scholarly journals Lesson learned by COVID-19 outbreak: multilevel triage strategies in patients admitted to the emergency room in southern Italy

2021 ◽  
Vol 15 (3) ◽  
Author(s):  
Pierpaolo Di Micco ◽  
Michele Imparato ◽  
Maria Teresa Iannuzzo ◽  
Andrea Fontanella
Keyword(s):  
Emergency Room ◽  
Respiratory Symptoms ◽  
Distress Syndrome ◽  
Southern Italy ◽  
Human Contact ◽  
The World ◽  
Speed Up ◽  
Multi Level ◽  
Selection Of Patients ◽  
Selection Of

After identifying a novel disease inducing a severe acute respiratory syndrome-related to coronavirus 2 (SARS-CoV-2) for epidemic pneumonia in China, the diffusion of infection is ongoing around the world, and Italy has been the second country in which an epidemic has been demonstrated. Clinical features of this infection may be summarized in viral pneumonia that SARS or acute respiratory distress syndrome (ARDS) may complicate. For this reason, this epidemic has been considerably more aggressive than the previous epidemic of SARS and Middle-East respiratory syndrome. Coronavirus disease 2019 (COVID-19) showed an easy diffusion from human to human and also showed to be more contagious than other viruses. So human contact should be avoided at the emergency room and for inpatients too. The Triage should be adapted to these new features in order to speed up procedures for the care of infected patients at high risk of morbidity and mortality for SARS and ARDS and for traditional access to the emergency room. Based on our experiences, this flow chart has been designed with a multi-level triage in which patients have been divided for admission to the emergency room into patients with fever/respiratory symptoms and patients without fever\respiratory symptoms, to improve medical performances while treating COVID-19. This organized, multilevel triage permitted a good selection of patients admitted to the emergency room during the epidemic of COVID-19 in Southern Italy.

scholarly journals Survival of Patients with Multi-Level Malignant Bowel Obstruction on Total Parenteral Nutrition at Home

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 889
Author(s):  
Tomasz Dzierżanowski ◽  
Jacek Sobocki
Keyword(s):  
Parenteral Nutrition ◽  
Bowel Obstruction ◽  
Water Retention ◽  
Malignant Bowel Obstruction ◽  
Short Survival ◽  
Laboratory Markers ◽  
Multi Level ◽  
Medical Registry ◽  
Selection Of Patients ◽  
Selection Of

Home parenteral nutrition (HPN) may improve the survival in selected patients with malignant bowel obstruction. This retrospective, medical registry-based study aimed to identify clinical and laboratory markers predicting short survival, which would allow a more accurate selection of patients that would benefit from HPN in inoperative bowel obstruction. In a retrospective analysis of 114 patients receiving HPN, the median survival was 89 days after discharge home, and the three and six-month survival probability was 48% and 26%, respectively. Parenteral nutrition was provided during 98% of overall survival time and ended on a median of one day before the patient’s death. Discontinuing chemotherapy, anemia, severe hypoalbuminemia, and water retention appeared correlated with survival shorter than three months. In these cases, routine initiation of HPN should be discouraged, as it may not bring any benefits to the patient. The decision on the initiation of HPN should be made along with continuing or initiating chemotherapy.

scholarly journals A Career Success of the Distributors in Multi-Level Marketing (MLM) Company

2014 ◽  
Vol 6 (6) ◽  
pp. 309-316
Author(s):  
Elisabet Siahaan ◽  
Yasmin Chairunisa M. .
Keyword(s):  
Qualitative Methods ◽  
Significant Influence ◽  
Career Success ◽  
Direct Sales ◽  
The World ◽  
Career Structure ◽  
Multi Level ◽  
Quantitative And Qualitative Methods ◽  
Entrepreneurial Competency ◽  
Selection Of

Nowadays, MLM Company around the world are highly developed, and companies especially in Indonesia have been using a system of direct sales to the consumers. The career structure in MLM Company has been very much acknowledged. However, not all MLM distributors are able to achieve the line of succession. The purpose of this research is to analyse the main causes of career success in MLM Company. This study uses both quantitative and qualitative methods. The selection of samples is carried out using a snowball technique which retrieved as many as 198 distributors registered at the Multi-Level Marketing (MLM) Company in Medan, namely; PT. Herbalife Indonesia, PT. Orindo Ayu (Oriflame), PT. Sophi Martin Indonesia, PT. K-link, PT. Tupperware Indonesia and PT. Amway Indonesia. The result of the study finds that entrepreneurial competency and committment simultaneously have a significant influence to the career success of MLM distributors. Moreover, the study finds a partial relationship between the entrepreneurial commitment and motivation that has a significant effect on career success, while the entrepreneurial competency does not partially influence the success of career significantly. The results also show that entrepreneurial motivation is a moderating variable that is able to strengthen the influence of the entrepreneurial commitment to career success, as well as between the entrepreneurial competency and career success.

