scholarly journals Problem based review: The patient with recent onset Polyarthritis

2014 ◽  
Vol 13 (3) ◽  
pp. 132-138
Author(s):  
Ernest Suresh ◽  
◽  
Preetha Venugopalan Menon ◽  
May Zin Myint ◽  
◽  
...  
Keyword(s):  
Diagnostic Approach ◽  
Case Vignette ◽  
Illustrative Case ◽  
Initial Management ◽  
Recent Onset ◽  
Early Stages ◽  
Life Threatening ◽  
Acute Polyarthritis

A wide variety of conditions can present as acute polyarthritis, ranging from those that are potentially life threatening, to those that are self-limiting, and those that represent the early stages of a persistent and potentially destructive form of arthritis. In this article, we describe the diagnostic approach and initial management of patients with recent onset polyarthritis, with the aid of an illustrative case vignette.

scholarly journals Autoimmune Brainstem Encephalitis: An Illustrative Case and a Review of the Literature

2021 ◽  
Vol 10 (13) ◽  
pp. 2970
Author(s):  
Romy Zoghaib ◽  
Ali Sreij ◽  
Nancy Maalouf ◽  
Joumana Freiha ◽  
Raghid Kikano ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Diagnostic Approach ◽  
Illustrative Case ◽  
Systemic Diseases ◽  
Brainstem Encephalitis ◽  
Review Of The Literature ◽  
Wide Range ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Appropriate Therapy

Autoimmune brainstem encephalitis (BSE) is a rare neurological condition with a wide range of underlying etiologies. It can be subdivided into two broad groups: a primary inflammatory disease of the central nervous system (CNS) or a brainstem disorder secondary to systemic diseases where the CNS is only one of many affected organs. Symptoms range from mild to life-threatening manifestations. Most cases respond well to immunotherapy. Therefore, broad and in-depth knowledge of the various inflammatory disorders that target the brainstem is essential for guiding the diagnostic approach and assisting in early initiation of appropriate therapy. We herein report on a case of BSE and provide an overview of the various causes of autoimmune BSE with an emphasis on the clinical manifestations and diagnostic approach.

LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY.

2019 ◽  
Author(s):  
Madan Goyal ◽  
R K Goel
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Critical View Of Safety ◽  
Recent Onset ◽  
Conversion To Open Cholecystectomy ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fluid Collections ◽  
A Prospective Study

Acute cholecystitis (AC) is a potentially life-threatening condition. LC was initially considered to be a relative contraindication for laparoscopic cholecystectomy (LC), but with increase in general expertise, early LC was recommended in selected patients1. Aprospective study of LC in grade 1 and 2 AC patients with mild to moderate inflammatory changes in the gallbladder and no significant organ dysfunction, was performed during October 2016 to July 2019. A total of 78 patients, out of 408 cholecystectomies performed during this period, were included in this study. Criteria for diagnosing AC was, recent onset of pain in right hypochondrium, fever, leucocytosis, pericholecystic fluid collections, subserosal oedema on ultrasound, pyocele and other pathological evidence of AC. Patients presented and operated within 4 days of onset of symptoms showed better results as compared to those who could be operated after 4 days and within 14 days. Five patients required conversion to open cholecystectomy because of complex adhesions in 2, critical view of safety was unachievable in 2 and in 1 for troublesome bleeding.

scholarly journals Organophosphorus Poisoning

2008 ◽  
Vol 47 (172) ◽  
Author(s):  
Buddhi Prasad Paudyal
Keyword(s):  
Signs And Symptoms ◽  
Clinical Problem ◽  
Acute Poisoning ◽  
The Body ◽  
Organophosphorus Insecticides ◽  
Basic Principles ◽  
Initial Management ◽  
Organophosphorus Poisoning ◽  
Life Threatening ◽  
History Of

Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, withthousands of deaths occurring every year. Most of these pesticide poisoning and subsequentdeaths occur in developing countries following a deliberate self ingestion of the poison. Metacid(Methyl parathion) and Nuvan (Dichlorovos) are commonly ingested OP pesticides; Dimethoate,Profenofos, and Chlorpyrifos are other less frequently ingested compounds in Nepal. The toxicityof these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzymeleading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptorsin various parts of the body. Acutely, these patients present with cholinergic crisis; intermediatesyndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosisdepends on the history of exposure to these pesticides, characteristic manifestations of toxicityand improvements of the signs and symptoms after administration of atropine. The supportivetreatment of OP poisoning includes the same basic principles of management of any acutelypoisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastriclavage and activated charcoal are routinely used decontamination procedures, but their valuehas not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, andcan reverse the life threatening features of this acute poisoning. However, there are no clearcut guidelines on the dose and duration of atropine therapy in OP poisoning. Cholinesterasereactivators, by regenerating AChE, can reverse both the nicotinic and muscarinic effects;however, this benefit has not been translated well in clinical trials. All these facts highlight thatthere are many unanswered questions and controversies in the management of OP poisoningand there is an urgent need for research on this aspect of this common and deadly poisoning.Key Words: poisoning, organophosphorus insecticides, decontamination, antidotes

Prediction Models

2021 ◽  
pp. 50-69
Author(s):  
Amit Kumar Tyagi
Keyword(s):  
Predictive Modeling ◽  
Prediction Models ◽  
Medical Science ◽  
Rapid Change ◽  
Well Being ◽  
Smart Devices ◽  
Prediction Modeling ◽  
Early Stages ◽  
Life Threatening

Having/living convenient life through smart devices, people are more interested or more dependent on to predict something for future (i.e., with respect to their health, business, etc.). For that, many prediction models by several researchers are being used in many applications. Due to a vast (rapid) change in lifestyle, people are more prone to a number of life-threatening diseases when it comes to their well-being. Many of these diseases start developing their symptoms in their early stages. But, still many of these diseases like cancer, kidney damages remain unidentified in their developing stages. The earlier a disease is predicted, the easier it becomes to cure it and even prevent it. Predictive modeling provides a huge step forward in medical science in preventing the risk among patients. Prediction modeling is the process of analyzing current conditions to predict future results.

