scholarly journals Palliative Withdrawal of Mechanical Ventilation and Other Life Supports

2021 ◽  
Author(s):  
Lauren F. Goodman
Keyword(s):  
Life Support ◽  
Family Values ◽  
Current Treatment ◽  
Patient Comfort ◽  
Treatment Modalities ◽  
Medical Procedure ◽  
Thought Processes ◽  
Airway Trauma ◽  
Case Vignettes ◽  
Ventilator Settings

Palliative or compassionate withdrawal of mechanical ventilator support at the end of life aims to optimize comfort, alleviate suffering, and allow a natural death in patients for whom life supports are not achieving desired goals. Palliative withdrawal is a medical procedure and must be treated as such. Appropriate planning and preparations are required to optimize patient comfort, which is the goal of the procedure. Many institutions have a “one size fits all” approach to this process, but individual patient factors require consideration to meet the patient’s needs. Some of these factors include patient pathophysiology (airway edema, airway trauma, hemoptysis, secretions), current treatment modalities (ventilator settings, medications including sedatives, vasopressors, inotropes, inhaled agents, neuromuscular blockade agents), and patient and family values and preferences. This chapter will discuss the implications of each of these factors and propose methods for successful transitions to comfort-focused care. Case vignettes will demonstrate the thought processes involved and model optimal management. Common ethical considerations and questions regarding palliative withdrawal of life support will also be discussed.

The Use of Mesenchymal Stem Cells and their Derived Extracellular Vesicles in Cardiovascular Disease Treatment

2020 ◽  
Vol 15 (7) ◽  
pp. 623-638
Author(s):  
Saeideh Gholamzadeh Khoei ◽  
Fateme Karimi Dermani ◽  
Sara Malih ◽  
Nashmin Fayazi ◽  
Mohsen Sheykhhasan
Keyword(s):  
Cardiovascular Disease ◽  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Extracellular Vesicles ◽  
Adult Stem Cells ◽  
Heart Diseases ◽  
Therapeutic Option ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Cellular Source

Background: Cardiovascular disease (CVD), including disorders of cardiac muscle and vascular, is the major cause of death globally. Many unsuccessful attempts have been made to intervene in the disease's pathogenesis and treatment. Stem cell-based therapies, as a regeneration strategy, cast a new hope for CVD treatment. One of the most well-known stem cells is mesenchymal stem cells (MSCs), classified as one of the adult stem cells and can be obtained from different tissues. These cells have superior properties, such as proliferation and highly specialized differentiation. On the other hand, they have the potential to modulate the immune system and anti-inflammatory activity. One of their most important features is the secreting the extracellular vesicles (EVs) like exosomes (EXOs) as an intercellular communication system mediating the different physiological and pathophysiological affairs. Methods: In this review study, the importance of MSC and its secretory exosomes for the treatment of heart disease has been together and specifically addressed and the use of these promising natural and accessible agents is predicted to replace the current treatment modalities even faster than we imagine. Results: MSC derived EXOs by providing a pro-regenerative condition allowing innate stem cells to repair damaged tissues successfully. As a result, MSCs are considered as the appropriate cellular source in regenerative medicine. In the plethora of experiments, MSCs and MSC-EXOs have been used for the treatment and regeneration of heart diseases and myocardial lesions. Conclusions: Administration of MSCs has been provided a replacement therapeutic option for heart regeneration, obtaining great attention among the basic researcher and the medical doctors.

scholarly journals Infective Aortic Valve Endocarditis Causing Embolic Consecutive ST-Elevation Myocardial Infarctions

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Kanksha Peddi ◽  
Alexander L. Hsu ◽  
Tomas H. Ayala
Keyword(s):  
Myocardial Infarction ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Index Case ◽  
Current Treatment ◽  
Myocardial Infarctions ◽  
Treatment Modalities ◽  
The Past ◽  
First Case ◽  
St Elevation

ST-elevation myocardial infarction (STEMI) is a rare and potentially fatal complication of infective endocarditis. We report the ninth case of embolic native aortic valve infective endocarditis causing STEMI and the first case to describe consecutive embolisms leading to infarctions of separate coronary territories. Through examination of this case in the context of the previous eight similar documented cases in the past, we find that infective endocarditis of the aortic valve can and frequently affect more than a single myocardial territory and can occur consecutively. Further, current treatment modalities for embolic infective endocarditis causing acute myocardial infarction are limited and unproven. This index case illustrates the potential severity of complications and the challenges in developing standardized management for such patients.

scholarly journals Role of Vitamin D in the Prevention of Pancreatic Cancer

2010 ◽  
Vol 2010 ◽  
pp. 1-9 ◽  
Author(s):  
Pubudu Bulathsinghala ◽  
Kostas N. Syrigos ◽  
Muhammad W. Saif
Keyword(s):  
Pancreatic Cancer ◽  
Vitamin D ◽  
Dietary Intake ◽  
Sun Exposure ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Hydroxyvitamin D ◽  
Vitamin D Levels ◽  
Advanced Stages

Pancreatic cancer is a malignancy of poor prognosis which is mostly diagnosed at advanced stages. Current treatment modalities are very limited creating great interest for novel preventive and therapeutic options. Vitamin D seems to have a protective effect against pancreatic cancer by participating in numerous proapoptotic, antiangiogenic, anti-inflammatory, prodifferentiating, and immunomodulating mechanisms. 25-hydroxyvitamin D [25(OH)D] serum concentrations are currently the best indicator of vitamin D status. There are three main sources of vitamin D: sun exposure, diet,and dietary supplements. Sun exposure has been associated with lower incidence of pancreatic cancer in ecological studies. Increased vitamin D levels seem to protect against pancreatic cancer, but caution is needed as excessive dietary intake may have opposite results. Future studies will verify the role of vitamin D in the prevention and therapy of pancreatic cancer and will lead to guidelines on adequate sun exposure and vitamin D dietary intake.

