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Scabies is one of the most common and, in terms of burden of disease, one of the most significant skin diseases worldwide. In Germany, an increase in cases is currently being discussed, for which reliable data have been lacking until now.The goal is to clarify the prevalence and treatment of scabies in Germany.Multisource analyses of treatment data from a nationwide statutory health insurance company, the Federal Statistical Office and company skin screenings.In Germany, the number of cases of scabies has been rising since 2009 and especially since 2014. In the outpatient setting, there was an increase of 52.8% to around 128,000 treatment cases between 2010 and 2015. Currently, more than 11,000 inpatient cases are documented annually in Germany with scabies as the main diagnosis (ICD-10 B86). The increase between 2010 and 2016 was about 306%. The main outpatient specialist groups providing care are dermatologists and general practitioners, while in the inpatient sector treatment is provided by departments of dermatology, paediatrics and internal medicine.Due to the aforementioned development of prevalence and incidence, the need for care will remain at a high level in the future, which suggests an increased need for education and early detection.HINTERGRUND: Skabies stellt weltweit eine der häufigsten und hinsichtlich der Krankheitslast bedeutendsten Hautkrankheiten dar. In Deutschland wird derzeit eine Zunahme von Fällen diskutiert, wofür bisher belastbare Zahlen fehlten.Häufigkeit und Versorgungsmerkmale der Skabies in Deutschland.Multi-Source-Analysen aus Versorgungsdaten einer bundesweiten gesetzlichen Krankenversicherung, des Statistischen Bundesamtes und von betrieblichen Hautscreenings.In Deutschland weist Skabies seit 2009 und insbesondere seit 2014 eine steigende Versorgungsprävalenz auf. Im ambulanten Bereich findet sich ein Anstieg zwischen 2010 und 2015 von 52,8 % auf etwa 128.000 Behandlungsfälle. Stationär werden in Deutschland derzeit jährlich über 11.000 Fälle mit Skabies als Hauptdiagnose (ICD-10 B86) dokumentiert. Der Anstieg zwischen 2010 und 2016 betrug etwa 306 %. Hauptversorgende ambulante Fachgruppen sind Dermatologen und Hausärzte, im stationären Bereich Fachabteilungen für Dermatologie, Pädiatrie und Innere Medizin.Der Versorgungsbedarf wird zukünftig aufgrund der vorgenannten Entwicklung von Prävalenz und Inzidenz weiter auf einem hohen Niveau bleiben, was einen erhöhten Aufklärungs- und Früherkennungsbedarf nahelegt.

Objective With the increasing complexity of oncological therapy, the number of inpatient admissions to radiotherapy and non-radiotherapy departments might have changed. In this study, we aim to quantify the number of inpatient cases and the number of radiotherapy fractions delivered under inpatient conditions in radiotherapy and non-radiotherapy departments. Methods The analysis is founded on data of all hospitalized cases in Germany based on Diagnosis-Related Group Statistics (G-DRG Statistics, delivered by the Research Data Centers of the Federal Statistical Office). The dataset includes information on the main diagnosis of cases (rather than patients) and the performed procedures during hospitalization based on claims of reimbursement. We used linear regression models to analyze temporal trends. The considered data encompass the period from 2008 to 2017. Results Overall, the number of patients treated with radiotherapy as inpatients remained constant between 2008 (N = 90,952) and 2017 (N = 88,998). Starting in January 2008, 48.9% of 4000 monthly cases received their treatment solely in a radiation oncology department. This figure decreased to 43.7% of 2971 monthly cases in October 2017. We found a stepwise decrease between December 2011 and January 2012 amounting to 4.3%. Fractions received in radiotherapy departments decreased slightly by 29.3 (95% CI: 14.0–44.5) fractions per month. The number of days hospitalized in radiotherapy departments decreased by 83.4 (95% CI: 59.7, 107.0) days per month, starting from a total of 64,842 days in January 2008 to 41,254 days in 2017. Days per case decreased from 16.2 in January 2008 to 13.9 days in October 2017. Conclusion Our data give evidence to the notion that radiotherapy remains a discipline with an important inpatient component. Respecting reimbursement measures and despite older patients with more comorbidities, radiotherapy institutions could sustain a constant number of cases with limited temporal shifts.

Összefoglaló. Bevezetés: A csípőtáji törések jelentősen terhelik az egészségügyi ellátórendszereket. Magyarországon 13 000–15 000 beteg szenved évente csípőtáji törést, jelentős részük műtéten is átesik. A betegek túlélését vizsgálták a EuroHOPE és BRIDGE kutatások, amelyek a Nemzeti Egészségbiztosítási Alapkezelőnek a finanszírozási célból gyűjtött, esetszintű adataira támaszkodtak. Az ilyen jellegű adatok megbízhatóságát több kutatás vizsgálta eltérő eredményekkel, ezért a további vizsgálatok előtt szükségesnek tartottuk a csípőtáji törésekre vonatkozóan is ellenőrizni őket. Célkitűzés: Egy magyarországi kórház reprezentatívan kiválasztott eseteinek vizsgálatán keresztül annak megállapítása, hogy a finanszírozási adatbázis adatai megfelelnek-e a betegdokumentációban rögzített adatoknak. Módszer: Egy magyarországi kórházba 2015-ben csípőtáji töréssel felvett betegek kórlapjainak anonim, reprezentatív mintáját összevetettük a EuroHOPE és BRIDGE kutatások adatbázisával tíz különböző adatelemre vonatkozóan. Az adatbázisokat rekordszinten párosítottuk, az egyezést adatelemre és rekordra vonatkozóan néztük. Eredmények: A reprezentatív minta 259 esetet tartalmazott. Az adatbázisok összevetése során nem találtunk eltérést a beteg neme, életkora, ápolást indokló fődiagnózisa és az osztályról történő távozás dátuma esetén. Egy eltérést találtunk az osztályos felvétel dátumában, a műtét dátumában öt darabot. A beteg további sorsa esetén tíz eltérést találtunk. A műtéttípusok esetén is alacsony mértékű (2–4 eset) eltérést tapasztaltunk. Jelentős mértékű eltérést a társbetegségek és a szövődmények esetén találtunk. Következtetés: Eredményeink alapján további vizsgálatokhoz felhasználhatók az alfanumerikus kódokat, számokat vagy dátumokat tartalmazó mezők (például fődiagnózis, felvételi és távozási dátumok), a társbetegségekre és a szövődményekre vonatkozó adatok azonban nem alkalmazhatók mélyebb elemzések során. Orv Hetil. 2021; 162(18): 712–719. Summary. Introduction: Hip fractures pose a heavy burden on healthcare systems. In Hungary, 13 000–15 000 patients experience hip fractures, most of them undergo surgery. Their survival was examined by the EuroHOPE and BRIDGE studies, using patient level data from the National Health Insurance Fund. Data from healthcare financing reports have been examined worldwide, with contradicting results, so we considered it necessary to observe data validity for hip fractures before further analysis. Objective: The aim of our study was to observe a representative sample of patient records in a Hungarian hospital in order to validate the finance reports. Method: We matched a representative sample of hip fracture patient records in a Hungarian hospital with hip fractures in 2015 with the database of the EuroHOPE and BRIDGE studies. The databases were matched on record level, the analysis included ten data fields and was conducted for data fields and records. Results: The sample included 259 cases. No differences were observed in the patients’ gender, age and main diagnosis, or dates of discharge. One difference was observed in the dates of admission, and 5 in the dates of surgery. Minor differences were found in the types of surgery (2–4 cases), but the differences between the databases in comorbidities and complications were large. Conclusion: Based on our results, we can conclude that data fields containing alphanumeric codes, numbers or dates (e.g., main diagnosis, admission, discharge and surgery dates) can be used for further analysis, but comorbidity and complication data are not recommended for research purposes. Orv Hetil. 2021; 162(18): 712–719.

