scholarly journals Rifampicin Induced Hyperbilirubinemias: A Case Report.

2019 ◽  
pp. 1-4
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Health Care Team ◽  
Low Grade ◽  
Gradual Improvement ◽  
Learning Programs ◽  
History Of ◽  
Chest X Ray ◽  
Hepatitis C Viruses ◽  
Anti Tubercular Therapy

Abstract Anti-tubercular therapy (ATT) induced hepatitis is a major problem which a physician encounters in his clinical practice. A case of 28-year old female, weighing 45 kg was brought to hospital with the chief complains of low-grade fever for the past two months, cough, shortness of breath and 4-5 kg weight loss in two months. She had no history of hypertension (HTN), diabetes mellitus (DM), pulmonary tuberculosis (PTB). Her Chest X-ray showed right sided bilateral pulmonary TB and sputum acid fast bacilli (AFB) smear was repeatedly positive. Pulmonologist has started Category-I anti-tubercular regimen (Rifampicin, Isoniazid, Pyrazinamide and Ethambutol) under DOTS as per RNTCP guidelines. After 7 days of starting the treatment (DOTS regimen), she noticed yellowish discoloration of sclera, orange discoloration of urine but in spite of this she continued the drug for a further two weeks. Patient was found to be developing hepatotoxicity with the findings of elevated total bilirubin (10.2 mg/dl), conjugated bilirubin (2.5 mg/dl) and unconjugated bilirubin (7.2 mg/dl). Viral markers for hepatitis including hepatitis B viruses (HBsAg), hepatitis C viruses (HCV), human immunodeficiency virus (HIV), were all are non-reactive. Pulmonologist made provisional diagnosis of anti-tubercular drugs (specially rifampicin) induced hyperbilirubinemias. Pulmonologist initially hold Rifampicin and Pyrazinamide, but started Isoniazid, Ethambutol, Ofloxacin, Pyridoxine along with liver enzyme. She showed gradual improvement as bilirubin after one-week had dropped down to 1.2 mg/dl. Rifampicin was added to the regimen and the serum bilirubin checked after 1 week was found 1 mg/dl. Pyrazinamide was added after repeated LFTs showed normal values. Patient continued her drugs and came for review after three months. She was advised to continue and complete the course of anti-tubercular drugs. Since Rifampicin is the most important first line anti-tubercular drug it is very important to restart this drug in order to have a satisfactory response to anti-tubercular therapy. We have reported this case because of its rarity in clinical practice. As a health care team member clinical pharmacist are need to be made aware of these potentially fatal adverse effects associated with anti-tubercular therapy via conduction of quality-based seminars, published medical literature, conferences, learning programs and health care camps.

scholarly journals Plain Language Summary: Nosebleed (Epistaxis)

2020 ◽  
Vol 162 (1) ◽  
pp. 26-32
Author(s):  
David E. Tunkel ◽  
Sarah M. Holdsworth ◽  
Jacqueline D. Alikhaani ◽  
Taskin M. Monjur ◽  
Lisa Satterfield
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Medical Advice ◽  
Care Providers ◽  
Plain Language ◽  
Treatment And Prevention ◽  
History Of ◽  
Or History

This plain language summary explains nosebleeds, also known as epistaxis (pronounced ep-ih-stak-sis), to patients. The summary applies to any individual aged 3 years and older with a nosebleed or history of nosebleed who needs medical treatment or wants medical advice. It is based on the 2020 “Clinical Practice Guideline: Nosebleed (Epistaxis).” This guideline uses research to advise doctors and other health care providers on the diagnosis, treatment, and prevention of nosebleeds. The guideline includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to help patients ask questions and make decisions in their own care.

