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https://www.readbyqxmd.com/read/28810113/an-unusual-presentation-of-an-unusual-disease-spontaneous-pneumomediastinum
#1
Kalyan Chakravarthy Potu, Maheedhar Gedela, Kashif Abbas Shaikh, Sujithasree Ketineni, Eric Larson
We report a case of spontaneous pneumomediastinum with unusual clinical presentation. The most common symptoms of spontaneous mediastinum are chest pain and shortness of breath. Our patient presented with neck swelling and change in voice, an unusual presentation for spontaneous pneumothorax. A 30-year-old previously healthy man presented with complaints of neck swelling and hoarseness of voice beginning after an intense coughing spell. He had no other complaints. He denied any trauma to the chest, nausea, vomiting, recent air travel, scuba diving or recreational drug use...
November 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28808886/assessment-of-pharmacokinetic-interactions-between-obeticholic-acid-and-caffeine-midazolam-warfarin-dextromethorphan-omeprazole-rosuvastatin-and-digoxin-in-phase-1-studies-in-healthy-subjects
#2
Jeffrey E Edwards, Lise Eliot, Andrew Parkinson, Sharon Karan, Leigh MacConell
INTRODUCTION: Obeticholic acid (OCA), a potent and selective farnesoid X receptor agonist, is indicated for the treatment of primary biliary cholangitis (PBC). We investigated the potential drug-drug interaction effect of OCA on metabolic CYP450 enzymes and drug transporters. METHODS: Five phase 1 single-center, open-label, fixed-sequence, inpatient studies were conducted in healthy adult subjects to evaluate the effect of oral daily doses of 10 or 25 mg OCA on single-dose plasma pharmacokinetics of specific probe substrates for enzymes CYP1A2 (caffeine, R-warfarin), CYP3A (midazolam, R-warfarin), CYP2C9 (S-warfarin), CYP2D6 (dextromethorphan), CYP2C19 (omeprazole), and drug transporters, BCRP/OATP1B1/OATP1B3 (rosuvastatin), and P-gp (digoxin)...
August 14, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28808209/herpes-zoster-in-breast-cancer-a-case-report
#3
Mohammad Darvishi, Narges Vasei
There is little information on herpes zoster infection in breast cancer patients as a complication during adjuvant chemotherapy. We report a case of herpes zoster in a 65-year-old woman presented with low grade fever and vital signs together with skin symptoms such as severe edema, irritation and itching in the left breast where there was wound drainage. PCR test revealed varicella zoster virus. To the best of our knowledge, the histologic features coupled with PCR led to a diagnosis of herpes zoster.
July 13, 2017: Journal of Biomedical Research
https://www.readbyqxmd.com/read/28808093/are-disagreements-in-caregiver-and-patient-assessment-of-patient-health-associated-with-increased-caregiver-burden-in-caregivers-of-older-adults-with-cancer
#4
Tina Hsu, Matthew Loscalzo, Rupal Ramani, Stephen Forman, Leslie Popplewell, Karen Clark, Vani Katheria, Rex Strowbridge, Redmond Rinehart, Dan Smith, Keith Matthews, Jeff Dillehunt, Tao Feng, David Smith, Canlan Sun, Arti Hurria
BACKGROUND: As patients age, caregivers increasingly provide essential support and patient information. We sought to determine if patient-caregiver assessments of patient health differ and if differences contribute to burden in caregivers of older adults with cancer. MATERIALS AND METHODS: One hundred patients, aged ≥65, and their caregivers independently assessed patient function, comorbidity, nutrition, social activity, social support, and mental health. Caregivers completed the Caregiver Strain Index (CSI)...
