Accidental adrenaline auto-injector-induced digital ischaemia: a proposed treatment algorithm

2021 ◽  
Vol 14 (4) ◽  
pp. e237016
Author(s):  
Elizabeth Rajiah ◽  
Andrew R McKean ◽  
Charles Bain
Keyword(s):  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Hand Surgery ◽  
Adverse Outcomes ◽  
Volar Aspect ◽  
Digital Necrosis ◽  
The Uk ◽  
Digital Ischaemia ◽  
Digital Block

Increased numbers of adrenaline auto-injectors (AAIs) are in circulation in the UK. The rate of accidental auto-injection injuries has increased during this time. Various treatment strategies are described in the literature. We present the case of a 32-year-old, right-hand-dominant man who sustained an unintentional AAI injury to the volar aspect of his right thumb. On presentation to the emergency department, the thumb was ischaemic. There was no improvement with simple conservative measures (warm soaks). The patient was referred to our tertiary hand surgery service and a digital block using 2% lidocaine promoted reversal of ischaemia within 2 hours with no long-term sequelae. Phentolamine rescue, on standby, was not necessary in this case. In this case report, we highlight the therapeutic challenges associated with managing AAI injury and propose an evidence-based treatment algorithm to prevent risk of severe adverse outcomes such as digital necrosis.

scholarly journals Pathological gambling: an overview of assessment and treatment

2005 ◽  
Vol 11 (6) ◽  
pp. 450-456 ◽  
Author(s):  
Sanju George ◽  
Vijaya Murali
Keyword(s):  
Pathological Gambling ◽  
Psychiatric Comorbidity ◽  
Treatment Strategies ◽  
Appropriate Treatment ◽  
Assessment And Treatment ◽  
Scant Attention ◽  
Assessment Techniques ◽  
The Individual ◽  
The Uk

Pathological gambling has so far received scant attention in the psychiatric literature. It has a prevalence rate of about 1% in most countries, and with the deregulation of gambling in the UK the prevalence is set to rise here. Pathological gambling can adversely affect the individual, family and society, and also carries high rates of psychiatric comorbidity. Early identification and appropriate treatment can limit the long-term adverse consequences and improve outcome. This article reviews assessment techniques and tools, and treatment strategies for pathological gambling.

scholarly journals Acute blue finger syndrome: a rare benign cause of acute digit discolouration

2019 ◽  
Vol 12 (1) ◽  
pp. e223365
Author(s):  
Kiran Dhaliwal ◽  
Colin Thomas Brewster ◽  
Sivarajasingham Pakeerathan
Keyword(s):  
Rapid Assessment ◽  
Middle Finger ◽  
X Rays ◽  
Benign Condition ◽  
Volar Aspect ◽  
History Of ◽  
The Right ◽  
Digital Ischaemia ◽  
First Time

Acute blue finger syndrome is a rare benign condition that mimics digital ischaemia. We discuss the case of a 32-year-old woman who presented with a 6hour history of blue discolouration of the middle finger of the right hand, associated with pain and swelling. There was no history of trauma and this was the first time that the patient had experienced these symptoms. Examination found blue discolouration of the digit primarily on the volar aspect with associated swelling. All investigations, including blood tests, X-rays and Doppler scanning, were normal. The symptoms resolved spontaneously within 48 hours. There were no recurrent episodes or long-term sequelae. Patients presenting with an acutely blue finger need rapid assessment to exclude digit ischaemia. Knowledge of this rare benign condition may prevent unnecessary distress, invasive investigations and potentially harmful treatment of a healthy patient.

scholarly journals Hyperglycemia and Acute Coronary Syndrome

2008 ◽  
Vol 109 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Prakash Deedwania ◽  
Mikhail Kosiborod ◽  
Eugene Barrett ◽  
Antonio Ceriello ◽  
William Isley ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Current State ◽  
Elevated Glucose ◽  
Coronary Syndromes ◽  
Short And Long Term ◽  
Poor Outcomes

