 | | Major Adverse Cardiovascular Events Following Partial Nephrectomy | Major Adverse Cardiovascular Events Following Partial Nephrectomy
Major Adverse Cardiovascular Events Following Partial Nephrectomy
Overview
Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.
The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index.
This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection. | 3 | | R465.00 |  |
| | INSPIRE: A European training network to foster research and training in cardiovascular safety pharmacology | INSPIRE: A European training network to foster research and training in cardiovascular safety pharmacology
INSPIRE: A European training network to foster research and training in cardiovascular safety pharmacology
Overview Safety pharmacology is an essential part of drug development aiming to identify, evaluate and investigate undesirable pharmacodynamic properties of a drug primarily prior to clinical trials. In particular, cardiovascular adverse drug reactions (ADR) have halted many drug development programs. Safety pharmacology has successfully implemented a screening strategy to detect cardiovascular liabilities, but there is room for further refinement. In this setting, we present the INSPIRE project, a European Training Network in safety pharmacology for Early-Stage Researchers (ESRs), funded by the European Commission's H2020-MSCA-ITN programme. INSPIRE has recruited 15 ESR fellows that will conduct an individual PhD-research project for a period of 36 months. INSPIRE aims to be complementary to ongoing research initiatives. With this as a goal, an inventory of collaborative research initiatives in safety pharmacology was created and the ESR projects have been designed to be complementary to this roadmap. Overall, INSPIRE aims to improve cardiovascular safety evaluation, either by investigating technological innovations or by adding mechanistic insight in emerging safety concerns, as observed in the field of cardio-oncology. Finally, in addition to its hands-on research pillar, INSPIRE will organize several summer schools and workshops that will be open to the wider community as well. In summary, INSPIRE aims to foster both research and training in safety pharmacology and hopes to inspire the future generation of safety scientists.
Authors Pieter-Jan D. Gunsa, et al.
Journal Journal of Pharmacological and Toxicological Methods | 3 | | R400.00 | |
| | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Overview The purpose of this study is to state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early-stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. It was concluded that SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease. Authors Scott J. Genshaft, MD, Robert D. Suh, MD, Fereidoun Abtin, MD, Mark O. Baerlocher, MD, Albert J. Chang, MD, Sean R. Dariushnia, MD, A. Michael Devane, MD, Salomao Faintuch, MD, MS, Elizabeth A. Himes, BS, Aaron Lisberg, MD, Siddharth Padia, MD, Sheena Patel, MPH, Alda L. Tam, MD, MBA, and Jane Yanagawa, MD Journal J Vasc Interv Radiol
| 3 | | R420.00 | |
| | HIV and Aids | HIV and Aids
Overview
HIV disease is caused by infection with HIV-1 or HIV-2, which are retroviruses in the Retroviridae family, Lentivirus genus. Human immunodeficiency virus (HIV) is a blood-borne virus typically transmitted via sexual intercourse, shared intravenous drug paraphernalia, and mother-to-child transmission (MTCT), which can occur during the birth process or during breastfeeding. The patient with HIV may present with signs and symptoms of any of the stages of HIV infection. No physical findings are specific to HIV infection; the physical findings are those of the presenting infection or illness. Examples of manifestations include acute seroconversion manifests as a flulike illness, consisting of fever, malaise, generalized rash, generalized lymphadenopathy is common and may be a presenting symptom. This course covers the screening, diagnosis, medication and management of Aids.
Author: Sharespike | 3 | | R425.00 | |
| | Hypertension Part 3 | Hypertension Part 3
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Hypertension Part 2 | Hypertension Part 2
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Bee Sting and Anaphylaxis | Bee Sting and Anaphylaxis
Bee Sting and Anaphylaxis
Overview Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While most stings cause only minor problems, stings cause a significant number of deaths.
Target organs are the skin, vascular system, and respiratory system. Pathology is like other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis is a common and life-threatening consequence of Hymenoptera stings and is typically a result of sudden systemic release of mast cells and basophil mediators. Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases
This study aims to discuss the different stings, prognosis and emergency reactions and treatment thereto.
Author Sharespike | 3 | | R410.00 | |
| | Ischemic Stroke Part 2 | Ischemic Stroke Part 2
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Ischemic Stroke Part 1 | Ischemic Stroke Part 1
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Ventricular Tachycardia Part 2 | Ventricular Tachycardia Part 2
Ventricular Tachycardia Part 2
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | Ventricular Tachycardia Part 1 | Ventricular Tachycardia Part 1
Ventricular Tachycardia Part 1
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | Wide Complex Tachycardia | Wide Complex Tachycardia
Overview
Correct diagnosis of wide complex tachycardia (WCTs) can be challenging. With EMS providers' ever-expanding scope of practice, it is no longer safe to label any rhythm that is wide and fast as ventricular tachycardia (VT). Though many paramedic curricula do not address advanced cardiac dysrhythmias and treatments, several EMS departments have protocols that require advanced training in 12-lead ECG interpretation and treatment of specific cardiac dysrhythmias. One must possess the proper diagnostic tools and knowledge to decide whether a WCT is VT or SVT with aberrant conduction. EMS providers should be able to differentiate VT and SVT with aberrant conduction with confidence and a high degree of certainty. In order to understand the visual differences between VT and SVT with aberrant conduction, one must first understand the basic pathophysiology behind the two dysrhythmias. The first steps are maintenance of the patient’s airway with assisted breathing if necessary, cardiac monitoring to identify the heart rhythm, monitoring of blood pressure and oximetry, and establishing intravenous access. In the emergency setting, a wide-complex tachycardia always should be considered as ventricular tachycardia unless proven otherwise, as treatment must be initiated immediately to avoid degeneration into ventricular fibrillation.
| 3 | | R425.00 | |
| | Unstable Angina | Unstable Angina
Overview
Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which also includes ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Unstable angina is considered to be an ACS in which there is myocardial ischemia without detectable myocardial necrosis (ie, cardiac biomarkers of myocardial necrosis —such as creatine kinase MB isozyme, troponin, myoglobin—are not released into the circulation).
With unstable angina, symptoms may (1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitro-glycerine. Symptoms of unstable angina are similar to those of myocardial infarction (MI).
The traditional term unstable angina was meant to signify the intermediate state between myocardial infarction (MI) and the more chronic state of stable angina. The old term pre-infarction angina conveys the clinical intent of intervening to attenuate the risk of MI or death. Patients with this condition have also been categorized by presentation, diagnostic test results, or course over time; these categories include new-onset angina, accelerating angina, rest angina, early postinfarct angina, and early post-revascularization angina.
This course deals with the causes and management of unstable angina.
| 3 | | R425.00 | |
| | Severe Distress – COVID 19 | Severe Distress – COVID 19
Severe Distress – COVID 19
Overview
Since the emergence of the 2019 novel coronavirus (SARS-CoV-2) infection in December 2019, the coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. The clinical spectrum of patients with COVID-19 ranges from asymptomatic or mild symptoms to critical disease with a high risk of mortality.
