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1.
Ethiop. j. health dev. (Online) ; 36(2): 1-9, 2022. tables, figures
Article in English | AIM | ID: biblio-1380275

ABSTRACT

Background: Type 1 diabetes mellitus (T1DM) is a common autoimmune disorder that often presents in children.In these patients, diabetic ketoacidosis (DKA) is one of the most common and serious acute complications, which is associated with significant morbidity and mortality. The study aimed to assess the clinical profiles and outcomes of children admitted with DKA. Objective: To assess the clinical manifestations and treatment outcomes of DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conducted on 175 pediatric diabetic ketoacidosis children,who were admitted to the emergency units of two hospitals in Addis Ababa from September 2015 to February 2020 and whose medical records contained complete pertinent data. Patients were between the ages of 0 to 12 years. Proportional samples were taken from each hospital and data was collected retrospectively using a formatted checklist. The data was checked for its inclusiveness and entered Epi Info. version 4.6 and then transferred into SPSS version 25 software for further analysis. Result: DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were above the age of 10. A high-income level of the caretakers was found to be protective against DKA during the diagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting in a mortality rate of 6.9%. Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DM at first presentation. The age of presentation and clinical symptoms of the studied participants were like other international studies. Community education regarding the signs and symptoms of childhood DM can further prevent the development of DKA. [Ethiop. J. Health Dev. 2022; 36(2):000-000]


Subject(s)
Humans , Male , Female , Child , Diabetic Ketoacidosis , Therapeutics , Precipitating Factors , Treatment Outcome , Diabetes Mellitus , Hospitals
2.
Ethiop. j. health dev. (Online) ; VOL. 36 NO. 2 (2022)(2): 1-9, 2022-06-07. Tables
Article in English | AIM | ID: biblio-1380447

ABSTRACT

Type 1 diabetes mellitus(T1DM)is a common autoimmune disorder that often presents in children. In these patients, diabetic ketoacidosis(DKA)is one of the most common and serious acute complications, which isassociated with significant morbidity and mortality. The study aimed to assess the clinical profilesand outcomesof children admitted with DKA.Objective:To assess the clinical manifestationsand treatment outcomesof DKA patients in two tertiary hospitals in Addis Ababa. Methods: A hospital-based retrospective analysis was conductedon175 pediatric diabetic ketoacidosis children, who wereadmitted to the emergency units of two hospitalsin Addis Ababafrom September 2015 to February 2020andwhose medical records contained complete pertinent data. Patients were between theages of0 to 12 years.Proportional samples were taken from each hospitaland data wascollected retrospectively using a formatted checklist. The data waschecked for its inclusiveness and enteredEpi Info. version4.6 andthen transferred into SPSS version 25 software for further analysis. Result:DKA was the presenting manifestation of Diabetes in 78.3% of patients and 21.7% were already known cases of Diabetes. Half (50.9%) of the study participants were diagnosed with DKA in the age range of 5 to 10 years and almost one-third (30.9%) were abovethe age of 10. A high-incomelevel of the caretakers wasfound to be protective against DKA during thediagnosis of T1DM. Out of the 175 children admitted, 12 passed on, resulting ina mortality rate of 6.9%.Conclusion: The majority of the known DM patients presented with DKA after the omission of insulin and a newly diagnosed T1DMat first presentation.The age of presentation and clinical symptoms of the studied participantswere likeother international studies. Community education regardingthe signs and symptoms of childhood DM can further prevent the development of DKA.[Ethiop. J. Health Dev. 2022; 36(2):000-000]Keywords: Diabetic ketoacidosis, Treatment outcome, and precipitating factors


Subject(s)
Diabetic Ketoacidosis , Child Mortality , Diabetes Mellitus, Type 1 , Pediatric Obesity , Signs and Symptoms , Precipitating Factors , Morbidity
3.
Rev. Eugenio Espejo ; 15(3): 49-58, 20210830.
Article in Spanish | LILACS | ID: biblio-1337952

ABSTRACT

El objetivo principal de la presente investigación fue analizar la relación entre la autoestima, concebida como la percepción de las cualidades y características contenidas en el propio auto-concepto y los factores de victimización correspondientes al fenómeno del bullying. Para ello, se contó con una muestra de 341 estudiantes de unidades educativas de la provincia de Chimbo-razo, donde se analizaron los datos obtenidos de las baterías psicológicas aplicadas: Test de autoestima de Rosenberg y la Escala de victimización en la escuela. La media de nivel del nivel de autoestima es de =29,81, con una desviación estándar δ = 4,47. Por otro lado, al considerar los factores del bullying, el tipo de victimización más frecuente entre la muestra ha sido la relacional (= 15,48; DT= 4,90), seguido de la manifiesta verbal (= 8,14; DT= 2,32), y el menos habitual la manifiesta física (= 4,88; DT= 1,14). Se encontró que la mayor parte de los estudiantes presentan autoestima alta. Tanto en la victimización relacional, manifiesta física como en la manifiesta verbal existieron diferencias con respecto al género. Finalmente, se observó relaciones significativas positivas y negativas entre la autoestima y los diferentes factores de victimización.


The main objective of this research was to analyze the relationship between selfesteem, conceived as the perception of the qualities and characteristics contained in the selfconcept itself, and the victimization factors corresponding to the phenomenon of bullying. For this, a sample of 341 students from educational units in the province of Chimborazo was used. The data obtained from the applied psychological batteries were analyzed: the Rosenberg SelfEsteem Test and the School Victimization Scale. The mean level of the level of selfesteem is  = 29.81, with a stan-dard deviation δ = 4.47. On the other hand, when considering bullying factors, the most frequent type of victimization among the sample has been relational ( = 15.48; SD = 4.90), followed by verbal manifest ( = 8.14; DT = 2.32), and the least common is physical manifestation ( = 4.88; DT = 1.14). It was found that most of the students have high selfesteem. There were differences with respect to gender in relational victimization, physical and verbal manifest. Finally, signifi-cant positive and negative relationships were observed between self-esteem and the different victimization factors.