Migration to our country has led epidemiologic changes in Hospital de Linares, which motivated this study. The objective is to know the epidemiologic changes in the Maternity Ward en Neonate Unit of a High Complexity. We analyzed the admission of the Haitian women and their offspring throughout 2016 to 2018. We used descriptive stratigraphy and were compared using chi-squared test. Out of 6911 women that gave birth, we found 81 Haitian women. Out of 1499 neonates that were hospitalized, 31 were of Haitian background. We saw an important increase in the number of Haitian women giving birth even though the general birth rate was decreasing. Subsequently there was an increase in the hospitalization of neonates born to Haitian mothers, even though the general neonate hospitalization rate was decreasing and in a higher percentage when compared to the neonates born to women from other nations. The main diagnosis were severe SGA (25 %), Hypoglycemia and Hyperbilirubin. We observed a higher number of total hospitalized period in newborns of Haitian background compared to other nationalities. It’s interesting the increase in Haitian background neonates, the higher percentage of severe SGA and the longer stay due to the language andcultural barrier that influences on the mothers following the medical indications.

Introducción: Las infecciones respiratorias agudas (IRAS) se definen como el conjunto de enfermedades del aparato respiratorio causadas por microorganismos virales, bacterianos u otros, caracterizados síntomas respiratorios y son consideradas la mayor causa de morbimortalidad infantil en países en vías de desarrollo. Objetivo: Describir la frecuencia de IRAS en menores de 5 años atendidos en el Centro de Salud Rio Blanco de enero a diciembre del año 2017. Materiales y Métodos: Se trata de un estudio descriptivo, de corte transversal. El universo son todos los menores de 5 años que acudieron al Centro de Salud Río Blanco del 2017, siendo en total 3 510. Resultados: se identificó un 31% de frecuencia de IRAS, un 44% de faringoamigdalitis como diagnostico principal, leve predominio no significativo en el sexo femenino, mayor frecuencia en edades mayores de 2 años y mayor frecuencia en invierno. Conclusiones: se evidencia una alta frecuencia de IRAS en la población estudiada con características similares a las estimadas en la literatura para las condiciones del medio.

The study aimed to investigate the demographic characteristics, clinical features, diagnoses, and treatments of hospitalized exacerbation COPD patients, as well as their disease prognoses and economic costs. The study planned to enroll 7600 hospitalized patients (aged ≥18 years with main diagnosis as AECOPD). Study patients were recruited since September 2017, followed up with a 3-year observing period. In the baseline visit, information on demographic characteristics, clinical features, diagnoses, and treatments were collected. In the following visits, treatments and examinations, recurrence of AECOPD, re-admission to hospital, complications, and mortality were recorded. Several validated questionnaires were applied at specific visits. This study included data from 1 September 2017 until 31 December 2022. The data would be used to estimate all-cause mortality during hospital stay, AECOPD recurrence within 1 month after discharge, all-cause and cause-specific mortality, frequency of AECOPD recurrence, lung function, life quality, healthcare costs in the study period, etc.

Home treatment (HT) has been proposed as an alternative to inpatient treatment for individuals in acute mental crises. However, there is limited evidence concerning the effectiveness of HT to date. The aim of this study was to investigate which patients benefit most from HT. The concept and utilization of two HT services in Switzerland were retrospectively compared based on routine medical data of all patients who were treated in one of the two HT services between July 2016 and December 2017. We examined which patient characteristics were related to successful replacement of hospital care by HT based on a calculated success score using binary regression analyses. The whole sample included 408 individuals with an average age of 43 years and of whom 68% were female. As a result of conceptual similarities, in both HT settings, the typical patient was middle-aged, female and having an affective disorder as the main diagnosis. Half of the treatment cases met the criteria of successful replacement of hospital care (> 50% of the total treatment episodes in HT, treatment duration