The History of the Neonatal Nurse Practitioner: Reflections from “Under the Looking Glass”

2002 ◽  
Vol 21 (5) ◽  
pp. 51-60 ◽  
Author(s):  
Patricia Johnson
Keyword(s):  
Health Care ◽  
Nurse Practitioner ◽  
Newborn Care ◽  
Medical Personnel ◽  
Health Care Team ◽  
Advanced Practice ◽  
Health Care Environment ◽  
Educational Preparation ◽  
History Of ◽  
Personnel Shortages

The neonatal nurse practitioner (NNP) emerged in the 1970s. During the first two decades, nurses who functioned in this new advanced-practice role were forced to overcome interprofessional isolation, variable educational preparation, underutilization, and title ambiguity. However, after nearly 30 years of evolution influenced by the changing health care environment, technological advancements in newborn care, medical personnel shortages, and the advanced-practice nurse movement, the NNP is now a recognized member of the neonatal health care team nationwide. The NNP has achieved the level of provider status, but only after successfully overcoming many practice restrictions and restraints over the decades. This article chronicles the history of the NNP and recounts the external and internal elements that contributed to the development of this profession.

scholarly journals Iatrogenic tramadol addiction

2017 ◽  
Vol 69 (1) ◽  
pp. 57 ◽  
Author(s):  
Prabhat Chand ◽  
Naveen Jayaram ◽  
Pratima Murthy
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Family History ◽  
Health Care Professionals ◽  
Opioid Analgesic ◽  
Routine Clinical Practice ◽  
Limited Time ◽  
Over The Counter ◽  
Time Period ◽  
History Of

<p>Tramadol, either alone or in combination with paracetamol, is a commonly prescribed opioid analgesic in routine clinical practice. It has reportedly low abuse potential. There are, however, a few reports of tramadol misuse among health care professionals and persons with a family history of addiction. We describe the clinical profile of three women developing addiction to tramadol. In all these cases tramadol was initially prescribed for pain by the physician. Physicians should not only prescribe tramadol cautiously and for a limited time period but also be trained in identifying misuse (self‑use, over the counter procuring, using for mind altering<br />properties) and dependence (craving, withdrawal symptoms etc.).</p>

scholarly journals Isolated pancreatic tuberculosis presenting as obstructive jaundice

2021 ◽  
Vol 8 (4) ◽  
pp. 1296
Author(s):  
Muhammad Salman Shafique ◽  
Sayyam Fatima
Keyword(s):  
Obstructive Jaundice ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Tuberculosis Patient ◽  
Head Region ◽  
Gradual Improvement ◽  
Pancreatic Tuberculosis ◽  
History Of ◽  
Diagnostic Work ◽  
Anti Tubercular Therapy

A 36-year-old male patient presented in surgical clinic with complaints of abdominal pain and progressively increasing yellowish discoloration of his skin and sclera for last 1 month. He was deeply jaundiced with mild tenderness in epigastric region. He had a strong family history of tuberculosis. Diagnostic work-up revealed obstructive jaundice secondary to pancreatic tuberculosis. Tomographic examination revealed a pancreatic head mass with peripancreatic lymphadenopathy. Endoscopic ultrasound (EUS) showed a mass at pancreatic head region & EUS guided fine needle aspiration revealed tuberculosis. Patient was started on anti-tubercular therapy with gradual improvement of symptoms over the course of treatment.

The Trilogy of Health Care: Caring and Healing of the Clinician

2021 ◽  
pp. 002436392110555
Author(s):  
Bro. Ignatius Perkins ◽  
Allen H. Roberts
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Daily Living ◽  
Human Person ◽  
Early Discharge ◽  
The United States ◽  
The Core ◽  
Effective Interventions ◽  
History Of ◽  
Caring And Healing

Today, more than we are aware of in the history of health services in the United States, is the critical need to reclaim and apply the core values and principles that inspired physicians and nurses to respond to their original call become consolers and healers of the sick and those in distress, and to refocus our attention on the person of the healer. In clinical practice today, we are endowed with enormously effective interventions that were unimaginable only a few decades earlier. In light of the fund of knowledge, clinical competencies, and technological advancements that we bring to bear in our experience in caring for our patients, the learning curve is never flat, never complete, and never static. Newer, safer, and more effective interventions in the cure of illnesses, management to relieve stress, moderate fear of surgery, and to promote healing that often lead to early discharge and return to normal activities of daily living are readily available in clinical practice. Yet, there are looming threats that compromise the person of clinician, for example, dehumanization, consumerism, commodification, and fungeability of the human person. This article will describe the Trilogy of Health Care: Caring and Healing of the Clinician and its application to the care and healing of physicians and nurses as they accompany one another in caring for a world in need of healing and hope.