Subject(s)
Humans , Male , Female , Adolescent , Schools , Students , Bullying , Self Concept , Precipitating Factors , Victims Identification
4.
Rev. colomb. psiquiatr ; 50(1): 52-56, Jan.-Mar. 2021. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1251634

ABSTRACT

RESUMEN El trastorno por consumo de alcohol es una de las principales causas de morbimortalidad en el mundo. La enfermedad hepática alcohólica es una complicación común de este trastorno y la encefalopatía hepática es una seria comorbilidad de la cirrosis alcohólica. Los factores precipitantes pueden relacionarse con infección, sangrado gastrointestinal, deshidratación o efectos de psicofármacos (p. ej., benzodiacepinas e hipnóticos no benzodiacepínicos). Se expone un caso del manejo hospitalario de un paciente con un trastorno severo por consumo de alcohol, cirrosis y encefalopatía hepática, quien desarrolla síntomas de abstinencia alcohólica durante su hospitalización y la complejidad del manejo antagónico de un delirium gabaérgico propio de la encefalopatía hepática en el contexto de un delirium glutamatérgico-noradrenérgico por abstinencia alcohólica.


ABSTRACT Alcohol use disorder is one of the main causes of morbidity and mortality in the world. Alcoholic liver disease is a common complication of this disorder, and hepatic encephalopathy is a serious complication of alcoholic cirrhosis. Precipitating factors may be related to infection, gastrointestinal bleeding, dehydration or the effects of psychotropic drugs (e.g. benzodiazepines and non-benzodiazepine hypnotics). We present a case of the hospital management of a patient with a severe alcohol use disorder, cirrhosis and hepatic encephalopathy who developed alcohol withdrawal symptoms while in hospital, and discuss the complexity of the antagonistic management of a GABAergic delirium characteristic of hepatic encephalopathy in the context of a glutamatergic-noradrenergic delirium due to alcohol withdrawal.


Subject(s)
Humans , Male , Aged , Substance Withdrawal Syndrome , Precipitating Factors , Delirium , Psychotropic Drugs , Therapeutics , Benzodiazepines , Comorbidity , Dehydration , Alcoholism , Hypnotics and Sedatives , Liver Cirrhosis, Alcoholic , Liver Diseases, Alcoholic
5.
Rev. bras. educ. méd ; 45(1): e009, 2021.
Article in Portuguese | LILACS | ID: biblio-1155910

ABSTRACT

Resumo: Introdução: A síndrome de burnout causa repercussão com impactos individuais, sociais e econômicos. A tríade que representa a síndrome acomete milhões de trabalhadores pelo mundo, incluindo os trabalhadores da área da saúde e, entre eles, os médicos. Pesquisas apontam um incremento das taxas de burnout entre médicos e residentes, mas pouco se fala sobre a síndrome em estudantes de Medicina. Objetivo: Ao observarmos o adoecimento constante de estudantes, identificamos a necessidade de compreender mecanismos que possam ser considerados disparadores. Assim, investigamos a percepção dos estudantes de Medicina que cursam o estágio supervisionado sobre a síndrome de burnout e a autoidentificação dos sintomas. Método: Realizamos pesquisa qualitativa do tipo estudo de caso utilizando grupo focal como ferramenta metodológica. Participaram desta pesquisa 22 internos divididos em três grupos focais. As falas foram analisadas segundo a análise de conteúdo. Resultados: Dessas análises e de suas inferências, delinearam-se quatro categorias: "(Con)fusão de papéis: o processo de deixar de ser estudante"; "Uma síndrome (in)visível: a banalização do sofrimento"; "Tornar-se médico: forjado no sofrimento"; "(Des)identificação: efeitos de um processo nada fácil". Conclusão: Os estudantes desconheciam a síndrome e não foram capazes de reconhecer os sintomas dela durante a formação. O achado significativo apontou para a sobrecarga relacionada à falta de tempo e como esta gera um processo de sofrimento nos estudantes. Acredita-se, portanto, que o processo de ensino precisa ser repensado para que os estudantes possam, de fato, aprender e apreender todos os significados que a universidade tem potencialmente a lhes oferecer.


Abstract: Introduction: Burnout syndrome has individual, social and economic impacts. The triad that represents the syndrome affects millions of workers around the world, including healthcare workers and, among them, doctors. Research points to an increase in burnout rates among doctors and residents, but little is said about the syndrome in medical students. Objective: By observing students constantly falling ill, we identified the need to understand mechanisms that can be considered triggers. Thus, we investigated how medical interns viewed Burnout Syndrome and the self-identification of symptoms. Method: We carried out qualitative case study research using a focus group as a methodological tool. Twenty-two medical students participated in this study, divided into 3 focus groups. The statements were submitted to Content Analysis. Results: From these analyses and their inferences, four categories were outlined: '(Con)fusion of roles: the process of ceasing to be a student'; 'A (in)visible syndrome: the trivialization of suffering'; 'Becoming a doctor: forged in suffering'; '(Mis)identification: effects of a far from easy process'. Conclusion: Students were unaware of the syndrome and were unable to recognize its symptoms during training. The significant finding pointed to the burden related to lack of time and how it generates a process of suffering in students. Thus, it is believed that the teaching process needs to be rethought so that students can, in fact, learn and grasp all the meanings that the University potentially has to offer.


