scholarly journals Endoscopic Decompression in Colonic Distension

2021 ◽  
Vol 37 (2) ◽  
pp. 142-148
Author(s):  
Sebastian Belle
Keyword(s):  
Therapeutic Strategy ◽  
Medical Condition ◽  
Clinical Success ◽  
Medical Emergency ◽  
High Morbidity ◽  
Evidence Based ◽  
Malignant Obstruction ◽  
Colonic Volvulus ◽  
Endoscopic Decompression ◽  
Colonic Distension

<b><i>Background:</i></b> Acute colonic distension is a medical emergency with high morbidity and mortality. Clinically important causes of colonic distension are acute colonic pseudo-obstruction, colonic volvulus, and malignant obstruction. Endoscopic decompression is one established therapeutic strategy. <b><i>Summary:</i></b> This therapeutic review will give an overview of possible therapeutic strategies based on the recently published literature, focusing on endoscopic decompression and summarizing the other therapeutic possibilities. The review discusses separately the therapeutic options of acute colonic pseudo-obstruction, colonic volvulus, and malignant obstruction, providing an evidence-based orientation for clinical use. <b><i>Key Messages:</i></b> Endoscopic decompression of colonic distension is an established therapy with high clinical success. The technique and its position in the therapy sequence differ depending on the medical condition, the trigger of the colonic distension, and the local expertise.

scholarly journals Novel therapeutic interventions towards improved management of septic arthritis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian Wang ◽  
Liucai Wang
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Clinical Success ◽  
Treatment Protocol ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Medical Emergency ◽  
Success Rates ◽  
Joint Infections ◽  
Novel Therapeutic

AbstractSeptic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

Abstract 1787: Vertebral Artery Stent Placement for Symptomatic Patients: One-Year Follow-up

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Samir N Patel ◽  
J. Stephen Jenkins ◽  
Christopher J White ◽  
Paul McMullan ◽  
J.P. Reilly ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Clinical Success ◽  
High Morbidity ◽  
Symptom Resolution ◽  
Non Invasive ◽  
Procedural Success ◽  
Repeat Angiography ◽  
One Year

Background : Symptomatic vertebral artery stenosis (VAS) has a five-year stroke risk of 30%–35%. Mortality associated with posterior circulation (PC) strokes is high, ranging from 20%–30%. Surgical revascularization is rarely performed due to high morbidity and mortality. Endovascular revascularization with stents offers a potential treatment option for these patients. Methods : One hundred nine patients (116 arteries, 70% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995–2006. Symptoms included vertigo (63%), visual changes (31%), syncope (11%), ataxia (7%), and drop attack (5%). Four patients had asymptomatic critical stenosis. Sixty-one patients (56%) had bilateral VAS, 74 patients (69%) had concomitant carotid disease, and 43 patients (39%) had a prior stroke. Procedural success was defined as residual stenosis of ≤ 20% without peri-procedural stroke or death. Clinical success was defined as procedural success with symptom resolution. Restenosis was defined as angiographic narrowing within the stent of ≥ 70% or > 50% with recurrent symptoms, or evidence of severe stenosis on non-invasive imaging (ultrasound, CT, or MR). Results : Procedural and clinical success was achieved in 108 (99.1%) and 95 (94.3%) patients, respectively. At one year, follow-up was obtained in 91 patients (83.5%), 6 patients (5.5%) had died, 5 patients (5.3%) experienced a PC stroke, and 47 patients (43.1%) underwent repeat angiography and/or non-invasive imaging. Eighty-seven of the 91 patients were initially symptomatic, 69 (79.3%) of which were symptom-free at one year. Three of those that had recurrent symptoms never achieved clinical success, 9 had developed restenosis, and 7 underwent successful re-intervention. At median follow-up of 31 months (lower and upper quartiles of 13.0 and 51.8 months), 72.5% were alive and 71.6% remained symptom-free. Conclusion : Our data demonstrates that stenting for VAS can be successfully performed in 99% of patients without peri-procedural stroke or death and is associated with durable symptom resolution in approximately 80% of patients at one year. In these high-risk patients, endovascular therapy for symptomatic VAS appears to be safe and effective at relieving symptoms.