Introdução: Com vista à redução da mortalidade associada ao enfarte agudo do miocárdio (EAM), foi implementada a nível nacional, em 2007, a Via Verde Coronária (VVC). Existem poucos estudos sobre o desempenho destes protocolos a nível intra-hospitalar e, por isso, pretende-se caracterizar os principais diagnósticos dos doentes incluídos na VVC e avaliar a proporção de casos de EAM. Material e Métodos: Foi realizado um estudo observacional retrospetivo no serviço de urgência de um hospital do Alentejo (06/2017-05/2018). Foram incluídos doentes com ≥ 18 anos e que apresentassem sintomas sugestivos de EAM. Os principais diagnósticos foram retirados dos processos clínicos e calculou-se a proporção de casos admitidos com EAM. Realizou- se análise estatística uni e bi-variada (IBM SPSS v.27.0). Resultados: Foram incluídos 338 doentes: 56,5% (n = 191) eram homens e a idade média foi 63,9 ± 15,1 {19;96} anos. A maioria dos diagnósticos estabelecidos classificaram- -se como enquadrados no sistema circulatório (61,2%, n = 207). A proporção do EAM foi de 27,2% (n = 92/338). Foram observados significativamente mais fatores de risco cardiovascular nos doentes com EAM, comparativamente aos doentes sem EAM (2,83 ± 1,54 vs 2,06 ± 1,49 fatores de risco/doente, respetivamente; p < 0,001) e em doentes com EAM sem elevação do segmento ST e EAM com elevação do segmento ST (3,25±1,36 vs 1,81 ± 1,50 fatores de risco/doente, respetivamente; p < 0,001). Os doentes com diagnóstico de EAM registaram um tempo de dor significativamente inferior aos doentes sem EAM (6,24 ± 9,08 vs 10,53 ± 18,23 horas de dor, respetivamente; p = 0,032). Conclusão: A maioria dos diagnósticos nos doentes da VVC foi do sistema circulatório e cerca de um quarto apresentaram EAM., Medicina Interna, Vol. 28 N.º 3 (2021): Julho / Setembro

Introducción: El término Tele dermatología (TD) se define como “información y tecnología de telecomunicación para brindar servicios dermatológicos a distancia”. En múltiples estudios se ha certificado la confiabilidad y aplicabilidad de esta herramienta y costo-efectividad. Esta estrategia se evalúa con indicadores como el ahorro logrado y el tiempo de espera. En Baja California Sur existe un dermatólogo que atiende a toda la zona. Objetivo General: Identificar y describir los beneficios en ahorro logrado y tiempo diferido de duración por tele consulta de dermatología en pacientes atendidos en Guerrero Negro, Baja California Sur. Material y métodos: Estudio observacional de costo efectividad. Se revisaron 58 expedientes de pacientes atendidos en la tele consulta de dermatología en Guerrero Negro. Se analizaron variables demográficas, motivo de atención, unidad de referencia, ahorro logrado y tiempo de espera. Estudio sin riesgo. Autorizado por el comité de ética e investigación. Resultados: El 81.6% fueron mujeres, de 31 a 50 años el 29.3%, amas de casa en un 24.1%, el principal diagnóstico fue la dermatosis, el 50% pertenecen a la Unidad de Medicina familiar No. 35. El tiempo real en horas para obtener una tele consulta vs consulta presencial fue de 638.50 + 879.05 vs 1,165.71 + 671.69 (p=0.000; IC 95% 0.000 – 0.050). Se comparó el costo en pesos mexicanos del traslado de la tele consulta versus consulta presencial $302.08 ± 695.62 vs $5,014±$5,377.28 (p=0.003 IC 95% 0.000 – 0.050) Conclusiones: En este estudio, la estrategia de tele dermatología fue costo efectiva , benefició principalmente a mujeres de 31 a 50 años, amas de casa con diagnóstico de dermatosis, cuya adscripción principal fue la Unidad de Medicina Familiar No. 35 en Guerrero Negro, en menor proporción a las unidades médicas ubicadas geográficamente en islas. Palabras clave: Tele consulta, ahorro logrado, tiempo diferido de la consulta, Tele dermatología.

Objectives: The study aimed to analyze and update the impact of pertussis on the Italian population by evaluating pertussis-related hospital admissions in the period 2001–2014. Design or methods: Hospital Discharge Records (HDR) were provided by the National Archive of HDR data of the Ministry of Health. Only hospitalizations included in the primary diagnosis were evaluated. Significant trends over the considered years were assessed as average annual percent changes (AAPC) applying the Joinpoint model. Results: A total of 7,102 hospital admissions for pertussis (main diagnosis) were registered; the trend of hospitalizations progressively decreased from >1/100,000 inhabitants in the years 2001-2004 to 0.64/100,000 inhabitants in 2014. A great part of hospitalizations (63.6%) involved subjects

The current study analyzes the efficacy of acceptance and commitment therapy (ACT) focused on repetitive negative thinking (RNT) for child depression. A randomized, nonconcurrent, multiple-baseline design was conducted with nine children, aged between 8 and 13 years, who showed a main diagnosis of child depression. Measures of psychological inflexibility, RNT, and generalized pliance were administered on a weekly basis throughout the study, whereas measures of emotional symptoms and parents’ report of problematic behavior were applied at pretreatment, posttreatment, and the 4-week follow-up. All participants showed evidence of a treatment effect for psychological inflexibility and RNT. The standardized mean difference effect sizes for single-case experimental designs were very large for these measures. No participant showed the diagnosis of child depression or comorbid disorders at the 4-week follow-up. Pretreatment to follow-up changes in emotional symptoms and problematic behavior reported by parents were statistically significant, with large effect sizes. RNT-focused ACT interventions for child depression deserve further empirical tests.

