Aims: To study the effect of a large infectious-like event on admissions to, and bed occupancy in, a very large acute hospital in Reading (western Berkshire) England, observed to commence in the early part of 2012. These changes occurred in parallel with infectious-like spread of an agent leading to increased medical admissions across the whole of Berkshire. Study Design: Longitudinal study of hospital admissions, bed occupancy and deaths. Place and Duration of Study: Admissions and deaths at the Royal Berkshire Hospital NHS Foundation Trust (England) between April 2008 and September 2013. Methodology: A running 12 month total of admissions, deaths and occupied beds was constructed from aggregated hospital admission and discharge data. Trends were analysed by admission type, discharge destination, specialty, International Classification of Diseases (ICD-10) primary diagnosis and Healthcare Resource Group (HRG) v4 chapter. Results: Admissions, deaths and occupied beds all showed a simultaneous step-like increase around March to June of 2012, which led to considerable operational pressure and a marked reduction in elective overnight surgery due to reduced bed availability. The increase in in-hospital deaths exhibited a curious time cascade which was specific for various diagnoses. Deaths first increased for those with cancers or intestinal conditions in January 2012, followed by hepatic, diabetic and asthma in February 2012, then a time series of other conditions, through to arthritis and arthrosis conditions in July 2012. All of these occurred at a time when deaths across the whole of the UK showed a large and unexpected increase. Conclusion: A new type of infectious event is strongly implicated which appears to exert its clinical effects via some form of immune impairment. The agent leads to a persistent infection. The immune modifying virus, cytomegalovirus, which (in other studies) is associated with a 20% higher odds ratio for all-cause mortality, has been circumstantially implicated, however, this requires confirmation.
Background: Respiratory Syncytial Virus (RSV) is an important cause of acute respiratory tract infections among infants and children requiring hospitalization. No data is available concerning RSV epidemiological and demographic characteristics among Lebanese children. Methods: This is an observational comparative retrospective and prospective study including two RSV seasons from October 2012 till March 2014 conducted at Makassed General Hospital, Lebanon. RSV rapid antigen detection test (Respi-Strip) was used for detection of RSV in nasopharyngeal wash swabs collected from all children 0 to 13 years with acute respiratory symptoms admitted at our hospital. Enrolled patients were divided according to age group and Respi-Strip results. Clinical presentation, risk factors, management interventions, course in hospital and severity parameters were compared between the different groups. Results: Among the 443 patients enrolled in the study, 98 (22.1%) were RSV positive. RSV was mostly found among younger ages (P<0.0001). Younger ages were most likely to present with moderate or severe respiratory distress (P=0.014). Patients with RSV had a more severe course during hospitalization in all parameters (P=0.0001). However, both groups received same management during their stay including bronchodilators, α-adrenergic, steroids and antibiotics despite the latest AAP guidelines. Conclusion: Respiratory Syncytial Virus is major cause of hospitalization among Lebanese children. It has a severe course even in previously healthy children and thus, immunoprophylaxis should be highly stressed on by clinicians.
Background: The implementation of the antimicrobial therapy greatly improved Buruli Ulcer (BU) care. Nevertheless, the disease still imposes significant burden. In rural endemic areas, many patients are being healed from the disease with disabling sequels. They are living without social assistance in a context of poverty. Various researches have evaluated the therapeutic modalities that are used to control the BU disease, but any study on the quality of life (QOL) of the patients healed from BU has been reported. Methodology/Principal Findings: A total of 105 patients healed from Buruli ulcer and, 105 control subjects without Buruli ulcer history are enrolled in the study after giving well-informed consent. The Medical Outcome Study Short Form (SF-36) is administrated to access their QOL. The study is approved by the Ethical committee of the Faculty of Health Sciences of the University of Abomey-Calavi (UAC). All the patients have a weak QOL than control subjects. The deterioration affects their physical functioning, their physical role, their emotional role and their mental health (p<0.05). However, in spite of their low QOL, subjects aged from 40 years old and over (p = 0.003), and subjects married, divorced or widowed (p = 0.01) work physically better than the other sub-groups, even if they are mentally weaker. In a Spearman correlation test, we have observed significant relationships of socio-economic variable with the decrease of SF-36 subscale values. Conclusion/Significance: BU patients are healed in a long-term physically and psychologically marked by the sequels induced by the disease. The results of the present study suggest that interventions and supports are needed to improve the QOL of these patients.
