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Clinical pearls

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https://www.readbyqxmd.com/read/29149863/pearls-and-pitfalls-in-comprehensive-critical-care-echocardiography
#1
REVIEW
Sam Orde, Michel Slama, Andrew Hilton, Konstantin Yastrebov, Anthony McLean
Critical care echocardiography is developing rapidly with an increasing number of specialists now performing comprehensive studies using Doppler and other advanced techniques. However, this imaging can be challenging, interpretation is far from simple in the complex critically ill patient and mistakes can be easy to make. We aim to address clinically relevant areas where potential errors may occur and suggest methods to hopefully improve accuracy of imaging and interpretation.
November 17, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29142340/clinical-pearls-etiologies-of-superscan-appearance-on-fluorine-18-fludeoxyglucose-positron-emission-tomography-computed-tomography
#2
REVIEW
John Joseph Manov, Patrick J Roth, Russ Kuker
The term "superscan" usually refers to a characteristic pattern on skeletal scintigraphy consisting of symmetrically intense and diffuse radiotracer uptake in the skeleton with absent or diminished visualization of the genitourinary system and soft tissues. Superscans and superscan-like appearances have also been described on fluorine-18-fludeoxyglucose positron emission tomography-computed tomography (18-F-FDG PET/CT). We review reported cases of 18-F-FDG PET/CT superscans and propose criteria for differentiating pathologic superscans from physiologic causes...
October 2017: Indian Journal of Nuclear Medicine: IJNM: the Official Journal of the Society of Nuclear Medicine, India
https://www.readbyqxmd.com/read/29138201/effect-of-iron-and-zinc-biofortified-pearl-millet-consumption-on-growth-and-immune-competence-in-children-aged-12-18-months-in-india-study-protocol-for-a-randomised-controlled-trial
#3
Saurabh Mehta, Julia L Finkelstein, Sudha Venkatramanan, Samantha L Huey, Shobha A Udipi, Padmini Ghugre, Caleb Ruth, Richard L Canfield, Anura V Kurpad, Ramesh D Potdar, Jere D Haas
INTRODUCTION: Biofortified crops represent a sustainable agricultural solution for the widespread micronutrient malnutrition in India and other resource-limited settings. This study aims to investigate the effect of the consumption of foods prepared with iron- and zinc-biofortified pearl millet (FeZn-PM) by children on biomarkers of iron and zinc status, growth, and immune function. METHODS AND ANALYSIS: We will conduct a randomised controlled feeding trial in identified slums of Mumbai, India among 200 children aged between 12 and 18 months...
November 14, 2017: BMJ Open
https://www.readbyqxmd.com/read/29136875/a-turn-on-competitive-immunochromatographic-strips-integrated-with-quantum-dots-and-gold-nano-stars-for-cadmium-ion-detection
#4
Meng Xiao, Qiangqiang Fu, Haicong Shen, Yuan Chen, Wei Xiao, Daoguang Yan, Xiaojiang Tang, Zhiyong Zhong, Yong Tang
Immunochromatographic strips (ICSs) are inexpensive, simple, portable, and robust, and therefore have many uses in the medicinal, agricultural, and environmental industries. For detection of small molecules, current ICSs are competitive format (competitive ICSs, CICSs), which only offer a turn-off readout mode, and therefore lead to low sensitivity when evaluating results by the naked eye. To overcome this problem, we report a turn-on CICSs that relies on the ability of gold nano-stars (AuNSs) quenching the signal of quantum dots (QDs)...
