1,721,010 research outputs found
Diagnostic delay due to COVID-19 pandemic: a case of uncontrolled growth of peripheral giant cell granuloma
No full textCOVID-19: a global health system unfit for purpose
No full textThe COVID-19 pandemic has exposed critical weaknesses in global health systems, highlighting deep-rooted socioeconomic disparities and systemic vulnerabilities. Lower-income communities, particularly ethnic minorities, faced dispro-portionately higher infection and mortality rates due to overcrowding, limited healthcare access, and occupational expo-sure. Additionally, resource-limited settings and conflict-affected regions, such as Syria, encountered severe challenges in managing the pandemic due to fragile healthcare infrastructures. The pandemic also emphasized the role of community-driven interventions and the necessity of equitable healthcare policies. This narrative review synthesizes evidence from peer-reviewed studies, policy reports, and public health data to examine the interplay between socioeconomic disparities, healthcare accessibility, and pandemic outcomes. A systematic search of relevant literature was conducted to identify key factors contributing to health inequities during COVID-19, with a focus on healthcare workforce shortages, international migration, and the effectiveness of preventative measures. Findings indicate that lower-income populations experienced higher morbidity and mortality rates due to structural inequities in healthcare access and social determinants of health. The global shortage of healthcare workers, exacerbated by international migration, further strained health systems, particularly in low-resource settings. In conflict-affected regions, fragile healthcare infrastructures struggled to contain the virus. Community-driven interventions, including vaccination campaigns and localized public health initiatives, played a critical role in mitigating disease spread. However, systemic barriers persist, limiting the effectiveness of these mea-sures. Addressing global health inequities requires a multifaceted approach that integrates economic policies, healthcare reforms, and international collaboration. Strengthening primary care, investing in healthcare workforce retention, and re-ducing socioeconomic disparities are essential for building resilient health systems. The pandemic underscores the urgent need for structural reforms to enhance global pandemic preparedness and promote equitable health outcomes worldwide
Sustainable universal access to essential medicines amidst conflict: a stakeholder analysis of primary care in Syria
No full textINTRODUCTION: Sustainable Development Goal (SDG) Indicator 3.b.3 is defined as the proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis. Data for these three dimensions is collected and measured as part of the World Health Organization (WHO) Medicines Strategy, which recognizes that sufficient access to medicines is an indispensable element of quality healthcare delivery. Among other long-term consequences, internal conflict in Syria has led to the breakdown of health systems, lack of qualified medical personnel, and shortage of medicines. EVIDENCE ACQUISITION: This report investigates the power and relationship dynamics between key stakeholders involved in the delivery of essential medicines in Syria. A stakeholder analysis was conducted to identify key actors, their influence, and accountability in ensuring access to medicines. Additionally, policy and healthcare system evaluations were performed to assess barriers to universal medicine delivery. EVIDENCE SYNTHESIS: Findings indicate a fragmented healthcare system with multiple actors, including government agencies, international organizations, and local providers, often operating with limited coordination. The role of humanitarian aid has been crucial, but supply chain disruptions, regulatory barriers, and financial constraints continue to hinder consistent access to essential medicines for chronic diseases in primary care. CONCLUSIONS: To improve the universal delivery of essential medicines in Syria, stronger coordination among stake-holders, regulatory reforms, and sustainable funding mechanisms are required. Strengthening local pharmaceutical pro-duction, enhancing supply chain management, and increasing international support for medicine accessibility are critical to addressing the ongoing crisis
Efficacy of a Non-addictive Nasal Irrigation Based on Sea Salt Enriched with Natural Enzymes among Patients with Sinusitis: An In Vivo, Randomized, Controlled Trial
Full text linkBACKGROUND: Chronic rhinosinusitis (CRS) is a common condition that is defined as inflammation of the nose and paranasal sinuses. Nasal irrigation plays an important role in the treatment of CRS. Evidence from basic research favors hypertonic saline over isotonic saline for mucociliary clearance, but evidence from clinical studies is controversial. AIM: This study aims to investigate the hypothesis that the use of daily nasal irrigation based on sea salt, enriched with natural enzymes and lysozyme, may be useful in patients with CRS. PATIENT AND METHODS: Patients (30 men and 30 women) 18–55 years old (mean age 41 ± 3 y.o.), with two episodes of acute sinusitis or one episode of chronic sinusitis per year for 2 consecutive years, were enrolled stratified by sex and age and randomly divided into two groups supplementation: Group A (test) and Group B (control/placebo). Moreover, an exit questionnaire was asked to Group A subjects to report whether their sinus-related quality of life has gotten worse, stayed the same, or improved (scale from 0 to ±100%). RESULTS: The result showed that in the test group (A) from T0 to T1, a reduction of 17.65% for the symptoms related headache and/or facial pressure and a reduction of the 18.18%, for the symptoms relates to congestion and/or nasal discharge. On the other hand, the control group (B) shown less difference between T0 and T1. CONCLUSIONS: This study strengthens the argument that the tested formulation is a safe, well-tolerated, long-term therapy that patients with chronic sinonasal complaints can and will use at home with minimal training and follow-up
Challenging Axillary Lymph Nodes on PET/CT in Cancer Patients throughout COVID-19 Vaccination Era
