 |  | 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 | | R165.00 |  |
 |  | Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour | Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour
Relationship between dental experiences, oral hygiene education and self-reported oral hygiene behaviour
Overview
Many preventive approaches in dentistry aim to improve oral health through behavioural instruction or intervention concerning oral health behaviour. However, it is still unknown which factors have the highest impact on oral health behaviours, such as toothbrushing or regular dental check-ups.
Various external and internal individual factors such as education, experience with dentists or influence by parents could be relevant. Therefore, the present observational study investigated the influence of these factors on self-reported oral heath behaviour. Dental anxiety and current negative dental experiences reduced participants’ dental self-efficacy perceptions as well as the self-inspection of one’s teeth. While parental care positively influenced the attitude towards one’s teeth, dental self-efficacy perceptions significantly correlated with attitude towards oral hygiene, self-inspection of one’s teeth and parental care.
Dental anxiety, dental experiences, parents’ care for their children’s oral hygiene and dental self-efficacy perceptions influence the attitude towards oral hygiene and one’s own oral cavity as well as the autonomous control of one’s own dental health.
Journal
PLoS ONE
| 3 | | R165.00 |  |
| | Loneliness, Ageism, and Mental Health: The buffering role of resilience in seniors | Loneliness, Ageism, and Mental Health: The buffering role of resilience in seniors
Loneliness, Ageism, and Mental Health: The buffering role of resilience in seniors
Ageism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors’ mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied.
Resilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.
Journal International Journal of Clinical Health Psychology Volume 23 Issue 1
| 3 | | R465.00 |  |
| | COVID-19 in Pediatrics | COVID-19 in Pediatrics
Overview In 2019, a novel coronavirus emerged called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). Initially identified in Wuhan, China, COVID-19 spread internationally and became a global pandemic. Most pediatric COVID-19 cases were milder than in adults, but in the early Spring of 2020, a new inflammatory syndrome emerged in children who had evidence of prior SARS CoV-2 infection, called Multisystem Inflammatory Syndrome in Children (MIS-C). As of March 2021, there were approximately 2,592,619 cases of COVID-19 in people under 18 in the United States and 300 deaths. Of all American cases, 2.1% were in children aged 0 to 4 years old, and another 10.2% were in those aged 5 to 17. Prevalence varies by age, with estimates ranging from 17% for children under 2 years old to 25% of children ages 6 to 10 years old, and 23% in 10 to 14 years old. The severity of the disease is generally lower for children, with only 1% to 5% of pediatric cases qualifying as severe versus to 10% to 20% in adults. This finding is thought to reflect the lower levels of angiotensin-converting enzyme 2 expression in alveolar cells, which is the mechanism by which SARS-CoV-2 enters cells. Being older than 12 years and having a high initial C-reactive protein (CRP) are risk factors for admission to a pediatric intensive care unit, and high CRP, leukocytosis, and thrombocytopenia are risk factors for organ dysfunction. Viral load and young age, specifically children under 1 year of age, are other risk factors for more severe disease. This study describes the features, diagnosis, and treatment of pediatric COVID-19 and MIS-C based on the data available at the time of publication.
Authors Case SM, Son MB
Journal Rheumatic Disease Clinics of North America
| 3 | | R165.00 |  |
| | 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 | | R195.00 |  |
| | 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 | | R145.00 |  |
| | 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 | | R145.00 |  |
| | 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 | | R145.00 |  |
| | 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 | | R135.00 |  |
| | Amebiasis | Amebiasis
Overview Amebiasis is caused by Entamoeba histolytica, a protozoan that is found worldwide. The highest prevalence of amebiasis is in developing countries where barriers between human faeces and food and water supplies are inadequate.
Although most cases of amebiasis are asymptomatic, dysentery and invasive extraintestinal disease can occur. Amebic liver abscess is the most common manifestation of invasive amebiasis, but other organs can also be involved, including pleuropulmonary, cardiac, cerebral, renal, genitourinary, peritoneal, and cutaneous sites. In developed countries, amebiasis primarily affects migrants from and travellers to endemic regions, men who have sex with men, and immunosuppressed or institutionalized individuals.
The National Institute of Allergy and Infectious Diseases (NIAID) has classified E histolytica as a category B biodefense pathogen because of its low infectious dose, environmental stability, resistance to chlorine, and ease of dissemination through contamination of food and water supplies.
E histolytica is transmitted via ingestion of the cystic form (infective stage) of the protozoa. Viable in the environment for weeks to months, cysts can be found in soil contaminated with faecal, fertilizer, or water or on the contaminated hands of food handlers. Faecal-oral transmission can also occur in the setting of anal sexual practices or direct rectal inoculation through colonic irrigation devices.
Author Sharespike
| 3 | | R179.00 |  |
| | Asthma Exacerbation Part 2 | Asthma Exacerbation Part 2
Asthma Exacerbation Part 2
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents.
Author Sharespike
| 3 | | R145.00 |  |
| | Asthma Exacerbation Part 1 | Asthma Exacerbation Part 1
Asthma Exacerbation Part 1
Overview
Asthma is a common chronic disease worldwide and affects approximately 26 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children, and it is a common cause of hospitalization for children in the United States.
The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The mechanism of inflammation in asthma may be acute, subacute, or chronic, and the presence of airway edema and mucus secretion also contributes to airflow obstruction and bronchial reactivity. Varying degrees of mononuclear cell and eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium, smooth muscle hyperplasia, and airway remodelling are present. Physical findings vary with the severity of the asthma and with the absence or presence of an acute episode and its severity. Pharmacologic management includes the use of relief and control agents. Author Sharespike
| 3 | | R145.00 |  |
| | Acute Leukemia Part 2 | Acute Leukemia Part 2
Overview There are various forms of acute Leukemia of which most of these are discussed in Parts 1 and 2 of this study. In Part 2 Acute Lymphoblastic Leukemia (ALL) is disccused. Acute lymphoblastic leukemia (acute lymphocytic leukemia, ALL) is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. Acute lymphoblastic leukemia (ALL) is the most common type of cancer and leukemia in children in the United States. Median age at diagnosis is 16 years. ALL accounts for 74% of pediatric leukemia cases. Historically, patients with ALL were divided into three prognostic groups: good risk, intermediate risk, and poor risk.
In adults, ALL is less common than acute myeloid leukemia (AML). The American Cancer Society estimates that 6150 cases of ALL (adult and pediatric) will occur in the United States in 2020, resulting in 1520 deaths. The estimated 5-year survival is 68.6%. The favourable survival rate is due to the high cure rate of ALL in children. Prognosis declines with increasing age, and the median age at death is 56 years. Only 20-40% of adults with acute lymphoblastic leukemia (ALL) are cured with current treatment regimens.
The diagnosis, treatment and effects of Leukemia are addressed here in Part 2.
Author Sharespike
| 3 | | R155.00 |  |
| | Acute Leukemia Part 1 | Acute Leukemia Part 1
Overview There are various forms of acute Leukemia of which most of these are discussed in Parts 1 and 2 of this study. In Part 1 Acute Lymphoblastic Leukemia is disccused. This is a malignant (clonal) disease of the bone marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells of the marrow. A proposed mechanism for some cases of childhood ALL is a two-step process of genetic mutation and exposure to infection. In contrast, most adults with ALL have no identifiable risk factors.
Acute promyelocytic leukemia (APL) is a unique subtype of acute leukemia characterized by abnormal proliferation of promyelocytes, life-threatening coagulopathy, and the chromosome translocation. The discovery and elucidation of the molecular pathogenesis for APL has led to the introduction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) therapies, which improved the prognosis of APL patients significantly.
The diagnosis, treatment and effects of these types of Leukemia are addressed.
Author Sharespike
| 3 | | R155.00 |  |
| | 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 | | R135.00 |  |
| | 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 | | R135.00 |  |
| | 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
| 3 | | R135.00 |  |
| | 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 | | R135.00 |  |
| | 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 | | R135.00 |  |
| | The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial | The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial
The Effects of a Recollection-Based Occupational Therapy Program of Alzheimer’s Disease: A Randomized Controlled Trial
Overview: Considering the high socio-economic costs related to the increasing number of dementia patients and their poor quality of life and that of their families, it is important to identify the condition early on and provide an appropriate intervention. This study organized a recollection-based occupational therapy program: a nonpharmacological intervention consisting of five categories of activities (physical, horticultural, musical, art, and instrumental activity of daily living; IADL) and applied it to those having a mild stage of Alzheimer’s disease. The experimental group participated in a total of 24 sessions––five times per week for one hour per session––while the control group took part in regular activities offered by the existing facilities. The experimental group presented improved cognitive functions, reduced depression, and enhanced quality of life; the two groups showed a statistically significant difference in every category. This study is meaningful in that it made a cognitive stimulation program concerning five different categories, implemented it for people suffering mild dementia, and confirmed positive outcomes. If a systemic version of the program is offered in dementia care facilities, it is expected to make a considerable contribution to the care of dementia patients.
