 | | HIV and Aids Part 2 | HIV and Aids Part 2
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. All patients who are diagnosed with HIV should be initiated on ART as soon as possible.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome).
Exceptions to this include patients presenting with cryptococcal meningitis (CM) or central nervous system tuberculosis (tuberculous meningitis (TBM) or tuberculoma).
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| | HIV and Aids Part 1 | HIV and Aids Part 1
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. Symptoms vary depending on the stage of infection and these include: - Acute stage, which resembles the flu, with fever, malaise, and a generalized rash;
- Asymptomatic stage which generally, has no symptoms.
- Lymphadenopathy, which presents with swelling of lymph nodes, which can be a primary symptom.
- AIDs, which is the advanced stage marked by severe infections or cancers.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome).
Sharespike Knowledge Studio | 3 | | R485.00 | |
| | Ebola Virus Infection | Ebola Virus Infection
Overview
Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome. The genus Ebolavirus currently is classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo ebolavirus. The outbreak of Ebola virus disease in West Africa from 2014 to 2016, involving Zaire ebolavirus, was the largest outbreak of Ebola virus disease in history.
As of September 17, 2019, an active outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) had resulted in 3,034 confirmed and 111 probable cases of Ebola virus disease, including 2,103 attributable deaths. An experimental vaccine has been credited with limiting the outbreak’s scope.
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| | Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study | Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study
Oral Transmucosal Fentanyl Citrate Analgesia in Prehospital Trauma Care: an observational cohort study
Overview
Pain is a common prehospital symptom in trauma patients and requires timely management. Recent studies have indicated that up to 43% of trauma patients experience inadequate analgesia after prehospital treatment, suggesting the need for improvement. Evidence supports the prehospital use of oral transmucosal fentanyl citrate (OTFC) in military settings.
This observational cohort study examined the use of oral transmucosal fentanyl citrate (OTFC) for prehospital trauma care in remote and challenging environments. Conducted at three ski and bike resorts in Switzerland, the study involved 177 patients treated by trained EMS providers. Results indicated that OTFC is safe, effective, and practical for managing severe pain without the need for intravenous lines. Side effects were rare and mild.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Journal 31 Issue 2
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| | Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h | Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h
Diagnostic performance of Glial Fibrillary Acidic Protein and Prehospital Stroke Scale for identification of stroke and stroke subtypes in an unselected patient cohort with symptom onset < 4.5 h
Overview Rapid treatment of stroke is critical for patient outcomes. This study examined glial fibrillary acidic protein (GFAP) alone and with the Prehospital Stroke Score (PreSS) for identifying acute stroke within 4.5 hours of symptom onset. Clinical data and serum samples were collected from Treat-NASPP. Patients with suspected stroke and symptoms lasting = 4.5 hours had blood samples taken and were evaluated using NIHSS. NIHSS was later translated into PreSS, and GFAP was measured with SIMOA. Results showed GFAP alone identified ICrH in unselected patients. When combined with PreSS, GFAP identified subgroups with high proportions of stroke mimics, ICrH, LVO, and AIS (non-LVO strokes). Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2023 31:1
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| | Factors influencing streaming to general practitioners in emergency departments: A qualitative study | Factors influencing streaming to general practitioners in emergency departments: A qualitative study
Factors influencing streaming to general practitioners in emergency departments: A qualitative study
Overview Emergency Department (ED) attendance is rising globally, with many cases that could be managed in general practice. In England, policies require some patients in EDs to be "streamed" or directed to general practitioners (GPs) working within or alongside EDs. However, evidence for this approach is limited, and the processes involved lack thorough exploration. This study investigates patient streaming to GPs across 10 sites in England. Using qualitative data from 186 observations and 226 interviews with healthcare professionals, six key themes were identified that influence streaming success: structural support, personnel development, effective protocols, negotiation of primary/secondary care boundaries, interprofessional relationships, and patient safety concerns. The study found that the skills of streaming nurses and the collaboration between streamers and GPs were critical for safe and effective streaming. However, there was no single streaming model linked to success. Instead, various factors contributed to good practice, and the issue of "inappropriate" streaming—where patients were misdirected—was identified as a challenge. The study offers key recommendations to improve streaming practices and highlights the importance of tailored solutions across different sites to enhance the effectiveness of streaming in EDs.
