Clinical Management of Pulmonary Disorders and Diseases0 تومان
Non-small cell lung cancer (NSCLC) is a serious health problem. Identifying factors affecting quality of life (QoL) may help modify risk factors and improve survival. The study included 180 patients treated for NSCLC in the Lower Silesian Center of Lung Diseases between January and December 2015. QoL was assessed with QLQ-C30 and QLQ-LC13 scales. General physical functioning was measured with the ECOG Performance Status scale. The clinical and sociodemographic data were retrieved from medical records. The influence of clinical and sociodemographic factors on QoL was examined. NSCLC reduced the global QoL (47.1 23.4) and emotional functioning (57.8 28.8); cognitive functioning was affected in least (76.0 21.0). The patients reported fatigue (42.2 26.2), sleep problems (42.0 30.8), cough (49.8 24.0), and taking analgesics (50.3 37.1) as the most limiting factors. The worsening of a health condition expressed by the length of malignant disease; the presence of comorbidities, metastases, the cluster of symptoms, worse spirometric indices, and living alone had a negative influence on QoL. In conclusion, patients with NSCLC experience reduced QoL and emotional functioning. Proper treatment of comorbidities and symptom management may improve QoL in these patients.
Comorbidity in Rheumatic Diseases0 تومان
Comorbidity is a condition that coexists along with the disease of interest. Comorbidities could be related to the primary disease, its treatment, or be completely independent. Comorbidities could also be a historic medical condition that is presently active or inactive. The relationship between rheumatic diseases and comorbidities is intriguing in that whereas certain comorbidities occur more frequently in rheumatic diseases, the rheumatic diseases and their treatments could themselves lead to some of these comorbidities. Higher prevalence of comorbidities in rheumatic disease patients compared with those without rheumatic disease could be partly due to a higher inﬂammatory burden, an overlapping pathophysiology with rheumatic diseases, or increased prevalence as a result of frequent monitoring and screening, and improved survival among these patients. An example of this would be the higher incidence and prevalence of cardiovascular disease (CVD) and traditional cardiovascular (CV) risk factors like dyslipidemia, diabetes and insulin resistance in rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). Another example would be systemic sclerosis (SSc)-related lung involvement or lupus nephritis where early recognition and management of these disease-related complications has a potential to improve survival. While recent advances have been invaluable to the therapeutic armamentarium of rheumatic diseases, long-term treatment-related risks like infection and malignancy have emerged as concerns. The use of medications like disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inﬂammatory drugs (NSAIDs), and glucocorticoids for inﬂammatory arthritis also contribute to comorbidities.
Degenerative Diseases of the Cervical Spine0 تومان
The current trend in cervical spinal surgery is affected by continuous optimisation of intervertebral cages and disc prostheses. The latter have been developed since the 1990s based on experiences with lumbar prostheses. The initial focus was put on different designs with titanium endplates and a plastic core. Nowadays, there is a development of single unit implants made of elastic polymeric material. To what extent these implants provide an approximation to physiological conditions in shape, function and bony anchorage is still unclear.
Depression and Anxiety in Patients with Chronic Respiratory Diseases0 تومان
Mood disorders are often eclipsed by the primary task of respiratory management in those with chronic respiratory diseases. This is likely for a variety of reasons, including that it is not the forte of the primary respiratory provider to identify and/or manage these symptoms, that the presenting problem is the respiratory illness itself and that resources to identify and manage quality of life issues and mood disorders are often lacking. Though pharmacological options are generally readily available, identification of the mood disturbance is, in itself, time-consuming and requires some expertise to properly identify. Additionally, resources of psychotherapists with expertise in behavioral medicine are lacking. The largest of psychosocial problems faced by those with respiratory illnesses might be the same issues as those faced by any patient facing significant medical challenges. Though there may be some common psychosocial difficulties between the patients who share specific medical disorders, to some degree, individual differences with regard to resilience, coping strategies, comorbid complications, disease manifestation, hardiness, meaning attributed to the disease, and psychosocial supports all influence the direction and toll the disease itself may take on the individual. Lazarus describes a pattern of appraisal which is critical to any stressors; this involves the person evaluating the threat of the stress as well as the resources they need to minimize, tolerate, or eradicate the stressor. This appraisal process is critical to the patient’s future steps of how to rally resources to address the needs for managing the illness. It is at this stage that the patient is in vital need of resources to facilitate decision making and that they are vulnerable to decompensation in decision processing if they cannot rally these resources.
DISEASES OF THE CHEST AND HEART 2015-20180 تومان
Primary lung cancer is the leading cause of cancer mortality in the world and its incidence is expected to rise in the next several decades, especially in more recently industrialized countries such as China. This high mortality is largely explained by the fact that patients with lung cancer often present with advanced stage disease. Imaging is important in the early detection and clinical staging of lung cancer. Indeed, both the therapeutic options and the management of patients with lung cancer are to a considerable degree dependent upon disease stage at presentation. Detailed knowlegde and the appropriate use of imaging in the staging evaluation of patients with non-small cell lung cancer (NSCLC) are required to avoid unnecessary procedures, excess radiation, and redundant information. This is facilitated by the use of guidelines as well as the participation of multidisciplinary teams in which radiologists, pathologists, pulmonologists, surgeons, and medical and radiation oncologists discuss and reach a consensus on individualized imaging and treatment. The main objective of this chapter is to review the basic concepts related to the detection, staging, and follow-up of patients with NSCLC.