Fifteen-minute consultation: The limping child

2019 ◽  
Vol 105 (3) ◽  
pp. 137-141 ◽  
Author(s):  
Jonathan Adamson ◽  
Thomas Waterfield
Keyword(s):  
Risk Management ◽  
Diagnostic Approach ◽  
Common Presentation ◽  
Life Threatening

The limping child is a common presentation to paediatric services. In most instances the cause is benign with few, if any, investigations required. There is, however, always that concern that the limping child may have an underlying limb-threatening or life-threatening disease. This poses a challenge to clinicians, who must find that balance between correctly identifying disease early and avoiding the risks and harms of overinvestigation. In this article we discuss the diagnostic approach to the limping child and present a structure for assessment, investigation and risk management.

Initial Management of Simulated Life-threatening Emergencies by Nurse Anesthetists and Anesthesiologists.

2007 ◽  
Vol 2 (1) ◽  
pp. 49
Author(s):  
Bernadette Henrichs ◽  
Michael Avidan ◽  
David Murray ◽  
Julie Woodhouse ◽  
Joseph Kras ◽  
...  
Keyword(s):  
Nurse Anesthetists ◽  
Initial Management ◽  
Life Threatening

Management of Acute Contrast Reactions—Understanding Radiologists' Preparedness and the Efficacy of Simulation-Based Training in Canada

2018 ◽  
Vol 69 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Tyler M. Coupal ◽  
Anne R. Buckley ◽  
Sanjiv Bhalla ◽  
Jessica L. Li ◽  
Stephen G.F. Ho ◽  
...  
Keyword(s):  
National Level ◽  
Daily Practice ◽  
Training Model ◽  
Initial Management ◽  
Mandated Training ◽  
Comfort Levels ◽  
Correct Dose ◽  
Simulation Based ◽  
Before And After ◽  
Life Threatening

Purpose Acute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice. The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level. Methods This was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data. Results A total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) ( P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals. Conclusions Acute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

Urinary incontinence principles

2017 ◽  
Author(s):  
Christopher R. Chapple ◽  
Nadir I. Osman
Keyword(s):  
Urinary Incontinence ◽  
Neural Control ◽  
Well Being ◽  
Initial Management ◽  
Lost Productivity ◽  
Life Threatening ◽  
The Individual ◽  
Aetiological Spectrum ◽  
Broad Overview

Urinary incontinence (UI) is a highly prevalent and bothersome problem that affects men and women of all ages. The aetiological spectrum of UI is wide, encompassing dysfunctions of the lower urinary tract, its neural control, the pelvic floor as well as other factors such as the side effects of pharmacotherapy. Although not life-threatening, UI frequently impacts upon the quality of life, psychological and emotional well-being of affected individuals. Additionally, UI imposes a tremendous economic burden on both the individual and the wider society in costs of nursing care, treatments, and lost productivity. The purpose of this chapter is to provide a broad overview of the epidemiology, aetiopathophysiology of UI, and to discuss the approach to the assessment, investigation, and initial management of the patient presenting with UI.

Management of vascular complications of head and neck cancer

2011 ◽  
Vol 126 (2) ◽  
pp. 111-115 ◽  
Author(s):  
J Rimmer ◽  
C E B Giddings ◽  
F Vaz ◽  
J Brooks ◽  
C Hopper
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Case Reports ◽  
High Risk Patient ◽  
Vascular Complications ◽  
Morbidity And Mortality ◽  
Illustrative Case ◽  
Life Threatening ◽  
Radiation Induced

AbstractBackground:Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.Method:We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.Conclusion:It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.

scholarly journals Two Faces of TGF-Beta1 in Breast Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-16 ◽  
Author(s):  
Joanna Magdalena Zarzynska
Keyword(s):  
Breast Cancer ◽  
Cell Cycle Progression ◽  
Epithelial To Mesenchymal Transition ◽  
Current Knowledge ◽  
Clinical Investigation ◽  
Mesenchymal Transition ◽  
Early Stages ◽  
New Therapeutic Approaches ◽  
Genes Encoding ◽  
Life Threatening

Breast cancer (BC) is potentially life-threatening malignancy that still causes high mortality among women. Scientific research in this field is focused on deeper understanding of pathogenesis and progressing of BC, in order to develop relevant diagnosis and improve therapeutic treatment. Multifunctional cytokine TGF-β1 is one of many factors that have a direct influence on BC pathophysiology. Expression of TGF-β1, induction of canonical and noncanonical signaling pathways, and mutations in genes encoding TGF-β1 and its receptors are correlated with oncogenic activity of this cytokine. In early stages of BC this cytokine inhibits epithelial cell cycle progression and promotes apoptosis, showing tumor suppressive effects. However, in late stages, TGF-β1 is linked with increased tumor progression, higher cell motility, cancer invasiveness, and metastasis. It is also involved in cancer microenvironment modification and promotion of epithelial to mesenchymal transition (EMT). This review summarizes the current knowledge on the phenomenon called “TGF-β1 paradox”, showing that better understanding of TGF-β1 functions can be a step towards development of new therapeutic approaches. According to current knowledge several drugs against TGF-β1 have been developed and are either in nonclinical or in early stages of clinical investigation.

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