scholarly journals Barosinusitis: Comprehensive Review and Proposed New Classification System

2017 ◽  
Vol 8 (3) ◽  
pp. ar.2017.8.0221 ◽  
Author(s):  
Reza Vaezeafshar ◽  
Alkis J. Psaltis ◽  
Vidya K. Rao ◽  
David Zarabanda ◽  
Zara M. Patel ◽  
...  
Keyword(s):  
Paranasal Sinuses ◽  
Case Reports ◽  
Ambient Pressure ◽  
Management Strategies ◽  
Upper Airway ◽  
Improve Patient Care ◽  
Signs And Symptoms ◽  
Comprehensive Review ◽  
Sinus Barotrauma ◽  
Improve Patient

Background Barosinusitis, or sinus barotrauma, may arise from changes in ambient pressure that are not compensated by force equalization mechanisms within the paranasal sinuses. Barosinusitis is most commonly seen with barometric changes during flight or diving. Understanding and better classifying the pathophysiology, clinical presentation, and management of barosinusitis are essential to improve patient care. Objectives To perform a comprehensive review of the available literature regarding sinus barotrauma. Methods A comprehensive literature search that used the terms “barosinusitis,” “sinus barotrauma,” and “aerosinusitis” was conducted, and all identified titles were reviewed for relevance to the upper airway and paranasal sinuses. All case reports, series, and review articles that were identified from this search were included. Selected cases of sinus barotrauma from our institution were included to illustrate classic signs and symptoms. Results Fifty-one articles were identified as specifically relevant to, or referencing, barosinusitis and were incorporated into this review. The majority of articles focused on barosinusitis in the context of a single specific etiology rather than independent of etiology. From analysis of all the publications combined with clinical experience, we proposed that barosinusitis seemed to fall within three distinct subtypes: (1) acute, isolated barosinusitis; (2) recurrent acute barosinusitis; and (3) chronic barosinusitis. We introduced this terminology and suggested independent treatment recommendations for each subtype. Conclusion Barosinusitis is a common but potentially overlooked condition that is primed by shifts in the ambient pressure within the paranasal sinuses. The pathophysiology of barosinusitis has disparate causes, which likely contribute to its misdiagnosis and under diagnosis. Available literature compelled our proposed modifications to existing classification schemes, which may allow for improved awareness and management strategies for barosinusitis.

Inconsistent approach to the treatment of chronic digoxin toxicity in the United States

2009 ◽  
Vol 28 (5) ◽  
pp. 285-292 ◽  
Author(s):  
BM Kirrane ◽  
RE Olmedo ◽  
LS Nelson ◽  
M. Mercurio-Zappala ◽  
MA Howland ◽  
...  
Keyword(s):  
Admission Rate ◽  
Improve Patient Care ◽  
Digoxin Concentration ◽  
Signs And Symptoms ◽  
The United States ◽  
Digoxin Toxicity ◽  
Emergency Physicians ◽  
Significant Difference ◽  
Evidence Based Guidelines ◽  
Improve Patient

Evidence-based guidelines do not exist for the treatment of patients with chronic mild—moderate digoxin toxicity. We sought to evaluate differences among specialists in the use of digoxin-specific antibody fragments and the decision to admit these patients. A sample of cardiologists, emergency physicians, and medical toxicologists was surveyed. The survey detailed four hypothetical cases of chronic digoxin toxicity created by consensus among authors. All cases had the same digoxin concentration, but signs and symptoms varied in an attempt to explore four different thresholds. For each scenario, clinicians made decisions about admission and treatment. Survey response varied: cardiologists 17%, emergency physicians 6.7%, and toxicologists 39%. Statistically significant difference was found in the administration of Fab among cardiologists (67%), emergency physicians (82%), or toxicologists (91.5%) and admission rate (cardiologists 34%, emergency physicians 28%, and toxicologists 46%). Differences exist among clinicians of various specialties regarding treatment of chronic digoxin toxicity. These differences may reflect diverse perspectives or knowledge gaps and may translate into excess cost or less than ideal care. Exploring these differences may improve patient care, improve interactions among providers, and set the stage for development of consensus guidelines and research.

