 | | The Effect of Exercise Training on Blood Lipids: A systematic review | The Effect of Exercise Training on Blood Lipids: A systematic review
The Effect of Exercise Training on Blood Lipids: A systematic review
Summary: The Effect of Exercise Training on Blood Lipids
Exercise training (ExTr) improves lipid markers such as total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and very low-density lipoprotein (VLDL). A systematic review and meta-analysis of 148 randomized controlled trials (RCTs) showed significant but modest improvements in these lipid markers with aerobic (AT), resistance (RT), and combined training (CT). The study found CT to be optimal for managing dyslipidemia. Meta-regression indicated that each additional weekly aerobic session and minute of training further improved TC and HDL levels. The analysis confirmed sufficient data to support the benefits of ExTr on lipid profiles.
Journal: Sports Medicine 2024
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| | HIV and Aids Part 2 | HIV and Aids Part 2
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. All patients who are diagnosed with HIV should be initiated on ART as soon as possible.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome).
Exceptions to this include patients presenting with cryptococcal meningitis (CM) or central nervous system tuberculosis (tuberculous meningitis (TBM) or tuberculoma).
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| | HIV and Aids Part 1 | HIV and Aids Part 1
Overview
HIV (Human Immunodeficiency Virus) is a virus transmitted through sexual contact, shared needles, and from mother to child during childbirth or breastfeeding. It belongs to the Retroviridae family. Symptoms vary depending on the stage of infection and these include: - Acute stage, which resembles the flu, with fever, malaise, and a generalized rash;
- Asymptomatic stage which generally, has no symptoms.
- Lymphadenopathy, which presents with swelling of lymph nodes, which can be a primary symptom.
- AIDs, which is the advanced stage marked by severe infections or cancers.
HIV can also lead to complications like dementia and chronic diarrhea with weight loss (HIV wasting syndrome).
Sharespike Knowledge Studio | 3 | | R485.00 | |
| | Ebola Virus Infection | Ebola Virus Infection
Overview
Ebola virus is one of at least 30 known viruses capable of causing viral hemorrhagic fever syndrome. The genus Ebolavirus currently is classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo ebolavirus. The outbreak of Ebola virus disease in West Africa from 2014 to 2016, involving Zaire ebolavirus, was the largest outbreak of Ebola virus disease in history.
As of September 17, 2019, an active outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) had resulted in 3,034 confirmed and 111 probable cases of Ebola virus disease, including 2,103 attributable deaths. An experimental vaccine has been credited with limiting the outbreak’s scope.
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| | Pre-hospital Endotracheal Intubation in Severe Traumatic Brain Injury: Ventilation Targets and Mortality—a Retrospective Study of 308 Patients | Pre-hospital Endotracheal Intubation in Severe Traumatic Brain Injury: Ventilation Targets and Mortality—a Retrospective Study of 308 Patients
Pre-hospital Endotracheal Intubation in Severe Traumatic Brain Injury: Ventilation Targets and Mortality—a Retrospective Study of 308 Patients
Overview Traumatic brain injury (TBI) remains one of the main causes of mortality and long-term disability worldwide. Maintaining physiology of brain tissue to the greatest extent possible through optimal management of blood pressure, airway, ventilation, and oxygenation, improves patient outcome. We studied the quality of prehospital care in severe TBI patients by analysing adherence to recommended target ranges for ventilation and blood pressure, prehospital time expenditure, and their effect on mortality, as well as quality of prehospital ventilation assessed by arterial partial pressure of CO2 (PaCO2) at hospital admission. Normocapnia at hospital admission was strongly associated with reduced probability of mortality. Prehospital and on scene times had no impact on mortality. Conclusions PaCO2 at hospital admission is strongly associated with mortality risk, but normocapnia is achieved only in a minority of patients. Therefore, the time required for placement of an arterial cannula and prehospital blood gas analysis may be warranted in severe TBI patients requiring on-scene tracheal intubation.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Volume 31 Issue 46 | 3 | | R420.00 | |
| | Risk stratification tools for patients with syncope in emergency medical services and emergency departments: a scoping review | Risk stratification tools for patients with syncope in emergency medical services and emergency departments: a scoping review
Risk stratification tools for patients with syncope in emergency medical services and emergency departments: a scoping review
Overview Risk stratification for patients experiencing syncope presents a significant challenge in (prehospital) emergency care. Emergency Medical Services (EMS) and Emergency Department (ED) professionals must quickly distinguish between high-risk and low-risk syncope patients, often under time constraints and with limited resources. Researchers conducted a comprehensive review to identify risk stratification tools for patients experiencing syncope in prehospital and emergency care settings. They reviewed 5385 studies, selecting 38 that discussed 19 distinct tools, mainly developed for Emergency Department (ED) use. One tool was designed specifically for Emergency Medical Services (EMS). Most tools lack thorough validation, though they typically include history, physical examination, electrocardiogram, and additional tests to assess risk. The study highlights the importance of developing validated risk stratification tools to improve the management of syncope patients in emergency settings.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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| | Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study | Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study
Overview
Post-intubation hypotension (PIH) is common after prehospital emergency anaesthesia (PHEA) and is linked to increased mortality in trauma patients. A multi-centre retrospective study in the UK found that clinician judgment and provider intuition are the most reliable predictors of PIH, often influencing the administration of reduced doses of induction medications for high-risk patients.
Journal Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Volume 31 Issue 26
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| | The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial | The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial
The impact of an open-label design on human amniotic membranes vs. silver sulfadiazine dressings for second-degree burns: a randomized controlled clinical trial
Overview Proper medical management of burn wounds is crucial due to their significant psycho-emotional, socioeconomic impacts, and severe pain. The employment of synthetic and biological dressings enhances healing and minimizes complications associated with burn wounds. This study aims to compare the effectiveness of human amniotic membrane (hAM) dressings versus conventional silver sulfadiazine (SSDZ) ointment dressings in treating second-degree burn wounds. Burn injuries pose a major challenge for both societies and healthcare systems globally [1]. Burns represent the fourth most common type of injury worldwide, following accidents, falls, and violence [2]. Historically, burn wounds have been linked with poor prognosis. Nearly 50% of burn patients are admitted to specialized burn units, with approximately 200,000 to 300,000 individuals succumbing to fire-related burns annually around the world [3]. Burn wounds are categorized into first-degree (epidermal injury), second-degree (dermal and epidermal injury), third-degree (damage to the entire skin layer), and fourth degree (damage extending to the hypodermal layer) [4]. Second-degree burn wounds are the most prevalent and painful, representing over 50% of all burn injuries. In conclusion, despite its higher cost, hAM, as an advanced therapeutic dressing, demonstrates clear advantages over SSDZ ointment in terms of wound healing and pain management.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Evaluation of macular retinal oximetry across different levels of diabetic retinopathy: a cross sectional study | Evaluation of macular retinal oximetry across different levels of diabetic retinopathy: a cross sectional study
Evaluation of macular retinal oximetry across different levels of diabetic retinopathy: a cross sectional study
Overview Diabetic retinopathy (DR) is a leading cause of prevent¬able blindness in working aged Americans. It is char¬acterized by vascular and neuronal changes that can lead to inflammation, oxidative stress, and retinal ischemia]. These structural and functional changes significantly affect the metabolic demand and activity in the retina. Retinal oxygen saturation has been evaluated as a meta¬bolic biomarker for the retina that is altered in DR. In non-proliferative DR (NPDR), oxygen saturation in the larger vessels is positively correlated with increasing severity of DR. However, in proliferative DR, oxy¬gen saturation may continue to increase or decline. The initial climb in oxygen saturation is thought to be the result of a compensatory mechanism in response to the increase in ischemic changes that occur as DR progresses. Retinal oximetry provides a non-invasive measurement of oxygen saturation within the retinal vasculature This study evaluates retinal oxygen saturation and vessel density within the macula and correlates these measures in controls and subjects with type 2 diabetes (DM) with (DMR) and without (DMnR) retinopathy. Changes in retinal oxygen saturation have not been evaluated regionally in diabetic patients. In conclusion this study is the first to evaluate the relationship between macular oxygen saturation and SCP vascular density at different levels of retinopathy. This may be useful to track patients with DM as they move through stages of retinopathy.