Journal: International Journal of Nursing Studies Volume 120 Issue 10 | 3 | | R485.00 | |
| | Enterobacter Infection | Enterobacter Infection
Overview
Enterobacter infections can include bacteremia, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections (UTIs), endocarditis, intra-abdominal infections, septic arthritis, osteomyelitis, CNS infections, and ophthalmic infections. Enterobacter infections can necessitate prolonged hospitalization, multiple and varied imaging studies and laboratory tests, various surgical and nonsurgical procedures, and powerful and expensive antimicrobial agents. Enterobacter infections do not have a clinical presentation that is specific enough to differentiate them from other acute bacterial infections. Bacteremia Signs of Enterobacter bacteremia include various symptoms and cause lower respiratory tract infections can manifest identically to those caused by Streptococcus Pneumoniae or other organisms Enterobacter infections do not have a clinical presentation that is specific enough to differentiate them from other acute. This course addresses the symptoms and the causes.
Sharespike Knowledge Studio | 3 | | R485.00 | |
| | Prediction of osteoporosis using MRI and CT scans with unimodal and multimodal deep-learning models | Prediction of osteoporosis using MRI and CT scans with unimodal and multimodal deep-learning models
Prediction of osteoporosis using MRI and CT scans with unimodal and multimodal deep-learning models
Overview Osteoporosis involves the systematic degeneration of the human skeleton, leading to decreased quality of life and increased mortality risk. Predicting osteoporosis can help reduce these risks and enable patients to take necessary precautions. Deep-learning models have shown accurate results using various imaging modalities. This research aimed to develop unimodal and multimodal deep-learning diagnostic models to predict bone mineral loss in the lumbar vertebrae using magnetic resonance (MR) and computed tomography (CT) imaging. Osteoporosis is a systemic skeletal degenerative disease marked by the deterioration of bone tissue microstructure and low bone mineral density (BMD), resulting in increased bone fragility and fracture susceptibility. Fragility fractures are the main complication of osteoporosis, impacting morbidity, mortality, and quality of life. As the elderly population grows, osteoporosis prevalence is rising. By 2020, it was estimated that approximately 12.3 million individuals over 50 in the United States would have osteoporosis. Research by Tuzun et al. indicated that the prevalence of osteoporosis among Turkish citizens increases with age, affecting 3%-4% of individuals at age 50 and more than 30% by age 80. These numbers are projected to increase by 64% (870,000 men and 1,841,000 women) by 2035. This study showed that osteoporosis could be accurately predicted using the proposed models with both MR and CT images, with a multimodal approach enhancing prediction accuracy. Further research involving prospective studies with a larger patient cohort may facilitate integrating these technologies into clinical practice.
Journal Diagnostic and Interventional Radiology
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| | Relationship between chronic disease and depression: the mediating effect of pain | Relationship between chronic disease and depression: the mediating effect of pain
Relationship between chronic disease and depression: the mediating effect of pain
Overview The incidence of depression was high in people who were female, less educated, unmarried, living in rural areas, and working. Chronic diseases have a high incidence in China and may cause pain and depression. However, the association of chronic diseases with pain and the incidence of depression has not been comprehensively investigated.
The study population was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The main outcome was the incidence of depression. The main independent variable was chronic disease (no chronic disease, one chronic disease, and two or more chronic diseases). The mediators were the degree of pain (no pain, mild pain, and moderate to severe pain) and whether measures were taken to relieve pain (measures taken and no measures taken). In conclusion the degree of pain had a partial mediating effect on chronic disease and depression. Pain relief measures should be considered when treating patients with depression.
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| | Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study | Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study
Incidence rate and risk factors of surgical wound infection in general surgery patients: A cross-sectional study
Overview Hospital-acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross-sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. Among these, Staphylococcus aureus was the predominant species, followed by coagulase-negative staphylococci. In addition, the most common Gram-negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections.
