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1.
J Vet Med Educ ; 47(4): 482-487, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33151116

RESUMO

Pain recognition and treatment in companion animals are important aspects of veterinary medicine, yet the teaching of these concepts may not be adequate at all academic institutions. This study was designed to evaluate veterinary students' ability to recall signs of pain and specific analgesic drugs in dogs and cats. We hypothesized that students in the fourth, or final, year of their veterinary curriculum would have a better understanding of pain recognition and be able to recall more analgesic options. A brief, voluntary, and anonymous open question survey was made available to all veterinary students, years 1 to 4, at our institution. The questions included, "How does a cat/dog show signs of pain?" and "What pain medications are used in cats/dogs?" Survey responses were collated according to the students' year in the curriculum, and the most common responses for signs of pain and analgesic medications recalled by the students in both the cat and dog were compared for significant differences. Results showed that students in the class of 2017 (seniors) had no superior recall of analgesic medications or recognition of pain in cats or dogs compared to the other classes. Vocalization was the most common sign of pain recalled with at least 50% responses from all classes. Carprofen was the most commonly recalled analgesic for dogs (the difference between classes, p = .04). Meloxicam was the most commonly recalled analgesic for cats (the difference among classes, p < .001). Based on these results, areas of improvement were identified for our analgesic curriculum.


Assuntos
Doenças do Gato , Doenças do Cão , Educação em Veterinária , Analgésicos/uso terapêutico , Animais , Doenças do Gato/diagnóstico , Doenças do Gato/tratamento farmacológico , Gatos , Cães , Humanos , Dor/diagnóstico , Dor/tratamento farmacológico , Dor/veterinária , Estudantes
2.
Harefuah ; 159(11): 781-782, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210845

RESUMO

INTRODUCTION: A 16 years old girl presented with gradual foot pain after running 2 kilometers. Conservative treatment that consisted of rest and high dose of analgesia had no effect. An MRI scan revealed a partial tear of the abductor hallucis muscle with diffuse edema in the compartment. Under general anesthesia compartmental pressure was measured. The involved compartment's pressure was 130 mm/hg while the contralateral foot measured 10 mm/hg. Immediate fasciotomy was performed with instant pain relief. No analgesics were needed following surgery. Compartment syndrome usually develops following trauma. In unusual cases the syndrome can appear due to other causes, such as muscle tear and present with different clinical signs and rates of presentation. Exertional compartment syndrome presents in the pediatric population, but can rarely present in the foot. High clinical suspicion and awareness can help the diagnosis in challenging cases.


Assuntos
Síndromes Compartimentais , Corrida , Adolescente , Criança , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Fasciotomia , Feminino , , Humanos , Dor/diagnóstico , Dor/etiologia
3.
J Vasc Interv Radiol ; 31(11): 1745-1752, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33129427

RESUMO

PURPOSE: To evaluate the effectiveness of radiofrequency (RF) ablation as measured by change in worst pain score from baseline to 3 mo after RF ablation for the palliative treatment of painful bone metastases. MATERIALS AND METHODS: One hundred patients (mean age, 64.6 y) underwent RF ablation for metastatic bone disease and were followed up to 6 mo. Subjects' pain and quality of life were measured before RF ablation and postoperatively by using the Brief Pain Index and European Quality of Life questionnaires. Opioid agent use and device-, procedure-, and/or therapy-related adverse events (AEs) were collected. RESULTS: Eighty-seven patients were treated for tumors involving the thoracolumbar spine and 13 for tumors located in the pelvis and/or sacrum. All ablations were technically successful, and 97% were followed by cementoplasty. Mean worst pain score decreased from 8.2 ± 1.7 at baseline to 3.5 ± 3.2 at 6 mo (n = 22; P < 0.0001 for all visits). Subjects experienced significant improvement for all visits in average pain (P < .0001), pain interference (P < .0001), and quality of life (P < .003). Four AEs were reported, of which 2 resulted in hospitalization for pneumonia and respiratory failure. All 30 deaths reported during the study were attributed to the underlying malignancy and not related to the study procedure. CONCLUSIONS: Results from this study show rapid (within 3 d) and statistically significant pain improvement with sustained long-term relief through 6 mo in patients treated with RF ablation for metastatic bone disease.