August 14, 2017: Oncologist
https://www.readbyqxmd.com/read/28807193/does-increased-prehospital-time-lead-to-a-trial-of-life-effect-for-patients-with-blunt-trauma
#5
Thomas W Clements, Kelly Vogt, S Morad Hameed, Neil Parry, Andrew W Kirkpatrick, Sean C Grondin, Elijah Dixon, Jessica McKee, Chad G Ball
BACKGROUND: Variance in prehospital time among severely injured blunt trauma patients is dependent upon numerous factors. Effects on subsequent mortality and trauma team activation (TTA) rates are also unclear. The primary aim of this study was to evaluate the relationship between prehospital time and mortality at level I trauma referral centers amongst critically blunt injured patients. MATERIALS AND METHODS: This multiinstitutional study from three geographically distinct level I trauma centers analyzed all severely blunt injured patients (Injury Severity Score [ISS] ≥12)...
August 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28804692/one-case-with-dexmedetomidine-induced-stuporous-state-in-epileptic-patient-undergoing-abdominal-surgery
#6
Dong-Ji Han, Zhi-Gang He, Zhi-Qiang Zhou, Li Feng, Cheng Liu, Yan Xiang, Hong-Bing Xiang
A 56-year-old epileptic patient underwent right hemicolectomy and cholecystectomy surgery under general endotracheal anesthesia. Anesthesia was maintained with sevoflurane, and sufentanil, rocuronium, and dexmedetomidine infusions. After the operation and confirmation of neuromuscular recovery, the patient woke from anesthesia within 15 min and successfully extubated. After the vital signs of patient were stable, the patient was transported to post anesthesia care unit (PACU). 6 h after the surgery, he fell into a stuporous state for lasting 14 h and EEG showed no epileptiform discharges...
2017: American Journal of Neurodegenerative Disease
https://www.readbyqxmd.com/read/28803272/inpatient-monitoring-of-decompensated-heart-failure-what-is-needed
#7
REVIEW
Danish Ali, Prithwish Banerjee
PURPOSE OF REVIEW: Acute decompensated heart failure is a serious and common condition where close monitoring of symptoms, vital signs, haemodynamic and other markers are needed after the patient is admitted to hospital as the in-hospital outcome is poor. This review focuses on advances in the assessment and monitoring of these patients. RECENT FINDINGS: The adoption of the CHAMP acronym to identify precipitating factors and of the classification using wet-warm, wet-cold, dry-warm and dry-cold categories is an improvement regarding assessment...
August 12, 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28803087/effect-of-prophylactic-fentanyl-buccal-tablet-on-episodic-exertional-dyspnea-a-pilot-double-blind-randomized-controlled-trial
#8
David Hui, Kelly Kilgore, Susan Frisbee-Hume, Minjeong Park, Diane Liu, Diwakar D Balachandran, Eduardo Bruera
CONTEXT: Episodic dyspnea is one of the most common, debilitating and difficult-to-treat symptoms. OBJECTIVE: We conducted a pilot study to examine the effect of prophylactic FBT on exercise-induced dyspnea. METHODS: In this parallel, double-blind randomized placebo-controlled trial, opioid-tolerant patients were asked to complete a 6 minute walk test (6MWT) at baseline, then a second 6MWT 30 minutes after a single dose of FBT (equivalent to 20-50% of their total opioid dose) or matching placebo...
August 9, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28802696/community-acquired-pneumonia-visualized-on-computed-tomography-but-not-chest-x-ray-pathogens-severity-and-clinical-outcomes
#9
Cameron P Upchurch, Carlos G Grijalva, Richard G Wunderink, Derek J Williams, Grant W Waterer, Evan J Anderson, Yuwei Zhu, Eric M Hart, Frank Carroll, Anna M Bramley, Seema Jain, Kathryn M Edwards, Wesley H Self
BACKGROUND: The clinical significance of pneumonia visualized on computed tomography (CT) in the setting of a normal chest x-ray (CXR) is uncertain. METHODS: In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens, and outcomes of patients with pneumonia visualized on CT but not on concurrent CXR (CT-only pneumonia) and those with pneumonia visualized on CXR...
