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1.
Bone Joint J ; 102-B(5): 556-567, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349600

RESUMEN

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.


Asunto(s)
Síndrome del Músculo Piriforme/diagnóstico , Síndrome del Músculo Piriforme/terapia , Ciática/diagnóstico , Ciática/terapia , Terapia Combinada , Diagnóstico Diferencial , Diagnóstico por Imagen , Electrodiagnóstico , Humanos , Anamnesis , Examen Físico , Síndrome del Músculo Piriforme/fisiopatología , Nervio Pudendo/fisiopatología , Nervio Ciático/fisiopatología , Ciática/fisiopatología
2.
Nurse Pract ; 45(5): 48-54, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32332233

RESUMEN

Infertility is a growing issue for couples. Primary care NPs can manage initial treatment as well as address the emotional and financial burdens of patients experiencing infertility. NPs can provide timely access to investigations and treatment, helping patients achieve their goal of pregnancy sooner.


Asunto(s)
Infertilidad/enfermería , Enfermeras Practicantes , Enfermería de Atención Primaria , Técnicas de Laboratorio Clínico , Femenino , Humanos , Infertilidad/tratamiento farmacológico , Masculino , Anamnesis , Examen Físico/enfermería , Derivación y Consulta
3.
Urol Clin North Am ; 47(2): 129-138, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32272984

RESUMEN

A male factor is a contributor in 50% of cases of infertility. Although assisted reproductive techniques can often bypass the need to improve semen parameters, the evaluation of the infertile man remains critical. Current methods for evaluating the infertile man are discussed, beginning with the basic workup that all suspected infertile men should undergo, followed by subsequent evaluation steps. Although the fundamental components of the evaluation have remained consistent, several new tools are available to assist in identifying the underlying etiology. As our understanding of male fertility expands, the technologies available to diagnose and ultimately treat it continue to evolve.


Asunto(s)
Infertilidad Masculina/diagnóstico , Infertilidad Masculina/etiología , Pruebas Genéticas , Humanos , Infertilidad Masculina/genética , Masculino , Anamnesis , Examen Físico , Análisis de Semen
4.
Med Clin North Am ; 104(3): 439-454, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32312408

RESUMEN

Anorexia and cachexia, nausea and vomiting, and constipation are gastrointestinal symptoms that commonly accompany serious illness. Basic science and clinical research continue to improve the understanding of their pathophysiology. Thorough assessment necessitates history, physical examination, and laboratory and diagnostic testing. Pharmacologic management attempts to counteract or reverse the underlying pathophysiologic mechanisms that accompany each symptom, which may benefit from a multimodal approach to achieve adequate control. Future improvements in management require investments in clinical research to determine the efficacy of novel agents along with comparator studies to better understand which treatments should be used in what sequence or combination.


Asunto(s)
Anorexia/tratamiento farmacológico , Caquexia/tratamiento farmacológico , Estreñimiento/tratamiento farmacológico , Enfermedades Gastrointestinales/tratamiento farmacológico , Náusea/tratamiento farmacológico , Vómitos/tratamiento farmacológico , Analgésicos Opioides/efectos adversos , Anorexia/epidemiología , Anorexia/fisiopatología , Biomarcadores/metabolismo , Caquexia/epidemiología , Caquexia/fisiopatología , Terapia Combinada/métodos , Estreñimiento/inducido químicamente , Estreñimiento/epidemiología , Estreñimiento/fisiopatología , Enfermedad Crítica , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/patología , Enfermedades Gastrointestinales/fisiopatología , Humanos , Inflamación/metabolismo , Inflamación/prevención & control , Náusea/epidemiología , Náusea/fisiopatología , Cuidados Paliativos/métodos , Examen Físico/métodos , Examen Físico/normas , Calidad de Vida/psicología , Receptores de Neurotransmisores/efectos de los fármacos , Vómitos/epidemiología
5.
Am J Med ; 133(4): e166, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32331577
9.
Orthop Clin North Am ; 51(2): 241-258, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32138862

RESUMEN

The glenohumeral joint is prone to instability. Patients with instability should have a physical examination. Imaging studies can provide additional information. Classification schemes that into account soft tissue pathology, neuromuscular control, bone loss, and activity level. An arthroscopic Bankart repair is the mainstay for unidirectional instability. Bone block procedures are indicated for patients with bone loss or a failed attempt at stabilization surgery. The arthroscopic Latarjet is a promising option for these patients. For patients with multidirectional instability, prolonged rehabilitation is indicated, followed by capsular plication or inferior capsular shift if instability is unresponsive to physical therapy.


