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1.
Pediatr Ann ; 51(1): e15-e21, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35020509

RESUMEN

Cancer predisposition syndromes (CPS), or genetic syndromes leading to increased cancer risk, are responsible for at least 10% of all childhood cancers. With advances in both tumor and germline sequencing, these syndromes have been uncovered both in patients with and without syndromic features and family history of cancer. Recognition of CPS in children and use of associated screening guidelines can improve morbidity and mortality from childhood cancer. Given the multidisciplinary approach needed for management of CPS, knowledge of clinical features and surveillance guidelines are essential for the general pediatrician. Pediatricians also play a vital role in anticipatory guidance regarding cancer prevention strategies and management of psychosocial stressors associated with ongoing screening. This article discusses 10 of the more common pediatric CPS, reasons to refer patients for CPS genetic testing and evaluation, and general cancer prevention strategies. [Pediatr Ann. 2022;51(1):e15-e21.].


Asunto(s)
Pruebas Genéticas , Neoplasias , Niño , Predisposición Genética a la Enfermedad , Humanos , Anamnesis , Neoplasias/diagnóstico , Neoplasias/genética , Pediatras
2.
J Med Case Rep ; 16(1): 8, 2022 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-34996519

RESUMEN

BACKGROUND: Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. CASE PRESENTATION: A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. CONCLUSION: Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.


Asunto(s)
Neoplasias Mandibulares , Osteoma , Adulto , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/cirugía , Anamnesis , Osteoma/diagnóstico por imagen , Osteoma/cirugía , Extracción Dental
3.
JAAPA ; 35(1): 16-20, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34908557

RESUMEN

ABSTRACT: Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are different in children than adults. This article describes the presentation, physical examination, diagnosis, and treatment of common causes of acute abdominal pain in children and discusses emerging trends in diagnosis and treatment.


Asunto(s)
Abdomen Agudo , Dolor Abdominal , Abdomen Agudo/diagnóstico , Abdomen Agudo/etiología , Abdomen Agudo/terapia , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Adulto , Niño , Diagnóstico Diferencial , Humanos , Anamnesis , Examen Físico
4.
Gene ; 809: 146027, 2022 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-34673212

RESUMEN

Vitiligo is an autoimmune progressive skin depigmenting disease. Tumor necrosis factor alpha (TNF-α) is a pro-inflammatory cytokine and plays a crucial role in vitiligo development. Since there are conflicting results and consensus is lacking for the association of the TNFA gene -308 G > A polymorphism with vitiligo susceptibility; we performed a meta-analysis of all the available studies to investigate the association of TNFA -308 G > A polymorphism with vitiligo risk. 11 studies involving 2199 vitiligo patients and 3083 controls were included in the meta-analysis. The meta-analysis revealed an increased vitiligo risk with "AA", "GA" and "AA" + "GA" genotypes and 'A' allele in the overall (p = 0.006, p = 0.003, p = 0.001 & p = 0.003) and Egyptian populations (p = 0.001, p < 0.00001, p < 0.00001 & p = 0.002). Moreover, we found association for "GA" and "AA" + "GA" genotypes in Asian population (p = 0.0009 & p = 0.005) and for 'A' allele in Asian and middle eastern populations (p = 0.04 & p = 0.0002). Interestingly the disease activity based analysis revealed significant association for "GA", "AA" + "GA" genotypes and 'A' allele with active vitiligo patients in the North American population (p = 0.02). Moreover, we found significant association for "GA", "AA" + "GA" genotypes and 'A' allele with localized vitiligo in overall (p = 0.02, p = 0.02 & p = 0.04) and Asian (p = 0.004, p = 0.003 & p = 0.01) populations. Overall, our meta-analysis suggests the involvement of susceptible 'A' allele with: i) vitiligo susceptibility in overall population and specifically with Asian, Middle Eastern and Egyptian populations; ii) vitiligo disease activity in North American population and iii) localized vitiligo in overall population and specifically in Asian population.


Asunto(s)
Polimorfismo de Nucleótido Simple , Factor de Necrosis Tumoral alfa/genética , Vitíligo/genética , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Anamnesis
5.
Esc. Anna Nery Rev. Enferm ; 26: e20210178, 2022. graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1339878