Subject(s)
Humans , Students, Medical/psychology , Burnout, Psychological/diagnosis , Internship and Residency , Perception , Precipitating Factors , Curriculum , Diagnostic Self Evaluation
6.
Más Vita ; 2(4): 34-41, dic. 2020.
Article in Spanish | LILACS, LIVECS | ID: biblio-1372864

ABSTRACT

Definido como la inasistencia continua del enfermo a la terapia antituberculosa por un mes o más, representa un excedente de gasto en salud pública. Asimismo, es uno de los problemas de salud pública mayormente reportados a nivel mundial como un resultado no satisfactorio de la estrategia tuberculosis. Objetivo: determinar los factores desencadenantes del abandono del tratamiento antifímico. Resultados: el principal factor desencadenante de abandono terapéutico en el Distrito 09D13, corresponde a la dimensión factores del paciente, ubicando dentro de este a la mejoría sintomatológica secundaria a un tratamiento parcial en el primer lugar, con un 94,1%, con predominio sobre el sexo masculino y en edades de 20 a 49 años. Conclusión: Los principales factores prevalentes en este estudio que desencadenan los abandonos fueron asociados a factores del paciente, en primer lugar, la mejoría sintomática, seguido por una situación económica deficiente. El tercer factor estuvo asociado al servicio de salud, como la falta de conocimiento sobre la enfermedad. El estudio correlacional, establece que existe una relación positiva considerable entre la falta de vivienda y el consumo de alcohol, ambos factores no se muestran como los más prevalentes por sí solos, la perspectiva sugiere que cuando ambos factores se juntan se fortalece el factor desencadenante de abandono de la terapia antifímica(AU)


Defined as the continuous absence of the patient to antituberculous therapy for a month or more, represents an excess of public health spending. It is one of the public health problems most reported and worldwide as an unsatisfactory result of the tuberculosis strategy. Objective: to determine the triggers for the abandonment of antifungal treatment. Results: the main triggering factor for treatment abandonment in District 09D13 corresponds to the patient factors dimension, placing within this the symptomatic improvement secondary to a partial treatment in the first place, with 94.1%, with a predominance of the male sex and in ages from 20 to 49 years. Conclusion: The main prevalent factors in this study that trigger dropouts were associated with patient factors, firstly, symptomatic improvement, followed by a poor economic situation. The third factor was associated with the health service, such as the lack of knowledge about the disease. The correlational study establishes that there is a considerable positive relationship between homelessness and alcohol consumption, both factors not shown as the most prevalent by themselves, the perspective suggests that combination of both factors triggers discontinuation of antifungal therapy(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Patient Dropouts , Tuberculosis/drug therapy , Precipitating Factors , Socioeconomic Factors , Therapeutics , Public Health , Health Services
7.
Rev. enferm. UERJ ; 28: e52825, jan.-dez. 2020.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1146276

ABSTRACT

Objetivo: identificar os impactos na saúde mental de bombeiros relacionados ao estresse da exposição ocupacional. Método: trata-se de uma revisão integrativa da literatura nas bases de dados CINAHL (EBSCO), PsycINFO, MEDLINE®, LILACS, Web of Science, Scopus e SCIELO. Para a estratégia de busca utilizou-se os descritores: "Occupational Stress", "Firefighters", "Occupational Exposure". Como critérios de inclusão estabeleceu-se: artigos originais; entre os anos de 2009 e 2019; disponíveis completos; estudos transversais; nos idiomas português, inglês e/ou espanhol; e cuja população de estudo incluíssem bombeiros. Resultados: nessa revisão foram analisados 11 artigos. Evidenciou-se que a exposição de bombeiros impactou o desencadeamento de sintomas de depressão e transtorno de estresse pós-traumático. Conclusão: as evidências deste estudo demonstraram que a exposição ocupacional de bombeiros interfere no seu padrão de saúde mental causando estresse por meio do sofrimento psíquico. Este estudo alerta para a necessidade de intervenção e promoção à saúde do bombeiro.


Objective: to identify mental health impacts of occupational exposure-related stress among firefighters. Method: this integrative literature review searched the CINAHL (EBSCO), PsycINFO, MEDLINE®, LILACS, Web of Science, Scopus and SCIELO databases, suing the descriptors: "Occupational Stress", "Firefighters", "Occupational Exposure". The inclusion criteria were: original articles; between the years 2009 and 2019; full text available; cross-sectional studies; in Portuguese, English and/or Spanish; and whose study population included firefighters. Results: 11 articles were analyzed. Firefighters' exposure was found to impact the triggering of depressive symptoms and post-traumatic stress disorder. Conclusion: the evidence in this study demonstrated that firefighters' occupational exposure interferes with their mental health patterns, causing stress through psychological suffering. This study warns of the need for intervention and promotion of firefighters' health.


Objetivo: identificar los impactos en la salud mental del estrés relacionado con la exposición ocupacional entre los bomberos. Método: esta revisión integradora de la literatura buscó en las bases de datos CINAHL (EBSCO), PsycINFO, MEDLINE®, LILACS, Web of Science, Scopus y SCIELO, demandando los descriptores: "Estrés ocupacional", "Bomberos", "Exposición ocupacional". Los criterios de inclusión fueron: artículos originales; entre los años 2009 y 2019; Texto completo disponible; estudios transversales; en portugués, inglés y / o español; y cuya población de estudio incluyó bomberos. Resultados: se analizaron 11 artículos. Se descubrió que la exposición de los bomberos afecta la activación de síntomas depresivos y el trastorno de estrés postraumático. Conclusión: la evidencia de este estudio demostró que la exposición ocupacional de los bomberos interfiere con sus patrones de salud mental, provocando estrés a través del sufrimiento psicológico. Este estudio advierte de la necesidad de intervención y promoción de la salud de los bomberos.


