Congenital hernia of the diaphragmatic dome (CHDD) is an embryonic malformation in which all or part of the diaphragmatic dome fails to develop properly. In the majority of cases (80% to 90%), this malformation affect...Congenital hernia of the diaphragmatic dome (CHDD) is an embryonic malformation in which all or part of the diaphragmatic dome fails to develop properly. In the majority of cases (80% to 90%), this malformation affects the left posterolateral part of the diaphragm, while in 10% to 15% of cases it affects the right. Bilateral cases are extremely rare, accounting for less than 1% of cases. This malformation is estimated to occur at a frequency of around 1 in 3500 births, with a male predominance. The diaphragmatic defect causes the abdominal organs to rise into the thoracic cavity during critical phases of lung development. These anomalies result in bilateral pulmonary hypoplasia, a reduced number of pulmonary vessels, and pulmonary arterial hypertension (PAH). The combination of these anatomical and functional anomalies, in varying degrees, explains the wide variability of symptoms at birth. Diagnosis is usually made prenatally by ultrasound, which enables severe forms of the disease to be detected and appropriate management initiated. The prognosis remains generally grave, with a neonatal mortality rate of between 30% and 60% depending on the study, and around half of all children will have long-term sequelae.展开更多
Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to success...Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical de展开更多
The"Crime of Flores Street"is one of the most famous cases of poisoning to divide public opinion in Portugal in the late 19th century, and it also demonstrated the weaknesses of the Portuguese medicolegal sy...The"Crime of Flores Street"is one of the most famous cases of poisoning to divide public opinion in Portugal in the late 19th century, and it also demonstrated the weaknesses of the Portuguese medicolegal system and attested to the importance of toxicological analysis. Vicente Urbino de Freitas was a prominent doctor, graduating from the Faculty of Medicine of the University of Coimbra in 1875. He later became Professor of Physiology at the Porto Medical-Surgical School and author of a number of books on leprosy. In 1877, he married Maria das Dores Basto Sampaio Freitas, and this was followed by the death of a number of her close relatives in suspicious circumstances, notably her brother José António Sampaio Junior and nephew Mário Guilherme Augusto de Sampaio. This review aims to retell the story of Portugal's first significant medicolegal case as well as the accompanying judicial drama that gave birth to Forensic Toxicology in Portugal and prompted the medicolegal organization that exists today. This research was carried out over a 10-year period and repre-sents undeniable historical value given the rarity of the facts compiled. At the heart of this forensic case was the use of toxicological analyses in court for which the Chemist Antònio Joaquim Ferreira da Silva played a key role. This toxicological report revealed high concen-trations of morphine, delphinine and narceine in viscera and in Mario's urine. The Mario's cause of death was attributed to poisoning by opium alkaloids. Despite the strong judicial evidence, doubts still remains as to whether Vicente Urbino de Freitas was a"monster"or a victim of circumstances and a hapless martyr.展开更多
Context and Objective: The practice of outpatient anaesthesia has many advantages over anesthesia with conventional hospitalisation, particularly in the reduction of post-operative complications and the faster resumpt...Context and Objective: The practice of outpatient anaesthesia has many advantages over anesthesia with conventional hospitalisation, particularly in the reduction of post-operative complications and the faster resumption of activity, etc. No study has been carried out on this subject in our community;this study was carried out in order to come up with a concrete state of play when it comes to outpatient anesthesia for medical and surgical procedures in the city of Kinshasa. Methodology: This was a cross-sectional study, which took place in seven hospitals in the city of Kinshasa from 1 November 2020 to 31 January 2021. The population consisted of all patients who received outpatient anesthesia and the included patients had signed an informed consent. The variables of the study were the general profile of patients, surgical procedures and indications, anesthetic data and patient evolution. Statistical analyses were performed with SPPS 21.0 with p Results: We collected data from 971 patients who had undergone anesthesia in the seven medical facilities in the city of Kinshasa. Among these patients, 394 had benefited from outpatient anesthesia, i.e. a frequency of outpatient anesthesia estimated at 40.5%. Three hundred and ninety-four (394) patients were selected. They were 58.6% women and 41.4% men i.e. a sex ratio M/F of 0.7. The mean age was 39.3 ± 18.7 years with the extremes of 1 and 82 years. Gastroscopy was the most performed (operative) procedure (21.6%). Patients were classified as ASA 1 in 75.1%, narcosis (80.7%) using propofol (80.2%) was the most used anesthetic technique and performed by a specialist doctor in Anesthesia in 65.5%. Suxamethonium was the most used curare in 13.2%. Fentanyl was the most used opioid in 14.5%. Bupivacaine (10.9%) was the most widely used local anesthetic. Eleven patients or 3.2% had complications and, i.e. (0.8%) were hospitalized, class ASA II appeared to be a factor associated with complications. Conclusion: Ambulatory anesthesia is a reality in the city of Kinshasa;howeve展开更多