The aim: to analyze the structure of medical prescriptions for quercetin and its derivatives in Ukraine Materials and methods.We used data from an expert survey of doctors from 25 cities of Ukraine, which was conducted during 2017-2018. The survey involved doctors of various specialties who had «very high» (k ≥ 0.91), «high» (k = 0.71-0.90) and «satisfactory» (k = 0.51-0.70) level of competence. This indicator was determined using five coefficients (k1+n), which characterized the level of theoretical and applied training of specialists in the organization of the medical and diagnostic process for patients suffering from various types of angiopathies. We used the historical, analytical, comparative, systemic, logical, hypothetical-deductive, mathematical and statistical methods, as well as the expert survey method. Results.It was found that the largest number of appointments (51.82%) was made by therapists/family doctors, and the smallest - by endocrinologists (3.6%). The vast majority of respondents (except for allergologists and endocrinologists) prescribed these drugs in treatment according to the main diagnosis of the patient. At the same time, only therapists/family doctors and cardiologists prescribed quercetin and its derivatives in a wide range of development of the clinical picture of the pathology, namely the main diagnosis, with its complications and associated diseases. Doctors of all specialties, except for otolaryngologists noted the use of quercetin and its derivatives in the treatment of concomitant pathologies of sick patients. The first position in the structure of medical appointments (1st level of ICD-10) was taken by appointments in the treatment of I-diseases of the circulatory system (78.97%), the second – by J-diseases of the respiratory system (11.30%), and the third – K-digestive system diseases (6.04%). In the structure of prescriptions for patients with cardiovascular pathologies, the largest share was made in the treatment of angina pectoris (49.60%), in the second position – chronic ischemic heart disease (21.61%), and in the third – other cerebrovascular diseases (10.60%). Conclusions.It was proved that the highest prescribing rates of quercetin and its derivatives were carried out by therapists/family doctors in the treatment of diseases of the cardiovascular system according to the main diagnosis, its complications and associated pathologies. The low level or lack of prescription of drugs of this group in doctors of other specialties requires further research in the indicated direction

It was conducted a comprehensive survey of 87 women aged 22-54 years who had chronic noncalculous cholecystitis as the main diagnosis, and hyperplasia of the thyroid gland was firstly established in the conditions of the resort Truskavets, and accordingly, these women did not use drugs for its treatment. It was found that in the presence of thyroid gland hyperplasia and noncalculous cholecystitis, thyroid status in women is characterized by hypofunction of the thyroid gland, and changes in it functioning occur by the type of hypothyroidism. The thyroid status of such patients, according to some features, corresponds to subclinical, in some cases – manifest primary hypothyroidism in addition with the syndrome of "low T3". The values of the parameters that characterize the hormonal status of the patients, in its pure form not meet any of these pathological conditions.

Psychiatric hospitalization poses a risk for Posttraumatic Stress Disorder (PTSD), partly because of coercion. However, the role of legal status is less clear, while factors like insight, exposure to violence and affective disorders have not been addressed adequately. The present study aims at assessing PTSD rates after hospitalization and evaluating the potential role of these factors. 98 inpatients were assessed for PTSD, insight, main diagnosis, adverse events during hospitalization and legal status. Assessment took place at discharge (T1) and three months later (T2). Three months after discharge, 74.2% of patients with affective disorders met symptom-criteria for PTSD. Voluntarily hospitalized patients had more severe PTSD-symptoms. This relation vanished after controlling for affective disorders. The latter, as well as exposure to violence were the most significant risk factors at T2. Female gender, marital status (not married) and employment status (not employed), were additional risk factors at T1, while involuntary medication had a negative effect on PTSD-symptoms. Voluntarily hospitalized patients are more vulnerable to PTSD, due to higher rates of affective disorders. Females suffering from affective disorders who are not married and not employed should be monitored for PTSD symptoms during and after hospitalization, especially if exposed to violence.

BACKGROUND Recent studies have demonstrated that urgent care decreases the risk of subsequent stroke after transient ischemic attack (TIA). In response to heterogeneous TIA management observed in our area, we developed a structured pathway, in accordance with current guidelines and adapted to local resources. We aim to assess the effect of local implementation of this care pathway on TIA management in emergency departments (EDs) in the Rhone area (France). PATIENTS AND METHODS EDs of 5 centers that had a minimum of 30 TIA/year in Lyon and Bourgoin-Jallieu participated. The first 30 consecutive patients who had a TIA as main diagnosis admitted to one of these EDs from January 1 to December 31, 2013 and from January 1 to December 31, 2016, that is, before-and-after care pathway implementation, respectively, were retrospectively included in the study. The primary outcome was the adequate management of TIA defined as having had appropriate workup and antithrombotic treatment within 24 hours. RESULTS A total of 141 patients were included in 2013 and 150 in 2016. There was a significant increase of complete (intracrania and extracranial) vessel imaging from 2013 to 2016 (n=42, 29.8% in 2013 vs. n=118, 78.7% in 2016; P

Introduction: Nowadays clinicians don't have a useful tumoral marker to perform the follow up of patients affected of head and neck cancers (H&NC). Objectives: To analyse the operative characteristics of prealbumin (PRB) as a tumoral activity marker in those affected of head and neck cancer compared with albumin, total proteins, carcinoembryonic antigen, and alfa fetoprotein. Methods: It was performed an observational prospective study with patients visited in Hospital Universitari Arnau de Vilanova de Lleida (Spain) with the main diagnosis of H&NC. During study time main epidemiological, clinical, and analytical (including PRB) characteristics were collected in 3 times: at diagnosis, after finishing the treatment and 12 months later. Results: Blood samples were obtained from 138 patients from the 1st January 2007 till the 1st February 2010. Median age was 62.5 (29-89) years and 121 (88%) were males. Most frequent histological diagnosis was scamous carcinoma 87 cases (63%). 19 patients (14.5) died during that time. Sensitivity, specificity, positive and negative predictive values of PRB were 63%, 100%, 100%, 87% respectively. The area under receiver operating characteristic curve was 0.87 (CI 0.76-0.98), that was better than other parameters studied. Conclusions: Prealbumin is a useful tumoral activity marker in those affected of head and neck cancer and it could be a useful tool in these patients follow up.