Asunto(s)
Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Articulación del Hombro/cirugía , Artroscopía , Toma de Decisiones , Humanos , Internacionalidad , Inestabilidad de la Articulación/clasificación , Inestabilidad de la Articulación/diagnóstico , Examen Físico , Luxación del Hombro/clasificación , Luxación del Hombro/diagnóstico , Articulación del Hombro/anatomía & histología
10.
West J Emerg Med ; 21(2): 336-342, 2020 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-32191191

RESUMEN

INTRODUCTION: Skin and soft tissue infections (SSTI) occur along a continuum from cellulitis to abscess. Point-of-care ultrasound (POCUS) is effective in differentiating between these two diagnoses and guiding acute management decisions. Smaller and more superficial abscesses may not require a drainage procedure for cure. The goal of this study was to evaluate the optimal abscess size and depth cut-off for determining when a drainage procedure is necessary. METHODS: We conducted a retrospective study of adult patients with a SSTI who had POCUS performed. Patients were identified through an ultrasound database. We reviewed examinations for the presence, size, and depth of abscess. Medical records were reviewed to determine acute ED management and assess outcomes. The primary outcome evaluated the optimal abscess size and depth when a patient could be safely discharged without a drainage procedure. We defined a treatment failure as a return visit within seven days requiring admission, change in antibiotics, or drainage procedure. RESULTS: A total of 162 patients had an abscess confirmed on POCUS and were discharged from the ED without a drainage procedure. The optimal cut-off to predict treatment failure by receiver operating curve analysis was 1.3 centimeters (cm) in longest dimension with a sensitivity of 85% and specificity of 37% (area under the curve [AUC] 0.60, 95% confidence interval [CI], 0.44-0.76), and 0.4cm in depth with a sensitivity of 85% and specificity of 68% (AUC 0.83, 95% CI, 0.74-93). CONCLUSION: This retrospective data suggests that abscesses greater than 0.4 cm in depth from the skin surface may require a drainage procedure. Those less than 0.4 cm in depth may not require a drainage procedure and may be safely treated with antibiotics alone. Further prospective data is needed to validate these findings and to assess for an optimal size cut-off when a patient with a skin abscess may be discharged without a drainage procedure.


Asunto(s)
Absceso , Sistemas de Atención de Punto , Infecciones de los Tejidos Blandos , Ultrasonografía , Absceso/diagnóstico por imagen , Absceso/terapia , Adulto , Antibacterianos/uso terapéutico , Celulitis (Flemón) , Drenaje/métodos , Femenino , Humanos , Masculino , Registros Médicos , Persona de Mediana Edad , Alta del Paciente , Examen Físico , Estudios Retrospectivos , Sensibilidad y Especificidad , Infecciones de los Tejidos Blandos/diagnóstico por imagen , Infecciones de los Tejidos Blandos/terapia , Insuficiencia del Tratamiento , Ultrasonografía/métodos
11.
J Med Syst ; 44(5): 92, 2020 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-32189085

RESUMEN

An electronic health (e-health) system, such as a medical cyber-physical system, offers a number of benefits (e.g. inform medical diagnosis). There are, however, a number of considerations in the implementation of the medical cyber-physical system, such as the integrity of medical / healthcare data (e.g. manipulated data can result in misdiagnosis). A number of digital signature schemes have been proposed in recent years to mitigate some of these challenges. However, the security of existing signatures is mostly based on conventional difficult mathematical problems, which are known to be insecure against quantum attacks. In this paper, we propose a certificateless signature scheme, based on NTRU lattice. The latter is based on the difficulty of small integer solutions on the NTRU lattice, and is known to be quantum attack resilience. Security analysis and performance evaluations demonstrate that our proposed scheme achieves significantly reduced communication and computation costs in comparison to two other competing quantum resilience schemes, while being quantum attack resilience.


