severe physiological and laboratory perturbations than patients admitted following surgical or obstetric interventions. Higher APACHE II (Acute Physiology and Chronic Health Evaluation) score, age and lactate, and lower oxygen saturation measure by pulse oximetry/inspiratory oxygen fraction (SpO2/FiO2) ratio, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, OPALS (oxygen (SpO2/FiO2) ≤185; platelets ≤196×109·L−1; age ≥37.5 years; lactate ≥2.45 mmol·L−1; sodium ≤130.5 mmol·L−1), identified medical patients at increasing risk of hospital mortality. One (11%) out of nine patients who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge.These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.
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Pullon, Sue, Eileen McKinlay, Louise Beckingsale, Meredith Perry, Ben Darlow, Ben Gray, Peter Gallagher, Kath Hoare, and Sonya Morgan. "Interprofessional education for physiotherapy, medical and dietetics students: a pilot programme." Journal of Primary Health Care 5, no. 1 (2013): 52. http://dx.doi.org/10.1071/hc13052.
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INTRODUCTION: Interprofessional education (IPE) has been shown to enhance interprofessional practice among health professionals. Until recently there has been limited opportunity to undertake such initiatives within existing pre-registration degree courses in New Zealand. AIM: This study aimed to test the feasibility of delivering an interprofessional component within existing health professional courses for medicine, physiotherapy and dietetics at the University of Otago, Wellington, New Zealand. METHODS: An interprofessional case-based course component (on chronic condition management) was developed by academic clinical teachers from schools of medicine, physiotherapy and dietetics at the same location. Evaluation was undertaken using a previously validated pre- and post-survey tool, to ascertain changes in attitude among students towards interprofessional practice, IPE and the effectiveness of health care teams. Focus groups were conducted with students and teachers. RESULTS: Survey results indicated pre-existing positive attitudes to interprofessional practice and education among students. There was a statistically significant increase in positive attitude towards such practice and education, and increased confidence in the effectiveness of heath care teams. Focus group findings were consistent with the survey results for students, and highlighted challenges experienced by the teachers. DISCUSSION: Students and teachers alike enjoyed the interprofessional interaction and benefited from a collaborative approach to chronic condition management. The timing and nature of learning activities and assessment methods created logistical challenges. Such course components have potential to improve collaborative practice and the quality and safety of health care among graduates. Interprofessional course components need to be equitable across disciplines and embedded in the unidisciplinary courses. KEYWORDS: Dietetics; education; interprofessional relations; medicine; New Zealand; physiotherapy; primary health care
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Saeed, Amir, Eslam Shorafa, Anahita Sanaeidashti, and Mohammad Rahim Kadivar. "Clinical presentation of paediatric patients with COVID-19 admitted to a single paediatric intensive care unit (PICU) in Iran." BMJ Paediatrics Open 4, no. 1 (September 2020): e000715. http://dx.doi.org/10.1136/bmjpo-2020-000715.
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ObjectivesTo describe the clinical characteristics of paediatric patients admitted to a single paediatric intensive care unit (PICU) in Iran with COVID-19.MethodsA cross-sectional study of paediatric patients who were admitted to a COVID-19-dedicated PICU from 16 March 2020 to 21 April 2020 with COVID-19.ResultsSix children had confirmed COVID-19 and four had suspected COVID-19. Six had pre-existing chronic medical conditions. Nine had respiratory failure and needed ventilation. Five children, of whom four had chronic medical conditions, died. Four had cardiac arrhythmias. Clinical presentation included fever and cough.ConclusionCOVID-19 can be fatal in paediatric patients, especially in those with a chronic medical condition.
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Lindsay, Pat. "Obstetric complications and medical complexities in pregnancy. Part 1." British Journal of Healthcare Assistants 14, no. 8 (September 2, 2020): 383–89. http://dx.doi.org/10.12968/bjha.2020.14.8.383.
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Childbearing is a normal physiological process and one that most women experience at least once in their lives—81% in 2018 ( Office for National Statistics, 2019 ). The majority will have a safe and trouble-free pregnancy, birth and postnatal period. However, a few will experience complications. Some of these arise in previously healthy women when the progress of the pregnancy deviates from normal. Other women enter pregnancy with a pre-existing medical condition that may complicate progress and require additional attention and monitoring. Maternity support workers (MSWs) are an essential part of safe care. The service they give will be enhanced by knowledge of some of the conditions that may arise. This paper provides a brief overview of some of the issues.
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Lindsay, Pat. "Obstetric complications and medical complexities in pregnancy. Part 2." British Journal of Healthcare Assistants 14, no. 9 (October 2, 2020): 438–43. http://dx.doi.org/10.12968/bjha.2020.14.9.438.
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Childbearing is a normal physiological process and one that most women experience at least once in their lives—81% in 2018 ( Office for National Statistics, 2019 ). The majority will have a safe and trouble-free pregnancy, birth and postnatal period. However, a few will experience complications. Some of these arise in previously healthy women when the progress of the pregnancy deviates from normal. Other women enter pregnancy with a pre-existing medical condition that may complicate progress and require additional attention and monitoring. Maternity support workers (MSWs) are an essential part of safe care. The service they give will be enhanced by knowledge of some of the conditions that may arise. This paper provides a brief overview of some of the issues.
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Carney, Madeline, Myra Quiroga, Luke Mounce, Elizabeth Shephard, Willie Hamilton, and Sarah Price. "Effect of pre-existing conditions on bladder cancer stage at diagnosis: a cohort study using electronic primary care records in the UK." British Journal of General Practice 70, no. 698 (July 13, 2020): e629-e635. http://dx.doi.org/10.3399/bjgp20x710921.
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BackgroundPre-existing concurrent medical conditions (multimorbidity) complicate cancer diagnosis when they provide plausible diagnostic alternatives for cancer symptoms.AimTo investigate associations in bladder cancer between: first, pre-existing condition count and advanced-stage diagnosis; and, second, comorbidities that share symptoms with bladder cancer and advanced-stage diagnosis.Design and settingThis observational UK cohort study was set in the Clinical Practice Research Datalink with Public Health England National Cancer Registration and Analysis Service linkage.MethodIncluded participants were aged ≥40 years with an incident diagnosis of bladder cancer between 1 January 2000 and 31 December 2015, and primary care records of attendance for haematuria, dysuria, or abdominal mass in the year before diagnosis. Stage at diagnosis (stage 1 or 2 versus stage 3 or 4) was the outcome variable. Putative explanatory variables using logistic regression were examined, including patient-level count of pre-existing conditions and ‘alternative-explanations’, indicating whether pre-existing condition(s) were plausible diagnostic alternatives for the index cancer symptom.ResultsIn total, 1468 patients (76.4% male) were studied, of which 399 (35.6%) males and 217 (62.5%) females had alternative explanations for their index cancer symptom, the most common being urinary tract infection with haematuria. Females were more likely than males to be diagnosed with advanced-stage cancer (adjusted odds ratio [aOR] 1.62; 95% confidence interval [CI] = 1.20 to 2.18; P = 0.001). Alternative explanations were strongly associated with advanced-stage diagnosis in both sexes (aOR 1.69; 95% CI = 1.20 to 2.39; P = 0.003).ConclusionAlternative explanations were associated with advanced-stage diagnosis of bladder cancer. Females were more likely than males to be diagnosed with advanced-stage disease, but the effect was not driven entirely by alternative explanations.
