Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively

Methicillin-resistant Staphylococcus aureus Toxic Shock Syndrome

Case ReportsLetterSCOPUS: le.jinfo:eu-repo/semantics/publishe

Perlindungan Konsumen Undang-Undang No.8 tahun 1999 terhadap Pelecehan oleh Mitra Grab Jasa Transportaasi Online

Hasil penelitian ini menunjukkan bahwa masyarakat dapat memahami terkait dengan perlindungan konsumen atas pelecehan seksual yang terjadi pada konsumen pengguna jasa transportasi online. Dan terhadap pelaku pelecehan seksual teersebut dapat dihukum dengan ketentuan hukum yang berlaku serta dapat diberikan sanksi oleh pihak perusahaan berupa pembekuan akun mitra bahkan bisa saja sampai pada putus mitra sesuai dengan kode etik perusahaan jasa transportasi online

Fluoroquinolones or fortified antibiotics for treating bacterial keratitis: systematic review and meta-analysis of comparative studies

OBJECTIVE: To review published clinical studies having compared fluoroquinolones with fortified antibiotics in the treatment of bacterial keratitis. DESIGN: Systematic review of randomized and nonrandomized trials published between 1991 and 2011, and meta-analysis of efficacy results. PARTICIPANTS: Eight randomized and 5 nonrandomized studies comparing the efficacy and safety of fortified antibiotics or fluoroquinolones for treating bacterial keratitis. METHODS: This study reviewed the efficacy and safety data. Meta-analysis of efficacy data considered all comparative studies, as well as the subsets of nonrandomized studies, of randomized studies, and of randomized studies limited to bacteriologically proven bacterial keratitis. Healing, defined as complete re-epithelialization within predefined time frame with the assigned treatment, was used as primary efficacy end point. Safety was assessed by the report of negative side effects and severe complications in the 2 treatment arms. RESULTS: Fluoroquinolones prescribed as empiric initial treatment of bacterial keratitis are at least as effective as combined fortified antibiotics, with odds ratio based on random-effects model of 1.473 (0.902-2.405) for all studies, 2.374 (1.082-5.206) for nonrandomized studies, 1.050 (0.636-1.732) for randomized studies only, and 1.199 (0.477-3.011) for randomized studies restricted to patients in whom a bacterial infection was confirmed by microbiology. Reports of tolerance also appear in favor of fluoroquinolones. CONCLUSIONS: Based on these data, it seems reasonable to consider fluoroquinolone as the first choice for empirical treatment in most cases of suspected bacterial keratitis

Subjective Evaluation of the Voice by the V.H.I. and Estimation of the Prevalence of Vocal Disorders among 723 Teachers

The literature shows that 20% of the teachers suffer from a vocal disorder. The researchers find frequent symptoms such as roughness, vocal fatigue and aggravation of the mean F0, peri-laryngeal pain and physical discomfort. Dysphonia is more frequent in female teachers. Age, years of experience, type of subject taught and environmental factors, vocal abuse, and stress have an impact on voice. They diminish the vocal performances of these professionals which has negative financial consequences. In our study, the voice of 723 teachers were evaluated by means of the VHI (F: 634, M: 89), teaching in ordinary schools or in positive discrimination schools. Fifteen municipality in the Brussel area participated in the study. We obtain a good test retest reliability for the whole group (F: 0,774 ; E: 0.749 ; P: 0.806 ; G : 0.836 – p>0.001). The scores at the retest are significantly lower for the global scores and the three subscales (G p<0.001, F p<0.001 ; E p=0.003 et P p<0.001). Intra-scale correlation is high (F versus E : 0.434 ; F vs P :0.455 ; E vs P : 0.527). The prevalence of vocal disorders was computed with regard to past ENT and speech pathology history and actual treatments, it was evaluated to 10,5%. Teachers who had been consulting an ENT or a speech language pathologist had higher scores at the global VHI. The elder the subjects are and the more teaching experience they have, the lesser they report vocal disorders (p=0.026 et p=0.013). The variables sex (p≥ 0.063), subject taught (p≥ 0.468), smoking (p=0.757), type of school (p≥ 0.867) and class grade (p≥ 0.212) do not have a significant impact on the VHI scores

Evaluation subjective de la voix (VHI) chez 723 enseignants en région Bruxelloise.

