RESUMEN
OBJECTIVES: This study was conducted to assess transfusion knowledge between different specialty board residents and to identify areas of need for further education. BACKGROUND: Physicians' knowledge of transfusion medicine (TM) is critical for patients' safety. Many clinicians who are involved in day-to-day transfusion practice have little or no formal training in TM. There are no studies to assess physician's TM knowledge locally. METHODS: A comprehensive anonymous survey was developed to assess baseline TM knowledge of all the residents. The survey is composed of different sections, including a questionnaire on resident's demographics, resident's self-reflection on their TM knowledge and 30 multiple choice questions addressing basic and clinical TM knowledge in two major domains: component selection and transfusion practice and transfusion safety and transfusion reactions. Finally, the residents' opinion on educational needs was assessed. RESULTS: A total of 130 residents were surveyed. The lowest score obtained among the two major domains assessed was in the transfusion safety and transfusion reaction domain, with a mean score of 4·34 of 15 (SD ± 3·27). The mean score obtained on component selection and transfusion practice was 7·1 of 15 (SD ± 3·74). A substantial proportion of the residents (74·7%) admitted minimal baseline knowledge in the field of TM. Finally, 94·5% of the residents admitted the need for more education during residency, whereas 49·5% thought additional education is required during the first year of practice. CONCLUSION: This survey shows serious TM knowledge deficiency and indicates the need for additional education among all physicians during training.
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Transfusión Sanguínea , Cirugía General/educación , Internado y Residencia , Conocimiento , Consejos de Especialidades , Adulto , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To prospectively document musculoskeletal magnetic resonance imaging (MRI) use and how it affects diagnosis, playing status, and treatment of Division I university athletes. We hypothesized that MRI often has little or no effect on the diagnosis or treatment plan. DESIGN: Cross-sectional study. SETTING: Division I university sports medicine program. PATIENTS: Division I university varsity athletes. INTERVENTIONS: Data were collected of musculoskeletal MRI use in varsity student athletes for 2 full academic years from 2010 to 2012 at a National Collegiate Athletic Association Division I institution. MAIN OUTCOME MEASURES: Timing of the injury, first physician visit, and MRI and pre- and post-MRI diagnosis, playing status, and treatment (surgical vs nonsurgical). RESULTS: Eighty-six MRIs were obtained during the 2 years studied. Average age was 19.9 (18-23) years. Forty-five percent of injuries occurred during competition season, 34% occurred preseason, and 21% occurred postseason. There was a change in diagnosis in 13 athletes (15.1%, 1 led to surgery performed after completion of the season), and there was a change in participation status in 8 athletes (9.3%, 5 increased and 3 decreased). Treatment plan changed in 1 athlete (1.2%). No athlete required surgery immediately after an MRI that was not already being planned. Every athlete treated nonsurgically pre-MRI was able to finish their season. CONCLUSIONS: Magnetic resonance imaging was obtained in 14% of athletes and did not demonstrate a clear benefit over history, examination, and radiographs. Magnetic resonance imaging did change diagnosis in 15% of cases, though it did not appreciably change the playing status or treatment plan.
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Traumatismos en Atletas/diagnóstico , Imagen por Resonancia Magnética/métodos , Universidades , Adolescente , Traumatismos en Atletas/terapia , Estudios Transversales , Femenino , Traumatismos de la Mano/diagnóstico , Traumatismos de la Mano/terapia , Humanos , Traumatismos de la Rodilla/diagnóstico , Traumatismos de la Rodilla/terapia , Imagen por Resonancia Magnética/estadística & datos numéricos , Masculino , Estudios Prospectivos , Medicina Deportiva , Traumatismos de la Muñeca/diagnóstico , Traumatismos de la Muñeca/terapia , Adulto JovenRESUMEN
Golf has great popularity as a spectator sport, as well as a participation sport. Providing coverage for golf events can range from mass event coverage for large professional tournaments to provision of injury care at local golf events. This article provides a brief introduction to the game of golf for those unfamiliar with its play, an overview of the types of injuries seen, and consideration in providing care for a variety of golf competitions.