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Baguiya, Adama, Mercedes Bonet, José Guilherme Cecatti, Vanessa Brizuela, Ala Curteanu, Meile Minkauskiene, Kapila Jayaratne, et al. "Perinatal outcomes among births to women with infection during pregnancy." Archives of Disease in Childhood 106, no. 10 (September 2, 2021): 946–53. http://dx.doi.org/10.1136/archdischild-2021-321865.
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ObjectiveThis study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC).DesignWe conducted a 1-week inception hospital-based cohort study.SettingThe study was carried out in 408 hospitals in 43 LMIC of all the WHO regions in 2017.PatientsWe included women with suspected or confirmed infection during pregnancy with at least 28 weeks of gestational age up to day-7 after birth. All babies born to those women were followed from birth until the seventh day after childbirth. Perinatal outcomes were considered at the end of the follow-up.Main outcome measuresPerinatal outcomes were (i) babies alive without severe complication, (ii) NNM and (iii) perinatal death (stillbirth and early neonatal death).Results1219 births were analysed. Among them, 25.9% (n=316) and 10.1% (n=123) were NNM and perinatal deaths, respectively. After adjustment, maternal pre-existing medical condition (adjusted odds ratios (aOR)=1.5; 95% CI 1.1 to 2.0) and maternal infection suspected or diagnosed during labour (aOR=1.9; 95% CI 1.2 to 3.2) were the independent risk factors of NNM. Maternal pre-existing medical condition (aOR=1.7; 95% CI 1.0 to 2.8), infection-related severe maternal outcome (aOR=3.8; 95% CI 2.0 to 7.1), mother’s infection suspected or diagnosed within 24 hours after childbirth (aOR=2.2; 95% CI 1.0 to 4.7) and vaginal birth (aOR=1.8; 95% CI 1.1 to 2.9) were independently associated with increased odds of perinatal death.ConclusionsOverall, one-third of births were adverse perinatal outcomes. Pre-existing maternal medical conditions and severe infection-related maternal outcomes were the main risk factors of adverse perinatal outcomes.
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Clark, Margaret. "Lung Volume Reduction with Video Assisted Thoracic Surgery." British Journal of Perioperative Nursing (United Kingdom) 12, no. 10 (October 2002): 365–69. http://dx.doi.org/10.1177/175045890201201003.
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This article aims to describe lung volume reduction (LVR) and some aspects of perioperative care. LVR is a surgical treatment for emphysema. An understanding of the operation and the patient's pre-existing medical condition is important for skilled and appropriate care, particularly in anaesthetic and recovery rooms.
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Kansara, Tejal N., Tushar M. Shah, and Foram R. Lalcheta. "A study of maternal mortality due to non-obstetric causes." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 5 (April 29, 2019): 2027. http://dx.doi.org/10.18203/2320-1770.ijrcog20191961.
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Background: Pregnancy, although being considered a physiological state, carries the risk of serious maternal morbidity and at times mortality, due to various complications that may arise during pregnancy, labour or thereafter. The existing medical condition, infection, and surgical condition which is collectively called as non- obstetric cause pre disposes a women for more complication than a non-pregnant women, so much so that it can lead to maternal mortality. Thus, Pregnancy is more vulnerable state and present study was carried out to study, analyse and review various non-obstetrics causes of death of women during pregnancy or within 42 days of termination of pregnancy in Tertiary care centre.Methods: This was an Observational study, conducted in the department of obstetrics and gynaecology, at a tertiary care hospital attached with medical college, from October 2016 to October 2018. The details of maternal deaths were collected from various departments with non- obstetric causes and analyzed.Results: The total number of deliveries in my study period was 15,208. There were 197 maternal mortality in our study period, of which 51 women died of non-obstetric causes. The most common cause of maternal mortality in our study was hepatic cause i.e. 33.33% amongst which viral hepatitis was the most common cause followed by respiratory (19.60%), infectious (15.18%), heamoglobinopathy (13.72%), cardiac (5.88%), neurological (5.88%), surgical (5.88%) causes.Conclusions: Looking into our study, maternal mortality can be reduced by identifying various different indirect medical causes which are preventable by proper pre-pregnancy evaluation for pre-existing comorbid conditions.
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De La Cruz, Evy, Yazmin Gamez, Jaini Patel, Laija Shah, and Darpan I. Patel. "The Effects of the COVID-19 Pandemic on Individual’s Physical Activity Levels and Mental Health: A Descriptive, Cross-Sectional Study in Mumbai." Shanlax International Journal of Arts, Science and Humanities 10, no. 1 (July 1, 2022): 16–23. http://dx.doi.org/10.34293/sijash.v10i1.4779.
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Background: COVID-19 has impacted the well-being of individuals living in India. Lockdowns have helped prevent the spread of COVID-19. Alternatively, this has led to negative impacts on maintaining healthy lifestyles. This study describes the physical activity and mental health status of Mumbai residents living with and without pre-existing illnesses.
Objective: This descriptive, cross-sectional study reviews survey responses from participants from Mumbai, India.
Methods and Material: An online survey was disseminated via social media platforms. Respondents answered questions regarding their demographics, health history, mental status, and physical activity levels pre-pandemic and after the COVID-19 pandemic declaration.Descriptive statistical analysis was completed. A paired sample t-test was used to calculate differences between pre-pandemic and post-pandemic effects. Significance was set at p<0.05.
Results: A total of 146 responses were returned. Approximately 42% of participants reported having one or more pre-existing medical condition. Total participants reported increased sedentary lifestyle after the declared pandemic (p=0.0001per weekday and p=0.006per weekend). Although not significant, physical activity levels were reduced by 35% in participants with pre-existing medical conditions. Respondents reported having increased feelings of nervousness, anxious, or being on edge post-COVID (p=0.01). Significant decrease in general feelings of sadness (p=0.006), anxiety (p=0.03) and stress (p=0.002) post-COVID were also reported.
Conclusions: Quarantine measures trigger psychological problems in certain areas. Physical activity has benefits to reduce COVID-19 infection while also promoting psychological health, thus promoting physical activity should be a public health priority.
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Ong, Paul M., Chhandara Pech, Nataly Rios Gutierrez, and Vickie M. Mays. "COVID-19 Medical Vulnerability Indicators: A Predictive, Local Data Model for Equity in Public Health Decision Making." International Journal of Environmental Research and Public Health 18, no. 9 (April 30, 2021): 4829. http://dx.doi.org/10.3390/ijerph18094829.
