Crying babies

2021 ◽  
Vol 14 (3) ◽  
pp. 185-192
Author(s):  
Harriet Goodhead ◽  
Hannah Wilkinson ◽  
Lily Craver
Keyword(s):  
Differential Diagnoses ◽  
Normal Infant ◽  
Normal Behaviour ◽  
Infant Crying ◽  
Life Threatening ◽  
Management Approaches

‘My baby won’t stop crying doctor!’ - This presentation to a GP surgery can make even the more experienced practitioner feel uneasy. The complaint is non-specific with a broad range of differential diagnoses including severe or potentially life-threatening pathologies. Despite this, it is reassuring to know that in most cases, infant crying is not only a benign but also a normal behaviour. This article will discuss how to distinguish normal infant crying from a pathological cause and subsequent management approaches.

Chest Pain

2014 ◽  
Vol 25 (3) ◽  
pp. 279-283
Author(s):  
Joan E. King ◽  
Kathy S. Magdic
Keyword(s):  
Chest Pain ◽  
Treatment Plan ◽  
Tension Pneumothorax ◽  
Differential Diagnoses ◽  
Coronary Syndrome ◽  
Satisfaction Of Search ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Valvular Diseases ◽  
Gastric Reflux

When a patient complains of chest pain, the first priority is to establish whether the situation is life threatening. Life-threatening differential diagnoses that clinicians must consider include acute coronary syndrome, cardiac tamponade, pulmonary embolus, aortic dissection, and tension pneumothorax. Nonthreatening causes of chest pain that should be considered include spontaneous pneumothorax, pleural effusion, pneumonia, valvular diseases, gastric reflux, and costochondritis. The challenge for clinicians is not to be limited by “satisfaction of search” and fail to consider important differential diagnoses. The challenge, however, can be met by developing a systematic method to assess chest pain that will lead to the appropriate diagnosis and appropriate treatment plan.

Near Miss Sudden Infant Death Syndrome Episodes? A Clinical and Electrocardiographic Correlation

PEDIATRICS ◽  
1986 ◽  
Vol 77 (6) ◽  
pp. 811-815 ◽  
Author(s):  
Ehud Krongrad ◽  
Linda O'Neill
Keyword(s):  
High Risk ◽  
Sudden Infant Death ◽  
Near Miss ◽  
Hard Copy ◽  
Sudden Infant ◽  
Normal Infant ◽  
Objective Data ◽  
Life Threatening ◽  
High Risk Populations ◽  
Home Monitor

The study was carried out to validate objectively the relationship between clinical impressions of parents and ECG evidence of life-threatening arrhythmias in infants considered to be at high risk. Twenty infants considered to be at high risk were provided with a hospital grade home monitor with a hard copy-recording capability (n = 12) and/or an ECG telephone transmision system (n = 8). There were 93 alarms considered by the parents as true alarms. All of the ECG tracings recorded during the 93 episodes were normal. Infant stimulation was provided for 11 infants and was not administered during 82 of these alarms. None of the infants died and all are well at 1 year of age. Our data raises questions regarding parental clinical ability to correctly perceive a true near miss episode in most cases and may explain, in part, the lack of consistency noted in previously published physiologic studies of "high risk" populations. Finally, the study raises further questions regarding the use of parental impression alone without supportive objective data as an indication for therapy in the majority of such patients. Research efforts and application of therapeutic measures will benefit greatly by development of objective data to support and supplement parental clinical observations.

The management of unexplained collapse in service age personnel

2015 ◽  
Vol 101 (2) ◽  
pp. 160-166
Author(s):  
AS Martin ◽  
IA Edgar ◽  
J Walker
Keyword(s):  
Differential Diagnosis ◽  
Differential Diagnoses ◽  
Medical Practitioners ◽  
Diagnosis And Management ◽  
Common Presentation ◽  
Methodical Approach ◽  
Wide Range ◽  
Life Threatening ◽  
The Military ◽  
The Impact

AbstractUnexplained collapse is a common presentation to medical practitioners, with a wide range of differential diagnoses making assessment problematic. Without a methodical approach to the patient presenting with unexplained collapse, potentially life-threatening conditions may not be recognised, whilst benign presentations can be over-investigated. This article will review the assessment, differential diagnosis and management of unexplained collapse, whilst considering the impact in the military environment.

