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1.
Emerg Med Clin North Am ; 38(4): 771-782, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981616

RESUMO

Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication.


Assuntos
Parada Cardíaca/terapia , Prevenção Secundária , Temperatura Corporal , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Eletrocardiografia , Eletroencefalografia , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/etiologia , Humanos , Hipóxia-Isquemia Encefálica/prevenção & controle , Anamnese , Transferência de Pacientes , Intervenção Coronária Percutânea , Exame Físico , Prognóstico , Radiografia Torácica , Respiração Artificial , Convulsões/diagnóstico , Convulsões/etiologia , Tomografia Computadorizada por Raios X
2.
Emerg Med Clin North Am ; 38(4): 871-889, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981623

RESUMO

Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient's shock index is greater than 1.0. Promptly reverse coagulopathies secondary to oral anticoagulant or antiplatelet use. Use thromboelastography or rotational thromboelastometry to guide further transfusions. Secure a definitive airway and minimize aspiration.


Assuntos
Hemorragia Gastrointestinal/terapia , Manuseio das Vias Aéreas , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticoagulantes/efeitos adversos , Antifibrinolíticos/uso terapêutico , Oclusão com Balão , Fatores de Coagulação Sanguínea/administração & dosagem , Transfusão de Sangue/métodos , Cateteres , Serviço Hospitalar de Emergência , Fator Xa/administração & dosagem , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Infusões Intraósseas , Infusões Intravenosas , Anamnese , Exame Físico , Inibidores da Bomba de Prótons/uso terapêutico , Proteínas Recombinantes/administração & dosagem , Ressuscitação , Tromboelastografia , Vasoconstritores/uso terapêutico
4.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32719089

RESUMO

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.


Assuntos
Circuncisão Feminina , Criança , Maus-Tratos Infantis , Cicatriz/etiologia , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/classificação , Circuncisão Feminina/legislação & jurisprudência , Circuncisão Feminina/psicologia , Competência Clínica , Confidencialidade , Documentação , Feminino , Doenças Urogenitais Femininas/etiologia , Procedimentos Cirúrgicos em Ginecologia , Humanos , Infecções/etiologia , Infertilidade Feminina/etiologia , Consentimento Livre e Esclarecido , Classificação Internacional de Doenças , Notificação de Abuso , Anamnese , Saúde Mental , Dor/etiologia , Pediatras , Exame Físico , Prevalência , Refugiados/legislação & jurisprudência , Sexualidade
5.
Geriatr Gerontol Int ; 20(8): 785-790, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32627291

RESUMO

AIM: The majority of pneumonia in the elderly is attributed to aspiration. Identifying the cause of aspiration is essential for efficient treatment and prevention. However, the methodology on how to investigate the causes is not established. Therefore, we studied cases that were initially admitted for pneumonia and were newly diagnosed with an underlying cause of aspiration. This is the first study to analyze such cases collectively. METHODS: This was a retrospective study. Patients aged 65 years or older admitted for pneumonia from October 2012 to November 2018 and were newly diagnosed with a cause of aspiration after admission was included. Patients were excluded if they had hospital-acquired pneumonia, interstitial lung disease, or obstructive pneumonia or were immunocompromised. RESULTS: In total, 4043 patients were admitted for pneumonia and 125 cases who were newly diagnosed with causes of aspiration after admission were included in the study. This constituted 30.7% of suspected aspiration pneumonia cases in which there was no known cause of aspiration on admission. The most common conditions newly identified were neurologic disorders, upper gastrointestinal disorders, drug-induced conditions, and head and neck disease. Some were lethal. The diagnosis enabled treatment of the underlying condition and prevention of aspiration in most cases. The most common sign that lead to the diagnosis was symptoms seen from admission, followed by chronic symptoms. CONCLUSION: In 30.7% of those with suspected aspiration pneumonia with an unknown cause, a cause of aspiration was newly diagnosed. Careful history taking concerning neurological, gastrointestinal and drug-induced disorders is essential in elderly patients with pneumonia. Geriatr Gerontol Int 2020; 20: 785-790.