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This article reports the outcome of a project to develop and assess a predictive model of vulnerability indicators for COVID-19 infection in Los Angeles County. Multiple data sources were used to construct four indicators for zip code tabulation areas: (1) pre-existing health condition, (2) barriers to accessing health care, (3) built environment risk, and (4) the CDC’s social vulnerability. The assessment of the indicators finds that the most vulnerable neighborhoods are characterized by significant clustering of racial minorities. An overwhelming 73% of Blacks reside in the neighborhoods with the two highest levels of pre-existing health conditions. For the barriers to accessing health care indicator, 40% of Latinx reside in the highest vulnerability places. The built environment indicator finds that selected Asian ethnic groups (63%), Latinx (55%), and Blacks (53%) reside in the neighborhoods designated as high or the highest vulnerability. The social vulnerability indicator finds 42% of Blacks and Latinx and 38% of selected Asian ethnic group residing in neighborhoods of high vulnerability. The vulnerability indicators can be adopted nationally to respond to COVID-19. The metrics can be utilized in data-driven decision making of re-openings or resource distribution such as testing, vaccine distribution and other pandemic-related resources to ensure equity for the most vulnerable.
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Almatrooshi, Ibtisam Obaid, and Nelofar Sami Khan. "Impact of age dominating over the pre-existing comorbidities influencing the D-Dimer levels in SARS-COV-2 infection." Journal of Applied and Natural Science 15, no. 1 (March 19, 2023): 120–27. http://dx.doi.org/10.31018/jans.v15i1.4231.
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COVID-19-related disease severity is more commonly seen in elderly patients with comorbidities, and hypercoagulability has been demonstrated to be involved in the disease progression. This study aimed to evaluate the level of D-Dimer in hospitalized SARS-COV-2 infected patients and to determine the influence of age, gender, Body Mass Index (BMI), and comorbidities on D-dimer value and correlate it with disease severity. This case-control retrospective study retrieved patient data on demographic characteristics, vital functions, comorbidities, disease severity [National Institutes of Health (NIH) classification], and D-dimer from medical records of Thumbay University Hospital, Ajman, United Arab Emirates. SPSS-Version-28 was used for data analysis; a Chi-Square test was done to compare the distribution of comorbidities and disease severity between demographic categories. An independent sample t-test and one-way ANOVA were done to compare mean levels of D-Dimer between two or more categories, respectively. The majority of patients were males, ˃40 years of age, overweight/obese, with 30% having one comorbidity and 20% having ≥2 comorbidities. Among the total, three-quarters had moderate, and one-quarter had severe disease conditions, irrespective of gender or BMI, with an increasing trend of severe cases in the older age group and with comorbidities. Increased D-dimer levels were seen in the majority of SARS-COV-2-infected hospitalized patients, with age as the primary determinant, irrespective of absence or presence of comorbidity, though the trend of higher prevalence of elevated D-dimer value in the multiple comorbid groups and more severe condition was observed. Supporting SAR-COV-2 as a coagulopathic condition, D-dimer concentrations can be a helpful marker of disease progression and can be considered to guide the clinical treatment.
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Deledda, Giuseppe, Niccolò Riccardi, Stefania Gori, Sara Poli, Matteo Giansante, Eleonora Geccherle, Cristina Mazzi, et al. "The Impact of the SARS-CoV-2 Outbreak on the Psychological Flexibility and Behaviour of Cancelling Medical Appointments of Italian Patients with Pre-Existing Medical Condition: The “ImpACT-COVID-19 for Patients” Multi-Centre Observational Study." International Journal of Environmental Research and Public Health 18, no. 1 (January 5, 2021): 340. http://dx.doi.org/10.3390/ijerph18010340.
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Psychological distress imposed by the SARS-CoV-2 outbreak particularly affects patients with pre-existing medical conditions, and the progression of their diseases. Patients who fail to keep scheduled medical appointments experience a negative impact on care. The aim of this study is to investigate the psychosocial factors contributing to the cancellation of medical appointments during the pandemic by patients with pre-existing health conditions. Data were collected in eleven Italian hospitals during the last week of lockdown, and one month later. In order to assess the emotional impact of the SARS-CoV-2 outbreak and the subject’s degree of psychological flexibility, we developed an ad hoc questionnaire (ImpACT), referring to the Acceptance and Commitment Therapy (ACT) model. The Impact of Event Scale-Revised (IES-R), the Depression, Anxiety and Stress Scale (DASS) and the Cognitive Fusion Questionnaire (CFQ) were also used. Pervasive dysfunctional use of experiential avoidance behaviours (used with the function to avoid thought, emotions, sensations), feelings of loneliness and high post-traumatic stress scores were found to correlate with the fear of COVID-19, increasing the likelihood of cancelling medical appointments. Responding promptly to the information and psychological needs of patients who cancel medical appointments can have positive effects in terms of psychological and physical health.
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Patel, Darpan I., Yazmin Gamez, Lajja Shah, and Jaini Patel. "Decline of Psychological Health Following the Designation of COVID-19 as a Pandemic: Descriptive Study." Journal of Medical Internet Research 23, no. 4 (April 22, 2021): e24964. http://dx.doi.org/10.2196/24964.
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Background COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, and as of this writing, Texas, United States, has reported >675,000 cases with over 14,000 deaths. Many of the preventive measures implemented during the pandemic can increase sedentary lifestyles, which can lead to the development of chronic diseases, including obesity, among the general population and cause serious threats to people’s physical health and overall quality of life. Individuals with pre-existing comorbidities are at an increased risk of COVID-19 and may hence have higher levels of stress. Objective This study aimed to investigate the relationship between physical activity levels and mental health status on an individual level and to compare them between those with and those without comorbidities in a cohort of Texas residents, before and after COVID-19 was declared a pandemic. Methods An electronic survey was disseminated throughout various regions of Texas. In total, 160 individuals were asked questions about their demographic characteristics, time spent on daily physical activities, and daily mental health status before and after COVID-19 was declared a pandemic. Frequency distributions and descriptive statistics were analyzed. Results Overall, 94 (58%) participants reported having ≥1 medical condition, and 31 (13.1%) had >3 medical conditions. Physical activity levels among participants with ≥1 pre-existing comorbidity drastically—but not significantly—decreased, as evident from a 10% increase in sedentary lifestyles after COVID-19 was declared a pandemic. On the contrary, we observed a 9% increase in the number of individuals without a pre-existing comorbidity who reported 30-60 min of physical activity per week. There was a 2-fold increase in the number of participants reporting more frequent feelings of nervousness, too much worry, trouble relaxing, and the fear of something awful happening after the pandemic. More specifically, individuals with pre-existing medical conditions reported, on average, a 10% higher incidence of feelings of stress, anxiety, and sadness compared to their healthy counterparts after COVID-19 was declared a pandemic. Conclusions Stressful life conditions and chronic comorbidities are risk factors that can affect mental health and reduce the ability to perform activities of daily life. Therefore, when implementing pandemic protocols, municipalities should consider providing mental health support to their citizens to protect them from this rather inconspicuous adverse effect.
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Shah, K., C. Trivedi, and H. Mekala. "Mood disorders and suicides during coronavirus pandemic." European Psychiatry 64, S1 (April 2021): S294. http://dx.doi.org/10.1192/j.eurpsy.2021.789.
