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Medical reasoning

Christopher Rowe, Eric Vittinghoff, Glenn-Milo Santos, Emily Behar, Caitlin Turner, Phillip Coffin
OBJECTIVES: Opioid overdose mortality has tripled in the USA since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events...
October 20, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Daniel López López, Paula Torreiro Pazo, Marta E Losa Iglesias, Ricardo Becerro de Bengoa Vallejo
We sought to explore the relationship between the podiatric medical student and the patient as it relates to the act of gift-giving as a sign of gratefulness for the services provided. This article presents the clinical case of a man who visited a podiatric medical student because of pain in his feet and subsequently presented the student with several gifts. Philanthropy, empathy, a positive attitude, treatment instructions, and the time devoted to the patient are some of the reasons why patients offer gifts to podiatric medical students...
September 2, 2016: Journal of the American Podiatric Medical Association
Ruaim A Muaygil
Advances in reproductive medicine have provided new, and much needed, hope for millions of people struggling with infertility. Gestational surrogacy is one such development that has been gaining popularity with infertile couples, especially those unable to benefit from other reproductive procedures such as In Vitro Fertilization. For many Muslim couples, however, surrogacy remains a nonviable option. Islamic scholars have deemed the procedure incompatible with Islam and have prohibited its use. This paper examines the arguments presented for proscribing surrogacy arrangements in Sunni Islam in particular...
October 20, 2016: Developing World Bioethics
Michele Carron
Non-invasive ventilation (NIV) has assumed an important role in the management of acute respiratory failure (ARF). NIV, compared with standard medical therapy, improves survival and reduces complications in selected patients with ARF. NIV represents the first-line intervention for some forms of ARF, such as chronic obstructive pulmonary disease (COPD) exacerbations and acute cardiogenic pulmonary edema. The use of NIV is also well supported for immunocompromised patients who are at high risk for infectious complications from endotracheal intubation...
September 2016: Annals of Translational Medicine
Jesica F Ramírez, Beatriz Porras, Elizabeth Borrero, Sandra P Martínez
BACKGROUND: Malaria worldwide annual reported cases range between 250 and 500 million and nearly half a million deaths are reported every year. Colombia has a vast expanse of territory with environmental and social conditions conducive to malaria transmission, which is the reason why it has second place in Latin America for the number of cases of malaria. METHODS: This is a retrospective, paired, case-control study that compares patients with severe malaria and malaria patients without mention of complication...
October 19, 2016: Malaria Journal
Michael Dau, Amir Edalatpour, Ralf Schulze, Bilal Al-Nawas, Abdulmonem Alshihri, Peer W Kämmerer
OBJECTIVES: The aim of this study was to compare the subjective quality rating of panoramic radiography (PAN) and cone beam computed tomography (CBCT) in planning of dental implant procedures by clinicians with different educational background. METHODS: Radiographic images (PAN and CBCT) of 42 patients were examined as follows: 10 maxillary (MX) anterior region, 16 MX posterior region and 16 mandibular (MD) posterior region. These sites were used for planning of dental implant insertion...
October 19, 2016: Dento Maxillo Facial Radiology
Osama Mosa, Milan Skitek, Ales Jerin
CONTEXT AND OBJECTIVE: Acute kidney injury (AKI) is still a headache for clinicians and scientists as a possible reason for increased death among intensive care unit (ICU) patients after invasive cardiac surgery. Furthermore, the diagnostic process for AKI using conventional biomarkers is not sufficient to ensure early warning of this condition because of the morbid influence of non-renal factors that definitively delay the time for the prognosis. These imposed limitations have led to significant amounts of research targeted towards identifying novel biomarkers for AKI with a sustained degree of sensitivity and specificity...
October 13, 2016: São Paulo Medical Journal, Revista Paulista de Medicina
Emily McNicholas, Ahmed H Abdelhafiz
Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.
