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1.
N Z Med J ; 134(1538): 135-138, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239153

RESUMO

Medical students from the University of Otago, Christchurch Department of Medicine were involved in their local COVID-19 response. A group of ten students helped with the assessment of individuals at community-based assessment centres or mobile testing units. They primarily helped assess and test individuals alongside experienced healthcare workers. The students gained valuable clinical and public health experience. Key learning points were the risks of pandemic involvement, identifying local barriers to healthcare and developing an appreciation for an evolving health response. Overall, students felt that preparation for future involvement could benefit further pandemic responses.


Assuntos
COVID-19/diagnóstico , Estudantes de Medicina , Teste para COVID-19 , Humanos , Anamnese , Nasofaringe/virologia , Nova Zelândia , Equipamento de Proteção Individual , SARS-CoV-2
3.
Emerg Med Clin North Am ; 39(3): 589-603, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215404

RESUMO

Emergency medicine clinicians are mandated reporters, legally, which obligates clinicians to report any behavior suspicious for child maltreatment to local authorities. Pediatric patients often present to the emergency department with concern for physical injury and other pervasive complaints. In some cases, these injuries are nonaccidental. To appropriately advocate and protect children from further physical and emotional trauma, it is important for clinicians to recognize the signs and symptoms of child maltreatment and sexual abuse.


Assuntos
Maus-Tratos Infantis/diagnóstico , Cuidadores , Criança , Desenvolvimento Infantil , Serviços de Proteção Infantil , Diagnóstico Diferencial , Diagnóstico por Imagem , Medicina Legal , Humanos , Notificação de Abuso , Anamnese , Síndrome de Munchausen Causada por Terceiro/diagnóstico , Exame Físico , Profilaxia Pós-Exposição , Encaminhamento e Consulta , Doenças Sexualmente Transmissíveis/prevenção & controle , Tempo para o Tratamento
4.
Emerg Med Clin North Am ; 39(3): 641-660, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215407

RESUMO

There are a growing number of medically complex children with implanted devices. Emergency physicians with a basic knowledge of these devices can troubleshoot and fix many of the issues that may arise. Recognition of malfunction of these devices can reduce morbidity and mortality among this special population. In this article, we review common issues that may arise in children with gastrostomy tubes, central nervous system shunts, cochlear implants, and vagal nerve stimulators.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Implantes Cocleares/efeitos adversos , Nutrição Enteral/efeitos adversos , Estimulação do Nervo Vago/efeitos adversos , Encéfalo/diagnóstico por imagem , Criança , Serviço Hospitalar de Emergência , Falha de Equipamento , Gastrostomia/efeitos adversos , Humanos , Infecções/diagnóstico , Infecções/etiologia , Anamnese , Medicina de Emergência Pediátrica , Exame Físico , Estimulação do Nervo Vago/instrumentação
5.
Cent Eur J Public Health ; 29(2): 83-89, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34245546

RESUMO

OBJECTIVES: Globally, child mortality from external causes is in decline, but it is still among the leading causes of child deaths. The aim of this first national study was to determine trends of mortality rates from external causes among children aged 1-14 years in Serbia. METHODS: Mortality data were collected from the database of the Statistical Office of Serbia. Joinpoint analysis was used to assess the average annual percentage change (APC) and the corresponding 95% confidence interval (CI) in mortality from 1997 to 2016. RESULTS: In the 1997-2016 period, there were 1,388 child deaths from external causes. They contributed to 29.4% of child mortality in total, from 34.8% in 1997 to 21.8% in 2016. Mortality rate was two times higher among boys (8.1 per 100,000) than girls (4.1 per 100,000). Transport accidents (37.6%), followed by drowning and submersion (18.2%), represented more than half of all deaths due to external causes. Since 1997, mortality rate showed a significant downward trend in boys by -5.4% (95% CI -6.8 to -3.9) yearly for unintentional injuries and significantly by -10% (95% CI -19.0 to 0.1) yearly for intentional injuries. Among girls, death rate for unintentional injuries decreased significantly by -7.1% (95% CI -9.0 to -5.1) yearly and decreased insignificantly for intentional injuries by -2.1% (95% CI -15.3 to 13.1) yearly. CONCLUSIONS: The external causes of death, despite the substantial decline in mortality, are still present among children aged 1-14 years in Serbia. Therefore, implementation of nationwide programmes for prevention of external causes of death is urgent.