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IntroductionThe outbreak of COVID-19 has disrupted the lives of countless people worldwide. The pandemic has imposed a sense of uncertainty and anxiety, as the world could not predict or prepare for this crisis. It is important to study risk factors, including employment, marital status, and pre-existing medical or psychiatric conditions to effectively handle this pandemic’s mental health impact.ObjectivesWe aim to evaluate factors contributing to the suicides and mood disorders during the coronavirus pandemic.MethodsWe examined MeSH terms “COVID-19” in the context of “Mood Disorders,” “Suicide,” “Suicidal Ideation,” “Assisted or Suicide, Attempted or Suicide,” “Risk Factors.” We identified eight case studies for the qualitative synthesis per the PRISMA guidelines, searching Medline, PubMed, PubMed Central, and PsychInfo databases until August 2020.ResultsWe identified that the population of all age groups and sex are at risk of stress and mental illness due to the pandemic. Several factors are attributed to the increased risk of mood disorders and suicide. Not having pre-existing psychiatric or medical condition is not a protective factor, since suicide was attempted or committed due to external factors such as economic and social.ConclusionsThe pandemic has increased the risk of mood disorder and suicides in the population. Focus should be on the behavioral and psychological first aid to curb stress.
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Lopez-Olivo, Maria A., Gabrielle F. Duhon, Juan I. Ruiz, Mehmet Altan, Hussein Tawbi, Adi Diab, Clifton O. Bingham, et al. "Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study." Cancers 15, no. 10 (May 10, 2023): 2690. http://dx.doi.org/10.3390/cancers15102690.
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Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions).
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Hamzani, Yafit, Helena Demetriou, Adi Zelnik, Nir Cohen, Michael J. Drescher, Gavriel Chaushu, and Bahaa Haj Yahya. "Impact of Comorbidities on Hospitalization for Injuries in Riders of Electric Bikes and Powered Scooters: A Retrospective Cross-Sectional Study." Medicina 58, no. 5 (May 13, 2022): 659. http://dx.doi.org/10.3390/medicina58050659.
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Background and Objectives: Injuries associated with electric bikes (E-bikes) and powered scooters (P-scooters) have increased yearly worldwide. We aimed to evaluate the impact of pre-existing comorbidities on the probability of hospitalization for injuries in riders of E-bikes and P-scooters. Materials and Methods: A retrospective cross-sectional study design was used. The cohort included patients referred to the emergency department (ED) of a tertiary medical center in 2014–2020 for injuries sustained while riding an E-bike or P-scooter. Data were collected from the medical files on demographics, clinical characteristics including pre-existing comorbidities and permanent use of medications, and injury characteristics. Findings were compared between patients referred for hospitalization from the ED and patients discharged home. Results: Of the 1234 patients who met the inclusion criteria, 202 (16.4%) had a prior medical condition and 167 (13.5%) were taking medication on a permanent basis. A significant relationship was found between hospitalization and having a medical condition (𝜒2(1) = 9.20, p = 0.002) or taking medication on a permanent basis (𝜒2(1) = 6.24, p = 0.01). Hospitalization for injuries was more likely in patients with a comorbidity (27.8%) than those without a comorbidity (15.5%), and in patients who were on permanent drug therapy (22.2%) than in patients who were not (12.9%). Surprisingly, anticoagulant intake specifically had no effect on the probability of hospital admission. Conclusions: Patients with comorbidities have a higher incidence of hospitalization for E-bike- and P-scooter-associated injuries. Therefore, physicians may take into account comorbidities for the effective management of this patient group’s injuries.
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Piwuna, CG, TO Piwuna, N. Dami, MA Bankat, TM Agbir, and CN Nwoga. "Depression among Older Adult Prisoners at the Jos Central Prison- North Central Nigeria." Journal of BioMedical Research and Clinical Practice 2, no. 3 (December 6, 2019): 167–71. http://dx.doi.org/10.46912/2i3.2019119.
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This study was carried out to determine the prevalence of depression and its correlates among Older Adult Prisoners at the Jos Central Prison, North Central Nigeria. The study was a cross-sectional descriptive chart, conducted at the Jos Central prisons on eighty-six (86) older prisoners between June 2012 to December 2012. Bio-demographic data and history of any chronic medical condition as well as that of psychiatric condition were also obtained from their clinical records in the clinic located within the prison. Depression was assessed using the Geriatric Depression Scale (GDS) on all the volunteers 50 years and above. The GDS measures cognitive, affective, functional state and a factor that reflects helplessness and fear for the future. The study was largely composed of male making up to 99%. The age range was between 50 to 75 years with a mean 54.36 (SD 3.24) with most of them between 50 to 60 years (90%). A quarter (25%) had not received any form of education while 7 out of 10 had received some form of education. Majority of them were employed (skilled or un-skilled employment) before incarceration. Only 2% were unemployed before their incarceration. Those incarcerated for violent crimes (65%) nearly doubled those in prison for non-violent crimes 35%. Occupational status, pre-existing medical conditions and the perception of their health status before incarceration were found to be statistically significant. Type of crimes committed was not statistically significant. Known chronic medical condition(s) was a risk factor in the inmates developing depression (P-value =0.009). In comparing the specific medical conditions with depression, significant findings were found (P-value= 0.003). The study revealed a prevalence of depression at 59% in older prisoners of 50 years and above. The significant predictors of depression include occupational status, pre-exisitng medical conditions, and the perception of their health status before incarceration were found to be statistically significant.
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Piwuna, CG, TO Piwuna, N. Dami, MA Bankat, TM Agbir, and CN Nwoga. "Depression among Older Adult Prisoners at the Jos Central Prison- North Central Nigeria." Journal of BioMedical Research and Clinical Practice 2, no. 3 (December 6, 2019): 167–71. http://dx.doi.org/10.46912/jbrcp.119.
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This study was carried out to determine the prevalence of depression and its correlates among Older Adult Prisoners at the Jos Central Prison, North Central Nigeria. The study was a cross-sectional descriptive chart, conducted at the Jos Central prisons on eighty-six (86) older prisoners between June 2012 to December 2012. Bio-demographic data and history of any chronic medical condition as well as that of psychiatric condition were also obtained from their clinical records in the clinic located within the prison. Depression was assessed using the Geriatric Depression Scale (GDS) on all the volunteers 50 years and above. The GDS measures cognitive, affective, functional state and a factor that reflects helplessness and fear for the future. The study was largely composed of male making up to 99%. The age range was between 50 to 75 years with a mean 54.36 (SD 3.24) with most of them between 50 to 60 years (90%). A quarter (25%) had not received any form of education while 7 out of 10 had received some form of education. Majority of them were employed (skilled or un-skilled employment) before incarceration. Only 2% were unemployed before their incarceration. Those incarcerated for violent crimes (65%) nearly doubled those in prison for non-violent crimes 35%. Occupational status, pre-existing medical conditions and the perception of their health status before incarceration were found to be statistically significant. Type of crimes committed was not statistically significant. Known chronic medical condition(s) was a risk factor in the inmates developing depression (P-value =0.009). In comparing the specific medical conditions with depression, significant findings were found (P-value= 0.003). The study revealed a prevalence of depression at 59% in older prisoners of 50 years and above. The significant predictors of depression include occupational status, pre-exisitng medical conditions, and the perception of their health status before incarceration were found to be statistically significant.
