scholarly journals Biphasic Anaphylaxis: A Review of the Incidence, Characteristics and Predictors

2010 ◽  
Vol 3 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Anne K. Ellis
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health Care Professional ◽  
Predictive Factors ◽  
Lower Risk ◽  
Risk Group ◽  
Second Phase ◽  
Quarter Century ◽  
True Incidence ◽  
Life Threatening

While it has been recognized for over a quarter century that anaphylactic reactions have the potential to follow a biphasic course, reports on the incidence of biphasic anaphylaxis are conflicting, and the search for reliable predictive factors of such responses has been challenging. Further adding to the complexity of this clinical entity are the widely variable durations of the asymptomatic window, and the similarly variable reports on second phase severity. This review aims to provide the health care professional with a better understanding of the true incidence, nature, and risk factors for this type of reactivity by consolidating and summarizing the available literature on the topic of biphasic anaphylaxis. As our body of evidence builds, patterns are emerging to suggest that those patients with an initial presentation requiring more than one dose of epinephrine, those who have life-threatening initial presenting features, and those who otherwise take longer to stabilize, are in this higher risk group, and would be more likely to benefit from prolonged in hospital observation. Conversely, patients who respond rapidly to the immediate administration of epinephrine may be at lower risk, but this finding requires confirmation by others. Further prospective evaluations of biphasic anaphylaxis will greatly aid our understanding of this condition.

scholarly journals Bacterial purulent meningitis in children: is there a light at the end of the tunnel?

2021 ◽  
Vol 20 (4) ◽  
pp. 28-34
Author(s):  
A. A. Vilnits ◽  
N. V. Skripchenko ◽  
E. Yu. Gorelik ◽  
A. V. Astapova ◽  
K. V. Markova ◽  
...  
Keyword(s):  
Health Care ◽  
Literature Review ◽  
High Mortality ◽  
Risk Group ◽  
Morbidity And Mortality ◽  
Strict Adherence ◽  
Purulent Meningitis ◽  
Life Threatening ◽  
Heavy Burden ◽  
Meningitis In Children

Bacterial purulent meningitis is a life-threatening disease characterized by high mortality and severe consequences in survivors. Despite the modern possibilities of medicine, the disease continues to be a heavy burden on health care, the economy and society everywhere.Aim. To draw the attention of doctors to the problems associated with modern features of epidemiology, the consequences and possibilities of preventing bacterial purulent meningitis, especially in children, who constitute the main risk group for the development of this pathology.Literature review of Russian and foreign publications on the problem under consideration presented.Vaccination is recognized as one of the main tools for reducing morbidity and mortality from meningitis. Prophylactic vaccinations against N. meningitidis, Str.pneumoniae, H. influenzae, along with strict adherence to anti-epidemic measures in hospitals providing care to newborns, can help reduce the incidence of purulent meningitis in children and improve outcomes if they develop.

scholarly journals Osteoporosis

2004 ◽  
Vol 2 (3) ◽  
pp. 5-11
Author(s):  
M. Allison Ford ◽  
Martha A. Bass
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Bone Loss ◽  
Health Care Professional ◽  
Home Health Care ◽  
Weight Bearing ◽  
Measurement Techniques ◽  
Home Health ◽  
Health Issue ◽  
Bone Measurement

Osteoporosis is a serious health issue causing premature disability to millions of Americans. Costs associated with this disease exceed 13.8 billion dollars per year. Women have a greater risk for osteoporosis than men. However, men are also susceptible to bone loss and osteoporosis. Osteoporosis education for the health care professional is warranted. Understanding risk factors and utilizing bone measurement techniques will result in earlier detection of osteoporosis. Adequate calcium intakes and weight bearing exercise is essential in prevention and maintenance of osteoporosis. This article discusses osteoporosis as a home health care issue.

scholarly journals Risk Factors of Aggressive Clinical Presentation in Patients with Angiographically Aggressive Cranial Dural Arteriovenous Fistulas

