scholarly journals Sincope: clinic risk determination and therapeutic management

2007 ◽  
Vol 1 (2) ◽  
pp. 51-62
Author(s):  
Fabio Mecca ◽  
Enrica Favaro ◽  
Claudio Marengo
Keyword(s):  
Risk Stratification ◽  
Physical Examination ◽  
Medical History ◽  
Patient Management ◽  
Limited Resources ◽  
Correct Identification ◽  
Frequent Symptom ◽  
Pathological Mechanism ◽  
Wide Group

Syncope is a frequent symptom characterizing a wide group of pathologies with very different prognosis. By this reason, it is necessary a careful risk stratification for a better patient management. For this aim medical history and physical examination are fundamental. Diagnostic exams complete and confirm diagnostic suspiciousness formulated by medical history and examination, but rarely give elements for unexpected diagnosis. Correct identification of pathological mechanism of syncope and determination of associated clinical risk allow the best patient management avoiding dangerous discharge but also, in relation to increasingly limited resources, inappropriate hospitalizations.

Thromboplastin Related Differences in the Determination of International Normalised Ratio: A Cause for Concern?

1994 ◽  
Vol 72 (03) ◽  
pp. 426-429 ◽  
Author(s):  
S Kitchen ◽  
I D Walker ◽  
T A L Woods ◽  
F E Preston
Keyword(s):  
Patient Management ◽  
External Quality Assessment ◽  
Oral Anticoagulant Therapy ◽  
Warfarin Dosage ◽  
External Quality ◽  
External Quality Assessment Scheme ◽  
International Normalised Ratio ◽  
The Uk ◽  
The Relationship

SummaryWhen the International Normalised Ratio (INR) is used for control of oral anticoagulant therapy the same result should be obtained irrespective of the laboratory reagent used. However, in the UK National External Quality Assessment Scheme (NEQAS) for Blood Coagulation INRs determined using different reagents have been significantly different.For 18 NEQAS samples Manchester Reagent (MR) was associated with significantly lower INRs than those obtained using Diagen Activated (DA, p = 0.0004) or Instrumentation Laboratory PT-Fib HS (IL, p = 0.0001). Mean INRs for this group were 3.15, 3.61, and 3.65 for MR, DA, and IL respectively. For 61 fresh samples from warfarin-ised patients with INRs of greater than 3.0 the relationship between thromboplastins in respect of INR was similar to that observed for NEQAS data. Thus INRs obtained with MR were significantly lower than with DA or IL (p <0.0001). Mean INRs for this group were 4.01, 4.40, and 4.59 for MR, DA, and IL respectively.We conclude that the differences between INRs measured with the thromboplastins studied here are sufficiently great to influence patient management through warfarin dosage schedules, particularly in the upper therapeutic range of INR. There is clearly a need to address the issues responsible for the observed discrepancies.

A new multisystem inflammatory syndrome temporally associated with SARS-CoV-2 in a 6-year-old boy

2020 ◽  
Vol 16 (3) ◽  
pp. 295-300
Author(s):  
Agnieszka Pawłowska-Kamieniak ◽  
◽  
Milena Wronecka ◽  
Natalia Panasiuk ◽  
Karolina Kasiak ◽  
...  
Keyword(s):  
Child Health ◽  
Physical Examination ◽  
Medical History ◽  
Royal College ◽  
New Disease ◽  
Imaging Findings ◽  
Inflammatory Syndrome ◽  
And Child Health

In December 2019, China reported cases of infections caused by a new zoonotic coronavirus, which gradually developed into a pandemic. The disease was initially believed to be mild in children. In April 2020, a possible relationship between a new paediatric multisystem inflammatory syndrome and SARS-CoV-2 was found. In May, the Royal College of Paediatrics and Child Health published the criteria for the diagnosis of this new disease. We present a case of a 6-year-old boy retrospectively diagnosed with SARS-CoV-2-related multisystem inflammatory syndrome based on medical history, physical examination, laboratory and imaging findings, as well as the available literature.

The Clinical Method and Subjectivity in Medicine

2018 ◽  
Author(s):  
J. Donald Boudreau ◽  
Eric J. Cassell ◽  
Abraham Fuks
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Record ◽  
Chronic Conditions ◽  
Process Of Care ◽  
Clinical Method ◽  
Functional Assessments ◽  
Contemporary Medicine

The clinical method is defined as the means by which doctors gather information about their patients, think about and evaluate these medical facts, and enter the facts into their process of care. Its key components are the medical history, including the process by which it is acquired from patients and its subsequent documentation in the medical record, as well as the physical examination. Characteristics, such as the reproducibility and accuracy of various components, are discussed with a reference to prevailing opinions of subjectivity and objectivity in medicine. It is argued that as a consequence of a shift in the prevalence of illness, from acute to chronic conditions, a misalignment exists between the clinical method currently taught and contemporary medicine. It is suggested that a renewed and repurposed clinical method must incorporate enhanced strategies for functional assessments.