August 9, 2017: Chest
https://www.readbyqxmd.com/read/28801782/common-pediatric-medical-emergencies-in-office-practice
#10
Bharat Mehra, Suresh Gupta
General Practitioners frequently see children with medical conditions that may evolve into an emergency if not promptly attended to. The most common emergencies encountered in pediatric office practice are respiratory distress, dehydration, anaphylaxis, seizures and trauma. Assessment of children is sometimes difficult as the signs and symptoms might be subtle and not markedly expressed. Also, normal value of vital signs vary with age, thus their interpretation requires discrete knowledge of age appropriate values...
August 12, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28801082/-how-to-videos-improve-residents-performance-of-essential-perioperative-electronic-medical-records-and-clinical-tasks
#11
Veronica Zoghbi, Robert C Caskey, Kristoffel R Dumon, Jacqueline M Soegaard Ballester, Ari D Brooks, Jon B Morris, Daniel T Dempsey
OBJECTIVE: The ability to use electronic medical records (EMR) is an essential skill for surgical residents. However, frustration and anxiety surrounding EMR tasks may detract from clinical performance. We created a series of brief, 1-3 minutes "how to" videos demonstrating 7 key perioperative EMR tasks: booking OR cases, placing preprocedure orders, ordering negative-pressure wound dressing supplies, updating day-of-surgery history and physical notes, writing brief operative notes, discharging patients from the postanesthesia care unit, and checking vital signs...
August 8, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28800211/pharmacokinetics-and-bioequivalence-of-branded-and-generic-formulations-of-dofetilide-0-5-mg-capsules-after-single-dose-administration-in-healthy-subjects
#12
James T VanderLugt, Charles Bon, Dean Knuth, Rhonda Schreiber, Michael D Ruff
Class III antiarrhythmics are preferred therapy for managing atrial fibrillation/flutter. Dofetilide 0.5-mg capsules were US Food and Drug Administration (FDA) approved in 1999 to treat atrial fibrillation/flutter. Bioequivalence of generic dofetilide is important for treating arrhythmias because drug concentrations must be consistent to maintain normal sinus rhythm. Generic dofetilide 0.5-mg capsule pharmacokinetics were compared with branded product in 2 open-label, 2-way crossover, single-dose studies - 1 study each in fasted and fed healthy subjects...
August 11, 2017: Clinical Pharmacology in Drug Development
https://www.readbyqxmd.com/read/28796652/acyanotic-hypoxia-in-a-febrile-child
#13
Fiona Murphy, Julian Blackham, John Moppett, Mark Lyttle
Glucose-6-phosphate dehydrogenase deficiency affects approximately 400 million people worldwide and is an X-linked disorder most commonly found in individuals of African, Asian, Mediterranean, and Middle Eastern descent. It can present with acute hemolysis in response to certain drugs, infections, or fava beans, and affected individuals may not be aware that they have glucose-6-phosphate dehydrogenase deficiency. This case illustrates the importance of those working in the acute and urgent care sector having an awareness of the condition and the value of a full set of vital signs in an unwell child...
August 7, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28795675/-clinical-application-of-abdominal-lifting-and-compression-cardiopulmonary-resuscitation-method-for-treatment-of-patients-with-cardiac-arrest
#14
Haishan Li, Liu Ji, Jingjing Wang
OBJECTIVE: To investigate the clinical application of rhythmic abdominal lifting and compression cardiopulmonary resuscitation (ALC-CPR) in cardiac arrest (CA) patients with conventional cardiopulmonary resuscitation (CPR) contraindication (chest rib fracture, chest trauma, etc.). METHODS: The clinical data of patients with CA in emergency department of Hefei Second People's Hospital from June 2015 to December 2016 were analyzed retrospectively, and the patients with weights 40-150 kg and CA≤20 minutes, and resuscitated with ALC-CPR were selected...