Subject(s)
Humans , Male , Female , Stress, Psychological , Firefighters/psychology , Occupational Stress , Stress Disorders, Post-Traumatic , Working Conditions , Occupational Risks , Precipitating Factors , Occupational Health , Depression
8.
Rev. chil. enferm. respir ; 36(3): 176-201, set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138552

ABSTRACT

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo, en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.


Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren


Subject(s)
Humans , Child , Asthma/diagnosis , Asthma/therapy , Oxygen Inhalation Therapy , Respiratory Function Tests , Asthma/classification , Asthma/drug therapy , Vitamin D/blood , Severity of Illness Index , Nebulizers and Vaporizers , Radiography, Thoracic , Precipitating Factors , Chile , Consensus , Diagnosis, Differential
9.
Rev. colomb. psiquiatr ; 49(2): 76-83, abr.-jun. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1115647

ABSTRACT

ABSTRACT Objective: To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals. Methods: We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs). Results: A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa = 1.15), the number of hours they sleep per day (PRa = 1.23), being a woman (PRa = 3.33), performing the internship in a province (PRa = 0.25), studying at a public university (PRa = 0.64), living with parents (PRa = 0.65) or alone (PRa = 0.33), and having perceived some type of abuse (PRa = 1.07). Conclusions: A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.


RESUMEN Objetivo: Estimar la prevalencia de depresión y maltrato e identificar sus factores asociados en los internos de Medicina de los hospitales peruanos. Métodos: Estudio multicéntrico, transversal y analítico, llevado a cabo durante los meses de marzo a mayo de 2016. Conformaron la población los internos de Medicina en 18 sedes hospitalarias de Lima y provincias. Se aplicó una encuesta que incluía características sociodemográficas y una escala para medir la percepción de maltrato (psicológico, físico y sexual). Asimismo, para evaluar la depresión, se usó el cuestionario PHQ-9 en su versión en español. Se usó regresión de Poisson con varianzas robustas para calcular las razones de prevalencia (RP). Resultados: Participaron 402 internos de Medicina; la mediana de edad fue 25 [intervalo intercuartílico, 21-33] años y el 52,7% eran varones. Además, el 25,4% padecía depresión. En el modelo ajustado, las variables asociadas con padecer depresión son edad (RPa = 1,15), cuántas horas duermen durante el día (RPa = 1,23), ser mujer (RPa = 3,33), realizar el internado en provincia (RPa = 0,25), estudiar en una universidad pública (RPa = 0,64), vivir con sus padres (RPa = 0,65) o solo (RPa = 0,33) y percibir algún tipo de maltrato (RPa = 1,07). Conclusiones: La cuarta parte de los internos encuestados tenían depresión. Es necesario realizar un cribado temprano para identificar posibles maltratos percibidos y otros factores desencadenantes de depresión, y así evitar repercusiones negativas en el desempeño laboral y la salud mental general durante el internado médico.


Subject(s)
Humans , Male , Female , Adult , Mass Screening , Mental Health , Internship and Residency , Peru , Universities , Precipitating Factors , Prevalence , Surveys and Questionnaires , Depression , Work Performance , Medicine , Methods
10.
ABCS health sci ; 45: e020015, 02 jun 2020. tab
Article in English | LILACS | ID: biblio-1123703

ABSTRACT

INTRODUCTION: Coronary artery disease is the largest cause of mortality in the world. The main risk factors for its development include systemic arterial hypertension and type 2 diabetes mellitus. OBJECTIVE: To search for predictors of the development of plaques and obstructions in coronary arteries and to determine whether the exercise test is a reliable pretest for coronary angiotomography. METHODS: 883 computed tomography reports of coronaries were analyzed. Sociodemographic information, health conditions and results of the exercise test from patients were collected, along with calcium score, percentile and number of arterial segments with significant obstruction. The data were analyzed using descriptive and inferential statistics. Significance was considered for p<0.05. RESULTS: It observed that the statistically significant predictors to the calcium score were male, being over 60 years old, having type 2 diabetes mellitus and systemic arterial hypertension. There was no relationship with high BMI and coronary obstruction. Regarding the exercise test, it was possible to observe that the majority of individuals who were positive in the exercise test, did not have a positive calcium score or significant coronary obstructions. CONCLUSION: The predictors for the development of coronary plaques and obstructions were male, aged ≥60 years, having type 2 diabetes mellitus and systemic arterial hypertension.


INTRODUÇÃO: A doença arterial coronariana representa a maior causa de mortalidade no mundo, sendo que os principais fatores de risco para o seu desenvolvimento incluem a hipertensão arterial sistêmica e a diabetes mellitus tipo 2. OBJETIVO: Detectar os preditores para o desenvolvimento de placas e obstruções coronarianas detectadas através da tomografia computadorizada de artérias coronárias além de determinar se o teste de esforço é um pré-teste fidedigno para a realização angiotomografia coronariana. MÉTODOS: Foi realizada análise de 883 laudos de exames de TC de coronárias e coletados dados sociodemográficos, de saúde e o resultado do teste de esforço, juntamente com escore de cálcio, percentil e quantidade de segmentos arteriais com obstruções significativas. Os dados foram analisados pela estatística descritiva e inferencial (p<0,05). RESULTADOS: Foi possível observar que os preditores com valores estatisticamente significantes em relação ao escore de cálcio foi ser do sexo masculino, possuir idade acima de 60 anos, portar diabetes mellitus tipo 2 e hipertensão arterial sistêmica, não houve relação entre IMC elevado, que sugere sobrepeso, e obstrução coronariana. Em relação ao teste de esforço foi possível observar que a maioria dos indivíduos que apresentaram positividade no teste de esforço, não apresentavam escore de cálcio positivo ou obstruções coronarianas significativas. CONCLUSÃO: Os preditores para o desenvolvimento de placas e obstruções coronarianas foi pertencer ao sexo masculino, apresentar idade ≥60 anos, ser portadores de diabetes mellitus tipo 2 e hipertensão arterial sistêmica.