Assuntos
Ferimentos e Lesões , Adolescente , Causalidade , Causas de Morte , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Anamnese , Mortalidade , Sérvia/epidemiologia
6.
BMC Infect Dis ; 21(1): 535, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098882

RESUMO

BACKGROUND: During the SARS-CoV-2 pandemic a mass casualty incident of ambulatory patients occurred at the COVID-19 rapid response infrastructure (CRRI) facility at the University Hospital of Cologne (UHC). We report the development of a patient-centred mobile-device solution to support efficient management of the facility, triage of patients and rapid delivery of test results. METHODS: The UHC-Corona Web Tool (CWT) was developed as a web-based software useable on each patient's smartphone. It provides, among others, a self-reported medical history including type and duration of symptoms and potential risk contacts and links all retrieved information to the digital patient chart via a QR code. It provides scheduling of outpatient appointments and automated transmission of SARS-CoV-2 test results. RESULTS: The UHC-CWT was launched on 9 April 2020. It was used by 28,652 patients until 31 August 2020. Of those, 15,245 (53,2%) consulted the CRRI, representing 43,1% of all CRRI patients during the observed period. There were 8304 (29,0%) specifications concerning travel history and 17,145 (59,8%) indications of ≥1 symptom of SARS-CoV-2 infection. The most frequently indicated symptoms were sore throat (60,0%), headache (50,7%), common cold (45,1%) and cough (42,6%) while 11,057 (40,2%) patients did not report any symptoms. After implementation of the UHC-CWT, the amount of patient contacts per physician rose from 38 to 98,7 per day. The personnel for communication of test results were reduced from four on seven days to one on five days. CONCLUSION: The UHC-CWT is an effective digital solution for management of large numbers of outpatients for SARS-CoV-2 testing.


Assuntos
Teste para COVID-19/métodos , COVID-19/diagnóstico , Internet , Triagem/métodos , Instituições de Assistência Ambulatorial , Registros Eletrônicos de Saúde , Alemanha , Hospitais Universitários , Humanos , Masculino , Anamnese , Pandemias , Smartphone , Inquéritos e Questionários , Viagem
7.
BMJ Case Rep ; 14(6)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167969

RESUMO

A case of neonatal death due to neonatal purpura fulminans (NPF) was brought to community physicians' notice by the auxiliary nurse midwife in her catchment area as part of the routine demographic health surveillance. The community physician then conducted the child death review in the community. The neonate was born out of consanguineous marriage (mother married to her first-degree maternal cousin) with spontaneous conception. This neonate was fourth in the birth order. The second-order and third-order births had also suffered from NPF and died. The baby was delivered in a tertiary care setting, and the paediatric surgeon planned debridement of the affected part on the third day of the birth, as per the mother. However, due to inadequate counselling regarding the procedure, mother left the hospital without seeking care against medical advice, and the child died at home.


Assuntos
Tocologia , Médicos , Púrpura Fulminante , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Anamnese , Gravidez
8.
Medicine (Baltimore) ; 100(26): e26465, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190170

RESUMO

ABSTRACT: Acute dystonic reactions are a worrying reason for presentation to the pediatric emergency department and the pediatric neurology clinic in childhood. It must be diagnosed and treated quickly. The aim of this study was to examine the clinical presentations, etiological factors, and prognosis of patients presenting to our regional tertiary pediatric neurology clinic with a diagnosis of acute dystonic reactions in children.Nine pediatric patients who were treated for acute dystonic reactions between May, 2018 and May, 2020 and had adequate follow-up were included in the study. Medical record data were reviewed age, gender, etiology, features of family, treatment, and results.Three of the patients were female and 6 were male. Their average age was 11 years (4-17). All patients were evaluated as a drug-induced acute dystonic reaction. Of the 9 patients, 5 were due to metoclopramide, 3 were due to risperidone, and 1 was due to aripiprazole. It was learned that a similar situation against other drugs developed in the family history of 3 patients. As a treatment, all of them were intramuscularly applied biperiden suitable for their weight and 30 minutes dramatic improvement was observed. Additional dose had to be administered in only 1 case. All cases were discharged for 24 hours. No problem was observed in their follow-up.Drug-induced acute dystonic reaction can be diagnosed and has a clinical picture that completely resolves when effective treatment is applied. However, it should not be forgotten that it can reach life-threatening dimensions clinically.