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Golf/lesiones , Conducta de Masa , Fenómenos Biomecánicos , Servicios Médicos de Urgencia , Tratamiento de Urgencia , Humanos , Traumatismos por Acción del Rayo/epidemiología , Traumatismos por Acción del Rayo/prevención & control , Recuperación de la Función , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/terapia , Medicina Deportiva , Extremidad Superior/lesiones , Tiempo (Meteorología)RESUMEN
BACKGROUND: Non-invasive ventilation (NIV) is an established treatment option for cystic fibrosis (CF) patients with type 2 respiratory failure but the benefits of this therapy remain unclear. This study examined the long-term outcomes and response to NIV in a large adult CF cohort. METHODS: All patients attending a UK adult CF Centre receiving NIV as treatment for hypercapnic respiratory failure over a nine-year period were studied prospectively. Detailed clinical data was recorded and longitudinal data measurements were examined for the three years pre and post NIV initiation to assess effect of this intervention. RESULTS: 94 patients, mean age 29.9 (SD 9.7) years, percent predicted FEV1 21.5 (7.3), received NIV. All patients commenced NIV in a hospital setting. 21 remain alive, 24 received double lung transplant, 49 died without lung transplantation. NIV use was associated with a stabilisation and improvement in both FEV1 and FVC from NIV set up to three years post follow-up, in addition to an increase in body mass index and attenuation of PCO2 (all p<0.001). No single parameter was found to predict long-term NIV response but baseline PCO2 (p=0.005), CRP (p=0.004) and age (p=0.009) were identified as independent predictors of mortality. CONCLUSIONS: NIV use in CF adults is associated with improvements in lung function and attenuation of hypercapnia which is maintained for up to three years post NIV initiation. Outcomes for CF patients with severe pulmonary disease commenced on NIV have significantly improved with fifty percent of patients expected to survive for approximately five years.
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Fibrosis Quística/terapia , Ventilación no Invasiva , Insuficiencia Respiratoria/terapia , Adulto , Índice de Masa Corporal , Fibrosis Quística/fisiopatología , Femenino , Humanos , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Intercambio Gaseoso Pulmonar , Pruebas de Función Respiratoria , Insuficiencia Respiratoria/fisiopatología , Reino UnidoRESUMEN
To study telomere length dynamics in hematopoietic cells with age, we analyzed the average length of telomere repeat sequences in diverse populations of nucleated blood cells. More than 500 individuals ranging in age from 0 to 90 yr, including 36 pairs of monozygous and dizygotic twins, were analyzed using quantitative fluorescence in situ hybridization and flow cytometry. Granulocytes and naive T cells showed a parallel biphasic decline in telomere length with age that most likely reflected accumulated cell divisions in the common precursors of both cell types: hematopoietic stem cells. Telomere loss was very rapid in the first year, and continued for more than eight decades at a 30-fold lower rate. Memory T cells also showed an initial rapid decline in telomere length with age. However, in contrast to naive T cells, this decline continued for several years, and in older individuals lymphocytes typically had shorter telomeres than did granulocytes. Our findings point to a dramatic decline in stem cell turnover in early childhood and support the notion that cell divisions in hematopoietic stem cells and T cells result in loss of telomeric DNA.
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Granulocitos/citología , Células Madre Hematopoyéticas/citología , Subgrupos de Linfocitos T/citología , Telómero/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento/genética , Envejecimiento/patología , Niño , Preescolar , Femenino , Citometría de Flujo , Humanos , Memoria Inmunológica , Hibridación Fluorescente in Situ , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Subgrupos de Linfocitos T/inmunología , Secuencias Repetidas Terminales , Gemelos Dicigóticos/genética , Gemelos Monocigóticos/genéticaRESUMEN
BACKGROUND AND OBJECTIVES: The low prevalence antigen, Be(a), is produced by a complex that also produces weak c, e and f (ce). We report here the molecular basis associated with Be(a) antigen expression. MATERIALS AND METHODS: Peripheral blood samples from four Be(a+) probands were tested. Haemagglutination, gDNA extraction, PCR-based assays, reticulocyte RNA isolation, Rh-cDNA analyses, and sequencing were performed by standard procedures. RESULTS: RBCs from Probands 1 and 3 were D-C-E-c+e+, and from Probands 2 and 4 were D+C+E-c+(W)e+. In proband 1, cDNA sequencing of RHCE revealed heterozygosity of nucleotide (nt) 662C/G in exon 5 of RHCE*ce. No other nucleotide changes were observed. As the 662C>G nucleotide change ablates a MscI restriction enzyme cleavage site, PCR-RFLP analysis was performed and the RHCE*ce nt 662C/G heterozygosity was detected on gDNA from the four probands and two children from both Proband 3 and Proband 4. CONCLUSION: The low prevalence Rh antigen, Be(a), is associated with a single nucleotide change in exon 5 of RHCE*ce; that of 662C>G and this change is predicted to alter proline at amino acid position 221 of Rhce to arginine. The fundamental differences in the properties of these two amino acids may impose a steric and/or charge-related effect on the protein, and thereby provide an explanation for the weakened expression of c, e and f (ce) antigens in the Be(a) phenotype.