Journal BMC Ophthalmology Volume 25 Issue 1 | 3 | | R485.00 | |
| | Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study | Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study
Outcome of laparoscopic feeding jejunostomy, comparison of a pure laparoscopic technique with Witzel’s tunnel to open technique: a retrospective cohort study
Overview Obstructive upper GI cancer commonly uses feeding jejunostomy as a standard procedure. Surgeons implemented laparoscopic feeding jejunostomy via minimally invasive surgery, employing a variety of techniques. This study assessed the perioperative results, safety, and costs associated with laparoscopic versus open jejunostomy surgeries. We used only Witzel’s tunnel and standard laparoscopic instruments. We collected data from all patients who underwent feeding jejunostomy between January 2016 and June 2018. We recorded pertinent data on baseline, surgical outcomes, postoperative results, complications, and costs. The study excluded patients with jejunostomy as a conversion or an addition. It was concluded that Laparoscopic jejunostomy feeding was safe, and postoperative morphine consumption was lower. Increasing operational costs did not have a significant impact on overall expenditures. Witzel’s tunnel may reduce jejunostomy site infections.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia | Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia
Postoperative outcomes after splenectomy: a 20-year single-center experience in Colombia
Overview Splenectomy indications are well documented; however, several infectious complications and potentially life-threatening conditions could arise after splenectomy. We aim to describe a 20-year single-center experience of postoperative outcomes after splenectomy and perform a subgroup analysis according to approach and surgical setting with a 30-day, 90-day, and 1-year follow-up. This study describes a 20-year single-center experience in Colombia, analysing postoperative outcomes after splenectomy with a focus on 30-day, 90-day, and 1-year follow-up periods. Splenectomy, often performed for trauma, abscesses, aneurysms, and malignant conditions, can lead to serious complications. The findings align with international data on postoperative complications and overwhelming post-splenectomy syndrome (OPSI). Further research is recommended to improve management strategies and outcomes, especially for high-risk groups.
Journal BMC Surgery Volume 24 Issue 1 | 3 | | R485.00 | |
| | Impact of early surgical complications on kidney transplant outcomes | Impact of early surgical complications on kidney transplant outcomes
Impact of early surgical complications on kidney transplant outcomes
Overview
Kidney transplantation (KT) improves clinical outcomes of patients with end stage renal disease. Little has been reported on the impact of early post-operative surgical complications (SC) on long-term clinical outcomes following KT. This article sought to determine the impact of vascular complications, urological complications, surgical site complications, and peri-graft collections within 30 days of transplantation on patient survival, graft function, and hospital readmissions. Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, offering improved survival and quality of life for the vast majority of patients when compared to other renal replacement therapies. Despite improving patient and graft survival rates over time, the morbidity and mortality associated with postoperative complications remain a significant clinical concern. Early postoperative surgical complications (SC) vary in severity and can be classified according to Clavien Grades. The main categories of SC associated with KT are vascular, urological, peri-graft fluid collections, and surgical site complications. It was concluded that early SC following KT are common and have a significant influence on long-term patient outcomes.
Journal BMC Surgery
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| | Physically Active Lifestyle Attenuates Impairments on Lung Function and Mechanics in Hypertensive Older Adults | Physically Active Lifestyle Attenuates Impairments on Lung Function and Mechanics in Hypertensive Older Adults
Physically Active Lifestyle Attenuates Impairments on Lung Function and Mechanics in Hypertensive Older Adults
Overview Physical activity attenuates hypertension in older adults, but its impact on pulmonary function and mechanics in hypertensive older adults is unknown. The study seeks to understand whether a physically active lifestyle can improve respiratory capacity, the mechanical efficiency of the lungs, and, consequently, the quality of life of these individuals, comparing data between groups of active and sedentary hypertensive older adults.
This is a cross-sectional study. 731 older adults were evaluated, stratified into two initial groups: hypertensive older adults (HE; n = 445) and non-hypertensive older adults (NHE; n = 286). For a secondary analysis, we used the International Physical Activity Questionnaire to sub-stratify HE and NHE into four groups: physically inactive hypertensive (PIH; n = 182), active hypertensive (AH; n = 110), physically inactive non-hypertensive (PINH; n = 104), and active non-hypertensive (ANH; n = 65). Lung function was measured by spirometry, and lung mechanics were assessed by impulse oscillometry.
It was concluded that hypertension is associated with impaired lung function and mechanics in older adults, and a physically active lifestyle attenuates these dysfunctions.
Journal
Advances in Respiratory Medicine Volume 92 Issue 4
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| | Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: A Single-center Experience | Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: A Single-center Experience
Inherited Thrombophilia and Risk of Thrombosis in Children with Cancer: A Single-center Experience
Overview Thrombosis is an increasingly recognized complication of childhood malignancy and its treatment. The incidence and etiology of pediatric cancer-related thrombosis is still not well understood. The aim of this study was to evaluate the prevalence of common prothrombotic genetic conditions in children with cancer, the frequency of thrombosis, and the role of inherited thrombophilia in the development of thrombosis in a pediatric oncology population.
Forty-seven children (36 treated for haematological malignancies and 11 for solid tumours) with a median age of 8.8. years (range 0.4 – 19.3 years) were included in the study. Genetic polymorphisms of Factor V Leiden (G1691A), prothrombin G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T were determined by real-time polymerase chain reaction-based DNA analysis.
It was concluded that thrombosis is an important complication of childhood cancer. The risk of thrombosis may be increased in patients with Factor V Leiden. In the absence of consensus guidelines, our results support the recommendation for thrombophilia screening in children with cancer.
Journal
Acta Medica Academica | 3 | | R485.00 | |
| | Factors Predictive of In-Hospital Mortality in Patients with Systemic Lupus Erythematosus: A Single-Centre Retrospective Analysis | Factors Predictive of In-Hospital Mortality in Patients with Systemic Lupus Erythematosus: A Single-Centre Retrospective Analysis
Factors Predictive of In-Hospital Mortality in Patients with Systemic Lupus Erythematosus: A Single-Centre Retrospective Analysis
Overview This article investigates the causes and factors predictive of in-hospital death among patients with systemic lupus erythematosus (SLE) admitted to a tertiary care hospital in Thailand.
They retrospectively reviewed the records of patients with SLE admitted between 2017 and 2021. We collected data related to age, sex, body mass index, comor¬bidities, disease duration, medication usage, clinical symptoms, vital signs, laboratory results, evidence of infection, presence of systemic inflammatory response syndrome, quick sepsis-related organ assessment scores, and SLE disease activity on the date of admission. The length of hospitalization, treatment administered, and subsequent clinical outcomes (including in-hospital complications and death) were also recorded.
It was concluded that infection was the major cause of mortality in patients with SLE. Prior hospitalization within 3 months, initial infection on admission, vasopressor use, and mechanical ventilation during admission are independent risk factors for in-hospital mortality in patients with SLE.
Journal
Acta medica academica
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| | Influence of pain neuroscience education and exercises for the management of neck pain: A meta-analysis of randomized controlled trials | Influence of pain neuroscience education and exercises for the management of neck pain: A meta-analysis of randomized controlled trials
Influence of pain neuroscience education and exercises for the management of neck pain: A meta-analysis of randomized controlled trials
Overview It is elusive to combine pain neuroscience education with exercises to treat neck pain, and this meta-analysis aims to study the efficacy of pain neuroscience education plus exercises for the treatment of neck pain. Several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systemically searched from inception to August 2023, and we included the randomized controlled trials (RCTs) assessing the effect of pain neuroscience education plus exercises on the relief of neck pain.
It was concluded that pain neuroscience education plus exercises is effective for the relief of neck pain.