Assuntos
Aripiprazol/efeitos adversos , Biperideno/administração & dosagem , Distonia , Metoclopramida/efeitos adversos , Risperidona/efeitos adversos , Idade de Início , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Aripiprazol/administração & dosagem , Criança , Suscetibilidade a Doenças , Antagonistas dos Receptores de Dopamina D2/administração & dosagem , Antagonistas dos Receptores de Dopamina D2/efeitos adversos , Distonia/induzido quimicamente , Distonia/diagnóstico , Distonia/tratamento farmacológico , Distonia/epidemiologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Anamnese , Metoclopramida/administração & dosagem , Parassimpatolíticos/administração & dosagem , Risperidona/administração & dosagem , Resultado do Tratamento , Turquia/epidemiologia
9.
Am Fam Physician ; 103(11): 663-671, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34060792

RESUMO

Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care. Most cases of tinnitus are benign and idiopathic and are strongly associated with sensorineural hearing loss. A standard workup begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment. Less common but potentially dangerous causes such as vascular tumors and vestibular schwannoma should be ruled out. A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems. Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss. Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus. Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive. Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively. Avoidance of noise exposure may help prevent the development or progression of tinnitus. Providing information about the natural progression of tinnitus and being familiar with the causes that warrant additional evaluation, imaging, and specialist involvement are essential to comprehensive care.


Assuntos
Zumbido/diagnóstico , Zumbido/terapia , Testes Auditivos , Humanos , Anamnese , Exame Físico , Fatores de Risco , Zumbido/etiologia
10.
J Safety Res ; 77: 40-45, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34092326

RESUMO

INTRODUCTION: Veterans are at heightened risk of being in a motor-vehicle crash and many fail on-road driving evaluations, particularly as they age. This may be due in part to the high prevalence of age-associated conditions impacting cognition in this population, including neurodegenerative diseases (e.g., Alzheimer's Disease) and acquired neurological conditions (e.g., cerebrovascular accident). However, understanding of the impact of referral diagnosis, age and cognition on Veterans' on-road driving performance is limited. METHODS: 109 Veterans were referred for a driving evaluation (mean age = 72.0, SD = 11.5) at a driving assessment clinic at the Minneapolis Veterans Affairs Healthcare System. Of the 109 Veterans enrolled, 44 were referred due to a neurodegenerative disease, 37 due to an acquired neurological condition, and 28 due to a non-neurological condition (e.g., vision loss). Veterans completed collection of health history information and administration of cognitive tests assessing visual attention, processing speed, and executive functioning, as well as a standardized, on-road driving evaluation. RESULTS: A total of 17.9% of Veterans failed the on-road evaluation. Clinical diagnostic group was not associated with failure rate. Age was not associated with failure rates in the full sample or within diagnostic groups. After controlling for age, poorer processing speed and selective/divided attention were associated with higher failure rates in the full sample. No cognitive tests were associated with failure rates within diagnostic groups. CONCLUSION: Referral diagnosis and age alone are not reliable predictors of Veterans' driving performance. Cognitive performance, specifically speed of processing and attention, may be helpful in screening Veterans' driving safety. Practical Applications: Clinicians tasked with assessing Veterans' driving safety should take into account cognitive performance, particularly processing speed and attention, when making decisions regarding driving safety. Age and referral diagnosis, while helpful information, are insufficient to predict outcomes on driving evaluations.