Acknowledgements: Authors: DeokJu Kim Journal: Occupational Therapy International
| 3 | | R130.00 |  |
| | 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)
| 3 | | R130.00 |  |
| | Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care | Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care
Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care
Overview: The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease has gripped the entire international community and caused widespread public health concerns. Despite global efforts to contain the disease spread, the outbreak is still on a rise because of the community spread pattern of this infection. This is a zoonotic infection, similar to other coronavirus infections, that is believed to have originated in bats and pangolins and later transmitted to humans. Once in the human body, this coronavirus (SARS-CoV-2) is abundantly present in nasopharyngeal and salivary secretions of affected patients, and its spread is predominantly thought to be respiratory droplet/contact in nature. Dental professionals, including endodontists, may encounter patients with suspected or confirmed SARS-CoV-2 infection and will have to act diligently not only to provide care but at the same time prevent nosocomial spread of infection. Thus, the aim of this article is to provide a brief overview of the epidemiology, symptoms, and routes of transmission of this novel infection. In addition, specific recommendations for dental practice are suggested for patient screening, infection control strategies, and patient management protocol. Acknowledgement
Authors: Amber Ather, BDS, DDS, Biraj Patel, BDS, Nikita B. Ruparel, MS, DDS, PhD, Anibal Diogenes, DDS, MS, PhD, and Kenneth M. Hargreaves, DDS, PhD
Journal: JOE – Journal of Endodontics
| 3 | | R130.00 |  |
| | 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 | | R135.00 |  |
| | 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 | | R135.00 |  |
| | 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 | | R135.00 |  |
| | 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
| 3 | | R135.00 |  |
| | 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 | | R135.00 |  |
| | Respiratory Stress Syndrome | Respiratory Stress Syndrome
Respiratory Stress 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 | | R135.00 |  |
| | Preeclampsia for EMS | Preeclampsia for EMS
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 | | R110.00 |  |
| | Medical Laboratory Phlebotomists Part 2 | Medical Laboratory Phlebotomists Part 2
Medical Laboratory Phlebotomists Part 2
Overview Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture to obtain a sample for analysis and diagnosis. Phlebotomy is also done as part of the patient's treatment for certain blood disorders. Phlebotomy that is part of treatment (therapeutic phlebotomy) is performed to treat polycythemia vera, a condition that causes an elevated red blood cell volume (haematocrit). Phlebotomy is also prescribed for patients with disorders that increase the amount of iron in their blood to dangerous levels, such as hemochromatosis, hepatitis B, and hepatitis C. Patients with pulmonary edema may undergo phlebotomy procedures to decrease their total blood volume. This course, Part 2 discusses Urinalysis, Body Fluids, Clinical Immunology, Professional Authority, Society Authorisation, Code of Ethics, Special Culture, Professional Organisations and Professionalism are discussed.
Sharespike
| 3 | | R110.00 |  |
| | Medical Laboratory Phlebotomists Part 1 | Medical Laboratory Phlebotomists Part 1
Medical Laboratory Phlebotomists Part 1
Overview
Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture to obtain a sample for analysis and diagnosis. Phlebotomy is also done as part of the patient's treatment for certain blood disorders. Phlebotomy is also used to remove blood from the body during blood donation and for analysis of the substances contained within it. Phlebotomy is performed by a nurse or a technician known as a phlebotomist. Blood is usually taken from a vein on the back of the hand or just below the elbow. Some blood tests, however, may require blood from an artery. Properly performed, phlebotomy does not carry the risk of mortality. It may cause temporary pain and bleeding, but these are usually easily managed. Phlebotomy is a necessary medical procedure and is required for a wide variety of other procedures. This course discusses such procedures in more detail and also Urinalysis and Microbiology as a matter of interest. In part 2 of this course Urinalysis, Body Fluids, Clinical Immunology, Professional Authority, Society Authorisation, Code of Ethics, Special Culture, Professional Organisations and Professionalism are discussed.
Authors Sharespike
| 3 | | R110.00 |  |
| | Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian Hospitals | Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian Hospitals
Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian Hospitals
Overview: This study aimed to evaluate the psychometric properties of the Indonesian version of the Care Dependency Scale (CDS) among stroke survivors.
The study was undertaken in four hospitals. We analysed datasets obtained from 109 stroke survivors on inpatient wards and in outpatient clinics, who were rated by nurses to determine the CDS reliability coefficients. The Cronbach’s a and Cohen’s kappa coefficients were applied. Concurrent validity was conducted for the data on care dependency, which were collected from 49 of these 109 participants on inpatient wards by nurses using the CDS and the Barthel Index. A Spearman’s rank correlation analysis was conducted to measure the association between the CDS and the Barthel Index results.
In conclusion, an analysis of the results of the CDS tested on the inpatient ward and in the out-patient clinic revealed a high level of internal consistency. A significant, moderate correlation was observed between the CDS and Barthel Index results. The CDS can be recommended for use as a tool for the assessment and evaluation of stroke survivors who are receiving acute or long-term care.
Authors: Nursiswati Nursiswati, Ruud J.G. Halfens, Christa Lohrmann Journal: International Journal of Nursing Sciences
| 3 | | R120.00 |  |
| | 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 | | R145.00 |  |
| | 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 | | R145.00 |  |
| | 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 | | R145.00 |  |
| | 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 | | R140.00 |  |
| | 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 | | R140.00 |  |
| | 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 | | R120.00 |  |
| | 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 | | R120.00 |  |
| | Catastrophe in Radiology: Considerations Beyond Common Emergencies | Catastrophe in Radiology: Considerations Beyond Common Emergencies
Catastrophe in Radiology: Considerations Beyond Common Emergencies
Overview Organizations around the world increasingly prepare for the “what ifs” of our environments. Regulating and certifying agencies mandate organizational plans for threat management to include risk factor identification, threat mitigation, prevention (when possible), response to, and recovery from the event.
Disasters often occur without warning and have the potential to affect large numbers of people. Those in the radiology environment experience unique effects on them, their equipment, and their ability to provide quality patient care. Lessons can be learned by reviewing events and their impact on imaging departments around the world. Radiology departments need to be actively involved in the disaster planning and the management of disasters when they occur. Common themes emerge regardless of the type of disaster, and these themes should be included in all planning.
Even with an ever-increasing amount of information available and regulations to comply with, radiology departments are still often excluded from a hospital's disaster management plan and drills. Often, it is not until an organization experiences a catastrophic event that the identification of a plan for radiology's role during a disaster comes to mind.
Authors Valerie Aarne Grossman Journal Journal of Radiology Nursing (2020)
| 3 | | R165.00 |  |
| | Status of Vaccination Against Hepatitis B Among Dental Assistants of Multan | Status of Vaccination Against Hepatitis B Among Dental Assistants of Multan
Status of Vaccination Against Hepatitis B Among Dental Assistants of Multan
Overview: Direct contact of dental health care workers (and doctors) with patients makes them prone to get infection with hepatitis B and other communicable disease. Dentists are profoundly at risk of getting infected from patient's saliva and blood. Stick Injuries with needle or other sharp instruments used during medical procedures and blood transfusion have the risk to transfer hepatitis B among the medicinal services specialists. It is important to prepare for safety measures to avoid cross infection with Hepatitis B.4 Dental assistants work closely with patients, under the guidance of a dental surgeon. It is an ethical duty of an employee to protect the patient and health care assistant from cross infection contamination.6 Immunization against Hepatitis B should be mandatory for every health care worker. The Objective of this study was to find out the status of vaccination against of Hepatitis B virus among dental assistants of Multan. It was concluded that lack of motivation was the main reason for not receiving vaccination. Self-reported rate of hepatitis B vaccination among Dental Assistants of Multan was low. Lack of motivation was the main impediment.
Authors: Mohsin Javaid, Muhammad Jamil, Mustafa Sajid
Journal: Javaid M, Jamil M, Sajid M. Status of vaccination against hepatitis B among dental assistants of multan. J Pak Dent Assoc 2020;29(1):42-45. DOI:
| 3 | | R125.00 |  |
| | The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective | The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
Overview Despite evidence demonstrating that medications for opioid use disorder (OUD) reduce morbidity and mortality, most patients do not receive treatment. The National Academies of Science call for more research exploring the patient’s perspective of treatment modalities to increase access to individualized, patient-centred care. The aim of this article is to build on existing literature by describing patient experiences treated for OUD in a rural family medicine setting. Participants’ experiences with OBOT were generally positive and shaped by societal structures and institutions, their life before treatment, their treatment history, and the kind of care they received in OBOT. Patients identified accessibility and privacy as advantages to receiving OBOT in primary care. This research identifies ways providers can provide individualized and effective OUD treatment within the family medicine setting.
Authors Claire Kane, BA, Catherine Leiner, Chase Harless, Kathleen A. Foley, E. Blake Fagan, and Courtenay Gilmore Wilson
Journal J Am Board Fam Med: first published as 10.3122/jabfm.2020.04.190389 on 16 July 2020
| 3 | | R130.00 |  |
| | 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 | | R130.00 |  |
| | Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors | Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors
Prevalence of SARS-CoV-2 infection in general practitioners and nurses in primary care and nursing homes in the Healthcare Area of León and associated factors
Overview To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centres and nursing homes in the Healthcare Area of León (Spain). The work centre, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.
Authors: V. Martín, T. Fernández-Villa, M. Lamuedra Gil de Gomez, O. Mencía-Ares, A. Rivero Rodríguez, S. Reguero Celada, M. Montoro Gómez, M.T. Nuevo Guisado, C. Villa Aller, C. Díez Flecha, A. Carvajal, J.P. Fernández Vázquez
Journal: Semergen. 2020;46(S1):42---46
| 3 | | R110.00 |  |
| | Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project | Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project
Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project
Overview Prevention of infectious diseases through immunisation of the growing ageing adult population is essential to improve healthy ageing. However, many licenced and recommended vaccines for this age group show signs of waning of the protective effect due to declining immune responses (immunosenescence) and decreasing vaccine uptake. Today’s major challenge is to improve vaccine effectiveness and uptake and to deploy efficient vaccination strategies for this age group. The Vaccines and Infectious diseases in the Ageing population (VITAL) project, with partners from 17 academic & research groups and public institutes as well as seven industry collaborators, aims to address this challenge. The ambition is to provide evidence-based knowledge to local decision makers. Using a holistic and multidisciplinary approach and novel analytical methods, VITAL will provide tools that allow the development of targeted immunisation programs for ageing adults in European countries. The project is based on four pillars focussing on the assessment of the burden of vaccine-preventable diseases in ageing adults, the dissection of the mechanisms underlying immuno-senescence, the analysis of the clinical and economic public health impact of vaccination strategies and the development of educational resources for healthcare professionals.