Subject(s)
Humans , Male , Female , Coronary Artery Disease , Coronary Vessels/diagnostic imaging , Exercise Test , Computed Tomography Angiography , Precipitating Factors , Cross-Sectional Studies , Life Style
11.
Estud. pesqui. psicol. (Impr.) ; 19(1): 71-88, jan.-abr. 2019. tab, ilus
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-999327

ABSTRACT

Este estudo avaliou a percepção de estresse e estressores de enfermeiros de um hospital universitário e coletou sugestões de ações para amenizar o estresse. O estudo, descritivo, transversal, qualitativo e quantitativo foi realizado com 70 enfermeiros de diversas unidades de um hospital. Utilizou-se a Escala de Estresse de Bianchi e uma pergunta aberta. Os dados quantitativos foram analisados pelo programa SPSS e foram feitas análises descritivas e inferenciais. Para os dados qualitativos, utilizou-se a técnica de análise de conteúdo de Bardin. Resultados indicaram que a maior parte (67%) dos sujeitos apresentou nível médio de estresse. O domínio B (atividades relacionadas ao funcionamento adequado da unidade) teve a média de escore de estresse mais alta (5,2) em todas as unidades estudadas. A média de estresse dos enfermeiros que exercem função de chefia foi significantemente maior do que a média dos que não exercem (p=0,002). A área temática "Melhores condições para o trabalho" foi a mais citada como sugestão para amenizar o estresse. Os dados obtidos indicaram que a situação atual de precarização do hospital está relacionada com o estresse dos enfermeiros. Considera-se que o estudo permitiu ampla compreensão sobre o estresse e estressores em enfermeiros do hospital e subsídios para estudos posteriores.(AU)


This study evaluated the perception of stress and stressors of nurses at a university hospital and collected suggestions for actions to relieve stress. Descriptive, cross-sectional qualitative and quantitative study with 70 nurses from different hospital units. The Bianchi Stress Scale was used and an open question was applied. The quantitative data were analyzed using the SPSS program and descriptive and inferential analyzes were used. For qualitative data, the Bardin content analysis technique was used. The results indicated that most of the participants (67%) had a medium level of stress. Domain B (activities related to the proper functioning of the unit) had the highest average stress score in all units studied. The mean stress level of nurses who performed leadership was significantly higher than the average of those who did not (p = 0.002). The thematic area "Better conditions for work" was the most cited as a suggestion to relieve stress. The data obtained indicates that the current situation of precariousness of the hospital is related to the nurses' stress. It is considered that the study allowed a broad understanding on the stress and stressors of hospital nurses and subsidies for further studies.(AU)


Este estudio evaluó la percepción del estrés y estresores de enfermeros de un hospital universitario y recogió sugerencias de acciones para amenizar el estrés. Estudio descriptivo, transversal, cualitativo y cuantitativo se realizó con 70 enfermeros de varias unidades de un hospital. Se utilizó la Escala de estrés de Bianchi y una pregunta abierta. Los datos cuantitativos fueron analizados por el programa SPSS. Para los datos cualitativos se utilizó la técnica de análisis de contenido de Bardin. Los resultados indicaron que 67% presentaron un nivel medio de estrés. El dominio B (actividades relacionadas al funcionamiento adecuado de la unidad) tuvo el promedio de puntuación de estrés más alta (5,2) en todas las unidades estudiadas. El promedio de estrés de los enfermeros que ejercen función de dirección fue significativamente mayor que el promedio de los que no ejercen (Test t de student p = 0,002). El área temática "Mejores condiciones para el trabajo" fue la más citada como sugerencia para amenizar el estrés. Los datos obtenidos indican que la situación de precarización del hospital está relacionada con el estrés de los enfermeros. Se considera que el estudio permitió una amplia comprensión sobre el estrés y estrés de los enfermeros del hospital y subsidios para estudios posteriores.(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Precipitating Factors , Occupational Stress/psychology , Hospitals, University , Working Conditions , Health , Health Personnel , Nurses, Male/psychology
12.
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 707-712, abr.-maio 2019. il, tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-988183

ABSTRACT

Objective: The study's goal has been to analyze, through the Ishikawa Diagram, the causes and solutions of HIV infection in nursing professionals due to sharps handling. Methods: It is a literature review based on the Construction of the Ishikawa Diagram, which was carried out in May 2017 in the PubMed and Virtual Health Library databases. Results: The following are the main causes of HIV infection through sharps: work overload, perception of frail risk, careless use of needles, lack of training. Regarding the solutions: adequate post-exposure management, implementing and monitoring compliance with biosafety standards, improving the notification of accidents with sharps. Conclusion: There is a need to alerting managers towards intervening in the factors that might trigger accidents with sharp materials by the nursing team


Objetivo: Analisar por meio do Diagrama de Ishikawa as causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem no manuseio de materiais perfurocortantes. Métodos: Revisão da literatura baseada na Construção do Diagrama de Ishikawa, realizado em maio de 2017 nas bases de dados Pubmed e Biblioteca Virtual de Saúde. Resultados: Dentre as causas da infecção ao HIV através de perfurocortantes: sobrecarga de trabalho, percepção de risco fragilizada, utilização descuidada de agulhas, ausência de treinamento. Quanto às soluções: gestão pós exposição adequada, implementar e fiscalizar o cumprimento das normas de biossegurança, aprimorar a notificação de acidentes com materiais perfurocortantes. Conclusão: Destaca-se a necessidade de sensibilizar gestores para intervir nos fatores que podem desencadear acidentes com materiais perfurocortantes pela equipe de enfermagem


