سبد خرید

Current Clinical Neurology

The frst reference to status epilepticus (SE) dates back to 700–600 BC in Babylonian cuneiform tablets, yet our understanding of this condition remains limited. SE is not simply a long seizure; mechanistically, it is a different entity. Our clinical experience suggests that an underlying etiology, systemic factors, and genetic background influence the generation and progression of SE as well as its sequelae. Understanding the underlying pathophysiology of SE is key to developing effective treatment and a topic of rigorous scientifc research. In this chapter, we will review different forms of SE and delineate available treatments. We will describe common animal models of SE used to study basic physiology in order to develop novel treatments, as well as discuss challenges that the scientifc community faces when trying to translate animal data into clinical practice.

The Textbook of Clinical Sexual Medicine

Kolodny, Masters, and Johnson coined the term sexual medicine in their well-known Textbook of Sexual Medicine .Sexual medicine is the branch of medicine that focuses on the evaluation and treatment of sexual disorders, which have a high prevalence rate. Approximately 43% of women and 31% of men are affected by these disorders .Today the feld of sexual medicine continues to evolve. There have been recent changes in classifcation of disorders, advancements in pharmaceutical management, and improvement in behavioral therapies. This introductory chapter provides a concise review of relevant topics to sexual medicine including recent classifcation changes in the International Classifcation of Diseases, 10th edition (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5).

Urolithiasis in Clinical Practice

Humans are afflicted by the urinary stone disease since the dawn of time. Today this ailment is considered as the third most frequent urological pathological condition after infections and prostatic diseases, and statistics show a worldwide increase in its incidence and prevalence. In 1994 data from the US National Health and Nutrition Examination Survey (NHANES) estimated the prevalence of stone disease at 5.2% of the American population, marking a significant increase compared to the year 1980 when a prevalence of only 3.2% has been observed . A more recent study performed in 2010 suggested a further increase reaching 8.8% prevalence, roughly equivalent to 1 in 11 people . The same trends have been observed all over the world and the highest prevalence of urinary stones was reported in Saudi Arabia with an estimated value of 20% .
Inexorably, urolithiasis treatment costs have dramatically increased and constitute a heavy economic burden today. In the United States alone, urinary stones have caused two million outpatient visits in the year 2000, corresponding to a 40% increase compared to 1994 .

Clinical Cases in LAA Occlusion

When starting or expanding a LAA closure program, the imminent question certainly raised by referring physicians, and possibly even by some patients, is: why go for a potentially risky cardiac intervention if a well proven drug therapy like NOAC is available? Many patients prefer a single 2–3 days hospital stay with a low risk cardiac intervention similar to pulmonary vein isolation or PFO closure, over a long-term therapy which increases sensitivity to skin bruises, gastro-intestinal bleeding and other side effects. Non-interventional general practitioners or other colleagues not close to the feld may argue that evidence is not suffcient as the number of patients included in prospective trials is low and only available for the Watchman device. Randomized trials and prospective registries in over 500,000 patients treated with NOAC’s are available. In the absence of a randomized trial comparing NOAC therapy to LAA closure, in-depth discussion of the available data is necessary to achieve consensus. This chapter focusses on a critical appraisal of NOAC study data and provides a simple algorithm incorporating both US and European guidelines regarding indication for LAA closure.

Emergency Clinical Diagnosis

The demands on emergency departments are rising worldwide. Simultaneously, the scope of practice of emergency medicine continues to expand. This is fuelled by an ageing population, complex medical presentations, rising patient expectations, diffculties with access to primary care facilities, and the desire for second opinions in the case of diagnostic delay or failure in primary care settings. Diagnostic failure is the leading source of clinical complaints and of medico-legal litigation involving emergency departments. The emergency practitioner not only needs to be profcient in the evaluation of common highstakes conditions, but also has to be aware of malignant disease and rarer conditions that can present to the emergency department and facilitate their diagnosis and subsequent management. This ensures more effective communication with specialists receiving referrals. In particular, the new diagnosis of cancer is increasingly being made in the emergency setting. Once the correct diagnosis is made, it is recognised that treatment protocols and referral pathways can vary widely and that local guidance is more appropriate. Diagnostic accuracy, however, remains a universal common concern. This book aims to provide the emergency practitioner with diagnostic aide-memoires and checklists as part of the front-line diagnostic armamentarium.