Assuntos
Anamnese , Pneumonia Aspirativa/etiologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco
7.
Mayo Clin Proc ; 95(6): 1268-1275, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32498779

RESUMO

Breast cancer-screening guidelines increasingly recommend that clinicians perform a risk assessment for breast cancer to inform shared decision making for screening. Precision medicine is quickly becoming the preferred approach to cancer screening, with the aim of increased surveillance in high-risk women, while sparing lower-risk women the burden of unnecessary imaging. Risk assessment also informs clinical care by refining screening recommendations for younger women, identifying women who should be referred to genetic counseling, and identifying candidates for risk-reducing medications. Several breast cancer risk-assessment models are currently available to help clinicians categorize a woman's risk for breast cancer. However, choosing the appropriate model for a given patient requires a working knowledge of the strengths, weaknesses, and performance characteristics of each. The aim of this article is to provide a stepwise approach for clinicians to assess an individual woman's risk for breast cancer and describe the features, appropriate use, and performance characteristics of commonly encountered risk-prediction models. This approach will help primary care providers engage in shared decision making by efficiently generating an accurate risk assessment and make clear, evidence-based screening and prevention recommendations that are appropriately matched to a woman's risk for breast cancer.


Assuntos
Neoplasias da Mama/diagnóstico , Programas de Rastreamento/normas , Medição de Risco/métodos , Neoplasias da Mama/prevenção & controle , Tomada de Decisão Compartilhada , Feminino , Humanos , Anamnese , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/métodos
8.
Rev. Asoc. Méd. Argent ; 133(2): 13-16, jun. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1119924

RESUMO

Se destaca la importancia de la primera consulta médica del paciente joven, que llega a la guardia médica y es recibido por un médico generalista. Es el momento ideal para realizar una medicina basada en la prevención de enfermedades orgánicas, socioculturales y psicopedagógicas que puedan comprometer la salud del adolescente. Se señalan algunos datos que el médico generalista puede obtener en esta primera entrevista sobre anomalías en el desarrollo puberal y factores de riesgo socioculturales y psicopedagógicos que pueden poner en riesgo la salud y la vida del adolescente que consulta, para realizar la posterior derivación al especialista en adolescentes.


The importance of the first medical consultation of the young patient is highlighted. It's the ideal moment to carry out a medicine based on the prevention of organic, sociocultural and psychopedagogical diseases that may compromise adolescent health. Some data that the general practitioner can obtain in this first interview about anomalies in pubertal development, sociocultural and psychopedagogical risk factors that may put at risk the health and life of the adolescent who consults and make your subsequent referral to the Teen Specialist, are point out.


Assuntos
Humanos , Adolescente , Saúde do Adolescente , Prevenção de Doenças , Clínicos Gerais , Visita a Consultório Médico , Exame Físico , Relações Médico-Paciente , Anamnese
9.
PLoS One ; 15(6): e0234000, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479516