Coronavirus disease 2019 (COVID-19) is the illness associated with the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was initially noted during an outbreak of respiratory illness in the population of Wuhan, the capital of Hubei province, China. The first cases were seen in November 2019, with COVID-19 quickly spreading throughout the city. The World Health Organization (WHO) was notified of the outbreak on December 31, 2019. The cases continued to spread outside of the area and then across the world. COVID-19 was reported as a global health emergency by the end of January 2020. As the worldwide case numbers increased, the WHO declared on March 11, 2020, that COVID-19 had reached the pandemic stage. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
| 3 | | R425.00 | |
| | Sceptic Shock Part 2 | Sceptic Shock Part 2
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R425.00 | |
| | Sceptic Shock Part 1 | Sceptic Shock Part 1
Overview
Sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. Septic shock occurs in a subset of patients with sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality.
Patients with sepsis may present in a myriad of ways, and a high index of clinical suspicion is necessary to identify subtle presentations. The hallmarks of sepsis and septic shock are changes that occur at the microvascular and cellular level and may not be clearly manifested in the vital signs or clinical examination.
Patients with sepsis and septic shock require admission to the hospital. Initial treatment includes support of respiratory and circulatory function, supplemental oxygen, mechanical ventilation, and volume infusion.
In the past few decades, the discovery of endogenous mediators of the host response has led to the recognition that the clinical syndrome of sepsis is the result of excessive activation of host defence mechanisms rather than the direct effect of microorganisms. Sepsis and its sequelae represent a continuum of clinical and pathophysiologic severity.
Author Sharespike
| 3 | | R425.00 | |
| | Respiratory Distress Syndrome | Respiratory Distress Syndrome
Respiratory Distress Syndrome
Overview
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the new-born infant.
Shortness of breath is a common complaint encountered by the EMS provider. We often hear it as part of a litany of other S/S or as a primary chief complaint. In either case SOB is never to be taken lightly and its causes should always be thoroughly investigated. My desire with this article is to give you some tips on how to streamline your treatment and formulate your thoughts as to how to proceed. In all cases the EMS team is responsible to respond to the needs of the patient. Hypoxia, regardless of the source needs to be vigorously addressed. The lungs need to be opened or cleared as determined by the physical exam. The cause of the SOB needs to be determined and addressed. Education and counselling of parents, caregivers, and families of premature infants must be undertaken as part of discharge planning. These individuals should be advised of the potential problems infants with respiratory distress syndrome may encounter during and after their nursery stay.
Author
Sharespike
| 3 | | R425.00 | |
| | Preeclampsia for MD's | Preeclampsia for MD's
Overview
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema.
Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.).
In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia.
Eclampsia is defined as seizures that cannot be attributable to other causes in a woman with preeclampsia. HELLP syndrome (haemolysis, elevated liver enzyme, low platelets) may complicate severe preeclampsia.
Because the clinical manifestations of preeclampsia can be heterogeneous, diagnosing preeclampsia may not be straightforward. Preeclampsia without severe features may be asymptomatic. Many cases are detected through routine prenatal screening.
Authors
Sharespike
| 3 | | R380.00 | |
| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions. The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities. Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike | 3 | | R420.00 | |
| | Hypertension Part 1 | Hypertension Part 1
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment. As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Sleep and the athlete: narrative review and 2021 expert consensus recommendations | Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Overview An ever-growing volume of peer-reviewed Publications speaks to the recent and rapid growth in scope and understanding of sleep for optimal athlete health and performance.
Herein, a panel of international experts review the current knowledge on sleep and the athlete, briefly covering the background, exploring continued controversies, highlighting fruitful avenues for future research and providing practical recommendations. The introduction section covers the need for sleep, including sleep architecture and the restorative benefits of sleep for the brain and body.
Pitfalls and challenges measuring athlete sleep are reviewed, and practical recommendations provided. The following section, entitled sleep and the athlete, covers the influence of sleep inadequacy and sleep extension on athletic performance. This article reviews the evidence that elite athletes are particularly susceptible to sleep inadequacy, for example, during intensified training and in those reporting symptoms of over-reaching and overtraining. The final section, entitled strategies to improve sleep, provides practical recommendations to alleviate the symptoms of jet lag, nutritional strategies to enhance sleep and a toolbox for practitioners to manage and optimise athlete sleep.
Authors Neil P Walsh et al.
Journal British Journal Sports Med 2020
| 3 | | R420.00 | |
| | Convulsions and Seizures | Convulsions and Seizures
Overview Emergency services attend patients who are having a seizure on almost a daily basis. Consequently, they should understand the disease processes related to seizures and be confident in their prehospital management. In general, with the exception of a patient in Status Epilepticus, seizure management should be relatively straight forward. So, what is a seizure and what causes it? Basically, a seizure is any unusually excessive neuronal firing from the brain which manifests as changes in a patient’s motor/sensory control, sensory perception, behaviour and autonomic function.
At a chemical level a seizure occurs when there is a sudden biochemical imbalance between the excitatory neurotransmitters and inhibitory neurotransmitters. The primary excitatory neurotransmitter found in the human central nervous system is called N-Methyl D Aspartate (NMDA); whereas the primary inhibitory neurotransmitter is called gamma-amino butyric acid (GABA). When there is an imbalance between these chemical mediators repeated firing and excitations of the neuronal cells occur.
Depending on the area of the brain in which this occurs, the seizure will manifest as a focal seizure, sensory change, behaviour disturbance, or complete tonic and clonic muscular activity. This course addresses important aspects relating to convulsions and seizures
| 3 | | R460.00 | |
| | Bradycardia | Bradycardia
Overview Anaphylaxis is a life-threatening emergency that requires immediate prehospital care, but to date all treatment guidelines have been based on an in-hospital treatment. At EMS World Expo Peter Taillac, MD, detailed the process of an expert panel to research and publish an evidence-based guideline (EBG) for the recognition and treatment of anaphylaxis. The expert panel attempted to answer a series of questions about anaphylaxis assessment and treatment through literature research and review. The guideline is intended to serve as the scientific basis for future EMS anaphylaxis protocols.
Good evidence suggests that physicians under-prescribe epinephrine and that patients (or their parents) fail to use epinephrine as quickly as possible. Accordingly, at discharge, all patients should be provided an epinephrine autoinjector and should receive proper instruction on how to self-administer it in case of a subsequent episode.
| 3 | | R420.00 | |
| | Anaphylactic Reaction Protocol | Anaphylactic Reaction Protocol
Anaphylactic Reaction Protocol
Overview Anaphylaxis is a life-threatening emergency that requires immediate prehospital care, but to date all treatment guidelines have been based on an in-hospital treatment. At EMS World Expo Peter Taillac, MD, detailed the process of an expert panel to research and publish an evidence-based guideline (EBG) for the recognition and treatment of anaphylaxis. The expert panel attempted to answer a series of questions about anaphylaxis assessment and treatment through literature research and review. The guideline is intended to serve as the scientific basis for future EMS anaphylaxis protocols.