Assuntos
Exame para Habilitação de Motoristas/estatística & dados numéricos , Doenças Neurodegenerativas/epidemiologia , Veteranos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atenção , Condução de Veículo , Cognição , Função Executiva , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Testes Neuropsicológicos
11.
JAMA ; 325(23): 2381-2391, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34128995

RESUMO

Importance: Chronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world's female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions. Observations: Chronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process. Conclusions and Relevance: Chronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.


Assuntos
Dor Pélvica , Dor Crônica , Terapia Combinada , Comorbidade , Feminino , Humanos , Anamnese , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Dor Pélvica/terapia , Pelve/inervação , Exame Físico/métodos , Exame Físico/psicologia
12.
Medicine (Baltimore) ; 100(25): e26443, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160437

RESUMO

RATIONALE: Autosomal dominant hypocalcaemia type 1 (ADH1) is a genetic disease characterized by benign hypocalcemia, inappropriately low parathyroid hormone levels and mostly hypercalciuria. It is caused by the activating mutations of the calcium-sensing receptor gene (CASR), which produces a left-shift in the set point for extracellular calcium. PATIENT CONCERNS: A 50-year-old man presenting with muscle spasms was admitted into the hospital. He has a positive familial history for hypocalcemia. Auxiliary examinations demonstrated hypocalcemia, hyperphosphatemia, normal parathyroid hormone level and nephrolithiasis. A missense heterozygous variant in CASR, c 613C > T (p. Arg205Cys) which has been reported in a familial hypocalciuric hypercalcemia type 1 patient was found in the patient's genotype. It is the first time that this variant is found associating with ADH1. The variant is predicted vicious by softwares and cosegregates with ADH1 in this pedigree. CASR Arg205Cys was deduced to be the genetic cause of ADH1 in the family. DIAGNOSIS: The patient was diagnosed with ADH1 clinically and genetically. INTERVENTIONS: Oral calcitriol, calcium and hydrochlorothiazide were prescribed to the patient. OUTCOMES: After the treatments for 1 week, the patient's symptom was improved and the re-examination revealed serum calcium in the normal range. A 3-month follow-up showed his symptom was mostly relieved. LESSONS: The variant of CASR Arg205Cys, responsible for ADH1 in this family, broadened the genetic spectrum of ADH1. Further and more studies are required to evaluate the correlation between genotype and phenotype in ADH1 patients.


Assuntos
Cálcio/administração & dosagem , Hipercalciúria/diagnóstico , Hipocalcemia/diagnóstico , Hipoparatireoidismo/congênito , Receptores de Detecção de Cálcio/genética , Calcitriol/administração & dosagem , Cálcio/sangue , Análise Mutacional de DNA , Quimioterapia Combinada/métodos , Feminino , Testes Genéticos , Heterozigoto , Humanos , Hidroclorotiazida/administração & dosagem , Hipercalciúria/sangue , Hipercalciúria/genética , Hipocalcemia/sangue , Hipocalcemia/genética , Hipoparatireoidismo/sangue , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/genética , Masculino , Anamnese , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Linhagem , Resultado do Tratamento
14.
Clin Dermatol ; 39(1): 45-51, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33972051

RESUMO

Dermatology is a clinical and visual discipline, which makes it the quintessential medical specialty for spot diagnosis and telemedicine. The COVID-19 pandemic has led to an unprecedented worldwide renaissance of teledermatology (TD). It has helped deliver high-quality medical care, while protecting the medical personnel and vulnerable patients from potential infection. Examining a patient from a distance through digital photography has many drawbacks, including lack of physical touch, difficulties in performing full body examinations, and several legal and ethical issues. We summarize have summarized the more common pitfalls and highlight the key aspects of direct patient-to-physician TD. Basic practical advice includes the use of TD for obtaining patient history, examining patient-captured photographs for inflammatory skin disease, and skin cancer screening.