Hyperglycemia is common and associated with markedly increased mortality rates in patients hospitalized with acute coronary syndromes (ACS). Despite the fact that several studies have documented this association, hyperglycemia remains underappreciated as a risk factor, and it is frequently untreated in ACS patients. This is in large part due to limitations of prior studies, and the remaining critical gaps in our understanding of the relationship between hyperglycemia and poor outcomes. The main objective of the present statement is to summarize the current state of knowledge regarding the association between elevated glucose and patient outcomes in ACS and to outline the most important knowledge gaps in this field. These gaps include the need to specifically define hyperglycemia, develop optimal ways of measuring and tracking glucose values during ACS hospitalization, and better understand the physiological mechanisms responsible for poor outcomes associated with hyperglycemia. The most important issue, however, is whether elevated glucose is a direct mediator of adverse outcomes in ACS patients or just a marker of greater disease severity. Given the marked increase in short- and long-term mortality associated with hyperglycemia, there is an urgent need for definitive large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes and to define specific glucose treatment targets. Although firm guidelines will need to await completion of these clinical trials, the present statement also provides consensus recommendations for hyperglycemia management in patients with ACS on the basis of the available data.

scholarly journals The First Registry: Follow-up in Rivaroxaban Patients in the Setting of Venous Thromboembolism

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4737-4737
Author(s):  
Kathryn Jane Lang ◽  
Vicente Solis ◽  
Jignesh Patel ◽  
Julia Czuprynska ◽  
Lara N Roberts ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
Treatment Algorithm ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Adverse Outcomes ◽  
Long Term Outcomes ◽  
The Impact

Abstract The direct oral anticoagulants (DOACs) are revolutionising the management of acute venous thromboembolism (VTE). Although favourable short term outcomes have been demonstrated with these agents, there is a growing need to improve our understanding of biological and clinical predictors of longer-term outcomes with all DOACs. In addition to reducing the need for dual anticoagulant coverage, the use of oral rivaroxaban, has accelerated the implementation of outpatient and early discharge treatment protocols for VTE, in particular for pulmonary embolism (PE). Although clinical trials provide evidence of efficacy and safety, there is a need for ongoing assessment of outcomes in unselected populations treated in routine 'real-world' clinical practice. As for most drugs, conditions requiring special attention include advanced age, impaired renal or liver function, extremes of body weight, presence of multiple co-morbidities, and the need for concomitant therapies. Such conditions commonly co-exist, particularly in elderly patients. In clinical practice patients aged 80 years or older and requiring anticoagulation are becoming increasingly common. In addition, trials do not report long-term adverse outcomes after VTE; aside from bleeding, currently there are no long-term data that assess the impact of the DOACs as part of a single-drug treatment algorithm on long-term recurrence. The FIRST registry will assess long-term outcomes of patients with acute VTE treated with rivaroxaban from diagnosis - our hypothesis is that the long-term outcomes for such patients will be favourable due to consistent anticoagulation intensity, particularly during the acute phase of thrombosis. There are currently no data describing post-thrombotic syndrome (PTS) or chronic thromboembolic pulmonary hypertension (CTEPH) incidence rates in patients treated with DOACs. Patients enrolled onto the FIRST registry will be followed up for five years with primary end-points defined as incidence of long-term sequelae (PTS and CTEPH, defined clinically) and secondary endpoints including recurrence, bleeding and anticoagulation related satisfaction and adherence scores. Analysis of these data may also contribute to improved risk stratification strategies to identify patients who have the greatest risk of adverse bleeding events, recurrence and long-term VTE-related morbidity. Recruitment is currently underway at 20 UK hospitals, with a target of 1500 patients, to be achieved by summer 2017. Disclosures No relevant conflicts of interest to declare.

Multidisciplinary Evidence to Treat Bilingual Individuals with Aphasia

2008 ◽  
Vol 15 (3) ◽  
pp. 66-72 ◽  
Author(s):  
José G. Centeno
Keyword(s):  
Stroke Rehabilitation ◽  
Culturally Diverse ◽  
Treatment Strategies ◽  
The United States ◽  
Intervention Strategies ◽  
Steady Increase ◽  
Clinical Procedures ◽  
Bilingual Speakers ◽  
Aphasic Clients

Abstract The steady increase in linguistic and cultural diversity in the country, including the number of bilingual speakers, has been predicted to continue. Minorities are expected to be the majority by 2042. Strokes, the third leading cause of death and the leading cause of long-term disability in the U.S., are quite prevalent in racial and ethnic minorities, so population estimates underscore the imperative need to develop valid clinical procedures to serve the predicted increase in linguistically and culturally diverse bilingual adults with aphasia in post-stroke rehabilitation. Bilingualism is a complex phenomenon that interconnects culture, cognition, and language; thus, as aphasia is a social phenomenon, treatment of bilingual aphasic persons would benefit from conceptual frameworks that exploit the culture-cognition-language interaction in ways that maximize both linguistic and communicative improvement leading to social re-adaptation. This paper discusses a multidisciplinary evidence-based approach to develop ecologically-valid treatment strategies for bilingual aphasic individuals. Content aims to spark practitioners' interest to explore conceptually broad intervention strategies beyond strictly linguistic domains that would facilitate linguistic gains, communicative interactions, and social functioning. This paper largely emphasizes Spanish-English individuals in the United States. Practitioners, however, are advised to adapt the proposed principles to the unique backgrounds of other bilingual aphasic clients.