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Eritroblastosis Fetal/genética , Exones/genética , Polimorfismo de Nucleótido Simple , Sistema del Grupo Sanguíneo Rh-Hr/genética , Adulto , Alelos , Sustitución de Aminoácidos , ADN Complementario/genética , Femenino , Genotipo , Humanos , Recién Nacido , Masculino , Reacción en Cadena de la Polimerasa , Polimorfismo de Longitud del Fragmento de Restricción , Embarazo , Análisis de Secuencia de ADNRESUMEN
Ice hockey is an exciting sport that is growing in popularity in the United States. Injuries are a common part of the sport, with more injuries occurring in games compared with practice. Higher levels of competition have been shown to correlate with increased frequency of injury. Most frequently, injuries occur to the face, head, and neck, including concussions, contusions, lacerations, and dental injury. Lower extremity injuries include medial collateral ligament injury, meniscus tear, and high ankle sprains. Upper extremity injuries include acromioclavicular joint injury, glenohumeral dislocation, and various contusions and sprains. Groin and lower abdominal strains also are common. Women's hockey participation is increasing, with data that suggest injuries similar to those seen in men's hockey.
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Servicios Médicos de Urgencia/organización & administración , Hockey/lesiones , Adolescente , Adulto , Conmoción Encefálica/epidemiología , Conmoción Encefálica/etiología , Conmoción Encefálica/terapia , Niño , Traumatismos Craneocerebrales/epidemiología , Traumatismos Craneocerebrales/etiología , Traumatismos Craneocerebrales/terapia , Traumatismos Faciales/epidemiología , Traumatismos Faciales/etiología , Traumatismos Faciales/terapia , Femenino , Humanos , Incidencia , Extremidad Inferior/lesiones , Masculino , Traumatismos del Cuello/epidemiología , Traumatismos del Cuello/etiología , Traumatismos del Cuello/terapia , Estados Unidos/epidemiología , Extremidad Superior/lesiones , Recursos Humanos , Adulto JovenRESUMEN
Back pain is one of the most common reasons cited for patients to see a physician. It also is the most frequently reported injury in golf. Any physician caring for golfers must therefore understand common causes of back pain, its treatment, and prevention strategies to reduce the burden of future injury.
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Traumatismos en Atletas/diagnóstico , Golf , Dolor de la Región Lumbar/diagnóstico , Traumatismos en Atletas/rehabilitación , Humanos , Dolor de la Región Lumbar/rehabilitaciónAsunto(s)
Cromosomas Humanos X , Hemofilia B/genética , Eliminación de Secuencia , Adolescente , Secuencia de Bases , Humanos , MasculinoRESUMEN
Golf is an asymmetric sport with unique patterns of injury depending upon the skill level. Higher handicap players typically experience injuries that result from swing mechanics, whereas lower handicap and professional players have overuse as the major cause of their injuries. The majority of shoulder injuries affecting golfers occur in the nondominant shoulder. Common shoulder injuries include subacromial impingement, rotator cuff pathology, glenohumeral instability, and arthritis involving the acromioclavicular and/or glenohumeral joints. Lead arm elbow pain resulting from lateral epicondylosis (tennis elbow) is the leading upper extremity injury in amateur golfers. Tendon injury is the most common problem seen in the wrist and forearm of the golfer. Rehabilitation emphasizing improvement in core muscle streng is important in the treatment of golf injury. Emerging treatments for tendinopathy include topical nitrates, ultrasound-guided injection of therapeutic substances, and eccentric rehabilitation. There is evidence supporting physiotherapy, and swing modification directed by a teaching professional, for treatment of upper extremity golf injuries. This article focuses on upper extremity injuries in golf, including a discussion of the epidemiology, causes, diagnosis, treatment, and prevention of injuries occurring in the shoulder, elbow, wrist, and hand.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Trastornos de Traumas Acumulados/diagnóstico , Trastornos de Traumas Acumulados/terapia , Golf/lesiones , Extremidad Superior/lesiones , HumanosRESUMEN
Injury-tracking software is becoming a necessity in the athletic training room to organize care and meet requirements for record-keeping. A variety of competing products is available, including workstation, local network, and Internet-based programs. Most of these systems are commercially available, while the NCAA Internet-based system is available for member institutions at no cost. A few of the injury-tracking systems have gained wider use and are reviewed here.
