다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak. Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity. Results: From the 4621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organisational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training and resources, were associated with less psychological distress. Conclusions: This review highlights the key factors to identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to three years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

/pdf/factors-associated-with-psychological-distress-in-health-3aqury17e1.pdf

Factors Associated With Psychological Distress in Health-Care Workers During an Infectious Disease Outbreak: A Rapid Systematic Review of the Evidence

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are emerging in southeast Queensland, Australia, but the incidence of carriage of CA-MRSA strains is unknown. The aim of this study was to assess the nasal carriage rate of S. aureus, including CA-MRSA strains, in the general adult population of southeast Queensland. 396 patients presenting to general practices in two Brisbane suburbs and 303 volunteers randomly selected from the electoral rolls in the same suburbs completed a medical questionnaire and had nasal swabs performed for S. aureus. All isolates of S. aureus underwent antibiotic susceptibility testing and single-nucleotide polymorphism (SNP) and binary typing, including determination of Panton–Valentine leukocidin (PVL). The nasal carriage rate of methicillin-susceptible S. aureus (MSSA) was 202/699 (28%), a rate similar to that found in other community-based nasal carriage studies. According to multivariate analysis, nasal carriage of S. aureus was associated with male sex, young adult age group and Caucasian ethnicity. Only two study isolates (one MSSA and one CA-MRSA) carried PVL. The nasal carriage rate of MRSA was low, at 5/699 (0.7%), and only two study participants (0.3%) had CA-MRSA strains. CA-MRSA is an emerging cause of infection in southeast Queensland, but as yet the incidence of carriage of CA-MRSA in the general community is low.

Nasal carriage of Staphylococcus aureus, including community-associated methicillin-resistant strains, in Queensland adults

Background Healthcare workers are at high risk of developing sleep disorders during an outbreak. This study aimed to measure severity of sleep difficulty and its correlation with duration of deal with suspected/confirmed cases of novel coronavirus (COVID-19) in physicians. Methods In this cross-sectional study, 268 physicians from different medical settings were included during the COVID-19 outbreak. Results The mean age and experience of physicians were 35.06 (33-70 years) and 10.13 years. The median duration of dealing with suspected/confirmed cases of COVID-19 was 1.0 (0-30 days). The mean sleep score and stress of physicians were 8.43 of 24.0 and 4.20 of 10, respectively. More than two-thirds of the physicians were sleepless (68.3%) and majority had stress (93.7%). The study did not find a significant difference in sleep score of physicians with different specialties (P = 0.059). However, most physicians were sleepless; including anesthesia and intensive care (77.8%); general physicians (80.8%), and obstetrics and gynecology (80.0%). They were sleepless in morning (58.7%); evening (77.8%); night (100%); and multi-shift (70.9%). The physicians who dealt with suspected or confirmed cases of COVID-19 or with stress had more escalated sleep compared to those who did not deal with patients or without stress (9.39 vs. 7.17 and 8.78 vs. 2.69 P < 0.001). The sleep of physicians was escalated with increasing stress (r = 0.558; P < 0.001) and a number of days that physicians dealt with suspected/confirmed cases of COVID-19 (r = 0.210; P = 0.001), respectively. Conclusion The study confirmed that working with COVID-19 patients has a negative effect on the sleep of physicians.

Insomnia and stress of physicians during COVID-19 outbreak

ABSTRACT Polycyclic aromatic hydrocarbons (PAHs) are legacy pollutants of considerable public health concern. Polycyclic aromatic hydrocarbons arise from natural and anthropogenic sources and are ubiquitously present in the environment. Several PAHs are highly toxic to humans with associated carcinogenic and mutagenic properties. Further, more severe harmful effects on human- and environmental health have been attributed to the presence of high molecular weight (HMW) PAHs, that is PAHs with molecular mass greater than 300 Da. However, more research has been conducted using low molecular weight (LMW) PAHs). In addition, no HMW PAHs are on the priority pollutants list of the United States Environmental Protection Agency (US EPA), which is limited to only 16 PAHs. However, limited analytical methodologies for separating and determining HMW PAHs and their potential isomers and lack of readily available commercial standards make research with these compounds challenging. Since most of the PAH kinetic data originate from animal studies, our understanding of the effects of PAHs on humans is still minimal. In addition, current knowledge of toxic effects after exposure to PAHs may be underrepresented since most investigations focused on exposure to a single PAH. Currently, information on PAH mixtures is limited. Thus, this review aims to critically assess the current knowledge of PAH chemical properties, their kinetic disposition, and toxicity to humans. Further, future research needs to improve and provide the missing information and minimize PAH exposure to humans.

Polycyclic aromatic hydrocarbons (PAHs): Updated aspects of their determination, kinetics in the human body, and toxicity

Introduction The thyroid gland has a very important role in hematopoiesis, blood disorders are frequently seen in patients with thyroid disorders. Thyroid hormones have direct effect on blood parameters by stimulating erythrocytes precursors and indirectly by enhancing erythropoietin production. Patients and methods This is a case-control study which included 300 subjects who were grouped to 3 equal groups as a control, hypothyroidism, and hyperthyroidism groups. Patients with inherited or acquired red cell abnormalities, those receiving treatment for thyroid disorder or anemia, patient with chronic diseases, aged Results The mean age of patients is 40.72 years, and females constituted 60.7% of cases. The analyses showed a significant difference the RBC, HB, MCV, MCHC, RDW, and WBC (P values 0.000, 0.000, 0.001, 0.012.0.002, and 0.027) respectively, while platelets showed no significant correlation (P value 0.08). The univariate analyses showed that RBC, the HB, and the WBC were the most severely affected parameters (Sig. 0.000, 0.000, and 0.005) respectively. Conclusion The study concluded that females are more affected by thyroid disorders than males and the peak age is at the forties, thyroid dysfunction affect all blood parameters except platelets.The follow up of patients with thyroid disorders should include the complete blood count and patients diagnosed with anemia should be evaluated for thyroid disorders before iron therapy. Cases of anemia that resist treatment should be investigated for the possibility of thyroid dysfunction.