Gastrointestinal Bleeding in Congenital Bleeding Disorders

2022 ◽  
Author(s):  
Amir Samii ◽  
Mahshaad Norouzi ◽  
Abbas Ahmadi ◽  
Akbar Dorgalaleh
Keyword(s):  
Gastrointestinal Bleeding ◽  
Management Strategies ◽  
Coagulation Factor ◽  
Bleeding Disorders ◽  
Individual Factor ◽  
Threatening Condition ◽  
Potential Risk Factors ◽  
Risk Patients ◽  
Life Threatening ◽  
Management Approaches

AbstractGastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.

Epistaxis After Orthognathic Surgery: Literature Review and Three Case Studies

2021 ◽  
pp. 194338752110080
Author(s):  
Alisa Girard ◽  
Christopher D. Lopez ◽  
Jonlin Chen ◽  
David Perrault ◽  
Nikhil Desai ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Studies ◽  
Orthognathic Surgery ◽  
Imaging Modality ◽  
Postoperative Bleeding ◽  
Treatment Algorithm ◽  
Management Algorithm ◽  
Life Threatening ◽  
Flow Through ◽  
Management Approaches

Study Design: This is a literature review with 3 case studies. Objective: Intraoperative and postoperative bleeding are the most common complications of orthognathic surgery and have the potential to become life-threatening. The rarity of severe postoperative epistaxis has resulted in limited characterization of these cases in the literature. The purpose of this study is to 1) differentiate various presentations of epistaxis following orthognathic surgery in the literature, 2) identify management approaches, and 3) to synthesize a treatment algorithm to guide future management of postoperative epistaxis. Methods: A literature search of PubMed was conducted and 28 cases from 17 studies were assessed. Results: Bleeding within the first week may indicate isolated epistaxis, often resolved with local tamponade. Half of cases were attributed to pseudoaneurysm rupture (n = 14), with epistaxis onset ranging from postoperative day 6 to week 9. Angiography was used in most cases (n = 17), often as the primary imaging modality (n = 11). Nasal endoscopy is a less invasive and effective alternative to angiography with embolization. Proximal vessel ligation was used in 3 cases but is not preferred because collaterals may reconstitute flow through the defect and cause rebleeding. Repeat maxillary down-fracture with surgical exploration was described in 4 cases. Conclusions: As outlined in our management algorithm, nasal packing and tamponade should be followed by either local electrocautery or vascular imaging. Angiography with embolization is the preferred approach to diagnosis and management, whereas surgical intervention is reserved for cases of embolization failure or unavailability.

The variability in how physicians think: a casebased diagnostic simulation exercise

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Ashwin Gupta ◽  
Martha Quinn ◽  
Sanjay Saint ◽  
Richard Lewis ◽  
Karen E. Fowler ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Hospital Medicine ◽  
Final Diagnosis ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Academic Medical ◽  
Interview Format ◽  
Life Threatening ◽  
Diagnostic Simulation ◽  
Diagnostic Thinking

AbstractObjectivesLittle is known about how physician diagnostic thinking unfolds over time when evaluating patients. We designed a case-based simulation to understand how physicians reason, create differential diagnoses, and employ strategies to achieve a correct diagnosis.MethodsBetween June 2017 and August 2018, hospital medicine physicians at two academic medical centers were presented a standardized case of a patient presenting with chest pain who was ultimately diagnosed with herpes zoster using an interview format. Case information was presented in predetermined aliquots where participants were then asked to think-aloud, describing their thoughts and differential diagnoses given the data available. At the conclusion of the interview, participants were asked questions about their diagnostic process. Interviews were recorded, transcribed, and content analysis was conducted to identify key themes related to the diagnostic thinking process.ResultsSixteen hospital medicine physicians (nine men, seven women) participated in interviews and four obtained the correct final diagnosis (one man, three women). Participants had an average of nine years of experience. Overall, substantial heterogeneity in both the differential diagnoses and clinical reasoning among participants was observed. Those achieving the correct diagnosis utilized systems-based or anatomic approaches when forming their initial differential diagnoses, rather than focusing on life-threatening diagnoses alone. Evidence of cognitive bias was common; those with the correct diagnosis more often applied debiasing strategies than those with the incorrect final diagnosis.ConclusionsHeterogeneity in diagnostic evaluation appears to be common and may indicate faulty data processing. Structured approaches and debiasing strategies appear helpful in promoting diagnostic accuracy.

Was tun bei akutem Thoraxschmerz?