RESUMEN

Resumo Objetivo conhecer as percepções e perspectivas dos profissionais da saúde para o desenvolvimento da Prevenção Quaternária na Atenção Primária à Saúde. Método Pesquisa Apreciativa, que aplicou as fases do "ciclo 4-D", na língua inglesa: discovery, dream, design e destiny. Este artigo analisa os resultados referentes à fase discovery (descoberta), de cujos dois encontros correspondentes participaram nove profissionais da Atenção Primária. Realizou-se análise de conteúdo, seguindo as etapas de pré-análise, exploração do material e tratamento dos dados. Resultados a Prevenção Quaternária representa uma potencialidade na inovação da atenção, com possibilidade de reduzir a medicalização social, que ocorre mediante a sobremedicalização, sobrediagnósticos e sobretratamentos. Como perspectivas, é apresentada a necessidade de conscientização da sociedade e dos profissionais sobre esses excessos e de (re) posicionamento da indústria, do mercado e da mídia sobre o significado de "estar saudável". Conclusão e implicações para prática é necessário atentar para a ética na prestação de cuidados quanto ao rastreio, diagnóstico e tratamento de doenças. A Prevenção Quaternária tem potencial para reverter um modelo hegemônico em relação ao cuidado de indivíduos e famílias ao fomentar a integralidade. A Enfermagem, como prestadora do cuidado, junto com a equipe multiprofissional, deve incorporar ações de Prevenção Quaternária em suas práticas.


Resumen Objetivo conocer las percepciones y perspectivas de los profesionales de la salud para el desarrollo de la Prevención Cuaternaria en Atención Primaria de Salud. Método Investigación Apreciativa, que aplicó las fases del "ciclo 4-D", en inglés: discovery, dream, design y destiny Este artículo analiza los resultados de la fase discovery (descubrimiento), en cuyos dos encuentros correspondientes participaron nueve profesionales de Atención Primaria. Se realizó análisis de contenido, siguiendo los pasos de pre-análisis, exploración de material y procesamiento de datos. Resultados la Prevención Cuaternaria representa un potencial en la innovación asistencial, con posibilidad de reducir la medicalización social, que se produce por sobremedicalización, sobrediagnóstico y sobretratamiento. Como perspectivas, se presenta la necesidad de concienciar a la sociedad y los profesionales sobre estos excesos y de (re) posicionar a la industria, el mercado y los medios de comunicación sobre el significado de "estar sano". Conclusión e implicaciones para la práctica es necesario prestar atención a la ética en la prestación de cuidados en cuanto al cribado, diagnóstico y tratamiento de enfermedades. La Prevención Cuaternaria tiene el potencial de revertir un modelo hegemónico en relación al cuidado de las personas y familias al promover la integralidad. La Enfermería, como proveedora de cuidados, junto con el equipo multidisciplinario, deben incorporar las acciones de Prevención Cuaternaria en sus prácticas.


Abstract Objective to know the perceptions and perspectives of health professionals for the development of Quaternary Prevention in Primary Health Care. Method an Appreciative Research, which applied the phases of the "4-D cycle": discovery, dream, design and destiny. This article analyzes the results referring to the discovery phase (discovery), in which nine professionals from Primary Care participated in two corresponding meetings. Content analysis was performed, following the steps of pre-analysis, material exploration and data treatment. Results the Quaternary Prevention represents a potentiality in care innovation, with the possibility of reducing social medicalization, which occurs through over-medicalization, over-diagnosis and overtreatment. As perspectives, it is presented the need for society and professionals to be aware of these excesses and the (re) positioning of the industry, market and media about the meaning of "being healthy". Conclusion and implications for the practice it is necessary to pay attention to ethics in care provision regarding screening, diagnosis and treatment of diseases. Quaternary Prevention has potential to revert a hegemonic model in relation to the care of individuals and families by promoting integrality. Nursing, as a care provider, together with the multi-professional team, must incorporate Quaternary Prevention actions in its practices.


Asunto(s)
Humanos , Atención Primaria de Salud , Personal de Salud , Medicalización , Prevención Cuaternaria , Terapias Complementarias , Comercialización de los Servicios de Salud , Educación en Salud , Investigación Cualitativa , Educación Continua , Gestor de Salud , Uso Excesivo de los Servicios de Salud , Anamnesis
6.
Recurso Educacional Abierto en Español | CVSP - Regional | ID: oer-3988

RESUMEN

Evaluación clinica de la enfermidade


Asunto(s)
Mycobacterium leprae , Atención Primaria de Salud , Anamnesis
7.
JAMA Netw Open ; 4(12): e2138780, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34905003