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Piwuna, CG, TO Piwuna, N. Dami, MA Bankat, TM Agbir, and CN Nwoga. "Depression among Older Adult Prisoners at the Jos Central Prison- North Central Nigeria." Journal of BioMedical Research and Clinical Practice 2, no. 3 (December 6, 2019): 167–71. http://dx.doi.org/10.46912/jbrcp.v2.i3.2019.119.
Full textAbstract:
This study was carried out to determine the prevalence of depression and its correlates among Older Adult Prisoners at the Jos Central Prison, North Central Nigeria. The study was a cross-sectional descriptive chart, conducted at the Jos Central prisons on eighty-six (86) older prisoners between June 2012 to December 2012. Bio-demographic data and history of any chronic medical condition as well as that of psychiatric condition were also obtained from their clinical records in the clinic located within the prison. Depression was assessed using the Geriatric Depression Scale (GDS) on all the volunteers 50 years and above. The GDS measures cognitive, affective, functional state and a factor that reflects helplessness and fear for the future. The study was largely composed of male making up to 99%. The age range was between 50 to 75 years with a mean 54.36 (SD 3.24) with most of them between 50 to 60 years (90%). A quarter (25%) had not received any form of education while 7 out of 10 had received some form of education. Majority of them were employed (skilled or un-skilled employment) before incarceration. Only 2% were unemployed before their incarceration. Those incarcerated for violent crimes (65%) nearly doubled those in prison for non-violent crimes 35%. Occupational status, pre-existing medical conditions and the perception of their health status before incarceration were found to be statistically significant. Type of crimes committed was not statistically significant. Known chronic medical condition(s) was a risk factor in the inmates developing depression (P-value =0.009). In comparing the specific medical conditions with depression, significant findings were found (P-value= 0.003). The study revealed a prevalence of depression at 59% in older prisoners of 50 years and above. The significant predictors of depression include occupational status, pre-exisitng medical conditions, and the perception of their health status before incarceration were found to be statistically significant.
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Dasanu, Constantin A., Steven C. Plaxe, Iliana M. Popescu, Varun Gupta, Eric Sontz, and Ion Codreanu. "Severe left atrial enlargement due to carfilzomib use in multiple myeloma." Journal of Oncology Pharmacy Practice 25, no. 8 (January 12, 2019): 2045–48. http://dx.doi.org/10.1177/1078155218825298.
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Several cardiovascular effects have been attributed to carfilzomib in the recent literature. These side effects must be recognized promptly by treating physicians and pharmacists. Special attention is required in patients with pre-existing cardiac conditions, liver function abnormalities and/or advanced age. This is the first report of a severe left atrial enlargement due to carfilzomib use in the setting of multiple myeloma. This condition improved dramatically seven months after cessation of carfilzomib. The authors discuss further various cardiac and vascular abnormalities linked with carfilzomib in the medical literature. Prompt withdrawal of this agent is essential in these cases as it may prevent dismal outcomes.
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Al-Zahiri, Jasmine, Akanksha Kumar, Arun Nair, and Tabitha Watts. "Prevalence of Neonatal Polycythemia and an Assessment of Its Related Risk Factors." Journal of Pediatrics Review 10, no. 4 (October 1, 2022): 297–304. http://dx.doi.org/10.32598/jpr.10.4.1053.1.
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Background: Neonatal polycythemia is a condition that is incidentally encountered in clinical practice. It is characterized by elevated hemoglobin levels (above 22 g/dL) and hematocrit ratios above 65%. It is important to understand both the prevalence as well as the related risk factors of this condition as untreated preventable risk factors can result in the development of hyperviscosity syndromes leading to potential multiple organ failure. Prevalence and Risk Factors: Risk factors include the presence of twin-to-twin transfusion, pre-eclampsia, maternal hypertension, operator-dependent cord clamping, and the presence of co-morbid conditions in neonates. The prevalence of neonatal polycythemia varies among regions and factors that may affect this variation include elevation above sea level of the patient and the mother, management of perinatal conditions such as gestational diabetes mellitus, and the method of delivery. Conclusions: From this study, it is evident that not only do existing neonatal and maternal risk factors such as twin-to-twin transfusion syndrome and post-term deliveries, respectively, increase the risk of neonatal polycythemia but also the geographical and socioeconomic status are major factors. It is therefore imperative to conduct more thorough large-scale cohort studies to further understand the reasons for this.
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Lui, Sheng Jie, Cheng Xiang, and Shonali Krishnaswamy. "KAMEL: Knowledge Aware Medical Entity Linkage to Automate Health Insurance Claims Processing." Proceedings of the AAAI Conference on Artificial Intelligence 38, no. 21 (March 24, 2024): 22797–805. http://dx.doi.org/10.1609/aaai.v38i21.30314.
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Automating the processing of health insurance claims to achieve "Straight-Through Processing" is one of the holy grails that all insurance companies aim to achieve. One of the major impediments to this automation is the difficulty in establishing the relationship between the underwriting exclusions that a policy has and the incoming claim's diagnosis information. Typically, policy underwriting exclusions are captured in free-text such as "Respiratory illnesses are excluded due to a pre-existing asthma condition". A medical claim coming from a hospital would have the diagnosis represented using the International Classification of Disease (ICD) codes from the World Health Organization. The complex and labour-intensive task of establishing the relationship between free-text underwriting exclusions in health insurance policies and medical diagnosis codes from health insurance claims is critical towards determining if a claim should be rejected due to underwriting exclusions. In this work, we present a novel framework that leverages both explicit and implicit domain knowledge present in medical ontologies and pre-trained language models respectively, to effectively establish the relationship between free-text describing medical conditions present in underwriting exclusions and the ICD-10CM diagnosis codes in health insurance claims. Termed KAMEL (Knowledge Aware Medical Entity Linkage), our proposed framework addresses the limitations faced by prior approaches when evaluated on real-world health insurance claims data. Our proposed framework have been deployed in several multi-national health insurance providers to automate their health insurance claims.
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Liauw, Djai Yen, and Vionita Simanjuntak. "THYROID CRISIS AS THE CAUSE OF SUDDEN DEATH: AN AUTOPSY FINDING." Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya 11, no. 1 (January 17, 2024): 32–38. http://dx.doi.org/10.32539/jkk.v11i1.227.
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Sudden death can occur due to previously known or undiagnosed thyroid diseases. This case reports the death of a 21-year-old woman with symptoms suggestive of thyroid crisis. The victim’s family suspected foul play based on physical findings on the body. However, police investigation and autopsy results revealed a history of pre-existing thyroid disease. The autopsy findings showed enlargement of the thyroid gland and lung edema. Forensic histology also revealed chronic inflammation in the thyroid gland and bleeding in the lung tissue. In conclusion, the victim’s death was attributed to poorly controlled hyperthyroidism which leads to thyroid crisis. This case highlights the importance of proper management and treatment of thyroid diseases, as well as knowledge of physical signs related to postmortem changes. In this context, the case does not fulfill criminal elements but is more related to the pre-existing health condition of the victim. Therefore, a comprehensive analysis is conducted, considering the available information, including the victim’s medical history, witness testimonies, autopsy findings, and other relevant evidence. The investigation of this case holds broad significance, not only in the medical and forensic aspects but also in terms of legal and justice implications.