2019 ◽  
Vol 144 (17) ◽  
pp. 1223-1228
Author(s):  
Bernhard Haring ◽  
Alexander Schmidt ◽  
Stefan Frantz
Keyword(s):  
Clinical Practice ◽  
Chest Pain ◽  
Physical Examination ◽  
Laboratory Tests ◽  
Acute Chest Pain ◽  
Differential Diagnoses ◽  
Life Threatening ◽  
Cardinal Symptoms

AbstractAcute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.

Effectiveness of Educational Materials Designed to Improve Knowledge Regarding Crying and Shaken Baby Syndrome in Mothers of Hispanic Population

2021 ◽  
pp. 154041532110402
Author(s):  
Randa J Jalloul ◽  
Aida Vigil ◽  
Han-Yang Chen ◽  
Clara Ward
Keyword(s):  
Demographic Data ◽  
Shaken Baby Syndrome ◽  
Abusive Head Trauma ◽  
Health Department ◽  
Normal Infant ◽  
Hispanic Population ◽  
Harris County ◽  
Infant Crying ◽  
Post Test ◽  
Clinic Site

Background: Caregiver frustration with inconsolable crying is a commonly cited antecedent factor of Abusive head trauma (AHT) in infants. Objective: To assess the effectiveness of an educational intervention to improve patients’ knowledge of normal crying patterns in infants and the implications of AHT among women of Hispanic population. Methods: The Period of PURPLE Crying program was piloted as part of Centering Prenatal Care at an outpatient clinic site in the Harris County Health Department system, which cares for a primarily underserved and Spanish speaking population. Educational material and direct counseling were delivered by the clinician. Demographic data was collected and a pre- and post-test survey was administrated to assess participant’s knowledge and behavior. Results: Between April 2017 and April 2018, 63 Hispanic women were included in this study. Prior to implementation of the educational tool, most of the survey questions were answered incorrectly. After the intervention, knowledge regarding normal infant crying patterns was significantly improved in all questions. However, knowledge gaps persisted especially in relation to the adequacy of parents’ ability to soothe a crying infant and normalcy of excessive crying. Conclusions: The educational curriculum was an effective tool for improving knowledge about normal infant crying patterns in Hispanic mothers.

scholarly journals Management of Submassive Bilateral Pulmonary Embolism in an Adolescent Female

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Adeline Yi Ling Lim ◽  
John Roy ◽  
Ajay Kevat
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Decision Making ◽  
Pediatric Population ◽  
Oral Contraceptive Pill ◽  
Clinical Decision ◽  
Adolescent Female ◽  
Rare Presentation ◽  
Systemic Thrombolysis ◽  
Life Threatening ◽  
Management Approaches

Pulmonary embolism (PE) is a rare presentation in the pediatric population. We report a case of submassive PE in an adolescent female following commencement of a combined oral contraceptive pill (COCP). In the setting of cardiac dysfunction, she received systemic thrombolysis with significant reduction of clot burden and clinical improvement objectively demonstrated shortly thereafter. This case highlights challenges in clinical decision-making regarding surgical or catheter-based interventions versus medical management approaches when addressing life-threatening PE in children. Our case demonstrates that submassive PE in pediatrics can be managed successfully with systemic thrombolysis and therapeutic anticoagulation.

Assembly of VP26 in herpes simplex virus-1 capsid implicated by 3-D structure of recombinant capsid

1995 ◽  
Vol 53 ◽  
pp. 840-841
Author(s):  
Z. Hong Zhou ◽  
Jing He ◽  
Joanita Jakana ◽  
J. D. Tatman ◽  
Frazer J. Rixon ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
3D Structure ◽  
Structure Study ◽  
Herpes Simplex Virus 1 ◽  
Shell Proteins ◽  
Life Threatening ◽  
Infected Cells ◽  
Simplex Virus ◽  
Hsv 1

Herpes simplex virus-1 (HSV-1) is a ubiquitous virus which is implicated in diseases ranging from self-curing cold sores to life-threatening infections. The 2500 Å diameter herpes virion is composed of a glycoprotein spike containing, lipid envelope, enclosing a protein layer (the tegument) in which is embedded the capsid (which contains the dsDNA genome). The B-, and A- and C-capsids, representing different morphogenetic stages in HSV-1 infected cells, are composed of 7, and 5 structural proteins respectively. The three capsid types are organized in similar T=16 icosahedral shells with 12 pentons, 150 hexons, and 320 connecting triplexes. Our previous 3D structure study at 26 Å revealed domain features of all these structural components and suggested probable locations for the outer shell proteins, VP5, VP26, VP19c and VP23. VP5 makes up most of both pentons and hexons. VP26 appeared to bind to the VP5 subunit in hexon but not to that in penton.

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