Authors Debbie Van Baarle, Kaatje Bollaerts, Giuseppe Del Giudice, Stephen Lockhart, Christine Luxemburger, Maarten J. Postma, Aura Timen, Baudouin Standaert
Journal Vaccine 38 (2020) 5896–5904 https://doi.org/10.1016/j.vaccine.2020.07.005
URL https://www.sciencedirect.com/science/article/pii/S0264410X20309051?via%3Dihub
| 3 | | R110.00 |  |
| | Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours | Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours
Ways in which healthcare interior environments are associated with perceived safety against infectious diseases and coping behaviours
Overview
Global pandemic outbreaks are a cause of fear. Healthcare workers (HCWs), especially those fighting the pathogens at the front line, are at higher risk of being infected while they treat patients. In addition, various environmental fomites in hospitals, which may carry infectious agents, can increase the risk of acquiring an infectious disease.
To deliver the best healthcare practice, it is critical that HCWs feel safe and protected against infectious diseases. The aim of this study was to improve understanding of HCWs’ hand hygiene (HH) behaviours and perceptions of infectious diseases from a psychological perspective.
This study found that an increase in the number of HH stations at convenient locations would increase HH compliance and perceived safety against infectious diseases among HCWs. In response to the current research gap in psychological aspects associated with HH, this study found that HCWs’ coping behaviours can be predicted by their perceived likelihood of contamination and perceived vulnerability.
Author S. Bae
Journal Journal of Hospital Infection 106 (2020) 107e114 https://doi.org/10.1016/j.jhin.2020.06.022
URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308774/pdf/main.pdf
| 3 | | R140.00 |  |
| | Probiotics and Protection of the Stomach | Probiotics and Protection of the Stomach
Probiotics and Protection of the Stomach
Overview Probiotics are living organisms and have beneficial effects when they colonize the body, assuming they can stay alive long enough to do so. Probiotic treatments are packed with bacteria, but once swallowed, their numbers are dramatically diminished by the stomach's acidity, lowering the chances of therapeutic effect. Probiotics can live or die under a variety of circumstances. One such circumstance is time. Some bacteria make spores which can live for many years and then blossom and grow. Most probiotics do not make spores, so they gradually die off if they do not find a comfortable place to grow, meaning a moist, warm friendly environment like the colon. Stomach acid is extraordinarily strong. It does and will kill most bacteria that get into the stomach each day. Antibiotics can also kill the bacteria in your body. So, how do you protect the probiotic bacteria you take, from this bacteria execution chamber which everyone has inside them?
Acknowledgements Du Pont Dinesco Capsugel R&D Team and Dr Keith Hutchison Elsevier – LWT Food Science and Technology
| 2 | | R0.00 |  |
| | Probiotics and Protection of the Stomach | Probiotics and Protection of the Stomach
Probiotics and Protection of the Stomach
Overview Probiotics are living organisms and have beneficial effects when they colonize the body, assuming they can stay alive long enough to do so. Probiotic treatments are packed with bacteria, but once swallowed, their numbers are dramatically diminished by the stomach's acidity, lowering the chances of therapeutic effect. Probiotics can live or die under a variety of circumstances. One such circumstance is time. Some bacteria make spores which can live for many years and then blossom and grow. Most probiotics do not make spores, so they gradually die off if they do not find a comfortable place to grow, meaning a moist, warm friendly environment like the colon. Stomach acid is extraordinarily strong. It does and will kill most bacteria that get into the stomach each day. Antibiotics can also kill the bacteria in your body. So, how do you protect the probiotic bacteria you take, from this bacteria execution chamber which everyone has inside them?
Acknowledgements Du Pont Dinesco Capsugel R&D Team and Dr Keith Hutchison Elsevier – LWT Food Science and Technology
| 2 | | R299.00 |  |
| | 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 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | 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, MD
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Trauma Part 2 | Clinical Practice Guidelines: Trauma Part 2
Clinical Practice Guidelines: Trauma Part 2
Overview “Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004). The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis. Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers. Acknowledgement Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | Clinical Practice Guidelines: Pain and Procedural Sedation | Clinical Practice Guidelines: Pain and Procedural Sedation
Clinical Practice Guidelines: Pain and Procedural Sedation
Overview “The management of acute traumatic pain is a crucial component of pre-hospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based protocols” (Gausche-Hill et al., 2014). Pain management is also frequently based on the assessment of need by a provider, rather than the requirements of patients. Historically only Entonox and morphine have been available for pre-hospital pain management in the local setting with the more recent introduction of ketamine. Availability of appropriate and effective treatment options, especially for non-ALS providers, remains a challenge. Situations requiring procedural sedation and analgesia in the pre-hospital setting are common and may range from alignment of fracture to extrication and complex disentanglement during medical rescue. Until recently South African pre-hospital providers did not have agents suitable for this purpose, particularly in the setting of severe trauma and hypotension. As ketamine has been introduced into some scopes of practice providing safe and effective dissociative procedural analgesia has become a possibility. However, the use of procedural sedation and analgesia is not without risks and, at this time, no uniform practice has been suggested in the South African pre-hospital setting. Acknowledgement Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 4 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 4
Clinical Practice Guidelines: Obstetrics and Gynecology Part 4
Overview There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice. Acknowledgement Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 3 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 3
Clinical Practice Guidelines: Obstetrics and Gynecology Part 3
Overview There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice. Acknowledgement Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Obstetrics and Gynaecology Part 2 | Clinical Practice Guidelines: Obstetrics and Gynaecology Part 2
Clinical Practice Guidelines: Obstetrics and Gynaecology Part 2
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018)
Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Obstetrics and Gynecology Part 1 | Clinical Practice Guidelines: Obstetrics and Gynecology Part 1
Clinical Practice Guidelines: Obstetrics and Gynecology Part 1
Overview
There were no evidence-based clinical practice guidelines addressing obstetric issues from a purely pre-hospital emergency services perspective. Despite this, there were many high-quality recommendations from in hospital and other types of health facilities (e.g. midwife run delivery units) which are directly applicable to pre-hospital management of obstetrics. The delivery and birth process will ideally not occur in the pre-hospital environment, but every practitioner needs to be able to manage a delivery and to intervene where necessary within the limits of their scope of practice. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Neonatal Resuscitation | Clinical Practice Guidelines: Neonatal Resuscitation
Clinical Practice Guidelines: Neonatal Resuscitation
Overview
Monitoring equipment for neonates and infants may not be uniformly available to all EMS providers. All ALS providers should have monitoring equipment appropriate for neonates. It is recommended that oximetry be used when resuscitation can be anticipated, when PPV is administered, when central cyanosis persists beyond the first 5 to 10 minutes of life, or when supplementary oxygen is administered. In summary, from the evidence reviewed in the 2010 CoSTR and subsequent review of delaying cord clamping and cord milking in preterm new-borns in the 2015 ILCOR systematic review, delaying cord clamping for longer than 30 seconds is reasonable for both term and preterm infants who do not require resuscitation at birth. It is recommended that the temperature of newly born non-asphyxiated infants be maintained between 36.5°C and 37.5°C after birth through admission and stabilisation. Targeted temperature management requires specific equipment and well established systems and protocol and system wide clinical governance. In neonates it may also require the establishment of dedicated, specialized and equipped retrieval teams.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Fever and Sepsis | Clinical Practice Guidelines: Fever and Sepsis
Clinical Practice Guidelines: Fever and Sepsis
Overview
Feverish illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. Despite advances in healthcare, infections remain a leading cause of death in children under the age of 5 years. Fever in young children can be a diagnostic challenge for healthcare professionals because it is often difficult to identify the cause. In most cases, the illness is due to a self-limiting viral infection. However, fever may also be the presenting feature of serious bacterial infections such as meningitis and pneumonia. A significant number of children have no obvious cause of fever despite careful assessment. These children with fever without apparent source are of concern to healthcare professionals because it is especially difficult to distinguish between simple viral illnesses and life-threatening bacterial infections in this group.
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies | Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Clinical Practice Guidelines: Cerebrovascular Accident (Stroke) and General Care in Emergencies
Overview
There is growing evidence that good early stroke management can reduce damage to the brain and minimise the effects of stroke. Because of this early recognition of stroke, the subsequent response of individuals to having a stroke, and the timing and method by which people are transferred to hospital are important to ensure optimal outcomes. In this hyperacute phase of care, the ambulance service provides a central, coordinating role (Australian Government Health and Medical Research Council, 2007). Appropriate diagnosis of stroke and immediate referral to a stroke team is vital given advances in hyperacute treatments (Australian Government Health and Medical Research Council, 2007).