RESUMO

BACKGROUND: While there are advances in medicine and pharmaceutical care, the burden of medication use has also grown with polypharmacy. In this regard, cardiovascular patients are subjected to polypharmacy for a longer period. OBJECTIVE: The present study aimed to assess the prevalence and predictors of polypharmacy in cardiovascular outpatients attending the University of Gondar Comprehensive specialized hospital, northwest Ethiopia. METHODS: A hospital-based cross-sectional study was employed at the University of Gondar Comprehensive Specialized Hospital from March 30 -May 30, 2019. The unique medical registration number of 424 patients was selected by using systematic random sampling to trace the medical chart and followed with an interview to explore the factors related to polypharmacy. All the Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) version 22. Bivariable and multivariable logistic regressions were used to identify the predictors of polypharmacy in cardiovascular patients. RESULT: The mean age of the respondents was 56.83 ± 15.27 years. The mean number of medications per patient was 3.3±1.6. The prevalence of polypharmacy was 24.8% in cardiovascular outpatients while cardiovascular specific polypharmacy was 9.2%. Elderly (aged ≥ 65 years and above) patients were nearly two times more likely to had polypharmacy prescriptions with AOR: 1.97; 95% CI: 1.08-3.61; p = 0.027. Patients with abnormal weight (underweight AOR: 4.51; 95% CI: 1.42-14.30; p = 0.010, overweight AOR: 3.78; 95% CI: 1.83-7.83; p<0.001 and obese AOR: 5.1; 95% CI: 2.04-12.75 p<0.001) are more likely to have polypharmacy. Having a family history of CVD increase the likelihood of polypharmacy more than double; AOR: 2.40; 95% CI: 1.17-4.93; p = 0.017. A unit increase in Charlson comorbidity index score resulted in a nearly threefold likelihood of polypharmacy with AOR: 2.83; 95% CI 1.91-3.89; p<0.001. CONCLUSION: One out of four cardiovascular patients attending the outpatient clinic was on polypharmacy. The elderly age, abnormal body mass index (non-normal weight), family history of cardiovascular diseases and increasing Charlson morbidity index were the predictors of polypharmacy in cardiovascular patients. Clinicians should ensure the relevance of all prescribed medications and pharmaceutical care targeting at the prevention of inappropriate polypharmacy would be pivotal to reduce polypharmacy associated burdens.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Doenças Cardiovasculares/tratamento farmacológico , Hospitais Universitários/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Polimedicação , Adolescente , Adulto , Fatores Etários , Idoso , Índice de Massa Corporal , Estudos Transversais , Etiópia , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Anamnese , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
10.
PLoS One ; 15(6): e0234573, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525931

RESUMO

BACKGROUND: Globally, the under-10 years of age mortality has not been comprehensively studied. We applied the life-course perspective in the analysis and interpretation of the event history demographic and verbal autopsy data to examine when and why children die before their 10th birthday. METHODS: We analysed a decade (2005-2015) of event histories data on 22385 and 1815 verbal autopsies data collected by Iganga-Mayuge HDSS in eastern Uganda. We used the lifetable for mortality estimates and patterns, and Royston-Parmar survival analysis approach for mortality risk factors' assessment. RESULTS: The under-10 and 5-9 years of age mortality probabilities were 129 (95% Confidence Interval [CI] = 123-370) per 1000 live births and 11 (95% CI = 7-26) per 1000 children aged 5-9 years, respectively. The top four causes of new-born mortality and stillbirth were antepartum maternal complications (31%), intrapartum-related causes including birth injury, asphyxia and obstructed labour (25%), Low Birth Weight (LBW) and prematurity (20%), and other unidentified perinatal mortality causes (18%). Malaria, protein deficiency including anaemia, diarrhoea or gastrointestinal, and acute respiratory infections were the major causes of mortality among those aged 0-9 years-contributing 88%, 88% and 46% of all causes of mortality for the post-neonatal, child and 5-9 years of age respectively. 33% of all causes of mortality among those aged 5-9 years was a share of Injuries (22%) and gastrointestinal (11%). Regarding the deterministic pattern, nearly 30% of the new-borns and sick children died without access to formal care. Access to the treatment for the top five morbidities was after 4 days of symptoms' recognition. The childhood mortality risk factors were LBW, multiple births, having no partner, adolescence age, rural residence, low education level and belonging to a poor household, but their association was stronger among infants. CONCLUSIONS: We have identified the vulnerable groups at risk of mortality as LBW children, multiple births, rural dwellers, those whose mother are of low socio-economic position, adolescents and unmarried. The differences in causes of mortalities between children aged 0-5 and 5-9 years were noted. These findings suggest for a strong life-course approach in the design and implementation of child health interventions that target pregnant women and children of all ages.