2021 ◽  
Vol 10 (24) ◽  
pp. 5835
Author(s):  
Hung-Yu Wen ◽  
Hsien-Chung Chen ◽  
Shun-Tai Yang
Keyword(s):  
Risk Factors ◽  
Lower Risk ◽  
Clinical Presentation ◽  
Risk Group ◽  
Univariate Analysis ◽  
Venous Drainage ◽  
Arteriovenous Fistulas ◽  
Clinical Presentations ◽  
Significant Difference ◽  
Potential Risk Factors

Compared to nonaggressive cranial dural arteriovenous fistulae (cDAVF), aggressive cDAVF carries leptomeningeal venous drainage (LVD) and has approximately 15% annual risk of hemorrhagic and non-hemorrhagic aggressive neurological presentations. In terms of aggressive clinical presentations, the previous classification does not adequately differentiate the higher risk group from the lower risk group. Herein, we retrospectively collected a series of patients with aggressive cDAVF and explored the risk factors for differentiating the higher-risk group from the lower-risk group with aggressive clinical presentations. We retrospectively collected patients with aggressive cDAVF from March 2011 to March 2019. The risk of aggressive clinical presentation was recorded. Risk factors were included in the analysis for aggressive clinical presentations. From March 2011 to March 2019, 37 patients had aggressive cDAVF. Among them, 24 presented with aggressive clinical presentation (20, hemorrhagic presentation; four, non-hemorrhagic presentation). In patients presenting with hemorrhage, four patients experienced early rebleeding after diagnosis. In the univariate analysis, risk location, directness of LVD, exclusiveness of LVD, and venous strain were significantly different in patients with aggressive clinical presentation. In the multivariate analysis, exclusiveness of LVD and venous strain were observed, with a significant difference between patients with aggressive clinical presentation and those with benign clinical presentation. Among patients with angiographically aggressive cDAVFs, approximately 65% presented with aggressive clinical presentations in our series. Among all potential risk factors, patients with exclusiveness of LVD and venous strain have even higher risk and should be treated aggressively and urgently.

Incidence and Predictive Factors of Symptomatic Thrombosis Related to Peripherally Inserted Central Catheters In Chemotherapy Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4206-4206
Author(s):  
Andrew Aw ◽  
Joshua Koczerginski ◽  
Sheryl McDiarmid ◽  
Marc Carrier ◽  
Jason Tay
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Predictive Factors ◽  
Metastatic Cancer ◽  
Univariate Analysis ◽  
Significant Risk ◽  
True Incidence ◽  
Number Of Patients ◽  
Chemotherapy Patients ◽  
Catheter Related Thrombosis

Abstract Abstract 4206 Background: The use of peripherally inserted central catheter (PICC) lines has significantly enhanced the management of chemotherapy patients. While deep vein thrombosis (DVT) of a catheterized vein is a common and potentially serious complication, such thromboses are frequently asymptomatic. Indeed, the true incidence of symptomatic catheter-related DVT in cancer patients remains unclear, and there is a lack of reliable data on the risk factors of catheter-related thrombosis. Moreover, little work has focused on predictive factors of symptomatic events related specifically to PICC lines in chemotherapy patients. Methods: We performed a retrospective cohort study of consecutive cancer patients who received an ultrasound guided PICC line for the administration of chemotherapy at The Ottawa Hospital between September 1, 2009 and December 31, 2009. Relevant demographic, clinical and laboratory characteristics were collected, including factors previously suggested as being predictive of catheter-related DVT. Univariate and multivariate logistic regression analyses were performed for symptomatic PICC-related DVT, defined as a clot in one or more of the deep veins of the catheterized arm leading to and confirmed by Doppler ultrasound. Results: In total, 340 cancer patients obtained PICC lines for the administration of chemotherapy. Of these patients, 19 (5.6%; 95% CI: 3.6–8.6) developed symptomatic PICC-related DVT. In the univariate analysis, demographic factors were not significant predictors of PICC-related DVT, including gender, age, body mass index and smoking status. Interestingly, factors previously suggested as being associated with central venous catheter-related clots in prior studies were not significant determinants in our analysis; in particular, side of line placement (p=0.281), catheter tip location (p=0.539), number of lumens (p=0.911), number of insertion attempts (p=0.964), and catheter repositioning (p=0.731) were not predictive. Importantly, patients with diabetes were three times more likely to develop PICC-related DVT (OR 3.0, p=0.039), while the presence of chronic obstructive pulmonary disease (COPD) or metastatic cancer increased the odds of developing PICC-related DVT (OR 3.3, p=0.078; OR 2.3, p=0.083 respectively). Diabetes remained a significant risk factor after adjustment for effect of metastases and COPD (OR 3.175, p=0.039). Further, the presence of metastases was a significant predictor (OR 3.34, p=0.024) in our multivariate model. Conclusion: Symptomatic PICC-related DVT are frequent in cancer patients receiving chemotherapy. Previously described factors associated with catheter-related thrombosis, such as tip location, lumen size, and side of catheter, were not predictive of PICC-related DVT in our study. In addition, known risk factors for DVT, including gender and obesity, were not predictive, which may suggest an alternate pathophysiologic process in this particular population. Diabetes, advanced disease and COPD appear to increase the risk of developing PICC-related DVT in chemotherapy patients, although the biologic mechanism of this result is not clear. To our knowledge, this is the largest study to date to exclusively examine PICC-associated DVT in cancer patients. Further studies with larger number of patients are required to better characterize risk factors and their relative impact in developing PICC-related DVT. Disclosures: Tay: Ortho-Biotech: Honoraria; Pfizer: Honoraria.