Using the Change4Life Disney Branded 10-minute Shake Ups During the COVID-19 ‘Lockdown’

2020 ◽  
Author(s):  
Emily Budzynski-Seymour ◽  
James Steele ◽  
Michelle Jones
Keyword(s):  
Perceived Exertion ◽  
Affective Responses ◽  
Online Resources ◽  
Future Research ◽  
Affective States ◽  
Perceived Effort ◽  
Qualitative Feedback ◽  
Bidirectional Relationship ◽  
The Uk

Physical activity (PA) is considered essential to overall health yet it is consistently reported that children are failing to meet the recommended levels. Due to the bidirectional relationship between affective states and PA, affective responses are a potential predictor to long term engagement. Since late March 2020 the UK government enforced ‘lockdown’ measures to help control the spread of Coronavirus (COVID-19); however, this has impacted children’s PA. Using online resources at home to support PA is now common. The primary aim of this research was to investigate the use of the Change4Life 10-minute Shake Ups to support PA by examining the effects of Disney branding upon children’s (n=32) post activity affective responses and perceived exertion. The secondary was to investigate the effect of the lockdown on PA habits. Children had similar positive affective responses and perceived effort to activities; however, branding was considered to be a key contributing factor based upon qualitative feedback from parents. Children’s PA levels dropped slightly since ‘lockdown’ was imposed; though online resources have been utilised to support PA. The use of immersive elements such as characters and narrative in PA sessions, as well as utilising online resources during ‘lockdown’ appear potentially promising for future research.

NF-κB as a Key Mediator of Brain Inflammation in Alzheimer’s Disease

2019 ◽  
Vol 18 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Chul Ju Hwang ◽  
Dong-Young Choi ◽  
Mi Hee Park ◽  
Jin Tae Hong
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Treatment Strategies ◽  
Close Correlation ◽  
Specific Protein ◽  
Brain Inflammation ◽  
Cytokines And Chemokines ◽  
Inflammatory Drugs ◽  
Peptide Fibrils

Alzheimer’s disease is the most common form of dementia. It is characterized by betaamyloid peptide fibrils which are extracellular deposition of a specific protein, accompanied by extensive neuroinflammation. Various studies show the presence of a number of inflammation markers in the AD brain: elevated inflammatory cytokines and chemokines, and an accumulation of activated microglia in the damaged regions. NF-κB is a family of redox sensitive transcriptional factors, and it is known that NF-κB has binding sites in the promoter region of the genes involved in amyloidogenesis and inflammation. Long-term use of non-steroidal anti-inflammatory drugs prevents progression of AD and delays its onset, suggesting that there is a close correlation between NF-κB and AD pathogenesis. This study aims to (1) assess the association between NF-κB activity and AD through discussion of a variety of experimental and clinical studies on AD and (2) review treatment strategies designed to treat or prevent AD with NF-κB inhibitors.

GA: Armani’s Giorgio Armani

2018 ◽  
Author(s):  
Paul Brooker ◽  
Margaret Hayward
Keyword(s):  
Final Section ◽  
The Body ◽  
Body Shop ◽  
The Third ◽  
Haute Couture ◽  
Fashion Designer ◽  
The Body Shop ◽  
The Uk ◽  
Career Woman

The Armani high-fashion example illustrates the importance of adaptive rational methods in his founding and developing of an iconic high-fashion firm. Armani adapted stylistically to fashion’s new times in the 1970–80s by creating a new style catering for the career woman. His stylistic adaptation is compared with that of another famous Italian fashion designer, Versace, who instead modernized haute couture fashion and created a succession of glamourous styles. Both leaders exploited the same opportunity but in different ways. The third section compares these leaders’ legacies in the 1990s–2000s and assesses from a long-term perspective how capably they had used adaptive rational methods. The final section shifts the focus from fashion to the cosmetics industry and from Italy to the UK. Anita Roddick used adaptive rational methods to establish The Body Shop corporation in the 1970s–80s. However, she then abandoned rational methods with dire results for her corporation in the 1990s.

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