scholarly journals COVID-19 and Neurosurgery: A Comprehensive Review of Literature

2021 ◽  
Author(s):  
Aysha Albastaki ◽  
Abdulaziz Isa Aljawder
Keyword(s):  
Mental Health ◽  
Nervous System ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Review Of Literature ◽  
Primary Target ◽  
Comprehensive Review ◽  
The World ◽  
Coronavirus Infection ◽  
The Impact

Abstract The 2019 Coronavirus Infection (COVID-19) first appeared in Wuhan, Hubei Province, China, in December 2019 and has disseminated rapidly to almost every region of the world to become a pandemic. COVID-19 is initiated by severe acute respiratory syndrome CoV-2. The principal signs and symptoms are related to the respiratory and cardiovascular systems; however, the nervous system is another primary target of this devastating disease, according to numerous case reports and some reviews that have been published. Moreover, neurosurgical issues have also been dramatically affected. This comprehensive review aims to summarize the impact of COVID-19 on neurosurgical issues. In addition, we aim to serve as a reference for neurosurgeons dealing with neurosurgical cases of the disease. The article emphasized neurological display of COVID-19, neurosurgical practice, contagion control and precautions, residency, and education in neurosurgery, neurosurgeons' mental health. In addition to that, the article also provides some recommendations.

Implementing Practice Management Strategies to Improve Patient Care: The EPIC Project

2012 ◽  
Vol 15 (2) ◽  
pp. 46-51
Author(s):  
David Attwell ◽  
Leslie Rogers-Warnock ◽  
Joanna Nemis-White
Keyword(s):  
Patient Care ◽  
Management Strategies ◽  
Improve Patient Care ◽  
Practice Management ◽  
Improve Patient

scholarly journals Presentation and management of N-acetylglutamate synthase deficiency: a review of the literature

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Aileen Kenneson ◽  
Rani H. Singh
Keyword(s):  
Current Knowledge ◽  
Case Reports ◽  
Management Strategies ◽  
Clinical Signs ◽  
Case Series ◽  
Signs And Symptoms ◽  
Protein Restriction ◽  
Therapeutic Trials ◽  
Acetylglutamate Synthase ◽  
Clinical Signs And Symptoms

Abstract Background N-Acetylglutamate synthase (NAGS) deficiency is an extremely rare autosomal recessive metabolic disorder affecting the urea cycle, leading to episodes of hyperammonemia which can cause significant morbidity and mortality. Since its recognition in 1981, NAGS deficiency has been treated with carbamylglutamate with or without other measures (nutritional, ammonia scavengers, dialytic, etc.). We conducted a systematic literature review of NAGS deficiency to summarize current knowledge around presentation and management. Methods Case reports and case series were identified using the Medline database, as well as references from other articles and a general internet search. Clinical data related to presentation and management were abstracted by two reviewers. Results In total, 98 cases of NAGS deficiency from 79 families, in 48 articles or abstracts were identified. Of these, 1 was diagnosed prenatally, 57 were neonatal cases, 34 were post-neonatal, and 6 did not specify age at presentation or were asymptomatic at diagnosis. Twenty-one cases had relevant family history. We summarize triggers of hyperammonemic episodes, diagnosis, clinical signs and symptoms, and management strategies. DNA testing is the preferred method of diagnosis, although therapeutic trials to assess response of ammonia levels to carbamylglutamate may also be helpful. Management usually consists of treatment with carbamylglutamate, although the reported maintenance dose varied across case reports. Protein restriction was sometimes used in conjunction with carbamylglutamate. Supplementation with citrulline, arginine, and sodium benzoate also were reported. Conclusions Presentation of NAGS deficiency varies by age and symptoms. In addition, both diagnosis and management have evolved over time and vary across clinics. Prompt recognition and appropriate treatment of NAGS deficiency with carbamylglutamate may improve outcomes of affected individuals. Further research is needed to assess the roles of protein restriction and supplements in the treatment of NAGS deficiency, especially during times of illness or lack of access to carbamylglutamate.