Journal Int Wound Journal. | 3 | | R485.00 | |
| | Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in the Elderly | Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in the Elderly
Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in the Elderly
Overview
As old population is dramatically growing, the detection of early cognitive deficit will become increasingly crucial. Effective cognitive screening test with quick and convenient merits will ensure recognition of early cognitive deficit and timely intervention. This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly.
The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated.
Many screening tools are currently available, but no tools meet the four important requirements for widespread use in clinical practice or large-scale epidemiological studies — that is, capture a clinically acceptable range of cognitive domains, take short time to administrate (around 5 minutes), have high accuracy for detecting cognitive impairment, and incorporate visual recall, which is the earliest deficits in Alzheimer’s disease (AD) patients. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.
Journal
JKL International LLC Aging and Disease Volume 10, Number 6 URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844584/pdf/ad-10-6-1258.pdf | 3 | | R425.00 | |
| | Blood-brain barrier pathology in patients with severe mental disorders: a systematic review and meta-analysis of biomarkers in case-control studies | Blood-brain barrier pathology in patients with severe mental disorders: a systematic review and meta-analysis of biomarkers in case-control studies
Blood-brain barrier pathology in patients with severe mental disorders: a systematic review and meta-analysis of biomarkers in case-control studies
Overview Blood-brain barrier (BBB) pathology may be associated with mental disorders. The aim of this systematic review and meta-analysis is to identify, evaluate and summarize available evidence on whether potential biomarkers of BBB pathology are altered in patients with schizophrenia spectrum disorders, major depression and bipolar disorder compared to healthy controls. The findings implicate occurrence of BBB pathology in patients with schizophrenia spectrum disorders, major depression and bipolar disorder compared to healthy controls. However, definite conclusions cannot be drawn, mainly because the investigated biomarkers are indirect measures of BBB pathology.
Authors Jesper Futtrup, Rebecca Margolinsky, Michael Eriksen Benros, Torben Moos, Lisa Juul Routhe, Jørgen Rungby, Jesper Krogh
Journal Brain, Behavior, & Immunity - Health | 3 | | R400.00 | |
| | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Overview The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. This study aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. A national cohort study was conducted in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Patients were excluded if they did not have a neurological consultation or neurological investigations or both or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR or respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall.
Authors Stephen T J Ray et al
Journal The Lancet Child & Adolescent Health | 3 | | R410.00 | |
| | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Overview To understand the motivations of rural-practicing primary care clinicians who participate in an intensive multiyear pragmatic randomized behavioural obesity intervention trial, Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER).
Structured interviews were conducted with 21 family medicine clinicians who were study leads at participating rural practices. Themes emerged through an analysis of transcripts and interview notes by using the constant comparative method.
The analysis revealed 3 main themes. First, primary care clinicians participated in RE-POWER because it provided a concrete plan to address their recurring clinical care need for effective obesity treatment and management. Second, participation offered help to frustrated physicians who felt a deep professional duty to care for all their patients’ problems but were dissatisfied with current obesity management. Third, participation was also attractive to rural primary care clinicians because it provided a visible and sustainable way to demonstrate their commitment to improving the health of patients and the broader community.
The findings show that clinicians are motivated to try solutions for a clinical problem— in this case obesity—when that clinical problem is also closely connected to a particularly frustrating area of clinical care that challenges their professional identity. Our data suggest that a motivation to close the gap between ideal and real practice can become such a high priority that clinicians are sometimes willing to try potential solutions, such as engagement in research, that they otherwise would not consider.
Authors Joanna Veazey Brooks, PhD, MBE, Kim S. Kimminau, PhD, Stacy McCrea-Robertson, MS, and Christie Befort, PhD Journal Journal of the American Board of Family Medicine | 3 | | R455.00 | |
| | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Overview Women physicians continue to comprise the minority of leadership roles in Academic Family Medicine (AFM) faculty across North American medical schools. This study quantified the current state of gender disparity by analysing academic position, leadership ranking, and research productivity.
A database for 6,746 AFM faculty members was generated. Gender and academic profiles were obtained for 2,892 academic ranks and 1,706 leadership roles by searching faculty listings enlisted in Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS).
