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https://www.readbyqxmd.com/read/28820232/recognizing-and-managing-adrenal-disorders-in-the-emergency-department
#1
Amy Cutright, Stephen Ducey, Claudia L. Barthold
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28819575/therapeutic-approach-to-the-management-of-severe-asymptomatic-hyponatremia
#2
Thaofiq Ijaiya, Sandhya Manohar, Kameswari Lakshmi
Hyponatremia is an electrolyte imbalance encountered commonly in the hospital and ambulatory settings. It can be seen in isolation or present as a complication of other medical conditions. It is therefore a challenge to determine the appropriate therapeutic intervention. An understanding of the etiology is key in instituting the right treatment. Clinicians must not be too hasty to correct a random laboratory value without first understanding the physiologic principle. We present such a case of a patient who presented with sodium of 98 mmol/L, the lowest recorded in the current literature, and yet was asymptomatic...
2017: Case Reports in Nephrology
https://www.readbyqxmd.com/read/28816945/99mtc-pertechnetate-avid-metastases-from-differentiated-thyroid-cancer-are-prone-to-benefit-from-131i-therapy-a-prospective-observational-study
#3
Min Liu, Li Chai, Qiong Luo, Maomei Ruan, Lingxiao Cheng, Zhongwei Lv, Libo Chen
The aim of this study is to determine the contribution of neck and chest Tc-pertechnetate scan to the management of postoperative patients with suspicious metastatic differentiated thyroid cancer (DTC), particularly to the prediction of response to radioiodine (I) therapy. Just before I administration, a total of 184 postoperative DTC patients with stimulated serum thyroglobulin (ssTg) >10 ng/mL were enrolled to undergo neck and chest Tc-pertechnetate scan, which were directly compared with post-therapeutic I scan to determine the concordance of site and number of metastatic lesions...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28816882/a-narrative-review-of-adherence-to-subarachnoid-hemorrhage-guidelines
#4
Paolo Gritti, Oluwaseun Akeju, Ferdinando L Lorini, Luigi A Lanterna, Carlo Brembilla, Federico Bilotta
Over the past 2 decades, a large number of guidelines for aneurysmal subarachnoid hemorrhage (aSAH) management have been proposed. The primary aim of these "evidence-based" guidelines is to improve the care of aSAH patients by summarizing and making current knowledge readily available to clinicians. However, an investigation into aSAH guidelines, their changes along time and their successful translation into clinical practice is still lacking.We performed a literature search of historical events and subarachnoid hemorrhage guidelines using the Entrez PubMed NIH, Embase, and Cochrane databases for articles published up to November of 2016...
August 14, 2017: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/28815445/identification-and-treatment-optimization-of-comorbid-depression-in-rheumatoid-arthritis
#5
Mellissa H Withers, Louella T Gonzalez, George A Karpouzas
Patients with rheumatoid arthritis (RA) suffer from high rates of depression but depression often remains undiagnosed and untreated among RA patients. Because of its high prevalence and its profound impact on functional disability and health-related quality of life, prompt recognition and management of comorbid depression is urgently needed in patients with RA. Rheumatologists face the challenge of addressing depression in their clinical interactions with patients. The purpose of this paper is to present the prevalence of comorbid depression in RA, to delineate the consequences of depression among RA patients, to discuss the barriers to the identification of depression among RA patients, and to outline a set of recommendations to identify and treat comorbid depression that could be implemented within the rheumatology clinic setting...