Evidence-based guidelines for acute stabilization and management of neonates with persistent pulmonary hypertension of the newborn

2021 ◽  
Author(s):  
Molly K Ball ◽  
Ruth Seabrook ◽  
Elizabeth M Bonachea ◽  
Bernadette Chen ◽  
Omid Fathi ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Neonatal Intensive Care ◽  
Best Practice ◽  
Clinical Care ◽  
Persistent Pulmonary Hypertension ◽  
High Morbidity ◽  
Evidence Based ◽  
Extensive Literature ◽  
Disciplinary Expertise ◽  
Evidence Based Guidelines

Persistent pulmonary hypertension of the newborn, or PPHN, represents a challenging condition associated with high morbidity and mortality. Management is complicated by complex pathophysiology and limited neonatal specific evidence-based literature, leading to a lack of universal contemporary clinical guidelines for the care of these patients. To address this need and to provide consistent high-quality clinical care for this challenging population in our neonatal intensive care unit, we sought to develop a comprehensive clinical guideline for the acute stabilization and management of neonates with PPHN. Utilizing cross-disciplinary expertise and incorporating an extensive literature search to guide best practice, we present an approachable, pragmatic, and clinically relevant guide for the bedside management of acute PPHN.

scholarly journals P.039 mTOR inhibitors as a new therapeutic strategy in treatment resistant epilepsy in hemimegalencephaly: a case report

2017 ◽  
Vol 44 (S2) ◽  
pp. S23-S23
Author(s):  
Q Xu ◽  
H Sarnat ◽  
S Uliel-Sibony ◽  
C Boelman ◽  
M Connolly ◽  
...  
Keyword(s):  
Therapeutic Strategy ◽  
Refractory Epilepsy ◽  
Focal Cortical Dysplasia ◽  
Mtor Inhibitors ◽  
Response To Treatment ◽  
Definitive Treatment ◽  
High Morbidity ◽  
Treatment Resistant ◽  
Integral Role ◽  
First Time

Background: Hemimegalencephaly (HME) is a hamartomatous malformation of one cerebral hemisphere, resulting in refractory epilepsy, intellectual disability, and autistic features. Hemispherectomy is the definitive treatment, but there is risk of high morbidity and mortality, especially when done in early infancy. Various preclinical studies have shown that dysregulation of the mTOR pathway has an integral role in the development of various epilepsy syndromes, including tuberous sclerosis complex (TSC), focal cortical dysplasia and HME. Recently, mTOR inhibitors were proven to be effective in treating seizures in TSC. Methods: We present a case of a 6 day old female with refractory epilepsy despite the trial of 9 anti-seizure medications and the ketogenic diet. As the patient was awaiting epilepsy surgery, an mTOR inhibitor, rapamycin was initiated. Results: After 1 week of the initiation, she had over a 50% reduction in seizures. At two weeks, the parents felt that for the first time, she was making developmental gains. She also appeared brighter and more interactive. Due to her response to treatment, her hemispherectomy was deferred to when she is older, so there will be a decreased risk of complications from the surgery. Conclusions: This case exemplifies how mTOR inhibitors should be considered as a treatment option for patients with HME and refractory epilepsy.