Introduccion: las infecciones respiratorias asociadas a ventilacion mecanica (IRAV), sean neumonia o traqueobronquitis, son importantes complicaciones en UCI. Objetivo: caracterizar los aspectos epidemiologicos, clinicos y microbiologicos de IRAV. Materiales y metodo: estudio retrospectivo de todos los pacientes admitidos a la UCI Medico Quirurgica de la Clinica San Juan de Dios, durante el periodo de un ano, con diagnostico de traqueobronquitis asociada a ventilacion mecanica (TAV) o neumonia asociada a ventilacion mecanica (NAV), con cultivos de aspirado de secrecion traqueal informados como positivos. Resultados : se presentaron 22 casos de IRAV. La presencia de IRAV fue del 11.9%, de TAV 6.8% y de NAV 5.6% de los 176 pacientes que requirieron ventilacion mecanica por mas de dos dias. La mediana de edad para NAV fue de 76 + 16 anos, mientras que para la TAV de 68 + 18 anos. Los principales diagnosticos de ingreso de los pacientes con IRAV fueron neurologicos (40.9%) y pulmonares (31.8%). Predominaron los germenes gram negativos (95.5%) y los microrganismos multirresistentes en ambos tipos de infecciones (59.1%). Hubo alta frecuencia de uso de antibioticoterapia previa al diagnostico (95.5%), traqueostomia (81.8%) y transfusiones de hemoderivados (50%). La mortalidad en UCI fue 25% para TAV y 40% para NAV, mientras que la mortalidad hospitalaria de IRAV fue 50%. Conclusion: existe alta mortalidad, presencia de microorganismos gram negativos involucrados y elevada multirresistencia antibiotica en ambas formas de IRAV. Se deben implementar medidas encaminadas a la prevencion y al adecuado manejo de estas infecciones en UCI. Rev.cienc.biomed. 2015;6(1):38-44 PALABRAS CLAVE Dispositivos de proteccion respiratoria; Respiracion artificial; Cuidados intensivos; Neumonia bacteriana. SUMMARY Introduction : the ventilator-associated respiratory infections (VARI), pneumonia or tracheobronchitis, are important complications in intensive care units (ICU). Objective : To characterize the epidemiological, clinical and microbiological aspects of VARI. Methods: retrospective study of all patients who were admitted to the ICU of the Clinica San Juan de Dios, during the period of one year, with diagnosis of Ventilator-Associated tracheobronchitis (VAT) or Ventilator-associated pneumonia (VAP), with cultures of endotraqueal secretion informed as positive. Results: 22 cases of VARI were presented. The presence of VARI was 11.9%, VAT 6.8% and VAP 5.6% of the 176 patients who required mechanical ventilation for more than two days. The median of age for VAP was 76 + 16 years, while for VAT of 68 + 18 years. The main diagnosis of admission of the patients with VARI were neurological (40.9%) and pulmonary (31.8%). The gram-negative (95.5%) and multidrug-resistant microorganisms of both infections (59.1%) predominated. Also, there was high frequency of use of antibioticotherapy previous to the diagnosis (95.5%), tracheostomy (81.8%) and transfusion of hemoderivative (50%). The mortality in ICU was 25% for VAT and 40% por VAP, while the in-hospital mortality of VARI was 50%. Conclusion: there is high mortality, presence of gram-negative microorganisms involved and high multidrug resistance in both forms of VARI. Measures oriented to the prevention and management of these infections in ICU must be implemented. Rev. cienc.biomed. 2015;6(1):38-44 KEYWORDS Respiratory protective devices; Artificial respiration; Intensive care; Bacterial pneumonia.

Dermatological problems are not usually related to intensive medicine because they are considered to have a low impact on the evolution of critical patients. Despite this, dermatological manifestations (DMs) are relatively frequent in critically ill patients. In rare cases, DMs will be the main diagnosis and will require intensive treatment due to acute skin failure. In contrast, DMs can be a reflection of underlying systemic diseases, and their identification may be key to their diagnosis. On other occasions, DMs are lesions that appear in the evolution of critical patients and are due to factors derived from the stay or intensive treatment. Lastly, DMs can accompany patients and must be taken into account in the comprehensive pathology management. Several factors must be considered when addressing DMs: on the one hand, the moment of appearance, morphology, location, and associated treatment and, on the other hand, aetiopathogenesis and classification of the cutaneous lesion. DMs can be classified into 4 groups: life-threatening DMs (uncommon but compromise the patient’s life); DMs associated with systemic diseases where skin lesions accompany the pathology that requires admission to the intensive care unit (ICU); DMs secondary to the management of the critical patient that considers the cutaneous manifestations that appear in the evolution mainly of infectious or allergic origin; and DMs previously present in the patient and unrelated to the critical process. (is review provides a characterization of DMs in ICU patients to establish a better identification and classification and to understand their interrelation with critical illnesses.

espanolEl Sindrome de Van der Woude (SVW) es una anomalia infrecuente que afecta a estructuras orofaciales y ha sido insuficientemente reportada en America Latina, su identificacion puede ser pasada por alto debido a que esta intimamente relacionada con labio y paladar fisurado. El objetivo del articulo es realizar segun nuestro conocimiento, el primer reporte en Ecuador sobre este Sindrome que se caracteriza por la asociacion congenita de senos en labios inferiores con labio leporino y paladar hendido. En la Clinica de Labio y Paladar Fisurado de la Universidad Catolica de Cuenca se presento en consulta una paciente de 6 anos con las siguientes caracteristicas: fistulas labiales simetricas en el labio inferior; asintomatico y con secuelas de labio y paladar fisurado (LPF) con salivacion extrema y goteo por la zona labial a la masticacion. El SVW puede contar con otros hallazgos clinicos importantes como: pliegues cutaneos en los miembros, hipodoncia, uvula bifida, anquiloglosia y perdida de la audicion neurosensorial, de los cuales la paciente unicamente presento uvula bifida y las fistulas labiales ademas de la secuela de LPF. El principal diagnostico es meramente clinico, por lo tanto, no se necesitan diagnosticos complementarios, utilizandose los estudios de rutina como examenes de laboratorio pre operatorios, mas la valoracion anestesica y cardiologica pediatrica. La paciente presento secuelas de su primera cirugia de LPF por lo que se procedio a una nueva intervencion y a la escision de las fistulas labiales sin ningun tipo de secuela resultante. Conclusion: En un caso de Labio y Paladar Fisurado con fistulas labiales siempre se debera realizar interconsulta con Pediatria para descartar sindromes asociados y proceder a su escision quirurgica, para evitar molestias durante la masticacion del paciente y con fines posteriormente esteticos. La tecnica quirurgica realizada fue la Tecnica en Huso (Fistulectomia), con la cual elimina de manera completa el trayecto ductal y se realiza un cierre por planos del labio, resultando sin secuelas EnglishThe Van der Woude Syndrome is a rare anomaly that affects orofacial structures and has been insufficiently reported in Latin America; its identification can be overlooked because it is closely related to cleft lip and palate. The objective of the article is to carry out, to our knowledge, the first report in Ecuador on this Syndrome characterized by the congenital association of sinuses in the lower lips with cleft lip and palate. In the Clinic of Lip and Cleft Palate of the Catholic University of Cuenca, a 6-year-old patient with the following characteristics presented in consultation: symmetrical lip fistulas on the lower lip; Asymptomatic and with sequelae of the lip and palate fissured with extreme salivation and dripping through the lip area upon chewing. The SVW may have other important clinical findings such as: skin folds in the limbs, hypodontia, bifid uvula, hookworm, and sensorineural hearing loss, of which the patient only presented bifid uvula and lip fistulas in addition to the sequela of LPF. The main diagnosis is purely clinical, therefore, complementary diagnoses are not needed, using routine studies such as preoperative laboratory exams, plus pediatric anesthesia and cardiology evaluation. The patient had sequelae from her first LPF surgery, so she underwent a new intervention and excision of the lip fistulas without any resulting sequela. Conclusion: In a case of cleft lip and palate with lip fistulas, an inter-consultation with pediatrics should always be carried out to rule out associated syndromes and proceed to their surgical excision, to avoid discomfort during the patient's chewing and for later cosmetic purposes. The surgical technique performed was the Spindle Technique (Fistulectomy), with which the ductal path is completely eliminated and a plane closure of the lip is performed, resulting in no sequelae.