Good evidence suggests that physicians under-prescribe epinephrine and that patients (or their parents) fail to use epinephrine as quickly as possible. Accordingly, at discharge, all patients should be provided an epinephrine autoinjector and should receive proper instruction on how to self-administer it in case of a subsequent episode.
| 3 | | R410.00 | |
| | Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection | Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection
Predisposing factors and radiological features in patients with internal carotid artery dissection or vertebral artery dissection
Overview
Cranio-cervical artery dissection (CAD) refers to a tear in the artery lining, resulting in an intramural hematoma toward the intima or the adventitia of the internal carotid artery or vertebral artery. CAD is an important cause of ischemic stroke in young and middle-aged individuals. However, very few studies have compared the differential features between internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD), including both cervical and intracranial artery dissections. CAD can affect the cranial or cervical portion of the internal carotid artery or vertebral artery. The predisposing factors, clinical presentation, radiological imaging, and outcome may differ between ICAD and VAD.
We conducted a study to investigate the predisposing factors and radiological features in patients with ICAD or VAD. It was found that the distribution of cervical and intracranial artery dissections was different between ICAD and VAD. The frequencies of radiological features such as double lumen, intimal flap, and dissecting aneurysms also differed in patients with ICAD and VAD.
Authors Yongjun Wu, Hongbin Chen, Shihui Xing, Shuangquan Tan, Xinran Chen, Yan Tan, Jinsheng Zeng and Jian Zhang
| 3 | | R390.00 | |
| | Clinical Practice Guidelines: Adult Resuscitation Part 1 | Clinical Practice Guidelines: Adult Resuscitation Part 1
Clinical Practice Guidelines: Adult Resuscitation Part 1
Overview
The correct and timely identification of cardiac arrest is critical to ensuring (1) the appropriate dispatch of a high-priority response, (2) the provision of telephone CPR instructions, and (3) the activation of community first responders carrying automated external defibrillators (AED) (Travers et al., 2015). Rapid defibrillation is a powerful predictor of successful resuscitation following ventricular fibrillation (VF) sudden cardiac arrest (SCA). (Berg et al., 2010a) Advanced life support (ALS) is still considered a vital link in the chain of survival for patients with out-of-hospital cardiac arrest. Despite this the quality of evidence for many ALS interventions remains poor (Callaway et al., 2015) as do the outcomes of patients, particularly those suffering unwitnessed out-of-hospital cardiac arrest were CPR and defibrillation is delayed. As part of the development of these guidelines, the core guideline panel opted to adopt the AHA resuscitation guidelines for advanced cardiac life support. It should therefore be noted that for recommendations not reviewed by the AHA in the 2015 edition, the 2010 recommendation are considered valid.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2 | Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2
Clinical Practice Guidelines: Acute Coronary Care Syndrome Part 2
Overview
Chest pain and acute dyspnoea are among the most frequent causes of out-of-hospital emergency medical services (EMS) activation. The challenge of the pre-hospital management of chest pain, beyond rapid diagnosis, is the treatment and transfer of patients with major cardiovascular emergencies to adequate centres (Beygui et al., 2015). The required system infrastructure (i.e. local protocols and pathways of care) needs to be in place for EMS cardiovascular emergency objectives to be met. Not all recommendations below are readily implementable as local infrastructure must still be developed in South Africa. The care of ST-elevation myocardial infarction (STEMI) patients in the pre-hospital setting should be based on regional STEMI networks. Such networks include one or more hospitals and EMS organisations which have a shared protocol for the choice of reperfusion strategy, adjunctive therapy and patient transfer in order to provide consistent treatment to patients. Such protocols should be formally discussed between all components of the network and be available in writing (Beygui et al., 2015). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Clinical Practice guidelines: Acute Coronary Care Syndrome Part 1 | Clinical Practice guidelines: Acute Coronary Care Syndrome Part 1
Clinical Practice guidelines: Acute Coronary Care Syndrome Part 1
Overview
Chest pain and acute dyspnoea are among the most frequent causes of out-of-hospital emergency medical services (EMS) activation. The challenge of the pre-hospital management of chest pain, beyond rapid diagnosis, is the treatment and transfer of patients with major cardiovascular emergencies to adequate centres (Beygui et al., 2015). The required system infrastructure (i.e. local protocols and pathways of care) needs to be in place for EMS cardiovascular emergency objectives to be met. Not all recommendations below are readily implementable as local infrastructure must still be developed in South Africa. The care of ST-elevation myocardial infarction (STEMI) patients in the pre-hospital setting should be based on regional STEMI networks. Such networks include one or more hospitals and EMS organisations which have a shared protocol for the choice of reperfusion strategy, adjunctive therapy and patient transfer in order to provide consistent treatment to patients. Such protocols should be formally discussed between all components of the network and be available in writing (Beygui et al., 2015). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R410.00 | |
| | Tuberculosis Part 2 | Tuberculosis Part 2
Overview
Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors:
Thomas E Herchline,Thomas E Herchline, Judith K Amorosa, Judith K Amorosa. | 3 | | R420.00 | |
| | Tuberculosis Part 1 | Tuberculosis Part 1
Overview Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. Classic clinical features associated with active pulmonary TB in elderly individuals with TB may not display typical signs and symptoms. The absence of any significant physical findings does not exclude active TB. Classic symptoms are often absent in high-risk patients, particularly those who are immunocompromised or elderly. It is important to isolate patients with possible TB in a private room with negative pressure.
Acknowledgements Authors: Thomas E Herchline and Judith K Amorosa | 3 | | R420.00 | |
| | Diabetes Mellitus Part 3 | Diabetes Mellitus Part 3
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori
| 3 | | R420.00 | |
| | Diabetes Mellitus Part 1 | Diabetes Mellitus Part 1
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Acute Management of Stroke | Acute Management of Stroke
Acute Management of Stroke
Overview:
The goal for the acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival. Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours.
Newer stroke trials have explored the benefit of using neuroimaging to select patients who are most likely to benefit from thrombolytic therapy and the potential benefits of extending the window for thrombolytic therapy beyond the guideline of 3 hours with t-PA and newer agents. CT angiography may demonstrate the location of vascular occlusion. CT perfusion studies can produce perfusion images and together with CT angiography are becoming more available and utilized in the acute evaluation of stroke patients. Advanced neuroimaging with diffusion and perfusion imaging may then serve an important role in identifying potentially salvageable tissue at risk and guiding clinical decision-making regarding therapy.
Acknowledgements:
Authors:
Edward C Jauch | 3 | | R440.00 | |
| | A prospective study of frequency of eating restaurant prepared meals (cardiometabolic mortality) | A prospective study of frequency of eating restaurant prepared meals (cardiometabolic mortality)
A prospective study of frequency of eating restaurant prepared meals (cardiometabolic mortality)
Overview
Restaurant prepared foods are known to be energy-dense and high in fat and sodium, but lower in protective nutrients. There is evidence of higher risk of adiposity, type II diabetes, and heart disease in frequent consumers of restaurant meals. However, the risk of mortality as a long-term health consequence of frequent consumption of restaurant meals has not been examined. We examined the prospective risk of all-cause and coronary heart disease, cerebrovascular disease and diabetes (cardiometabolic) mortality in relation to frequency of eating restaurant prepared meals in a national cohort.