Sudden death due to ruptured oesophageal varices – autopsy-based case report

2020 ◽  
Vol 88 (4) ◽  
pp. 189-191
Author(s):  
Nagendra Singh Sonwani ◽  
Navneet Ateriya ◽  
Arvind Kumar ◽  
Anil Kohli ◽  
Kalyan Kumar Banerjee
Keyword(s):  
Chronic Alcoholism ◽  
Medical Emergency ◽  
Oesophageal Varices ◽  
High Morbidity ◽  
Forensic Pathologist ◽  
Threatening Condition ◽  
Life Threatening ◽  
Cirrhotic Patients ◽  
Acute Haemorrhage

Acute haemorrhage from ruptured oesophageal varices is a serious consequence of portal hypertension in cirrhotic patients. It represents a medical emergency with a high morbidity and mortality rate. Studies over the years have shown a direct link with chronic alcoholism in the development of such complications. Although the gastrointestinal system accounts for a few numbers of sudden deaths, bleeding through ruptured varices represent a life-threatening condition. The role of forensic pathologist is vital in dealing with sudden deaths. Here, we report a case of a 46-year-old man who died suddenly following the rupture of oesophageal varices.

scholarly journals Clinical Profile and Underlying Cause of Acute Pancreatitis among a Group of Bangladeshi Patients

2020 ◽  
Vol 32 (1) ◽  
pp. 21-24
Author(s):  
ANM Saifullah ◽  
Madhu Sudan Saha ◽  
Bimal Chandra Shil ◽  
Ali Monsur Md Shariful Islam ◽  
Arifa Akhter ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Gall Stone ◽  
Clinical Profile ◽  
Medical Emergency ◽  
High Morbidity ◽  
Cross Sectional ◽  
Medical College ◽  
North East ◽  
Medicine Today

Introduction:Acute Pancreatitis is a medical emergency, which is one of the most common conditions for hospital admission. Very few studies have yet investigated in Bangladesh. Objective of this study was to define demographic characteristics, clinical profile & underlying etiologies. Materials and Methods: This hospital based cross sectional descriptive study was performed in Sir Salimullah Medical College Mitford Hospital, Dhaka & North East Medical College, Sylhet, Bangladesh from January 2015 to December 2017. One hundred and five consecutive patients of acute pancreatitis (AP) were enrolled for this study. Clinical features and investigations were systematically recorded. Diagnosis of acute pancreatitis was made by the presence of the two of the three following criteria: i. abdominal pain consistent with the disease ii. serum amylase and /or lipase greater than three times from the upper limit of normal, and/or iii. characteristic findings of abdominal imaging. Results: Total of 105 patients took part in the study, of them 65 were male. The mean age was 42.76 ±15.88. Abdominal pain & vomiting was the most common mode of presentation. Gall stone and hypertriglyceridaemia were responsible of 20% of acute pancreatitis. Ascariasis also causes acute pancreatitis in two patients. Conclusion: Acute pancreatitis is a condition associated with high morbidity and mortality. Ascariasis also causes acute pancreatitis in endemic area. Patients usually respond conservative treatment but endoscopic treatment is effective in few cases. Surgery is rarely required. Medicine Today 2020 Vol.32(1): 21-24

scholarly journals TRENDS OF POISONING AMONG CHILDREN AT KASTURBA HOSPITAL, MANIPAL

2013 ◽  
Vol 03 (02) ◽  
pp. 025-028
Author(s):  
Pratik Vijay Tarvadi ◽  
Shankar M. Bakkannavar ◽  
Manjunath S. ◽  
Vikram Palimar ◽  
G. Pradeep Kumar ◽  
...  
Keyword(s):  
Developing Countries ◽  
Retrospective Study ◽  
Forensic Medicine ◽  
Morbidity And Mortality ◽  
Medical Emergency ◽  
High Morbidity ◽  
Kasturba Medical College ◽  
Infants And Toddlers ◽  
Medical College ◽  
Childhood Poisoning

Abstract Background: Pediatric poisoning is a common medical emergency and also associated with a high morbidity and mortality in children. In developing countries like India, poisoning emergencies are becoming a major cause of mortality in infants and toddlers. Among the various studies conducted on poisoning in our country, the study on poisoning is predominantly on adults and hence this study is taken up to understand the incidence of childhood poisoning cases. Method: A ten year retrospective study from January 1999 to December 2008 was conducted at the Department of Forensic Medicine & Toxicology, Kasturba Medical College, Manipal, to comprehend the magnitude of childhood poisoning cases at Kasturba Hospital, Manipal. Results: Insecticide poisoning was the most predominant poisoning followed by venomous bites. Conclusion: Our study examines the most common poison involved and route of intake among children to identify specific ages at risk and give suggestions so as to reduce the morbidity and mortality.