Each patient has his/her own individual characteristics. It is given by his/her main diagnosis and its detailed description...

Background: A few studies in high-income countries have investigated the relationship between ambient temperature and/or precipitation and the occurrence of gastroenteritis. In most of the cases, hot temperatures and heavy precipitation events have been related to increases in infections. This is of concern as climate change predictions indicate an increase of those extreme events. Our aim was to evaluate the association between meteorological variables and daily gastroenteritis hospitalizations in Spain for the period 1997–2013. Methods: We obtained data on all hospitalizations which occurred in Spain for the study period from administrative databases and selected those with gastroenteritis as the main diagnosis. Meteorological data was obtained from the European Climate Assessment & Dataset. Daily counts of hospitalizations were linked to meteorological variables in a retrospective ecological time series study using quasi-Poisson regression models with overdispersion and applying the Distributed Lag Non-linear Model (DLNM) framework. Results: Both high and cold temperatures increased the risk of gastroenteritis hospitalizations (relative risk (RR) = 1.21, 95% confidence interval (CI): 1.09, 1.34; and RR = 1.07, 95% CI: 1.00, 1.15, respectively), whereas heavy precipitation was found protective for those hospitalizations (RR = 0.74, 95% CI: 0.63, 0.86). Hot temperatures increased hospitalizations for gastroenteritis classified as foodborne or idiopathic but not those in the group of Others, which were composed mainly of infections by rotavirus and were associated with cold temperatures. Conclusions: Our findings suggest an important role of ambient temperatures, especially hot temperatures, in increasing gastroenteritis hospitalizations, while the exposure to heavy precipitation events pose opposite and unexpected effects on these infections. Keywords: Gastroenteritis, Hospitalizations, Extreme temperatures, Rainfall, Precipitation, Climate change

Assessment and Therapy of Adolescent Identity Diffusion Identity diffusion, one of the main diagnosis criteria for borderline personality disorder (BPD), is characterized by a lack of coherent sense of self and of significant others, paired with a painful sense of incoherence. The revision of the age limit for the diagnosis of personality disorders in DSM-5 has opened the doors to research on diagnosis and treatment of BPD in adolescence. This paper offers a summary of past and present work on the diagnosis and therapy of identity disturbance in adolescent patients.

Summary Background Follow-up care and rehabilitation services [soins de suite et readaptation (SSR)], especially cardiac rehabilitation (CR), constitute a key stage for patients who have had an acute myocardial infarction (AMI). Aims To study admission to SSR, especially for CR, among patients hospitalized for AMI in France in 2014, and its temporal trend between 2010 and 2014. Methods We used the French National Hospital Database to select patients hospitalized with a main diagnosis of AMI (identified by ICD-10 codes I21 to I23) in the first semester of each year from 2010 to 2014. We then searched for rehabilitation admission in the 6 months after the index hospitalization. We calculated age-standardized rates of admission for CR and for other rehabilitation purposes. The average annual percentage change in admission rates was analysed by Poisson regression. Results In 2014, among the 29,424 patients hospitalized for an AMI in the first 6 months of the year, 10,873 (36.9%) were subsequently admitted to SSR units. More specifically, the age-standardized rate of patients hospitalized in CR units reached 28.4% (n = 8380), and was greater among men (29.6%, n = 6707) than among women (24.9%, n = 1673). Between 2010 and 2014, rates of admission for CR increased by 5.0% per year in men and 6.6% per year in women. We found a great increase in ambulatory CR management, which accounted for half of the admissions for CR in 2014. Conclusions Favourable trends in rates of admission for CR were reported in both sexes and at all ages, except the oldest. The increase in ambulatory management contributed to these changes. Despite these trends, rates of admission for CR after AMI remain low.