Introduction: Gangrene of the external genitalia organs (EGO) is a medico-surgical emergency that is still very common in Third World countries. The main etiologies are urogenital, dermocutaneous and proctological. Mo...Introduction: Gangrene of the external genitalia organs (EGO) is a medico-surgical emergency that is still very common in Third World countries. The main etiologies are urogenital, dermocutaneous and proctological. Mortality remains very high despite therapeutic advances. Our aim was to report on the epidemiological, diagnostic and therapeutic aspects of gangrene of the external genitalia, and to identify prognostic factors. Patients and Method: This was a 5-year retrospective descriptive study, from February 2016 to February 2021, of cases of gangrene of the external genitalia admitted to and treated in the Urology Department of Abeche University Hospital. Results: We collected 49 cases of gangrene of the external genitalia. The mean age of patients was 42 ± 16.81, with extremes of 20 and 81 years. The age group most concerned was between 20 and 29. The most frequent reasons for consultation were suppuration of the external genitalia and scrotal swelling. The average consultation time was 19.05 ± 16.02 days. The most common comorbidity was diabetes (35.9%). The most frequent pathological antecedents were urinary tract infections and endourethral maneuvers, reported in 40.5% and 38.7% respectively. Urogenital aetiology was predominant in 54.7%, and idiopathic in 35.9%. Lesions involved the scrotum in 60.6%, the scrotum and penis in 16.5%, and the penis alone in 5.7% of cases. Lesions extended to the perineum in 13.6% of cases, and to the abdomen in 3.6%. Vascular filling via the central venous line was performed in 58.6% of cases, and via the peripheral venous line in 41.4%. 3rd-generation cephalosporins and associated imidazoles were the most commonly used antibiotics. Necrosectomy was performed in 37 patients (73.4%), debridement combined with bypass cystostomy in 26.6% of cases. Colostomy was performed in 4% of cases. 90.8% of patients were cured and 9.2% died. The average hospital stay was 30 ± 75 days. Conclusion: The gangrene of the external genitalia is a medical and surgical emergency which has become 展开更多
文摘Congenital hernia of the diaphragmatic dome (CHDD) is an embryonic malformation in which all or part of the diaphragmatic dome fails to develop properly. In the majority of cases (80% to 90%), this malformation affects the left posterolateral part of the diaphragm, while in 10% to 15% of cases it affects the right. Bilateral cases are extremely rare, accounting for less than 1% of cases. This malformation is estimated to occur at a frequency of around 1 in 3500 births, with a male predominance. The diaphragmatic defect causes the abdominal organs to rise into the thoracic cavity during critical phases of lung development. These anomalies result in bilateral pulmonary hypoplasia, a reduced number of pulmonary vessels, and pulmonary arterial hypertension (PAH). The combination of these anatomical and functional anomalies, in varying degrees, explains the wide variability of symptoms at birth. Diagnosis is usually made prenatally by ultrasound, which enables severe forms of the disease to be detected and appropriate management initiated. The prognosis remains generally grave, with a neonatal mortality rate of between 30% and 60% depending on the study, and around half of all children will have long-term sequelae.
文摘Background:Hospitals have reported that implementing rapid response system activation(RRS)activation has increased patient safety.As a result,there has been growing interest in identifying factors that lead to successful RRS activation.While introducing an automated RRS activation system has prompted nurses to be more vigilant about monitoring vital signs,it has not necessarily encouraged them to conduct thorough patient assessments to identify early signs of deterioration.Purpose:The current study aimed to assess nurses’attitudes towards RRS activation for clinically deteriorated patients in the clinical units of King Abdul-Aziz Hospital.Methods:A descriptive cross-sectional research design was utilised in the study,and 144 nurses working in the medical and surgical units of King Abdul-Aziz Hospital were recruited to participate using a convenient non-probability sampling technique.Results:The study’s findings reported that nurses have a positive attitude towards RRS benefits(Mean=3.70;SD=0.70).Their overall attitude towards RRS activation among clinically deteriorated patients is still low positive(Mean=2.71;SD=0.61).The nurses’attitudes towards RRS benefits significantly differ among nationalities and the clinical area/unit where they were assigned,with a P-value of 0.0194 and 0.000,respectively.Attitudes towards RRS barriers significantly differ among nationality(P-value=0.0037),education level(P-value=0.0032),area of assignment(P-value=0.020),and whether they have a good understanding of abnormal observations(P-value=0.0122).Regarding the nurses’attitude towards management belief,the significant result is only with the clinical area/unit of assignment with a P-value of 0.000.Conclusion:The current study found a low positive attitude towards RRS activation among ward nurses,especially given that monitoring vital signs is critical to their job.Nurses may fear being perceived as clinically inept for redundant activations caused by poor quality,but their attitude towards activating the RRS in clinical de
基金Ricardo Dinis-Oliveira acknowledges Fundacao para a Ciencia e a Tecnologia(FCT)for his Investigator Grant[grant number IF/01147/2013]This work was supported by FEDER under Program PT2020[grant number 007265-UID/QUI/50006/2013].