Les études montrent qu’en moyenne 20% des enseignants présentent des troubles vocaux. Les auteurs relèvent des symptômes fréquents comme la raucité, la fatigue vocale, l’aggravation de la voix, les douleurs péri-laryngées et la sensation d’inconfort physique. Ils rapportent que la dysphonie est plus fréquente chez les femmes. L’âge, le nombre d’années d’expérience, le type de cours enseigné les facteurs environnementaux, l’abus, le malmenage vocal et le stress ont un impact sur la voix. Ces facteurs amenuisent les performances vocales professionnelles des enseignants et ont des conséquences non négligeables en terme d’économie. Dans notre étude, nous avons évalué la voix de 723 enseignants (F :634/ H :89), exerçant en écoles ordinaires ou en écoles à discrimination positive, à l’aide du VHI. Nous avons établi un premier état des lieux dans 15 communes de la région bruxelloise. Des mesures de fiabilité, de pertinence et de cohérence ont été réalisées. Nous obtenons une bonne fiabilité test-retest (F : 0,774 ; E : 0.749 ; P : 0.806 ; G : 0.836 – p>0.001 pour tous). Les scores du re-test sont significativement inférieurs pour les 3 sous-échelles (F p<0.001 ; E p=0.003 et P p<0.001) et le score global (p<0.001). La corrélation entre les 3 sous échelles est élevée (FvsE : 0.434 ; FvsP :0.455 ; EvsP : 0.527). La prévalence des troubles vocaux a été calculée en tenant compte des variables antécédents ORL, logopédiques et des traitements logopédiques en cours. Elle s’élève à 10,5%. Les enseignants ayant été confronté à une difficulté vocale (vu par un ORL ou/et un logopède) présentent donc des scores plus élevés au VHI global. Par contre, nous observons que plus les sujets sont âgés et ont de l’expérience moins ils ont de troubles vocaux (p=0.026 et p=0.013). De même, les variables telles que le genre (p≥ 0.063), la matière enseignée (p≥ 0.468), le fait de fumer (p=0.757), le type (p≥ 0.867) et le degré d’enseignement (p≥ 0.212) n’influent pas de manière significative les scores aux V.H.I

Information Internet en langue française en oncologie ORL

Objective: Internet has become the first place where patients go when seeking information on their disease. The type and the quality of the medical information available on French-language websites is poorly known, especially in the field of head and neck surgery. The purpose of this study was to evaluate the quality of these sites. Materials and methods: We entered six keywords-"cancer du larynx", "cancer de l'amygdale", "cancer de la thyroïde", "carcinome papillaire de la thyroïde", "cancer de la langue", and "cancer de la parotide"-in two different search engines and, for each keyword, the first 50 websites were reviewed using the tool called DISCERN. With two head and neck surgeons, we rated their contents in terms of quality and comprehension. Results: On 600 websites only 95 (16%) contained information that proved to be somewhat useful to patients. According to our scoring system, 8% of websites were found to be excellent, 24% good, 14% fairly good, 15% mediocre, 27% poor, and 12% very poor. Just over 60% of the websites were found to be clear. The study also showed that the order in which these websites were ranked in the search engine, their affiliation, the target population, or who financed them had little impact on quality. The websites were more likely to be high quality if they were managed by doctors and had bibliographical references as well as a date indicating a recent website update. Conclusion: This study again shows that the search for medical information on the Internet is time-consuming and often disappointing: very few websites provide information that is both clear and exhaustive. However, we also found that very few websites contained information that was seriously inaccurate. Given the growing popularity of the Internet, a high-quality French-language website specializing in head an neck surgery would be highly beneficial to patients, as would an ENT portal that would take them to selected websites, saving time and providing a guarantee of quality. © 2009 Elsevier Masson SAS. All rights reserved

Rash purpurique après prise de lisinopril.

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