Assuntos
Neoplasias Ósseas/cirurgia , Dor/prevenção & controle , Cuidados Paliativos , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Cementoplastia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Dor/mortalidade , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Fatores de Tempo , Resultado do Tratamento
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4526-4529, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019000

RESUMO

We developed an objective real-time pain detection method using a smartphone and a wrist-worn wearable device to collect electrodermal activity (EDA) signals. Recently, various researchers have developed pain management applications. However, they rely on subjective self-reported pain scores or the video camera of a smartphone to detect pain, but the latter method's accuracy needs further improvement. In our work, we use a wrist-worn EDA device which transmits data via Bluetooth to a smartphone. A smartphone application was developed to analyze the EDA data so that near real-time processed pain detection information can be displayed. The analysis of EDA is based on estimating time-varying spectral power in the frequency range (0.08-0.24 Hz) associated with the sympathetic nervous system. This time-varying characterization of EDA is termed TVSymp. In this work, we also examined whether removing baseline EDA fluctuations from TVSymp would provide more accurate results. This was carried out by taking the moving average of the EDA response prior to stimulus and subtracting that value from the EDA response post stimulus. This approach is termed modified TVSymp (MTVSymp). Pain stimuli were induced in ten subjects using a thermal grill, which gives intense pain perception without damaging skin tissues. We compared both TVSymp and MTVSymp in detecting pain induced by the thermal grill using machine learning approaches. We found the accuracy of pain detection of TVSymp and MTVSymp to be 80% and 90%, respectively.


Assuntos
Smartphone , Resposta Galvânica da Pele , Humanos , Dor/diagnóstico , Manejo da Dor , Percepção da Dor
6.
Medicine (Baltimore) ; 99(40): e22538, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019462

RESUMO

The current studies revealed inconsistent relationship between reproductive factors and osteoarthritis. Community-based research has not been conducted in China. The study was to examine the association of reproductive factors with the prevalence of knee osteoarthritis (OA).Through a multistage stratified random sampling method, 10 streets or villages from 5 cities in Hunan province were randomly selected, a total 2746 eligible women aged 50 to 83 were recruited in this cross-sectional study. A structured questionnaire including demographic factors, socio-economic status, reproductive factors, and knee OA was used. According to the criteria of American College of Rheumatology, clinical knee OA was assessed by doctors in community or village health clinics for knee pain, age, morning stiffness, crepitus on active motion or for knee pain, morning stiffness, crepitus on active motion, and tenderness of the bony navigation of the joint. Self-reported age of menarche, parity, abortion history, and menopausal status were collected.The prevalence of knee OA was 13.44%. Abortion is associated with knee OA (odds ratio [OR] = 1.271, 95% confidence interval [CI] = 1.007, 1.606), but age at menarche, parity, and menopausal status were not the factors. Furthermore, age (OR = 1.040, 95% CI = 1.020, 1.060), weight (OR = 1.019, 95% CI = 1.004, 1.035), higher education level (OR = 1.530, 95% CI = 1.121, 2.088), higher monthly household income (OR = .583, 95% CI = 0.441, 0.770 for 3000-4999 ¥ and OR = 0.599, 95% CI = 0.431, 0.833 for 5000 ¥ or more), and chronic gastritis (OR = 3.364, 95% CI = 2.548, 4.442) were associated with knee OA.Abortion may increase the risk of knee OA. Special attention should be paid to women with a history of abortion, and women who are planning to abort should be informed of the risk of knee OA later in life. The relationship between abortion and knee OA should be interpreted with caution and further confirmed.


