Clinicians, professors of medicine in general, students, and professionals from the health sciences tend to focus their efforts on technical training related to their discipline in practice as well as activities that produce some benefit direct or personal satisfaction. It is unusual to devote time and effort to training in areas such as teaching or expand their skills in sociological and organizational aspects. Would you like to take a course on strategic planning if not a director or officer of the hospital? Manage time in your schedule for a workshop on communication and conflict management? Have room in your schedule for educational activities on leadership, organizational change, and diffusion of innovations, science or science complexity of implementation? Generally, doctors and teachers do not spend much time on these activities (at least voluntarily) because we feel that what we have learned from these topics on personal experience is enough [1]. Effective teamwork, not only in the operating room but also throughout the perioperative route is considered an important and critical component of the safety and effectiveness of surgical care and leads to good results and quick recovery of surgical patients. Therefore, considerable efforts have been made to understand how teams work within the route of surgical care and to improve teamwork [2]. The simple act of bringing together some experts does not guarantee that turned out an expert team. Given the evidence suggests that teamwork in the operating room sometimes is far from harmonious and effective, the importance of training the surgical team to work effectively is receiving international acceptance as a key strategy to maximize safety in surgery. This systematic literature review aims to present a review of literature that focuses on the importance and role of leadership skills in the surgeon and how these skills can play a significant role in increasing the quality of care and patients’ safety in operating room (OR) settings.
Introduction: One of the basic pillars of hemodialysis is its adequacy, which is achieved by stabilizing hemodynamic parameters. This is especially important in the hemodialysis adequacy of diabetic patients. The current study aims to determine the effect of lowering the dialysate temperature on hemodynamic indices and dialysis adequacy of diabetic patients. Materials and methods: This is a clinical trial that was performed on 32 diabetic patients admitted to the Dialysis Ward of Ali ibn Abi Talib Hospital affiliated with Zahedan University of Medical Sciences in 2017. The research subjects were selected using the convenience sampling method from eligible patients. Each patient underwent hemodialysis twice; i.e. routine dialysate temperature (37° C) and cold dialysate temperature (36 °C). Except for lowering the dialysate temperature to (36 °C), all other conditions were the same during the study. Blood pressure (BP) and pulse rate of patients were monitored before and after dialysis and during the first, second, and third hours after dialysis; however, the body temperature and weight of patients were monitored before and after each dialysis session. Patients' blood samples were collected at each stage before and after dialysis to evaluate urea and calculate dialysis adequacy. Data analysis was carried out using descriptive statistics, paired t-test, and one-way repeated measures ANOVA in SPSS Ver. 21. P-value <0.05 was considered as the significant level. Results: Systolic, diastolic, and mean arterial blood pressure among patients who underwent hemodialysis with normal dialysate temperature were significantly lower than those who underwent hemodialysis with cold dialysate temperature (p<0.05). There were no significant differences between cold and routine dialysis in terms of changes in body temperature before and after dialysis. The dialysis adequacy at 36 °C showed a significant increase as compared to 37° C. Conclusion: The results of the present study showed that hemodialysis with cold solution (36 °C) stabilized hemodynamic variables and improved dialysis adequacy among diabetic patients, therefore, this treatment is recommended in hemodialysis wards.
Backgrounds: Medication errors are one of the most common errors that are associated with adverse effects on patients and may even lead to mortality. One of the methods for determining patient safety in hospitals is assessing the prevalence of medication errors. In this regard, medication reconciliation is used to improve drug safety in the treatment process. The present study was conducted on 7564 patients in the emergency department of one of the hospitals in Tehran, Iran. Methods: In total, 256 adult patients with a mean of 45 years, who had been admitted to the emergency department of a hospital in the past six months and had used at least three drugs before admission, were entered into the study. In this study, the effect of medication reconciliation on admitted patients was assessed to prevent drug errors at the time of admission by pharmacists. The main outcome measure was Type and Frequency Percentage of Drug Differences Observed during Medication Reconciliation were measured. Results: According to the results, the presence of a trained pharmacist was significantly effective in medication reconciliation for enhancing patient safety and treatment process accuracy. In addition, it was concluded that age, the condition of hospitalization, and medical center personnel had a direct relationship with the frequency of medication discrepancies. Conclusion: The presence of a trained pharmacist to perform the medication reconciliation process significantly affected the improvement of patient safety and the accuracy of the treatment process.