The results were robust to effect modification by baseline BMI, years of education, and baseline morbidity. Expectedly, the 24-h dietary intakes of whole grains, fruits, dietary fiber, folate, vitamin C, potassium and magnesium at baseline were lower, but energy, energy density, and energy from fat were higher in more frequent restaurant meal reporters. Although both self-reported food group and nutrient intakes, and serum concentrations of several nutritional biomarkers in more frequent reporters of restaurant meals were suggestive of poor quality of diets reported at baseline, we found no prospective associations with mortality from all-causes or cardiometabolic diseases in this national cohort.
Acknowledgement
Author Ashima K. Kant and Barry I. Graubard
Journal PLoS One Volume 13 Issue 1
Publisher Cross Mark | 3 | | R378.00 | |
| | Extracorporeal human whole blood in motion, as a tool to predict first-infusion reactions and mechanism-of-action of immune-therapeutics | Extracorporeal human whole blood in motion, as a tool to predict first-infusion reactions and mechanism-of-action of immune-therapeutics
Extracorporeal human whole blood in motion, as a tool to predict first-infusion reactions and mechanism-of-action of immune-therapeutics
Overview
First infusion reactions along with severe anaphylactic responses can occur as a result of systemic administration of therapeutic antibodies. The underlying mechanisms by which monoclonal antibodies induce cytokine release syndrome (CRS) can involve direct agonistic effects via the drug target, or a combination of target-engagement along with innate receptor interactions.
One assay that has not been assessed for its capacity to predict CRS is the modified Chandler loop model. On the other hand, non-agonistic antibodies associated with no or low infusion reactions in the clinic, namely cetuximab and natalizumab, neither induce cytokine release nor cause false positive responses. Additionally, the value of an intact complement system in the assay is highlighted by the possibility to dissect out the mechanism-of-action of alemtuzumab and rituximab. The loop assay can either complement lymph node-like assays or stand-alone to investigate drug/blood interactions during preclinical development, or for individual safety screening prior to first-in-man clinical trial.
Acknowledgement
Authors Erika A.K. Fletcher, Mohamed Eltahir, Frida Lindqvist, Jonas Rieth, Gunilla Törnqvist, Justyna Leja-Jarblad and Sara M. Mangsbo
Journal International Immunopharmacology Volume 54
| 3 | | R410.00 | |
| | Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series | Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series
Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series
Overview
Accidental and iatrogenic foreign body injuries to heart require immediate attention and its timely management is cornerstone to the life of an individual. We describe in detail five cases of Accidental and iatrogenic foreign body injuries to heart encountered between January 2013 and July 2016. Our series included the following: needle stick injury to the right atrium retained catheter fragments in the distal main pulmonary artery, right ventricle injury during catheterisation study, right ventricle injury during permanent pacemaker lead placement, device migration in atrial septal defect closure. Foreign bodies were removed from the cardiac cavities when the patient presented with features of infection, cardiac tamponade, anxiety, and haemodynamic instability. Foreign bodies in the heart should be removed irrespective of their location and symptomatology. Asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; asymptomatic foreign bodies without associated risks factors or diagnosed accidentally after the injury also need surgical intervention to allay fears of anxiety in patient and their relatives, to prevent any late complications as well as for medico-legal purpose.
ACKNOWLEDGEMENTS:
Authors: Rupesh Kumar; Sandeep Singh Rana; Sanjay Kumar; Deepanwita Das; Monalisa Datta
Journal: J Clin Diagn Res (Journal of Clinical Diagnostic Research) Volume 11 Issue 3
Publisher: JCDR Research and Publications Private Limited | 3 | | R410.00 | |
| | Cancer and Heart Failure: Understanding the Intersection. | Cancer and Heart Failure: Understanding the Intersection.
Cancer and Heart Failure: Understanding the Intersection.
Overview
Cancer and cardiovascular disease account for nearly half of all deaths in the US. The majority of cancer therapies are known to cause potential cardiac toxicity in some form. Patients with underlying cardiac disease are at a particularly increased risk for worse outcomes following cancer therapy.
Cardiac risk factors include but are not limited to age, female gender, history of myocardial infarction or LVD and tachycardia, as this may be an early sign of cardiac damage.44 Cardiac biomarkers may provide an additive role in this setting. For patients considered to be at higher risk for the development of cardiotoxicity, a cardio-oncology consultation should be offered.
Whether patients with pre-existing cardiovascular disease require cancer therapy with potentially cardiotoxic agents or previously healthy patients develop cardiac complications from cancer therapy, a collaborative patient-centred approach between the cardiologist and oncologist is essential to successful patient care.
Most alarming is the potential for heart failure as a result of cancer treatment, which may lead to early disruption or withdrawal of life-saving cancer therapies and can potentially increase cardiovascular mortality. A multi-disciplinary cardio-oncology approach can improve outcomes through early surveillance, prevention and treatment strategies. Acknowledgement
Author Carine E Hamo and Michelle W Bloo Journal Cardiac Failure Review
Publisher Radcliffe Cardiology 2017
| 3 | | R425.00 | |
| | A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma | A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma
A Rare Cause of Abdominal Pain in Childhood: Cardiac Angiosarcoma
Overview
Cardiac angiosarcomas are extremely rare in childhood, they are rapidly progressive tumours that often present themselves as diagnostic dilemmas, resulting in delayed diagnosis. Also, extracardiac manifestations, including abdominal pain, are extremely rare in patients with intracardiac tumours. We herein present the case of a 15-year-old girl who presented with abdominal pain. Echocardiography and thoracic computed tomography showed right atrial mass.
Primary cardiac angiosarcomas in all age groups mostly occur in the right atrium. The most common complaints presented are dyspnea and chest pain, usually related to a malignant cardiac effusion. The pericardium is frequently involved with a right sided angiosarcoma; cardiac tamponade and pericardial effusion are common complications. Our patient had a massive pericardial effusion and malignant cells were seen in cytologic examination.
The patient underwent surgery, chemotherapy, and radiotherapy. Eight months after treatment, abdominal recurrence was detected. The abdominal mass was resected, and radiotherapy and new chemotherapy protocol were given. The present case illustrates a rare case of primary cardiac angiosarcoma posing a diagnostic dilemma in an adolescent girl. Acknowledgement
Authors Elvan Caglar Citak, MD, PhD; Murat Ozeren, MD; M. Kerem Karaca, MD; Derya Karpuz, MD; Feryal Karahan, MD; Eda , Bengi Yilmaz, MD; Yuksel Balci, MD; Pelin Ozcan Kara, MD; Rabia Bozdogan Arpaci, MD Journal Brazilian Journal of Cardiovascular Surgery
| 3 | | R460.00 | |
| | Oral Health Status of Adult Heart Transplant Recipients in China | Oral Health Status of Adult Heart Transplant Recipients in China
Oral Health Status of Adult Heart Transplant Recipients in China
Overview
Limited information on the oral health status of adult heart transplant recipients (HTRs) is known. A prerequisite dental evaluation is usually recommended for patients’ post-organ transplantation because lifelong immune-suppression may predispose them to infection spread. The aim of this study was to investigate the oral health status of Chinese adult HTRs and determine the association between oral health status and history of heart transplantation (HT). We carried out a cross-sectional study to collect clinical, demographic, socioeconomic, and behavioral data from 81 adult patients who received heart transplantation during 2014 to 2015 in China. Clinical examinations for the presence of dental plaque, dental calculus, dental caries, and periodontal health conditions were performed in a standardized manner by one trained examiner.
