scholarly journals Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dalal Al Hasan ◽  
Ameen Yaseen ◽  
Mohammad Al Roudan ◽  
Lee Wallis
Keyword(s):  
Severe Hypoglycaemia ◽  
Management Strategies ◽  
Severe Hypoglycemia ◽  
Inclusion Criteria ◽  
Initial Management ◽  
Scene Management ◽  
Prehospital Management ◽  
Improve Patient Management ◽  
Current Guidelines ◽  
Improve Patient

Abstract Background The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. Method This was a prospective analysis of severe hypoglycaemia cases retrieved from emergency medical services (EMS) archived data between 1 January and 30 June 2020. The severe hypoglycaemia cases were then sub-grouped based on EMS personal initial management and compared in terms of scene time, transportation rate, complications and outcomes. The primary outcomes were GCS within 10–30 min and normal random blood glucose (RBS) within 10–30 min. Results A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. Intramuscular glucagon was used on scene in 89% of the hypoglycaemic events. Most of the severe hypoglycaemia patients regained normal GCS on scene (76.5%). When we compared the two scene management strategies for severe hypoglycaemia cases, parenteral glucose administration prolonged the on-scene time (P = .002) but was associated with more favourable scene outcomes than intramuscular glucagon, with normal GCS within 10–30 min (P = .05) and normal RBS within 10–30 min (P = .006). Conclusion: Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personals is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. More research should be invested in improving and structuring the prehospital management of severe hypoglycaemia. One goal is to clarify the superiority of parenteral glucose over intramuscular glucagon in the prehospital setting.

scholarly journals A novel 8.7-kb mitochondrial genome deletion accurately detects endometriosis in the plasma of symptomatic women

2020 ◽  
Vol 14 (2) ◽  
pp. 97-107
Author(s):  
Andrew Harbottle ◽  
Andrea Maggrah ◽  
Robert Usher ◽  
Elise Desa ◽  
Jennifer M Creed
Keyword(s):  
Diagnostic Accuracy ◽  
Case Control ◽  
Menstrual Phase ◽  
Pcr Assay ◽  
Potential Biomarker ◽  
Significant Difference ◽  
Mtdna Deletion ◽  
Disease Subtypes ◽  
Improve Patient Management ◽  
Improve Patient

Aim: To evaluate an 8.7-kb mitochondrial DNA (mtDNA) deletion as a potential biomarker of endometriosis. Materials & methods: We tested the diagnostic accuracy of the 8.7-kb deletion real-time PCR assay using 182 prospectively collected blood samples from females presenting with symptoms of endometriosis in a case–control format. Results: The assay differentiated between endometriosis and controls (area under curve: 0.74–0.89) with a statistically significant difference (p < 0.05) in 8.7-kb deletion levels measured for all disease subtypes and stages. No correlation was seen between 8.7-kb deletion levels and participant or specimen age, hormone status or menstrual phase. Conclusion: The diagnostic accuracy of the 8.7-kb deletion for endometriosis suggests potential utility in the clinic to improve patient management.

scholarly journals Anesthesia for Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA)

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Fulya YILMAZ ◽  
Koray BAS
Keyword(s):  
Demographic Data ◽  
Surgical Techniques ◽  
Hemodynamic Parameters ◽  
Safe Anesthesia ◽  
Close Cooperation ◽  
Improve Patient Management ◽  
Conventional Open Surgery ◽  
Vestibular Approach ◽  
Improve Patient ◽  
Endoscopic Parathyroidectomy

Abstract Background After thyroid diseases, hyperparathyroidism is one of the most common endocrine surgical diseases. The increasing diagnosis of thyroid pathologies in early stages and a societal emphasis on physical appearances, especially in young women, have led to the development of new surgical techniques alternative to conventional transcervical incision consistently. Here, we describe our anesthesia experience for parathyroidectomy with Transoral Endoscopic Parathyroidectomy by Vestibular Approach (TOEPVA). Patients who undergo TOEPVA at our institution between November 2018 and April 2019 were reviewed. Demographic data and hemodynamic parameters were reported. Results Seven patients were operated successfully by this technique, none of which required conversion to conventional open surgery. Two patients required atropine and one patient required ephedrine during insufflation. Conclusion After induction of anesthesia with propofol, remifentanil, and rocuronium and anesthesia managed by desflurane co-administered with continuous infusion of remifentanil provide feasible and safe anesthesia for TOEPVA. However, especially during hydrodissection and insufflation, a close cooperation between surgeon and anesthetist has a great value to improve patient management.