Assuntos
Aborto Espontâneo/epidemiologia , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/etiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/patologia , Dor/diagnóstico , Dor/epidemiologia , Prevalência , Radiografia/métodos , Medição de Risco , Autorrelato , Classe Social , Inquéritos e Questionários
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2869-2872, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018605

RESUMO

The goal of this paper is to investigate whether motor imagery tasks, performed under pain-free versus pain conditions, can be discriminated from electroencephalography (EEG) recordings. Four motor imagery classes of right hand, left hand, foot, and tongue are considered. A functional connectivity-based feature extraction approach along with a long short-term memory (LSTM) classifier are employed for classifying pain-free versus under-pain classes. Moreover, classification is performed in different frequency bands to study the significance of each band in differentiating motor imagery data associated with pain-free and under-pain states. When considering all frequency bands, the average classification accuracy is in the range of 77:86-80:04%. Our frequency-specific analysis shows that the gamma band results in a notably higher accuracy than other bands, indicating the importance of this band in discriminating pain/no-pain conditions during the execution of motor imagery tasks. In contrast, functional connectivity graphs extracted from delta and theta bands do not seem to provide discriminatory information between pain-free and under-pain conditions. This is the first study demonstrating that motor imagery tasks executed under pain and without pain conditions can be discriminated from EEG recordings. Our findings can provide new insights for developing effective brain computer interface-based assistive technologies for patients who are in real need of them.


Assuntos
Interfaces Cérebro-Computador , Imaginação , Eletroencefalografia , Humanos , Imagens, Psicoterapia , Dor/diagnóstico
9.
J Vasc Interv Radiol ; 31(11): 1753-1762, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33012648

RESUMO

A systematic review and meta-analysis of pain response after radiofrequency (RF) ablation over time for osseous metastases was conducted in 2019. Analysis used a random-effects model with GOSH plots and meta-regression. Fourteen studies comprising 426 patients, most with recalcitrant pain, were identified. Median pain reduction after RF ablation was 67% over median follow-up of 24 weeks (R2 = -.66, 95% confidence interval -0.76 to -0.55, I2 = 71.24%, fail-safe N = 875) with 44% pain reduction within 1 week. A low-heterogeneity subgroup was identified with median pain reduction after RF ablation of 70% over 12 weeks (R2 = -.75, 95% confidence interval -0.80 to -0.70, I2 = 2.66%, fail-safe N = 910). Addition of cementoplasty after RF ablation did not significantly affect pain scores. Primary tumor type and tumor size did not significantly affect pain scores. A particular, positive association between pain after RF ablation and axial tumors was identified, implying possible increased palliative effects for RF ablation on axial over appendicular lesions. RF ablation is a useful palliative therapy for osseous metastases, particularly in patients with recalcitrant pain.


Assuntos
Neoplasias Ósseas/cirurgia , Aprendizado de Máquina , Dor/prevenção & controle , Cuidados Paliativos , Ablação por Radiofrequência , Adulto , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Cementoplastia , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Dor/mortalidade , Medição da Dor , Qualidade de Vida , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Fatores de Tempo , Resultado do Tratamento
10.
Ther Umsch ; 77(6): 263-269, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32930079

RESUMO

Pain assessment of CRPS in Hand Therapy Abstract. Pain massively controls everyday life of affected persons. In case of a nerve being damaged, pain becomes more complex, as the trophism of the affected skin area may significantly be altered in addition to loss of sensibility and / or motor function. Quantifying pain is, therefore, difficult. Nevertheless, there exists a broad variety of pain assessments in hand therapy. A comprehensive documentation of pain and its effects on the patients' life are therefore pivotal for the individual design of therapy. Guidelines recommend an early start of therapy, a multimodal approach and a mixture of drug and non-drug interventions. However, specific recommendations are difficult to make, as the course of therapy is often complex and varies from person to person. Therefore, open and transparent communication, a stable therapeutic relationship, professional knowledge and active involvement of those affected are a prerequisite for successful therapy. In this article, the most frequently used assessments for pain in hand therapy are presented, as they are applied, for example, in complex regional pain syndromes. The clinical examination of allodynia is described in more detail by means of a patient example. Potential therapy goals and contents are illustrated. Despite all launched therapy interventions, treatment of pain remains a challenge that is best approached in an interdisciplinary setting and with the support of those affected.