August 16, 2017: Rheumatology and Therapy
https://www.readbyqxmd.com/read/28814857/when-is-dual-bronchodilation-indicated-in-copd
#6
REVIEW
Mike Thomas, David Mg Halpin, Marc Miravitlles
Inhaled bronchodilator medications are central to the management of COPD and are frequently given on a regular basis to prevent or reduce symptoms. While short-acting bronchodilators are a treatment option for people with relatively few COPD symptoms and at low risk of exacerbations, for the majority of patients with significant breathlessness at the time of diagnosis, long-acting bronchodilators may be required. Dual bronchodilation with a long-acting β2-agonist and long-acting muscarinic antagonist may be more effective treatment for some of these patients, with the aim of improving symptoms...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28814591/spleno-renal-artery-transposition-in-a-solitary-functioning-kidney-for-treatment-resistant-hypertension-and-acute-kidney-injury
#7
Subash Somalanka, Fiona E Harris, Eric Chemla, Rebecca Jo Suckling, Pauline A Swift
Renal Artery Stenosis (RAS) is an important cause of treatment-resistant hypertension. Uncontrolled hypertension with RAS can cause progressive chronic kidney disease (CKD) leading to end-stage kidney disease. Therapeutic revascularisation can be helpful in appropriate circumstances where pharmaceutical intervention has failed and significant renovascular disease contributes to resistant hypertension. We present an interesting case of a Caucasian male with peripheral vasculopathy, abdominal aortic aneurysm (AAA), single functioning kidney and ostial RAS caused by stent struts from an endovascular AAA stent graft...
August 16, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28814260/neonatal-abstinence-syndrome-management-a-review-of-recent-evidence
#8
Matthew Grossman, Carl Seashore, Alison Volpe Holmes
BACKGROUND: The evaluation and management of infants with neonatal abstinence syndrome (NAS), the constellation of opioid withdrawal specific to newborns, has received renewed attention over the past decade during a new epidemic of opioid use, misuse, abuse, and dependence. Infants with NAS often endure long and costly hospital stays. OBJECTIVE: We aim to review recent literature on the management and outcomes of infants with, and at risk for, opioid withdrawal...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28810966/the-importance-of-medical-readiness-training-exercises-maintaining-medical-readiness-in-a-low-volume-combat-casualty-flow-era
#9
Kelly C Mead, David J Tennent, Daniel J Stinner
INTRODUCTION: Ringed external fixation has demonstrated promising results in the management of severe combat-related extremity injuries. The purpose of this study was to identify and compare rates of wartime-related surgical cases at times of high and low casualty time periods, and then compare these case numbers with those performed during a 2-week Medical Readiness Training Exercise (MEDRETE) in Honduras. MATERIALS AND METHODS: A retrospective review was performed of patients treated at a single Military Treatment Facility with definitive ringed external fixators during a 2-year period of high-volume combat casualty flow (January 2009-December 2010) and a subsequent 2-year period of low-volume combat casualty flow (January 2013-December 2014)...
July 2017: Military Medicine
https://www.readbyqxmd.com/read/28809368/deep-neck-infections-a-single-center-analysis-of-63-cases
#10
P Kauffmann, R Cordesmeyer, M Tröltzsch, C Sömmer, R Laskawi
BACKGROUND AND PURPOSE: With the use of antibiotic therapy, the incidence of deep neck infections has decreased in recent decades. The aim of this investigation was to review the clinical course and the management of deep neck infections in our department, compare them to the experiences of the common literature and identify predisposing factors for lethal complications. MATERIAL AND METHODS: In this single-center analysis, 63 patients with deep neck infections were treated surgically...