Objetivo: Analizar por medio del Diagrama de Ishikawa las causas y soluciones de la infección al VIH adquirida por profesionales de enfermería en el manejo de materiales punzocortantes. Métodos: Revisión de la literatura basada en la construcción del diagrama de Ishikawa, realizado en mayo de 2017 en las bases de datos Pubmed y Biblioteca Virtual de Salud.Resultados: Entre las causas de la infección por el VIH a través de punzocortantes: sobrecarga de trabajo, percepción de riesgo fragilizada, utilización descuidada de agujas, ausencia de entrenamiento. En cuanto a las soluciones: gestión post exposición adecuada, implementar y fiscalizar el cumplimiento de las normas de bioseguridad, mejorar la notificación de accidentes con materiales punzocortantes. Conclusión: Se destaca la necesidad de sensibilizar a los gestores para intervenir en los factores que pueden desencadenar accidentes con materiales punzocortantes por el equipo de enfermería


Subject(s)
Humans , Male , Female , Wounds, Stab/etiology , Accidents, Occupational/statistics & numerical data , HIV/pathogenicity , Nursing, Team , Precipitating Factors , Risk Factors , Occupational Health , Containment of Biohazards
13.
Asian Spine Journal ; : 135-145, 2019.
Article in English | WPRIM | ID: wpr-739302

ABSTRACT

STUDY DESIGN: Prospective cohort study. PURPOSE: The study was aimed at evaluating clinicoradiological factors affecting recovery of neurological deficits in cases of lumbar disc herniation (LDH) treated by lumbar microdiscectomy. OVERVIEW OF LITERATURE: The majority of the available literature on neurological recovery following neurodeficit is limited to retrospective series. The literature is currently limited regarding variables that can help predict the recovery of neurodeficits following LDH. METHODS: A prospective analysis was performed on 70 consecutive patients who underwent lumbar microdiscectomy (L1–2 to L5–S1) owing to neurological deficits due to LDH. Patients with motor power ≤3/5 in L2–S1 myotomes were considered for analysis. Follow-up was performed at 2, 6, and 12 months to note recovery of motor deficits. Clinicoradiological parameters were compared between the recovered and nonrecovered groups. RESULTS: A total of 65 patients were available at the final follow-up: 41 (63%) had completely recovered by 2 months; four showed delayed recovery at the 6-month follow-up; and 20 (30.7%) showed no recovery at 1 year. Clinicoradiological factors, including diabetes, complete initial deficit, areflexia, multilevel disc prolapse, longer duration since initial symptoms, and ≥2 previous symptomatic episodes were associated with a significant risk of poorer recovery (p 0.05 for all). Diabetes mellitus (p=0.033) and complete initial motor deficit (p=0.028) were significantly associated with delayed recovery in the multivariate analysis. CONCLUSIONS: The overall neurological recovery rate in our study was 69%. Diabetes mellitus (p=0.033) and complete initial motor deficit were associated with delayed motor recovery.


Subject(s)
Cohort Studies , Constriction, Pathologic , Diabetes Mellitus , Follow-Up Studies , Humans , Intervertebral Disc Displacement , Multivariate Analysis , Neurologic Manifestations , Occupations , Precipitating Factors , Prognosis , Prolapse , Prospective Studies , Reflex , Retrospective Studies , Smoke , Smoking , Urinary Bladder
14.
Article in Portuguese | LILACS | ID: biblio-1026516

ABSTRACT

Introdução: A radioterapia é uma das modalidades terapêuticas de escolha para os tratamentos adjuvante e neoadjuvante, em pacientes com câncer de mama. Tal modalidade provoca reação de pele dolorosa conhecida como radiodermatite. Objetivo: Avaliar os fatores associados com o aparecimento de radiodermite após radioterapia e a sua associação com o maior grau de toxicidade nesses pacientes. Método: Estudo retrospectivo, com 117 pacientes com de câncer de mama submetidos à radioterapia conformacional 3D, entre 2016 a 2018, em doses variáveis. Dados pessoais foram coletados a partir de prontuário, e o grau de radiodermite estabelecido segundo os critérios do grupo de oncologia radioterápica. O total de 15 potenciais preditivos foram elencados e analisados por estatísticas univariada e multivariada. Resultados: A população do estudo apresentou uma média de 50 anos, 47% relataram alguma comorbidade, 59,83% realizaram cirurgia radical e 81,19% desenvolveram radiodermite. Observou-se, em análise multivariada, associação do desenvolvimento de radiodermite com maiores doses da radiação (p=0,011) e com uso de bólus diário (p=0,009). Conclusão: As principais variáveis que culminaram em maiores graus de radiodermite foram a dose da radiação e o uso de bólus diário. Categorizando os fatores preditivos, identificam-se o paciente com maior risco de lesões graves e a possibilidade da criação de protocolos mais eficazes na prevenção das radiodermatites.