Aim: Delivery of smoking cessation supports via primary health care settings could be an effective way to increase people access to cessation services. This study was aimed at evaluating structural characteristics of smoking cessation services established within the Iranian Primary Health care system. Materials and Methods: In order to obtain structural information about smoking cessation services, firstly a phone call was made with coordinating authorities of tobacco control programs in each university which are under supervision of Ministry of Health. Secondly, after describing the objectives of project they were asked to fill the related questionnaire. The questionnaire was available at MOH website and follow-up for its completion was done via telephone call. Results: Smoking cessation centers started their activities in 2007 and their number increased between 2008 and 2011. In all primary health centers, smoking cessation services are provided free of charge. In sixty percents of centers individual therapy was used, a combination therapy (including pharmacotherapy) is highly preferred. Nicotine patch was the most common drug which is used (62%) in smoking cessation clinics. General physicians are the main providers of smoking cessation programs in health care centers (87%). The number of smoking cessation centers in primary health care system decreased during years of 2011(89 centers) and 2012(79 centers) compare with 158 centers in 2010. There isn’t national quit line in Iran. Conclusion: This study shows smoking cessation programs provided in primary health care system in Iran. The present study gathered useful and updated information on structural of smoking cessation services in Iran’s primary health care system.
Aims: Skin diseases are a common reason for consulting the general practitioner (GP). Few studies have been conducted that explore the topic of chronic skin disease from the patient's perspective. The aim of this paper was to investigate experiences and perceptions of people with chronic skin diseases and their respective pathways into the health care system. Study Design: Qualitative study Place and Duration of Study: GP practices and patients’ homes; between July 2011 and August 2012. Methodology: Interviews (20-30min) with 16 patients using a semi-structured guideline were conducted. Patients were identified by their respective GP. Adult patients suffering from a chronic skin disease were included. Interviews were taped and transcribed verbatim. Qualitative analysis was conducted by two independent raters. Results: There was a broad variety of pathways into the healthcare system with about half the respondents at first contacting lay people like family members or neighbours. Nearly all participants reported an adverse effect on private, social or work life. Some of our respondents felt stigmatized. Most respondents applied a range of self-management strategies, mainly in the form of different dietary habits; many patients had also made use of complementary therapies. There were different patient expectations concerning GPs and dermatologists respectively. Conclusion: Patients with chronic skin disease show a complex health seeking behaviour which can lead to delays in accessing the official health care system. There is a considerable impact on the quality of life. Further research should address how German GPs perceive the treatment of patients with chronic skin disease and how cooperation with dermatologists can be improved.
Background: Growth failure and restricted weight gain in very low birth weight (VLBW) infants remains extremely common despite advances in neonatal care. A majority of VLBW infants leave the hospital with weights below the 10th percentile for age. A variety of measures including nutritional interventions have been considered to achieve adequate weight gain in these infants for preventing short- and long-term lifetime complications. Objective: This study aims to profile factors that impact weight gain among VLBW infants in three Maternity and Children Hospitals in Jeddah City, the Kingdom of Saudi Arabia [KSA]. Methods: A prospective study with short follow-up selected a nonrandom sample of infants for collecting data related to parents and admitted VLBW infants in three hospitals. The medical files of actively admitted VLBW infants [n=61] to the neonatal intensive care unit (NICU) were daily examined for a period of four months through 1st January, 2013 to 30th April, 2013 until their discharge. Results: Within a variety of categorical and continuous parental and infants’ variables, joint family income and total formula milk fed to VLBW infants significantly correlated with weight gain in VLBW infants. However, the most powerful predictor of weight gain in VLBW infants was total formula milk fed to them. Conclusion: This study calls for further studies for identifying other predictors of weight gain in VLBW infants in Saudi Arabia.