RESUMEN

Importance: Individuals with limited English proficiency (LEP) may be unaware of underlying cardiovascular disease (CVD) owing to a lack of diagnostic testing or poor communication with health care practitioners. Objective: To evaluate whether participants with anginal symptoms and LEP would be less likely to report a history of CVD compared with those without LEP. Design, Study, and Participants: This population-based cross-sectional study combined data from 5 National Health and Nutrition Examination Survey (NHANES) cycles conducted from 2007 to 2016. Each cycle includes an interview that collects demographic, dietary, and health-related data as well as a medical examination component in which physiological measurements are taken. All NHANES participants aged 40 years or older who took the Rose questionnaire were included. Data were analyzed from September 2020 to April 2021. Exposures: LEP was defined as a participant receiving the survey in a non-English language or by interpreter. Main Outcomes and Measures: The 7-item Rose questionnaire assessed the presence of anginal symptoms. Self-reported CVD was defined as history of heart failure, coronary heart disease, angina pectoris, or myocardial infarction. The association between LEP status and self-reported CVD among those with anginal symptoms was determined in multivariable-adjusted models. All analyses were weighted per NHANES analytic protocols. Results: Among 19 320 participants (mean [SD] age, 57.8 [11.8] years; 9344 [47.2%] male; 4145 [10.6%] Black; 2743 [6.3%] Mexican American; 2111 [4.6%] other Hispanic; 8386 [71.6%] White; and 1935 [6.9%] other race), 583 (3.0%) reported anginal symptoms. Of these, most were non-LEP (484 [96.1%]), women (344 [62.1%]), White (251 [66.8%]), and did not report having CVD (347 [62.8%]). Among those with angina, 73 of 99 respondents with LEP (79.0%) reported not having a history of CVD, compared with 274 of 484 without LEP (61.4%; P = .002). Participants with LEP had 2.8-fold higher odds of not reporting a history of CVD compared with participants without LEP (odds ratio, 2.77; 95% CI, 1.38-5.55; P = .005). Conclusions and Relevance: Among NHANES participants reporting anginal symptoms, participants with LEP were more likely not to report having CVD. This discrepancy may be because of higher rates of undiagnosed CVD or lower awareness of such diagnoses among individuals with LEP. Our findings highlight the relevance of communication strategies for individuals with LEP to provide effective intervention and treatment for CVD prevention.


Asunto(s)
Angina de Pecho/diagnóstico , Dominio Limitado del Inglés , Anamnesis , Autoinforme , Adulto , Anciano , Anciano de 80 o más Años , Barreras de Comunicación , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Estados Unidos
8.
JAMA Netw Open ; 4(12): e2138775, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34905004

RESUMEN

Importance: Patients with type 1 diabetes (T1D) and a family history of type 2 diabetes (T2D) appear to be at a high risk of diabetes complications and other cardiovascular diseases. However, estimates of individual risks in patients in Taiwan are largely unavailable or unreliable. Objective: To evaluate the risk of diabetes complications and major adverse cardiovascular events (MACEs) in patients with T1D with a family history of T2D. Design, Setting, and Participants: A population-based cohort study used the Taiwan National Health Insurance Research Database. Participants included all individuals registered in that database on December 31, 2017, and followed up since March 1, 1995. The data were analyzed from December 6, 2018, to December 5, 2019. Exposure: Patients with T1D and a family history of T2D were evaluated. Main Outcomes and Measures: The prevalence and hazard ratios (HRs) of diabetes complications and other cardiovascular diseases in patients with T1D were analyzed. The MACEs were identified by diagnostic or procedural codes and heritability was formulated by the registry data of beneficiaries. Results: Of 27 370 965 individuals included in the database, 11 237 (mean [SD] age, 22.7 [14.4] years; 54% were female) had T1D. The crude prevalence of T1D was 0.04%, with a female to male ratio of 1.22: 1. The adjusted HRs in individuals who had a first-degree relative with T2D were 2.61 (95% CI, 1.32-5.16) for MACEs at an age at diagnosis of less than 20 years. Adjusted HRs were 1.44 (95% CI, 1.27-1.64) for diabetic neuropathy, 1.28 (95% CI, 1.12-1.47) for retinopathy, and 1.24 (95% CI, 1.06-1.47) for neuropathy at all ages of diagnosis. Conclusions and Relevance: In this study of patients in Taiwan with T1D, having relatives with T2D was associated with an increase in the individual risks of developing diabetes complications. Patients with T1D and a family history of T2D might have more complications and require close management.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/etiología , Retinopatía Diabética/etiología , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/epidemiología , Bases de Datos Factuales , Nefropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Anamnesis , Persona de Mediana Edad , Prevalencia , Modelos de Riesgos Proporcionales , Factores de Riesgo , Taiwán
9.
PLoS One ; 16(12): e0261824, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34962965