A Prognostic Enrichment Strategy for Selection of Patients With Acute Respiratory Distress Syndrome in Clinical Trials

2019 ◽  
Vol 47 (3) ◽  
pp. 377-385 ◽  
Author(s):  
Jesús Villar ◽  
Alfonso Ambrós ◽  
Fernando Mosteiro ◽  
Domingo Martínez ◽  
Lorena Fernández ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Enrichment Strategy ◽  
Selection Of Patients ◽  
Selection Of

scholarly journals The Angiotensin Converting Enzyme Deletion/Deletion Genotype Is a Risk Factor for Severe COVID-19: Implication and Utility for Patients Admitted to Emergency Department

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 844
Author(s):  
Anna Annunziata ◽  
Antonietta Coppola ◽  
Valentina Di Spirito ◽  
Rosa Cauteruccio ◽  
Antonella Marotta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Angiotensin Converting Enzyme ◽  
Genetic Screening ◽  
Distress Syndrome ◽  
Clinical Observation ◽  
Converting Enzyme ◽  
Single Centre ◽  
Selection Of Patients ◽  
Thrombophilic Mutations ◽  
Selection Of

Background and objective: Insertion/deletion polymorphisms of angiotensin-converting enzyme (ACE) have been previously described in association with adult respiratory distress syndrome (ARDS) and correlated to outcome. The ACE deletion/deletion(D/D)genotype represents a marker of thrombosis in subjects apparently without predisposing factors and/or traditional thrombophilic alterations and increases the risk of venous thromboembolism in subjects in whom a thrombogenic condition occurs. Thrombosis seems to play a role very early in the disease caused by SARS-CoV-2, in particular in those with severe COVID-19 pneumonia. The counterbalance between angiotensin-converting enzyme (ACE) and ACE2 activities in COVID-19 disease may play a crucial role in the thrombo-inflammatory process. We hypothesised that a genetic predisposition could condition the severity and complications of SARS-CoV-2 infection. Materials and methods: We conducted a spontaneous, single centre observational study in the Sub-Intensive Care Unit of A.O.R.N. Ospedali dei Colli, Cotugno Hospital, Naples (Italy). In this study, we performed genetic screening for ACE D/D genotype and other thrombophilic mutations in 20 patients affected by ARDS related to COVID-19 pneumonia, compared to 19 age- and sex-matched healthy controls. Results: All tested patients had multiple polymorphisms and, in particular, a significantly higher prevalence of ACE D/D polymorphism in severe COVID-19 patients Conclusion: We found that the majority of patients who tested positive for ACE D-D genotype and who were not associated with other risk factors for VTE showed an evolution to ARDS. This finding could have a predicting role in the selection of patients more prone to developing severe COVID-19 during clinical observation in emergency department.

Selection of patients for portal-systemic shunts

JAMA ◽  
1966 ◽  
Vol 196 (12) ◽  
pp. 1039-1044 ◽  
Author(s):  
R. E. Hermann
Keyword(s):  
Selection Of Patients ◽  
Selection Of

“To Corrupt a Man in the Midst of a Verse”: Ben Jonson and the Prose of the World

2017 ◽  
Vol 24 (1) ◽  
pp. 46-72
Author(s):  
Jacob Tootalian
Keyword(s):  
Mixed Mode ◽  
Ben Jonson ◽  
Digital Analysis ◽  
Interactive Engagement ◽  
Sentence Level ◽  
Linguistic Patterns ◽  
The World ◽  
Selection Of ◽  
Bartholomew Fair

Ben Jonson's early plays show a marked interest in prose as a counterpoint to the blank verse norm of the Renaissance stage. This essay presents a digital analysis of Jonson's early mixed-mode plays and his two later full-prose comedies. It examines this selection of the Jonsonian corpus using DocuScope, a piece of software that catalogs sentence-level features of texts according to a series of rhetorical categories, highlighting the distinctive linguistic patterns associated with Jonson's verse and prose. Verse tends to employ abstract, morally and emotionally charged language, while prose is more often characterized by expressions that are socially explicit, interrogative, and interactive. In the satirical economy of these plays, Jonson's characters usually adopt verse when they articulate censorious judgements, descending into prose when they wade into the intractable banter of the vicious world. Surprisingly, the prosaic signature that Jonson fashioned in his earlier drama persisted in the two later full-prose comedies. The essay presents readings of Every Man Out of his Humour and Bartholomew Fair, illustrating how the tension between verse and prose that motivated the satirical dynamics of the mixed-mode plays was released in the full-prose comedies. Jonson's final experiments with theatrical prose dramatize the exhaustion of the satirical impulse by submerging his characters almost entirely in the prosaic world of interactive engagement.

Perioperative acute internal carotid thrombosis after general surgery

2020 ◽  
Vol 99 (3) ◽  
pp. 136-140
Keyword(s):  
Cardiac Surgery ◽  
Internal Carotid ◽  
Right Hemicolectomy ◽  
Diagnostic Assessment ◽  
Left Carotid Artery ◽  
Perioperative Stroke ◽  
Internal Carotid Occlusion ◽  
Acute Brain Ischemia ◽  
Selection Of Patients ◽  
Selection Of

Introduction: The average incidence of perioperative stroke during major non-cardiac surgery is less than 1%, suggesting that it is rarely a major problem for the vast majority of patients. Methods: In our paper we present a 46-year-old patient undergoing acute right hemicolectomy who developed right-sided hemiparesis in the perioperative setting. Immediate CTAg examination showed an ischemic stroke in the left hemisphere as a result of left internal carotid thrombosis. A surgical procedure to recanalize the left carotid artery was performed 14 hours from the onset of neurological symptomatology and the neurological deficit gradually recovered fully. Conclusion: Our case report supports studies showing that a thorough diagnostic assessment allows the selection of patients who may benefit from urgent revascularization of acute internal carotid occlusion during the phase of acute brain ischemia.

COVID-19 in children: Pathogenesis and current status

2020 ◽  
Author(s):  
Lawrence Frenkel ◽  
Fernando Gomez ◽  
Joseph A Bellanti
Keyword(s):  
Respiratory Disease ◽  
Respiratory Symptoms ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Current Status ◽  
Current Evidence ◽  
Initial Description ◽  
Relationship Of ◽  
Inflammatory Syndrome ◽  
The Relationship

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C).Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions.Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19–associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C.Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2–associated MIS-C similar to KD.

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