Asunto(s)
Seguridad Computacional , Confidencialidad , Registros Electrónicos de Salud/normas , Algoritmos , Comunicación , Costos y Análisis de Costo , Errores Diagnósticos , Humanos , Examen Físico
13.
PLoS One ; 15(2): e0228355, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32027683

RESUMEN

A randomization test can be used to statistically test hypotheses in multiple baseline designs to complement the commonly used visual inspection analysis. A crossed factor simulation study was performed to investigate the power of a randomization test in an multiple baseline design. The results show that the degree of autocorrelation of the observations, the number of participants, the effect size, the overlap of possible start moments of the intervention between participants, the ratio of the number of measurements in the baseline- and intervention phase, a gradually emerging effect, and the number of measurements had strong main effects on the power. The two-way interactions between number of participants and effect size, and between the number of measurements and the number of start moments of the intervention also had a large effect. An online tool was developed to calculate the power of a multiple baseline design given several design characteristics.


Asunto(s)
Distribución Aleatoria , Proyectos de Investigación , Estudios de Casos Únicos como Asunto/métodos , Biometría , Simulación por Computador , Estudios Cruzados , Humanos , Observación , Examen Físico , Proyectos de Investigación/normas , Proyectos de Investigación/estadística & datos numéricos , Tamaño de la Muestra , Estudios de Casos Únicos como Asunto/estadística & datos numéricos
14.
Rev Col Bras Cir ; 46(6): e20192284, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32022108

RESUMEN

OBJECTIVE: to evaluate newborns with suspected hip instability, referred by pediatricians to a tertiary orthopedic service. METHODS: newborns from a public university maternity hospital, with suspected instability or risk factors for hip dysplasia, were referred to the Department of Orthopedics and Anesthesiology, Ribeirão Preto/SP, where we evaluated them clinically and through ultrasound examinations of the hips. Once we found dysplasia, we initiated treatment, and in cases in which there was only hip immaturity and normal clinical examination, we performed clinical and ultrasound observation and review at two or three months of age. RESULTS: we examined 448 newborns, with female predominance and average age at first evaluation of 27 days. The main cause of referral was pelvic presentation at delivery. In 8% there was a positive Ortolani sign and in 12.5%,. At orthopedic examination, 405 (90.5%) patients were normal, 8.5% had hip click and 1.1% had positive Ortolani test. At ultrasound, 368 (89.5%) had immaturity, 26 (6.3%) had moderate dysplasia and in 17 (4.1%) patients the hips were frankly dysplastic. All cases with positive Ortolani sign showed dysplasia at ultrasound. CONCLUSION: there was an excess diagnosis of hip instability in the pediatrician evaluation, which, however, allowed the patient a second assessment, in a more specialized environment and with more technological resources.


Asunto(s)
Luxación Congénita de la Cadera/diagnóstico , Luxaciones Articulares/diagnóstico , Inestabilidad de la Articulación/diagnóstico , Estudios Transversales , Femenino , Luxación Congénita de la Cadera/terapia , Humanos , Lactante , Recién Nacido , Luxaciones Articulares/terapia , Inestabilidad de la Articulación/terapia , Masculino , Dispositivos de Fijación Ortopédica , Procedimientos Ortopédicos/instrumentación , Examen Físico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Ultrasonografía
15.
BMJ ; 368: m609, 2020 02 24.
Artículo en Inglés | MEDLINE | ID: mdl-32094143
16.
Artículo en Chino | MEDLINE | ID: mdl-32062894