Introduction There are reports that diabetes mellitus reduces the risk of aortic aneurysms and many reports that diabetes mellitus reduces the risk of abdominal aortic aneurysms. In earlier years there were also studies that did not demonstrate any effects of diabetes on the rate of aortic aneurysms. Material and methods For the year 2012, between 1 January and 31 December, reports for services regarding treatment for aortic aneurysms were found. At the same time, the reports for services associated with diabetes with the main diagnosis of "diabetes mellitus" were found in National Health Fund databases for 2012 with the special determinants. Results In Poland in 2012 the mean incidence of aortic aneurysms in both sexes in the group of subjects with diabetes calculated per 100,000 subjects with diabetes was 167.78 ±49.10, and the mean incidence of aortic aneurysms in both sexes in the group of subjects without diabetes calculated per 100,000 of the general population after subtracting the number of subjects with diabetes was 27.72 ±9.40. The incidence of aortic aneurysms among subjects with diabetes was significantly higher (p < 0.001) than the incidence of aortic aneurysms among subjects without diabetes. Conclusions Aortic aneurysms were more frequently observed in the group of patients with diabetes than in those without diabetes. Aortic aneurysms were observed three times more frequently in men than in women. In Poland in 2012, 27.20% of patients diagnosed with aortic aneurysms also had diabetes.

IntroductionPaediatricians with Expertise in Cardiology assess children with a full history, examination, and often perform an echocardiogram. A minority are then referred to an outreach clinic run jointly with a visiting paediatric cardiologist. The accuracy of the echocardiography diagnosis made by the Paediatrician with Expertise in Cardiology is unknown.Materials and methodsWe conducted a retrospective review of clinic letters for children seen in the outreach clinic for the first time between March, 2004 and March, 2011. Children with CHD diagnosed antenatally or elsewhere were excluded. We recorded the echocardiography diagnosis made by the paediatric cardiologist and previously by the Paediatrician with Expertise in Cardiology.ResultsThe Paediatrician with Expertise in Cardiology referred 317/3145 (10%) children seen in the local cardiac clinics to the outreach clinic over this period, and among them 296 were eligible for inclusion. Their median age was 1.5 years (range 1 month–15.1 years). For 244 (82%) children, there was complete diagnostic agreement between the Paediatrician with Expertise in Cardiology and the paediatric cardiologist. For 29 (10%) children, the main diagnosis was identical with additional findings made by the paediatric cardiologist. The abnormality had resolved in 17 (6%) cases by the time of clinic attendance. In six (2%) patients, the paediatric cardiologist made a different diagnosis. In total, 138 (47%) patients underwent a surgical or catheter intervention.DiscussionPaediatricians with Expertise in Cardiology can make accurate diagnoses of CHD in children referred to their clinics. This can allow effective triage of children attending the outreach clinic, making best use of limited specialist resources.

Introducción: Las personas con diabetes e hipertensión experimentan con mayor frecuencia sintomatología depresiva, lo cual contribuye a un inadecuado automanejo de la enfermedad, que implica tareas como: la toma de la medicación, asistir a las consultas médicas, el conocimiento de signos y síntomas, además de la toma de decisiones. Objetivo: Por lo anterior, el objetivo de este trabajo es identificar la relación entre automanejo en general y sus dimensiones con síntomas depresivos en personas con diabetes e hipertensión. Método: Estudio transversal-correlacional con n=205 pacientes con diagnóstico de diabetes (100) e hipertensión (105). Muestreo no probabilístico por conveniencia. Se utilizó la estadística descriptiva y r de Pearson. Se aplicaron los instrumentos Partners in Health (PIH) y The Patient Health Questionnaire (PHQ-8). Resultados: Se encontró correlación estadísticamente significativa entre la sintomatología depresiva y el automanejo (r=-0.308 ρ

This study evaluated the impact of comorbid OCD on suicide attempt risk and suicide methods in 990 patients with main diagnosis of BD. Two hundred and one patients (20.3%) had lifetime comorbid OCD. No significant differences were found comparing rates of lifetime suicide attempts between patients with or without comorbid OCD (30.3% vs 24.6%). In the subgroup of patients with concomitant OCD more subjects performed suicide attempts with violent methods (48.3% vs 28.7%). Therefore, our results suggest a correlation between comorbid OCD and violent suicide attempts. This finding is worthy of interest and deserves to be explored by further studies.

В статье приводится статистический анализ сравнения количественных показателей по группе «Заключительный диагноз» для следующих палатных отделений Клинического госпиталя ФКУЗ «МСЧ МВД России по г. Москве»: гинекологическое отделение; кардиологическое отделение; оториноларингологическое отделение; пульмонологическое отделение; терапевтические отделения № 1, № 2, № 3; урологическое отделение; хирургическое отделение. Сравнения двух групп по количественным шкалам проводились на основе непараметрического критерия Манна-Уитни. Сравнения трех и более групп по количественным шкалам проводились на основе непараметрического критерия Краскела-Уоллеса. Для описания количественных показателей использовались среднее значение и стандартное отклонение в формате «M ± S». Уровень статистической значимости был зафиксирован на уровне вероятности ошибки 0.05 (α=0,05). Полученные результаты позволяют сделать вывод о том, различия показателя «Степень соответствия» между отдельными группами переменной «Заключительный диагноз» могут достигать более десяти единиц, но при этом разброс данных имеет также большие значения, что в итоге не позволяет сделать выводов о статистически значимых различиях между группами., The article provides a statistical analysis of the comparison of quantitative indicators for the group "Final Diagnosis" for the following wards of the Clinical Hospital of the Clinical Hospital FKUZ "MCH MIA of Russia in Moscow": gynecological department; cardiology department; ENT department; pulmonology department; therapeutic departments No. 1, No. 2, No. 3; urological department; surgery department. Comparisons of the two groups on quantitative scales were based on the nonparametric Mann-Whitney test. Comparisons of three or more groups on quantitative scales were carried out based on the non-parametric Kruskal-Wallace criterion. To describe the quantitative indicators, the mean value and standard deviation in the “M ± S” format were used. The level of statistical significance was fixed at the level of probability of error 0.05. The results allow us to conclude that the differences in the degree of compliance between the individual groups of the Final Diagnosis variable can reach more than ten units, but the scatter of the data is also large, which ultimately does not allow conclusions to be drawn on statistically significant differences between in groups., Уральский Медицинский Журнал, Выпуск 4 (187) 2020

This article considers fault of DC motors used in EKG-5A excavators of mining and processing branch of OJSC “MMK”. Quantitative ratios of faults and their types were identified. All motors were categorized by age. Proportion of “under risk” motors was determined. Such DC motors are eligible for fault diagnostics allowing to monitor fault at early stages. Analysis of main diagnosis methods was conducted and creation of recording system of sparking charges between brushes was justified. Approximate design for recording system with built-in antenna was presented. Main requirement for similar systems of fault monitoring and detection operating in harsh environments of DC motors in excavators were formed.