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Traumatismos en Atletas/clasificación , Traumatismos en Atletas/epidemiología , Bases de Datos Factuales , Almacenamiento y Recuperación de la Información/métodos , Sistemas de Registros Médicos Computarizados , Vigilancia de la Población/métodos , Programas Informáticos , Sistemas de Administración de Bases de Datos , Estados Unidos/epidemiología , Interfaz Usuario-ComputadorRESUMEN
Anti-basal ganglia antibodies (ABGA) have been associated with poststreptococcal encephalitis similar to encephalitis lethargica (EL). We report two children with parainfectious encephalitis of similar phenotype and IgG ABGA. However, the associated pathogens in the two cases differed; beta-hemolytic streptococcus and herpes zoster. ABGA may not be specific to poststreptococcal encephalitis, but rather a surrogate marker of an inflammatory mediated movement disorder, which may respond to immunotherapy.
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Autoanticuerpos/metabolismo , Ganglios Basales/inmunología , Herpes Zóster/sangre , Herpes Zóster/fisiopatología , Trastornos del Movimiento/etiología , Infecciones Estreptocócicas/sangre , Infecciones Estreptocócicas/fisiopatología , Adolescente , Niño , Femenino , Humanos , MasculinoRESUMEN
Golfers most frequently report injuries to the low back, nondominant shoulder, and elbow. Injury patterns differ between elite and recreational golfers; professional and elite golfers tend to experience golf injury related to overuse while amateur golfers may experience injury related to adverse swing technique and overuse. Therapeutic interventions should include assessment and treatment of deficiencies in the kinetic chain and professional instruction to modify swing technique. Changes in the swing may include instruction in a more efficient technique or shortening the swing to decrease biomechanical forces affecting the injured area.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/rehabilitación , Golf/lesiones , Traumatismos de la Espalda/diagnóstico , Traumatismos de la Espalda/rehabilitación , Fenómenos Biomecánicos , Trastornos de Traumas Acumulados/diagnóstico , Trastornos de Traumas Acumulados/rehabilitación , Humanos , Educación y Entrenamiento Físico , Lesiones del Hombro , Lesiones de CodoAsunto(s)
Baloncesto/lesiones , Lesiones Oculares/complicaciones , Perforaciones de la Retina/diagnóstico , Heridas no Penetrantes/complicaciones , Crioterapia , Técnicas de Diagnóstico Oftalmológico , Lesiones Oculares/etiología , Lesiones Oculares/terapia , Humanos , Masculino , Perforaciones de la Retina/etiología , Perforaciones de la Retina/terapia , Agudeza Visual , Adulto JovenRESUMEN
OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are standard therapy for osteoarthritis (OA). Topically applied NSAIDs reduce systemic exposure compared with oral NSAIDS, and European guidelines recommend their use. The NSAID diclofenac is available in a range of topical formulations. Diclofenac 1% gel and 1.5% four times daily and 2% twice daily (BID) solutions are approved to reduce pain from OA of the knee(s). The objective of this study was to investigate the efficacy and safety of diclofenac sodium 2% topical solution BID versus vehicle control solution for treating pain associated with OA of the knee. RESEARCH DESIGN AND METHODS: A phase II, 4 week, randomized, double-blind, parallel-group, two-arm, vehicle-controlled study compared pain relief with diclofenac sodium 2% topical solution versus control (vehicle only) in patients aged 40 to 85 years with radiographically confirmed primary OA of the knee. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01119898. MAIN OUTCOME MEASURES: The primary efficacy outcome was change from baseline to the final visit in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcomes included additional WOMAC subscales and patient global assessment of OA. Treatment-emergent adverse events (TEAEs), skin irritation, and vital signs were assessed and collected throughout the study. RESULTS: Of 260 patients randomized, 259 received ≥1 dose of study drug. Significantly greater reductions in least-squares mean (standard error) WOMAC pain scores were observed for diclofenac-treated (-4.4 [0.4]) versus vehicle-treated patients (-3.4 [0.4]) at the final visit (p = 0.040). The most commonly reported TEAEs were administration site conditions. The vehicle-treated group experienced slightly more TEAEs than the active treatment group (38.8% vs. 31.5%). No serious adverse events were reported. CONCLUSIONS: Administration of diclofenac sodium 2% topical solution BID resulted in significantly greater improvement in pain reduction in patients with OA of the knee versus vehicle control and was generally well tolerated.