February 1, 2018: Talanta
https://www.readbyqxmd.com/read/29132872/an-nrg-oncology-gog-study-of-molecular-classification-for-risk-prediction-in-endometrioid-endometrial-cancer
#5
Casey M Cosgrove, David L Tritchler, David E Cohn, David G Mutch, Craig M Rush, Heather A Lankes, William T Creasman, David S Miller, Nilsa C Ramirez, Melissa A Geller, Matthew A Powell, Floor J Backes, Lisa M Landrum, Cynthia Timmers, Adrian A Suarez, Richard J Zaino, Michael L Pearl, Paul A DiSilvestro, Shashikant B Lele, Paul J Goodfellow
OBJECTIVES: The purpose of this study was to assess the prognostic significance of a simplified, clinically accessible classification system for endometrioid endometrial cancers combining Lynch syndrome screening and molecular risk stratification. METHODS: Tumors from NRG/GOG GOG210 were evaluated for mismatch repair defects (MSI, MMR IHC, and MLH1 methylation), POLE mutations, and loss of heterozygosity. TP53 was evaluated in a subset of cases. Tumors were assigned to four molecular classes...
November 10, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/29121123/clinical-pearl-mastering-the-flexible-scalpel-blade-with-the-banana-practice-model
#6
Wesley Wu, Leonard Goldberg, Marc Rubenzik, Blake Zelickson
This article describes the various applications of the flexible scalpel blade (FSB), the utility of the banana as a convenient and exceptional training instrument, and the intricacies of mastering the technique for students of different training levels.
September 2017: Cutis; Cutaneous Medicine for the Practitioner
https://www.readbyqxmd.com/read/29092865/clinical-pearls
#7
EDITORIAL
Rhonda Board
No abstract text is available yet for this article.
November 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/29078961/new-parameters-describing-how-knee-ligaments-carry-force-in-situ-predict-interspecimen-variations-in-laxity-during-simulated-clinical-exams
#8
Carl W Imhauser, Robert N Kent, James Boorman-Padgett, Ran Thein, Thomas L Wickiewicz, Andrew D Pearle
Knee laxity, defined as the net translation or rotation of the tibia relative to the femur in a given direction in response to an applied load, is highly variable from person to person. High levels of knee laxity as assessed during routine clinical exams are associated with first-time ligament injury and graft reinjury following reconstruction. During laxity exams, ligaments carry force to resist the applied load; however, relationships between intersubject variations in knee laxity and variations in how ligaments carry force as the knee moves through its passive envelope of motion, which we refer to as ligament engagement, are not well established...
October 7, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/29068643/diagnosis-and-management-of-acute-exacerbation-of-chronic-obstructive-pulmonary-disease-digest
#9
Van Holden, Donald Slack Iii, Michael T McCurdy, Nirav G Shah, Nachi Gupta, Jeffrey Nusbaum
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a clinical diagnosis that is based on changes in dyspnea, cough, and/or sputum production in a COPD patient; however, patients presenting with an acute exacerbation may be undiagnosed or have a variety of comorbid conditions that can complicate diagnosis. This issue presents strategies and algorithms for the early use of evidence-based interventions, including appropriate use of antibiotics, bronchodilators, and corticosteroids, along with noninvasive ventilation with capnography, to minimize morbidity and mortality associated with this disease...