Assuntos
Síndromes da Dor Regional Complexa/diagnóstico , Mãos , Humanos , Hiperalgesia , Dor/diagnóstico , Medição da Dor , Modalidades de Fisioterapia
11.
PLoS One ; 15(9): e0234801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877411

RESUMO

BACKGROUND: Significant improvements in clinical outcome can be achieved by implementing effective strategies to optimise pain management, reduce sedative exposure, and prevent and treat delirium in ICU patients. One important strategy is the monitoring of pain, agitation and delirium (PAD bundle). We hypothesised that there is no sufficient financial benefit to implement a monitoring strategy in a Diagnosis Related Group (DRG)-based reimbursement system, therefore we expected better clinical and decreased economic outcome for monitored patients. METHODS: This is a retrospective observational study using routinely collected data. We used univariate and multiple linear analysis, machine-learning analysis and a novel correlation statistic (maximal information coefficient) to explore the association between monitoring adherence and resulting clinical and economic outcome. For univariate analysis we split patients in an adherence achieved and an adherence non-achieved group. RESULTS: In total 1,323 adult patients from two campuses of a German tertiary medical centre, who spent at least one day in the ICU between admission and discharge between 1. January 2016 and 31. December 2016. Adherence to PAD monitoring was associated with shorter hospital LoS (e.g. pain monitoring 13 vs. 10 days; p<0.001), ICU LoS, duration of mechanical ventilation shown by univariate analysis. Despite the improved clinical outcome, adherence to PAD elements was associated with a decreased case mix per day and profit per day shown by univariate analysis. Multiple linear analysis did not confirm these results. PAD monitoring is important for clinical as well as economic outcome and predicted case mix better than severity of illness shown by machine learning analysis. CONCLUSION: Adherence to PAD bundles is also important for clinical as well as economic outcome. It is associated with improved clinical and worse economic outcome in comparison to non-adherence in univariate analysis but not confirmed by multiple linear analysis. TRIAL REGISTRATION: clinicaltrials.gov NCT02265263, Registered 15 October 2014.


Assuntos
Delírio/terapia , Hipnóticos e Sedativos/uso terapêutico , Manejo da Dor/métodos , Adulto , Idoso , Delírio/diagnóstico , Delírio/economia , Gerenciamento Clínico , Feminino , Humanos , Hipnóticos e Sedativos/economia , Unidades de Terapia Intensiva/economia , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/economia , Manejo da Dor/economia , Respiração Artificial/economia , Respiração Artificial/métodos , Estudos Retrospectivos
12.
Rev Med Suisse ; 16(708): 1796-1800, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997449

RESUMO

Behavioural disorders in adults with mental disabilities are very common and represent a diagnostic challenge. In fact, they often hide a somatic problem, which is more frequent in this population compared to the general population. These somatic symptoms may cause or enhance psychiatric symptoms. People with mental disabilities often have difficulties expressing their pain, which often manifests itself as mood changes. Consequently, it is important to be able to identify the pain as a priority and to treat it. The general practitioner should therefore check for the most common somatic complaints in people with mental disabilities, with the help of the acronym DODUGO (Dental, Otic, Digestive, UroGenital, Orthopaedic).


Assuntos
Deficiência Intelectual , Sintomas Inexplicáveis , Comportamento Problema , Adulto , Humanos , Deficiência Intelectual/complicações , Deficiência Intelectual/psicologia , Dor/complicações , Dor/diagnóstico , Dor/psicologia , Transtornos da Personalidade/complicações , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/psicologia
13.
Pain Physician ; 23(4S): S205-S238, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32942812