Journal Medicine Volume 103 Issue 48
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| | Enterobacter Infection | Enterobacter Infection
Overview
Enterobacter infections can include bacteremia, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections (UTIs), endocarditis, intra-abdominal infections, septic arthritis, osteomyelitis, CNS infections, and ophthalmic infections. Enterobacter infections can necessitate prolonged hospitalization, multiple and varied imaging studies and laboratory tests, various surgical and nonsurgical procedures, and powerful and expensive antimicrobial agents. Enterobacter infections do not have a clinical presentation that is specific enough to differentiate them from other acute bacterial infections. Bacteremia Signs of Enterobacter bacteremia include various symptoms and cause lower respiratory tract infections can manifest identically to those caused by Streptococcus Pneumoniae or other organisms Enterobacter infections do not have a clinical presentation that is specific enough to differentiate them from other acute. This course addresses the symptoms and the causes.
Sharespike Knowledge Studio | 3 | | R485.00 | |
| | A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome | A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome
A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome
Overview Compartment syndrome associated with tibial plateau fractures represents a significant challenge for orthopedic surgeons. The conventional approach involves early fasciotomy and external fixation, followed by definitive fixation at a later stage. This study prospectively examined Schatzker Type V and VI tibial plateau fractures with impending compartment syndrome, treated with single-stage double incision fasciotomy, dual internal fixation, and Vacuum-Assisted Closure (VAC). The incidence of compartment syndrome in Schatzker Type V and VI tibial plateau fractures is notably high. Managing these fractures, particularly when accompanied by impending compartment syndrome, has proven to be exceptionally challenging. Over the years, various surgical treatments have been developed, each presenting unique advantages and disadvantages. Traditionally, patients were managed through initial fasciotomy and temporary external fixation, with definitive internal fixation occurring at a subsequent stage. Current literature supports multi-staged surgical interventions, with a predominant emphasis on traditional staged procedures; however, knee stiffness remains a significant drawback of this method. Single-stage surgeries in such cases have been associated with numerous complications. Our findings suggest that early double incision fasciotomy combined with definitive dual plate internal fixation and VAC as a single-stage intervention provides excellent to good functional outcomes, with a reduction in complications for patients experiencing impending compartment syndrome.
Journal Indian J Orthop Volume 57 Issue 9
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| | Head-to-head comparison of 18F-FDG PET/CT and 18F-FDG PET/MRI for lymph node metastasis staging in non-small cell lung cancer: a meta-analysis | Head-to-head comparison of 18F-FDG PET/CT and 18F-FDG PET/MRI for lymph node metastasis staging in non-small cell lung cancer: a meta-analysis
Head-to-head comparison of 18F-FDG PET/CT and 18F-FDG PET/MRI for lymph node metastasis staging in non-small cell lung cancer: a meta-analysis
Overview
This meta-analysis compared the diagnostic performance of 18F-fluorodeoxyglucose PET/CT with 18F-FDG PET/MRI in staging lymph node metastasis in non-small cell lung cancer (NSCLC). According to the 2020 Global Cancer Observatory, lung cancer has the highest mortality rate (about 18% of all cancer deaths) and the second highest incidence rate (around 11.4% of new cancer cases). NSCLC is the most common type, accounting for roughly 80% of lung cancers. Assessing distant and mediastinal lymph node metastases in NSCLC patients is crucial for staging, treatment planning, and prognosis. While CT is a commonly used non-invasive modality for mediastinal staging, it has limited sensitivity and reliability. Over the past decade, 18F-FDG PET/CT has been widely used to evaluate NSCLC due to its ability to distinguish between malignant and benign pulmonary nodules, improve staging accuracy, and predict histology, treatment response, and prognosis. The analysis included six studies with 434 patients. We searched PubMed, Web of Science, and Embase databases for relevant articles from November 1992 to September 2022, focusing on head-to-head comparisons of 18F-FDG PET/CT and 18F-FDG PET/MRI in NSCLC lymph node metastasis. Study quality was assessed using the Quality Assessment of Diagnostic Performance Studies-2 tool.
Journal
Diagnostic and Interventional Radiology Volume 30 Issue 2 | 3 | | R485.00 | |
| | Imaging findings of primary lung tumors in children | Imaging findings of primary lung tumors in children
Imaging findings of primary lung tumors in children
Overview
Pediatric lung tumors are primarily discussed in the surgical literature. However, there is limited research on their imaging findings, and only a few tumor types have been documented. This article aims to describe the imaging features of primary lung tumors in children. Primary lung tumors are uncommon in children and have a different histologic spectrum than adult lung tumors, which changes with age. Metastases and congenital lung masses constitute a substantial proportion of lung neoplasms in children. The incidence of primary, metastatic, and congenital/inflammatory lesions is reported to be 1:5:60. The most prevalent metastatic tumors in the lungs are Wilms tumor and osteosarcoma. Primary lung masses may be located in the tracheobronchial tree or parenchyma. Additionally, parenchymal involvement may occur secondarily through local invasion of mediastinal or chest wall masses. The symptoms associated with lung masses are non-specific, and there is no correlation between tumor size and malignancy. The most common tumors observed in this study were IMT and PPB, respectively. IMT is highly associated with calcification.
Journal
Diagnostic and Interventional Radiology
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| | Serum Magnesium is Inversely Associated with Body Composition and Metabolic Syndrome | Serum Magnesium is Inversely Associated with Body Composition and Metabolic Syndrome
Serum Magnesium is Inversely Associated with Body Composition and Metabolic Syndrome
Overview
Magnesium is vital to maintain normal physiological functions. We aimed to identify the association between serum magnesium and different measures of body adiposity among Qatari adults. We hypothesized that the association was mediated by depression and sleep duration.
The study included 1000 adults aged 20 years and above who attended the Qatar Biobank Study (QBB) between 2012 and 2019. Body adiposity was assessed using dual-energy X-ray absorptiometry (DEXA). Serum magnesium concentration was measured. Sub-optimal magnesium was defined as magnesium concentration less than 0.85 mmol/L. The association was examined using linear regression.
It was concluded that there was an inverse association between serum magnesium and fat mass, especially among those with an adequate sleep duration and without chronic conditions including diabetes, hypertension and depression.
Journal
Diabetes, Metabolic Syndrome and Obesity Volume 2023 Issue 16
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| | MR Imaging of Carotid Artery Atherosclerosis: Updated Evidence on High-Risk Plaque Features and Emerging Trends | MR Imaging of Carotid Artery Atherosclerosis: Updated Evidence on High-Risk Plaque Features and Emerging Trends
MR Imaging of Carotid Artery Atherosclerosis: Updated Evidence on High-Risk Plaque Features and Emerging Trends
Overview
MR imaging is well-established as the criterion standard for carotid artery atherosclerosis imaging. The capability of MR imaging to differentiate numerous plaque components has been demonstrated, including those features that are associated with a high risk of sudden changes, thrombosis, or embolization. The field of carotid plaque MR imaging is constantly evolving, with continued
insight into the imaging appearance and implications of various vulnerable plaque characteristics. This article will review the most up-to-date knowledge of these high-risk plaque features on MR imaging and will delve into 2 major emerging topics: the role of vulnerable plaques in cryptogenic strokes and the potential use of MR imaging to modify carotid endarterectomy treatment guidelines.
Journal
American Journal of Neuroradiology
Citation
Benson, J. C., Saba, L., Bathla, G., Brinjikji, W., Nardi, V., & Lanzino, G. (2023). MR Imaging of Carotid Artery Atherosclerosis: Updated Evidence on High-Risk Plaque Features and Emerging Trends. AJNR. American journal of neuroradiology, 44(8), 880–888. https://doi.org/10.3174/ajnr.A7921 | 3 | | R485.00 | |
| | Relationship between chronic disease and depression: the mediating effect of pain | Relationship between chronic disease and depression: the mediating effect of pain
Relationship between chronic disease and depression: the mediating effect of pain
Overview The incidence of depression was high in people who were female, less educated, unmarried, living in rural areas, and working. Chronic diseases have a high incidence in China and may cause pain and depression. However, the association of chronic diseases with pain and the incidence of depression has not been comprehensively investigated.
The study population was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The main outcome was the incidence of depression. The main independent variable was chronic disease (no chronic disease, one chronic disease, and two or more chronic diseases). The mediators were the degree of pain (no pain, mild pain, and moderate to severe pain) and whether measures were taken to relieve pain (measures taken and no measures taken). In conclusion the degree of pain had a partial mediating effect on chronic disease and depression. Pain relief measures should be considered when treating patients with depression.