The prevalence of the above conditions was compared with 63 age and sex matched controls. General linear regression analysis was used to assess associations between mean number of decayed, missing, and filled teeth (DMFT) and mean community periodontal index of treatment needs (CPITN) scores and history of heart transplant. Periodontal health status was positively associated with history of heart transplantation in Chinese adult HTRs.
Acknowledgement
Authors Ying Cao, Xi Chen, Yixin Jia, Yalin Lv and Zheng Sun
Journal Medicine (Baltimore) (2018 ) 97:38 (e12508)
Publisher Wolters Kluwer Health, Inc. | 3 | | R465.00 | |
| | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review
Overview
Cardiovascular evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published since 2016. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates. Despite the empirical debate regarding the cognitive benefit of de-worming for STH, the current ethical, clinical and health policy environments remain strongly skewed in favor of de-worming for child growth, prevention of anaemia and potentially avoidance of preventable cognitive deficits
Acknowledgement
Author
Noel Pabalan, Eloisa Singian, Lani Tabangay, Hamdi Jarjanazi, Michael J. Boivin, Amara E. Ezeamama
Journal PLoS Neglected Tropical Diseases
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766095/pdf/pntd.0005523.pdf
Publisher Cross Mark
| 3 | | R465.00 | |
| | Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase. | Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase.
Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase.
Mitochondrial DNA depletion by ethidium bromide decreases neuronal mitochondrial creatine kinase.
Overview
Mitochondrial DNA (mtDNA), the discrete genome which encodes subunits of the mitochondrial respiratory chain, is present at highly variable copy numbers across cell types. Though severe mtDNA depletion dramatically reduces mitochondrial function, the impact of tissue-specific mtDNA reduction remains debated. Previously, our lab identified reduced mtDNA quantity in the putamen of Parkinson's Disease (PD) patients who had developed L-DOPA Induced Dyskinesia (LID), compared to PD patients who had not developed LID and healthy subjects.
Here, we present the consequences of mtDNA depletion by ethidium bromide (EtBr) treatment on the bioenergetic function of primary cultured neurons, astrocytes and neuron-enriched cocultures from rat striatum. EtBr also increases glycolytic activity in astrocytes, whereas in neurons it reduces the expression of mitochondrial creatine kinase mRNA and levels of phosphor-creatine. Further, we show that mitochondrial creatine kinase mRNA is similarly downregulated in dyskinetic PD patients, compared to both non-dyskinetic PD patients and healthy subjects.
Our data support a hypothesis that reduced striatal mtDNA contributes to energetic dysregulation in the dyskinetic striatum by destabilizing the energy buffering system of the phospho-creatine/creatine shuttle.
Acknowledgement
Author Emily Booth Warren, Aidan Edward Aicher, Joshua Patrick Fessel and Christine Konradi
Journal PLoS ONE
Publisher Cross Mark
| 3 | | R455.00 | |
| | Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study) | Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Dysfunction of NaV1.4, a skeletal muscle voltage-gated sodium channel, in sudden infant death syndrome (case-control study)
Overview
Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant death in high-income countries. Central respiratory system dysfunction seems to contribute to these deaths.
Excitation that drives contraction of skeletal respiratory muscles is controlled by the sodium channel NaV1.4, which is encoded by the gene SCN4A. Variants in NaV1.4 that directly alter skeletal muscle excitability can cause myotonia, periodic paralysis, congenital myopathy, and myasthenic syndrome.
Rare SCN4A variants that directly alter NaV1.4 function occur in infants who had died from SIDS. These variants are predicted to significantly alter muscle membrane excitability and compromise respiratory and laryngeal function. These findings indicate that dysfunction of muscle sodium channels is a potentially modifiable risk factor in a subset of infant sudden deaths.
Acknowledgement
Author Dogan Roope Männikkö, Leonie Wong, David J Tester, Michael G Thor, Richa Sud, Dimitri M Kullmann, Mary G Sweeney, Costin Leu, Sanjay M Sisodiya, David R FitzPatrick, Margaret J Evans, Iona J M Jeffrey, Jacob Tfelt-Hansen, Marta C Cohen, Peter J Fleming, Amie Jaye, Michael A Simpson, Michael J Ackerman, Michael G Hanna, Elijah R Behr, Emma Matthews
Journal
Vol 391 April 14, 2018
Publisher
Cross Mark https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899997/pdf/main.pdf
| 3 | | R470.00 | |
| | 21st Century Cardio-Oncology: Identifying Cardiac Safety Signals in the Era of Personalised Medicine | 21st Century Cardio-Oncology: Identifying Cardiac Safety Signals in the Era of Personalised Medicine
21st Century Cardio-Oncology: Identifying Cardiac Safety Signals in the Era of Personalised Medicine
21st Century Cardio-Oncology: Identifying Cardiac Safety Signals
Overview
Cardiotoxicity is a well-established complication of oncology therapies. Cardio-myopathy resulting from anthracyclines is a classic example. However, some of our recent therapies have introduced an assortment of cardiovascular (CV) complications. At times, these devastating outcomes have only become apparent after drug approval and have limited the use of potent therapies. There is a growing need for better testing platforms, both for CV toxicity screening, as well as for elucidating mechanisms of cardio-toxicities of approved cancer therapies.
As the focus of anticancer therapies shifts from a broadly cytotoxic approach to more targeted molecular treatments, there is increasing concern for unexpected CV toxicities that have been reported through case reports and retrospective studies This review discusses the utility of nonclinical models (in vitro, in vivo, & in silico) available and highlights recent advancements in modalities like human stem cell-derived cardio-myocytes for developing more comprehensive cardio-toxicity testing and new means of cardio-protection with targeted anticancer therapies.}
Acknowledgement
Authors
Radek Calvin Chen Sheng, MD, Laleh Amiri-Kordestani, MD, Todd Palmby, PhD, Thomas Force, MD, Charles C. Hong, MD, PhD, Joseph C. Wu, MD, PhD, Kevin Croce, MD, PhD, Geoffrey Kim, MD, and Javid Moslehi, MD
Journal JACC Basic Transl Sci. 2016 August ; 1(5): 386–398.
Publisher Department of Health & Human Services USA
| 3 | | R450.00 | |
| | Imaging the heart in pulmonary hypertension: an update. | Imaging the heart in pulmonary hypertension: an update.