Aims: This study aims to investigate the small area spread of a presumed infectious agent, and to determine which factors determined the point of initiation, speed of the spread and the resulting increase in emergency medical admissions. Study Design: Analysis of a monthly time series of medical admissions using small area population aggregates of around 7,000 population contained within the census spatial unit called a Mid Super Output Area (MSOA). Place and Duration of Study: Emergency medical group admissions for residents of the six unitary authority locations in Berkshire, southern England between January 2008 and March 2013. Methodology: A running twelve month total of admissions was used to determine the point of initiation and the extent of a step-like increase in medical admissions. Results: Analysis shows evidence for spatial spread initiating around June 2011 through to March 2013. At onset, medical admissions increase and stay high for 12 to 18 months before beginning to abate. This spread commenced earlier among mainly Asian small areas (clustered from July 2011 onward) and later (clustered around March 2012) in predominantly affluent white areas. The observed percentage increase in admissions within the unitary authority areas varied from 25% to 51% (median value), however the average increase was highest as the geographic area became smaller, and this is suggested to arise from the aggregation of smaller social networks where the point of initiation of infectious spread occurs over time. The percentage increase in admissions displayed high single-year-of-age specificity suggestive of the immune phenomena called antigenic original sin, and is therefore suggestive of a different strain of an agent with previous outbreaks. The increase in emergency admissions showed a month-of-year pattern which appeared to follow the seasonal pattern of vitamin D levels in the blood. The presence of nursing homes, deprivation and ethnicity also has an effect on the average increase in admissions. Conclusion: It is suggested that all the above point to an outbreak of a previously uncharacterized type of infectious agent. There are profound implications regarding the use of standard five year age bands for the standardization of medical admission rates.
The surviving sepsis campaign (SSC) guidelines aimed to reduce mortality in severe sepsis and septic shock. The present study was performed to find out which and how many recommendations of the 2012 SSC update were based on significant effects from clinical studies in adult patients with severe sepsis and septic shock, leading to numbers needed to treat (NNTs). Every reference of the SSC 2012 guideline regarding clinical trials in adult patients was screened for absolute risk reduction regarding mortality to calculate NNTs. 17 relevant clinical trials out of 338 were identified. The NNTs ranged between 3.55 to 23.24. Significant reductions of mortality were detected, and items recommended in the SSC guidelines regarding early goal directed therapy (EGDT)/standard operating procedures (SOP)/sepsis bundles, early therapy with antibiotics, combined antibiotic therapy, and use of norepinephrine. Therapy with norepinephrine and the 6h bundles revealed the lowest NNTs. Significant reductions in mortality with restricted or no recommendations regarded therapy with hydrocortisone, therapy with high-dose antithrombin III, and enteral feeding with eicosapentaenoic acid, gamma-linolenic acid and antioxidants. In conclusion, only a few recommendations of the 2012 SSC guidelines are based on significant beneficial effects coming from clinical trials in patients with severe sepsis and septic shock. When transferring study results and NNTs, physicians should take into account the own setting and own subgroup of patients. If feasible, costs of additional treatment success may be quantified underlying NNTs.
The heart failure (HF) diseaseasome is marked by substantial alteration in networked signaling pathways. Reductionist paradigm HF investigative approaches have focused on the regulation of a single pathway or single pathway components. In support of a more comprehensive systems biology investigative paradigm, rapidly evolving experimental evidence supports extensive regulatory cross-talk between the TGFβ-superfamily, Wnt/β-catenin and Hippo signaling systems in homeostasis, myocardial development and a variety of non-myocardial diseases. After reviewing the basic components and integrated regulation of each of these three pathways, we review landmark studies in diverse conditions and diseases highlighting the likely critical importance of regulatory cross-talk between these three pathways in the HF.
Cancer of the oral cavity is one of the most common cancers. Oral cancer is still only detectable at a late stage, and the survival rate for an oral cancer patient has essentially remained unchanged over the past three decades. This study is concentrated on the oral precancerous lesions which are commonly seen in dental clinics and to give the general practitioners Knowledge for early detection of these lesions. A literature search was conducted using Medline, accessed via the National Library of Medicine PubMed interface, searching for articles relating to the precancerous oral lesions written in English.