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| | Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer | Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer
Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer
Overview The incidence of colorectal cancer increases with aging. Curative-intent surgery based on a minimally invasive concept is expected to bring survival benefits to elderly patients (aged over 80 years) with colorectal cancer who are frequently with fragile health status and advanced tumours. The study explored survival outcomes in this patient population who received robotic or laparoscopic surgery and aimed to identify an optimal surgical option for those patients. The clinical materials and follow-up data were retrieved on elderly patients with colorectal carcinoma who received robotic or laparoscopic surgery in our institution. The pathological and surgical outcomes were compared to examine the efficacy and safety of the two approaches. The DFS (disease-free survival) and OS (overall survival) results at 3 years after surgery were assessed to explore the survival benefits. It was concluded that robotic surgery was prized for elderly patients with colorectal cancer who developed anemia and/or haematological conditions.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942364/pdf/12877_2023_Article_3822.pdf
Journal BMC Geriatrics | 3 | | R485.00 | |
| | CT and clinical features for distinguishing endophytic clear cell renal cell carcinoma from urothelial carcinoma | CT and clinical features for distinguishing endophytic clear cell renal cell carcinoma from urothelial carcinoma
CT and clinical features for distinguishing endophytic clear cell renal cell carcinoma from urothelial carcinoma
Overview The aim was to characterize the clinical and multiphase computed tomography (CT) features of the distinguishing endophytic clear cell renal cell carcinoma (ECCRCC) from endophytic renal urothelial carcinoma (ERUC). Univariate and multivariate logistic regression analyses were performed to determine independent predictors for ECCRCC and to construct a predictive model that comprised clinical and CT characteristics for the differential diagnosis of ECCRCC and ERUC. Differential diagnostic performance was assessed using the area under the receiver operating characteristic curve (AUC). The independent predictors of ECCRCC were heterogeneous enhancement (odds ratio [OR] = 0.027, P = .005), hematuria (OR for gross hematuria = 53.995, P = .003; OR for microscopic hematuria = 31.126, P = .027), and an infiltrative growth pattern (OR = 24.301, P = .022). The AUC of the predictive model was 0.938 (P < .001, sensitivity = 84.10%, specificity = 95.20%), which had a better diagnostic performance than heterogeneous enhancement (AUC = 0.766, P = .001, sensitivity = 81.82%, specificity = 71.43%), hematuria (AUC = 0.786, P < .001, sensitivity = 81.82%, specificity = 66.67%), and infiltrative growth pattern (AUC = 0.748, P = .001, sensitivity = 90.48%, specificity = 59.09%). The independent predictors, as well as the predictive model of CT and clinical characteristics, may assist in the differential diagnosis of ECCRCC and ERUC and provide useful information for clinical decision making.
Journal Diagnostic Interventional Radiology
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| | Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients | Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients
Long-Term Outcomes of Venous Resections in Pancreatic Ductal Adenocarcinoma Patients
Overview The objective was to investigate whether pancreatic resections (PR) for pancreatic ductal adenocarcinoma (PDAC) is associated with worse survival when resection of the superior mesenteric vein/portal vein (SMV/PV) is required. PR for PDAC with resection of the superior mesenteric vein/portal vein (SMV/PV, PR+V resection) may be associated with inferior overall survival (OS) compared with PR without the need for SMV/PV resection (PR–V). We hypothesized that PR+V results in lower OS compared with PR–V. Overall, 2403 patients were identified. Six hundred two underwent exploration only (EXP group), whereas 412 underwent pancreatic resection with (PR+V group) and 1389 (PR–V) without SMV/PV resection. Five-year OS for the PR+V group was lower (20% vs 30%) compared with PR–V, although multivariate Cox proportional hazards modeling could not associate PR+V status with OS (Hazard ratio 1.11, P = 0.408). When correcting for confounders, PR+V was not associated with lower OS compared with PR–V. Journal Annals of Surgery Open | 3 | | R450.00 | |
| | The role of CT in decision for acute appendicitis treatment | The role of CT in decision for acute appendicitis treatment
The role of CT in decision for acute appendicitis treatment
Overview Acute appendicitis is the most common cause of acute abdomen requiring surgery. Although the standard treatment has been surgery, it has been seen in recent years that treatment is possible with antibiotics and non-operative observation. In this study, our aim is to determine whether the computed tomography (CT) findings in patients diagnosed with acute appendicitis can be used for directing treatment. As the successful and unsuccessful medical treatment groups were compared, the only significant parameter was the severity of mural enhancement (P = .005). CT findings may be helpful in patients with uncomplicated acute appendicitis whose treatment surgeons are indecisive about. We can recommend surgical treatment in cases with appendix diameter =13 mm, intra-abdominal free fluid, appendicolith, high CT appendicitis score, and severe mural enhancement.
Journal Diagnostic Interventional Radiology
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| | Clinical Outcomes of Radiofrequency Ablation Combined with Transarterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Non-hepatocellular Carcinoma Malignant Liver Tumours | Clinical Outcomes of Radiofrequency Ablation Combined with Transarterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Non-hepatocellular Carcinoma Malignant Liver Tumours
Clinical Outcomes of Radiofrequency Ablation Combined with Transarterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Non-hepatocellular Carcinoma Malignant Liver Tumours
Overview The purpose was to retrospectively evaluate the outcomes of radiofrequency ablation combined with transarterial chemoembolization using degradable starch microspheres for non-hepatocellular carcinoma malignant liver tumours. Technical success, safety, local tumour progression, and overall survival were evaluated. Safety was assessed according to the clinical practice guideline of the Society of Interventional Radiology. All treatment procedures were successfully completed. There were no major complications. The patients were treated with repeat radiofrequency ablation combined with transarterial chemoembolization using degradable starch microspheres. During median follow-up of 48 months (range, 4-77 months), 5 patients died (33%, 5/15). The overall survival rates were 100%, 85%, and 57% at 1, 3, and 5 years, respectively. The median overall survival time was 69 months. It was conclusion radiofrequency ablation combined with transarterial chemoembolization using degradable starch microspheres was safe and showed favourable local control for non-hepatocellular carcinoma malignant liver tumours.
Journal Interventional Radiology | 3 | | R485.00 | |
| | Major Adverse Cardiovascular Events Following Partial Nephrectomy | Major Adverse Cardiovascular Events Following Partial Nephrectomy
Major Adverse Cardiovascular Events Following Partial Nephrectomy
Overview
Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.
The cohort was derived from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer–Lemeshow test and compared to the RCRI and the AUB-HAS2 index.
This study proposes a novel procedure-specific cardiovascular risk index. The PN-A4CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection. | 3 | | R465.00 | |
| | Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study. | Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study.
Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study.
Overview
Impaired cognitive function of bladder cancer patients plays a role in coping with the kind of urinary diversion and may impact perioperative morbidity. In this study we therefore aimed to assess the prevalence of mild cognitive impairment in patients undergoing radical cystectomy.
Secondary objectives included correlation of common cognition tests, assessment of the admitting physician, and perioperative complication rates.
Patients undergoing radical cystectomy for bladder cancer were prospectively screened by neuropsychological tests including cognition tests [DemTect (Dementia Detection test), MMSE (Mini-Mental State Examination), clock drawing test] prior to surgery. Mild cognitive impairment was observed in more than a quarter of radical cystectomy patients prior to surgery. Preoperative assessment should be supplemented by neuropsychological testing such as the DemTect as mild cognitive impairment is often underestimated and associated with significantly higher perioperative complication rates. | 3 | | R425.00 | |
| | Gaining a Better Understanding of the Types of Organizational Culture to Manage Suffering at Work | Gaining a Better Understanding of the Types of Organizational Culture to Manage Suffering at Work
Gaining a Better Understanding of the Types of Organizational Culture to Manage Suffering at Work
Overview
Organizational culture is a central concept in research due to its importance in organizational functioning and suffering of employees. To better manage suffering, it is necessary to better understand the intrinsic characteristics of each type of culture and its relationships with the environment.