The Aim: of study is to assess the dynamics of medical undergraduates’ knowledge of bronchial asthma (BA) basics. Materials and Methods: Following up our multicenter research ASSA-1 (‘14-‘15, 7 cities, 521 medical majors), we started ASSA-2 project in 2017. Currently, we obtained the results from 249 undergraduates tested in 8 Russian and Ukrainian centers. The knowledge of BA basics such as definition, pathogenesis, diagnostics and treatment was evaluated by applying the 12 single-choice questions survey. Results: The average level of correct answers in both groups (ASSA-1 and ASSA-2) was not significantly increased (74.0%-72.6%), and varied from 56.8%-49.2% to 93.9%-90.0% in different questions. The most difficult questions were still related to exact BA definition in both groups (ASSA-1 and ASSA-2) 56.8%-49.2%, p The groups did not demonstrate any significant dynamics in the following questions: pathogenesis (70.8%-66.3%), instrumental and laboratory markers (65.6%-65.7%), main diagnosis methods (85.6%-87.6%), severity levels (80.6%-77.1%), self-control over BA (74.5%-71.9%), status asthmaticus definition (93.9%-90.0%), asthma attack therapy (78.9%-77.7%), fixed combination drugs (61.4%-60.2%). The knowledge of BA baseline therapy had significantly increased among ASSA-2 group in comparison to ASSA-1 (75.9%-64.5%, p Conclusion: It was revealed that despite the availability of plenty training and scientific literature in the area of bronchial asthma, the level of knowledge remains unsatisfactory. Thus, BA subject should be studied more thoroughly in higher schools.

Introduction Recent paleopathological cases have shown the usefulness of interdisciplinary odontological studies in the investigation of historical figures. Observation A macroscopic examination of the mandible of Saint-Louis (13th c. AD), conserved in the cathedral of Notre-Dame (Paris, France) was carried out, and compared with biographical data about the life and death of the King, and contemporaneous cases of infectious/inflammatory diseases. We found post-mortem tooth loss associated with moderate signs of infectious and inflammatory diseases, which precise diagnoses are discussed facing historical chronicles and sources: main diagnosis is scurvy, potentially associated with bacterial infection. Discussion Our results support the identification of the relics, and improve the knowledge about the saint's circumstances of death related to metabolic deficiencies and infections.

International audience; Objectives: To assess the relationship between changes of frailty status and intervening hospitalizations, using information of the GAZEL cohort, matched with the data of the French National Health Data System.Design: Observational cohort study.Participants: Community-dwelling adults of the GAZEL cohort (n = 12145; aged between 58 and 73 years in 2012).Measurements: Frailty was determined with the Strawbridge questionnaire in 2012, 2013 and 2014. Data regarding hospitalizations (notably their number, length of stay, emergency department use, and main diagnosis) were collected from the French National Health Data System. The relationship between intervening hospitalizations and changes of frailty status over time was assessed with multivariate Markov models.Results: The prevalence of frailty was 14% in 2012 and 2013 and 17% in 2014. A total of 2715 changes in frailty status were observed from 2012 to 2014. At least one hospitalization was recorded for 1453 people (12%) between the 2012 and 2013 questionnaires, and 1472 (13%) between the 2013 and 2014 questionnaires. No association was found between intervening hospitalizations and changes of frailty status (aHR 1.14 [0.97-1.35] for robust to frail transition and aHR 0.89 [0.73-1.08] for frail to robust transition). However, repeated hospitalizations, hospitalizations after emergency department use, surgery and several diagnosis groups were significantly associated with transitions towards frailty or its recovery.Conclusion: Hospitalizations encompass a wide range of clinical situations, some of them being associated with incident frailty. An early recognition of these situations could help to better prevent and manage frailty in the early old age.

Electro hydraulic servo valves (EHSV) constitute as core parts of many hydraulic actuators such as multi-functional spoilers (MFS) in aircraft systems. Their continuous health monitoring is important for the overall flight safety as well as economizing down times and repairs. Hence, diagnosis, prognosis and health monitoring (DPHM) of EHSVs is addressed in this paper for multiple modes of degradations that might be present in the system. The objective of this paper is to demonstrate how each mode of degradation may be isolated and estimated, and how the remaining useful life (RUL) of the EHSV can be assessed for a critically safe component under strict safety regulations. In this paper Bayesian tracking and particle filters are utilized to address three main diagnosis and prognosis problems, namely ‘isolation’, ‘estimation’, and the ‘remaining useful life’. Several case studies simulations have been provided to demonstrate and illustrate the capabilities of our proposed methodologies.

Este estudo buscou apresentar o perfil sociodemográfico dos usuários de um CAPS III, da cidade de São Paulo, que necessitaram do acolhimento como estratégia de cuidado no período de novembro de 2012 a dezembro de 2016. Também se analisaram as características dos acolhimentos em relação ao tempo de permanência e acolhimentos repetidos. Trata-se de um estudo descritivo exploratório de análise documental com abordagem quantitativa. Foram analisados o documento preenchido no CAPS referente aos acolhimentos e os prontuários dos usuários. A análise dos dados utilizou o Software Statistical Package for the Social Sciences (SPSS®), Versão 20. Verificou-se que a maioria dos usuários acolhidos era do sexo feminino, de cor branca, com escolaridade até o ensino médio, faixa etária dos 31 aos 59 anos e recebia benefício social. A principal hipótese diagnóstica foi de esquizofrenia, transtornos esquizotípicos e transtornos delirantes. A maioria dos usuários não precisou ficar no acolhimento mais do que cinco vezes e os acolhimentos, na sua maioria, não passaram de sete dias. O estudo contribuiu para compartilhar informações sobre o acolhimento noturno, que é uma importante estratégia de cuidado ainda pouco estudada.