Assuntos
COVID-19/prevenção & controle , Dermatite/diagnóstico por imagem , Dermatologia/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Telemedicina/métodos , COVID-19/epidemiologia , Dermatologia/ética , Dermatologia/legislação & jurisprudência , Detecção Precoce de Câncer/métodos , Humanos , Anamnese , Visita a Consultório Médico , Fotografação/normas , Telemedicina/ética , Telemedicina/legislação & jurisprudência
15.
Medicine (Baltimore) ; 100(18): e25192, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950917

RESUMO

BACKGROUND: Hypertension (HTN) has been considered as a health concern in developing countries. And Hui is a minority group with a large population in China. Its genetic background, inadequate access to health services, eating habits, religious belief, ethnic customs, and other factors differ from that of other ethnic groups, which may influence the prevalence of HTN. However, there is no current meta-analysis on the prevalence and risk factors of HTN among Hui population. Thus we conducted a systematic review aiming to estimate the pooled prevalence and risk factors of HTN among Hui population. METHODS: PubMed, The Cochrane library, Web of science, CINAHL Complete, Weipu Database (VIP), China Knowledge Resource Integrated Database (CNKI), Wanfang Database, and SinoMed were systematically searched from inception to February 28, 2020 with publication language restricted to English and Chinese. We included cross-sectional, case-control, or cohort studies that focused on prevalence and risk factors of HTN among Hui population. Two investigators independently assessed the risk of bias of the studies included in the review using tools developed by JBI. Meta-analysis was conducted using Stata 12.0 software package. RESULTS: Twenty-three studies were identified with a total of 30,565 study participants. The overall pooled prevalence of HTN was 28% (95% confidence interval [CI]: 24%-32%, I2 = 98.8%, P < .001). Stratified by gender, the pooled prevalence of HTN in Hui was 26% (95%CI: 20%-33%, I2 = 97.6%, P < .001) for males and 30% (95%CI: 23%-37%, I2 = 98.3%, P < .001) for females. Pooled prevalence of HTN in Hui was 2% (95%CI: 2%-6%, I2 = 70.6%, P = .065), 10% (95%CI: 3%-17%, I2 = 83.7%, P < .001), 22% (95%CI: 12%-32%, I2 = 87.9%, P < .001), 37% (95%CI: 20%-53%, I2 = 94.0%, P < .001), 39% (95%CI: 24%-54%, I2 = 97.7%, P < .001) and 42% (95%CI: 29%-56%, I2 = 95.6%, P < .001) for those aged 18 to 29, 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70 years, respectively. Pooled prevalence of HTN in Hui was 22% (95%CI: 14%-29%, I2 = 97.9%, P < .001) in urban areas and 23% (95%CI: 16%-30%, I2 = 95.8%, P < .001) in rural areas. Daily salt intake (odd ratio [OR] = 3.94, 95%CI: 3.03-5.13, I2 = 90.2%, P < 001), family history (OR = 3.50, 95%CI: 2.60-4.71, I2 = 95.3%, P < .001), smoking (OR = 1.84, 95%CI: 1.61-2.09, I2 = 59.6%, P < .001), drinking (OR = 1.74, 95%CI: 1.26-2.39, I2 = 95.3%, P = .001), weekly meat intake (OR = 1.92, 95%CI: 1.04-3.54, I2 = 96.5%, P = .036), body mass index (OR = 2.20, 95%CI: 1.81-2.66, I2 = 91.3%, P < .001), and areas (OR = 1.29, 95%CI: 1.10-1.51, I2 = 81.5%, P = .001) were risk factors of HTN in Hui, while physical exercise (OR = 0.76, 95%CI: 0.66-0.88, I2 = 62.7%, P < .001) was protective factor. CONCLUSIONS: The pooled prevalence of HTN among Hui people was 28%, daily salt intake, family history, drinking, smoking, weekly meat intake, body mass index, areas, and physical exercise were all risk factors for HTN among Hui population. Early screening and treatment of HTN among Hui population should be given due attention.