scholarly journals Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Retrospective Multicenter Study in the Northern French Alps

2021 ◽  
Vol 10 (7) ◽  
pp. 1359
Author(s):  
Julie Pinczon ◽  
Nicolas Terzi ◽  
Pascal Usseglio-Polatera ◽  
Gaël Gheno ◽  
Dominique Savary ◽  
...  
Keyword(s):  
Noninvasive Ventilation ◽  
Medical Emergency ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Acute Cardiogenic Pulmonary Edema ◽  
Prehospital Management ◽  
Medical Emergency Teams ◽  
Prehospital Diagnosis ◽  
Current Guidelines ◽  
Retrospective Multicenter Study

Noninvasive ventilation (NIV) improves the outcome of acute cardiogenic pulmonary edema (AcPE) and acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) but is not recommended in pneumonia. The aim of this study was to assess the appropriateness of the use of NIV in a prehospital setting, where etiological diagnostics rely mainly on clinical examination. This observational multicenter retrospective study included all the patients treated with NIV by three mobile medical emergency teams in 2015. Prehospital diagnoses and hospital diagnoses were extracted from the medical charts. The appropriateness of NIV was determined by matching the hospital diagnosis to the current guidelines. Among the 14,067 patients screened, 172 (1.2%) were treated with NIV. The more frequent prehospital diagnoses were AcPE (n = 102, 59%), acute respiratory failure of undetermined cause (n = 46, 28%) and aeCOPD (n = 17, 10%). An accurate prehospital diagnosis was more frequent for AcPE (83/88, 94%) than for aeCOPD (14/32, 44%; p < 0.01). Only two of the 25 (8%) pneumonia cases were diagnosed during prehospital management. Prehospital NIV was inappropriate for 32 (21%) patients. Patients with inappropriate NIV had a higher rate of in-hospital intubation than patients with appropriate NIV (38% vs. 8%; p < 0.001). This high frequency of inappropriate NIV could be reduced by an improvement in the prehospital detection of aeCOPD and pneumonia.

Fracture of the maxillary tuberosity: Troubleshooting in general dental practice and a proposed fracture classification

Dental Update ◽  
2021 ◽  
Vol 48 (2) ◽  
pp. 99-104
Author(s):  
Fiona Wright ◽  
Colin Ritchie ◽  
Nicholas J Malden ◽  
Eleni Besi
Keyword(s):  
General Practice ◽  
Patient Outcomes ◽  
Dental Practice ◽  
Fracture Classification ◽  
Initial Management ◽  
Appropriate Treatment ◽  
Maxillary Molar ◽  
Maxillary Tuberosity ◽  
Improve Patient ◽  
Timely Delivery

A tuberosity fracture can prevent or delay the timely delivery of the most appropriate treatment option for a maxillary molar. This is a relatively common complication, but should not prevent treatment in general practice provided the clinician has adequately risk assessed, planned and obtained informed consent. Should a fracture occur, its initial management in general practice is encouraged. This article aims to improve patient outcomes by providing a troubleshooting guide. A fracture classification is suggested to aid assessment, recognition and management. Should referral to secondary care be required, a classification system will provide a basis for discussion and clarity on further management. CPD/Clinical Relevance: This article provides a tuberosity fracture classification to guide clinicians in the management of patients who have sustained such a fracture.

scholarly journals Partizipative Erarbeitung von Bewirtschaftungsszenarien für den Tessiner Kastaniengürtel

2018 ◽  
Vol 169 (1) ◽  
pp. 18-25
Author(s):  
Francesca Cellina ◽  
Luca Pampuri ◽  
Marco Conedera ◽  
Davide Bettelini ◽  
Rudy Genazzi ◽  
...  
Keyword(s):  
Forest Management ◽  
Interest Groups ◽  
Participatory Design ◽  
Management Strategies ◽  
Additional Benefit ◽  
Forest Planning ◽  
Management Scenarios ◽  
Management Schemes ◽  
Near Future ◽  
Current Guidelines

