A unique approach to the treatment of posttraumatic stress disorder (PTSD) is difficult to support, because of the complexity and heterogeneity of this pathology. Multiple evidence-based guidelines for PTSD treatment exist, elaborated by prestigious institutions around the world, but a certain level of the inconsistency of their recommendations appears when these sources are compared with each other. Therefore, a review of current guidelines and extraction of the most supported by evidence recommendations is considered important for clinical practice, due to the need to approach such complex cases as PTSD-diagnosed patients in a stepwise manner. Structured monitoring of the clinical status during the treatment is also an important and rather neglected aspect of the case management in PTSD, and the necessity of follow-up visits for efficacy and tolerability should be taken into consideration. Psychotherapy (especially cognitive- behavioral oriented therapies and eye movement desensitization and reprocessing therapy) is supported by evidence as a first-line approach, as well as certain antidepressants, like the selective serotonin reuptake inhibitors and venlafaxine. Many second-line pharmacological agents and psychotherapies are also available, but there is an obvious need for more pragmatic trials with PTSD patients.
The treatment of diseases is based on pharmacological and non-pharmacological means, but adequate devices are needed for their application. Medicine uses a wide range of medical devices. Currently, many medical devices are used, many of them being disposable. As recognition of the importance of medical devices, the national authority of the drug is the ANMDM (National Agency for Medicines and Medical Devices). Medical devices are indispensable for therapy, and their evolution has led to an extraordinary diversification of the field and the emergence of industry related to the pharmaceutical industry, with specific laws and regulations.
Introduction: Despite the progress that has been made regarding the diagnosis, a worrying percentage of patients are still admitted in an emergency, with complicated colorectal tumors, which often require interventions without a curative visa. The study aims to analyze the factors involved in choosing the type of surgical treatment. Patients and methods: We included in the study a group of 431 patients admitted and operated in an emergency for complicated colorectal cancer in the Surgery II Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galați, between 2008-2017. We retrospectively analyzed the patients’ data and we made statistical correlations between the type of emergency surgery and epidemiological, clinical, paraclinical, and intraoperative factors. Results: Colostomy was mainly practiced in older patients (p<0.01), from rural areas (p<0.01), with associated cardiac diseases (p<0.01), with hydro electrolytic disorders (p<0.03), rectal tumors (p<0.01), peritoneal carcinomatosis (p<0.02), frozen pelvis (p<0.01). Hartmann's operations were associated with patients with: leukocytosis (p<0.01), intestinal perforation (p<0.01), sigmoid tumors (p<0.01). Internal derivations were associated with patients with: liver metastases (p<0.01), splenic angle tumors (p<0.01), tumors invading other organs (p<0.01), and stage IV of the disease (p<0.01). Resections with anastomosis were associated with transverse colon tumors (p<0.01), well-differentiated tumors (p<0.01). Conclusions: The type of emergency surgery performed correlated well with the age of patients, the area, the comorbidities, the history of the disease, cachexia, anemia, oligoanuria, hydroelectrolyte disorders, tumor complication, and location of the tumor, hepatic metastases, and tumors’ invasion in other organs, tumor grading and stage of the disease.
Background and Aim: Information on patients' experiences with and evaluations of health care is considered an essential outcome indicator to assess the quality of health care. This study aims to evaluate patient satisfaction with primary health care in a military setting. Methods: This cross-sectional study was conducted at the primary health care center located in a military setting, in Ankara, Turkey. A total of 3080 military personnel who received primary care in the last 12 months formed the population of the study. Turkish version of the European task force on patient evaluations of general practice care (EUROPEP) questionnaire was administered to the participants. Results: In the study, 2677 participants were reached with a response rate of 86.9%. The mean satisfaction rate (MSR) of clinical behaviour (69.3%) was higher than the MSR of the organization of care (58.4%). The MSR of the overall questionnaire was 67.1%. Significant differences were observed in the mean satisfaction scores of patients according to their descriptive characteristics including gender, age level, troop type, and the doctor providing the care. Conclusions: This study highlights the low patient satisfaction levels, which may have resulted from the fact that the study population was young and relatively healthy, and that there was no possibility of choosing the general practitioner. The EUROPEP questionnaire, which is an internationally validated and standardized instrument, can also be used to improve primary health care in military settings.
In an attempt to standardize the X-ray analysis and to create relevant correlations between it and the functional results, we present a pilot model of an artificial neural network based on a Bayesian belief network (BNN) designed for the automatic analysis of anteroposterior X-ray of the knee following total knee arthroplasty and more precisely the analysis of the tibial component. A prospective analysis was conducted in which 30 patients were analyzed and two groups resulted: the first was made up of 12 cases considered “normal” by the examiners (optimal positioning and cementation) and the second one, which was considered “pathological” (incorrect positioning or cementation) and included 16 cases. Based on 22 points established on the tibial component several geometric sizes (calculated parameters) were computed. Several parameters were compared and the results were up to 75% accuracy, 81.25% sensitivity, and 66.7% specificity. BBNs can be a solution for X-ray evaluation of total knee arthroplasty and can improve the understanding of its evolution. It needs confirmation in time, its accuracy rising with the number of patients introduced in the analysis algorithm.