No full textBackground: The unexpected detection of axillary lymphadenopathy (AxL) in cancer patients (pts) represents a real concern during the COVID-19 vaccination era. Benign reactions may take place after vaccine inoculation, which can mislead image interpretation in patients undergoing F-18-FDG, F-18-Choline, and Ga-68-DOTATOC PET/CT. They may also mimic loco-regional metastases or disease. We assessed PET/CT findings after COVID-19 first dose vaccination in cancer patients and the impact on their disease course management. Methods: We evaluated 333 patients undergoing PET/CT (257 F-18-FDG, 54 F-18-Choline, and 23 Ga-68 DOTATOC) scans after the first vaccination with mRNA vaccine (Pfizer-BioNTech) (study group; SG). The uptake index (SUVmax) of suspected AxL was defined as significant when the ratio was > 1.5 as compared to the contralateral lymph nodes. Besides, co-registered CT (Co-CT) features of target lymph nodes were evaluated. Nodes with aggregate imaging positivity were further investigated. Results: Overall, the prevalence of apparently positive lymph nodes on PET scans was 17.1% during the vaccination period. 107 pts of the same setting, who had undergone PET/CT before the COVID-19 pandemic, represented the control group (CG). Only 3 patients of CG showed reactive lymph nodes with a prevalence of 2.8% (p < 0.001 as compared to the vaccination period). 84.2% of SG patients exhibited benign characteristics on co-CT images and only 9 pts needed thorough appraisal. Conclusion: The correct interpretation of images is crucial to avoid unnecessary treatments and invasive procedures in vaccinated cancer pts. A detailed anamnestic interview and the analysis of lymph nodes' CT characteristics, after performing PET/CT, may help to clear any misleading diagnosis. Clinical Trial Registration Number: Protocol # 20210053954/CEUR 118/2021
Pneumomediastinum, pneumothorax and subcutaneous emphysema after tracheostomy closure. When less is more
Full text link: Pneumomediastinum is a threatening complication that might occur after tight surgical closure of tracheostomy is performed. Physiopathology of this condition is based on several factors, including direct trauma to the tracheal wall caused by surgical maneuvers or insufficient closure of soft tissue layers which do not seal air leakage. In this paper we explore this phenomenon by reporting the case of one patient undergoing surgical closure of tracheostomy after two weeks, who later developed subcutaneous emphysema followed by pneumomediastinum. Physiopatology is analyzed and management strategies for this condition are suggested based on our experience
Clinical and radiographic retrospective examination of data from patients who received endosseous zygomatic dental implants to support maxillary full-arch prostheses
No full textBACKGROUND: In recent decades, implant dentistry has evolved to become a highly predictable treatment modality in the rehabilitation of different types of edentulism. The present retrospective analysis aimed to report the middle-term outcome of severely atrophic jaws rehabilitated with extra-maxillary zygomatic implants placed in conjunction with standard implants. METHODS: Thirty-one patients were included in the present study with 62 zygomatic implants and 90 standard implants positioned. Outcome measures were prosthetic success/survival, implant success/survival, complications, modified Plaque Index (mPLI), modified Bleeding Index (mBI), mucosal seal efficacy evaluation (MSEE) >4 mm, and zygomatic implants classification level (ZICL). RESULTS: No implant and no prosthesis were lost; one patient had mucositis at one zygomatic implant; implant and prosthetic cumulative success rates at more than 3 years were respectively 98.4% and 87% using implant and patient as units of analysis. Mechanical and biological complications occurred in seven patients; all resolved. Eighty percent of the patients practiced proper hygiene and 77% of patients suffered absent or minor mucosal bleeding. Distribution of the variable “mucosal seal efficacy evaluation” led to 81% of sites with values less than 4, and 19% of sites with values higher than 4. In more than 80% of cases, so then, the zygomatic implants clinical level showed a level 1 at the end of the survey. CONCLUSIONS: With 100% survival rates, zygomatic bilateral prosthetic configurations were an effective therapeutic option for individuals with highly reabsorbed maxillae undergoing initial full-arch fixed rehabilitation
Assessment of psychological status by a comprehensive approach in thyroid cancer patients undergoing radionuclide therapy: A feasibility study
No full textThis feasibility study evaluated the psychological status of patients with differentiated thyroid cancer (DTC) before, during, and 40 days after administration of I-131 radionuclide therapy (RAI). We investigated the appropriateness of providing patient a comprehensive psychological assessment in an isolation ward. Thirty consecutive patients (Study Group; SG) who received RAI were enrolled. The tools used were the Hospital Anxiety and Depression Scale (HADS) at three different moments, and the Coping Responses Inventory (CRI) at baseline for each patient. A supportive approach was also implemented. Data were collected at the first specialist visit, at the day of admission, and at 40 days follow-up visit. A matched cohort of patients (Control Group; CG), who did not receive psycho-oncological counseling, was retrospectively studied only about their medical needs and requests. Staff exposure to radiation was also compared during SG and CG hospitalization, to assess a possible reduction of radiological risk for them. A significant difference between the basal, intermediate, and final psychological status was observed (p < 0.0001), which was found to be irrespective of the induced hypothyroidism. Patients showed a significant worsening of their status in terms of anxiety and depression after the consent, but it improved 40 days after treatment. Repeated measures analysis showed a similar trend in patients' psychological status over this period. At hospital discharge, patients showed indirect signs of increased well-being. CG required more nursing and medical interventions. Staff exposure was significantly lower during hospitalization of SG as compared to CG. This study demonstrates that timed psychological evaluation and appropriate support may help to reduce anxiety and depression of patients receiving a diagnosis of cancer and undergoing RAI. Moreover, an improvement of workplace safety was recorded
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