Assuntos
Hipertensão/epidemiologia , Grupos Minoritários/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Índice de Massa Corporal , China/epidemiologia , Comportamento Alimentar , Humanos , Hipertensão/prevenção & controle , Carne/efeitos adversos , Anamnese , Prevalência , Fatores de Risco , Fumar/epidemiologia , Cloreto de Sódio na Dieta/efeitos adversos
16.
Am Fam Physician ; 103(10): 597-604, 2021 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-33983001

RESUMO

Dyspareunia is recurrent or persistent pain with sexual intercourse that causes distress. It affects approximately 10% to 20% of U.S. women. Dyspareunia may be superficial, causing pain with attempted vaginal insertion, or deep. Women with sexual pain are at increased risk of sexual dysfunction, relationship distress, diminished quality of life, anxiety, and depression. Because discussing sexual issues may be uncomfortable, clinicians should create a safe and welcoming environment when taking a sexual history, where patients describe the characteristics of the pain (e.g., location, intensity, duration). Physical examination of the external genitalia includes visual inspection and sequential pressure with a cotton swab, assessing for focal erythema or pain. A single-digit vaginal examination may identify tender pelvic floor muscles, and a bimanual examination can assess for uterine retroversion and pelvic masses. Common diagnoses include vulvodynia, inadequate lubrication, vaginal atrophy, postpartum causes, pelvic floor dysfunction, endometriosis, and vaginismus. Treatment is focused on the cause and may include lubricants, pelvic floor physical therapy, topical analgesics, vaginal estrogen, cognitive behavior therapy, vaginal dilators, modified vestibulectomy, or onabotulinumtoxinA injections.


Assuntos
Dispareunia , Exame Ginecológico/métodos , Administração dos Cuidados ao Paciente/métodos , Qualidade de Vida , Estresse Psicológico , Adulto , Dispareunia/diagnóstico , Dispareunia/etiologia , Dispareunia/psicologia , Dispareunia/terapia , Feminino , Doenças dos Genitais Femininos/complicações , Exame Ginecológico/psicologia , Humanos , Anamnese/métodos , Anamnese/normas , Medição da Dor , Medição de Risco , Fatores de Risco , Estresse Psicológico/fisiopatologia , Estresse Psicológico/prevenção & controle
17.
BMJ ; 373: n877, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947661

RESUMO

OBJECTIVE: To assess the risk of colorectal cancer (CRC) in first degree relatives (parents and full siblings) of patients with precursor lesions (polyps) for CRC. DESIGN: Case-control study. SETTING: Linkage to the multi-generation register and gastrointestinal ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) histopathology cohort in Sweden. PARTICIPANTS: 68 060 patients with CRC and 333 753 matched controls. MAIN OUTCOME MEASURES: Multivariable adjusted odds ratios of CRC according to the number of first degree relatives with a colorectal polyp and the histology of polyps and age at diagnosis in first degree relatives. Subgroup analysis was also performed according to age at CRC diagnosis and evaluated the joint association of family history of colorectal polyps and family history of CRC. RESULTS: After adjusting for family history of CRC and other covariates, having a first degree relative with a colorectal polyp (8.4% (5742/68 060) in cases and 5.7% (18 860/333 753) in controls) was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). The odds ratios ranged from 1.23 for those with hyperplastic polyps to 1.44 for those with tubulovillous adenomas. To better put this risk in perspective, the age specific absolute risk of colon and rectal cancers was estimated according to family history of polyps based on the 2018 national CRC incidence in Sweden. For example, the absolute risk of colon cancer in individuals aged 60-64 years with and without a family history of colorectal polyp was, respectively, 94.3 and 67.9 per 100 000 for men and 89.1 and 64.1 per 100 000 for women. The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps (≥2 first degree relatives: 1.70, 1.52 to 1.90, P<0.001 for trend) and decreasing age at polyp diagnosis (<50 years: 1.77, 1.57 to 1.99, P<0.001 for trend). A particularly strong association was found for early onset CRC diagnosed before age 50 years (≥2 first degree relatives: 3.34, 2.05 to 5.43, P=0.002 for heterogeneity by age of CRC diagnosis). In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79 (1.52 to 2.10), with one first degree relative with CRC but no polyps was 1.70 (1.65 to 1.76), and with two or more first degree relatives with both polyps and CRC was 5.00 (3.77 to 6.63) (P<0.001 for interaction). CONCLUSIONS: After adjusting for family history of CRC, the siblings and children of patients with colorectal polyps are still at higher risk of CRC, particularly early onset CRC. Early screening for CRC might be considered for first degree relatives of patients with polyps.