Current Treatment Modalities of JIA-associated Uveitis and its Complications: Literature Review

2016 ◽  
Vol 24 (4) ◽  
pp. 431-439 ◽  
Author(s):  
Khawla Abu Samra ◽  
Armin Maghsoudlou ◽  
Ramak Roohipoor ◽  
Manuel Valdes-Navarro ◽  
Stacey Lee ◽  
...  
Keyword(s):  
Literature Review ◽  
Current Treatment ◽  
Treatment Modalities

Pectus Excavatum in the Adult: Current Treatment Modalities

2010 ◽  
pp. 481-488
Author(s):  
Dawn E. Jaroszewski ◽  
Jason D. Fraser ◽  
David M. Notrica
Keyword(s):  
Pectus Excavatum ◽  
Current Treatment ◽  
Treatment Modalities

Therapeutic Potential of Lymphoid Infiltrates in Breast Cancer

2021 ◽  
Vol 28 ◽  
Author(s):  
Xiao-Yang Chen ◽  
Puay Hoon Tan
Keyword(s):  
Breast Cancer ◽  
Immune Response ◽  
Immune System ◽  
Therapeutic Potential ◽  
Antibody Therapy ◽  
Tumour Microenvironment ◽  
Current Treatment ◽  
Adoptive Cell Transfer ◽  
Treatment Modalities ◽  
Patient Specific

: Despite diagnostic and therapeutic advances in breast cancer, it remains the most frequently diagnosed malignancy in females, with the highest cancer-related mortality rate in women globally. With an improved understanding of the complex interactions between breast cancer and the immune system, immunotherapy has shown great potential in clinical management, potentially adding to current treatment modalities. These immunotherapeutic approaches include adoptive cell transfer therapy, cancer vaccination, monoclonal antibody therapy, and oncolytic virus therapy. Depending on the immune cells and cytokines present, the tumour microenvironment (TME) can be immunosuppressive or favourable for mounting an immune response. Effector lymphocytes play an essential role during an anticancer immune response, but their activities can be suppressed by the hostile TME. Many studies have made good progress in the modulation of the immune response to allow the identification and elimination of tumour cells. However, the efficacy of these immunotherapies is patient-specific and highly dependent on the immunological profile of the tumour and its TME. This review will give an overview of breast cancer, the immune system as well as their complex relationship. Strategies and approaches that can harness the potential of immunotherapy that engages lymphocytes in the treatment of breast cancer, along with their current challenges, will also be discussed.

Sneezing, Wheezing, Having Trouble Breathing

2020 ◽  
pp. 179-188
Author(s):  
Renee Quarrie
Keyword(s):  
Emergency Department ◽  
Respiratory Distress ◽  
Emergency Management ◽  
Pediatric Patient ◽  
Childhood Asthma ◽  
Early Recognition ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Key Points ◽  
Routine Chest

This chapter deals with one of the most common chronic diseases of childhood—asthma. It reviews the diagnosis of this disease and the acute emergency management of a pediatric patient who presents to the emergency department in respiratory distress from asthma. The current treatment modalities and indications for their use are discussed. Key points include that asthma diagnosis in the pediatric patient is largely clinical; early recognition and intervention are critical for successful management of asthma exacerbations; early administration of corticosteroids is important as it has been shown to reduce the rate of hospitalization; and routine chest radiographs do not play a part in the management of asthma.

scholarly journals Towards an understanding of GPs’ viewpoint on diagnosing postnatal depression in general practice: a small-scale realist evaluation

2020 ◽  
Vol 21 ◽  
Author(s):  
Ashvanthi Nadira Sriranjan ◽  
Ruth Abrams ◽  
Geoff Wong ◽  
Sophie Park
Keyword(s):  
Primary Care ◽  
Postnatal Depression ◽  
Realist Evaluation ◽  
Small Scale ◽  
Thought Processes ◽  
Programme Theory ◽  
Self Reflection ◽  
Assessment Guidelines ◽  
Case Vignettes ◽  
Diagnostic Approaches

Abstract Background: Less than half of postnatal depression cases are identified in routine clinical assessment. Guidelines and current literature suggest that general practitioners (GPs) may have an opportunistic role in detecting postnatal depression due to their early contact and existing rapport with many new mothers. There is limited research on the diagnostic approaches chosen by GPs in different GP−patient contexts. Our small-scale study evaluates the thought processes of seven GPs based in one practice when forming a clinical diagnosis of postnatal depression under different contexts. Methods: Seven GP participants were interviewed using case vignettes about postnatal depression, based on an adapted Johari’s window framework. A realist approach to analysis was undertaken with the intention of understanding GPs’ responses to different situations. Context−mechanism−outcome configurations were constructed, and a programme theory was formed to consolidate the findings. Findings: Findings suggest that diagnoses may be a clinician-led or collaborative process between GP and patient. In collaborative contexts, stigmatising views were addressed by GPs, time for self-reflection was encouraged and mothers’ views were accounted for. Clinician-led diagnoses often occurred in contexts where there was a lack of acknowledgement of symptoms on behalf of the patient or where safety was a concern. The personal and clinical experience of GPs themselves, as well as effective communication channels with other primary care professionals, was significant mechanisms. Conclusion: GPs use a variety of strategies to support patient disclosure and acceptance of their condition. The complexity of GP−patient contexts may influence the clinical thought process. We address some of the gaps in existing literature by exploring postnatal depression diagnosis in primary care and provide tentative explanations to suggest what works, for whom and in what contexts.

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