Introduction: Osteoarthritis is considered as the most common joint disease. Sulfur mustard (SM) is a toxic compound, which was applied as a chemical warfare agent by Iraq against Iran veterans during 1980-1988. Chemical veterans suffer from chronic implications caused by sulfur mustard that not only adversely affect their quality of life, but also restrict their working abilities and their participation in social activities. This study aims to consider the prevalence of osteoarthritis disorders among Iranian SM-exposed veterans. Methods: In this cross-sectional study, 248 Iranian SM exposed patients were evaluated from 2013 to 2014. Veterans filled a special questionnaire for COPCORD studies and then general and specific rheumatology examinations were applied under the supervision of internists and rheumatologists. The obtained data from 245 filled questionnaires were analyzed by SPSS software and the results were reported as a percentage or mean ±SD. Results: Bone and joint pain (72%), knee joint pain (52.5%), Joint stiffness (49.2%), and shoulder joint pain (45.8%) were the most common type of complications in these patients. Osteoarthritis in at least one joint was the most common type of osteoarthritis in veterans. 69.5% of veterans had osteoarthritis in at least one joint. Knee osteoarthritis was the second most common type of osteoarthritis, which has been found in 58.4% of all veterans. The prevalence of neck osteoarthritis in all veterans was 23.9%. Conclusion: The total prevalence of musculoskeletal disorders among Iranian veterans was significantly higher than the average of society.
The pandemic called COVID-19 disease has an exponential course since the first cases were reported showing in 9th of May, 2020, more than 4 million cases of COVID-19. United States and European Council (EC), together with other European Union institutions, were closely monitoring the situation in order to take quick action. Objective: The aim of this article is to analyze the response to COVID 19 pandemic outbreak in term of strategy and money flow of Romanian health system in order to identify the strength and weakness and prepare for other similar provocative challenges. Global and national strategy: United States Government is delivering a comprehensive package of services to support international partners around the world in combatting this disease adding American expertise for global benefit, saving lives by improving international partners abilities to respond to the COVID-19, and reducing secondary impacts. Meanwhile European Union is focused on 6 major coordinates limit the spread of the virus, ensure and provide medical supplies, decrease negative economic impact, support jobs, promoting research and help European citizens to repatriate. Despite all negative elements a proper and relatively quick response of Romanian Public Health System was noticed and the taken measures were harmonized and synchronized with the European coordinates, prioritize initiatives, build an action plan, establish a communication plan, workforce optimization and management strategy. Conclusion: Global shock needs global response, with little or no government interventions, economic costs will be huge.
Clear cell acanthoma represent a benign solitary epidermal tumor of the clear glycogen containing epithelial cells, which is quite common in dermatologic practice. The etiology of this tumor formation is not known exactly at the moment. Clinically, the lesion appears as a single reddish papule or papule-nodule and the characteristic of this lesion is represented by a peripheral scaling collarette. Although solitary lesions represent the most common form of presentation of the acanthoma with clear cells, less than thirtieth cases of multiple clear cell acanthoma, from two up to four hundred lesions, have been described in the medical literature to date. The diagnosis based on clinical features frequently needs to be supported using a dermoscopy exam and, in most cases, a histopathology exam is required. The treatment consists is complete removal (standard surgical excision, cryotherapy, electrofulguration alone, carbon dioxide laser or shave removal or curettage followed by electrofulguration). For the cases with multiple lesions, cryotherapy, or topical 5- fluorouracil are preferred. We present the case of a 62-year-old male patient, presented to our Dermatology Department for multiple asymptomatic rounded papules and multiple exophytic nodular tumor formations (approximate fifteen), on the lower extremities, which had occurred approximately two years previously and gradually increased in number.
Non-compliance to diet and increased fluid intake can lead to unpleasant side effects and premature mortality in hemodialysis patients. Intervention strategies in educational and cognitive-behavioral domains can be used to improve diet compliance and restrict fluid intake in hemodialysis patients. The present study aimed to implement a participatory care model on diet compliance in patients undergoing hemodialysis referred to the Urmia Hemodialysis Center of Urmia in 1397. The present study is an experimental-randomized study that was performed on 60 patients undergoing diet without hemodialysis referring to Urmia Hemodialysis Center of Urmia. From 175 patients undergoing hemodialysis based on laboratory parameters of non-compliance patients and 60 patients were selected based on simple randomization and were randomly divided into intervention and control groups. After intervention steps of participatory care, diet compliance of the two groups was compared using the results of the comparable laboratory parameters. Analysis of the results of the present study showed that the collaborative care model significantly improved the results of laboratory parameters related to diet compliance in the intervention group compared to the results of the laboratory parameters before the intervention and the control group (p <0.05). Based on the results of the present study, it seems that participatory care intervention can be useful in improving diet compliance and fluid restriction in hemodialysis patients. The aim is to improve the quality of life of hemodialysis patients.
Artificial Intelligence (AI) has become an important tool for computer-aided diagnosis of medical imaging. This review aims to provide an overview for clinicians, explaining the relevant aspects of artificial intelligence and machine learning (ML) and presenting up-to-date applications of AI and ML techniques to medical imaging methods such as angiography, magnetic resonance, and echocardiography. For each imaging method, we present the acquisition process, the types of diagnostic test interpretation, and the challenges related to them, as well as how AI/ML techniques, have improved the process of decision making. A summary of selected works applying AI/ML techniques to medical imaging is organized into a table, which highlights the scope of the study, the dataset used, the details of each approach as well as the measured results, including objectives and criteria. The overall benefits of AI in medical imaging are extracted based on the diverse applications and high evaluation scores. In the end, cardiologists should have an advanced understanding of using AI to integrate clinical data and making the final decision in diagnosis.