Imaging the heart in pulmonary hypertension: an update.
Overview
Non-invasive imaging of the heart plays an important role in the diagnosis and management of pulmonary hypertension (PH), and several well-established techniques are available for assessing performance of the right ventricle, the key determinant of patient survival. While right heart catheterisation is mandatory for establishing a diagnosis of PH, echocardiography is the most important screening tool for early detection of PH. Cardiac magnetic resonance imaging (CMRI) is also a reliable and practical tool that can be used as part of the diagnostic work-up. Echocardiography can measure a range of haemodynamic and anatomical variables (e.g. pericardial effusion and pulmonary artery pressure), whereas CMRI provides complementary information to echocardiography via high-resolution, three-dimensional imaging. Together with echocardiography and CMRI, techniques such as high-resolution computed tomography and positron emission tomography may also be valuable for screening, monitoring and follow-up assessments of patients with PH, but their clinical relevance has yet to be established.
Technological advances have produced new variants of echocardiography, CMRI and positron emission tomography, and these permit closer examination of myocardial architecture, motion and deformation. Integrating these new tools into clinical practice in the future may lead to more precise non-invasive determination of diagnosis, risk and prognosis for PH.
Acknowledgement
Author:
Grünig E, Peacock AJ
Journal:
European respiratory review: an official journal of the European Respiratory Society.
Publisher:
ERS publications
http://err.ersjournals.com/content/24/138/653.long
| 3 | | R370.00 | |
| | Medical Tourism. | Medical Tourism.
Overview
BACKGROUND: Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment.
OBJECTIVE:
This article provides an outline of the current research around medical tourism, especially its impact on Australians.
DISCUSSION:
Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad
Acknowledgement
Author:
Leggat P
Journal:
Australian family physician.
Publisher:
Focus Environmental
| 3 | | R360.00 | |
| | Suicide in Pretoria: A retrospective review, 2007 - 2010. | Suicide in Pretoria: A retrospective review, 2007 - 2010.
Suicide in Pretoria: A retrospective review, 2007 - 2010.
Overview
Background: The World Health Organization has declared suicide a global ealth crisis, predicting that ~1.53 million people will commit suicide annually by 2020.
Obejective:
A study from South Africa reviewed 1 018 suicide cases in Pretoria over 4 years (1997 - 2000). Our study was undertaken to establish whether there have been substantial changes in the profile of suicide victims who died in Pretoria a decade later.
Methods:
Case records at the Pretoria Medico-Legal Laboratory were reviewed retrospectively from 2007 to 2010.
Results:
A total of 957 suicide cases were identified. Hanging was the most common method of suicide, followed by self-inflicted firearm injury. The true incidence of suicidal intake of prescription drugs/medication was difficult to determine, because of a backlog at the state toxicology laboratories. White males and females appeared to be over-represented among suicide victims, but there has been an increase in suicide among blacks. There seems to have been a substantial decrease in the use of firearms to commit suicide - possibly reflecting a positive outcome of gun control legislation that has been introduced in the interim.
Conclusion: Suicide continues to constitute almost 10% of all fatalities admitted to the Pretoria Medico-Legal Laboratory, confirming suicide as a major cause of mortality in our society. Further research is needed to clarify the profile of suicidal deaths, with a view to informing resource allocation and to improve preventive strategies
Acknowledgement
Author:
Engelbrecht C, Blumenthal R, Morris NK, Saayman G
Journal:
South African medical journal.
Publisher:
SAMJ Research
http://www.samj.org.za/index.php/samj/article/view/12015/8182
| 3 | | R410.00 | |
| | The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism. | The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism.
The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism.
Overview
Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome.
Consequently, assessing the RV/LV diameter ratio may help identify patients who are potential candidates for treatment at home instead of treatment in the hospital. A minority of patients develop chronic thromboembolic pulmonary hypertension (CTEPH) following acute PE, which is a life-threatening condition that can be diagnosed by CT. In proximal CTEPH, involving the more central pulmonary arteries, thrombectomy usually results in good outcome in terms of both functional status and long-term survival rate. CT is becoming the imaging method of choice for diagnosing CTEPH as it can identify patients who may benefit from thrombectomy.
New CT developments such as distensibility measurements and dual-energy or subtraction techniques may further refine diagnosis and prognosis for improved patient care.
Acknowledgement
Author:
Dogan H, de Roos A, Geleijins J, Huisman MV, Kroft LJ
Journal:
Diagnostic and interventional radiology (Ankara, Turkey)
Publisher:
Turkish Society of Radiology
http://www.dirjournal.org/sayilar/77/buyuk/307-3161.pdf
| 3 | | R380.00 | |
| | Ability in daily activities after early supported discharge models of stroke rehabilitation. | Ability in daily activities after early supported discharge models of stroke rehabilitation.
Ability in daily activities after early supported discharge models of stroke rehabilitation.
Overview
One of the major causes of disability in the Western world is stroke. There is also an assumption that the burden of stroke will rise in the long run because the population of elderly people is increasing fast. More so, there are currently better survivals after stroke. Thus, there is need for more knowledge about how different rehabilitation models in the municipality influence stroke survivors’ ability in activities of daily living (ADL).
The objective of this study was therefore to compare three models of outpatient rehabilitation, namely; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. The method used for this research was a group comparison study that was designed within a randomized control trial.
Results from this research indicated that there were no significant group differences in pre–post changed ADL ability measured by the AMPS. It was also concluded that more research needs to be done to find the best rehabilitation model to improve the quality of stroke survivors’ motor and process skills.
ACKNOWLEDGEMENT
AUTHORS: Tina Taule, Liv Inger Strand, Jörg Assmus & Jan Sture Kouen
JOURNAL: Scandinavian Journal of Occupational Therapy
PUBLISHERS: Taylor & Francis Group
URL: http://dx.doi.org/10.3109/11038128.2015.1042403 Overview
One of the major causes of disability in the Western world is stroke. There is also an assumption that the burden of stroke will rise in the long run because the population of elderly people is increasing fast. More so, there are currently better survivals after stroke. Thus, there is need for more knowledge about how different rehabilitation models in the municipality influence stroke survivors’ ability in activities of daily living (ADL).
The objective of this study was therefore to compare three models of outpatient rehabilitation, namely; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. The method used for this research was a group comparison study that was designed within a randomized control trial.
Results from this research indicated that there were no significant group differences in pre–post changed ADL ability measured by the AMPS. It was also concluded that more research needs to be done to find the best rehabilitation model to improve the quality of stroke survivors’ motor and process skills.
ACKNOWLEDGEMENT
AUTHORS: Tina Taule, Liv Inger Strand, Jörg Assmus & Jan Sture Kouen
JOURNAL: Scandinavian Journal of Occupational Therapy
PUBLISHERS: Taylor & Francis Group
URL: http://dx.doi.org/10.3109/11038128.2015.1042403
| 3 | | R420.00 | |
| | Acute Effects of Breaking up Prolonged Sitting on Fatigue and Cognition. | Acute Effects of Breaking up Prolonged Sitting on Fatigue and Cognition.