As in all scene responses, EMS personnel must assess and manage the patient’s airway, breathing, and circulation. Most patients with acute ischemic stroke do not require emergency airway management or acute interventions for respiratory and circulatory support (Jauch et al., 2013).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Airway Part 2 | Clinical Practice Guidelines: Airway Part 2
Clinical Practice Guidelines: Airway Part 2
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008). Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Adult Resuscitation Part 3 | Clinical Practice Guidelines: Adult Resuscitation Part 3
Clinical Practice Guidelines: Adult Resuscitation Part 3
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 | | R110.00 |  |
| | Clinical Practice Guidelines: Adult Resuscitation Part 2 | Clinical Practice Guidelines: Adult Resuscitation Part 2
Clinical Practice Guidelines: Adult Resuscitation Part 2
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)
| 3 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | Clinical Practice Guidelines: Airway Part 1 | Clinical Practice Guidelines: Airway Part 1
Clinical Practice Guidelines: Airway Part 1
Overview
Oxygen is one of the most common medications administered during the care of patients who present with medical emergencies. At present, oxygen appears to be administered for three main indications in the emergency setting, of which only one is evidence-based (British Thoracic Society Emergency Oxygen Guideline Group, 2008). Firstly, oxygen is given to correct hypoxaemia as there is good evidence that severe hypoxaemia is harmful. Secondly, oxygen is administered to ill patients prophylactically to prevent hypoxaemia. Recent evidence suggests that this practice may place patients at increased risk of the development of hypoxaemia, reactive oxygen species, and absorption atelectasis amongst other adverse effects. Thirdly, a very high proportion of medical oxygen is administered because most clinicians believe that oxygen can alleviate breathlessness; however, there is no evidence that oxygen relieves breathlessness in non-hypoxemic patients (British Thoracic Society Emergency Oxygen Guideline Group, 2008).
Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | Clinical Practice Guidelines: Respiratory | Clinical Practice Guidelines: Respiratory
Clinical Practice Guidelines: Respiratory
Overview
Asthma is a common condition which produces a significant workload for general practice, hospital outpatient clinics and inpatient admissions. Much of this morbidity relates to poor management (British Thoracic Society, 2014). Chronic obstructive pulmonary disease (COPD) is a group of disorders characterised by airway inflammation and airflow limitation that is not fully reversible. COPD should be distinguished from asthma because it is a progressive, disabling disease with increasingly serious complications and exacerbations. The symptoms, signs and physiology of these conditions can overlap with asthma and differentiation can be difficult, particularly in middle-aged smokers presenting with breathlessness and cough. This difficulty is compounded by the fact that most COPD patients exhibit some degree of reversibility with bronchodilators. Patients with severe chronic asthma, chronic bronchiolitis, bronchiectasis and cystic fibrosis may also present with a similar clinical pattern and partially reversible airflow limitation (The Thoracic Society of Australia and New Zealand, 2002). Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Seizures | Clinical Practice Guidelines: Seizures
Clinical Practice Guidelines: Seizures
Overview
Paediatric and adult seizures are managed in essentially the same way, with the focus on identification, injury prevention, rapid termination and prevention of ongoing seizures; ongoing attention must be paid to reversal of the cause of the seizure. Important differences in children relate to febrile seizures (covered in section 3: Fever & Sepsis) and easily correctable causes such as hypoglycaemia. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Clinical Practice Guidelines: Trauma Part 1 | Clinical Practice Guidelines: Trauma Part 1
Clinical Practice Guidelines: Trauma Part 1
Overview
“Injury is an increasingly significant health problem throughout the world. Every day, 16 000 people die from injuries, and for every person who dies, several thousand more are injured, many of them with permanent sequelae. Injury accounts for 16% of the global burden of disease. The burden of death and disability from injury is especially notable in low- and middle-income countries. By far the greatest part of the total burden of injury, approximately 90%, occurs in such countries” (Mock et al., 2004). The focus of pre-hospital trauma management remains the rapid access and extrication of patients to allow for the rapid assessment and control of bleeding, the airway and ventilation. There is a renewed focus on the importance of rapid transport as the most important factor for trauma survival remains time to access of definitive care and operative haemostasis. Bleeding remains one of the most important contributors to traumatic death. The prevention of the trauma triad of death: hypothermia, acidosis and coagulopathy remain an important goal. Haemodilution and the role of pre-hospital fluid management has also received significant attention. Many well-developed trauma systems are moving towards restrictive fluid management regimes, specific haemodynamic targets and the introduction of pre-hospital initiation of blood product administration. The control and prevention of bleeding remains a central focus for pre-hospital providers. Acknowledgement
Journal: Clinical Practice Guidelines (July 2018) Publisher: Health Professions Council of South Africa
| 3 | | R110.00 |  |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pnViral Pneumonia Part 3eumonia (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 | | R110.00 |  |
| | 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 Brawerman
| 3 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | 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 | | R110.00 |  |
| | Hyperglycemia | Hyperglycemia
Overview:
Hyperglycemia (also spelled hyperglycaemia or hyperglycæmia), is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a blood sugar level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 13.9–16.7 mmol/l (~250–300 mg/dl). For diabetics, glucose levels that are too hyperglycemic can vary from person to person, mainly due to the person's renal threshold of glucose and overall glucose tolerance. Hypoglycemia, also known as low blood sugar, is a fall in blood sugar to levels below normal. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures or death. A feeling of hunger, sweating, shakiness and weakness may also be present. Symptoms typically come on quickly. The most common cause of hypoglycemia is medications used to treat diabetes mellitus such as insulin and sulfonylureas. Risk is greater in diabetics who have eaten less than usual, exercised more than usual or drunk alcohol. Other causes of hypoglycemia include kidney failure, certain tumours (such as insulinoma), liver disease, hypothyroidism, starvation, inborn error of metabolism, severe infections, reactive hypoglycemia and several drugs including alcohol. Low blood sugar may occur in otherwise healthy babies who have not eaten for a few hours.
Acknowledgements:
Author:
Jasvinder Chawla
| 3 | | R410.00 |  |
| | Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues | Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues
Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues
Overview The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia.
The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.
Authors: Suzanne Delwel, Tarik T. Binnekade, Roberto S. G. M. Perez, Cees M. P. M. Hertogh, Erik J. A. Scherder, Frank Lobbezoo Journal: Clinical Oral Investigations
| 3 | | R390.00 |  |
| | Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors | Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors
Quantification of Free-Living Community Mobility in Healthy Older Adults Using Wearable Sensors
Overview
Understanding determinants of community mobility disability is critical for developing interventions aimed at preventing or delaying disability in older adults. To understand these determinants, capturing and measuring community mobility has become a key factor. The objectives of this paper are to present and illustrate the signal processing workflow and outcomes that can be extracted from an activity and community mobility measurement approach based on GPS and accelerometer sensor data and 2) to explore the construct validity of the proposed measurement approach using data collected from healthy older adults in free-living conditions.
Wear ability and usability of the devices used to capture free-living community mobility impact participant compliance and the quality of the data. The construct validity of the proposed approach appears promising but requires further studies directed at populations with mobility impairments.
Acknowledgement
Author Patrick Boissy, Margaux Blamoutier, Simon Brière and Christian Duval Journal Frontiers in Public Health
| 3 | | R110.00 |  |
| | Human Milk Oligosaccharides: 20-Fucosyllactose (20-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula | Human Milk Oligosaccharides: 20-Fucosyllactose (20-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula
Human Milk Oligosaccharides: 20-Fucosyllactose (20-FL) and Lacto-N-Neotetraose (LNnT) in Infant Formula
Overview
The authors reviewed the published evidence on the presence of oligosaccharides in human milk (HMO) and their benefits in in vitro and in vivo studies. The amount of HMOs in mother’s milk is a dynamic process as it changes over time. Many factors, such as duration of lactation, environmental, and genetic factors, influence the number of HMOs.
The limited clinical data suggest that the addition of HMOs to infant formula seems to be safe and well tolerated, inducing a normal growth and suggesting a trend towards health benefits. HMOs are one of the major differences between cow’s milk and human milk, and available evidence indicates that these components do have a health promoting benefit. The addition of one or two of these components to infant formula is safe and brings infant formula closer to human milk. More prospective, randomized trials in infants are needed to evaluate the clinical benefit of supplementing infant formula with HMOs.
Acknowledgement
Author Yvan Vandenplas, Bernard Berger, Virgilio Paolo Carnielli, Janusz Ksiazyk , Hanna Lagström, Manuel Sanchez Luna, Natalia Migacheva, Jean-Marc Mosselman, Jean-Charles Picaud, Mike Possner, Atul Singhal and Martin Wabitsch
Journal Nutrients 2018, Volume 10 Issue 9 Publisher MDPI
| 3 | | R380.00 |  |
| | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy | Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy
Laser Angiography to Assess the Vaginal Cuff During Robotic Hysterectomy
Overview
Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiography to assess vaginal cuff perfusion during RATLH.
This was a pilot feasibility trial incorporating 20 women who underwent RATLH for benign disease. Colpotomy was made with ultrasonic or monopolar instruments, whereas barbed or non-barbed suture was used for cuff closure. Time of instrument activation during colpotomy was recorded. Images were captured of vaginal cuff perfusion before and after cuff closure. Reviewers evaluated these images and determined areas of adequate cuff perfusion.