scholarly journals Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Giovanni Ostuzzi ◽  
Davide Papola ◽  
Chiara Gastaldon ◽  
Georgios Schoretsanitis ◽  
Federico Bertolini ◽  
...  
Keyword(s):  
Working Group ◽  
Medical Condition ◽  
Potential Interaction ◽  
Psychotropic Medications ◽  
Evidence Based ◽  
Medical Treatments ◽  
Safety Issues ◽  
Safety Risks ◽  
Novel Coronavirus ◽  
Practical Recommendations

Abstract Background The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. Methods In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug–drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. Results All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. Conclusions The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.

scholarly journals GENDER DIFFERENCES IN CHILDHOOD POISONING

2013 ◽  
Vol 03 (02) ◽  
pp. 069-072
Author(s):  
Pratik Vijay Tarvadi ◽  
Shankar M. Bakkannavar ◽  
Vikram Palimar ◽  
G. Pradeep Kumar ◽  
Mahabalesh Shetty ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Morbidity And Mortality ◽  
Medical Emergency ◽  
High Morbidity ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Childhood Poisoning ◽  
Males And Females ◽  
The Difference

Abstract Background: Accidental paediatric poisoning is a common medical emergency and also associated with a high morbidity and mortality in children. In developing countries like India, the poisoning emergencies are becoming a major cause of mortality in infants and toddlers. Among the various studies done on poisoning cases in our country, the study on poisoning is more or less only on adults and hence this study is taken up to understand the number of childhood poisoning cases (based on gender). Method: A ten year record based cross sectional study from January 1999 to December 2008 was conducted at the Department of Forensic Medicine & Toxicology, Kasturba Medical College, Manipal, to understand the magnitude of childhood poisoning cases among males and females at Kasturba Hospital, Manipal. Results: Male children were predominantly affected (male: female::1.32: 1). Most of the poisoning cases occurred at home in both the genders with boy to girl ratio based on percentage in indoor poisoning being 0.92:1 and boy to girl ratio based on percentage in outcome being 1.06:1. Conclusion: Our study examines the difference in place and outcome of poisoning among boys and girls to identify population at risk and give suggestions so as to reduce the morbidity and mortality.

Assessment and therapeutic strategy for agitation, confusion, and delirium in the ICU

2016 ◽  
Author(s):  
Michele C. Balas ◽  
E. Wesley Ely
Keyword(s):  
Risk Factors ◽  
Therapeutic Strategy ◽  
Signs And Symptoms ◽  
Therapeutic Strategies ◽  
Screening Tools ◽  
Evidence Based ◽  
Modifiable Risk Factors ◽  
Everyday Clinical Practice ◽  
Delirium Assessment ◽  
Effective Assessment

Agitation and delirium are conditions that are highly prevalent in the intensive care unit (ICU). Both are believed to be caused by a number of modifiable and non-modifiable risk factors, and present with a variety of signs and symptoms. Consequently, these conditions are notoriously difficult to detect and treat. Variations in sedative practices, misperceptions regarding delirium and its association with outcomes, and lack of knowledge regarding screening tools, may all impede effective assessment, and management of agitation and delirium. A further complication is that many of the medications used to treat critically-ill patients are now known to increase the risk of delirium. While studies conducted over the last decade have significantly contributed to our understanding of how best to diagnose, prevent, and manage these common conditions, this knowledge is not always successfully adopted into everyday clinical practice. This chapter provides readers with an evidence-based review of agitation and delirium assessment and therapeutic strategies applicable for use in the ICU setting.

Sign in / Sign up

Export Citation Format

Share Document