Participatory design of management scenarios for the Ticino chestnut belt Current guidelines for forest management ask for multi-functional management schemes, allowing a balance between different forest functions, such as production, protection, recreation and ecology. This requires adoption of multi-criteria processes for forest planning. In such a framework, involving stakeholders from the very beginning of the process might be an additional benefit: it would allow to identify possible broadly accepted forest management strategies, thus facilitating their implementation. In this paper, we present the methodologies and tools we developed between 2013 and 2016, in a process aimed at designing and assessing management scenarios for the chestnut belt forests in the Canton of Ticino (Switzerland). Structured and transparent comparison among the scenarios allowed around twenty representatives of cantonal offices and interest groups to make rational and informed choices, leading to the identification of two low-conflict, compromise management scenarios to be implemented in the near future.

scholarly journals Necrotizing fasciitis with prior leprosy: a case report

2020 ◽  
Vol 6 (6) ◽  
pp. 788
Author(s):  
Vannia C. Teng ◽  
Prima K. Esti ◽  
Sweety Pribadi
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Limited Resource ◽  
Masking Effect ◽  
Risk Indicator ◽  
Broad Spectrum Antibiotic ◽  
Life Threatening ◽  
Lrinec Score ◽  
Improve Patient Management ◽  
Improve Patient

<p class="abstract">Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with a high misdiagnosis rate. Here, we present the case of NF with hypoesthesia due to prior leprosy in a limited resource area. Laboratory risk indicator for NF (LRINEC) score was used to determine the diagnosis of NF. Resuscitation and broad-spectrum antibiotic were initiated, followed by surgical debridement due to lack of wound improvement and skin graft to cover the wound was done. This case report highlights the usage of LRINEC score to reduce misdiagnosis, ensure early diagnosis, and improve patient management in NF with masking effect.</p>

scholarly journals Initial management strategies for follicular lymphoma

2012 ◽  
Vol 1 (1) ◽  
pp. 35-45 ◽  
Author(s):  
Qiushi Chen ◽  
Turgay Ayer ◽  
Loretta J Nastoupil ◽  
Miray Seward ◽  
Hongzheng Zhang ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Management Strategies ◽  
Initial Management

Surgical Management of Bilateral Vocal Fold Paralysis in Children: A Systematic Review and Meta-analysis

2020 ◽  
pp. 019459982094489
Author(s):  
Ryan Kendall Thorpe ◽  
Sohit Paul Kanotra
Keyword(s):  
Vocal Fold ◽  
Web Of Science ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Vocal Fold Paralysis ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Initial Management ◽  
Bilateral Vocal Fold Paralysis ◽  
Meta Analyses

Objectives To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the outcomes of different GWS procedures in children who underwent initial tracheostomy, and the rate of decannulation in children who underwent tracheostomy alone versus tracheostomy followed by GWS. Data Sources PubMed, Web of Science, Cochrane Library, and Embase were searched following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on September 9, 2019, with no date restriction. Review Methods Articles focusing on GWS or tracheostomy for initial management of BVFP were included. Articles describing patients who received no surgical intervention for BVFP were excluded. Results A total of 5989 articles were reviewed: 67 articles met inclusion criteria, and 240 patients were incorporated into the analysis. Patients who underwent primary GWS had an eventual tracheostomy rate of 6.0% (5/83). There were no statistically significant differences in the rate of tracheostomy, reoperation, or mortality among cricoid split, suture lateralization, and cordectomy/cordotomy. Patients who underwent primary tracheostomy failed to achieve decannulation in 36.9% (58/157) of cases. Decannulation was more likely in tracheostomized children who received GWS than those who did not (odds ratio, 6.336; P < .0001). Conclusions Most children who undergo primary GWS for BVFP avoid tracheostomy or reoperation. These data demonstrated no differences in surgical outcomes among the most common types of GWS for BVFP. For children who receive a tracheostomy as their first intervention for BVFP, GWS is associated with a significantly improved rate of decannulation.

scholarly journals Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Disease Society and the Canadian Thoracic Society

2000 ◽  
Vol 11 (5) ◽  
pp. 237-248 ◽  
Author(s):  
Lionel A Mandell ◽  
Thomas J Marrie ◽  
Ronald F Grossman ◽  
Anthony W Chow ◽  
Robert H Hyland ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Community Acquired Pneumonia ◽  
Evidence Based ◽  
Mixed Infections ◽  
Joint Effort ◽  
Initial Management ◽  
Serious Illness ◽  
The Past ◽  
Nursing Home Patients ◽  
Current Guidelines

Community-acquired pneumonia (CAP) is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in the knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity againstStreptococcus pneumoniaehas been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Diseases Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.

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