According to the study by Schein (2010), the organizational culture is a pattern of basic values and presuppositions that are shared and learned by a group while resolving the problems of external adaptation and internal integration. Each culture represents a different set of values and presuppositions. All organizations have all four types but in different proportions. This is a typological model because it aims to identify archetypes using different effectiveness criteria.
Contrary to what most of the literature suggests, we found almost no relationship between the environmental variables and the culture types. Strategy and competencies, in contrast, do have a significant predictive capacity, showing 9 links with the Clan culture, 7 with the Hierarchy culture, and 10 with the Market culture. In conclusion, this study has found the important characteristics of the types of organizational culture that could be useful to better manage the suffering of employees.
| 3 | | R489.00 | |
| | Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis | Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis
Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis
Extensive studies indicate that severe acute respiratory syndrome coronavirus (SARS-CoV-2) involves human sensory systems. A lack of discussion, however, exists given the auditory–vestibular system involvement in CoV disease 2019 (COVID-19). The present systematic review and meta-analysis were performed to determine the event rate (ER) of hearing loss, tinnitus, and dizziness caused by SARS-CoV-2.
Databases (PubMed, ScienceDirect, Wiley) and World Health Organization updates were searched using combined keywords: ‘COVID-19,’ ‘SARS-CoV-2,’ ‘pandemic,’ ‘auditory dysfunction,’ ‘hearing loss,’ ‘tinnitus,’ ‘vestibular dysfunction,’ ‘dizziness,’ ‘vertigo,’ and ‘otologic symptoms.’ Twelve papers met the eligibility criteria and were included in the study. These papers were single group prospective, cross-sectional, or retrospective studies on otolaryngologic, neurologic, or general clinical symptoms of COVID-19 and had used subjective assessments for data collection (case histories/medical records). The results of the meta-analysis demonstrate that the ER of hearing loss (3.1%, CIs: 0.01–0.09), tinnitus (4.5%, CIs: 0.012–0.153), and dizziness (12.2%, CIs: 0.070–0.204) is statistically significant in patients with COVID-19 (Z = -4.469, p = 0.001).
Journal
The Canadian Journal of Neurological Sciences Inc. | 3 | | R465.00 | |
| | Toward Improved Outcomes for Patients with Lung Cancer Globally: The Essential Role of Radiology and Nuclear Medicine | Toward Improved Outcomes for Patients with Lung Cancer Globally: The Essential Role of Radiology and Nuclear Medicine
Toward Improved Outcomes for Patients with Lung Cancer Globally: The Essential Role of Radiology and Nuclear Medicine
Key to achieving better population-based outcomes for patients with lung cancer is the improvement of medical imaging and nuclear medicine infrastructure globally. This paper aims to outline why and spark relevant health systems strengthening. The paper synthesizes the global lung cancer landscape, imaging referral guidelines (including resource-stratified ones), the reliance of TNM staging upon imaging, relevant multinational health technology assessments, and precisely how treatment selection and in turn patient outcomes hinge upon imaging findings. The final discussion presents data on current global gaps in both diagnostics (including imaging) and therapies and how, informed by such data, improved population-based outcomes are tangible through strategic planning.
Imaging findings are central to appropriate lung cancer patient management and can variably lead to life-prolonging interventions and/or to life-enhancing palliative measures. Early-stage lung cancer can be treated with curative intent but, unfortunately, most patients with lung cancer still present at advanced stages and many patients lack access to both diagnostics and therapies. Furthermore, half of lung cancer cases occur in low- and middle-income countries. The role of medical imaging and nuclear medicine in lung cancer management, as outlined herein, may help inform strategic planning.
Journal JCO Global Oncology | 3 | | R420.00 | |
| | Childhood Adverse Events and the Long-Term Effects on Mental Health | Childhood Adverse Events and the Long-Term Effects on Mental Health
Childhood Adverse Events and the Long-Term Effects on Mental Health
There has long been an association between family history and mental illness; however, recently researchers have focused on the correlation between childhood adverse events and mood disorders, specifically bipolar disorder. This study shows there is a strong correlation between CAE and PB, specifically, sexual abuse in females, maternal separation, economic difficulty and a family history of mental illness.
The findings suggest that females that experience childhood adverse events may be at a higher risk for developing bipolar disorder and the clinical outcome of bipolar disorder may also be affected by the type and number of childhood adverse events.
The results also suggest that schizophrenic spectrum disorders, bipolar disorder and major depressive disorder are associated with different childhood adverse events. Females who have recollections of childhood abuse are at an increased risk for depressive symptoms associated with bipolar disorder. Psychosocial interventions that are geared towards limiting childhood adverse events may reduce the incidence of mental illness, specifically bipolar disorder. | 3 | | R465.00 | |
| | Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of lumbar Degenerative Disorders: A Retrospective Study | Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of lumbar Degenerative Disorders: A Retrospective Study
Effectiveness of Extracorporeal Shock Wave Therapy Reduces Leg Cramps in Patients of lumbar Degenerative Disorders: A Retrospective Study
Overview
Muscle cramp is fundamentally a medical problem but also a sociological and an economic one. Muscle cramps which characterized by the painful, involuntary, and paroxysmal contraction of a muscle are common and can occur in a wide range of settings and are a highly distressing condition.
The symptoms lead to a decrease in the quality of life for patients and sometimes disturb the proper functioning of the entire body, stimulating the development of several complications and comorbidities.
The extracorporeal shock wave therapy (ESWT) has been fully utilized in orthopedics, but there are few studies in the treatment of lower limb spasm and pain caused by lumbar degenerative disorders (LDD). This study assesses the influence of ESWT in patients with LDD.
It was concluded that the ESWT is particularly effective effect for patients with LDD. The use of ESWT has a significant long-term influence on the reduction of pain, leg cramps, and the improvement of the general functional state in relation to the conventional motor improvement program.
Journal
Hindawi BioMed Research International
| 3 | | R425.00 | |
| | Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in the Elderly | Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in the Elderly
Five-Minute Cognitive Test as A New Quick Screening of Cognitive Impairment in the Elderly
Overview
As old population is dramatically growing, the detection of early cognitive deficit will become increasingly crucial. Effective cognitive screening test with quick and convenient merits will ensure recognition of early cognitive deficit and timely intervention. This study aims to develop a new evaluation method for quickly and conveniently screening cognitive impairment in the elderly.
The five-minute cognitive test (FCT) was designed to capture deficits in five domains of cognitive abilities, including episodic memory, language fluency, time orientation, visuospatial function, and executive function. Subsequently, FCT efficiencies in differentiating normally cognitive ability from cognitive impairment were explored and compared with that of the Mini-Mental Status Evaluation (MMSE). Equipercentile equating method was utilized to create a crosswalk between scores of the FCT and MMSE. Further, the association of scores of the FCT and MMSE with hippocampal volumes was investigated.
Many screening tools are currently available, but no tools meet the four important requirements for widespread use in clinical practice or large-scale epidemiological studies — that is, capture a clinically acceptable range of cognitive domains, take short time to administrate (around 5 minutes), have high accuracy for detecting cognitive impairment, and incorporate visual recall, which is the earliest deficits in Alzheimer’s disease (AD) patients. The FCT is a novel, reliable, and valid cognitive screening test for the detection of dementia at early stages.
Journal
JKL International LLC Aging and Disease Volume 10, Number 6 URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6844584/pdf/ad-10-6-1258.pdf | 3 | | R425.00 | |
| | Mixed reality applications in urology: Requirements and future potential | Mixed reality applications in urology: Requirements and future potential
Mixed reality applications in urology: Requirements and future potential
Overview Mixed reality (MR), the computer-supported augmentation of a real environment with virtual elements, becomes ever more relevant in the medical domain, especially in urology, ranging from education and training over surgeries. This study aimed to review existing MR technologies and their applications in urology. A non-systematic review of current literature was performed using the PubMed-Medline database using the medical subject headings (MeSH) term “mixed reality”, combined with one of the following terms: “virtual reality”, “augmented reality”, ‘’urology’’ and “augmented virtuality”. The relevant studies were utilized. It was found that medical students, urology residents and inexperienced urologists can gain experience thanks to MR technologies. MR applications are also used in patient education before interventions. For surgical support, the achievable accuracy is often not sufficient. The main challenges are the non-rigid nature of the genitourinary organs, intraoperative data acquisition, online and multimodal registration and calibration of devices. However, the progress made in recent years is tremendous in all respects and the gap is constantly shrinking.