The results indicated that women hold 46.11% (3,110/6,746) of faculty positions. The proportional composition decreased with increasing academic ranking (49.84% assistant, 46.78% associate, and 41.5% full professor). The same decreasing trend was demonstrated with leadership rank (57.14% minor leadership, 47.65% second-in-command, and 36.61 first-in command). Compared to their gender counterparts, women in AFM demonstrated lower publication productivity as measured by citation number (p=0.04) and years of study (p=0.008).
In conclusion it was found that the composition of academic family medicine faculty members included in this study demonstrated gender disparity. Inclusivity initiatives and policies to tackle the issue of female retention, promotion, and recruitment need to be further explored.
Authors Szu-Yu Tina Chen, Sabeena Jalal, Maryam Ahmadi, Kiran Khurshid, Nizar Bhulani, Ateeq U. Rehman, Aftab Ahmad, Jeffrey Ding, Terri-Leigh R. Aldred, Faisal Khosa
Journal Cureus
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| | 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 | |
| | Applying machine learning on health record data from general practitioners to predict suicidality | Applying machine learning on health record data from general practitioners to predict suicidality
Applying machine learning on health record data from general practitioners to predict suicidality
Overview Suicidal behaviour is difficult to detect in the general practice. Machine learning (ML) algorithms using routinely collected data might support General Practitioners (GPs) in the detection of suicidal behaviour. In this paper, we applied machine learning techniques to support GPs recognizing suicidal behaviour in primary care patients using routinely collected general practice data. Machine learning was applied to predict suicidal behaviour using general practice data. Our results showed that these techniques can be used as a complementary step in the identification and stratification of patients at risk of suicidal behaviour. The results are encouraging and provide a first step to use automated screening directly in clinical practice. Additional data from different social domains, such as employment and education, might improve accuracy.
Authors Kasper van Mens, Elke Elzinga, Mark Nielen, Joran Lokkerbol, Rune Poortvliet, Gé Donker, Marianne Heins, Joke Korevaarc, Michel Dückers, Claire Aussems, Marco Helbich, Bea Tiemens, Renske Gilissen, Aartjan Beekman, Derek de Beurs
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| | 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
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| | 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
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| | Vertigo, DIzziness and Imbalance | Vertigo, DIzziness and Imbalance
Vertigo, DIzziness and Imbalance
Overview
Dizziness and vertigo are among the most common symptoms causing patients to visit a physician (as common as back pain and headaches). Falling can be a direct consequence of dizziness in this population, and the risk is compounded in elderly persons with other neurologic deficits and chronic medical problems.
Mild hearing loss is the most common disability worldwide. The incidence of hearing loss is 25% in people younger than 25 years, and it reaches 40% in persons older than 40 years. About 25% of the population report tinnitus.
Primary care physicians evaluate most cases of dizziness and related symptoms. Their role and that of neurologists in this setting has increased over the past decade. This article outlines the clinical approach to dizziness with emphasis on differentiating peripheral from central dizziness and on office management of the most common diseases. It also addresses indications for referral to an otolaryngologist or neuro-otologist and for specialized auditory and vestibular testing.
To diagnose dizziness, physicians must use the essential tools of history, clinical examination, and follow-up. The etiology in most of these patients mainly involves a vestibular disorder, such as BPPV, Ménière disease, or bilateral vestibular hypofunction. Appropriate management and follow-up are necessary to improve the well-being of these patients.
Authors
Sharespike
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| | 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
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| | 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
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| | The eye: ‘‘An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic’’ | The eye: ‘‘An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic’’
The eye: ‘‘An organ that must not be forgotten in coronavirus disease 2019 (COVID-2019) pandemic’’
Overview The coronavirus family is a group of zoonotic viruses with some recognized reservoirs particularly some bats. A novel coronavirus emerged in the province of Wuhan (China) in December of 2019.The number of infected patients with serious respiratory infection quickly spread around the world to become a global pandemic. The clinical presentation and viral pathogenesis of the coronavirus disease named COVID-19 indicated that the virus is transmitted from person to person through infected droplets entering the respiratory mucosa. Close contact with infected individuals particularly in crowded environments has characterized the rapid spread of the infection. Clinical manifestations of the viral infection have mentioned the presence of some ocular findings such as conjunctival congestion, conjunctivitis and even corneal injury associated with the classical COVID-19 infection. Some animal models of different coronaviruses eye infection shave described the viral pathogenesis through tear and conjunctival sampling. On the other hand, we are recommended protective measure to prevent contagion and limit the spread of the virus in health care professionals and contact lenses wearers.