Vaginal cuff dehiscence is a morbid, potentially fatal complication that can occur after total hysterectomy from any approach. During the 20th century, very few cases were reported, and 95% occurred after total abdominal or vaginal hysterectomy, before the advent of laparoscopic hysterectomy1
Acknowledgement
Authors Benjamin D. Beran, MD, Marie Shockley, MD, Pamela Frazzini Padilla, MD, Sara Farag, MD, Pedro Escobar, MD, Stephen Zimberg, MD, Michael L. Sprague, MD
Journal JSLS (Journal of the Society of Laparoendoscopic Surgeons) Volume 22 Issue 2
| 3 | | R460.00 |  |
| | 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 |  |
| | Offspring sex impacts DNA methylation and gene expression in placentae from women with diabetes during pregnancy | Offspring sex impacts DNA methylation and gene expression in placentae from women with diabetes during pregnancy
Offspring sex impacts DNA methylation and gene expression in placentae from women with diabetes during pregnancy
Overview
We hypothesized that diabetes during pregnancy (DDP) alters genome-wide DNA methylation in placenta resulting in differentially methylated loci of metabolically relevant genes and downstream changes in RNA and protein expression.
We mapped genome-wide DNA methylation with the Infinium 450K Human Methylation Bead Chip in term fetal placentae from Native American and Hispanic women with DDP using a nested case-control design. Placentae from female offspring were 40% more likely to have significant gains in DNA methylation compared with placentae from male offspring exposed to DDP (p<0.001). Changes in DNA methylation corresponded to changes in RNA and protein levels for 6 genes: PIWIL3, CYBA, GSTM1, GSTM5, KCNE1 and NXN. Differential DNA methylation was detected at loci related to mitochondrial function, DNA repair, inflammation, oxidative stress.
In conclusion, we explain mechanisms responsible for the increased risk for obesity and type 2 diabetes in offspring of mothers with DDP
Acknowledgement
Author Jacqueline Alexander, April M. Teague, Jing Chen, Christopher E. Aston, Yuet-Kin Leung, Steven Chernausek, Rebecca A. Simmons and Sara E. Pinney
Journal
PLoS One Volume 13 Issue 2
Publisher
Crossmark
| 3 | | R425.00 |  |
| | The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery | The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery
The EQ-5D-5L is a valid approach to measure health related quality of life in patients undergoing bariatric surgery
Overview
Bariatric surgery is considered an effective treatment for individuals with severe and complex obesity. Besides reducing weight and improving obesity related comorbidities such as diabetes, bariatric surgery could improve patients' health-related quality of life. However, the frequently used instrument to measure quality of life, the EQ-5D has not been validated for use in bariatric surgery, which is a major limitation to its use in this clinical context. Our study undertook a psychometric validation of the 5 level EQ-5D (EQ-5D-5L) using clinical trial data to measure health-related quality of life in patients with severe and complex obesity undergoing bariatric surgery.
The most common types of bariatric surgery are laparoscopic Roux-en-Y gastric bypass, adjustable gastric band surgery and laparoscopic sleeve gastrectomy, with each having its respective benefits and risks. The Roux-en-Y gastric bypass restricts the volume of food eaten by creating a small thumb-sized pouch from the upper stomach and a bypass of the remaining stomach. Bypass alters physiology and anatomy in such a way as to achieve early and generally rapid weight loss but carries risks of serious early morbidity [4, 5]. Longer-term complications include the need for re-operation because of the development of internal hernias or intestinal obstruction and nutritional deficiencies
Acknowledgement
Authors Jilles M. Fermont1, Jane M. Blazeby, Chris A. Rogers, Sarah Wordsworth, on behalf of the By-Band-Sleeve Study Management Group
Journal PLoS One
| 3 | | R460.00 |  |
| | Commensal bacteria produce GPCR ligands that mimic human signalling molecules | Commensal bacteria produce GPCR ligands that mimic human signalling molecules
Commensal bacteria produce GPCR ligands that mimic human signalling molecules
Overview
Commensal bacteria are believed to play important roles in human health. The mechanisms by which they affect mammalian physiology are poorly understood; however, bacterial metabolites are likely to be key components of host interactions. Here, we use bioinformatics and synthetic biology to mine the human microbiota for N-acyl amides that interact with G-protein-coupled receptors. GPR119 is most highly expressed in the pancreas and duodenum, S1PR4 in the spleen and lymph node, G2A in the lymph node and appendix, PTGIR in the lung and appendix and PTGER4 in the bone marrow and small intestine.
Commensal GPR119 agonists regulate metabolic hormones and glucose homeostasis as efficiently as human ligands although future studies are needed to define their potential physiologic role in humans. This work suggests that chemical mimicry of eukaryotic signaling molecules may be common among commensal bacteria and that manipulation of microbiota genes encoding metabolites that elicit host cellular responses represents a new small molecule therapeutic modality.
Acknowledgement
Author Louis J. Cohen, Daria Esterhazy, Seong-Hwan Kim, Christophe Lemetre, Rhiannon R. Aguilar, Emma A. Gordon, Amanda J. Pickard, Justin R. Cross, Ana B. Emiliano, Sun M. Han1, John Chu, Xavier Vila-Farres, Jeremy Kaplitt, Aneta Rogoz, Paula Y. Calle, Craig Hunter, J. Kipchirchir Bitok, and Sean F. Brady
Journal Nature
Publisher Department of Health & Human Services – USA
| 3 | | R395.00 |  |
| | 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 |  |
| | Role of viral and bacterial pathogens in causing pneumonia among Western Australian children | Role of viral and bacterial pathogens in causing pneumonia among Western Australian children
Role of viral and bacterial pathogens in causing pneumonia among Western Australian children
Overview
Pneumonia is the leading cause of childhood morbidity and mortality globally. Introduction of the conjugate Haemophilus influenzae B and multivalent pneumococcal vaccines in developed countries including Australia has significantly reduced the overall burden of bacterial pneumonia.
Many respiratory pathogens that are known to cause pneumonia are also identified in asymptomatic children, so the true contribution of these pathogens to childhood community-acquired pneumonia (CAP) remains unclear. We aim to determine the contribution of bacteria and viruses to childhood CAP to inform further development of effective diagnosis, treatment and preventive strategies.
Nasopharyngeal swabs are collected from both cases and controls to detect the presence of viruses and bacteria by PCR; pathogen load will be assessed by quantitative PCR. The prevalence of pathogens detected in cases and controls will be compared, the OR of detection and population attributable fraction to CAP for each pathogen will be determined; relationships between pathogen load and disease status and severity will be explored.
Acknowledgement
Authors Natalie Mejbah Uddin Bhuiyan, Thomas L Snelling, Rachel West, Jurissa Lang, Tasmina Rahman, Meredith L Borland, Ruth Thornton, Lea-Ann Kirkham, Chisha Sikazwe, Andrew C Martin, Peter C Richmond, David W Smith, Adam Jaffe, Christopher C Blyth.
Journal BMJ Open Publisher Cross Mark
| 3 | | R430.00 |  |
| | Ebolaviruses: New roles for old proteins | Ebolaviruses: New roles for old proteins
Ebolaviruses: New roles for old proteins
Overview
In 2014, the world witnessed the largest Ebolavirus outbreak in recorded history. The subsequent humanitarian effort spurred extensive research, significantly enhancing our understanding of ebolavirus replication and pathogenicity. The main functions of each ebolavirus protein have been studied extensively since the discovery of the virus in 1976; however, the recent expansion of ebolavirus research has led to the discovery of new protein functions. The international containment effort spurred extensive research that is enhancing.
These newly discovered roles are revealing new mechanisms of virus replication and pathogenicity, whilst enhancing our understanding of the broad functions of each ebolavirus viral protein (VP). Many of these new functions appear to be unrelated to the protein's primary function during virus replication. Such new functions range from bystander T-lymphocyte death caused by VP40-secreted exosomes to new roles for VP24 in viral particle formation. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity.
Acknowledgement Authors Diego Cantoni and Jeremy S. Rossman Journal PLoS Neglected Tropical Diseases Publisher Cross Mark
| 3 | | R420.00 |  |
| | Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism | Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism
Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism
Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism
Overview
Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough.
Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multi-disciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards.
It becomes essential to further scientific knowledge of the causes of maternal death. In such a way, it will be possible to improve the quality standards of care and avert many pregnancy-related deaths. It is well-known how age of the mother also plays a role in determining the likelihood of developing AFE.
Acknowledgements
Authors S. Zaami , E. Marinelli and G. Montanari Vergallo
Journal Clin Ter 2017 Volume 168 Issue 3
| 3 | | R455.00 |  |
| | Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial | Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Effects of Aerobic Exercise on Brain Metabolism and Grey Matter Volume in Older Adults: Results of the Randomised Controlled SMART Trial
Overview
There is mounting evidence that aerobic exercise has a positive effect on cognitive functions in older adults. The present study used magnetic resonance spectroscopy and quantitative MRI to systematically explore the effects of physical activity on human brain metabolism and grey matter (GM) volume in healthy aging. The main outcomes were the change in cerebral metabolism and its association to brain-derived neurotrophic factor (BDNF) levels as well as changes in GM volume. We found that cerebral choline concentrations remained stable after 12 weeks of aerobic exercise in the intervention group, whereas they increased in the waiting control group.
No effect of training was seen on cerebral N-acetylaspartate concentrations, nor on markers of neuronal energy reserve or BDNF levels. Further, we observed no change in cortical GM volume in response to aerobic exercise. The finding of stable choline concentrations in the intervention group over the 3 month period might indicate a neuro-protective effect of aerobic exercise. Choline might constitute a valid marker for an effect of aerobic exercise on cerebral metabolism in healthy aging.
Acknowledgement
S Matura, J Fleckenstein, R Deichmann, T Engeroff, E Füzéki, E Hattingen, R Hellweg, B Lienerth, U Pilatus, S Schwarz, VA Tesky, L Vogt, W Banzer and J Pantel.