Authors Gerd Reis, Mehmet Yilmaz, Jason Rambach, Alain Pagani, Rodrigo Suarez-Ibarrola, Arkadiusz Miernik, Paul Lesur, Nareg Minaskan
| 3 | | R400.00 | |
| | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs | Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs
Overview
The purpose of this study is to state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early-stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements.
A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. It was concluded that SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease.
Authors Scott J. Genshaft, MD, Robert D. Suh, MD, Fereidoun Abtin, MD, Mark O. Baerlocher, MD, Albert J. Chang, MD, Sean R. Dariushnia, MD, A. Michael Devane, MD, Salomao Faintuch, MD, MS, Elizabeth A. Himes, BS, Aaron Lisberg, MD, Siddharth Padia, MD, Sheena Patel, MPH, Alda L. Tam, MD, MBA, and Jane Yanagawa, MD
Journal J Vasc Interv Radiol
| 3 | | R420.00 | |
| | Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization | Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization
Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization
Overview Prostatic artery embolization (PAE) is a promising alternative to traditional surgical options for treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). However, as with any developing area of investigation, there is a need to assemble consistent high-quality data that clarify the role of that therapy and allow for systematic analyses of multiple studies.
The objective of this Reporting Standards document is to define a consistent nomenclature and terminology with which investigators can communicate the results of PAE trials to facilitate subsequent comparisons of published techniques, embolic materials, patient populations, and outcomes. The intent is to systematize the reporting of PAE data so that higher levels of evidence can be sought. Reporting Standards are not intended to validate or recommend technical aspects of PAE, but to promote transparent, detailed, and uniform reporting of relevant data.
Authors Andre B. Uflacker, MD, Ziv J Haskal, MD, Mark O. Baerlocher, MD, Shivank S. Bhatia, MD, Francisco C. Carnevale, MD, PhD, Sean R. Dariushnia, MD, Salomao Faintuch, MD, MS, Ron C. Gaba, MD, MS, Jafar Golzarian, MD, Mehran Midia, MD, Boris Nikolic, MD, MBA, Marc R. Sapoval, MD, PhD, and T. Gregory Walker, MD
Journal J Vasc Interv Radiol | 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 | | R435.00 | |
| | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study | Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Overview The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. This study aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. A national cohort study was conducted in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Patients were excluded if they did not have a neurological consultation or neurological investigations or both or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR or respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall.
Authors Stephen T J Ray et al
Journal The Lancet Child & Adolescent Health | 3 | | R410.00 | |
| | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial | Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Rural Family Medicine Clinicians’ Motivations to Participate in a Pragmatic Obesity Trial
Overview To understand the motivations of rural-practicing primary care clinicians who participate in an intensive multiyear pragmatic randomized behavioural obesity intervention trial, Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER).
Structured interviews were conducted with 21 family medicine clinicians who were study leads at participating rural practices. Themes emerged through an analysis of transcripts and interview notes by using the constant comparative method.
The analysis revealed 3 main themes. First, primary care clinicians participated in RE-POWER because it provided a concrete plan to address their recurring clinical care need for effective obesity treatment and management. Second, participation offered help to frustrated physicians who felt a deep professional duty to care for all their patients’ problems but were dissatisfied with current obesity management. Third, participation was also attractive to rural primary care clinicians because it provided a visible and sustainable way to demonstrate their commitment to improving the health of patients and the broader community.
The findings show that clinicians are motivated to try solutions for a clinical problem— in this case obesity—when that clinical problem is also closely connected to a particularly frustrating area of clinical care that challenges their professional identity. Our data suggest that a motivation to close the gap between ideal and real practice can become such a high priority that clinicians are sometimes willing to try potential solutions, such as engagement in research, that they otherwise would not consider.
Authors Joanna Veazey Brooks, PhD, MBE, Kim S. Kimminau, PhD, Stacy McCrea-Robertson, MS, and Christie Befort, PhD Journal Journal of the American Board of Family Medicine | 3 | | R455.00 | |
| | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools | Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools
Overview Women physicians continue to comprise the minority of leadership roles in Academic Family Medicine (AFM) faculty across North American medical schools. This study quantified the current state of gender disparity by analysing academic position, leadership ranking, and research productivity.
A database for 6,746 AFM faculty members was generated. Gender and academic profiles were obtained for 2,892 academic ranks and 1,706 leadership roles by searching faculty listings enlisted in Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS).
The results indicated that women hold 46.11% (3,110/6,746) of faculty positions. The proportional composition decreased with increasing academic ranking (49.84% assistant, 46.78% associate, and 41.5% full professor). The same decreasing trend was demonstrated with leadership rank (57.14% minor leadership, 47.65% second-in-command, and 36.61 first-in command). Compared to their gender counterparts, women in AFM demonstrated lower publication productivity as measured by citation number (p=0.04) and years of study (p=0.008).
In conclusion it was found that the composition of academic family medicine faculty members included in this study demonstrated gender disparity. Inclusivity initiatives and policies to tackle the issue of female retention, promotion, and recruitment need to be further explored.
Authors Szu-Yu Tina Chen, Sabeena Jalal, Maryam Ahmadi, Kiran Khurshid, Nizar Bhulani, Ateeq U. Rehman, Aftab Ahmad, Jeffrey Ding, Terri-Leigh R. Aldred, Faisal Khosa
Journal Cureus
| 3 | | R410.00 | |
| | Hypertension Part 3 | Hypertension Part 3
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Hypertension Part 2 | Hypertension Part 2
Overview Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Bee Sting and Anaphylaxis | Bee Sting and Anaphylaxis
Bee Sting and Anaphylaxis
Overview Hymenoptera stings account for more deaths in the United States than any other envenomation. The order Hymenoptera includes Apis species, ie, bees (European, African), vespids (wasps, yellow jackets, hornets), and ants. Most deaths result from immediate hypersensitivity reactions and anaphylaxis. Severe anaphylactoid reactions occur occasionally when toxins directly stimulate mast cells. In addition to immunologic mechanisms, some injury occurs from direct toxicity. While most stings cause only minor problems, stings cause a significant number of deaths.
Target organs are the skin, vascular system, and respiratory system. Pathology is like other immunoglobulin E (IgE)–mediated allergic reactions. Anaphylaxis is a common and life-threatening consequence of Hymenoptera stings and is typically a result of sudden systemic release of mast cells and basophil mediators. Urticaria, vasodilation, bronchospasm, laryngospasm, and angioedema are prominent symptoms of the reaction. Respiratory arrest may result in refractory cases
This study aims to discuss the different stings, prognosis and emergency reactions and treatment thereto.
Author Sharespike | 3 | | R410.00 | |
| | 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 | | R425.00 | |
| | 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 | | R465.00 | |
| | 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 | | R465.00 | |
| | Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients | Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients
Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients
Overview Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. This study investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture. A cross-sectional study was conducted to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019. The behaviour of physicians and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment is documented in this study. | 3 | | R420.00 | |
| | Ischemic Stroke Part 2 | Ischemic Stroke Part 2
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | Ischemic Stroke Part 1 | Ischemic Stroke Part 1
Overview
Ischemic stroke is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than haemorrhagic stroke.
We should consider stroke in any patient presenting with acute neurologic deficit or any alteration in level of consciousness. Although symptoms can occur alone, they are more likely to occur in combination. No historical feature distinguishes ischemic from haemorrhagic stroke, although nausea, vomiting, headache, and sudden change in level of consciousness are more common in haemorrhagic strokes. In younger patients, a history of recent trauma, coagulopathies, illicit drug use (especially cocaine), migraines, or use of oral contraceptives should be elicited.
Emergent brain imaging is essential for evaluation of acute ischemic stroke. Noncontrast computed tomography (CT) scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke.