Assuntos
Causas de Morte , Mortalidade da Criança , Mortalidade Infantil , Adolescente , Adulto , Criança , Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Saúde do Lactente/estatística & dados numéricos , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Anamnese/estatística & dados numéricos , Fatores Socioeconômicos , Uganda
13.
Ann R Coll Surg Engl ; 102(8): 590-593, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436722

RESUMO

INTRODUCTION: In June 2013, the National Institute for Health and Care Excellence (NICE) published guidance on the management of women with a family history (FH) of breast cancer (BC) and a personal diagnosis of BC. When diagnosed with BC, pressure of timely treatment takes priority and there is potential for a significant FH to be overlooked. This can affect treatment options and follow-up imaging (FUI) surveillance. METHODS: The practice in our breast unit was compared with the NICE guidance with regard to arranging appropriate FUI and referral to the genetics team for women diagnosed with BC with a FH of BC. Data were obtained retrospectively on 200 women with BC, identified from the breast multidisciplinary team meetings from January to March 2014. Initial audit showed poor compliance with recording of FH. A standardised history taking proforma was produced for clinic use. A re-audit was conducted on a further 200 women between May and July 2016. RESULTS: In the initial audit, FH was taken in 151 women (76%) compared with 174 women (87%) in the re-audit. Thirty-seven women (25%) were thought to be of moderate risk (MR) or high risk (HR) based on FH in the first audit. Re-audit identified 35 women (20%) with MR or HR FH. Under half (43%) of the women of HR were referred to the genetics team initially; this increased to 70% in the second audit. While almost half (46%) of the women with MR or HR had inappropriate FUI in the initial audit, this fell to 11% in the re-audit. CONCLUSIONS: A proportion of women diagnosed with BC would fall into the MR or HR categories as defined in the NICE FH guidance. Inadequate recording of FH could result in inadequate FUI surveillance and in some cases missing the opportunity for a genetic referral to assess suitability for gene testing.


Assuntos
Neoplasias da Mama , Tomada de Decisão Clínica , Anamnese , Medição de Risco , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Tempo para o Tratamento
14.
Arch Phys Med Rehabil ; 101(8): 1322-1331, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32376326

RESUMO

OBJECTIVE: To investigate whether a family history of low back pain (LBP) influences patient outcomes and treatment effects following home exercises in older people with chronic LBP. DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Local community. PARTICIPANTS: People older than 55 years with chronic LBP (N=60). INTERVENTIONS: Participants in the intervention group completed video game exercises for 60 minutes 3 times per week for 8 weeks. Participants in the control group were instructed to maintain their usual levels of activity and care seeking behaviors. MAIN OUTCOMES MEASURES: Participants indicated whether any of their immediate family members had a history of "any" LBP or "activity-limiting" LBP at baseline. We collected self-reported measures of pain, function, pain self-efficacy, care seeking, physical activity, disability, fear of movement and/or reinjury, and falls efficacy at baseline, 8 weeks, 3 months, and 6 months. We performed regression analyses to determine whether a family history of LBP predicted patient outcomes and moderated the effects of home exercise. RESULTS: Participants with a family history of any LBP were less likely to be highly active than those without a family history (odds ratio, 0.08; 95% CI, 0.01-0.42; P=.003). Home-based video game exercises led to improvements in function in those without a family history of activity-limiting LBP (ß=1.78; 95% CI, 0.56-3.00; P=.006) but not in those with a family history (ß=-0.17; 95% CI, -2.56 to 2.21; P=.880) (interaction P=.049). A family history of LBP did not influence the remaining patient outcomes or treatment effects. CONCLUSIONS: A family history of LBP appears to negatively influence physical activity levels in older people with chronic LBP. Further, home-based video game exercises appear to be beneficial for older people with chronic LBP that do not have a family history of LBP.


Assuntos
Dor Crônica/reabilitação , Terapia por Exercício/métodos , Dor Lombar/reabilitação , Anamnese , Idoso , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente , Desempenho Físico Funcional , Resultado do Tratamento , Jogos de Vídeo
19.
Bone Joint J ; 102-B(5): 556-567, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349600

RESUMO

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.


Assuntos
Síndrome do Músculo Piriforme/diagnóstico , Síndrome do Músculo Piriforme/terapia , Ciática/diagnóstico , Ciática/terapia , Terapia Combinada , Diagnóstico Diferencial , Diagnóstico por Imagem , Eletrodiagnóstico , Humanos , Anamnese , Exame Físico , Síndrome do Músculo Piriforme/fisiopatologia , Nervo Pudendo/fisiopatologia , Nervo Isquiático/fisiopatologia , Ciática/fisiopatologia
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