Journal Nature Translational Psychiatry (2017) 7, e1172
Publisher Unknown Creative Commons, Open Access doi:10.1038/tp.2017.135
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538117/pdf/tp2017135a.pdf
| 3 | | R445.00 |  |
| | The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery | The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
The role of procalcitonin in the diagnosis of bacterial infection after major abdominal surgery
Overview
Postsurgical infections represent an important cause of morbidity after abdominal surgery. The microbiological diagnosis is not achieved in at least 30% of culture with consequent worsening of patient outcome. In this study, procalcitonin measurement, during the first 3 days after abdominal surgery, has been evaluated for the early diagnosis of postsurgical infection. Receiver operating characteristic (ROC) analysis was performed to define the diagnostic ability of PCT in case of post-surgical infections.
PCT values resulted significantly different between patients developing or not developing postsurgical infections. PCT >1.0ng/mL at first or second day after surgery and >0.5ng/mL at third day resulted diagnostic for infectious complication, whereas a value <0.5 ng/mL at the fifth day after surgery was useful for early and safety discharge of patients. In conclusion, PCT daily measurement could represent a useful diagnostic tool improving health care in the postsurgical period following major abdominal surgery and should be recommended.
Acknowledgement
Author Silvia Spoto, Emanuele Valeriani, Damiano Caputo, Eleonora Cella, Marta Fogolari, MDe, Elena Pesce, Maria Tea Mulè, Mariacristina Cartillone, Sebastiano Costantino, MDa, Giordano Dicuonzo, Roberto Coppola, Massimo Ciccozzi and Silvia Angeletti,
Journal Medicine (2018) Volume 97 Issue 3
Publisher Wolters Kluwer Health, Inc.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779742/pdf/medi-97-e9496.pdf
| 3 | | R455.00 |  |
| | Structure and assembly of the Ebola virus nucleocapsid | Structure and assembly of the Ebola virus nucleocapsid
Structure and assembly of the Ebola virus nucleocapsid
Structure and assembly of the Ebola virus nucleocapsid
Overview
Ebola and Marburg viruses are filoviruses: filamentous, enveloped viruses that cause haemorrhagic fever1. Filoviruses are within the order Mononegavirales2 which also includes rabies virus, measles virus, and respiratory syncytial virus. Mononegaviruses have non-segmented, single-stranded negative-sense RNA genomes that are encapsidated by nucleoprotein (NP) and other viral proteins to form a helical nucleocapsid (NC). NC acts as a scaffold for virus assembly and as a template for genome transcription and replication. Insights into NP-NP interactions have been derived from structural studies of oligomerized, RNA-encapsidating NP3–6 and cryo-electron microscopy (cryo-EM) of NC7–12 or NC-like structures11–13. There have been no high-resolution reconstructions of complete mononegavirus NCs.
Here, we have applied cryo-electron tomography and sub-tomogram averaging to determine the structure of Ebola virus NC within intact viruses and recombinant NC-like assemblies. These structures reveal the identity and arrangement of the NC components, and suggest that the formation of an extended alpha-helix from the disordered C-terminal region of NP-core links NP oligomerization, NC condensation, RNA encapsidation, and accessory protein recruitment. Acknowledgement
Author William Wan, Larissa Kolesnikova, Mairi Clarke, Alexander Koehler, Takeshi Noda, Stephan Becker and John A. G. Briggs.
Journal Nature. 2017 November 16; 551(7680-397)
Publisher URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714281/pdf/emss-74396.pdf
| 3 | | R455.00 |  |
| | Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening | Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening Overview
The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening.
During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.
Acknowledgement
Authors Philomena Raftery, Orla Condell, Christine Wasunna, Jonathan Kpaka, Ruth Zwizwai, Mahmood Nuha, Mosoka Fallah, Maxwell Freeman, Victoria Harris, Mark Miller, April Baller, Moses Massaquoi, Victoria Katawera, John Saindon, Philip Bemah, Esther Hamblion, Evelyn Castle, Desmond Williams, Alex Gasasira, Tolbert Nyenswah.
Journal PLoS Neglected Tropical Diseases Volume 12 Issue 1
Publisher
Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755746/pdf/pntd.0006135.pdf
| 3 | | R465.00 |  |
| | Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study: | Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study:
Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study:
Gabapentin, opioids, and the risk of opioid related death: A population-based nested case control study:
Overview
Prescription opioid use is highly associated with risk of opioid-related death, with 1 of every 550 chronic opioid users dying within approximately 2.5 years of their first opioid prescription. Although gabapentin is widely perceived as safe, drug-induced respiratory depression has been described when gabapentin is used alone or in combination with other medications.
However, no published studies have examined whether concomitant gabapentin therapy is associated with an increased risk of accidental opioid related death in patients receiving opioids. The objective of this study was to investigate whether co-prescription of opioids and gabapentin is associated with an increased risk of accidental opioid-related mortality. We conducted a population-based nested case-control study among opioid users who were residents of Ontario, Canada.
In this study we found that among patients receiving prescription opioids, concomitant treatment with gabapentin was associated with a substantial increase in the risk of opioid-related death. Clinicians should consider carefully whether to continue prescribing this combination of products and, when the combination is deemed necessary, should closely monitor their patients and adjust opioid dose accordingly. Future research should investigate whether a similar interaction exists between pregabalin and opioids.
Acknowledgement
Author Tara Gomes, David N. Juurlink, Tony Antoniou, Muhammad M. Mamdani, J. Michael Paterson and Wim van den Brink.
Journal PLoS Medicine Volume 14 Issue 10
Publisher Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626029/pdf/pmed.1002396.pdf
| 3 | | R470.00 |  |
| | Apoptosis-related microRNA-145-5p enhances the effects of pheophorbide a-based photodynamic therapy in oral cancer. | Apoptosis-related microRNA-145-5p enhances the effects of pheophorbide a-based photodynamic therapy in oral cancer.
Apoptosis-related microRNA-145-5p enhances the effects of pheophorbide a-based photodynamic therapy in oral cancer.
Overview
MicroRNAs (miRNAs) regulate key biological processes, and their aberrant expression has been related to cancer development. Photodynamic therapy (PDT) has emerged as one of the most promising modalities for cancer treatment. However, the application of PDT has been limited to superficially localized human cancerous and precancerous lesions. To increase the usefulness of both PDT and miRNAs in cancer therapy, this study investigated whether apoptosis-related miRNA expression is influenced by PDT in oral cancer and whether miRNAs can enhance PDT efficacy.
To achieve this goal, we performed a miRNA array-based comparison of apoptosis-related miRNA expression patterns following PDT using pheophorbide a (Pa) as a photosensitizer. After Pa-PDT, 13.1% of the miRNAs were down-regulated, and 16.7% of the miRNAs were up-regulated. Representative miRNAs were selected according to expression difference: miR-9-5p, miR-32-5p, miR-143-3p, miR-145-5p, miR-192-5p, miR- 193a-5p, miR-204-5p, miR-212-3p, miR-338-3p, and miR-451a. Among them, only miR- 145-5p showed the consistent reduction repeatedly in all cell lines after Pa-PDT. Further, the combined treatment of a miR-145-5p mimic and Pa-PDT increased phototoxicity, reactive oxygen species generation, and apoptotic cell death, suggesting that miRNAs expression could be a useful marker for enhancing the therapeutic effect of Pa-PDT. This study will provide a promising strategy for introducing miRNA as cancer therapy.
Acknowledgement
Author: Sook Moon, Do Kyeong, Jin Kim
Journal: Oncotarge
Publisher: Advance publications 2017
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471045/pdf/oncotarget-08-35184.pdf
| 3 | | R350.00 |  |
| | Postoperative Pain in Children After Dentistry Under General Anesthesia. | Postoperative Pain in Children After Dentistry Under General Anesthesia.
Postoperative Pain in Children After Dentistry Under General Anesthesia.
Overview
The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use.
The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R = 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005).
In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics. Acknowledgement
Author: Wong M, Copp PE, Haas DA
Journal: Anesthesia progress
Publisher: American Dental Society of Anesthesiology
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675339/pdf/i0003-3006-62-4-140.pdf
| 3 | | R450.00 |  |
| | Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications. | Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.
Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.
Overview
Concerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation. Acknowledgement
Author: Vassalini M, Verzeletti A, De Ferrari F
Journal: Monaldi archives for chest disease
Publisher: PIME Editrice
http://www.monaldi-archives.org/index.php/macd/article/view/25/728
| 3 | | R430.00 |  |
| | 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 |  |
| | A client-centred ADL intervention: three-month follow-up of a randomized controlled trial. | A client-centred ADL intervention: three-month follow-up of a randomized controlled trial.
A client-centred ADL intervention: three-month follow-up of a randomized controlled trial.
Overview
Stroke has proven to cause restrictions in everyday lives of both those suffering from stroke and the significant others taking care of the stroke patients. The aim of this study was therefore to study a client-centred activities of daily living (ADL) intervention (CADL) compared with the usual ADL intervention (UADL) in people with stroke.
The variables that were taken into consideration included independence in ADL, perceived participation, life satisfaction, use of home-help service, and satisfaction with training and, in their significant others, regarding: caregiver burden, life satisfaction, and informal care. During the study, 16 rehabilitation units were randomly assigned or chosen to deliver CADL or UADL.
The study was conducted on stroke patients who had been treated in the stoke units about three months after stroke. It is worth noting that the chosen patients were all independent and had not been diagnosed of dementia. Thus, they were fully able to understand instructions. Findings from this study revealed that at three months, there was no difference in the outcomes between the CADL group and the UADL group or their significant others.