Involvement of a physician with a special interest and training in stroke is ideal. Stroke care units with specially trained nursing and allied healthcare personnel have clearly been shown to improve outcomes.
Author Sharespike
| 3 | | R410.00 | |
| | 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 | | R425.00 | |
| | Ventricular Tachycardia Part 2 | Ventricular Tachycardia Part 2
Ventricular Tachycardia Part 2
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | Ventricular Tachycardia Part 1 | Ventricular Tachycardia Part 1
Ventricular Tachycardia Part 1
Overview
Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, at an estimated rate of approximately 300,000 deaths per year. VT refers to any rhythm faster than 100 (or 120) beats/min, with three or more irregular beats in a row, arising distal to the bundle of His. The rhythm may arise from the working ventricular myocardium, the distal conduction system, or both.
Symptoms of VT are often a function of the associated heart rate, or the causal process, such as an acute myocardial infarction (MI). They may include the following bulleted items. VT may also be asymptomatic, or the symptoms may be those of the associated triggered therapy (eg, an implantable cardioverter-defibrillator [ICD] shock).
Clinically, VT may be reflected in symptoms such as syncope, palpitations, and dyspnea. It is often, but not always, associated with hemodynamic compromise, particularly if the left ventricle is impaired or the heart rate is especially fast. With some exceptions, VT is associated with increased risk of sudden death.
Author Sharespike
| 3 | | R425.00 | |
| | 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 | | R435.00 | |
| | Wide Complex Tachycardia | Wide Complex Tachycardia
Overview
Correct diagnosis of wide complex tachycardia (WCTs) can be challenging. With EMS providers' ever-expanding scope of practice, it is no longer safe to label any rhythm that is wide and fast as ventricular tachycardia (VT). Though many paramedic curricula do not address advanced cardiac dysrhythmias and treatments, several EMS departments have protocols that require advanced training in 12-lead ECG interpretation and treatment of specific cardiac dysrhythmias. One must possess the proper diagnostic tools and knowledge to decide whether a WCT is VT or SVT with aberrant conduction. EMS providers should be able to differentiate VT and SVT with aberrant conduction with confidence and a high degree of certainty. In order to understand the visual differences between VT and SVT with aberrant conduction, one must first understand the basic pathophysiology behind the two dysrhythmias. The first steps are maintenance of the patient’s airway with assisted breathing if necessary, cardiac monitoring to identify the heart rhythm, monitoring of blood pressure and oximetry, and establishing intravenous access. In the emergency setting, a wide-complex tachycardia always should be considered as ventricular tachycardia unless proven otherwise, as treatment must be initiated immediately to avoid degeneration into ventricular fibrillation.
| 3 | | R425.00 | |
| | Unstable Angina | Unstable Angina
Overview
Unstable angina belongs to the spectrum of clinical presentations referred to collectively as acute coronary syndromes (ACSs), which also includes ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Unstable angina is considered to be an ACS in which there is myocardial ischemia without detectable myocardial necrosis (ie, cardiac biomarkers of myocardial necrosis —such as creatine kinase MB isozyme, troponin, myoglobin—are not released into the circulation).
With unstable angina, symptoms may (1) occur at rest; (2) become more frequent, severe, or prolonged than the usual pattern of angina; (3) change from the usual pattern of angina; or (4) not respond to rest or nitro-glycerine. Symptoms of unstable angina are similar to those of myocardial infarction (MI).
The traditional term unstable angina was meant to signify the intermediate state between myocardial infarction (MI) and the more chronic state of stable angina. The old term pre-infarction angina conveys the clinical intent of intervening to attenuate the risk of MI or death. Patients with this condition have also been categorized by presentation, diagnostic test results, or course over time; these categories include new-onset angina, accelerating angina, rest angina, early postinfarct angina, and early post-revascularization angina.
This course deals with the causes and management of unstable angina.
| 3 | | R425.00 | |
| | Severe Distress – COVID 19 | Severe Distress – COVID 19
Severe Distress – COVID 19
Overview Since the emergence of the 2019 novel coronavirus (SARS-CoV-2) infection in December 2019, the coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. The clinical spectrum of patients with COVID-19 ranges from asymptomatic or mild symptoms to critical disease with a high risk of mortality. Coronavirus disease 2019 (COVID-19) is the illness associated with the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was initially noted during an outbreak of respiratory illness in the population of Wuhan, the capital of Hubei province, China. The first cases were seen in November 2019, with COVID-19 quickly spreading throughout the city. The World Health Organization (WHO) was notified of the outbreak on December 31, 2019. The cases continued to spread outside of the area and then across the world. COVID-19 was reported as a global health emergency by the end of January 2020. As the worldwide case numbers increased, the WHO declared on March 11, 2020, that COVID-19 had reached the pandemic stage.
The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic.
| 3 | | R425.00 | |
| | 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 | | R425.00 | |
| | 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 | | R425.00 | |
| | Respiratory Distress Syndrome | Respiratory Distress Syndrome
Respiratory Distress Syndrome
Overview
Respiratory distress syndrome, also known as hyaline membrane disease, occurs almost exclusively in premature infants. The incidence and severity of respiratory distress syndrome are related inversely to the gestational age of the new-born infant.
Shortness of breath is a common complaint encountered by the EMS provider. We often hear it as part of a litany of other S/S or as a primary chief complaint. In either case SOB is never to be taken lightly and its causes should always be thoroughly investigated. My desire with this article is to give you some tips on how to streamline your treatment and formulate your thoughts as to how to proceed. In all cases the EMS team is responsible to respond to the needs of the patient. Hypoxia, regardless of the source needs to be vigorously addressed. The lungs need to be opened or cleared as determined by the physical exam. The cause of the SOB needs to be determined and addressed. Education and counselling of parents, caregivers, and families of premature infants must be undertaken as part of discharge planning. These individuals should be advised of the potential problems infants with respiratory distress syndrome may encounter during and after their nursery stay.
Author
Sharespike
| 3 | | R425.00 | |
| | Preeclampsia for MD's | Preeclampsia for MD's
Overview
Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks' gestation and can present as late as 4-6 weeks post-partum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema.
Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient, OR (2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy.).
In addition to the blood pressure criteria, proteinuria of greater than or equal to 0.3 grams in a 24-hour urine specimen, a protein (mg/dL)/creatinine (mg/dL) ratio of 0.3 or higher, or a urine dipstick protein of 1+ (if a quantitative measurement is unavailable) is required to diagnose preeclampsia.
Eclampsia is defined as seizures that cannot be attributable to other causes in a woman with preeclampsia. HELLP syndrome (haemolysis, elevated liver enzyme, low platelets) may complicate severe preeclampsia.
Because the clinical manifestations of preeclampsia can be heterogeneous, diagnosing preeclampsia may not be straightforward. Preeclampsia without severe features may be asymptomatic. Many cases are detected through routine prenatal screening.
Authors
Sharespike
| 3 | | R380.00 | |
| | Dyspnea: Pathophysiology and a clinical approach - EMT | Dyspnea: Pathophysiology and a clinical approach - EMT
Dyspnea: Pathophysiology and a clinical approach - EMT
Overview
Dyspnea is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity and may either be acute or chronic. This is a common and often distressing symptom reported by patients, and accounts for nearly half of hospital admissions.
The distinct sensations often reported by patients include effort/work of breathing, chest tightness, and air hunger (a feeling of not enough air on inspiration). Dyspnea should be assessed by the intensity of these sensations, the degree of distress involved, and its burden or impact on instrumental activities.
Dyspnea is a common and often distressing symptom and a frequent reason for general practitioner and clinic visits. Dyspnea is symptom, and its experience is subjective and varies greatly among individuals exposed to the same stimuli or with similar pathologies. This differential experience of Dyspnea among individuals emanates from interactions among multiple physiological, psychological, social, and environmental factors that induce secondary physiological and behavioural responses. The management of Dyspnea will depend on the underlying cause.
Author
Sharespike | 3 | | R420.00 | |
| | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma | Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Emphysema, Chronic obstructive pulmonary disease (COPD), Asthma
Overview Emphysema and chronic bronchitis are airflow-limited states contained within the disease state known as chronic obstructive pulmonary disease (COPD). Just as asthma is no longer grouped with COPD, the current definition of COPD put forth by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) also no longer distinguishes between emphysema and chronic bronchitis.