Assuntos
Pólipos do Colo/epidemiologia , Neoplasias Colorretais/epidemiologia , Anamnese , Lesões Pré-Cancerosas/epidemiologia , Reto/patologia , Crianças Adultas/estatística & dados numéricos , Idade de Início , Idoso , Estudos de Casos e Controles , Colo/patologia , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/prevenção & controle , Feminino , Humanos , Masculino , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Sistema de Registros/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Fatores Sexuais , Irmãos , Suécia/epidemiologia
18.
Clin Podiatr Med Surg ; 38(3): 461-481, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34053655

RESUMO

Pathologic affects from a cavus foot deformity range from flexible subtle to rigid severe deformities and are related to many pathologic conditions of the foot and ankle. Understanding the underlying deformity and the deforming force is essential in treating the cavus ankle and foot. Every deformity is different and unique to a given patient; therefore, surgical plans should be modified to each patient.


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/terapia , Pé Cavo/terapia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Tratamento Conservador , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Anamnese , Procedimentos Ortopédicos , Exame Físico , Pé Cavo/diagnóstico , Pé Cavo/fisiopatologia
19.
Clin Sports Med ; 40(3): 471-490, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34051941

RESUMO

Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Conservative management is first-line for low-grade injury with surgical intervention indicated for refractory symptoms, severe spondylolisthesis, or considerable neurologic deficit. Prompt diagnosis and management of spondylolysis leads to good outcomes and return to competition for most athletes.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Vértebras Lombares/lesões , Espondilolistese/diagnóstico , Espondilolistese/terapia , Espondilólise/diagnóstico , Espondilólise/terapia , Traumatismos em Atletas/diagnóstico por imagem , Tratamento Conservador , Diagnóstico Diferencial , Humanos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Anamnese , Exame Físico , Volta ao Esporte , Espondilolistese/diagnóstico por imagem , Espondilólise/diagnóstico por imagem
20.
Rev. Odontol. Araçatuba (Impr.) ; 42(1): 33-37, jan.-abr. 2021. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1252851

RESUMO

Durante a formação dentária, distúrbios de desenvolvimento podem acontecer, causando anomalias de número, forma, tamanho, estrutura e posição, além de apresentarem anormalidade no padrão sequencial de irrupção. Uma boa anamnese, associada a palpação e exames de imagens são indispensáveis para um diagnóstico precoce e favorável destas alterações. Os exames de imagem determinarão a relação espacial destes dentes com as estruturas nobres adjacentes. O objetivo deste trabalho é relatar a presença de supranumerário unilateral e impactação bilateral de caninos permanentes, ambas anomalias com proximidade da cavidade nasal e seio maxilar, ressaltando a importância do diagnóstico preciso através de exames clínico e de imagens, que direcionam o planejamento terapêutico específico para cada caso, bem como a associação multidisciplinar para obtenção de um resultado satisfatório do quadro e melhora da qualidade de vida do paciente(AU)


During dental formation, developmental disorders can occur, causing anomalies of number, shape, size and position, in addition to presenting abnormality in the sequential pattern of irruption. Anamnesis associated with palpation are indispensable for an early diagnosis of these alterations. Imaging exams will determine the spatial relationship between these teeth and the adjacent noble structures. The aim of this study was to report the presence of unilateral supernumerary and bilaterally impacted canines, both anomalies with proximity of nasal cavity and maxillary sinus, emphasizing the importance of accurate diagnosis through clinical and imaging exams, that direct the specific therapeutic planning for each case, as well as the multidisciplinary association to obtain satisfactory results and improve the life quality of patients(AU)


Assuntos
Dente Supranumerário , Dente não Erupcionado/terapia , Dente não Erupcionado/diagnóstico por imagem , Aparelhos Ativadores , Dente Canino , Seio Maxilar , Anamnese , Cavidade Nasal
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