ACKNOWLEDGEMENT
AUTHORS: Ann-Sofie Bertilsson1, Maria Ranner1 Lena Von Koch1 Gunilla Eriksson, Ulla Johansson, Charlotte Ytterberg, Susanne Guidetti and Kerstin Tham JOURNAL: Taylor & Francis online URL: http://www.tandfonline.com/
| 3 | | R89.00 |  |
| | A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority. | A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority.
A survey on self-assessed well-being in a cohort of chronic locked-in syndrome patients: happy majority, miserable minority.
OVERVIEW
Locked-in syndrome (LIS) is defined by quadriplegia and aphonia with a primary mode of communication by either eye movements or blinking. LIS is often caused by an acute (vascular) anterior pontine brainstem lesion. However, locked-in syndrome (LIS) also consists of anarthria and quadriplegia while consciousness is preserved.
With appropriate medical care, patients can nevertheless survive for decades. This study therefore aimed at exploring self-reported quality of life in chronic LIS patients. During the research, 168 LIS members of the French Association for LIS were invited to answer a questionnaire on medical history, status and end-of-life issues. These members however, self-assessed their global subjective well-being with the Anamnestic Comparative Self-Assessment (ACSA) scale, whose +5 and _5 anchors were their memories of the best period in their life before LIS and their worst period ever, respectively.
The data for this study stressed the need for extra palliative efforts directed at mobility and recreational activities in LIS and the importance of anxiolytic therapy.
ACKNOWLEDGEMENT
AUTHORS: Marie-Aure´ lie Bruno, Jan L Bernheim, Didier Ledoux, Fre´de´ ric Pellas, Athena Demertzi, Steven Laureys JOURNAL: Neurology Research PUBLISHER: BMJ Open URL: http://bmjopen.bmj.com
| 3 | | R89.00 |  |
| | Early Administration of Epinephrine (Adrenaline) in Patients with Cardiac Arrest. | Early Administration of Epinephrine (Adrenaline) in Patients with Cardiac Arrest.
Early Administration of Epinephrine (Adrenaline) in Patients with Cardiac Arrest.
Overview
For many decades, Epinephrine (adrenaline) has been used in resuscitation after cardiac arrest. However, the provisions of epinephrine is currently suggested by both the American Heart Association (AHA) and the European Resuscitation Council (ERC) in both shockable and non-shockable rhythms.
This study therefore had two objectives which included evaluating whether patients who experience cardiac arrest in hospitals receive epinephrine (adrenaline) within the two minutes after the first defibrillation as well as to evaluate the association between early administration of epinephrine and outcomes in this population. The data for this study was obtained from more than 300 hospitals in the United States. Participants for this study were adults in hospitals who experienced cardiac arrest with an initial shockable rhythm. These 2978 participants were also patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation.
The study was concluded that half of patients with a persistent shockable rhythm received epinephrine within two minutes after the first defibrillation, contrary to current American Heart Association guidelines.
ACKNOWLEDGEMENT
AUTHORS: Lars W Andersen, Tobias Kurth, Maureen Chase, Katherine M Berg, Michael N Cocchi, Clifton Callaway, Michael W Donnino JOURNAL: BMJ Open PUBLISHER: The BMJ Group URL: http://www.bmj.com
| 3 | | R89.00 |  |
| | Effect of Knowledge about Hypertension on the control of High Blood Pressure. | Effect of Knowledge about Hypertension on the control of High Blood Pressure.
Effect of Knowledge about Hypertension on the control of High Blood Pressure.
OVERVIEW
High blood pressure (HIP) is a major cause of both chronic diseases and death. More so, it is estimated that HT is responsible for 45% of deaths due to heart diseases and 51% of deaths due to stroke.
The aim of this study was to search the effect of knowledge about hypertension and socio-demographic characteristics on controlling high blood pressure levels among patients diagnosed with hypertension. The population for this cross-sectional study was obtained from 850 subjects diagnosed with hypertension and applied to primary health care centres in Yozgat province centre, in 2013. The data for this research was collected via 15-item hypertension knowledge questionnaire and personal information survey prepared in accordance with the literature.
The results of this study indicated that the effects of other socio-demographic parameters on the knowledge level were not significant even after multivariate analysis. Also, majority of the subjects had inadequate knowledge about hypertension, two third of the subjects did not imply significant life style modification for hypertension.
ACKNOWLEDGEMENT
AUTHORS: Mahmut Kilic, Tugba Uzunçakmak, Huseyin Ede JOURNAL: International Journal of the Cardiovascular Academy PUBLISHER: Elsevier URL: https://www.elsevier.com
| 3 | | R89.00 |  |
| | Estimating the Risk of Chronic Pain. | Estimating the Risk of Chronic Pain.
Estimating the Risk of Chronic Pain.
OVERVIEW Low back pain (LBP) is a dangerous condition which is equally a major global health problem. As a matter of fact, LBP, compared to all other diseases and health conditions, is responsible for the most years lived with disability.
This study thus aims at investigating the appropriate interventions that could be a promising approach to prevent the onset of chronic LBP. This research also sought to investigate the prognostic models that are available to accurately predict the onset of chronic LBP. In other words, the primary objective of this study was to develop and validate a prognostic model to estimate the risk of chronic LBP.
The hypothesis of this study was that the most problematic type of LBP is chronic LBP which has a poor prognosis and it’s costly, with interventions which are only moderately effective. Data for this research was collected from 2,758 patients with acute LBP. These patients were attending primary care in Australia between 5 November 2003 and 15 July 2005. The study was concluded that acute LBP may be a useful tool for estimating risk of chronic LBP.
ACKNOWLEDGEMENT
AUTHORS: Adrian C. Traeger, Nicholas Henschke, Markus Hübscher, Christopher M. Williams, Steven J. Kamper, Christopher G. Maher, G. Lorimer Moseley, James H. McAuley JOURNAL: PLOS Medicine PUBLISHER: PLOS Library of Science URL: https://www.plos.org
| 3 | | R89.00 |  |
| | Exploring Areas of Consensus and Conflict Around Values Underpinning Public Involvement in Health and Social Care Research. | Exploring Areas of Consensus and Conflict Around Values Underpinning Public Involvement in Health and Social Care Research.
Exploring Areas of Consensus and Conflict Around Values Underpinning Public Involvement in Health and Social Care Research.
OVERVIEW Presently, there is a growing interest internationally in the potential benefits of public involvement (PI) in health as well as in social care research. However, there has been little examination of values underpinning PI or how these values might differ for different groups with an interest in PI in the research process.
The aim of this study was to explore areas of consensus and conflict around normative, substantive and process-related values underpinning PI. The setting of this research was the UK health and social care community. The participants of this study were therefore stake holders in PI research, members of the public research managers, commissioners as well as funders. All the participants of this study were identified through research networks, online searches and a literature review.
Results of the study revealed that high levels of consensus for many normative, substantive and process-related issues were identified. The results equally indicated that there were also areas of conflict in relation to issues of bias and representativeness, and around whether the purpose of PI in health and social care research is to bring about service change or generate new knowledge.
ACKNOWLEDGEMENT
AUTHORS: D Snape, J Kirkham, J Preston, J Popay, N Britten, M Collins, K Froggatt, A Gibson, F Lobban, K Wyatt, A Jacoby JOURNAL: BMJ open PUBLISHER: BMJ Group URL: http://www. group.bmj.com
| 3 | | R89.00 |  |
| | Exposure to air pollution and meteorological factors associated with children’s primary care visits at night due to asthma attack. | Exposure to air pollution and meteorological factors associated with children’s primary care visits at night due to asthma attack.
Exposure to air pollution and meteorological factors associated with children’s primary care visits at night due to asthma attack.
OVERVIEW The Exposure to ambient air pollutants such as particulate matter (PM), ozone and nitrogen dioxide (NO2) is associated with many adverse health outcomes. Such health outcomes range from increased symptoms of allergic airway disease to increased mortality. It has been researched that children are susceptible to air pollution and meteorological factors because their lungs are still growing and their immune and pulmonary systems are developing.
The objective of this study was to examine the association of outdoor air pollution and meteorological parameters with primary care visits (PCVs) at night due to asthma attack. This study took place in a primary care clinic in Himeji City, Japan and the participants were 1447 children aged0–14 years. The participants were children who had visited the clinic with an asthma attack from April 2010 until March 2013. During the study, daily concentrations of air pollutants and meteorological parameters were measured.
The primary outcome of this research were PCVs at night due to asthma attack. The findings of this study nevertheless supported an association between ozone and PCVs and suggest that certain meteorological items may be associated with PCVs.
ACKNOWLEDGEMENT
AUTHORS: Seyed Alireza Derakhshanrad, Emily Piven, Seyed Ali Hosseini Farahnaz Mohammadi Shahboulaghi, Homer Nazeran & Mehdi Rassafiani JOURNAL: BMJ Open PUBLISHER: BMJ Open Group URL: http://www.group.bmj.com
| 3 | | R89.00 |  |
| | Interventions to prevent or reduce the level of frailty in community-dwelling older adults. | Interventions to prevent or reduce the level of frailty in community-dwelling older adults.
Interventions to prevent or reduce the level of frailty in community-dwelling older adults.
OVERVIEW
The population of most countries of the world is aging with older. Older people are however more vulnerable to poor health outcomes and are less able to recover from an acute stress because of physiological changes, that is, declines in muscle mass and kidney, lung and cardiovascular organ functioning.