Exosomes in Cardiovascular Diseases0 تومان
Cytoplasm of eukaryotic cells contains several compartments, including transGolgi network, mitochondria, peroxisomes, endoplasmic reticulum, having different functions. Transport of macromolecules among these dynamic structures is mediated by vesicles moving in a densely populated microenvironment . In some instances, part of these vesicles are released into the extracellular milieu. Extracellular vesicles (EVs) are part of mechanism of intercellular communication, a function of vital importance for multicellular organisms. For decades, intercellular communication has been thought to be solely regulated by cell-to-cell contact and release of soluble molecules into the extracellular space. These molecules transmit the signal through their uptake or binding to specifc receptors on target cells. However, the discovery of vesicular structures released into the extracellular space containing a multitude of factors including signaling molecules, proteins and nucleic acids, has opened a new frontier in the study of signal transduction, thereby adding a new level of complexity to our understanding of cell-to-cell communication. Body ﬂuids (e.g., blood, urine, saliva, amniotic ﬂuid, bronchoalveolar lavage ﬂuid, synovial ﬂuid, breast milk) contain various types of membrane- enclosed vesicles recognizing different pathways of biogenesis. These vesicles possess different biophysical features and functions in health, e.g., protein clearance, immune regulation , cell signaling , as well as in disease, such as in infections and cancer . Originally, EVs were thought to be garbage bags through which cells eject their waste. Today, it is widely accepted that EVs are key components of the intercellular communication network.
Pathogenesis of Periodontal Diseases0 تومان
Periodontal disease, or periodontitis, is a globally widespread pathology of the human oral cavity. Indeed, approximately 10% of the global adult population is highly vulnerable to severe periodontitis. Another 10–15% appears to be completely resistant to it, while the remainder vary between these two extremes . Moreover, the prevalence of periodontitis is peaking at the fourth decade of life and increasing to 70–85% in the age group of 60–65 . Strikingly, despite major improvements in oral hygiene practices today, these proportions are not far from what was reported in possibly the frst epidemiological report of periodontitis in humans back in 1918 (then defned as periodontoclasia or pyorrhea alveolaris). According to that, the prevalence of the disease in the Chicago area was 13% in the age range of 20–24, 68% in 30–39, and 88% over 50. Much recent data from USA showed that there is not a drop but rather an increase in these numbers among the older individuals . That means that periodontitis is an inevitable oral pathology of the human population, and its prevalence increases with age. Taking also underconsideration the increasing life expectancy, periodontitis is a growing health problem. Despite the persistence of severe periodontitis even in the twenty-frst century, the last 100 years have witnessed a signifcant progress in our understanding of its pathogenesis, that is, the conglomerate of biological processes that lead to the disease. Nevertheless, the actual “coordinator(s) ”of the disease is still an issue of intense debate. Microbiology researchers place emphasis in seeking species, or combinations of them, associated with different clinical forms of the disease. On the other side, immunologists are in pursuit of cells and molecules that orchestrate the tissue-destructive inﬂammation, as a result of the bacterial challenge.
Pediatric Demyelinating Diseases of the Central Nervous System and Their Mimics0 تومان
A 4-year-old boy with no past medical history presented to the emergency room with a 4-day history of progressive weakness and sleepiness. His parents initially noticed drooling followed by weakness and diffculty walking. On the day of admission, he was noted to have asymmetry of the face and left-sided arm and leg weakness. In addition, he had altered mental status alternating between lethargy and aggressive behaviors. There was no history of recent illness, immunization, or trauma. No family history of autoimmune disorders was reported. Upon admission he was lethargic with intermittent irritability but responded to simple commands. There were no meningeal signs. His cranial nerve examination showed ﬂattening of the nasolabial fold on the left side. There was no afferent pupillary defect. He demonstrated left-sided weakness of the upper and lower extremities with an ipsilateral extensor plantar response. Strength in the right arm and leg was normal. Due to the weakness, the patient had diffculty performing fnger-to-nose testing on the left and was unable to walk. No sensory defcits were noted, and there was no truncal or appendicular ataxia.
Vascular Diseases for the Non-Specialist0 تومان
Scientifc valid evidence may be acquired from a number of studies capable of supporting or denying a theory about a healthcare treatment, a diagnostic intervention, or about the frequency of occurrence of a health event. However, the translation of scientifc knowledge into decisions in healthcare requires methodological expertise and comprehension of the potentials and limitations of each type of evidence. In this chapter, we invite the readers to think more scientifcally in their daily practice. We didactically discuss relevant aspects related to the clinical question and study design, and we use this discussion to guide the reader to an improved comprehension of how to use systematic reviews in the context of evidence-based healthcare. Finally, we present some tools and resources to help professionals to search for qualifed and preapraised evidence to inform their clinical decisions.
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