2016: Acute Medicine
Elizabeth A Atchison, Ahmed F Omar, Raymond Iezzi, Andrew J Barkmeier, Sophie J Bakri
PURPOSE: To examine the safety outcomes of an intravitreal injection-only clinic where patients needing long-term anti-vascular endothelial growth factor therapy are treated with injections at a predetermined interval for a set number of injections without an accompanying clinic visit. METHODS: This is a retrospective chart review of all patients with exudative macular degeneration treated in an intravitreal injection clinic over a 4-year period. Data on the outcome measures of interest were gathered from electronic medical records...
October 18, 2016: Retina
Jamshid Roozbeh, Leila Malekmakan, Mohammad Mostafa Harifi, Taraneh Tadayon
OBJECTIVES: Autosomal dominant polycystic kidney disease is the most common hereditary disorder resulting in end-stage renal disease that can affect other organs besides kidneys. Extrarenal involvement may increase mortality and morbidity. Approximately 50% of patients with this disorder require renal transplant. Posttransplant complications have been reported to be equal in these patients versus other recipients. We conducted this study to determine and compare characteristics and outcomes of transplanted patients with this disease versus other recipients at the only transplant center in southern Iran...
October 14, 2016: Experimental and Clinical Transplantation
M Ariel Geer Wallace, Tzipporah M Kormos, Joachim D Pleil
Environmental health science aims to link environmental pollution sources to adverse health outcomes to develop effective exposure intervention strategies that reduce long-term disease risks. Over the past few decades, the public health community recognized that health risk is driven by interaction between the human genome and external environment. Now that the human genetic code has been sequenced, establishing this "G × E" (gene-environment) interaction requires a similar effort to decode the human exposome, which is the accumulation of an individual's environmental exposures and metabolic responses throughout the person's lifetime...
October 19, 2016: Journal of Toxicology and Environmental Health. Part B, Critical Reviews
Jeanne M O Eloundou-Mbebi, Anika Küken, Nooshin Omranian, Sabrina Kleessen, Jost Neigenfind, Georg Basler, Zoran Nikoloski
Maintenance of functionality of complex cellular networks and entire organisms exposed to environmental perturbations often depends on concentration robustness of the underlying components. Yet, the reasons and consequences of concentration robustness in large-scale cellular networks remain largely unknown. Here, we derive a necessary condition for concentration robustness based only on the structure of networks endowed with mass action kinetics. The structural condition can be used to design targeted experiments to study concentration robustness...
October 19, 2016: Nature Communications
Hille Haker
This essay explores the two main objectives of Bishop's book, which he analyzes in the context of the care for the dying: (1) the medical metaphysics underlying medical science and (2) biopolitics as governance of the human body. This essay discusses Bishop's claims in view of newer developments in medicine, especially the turn to the construction of life, and confronts the concept of the patient's sovereignty with an alternative model of vulnerable agency. In order to overcome the impasses of contemporary bioethics, the essay argues that practical reason requires a two-fold ethics: first, it must develop a new hermeneutics of illness and disease, and second, in order to protect the individuals in the process of dying, moral claims concerning death must be based on the concept of human rights...
October 6, 2016: Journal of Medicine and Philosophy
Ejiofor T Ugwu, Casmir Jg Orjioke, Ekenechukwu E Young
BACKGROUND: Self monitoring of blood glucose (SMBG) is a useful adjunct to lifestyle modification and medications for optimal management of type 2 diabetes mellitus (DM). This study was aimed at evaluating the practice, cost and associations of SMBG in subjects with type 2 DM in Enugu, Nigeria. METHODS: In a cross-sectional survey conducted at the diabetes clinic in three hospitals, 366 type 2 diabetic subjects aged 18-65 years were consecutively interviewed. Socio-demographic and clinical information were documented and glycated hemoglobin was performed for all the participants...
October 14, 2016: Current Diabetes Reviews
Jop P Verweij, Gert J M Hassing, Marta Fiocco, Pascal N W J Houppermans, J P Richard van Merkesteyn
The aim of this study was to analyse the incidence of removal of MESH plates because of symptoms after Le Fort I osteotomy (LF1). The medical files of patients treated with LF1 were retrospectively reviewed. The occurrence of MESH plate removal, indication for removal and time between insertion and removal were noted. The medical literature was reviewed to quantify the reported incidences of removal of titanium osteosynthesis material after LF1. A total of 158 patients were included in this study. LF1 was performed and fixed with MESH plates in 150 patients...