RESUMO

BACKGROUND: The COVID pandemic has impacted almost every aspect of human interaction, causing global changes in financial, health care, and social environments for the foreseeable future. More than 1.3 million of the 4 million cases of COVID-19 confirmed globally as of May 2020 have been identified in the United States, testing the capacity and resilience of our hospitals and health care workers. The impacts of the ongoing pandemic, caused by a novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have far-reaching implications for the future of our health care system and how we deliver routine care to patients. The adoption of social distancing during this pandemic has demonstrated efficacy in controlling the spread of this virus and has been the only proven means of infection control thus far. Social distancing has prompted hospital closures and the reduction of all non-COVID clinical visits, causing widespread financial despair to many outpatient centers. However, the need to treat patients for non-COVID problems remains important despite this pandemic, as care must continue to be delivered to patients despite their ability or desire to report to outpatient centers for their general care. Our national health care system has realized this need and has incentivized providers to adopt distance-based care in the form of telemedicine and video medicine visits. Many institutions have since incorporated these into their practices without financial penalty because of Medicare's 1135 waiver, which currently reimburses telemedicine at the same rate as evaluation and management codes (E/M Codes). Although the financial burden has been alleviated by this policy, the practitioner remains accountable for providing proper assessment with this new modality of health care delivery. This is a challenge for most physicians, so our team of national experts has created a reference guide for musculoskeletal and neurologic examination selection to retrofit into the telemedicine experience. OBJECTIVES: To describe and illustrate musculoskeletal and neurologic examination techniques that can be used effectively in telemedicine. STUDY DESIGN: Consensus-based multispecialty guidelines. SETTING: Tertiary care center. METHODS: Literature review of the neck, shoulder, elbow, wrist, hand, lumbar, hip, and knee physical examinations were performed. A multidisciplinary team comprised of physical medicine and rehabilitation, orthopedics, rheumatology, neurology, and anesthesia experts evaluated each examination and provided consensus opinion to select the examinations most appropriate for telemedicine evaluation. The team also provided consensus opinion on how to modify some examinations to incorporate into a nonhealth care office setting. RESULTS: Sixty-nine examinations were selected by the consensus team. Household objects were identified that modified standard and validated examinations, which could facilitate the examinations.The consensus review team did not believe that the modified tests altered the validity of the standardized tests. LIMITATIONS: Examinations selected are not validated for telemedicine. Qualitative and quantitative analyses were not performed. CONCLUSIONS: The physical examination is an essential component for sound clinical judgment and patient care planning. The physical examinations described in this manuscript provide a comprehensive framework for the musculoskeletal and neurologic examination, which has been vetted by a committee of national experts for incorporation into the telemedicine evaluation.


Assuntos
Infecções por Coronavirus , Exame Neurológico/métodos , Ortopedia/métodos , Dor/diagnóstico , Pandemias , Pneumonia Viral , Telemedicina/métodos , Betacoronavirus , Humanos , Exame Neurológico/tendências , Ortopedia/tendências , Telemedicina/tendências , Estados Unidos
15.
Rev Med Suisse ; 16(701): 1421-1427, 2020 Aug 05.
Artigo em Francês | MEDLINE | ID: mdl-32833357

RESUMO

The elbow joint is highly congruent and subject to less stress than other joints. This contributes to a rather low incidence of pathologies in the general population. However, in athletes who perform repeated movements with supraphysiological forces, diverse pathologies may appear. The objective of this article is to develop an anatomopathological approach to elbow pain in order to identify its origin. A rapid and precise diagnosis allows initiating an adequate treatment and minimizing time of sporting activity arrest.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Articulação do Cotovelo/lesões , Cotovelo/lesões , Traumatismos em Atletas/complicações , Humanos , Dor/diagnóstico , Dor/etiologia , Dor/prevenção & controle
16.
J Vasc Interv Radiol ; 31(8): 1292-1299, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32654960

RESUMO

PURPOSE: To assess the use of opioid analgesics and/or antiemetic drugs for pain and nausea following selective chemoembolization with doxorubicin-based conventional (c)-transarterial chemoembolization versus drug-eluting embolic (DEE)-transarterial chemoembolization for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: From October 2014 to 2016, 283 patients underwent 393 selective chemoembolization procedures including 188 patients (48%) who underwent c-transarterial chemoembolization and 205 (52%) who underwent DEE-transarterial chemoembolization. Medical records for all patients were retrospectively reviewed. Administration of postprocedural opioid and/or antiemetic agents were collated. Time of administration was stratified as phase 1 recovery (0-6 hours) and observation (6-24 hours). Logistic regression model was used to investigate the relationship of transarterial chemoembolization type and use of intravenous and/or oral analgesic and antiemetic medications while controlling for other clinical variables. RESULTS: More patients treated with DEE-transarterial chemoembolization required intravenous analgesia in the observation (6-24 hours) phase (18.5%) than those treated with c-transarterial chemoembolization (10.6%; P = .033). Similar results were noted for oral analgesic agents (50.2% vs. 31.4%, respectively; P < .001) and antiemetics (17.1% vs. 7.5%, respectively; P = .006) during the observation period. Multivariate regression models identified DEE-transarterial chemoembolization as an independent predictor for oral analgesia (odds ratio [OR], 1.84; P = .011), for intravenous and oral analgesia in opioid-naïve patients (OR, 2.46; P = .029) and for antiemetics (OR, 2.56; P = .011). CONCLUSIONS: Compared to c-transarterial chemoembolization, DEE-transarterial chemoembolization required greater amounts of opioid analgesic and antiemetic agents 6-24 hours after the procedure. Surgical data indicate that a persistent opioid habit can develop even after minor surgeries, therefore, caution should be exercised, and a regimen of nonopiate pain medications should be considered to reduce postprocedural pain after transarterial chemoembolization.