Introduction: Radiotherapy is one of the therapeutic modalities chosen for adjuvant and neoadjuvant treatment in patients with breast cancer. This modality causes a painful skin reaction known as radiodermatitis. Objective:To evaluate the factors related with the appearance of radiodermatitis after radiotherapy and their relationship with the highest degree of toxicity in patients with breast cancer. Method: Retrospective study, with 117 patients with breast cancer submitted to 3D conformational radiotherapy between 2016 and 2018, at variable doses. Personal data were collected from medical records, and the degree of radiodermatitis established according to the criteria of the Radiation Oncology Group. The total of 15 predictive factors in potential were listed and later analyzed by univariate and multivariate statistics. Results: The study population presented an average of 50 years, 47% reported some comorbidities, 59.83% underwent radical surgery and 81.19% developed radiodermatitis. In a multivariate analysis, there was an association between development of radiodermatitis and higher doses of radiation (p=0.011) and daily bolus use (p=0.009). Conclusion:The main elements that culminated in higher degrees of radiodermatitis were the dose of radiation and the use of daily bolus. By categorizing the predictive factors, we can identify the patient with the highest risk of severe skin lesions and enables the creation of more effective protocols for the prevention of radiodermatitis.


Introducción: La radioterapia es una modalidad terapéutica para tratamiento adyuvante y neoadyuvante, en pacientes con cáncer de mama. Tal modalidad provoca reacción de piel dolorosa conocida como radiodermatitis. Objetivo: Evaluar factores conexos con la aparición de radiodermatitis tras la radioterapia y su asociación con el mayor grado de toxicidad. Método: Estudio retrospectivo, con 117 pacientes con cáncer de mama sometidos a la Radioterapia Conformacional 3D entre 2016 a 2018. Los datos personales fueron recolectados a partir de prontuario, así como el grado de radiodermatitis establecido según los criterios del grupo de oncología radioterápica. El total de 15 potencial predictivos fueron enumerados y posteriormente analizados por estadística univariana y multivariada. Resultados: La población del estudio presentó un promedio de 50 años, el 47% informó de algunas comorbilidades, el 59,83% se sometió a cirugía radical y el 81,19% desarrolló radiodermatitis. En un análisis multivariado, hubo una asociación entre el desarrollo de radiodermatitis y dosis más altas de radiación (p=0.011) y el uso diario de bolos (p=0.009). Conclusión: Las principales variables que culminaron en mayores grados de radiodermatitis fueron la dosis de radiación y el uso de bolos diarios. Al categorizar los factores predictivos, podemos identificar al paciente con el mayor riesgo de lesiones cutáneas graves y permitir la creación de protocolos más efectivos para la prevención de la radiodermatitis.


Subject(s)
Humans , Radiodermatitis/diagnosis , Radiotherapy/adverse effects , Breast Neoplasms/complications , Precipitating Factors , Retrospective Studies , Toxicity Tests, Acute
15.
Postgrad. Med. J. Ghana ; 8(2): 79-85, 2019. ilus
Article in English | AIM | ID: biblio-1268722

ABSTRACT

Objectives: To investigate factors contributing to neonatal admission outcomes at Effia Nkwanta Regional Hospital (ENRH) Method: All neonatal admissions to the Neonatal & Intensive Care Unit (NICU) of the hospital that were entered into the DHIMS2 database were extracted and complemented with additional information from patients' folder review. The data from the two sources were merged and analysed using SPSS version 21. Univariate and multivariate regression analysis was performed to identify factors associated with admission outcomes, taking statistical significance as p < 0.05. ARC-GIS version 10.1 was used to describe the geospatial distribution of health facilities referring to ENRH. Setting: Neonatal & Intensive Care Unit of ENRH Participants: All neonates admitted to NICU between January and December 2015. Intervention: None Results: Nine Hundred and Ninety-Three out of the 1150 neonatal admissions were entered into DHIMS2. Fifty-two percent were males, 57.3% were delivered through Caesarean Section, 72% were admitted within 2 days of birth, and 56.8% had normal birth weight. FiftyEight percent of the neonates were delivered at the ENRH, whilst 39.9% were referred from health facilities located within Sekondi-Takoradi Metropolis. At 1 minute, only 14% of the neonates had normal Apgar score (8-10), and this improved to 50% at 5 minutes. The main causes of neonatal admission were birth asphyxia 21.0%, followed by prematurity 17.5%, neonatal jaundice 17.1% and neonatal sepsis 14.5%. The death rate was 18% with more than 80% of the deaths occurring during the early neonatal period. More than 80% of deaths were due to four admission diagnoses: birth asphyxia, prematurity, neonatal jaundice, neonatal sepsis. Factors associated with adverse admission outcome are: low birth weight, delivery by Caesarean Section and low Apgar score at 5 minutes. Conclusions: The institution of appropriate interventions to reduce or manage the four major causes of adverse neonatal admission outcomes will significantly reduce neonatal mortality in the hospital


Subject(s)
Ghana , Hospital Planning , Infant Mortality , Infant, Newborn , Intensive Care Units , Intensive Care, Neonatal , Patient Admission/statistics & numerical data , Precipitating Factors
16.
Rev. medica electron ; 40(6): 2262-2284, nov.-dic. 2018.
Article in Spanish | LILACS, CUMED | ID: biblio-1103732

ABSTRACT

El presente trabajo tiene como objetivo demostrar la vigencia del Ideario Martiano acerca de la importancia del cuidado y protección del medio ambiente. En el desarrollo del mismo se demuestra cómo él encontraba respuesta a cada una de las interrogantes que surgieron en relación al medio ambiente. Se analiza la situación actual a nivel mundial y nacional y se propone qué se puede hacer desde la escuela y la comunidad ante los retos del siglo XXI, tomando como base las ideas de José Martí y llevándolas a nuestro tiempo, las cuales engarzan con magnífica empatía. Se realiza un análisis del municipio de Cárdenas de forma general y en particular del Consejo Popular Pueblo Nuevo Norte y los centros educacionales que en él se encuentran; se enfatiza en las características particulares de cada lugar; se vincula a la escuela con la comunidad correspondiente y se señala el papel rector que desarrolla en la formación de la personalidad de los estudiantes, como cumplir con los objetivos formativos en relación con la educación ambiental y la necesidad de lograrlas cumpliendo de esta forma con el legado de nuestro apóstol José Martí (AU).