Colorectal cancer is an important health problem, being the third most frequent cancer pathology both in men and women. Programmes have been developed to decrease CRC incidence and mortality, including primary prevention strategies focusing on population education regarding diet and physical activity and secondary prevention programmes such as screening. Modifiable risk factors are known to be diet, obesity, smoking, alcohol and read meat consumption. Non-modifiable risk factors are age, inflammatory bowel disease, genetic syndromes and family history of colorectal cancer.
HBOT has been used quite extensively in the last couple of decades. But there are not many centers that offer this treatment, even in civilian situations. This review has described the rationale and clinical evidence for equipping medical centers with HBO systems, especially in military areas. A narrative review of all the literature available on HBOT in combat-related injuries, studies were retrieved from systematic searches on Science Direct, PubMed, SCOPUS, ISC, Google Scholar, and by cross-referencing until 2020. First, the etiological mechanisms of action of HBOT were discussed. Furthermore, we have provided an overview of 117 studies that clinically investigated the effect of HBOT in the last couple of decades. Therefore, based on the number of studies showing a positive effect, to speed up the treatment process, especially in war-related injuries, it is better to provide its infrastructure and equip hospitals and centers with HBO.
Introduction. The primary tonsillar neoplasm is a common malignancy of the head and neck, alcohol and/or cigarette smoke and Human Papilloma Virus is the main etiological agent. This study offers a retrospective analysis of the tonsillar neoplasm cases in a tertiary medical center from Romania. Patients and methods. We present a 4-year (2015-2018) retrospective study on 72 patients diagnosed with tonsillar neoplasm in our clinic, previously untreated patients. The study was included only the patients diagnosed through histopathological evaluation with tonsillar neoplasm. We searched the cases in our clinic database, and we collected data about age, gender, symptoms on admission, findings of the objective physical examination, oro-pharyngoscopy, medical imaging examination results, histopathological results, stage of the disease, therapeutic management. Results. The group composition is: 75% men and 25% women, 62.5% of them are smokers. Dysphagia/swallowing discomfort was the most common symptom identified, and the non-keratinized squamous cell carcinoma was the most common histopathological form. Stage I tonsil carcinoma was diagnosed in 25% of the cases, stage II in 15.3%, while 47.2% of the cases had stage III or IV. None of the patients presented distant metastases. Lymphoma was diagnosed in 12.5% of the cases. We performed for all patients in stages I and II underwent total unilateral tonsillectomy. For the patients in stages III and IV, we performed surgery after radiotherapy-chemotherapy treatment or only radiotherapy-chemotherapy. Conclusions. In Romania, smoking is still the most important risk factor for tonsil cancer. The majority of patients have visited a doctor only when dysphagia and, above all, palpable cervical adenopathy, were present, and the tumor was in the advanced stage. In Romania, the ENT-oncology integrated medical services are few, in most cases patients are lost from otorhinolaryngological follow-up. 1 Department of Head-Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 2 Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 3 Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 4 Department of Pathology, University Clinical Hospital of Railway Company, Cluj-Napoca, Romania 5 Department of Pathology, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania 6 Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 7 Department of Head and Neck Surgery and Otorhinolaryngology, University Emergency Hospital, Bucharest, Romania 8 Department of Anatomy and Embryology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania 9 Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania 356
A symbiotic association between humans and microbes has been established over time. Disruptions in gut homeostasis have been linked to immune-mediated inflammatory diseases. Factors such as genetics, environment, diet, age, and medication play a major role in shaping the intestinal microbiome. An altered gut microbiome seems to modulate the progression and severity of inflammatory rheumatic diseases. Disruptions in the eubiotic state of the intestinal microbiome might promote intestinal and extraintestinal autoimmune and inflammatory disorders, although the mechanisms involved are not well understood. In this review, we provide a general overview of several studies concerning intestinal microbiome perturbations and their implications in rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus. Furthermore, we discuss the relationship between diet, intestinal microbiota, and inflammation.