September 23, 2016: Journal of Cranio-maxillo-facial Surgery
Daniel Hausmann, Cristina Zulian, Edouard Battegay, Lukas Zimmerli
BACKGROUND: Decision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient's condition. OBJECTIVE: The principal aim of the present study was to trace and map the individual diagnostic process of real medical cases using a Decision Process Matrix [DPM]). METHODS: The naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in an emergency department, and a DPM was drawn up according to a semi-structured technique following four steps: 1) observing and recording relevant information throughout the entire diagnostic process, 2) assessing options in terms of suspected diagnoses, 3) drawing up an initial version of the DPM, and 4) verifying the DPM, while adding the confidence ratings...
October 18, 2016: BMC Medical Informatics and Decision Making
Horng-Chyuan Lin, Sang-Heon Cho, Aloke Gopal Ghoshal, Abdul Razak Bin Abdul Muttalif, Sanguansak Thanaviratananich, Shalini Bagga, Rab Faruqi, Shiva Sajjan, Camilla L Cahill, Kim K Hamrosi, De Yun Wang
Chronic respiratory diseases such as asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), and rhinosinusitis are becoming increasingly prevalent in the Asia-Pacific region. The Asia-Pacific Burden of Respiratory Diseases (APBORD) study was a cross-sectional, observational study which examined the disease and economic burden of AR, asthma, COPD, and rhinosinusitis across Asia-Pacific using 1 standard protocol. Here we report symptoms, healthcare resource use (HCRU), work impairment, and associated cost in Taiwan...
July 2016: Medicine (Baltimore)
Sanguansak Thanaviratananich, Sang-Heon Cho, Aloke Gopal Ghoshal, Abdul Razak Bin Abdul Muttalif, Horng-Chyuan Lin, Chaicharn Pothirat, Benjamas Chuaychoo, Songklot Aeumjaturapat, Shalini Bagga, Rab Faruqi, Shiva Sajjan, Santwona Baidya, De Yun Wang
Asia-Pacific Burden of Respiratory Diseases (APBORD) was a cross-sectional, observational study examining the burden of respiratory disease in adults across 6 Asia-Pacific countries.This article reports symptoms, healthcare resource utilization (HCRU), work impairment and cost burden associated with allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis in Thailand.Consecutive participants aged ≥18 years with a primary diagnosis of AR, asthma, COPD, or rhinosinusitis were enrolled at 4 hospitals in Thailand during October 2012 and October 2013...
July 2016: Medicine (Baltimore)
Sarah Ma Caney
OBJECTIVES: The objective of this study was to learn about owner experiences of chronic kidney disease (CKD), focusing on use of therapeutic renal diets (TRDs) and intestinal phosphate binders (IPBs). METHODS: An online survey was promoted to UK-based cat owners. RESULTS: In total, 859 owners participated. Most cats (n = 620; 72.18%) had two or more clinical signs at the time of their CKD diagnosis. Most common were polydipsia (n = 462; 53...
October 17, 2016: Journal of Feline Medicine and Surgery
Angelo Sisto, Diomira Luongo, Lucia Treppiccione, Palmira De Bellis, Donato Di Venere, Paola Lavermicocca, Mauro Rossi
The most recent trend in research on probiotic bacteria aims at the exploitation of bioactive bacterial compounds that are responsible for health-promoting effects and suitable for medical applications. Therefore, the main purpose of this study was to ascertain if the immunomodulatory effects of L. paracasei strains on dendritic cells (DCs) were caused by bacterial metabolites released in the culture medium. For that reason, bacterial strains were grown in two media generally used for the culture of DCs, and the effects of culture filtrates on the maturation of DCs and cytokine production were evaluated...
October 14, 2016: Nutrients
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