RESUMEN

Bacterial sexually transmitted infections (STIs) continue to be a worsening public health concern in the United States (US). Though the national incidence of HIV infection has decreased over recent years, that of chlamydia, gonorrhea, and syphilis have not. Despite national recommendations on prevention, screening, and treatment of these STIs, these practices have not been standardized. Nine Health Resources and Services Administration Ryan White HIV/AIDS Program funded clinics across 3 US jurisdictions (Florida, Louisiana, and Washington, DC), were selected as clinical demonstration sites to be evaluated in this mixed method needs assessment to inform a multi-site, multi-level intervention to evaluate evidence-based interventions to improve STI screening and testing of bacterial STIs among people with or at risk for HIV. These 3 US jurisdictions were selected due to having higher than national average incidence rates of HIV and bacterial STIs. Descriptive statistics and deductive analysis were used to assess quantitative and qualitative needs assessment data. Results indicate the following needs across participating sites: inconsistent and irregular comprehensive sexual behavior history taking within and among sites, limited routine bacterial STI testing (once/year and if symptomatic) not in accordance with CDC recommendations, limited extragenital site gonorrhea/chlamydia testing, limited annual training on STI-related topics including LGBTQ health and adolescent/young adult sexual health, and limited efforts for making high-STI incidence individuals feel welcome in the clinic (primarily LGBTQ individuals and adolescents/young adults). These findings were used to identify interventions to be used to increase routine screenings and testing for bacterial STIs.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Evaluación de Necesidades , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/terapia , Adolescente , Adulto , District of Columbia , Medicina Basada en la Evidencia , Femenino , Florida , Infecciones por VIH/complicaciones , Humanos , Louisiana , Tamizaje Masivo/estadística & datos numéricos , Anamnesis , Embarazo , Complicaciones del Embarazo , Desarrollo de Programa , Investigación Cualitativa , Riesgo , Conducta Sexual , Enfermedades de Transmisión Sexual/complicaciones , Adulto Joven
15.
PLoS One ; 16(12): e0261298, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34932566

RESUMEN

Models of attention demonstrated the existence of top-down, bottom-up, and history-driven attentional mechanisms, controlled by partially segregated networks of brain areas. However, few studies have examined the specific deficits in those attentional mechanisms in intellectual disability within the same experimental setting. The aim of the current study was to specify the attentional deficits in intellectual disability in top-down, bottom-up, and history-driven processing of multisensory stimuli, and gain insight into effective attentional cues that could be utilized in cognitive training programs for intellectual disability. The performance of adults with mild to moderate intellectual disability (n = 20) was compared with that of typically developing controls (n = 20) in a virtual reality visual search task. The type of a spatial cue that could aid search performance was manipulated to be either endogenous or exogenous in different sensory modalities (visual, auditory, tactile). The results identified that attentional deficits in intellectual disability are overall more pronounced in top-down rather than in bottom-up processing, but with different magnitudes across cue types: The auditory or tactile endogenous cues were much less effective than the visual endogenous cue in the intellectual disability group. Moreover, the history-driven processing in intellectual disability was altered, such that a reversed priming effect was observed for immediate repetitions of the same cue type. These results suggest that the impact of intellectual disability on attentional processing is specific to attentional mechanisms and cue types, which has theoretical as well as practical implications for developing effective cognitive training programs for the target population.


Asunto(s)
Atención/fisiología , Percepción Auditiva/fisiología , Señales (Psicología) , Discapacidad Intelectual/fisiopatología , Tiempo de Reacción , Realidad Virtual , Percepción Visual/fisiología , Estimulación Acústica , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Discapacidad Intelectual/psicología , Masculino , Anamnesis , Persona de Mediana Edad , Estimulación Luminosa , Adulto Joven
18.
J Pak Med Assoc ; 71(11): 2674-2675, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34783760

RESUMEN

History taking and clinical interviewing is usually the start of medical contact with patients with chronic diseases like diabetes mellitus in primary care. The current novel corona virus-19 epidemic has limited our ability to conduct in-person consultations with patients as before and most of us limit physical contact to the minimum. This has made the process of history taking either by virtual consultations or physically in our offices but by maintaining appropriate physical distance more important than even before. This review summarizes an easy-to-understand hierarchy of questioning to help us in maximizing the information obtained by history taking. We initiate the clinical interview with a warm welcome and first focus on the primary felt need of the patient. Then we interview the patient about his duration and current control of his diabetes. The second part of the interview focuses on current clinical status including reviewing for complications and co-morbidities. The third part focuses on current ongoing management including life style, diet, glucose lowering and other drugs and the use of complementary and alternative medicines. The fourth part of the interview focuses on emotional status including religious and cultural beliefs about diabetes management and presence of diabetes related distress. Special attention should be paid to the financial status of patients who are paying for their treatment out of pocket. The interview should conclude with summarization of current issues with regards to diabetes management and a therapeutic plan individualized for the patient.


Asunto(s)
COVID-19 , Diabetes Mellitus , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Humanos , Anamnesis , Atención Primaria de Salud , SARS-CoV-2
20.
Torture ; 31(1): 37-52, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34606476

RESUMEN

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Asunto(s)
COVID-19/epidemiología , Relaciones Médico-Paciente/ética , Refugiados/psicología , Consulta Remota/ética , Teléfono , Tortura , Humanos , Anamnesis , Pandemias , Examen Físico , SARS-CoV-2 , Reino Unido/epidemiología
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