Occupational therapy

2013 ◽  
pp. 590-599 ◽  
Author(s):  
Liisa Holsti ◽  
Catherine L. Backman ◽  
Joyce M. Engel
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Occupational Therapists ◽  
Health Care Team ◽  
Evidence Based ◽  
Treatment Goals ◽  
Children And Families ◽  
Theoretical Frameworks ◽  
Daily Lives ◽  
The Everyday

Occupational therapists specialize in how pain impacts the development and maintenance of the occupations (self-care, productivity, leisure) of the daily lives of infants and youth in pain. Occupational therapists, working with families and other members of the health care team, use both generic and specific theoretical frameworks and models to guide clinical practice. These models ensure that a client-centred approach is used. In the everyday settings of the child, and using evidence-based practice, occupational therapists facilitate the treatment goals of children and families by integrating specific strategies, such as feeding, positioning, energy conservation, and adaptive equipment.

scholarly journals Appendiceal mucocoele with midgut malrotation

2016 ◽  
Vol 98 (7) ◽  
pp. e138-e140 ◽  
Author(s):  
D Yap ◽  
J Hassall ◽  
GL Williams ◽  
ES McKain
Keyword(s):  
English Literature ◽  
Cystic Mass ◽  
General Surgeon ◽  
Low Grade ◽  
Significant Past Medical History ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Upper Abdominal ◽  
Initial Blood

Introduction Malrotation of the midgut and appendiceal mucocoele are both extremely rare pathological conditions in adults. To our knowledge, there are only two reported cases in the English literature with a combination of both conditions. Case History A 65-year-old man presented with a 10-day history of upper abdominal pain associated with abdominal bloating and weight loss. He was otherwise fit and healthy with no significant past medical history. On examination, his abdomen was soft with tenderness and palpable fullness over the left upper quadrant. The initial blood test, chest x-ray and abdominal x-ray demonstrated no significant abnormality. Computed tomography showed a 17cm x 8cm x 6cm elongated cystic mass with possible malrotation of the intestines. Histopathology showed a low grade mucinous tumour of the appendix. At 12 months following surgery, there was no evidence of recurrence or postoperative complications and the patient was discharged from the care of the colorectal team. Conclusions We report a patient with a combination of two rare conditions. This case illustrates how a combination of pathologies can present a challenge to the unwary general surgeon.

scholarly journals Incidence of tuberculosis in enlarged neck nodes, our experience

1970 ◽  
Vol 7 (1) ◽  
pp. 54-58 ◽  
Author(s):  
M Maharjan ◽  
S Hirachan ◽  
PK Kafle ◽  
M Bista ◽  
S Shrestha ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Fine Needle ◽  
History Of ◽  
Chest X Ray ◽  
Needle Aspiration Cytology ◽  
Anti Tubercular Therapy ◽  
Tubercular Lymphadenitis

Objectives: To determine the incidence of tuberculous lymphadenitis in enlarged neck nodes. Materials and methods: Continuous prospective study is carried out in the department of otorhinolaryngology head & neck surgery, Kathmandu Medical College, Kathmandu, during two years, from January 2006 to January 2008. The study included a group of 155 patients with cervical lymphadenopathy. Each patient underwent a detail clinical Ear, Nose and Throat (ENT) examination and a battery of investigations which included Fine Needle Aspiration Cytology (FNAC) of the nodes, Montoux's test, blood Erythrocyte Sedimentation Rate (ESR) and chest X-ray. Those patients with tubercular lymphadenitis were referred to Directly Observed Therapy System (DOTS) clinic for anti-tubercular therapy. Others with reactive lymphadenitis were treated with antibiotic and those with metastatic neck nodes were treated accordingly. Results: Of the 155 cases with enlarged neck nodes, 83 (54%) had tubercular lymphadenitis. Fifty two (33%) cases had reactive lymphadenitis and 17 (11%) cases were diagnosed with metastatic neck nodes. Fine needle aspiration cytology was found to be highly effective in the diagnosis of tubercular lymphadenitis with 94% accuracy. Majority of patients were otherwise healthy adults, aged between 8 - 71 years. No difference was observed between male and female in this study. Posterior triangle (PT) nodes were most commonly affected group of nodes accounting for 35 (42%) cases and preauricular region 1 (1%) case being the least commonly affected site. Fifteen (18%) cases presented with abscess formation. Only 42 (50%) cases had family history of tuberculosis but 8 (9%) patients had previous history of various forms of tuberculosis. Twelve (14%) patients had positive chest X-ray findings suggesting of concurrent pulmonary tuberculosis. All the patients were referred to DOTS clinic and were treated with category (CAT) - III anti tubercular therapy (ATT). Others with concurrent pulmonary tuberculosis were treated with CAT I regime. None of the patients required surgical treatment. Conclusion: There is high incidence of tubercular cervical lymphadenitis in patients with enlarged neck nodes in developing countries like Nepal. Involvement of cervical lymphnodes are the most commonly affected group of nodes. Therefore, it is important that otolaryngologists are aware of tuberculosis in the head and neck region. Key words: Tuberculosis, Lymph node, Fine needle aspiration cytology, Lymphadenitis    doi: 10.3126/kumj.v7i1.1766       Kathmandu University Medical Journal (2009), Vol. 7, No. 1, Issue 25, 54-58         