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Montiel, Monica, Carlos Fernando Garcia Gerardi, Ernesto Gil Deza, Eduardo L. Morgenfeld, Gaston Martin Reinas, Edgardo G. J. Rivarola, and Felipe G. Gercovich. "Past medical history (PMH) in oncology: Which is the best source, the doctor or the patient? A prospective double blind study." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): e17539-e17539. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.e17539.
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e17539 Background: The usual way in which Argentinean doctors (Dr) register a patient’s (Pt) PMH in the Clinical record (CR) is the anamnesis. It has proved to be quite heterogeneous. At the Instituto Oncológico Henry Moore (IOHM) a PMH form was designed to be filled out by the Pt before the interview. The objective of this paper is to compare and contrast the amount and quality of PMH information registered by Pt and Dr through a double blind study in order to assess the usefulness of the PMH form. Methods: Between Dec 13th and Dec 20th, 2012, data was collected from all new Pt assisted at the IOHM. In the case that the PMH registered a severe pre-existing condition that was not present in the CR, the physician in charge was made aware of this fact. By indication of the IRB, an interim analysis had to be carried out a week after the study had begun. If the quantity of information proved to be 25% greater or the quality proved to be 5% greater in favor of Pt, the study should be finished. Results: A total of 73 P were included in a prospective double blind study. Sex: 42 males/31 females; Mean age 58.7y (range 21-88); Tumor diagnosis: urological 24, gynecological 17, gastrointestinal 11, other 21. PMH forms filled out by Pt showed 878 pre-existing medical conditions: mean 12 (range 1-35); the CR filled out by Dr showed 453 pre-existing medical conditions: mean 6 (range 0-21). In 3 CR, Dr registered data that Pt had not. A total of 67 CR (92%) showed less data than the PMH, Mean 6 (range 1-21). Quality analysis demonstrated that 15% of the unregistered data could be relevant in medical decisions. Due to the overwhelming differences between registries, the study was finished and the Pt´s PMH form was included as part of the CR at the IOHM. Conclusions: 1) The quality and quantity of data acquired by using the PMH form far exceeds that of the data registered by doctors in CR. 2) In 15% of all the cases, this information could be relevant in medical decision making. 3) In only 3 cases, doctors registered more data than patients using the PMH form. 4) A form filled out by the patient and reviewed by the doctors could be a significant tool on preventing malpractice.
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St Leger Dowse, Marguerite, Matthew K. Waterman, Rhodri Jones, and Gary R. Smerdon. "Aural health awareness and incident prevention in UK scuba divers." Diving and Hyperbaric Medicine Journal 52, no. 1 (March 31, 2022): 22–26. http://dx.doi.org/10.28920/dhm52.1.22-26.
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Introduction: Otological disorders, including Eustachian tube dysfunction (ETD), are commonly observed in divers. Data were gathered to observe the prevalence of ear disorders, and awareness of ear health recommendations for recreational divers in the United Kingdom. Methods: An anonymous online survey included: diver/diving demographics, the validated Eustachian Tube Dysfunction Questionnaire 7 (ETDQ-7) (a mean score of ≥ 2.1 indicating the presence of dysfunction), pre-existing ear health conditions, medications, decongestants and knowledge of diving and ear health guidance. Results: A total of 790 divers (64% males) responded (age range 16-80, median 47 years). An ETDQ-7 mean score of ≥ 2.1 was calculated in 315 of 790 respondents (40%), indicating varying degrees of ETD; 56/315 (18%) recorded a pre-existing ear condition. Ear disorders, (external, middle, and inner ear issues) since learning to dive were recorded by 628/790 (79%) of respondents; 291/628 (46%) did not seek medical advice. ETDQ-7 scores of ≥ 2.1 to 6.6 were reported by 293/628 (47%). Six reported inner ear decompression sickness. Decongestants were used by 183/790 (23%). Two hundred and seventy-seven of 790 divers (35%) had aborted a dive with ear problems. Only 214/790 (27%) of respondents were aware of the United Kingdom Diving Medical Committee guidance regarding ear health and diving. Conclusions: Ear problems and ETD since diving were widely reported in this cohort of divers, with not all divers in this study aware of ear health recommendations and advice.
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Moiseeva, Irina Е. "Hypertension in pregnancy in general practice." Russian Family Doctor 23, no. 2 (August 8, 2019): 15–20. http://dx.doi.org/10.17816/rfd2019215-20.
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Hypertension occurs in 5–30% of pregnant women. Its medical and social significance is associated with the risk of a negative impact on the course of pregnancy and on the condition of the fetus and newborn.This requires from the general practitioner to have enough knowledge and skills in this area.Clinical variants of hypertension in pregnancy include pre-existing hypertension (chronic hypertension), gestational hypertension, chronic hypertension complicated by preeclampsia, and preeclampsia/eclampsia.The main tasks of general practitioners — early diagnosis, proper treatment and prevention of complications of hypertension in pregnant women.
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Lippmann, John, David McD Taylor, Christopher Stevenson, Jo Williams, and Simon J. Mitchell. "Diving with pre-existing medical conditions." Diving and Hyperbaric Medicine Journal 47, no. 3 (September 30, 2017): 180–90. http://dx.doi.org/10.28920/dhm47.3.180-190.
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Ericsson, Charles D. "Travellers with pre-existing medical conditions." International Journal of Antimicrobial Agents 21, no. 2 (February 2003): 181–88. http://dx.doi.org/10.1016/s0924-8579(02)00288-1.
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Lieba-Samal, Doris, Patrick Platzer, Stefan Seidel, Petra Klaschterka, Astrid Knopf, and Christian Wöber. "Characteristics of acute posttraumatic headache following mild head injury." Cephalalgia 31, no. 16 (December 2011): 1618–26. http://dx.doi.org/10.1177/0333102411428954.
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Background: To examine the prevalence and characteristics of acute posttraumatic headache (APTH) attributed to mild head injury within a prospective, observational study design. Methods: We recruited 100 patients with acute mild head injury as defined in the International Classification of Headache Disorders, 2nd Edition (ICHD-2) presenting to the department of trauma surgery at the Medical University of Vienna. Patients underwent a detailed telephone interview between days 7 and 10 and between days 90 and 100 after the injury. Results: The prevalence of APTH was 66%. APTH had occurred within 24 hours after the trauma in 78% and lasted for a median of 3.0 days. Headache was unilateral in 45%. Aggravation by physical activity, nausea and photo-/phonophobia was present in 49%, 42% and 55%, respectively. The prevalence of APTH was related to conditions of chronic pain (excluding headache), pre-existing episodic headache, number of posttraumatic symptoms, anxiety and depression. At follow-up at 90–100 days, posttraumatic headache had abated in all patients. Conclusions: APTH attributed to mild head injury is a common but self-limiting condition frequently showing migrainous features. Participants with chronic pain other than headache, pre-existing headache and affective disorders are at higher risk of developing APTH. None of the patients developed chronic posttraumatic headache.