Effects of thyroid dysfunction on hematological parameters: Case controlled study

Introduction. The healthcare workers are at high risk of developing stress-related problems during outbreaks. This study aimed to explore the perceived stress and its relation to the duration of dealing with COVID-19 patients in medical doctors.Methods. The doctors who work in different medical settings in Iraqi Kurdistan during coronavirus outbreak were invited into this cross-sectional study. The doctors were invited from one pediatric, one emergency, one special corona, and one maternity and gynecology hospital. The "Perceived Stress Scale-10 (PSS)" measured the perceived degree of a doctor who experienced stress. The information was collected through a web-based technique to avoid the disease spread.Results. Doctors' mean duration of dealing with suspected/confirmed cases of COVID-19 was 1.2 (Range: 0-16 days). The mean stress score was 18.81 out of 40. Most of the doctors had a moderate level of stress (69.4%), followed by a low (21.1%) and a high level of stress (9.6%). The general physicians and medical lab specialties had higher stress scores; 21.56 and 19.88, respectively. The high level of stress was among general physicians and community and family medicine doctors; 20.0% and 25.0%, respectively. Whether or not doctors dealt with suspected/confirmed cases of COVID-19, did not have a significant difference over the perceived stress score; 19.02 vs. 18.87; P = 0.786). The mean score of stress was raised with increasing duration of dealing with suspected/confirmed cases of COVID-19; r = 0.202; P = 0.004 and decreased with increasing age (r = -0.141; P = 0.045), and clinical experience (r = -0.139, P = 0.048).Conclusion. This study showed that medical doctors are at a moderate level of perceived stress during the COVID-19 outbreak in Iraqi Kurdistan.

/pdf/the-consequences-of-the-covid-19-pandemic-on-perceived-2jrjo45bys.pdf

The consequences of the COVID-19 pandemic on perceived stress in clinical practice: Experience of Doctors in Iraqi Kurdistan.

Background Breast cancer is the most common type of cancer affecting women during their life, there are many histological types of breast cancer that have different biological behaviors. Tumors have different genetic and molecular differences which affect the expression of various hormone receptors. Patients and methods The aim of this study is to show the factors that determine the axillary lymph node involvement in patients with breast cancer in Duhok city. A total number of 479 female patients with breast cancer of various histological types, immunohistochemical characteristics, and clinical stages were included in this study. These patients underwent modified radical mastectomy and axillary lymph node dissection. Results The mean age of our patients was 48.24 years, the mean number of the positive lymph nodes were 2 lymph nodes, the median size of the tumor was 30 mm. A significant correlation was found with the size of the tumor and the estrogen receptor status (P values (0.000 and 0.042) respectively, while there was no significant correlation with other factors such as the age, stage of the tumor, grade of the tumor, tumor necrosis, progesterone and HER-2 receptors status. Conclusion Size of the tumor and the estrogen receptor status were the most common factors that determined axillary lymph node involvement in patients with breast cancer in our study.

Predictive factors affecting axillary lymph node involvement in patients with breast cancer in Duhok: Cross-sectional study.

Background Vitamin D deficiency is prevalent in most parts of the world. Its insufficiency or deficiency is implicated in bone diseases, some cancers, infectious diseases, heart disease, autoimmune and metabolic diseases including type 2 diabetes mellitus. Results The mean age of patients was 49.94 ± 9.36, while the mean age the controls was 48.95 ± 10.56. Females constituted 56.1% and males 43.9% in the cases group, while for the control group females were 54.8% and males were 43.9%. Low vitamin D levels were detected in 110 (71%) of cases and 63 (40.6%) of controls. There was a significant difference in vitamin D levels among cases and controls (p  Conclusion There is a high prevalence of hypo-vitaminosis D among patients with type-2 diabetes, particularly among patients with poor glycemic control and in those with longer diabetes durations. Vitamin-D deficiency is more prevalence in females, and those living in urban areas, those with obesity and patients with dyslipidemia.

Impact of vitamin D level on glycemic control in diabetes mellitus type 2 in Duhok.

A 35-year-old man presented with poorly localised lower abdominal pain for 3 months. Abdominal examination revealed lower abdominal tenderness, with normal other parts of examination. CT scan of the abdomen showed irregular multiloculated mass related to the upper part of the urinary bladder with mild rim enhancement in the postcontrast study with no areas of calcifications. During laparotomy, we found a mass attached to the superior part of the urinary bladder and arising from its wall. Complete excision was done without opening the cavity of the bladder. The mass was opened and was a hydatid cyst of the bladder containing multiple daughter cysts.

https://casereports.bmj.com/content/casereports/2018/bcr-2018-226341.full.pdf

Primary hydatid cyst of the urinary bladder.

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