Conservative treatment of a scoliosis patient after two heart surgeries in early childhood – A case report

Introduction: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).Patient presentation, management and outcome: Initially, the premenarchial female was 9 years old and had a Tanner stage 2–3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.Conclusion: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.Clinical implications: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

Paramedics’ confidence and perceived competence when attending to varied patient presentations: A mixed-method study.

Objective: Paramedics are routinely called to patients presenting with mental health concerns. Previous literature suggests paramedics find this patient group challenging. However, no study has investigated whether paramedics find mental health presentations (MHP) more challenging relative to other patient presentations, or whether certain paramedic variables relate to their perceived ability to manage MHP. This study investigates differences in paramedics’ perceived ability to attend to MHP compared to other patient presentations, and whether their perceived ability is related to their level of experience or location of work (metropolitan or rural). The study also explores paramedic’s experiences and perspectives of MHP. Method: Operational paramedics in Australia (n = 138) completed a survey assessing their perceived ability to respond to mental health, cardiac, respiratory and trauma-related presentations. A repeated measures ANOVA tested differences in perceived ability between these patient presentations. T-tests and Pearson’s correlations were conducted to determine whether years of experience or location of work related to their perceived ability for MHP. Nine paramedics were also interviewed and a thematic analysis conducted to gain insight into paramedic’s experiences and perspectives of MHP.Results: Paramedics reported a significantly lower perceived ability to respond to MHP relative to each other patient presentation measured. No relationships were found between a paramedic’s perceived ability to respond to MHP and their length of work experience or location of work. Interviews with paramedics revealed four superordinate themes: 1) inconsistent conceptualization of their role, 2) feelings of helplessness and frustration, 3) stigmatized views of patients with a mental illness, and 4) inconsistent views of knowledge and learning relating to MHP. Conclusion: Paramedics believe they have a significantly poorer ability to respond to MHP relative to other patient presentations. Education and training focused on defining a paramedic’s role for MHP as well as reducing stigmatized views of patients with a mental illness may improve paramedic’s care of this cohort of patients.

Uncertainty of leukoencephalopathies: a case report

Background Adult-onset leukoencephalopathies are a group of heterogeneous disorders characterized by white matter abnormalities. Leukoencephalopathy is usually encountered in children, but here we report a case with adult-onset leukoencephalopathy. Also, we explore this concept of uncertainty in medicine by discussing the approach to this case that has multiple possible etiologies. Case presentation A 70-year-old Caucasian male presented with a subacute onset of cognitive impairment and mood disturbances associated with behavioral changes. Neuroimaging demonstrated high-intensity lesions involving cerebral white matter. Progressive dementia and cognitive decline followed. Multiple possible etiologies are discussed based on the patient presentation and risk factors. Conclusion Adult-onset leukoencephalopathy can become a diagnostic challenge. Certain approaches need to be developed to explore the uncertainty of such conditions and to improve diagnostic yield.

Management of Panfacial Trauma: Sequencing and Pitfalls

Panfacial trauma refers to high-energy mechanism injuries involving two or more areas of the craniofacial skeleton, the frontal bone, the midface, and the occlusal unit. These can be distracting injuries in an unstable patient and, as in any trauma, Advanced Trauma Life Support (ATLS) protocols should be followed. The airway should be secured, bleeding controlled, and sequential examinations should take place to avoid overlooking injuries. When indicated, neurosurgery and ophthalmology should be consulted as preservation of brain, vision, and hearing function should be prioritized. Once the patient is stabilized, reconstruction aims to reduce panfacial fractures, restore the horizontal and vertical facial buttresses, and resuspend the soft tissue to avoid the appearance of premature aging. Lost or comminuted bone can be replaced with bone grafts, although adequate reduction should be ensured prior to any grafting. Operative sequencing can be performed from top-down and outside-in or from bottom-up and inside-out depending on patient presentation. All protocols can successfully manage panfacial injuries, and the emphasis should be placed on a systematic approach that works from known areas to unknown areas.

Karakteristik Pasien Trombosis Vena Dalam: Tinjauan Sistematik

Introduction: Deep vein thrombosis (DVT) is one of the biggest causes of death in the world. DVT has various risk factors so that DVT patient presentation can be different in each age, sex, and race group. This review aimed to obtain information regarding characteristics of deep vein thrombosis patients.Method: This study used qualitative approach that is library research using books and other literatures as the main object. This study was conducted using search engine, such as Pubmed, Google Scholar, and Clinical Key to obtain journals related with characteristics of deep vein thrombosis patients. Result: From 17 literatures, we found that characteristics of deep thrombosis patients are different in each age, sex, and race group. The severity of DVT increased with increasing age because of other conditions usually found in older age. Men are more susceptible to have DVT than women without reproductive risk factors such as pregnancy and menopause. African has more severe DVT presentation than other races. Lowest risk is found in Asian, although there is no significant difference in mortality between races.Conclusions: Characteristics of DVT patients (incidence rate, risk factors, location, and severity) vary in each age, sex, and race group.

Validation of a Belgian Prediction Model for Patient Encounters at Football Mass Gatherings

Background: To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium’s largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model. Methods: Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test. Results: A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = −5.566, P <.001, r = −.61; Hartman: Z = −4.245, P <.001, r = .47). Conclusion: When comparing the predicted patient encounters, only the Arbon model under-predicted patient presentations, but the Hartman and the PRIMA models consistently over-predicted. Because of continuous over-prediction, the PRIMA model showed significant differences in mean deviation of predicted PPR. The results of this study suggest that the PRIMA model can be used during planning for domestic and international football matches played at the King Baudouin Stadium, but more data and further research are needed.