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis. This process leads to reduced gas exchange, changes in airway dynamics that impair expiratory airflow, and progressive air trapping. Clinically, the term emphysema is used interchangeably with chronic obstructive pulmonary disease, or COPD.
The theory surrounding this definition has been around since the 1950s, with a key concept of irreversibility and/or permanent acinar damage. However, new data posit that increased collagen deposition leads to active fibrosis, which inevitably is associated with breakdown of the lung’s elastic framework.
Discussions on how obstructive diseases share similar phenotypes have been emerging and evolving within the literature. This course provides a particularly good outline.
Author Sharespike
| 3 | | R435.00 | |
| | Hypertension Part 1 | Hypertension Part 1
Overview
Hypertension is a leading risk factor for cardiovascular disease and a significant cause of morbidity and mortality. For patients who are symptomatic, however, uncontrolled elevations in blood pressure are true medical emergencies that require rapid intervention in the ED. It is therefore important to understand the disease of chronic hypertension and, perhaps more important, episodes of acute and uncontrolled elevations in blood pressure so that we, as prehospital care providers, can better stratify these patients into low- and high-risk groups that may or may not require transport to an ED for evaluation and treatment.
As we will discuss, it is reasonable to say that not every patient who presents with hypertension is at high risk of morbidity and mortality and absolutely requires evaluation and treatment at an ED. This is not to say EMTs and paramedics should talk patients out of going to EDs for evaluation. Rather, we will strive to give prehospital care providers a better understanding of the risks involved with acute hypertension so they can better work with their patients to find a solution that is safe, reasonable and responsible for everyone involved. This article discusses the topic of acute hypertension, hypertensive urgency and hypertensive emergencies in an effort to help EMS providers better understand these illnesses and help patients make the best decisions regarding their transport and care.
Authors:
Sharespike
| 3 | | R420.00 | |
| | Sleep and the athlete: narrative review and 2021 expert consensus recommendations | Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Sleep and the athlete: narrative review and 2021 expert consensus recommendations
Overview An ever-growing volume of peer-reviewed Publications speaks to the recent and rapid growth in scope and understanding of sleep for optimal athlete health and performance.
Herein, a panel of international experts review the current knowledge on sleep and the athlete, briefly covering the background, exploring continued controversies, highlighting fruitful avenues for future research and providing practical recommendations. The introduction section covers the need for sleep, including sleep architecture and the restorative benefits of sleep for the brain and body.
Pitfalls and challenges measuring athlete sleep are reviewed, and practical recommendations provided. The following section, entitled sleep and the athlete, covers the influence of sleep inadequacy and sleep extension on athletic performance. This article reviews the evidence that elite athletes are particularly susceptible to sleep inadequacy, for example, during intensified training and in those reporting symptoms of over-reaching and overtraining. The final section, entitled strategies to improve sleep, provides practical recommendations to alleviate the symptoms of jet lag, nutritional strategies to enhance sleep and a toolbox for practitioners to manage and optimise athlete sleep.
Authors Neil P Walsh et al.
Journal British Journal Sports Med 2020
| 3 | | R420.00 | |
| | 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 | | R410.00 | |
| | 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 | | R410.00 | |
| | 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 | | R410.00 | |
| | 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 Clinical Practice Guidelines: Trauma Part 1 | 3 | | R410.00 | |
| | Viral Pneumonia Part 3 | Viral Pneumonia Part 3
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19 The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Viral Pneumonia Part 1 | Viral Pneumonia Part 1
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease.
This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements
Authors:
Zab Mosenifar and Richard Brawerman | 3 | | R420.00 | |
| | Malaria | Malaria
Overview Malaria is a potentially life-threatening disease caused by infection with Plasmodium protozoa transmitted by an infective female Anopheles mosquito. Patients with malaria typically become symptomatic a few weeks after infection, though the symptomatology and incubation period may vary, depending on host factors and the causative species. Most patients with malaria have no specific physical findings, but splenomegaly may be present. In patients with suspected malaria, obtaining a history of recent or remote travel to an endemic area is critical. Asking explicitly if they travelled to a tropical area at any time in their life may enhance recall. Maintain a high index of suspicion for malaria in any patient exhibiting any malarial symptoms and having a history of travel to endemic areas.
It is also important to determine the patient's immune status, age, and pregnancy status; allergies or other medical conditions that he or she may have; and medications that he or she may be using.
Acknowledgements Authors:
Thomas E Herchline, Thomas E Herchline, Ryan Q Simon
| 3 | | R420.00 | |
| | Diabetes Mellitus Part 3 | Diabetes Mellitus Part 3
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori
| 3 | | R420.00 | |
| | Diabetes Mellitus Part 2 | Diabetes Mellitus Part 2
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Diabetes Mellitus Part 1 | Diabetes Mellitus Part 1
Overview Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Poorly controlled type 2 diabetes is associated with an array of microvascular, macrovascular, and neuropathic complications.
Microvascular complications of diabetes include retinal, renal, and possibly neuropathic disease. Macrovascular complications include coronary artery and peripheral vascular disease. Diabetic neuropathy affects autonomic and peripheral nerves.
This course focuses on the diagnosis and treatment of type 2 diabetes and its acute and chronic complications, other than those directly associated with hypoglycemia and severe metabolic disturbances, such as hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA).
Acknowledgements Author:
Khardori | 3 | | R420.00 | |
| | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer | Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer
Overview
The clinical application of robotic surgery in breast conserving surgery or volume replacement with robotic latissimus dorsi flap harvest (RLDFH) has been rarely reported. In this study, we report the preliminary experience and clinical outcome of robotic assisted quadrantectomy (RAQ) and immediate partial breast reconstruction (IPBR) with RLDFH.
The post-operative recovery was smooth except for seroma formation over the back, which was relieved after repeated aspiration at an outpatient clinic. The patient was satisfied with the post-operative scar and aesthetic outcome. No local recurrence, distant metastasis or case mortality was found during 5 months of follow-up. RAQ and IPBR with RLDFH is a safe alternative for small-to-medium-breast-size women with breast cancer who desire breast conservation and are indicated for volume replacement with autologous latissimus dorsi flap.
Acknowledgement
Authors Hung-Wen Lai, Shou-Tung Chen, Shih-Lung Lin, Ya-Ling Lin, Hwa-Koon Wu, Shu-Hsin Pai, Dar-Ren Chen and Shou-Jen Kuo,
Journal
Medicine Baltimore
Publisher Wolters Kluwer Health, Inc.
| 3 | | R420.00 | |
| | Mortality effects of timing alternatives for hip fracture surgery | Mortality effects of timing alternatives for hip fracture surgery
Mortality effects of timing alternatives for hip fracture surgery
Overview:
The appropriate timing of hip fracture surgery remains a matter of debate. It was sought to estimate the effect of changes in timing policy and the proportion of deaths attributable to surgical delay.
We estimated the expected population-average risks of inpatient death within 30 days if patients were surgically treated on day of admission, inpatient day 2, day 3 or after day 3. We weighted observations with the inverse propensity score of surgical timing according to confounders selected from a causal diagram.
Surgery on admission day or the following day was estimated to reduce postoperative mortality among medically stable patients with hip fracture. Hospitals should expedite operating room access for patients whose surgery has already been delayed for nonmedical reasons.
Acknowledgement
Authors:
Boris Sobolev PhD, Pierre Guy MD, Katie Jane Sheehan PhD, Lisa Kuramoto MSc, Jason M. Sutherland PhD, Adrian R. Levy PhD, James A. Blair MD, Eric Bohm MD, Jason D. Kim MPH, Edward J. Harvey MD, Suzanne N. Morin MD, Lauren Beaupre PhD, Michael Dunbar MD, Susan Jaglal PhD, James Waddell MD; for the Canadian Collaborative Study of Hip Fractures
Journal:
CMAJ Group Volume 190 Issue 31
Publisher:
National Centre for Biotechnology Information | 3 | | R460.00 | |