scholarly journals HEMODIALYSIS;

2019 ◽  
Vol 26 (01) ◽  
Author(s):  
Yasir Mehmood ◽  
Imran Ali ◽  
Kainat Zahra ◽  
Umair Ashraf
Keyword(s):  
Health Care ◽  
Case History ◽  
Sodium Succinate ◽  
Health Care Team ◽  
The Body ◽  
Care Team ◽  
Control Group ◽  
Toxic Substances ◽  
Different Types ◽  
History Of

Introduction: Hemodialysis is the most common method - used to remove waste and toxic substances from the body, hence it is used to treat patients of different types of renal failure. Upto 1960s, attempts were made to reduce the side/adverse effects associated with hemodialysis and to make hemodialysis an effective therapy. Now-a-days many advanced and sophisticated dialysis machines have been designed which make dialysis therapy more convenient and promising. Hemodialysis therapy requires complete coordination between the health care team which includes nephrologists, dietitian, nurse, technician and social worker. Patient and his/her family also coordinate the procedure to make hemodialysis more effective. But even with the use of modern and effective dialysis machines for therapy patients may still suffer from different types of complications.Objective: The purpose of this study was to observe those complications and also their management during and after dialysis. Place and conducted year:Data was collected by convenience sampling technique in local hospital of LahoreinDecember, 2016. Study design: Retrospective approach was used and notices the case history of 100 patients.Methods:Retrospective approach was used and the case history of 100 patients (from morning and evening shifts) who had hemodialysis over a 1-5 year period was noted. Demographic and clinical data of patients who died during dialysis were compared to the control group comprised of the survivors of hemodialysis. Data was analyzed using SPSS IBM version 16. Result:In this study it was observed that patients may suffer from various complications. 38% patients suffered from hypotension, 13% patients suffered from cramps, Itching was observed in 15% of patients, Vomiting was observed in 18% of the patients and in 5% patients dialysis reaction was observed. In order to manage these complications normal saline and 5% dextrose were administered to the patients. Hydrocortisone Sodium Succinate was administered intravenously in order to manage dialyzer reaction and session was postponed. Although hemodialysis is beneficial but it poses certain risks as well.Conclusion:Hemodialysis is associated with various life threatening complications however these complications occur in low frequency and these can be managed and prevented by various protective therapies by health care team and medical staff.

Interpreting the Physical Activity Guidelines for Health and Weight Management

2009 ◽  
Vol 6 (5) ◽  
pp. 651-656 ◽  
Author(s):  
Ross E. Andersen ◽  
John M. Jakicic
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Clinical Practice ◽  
Weight Management ◽  
Health Professionals ◽  
Physical Activity Guidelines ◽  
History Of ◽  
Active Lifestyles ◽  
Common Barriers ◽  
Current Guidelines

The aim of this review is to provide a scientific update on the current guidelines for both health and weight management. There has been confusion among health professionals as to which physical activity guidelines should be used to help various specific populations adopt more active lifestyles. We first review the history of the physical activity guidelines. Using the physical activity guidelines in clinical practice is also explored. We also describe common barriers to physical that overweight individuals report and we discuss when it is appropriate for a health care professional to seek a referral from an exercise scientist to help sedentary adults increase their levels of activity. It is important for individuals who care for overweight patients and sedentary adults to understand the current physical guidelines and how these guidelines can be worked into clinical practice.

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