文摘The"Crime of Flores Street"is one of the most famous cases of poisoning to divide public opinion in Portugal in the late 19th century, and it also demonstrated the weaknesses of the Portuguese medicolegal system and attested to the importance of toxicological analysis. Vicente Urbino de Freitas was a prominent doctor, graduating from the Faculty of Medicine of the University of Coimbra in 1875. He later became Professor of Physiology at the Porto Medical-Surgical School and author of a number of books on leprosy. In 1877, he married Maria das Dores Basto Sampaio Freitas, and this was followed by the death of a number of her close relatives in suspicious circumstances, notably her brother José António Sampaio Junior and nephew Mário Guilherme Augusto de Sampaio. This review aims to retell the story of Portugal's first significant medicolegal case as well as the accompanying judicial drama that gave birth to Forensic Toxicology in Portugal and prompted the medicolegal organization that exists today. This research was carried out over a 10-year period and repre-sents undeniable historical value given the rarity of the facts compiled. At the heart of this forensic case was the use of toxicological analyses in court for which the Chemist Antònio Joaquim Ferreira da Silva played a key role. This toxicological report revealed high concen-trations of morphine, delphinine and narceine in viscera and in Mario's urine. The Mario's cause of death was attributed to poisoning by opium alkaloids. Despite the strong judicial evidence, doubts still remains as to whether Vicente Urbino de Freitas was a"monster"or a victim of circumstances and a hapless martyr.
文摘Context and Objective: The practice of outpatient anaesthesia has many advantages over anesthesia with conventional hospitalisation, particularly in the reduction of post-operative complications and the faster resumption of activity, etc. No study has been carried out on this subject in our community;this study was carried out in order to come up with a concrete state of play when it comes to outpatient anesthesia for medical and surgical procedures in the city of Kinshasa. Methodology: This was a cross-sectional study, which took place in seven hospitals in the city of Kinshasa from 1 November 2020 to 31 January 2021. The population consisted of all patients who received outpatient anesthesia and the included patients had signed an informed consent. The variables of the study were the general profile of patients, surgical procedures and indications, anesthetic data and patient evolution. Statistical analyses were performed with SPPS 21.0 with p Results: We collected data from 971 patients who had undergone anesthesia in the seven medical facilities in the city of Kinshasa. Among these patients, 394 had benefited from outpatient anesthesia, i.e. a frequency of outpatient anesthesia estimated at 40.5%. Three hundred and ninety-four (394) patients were selected. They were 58.6% women and 41.4% men i.e. a sex ratio M/F of 0.7. The mean age was 39.3 ± 18.7 years with the extremes of 1 and 82 years. Gastroscopy was the most performed (operative) procedure (21.6%). Patients were classified as ASA 1 in 75.1%, narcosis (80.7%) using propofol (80.2%) was the most used anesthetic technique and performed by a specialist doctor in Anesthesia in 65.5%. Suxamethonium was the most used curare in 13.2%. Fentanyl was the most used opioid in 14.5%. Bupivacaine (10.9%) was the most widely used local anesthetic. Eleven patients or 3.2% had complications and, i.e. (0.8%) were hospitalized, class ASA II appeared to be a factor associated with complications. Conclusion: Ambulatory anesthesia is a reality in the city of Kinshasa;howeve
文摘Introduction: Gangrene of the external genitalia organs (EGO) is a medico-surgical emergency that is still very common in Third World countries. The main etiologies are urogenital, dermocutaneous and proctological. Mortality remains very high despite therapeutic advances. Our aim was to report on the epidemiological, diagnostic and therapeutic aspects of gangrene of the external genitalia, and to identify prognostic factors. Patients and Method: This was a 5-year retrospective descriptive study, from February 2016 to February 2021, of cases of gangrene of the external genitalia admitted to and treated in the Urology Department of Abeche University Hospital. Results: We collected 49 cases of gangrene of the external genitalia. The mean age of patients was 42 ± 16.81, with extremes of 20 and 81 years. The age group most concerned was between 20 and 29. The most frequent reasons for consultation were suppuration of the external genitalia and scrotal swelling. The average consultation time was 19.05 ± 16.02 days. The most common comorbidity was diabetes (35.9%). The most frequent pathological antecedents were urinary tract infections and endourethral maneuvers, reported in 40.5% and 38.7% respectively. Urogenital aetiology was predominant in 54.7%, and idiopathic in 35.9%. Lesions involved the scrotum in 60.6%, the scrotum and penis in 16.5%, and the penis alone in 5.7% of cases. Lesions extended to the perineum in 13.6% of cases, and to the abdomen in 3.6%. Vascular filling via the central venous line was performed in 58.6% of cases, and via the peripheral venous line in 41.4%. 3rd-generation cephalosporins and associated imidazoles were the most commonly used antibiotics. Necrosectomy was performed in 37 patients (73.4%), debridement combined with bypass cystostomy in 26.6% of cases. Colostomy was performed in 4% of cases. 90.8% of patients were cured and 9.2% died. The average hospital stay was 30 ± 75 days. Conclusion: The gangrene of the external genitalia is a medical and surgical emergency which has become