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Cairns, Mark K. "Unfit Assessments of Class 1 Medical Certificate Holders." Aerospace Medicine and Human Performance 92, no. 12 (December 1, 2020): 945–49. http://dx.doi.org/10.3357/amhp.5881.2021.
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INTRODUCTION: An aviation safety management system should consider and mitigate against all potential risks to flight safety. In addition to in-flight incapacitation, pilots falling below regulatory standards who are assessed as unfit may have represented a risk prior to that assessment. An analysis was undertaken of Class 1 certificate holders to determine factors correlated with unfit assessments.METHODS: Fitness assessments of pre-existing Class 1 certificate holders following medical examinations (to EASA Part-MED standards) or between medicals were studied between 1 January 2016 and 31 December 2019. Assessments where the outcome was ‘fit’ (N= 99,406) were compared with those where the outcome was ‘unfit’ (N= 7925). Analyses for correlation between unfit assessments against age, declared coexisting medical conditions, and the number of days since last assessed as fit were undertaken using SPSS.RESULTS: Unfit assessment likelihood and age were strongly correlated; there is, however, evidence for the ‘healthy worker effect’, with a fall in unfit assessments between 60–65 yr of age. There was no association between coexisting medical condition declaration and the likelihood of becoming unfit. The time interval between a fit and unfit assessment was significantly lower when comparing 20–60 and 61–63 yr old individuals.DISCUSSION: The analysis of unfit assessments shows strong correlation with increasing age and the possible presence of the healthy worker effect among commercial pilots. The decreased time from a previous fit assessment to an unfit assessment supports the reduced certificate validity period of Class 1 applicants over 60 yr of age.Cairns MK. Unfit assessments of Class 1 Medical certificate holders. Aerosp Med Hum Perform. 2021; 92(12):945–949
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Brigham, Christopher R. "Performing Quality Impairment Evaluations." Guides Newsletter 3, no. 4 (July 1, 1998): 1–3. http://dx.doi.org/10.1001/amaguidesnewsletters.1998.julaug01.
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Abstract An impairment evaluation aims to produce a report that is clear and consistent with the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, which outlines the three-step process of medical evaluation, analysis of the findings, and comparison of the results with the impairment criteria. This article reviews common errors that can occur in each of these steps. Medical evaluation is the basis for the evaluation of impairment and relies on the patient's medical history; the latter must include adequate background information, specify data sources, document pre-existing status and specifics of the injury, and document history from onset to current status. The medical evaluation should support a report that explains the effects of the medical condition on life activities; whether the medical condition is stable; whether the individual is likely to suffer incapacitation, injury, harm, or further impairment; and whether restrictions or accommodations are warranted. Common errors in this step include determinations of permanency and stability, and raters should be aware that the AMA Guides is used to assess impairment, not disability. Forms from the AMA Guides are appropriate and help mitigate errors. An audit form is included and can help physicians produce consistent, efficient reports.
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Wickwire, Emerson, and Jennifer Albrecht. "0554 Racial Disparities in Healthcare Resource Utilization among Older Adult Medicare Beneficiaries With Comorbid OSA and Depression." SLEEP 46, Supplement_1 (May 1, 2023): A244. http://dx.doi.org/10.1093/sleep/zsad077.0554.
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Abstract Introduction Depression and obstructive sleep apnea (OSA) are highly comorbid and independently associated with increased economic burden. Evidence suggests important racial disparities in diagnosis and treatment of each condition. This study sought to evaluate the economic burden of occult OSA among Black and White older adults with depression. We hypothesized that the impact of occult OSA on healthcare resource utilization would differ by race. Methods Data were derived from a 5% sample of Medicare administrative claims data. Inclusion criteria were age >64 years, 12 months continuous enrollment prior to OSA diagnosis, depression, and Black or White race. Undiagnosed OSA and pre-existing depression were defined using ICD-10 codes during the 12 months prior OSA diagnosis. HCRU was defined as monthly counts of inpatient, outpatient, and emergency department (ED) visits in each of the 12 months before OSA diagnosis. The relationship between undiagnosed OSA and HCRU was modeled using negative binomial regression. Inverse probability of treatment (IPT) weighting was used to balance covariates between groups. Effect modification by race was evaluated using an interaction term; estimates were stratified by race. Results Of 39,192 beneficiaries with pre-existing depression, 4,353 suffered undiagnosed OSA (n=325 Black adults, 7.5%). Relative to White beneficiaries with undiagnosed OSA, Black beneficiaries with undiagnosed OSA were more likely to be female (76.6% vs. 68.6%, p=.002) and to suffer multimorbidity (>7 comorbid conditions [71.7% vs 52.7%, p<.001]). In IPT weighted models and relative to Black non-sleep disordered controls, Black beneficiaries with undiagnosed OSA had higher inpatient (RtR 1.89; 95% CI 1.33, 2.71), outpatient (RtR 1.38; 95% CI 1.04, 1.83) and ED (RtR 1.83; 95% CI 1.22, 2.75) utilization. Relative to White non-sleep disordered controls, White beneficiaries with undiagnosed OSA demonstrated higher inpatient (rate ratio (RtR) 1.51; 95% CI 1.38, 1.65)), outpatient (RtR 1.18; 95% CI 1.10, 1.26) and ED (RtR 1.45; 95% CI 1.34, 1.57) utilization. The interaction between race and undiagnosed OSA was significant in all models (p<.001). Conclusion Among Medicare beneficiaries with pre-existing depression, comorbid undiagnosed OSA is associated with increased HCRU across multiple points of service. The strength of this association is greater among Black (vs White) beneficiaries. Support (if any) ResMed Foundation
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Tkachuk, Roman, Olena Koloskova, Mykola Garas, Tetyana Bilous, Iryna Gurina, Andii Polishchuk, and Viktoriia Antoniichuk. "Justification of Intensive care management of children with severe COVID19 (а case study)." Ukrainian Scientific Medical Youth Journal 144, no. 1 (March 28, 2024): 208–15. http://dx.doi.org/10.32345/usmyj.1(144).2024.208-215.