RESUMEN

Objective: To analyze the results of occupational physical examination for major occupational hazard exposed laborer in 2018 in Guangzhou, to provide scientific basis for occupational health supervise. Methods: In January 2019, descriptive epidemiological methods were used as the data sources of the Occupational Disease and Occupational Health Information Surveillance System and the report data of Guangzhou Occupational Health Inspection Agency, collecting 2733 employers from 28 Occupational Health Inspection Organizations in 11 administrative regions of Guangzhou from January to December 2018, as well as the occupational health examination data of 97688 workers exposed to the occupational-disease-risk factors, to analyze the inspection of suspected occupational diseases and contraindications during the period of work of the workers who were monitored for the occupational hazard factors (silicon dust, welding fume, benzene, lead, Ethylene Dichloride, N-hexane, high temperature and hand-transmitted vibration) . Results: Total 128 cases of suspected occupational disease were detected, including 3 suspected silicosis, 8 suspected welder's pneumoconiosis, 17 suspected other pneumoconiosis, 10 suspected benzene poisoning, 1 suspected lead poisoning and 89 suspected noise deafness. There were 2061 cases of occupational contraindication, among which 550 cases were contraindication of high temperature, 261 cases were benzene and 1089 cases were noise. Conclusion: The Occupational Health Inspection Institution of this city should continuously monitor the occupational health status of the harmful workers during their work, do a good job of prevention, and strengthen the labor protection.


Asunto(s)
Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/epidemiología , Exposición Profesional/análisis , Salud Laboral , Examen Físico , China , Humanos
17.
Br J Nurs ; 29(4): 204-210, 2020 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-32105532

RESUMEN

A child presenting with decreased level of conscious (dLOC) is of great concern due to the wide range of possible causes, and potential for death or serious long-term sequelae. It is therefore vital that health professionals can recognise a child with dLOC quickly, intervene appropriately and escalate for senior review as a matter of urgency. This article provides an explanation for the mechanisms of decreased consciousness, outlines the different causative pathologies, and provides a simple and logical approach to the first-line recognition and management that a health professional may apply when faced with such a patient. Illustrative case studies have been included, to demonstrate how children with dLOC may present in clinical practice.


Asunto(s)
Trastornos de la Conciencia/enfermería , Diagnóstico de Enfermería , Niño , Trastornos de la Conciencia/epidemiología , Trastornos de la Conciencia/fisiopatología , Diagnóstico Diferencial , Enfermería de Urgencia , Femenino , Humanos , Lactante , Masculino , Rol de la Enfermera , Examen Físico/enfermería
19.
Instr Course Lect ; 69: 255-272, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017732

RESUMEN

Compared with other joints in the body, examination of the shoulder continues to be a challenge for practitioners, whether they be trainers, physical therapists, primary care physicians, or orthopedic surgeons. There are many reasons for this challenge, the primary being the highly complex architecture of bony and soft-tissue anatomy which allows for the greatest range of motion of any joint of the body. As a result, the clinical examination as Ralph Hertel, MD, has commented "perhaps it is just not easy." His comment reflects that one cannot just expect to understand how to interpret the examination unless the observer has some knowledge of how the shoulder complex works, how to perform the basics of the examination, how to interpret radiographs, and how to integrate these variables into a diagnosis. This chapter will attempt to delineate the principles which make the shoulder examination more attainable, plus highlight the areas where a combination of factors is necessary to arrive at a diagnosis.


Asunto(s)
Articulación del Hombro , Hombro , Humanos , Examen Físico , Radiografía , Rango del Movimiento Articular
20.
Instr Course Lect ; 69: 349-362, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32017737

RESUMEN

Back pain and spinal deformity in the pediatric and adolescent patient population are common reasons for presentation to the orthopaedic surgeon, and although most conditions are benign and self-limiting, a standardized approach to the history and physical examination can identify concerning signs and symptoms as well as aid in determining the final diagnosis and a recommended treatment plan. The most common and concerning etiologies of back pain and spinal deformity will be reviewed, along with nonsurgical and surgical management of these conditions.


Asunto(s)
Examen Físico , Enfermedades de la Columna Vertebral , Columna Vertebral , Adolescente , Niño , Humanos
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