scholarly journals Impact of Coronary CT angiography in combination with CAD-RADS on the management of coronary artery disease patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Andre ◽  
S Seitz ◽  
P Fortner ◽  
R Sokiranski ◽  
F Gueckel ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
Coronary Ct Angiography ◽  
Patient Management ◽  
Male Gender ◽  
Coronary Ct ◽  
History Of ◽  
Artery Disease ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Siemens Healthineers Introduction Coronary CT angiography (CCTA) plays an increasing role in the detection and risk stratification of patients with coronary artery disease (CAD). The Coronary Artery Disease – Reporting and Data System (CAD-RADS) allows for standardized classification of CCTA results and, thus, may improve patient management. Purpose Aim of this study was to assess the impact of CCTA in combination with CAD-RADS on patient management and to identify the impact of cardiovascular risk factors (CVRF) on CAD severity. Methods CCTA was performed on a third-generation dual-source CT scanner in patients, who were referred to a radiology centre by their attending physicians. In a total of 4801 patients, CVRF were derived from medical reports and anamnesis. Results The study population consisted of 4770 patients (62.0 (54.0-69.0) years, 2841 males) with CAD (CAD-RADS 1-5), while 31 patients showed no CAD and were excluded from further analyses. Age, male gender and the number of CVRF were associated with more severe CAD stages (all p &lt; 0.001). 3040 patients (63.7 %) showed minimal or mild CAD requiring optimization of CVRF i.e. medical therapy but no further assessment at his time. A group of 266 patients (5.6 %) had a severe CAD defined as CAD-RADS 4B/5. In the multivariate regression analysis, age, male gender, history of smoking, diabetes mellitus and hyperlipidaemia were significant predictors for severe CAD, whereas arterial hypertension and family history of CAD did not reach significance. Of note, a subgroup of 28 patients (10.5 %) with a severe CAD (68.5 (65.5-70.0) years, 26 males, both p = n.s.) had no CVRF. Conclusions CCTA in combination with the CAD-RADS allowed for effective risk stratification of CAD patients. The majority of the patients showed non-obstructive CAD and, thus, could be treated conservatively without the need for further CAD assessment. CVRF out of arterial hypertension and family history had an impact on CAD severity reflected in higher CAD-RADs gradings. Of note, a relevant fraction of patients with CAD did not have any CVRF and, thus, may not be covered by risk stratification models. CAD-RADS n Age (years) Males (%) 1 1453 56.0 (50.0-62.0) 623 (42.9 %) 2 1587 62.0 (55.0-69.0) 918 (57.8 %) 3 1067 66.0 (59.0-71.0) 749 (70.2 %) 4A 397 66.0 (59.0-72.0) 317 (79.8 %) 4B 162 67.0 (61.0-74.0) 139 (85.8 %) 5 104 66.0 (58.5.0-77.0) 95 (91.3 %)

scholarly journals Prospect of positron emission tomography for abdominal aortic aneurysm risk stratification

2021 ◽  
Author(s):  
Richa Gandhi ◽  
Michael Bell ◽  
Marc Bailey ◽  
Charalampos Tsoumpas
Keyword(s):  
Positron Emission Tomography ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Risk Stratification ◽  
Patient Management ◽  
Emission Tomography ◽  
Clinical Implementation ◽  
Positron Emission ◽  
Abdominal Aortic

AbstractAbdominal aortic aneurysm (AAA) disease is characterized by an asymptomatic, permanent, focal dilatation of the abdominal aorta progressing towards rupture, which confers significant mortality. Patient management and surgical decisions rely on aortic diameter measurements via abdominal ultrasound surveillance. However, AAA rupture can occur at small diameters or may never occur at large diameters, implying that anatomical size is not necessarily a sufficient indicator. Molecular imaging may help identify high-risk patients through AAA evaluation independent of aneurysm size, and there is the question of the potential role of positron emission tomography (PET) and emerging role of novel radiotracers for AAA. Therefore, this review summarizes PET studies conducted in the last 10 years and discusses the usefulness of PET radiotracers for AAA risk stratification. The most frequently reported radiotracer was [18F]fluorodeoxyglucose, indicating inflammatory activity and reflecting the biomechanical properties of AAA. Emerging radiotracers include [18F]-labeled sodium fluoride, a calcification marker, [64Cu]DOTA-ECL1i, an indicator of chemokine receptor type 2 expression, and [18F]fluorothymidine, a marker of cell proliferation. For novel radiotracers, preliminary trials in patients are warranted before their widespread clinical implementation. AAA rupture risk is challenging to evaluate; therefore, clinicians may benefit from PET-based risk assessment to guide patient management and surgical decisions.