ACKNOWLEDGMENTS Authors Sandra C. Durán C, Diana C. Mayorga G Journal Journal of Optometry (2020)
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| | 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.
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| | 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.
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| | 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.
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| | Septic Shock Part 2 | Septic 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
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| | Septic Shock Part 1 | Septic 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 | |
| | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
| 3 | | R435.00 | |
| | 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 | |
| | Burn Resuscitation and Early Management | Burn Resuscitation and Early Management
Burn Resuscitation and Early Management
Overview Burn resuscitation refers to the replacement of fluids in burn patients to combat the hypovolemia and hypoperfusion that can result from the body’s systemic response to burn injury. The history of modern burn resuscitation can be traced back to observations made after large urban fires at the Rialto Theatre (New Haven, Conn) in 1921 and the Coconut Grove nightclub (Boston, Mass) in 1942. At the time, physicians noted that some patients with large burns survived the event but died from shock in the observation periods. Underhill and Moore identified the concept of thermal injury–induced intravascular fluid deficits in the 1930s and 1940s, and Evans soon followed with the earliest fluid resuscitation formulas in 1952. Up to that point, burns covering as little as 10-20% of total body surface area (TBSA) were associated with high rates of mortality.
Burns are a serious cause of human suffering and mortality globally. As many as 5% of burn victims will die as a result of their injuries, and many others will suffer disability, disfigurement, or scarring. This course addresses vital information regarding burn resuscitation and the early management thereof.
| 3 | | R465.00 | |
| | 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 | |
| | COVID-2019 -A comprehensive pathology insight | COVID-2019 -A comprehensive pathology insight
COVID-2019 -A comprehensive pathology insight
Overview Corona virus disease-2019 (COVID-19) caused by severe acute respiratory syndrome corona virus-2 (SARS CoV- 2), a highly contagious single stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Occasionally patient may present with gastro-intestinal, cardiac and neurologic symptoms with or without lung involvement. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. Other organs like liver and kidneys may be involved secondarily.
Currently the treatment is principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. During the pandemic there is paucity of literature on pathological features including pathogenesis, hence in this review we provide the current pathology centred understanding of COVID-19. Furthermore, the pathogenetic pathway is pivotal in the development of therapeutic targets.
Authors Chandrakumar Shanmugam, Abdul Rafi Mohammed, Swarupa Ravuri, Vishwas Luthra, Narasimhamurthy Rajagopal, Saritha Karre
Journal Pathology - Research and Practice 216 (2020) 153222
| 3 | | R440.00 | |
| | Adolescent knee pain: fracture or normal? A case report. | Adolescent knee pain: fracture or normal? A case report.
Adolescent knee pain: fracture or normal? A case report.
Overview Knee injuries are the second to fourth most common injuries in youth soccer. In this population, sprains/strains, fractures and contusions are most common. Due to variations in the developing skeleton, it can be difficult to rule out fractures. We present a case of a 13-year-old presenting to the emergency department (ED) with patellar pain after pivoting during a soccer game. After radiographic clearance, he was allowed to return to sport. Following another fall and ED visit, his full leg was casted. He presented to a chiropractor after cast removal, who made recommendations for progressive rehabilitation owing to the lack of evidence for fracture on radiographs. We suggest a thorough history, physical and Ottawa knee rules to determine whether We suggest a thorough history, physical and Ottawa knee rules to determine whether radiographs are indicated in the management of a pediatric knee injury. Due to normal skeletal variance, we recommend bilateral radiographs and if findings are ambiguous, consultation with a radiologist to confirm clinical suspicions.