August 15, 2017: Medicina Oral, Patología Oral y Cirugía Bucal
https://www.readbyqxmd.com/read/28808608/intrathecal-catheter-associated-inflammatory-mass-in-a-neurofibromatosis-type-1-patient-receiving-fentanyl-and-bupivacaine
#11
Derek G Southwell, Joseph A Osorio, Christopher S Liverman, Lauren M Friedman, Ramana K Naidu, Lawrence R Poree, Melanie M Henry, Line Jacques
BACKGROUND: Catheter-associated inflammatory masses (CIMs) are a rare but serious complication of intrathecal drug delivery devices. CIM formation is influenced by local medication concentration, which is determined in part by flow dynamics at the catheter tip. Underlying spinal pathologies, such as neoplasms, may alter flow at the catheter tip, thereby contributing to CIM formation. Moreover, they may also complicate the clinical and radiologic diagnosis of a CIM. CASE DESCRIPTION: A 36-year-old man with neurofibromatosis type 1 presented to our emergency department with complaints of increased back pain and leg weakness...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/28806189/the-use-of-optical-coherence-tomography-in-neuro-ophthalmology
#12
Noel C Y Chan, Carmen K M Chan
PURPOSE OF REVIEW: In the last decade, with the advances of optical coherence tomography (OCT) technology, different imaging protocols and analysis algorithms have been introduced to maximize the potential of this diagnostic tool in the evaluation of different eye diseases. This review aims to provide an update on these additional features, with respect to the management of a diverse range of neuro-ophthalmologic conditions. RECENT FINDINGS: Macular ganglion cell complex (mGCC) analysis has been shown to be superior to peripapillary retinal nerve fiber layer (pRNFL) analysis in certain settings, such as differentiating Leber's hereditary optic neuropathy from functional visual loss; monitoring neurodegenerative diseases or multiple sclerosis; and predicting visual loss in nonarteritic ischemic optic neuropathy...
August 12, 2017: Current Opinion in Ophthalmology
https://www.readbyqxmd.com/read/28804604/why-whey-camel-whey-protein-as-a-new-dietary-approach-to-the-management-of-free-radicals-and-for-the-treatment-of-different-health-disorders
#13
REVIEW
Gamal Badr, Nancy K Ramadan, Leila H Sayed, Badr M Badr, Hossam M Omar, Zeliha Selamoglu
The balance between free radicals and antioxidants is an important factor for maintaining health and slowing disease progression. The use of antioxidants, particularly natural antioxidants, has become an important strategy for dealing with this cause of widespread diseases. Natural antioxidants have been used as therapeutic tools against many diseases because they are safe, effective, and inexpensive and are among the most commonly used adjuvants in the treatment of several diseases. Camel whey protein (CWP) is considered a strong natural antioxidant because it decreases oxidative stress, enhances immune system function, and increases glutathione levels...
April 2017: Iranian Journal of Basic Medical Sciences
https://www.readbyqxmd.com/read/28801385/diagnostic-barriers-for-somatic-symptom-disorders-in-primary-care-study-protocol-for-a-mixed-methods-study-in-germany
#14
Christina Heinbokel, Marco Lehmann, Nadine Janis Pohontsch, Thomas Zimmermann, Astrid Althaus, Martin Scherer, Bernd Löwe
INTRODUCTION: Somatoform or somatic symptom disorders ((S)SD) are common and have a negative impact on the patients' health-related quality of life, healthcare use and costs. In primary care, which is central to the management of (S)SD, diagnosis and treatment tend to be delayed. There is a significant lack of evidence regarding the barriers in the diagnostic process of (S)SD in primary care and how interventions should be tailored to address them. The aim of this study is to analyse the diagnostic process in primary care that results in the diagnosis or non-diagnosis of a (S)SD...
August 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28800186/ameliorative-response-to-detoxification-psychotherapy-and-medical-management-in-patients-maintained-on-opioids-for-pain
#15
Molly Belkin, Howard Stephen Reinheimer, Jordan Levy, Brian Johnson
BACKGROUND AND OBJECTIVES: The prevalence of opioid-induced hyperalgesia (OIH) among patients maintained on opioids for chronic non-malignant pain has not been estimated. As a contribution toward establishing its prevalence, we report a case series of opioid maintained patients whose pain tolerance was measured by the cold pressor test at baseline. METHODS: A case series of 117 patients who had undergone detoxification was reviewed retrospectively. Most patients (n = 108) and selected non-addicted support persons who accompanied them (controls; n = 37) had cold pressor time (CPT) assessments at baseline...