INVESTIGATION OF TRANSVERSE CRACKS IN ANNULAR WELDED JOINTS OF MAIN GAS PIPELINES LINEAR PART

2021 ◽  
pp. 34-41
Author(s):  
V. A. Zaznobin ◽  
A. V. Nekrasov ◽  
A. V. Pankratov
Keyword(s):  
Welded Joints ◽  
Linear Part ◽  
Correct Identification ◽  
Gas Pipelines ◽  
Destructive Testing ◽  
Transverse Cracks ◽  
Additional Control ◽  
Non Destructive

Statistics of accidents and incidents on main gas pipelines in recent years indicate that almost half of the technogenic events occur due to depressurization in the area of annular welded joints, mainly joints containing defects made during construction and installation work during the construction of gas pipelines. The assessment of the degree of danger and the timing of external inspection and repair or replacement of defective annular welded joints largely depends on the quality of non-destructive testing, the correct identification of the types of defects and the objective determination of their geometric dimensions. To increase the reliability of the assessment of the degree of danger of the detected defects, it is necessary to use additional control methods, in particular, destructive ones. The paper presents the results of surveys and tests of metal fragments of annular welded joints of main gas pipelines containing transverse cracks of annular welded joints in order to determine the causes of the formation of these defects and to assess the degree of danger of the detected transverse cracks of the installation welds of main gas pipelines.

scholarly journals DECLINE OF CLINICAL ART AND TECNOLOGICAL MEDICINE BOOM

2021 ◽  
pp. 123-133
Author(s):  
José Antonio Rodríguez Montes
Keyword(s):  
Physical Examination ◽  
Medical History ◽  
Medical Practice ◽  
New Technologies ◽  
Clinical Skills ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Bedside Teaching ◽  
The Past

Currently there is a consensus that the clinical art have been greatly deteriorating during the past 50 years. This problem has raised worldwide attention through as increase in publications, courses, symposia and congress. The erosion of bedside teaching and the consequent decline of clinical skills, notably wrongfull and inadequate use of new technologies. At as result, it becomes difficult if not impossible obtain an appropiate collection of the synptoms sufferick for the sick. Together with the medical history, the physical examination is mandatory for the correct diagnosis and developing the treatment plan. In this paper, the decline of clinical art is exposed and how this ancient heritage of medical practice can be recovered.

scholarly journals A submandibular nodule revealing a relapsed bladder urothelial carcinoma

2021 ◽  
Vol 12 (e) ◽  
pp. e10-e10
Author(s):  
Aya Khemir ◽  
Nada Mansouri ◽  
Faten Gargouri ◽  
Fethi Bougrine
Keyword(s):  
Bladder Cancer ◽  
Physical Examination ◽  
Urothelial Carcinoma ◽  
Medical History ◽  
Tumor Cells ◽  
Microscopic Examination ◽  
Survival Rates ◽  
Cytokeratin 20 ◽  
Cytokeratin 7 ◽  
Total Recovery

A 69-year-old patient treated for infiltrating bladder transitional carcinoma many years ago presented with a submandibular nodule. The last was fortuitously discovered by the patient a month before he presented to consultation. Physical examination showed a firm subcutaneous nodule of 0.5 cm in diameter in the right submandibular region. At this level skin was inflamed/red and swollen. Otherwise physical examination was within normal. The described nodule above was biopsied. Microscopic examination showed infiltration of the dermis by a carcinomatous proliferation (Fig. 1). Tumor cells were arranged in small nests and clusters surrounded by a fibrous stroma. Tumor cells showed moderate nuclear atypia. Immunohistochemical staining showed positivity of tumor cells for Cytokeratin 7 and P63 (Fig. 2). Therefore, taking into consideration patient’s medical history, microscopic and immunohistochemical findings the diagnosis of CM from urothelial carcinoma was retained. The first case of CM from bladder carcinoma was reported in 1909 [3]. Since then many case have been reported [1,2]. According to cases reported in literature so far, the mean interval of time between the setting of bladder cancer and the appearance of CM is of 18 months approximately. Large tumor size and deep infiltration of the bladder wall are predictive factors of CM. However, cases of CM associated with superficial bladder carcinomas were reported [3]. The certain diagnosis is based on microscopic examination [1,3]. Pathologists should be aware of patient’s medical history to facilitate the diagnosis and choosing appropriate immunostains if necessary especially in front of a poorly differentiated carcinoma[3]. Urothelial carcinomas express Cytokeratin 7 and Cytokeratin 20 antibodies [3]. The occurring of CM in case of bladder cancer darken the prognosis [1,2]. Median survival rates are less than 12 months in published cases so far [1,3]. Treatment consists of chemotherapy if the patient could bare it [1]. Total recovery was detected in 70% of cases of CM treated with chemotherapy. Yet, it does not improve global survival rates [3].

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