Introduction: This study focuses on the Malaria endemic in the Thar Desert- The most populated desert in the world. Malarial endemicity in a desert environment is a unique and rare geographical presentation, as malaria is usually common in areas where there is rainfall and water stagnation - like ponds, fields, etc. In this study, we want to highlight the unique clinical presentation, lab findings, and reason behind the existence of malaria in the desert. Most importantly we also would like to share our innovative idea to eliminate breeding sites using Quadcopters and drones. Materials and methods: Study type – Prospective observation study, Study duration – October 2020 to December 2020, Sample size-103 cases, Inclusion criteria – all smear-positive Malaria cases, Exclusion criteria – Cases Referred to higher centers because of complications.Tools used for breeding site identification – Quadcopters and Drones with HD cameras. Since the area to be surveyed was vast (>30km), it was very difficult to do a manual survey in the harsh desert climate. The patients’ demographics, Clinical Presentations, and laboratory parameters were collected systematically in a predesigned format and entered into an excel sheet. The finding of our study was compared with the malaria cases from different parts of the country. Results: All malaria was identified as Plasmodium vivax. The mean age group was 36 years (min-21 and max-56). Clinical features- out of 103 cases, 78% of the patients presented with all 4 symptoms of fever, chills, headache, and bodyache.22% presented with atypical isolated symptoms of abdominal pain, vomiting, myalgia, severe joint pain. 77% of patients had mild hepatosplenomegaly, 7 patients presented with hypotension, and 2 were in sepsis. Lab parameters – 88% of the patients had anemia, of which 5% had severe anemia, 40% had leucopenia while 6% had leucocytosis.87%had thrombocytopenia, out of which 56% had a platelet count less than 50,000/ml. 2% had mild AKI, bilirubin levels were elevated in 53%, and 36% had transaminitis. Using technology, the survey of the entire area was done in 1 week and all the breeding sites were eliminated on the same day of identification and a drastic drop in malaria cases was noted. Conclusion: We conclude that desert malarial presentation of Plasmodium vivax is unique in clinical presentation and lab derangements compared to other malarial cases. Usage of technology like quadcopters and drones for breeding site identification played a major role in curtailing cases drastically in a very short period in an effective way.
Background: The incidence of congenital diaphragmatic hernia (CDH) has been reported to be 1 in 2000-5000 newborns. The late presentation can occur in 5-30% of all cases and it can be harder to diagnose, as symptoms are usually vague and non-specific. Methods: We performed a retrospective review of chart files of all patients admitted to our hospital with the diagnosis of congenital diaphragmatic hernia between 2010 and 2021. Result: Of the ninety-two cases of CDH treated in our hospital between 2010 and 2021, twenty-six (28%) were late presenting. In the late-presenting CDH group, we found a slight female preponderance, with fifteen female patients (58%) and eleven male patients. A posterolateral left defect in the diaphragm was noted in fifteen cases (58%), a right defect was noted in just one case (4%) and ten patients (38%) were diagnosed with an anterior diaphragmatic hernia. The age at diagnosis varied from 2 months to 14 years. Associated anomalies were noted in just four cases. In all cases, a thoracoabdominal radiograph was performed and ten patients also had a CT scan. Primary repair was performed in 25 of the 26 patients. The mortality rate in our study population was 11%, we reported 3 cases with unfavorable evolution. Conclusion: CDH presenting beyond the neonatal period is a usual finding and it represents a true diagnostic challenge.
Introduction: One of the cornerstones and common causes of kidney stone formation is the volume of fluid consumed during a 24- hour that influences on forming that by several mechanisms. Since fluid intake decreases during Ramadan, one of the common questions posed is whether Ramadan fasting is associated with the precipitating of stone formation. The present study was aimed to investigate the effect of Ramadan fasting on precipitating and Inhibitors of stone formation in patients with a history of renal kidney disease. Methods: The study population included all of the patients with kidney stone diseases who were seen at the Clinic of Urology and Nephrology affiliated with Baqiyatallah hospital during the month of Ramadan in 2014 and 2015. The number of 66 patients was chosen and included in the study through randomized simple sampling. All subjects underwent blood tests like serum uric acid, serum phosphate, serum calcium, and serum sodium. Samples were tested in terms of volume, magnesium, uric acid, Calcium, Phosphate, Sodium, citrate, oxalate, Calcium oxalate supersaturation, Calcium Phosphate supersaturation, Uric acid supersaturation. Results: Sixty-six eligible patients were included that the mean age was 48.35±12.10 years. Fourteen men and 52 women were included. There were no significant differences in the mean pH of urine, urinary sodium, urinary oxalate, super- saturated levels of calcium oxalate in the urine, urinary phosphate levels, and super-saturated levels of urinary calcium phosphate between the two groups (P>0.05). The average volume of urine, urinary magnesium, urinary calcium, urinary citrate, the uric acid level in the non-fasting group was higher than the fasting group (P0.05). There was no difference in the mean super-saturated level of uric acid between the two groups (P=0.035). Conclusion: There was controversial evidence on the effect of Ramadan fasting on kidney stone formation and there is not enough evidence in the present study that Ramadan fasting precipitates risk factors associated with calculus formation