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Antiinflamatorios no Esteroideos/administración & dosificación , Diclofenaco/administración & dosificación , Osteoartritis de la Rodilla/tratamiento farmacológico , Administración Tópica , Anciano , Química Farmacéutica , Método Doble Ciego , Femenino , Humanos , Articulación de la Rodilla/patología , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Resultado del TratamientoRESUMEN
The introduction of the newer generation of electronic cell counters allows the routine reporting of platelet numbers when the peripheral blood count is requested. In a 12-month period, 100 episodes of marked thrombocytosis (platelet count more than 900 X 10(9)/L) were found among 94 children. These patients were young (median age 9 months). All but one episode of marked thrombocytosis occurred as a phenomenon secondary to a variety of disease states. Infections, especially those involving the central nervous systems were the commonest cause of an elevated platelet count in this series. Malignant diseases alone were rarely associated with thrombocytosis of this magnitude. The elevated platelet count began to decline at a mean of 3 days after diagnosis, and no thrombotic or hemorrhagic complications were encountered. Marked thrombocytosis is a benign, common phenomenon in young children, but specific treatment is not required.
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Trombocitosis/epidemiología , Adolescente , Colombia Británica , Niño , Preescolar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Recién Nacido , Masculino , Recuento de Plaquetas , Trombocitosis/etiologíaRESUMEN
Hereditary hemochromatosis was diagnosed in three asymptomatic siblings following the unexpected finding of elevated serum iron concentrations. This diagnosis was confirmed by hepatic biopsy. Repeated phlebotomies resulted in a significant decline of serum iron and ferritin concentrations and a decrease of hepatic iron content. This report and a review of the literature indicate that the diagnosis of hereditary hemochromatosis must be considered more frequently in childhood. Organ dysfunction from iron overload may be minimized in children by the early commencement of regular phlebotomy.
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Hemocromatosis/genética , Niño , Preescolar , Femenino , Hemocromatosis/sangre , Hemocromatosis/patología , Homocigoto , Humanos , Hígado/patología , Hígado/ultraestructura , Masculino , Microscopía ElectrónicaRESUMEN
We investigated the effect of an intraoperative desmopressin acetate infusion on blood loss after cardiac operation in 60 children, by using a prospective, randomized, double-blind trial. Thirty patients received a desmopressin dose of 0.3 microgram/kg intravenously over 15 minutes at the conclusion of cardiac bypass, and 30 received a saline placebo. The two groups were comparable with respect to age, sex, cardiac lesion, presence of cyanosis, and prevalence of Down's syndrome. Results showed no significant difference in postoperative blood loss between the two groups (30.5 +/- 37.9 ml/kg in the placebo group versus 40.0 +/- 33.1 ml/kg in the desmopressin group). Postoperative bleeding time, total urine output, postinfusion hemodynamics, and postoperative coagulation studies did not differ significantly between the two groups. We conclude that postbypass desmopressin infusion does not reduce blood loss in children undergoing cardiac operations.
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Procedimientos Quirúrgicos Cardíacos , Desamino Arginina Vasopresina/administración & dosificación , Hemostasis Quirúrgica , Preescolar , Ensayos Clínicos como Asunto , Desamino Arginina Vasopresina/uso terapéutico , Método Doble Ciego , Femenino , Hemorragia/prevención & control , Humanos , Infusiones Intravenosas , Periodo Intraoperatorio , Masculino , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Distribución Aleatoria , OrinaRESUMEN
A simple and reliable technique for removal of ABO incompatible marrow red cells is described. This method requires a blood cell processor and third party red cells are used as a shelf. Using this technique, nine children age 0.5-11.5 years received allogeneic bone marrow transplantation from ABO incompatible donors. A median of 4.8 ml of incompatible red cells were transfused. There was no evidence of a hemolytic transfusion reaction in any patient. A median of 75% of nucleated marrow cells were recovered and used for transplantation. Engraftment occurred at the same time as with ABO compatible transplants. Autologous marrow red cells were reinfused into four young donors. This 'shelf' technique for red cell depletion is an acceptable method for processing small volume, ABO incompatible marrow harvests from pediatric donors.