October 20, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29063435/prescription-treatment-options
#10
Brad Ackerson, Ryan Thorpe, Matilda W Nicholas
Atopic dermatitis frequently requires the use of over-the-counter and prescription medications for effective management. Emollients and topical corticosteroids are effective for most patients and are the most commonly utilized agents by experienced dermatologists. Antihistamines, antibiotics, and calcineurin inhibitors may also prove helpful in the correct clinical scenarios. Severe atopic dermatitis, however, can be difficult to manage and not infrequently require substantial immunomodulatory medications. Targeted molecular therapies, such as dupilumab, are promising, emerging atopic dermatitis therapies...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29061624/right-for-me-protocol-for-a-cluster-randomised-trial-of-two-interventions-for-facilitating-shared-decision-making-about-contraceptive-methods
#11
Rachel Thompson, Ruth Manski, Kyla Z Donnelly, Gabrielle Stevens, Daniela Agusti, Michelle Banach, Maureen B Boardman, Pearl Brady, Christina Colón Bradt, Tina Foster, Deborah J Johnson, Zhongze Li, Judy Norsigian, Melissa Nothnagle, Ardis L Olson, Heather L Shepherd, Lisa F Stern, Tor D Tosteson, Lyndal Trevena, Krishna K Upadhya, Glyn Elwyn
INTRODUCTION: Despite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods. METHODS AND ANALYSIS: We will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt card and decision aids+training and (4) usual care...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29054315/cord-topographical-anatomy-and-its-role-in-evaluating-intramedullary-lesions
#12
REVIEW
James Andrew Spain, Scott Cressman, Horia Marin, Suresh C Patel, John J Corrigan, Brent Griffith
Intramedullary spinal lesions present a wide differential diagnosis including infectious, inflammatory, traumatic, ischemic, benign, or malignant neoplastic etiologies. Using knowledge of anatomy and physiology within the spinal cord, many similar appearing entities can be parsed into a prioritized differential. The purpose of this article is to review anatomy and pathophysiology of the spinal cord, with subsequent discussion of how this knowledge can be used to differentiate several similar appearing intramedullary pathologic processes...
September 18, 2017: Current Problems in Diagnostic Radiology
https://www.readbyqxmd.com/read/29053500/the-community-orthopaedic-surgeon-taking-trauma-call-pediatric-femoral-shaft-fracture-pearls-and-pitfalls
#13
J Eric Gordon, Charles T Mehlman
Pediatric femoral shaft fractures present many challenging patient care decisions. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention is commonplace in virtually all older children. Treatment is determined primarily by patient age as modified by clinical factors including mechanism of injury, weight, and skeletal maturity. Infants can be successfully treated by placement into a Pavlik harness, whereas children younger than 5 years are most commonly treated by early reduction and spica cast immobilization...
November 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29049055/oxidized-regenerated-cellulose-collagen-dressings-review-of-evidence-and-recommendations
#14
Stephanie Wu, Andrew J Applewhite, Jeffrey Niezgoda, Robert Snyder, Jayesh Shah, Breda Cullen, Gregory Schultz, Janis Harrison, Rosemary Hill, Melania Howell, Marcus Speyrer, Howard Utra, Jean de Leon, Wayne Lee, Terry Treadwell
OBJECTIVE: Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds. DESIGN: A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations...
November 2017: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/29040967/improvement-and-aggravation-of-spontaneous-unruptured-vertebral-artery-dissection
#15
Tomoya Shibahara, Masahiro Yasaka, Yoshiyuki Wakugawa, Koichiro Maeda, Takeshi Uwatoko, Takahiro Kuwashiro, Gregory Y H Lip, Yasushi Okada
BACKGROUND: Intracranial vertebral artery dissection (VAD) is a well-recognized cause of stroke in young and middle-aged individuals, especially in Asian populations. However, a long-term natural course remains unclear. We investigated the long-term time course of VAD using imaging findings to examine the rate and predisposing factors for improvement. METHODS: We registered 56 consecutive patients (40 males; mean age, 51.8 ± 10.7 years) with acute spontaneous VAD and retrospectively investigated neuroimaging and clinical course within 1 month and at 3 months ± 2 weeks, 6 months ± 2 weeks, and 12 months ± 2 weeks after onset to ascertain predisposing factors and time course for improvement...
October 17, 2017: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/29037481/surgical-outcomes-among-elderly-women-with-endometrial-cancer%C3%A2-treated-by-laparoscopic-hysterectomy-a-nrg-gynecologic-oncology-group-study
#16
Erin A Bishop, James J Java, Kathleen N Moore, Nick M Spirtos, Michael L Pearl, Oliver Zivanovic, David M Kushner, Floor Backes, Chad A Hamilton, Melissa A Geller, Jean Hurteau, Cara Mathews, Robert M Wenham, Pedro T Ramirez, Susan Zweizig, Joan L Walker
OBJECTIVE: Tolerance of and complications caused by minimally invasive hysterectomy and staging in the older endometrial cancer population is largely unknown despite the fact that this is the most rapidly growing age group in the United States. The objective of this retrospective review was to compare operative morbidity by age in patients on the Gynecologic Oncology Group Laparoscopic Surgery or Standard Surgery in Treating Patients With Endometrial Cancer or Cancer of the Uterus (LAP2) trial...