Assuntos
Analgésicos Opioides/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica , Neoplasias Hepáticas/tratamento farmacológico , Dor/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Antieméticos/administração & dosagem , Antieméticos/efeitos adversos , Carcinoma Hepatocelular/patologia , Quimioembolização Terapêutica/efeitos adversos , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/prevenção & controle , Dor/diagnóstico , Dor/etiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Vômito/induzido quimicamente , Vômito/prevenção & controle
17.
Am J Case Rep ; 21: e925771, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32699203

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) has been increasing all over the world. During the pandemic, a variety of presentations have been described. Nevertheless, some patients remain asymptomatic. Respiratory symptoms and gastrointestinal symptoms are often reported among these patients. CASE REPORT Here, we report a case with flank pain. Radiological images were significant for bilateral consolidation, which raised a high suspicion of COVID-19. Hence, on further investigation, he was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CONCLUSIONS In the time of the COVID-19 pandemic, patients with multiple comorbidities may present atypically. Flank pain, which is not a usual presentation, may raise the suspicion of COVID-19 infection.


Assuntos
Betacoronavirus , Pressão Sanguínea/fisiologia , Infecções por Coronavirus/complicações , Hipertensão/complicações , Isquemia Miocárdica/complicações , Dor/etiologia , Pneumonia Viral/complicações , Idoso , Comorbidade , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Humanos , Hipertensão/diagnóstico , Masculino , Isquemia Miocárdica/diagnóstico , Dor/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico
19.
Vasc Endovascular Surg ; 54(7): 625-632, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32666902

RESUMO

INTRODUCTION: Patients with vascular disease have higher mortality rates than age-matched peers and medical management of coexisting diseases may alter these outcomes. We sought to understand factors associated with medication nonadherence in vascular surgery patients at a single University vascular surgery clinic over a 3-month period. MATERIALS AND METHODS: Consecutive vascular surgery patients were surveyed from June to August 2019. The survey included demographic questions, the validated Morisky Medication Adherence Scale, the 4-item Patient Health Questionnaire for Anxiety and Depression scales, and other medication-related questions. Medical and surgical histories were retrospectively collected from charts. Univariate and multivariate analyses were used to compare among high, intermediate, and low adherence. RESULTS: A total of 128 (74%) of 174 patients met study inclusion criteria. On univariate analysis, lower medication adherence was associated with younger age (P = .004), anxiety and depression (P = .001), higher daily pain (P < .001), and patients who believed their medications were less important for treating their vascular disease (P < .001). Adherence was not associated with symptomatic vascular disease, gender, education level, marital status, employment, insurance, or the use of medication usage reminders. Multivariate analysis significantly predicted high adherence relative to low adherence with 5-year increase in age (odds ratio [OR] = 1.252, P = .021) and low adherence relative to high adherence with greater perceived pain (OR = 0.839, P = .016). CONCLUSIONS: Younger age and high level of pain were associated with lower medication adherence. Informing patients of the importance of prescribed medication and addressing anxiety or depression symptoms may improve adherence.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares , Adulto , Fatores Etários , Idoso , Ansiedade/diagnóstico , Ansiedade/psicologia , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/psicologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Doenças Vasculares/diagnóstico , Doenças Vasculares/psicologia
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