Acute Effects of Breaking up Prolonged Sitting on Fatigue and Cognition.
Overview
There are many evidences that prolonged sitting has a negative effect or consequence on health. As a matter of fact, findings from previous experimental studies demonstrated that uninterrupted sitting is deleteriously associated with metabolic parameters, blood pressure and markers of haemostasis when compared to sitting that is interrupted with short bouts of physical activity.
The objective of this study was therefore to compare the acute effects of uninterrupted sitting with sitting interrupted by brief bouts of light-intensity walking on self-reported fatigue, cognition, neuroendocrine biomarkers and cardio metabolic risk markers in overweight/obese adults. The study was conducted in a laboratory in Melbourne, Australia meanwhile the design was a randomized two-condition crossover trial. The study was conducted on 19 overweight or obese adults between the ages of 45 and 75 years old.
Results from the study revealed that during the active condition, fatigue levels were lower whereas heart rates were higher compared to the sedentary condition. The conclusion was that interrupting prolonged sitting with light intensity walking breaks may be an effective fatigue counter measure acutely.
ACKNOWLEDGEMENT
AUTHORS: Patrik Wennberg, Carl-Johan Boraxbekk, Michael Wheeler, Bethany Howard, Paddy C Dempsey, Gavin Lambert, Nina Eikelis, Robyn Larsen, Parneet Sethi, Jessica Occleston, Jenny Hernestål- Boman, Kathryn A Ellis, Neville Owen, David W Dunstan
JOURNAL: BMJ Open
PUBLISHERS: BMJ
URL: http://bmjopen.bmj.com/ | 3 | | R380.00 | |
| | Body Psychotherapeutic Treatment for Anxiety Disorders. | Body Psychotherapeutic Treatment for Anxiety Disorders.
Body Psychotherapeutic Treatment for Anxiety Disorders.
Edited By: David Wilson
An introduction to the field of body psychotherapy, which aims to address anxiety by intervening at the bodily level rather than the traditional reliance on verbal talking cures. Modern attachment theory has accumulated a rich source of data based on decades of audio-visual recordings, documenting the genesis of our earliest non-verbal patterns of interpersonal relating. It is hoped that this introduction will pave the way for clinicians frustrated with the limits of the talking cure to undertake further exploration in both theory and techniques suggested by body psychotherapeutic traditions as an adjunct to their existing clinical repertoire. | 3 | | R400.00 | |
| | Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease. | Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease.
Cardiopulmonary Physiotherapy: Pulmonary Rehabilitation for Management of Chronic Obstructive Pulmonary Disease.
Richard Casaburi, Ph.D., M.D., and Richard ZuWallack, M.D.
This online course discusses the successes and failures of a respiratory rehabilitation programme designed for an overweight, sedentary 61-year-old woman who has been diagnosed with chronic obstructive pulmonary disease.
| 3 | | R400.00 | |
| | Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self-controlled case series study. | Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self-controlled case series study.
Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self-controlled case series study.
OVERVIEW
There are evidences that drugs used in treating attention-deficit/hyperactivity disorder (ADHD) are efficacious in reducing symptoms of impulsivity and hyperactivity in children,1 but concerns have been expressed about possible adverse cardiovascular events with the first line treatment, methylphenidate.
Thus, the aim of this study was to determine whether treatment with methylphenidate in children and young people with attention-deficit/ hyperactivity disorder (ADHD) was associated with cardiovascular events. The design for this study was a self-controlled case series analysis meanwhile the setting was the Nationwide Health Insurance database, from 1 January 2008 to 31 December 2011, in South Korea. Participants of this study were 1224 patients aged =17 who had experienced an incident cardiovascular event and with at least one incident prescription for methylphenidate.
Major results of this study indicated that increased risk of arrhythmia was observed in all exposed time periods, that is, periods of treatment with methylphenidate - (incidence rate ratio 1.61, 95% confidence interval 1.48 to 1.74), and the risk was highest in the children who had congenital heart disease.
ACKNOWLEDGEMENT
AUTHORS: Ju-Young Shin, Elizabeth E Roughead, Byung-Joo Park, Nicole L Pratt
JOURNAL: Eighth International Congress on Peer Review and Scientific Publication
PUBLISHER: BMJ Group
URL: http://www.bmj.com | 3 | | R380.00 | |
| | Extended Prediction Rule to Optimise Early Detection of Heart Failure in Older Persons with Non-Acute Shortness of Breath. | Extended Prediction Rule to Optimise Early Detection of Heart Failure in Older Persons with Non-Acute Shortness of Breath.
Extended Prediction Rule to Optimise Early Detection of Heart Failure in Older Persons with Non-Acute Shortness of Breath.
OVERVIEW
Heart failure is an epidemic that is causing high rates in mortality, substantial lost in the quality of life as well as high healthcare costs. Older people are more susceptible to heart failure even though diagnosing it at an early stage is difficult since its symptoms are non-specific.
The objective of this study was therefore to develop a screening rule for detecting heart failure in the elderly with a diagnosis of chronic obstructive pulmonary disease. It is worth mentioning that this screening rule was developed based on an existing rule. During this study, cross-sectional data were used to validate, update and extend the original prediction rule according to a standardised state-of-the-art stepwise approach. The participants of this study were community-dwelling older people aged about 65 years old. These participants suffered from shortness of breath on exertion.
This study nonetheless resulted in excellent prediction of heart failure in the large domain of the elderly with shortness of breath.
ACKNOWLEDGEMENT
AUTHORS: Evelien E S van Riet, Arno W Hoes, Alexander Limburg, Marcel A J Landman,
JOURNAL: BMJ Open
PUBLISHER: BMJ Open Group
URL: http://www.group.bmj.com
| 3 | | R330.00 | |
| | Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records. | Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records.
Patient characteristics associated with risk of first hospital admission and re-admission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records.
OVERVIEW
Hospital admission for chronic obstructive pulmonary disease (COPD) is a significant burden on healthcare resources. The readmission rates are equally high. As a matter of fact, COPD is the second most common reason for emergency hospital admission in the UK.
The objective of this study was to investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The design of this study was a retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. The setting of this study was primary care in Lothian Scotland. Participants of this study were from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. The patients were however followed up until 2010, death or they left a participating practice.
Based on the results of this study, it was concluded that several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission.
ACKNOWLEDGEMENT
AUTHOR: L C Hunter, R J Lee, Butcher, C J Weir, C M Fischbacher, D McAllister, S H Wild, N Hewitt, R M Hardie
JOURNAL: Respiratory Medicine
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com
| 3 | | R355.00 | |
| | Periodontitis and bone metabolism in patients with advanced heart failure and after heart transplantation. | Periodontitis and bone metabolism in patients with advanced heart failure and after heart transplantation.
Periodontitis and bone metabolism in patients with advanced heart failure and after heart transplantation.