Review of Prelabor Rupture of the Membranes: Pathophysiologic Concepts and Novel Therapeutic Strategies

2020 ◽  
Vol 16 ◽  
Author(s):  
Saadia Ghafoor
Keyword(s):  
Management Strategies ◽  
Signs And Symptoms ◽  
Cochrane Library ◽  
Main Body ◽  
Scientific Publications ◽  
Timely Diagnosis ◽  
Narrative Literature Review ◽  
Contemporary Management ◽  
Online Library ◽  
Novel Therapeutic Strategies

Background:: Prelabor rupture of membrane (PROM) refers to the breakage of fetal membranes before the onset of labor, resulting in the leakage of amniotic fluid. PROM affects approximately 3% and 8% of preterm and term pregnancies. Because of associated high maternal and perinatal mortality, correct and timely diagnosis together with effective management is highly recommended to prevent adverse fetal and maternal outcomes. Objective:: To provide an overview of the novel concepts in the understanding of PROM including etiology, pathophysiology, risk factors, complications, assessment, diagnostic modalities, and contemporary management strategies for PROM at preterm and term. Methodology:: This narrative literature review was conducted through a literature search using the Cochrane library and electronic databases including PubMed, Web of Science, Medline, Scopus, Crossref, Google Scholar, Wiley online library, ScienceDirect with specific search terms in scientific publications published from March 1980 to March 2020. Main Body:: Preterm PROM has the potential to cause prenatal morbidity and mortality. It is imperative to monitor the signs and symptoms of an impending infection due to the risk of infectious morbidity with PROM at preterm and preterm. PROM at preterm and term requires prompt diagnosis followed by an appropriate management strategy. Conclusion:: The correct and timely diagnosis of PROM is essential for efficacious management. Furthermore, it can reduce avoidable emergent health care visits and related costs in a clinical setting subjected to pregnancy with suspected PROM. Further studies are needed to fill the gaps in identifying better diagnostic predictive tools in high- risk pregnancies.

Analytical Methods for the Determination of Sartans in Pharmaceutical Formulations and Biological Fluids: A Review

2020 ◽  
Vol 16 (3) ◽  
pp. 208-222
Author(s):  
Miglena Smerikarova ◽  
Stanislav Bozhanov ◽  
Vania Maslarska
Keyword(s):  
Biological Fluids ◽  
Pharmaceutical Preparations ◽  
Improve Patient Care ◽  
Pharmaceutical Formulations ◽  
Treatment Of Hypertension ◽  
Therapeutic Doses ◽  
Reliable Methods ◽  
Improve Patient

Background: Sartans are mostly used as a part of combination with additional medicines in the therapy of essencial hypertension. Preferred combinations are ARB and thiazide diuretics (Hydrochlorothiazide (HCT) and Chlorthalidone (CHL)) or ARB and calcium antagonists. The number of sartans mostly prescribed by specialists is only seven - Candesartan (CDS), Eprosartan (EPS), Irbesartan (IBS), Losartan (LOS), Olmesartan (OMS), Telmisartan (TMS) and Valsartan (VLS). Methods: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. According to our knowledge, a review devoted to the analysis of sartans was published in 2014. Results: Spectral methods are widely used in the analysis of bulk drugs and pharmaceutical dosage forms due to their relatively simple procedures, low reagent and sample consumption, speed, precision and accuracy combined with accessibility and comparatively low cost of common apparatus. Many papers for determination of sartans in bulk drugs and pharmaceutical preparations based on liquid chromatographic techniques were published in the available literature. Among these methods, HPLC takes the leading place but UPLC and HPTLC are also present. Conclusion: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. Since 2014, many articles have been published on the sartans analysis and this provoked our interest to summarize the latest applications in the analysis of sartans in pharmaceutical formulations and biological media. Articles published from 2014 to 2018 are covered.

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.

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