Chest Drains in Daily Clinical Practice

The chest wall represents the outer covering of the chest and shelters the organs inside the thorax. Due to its mobility and the wall structure, which is comparable to a cage, it plays an active role in the function of breathing when the intrathoracic volume is changed. During inspiration the volume increases and during expiration it decreases, therefore generating a negative or a positive pressure respectively. According to the law of Boyle-Mariotte, gases move constantly as a result of pressure and volume. The chest wall is construced as a cage with variable rods .The spaces within the rods are the intercostal spaces. This space has to be air tight, robust in regards to pressure, while also being adequately mobile for ventilation. This is possible with the help of the pleural space which is created by two sheets of pleura, the parietal and visceral layers. The pleural space allows the lung to slide during inspiration and expiration, keeping the lung expanded due to adhesive forces.

Orofacial Pain: Classifcation and Road Map to Clinical Phenotypes

The orofacial region consists of heterogeneous tissues that make diagnosing and treating pain conditions a challenging task. Vital to these processes are well-structured classifcation systems that cover the breadth of chronic orofacial pain conditions and provide diagnostic criteria to enhance our ability to properly identify and categorize clinical events in an agreed pattern. A revision of the classifcation systems for orofacial pain disorders developed respectively by the International Association for the Study of Pain, the International Headache Society, the American Academy of Orofacial Pain, and the American Academy of Craniofacial Pain reveals a number of defciencies and inconsistencies ranging from terminology to the structure itself and the set of diagnostic criteria. To improve communication and enable effective collaborative work, we are at the crossroads for the development of a new multiaxial classifcation system using ontological principles to build a
realistic and comprehensive representation of orofacial pain disorders. With research focusing on pain biomarkers, optimizing the systematization of data collection may contribute to identifying clinical phenotypes of chronic orofacial pain conditions that have the most impact on patient life.

Clinical Features of PTSD

John was driving his three young children to the park when they were struck head-on by a driver attempting to overtake a truck on a sharp bend. John’s car was wrecked and he developed posttraumatic stress disorder (PTSD), with the most severe symptoms being persistent nightmares of the accident, profound fear and avoidance of driving, and chronic tension, irritability, and guilt about not being able to swerve out of the path of the oncoming vehicle. His children received minor cuts and bruises, from which they quickly recovered. They had more diffculty overcoming the psychological impact of the crash. In the weeks afterward, the youngest, a 4-year-old girl, frequently complained of stomachaches and refused to be out of sight of her father for fear that something bad would happen. The two older boys, ages 7 and 8, had recurrent nightmares. During the day, the boys often engaged in stereotypical play, in which they pretended to be driving cars. They would crash into one other and both fall to the ground. The boys would then get up and run around pretending to shoot one another, shouting, “You’re the bad man!” “No, you’re the bad man!” Sometimes this escalated to the point that they physically fought with one another.

Clinical Approaches to Hospital Medicine

Heart failure (HF) affects more than 5.7 million adults in the United States and current projections estimate the prevalence of HF will continue to increase. Accounting for more than 1 million admissions annually, HF is the leading cause of hospitalization among the Medicare age group with an overall 1-year mortality rate of 29.6% . In 2013, total cost for HF was estimated to be $30.7 billion with 68% being attributable to direct medical costs. Projections show that by 2030, the total cost of HF will increase almost 127% to $69.7 billion with an estimated $244 spent annually for every US adult . As an emerging issue in hospital care, the hospitalist provider can anticipate a large portion of admissions with either primary or comorbid HF. In this article, we will discuss: • How to recognize HF and classify accordingly • Key treatment modalities • When to consult subspecialists • Risk factors for re-admission and strategies for prevention

Clinical Management of Pulmonary Disorders and Diseases

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.

درحال بارگذاری ...