October 14, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29019749/pearls-and-pitfalls-in-diagnosing-pediatric-urinary-bladder-masses
#17
Susan C Shelmerdine, Armando J Lorenzo, Abha A Gupta, Govind B Chavhan
Urinary bladder masses are rare in children, and the associated histologic features and prognoses in this population are different from those in adults. Most children with urinary bladder masses present with lower urinary tract symptoms, which may include hematuria, dysuria, frequent urination, and urgency to urinate. However, some of these masses may be identified incidentally or involve generic symptoms such as abdominal distention. In general, pediatric bladder tumors can be divided into those that originate from the bladder epithelium, known as urothelial neoplasms, and mesenchymal bladder neoplasms, which are more prevalent...
October 2017: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29019145/phylogenetic-and-genetic-characterization-of-a-2017-clinical-isolate-of-h7n9-virus-in-guangzhou-china-during-the-fifth-epidemic-wave
#18
Yongqiang Deng, Chunlin Li, Jianfeng Han, Yingfen Wen, Jian Wang, Wenxing Hong, Xiaofeng Li, Zhongyu Liu, Qing Ye, Jing Li, Changshuai Zhou, Lei Yu, Chengfeng Qin, Fuchun Zhang, Tao Jiang
Pathogenic H7N9 influenza viruses continue to pose a public health concern. The H7N9 virus has caused five outbreak waves of human infections in China since 2013. In the present study, a novel H7N9 strain (A/Guangdong/8H324/2017) was isolated from a female patient with severe respiratory illness during the fifth wave of the 2017 H7N9 epidemic. Phylogenetic analysis showed that the H7N9 viruses collected during the fifth wave belong to two different lineages: the Pearl River Delta lineage and the Yangtze River Delta lineage...
October 9, 2017: Science China. Life Sciences
https://www.readbyqxmd.com/read/29018747/pearls-and-pitfalls-in-the-management-of-duane-syndrome
#19
REVIEW
Seyhan B Özkan
Duane syndrome (DS) is a common form of congenital cranial dysinnervation disorders. The ocular motility pattern lies in a wide clinical spectrum, and the choice of treatment must be individualized depending on the severity of the clinical findings. There is no perfect method of treatment and no real "cure" in DS. In this paper, the aim is to give some guidelines to the reader for selection of the most appropriate treatment method for the patient.
January 2017: Taiwan Journal of Ophthalmology
https://www.readbyqxmd.com/read/28985901/systemic-manifestations-in-pyridox-am-ine-5-phosphate-oxidase-deficiency
#20
Réjean M Guerriero, Archana A Patel, Brian Walsh, Fiona M Baumer, Ankoor S Shah, Jurriaan M Peters, Lance H Rodan, Pankaj B Agrawal, Phillip L Pearl, Masanori Takeoka
OBJECTIVE: Pyridoxine is converted to its biologically active form pyridoxal-5-phosphate (P5P) by the enzyme pyridox(am)ine 5'-phosphate oxidase and serves as a cofactor in nearly 200 reactions in the central nervous system. Pyridox(am)ine 5'-phosphate oxidase deficiency leads to P5P dependent epilepsy, typically a neonatal- or infantile-onset epileptic encephalopathy treatable with P5P or in some cases, pyridoxine. Following identification of retinopathy in a patient with pyridox(am)ine 5'-phosphate oxidase deficiency that was reversible with P5P therapy, we describe the systemic manifestations of pyridox(am)ine 5'-phosphate oxidase deficiency...
June 3, 2017: Pediatric Neurology
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