The objective of this work is to demonstrate the validity of Marti´s thoughts about the importance and care of the environment. In the development of this work you can notice how he found answers to any question related to the environment. It is also analyzed the nowadays situations in the world and in Cuba, and we propose what to do from the school and community to face the challenges of the 21st century, taking into account José Marti's ideas and translating them to our time. It was carried out an analysis of Pueblo Nuevo Norte neighborhood and the schools located there; emphasis was made on the particular characteristics of every place; schools are linked with the community where they are located and the important role they play in the formation of the students´ personality is shown; among them accomplishing the formative objectives related to the environmental education and José Marti's ideas in relation with this theme (AU).


Subject(s)
Humans , Male , History, 18th Century , Politics , Social Conditions , Vocational Guidance , Environmental Health Education/history , Conservation of Natural Resources , Precipitating Factors , Environmental Health Education/prevention & control
18.
Rev. cuba. cir ; 57(1): 49-57, ene.-mar. 2018. tab
Article in Spanish | LILACS | ID: biblio-960346

ABSTRACT

Introducción: las fisuras anales son un problema de salud importante en la población cubana, incluso con la supresión de los factores desencadenantes, muchas de ellas tienden a la cronicidad; su evolución es tórpida, y es elevado el riesgo de complicación de las mismas. Objetivo: evaluar la cicatrización de las fisuras anales mediante lisado plaquetario en el Hospital General Docente Comandante Pinares de San Cristóbal. Método: se realizó un estudio cuasi experimental en el servicio de cirugía general del Hospital General Docente Comandante Pinares desde enero 2015 hasta junio 2017. Se incluyeron en el estudio todos los pacientes adultos, de ambos sexos, atendidos por el diagnóstico de fisura anal con inadecuada respuesta al tratamiento convencional y sin otras enfermedades de base que impidieran el uso de la terapia regenerativa. A todos los pacientes se les solicitó el consentimiento informado previa explicación de las características del estudio. Resultados: la hemorroidectomía fue el proceder más frecuente asociado a las fisuras anales. El dolor fue el síntoma predominante antes del tratamiento. La reducción del área de la fisura fue evidente en los tratados con lisado. El efecto final en los pacientes tratados con el método fue positivo. Conclusiones: se comprobó que el lisado plaquetario usado para la cicatrización de la fisura anal crónica fue efectivo con un resultado de satisfacción por parte de los pacientes, con un mínimo de reacciones adversas. Puede representar un futuro promisorio en el tratamiento de esta enfermedad(AU)


Introduction: Anal fissures are an important health problem in the Cuban population, even with the suppression of the triggering factors, many of them tend to chronicity; its evolution is torpid, and their risk for complication is high. Objective: To evaluate the healing of anal fissures by platelet lysate in Comandante Pinares General Teaching Hospital in San Cristóbal. Method: A quasi-experimental study was performed in the general surgery service of Comandante Pinares General Teaching Hospital, from January 2015 to June 2017. All adult patients, of both sexes, were attended upon diagnosis of anal fissure and were included in the study. with inadequate response to conventional treatment and without other underlying diseases that could prevent the use of regenerative therapy. All patients were asked for their informed consent prior explanation of the study characteristics. Results: Hemorrhoidectomy was the most frequent procedure associated with anal fissures. Pain was the predominant symptom before treatment. The reduction in the area of ​​the fissure was evident in those patients treated with the lysate. The final effect in patients treated with the method was positive. Conclusions: The usage of the platelet lysate for the healing of chronic anal fissure proved effective, with a result of patient satisfaction, with a minimum of adverse reactions. It may represent a promising future in the treatment of this disease(AU)


Subject(s)
Humans , Male , Female , Autoantigens/therapeutic use , Precipitating Factors , Regenerative Medicine/methods , Fissure in Ano/diagnosis , Data Collection/statistics & numerical data
19.
Article in English | WPRIM | ID: wpr-717478

ABSTRACT

OBJECTIVE: The pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles. METHODS: There are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records. RESULTS: The TAS ranged from −5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to −1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p < 0.01, Fisher's exact test). CONCLUSION: The TAS is a useful tool for differentiating the causality of CSH.


Subject(s)
Adult , Aging , Craniocerebral Trauma , Hematoma, Subdural, Chronic , Humans , Insurance , Intracranial Pressure , Medical Records , Precipitating Factors , Retrospective Studies
20.
Article in English | WPRIM | ID: wpr-713833

ABSTRACT

Surgery, anticoagulation therapy, pregnancy, and hormone treatments, such as bromocriptine, are well-characterized precipitating factors for pituitary apoplexy. However, whether cytotoxic chemotherapy for systemic cancer could cause pituitary apoplexy has not been investigated. Here, we present a case of a 41-year-old woman who developed a severe headache with decreased visual acuity after intravenous cytotoxic chemotherapy to treat metastatic breast cancer. Preoperative neuroimaging revealed pituitary adenoma with necrosis. Operative findings and pathologic examination concluded extensive necrosis with a small intratumoral hemorrhage in a pre-existing pituitary adenoma. We reviewed two additional previously published cases of pituitary apoplexy after systemic chemotherapy and suggest that cytotoxic chemotherapy may induce pituitary apoplexy.


Subject(s)
Adult , Breast Neoplasms , Breast , Bromocriptine , Drug Therapy , Female , Headache , Hemorrhage , Humans , Necrosis , Neuroimaging , Pituitary Apoplexy , Pituitary Neoplasms , Precipitating Factors , Pregnancy , Visual Acuity
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