August 11, 2017: American Journal on Addictions
https://www.readbyqxmd.com/read/28798299/diabetes-mellitus-is-associated-with-more-severe-brain-spontaneous-activity-impairment-and-gray-matter-loss-in-patients-with-cirrhosis
#16
Yun Fei Wang, Xiang Kong, Guang Ming Lu, Long Jiang Zhang
Recent studies showed many cirrhosis patients may have diabetes mellitus (DM), however, the effect of DM on brain in cirrhotic patients is unclear. This study included 34 cirrhosis patients (17 with DM, 17 without DM) and 17 age-, sex-matched healthy controls. MRI examination and neuropsychological tests were performed. Fractional amplitude of low-frequency fluctuation (fALFF) and voxel-based morphometry algorithms were used to obtain fALFF values and gray matter volume, which were compared and correlated with clinical variables...
August 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28794598/dramatic-mixed-response-of-lymphangitic-pulmonary-metastases-in-newly-diagnosed-prostate-cancer
#17
Elan Gorshein, Robin Burger, Anna Ferrari, Tina Mayer
Prostate adenocarcinoma, the most common cancer in males in the United States, is often diagnosed in the nonmetastatic setting. The prognosis with metastatic prostate cancer is less favorable, though treatment options are typically effective in controlling the disease for an extended period. Hormonal therapy is the backbone to the management of prostate cancer metastases, decreasing the level of the prostate-specific antigen and reducing the patient's cancer-related symptoms. Pulmonary metastases, a relatively uncommon initial site of disease involvement, are expected to respond in a similar fashion to hormonal therapy as other organ or bone involvement...
July 2017: Urology Annals
https://www.readbyqxmd.com/read/28790212/-neuro-endoscopic-surgery-for-multi-lobular-chronic-subdural-hematoma
#18
Toshihito Ishikawa, Katsuhiro Endo, Yuji Endo, Naoki Sato, Mamoru Ohta
BACKGROUND: Chronic subdural hematoma(CSDH)generally occurs in the elderly, and is usually treated by burr-hole craniotomy with closed-system drainage. Treatment of recurrent CSDH is more challenging, especially when the hematoma is multi-lobular. A variety of approaches to the management of multi-lobular CSDH have been described, including evacuation through a wide craniotomy, placement of an Ommaya reservoir, subdural peritoneal shunting, and embolization of the middle meningeal artery...
August 2017: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/28783529/creed-study-hypoglycaemia-during-ramadan-in-individuals-with-type-2-diabetes-mellitus-from-three-continents
#19
Abdul Jabbar, Mohamed Hassanein, Salem A Beshyah, Kristina S Boye, Maria Yu, Steven M Babineaux
AIMS: To describe diabetes treatment and hypoglycaemia in individuals with Type 2 diabetes mellitus during Ramadan. METHODS: A multi-country, retrospective, observational study with data captured before, during, and after Ramadan. We report on a cohort of people (N=3250) with Type 2 diabetes mellitus in four culturally distinct regions: Asia, North Africa, Europe, and the Middle East. RESULTS: During Ramadan, the proportion of participants on oral anti-diabetic medication alone ranged from 68...
July 13, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28780561/behaviour-change-interventions-for-the-management-of-raynaud-s-phenomenon-a-systematic-review-protocol
#20
Jo Daniels, John D Pauling, Christopher Eccelston
INTRODUCTION: Raynaud's phenomenon (RP) describes excessive peripheral vasospasm to cold exposure and/or emotional stress. RP episodes are associated with digital colour changes, pain and reduced quality of life. Pharmacological interventions are of low to moderate efficacy and often result in adverse effects such as facial flushing and headaches. Recommended lifestyle and behavioural interventions have not been evaluated. The objectives of the proposed systematic review are to assess the comparative safety and efficacy of behaviour change interventions for RP and identify what we can learn to inform future interventions...
August 4, 2017: BMJ Open
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