The aim of this study was therefore to address this gap by reviewing interventions and international polices that are designed to prevent or reduce the level of frailty in community-dwelling older adults. During this research, a scoping review was conducted using the updated guidelines of Arksey and O’Malley to systematically search the peer-reviewed journal articles to identify interventions that aimed to prevent or reduce the level of frailty. The scoping review however used robust methodology to search for available interventions focused on preventing or reducing the level of frailty in community-dwelling older adults.
This review nonetheless identified gaps in research and provided healthcare providers and policy makers with an overview of interventions that can be implemented to prevent or postpone frailty.
ACKNOWLEDGEMENT
AUTHORS: Martine T E Puts, Samar Toubasi, Esther Atkinson, Ana Patricia Ayala, Melissa Andrew, Maureen C Ashe, Howard Bergman, Jenny Ploeg, Katherine S McGilton JOURNAL: BMJ Innovations PUBLISHER: BMJ Group URL: http://bmjopen.bmj.com
| 3 | | R89.00 |  |
| | Pediatric Prehospital Medication Dosing Errors. | Pediatric Prehospital Medication Dosing Errors.
Pediatric Prehospital Medication Dosing Errors.
Overview
Prehospital dosing errors are increasingly becoming very rampant in most parts of the world. For instance, in the USA, approximately 56,000 children are affected by prehospital dosing each year. For these errors to be reduced drastically, the barriers, enablers as well as solutions from the paramedic (EMT-P) and medical director (MD) standpoint need to be understood. This study was therefore designed with the objective to investigate the drug dose delivery process, barriers and enablers to correct dosing and possible solutions to decrease errors. This study was conducted in Michigan through a mixed method of EMT-P and MDs made great use of focus groups. The participations were 35 EMT-P and 9 MDs. It is worth mentioning that the participants ranged from those who had not administered a drug dose to a child over the last 12 months to those who had been practicing for more than 10 years as well as those who had practiced for less than 1 year. By the end of the studies, barriers and potential solutions to reducing prehospital pediatric dose errors were identified.
ACKNOWLEDGEMENT
AUTHORS: John D. Hoyle, Jr., MD, Deborah Sleight, PhD, Rebecca Henry, PhD, Todd Chassee, MD, Bill Fales, MD, Brian Mavis, PhD JOURNAL: Prehospital Emergency Care PUBLISHERS: Tylor & Francis Group URL: http://dx.doi.org/10.3109/10903127.2015.1061625
| 3 | | R89.00 |  |
| | Peptic Ulcers | Peptic Ulcers
OVERVIEW
Peptic Ulcers are a common disease characterised by injuries of the gastrointestinal mucosa of the stomach or duodenum. The enzyme pepsin and gastric acid are factors involved in the pathogenesis of ulcers.
The most important risk factors for the development of peptic ulcers are infection with Helicobacter Pylori and the use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). If neither of these factors is present, an alternative aetiology must be sought, such as hypersecretory states (e.g. Zollinger-Ellison syndrome) or one of the other less common causes of ulcer disease, including Crohn's disease, vascular insufficiency, viral infection, radiation therapy, and cancer chemotherapy.
This study looks at the common causes and what medicine to treat with.
| 3 | | R325.00 |  |
| | 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 |  |
| | Prehospital Nitro-glycerin Safety in Inferior ST Elevation Myocardial Infarcation. | Prehospital Nitro-glycerin Safety in Inferior ST Elevation Myocardial Infarcation.
Prehospital Nitro-glycerin Safety in Inferior ST Elevation Myocardial Infarcation.
Overview
Patients with inferior ST elevation myocardial infarction also known as STEMI, are known to be more prone to developing hypertension once they are administered nitro-glycerin (NTG). Nonetheless, the current basic protocols of life support do not actually differentiate the location of STEMI before the administration of NGT.
The objective of this study was therefore to determine if the administration of NGT is much more likely to be associated with hypertension in inferior STEMI as compared to non-inferior STEMI. During the study, a retrospective chart review was conducted on prehospital patients with chest pain that is suspected to be of cardiac origin as well as computer-interpreted prehospital ECGs indicating “ACUTE MI.”. More so, a univariate analysis was used to compare the differences in hypertension proportions and a drop in systolic blood pressure between patients with inferior wall STEMI and those with non-inferior wall STEMI after the administration of nitro-glycerin.
During the study which lasted for 29 months, 1466 cases of STEMI were identified. Results from the findings nevertheless revealed that NTG administration to patients with chest pain and inferior STEMI on their computer-interpreted electrocardiogram is not associated with a higher rate of hypotension compared to patients with STEMI in other territories.
ACKNOWLEDGEMENT
AUTHORS: Laurie Robichaud, MDCM, Dave Ross, MD, Marie-Hélène Proulx, PCP, MSc, Sébastien Légarè,PCP, Charlene Vacon, AEMT-CC, PhD, Xiaoqing Xue, MSc, Eli Segal, MD, FRCP, CSPQ, FACEP JOURNAL: Prehospital Emergency Care PUBLISHERS: Tylor & Francis Group URL: http://dx.doi.org/10.3109/10903127.2015.1037480
| 3 | | R89.00 |  |
| | Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients. | Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients.
Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients.
OVERVIEW
Violent and agitated patients pose a serious challenge for emergency medical services (EMS) personnel. Rapid control of these patients is paramount to successful prehospital evaluation also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS), is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population.
We reviewed paramedic run sheets from five different areas in suburban Florida communities. 52 patients were identified as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. 26 of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine.
Records demonstrated that almost all patients (50/52) were rapidly sedated except for three patients no negative side effects were noted.
ACKNOWLEDGEMENT
AUTHORS: Kenneth A. Scheppke, MD, Joao Braghiroli, MD, Mostafa Shalaby, MD, Robert Chait, MD
JOURNAL: Western Journal of Emergency Medicine Volume XV, NO. 7: November 2014 PUBLISHER: WestJEM https://westjem.com
| 3 | | R89.00 |  |
| | 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 |  |
| | State of emergency medicine in South Africa. | State of emergency medicine in South Africa.
State of emergency medicine in South Africa.
OVERVIEW
Emergency medicine is a new speciality in South Africa. It was first registered in 2003, and there are now 30 specialists in the country, with 10 new graduates from local registrar training programmes and over 40 trainees on four programmes across the country. This article discusses the current structure of emergency care in South Africa.
South Africa is a young democracy. After decades of forced segregation, in 1994 the country abandoned the rule of apartheid and entered a new phase. High levels of poverty and unemployment contribute to an ever-increasing burden of disease.
South Africa faces a quadruple disease burden: violence, HIV/AIDS, infectious diseases and chronic diseases of lifestyle all take their toll, reducing the average life expectancy to 49 years for males and 52 for females [3]. Approximately one third of admissions to emergency centres (EC) in South Africa are due to injuries; in comparison, trauma makes up 12% of admissions in the US and about 8% in the UK [4].
ACKNOWLEDGEMENT
AUTHOR: F Jewkes
JOURNAL: Archives of Disease in Childhood
PUBLISHER: Elsevier https:// www.elsevier.com
| 3 | | R89.00 |  |
| | Use of Nalozone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts. | Use of Nalozone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.
Use of Nalozone by Emergency Medical Services during Opioid Drug Overdose Resuscitation Efforts.
Overview
One major component of resuscitation attempts by emergency medical services (EMS) for opioid drug overdoses is the administration of Naloxone. Nonetheless, it is imperative for EMS providers to first of all recognize the possibilities of an over dose of opioid in clinical encounters.
This study was a part of public health response to outbreak of opioid overdoses in Rhode Island. During this study, the researchers examined missed opportunities for naloxone administration and factors potentially influencing EMS providers’ decision to administer naloxone. Medical examiner files of people who had died because of an opioid related drug overdose between January 2012 and March 2014 at Rhode Island were reviewed. It was also evaluated whether these individuals received naloxone as part of their resuscitation efforts. More so, patients and scene characteristics of those who received naloxone and those who did not receive were compared chi-square, t-test and logistic regression analyses.
Findings from this study revealed that Women, older individuals, and those patients without clear signs of illicit drug abuse, were less likely to receive naloxone in EMS resuscitation attempts.
ACKNOWLEDGEMENT
AUTHORS: Steven Allan Sumner MD, Melissa C. Mercado-Crespo PhD, M. Bridget Spelke, Leonard Paulozzi MD, David E. Sugerman MD, Susan D. Hillis PhD & Christina Stanley MD JOURNAL: Prehospital Emergency Care PUBLISHERS: Taylor and Francis Online URL: http://dx.doi.org/10.3109/10903127.2015.1076096
| 3 | | R89.00 |  |
| | Women's Health: Endometriosis. | Women's Health: Endometriosis.
Women's Health: Endometriosis.
OVERVIEW
Endometriosis is an often very painful female reproductive disorder that is on the rise in Western countries. It is estimated to affect between seven and 10 percent of all women in the general population.
Endometriosis is a female reproductive disorder which affects the lining of the uterus, otherwise known as the endometrium.[1] This oestrogen-dependent disorder is defined by the presence of endometrial tissue outside of the uterus and becomes apparent after the start of menses.[2]
Did you know that a number of primary musculoskeletal impairments can manifest as pelvic pain? It is therefore important to be aware of the common signs and symptoms of endometriosis presents, especially those which masks as musculoskeletal. Then, once the diagnosis of endometriosis has been made, there is much the physiotherapist can do to assist the patient to deal with the disease. This comprehensive course will provide you with a clear understanding of the disease and the role you can play both in its diagnosis and treatment.
| 3 | | R89.00 |  |