Factores psicosociales que influyen en la relación médico paciente en la consulta de genética clínica.

The genetic clinical practice has been recognized as a consultation dedicated to the diagnosis and management of genetic disorders by the geneticist. However, the data on how genetic consultation works in Colombia are unknown and there is a lack of information about the other aspects of the genetic management of the population with genetic disorders. Materials and methods: An observational and semi-structured interview methodology was combined and performed in this study for two geneticists in one health institution of Cali, Colombia. The interview and observations were carried out in two and fourteen moments, respectively. Results: External and internal factors, which might influence and determine the dynamics of the consultation, were identified, such as barriers in the health system, type of consultation and personal beliefs of the geneticist. Conclusion: In summary, the holistic approach to the population with genetic disorders has to transcend the biological approach focused on deficiency and consider both the psychological and social approaches.Introducción: la genética clínica ha sido reconocida como una práctica dedicada al diagnóstico y al manejo de los trastornos genéticos por parte del médico genetista. Sin embargo, los datos sobre la forma como funciona la consulta de genética clínica en Colombia, son inexistentes y, sin información acerca de los retos en la atención a la población con enfermedad genética. Materiales y métodos: este estudio se llevó a cabo combinando la observación y la entrevista semi-estructurada a dos médicos genetistas de una institución de salud en Cali, con catorce observaciones y dos entrevistas. Resultados: se identificaron factores, internos y externos a la consulta, que influyeron en su dinámica: las barreras en el sistema de salud, la tipología de la consulta y los factores personales del médico genetista. Conclusión: se concluye que la atención integral de las personas con condiciones genéticas debe trascender el abordaje biológico, en la deficiencia, a un abordaje que también considere aspectos psicológicos y sociales

Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

Importance The rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists–head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic. Observations A high number of health care workers were infected during the first phase of the pandemic in the city of Wuhan, China. Subsequently, by adopting strict safety precautions, other regions were able to achieve high levels of safety for health care workers without jeopardizing the care of patients. The most common procedures related to the examination and treatment of upper aerodigestive tract diseases were reviewed. Each category was reviewed based on the potential risk imposed to health care workers. Specific recommendations were made based on the literature, when available, or consensus best practices. Specific safety recommendations were made for performing tracheostomy in patients with COVID-19. Conclusions and Relevance Preserving a highly skilled health care workforce is a top priority for any community and health care system. Based on the experience of health care systems in Asia and Europe, by following strict safety guidelines, the risk of exposure and infection of health care workers could be greatly reduced while providing high levels of care. The provided recommendations, which may evolve over time, could be used as broad guidance for all health care workers who are involved in the care of patients with COVID-19

A numerical method for the simulation of rough elastomeric contact

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Hearing voices and strange noises after sleeve gastrectomy

Patulous eustachian tube (PET) dysfunction is a rare complication of weight loss, which can be easily misdiagnosed. We present a case of PET dysfunction after laparoscopic sleeve gastrectomy. A 36-year-old Caucasian female with Class III morbid obesity (131 kg, BMI 46.6 kg/m2) successfully underwent laparoscopic sleeve gastrectomy. At her postoperative follow-up appointment six months later, her weight dropped to 96 kg and she complained of severe autophony (hearing of self-generated sounds), leading to anxiety and insomnia. She was initially misdiagnosed with a sinus infection by her primary care provider and was started on antibiotics. She was subsequently seen by an otolaryngologist who diagnosed her with PET. Weight loss can be a predisposing factor for PET. Our patient did not notice onset of symptoms of PET until significant weight loss (35 kg, 59.5% EWL)