OVERVIEW
Heart failure (HF) is a pro-inflammatory syndrome with multiorgan involvement caused by the inability of the heart to meet the metabolic demands of the body. The aims of this study are that heart failure (HF) is a multiorgan, pro- inflammatory syndrome that impairs bone metabolism. Pro-inflammatory cytokines and bone catabolism enhance periodontal disease, a local inflammatory, bacteria-induced disease that causes bone loss and periodontal soft tissue destruction.
Medical and dental examinations were performed on patients with HF (n = 39), following heart transplantation (post-HTx, n = 38) and controls (n = 32). Blood, saliva, and gingival crevicular fluid were analysed for bone metabolism and inflammation markers. However, adjustment of periodontal results for measures
of oral hygiene (plaque, bleeding on probing), systemic 25-hydroxyvitamin D, and race attenuated significant differences between groups.
In conclusion, it was found that patients with HF exhibit more severe periodontal disease associated with increased bone turnover markers when compared with control patients. However, local and systemic factors may account for this association and should be evaluated in future studies
ACKNOWLEDGEMENT
AUTHORS: Ulrike Schulze-Späte1,2 et al.
JOURNAL: ESC Heart Failure
PUBLISHERS: Wiley Online Library
URL: http://onlinelibrary.wiley.com
| 3 | | R425.00 | |
| | Potential Workload in Applying Clinical Practice Guidelines for Patients with chronic conditions and multimorbidity. | Potential Workload in Applying Clinical Practice Guidelines for Patients with chronic conditions and multimorbidity.
Potential Workload in Applying Clinical Practice Guidelines for Patients with chronic conditions and multimorbidity.
OVERVIEW
Multimorbidity, defined as the coexistence of chronic conditions, is becoming the norm in primary care settings. The objective of this study was to describe the potential workload for patients with multimorbidity when applying existing clinical practice guidelines.
The design for this study was a systematic analysis of clinical practice guidelines for chronic conditions and simulation modelling approach. Data was obtained from the National Guideline Clearinghouse index of US clinical practice guidelines. The most recent guidelines for adults with 1 of 6 prevalent chronic conditions in primary care (i.e. hypertension, diabetes, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), osteoarthritis and depression) were identified. From the guidelines, all recommended health-related activities (HRAs) such as drug management, self-monitoring, visits to the doctor, laboratory tests and changes of lifestyle for a patient aged 45–64 years with moderate severity of conditions were extracted.
Results from this study indicated that depending on the concomitant chronic condition, patients with 3 chronic conditions complying with all the guidelines would have to take a minimum of 6 to a maximum of 13 medications per day, visit a health caregiver a minimum of 1.2 to a maximum of 5.9 times per month, etc.
ACKNOWLEDGEMENT
AUTHOR: Céline Buffel du Vaure, Philippe Ravaud, Gabriel Baron, Caroline Barnes, Serge Gilberg, Isabelle Boutron
JOURNAL: BMJ Global Health
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com | 3 | | R375.00 | |
| | Practice Issues. | Practice Issues.
OVERVIEW
It is important to note that the responses to the various questions are the views independently expressed and are not necessarily opinions shared by cpdexpress.co.za. As matters involving Ethics and the law are subject to interpretation, the responses cannot, in any way, be regarded as binding or necessarily endorsed by the regulatory authorities.
There are ethical dilemmas regarding patients, colleagues and associates that one doesn’t even consider until they become issues in their practice. There are many questions to be asked regarding ethics, touting, canvassing, advertising, competition and many other issues that need to be addressed and this article addresses most of them. | 3 | | R450.00 | |
| | Private Practice: The Do's And Don'ts. | Private Practice: The Do's And Don'ts.
Private Practice: The Do's And Don'ts.
OVERVIEW
You have studied extensively to become a healthcare professional in your field of study. You have learned and become adept at identifying a vast range of conditions. You can diagnose and effectively treat those conditions within the scope of the discipline.
Now you are faced with a plethora of dilemmas. What is fair value for your services? What appliances are appropriate and reasonable? What commercial and legal structures are appropriate for you? What influence may these commercial and legal structures have on your clinical recommendations? Who may have access to your record cards? What responsibility can you delegate to your staff? Who carries final responsibility for payment of your claims – member or medical aid? What constitutes anti-competitive behavior?
This is a very informative article that will help you to run your practice within the various guidelines. | 3 | | R400.00 | |
| | Renal Failure and Acute Coronary Syndrome Due to Use of Cannabis in a 26 year old young male. | Renal Failure and Acute Coronary Syndrome Due to Use of Cannabis in a 26 year old young male.
Renal Failure and Acute Coronary Syndrome Due to Use of Cannabis in a 26 year old young male.
OVERVIEW
Cannabis, which is produced from leaves of plants called Cannabis sativa is mostly used by youths in most parts of the world, Europe inclusive. However, there are believes that cannabis is a relatively benign substance, just like alcohol and tobacco as compared to the adverse effects that heroin, ecstasy, and cocaine are associated with.
Although it is pleasure inducing, C. sativa has also some side effects in various organ systems, particularly the cardiovascular system. Sometimes, it may even threaten life. This paper is basically a case report of a 26-year-oldmale patient presenting to emergency department with acute coronary syndrome and acute renal failure. It is worth mentioning that this patient had used various forms of cannabis for a long time and had a number cardiovascular risk factors. In this article, the mechanism of action of cannabis was also discussed and analysed.
The study was concluded that coronary heart disease, acute coronary syndrome, and acute renal failure as a complication of cannabis use are likely to increase in the future.
ACKNOWLEDGEMENT
AUTHORS: Turgut Karabag, Burcu Ozturk, Seda Guven, Nurettin Coskun, Erkan Ilhan, Nihan Turhan Caglar
JOURNAL: International Journal of the Cardiovascular Academy
PUBLISHER: Elsevier Inc
URL: https://www.elsevier.com
| 3 | | R350.00 | |
| | Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE. | Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE.
Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE.
OVERVIEW
Venous thromboembolism (VTE) is a chronic condition with estimated incidence at 1 per 1000 person years. In fact, it is the third most common cardiovascular disease after heart attack.
This condition often presents as deep vein thrombosis (DVT), with some patients suffering an embolism in the lungs known as a pulmonary embolism. Therefore, the objective of this study was to review studies developing or validating a prognostic model for individual venous thromboembolism (VTE) recurrence risk following cessation of therapy for a first unprovoked VTE0. This review basically aims at determining whether reliable prognostic models exist and, if not, what further research is needed within the field.
For this study, bibliographic databases including MEDLINE, EMBASE and the Cochrane Library were searched using index terms relating to the clinical field and prognosis.by the end of the study, 3 unique prognostic models were identified including the HERDOO2 score, Vienna prediction model and DASH score.
ACKNOWLEDGEMENT
AUTHORS: Joie Ensor, Richard D Riley, David Moore, Kym E Snell, Susan Bayliss, David Fitzmaurice
JOURNAL: BMJ Open
PUBLISHER: BMJ Gourp
URL: http://bmjopen.bmj.com | 3 | | R325.00 | |