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the unprecedented COVID-19 pandemic that spread across the world and lasted for more than 3 years had significant medical and social consequences. Despite the fact that in the children's population the coronavirus infection has a milder course and a much lower risk of mortality, there are individual cases with pre-existing comorbidities that cause severe acute respiratory distress syndrome. Thus, in most cases, severe COVID-19 developed in children with pre-existing conditions, including: immunodeficiency, diabetes mellitus, bronchial asthma, etc. Therefore, comorbidities disposed children to progress to severe Covid-19 which requires treatments with more aggressive therapeutic tactics and personalised management. The article presents a clinical case of severe acute respiratory distress syndrome caused by the SARS-CoV-2 virus in an early age child. The patient was observed in the Anesthesiology and Intensive Therapy Department of the Chernivtsi Regional Children's Clinical Hospital. Due to acute respiratory infection, the child has been developing signs of respiratory failure. The available instrumental findings confirmed right lung pneumonia, complicated by pneumothorax. Laboratory tests confirmed leukocytosis, thrombocytopenia, hypertransfusion, increased procalcitonin, increased level of C-reactive protein, D-dimer and interleukin-6 as well as circulating immune complexes. The treatment regimen included respiratory protection (oxygen therapy), support of hemodynamics (infusion of glucose-saline solutions), administration of intravenous normal human immunoglobulin, a short course of parenteral glucocorticosteroids, the use of step-by-step combined antibacterial therapy and a direct-acting antiviral drug (remdesivir), and thromboembolism prophylaxis (low-molecular-weight heparin). Following intensive treatment, the child's condition was characterised by a slow positive dynamics, leading to full recovery. This case demonstrates the need for timely detection of life-threatening conditions caused by COVID-19 and requires an aggressive management of child's condition using a complex intensive therapy.
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Negrut, Nicoleta, Georgios Menegas, Sofia Kampioti, Maria Bourelou, Francesca Kopanyi, Faiso Dahir Hassan, Anamaria Asowed, Fatima Zohra Taleouine, Anca Ferician, and Paula Marian. "The Multisystem Impact of Long COVID: A Comprehensive Review." Diagnostics 14, no. 3 (January 24, 2024): 244. http://dx.doi.org/10.3390/diagnostics14030244.
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(1) Background: COVID-19 was responsible for the latest pandemic, shaking and reshaping healthcare systems worldwide. Its late clinical manifestations make it linger in medical memory as a debilitating illness over extended periods. (2) Methods: the recent literature was systematically analyzed to categorize and examine the symptomatology and pathophysiology of Long COVID across various bodily systems, including pulmonary, cardiovascular, gastrointestinal, neuropsychiatric, dermatological, renal, hematological, and endocrinological aspects. (3) Results: The review outlines the diverse clinical manifestations of Long COVID across multiple systems, emphasizing its complexity and challenges in diagnosis and treatment. Factors such as pre-existing conditions, initial COVID-19 severity, vaccination status, gender, and age were identified as influential in the manifestation and persistence of Long COVID symptoms. This condition is highlighted as a debilitating disease capable of enduring over an extended period and presenting new symptoms over time. (4) Conclusions: Long COVID emerges as a condition with intricate multi-systemic involvement, complicating its diagnosis and treatment. The findings underscore the necessity for a nuanced understanding of its diverse manifestations to effectively manage and address the evolving nature of this condition over time.
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Catibog, Krista Maye, Ian Theodore Cabaluna, Anna Lisa Ong-Lim, Chrizarah San Juan, Maria Angela Villa, and Leonila Dans. "Clinical Characteristics and Patient Symptoms Associated with Poor Outcomes among Children with COVID-19: A Rapid Review." Pediatric Infectious Disease Society of the Philippines Journal 22, no. 2 (September 7, 2021): 66–72. http://dx.doi.org/10.56964/pidspj20212202009.
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Objective: To identify specific clinical characteristics and patient signs and symptoms that increase the risk of developing severe/critical COVID-19 disease or death in the pediatric population, and identify strength of these associations Methodology: A systematic search was done in PubMed, Science Direct, Cochrane Library and grey literature databases focusing on severe and critical COVID-19 disease in the zero to eighteen year old age group until August 26, 2020. Data regarding patient characteristics, signs and symptoms on admission and disease severity were extracted. Outcomes measured were severe or critical COVID-19, Multisystem Inflammatory Syndrome in Children (MIS-C) or death. Results were pooled and meta-analyzed. Results: Four eligible studies with a total of 292 pediatric patients with COVID-19 were examined. Older children (MD=6.62, 95%CI=4.23 to 9.00, p-value<0.00001, I2=33%) significantly present with a higher percentage of severe disease. Shortness of breath (OR=8.14, 95%CI=2.33 to 28.47, p-value=0.001, I2=42%) was also found to be associated with severe COVID-19 disease. The presence of a pre-existing medical condition (OR=4.02, 95%CI=1.55 to 10.43, p-value=0.004, I2=0%), especially cardiac disease (OR=6.40, 95%CI=1.45 to 28.38, p-value=0.01, I 2=13%) and diabetes (OR=7.01, 95%CI=1.54 to 31.95, p-value=0.01, I2=0%) was noted to be a risk factor for severe disease. Conclusion: Based on poor quality observational studies, older age group, shortness of breath, and a pre-existing medical condition, especially cardiac disease or diabetes were found to be associated with poor outcomes in children with COVID-19.
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Perera, Manodhiya Hansini, Muskan Joshi, Arun Kumar Govindan, Sudeep Edpuganti, Naga Harika Korrapati, and Natalia Kiladze. "Impact of mask wear on the skin of clinical year medical students during the COVID-19 pandemic: A cross-sectional study." Cosmoderma 2 (October 18, 2022): 96. http://dx.doi.org/10.25259/csdm_100_2022.
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Objectives: Use of facial masks since the onset of the COVID-19 pandemic has led to a new type of mechanical acne termed Maskne. Long-term wear of masks can increase skin damage leading to de novo onset of, or worsening of pre-existing facial dermatoses such as acne, rosacea, and dermatitis. We have encountered numerous studies on the effects of mask wear on skin of health-care professionals, mainly COVID-19 first responders, but there seems to be scarce literature on the effects of mask wear in medical students. The objective of the study was to investigate how mask wear during the COVID-19 pandemic has influenced the skin condition of clinical year medical students from Georgian Medical Universities. Materials and Methods: A cross-sectional study was conducted online through a survey among 152 clinical year medical students (4th, 5th, and 6th years) of Georgian Medical Universities, from February 27, 2022, to April 18, 2022. Participants’ were asked a series of questions focusing on their mask habits such as type of mask worn, duration of wear, frequency of changing the mask, and about their skin condition before and after mask usage. Results: From a total of 151 respondents, of which 69.5% (n = 105) were female and 30.5% (n = 46) were male, with majority of participants from the 5th year 48.1% (n = 62), followed by 4th year 30.5% (n = 46) and 6th year 28.5% (n = 43), 51.4% (n = 76) of students experienced acne/rosacea or had their pre-existing acne/rosacea worsen since they started wearing masks. The top three common manifestations are closed comedones 65.8% (n = 52), pustules 43% (n = 34), and papules 26.6% (n = 21). However, there was no statistically significant relationship between the type of mask used and the daily duration of wear on facial dermatoses. Conclusion: Widespread use of masks may flare up acne in some medical students causing a negative impact on their self-confidence. One of the limitation of our study is the small sample size. Furthermore, information from the participants related to hereditary and acne exposome factors that may contribute to the development of, or worsening of acne was not carried out, and no follow-up was performed. The data were collected through an online survey only, without a physical examination in person of the participants’ skin. Therefore, the details reported are up to the participants’ discretion. Further research in this area needs to be carried out with a bigger sample size and with the diagnosis of mask acne confirmed by a medical professional. It is important to diagnose and treat this new age dermatological condition in a timely manner to prevent lasting adverse effects on skin condition.