Authors: Melissa Corso and Scott Howitt
Journal: The Journal of the Canadian Chiropractic Association Volume 62 Issue 2 | 3 | | R465.00 | |
| | Clinical Practice Guidelines: Pediatric Gastroenteritis | Clinical Practice Guidelines: Pediatric Gastroenteritis
Clinical Practice Guidelines: Pediatric Gastroenteritis
Overview
Infective gastroenteritis in young children is characterised by the sudden onset of diarrhoea, with or without vomiting. Most cases are due to an enteric virus, but some are caused by bacterial or protozoal infections. The illness usually resolves without treatment within days; however, symptoms are unpleasant and affect both the child and family or carers. Severe diarrhoea can quickly cause dehydration, which may be life threatening (National Institute for Health and Care Excellence, 2009).
Oral rehydration therapy is replacement of fluids and electrolytes, such as sodium, potassium, and chloride necessary for normal physiological functions and is effective in 95% of cases of mild to moderate dehydration. Oral rehydration therapy is less invasive, less expensive, is associated with less morbidity and can be dispensed outside of the hospital setting, while being as effective as IV treatment (Medical Services Commission, 2010).
Acknowledgement
Journal:
Clinical Practice Guidelines (July 2018)
Publisher:
Health Professions Council of South Africa | 3 | | R410.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease.
This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements
Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Malaria | Malaria
Overview Malaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Most patients with malaria have no specific physical findings, but splenomegaly may be present. In patients with suspected malaria, obtaining a history of recent or remote travel to an endemic area is critical. Asking explicitly if they travelled to a tropical area at any time in their life may enhance recall. Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas.
It is also important to determine the patient's immune status, age, and pregnancy status; allergies or other medical conditions that he or she may have; and medications that he or she may be using.
Acknowledgements Authors:
Thomas E Herchline, Thomas E Herchline, Ryan Q Simon
| 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 2 | Diabetes Mellitus Part 2
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 | |
| | Pharmacological and Dietary Factors in preventing Colorectal Cancer | Pharmacological and Dietary Factors in preventing Colorectal Cancer
Pharmacological and Dietary Factors in preventing Colorectal Cancer
Overview
Colorectal cancer (CRC) is the third most prevalent neoplasm worldwide and fourth most frequent reason of cancer-related death throughout the world. About 70% of malignant tumours are related to lifestyle and environmental factors, and better knowledge of their significance might reduce the prevalence of CRC. The cyclo-oxygenase-2 (COX-2) inhibitory and other direct and indirect pathways of aspirin are translated to inhibition proliferation and enhanced apoptosis of cancer cells.
A high energy diet consisting of red meat, animal fat, highly processed foods and unsaturated fats increases the risk of CRC. Carcinogenic role of fat and cholesterol depends on increased production of primary bile acids. Fruits, vegetables and grain are considered to have protective effects against adenoma and CRC. Excessive alcohol consumption, smoking and physical inactivity are considered as important CRC risk factors.
This article briefly summarizes current state of knowledge about the role of pharmacological and dietary prevention of colorectal cancer. Moreover, it indicates that despite many studies some aspects of this issue are not clear and require future studies.
Acknowledgement
Author M. Waluga, M. Zorniak, J. Fichna, M. Kukla and M. Hartleb
Journal Journal of Physiology and Pharmacology 2018
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| | Mortality effects of timing alternatives for hip fracture surgery | Mortality effects of timing alternatives for hip fracture surgery
Mortality effects of timing alternatives for hip fracture surgery
Overview:
The appropriate timing of hip fracture surgery remains a matter of debate. It was sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.
We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram.
Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
Acknowledgement
Authors:
Boris Sobolev PhD, Pierre Guy MD, Katie Jane Sheehan PhD, Lisa Kuramoto MSc, Jason M. Sutherland PhD, Adrian R. Levy PhD, James A. Blair MD, Eric Bohm MD, Jason D. Kim MPH, Edward J. Harvey MD, Suzanne N. Morin MD, Lauren Beaupre PhD, Michael Dunbar MD, Susan Jaglal PhD, James Waddell MD; for the Canadian Collaborative Study of Hip Fractures
Journal:
CMAJ Group Volume 190 Issue 31
Publisher:
National Centre for Biotechnology Information | 3 | | R460.00 | |