Trends and current questions of cardiovascular prevention in primary health care

2012 ◽  
Vol 153 (39) ◽  
pp. 1536-1546 ◽  
Author(s):  
István Ilyés ◽  
Zoltán Jancsó ◽  
Attila Simay
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Risk Group ◽  
Cardiovascular Prevention ◽  
Continuous Care ◽  
Primary Health

Although an impressive progress has been achieved in the treatment of cardiovascular diseases, they are at the top of the mortality statistics in Hungary. Prevention of these diseases is an essential task of the primary health care. Cardiovascular prevention is carried out at primary, secondary and tertiary levels using risk group and population preventive strategies. The two main tasks of primary cardiovascular prevention are health promotion and cardiovascular disease prevention, and its main programs are ensuring healthy nutrition, improving physical training and accomplishing an anti-smoking program. The essential form of secondary prevention is the screening activity of the primary health care. The majority of cardiovascular risk factors can be discovered during the doctor–patient consultation, but laboratory screening is needed for assessing metabolic risks. The official screening rules of the cardiovascular risk factors and diseases are based on diagnostic criteria of the metabolic syndrome; however, nowadays revealing of global cardiometabolic risks is also necessary. In patients without cardiovascular diseases but with risk factors, a cardiovascular risk estimation has to be performed. In primary care, there is a possibility for long term follow-up and continuous care of patients with chronic diseases, which is the main form of the tertiary prevention. In patients with cardiovascular diseases, ranking to cardiovascular risk groups is a very important task since target values of continuous care depend on which risk group they belong to. The methods used during continuous care are lifestyle therapy, specific pharmacotherapy and organ protection with drugs. Combined health education and counselling is the next element of the primary health care prevention; it is a tool that helps primary, secondary and tertiary prevention. Changes needed for improving cardiovascular prevention in primary care are the following: appropriate evaluation of primary prevention, health education and counselling, renewal of the cardiovascular screening system based on the notion of global cardiometabolic risk, creating a unified cardiovascular prevention guideline, and operating primary care cardiovascular prevention within the framework of an integrated prevention system. Orv. Hetil., 2012, 153, 1536–1546.

The Preschool Stuttering Screen for Health Care Professionals

2011 ◽  
Vol 21 (2) ◽  
pp. 59-62
Author(s):  
Joseph Donaher ◽  
Christina Deery ◽  
Sarah Vogel
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Differential Diagnosis ◽  
Preschool Children ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Evidence Based ◽  
Developmental Profile

Healthcare professionals require a thorough understanding of stuttering since they frequently play an important role in the identification and differential diagnosis of stuttering for preschool children. This paper introduces The Preschool Stuttering Screen for Healthcare Professionals (PSSHP) which highlights risk factors identified in the literature as being associated with persistent stuttering. By integrating the results of the checklist with a child’s developmental profile, healthcare professionals can make better-informed, evidence-based decisions for their patients.

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