August 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28793374/pain-assessment-by-emergency-nurses-at-triage-in-the-emergency-department-a-qualitative-study
#15
Marilène Vuille, Maryline Foerster, Eliane Foucault, Olivier Hugli
AIM: To investigate the assessment of pain intensity in the specific context of triage. BACKGROUND: Acute pain affects most patients admitted in emergency departments (ED) but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28793365/saving-lives-with-caring-assessments-how-tanzanian-nurse-midwives-and-obstetricians-negotiate-postpartum-practices
#16
Thecla W Kohi, Megan Aston, Lilian T Mselle, Danielle Macdonald, Columba Mbekenga, Gail Tomblin Murphy, Maureen White, Shawna OHearn, Sheri Price, Keisha Jefferies
INTRODUCTION: The Tanzanian Government has prioritized maternal and child health as an urgent health care issue. Nurse-midwives and obstetricians are the two main providers of care throughout the prenatal and postpartum periods. THE AIMS AND OBJECTIVES: The aim was to explore the nurse-midwives and obstetricians experiences delivering postpartum care assessments and how it was constructed through personal, social and institutional discourses. DESIGN: A qualitative design guided by a feminist poststructuralist methodology...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28791144/machine-learning-landscapes-and-predictions-for-patient-outcomes
#17
Ritankar Das, David J Wales
The theory and computational tools developed to interpret and explore energy landscapes in molecular science are applied to the landscapes defined by local minima for neural networks. These machine learning landscapes correspond to fits of training data, where the inputs are vital signs and laboratory measurements for a database of patients, and the objective is to predict a clinical outcome. In this contribution, we test the predictions obtained by fitting to single measurements, and then to combinations of between 2 and 10 different patient medical data items...
July 2017: Royal Society Open Science
https://www.readbyqxmd.com/read/28790291/-management-of-fluid-and-nutrition-after-lung-resection-to-prevent-complications
#18
Yukio Sato
It is necessary to understand the biological response and characteristic points for the appropriate management in the fluid and nutrition after lung resection. The characteristic points in the management of lung resection are the decrease of pulmonary vascular bed and the existence of bronchial stump. Due to the decrease of pulmonary vascular bed, the pressures of pulmonary artery and pulmonary microvasculature tend to rise, which could cause pulmonary edema. Therefore, the amount of fluid infusion should be less compared to ordinal management in the management after lung resection, especially pneumonectomy...
July 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28789825/the-effect-of-the-quality-of-vital-sign-recording-on-clinical-decision-making-in-a-regional-acute-care-trauma-ward
#19
Claire M Keene, Victor Y Kong, Damian L Clarke, Petra Brysiewicz
PURPOSE: Recording vital signs is important in the hospital setting and the quality of this documentation influences clinical decision making. The Modified Early Warning Score (MEWS) uses vital signs to categorise the severity of a patient's physiological derangement and illustrates the clinical impact of vital signs in detecting patient deterioration and making management decisions. This descriptive study measured the quality of vital sign recordings in an acute care trauma setting, and used the MEWS to determine the impact the documentation quality had on the detection of physiological derangements and thus, clinical decision making...
July 5, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28789642/uremic-encephalopathy-with-isolated-brainstem-involvement-revealed-by-magnetic-resonance-image-a-case-report
#20
Li-Jing Jia, Zhen-Zhen Qu, Xue-Qian Zhang, Yu-Juan Tian, Ying Wang
BACKGROUND: Uremic Encephalopathy (UE) is a neurological complication associated with acute or chronic renal failure. Imaging findings of UE may present involvement of the basal ganglia, cortical or subcortical regions, and white matter. We report a rare case of UE caused by neurogenic bladder with isolated brainstem involvement revealed by magnetic resonance imaging (MRI). Immediate therapy resulted in full recovery of neurological signs and changes on MRI. CASE PRESENTATION: A 14-year-old Han Chinese woman with a history of chronic renal failure caused by neurogenic bladder...
August 8, 2017: BMC Neurology
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